Repeat Breast Ultrasound Demonstrates Utility with Added Cancer Detection in Patients following Breast Imaging Second Opinion Recommendations.

Purpose: Second opinion consultation for patients with suspicious findings on breast imaging and patients with known breast cancer is not uncommon. We sought to determine the frequency of second opinion breast and axillary ultrasound imaging review and the subsequent impact on clinical management. Materials and Methods: An IRB-approved retrospective chart review was conducted on 400 consecutive patients with second opinion radiology interpretations performed by subspecialized breast radiologists at a designated cancer center, including mammogram and ultrasound review. The outside institution imaging reports were compared with second opinion reports to categorize ultrasound review discrepancies which were defined as any BI-RADS category change. The discrepancy frequency, relevant alterations in patient management, and added cancer detection were measured. Results: The second opinion imaging review resulted in discrepant findings in 108/400 patients (27%). Patients with heterogeneously or extremely dense breasts had higher discrepancy frequency (36% discrepancy, 68/187) than those with almost entirely fatty or scattered fibroglandular breast tissue (19% discrepancy, 40/213) with P = 0.0001. Discrepancies resulted in the following changes in impression/recommendations: 70 repeat ultrasounds for better characterization of a breast lesion, 11 repeat ultrasounds of a negative region, 20 repeat ultrasounds for benign axillary lymph nodes, 5 downgrades from probably benign to benign, and 2 upgrades from benign to suspicious. Repeat ultrasounds of the axilla in 19 patients resulted in 13 biopsy recommendations, and 4 were metastatic (PPV3 31%). In the breast, repeat ultrasounds in 81 patients resulted in 14 upgrades to suspicious. Of these, 5 yielded malignancy. In addition, one patient was upgraded from benign to suspicious based on the outside image, with pathology revealing malignancy (breast PPV3 40%). Breast lesion BI-RADS category downgrades in 27 patients resulted in 10 avoided biopsies. Ultimately, second opinion ultrasound review resulted in altered management in 12% of patients (47/400). This included discovery of additional breast malignancies in 6 patients, metastatic lymph nodes in 4 patients, excisional biopsy for atypia in 1 patient, 4 patients proceeding to mastectomy, 10 patients who avoided biopsies, and 22 patients who avoided follow-up of benign findings. Conclusions: In this study, subspecialized second opinion ultrasound review had an impact on preventing unnecessary procedures and follow-up exams in 8% of patients while detecting additional cancer in 2.5%.

"If You Don't Ask, I'm Not Going to Tell You": Using Community-Based Participatory Research to Inform Pregnancy Intention Screening Processes for Black and Latina Women in Primary Care.

BACKGROUND: Public health and medical professional organizations recommend screening women of reproductive age for pregnancy intention (PI) routinely in primary care. Existing PI screening tools may not address the complexity of intentions for women of color or lower socioeconomic status or be well-suited to primary care settings. This study sought to inform recommendations for carrying out PI screening meaningfully in primary care settings. METHODS: This community-based participatory research project united staff from a research institution, community health organization, and federally qualified health center in a predominantly Latina community in New York City. The Community Advisory Board members designed the research question, developed qualitative interview guides, and conducted in-depth interviews with 30 English- and Spanish-speaking female federally qualified health center patients ages 15 to 49. Community Advisory Board members developed an initial codebook using an inductive approach and refined themes throughout the coding process. After coding, Community Advisory Board members created a conceptual map representing relationships between key themes, and generated data-informed recommendations for PI screening practices that are relevant and feasible in the community context. RESULTS: Participants expressed a range of experiences with PI screening processes, depending on medical histories, attitudes, norms, and perceived benefits of screening. Three central themes emerged through frequency of occurrence, consistency in content, and relevance as reflected in concept mapping: agency, judgment and shame, and expertise versus authority. Recommendations included specific strategies and wording providers could use to explain the rationale and context for discussing PI. CONCLUSIONS: Future work should examine the experience and effectiveness of implementing these community-based participatory research-derived recommendations in primary care.

Building Community Capacity for Qualitative Research to Improve Pregnancy Intention Screening.

