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author:("Park, lyse")
1.  World Congress Integrative Medicine & Health 2017: part two 
Ee, Carolyn | Thuraisingam, Sharmala | Pirotta, Marie | French, Simon | Xue, Charlie | Teede, Helena | Kristoffersen, Agnete E. | Sirois, Fuschia | Stub, Trine | Engler, Jennifer | Joos, Stefanie | Güthlin, Corina | Felenda, Jennifer | Beckmann, Christiane | Stintzing, Florian | Evans, Roni | Bronfort, Gert | Keefe, Daniel | Taberko, Anna | Hanson, Linda | Haley, Alex | Ma, Haiwei | Jolton, Joseph | Yarosh, Lana | Keefe, Francis | Nam, Jung | Evans, Roni | Ojala, Liwanag | Kreitzer, Mary J. | Hanson, Linda | Fink, Careen | Kraft, Karin | Flower, Andrew | Lewith, George | Harman, Kim | Stuart, Beth | Bishop, Felicity L. | Frawley, Jane | Füleki, Lilla | Kiss, Eva | Vancsik, Tamas | Krenacs, Tibor | Funabashi, Martha | Pohlman, Katherine A. | Mior, Silvano | Thiel, Haymo | Hill, Michael D. | Cassidy, David J. | Westaway, Michael | Yager, Jerome | Hurwitz, Eric | Kawchuk, Gregory N. | O’Beirne, Maeve | Vohra, Sunita | Gaboury, Isabelle | Morin, Chantal | Gaertner, Katharina | Torchetti, Loredana | Frei-Erb, Martin | Kundi, Michael | Frass, Michael | Gallo, Eugenia | Maggini, Valentina | Comite, Mattia | Sofi, Francesco | Baccetti, Sonia | Vannacci, Alfredo | Di Stefano, Mariella | Monechi, Maria V. | Gori, Luigi | Rossi, Elio | Firenzuoli, Fabio | Mediati, Rocco D. | Ballerini, Giovanna | Gardiner, Paula | Lestoquoy, Anna S. | Negash, Lily | Stillman, Sarah | Shah, Prachi | Liebschutz, Jane | Adelstein, Pamela | Farrell-Riley, Christine | Brackup, Ivy | Penti, Brian | Saper, Robert | Sampedro, Isabel Giralt | Carvajal, Gilda | Gleiss, Andreas | Gross, Marie M. | Brendlin, Dorothea | Röttger, Jonas | Stritter, Wiebke | Seifert, Georg | Grzanna, Noelle | Stange, Rainer | Guendling, Peter W. | Gu, Wen | Lu, Yan | Wang, Jie | Zhang, Chengcheng | Bai, Hua | He, Yuxi | Zhang, Xiaoxu | Zhang, Zhengju | Wang, Dali | Meng, Fengxian | Hagel, Alexander | Albrecht, Heinz | Vollbracht, Claudia | Dauth, Wolfgang | Hagel, Wolfgang | Vitali, Francesco | Ganzleben, Ingo | Schultis, Hans | Konturek, Peter | Stein, Jürgen | Neurath, Markus | Raithel, Martin | Hagel, Alexander | Vollbracht, Claudia | Raithel, Martin | Konturek, Peter | Krick, Bianka | Haller, Heidemarie | Klose, Petra | Dobos, Gustav | Kümmel, Sherko | Cramer, Holger | Haller, Heidemarie | Saha, Felix J. | Kowoll, Anna | Ebner, Barbara | Berger, Bettina | Dobos, Gustav | Choi, Kyung-Eun | He, Lisha | Wang, Han | He, X. | Gu, C. | Zhang, Y. | Zhao, Linhua | Tong, Xiaolin | He, Lisha | Wang, Han | He, Xinhui | Gu, Chengjuan | Zhang, Ying | Zhao, Linhua | Tong, Xiaolin | He, Lisha | Wang, Han | He, Xinhui | Gu, Chengjuan | Zhang, Ying | Zhao, Linhua | Tong, Xiaolin | Ho, Robin S. T. | Chung, Vincent C. H. | Wu, Xinyin | Wong, Charlene H. L. | Wu, Justin C. Y. | Wong, Samuel Y. S. | Lau, Alexander Y. L. | Sit, Regina W. S. | Wong, Wendy | Holmes, Michelle | Bishop, Felicity | Calman, Lynn | Holmes, Michelle | Bishop, Felicity | Lewith, George | Newell, Dave | Field, Jonathan | Htut, Win L. | Han, Dongwoon | Choi, Da I. | Choi, Soo J. | Kim, Ha Y. | Hwang, Jung H. | Huang, Ching W. | Jang, Bo H. | Chen, Fang P. | Ko, Seong G. | Huang, Wenjing | Jin, De | Lian, Fengmei | Jang, Soobin | Kim, Kyeong H. | Lee, Eun K. | Sun, Seung H. | Go, Ho Y. | Ko, Youme | Park, Sunju | Jang, Bo H. | Shin, Yong C. | Ko, Seong G. | Janik, Hubert | Greiffenhagen, Natalie | Bolte, Jürgen | Kraft, Karin | Jaworski, Mariusz | Adamus, Miroslawa | Dobrzynska, Aleksandra | Jeitler, Michael | Jaspers, Jessica | von Scheidt, Christel | Koch, Barbara | Michalsen, Andreas | Steckhan, Nico | Kessler, Christian | Jin, De | Huang, Wen-jing | Pang, Bing | Lian, Feng-Mei | Jong, Miek | Baars, Erik | Glockmann, Anja | Hamre, Harald | Kainuma, Mosaburo | Murakami, Aya | Kubota, Toshio | Kobayashi, Daisuke | Sumoto, Yasuhiro | Furusyo, Norihiro | Ando, Shin-Ichi | Shimazoe, Takao | Kelber, Olaf | Verjee, S. | Gorgus, Eva | Schrenk, Dieter | Kemper, Kathi | Hill, Ellie | Kemper, Kathi | Rao, Nisha | Gascon, Gregg | Mahan, John | Kienle, Gunver | Dietrich, Jörg | Schmoor, Claudia | Huber, Roman | Kim, Weon H. | Han, Dongwoon | Ahmed, Mansoor | He, Luzhu | Hwang, Jung Hye | Kiss, Eva | Vancsik, Tamas | Meggyeshazi, Nora | Kovago, Csaba | Krenacs, Tibor | Klaus, Anne K. | Zerm, Roland | Pranga, Danilo | Ostermann, Thomas | Reif, Marcus | von Laue, Hans Broder | Brinkhaus, Benno | Kröz, Matthias | Klaus, Anne K. | Zerm, Roland | Pranga, Danilo | Recchia, Daniela Rodrigues | Ostermann, Thomas | Reif, Marcus | von Laue, Hans B. | Brinkhaus, Benno | Kröz, Matthias | Klein-Laansma, Christien T. | Jong, Mats | von Hagens, Cornelia | Jansen, Jean P. | van Wietmarschen, Herman | Jong, Miek C. | Ko, Youme | Sun, Seung-Ho | Go, Ho-Yeon | Jeon, Chan-Yong | Song, Yun-Kyung | Ko, Seong-Gyu | Koch, Anna K. | Rabsilber, Sybille | Lauche, Romy | Kümmel, Sherko | Dobos, Gustav | Langhorst, Jost | Cramer, Holger | Koch, Anna K. | Trifunovic-Koenig, Milena | Klose, Petra | Cramer, Holger | Dobos, Gustav | Langhorst, Jost | Koster, Evi | Baars, Erik | Delnoij, Diana | Kroll, Lena | Weiss, Kathrin | Kubo, Ai | Hendlish, Sarah | Altschuler, Andrea | Connolly, Nancy | Avins, Andy | Lauche, Romy | Recchia, Daniela Rodrigues | Cramer, Holger | Wardle, Jon | Lee, David | Sibbritt, David | Adams, Jon | Ostermann, Thomas | Lauche, Romy | Sibbritt, David | Park, Crystal | Mishra, Gita | Adams, Jon | Cramer, Holger | Lechner, Johann | Lee, Inseon | Chae, Younbyoung | Lee, Jisu | Cho, Seung H. | Choi, Yujin | Lee, Jee Y. | Ryu, Han S. | Yoon, Sung S. | Oh, Hye K. | Hyun, Lyun K. | Kim, Jin O. | Yoon, Seong W. | Lee, Ju-Yeon | Shin, Sang-Hoon | Jang, Min | Müller, Indra | Park, So-Hyun Janson | Lestoquoy, Anna S. | Laird, Lance | Negash, Lily | Mitchell, Suzanne | Gardiner, Paula | Li, Xiaofei | Wang, Yunhui | Zhen, Jianhua | Yu, He | Liu, Tiegang | Gu, Xiaohong | Liu, Hui | Ma, Weiguo | Zhang, Chengcheng | Shang, Xuezheng | Bai, Yu | Meng, Fengxian | Liu, Wei | Rooney, Collin | Smith, Amos | Lopes, Shirlene | Demarzo, Marcelo | do Patrocínio Nunes, Maria | Lorenz, Peter | Gründemann, Carsten | Heinrich, Miriam | Garcia-Käufer, Manuel | Grunewald, Franziska | Messerschmidt, Silke | Herrick, Anja | Gruber, Kim | Beckmann, Christiane | Knödler, Matthias | Huber, Roman | Steinborn, Carmen | Stintzing, Florian | Lu, Taoying | Wang, Lixin | Wu, Darong | Luberto, Christina M | Hall, Daniel L. | Chad-Friedman, Emma | Lechner, Suzanne | Park, Elyse R. | Luberto, Christina M. | Park, Elyse | Goodman, Janice | Luer, Sonja | Heri, Matthias | von Ammon, Klaus | Frei-Erb, Martin | Ma, Weiguo | Meng, Fengxian | Maggini, Valentina | Gallo, Eugenia | Landini, Ida | Lapucci, Andrea | Nobili, Stefania | Mini, Enrico | Firenzuoli, Fabio | McDermott, Clare | Lewith, George | Richards, Selwyn | Cox, Diane | Frossell, Sarah | Leydon, Geraldine | Eyles, Caroline | Raphael, Hilly | Rogers, Rachael | Selby, Michelle | Adler, Charlotte | Allam, Jo | Meng, Fengxian | Gu, Wen | Zhang, Chengcheng | Bai, Hua | Zhang, Zhengju | Wang, Dali | Bu, Xiangwei | Zhang, Honghong | Zhang, Jianpeng | Liu, Hui | Mikolasek, Michael | Berg, Jonas | Witt, Claudia | Barth, Jürgen | Miskulin, Ivan | Lalic, Zdenka | Miskulin, Maja | Dumic, Albina | Sebo, Damir | Vcev, Aleksandar | Mohammed, Nasr A. A. | Han, Dongwoon | Ahmed, Mansoor | Choi, Soo Jeung | Im, Hyea Bin | Hwang, Jung Hye | Mukherjee, Anwesha | Kandhare, Amit | Bodhankar, Subhash | Mukherjee, Anwesha | Kandhare, Amit | Thakurdesai, Prasad | Bodhankar, Subhash | Munk, Niki | Evans, Erica | Froman, Amanda | Kline, Matthew | Bair, Matthew J. | Musial, Frauke | Kristoffersen, Agnete E. | Alræk, Terje | Hamre, Harald J. | Stub, Trine | Björkman, Lars | Fønnebø, Vinjar M. | Pang, Bing | Lian, Feng-mei | Ni, Qing | Tong, Xiao-lin | Li, Xin-long | Liu, Wen-ke | Feng, Shuo | Zhao, Xi-yan | Zheng, Yu-jiao | Zhao, Xue-min | Lin, Yi-qun | Pang, Bing | Lian, Feng-mei | Tong, Xiao-lin | Zhao, Tian-yu | Zhao, Xi-Yan | Phd, Hui Che | Zhang, Chen | Pang, Bing | Liu, Feng | Tong, Xiao-lin | Zhao, Lin-hua | Zhao, Xue-min | Ye, Ru | Gu, Cheng-juan | Pang, Bing | Ni, Qing | Tong, Xiao-lin | Lian, Feng-mei | Zhao, Xi-yan | Jin, De | Zhao, Xue-min | Zheng, Yu-jiao | Lin, Yi-qun | Peng, Wenbo | Lauche, Romy | Sibbritt, David | Adams, Jon | Peng, Wenbo | Wardle, Jon | Cramer, Holger | Mishra, Gita | Lauche, Romy | Pohlman, Katherine A. | Mior, Silvano | Funabashi, Martha | De Carvalho, Diana | El-Bayoumi, Mohamed | Haig, Bob | Kelly, Kimbalin | Wade, Darrell J. | O’Beirne, Maeve | Vohra, Sunita | Portalupi, Emanuela | Gobo, Giampietro | Bellavita, Luigi | Guglielmetti, Chiara | Raak, Christa | Teuber, Myriam | Molsberger, Friedrich | von Rath, Ulrich | Reichelt, Ulrike | Schwanebeck, Uta | Zeil, Sabine | Vogelberg, Christian | Veintimilla, Dolores Rodríguez | Vollbracht, Claudia | Mery, Guerrero Tapia | Villavicencio, Marisol Maldonado | Moran, Sandra Herrera | Sachse, Christian | Gündlin, Peter W | Stange, Rainer | Sahebkarkhorasani, Monirsadat | Azizi, Hoda | Schumann, Dania | Lauche, Romy | Sundberg, Tobias | Leach, Matthew J. | Cramer, Holger | Seca, Susana | Greten, Henry | Selliah, Sugir | Shakya, Anu | Han, Dongwoon | Kim, Ha Yun | Choi, Da I. | Im, Hyea B. | Choi, Soo J. | Sherbakova, Anna | Ulrich-Merzenich, Gudrun | Kelber, Olaf | Abdel-Aziz, Heba | Sibinga, Erica | Webb, Lindsey | Ellen, Jonathan | Skrautvol, Kari | Nåden, Dagfinn | Song, Rhayun | Grabowska, Weronika | Osypiuk, Kamila | Diaz, Gloria V. | Bonato, Paolo | Park, Moonkyoung | Hausdorff, Jeffrey | Fox, Michael | Sudarsky, Lewis R. | Tarsy, Daniel | Novakowski, James | Macklin, Eric A. | Wayne, Peter M. | Song, Rhayun | Hwang, Inok | Ahn, Sukhee | Lee, Myung-Ah | Wayne, Peter M. | Sohn, Min K. | Sorokin, Oleg | Steckhan, Nico | Heydeck, Dagmar | Borchert, Astrid | Hohmann, Christoph-Daniel | Kühn, Harmut | Michalsen, Andreas | Kessler, Christian | Steckhan, Nico | Hohmann, Christoph-Daniel | Cramer, Holger | Michalsen, Andreas | Dobos, Gustav | von Scheidt, Christel | Kirschbaum, Clemens | Stalder, Tobias | Stöckigt, Barbara | Teut, Michael | Suhr, Ralf | Sulmann, Daniela | Brinkhaus, Benno | Streeter, Chris | Gerbarg, Patrica | Silveri, Marisa | Brown, Richard | Jensen, John | Stritter, Wiebke | Rutert, Britta | Eggert, Angelika | Längler, Alfred | Seifert, Georg | Holmberg, Christine | Sun, Jin | Deng, Xin | Li, Wen-Yuan | Wen, Bin | Robinson, Nicola | Liu, Jian-Ping | Sung, Hyun K. | Yang, Narae | Go, Ho Y. | Shin, Seon M. | Jung, Hee | Kim, Young J. | Jung, Woo S. | Park, Tae Y. | Suzuki, Kiyoshi | Ito, Toshinori | Uchida, Seiya | Kamohara, Seika | Ono, Naoya | Takamura, Mitsuyuki | Yokochi, Ayumu | Maruyama, Kazuo | Tapia, Patricio | Thabaut, Katarzyna | Brinkhaus, Benno | Stöckigt, Barbara | Thronicke, Anja | Kröz, Matthias | Steele, Megan | Matthes, Harald | Herbstreit, Cornelia | Schad, Friedemann | Tian, Jiaxing | Lian, Fengmei | Yang, Libo | Tong, Xiaolin | Tian, Tian | Zhang, Hewei | Tian, Xia | Wang, CongCong | Chai, Qian Yun | Zhang, Lijuan | Xia, Ruyu | Huang, Na | Fei, Yutong | Liu, Jianpin | Trent, Natalie | Miraglia, Mindy | Dusek, Jeffrey | Pasalis, Edi | Khalsa, Sat B. | Trifunovic-König, Milena | Klose, Petra | Cramer, Holger | Lauche, Romy | Koch, Anna | Dobos, Gustav | Langhorst, Jost | Uebelacker, Lisa | Tremont, Geoffrey | Gillette, Lee | Epstein-Lubow, Gary | Strong, David | Abrantes, Ana | Tyrka, Audrey | Tran, Tanya | Gaudiano, Brandon | Miller, Ivan | Ullmann, Gerhild | Ullmann, Gerhild | Li, Yuhua | Vaidya, Sujata | Marathe, Vinod | Vale, Ana C. | Motta, Jacquelyne | Donadão, Fabíola | Valente, Angela C. | Valente, Luana C. Carvalho | Ghelman, Ricardo | Vesovic, Dusan | Jevdic, Dragan | Jevdic, Aleksandar | Jevdic, Katarina | Djacic, Mihael | Letic, Dragica | Bozic, Drago | Markovic, Marija | Dunjic, Slobodan | Vesovic, Dusan | Jevdic, Dragan | Jevdic, Aleksandar | Jevdic, Katarina | Djacic, Mihael | Letic, Dragica | Bozic, Drago | Markovic, Marija | Ruscuklic, Gordana | Baksa, Dezire | Dunjic, Slobodan | Vesovic, Dusan | Jevdic, Dragan | Jevdic, Aleksandar | Jevdic, Katarina | Djacic, Mihael | Letic, Dragica | Bozic, Drago | Markovic, Marija | Ruscuklic, Gordana | Baksa, Dezire | Dunjic, Slobodan | Vesovic, Dusan | Jevdic, Dragan | Jevdic, Aleksandar | Jevdic, Katarina | Djacic, Mihael | Letic, Dragica | Bozic, Drago | Markovic, Marija | Ruscuklic, Gordana | Baksa, Dezire | Dunjic, Slobodan | Vesovic, Dusan | Jevdic, Dragan | Jevdic, Aleksandar | Jevdic, Katarina | Djacic, Mihael | Letic, Dragica | Bozic, Drago | Markovic, Marija | Vrca, Kenan | Dunjic, Slobodan | Vincent, Ann | Wahner-Roedler, Dietlind | Whipple, Mary | Vogelius, Maria M. | Vollbracht, Claudia | Friesecke, Iris | Gündling, Peter W. | Wahner-Roedler, Dietlind | Mahapatra, Saswati | Hynes, Rebecca | Van Rooy, Kimberly | Looker, Sherry | Ghosh, Aditya | Bauer, Brent | Cutshall, Susanne | Walach, Harald | Flores, Ana Borges | Walach, Harald | Ofner, Michael | Kastner, Andreas | Schwarzl, Gerhard | Schwameder, Hermann | Alexander, Nathalie | Strutzenberger, Gerda | Wang, Jie | Lu, Yan | Gu, Wen | Zhang, Chengcheng | Bu, Xianwei | Zhang, Honghong | Zhang, Jianping | He, Yuxi | Zhang, Xiaoxu | Meng, Fengxian | Wang, Shang | Yu, He | Shi, Jinfeng | Hao, Yu | Liu, Tiegang | Wu, Jun | Qiu, Zeji | Gu, Xiaohong | Wang, Yuh-Hai | Lou, Chi-Jung | Watts, Sam | Wayne, Peter | Osypiuk, Kamila | Vergara-Diaz, Gloria | Bonato, Paolo | Gow, Brian | Hausdorff, Jeffrey | Miranda, Jose | Sudarsky, Lewis | Tarsy, Daniel | Fox, Michael | Macklin, Eric | Wode, Kathrin | Bergqvist, Jenny | Bernhardsson, Britt-Marie | Nordberg, Johanna Hök | Kienle, Gunver | Sharp, Lena | Henriksson, Roger | Woo, Yeonju | Hyun, Min K. | Wu, Hao | Wang, Tian-Fang | Zhao, Yan | Wei, Yu | Tian, Lei | He, Lei | Wang, Xue | Wu, Ruohan | Feng, Shuo | Han, Mei | Caldwell, Patrina H. Y. | Liu, Shigang | Zhang, Jing | Liu, Jianping | Xia, Ruyu | Chai, Qianyun | Fei, Yutong | Guo, Zhongning | Wang, Congcong | Liu, Zhijun | Li, Xun | Zhang, Ying | Liu, Jianping | Yang, I. J. | Lincha, V. Ruberio | Ahn, S. H. | Lee, D. U. | Shin, H. M. | Yang, Lu | Sibbritt, David | Peng, Wenbo | Adams, Jon | Yang, N. | Sung, H. | Shin, S. M. | Go, H. Y. | Jung, H. | Kim, Y. | Park, T. Y. | Yap, Angela | Kwan, Yu H. | Tan, Chuen S. | Ibrahim, Syed | Ang, Seng B. | Yayi, Alfred | Han, Dongwoon | Im, Hyea Bin | Hwang, Jung Hye | Choi, Soo Jeung | Yoo, Jeong E. | Yoo, Ho R. | Jang, Sae B. | Lee, Hye L. | Youssef, Ala’a | Ezzat, Shahira | Motaal, Amira Abdel | El-Askary, Hesham | Yu, Xiaotong | Cui, Yashan | Zhang, Ying | Lian, Fengmei | Yun, Younghee | Ko, Youme | Ahn, Jin-Hyang | Jang, Bo-Hyung | Kim, Kyu-Seok | Ko, Seong-Gyu | Choi, Inhwa | Zerm, Roland | Glinz, Augustina | Pranga, Danilo | Berger, Bettina | ten Brink, Fadime | Reif, Marcus | Büssing, Arnd | Gutenbrunner, Christoph | Kröz, Matthias | Zerm, Roland | Helbrecht, Bert | Pranga, Danilo | Brinkhaus, Benno | Michalsen, Andreas | Kröz, Matthias | Zhang, Honghong | Fang, Tiesheng | Wang, Jie | Zhang, Chengcheng | He, Yuxi | Zhang, Xiaoxu | Zhang, Zhengju | Wang, Dali | Meng, Fengxion | Zhang, Jianping | Zhang, Chengcheng | Bai, Hua | Shen, Zhiming | Ma, Weiguo | Liu, Hui | Bai, Yu | Shang, Xuezheng | Meng, Fengxian | Zhang, Ruixin | Wu, Fan | Li, Ming | Xuan, Xinyun | Shen, Xueyong | Ren, Ke | Berman, Brian | Zhen, Jianhua | Li, Xiaofei | Gu, Xiaohong | Yu, He | Zheng, Zian | Wan, Yuxiang | Wang, Yunhui | Ma, Xueyan | Dong, Fei | Liu, Tiegang | Zhen, Jianhua | Li, Xiaofei | Gu, Xiaohong | Yu, He | Zheng, Zian | Wan, Yuxiang | Wang, Yunhui | Ma, Xueyan | Dong, Fei | Liu, Tiegang | Zick, Suzie | Harris, Richard | Bae, Go E. | Kwon, Jung N. | Lee, Hye Y. | Nam, Jong K. | Lee, Sang D. | Lee, Dong H. | Han, Ji Y. | Yun, Young J. | Lee, Ji H. | Park, Hye L. | Park, Seong H. | Bocci, Chiara | Ivaldi, Giovanni B. | Vietti, Ilaria | Meaglia, Ilaria | Guffi, Marta | Ruggiero, Rubina | Gualea, Marita | Longa, Emanuela | Bonucci, Massimo | Croke, Sarah | Rodriguez, Lourdes Diaz | Caracuel-Martínez, Juan C. | Fajardo-Rodríguez, Manuel F. | Ariza-García, Angélica | la Fuente, Francisca García-De | Arroyo-Morales, Manuel | Estrems, Maria S. | Gómez, Vicente G. | Estrems, Maria S. | Sabater, Mónica Valero | Ferreri, Rosaria | Bernardini, Simonetta | Pulcri, Roberto | Cracolici, Franco | Rinaldi, Massimo | Porciani, Claudio | Firenzuoli, Fabio | Baccetti, Sonia | Di Stefano, Mariella | Monechi, Maria V. | Gallo, Eugenia | Maggini, Valentina | Gori, Luigi | Rossi, Elio | Fisher, Peter | Hughes, John | Mendoza, Ariadna | MacPherson, Hugh | Witt, Claudia | Filshie, Jacqueline | Lewith, George | Di Francesco, Antonia | Bernardini, Alberto | Messe, Monica | Primitivo, Vincenzo | Iasella, Piera A. | Ghelman, Ricardo | Taminato, Monica | Alcantara, Jaqueline Do Carmo | De Oliveira, Katia R. | Rodrigues, Debora C. De Azevedo | Mumme, Juliana R. Campana | Sunakozawa, Olga K. Matsumoto | Filho, Vicente Odone | Seifert, Georg | Goldenberg, Joshua | Day, Andrew | Sasagawa, Masa | Ward, Lesley | Cooley, Kieran | Gunnarsdottir, Thora | Hjaltadottir, Ingibjorg | Hajimonfarednejad, Mahdie
