Reliability and validity of intervention characteristic measures for assessing barriers to evidence-based practice use.

Assessing barriers before implementing an evidence-based practice can increase the chances of successful implementation. This project evaluated measures of intervention characteristics that could affect implementation: evidence strength and quality; relative advantage; adaptability; trialability; complexity; design quality and packaging; perceived cost; compatibility; observability; risk; and burden. Measures (109 items total) for each intervention characteristic were developed in a previous study, using prior measures, and expert feedback. Measures were scored such that higher scores meant a more positive view. Healthcare personnel implementing a new practice (n = 175) completed two surveys, 1 month apart. Participants completed the intervention characteristic item banks and questions on the use of the evidence-based practice. Reliability and validity were assessed for each item bank. All measures had Cronbach's alphas over 0.7 (range: 0.700-0.932) indicating good reliability. Frequent users of the practice reported better levels of each determinant at the first (Cohen's d range: -0.239 to -0.687) and second surveys (Cohen's d range: -0.043 to -1.081) except for costs (0.096) with use on the second survey. This preliminary test of measures to assess determinants of implementing evidence-based practice supports the validity and reliability of these tools. Additional studies are needed to further test the psychometric properties of the measures and develop short forms of each intervention characteristic measure.

Measuring perceptions of healthcare personnel can help increase the use of evidence-based care. This study developed measures of eleven different types of perceptions. The measures were tested in a sample of 175 healthcare personnel. All eleven measures showed good reliability and validity. The measures can be used to assess perceptions in research and clinical care.

Prevalence and Correlates of Post-Diagnosis Alcohol Use among Cancer Survivors.

BACKGROUND: Alcohol is a risk factor for cancer and may pose unique risks for cancer survivors. Population-based studies of confirmed cancer cases are needed to estimate the extent of drinking among cancer survivors and to understand which survivors are most at risk of alcohol-related health problems. METHODS: Cancer survivors who resided in the Puget Sound Surveillance, Epidemiology, and End Results (SEER) region, were ages 21 to 74 years at diagnosis, and were 6 to 17 months post-diagnosis at the start of the recruitment period (April 2020-December 2020) were sent a survey that included demographics, substance use, mental health, and cancer-related items. Data from returned surveys (n = 1,488) were weighted to represent the characteristics of the Puget Sound SEER region. We estimated the prevalence of post-diagnosis alcohol use as well as demographic, behavioral, and clinical correlates of three levels of drinking: any drinking, drinking exceeding cancer prevention guidelines, and hazardous drinking. RESULTS: The weighted prevalence of any drinking, drinking exceeding cancer prevention guidelines, and hazardous drinking was 71%, 46.2%, and 31.6%, respectively. Higher income and cannabis use were associated with increased odds of all three drinking levels. Lower physical health quality of life, having non-colorectal gastrointestinal cancer, and receiving chemotherapy within the last month were associated with decreased odds of all three drinking levels. CONCLUSIONS: The prevalence of any drinking and at-risk drinking was higher than in previous studies and differed based on sociodemographic, substance use, and cancer-related factors. IMPACT: Findings highlight the importance of identifying and addressing risky alcohol use in cancer care settings.

Content validity of an item bank to assess intervention characteristic determinants of implementing evidence-based practices.

Background: Barriers and facilitators, collectively called determinants, of evidence-based practice implementation are key to identifying the best strategies for promoting implementation. Assessing determinants before implementation can help tailor strategies to those that would be most effective. Current measures of determinants are not comparable across implementation settings and implementation scientists and practitioners often have to create their own measures. This study was the first step in creating determinants item banks that are usable across settings and focused on intervention characteristics. We aimed to establish the content validity of the item bank. Method: This study used a concurrent mixed methods approach. Items for assessing intervention characteristic determinants were first identified through systematic reviews. Implementation scientists then completed a survey where they provided both quantitative and qualitative feedback on the items. Finally, three experts with both clinical and implementation experience provided feedback on redundancy and representativeness. Results: The systematic reviews identified over 1,959 items so subsequent steps were limited to focus on intervention characteristic determinants (271 items) such as adaptability of the practice. Based on feedback from thirty implementation scientists, the items were reduced to 92 but an additional 53 were added, most due to qualitative feedback. Items were also rewritten based on qualitative results. Three experts reviewed the remaining 145 items. Based on their feedback, the number of items was reduced to 109. Conclusions: Creating a determinants item bank was feasible and the final items had content validity. The next steps include testing reliability and validity in a larger sample of clinicians implementing evidence-based practices.

