1 Preferences and Beliefs of Lung and Colorectal Cancer Patients: The Role of Demographic and Socio-Economic Variables Julie Urmie, Ph.D., Elizabeth Chrischilles,

Slides:

Advertisements

Similar presentations

Common SPSS Procedures on Health and Medical Data Elizabeth Wiredu Edge Hill, Ormskirk, Lancashire.

Advertisements

Other tests.  More than one dependent variable/ outcome ◦ Often variables are related ◦ Need a procedure to estimate simultaneously.

Body mass index and waist circumference as predictors of mortality among older Singaporeans Authors: Angelique Chan, Chetna Malhotra, Rahul Malhotra, Truls.

Associations between Obesity and Depression by Race/Ethnicity and Education among Women: Results from the National Health and Nutrition Examination Survey,

Medicare Prescription Drug Coverage: Who Knew? (who sought and who intended) Presented at Academy Health Seattle WA June 25, 2006 Christopher Koepke, PhD.

Laura L. McDermott, PhD, FNP, RN Gale A. Spencer, PhD, RN Binghamton University Decker School of Nursing THE RELATIONSHIP AMONG BARRIERS AND FACILITATORS.

Effectiveness Of Nurse-clinician Led Smoking Cessation Clinic In Singapore Effectiveness Of Nurse-clinician Led Smoking Cessation Clinic In Singapore PRABHAKARAN.

® Introduction Low Back Pain and Physical Function Among Different Ethnicities Adelle A Safo, Sarah Holder DO, Sandra Burge PhD The University of Texas.

Exploring Multiple Dimensions of Asthma Disparities Using the Behavioral Risk Factor Surveillance System Kirsti Bocskay, PhD, MPH Office of Epidemiology.

Use of Spiritual Healing Therapy in Relation to Race and Ethnicity Catherine Simile, Ph.D. and Hanyu Ni, Ph.D. Division of Health Interview Statistics.

Sex Differences in the Prevalence and Correlates of Colorectal Cancer Testing: Health Information National Trends Survey Sally W. Vernon 1, Amy.

Health-related quality of life in diabetic patients and controls without diabetes in refugee camps in Gaza strip: a cross-sectional study By: Ashraf Eljedi:

Sexual Risk Behaviors of Self- identified and Behaviorally Bisexual HIV+ Men. By: Matt G. Mutchler, PhD; Miguel Chion, MD, MPH; Nancy Wongvipat, MPH; Lee.

RACIAL DISPARITIES IN PRESCRIPTION DRUG UTILIZATION AN ANALYSIS OF BETA-BLOCKER AND STATIN USE FOLLOWING HOSPITALIZATION FOR ACUTE MYOCARDIAL INFARCTION.

By Sanjay Kumar, Ph.D National Programme Officer (M&E), UNFPA – India

Impact of Cancer Diagnosis and Chemotherapy on Mammography Use Xinhua Yu, M.B., Ph.D. A. Marshall McBean, M.D., M.Sc. Beth A. Virnig, Ph.D., M.P.H Division.

ASSESSING ADULT LEARNING PREFERENCE FOR SUCCESSFUL WOUND CARE IN A COMPREHENSIVE WOUND CENTER Ranjita Misra, PhD, CHES 1, Lynn Lambert, BS, CWS. CHT 3,

Breast Cancer Detection, Treatment, and Survival in Medicare and Medicaid Insured Patients Cathy J. Bradley, Ph.D. Professor of Health Administration Co-leader,

Agency for Healthcare Research and Quality Advancing Excellence in Health Care Trends in the.

Knowledge, Cancer Fatalism and Spirituality as Predictors of Breast Cancer Screening Practices for African American and Caucasian Women Staci T. Anderson,

Disparities in Cancer September 22, Introduction Despite notable advances in cancer prevention, screening, and treatment, a disproportionate number.

Patient Empowerment Impacts Medication Adherence among HIV-Positive Patients in the Veteran’s Health Administration Tan Pham 1,2,3, Kristin Mattocks 1,2,

Ethnic Disparities in Early Breast Cancer Management among Asian Americans and Pacific Islanders Rebecca P. Gelber, MD, MPH Department of Medicine, University.

HOME ALONE: DETERMINANTS OF LIVING ALONE AMONG OLDER IMMIGRANTS IN CANADA AND THE U.S. SHARON M. LEE DEPARTMENT OF SOCIOLOGY POPULATION RESEARCH GROUP.

DISPARITIES IN ACCESS: Reality vs. Perception Peter J. Cunningham Jack Hadley 2008 AcademyHealth Annual Meeting June 8, 2008, Washington D.C.