doi:10.1186/s12906-017-1783-3
PMCID: PMC5498867
2.  A Post-Discharge Smoking-Cessation Intervention for Hospital Patients 
Introduction
Hospitalization provides an opportunity for smokers to quit, but tobacco-cessation interventions started in hospital must continue after discharge to be effective. This study aimed to improve the scalability of a proven effective post-discharge intervention by incorporating referral to a telephone quitline, a nationally available cessation resource.
Study design
A three-site RCT compared Sustained Care, a post-discharge tobacco-cessation intervention, with Standard Care among hospitalized adult smokers who wanted to quit smoking and received in-hospital tobacco-cessation counseling.
Setting/participants
A total of 1,357 daily smokers admitted to three hospitals were enrolled from December 2012 to July 2014.
Intervention
Sustained Care started at discharge and included automated interactive voice response telephone calls and the patient’s choice of cessation medication for 3 months. Each automated call advised cessation, supported medication adherence, and triaged smokers seeking additional counseling or medication support directly to a telephone quitline. Standard Care provided only medication and counseling recommendations at discharge.
Main outcome measures
Biochemically confirmed past 7–day tobacco abstinence 6 months after discharge (primary outcome); self-reported tobacco abstinence and tobacco-cessation treatment use at 1, 3, and 6 months, and overall (0–6 months). Analyses were done in 2015–2016.
Results
Smokers offered Sustained Care (n=680), versus those offered Standard Care (n=677), did not have greater biochemically confirmed abstinence at 6 months (17% vs 16%, p=0.58). However, the Sustained Care group reported more tobacco-cessation counseling and medication use at each follow-up and higher rates of self-reported past 7–day tobacco abstinence at 1 month (43% vs 32%, p<0.0001) and 3 months (37% vs 30%, p=0.008). At 6 months, the difference narrowed (31% vs 27%, p=0.09). Overall, the intervention increased self-reported 7-day abstinence over the 6-month follow-up (relative risk, 1.25; 95% CI=1.10, 1.40; p=0.0006).
Conclusions
A 3-month post-discharge smoking-cessation intervention for hospitalized smokers who wanted to quit did not increase confirmed tobacco abstinence at 6 months but did increase self-reported abstinence during the treatment period (3 months). Real-time linkage of interactive voice response calls to a quitline, done in this trial to increase scalability of a previously proven cessation intervention, demonstrated short-term promise but did not sustain long-term intervention effectiveness.
Clinical trial registration
NCT01714323
doi:10.1016/j.amepre.2016.04.005
PMCID: PMC5031242  PMID: 27647060
4.  Integrating Tobacco Treatment into Cancer Care: Study Protocol for a Randomized Controlled Comparative Effectiveness Trial 
Background
Despite the well-established risks of persistent smoking, 10-30% of cancer patients continue to smoke after diagnosis. Evidence based tobacco treatment has yet to be integrated into routine oncology care. This paper describes the protocol, manualized treatment, evaluation plan, and overall study design of comparing the effectiveness and cost of two treatments across two major cancer centers.
Methods/Design
A two-arm, two-site randomized controlled comparative effectiveness trial is testing the hypothesis that an Intensive Treatment (IT) intervention is more effective than a Standard Treatment (ST) intervention in helping recently diagnosed cancer patients quit smoking. Both interventions include 4 weekly counseling sessions and FDA-approved smoking cessation medication advice. The IT includes an additional 4 biweekly and 3 monthly booster sessions as well as dispensal of the recommended FDA-approved smoking cessation medication at no cost. The trial is enrolling patients with suspected or newly diagnosed cancer who have smoked a cigarette in the past 30 days. Participants are randomly assigned to receive the ST or IT condition. Tobacco cessation outcomes are assessed at 3 and 6 months. The primary study outcome is 7-day point prevalence biochemically-validated tobacco abstinence. Secondary study outcomes include the incremental cost-effectiveness of the IT vs. ST.
Discussion
This trial will answer key questions about delivering tobacco treatment interventions to newly diagnosed cancer patients. If found to be efficacious and cost-effective, this treatment will serve as a model to be integrated into oncology care settings nation-wide, as we strive to improve treatment outcomes and quality of life for cancer patients.
doi:10.1016/j.cct.2016.07.016
PMCID: PMC5035625  PMID: 27444428
Smoking Cessation; Tobacco Treatment; Cancer Patients; Randomized Controlled Trial; Motivational Interviewing; Pharmacotherapy
5.  The patient perspective: utilizing focus groups to inform care coordination for high-risk medicaid populations 
BMC Research Notes  2017;10:315.