Barriers prevent or impede an organization from using a new practice or innovation. Facilitators help promote the use of a new practice or innovation within an organization. Assessing barriers and facilitators before starting a new practice can help target barriers and increase the chances of successfully using the practice. This study created new measures of barriers and facilitators of using a new practice or innovation. Previous measures were identified through literature reviews. Implementation scientists provided feedback on the measures through an online survey. Three experts with clinical and implementation experience provided additional feedback. Measures were revised based on the survey and expert feedback. The next steps are to test the measures with clinicians implementing a new practice.

Challenges and Opportunities of Epidemiological Studies to Reduce the Burden of Cancers in Young Adults.

There are >1.9 million survivors of adolescent and young adult cancers (AYA, diagnosed at ages 15-39) living in the U.S. today. Epidemiologic studies to address the cancer burden in this group have been a relatively recent focus of the research community. In this article, we discuss approaches and data resources for cancer epidemiology and health services research in the AYA population. We consider research that uses data from cancer registries, vital records, healthcare utilization, and surveys, and the accompanying challenges and opportunities of each. To illustrate the strengths of each data source, we present example research questions or areas that are aligned with these data sources and salient to AYAs. Integrating the respective strengths of cancer registry, vital records, healthcare data, and survey-based studies sets the foundation for innovative and impactful research on AYA cancer treatment and survivorship to inform a comprehensive understanding of diverse AYA needs and experiences.

Mi Vida Saludable: Content Validity and Reliability of The Preferences and Self-Efficacy of Diet and Physical Activity Behaviors Questionnaire for Latina Women (PSEDPALW) for Cancer Survivors.

The purpose of this study is to conduct validity and reliability testing of a new instrument, the Preferences and Self-Efficacy of Diet and Physical Activity Behaviors Questionnaire for Latina Women (PSEDPALW), which is for women who identify as Latina and are breast cancer survivors. PSEDPALW measures preferences and self-efficacy for four behaviors: physical activity (PA), fruit and vegetable (FV) intake, dietary fat (DF) intake, and added sugar (AS) intake (eight scales in total). Validity testing was conducted through an expert panel review and a cognitive interviewing focus group (n = 4). Reliability was tested via internal consistency reliability (n = 118) and test-retest reliability (n = 30). Validity testing was used to refine PSEDPALW. Reliability testing was conducted on three versions with 104, 47, and 41 items. PA scales had acceptable Cronbach's α (>0.70) but low ICC (NS). FV and DF scales had acceptable Cronbach's α (>0.70), with preferences for the shorter (47- and 41-item) versions (Cronbach's α < 0.70), and all scales had moderate ICC (p < 0.05, except the FV scale on the 104-item version (p = 0.07)). The AS preferences scale had Cronbach's α < 0.70, with self-efficacy > 0.70 for all versions and ICC moderate for all versions (p ≤ 0.01). PSEDPALW may be useful to assess diet and physical activity preferences and self-efficacy in theory-based diet and physical activity interventions in women who identify as Latina and are breast cancer survivors.

Association of financial worry with substance use, mental health, and quality of life in cancer patients.