BACKGROUND: Community-based participatory research (CBPR), with an emphasis on co-learning and collaboration, holds promise for exploring the pregnancy intention (PI) screening needs of Latina patients and their health care providers. We describe a CBPR partnership exploring PI screening processes at a federally qualified health center in New York City, and lessons learned related to community participation, training, and collaboration between partners. METHODS: Stakeholders convened a community advisory board (CAB) to carry out CBPR. The CAB administered a biannual process evaluation to assess members' experiences with the project. RESULTS: Despite challenges, the CAB prioritized community participation, training, and collaboration. At three time points, members reported gaining research skills (93%, 100%, 100%), and believing in the project's potential to improve PI screening (100%, 100%, 100%). CONCLUSIONS: Building capacity for CBPR requires providing iterative training, navigating discrepancies between CAB members' interests and training needs, facilitating the meaningful participation of members with limited time and/or technical skills, and ensuring an equitable division of labor.

Primary care providers' responses to pregnancy intention screening challenges: community-based participatory research at an urban community health centre.

BACKGROUND: Incorporating pregnancy intention screening into primary care to address unmet preconception and contraception needs may improve delivery of family planning services. A notable research gap exists regarding providers' experiences conducting this screening in primary care. OBJECTIVE: To explore primary care providers' perceived challenges in conducting pregnancy intention screening with women of reproductive age and to identify strategies to discuss this in primary care settings. METHODS: This qualitative study emerged from a 2017 community-based participatory research project. We conducted semi-structured, in-depth interviews with 10 primary care providers who care for women of reproductive age at an urban federally qualified health centre. Analysis consisted of interview debriefing, transcript coding and content analysis with the Community Advisory Board. RESULTS: Across departments, respondents acknowledged difficulties conducting pregnancy intention screening and identified strategies for working with patients' individual readiness to discuss pregnancy intention. Strategies included: linking patients' health concerns with sexual and reproductive health, applying a shared decision-making model to all patient-provider interactions, practicing goal setting and motivational interviewing, fostering non-judgmental relationships and introducing pregnancy intention in one visit but following up at later times when more relevant for patients. CONCLUSIONS: Opportunities exist for health centres to address pregnancy intention screening challenges, such as implementing routine screening and waiting room tools to foster provider and patient agency and sharing best practices with providers across departments by facilitating comprehensive training and periodic check-ins. Exploring providers' experiences may assist health centres in improving pregnancy intention screening in the primary care setting.

Adapting the Get Yourself Tested Campaign to Reach Black and Latino Sexual-Minority Youth.

BACKGROUND: Culturally appropriate efforts are needed to increase sexually transmitted disease (STD) testing and care among Black and Latino sexual-minority youth, who are at high risk for STDs. Get Yourself Tested, a national testing campaign, has demonstrated success among youth, but it has yet to be assessed for relevance or impact among this population. METHOD: This effort included (1) formative and materials-testing research through focus groups; (2) adaptation of existing Get Yourself Tested campaign materials to be more inclusive of Black and Latino sexual-minority youth; (3) a 3-month campaign in four venues of New York City, promoting STD testing at events and through mobile testing and online and social media platforms; (4) process evaluation of outreach activities; and (5) an outcome evaluation of testing at select campaign venues, using a preexperimental design. RESULTS: During the 3-month campaign period, the number of STD tests conducted at select campaign venues increased from a comparable 3-month baseline period. Although testing uptake through mobile vans remained low in absolute numbers, the van drew a high-prevalence sample, with positivity rates of 26.9% for chlamydia and 11.5% for gonorrhea. This article documents the process and lessons learned from adapting and implementing a local campaign for Black and Latino sexual-minority youth.

Improving contraceptive choice: fidelity of implementation and the gap between effectiveness and efficacy.

Interventions to reduce unintended pregnancy through improved contraceptive use are a public health priority. A comprehensive process evaluation of a contraceptive assessment module intervention with demonstrated efficacy was undertaken. The 12-month process evaluation goal was to describe the extent to which the intervention was implemented as intended over time, and to identify programmatic adjustments to improve implementation fidelity. Quantitative and qualitative methods included staff surveys, electronic health record data, usage monitoring, and observations. Fidelity of implementation was low overall (<10% of eligible patients completed the entire module [dose received]). Although a midcourse correction making the module available in clinical areas led to increased dose delivered (23% vs. 30%, chi-square test p = .006), dose received did not increase significantly after this adjustment. Contextual factors including competing organizational and staff priorities and staff buy-in limited the level of implementation and precluded adoption of some strategies such as adjusting patient flow. Using a process evaluation framework enabled the research team to identify and address complexities inherent in effectiveness studies and facilitated the alignment of program and context.