Background
Care coordination programs for high-risk, high-cost patients are a critical component of population health management. These programs aim to improve outcomes and reduce costs and have proliferated over the last decade. Some programs, originally designed for Medicare patients, are now transitioning to also serve Medicaid populations. However, there are still gaps in the understanding of what barriers to care Medicaid patients experience, and what supports will be most effective for providing them care coordination.
Methods
We conducted two focus groups (n = 13) and thematic analyses to assess the outcomes drivers and programmatic preferences of Medicaid patients enrolled in a high-risk care coordination program at a major academic medical center in Boston, MA.
Findings
Two focus groups identified areas where care coordination efforts were having a positive impact, as well as areas of unmet needs among the Medicaid population. Six themes emerged from the focus groups that clustered in three groupings: In the first group (1) enrollment in an existing medical care coordination programs, and (2) provider communication largely presented as positive accounts of assistance, and good relationships with providers, though participants also pointed to areas where these efforts fell short. In the second group (3) trauma histories, (4) mental health challenges, and (5) executive function difficulties all presented challenges faced by high-risk Medicaid patients that would likely require redress through additional programmatic supports. Finally, in the third group, (6) peer-to-peer support tendencies among patients suggested an untapped resource for care coordination programs.
Conclusions
Programs aimed at high-risk Medicaid patients will want to consider programmatic adjustments to attend to patient needs in five areas: (1) provider connection/care coordination, (2) trauma, (3) mental health, (4) executive function/paperwork and coaching support, and (5) peer-to-peer support.
doi:10.1186/s13104-017-2638-1
PMCID: PMC5526300  PMID: 28743288
Medicaid; Care coordination; Care management; Accountable Care Organization; Focus Groups
6.  Fear of recurrence or progression as a link between somatic symptoms and perceived stress among cancer survivors 
Purpose
Many cancer survivors report experiencing somatic symptoms as well as elevated stress. Theoretical models have suggested that physical symptoms generate subjective stress via fears of recurrence or progression. To date, this indirect effect has not been established empirically. This study aimed to provide preliminary evidence as to whether fear of recurrence or progression is an intermediary between somatic symptom severity and perceived stress among heterogeneous cancer survivors.
Methods
Adult cancer survivors (N = 67; median 2.4 years since diagnosis; 34% male) presenting at a hospital survivorship clinic completed measures assessing somatic symptom severity (Patient Health Questionnaire-15 (PHQ-15)), perceived stress (four-item Perceived Stress Scale (PSS-4)), and fear of recurrence or progression (Assessment of Survivor Concerns (ASC)). Interrelatedness among variables was assessed using Pearson correlations. Indirect effects were modeled using 5000-iteration bootstrapping.
Results
Survivors endorsed a range of somatic symptom severity (29% minimal, 39% low, 18% medium, and 14% high). Somatic symptoms, perceived stress, and fear of recurrence or progression were all significantly positively correlated (rs 0.29 to 0.47). Controlling for time since diagnosis, there was a significant indirect effect of somatic symptom severity on stress via fear of recurrence or progression [B = 0.06, SE = 0.04 (95% CI 0.01–0.16)]. The model accounted for more than one third of the variance in perceived stress [R2 = 0.35, F(3,54) = 9.59, p < 0.001].
Conclusions
Survivors with greater somatic symptoms tended to report higher levels of stress, due in part to elevated fears of recurrence or progression. Our findings support concerns about recurrence or progression as a mechanism underlying stress states in cancer survivors. Efforts to assist survivors with stress management should teach strategies for managing cancer-related uncertainties stemming from somatic symptoms.
doi:10.1007/s00520-016-3533-3
PMCID: PMC5500975  PMID: 27966025
Cancer; Oncology; Survivorship; Fear of recurrence; Stress; Symptoms
7.  The Relationship Between Coping Strategies, Quality of Life, and Mood in Patients with Incurable Cancer 
Cancer  2016;122(13):2110-2116.
Background
Patients with incurable cancer face many physical and emotional stressors, yet little is known about their coping strategies or the relationship between their coping strategies, quality of life (QOL) and mood.
Methods
As part of a randomized trial of palliative care, this study assessed baseline QOL (Functional Assessment of Cancer Therapy–General), mood (Hospital Anxiety and Depression Scale), and coping (Brief COPE) in patients within 8 weeks of a diagnosis of incurable lung or gastrointestinal cancer and before randomization. To examine associations between coping strategies, QOL, and mood, we used linear regression, adjusting for patients’ age, sex, marital status, and cancer type.
Results
Participant Sample
There were 350 participants (mean age, 64.9 years), and the majority were male (54.0%), were married (70.0%), and had lung cancer (54.6%). Most reported high utilization of emotional support coping (77.0%), whereas fewer reported high utilization of acceptance (44.8%), self-blame (37.9%), and denial (28.2%). Emotional support (QOL: β = 2.65, P < .01; depression: β = −0.56, P = .02) and acceptance (QOL: β = 1.55, P < .01; depression: β = −0.37, P = .01; anxiety: β = −0.34, P = .02) correlated with better QOL and mood. Denial (QOL: β = −1.97, P < .01; depression: β = 0.36, P = .01; anxiety: β = 0.61, P < .01) and self-blame (QOL: β = −2.31, P < .01; depression: β = 0.58, P < .01; anxiety: β = 0.66, P < .01) correlated with worse QOL and mood.
Conclusion
Patients with newly diagnosed, incurable cancer use a variety of coping strategies. The use of emotional support and acceptance coping strategies correlated with better QOL and mood, whereas the use of denial and self-blame negatively correlated with these outcomes. Interventions to improve patients’ QOL and mood should seek to cultivate the use of adaptive coping strategies.
Precis
Patients with a new diagnosis of incurable cancer cope in a variety of unique ways. We found that patients’ use of certain coping strategies correlated with their QOL and mood, suggesting that evaluating and addressing patients’ coping behaviors may impact other key patient-reported outcomes.