Figure 1. Uninsured Rates Are Highest Among Hispanics and African Americans, 2005 Percent of adults ages 19–64 Note: Because of rounding, totals above.

The effect of surgeon volume on procedure selection in non-small cell lung cancer surgeries Dr. Christian Finley MD MPH FRCSC McMaster University.

INCIDENCE AND SURVIVAL TRENDS OF COLORECTAL CANCER FROM 2002 TO 2011 BE Ansa; E Alema-Mensah; MD Claridy; JQ Sheats; B Fontenot, and SA Smith Georgia Regents.

2012 State of the Science Congress on Nursing Research Jeanne Alhusen 1, Deborah Gross 1, Matthew Hayat 2, and Phyllis Sharps 1 1 Johns Hopkins University.

Predictors of Cancer-related Pain Improvement over 12 Months Hsiao-Lan Wang, PhD, RN, CMSRN, HFS Assistant Professor University of South Florida September,

End of Life Decisions by Adults with Cancer : Role of Religious Practices and Spiritual Beliefs Rudolph M. Navari, M.D., Ph.D. Assistant Dean and Director.

Health Disparities and Multicultural Practice Clarence H. Braddock III, MD, MPH, FACP Associate Professor of Medicine Associate Dean, Medical Education.

Exploring The Determinants Of Racial & Ethnic Disparities In Total Knee Arthroplasty: Health Insurance, Income And Assets Amresh Hanchate, PhD Health Care.

Debbie Postlethwaite RNP, MPH Adekemi Ogultala, MD Maqdooda Merchant MSc, MA.

Quality Measurement and Gender Differences in Managed Care Populations with Chronic Diseases Ann F. Chou Carol Weisman Arlene Bierman Sarah Hudson Scholle.

1 Mental Health in US Adults: The Role of Positive Social Support and Social Negativity in Personal Relationships Elizabeth M. Bertera, PhD Associate Professor.

Arnold School of Public Health Health Services, Policy, and Management 1 Drug Treatment Disparities Among African Americans Living with HIV/AIDS Carleen.

Differences in the Quality of the Patient- Physician Relationship Among Terminally Ill African American and White Patients: Impact on Advance Care Planning.

Urban and Rural Disparities in Tobacco Use Ming Shan, BS; Zach Jump, MA; Elizabeth Lancet, MPH National Conference on Health Statistics August 8, 2012.

Lipoatrophy and lipohypertrophy are independently associated with hypertension: the effect of lipoatrophy but not lipohypertrophy on hypertension is independent.

Shane Lloyd, MPH 2011, 1,2 Annie Gjelsvik, PhD, 1,2 Deborah N. Pearlman, PhD, 1,2 Carrie Bridges, MPH, 2 1 Brown University Alpert Medical School, 2 Rhode.

Self Confidence and Diversity at MIT Lizz Albany, Olivia Gierlich, Peter Lee, and Michael Plasmeier.

Physician Practice Style and Barriers to Referral: Los Angeles Women’s Health Study Danielle Rose Ash, PhD VA HSR&D/Greater Los Angeles Care System Co-Authors:

How Much Choice Do Seniors Want?: Survey Results on the Medicare Prescription Drug Benefit Janet Cummings Link* Thomas Rice* Yaniv Hanoch** *Department.

Racial Disparities in Primary Care and Utilization of Health Services at the End-of-Life Andrea Kronman, MD Boston University School of Medicine.

Trends in Cervical & Breast Cancer Screening Practices among Women in Rural & Urban Areas of the United States AcademyHealth 2008 Gender and Health Interest.

The Relationship between Nativity Status, Satisfaction with and Confidence in Health Care Florence J. Dallo, PhD MPH Academy Health Meeting 9 June 2008.

Council for the Advancement of Nursing Conference

The Usual Source of Care and Delivery of Preventive Services to Medicare Beneficiaries Academy Health, June 2005 Hoangmai Pham, MD, MPH Deborah Schrag,

F UNCTIONAL L IMITATIONS IN C ANCER S URVIVORS A MONG E LDERLY M EDICARE B ENEFICIARIES Prachi P. Chavan, MD, MPH Epidemiology PhD Student Xinhua Yu MD.

Medicaid and the 4 A’s: Use of 1115 Waivers and State Plan Amendments American Cancer Society Washington, Dc June 5, 2008 Erin Reidy

Factors Predicting Stage of Adoption for Fecal Occult Blood Testing and Colonoscopy among Non-Adherent African Americans Hsiao-Lan Wang, PhD, RN, CMSRN,

J. Aaron Johnson, PhD 1 and J. Paul Seale, MD 2 1 Institute of Public and Preventive Health and Department of Psychology, Georgia Regents University, Augusta,

Impact of Perceived Discrimination on Use of Preventive Health Services Amal Trivedi, M.D., M.P.H. John Z. Ayanian, M.D., M.P.P. Harvard Medical School/Brigham.

