Qualitative insights into how men with low-risk prostate cancer choosing active surveillance negotiate stress and uncertainty.

BACKGROUND: Active surveillance is a management strategy for men diagnosed with early-stage, low-risk prostate cancer in which their cancer is monitored and treatment is delayed. This study investigated the primary coping mechanisms for men following the active surveillance treatment plan, with a specific focus on how these men interact with their social network as they negotiate the stress and uncertainty of their diagnosis and treatment approach. METHODS: Thematic analysis of semi-structured interviews at two academic institutions located in the northeastern US. Participants include 15 men diagnosed with low-risk prostate cancer following active surveillance. RESULTS: The decision to follow active surveillance reflects the desire to avoid potentially life-altering side effects associated with active treatment options. Men on active surveillance cope with their prostate cancer diagnosis by both maintaining a sense of control over their daily lives, as well as relying on the support provided them by their social networks and the medical community. Social networks support men on active surveillance by encouraging lifestyle changes and serving as a resource to discuss and ease cancer-related stress. CONCLUSIONS: Support systems for men with low-risk prostate cancer do not always interface directly with the medical community. Spousal and social support play important roles in helping men understand and accept their prostate cancer diagnosis and chosen care plan. It may be beneficial to highlight the role of social support in interventions targeting the psychosocial health of men on active surveillance.

COVID-19 Vaccination Among Environmental Service Workers Using Agents of Change.

Introduction: Vaccine hesitancy remains a barrier to community immunity against SARS-CoV-2 infection. Health care workers are at risk both of infection and for nosocomial transmission, but have low rates of vaccine uptake due to hesitancy. This project sought to improve the SARS-CoV-2 vaccine uptake among environmental services (EVS) workers at a large academic regional medical center using a community-based participatory approach (CBPA). Methods: The CBPA engaged environmental service workers from January 2021 to March 2021. Public health experts and environmental services department leaders developed a 1-hour training for peer lay health educators (N=29), referred to as agents of change (AOC). AOC were trained on COVID-19 infection, benefits of SARS-CoV-2 vaccination, and techniques to address vaccine misinformation among their peers. Following the program, we conducted semistructured interviews with the AOC to document their experiences. Results: Analysis of the semistructured interviews shows that 89.6% of participants (N=26) felt the training was informative; 79.3% of participants (N=23) reported using personal testimony while engaging in discussions about vaccination with their peers, and the majority of participants (N=26, 89.6%) discussed vaccination outside of the workplace in other community settings. During the 2-month time span of the program, mRNA COVID-19 vaccination rates among the EVS staff increased by 21% (N=126 to N=189). Conclusion: Our CBPA program demonstrated an increase in mRNA COVID-19 vaccine uptake through using an AOC lay health educator model. As the need for COVID-19 vaccination continues, we must continue to investigate barriers and sources of hesitancy in order to address these through tailored interventions.

Can Peer Assessment Impact Self-efficacy During Small-Group Learning?

INTRODUCTION: While studies report positive correlations between students' perceptions of the learning environment and their reported self-efficacy, the role of peer assessment is poorly understood in this context. This study examines the process and impact of peer assessment on self-efficacy and perceptions of the learning environment during a small-group discussion-based course required of first-year medical students. METHODS: After spending time in small-group learning, students completed three peer assessments and reviewed three assessments of themselves. Analysis of the peer assessments included thematic coding of comments and word counts. Prior to and following the assessment period, students completed a survey including the Generalized Self-efficacy (GSE) Scale, and six locally-developed questions regarding the learning environment and perceptions of peer assessment. We performed paired-sample t tests to determine whether there were differences between the pre- and post-peer assessment surveys. The SUNY Upstate Institutional Review Board reviewed the study and determined it to be exempt. RESULTS: Peer assessment narratives referred most commonly to students' participation style and the need for greater participation. Word counts ranged widely. A paired sample t test indicated that the difference between pre and post peer assessment GSE scores was significant (P=.009), but the effect size was small (d=0.32). Perceptions of the learning environment did not change after the peer assessments. CONCLUSION: Peer assessment offers a potential strategy for enhancing self-efficacy in medical school small-group learning environments and requires few resources to implement, relative to the potential benefits.

Relationship Between COVID-19 Cases and Vaccination Rates in New York State Counties.