PURPOSE: Financial worry is an under-appreciated negative effect of cancer. The relationship of financial worry and health behaviors in cancer is poorly characterized and has important clinical implications. This study examined the association of financial worry with substance misuse, mood, and quality of life. METHODS: People with cancer (n = 1473; 6 to 20 months after diagnosis) were recruited from a SEER cancer registry in the Pacific Northwest. Participants completed an online survey assessing financial worry; misuse of cannabis, alcohol, and prescription drugs; tobacco smoking status; quality of life (physical and mental dimensions); anxiety; and depression. Multivariable regressions tested the association of financial worry to each health indicator and outcome. RESULTS: In adjusted analyses, financial worry was associated with being a current vs. never smoker (odds ratio (OR) = 1.91, 95% confidence interval (CI): 1.01, 3.60), and a positive screen for an anxiety (OR = 3.01, 95% CI: 1.93, 4.68) and depressive (OR = 3.08, 95% CI: 1.89, 5.00) disorder. Financial worry was not associated with cannabis, alcohol, or prescription drug misuse (all ps > 0.05), but was associated with a decrease in physical (ß = - 2.97, 95% CI: - 4.15, - 1.79) and mental (ß = - 5.27, 95% CI: - 6.59, - 3.96) quality of life. CONCLUSION: Financial worry among cancer survivors is associated with anxiety, depression, and worse quality of life. Of the evaluated substances, there was only an increased odds of current tobacco use with financial worry. Future longitudinal studies should inform the relationships between these factors. IMPLICATIONS FOR CANCER SURVIVORS: Financial worry and material hardship may both need to be addressed in cancer survivorship.

Exploration of Caregiver Interrater Agreement and Test-Retest Reliability on the Infant Cleft Observer Outcomes (iCOO).

Caregiver and observer-reported measures are frequently used as outcomes for research on infants and young children who are unable to report on their own health. Our team developed the Infant with Clefts Observation Outcomes Instrument (iCOO) for infants with cleft lip with or without cleft palate. This exploratory study compared test-retest and interrater reliabilities to inform whether differences in caregiver perspective might affect the iCOO.This study is a secondary analysis comparing caregiver interrater agreement to test-retest reliability. Twenty-five pairs of caregivers completed the iCOO before surgery, 1 week later for test-retest reliability, 2 days after surgery, and 2 months after surgery. Reliability was assessed using intraclass correlations (ICCs) and t-tests were used to compare ratings between caregivers.Infants had cleft lip (28%) or cleft lip and palate (72%). Primary caregivers were predominantly mothers (92%) and secondary caregivers were predominantly fathers (80%). Test-retest reliability met psychometric standards for most items on the iCOO (81%-86% of items). Caregiver agreement on the iCOO items was lower than test-retest reliability (33%-46% of items met psychometric standards). Caregivers did not systematically differ in whether they rated infants as healthier or less healthy than the other caregiver (5%-16% of items had statistically significant differences).Caregivers used the measure consistently, but had different experiences and perceptions of their infant's health and functioning. Future studies are needed to explore mechanisms for the differences in test-retest and interrater reliability. Whenever possible, the same caregiver should provide ratings of the infant, including on the iCOO.

Common methods of determining meaningful change in clinical practice: implications for precision patient-reported outcomes.

PURPOSE: Patient-reported outcomes (PROs) are used in clinical practice for several purposes, including to monitor whether a treatment is working or whether a patient is experiencing adverse events from treatment. This study surveyed oncology providers (OP) and mental health providers (MHP) to determine how clinicians from different disciplines determine individual-level meaningful change on PROs. Understanding how clinicians determine change on PROs could help inform methods for individualizing meaningful change definitions, an approach we have dubbed "Precision PROs". METHODS: Three hundred and forty-seven providers utilizing PROs completed an online survey about PRO use to monitor patients in clinical practice. A question on methods used to determine individual-level meaningful change on PROs was developed with input from clinicians. Multivariate logistic regression analyses were used to assess whether specific methods were associated with clinician characteristics. RESULTS: The most commonly reported method was comparing the previous score to the current score (65%). Other methods included examining the numerical scores without a visual aid (59%), considering other factors affecting scores (42%), comparing scores to norms (31%) and using a graph of scores (29%). Provider age was negatively associated with odds of using a graph (OR = 0.95, 95% CI 0.91, 1.0) but no other method. Provider gender, hours per week in clinical practice and years in practice were not associated with odds of using a specific method. CONCLUSIONS: Most providers determined individual-level meaningful change without a visual aid and used only the previous score and current score, the minimum number (2 scores) to determine change. Consistent with current practice, future research on methods of determining within-individual meaningful change for clinical use should focus on methods requiring two rather than three or more scores. When attempting to personalize within-individual change definitions (Precision PROs), methods examining a baseline and single follow-up may be most useful for clinical practice.