Men and Women are Different: Predictors of an Informed Decision about Colorectal Cancer Screening Kelly Brittain, PhD, RN Michigan State University 2012.

Janet H. Van Cleave PhD, RN1 Brian Egleston PhD2

Widening of Socioeconomic Disparities in U.S. Mortality from Major Cancers Ahmedin Jemal, PhD Elizabeth Ward, PhD June 10, 2008 Kinsey T, Jemal A, Liff.

Printed by Natural History of Sun Protection Behaviors in a Cohort of Children in Colorado Nancy L. Asdigian PhD,* Lori A. Crane.

Premature deaths due to Prostate Cancer: The Role of Diagnosis and Treatment Appathurai Balamurugan MD, MPH S William Ross MD Chris Fisher, BS Jim Files,

Introduction to Biostatistics Lecture 1. Biostatistics Definition: – The application of statistics to biological sciences Is the science which deals with.

Cultural competency, patient- physician communication and gender disparities in patient satisfaction Alice F. Yan, MD; Desiree Rivers, Ph.D., M.S.P.H.;

Correlates of HIV testing among youth in three high prevalence Caribbean Countries Beverly E. Andrews, Doctoral Candidate University.

Variation in place of death from cancer: studies in South East England Elizabeth Davies, Peter Madden, Victoria Coupland, Karen Linklater, Henrik Møller.

Disparities in process and outcome measures among adults with persistent asthma David M. Mosen, PhD, MPH; Michael Schatz, MD, MS; Rachel Gold, PhD; Winston.

Increased Physical Activity And Senior Center Participation

Exercise Adherence in Patients with Diabetes: Evaluating the role of psychosocial factors in managing diabetes Natalie N. Young,1, 2 Jennifer P. Friedberg,1,

Associations between Depression and Obesity: Findings from the National Health and Nutrition Examination Survey, Arlene Keddie, Ph.D. Assistant.

Lung Cancer Screening: Do Individual Health Beliefs Matter?

Receipt of Adjuvant Endometrial Cancer Treatment According to Race NRG Oncology/Gynecologic Oncology Group (GOG) 210 Study Ashley Felix, PhD, MPH Assistant.

Colorectal cancer survival disparities in California

Presentation transcript:

1 Preferences and Beliefs of Lung and Colorectal Cancer Patients: The Role of Demographic and Socio-Economic Variables Julie Urmie, Ph.D., Elizabeth Chrischilles, Ph.D., Jane Weeks, M.D., John Brooks, Ph.D., Jane Pendergast Ph.D., Dawn Provenzale, M.D., David Nerenz, Ph.D., Dee West, Ph.D. Academy Health Research Meeting, June 2006

2 Background Increasing recognition of the need to include patient preference measures into research on cancer treatment and outcomes. 1-4 Limited past research on patient preferences in cancer patients, particularly in quantitative studies. The CanCORS study includes several patient preference measures.

3 Background A better understanding of the link between preferences and demographic/ socio-economic variables is necessary before including them as predictors of treatment choice and outcomes.  How much variation in preferences is already explained by demographic and socio-economic variables? Past research provides some evidence of a link between demographic/socio-economic factors and preferences.  Older patients favor quality of life over quantity of life. 5  High levels of fatalism in certain racial groups and low income elderly. 6-9

4 Objectives & Research Questions To examine the relationship between fatalism/treatment preferences and socio- demographic factors in lung and colorectal cancer patients.  Do low income or low education patients have different preferences than high income or high education patients?  Do preferences differ by racial/ethnic group?  Do men have different preferences than women?

5 Data Source Data were from the CanCORS baseline patient survey.  Data collection was not complete at the time of data analysis so results are preliminary. Both colorectal and lung cancer patients were included. Three main preferences measures were used:  Fatalism  Quantity of Life vs. Quality of life (QOL)  Quantity of Life vs. Cost

6 Preference Variables Fatalism: A four item scale adapted from the Powe Fatalism Index  “When bad things happen, we are not supposed to know why, we are just supposed to accept them.”  “People die when it is their time to die and nothing can change that.”  “Everything that happens is part of God’s plan.”  “If bad things happen, it is because they were meant to be.”  Four response categories: SD, D, A, SA Scores were summed to create one fatalism score.