doi:10.1002/cncr.30025
PMCID: PMC5160928  PMID: 27089045
Coping Behavior; Quality of Life; Depression; Anxiety; Incurable Cancer; Palliative Care
8.  World Congress Integrative Medicine & Health 2017: Part one 
Brinkhaus, Benno | Falkenberg, Torkel | Haramati, Aviad | Willich, Stefan N. | Briggs, Josephine P. | Willcox, Merlin | Linde, Klaus | Theorell, Töres | Wong, Lisa M. | Dusek, Jeffrey | Wu, Darong | Eisenberg, David | Haramati, Aviad | Berger, Bettina | Kemper, Kathi | Stock-Schröer, Beate | Sützl-Klein, Hedda | Ferreri, Rosaria | Kaplan, Gary | Matthes, Harald | Rotter, Gabriele | Schiff, Elad | Arnon, Zahi | Hahn, Eckhard | Luberto, Christina M. | Martin, David | Schwarz, Silke | Tauschel, Diethard | Flower, Andrew | Gramminger, Harsha | Gupta, Hedwig H. | Gupta, S. 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H. | Wong, Hoi L. C. | Wu, Xin Y. | Wen, Grace Y. G. | Ho, Robin S. T. | Ching, Jessica Y. L. | Wu, Justin C. 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Alvaro | Rodríguez, Alfredo | Chang, Mayling | Gutiérrez, Soledad | Beissner, Florian | Beissner, Florian | Preibisch, Christine | Schweizer-Arau, Annemarie | Popovici, Roxana | Meissner, Karin | Beljanski, Sylvie | Belland, Laura | Rivera-Reyes, Laura | Hwang, Ula | Berger, Bettina | Sethe, Dominik | Hilgard, Dörte | Heusser, Peter | Bishop, Felicity | Al-Abbadey, Miznah | Bradbury, Katherine | Carnes, Dawn | Dimitrov, Borislav | Fawkes, Carol | Foster, Jo | MacPherson, Hugh | Roberts, Lisa | Yardley, Lucy | Lewith, George | Bishop, Felicity | Al-Abbadey, Miznah | Bradbury, Katherine | Carnes, Dawn | Dimitrov, Borislav | Fawkes, Carol | Foster, Jo | MacPherson, Hugh | Roberts, Lisa | Yardley, Lucy | Lewith, George | Bishop, Felicity | Holmes, Michelle | Lewith, George | Yardley, Lucy | Little, Paul | Cooper, Cyrus | Bogani, Patrizia | Maggini, Valentina | Gallo, Eugenia | Miceli, Elisangela | Biffi, Sauro | Mengoni, Alessio | Fani, Renato | Firenzuoli, Fabio | Brands-Guendling, Nadine | Guendling, Peter W. | Bronfort, Gert | Evans, Roni | Haas, Mitch | Leininger, Brent | Schulz, Craig | Bu, Xiangwei | Wang, J. | Fang, T. | Shen, Z. | He, Y. | Zhang, X. | Zhang, Zhengju | Wang, Dali | Meng, Fengxian | Büssing, Arndt | Baumann, Klaus | Frick, Eckhard | Jacobs, Christoph | Büssing, Arndt | Grünther, Ralph-Achim | Lötzke, Désirée | Büssing, Arndt | Jung, Sonny | Lötzke, Désirée | Recchia, Daniela R. | Robens, Sibylle | Ostermann, Thomas | Berger, Bettina | Stankewitz, Josephin | Kröz, Matthias | Jeitler, Mika | Kessler, Christian | Michalsen, Andreas | Cheon, Chunhoo | Jang, Bo H. | Ko, Seong G. | Huang, Ching W. | Sasaki, Yui | Ko, Youme | Cheshire, Anna | Ridge, Damien | Hughes, John | Peters, David | Panagioti, Maria | Simon, Chantal | Lewith, George | Cho, Hyun J. | Han, Dongwoon | Choi, Soo J. | Jung, Young S. | Im, Hyea B | Cooley, Kieran | Tummon-Simmons, Laura | Cotton, Sian | Luberto, Christina M. | Wasson, Rachel | Kraemer, Kristen | Sears, Richard | Hueber, Carly | Derk, Gwendolyn | Lill, JR | An, Ruopeng | Steinberg, Lois | Rodriguez, Lourdes Diaz | la Fuente, Francisca García-de | De la Vega, Miguel | Vargas-Román, Keyla | Fernández-Ruiz, Jonatan | Cantarero-Villanueva, Irene | Rodriguez, Lourdes Diaz | García-De la Fuente, Francisca | Jiménez-Guerrero, Fanny | Vargas-Román, Keyla | Fernández-Ruiz, Jonatan | Galiano-Castillo, Noelia | Diaz-Saez, Gualberto | Torres-Jimenez, José I. | Garcia-Gomez, Olga | Hortal-Muñoz, Luis | Diaz-Diez, Camino | Dicen, Demijon | Diezel, Helene | Adams, Jon | Steel, Amie | Wardle, Jon | Diezel, Helene | Steel, Amie | Frawley, Jane | Wardle, Jon | Broom, Alex | Adams, Jon | Dong, Fei | Yu, He | Liu, Tiegang | Ma, Xueyan | Yan, Liyi | Wan, Yuxiang | Zheng, Zian | Gu, Xiaohong | Dong, Fei | Yu, He | Wu, Liqun | Liu, Tiegang | Ma, Xueyan | Ma, Jiaju | Yan, Liyi | Wan, Yuxiang | Zheng, Zian | Zhen, Jianhua | Gu, Xiaohong | Dubois, Julie | Rodondi, Pierre-Yves | Edelhäuser, Friedrich | Schwartze, Sophia | Trapp, Barbara | Cysarz, Dirk
doi:10.1186/s12906-017-1782-4
PMCID: PMC5498855
9.  Positive psychological states and health behaviors in acute coronary syndrome patients: A qualitative study 
Journal of health psychology  2014;21(6):1026-1036.
Positive psychological states are linked to superior cardiac outcomes, possibly mediated through increased participation in health behaviors. Trained study staff conducted in-depth semi-structured interviews in the hospital and three months later for 34 patients diagnosed with an acute coronary syndrome. These interviews focused on positive psychological states, cardiac health behaviors, and their connection; the interviews were transcribed and independently coded using directed content analysis. Both optimism and positive affect were associated with completion of physical activity and healthy eating in a bidirectional manner. In contrast, gratitude, while common, was infrequently linked to completion of health behaviors.
doi:10.1177/1359105314544135
PMCID: PMC4490125  PMID: 25114026
Coronary heart disease; optimism; health behavior; adherence; qualitative methods
10.  Proceedings from the 9th annual conference on the science of dissemination and implementation 