Social risks and social needs in a health insurance exchange sample: a longitudinal evaluation of utilization.

BACKGROUND: Health systems are increasingly attempting to intervene on social adversity as a strategy to improve health care outcomes. To inform health system efforts to screen for social adversity, we sought to explore the stability of social risk and interest in assistance over time and to evaluate whether the social risk was associated with subsequent healthcare utilization. METHODS: We surveyed Kaiser Permanente members receiving subsidies from the healthcare exchange in Southern California to assess their social risk and desire for assistance using the Accountable Health Communities instrument. A subset of initial respondents was randomized to be re-surveyed at either three or six months later. RESULTS: A total of 228 participants completed the survey at both time points. Social risks were moderate to strongly stable across three and six months (Kappa range = .59-.89); however, social adversity profiles that included participants' desire for assistance were more labile (3-month Kappa = .52; 95% CI = .41-.64 & 6-month Kappa = .48; 95% CI = .36-.6). Only housing-related social risks were associated with an increase in acute care (emergency, urgent care) six months after initial screening; no other associations between social risk and utilization were observed. CONCLUSIONS: This study suggests that screening for social risk may be appropriate at intervals of six months, or perhaps longer, but that assessing desire for assistance may need to occur more frequently. Housing risks were associated with increases in acute care. Health systems may need to engage in screening and referral to resources to improve overall care and ultimately patient total health.

Theory of Planned Behavior and Mindfulness Intentions in Chronic Low Back Pain.

Objectives: Theory of planned of behavior (TPB) constructs have been linked to health behavior intentions. Intentions to try mindfulness-based stress reduction (MBSR), a first-line therapy for chronic low back pain (cLBP), have been less studied. This study aimed to identify which TPB constructs could inform strategies to improve adoption of MBSR. Methods: People with cLBP (n = 457) read a description of MBSR then completed survey items assessing TPB constructs: attitudes, norms, self-efficacy, perceived control, and intentions to try MBSR training. Results: Structural equation modeling showed self-efficacy/control (coefficient: 0.564), norms (0.245), and attitudes (0.131) were all positively associated with intentions to try mindfulness trainings. Conclusions: Results suggest self-efficacy/control may be the most strongly related TPB construct with intentions to try MBSR. Dissemination of MBSR for cLBP could focus on adapting the intervention to increase accessibility and improving available resources to overcome logistical barriers (online formats, drop-in classes). Supplementary Information: The online version contains supplementary material available at 10.1007/s12671-022-02022-2.

Financial worry in people with cancer: Relationship to employment and outcomes.

BACKGROUND: People with cancer experience financial hardship. Most previous research has focused on material financial burden rather than financial worry. This study investigated employment predictors of financial worry and examined outcomes potentially affected by financial worry. METHODS: Data from the 2018 National Health Interview Study was used and limited to people diagnosed with cancer and having complete data on relevant variables (n = 2049). Preliminary analyses indicated three dimensions of financial worry: healthcare; lifestyle; and basic needs. Outcomes included cost-related nonadherence, and presence of depressive symptoms and anxiety. Multivariable regressions examined the association of financial worry with cost-related nonadherence and mental health and employment characteristics (paid hourly; sick leave; employer size) with financial worry while controlling for demographics. RESULTS: Mean age was 68.10 years (range: 20-85), and most had skin (33.6%), prostate (12.5%) or breast (21.4%) cancer. Hourly pay predicted more financial worry about affording healthcare (p < 0.001), basic needs (p < 0.001) and lifestyle (p < 0.001). Having paid sick leave predicted less worry about basic needs (p = 0.003). Worry about affording healthcare predicted more cost-related nonadherence (p < 0.001) even when controlling for other variables associated with financial hardship. Worry about lifestyle (p = 0.193) and basic needs (p = 0.688) were not associated with cost-related nonadherence. Worry about lifestyle (p < 0.001) predicted depression. Worry about affording healthcare (p = 0.042) and lifestyle (p < 0.001) predicted anxiety. CONCLUSIONS: Research is needed to determine the value of financial worry screening, particularly about affording healthcare, as well as material financial hardship. Financial worry should be included as an outcome in policy evaluations and interventions for financial hardship.