INTRODUCTION: Vaccines against SARS-CoV-2 have been developed with unprecedented speed. The phased introduction of vaccines may be serving to offset the impact of new viral variants and policy relaxation. In order to assess the impact of vaccination, we examined a snapshot of vaccination rates across counties in a single state, at a single time point, comparing them with population-adjusted case counts. METHODS: We calculated descriptive statistics and bivariate correlations for vaccination rates and cases across counties in New York State (NYS). We conducted a linear regression using cases/100K population per NYS county, frozen at a single snapshot in time, as the outcome variable, predicted by percentage of each county's population (completed series/two doses), controlling for county population. RESULTS: Percentages with one dose and with two doses were highly correlated (r=.935, P<.001) with one another. Both the one dose and two dose z rates were negatively correlated with cases per 100K population (not significant). Population size was strongly correlated with cases per 100K (r=.715, P<.001). The two-dose vaccination rate was a significant negative predictor of cases per 100K population in NYS counties (ß= -.866, P=.031), with each percentage point of completed vaccination nearly equating to one case less in the daily count when controlling for county population size (ß =2.732, P<.001). CONCLUSION: While variants may impact vaccine effectiveness, current vaccination efforts are helping forestall some cases in NYS. Widespread vaccination is still an important goal. Primary care providers, public officials, and public health scientists should continue to urgently promote and support vaccination efforts.

Impact of a decision aid on newly diagnosed prostate cancer patients' understanding of the rationale for active surveillance.

OBJECTIVE: To compare newly diagnosed localized prostate cancer patients who did and did not view a decision aid (DA) on their knowledge of the rationale for active surveillance (AS). METHODS: A cross-sectional study was conducted among 452 newly diagnosed low-risk localized prostate cancer patients. Patients were mailed the video/DVD DA and completed a web-based questionnaire that contained two multiple choice questions assessing knowledge of the rationale for AS. Multivariable logistic regression was used to estimate the effect of the DA on knowledge of the rationale for AS. RESULTS: Patients who watched the DA were more likely to correctly respond to each rationale for AS question; both comparisons were statistically significant. After adjustment, men who viewed the DA were 2.9 times as likely to correctly respond to both rationale for AS questions than men who did not view the DA (95% CI: 1.9-4.5). CONCLUSION: Patients who viewed a DA better understand the reasons why AS is a viable treatment option for localized prostate cancer than patients who did not view a DA. PRACTICE IMPLICATIONS: Urology clinics and practices should implement the utilization of a treatment DA for newly diagnosed, localized prostate cancer prior to the patients' first cancer consultation.

Treatment trends, determinants, and survival of partial and radical nephrectomy for stage I renal cell carcinoma: results from the National Cancer Data Base, 2004-2013.

OBJECTIVE: To provide updated treatment trends, determinants, and survival of partial nephrectomy (PN) and radical nephrectomy (RN) across the USA. DATA SOURCES: Secondary data from the National Cancer Data Base (NCDB) participant user file from 2004 to 2013. The NCDB captures approximately 70% of all newly diagnosed cancer cases each year. STUDY DESIGN: Multivariable logistic regression was used to estimate odds ratios for RN overall. Kaplan-Meier, multivariable Cox regression, and log-rank test were used to characterize patient survival. DATA COLLECTION: Patients diagnosed with clinical stage I RCC who received either RN or PN as the primary surgical treatment were included. PRINCIPLE FINDINGS: The study consisted of 121,386 cases (PN = 57,016; RN = 64,370). The overall use of PN for stage I RCC increased by 24.2% over 9 years. An overall 5- and 10-year survival advantage was estimated following PN compared to RN; estimated overall risk of death was higher with RN. CONCLUSIONS: The use of PN for stage I RCC has continued to increase and is associated with an overall survival advantage. Multivariable analysis showed that disparities exist among sociodemographic groups that are also associated with treatment type and survival.

Cognitive and Affective Representations of Active Surveillance as a Treatment Option for Low-Risk Prostate Cancer.

Benefits of early diagnosis and treatment remain debatable for men with low-risk prostate cancer. Active surveillance (AS) is an alternative to treatment. The goal of AS is to identify patients whose cancer is progressing rapidly while avoiding treatment in the majority of patients. The purpose of this study was to explore cognitive and affective representations of AS within a clinical environment that promotes AS a viable option for men with low-risk prostate cancer. Participants included patients for whom AS and active treatment were equally viable options, as well as practitioners who were involved in consultations for prostate cancer. Data were generated from semistructured interviews and audits of consultation notes and were analyzed using thematic analysis. Nineteen patients and 16 practitioners completed a semistructured interview. Patients generally viewed AS as a temporary strategy that was largely equated with inaction. There was variation in the degree to which inaction was viewed as warranted or favorable. Patient perceptions of AS were generally malleable and able to be influenced by information from trusted sources. Encouraging slow deliberation and multiple consultations may facilitate greater understanding and acceptance of AS as a viable treatment option for low-risk prostate cancer.