7 Preference Variables Quantity of Life vs. Quality of Life Tradeoff  “If you had to make a choice now, would you prefer treatment that extends life as much as possible, even if it means having more pain and discomfort, or would you want treatment that focuses on relieving pain and discomfort as much as possible, even if it means not living as long.”  2 response categories

8 Preference Variables Quantity of Life vs. Cost Tradeoff  “If you had to make a choice now, would you prefer treatment that extends life as much as possible, even if it means using up all of your financial resources, or would you want treatment that costs you less, even if it means not living as long?”  2 response categories

9 Statistical Models OLS Regression predicting fatalism Logistic regression predicting quality of life vs. quantity of life tradeoff (quality of life = 0; quantity of life = 1). Logistic regression predicting cost vs. quantity of life tradeoff (cost = 0; quantity of life = 1) All three models used unweighted estimates.

10 Independent Variables Age Gender (female = 0; male = 1) Cancer type (colon = 0; lung = 1) Education (less than HS grad = reference; HS grad; some 4- year or trade; 4-year grad; some grad school or professional) Race (white,non-Hispanic = reference; white, Hispanic; Black; Asian; Other) Living Arrangement (married/living with partner = 1; else = 0) Income (less than $10,000 = reference; $10,000 to less than $20,000; $20,000 to less than $40,000; $40,000 to less than $60,000; $60,000 or more) Health insurance status (no insurance = 0; insurance = 1)

11 Distribution of Fatalism Scores Mean = (S.D. = 2.58). Higher scores signify higher levels of Fatalism. Cronbach’s Alpha = N =4,129N = 3,807

12 Distribution of Quantity vs. QOL & Quantity vs. Cost

13 Multivariate OLS Results for Fatalism Higher levels of fatalism:  People who were married/living with partner (p < 0.01).  African-Americans and Asians (p < 0.01).  White, Hispanics (p = 0.06), Other Race (p = 0.07).  Older adults (p = 0.08) Lower levels of fatalism:  Men (p <0.01).  All higher education levels (p <0.01).  The three highest income categories (p < 0.05). Insurance coverage and type of cancer were not significant at p < Demographic/socio-economic variables explained 12.6 percent of variation in fatalism.

14 Multivariate Logistic Results for Quantity of Life vs. QOL Tradeoff Significant odds ratios for the model predicting a preference for quantity of life over QOL.  AgeOR = 0.97 (p < 0.01)  Married/partnerOR = 1.32 (p < 0.01)  African-AmericanOR = 1.33 (p < 0.01)  MaleOR = 1.41 (p < 0.01)

15 Multivariate Logistic Results for Quantity of Life vs. Cost Tradeoff Significant odds ratios for the model predicting a preference for quantity of life over conserving resources.  Married/partnerOR = 0.73 (p < 0.01)  AgeOR = 0.97 (p < 0.01)  MaleOR = 1.14 (p = 0.08)  AsianOR = 1.59 (p < 0.01)  African-AmericanOR = 2.78 (p < 0.01)

16 Limitations Preliminary Results.  Baseline survey data not complete at the time of analysis.  Missing data.  No sampling weights used.  No interaction effects were examined.  No comorbidity and staging information was included.

17 Conclusions There are some important and complex differences in preferences among different socio-economic and demographic groups. This complexity and the limited amount of variation in preferences explained by socio- demographic variables show the importance of including explicit measures of preferences in models predicting treatment choice and outcomes.

18 References 1. Kassirer JP. Incorporating patients preferences into medical decisions. The New England Journal of Medicine. 1994;330(26): Silvestri G, Pritchard R, Welch G. Preferences for chemotherapy in patients with advanced non-small cell cancer: descriptive study based on scripted interviews. British Medical Journal. 1998;317: Redmond K. Assessing patients’ needs and preferences in the management of advanced colorectal cancer. British Journal of Cancer. 1998;77(S2): Earle CC, Vendetti LN, Neuman Pj et al. Who gets chemotherapy for metastatic lung cancer? Chest. 2000;117(5): Stiggelbout AM, De Haes JM, Kiebert GM, Kievet J, Leer JH. Tradeoffs between quality and quantity of life development of the QQ questionnaire for cancer patient attitudes. Medical Decision Making. 1996;16: Powe BD. Fatalism among elderly African Americans: effects on colorectal screening. Cancer Nursing. 1995;18(5): Powe BD. Cancer fatalism among elderly Caucasians and African Americans. Oncology Nursing Forum. 1995;22(9): Powe BD and Weinrich S. An intervention to decrease cancer fatalism among rural elders. Oncology Nursing Forum, 1999;26(3): Chavas LR, Hubbell FA, Mishra SI, Valdez RB. The influence of fatalism on self- reported use of papanicolaou smears. American Journal of Preventive Medicine. 1997;13(6):