An experimental study to inform adoption of mindfulness-based stress reduction in chronic low back pain.

BACKGROUND: Chronic low back pain is a common and sometimes disabling condition, and mindfulness-based stress reduction is recommended as a first line of therapy. This study tested whether different descriptions of mindfulness training altered based on influential intervention characteristics increased adoption intentions. METHODS: People with chronic low back pain (n = 452) were randomized to review one of four mindfulness training descriptions in an online survey using a 2 × 2 factorial design. The first factor was evidence strength and quality with relative advantage (ER). The second factor was adaptability, trialability, complexity, and design quality and packaging (AD). Each factor had two levels: a description of standardized mindfulness training that described each intervention characteristic and a patient-centered description emphasizing flexibility and patient testimonials. The primary outcomes were intentions to try mindfulness training and practice mindfulness at home. Using structural equation modeling with a bootstrapped distribution, we tested six mediators, three of which are Theory of Planned Behavior predictors of intention-self-efficacy, norms, and attitudes- and the other three are predictors of adoption-feasibility, appropriateness, and acceptability. RESULTS: Overall, the mindfulness training descriptions were not associated with an increase in intentions compared to the classic vignette (11/12 p's > 0.05). Most descriptions were unrelated to mediators except the classic ER with patient-centered AD was associated with higher self-efficacy/control and feasibility (p's ≤ 0.05; standardized effect range: 0.111-0.125). Self-efficacy/control (training standardized coefficient: 0.531, home: 0.686), norms (training: 0.303, home: 0.256), and attitudes (training: 0.316, home: 0.293) were all positively associated with intentions to adopt mindfulness training and home practice. Feasibility (training: 0.185; home: 0.293) and acceptability (training: 0.639; home: 0.554) were positively related to intentions to adopt mindfulness training. Appropriateness was related to intentions to adopt home practice (0.187) but not mindfulness training (0.100). None of the indirect effects from experimental group to intentions was significant (all p's > 0.05). CONCLUSIONS: Self-efficacy/control and acceptability may be key mediators for increasing patient adoption of mindfulness. Because experimental manipulation did not substantially change intentions to adopt mindfulness, the presentation and delivery of MBSR may need to be tailored to the individual patient's needs rather than a specific format for chronic low back pain.

Social Risk Factors and Desire for Assistance Among Patients Receiving Subsidized Health Care Insurance in a US-Based Integrated Delivery System.

PURPOSE: Because social conditions such as food insecurity and housing instability shape health outcomes, health systems are increasingly screening for and addressing patients' social risks. This study documented the prevalence of social risks and examined the desire for assistance in addressing those risks in a US-based integrated delivery system. METHODS: A survey was administered to Kaiser Permanente members on subsidized exchange health insurance plans (2018-2019). The survey included questions about 4 domains of social risks, desire for help, and attitudes. We conducted a descriptive analysis and estimated multivariate modified Poisson regression models. RESULTS: Of 438 participants, 212 (48%) reported at least 1 social risk factor. Housing instability was the most common (70%) factor reported. Members with social risks reported more discomfort being screened for social risks (14.2% vs 5.4%; P = .002) than those without risks, although 90% of participants believed that health systems should assist in addressing social risks. Among those with 1-2 social risks, however, only 27% desired assistance. Non-Hispanic Black participants who reported a social risk were more than twice as likely to desire assistance compared with non-Hispanic White participants (adjusted relative risk [RR] 2.2; 95% CI, 1.3-3.8). CONCLUSIONS: Athough most survey participants believed health systems have a role in addressing social risks, a minority of those reporting a risk wanted assistance and reported more discomfort being screened for risk factors than those without risks. Health systems should work to increase the comfort of patients in reporting risks, explore how to successfully assist them when desired, and offer resources to address these risks outside the health care sector.VISUAL ABSTRACT.

Interest in Mindfulness Training for Chronic Low-Back Pain: Results from a Vignette-driven, Web-based Survey of Patients.

Objectives: Mindfulness-based stress reduction (MBSR) has been found effective for improving chronic low-back pain (cLBP). However, little data exist regarding how attractive this technique is to Americans as a therapy for cLBP. Design: Survey of randomly selected persons with cLBP. Settings/Location: Respondents were recruited from Kaiser Permanente Washington and one-time surveys were completed online. Patients: Adults 18-80 years of age with cLBP. Surveys: The study was conducted between December 2019 and August 2020. Outcome measures: The survey described an evidence-based classic MBSR course and then asked respondents about their sociodemographic characteristics, their current back pain, previous back pain treatments, behavioral risk factors for back pain, and four outcomes indicative of intention to engage in MBSR. Results: Four-hundred fifty-seven respondents completed the survey. Respondents were primarily women, white, educated, and with back pain for more than 5 years. About half had previously used a mind-body therapy for their pain. Overall, they reported moderate to high intention to try mindfulness classes and practice at home (median of 5 with 50% of the observations between 4 and 6, and 5.7, 50% of the observations between 4.3 and 6.3, respectively, on a 7-point scale). They reported a willingness to spend a median of 3 h/week learning mindfulness and 3.5 h/week practicing mindfulness techniques (for both outcomes, 50% of the respondents reported between 2 and 5 h). Few patient characteristics predicted intention to engage in MBSR, with no variable predicting all outcomes. The magnitude of the effect associated with significant predictors was small. Conclusion: Classic MBSR appealed to many survey respondents, in that they reported high interest in learning MBSR and intention to practice at home. The amount of time they reported being willing to spend learning MBSR and practicing at home is consistent with the time commitment in the original course.

Tailoring Pain Interference Measurement in People with Cancer: A Feasibility Study.

CONTEXT: Most patient-reported outcomes (PRO) are not directly tailored to an individual patient's values, partially because tailored PROs require clinical interviews or are difficult to use in statistical analyses. OBJECTIVES: This study tested a method for tailoring pain PROs, Precision PROs, that can be implemented, and analyzed using standard statistical tests. METHODS: People with cancer and pain (n = 231) completed an online survey and then a second survey (n = 161) one to two weeks later. Participants reviewed the PROMIS pain interference item bank, chose the four items most important to their quality of life, and then completed those items. Kappas compared choices between the two surveys. Participants completed measures of pain intensity, physical function, and a standard pain interference measure. RESULTS: All participants were able to select four items that were personally meaningful. Only one item (enjoyment of life) was chosen by more than half the sample (50.6%). Kappas for item choice were in the moderate to nearly perfect range for 32 of 35 items. The majority of the sample (59%) preferred tailoring their own PRO questions to completing a previously determined, non-patient-specific PRO. The Precision PRO scores had similar associations with pain intensity and physical function as the standard pain interference measure. CONCLUSION: The Precision PRO approach was feasible, more preferred by patients, and showed consistency over a short timeframe. This approach could be used to make PRO assessment in clinical care and clinical trials more patient-centered. Additional research is needed to determine the generalizability of this approach to other outcomes and populations.

The Inventory of Physical Activity Barriers for Adults 50 Years and Older: Refinement and Validation.

BACKGROUND AND OBJECTIVES: Due to health consequences associated with insufficient physical activity (PA), particularly among aging adults, health care providers should assess and address lack of PA participation. Addressing lack of PA means developing individualized PA prescriptions that incorporate solutions to PA participation barriers. Assessing PA participation barriers can be done through the Social Ecological Model-based Inventory of Physical Activity Barriers Scale (IPAB). This study aimed to refine the initial 40-item IPAB and determine its reliability and validity. RESEARCH DESIGN AND METHODS: Five hundred and three community-dwelling adults 50 years and older completed a demographic and health questionnaire, the Physical Activity Vital Sign, the IPAB, and a feedback questionnaire. For scale refinement, half of the data were used for exploratory factor analysis and the other half for confirmatory factor analysis. The refined scale underwent reliability and validity assessment, including internal consistency, test-retest reliability, and construct validity. RESULTS: The refined scale contains 27 items consisting of 7 factors and 1 stand-alone item: (a) environmental, (b) physical health, (c) PA-related motivation, (d) emotional health, (e) time, (f) skills, (g) social, and (h) energy (a stand-alone item). The 27-item IPAB has good internal consistency (alpha = 0.91) and high test-retest reliability (intraclass correlation coefficient = 0.99). The IPAB's mean scores were statistically different between those who met the recommended levels of PA and those who did not (p < .001). DISCUSSION AND IMPLICATIONS: The information gathered through the IPAB can guide discussions related to PA participation barriers and develop individualized PA prescriptions that incorporate solutions to the identified barriers.

Feasibility of a patient-centered method to determine meaningful change in pain intensity on a survey of patients with a history of cancer.

Introduction: Current methods of determining minimally important differences (MIDs) in patient-reported outcomes (PROs) do not incorporate individual patient values. Objectives: This study tested the feasibility of having cancer patients define a personally meaningful change in pain intensity, a method we have termed Precision PROs. Methods: Adults with cancer and pain (n = 231) completed an electronic questionnaire twice over 2 weeks. Participants were then given their pain intensity scores with an explanation of score meaning. Participants then defined their own MIDs for an increase and decrease in pain intensity. Participants also answered 3 questions testing their understanding of the MID concept. Results: The majority of participants could define an individually meaningful increase (97% [n = 223]) and individually meaningful decrease (98% [n = 226]) in pain intensity. Seventy-two percent of participants (n = 166) answered all test questions correctly and 26% (n = 60) answered 2 of 3 correctly. Using the individual MID, 32% (95% CI: 25.3, 40.0) of the sample experienced a meaningful change between the 2 surveys, more than other methods (z-test: 14%, 95% CI: 9.4, 20.6; distribution-based method: 24%, 95% CI: 17.7, 31.1). Conclusions: This study showed the feasibility of the Precision PRO individual MID, which could be used in clinical care or clinical trials. Further studies are needed to compare the individual MID to current methods.

A comparison of oncologist versus mental health provider attitudes towards standardized and tailored patient-reported outcomes.

BACKGROUND: Patient-reported outcomes (PROs) can be used to monitor patients during treatment. Healthcare provider preferences for individualized vs. standardized PROs have been understudied. METHODS: This study surveyed oncology and mental health providers to compare attitudes towards individualized and standardized PROs. We have developed a method for individualizing PROs, called precision PROs, and the survey specifically assessed preferences for this method. We compared attitudes and preferences by provider type and by whether respondents were current or never users of PROs. RESULTS: Oncology providers expressed more positive attitudes for standardized PROs in treatment planning compared to mental health providers (F(1,440) = 5.978, p = 0.015). The interaction between provider type (oncology vs. mental health) and type of PRO (individualized vs. standardized) was not significant for the attitudes about the clinical utility of PROs (p = 0.709). When directly asked about the precision PRO approach, oncologists were less likely to prefer standardized items (OR = 0.478, p = 0.001) or have no preference (OR = 0.445, p = 0.007) to the precision PRO approach when compared to mental health providers. Qualitative analyses suggested standardized PROs may be simpler or easier to understand whereas individualized PROs better capture patient variability and the unique aspects of each patient's condition. Some mental health providers expressed reticence about letting patients choose how to tailor PROs. Never users of PROs reported more positive attitudes towards individualized measures than standardized measures whereas current users of PROs did not have a difference in attitudes (p = 0.010). User status was mostly unrelated to preferences. CONCLUSION: Results suggest that healthcare provider preference for individualized PROs may differ by medical specialty. How PROs are tailored may need to differ by discipline. This is particularly important given that previous research showing a preference for individualized PROs over standardized was conducted with psychotherapists. Further research on patient preferences for individualized and standardized PROs is warranted as is research on the clinical utility of individualized PROs such as the precision PRO approach.

Financial Anxiety is Associated With Cancer Screening Adherence in Women at High Risk of Breast Cancer.

BACKGROUND: Previous studies have examined the impact of material financial hardship on cancer screening but without focusing on the psychological aspects of financial hardship. PURPOSE: This study examined the effects of different types of financial anxiety on adherence to breast cancer screening in women at high risk of breast cancer. Adherence to cervical cancer screening was also examined to determine whether associations between financial anxiety and screening adherence were unique to breast cancer screening or more general. METHODS: Women (n = 324) aged 30-50 and at high risk for inherited breast cancer completed a survey on general financial anxiety, worry about affording healthcare, financial stigma due to cancer risk, and adherence to cancer screening. Multivariate analyses controlled for poverty, age, and race. RESULTS: More financial anxiety was associated with lower odds of mammogram adherence (odds ratio [OR] = 0.97, confidence interval [CI] = 0.94, 0.99), Pap smear adherence (OR = 0.98, CI = 0.96, 0.996), and clinical breast examination adherence (OR = 0.98, CI = 0.96, 0.995). More worry about affording healthcare was associated with lower odds of clinical breast examination adherence (OR = 0.95, CI = 0.91, 0.9992) but not mammogram or Pap smear adherence (p > .05). Financial stigma due to cancer risk was associated with lower odds of Pap smear adherence (OR = 0.87, CI = 0.77, 0.97) but no other cancer screenings (p > .07). CONCLUSIONS: Financial anxiety may impede cancer screening, even for high-risk women aware of their risk status. Clinical interventions focused on social determinants of health may also need to address financial anxiety for women at high risk of breast cancer.

Association of Financial Worry and Material Financial Risk with Short-Term Ambulatory Healthcare Utilization in a Sample of Subsidized Exchange Patients.

BACKGROUND: Financial burden can affect healthcare utilization. Few studies have assessed the short-term associations between material (debt, trouble paying rent) and psychological (worry or distress about affording future healthcare) financial risks, and subsequent outpatient and emergency healthcare use. Worry was defined as concerns about affording future healthcare. OBJECTIVE: Examine whether worry about affording healthcare is associated with healthcare utilization when controlling for material risk and general anxiety DESIGN: Longitudinal observational study PARTICIPANTS: Kaiser Permanente members with exchange-based federally subsidized health insurance (n = 450, 45% response rate) MAIN MEASURES: Survey measures of financial risks (material difficulty paying for medical care and worry about affording healthcare) and general anxiety. Healthcare use (primary care, urgent care, emergency department, and outpatient specialty visits) in the 6 months following survey completion. KEY RESULTS: Emergency department and primary care visits were not associated with material risk, worry about affording care, or general anxiety in individual and pooled analyses (all 95% confidence intervals (CI) for relative risk (RR) included 1). Although no individual predictor was associated with urgent care use (all 95% CIs for RR included 1), worry about affording prescriptions (relative risk (RR) = 2.01; 95% CI 1.14, 3.55) and general anxiety (RR = 0.38; 95% CI 0.15, 0.95) were significant when included in the same model, suggesting the two confounded each other. Worry about affording healthcare services was associated with fewer specialty care visits (RR = 0.40; 95% CI 0.25, 0.64) even when controlling for material risk and general anxiety, although general anxiety was also associated with more specialty care visits (RR = 1.98; 95% CI, 1.23, 3.18). CONCLUSIONS: Screening for both general anxiety and financial worry may assist with specialty care utilization. Identifying these concerns may provide more opportunities to assist patients. Future research should examine interventions to reduce worry about cost of care.