Chambers, David | Simpson, Lisa | Neta, Gila | Schwarz, Ulrica von Thiele | Percy-Laurry, Antoinette | Aarons, Gregory A. | Neta, Gila | Brownson, Ross | Vogel, Amanda | Stirman, Shannon Wiltsey | Sherr, Kenneth | Sturke, Rachel | Norton, Wynne E. | Varley, Allyson | Chambers, David | Vinson, Cynthia | Klesges, Lisa | Heurtin-Roberts, Suzanne | Massoud, M. Rashad | Kimble, Leighann | Beck, Arne | Neely, Claire | Boggs, Jennifer | Nichols, Carmel | Wan, Wen | Staab, Erin | Laiteerapong, Neda | Moise, Nathalie | Shah, Ravi | Essock, Susan | Handley, Margaret | Jones, Amy | Carruthers, Jay | Davidson, Karina | Peccoralo, Lauren | Sederer, Lloyd | Molfenter, Todd | Scudder, Ashley | Taber-Thomas, Sarah | Schaffner, Kristen | Herschell, Amy | Woodward, Eva | Pitcock, Jeffery | Ritchie, Mona | Kirchner, JoAnn | Moore, Julia E. | Khan, Sobia | Rashid, Shusmita | Park, Jamie | Courvoisier, Melissa | Straus, Sharon | Blonigen, Daniel | Rodriguez, Allison | Manfredi, Luisa | Nevedal, Andrea | Rosenthal, Joel | Smelson, David | Timko, Christine | Stadnick, Nicole | Regan, Jennifer | Barnett, Miya | Lau, Anna | Brookman-Frazee, Lauren | Guerrero, Erick | Fenwick, Karissa | Kong, Yinfei | Aarons, Gregory | Lengnick-Hall, Rebecca | Fenwick, Karissa | Henwood, Benjamin | Sayer, Nina | Rosen, Craig | Orazem, Robert | Smith, Brandy | Rosen, Craig | Zimmerman, Lindsey | Lounsbury, David | Rosen, Craig | Kimerling, Rachel | Trafton, Jodie A. | Lindley, Steven | Bhargava, Rahul | Roberts, Hal | Gibson, Laura | Escobar, Gabriel J. | Liu, Vincent | Turk, Benjamin | Ragins, Arona | Kipnis, Patricia | Gruszkowski, Ashley Ketterer | Kennedy, Michael W. | Drobek, Emily Rentschler | Turgeman, Lior | Milicevic, Aleksandra Sasha | Hubert, Terrence L. | Myaskovsky, Larissa | Tjader, Youxu C. | Monte, Robert J. | Sapnas, Kathryn G. | Ramly, Edmond | Lauver, Diane R | Bartels, Christie M | Elnahal, Shereef | Ippolito, Andrea | Peabody, Hillary | Clancy, Carolyn | Cebul, Randall | Love, Thomas | Einstadter, Douglas | Bolen, Shari | Watts, Brook | Yakovchenko, Vera | Park, Angela | Lukesh, William | Miller, Donald R. | Thornton, David | Drainoni, Mari-Lynn | Gifford, Allen L. | Smith, Shawna | Kyle, Julia | Bauer, Mark S | Eisenberg, Daniel | Liebrecht, Celeste | Barbaresso, Michelle | Kilbourne, Amy | Park, Elyse | Perez, Giselle | Ostroff, Jamie | Greene, Sarah | Parchman, Michael | Austin, Brian | Larson, Eric | Ferreri, Stefanie | Shea, Chris | Smith, Megan | Turner, Kea | Bacci, Jennifer | Bigham, Kyle | Curran, Geoffrey | Ferreri, Stefanie | Frail, Caity | Hamata, Cory | Jankowski, Terry | Lantaff, Wendy | McGivney, Melissa Somma | Snyder, Margie | McCullough, Megan | Gillespie, Chris | Petrakis, Beth Ann | Jones, Ellen | Park, Angela | Lukas, Carol VanDeusen | Rose, Adam | Shoemaker, Sarah J. | Curran, Geoffrey | Thomas, Jeremy | Teeter, Benjamin | Swan, Holly | Teeter, Benjamin | Thomas, Jeremy | Curran, Geoffrey | Balamurugan, Appathurai | Lane-Fall, Meghan | Beidas, Rinad | Di Taranti, Laura | Buddai, Sruthi | Hernandez, Enrique Torres | Watts, Jerome | Fleisher, Lee | Barg, Frances | Miake-Lye, Isomi | Olmos, Tanya | Chuang, Emmeline | Rodriguez, Hector | Kominski, Gerald | Yano, Becky | Shortell, Stephen | Hook, Mary | Fleisher, Linda | Fiks, Alexander | Halkyard, Katie | Gruver, Rachel | Sykes, Emily | Vesco, Kimberly | Beadle, Kate | Bulkley, Joanna | Stoneburner, Ashley | Leo, Michael | Clark, Amanda | Smith, Joan | Smyser, Christopher | Wolf, Maggie | Trivedi, Shamik | Hackett, Brian | Rao, Rakesh | Cole, F. Sessions | McGonigle, Rose | Donze, Ann | Proctor, Enola | Mathur, Amit | Sherr, Kenneth | Gakidou, Emmanuela | Gloyd, Stephen | Audet, Carolyn | Salato, Jose | Vermund, Sten | Amico, Rivet | Smith, Stephanie | Nyirandagijimana, Beatha | Mukasakindi, Hildegarde | Rusangwa, Christian | Franke, Molly | Raviola, Giuseppe | Cummings, Matthew | Goldberg, Elijah | Mwaka, Savio | Kabajaasi, Olive | Cattamanchi, Adithya | Katamba, Achilles | Jacob, Shevin | Kenya-Mugisha, Nathan | Davis, J. Lucian | Reed, Julie | Ramaswamy, Rohit | Parry, Gareth | Sax, Sylvia | Kaplan, Heather | Huang, Keng-yen | Cheng, Sabrina | Yee, Susan | Hoagwood, Kimberly | McKay, Mary | Shelley, Donna | Ogedegbe, Gbenga | Brotman, Laurie Miller | Kislov, Roman | Humphreys, John | Harvey, Gill | Wilson, Paul | Lieberthal, Robert | Payton, Colleen | Sarfaty, Mona | Valko, George | Bolton, Rendelle | Lukas, Carol VanDeusen | Hartmann, Christine | Mueller, Nora | Holmes, Sally K. | Bokhour, Barbara | Ono, Sarah | Crabtree, Benjamin | Gordon, Leah | Miller, William | Balasubramanian, Bijal | Solberg, Leif | Cohen, Deborah | McGraw, Kate | Blatt, Andrew | Pittman, Demietrice | McCullough, Megan | Hartmann, Christine | Kales, Helen | Berlowitz, Dan | Hudson, Teresa | Gillespie, Chris | Helfrich, Christian | Finley, Erin | Garcia, Ashley | Rosen, Kristen | Tami, Claudina | McGeary, Don | Pugh, Mary Jo | Potter, Jennifer Sharpe | Helfrich, Christian | Stryczek, Krysttel | Au, David | Zeliadt, Steven | Sayre, George | Gillespie, Chris | Leeman, Jennifer | Myers, Allison | Grant, Jennifer | Wangen, Mary | Queen, Tara | Morshed, Alexandra | Dodson, Elizabeth | Tabak, Rachel | Brownson, Ross C. | Sheldrick, R. Chris | Mackie, Thomas | Hyde, Justeen | Leslie, Laurel | Yanovitzky, Itzhak | Weber, Matthew | Gesualdo, Nicole | Kristensen, Teis | Stanick, Cameo | Halko, Heather | Dorsey, Caitlin | Powell, Byron | Weiner, Bryan | Lewis, Cara | Powell, Byron | Weiner, Bryan | Stanick, Cameo | Halko, Heather | Dorsey, Caitlin | Lewis, Cara | Weiner, Bryan | Dorsey, Caitlin | Stanick, Cameo | Halko, Heather | Powell, Byron | Lewis, Cara | Stirman, Shannon Wiltsey | Carreno, Patricia | Mallard, Kera | Masina, Tasoula | Monson, Candice | Swindle, Taren | Curran, Geoffrey | Patterson, Zachary | Whiteside-Mansell, Leanne | Hanson, Rochelle | Saunders, Benjamin | Schoenwald, Sonja | Moreland, Angela | Birken, Sarah | Powell, Byron | Presseau, Justin | Miake-Lye, Isomi | Ganz, David | Mittman, Brian | Delevan, Deborah | Finley, Erin | Hill, Jennifer N. | Locatelli, Sara | Bokhour, Barbara | Fix, Gemmae | Solomon, Jeffrey | Mueller, Nora | Lavela, Sherri L. | Scott, Victoria | Scaccia, Jonathan | Alia, Kassy | Skiles, Brittany | Wandersman, Abraham | Wilson, Paul | Sales, Anne | Roberts, Megan | Kennedy, Amy | Chambers, David | Khoury, Muin J. | Sperber, Nina | Orlando, Lori | Carpenter, Janet | Cavallari, Larisa | Denny, Joshua | Elsey, Amanda | Fitzhenry, Fern | Guan, Yue | Horowitz, Carol | Johnson, Julie | Madden, Ebony | Pollin, Toni | Pratt, Victoria | Rakhra-Burris, Tejinder | Rosenman, Marc | Voils, Corrine | Weitzel, Kristin | Wu, Ryanne | Damschroder, Laura | Lu, Christine | Ceccarelli, Rachel | Mazor, Kathleen M. | Wu, Ann | Rahm, Alanna Kulchak | Buchanan, Adam H. | Schwartz, Marci | McCormick, Cara | Manickam, Kandamurugu | Williams, Marc S. | Murray, Michael F. | Escoffery, Ngoc-Cam | Lebow-Skelley, Erin | Udelson, Hallie | Böing, Elaine | Fernandez, Maria E. | Wood, Richard J. | Mullen, Patricia Dolan | Parekh, Jenita | Caldas, Valerie | Stuart, Elizabeth A. | Howard, Shalynn | Thomas, Gilo | Jennings, Jacky M. | Torres, Jennifer | Markham, Christine | Shegog, Ross | Peskin, Melissa | Rushing, Stephanie Craig | Gaston, Amanda | Gorman, Gwenda | Jessen, Cornelia | Williamson, Jennifer | Ward, Dianne | Vaughn, Amber | Morris, Ellie | Mazzucca, Stephanie | Burney, Regan | Ramanadhan, Shoba | Minsky, Sara | Martinez-Dominguez, Vilma | Viswanath, Kasisomayajula | Barker, Megan | Fahim, Myra | Ebnahmady, Arezoo | Dragonetti, Rosa | Selby, Peter | Farrell, Margaret | Tompkins, Jordan | Norton, Wynne | Rapport, Kaelin | Hargreaves, Margaret | Lee, Rebekka | Ramanadhan, Shoba | Kruse, Gina | Deutsch, Charles | Lanier, Emily | Gray, Ashley | Leppin, Aaron | Christiansen, Lori | Schaepe, Karen | Egginton, Jason | Branda, Megan | Gaw, Charlene | Dick, Sara | Montori, Victor | Shah, Nilay | Korn, Ariella | Hovmand, Peter | Fullerton, Karen | Zoellner, Nancy | Hennessy, Erin | Tovar, Alison | Hammond, Ross | Economos, Christina | Kay, Christi | Gazmararian, Julie | Vall, Emily | Cheung, Patricia | Franks, Padra | Barrett-Williams, Shannon | Weiss, Paul | Kay, Christi | Gazmararian, Julie | Hamilton, Erica | Cheung, Patricia | Kay, Christi | Vall, Emily | Gazmararian, Julie | Marques, Luana | Dixon, Louise | Ahles, Emily | Valentine, Sarah | Monson, Candice | Shtasel, Derri | Stirman, Shannon Wiltsey | Parra-Cardona, Ruben | Northridge, Mary | Kavathe, Rucha | Zanowiak, Jennifer | Wyatt, Laura | Singh, Hardayal | Islam, Nadia | Monteban, Madalena | Freedman, Darcy | Bess, Kimberly | Walsh, Colleen | Matlack, Kristen | Flocke, Susan | Baily, Heather | Harden, Samantha | Ramalingam, NithyaPriya | Alia, Kassy | Scaccia, Jonathan | Scott, Victoria | Ramaswamy, Rohit | Wandersman, Abraham | Gold, Rachel | Cottrell, Erika | Hollombe, Celine | Dambrun, Katie | Bunce, Arwen | Middendorf, Mary | Dearing, Marla | Cowburn, Stuart | Mossman, Ned | Melgar, Gerry | Hopfer, Suellen | Hecht, Michael | Ray, Anne | Miller-Day, Michelle | BeLue, Rhonda | Zimet, Greg | Nelson, Eve-Lynn | Kuhlman, Sandy | Doolittle, Gary | Krebill, Hope | Spaulding, Ashley | Levin, Theodore | Sanchez, Michael | Landau, Molly | Escobar, Patricia | Minian, Nadia | Selby, Peter | Noormohamed, Aliya | Zawertailo, Laurie | Baliunas, Dolly | Giesbrecht, Norman | Le Foll, Bernard | Samokhvalov, Andriy | Meisel, Zachary | Polsky, Daniel | Schackman, Bruce | Mitchell, Julia | Sevarino, Kaitlyn | Gimbel, Sarah | Mwanza, Moses | Nisingizwe, Marie Paul | Michel, Catherine | Hirschhorn, Lisa | Lane-Fall, Meghan | Beidas, Rinad | Di Taranti, Laura | Choudhary, Mahrukh | Thonduparambil, Della | Fleisher, Lee | Barg, Frances | Meissner, Paul | Pinnock, Hilary | Barwick, Melanie | Carpenter, Christopher | Eldridge, Sandra | Grandes-Odriozola, Gonzalo | Griffiths, Chris | Rycroft-Malone, Jo | Murray, Elizabeth | Patel, Anita | Sheikh, Aziz | Taylor, Stephanie J. C. | Mittman, Brian | Guilliford, Martin | Pearce, Gemma | Korngiebel, Diane | West, Kathleen | Burke, Wylie | Hannon, Peggy | Harris, Jeffrey | Hammerback, Kristen | Kohn, Marlana | Chan, Gary K. C. | Mafune, Riki | Parrish, Amanda | Helfrich, Christian | Beresford, Shirley | Pike, K. Joanne | Shelton, Rachel | Jandorf, Lina | Erwin, Deborah | Charles, Thana-Ashley | Parchman, Michael | Baldwin, Laura-Mae | Ike, Brooke | Fickel, Jacqueline | Lind, Jason | Cowper, Diane | Fleming, Marguerite | Sadler, Amy | Dye, Melinda | Katzburg, Judith | Ong, Michael | Tubbesing, Sarah | McCullough, Megan | Simmons, Molly | Yakovchenko, Vera | Harnish, Autumn | Gabrielian, Sonya | McInnes, Keith | Smith, Jeffrey | Smelson, David | Ferrand, John | Torres, Elisa | Green, Amy | Aarons, Gregory | Bradbury, Angela R. | Patrick-Miller, Linda J. | Egleston, Brian L. | Domchek, Susan M. | Olopade, Olufunmilayo I. | Hall, Michael J. | Daly, Mary B. | Fleisher, Linda | Grana, Generosa | Ganschow, Pamela | Fetzer, Dominique | Brandt, Amanda | Chambers, Rachelle | Clark, Dana F. | Forman, Andrea | Gaber, Rikki S. | Gulden, Cassandra | Horte, Janice | Long, Jessica | Lucas, Terra | Madaan, Shreshtha | Mattie, Kristin | McKenna, Danielle | Montgomery, Susan | Nielsen, Sarah | Powers, Jacquelyn | Rainey, Kim | Rybak, Christina | Seelaus, Christina | Stoll, Jessica | Stopfer, Jill | Yao, Xinxin Shirley | Savage, Michelle | Miech, Edward | Damush, Teresa | Rattray, Nicholas | Myers, Jennifer | Homoya, Barbara | Winseck, Kate | Klabunde, Carrie | Langer, Deb | Aggarwal, Avi | Neilson, Elizabeth | Gunderson, Lara | Escobar, Gabriel J. | Gardner, Marla | O’Sulleabhain, Liam | Kroenke, Candyce | Liu, Vincent | Kipnis, Patricia
Implementation Science : IS  2017;12(Suppl 1):48.
doi:10.1186/s13012-017-0575-y
PMCID: PMC5414666
11.  Factor Structure and Stability of Smoking-Related Health Beliefs in the National Lung Screening Trial 
Nicotine & Tobacco Research  2015;18(3):321-329.
Introduction:
Absolute and comparative risk perceptions, worry, perceived severity, perceived benefits, and self-efficacy are important theoretical determinants of tobacco use, but no measures have been validated to ensure the discriminant validity as well as test-retest reliability of these measures in the tobacco context. The purpose of the current study is to examine the reliability and factor structure of a measure assessing smoking-related health cognitions and emotions in a national sample of current and former heavy smokers in the National Lung Screening Trial.
Methods:
A sub-study of the National Lung Screening Trial assessed current and former smokers’ (age 55–74; N = 4379) self-reported health cognitions and emotions at trial enrollment and at 12-month follow-up. Items were derived from the Health Belief Model and Self-Regulation Model.
Results:
An exploratory factor analysis of baseline responses revealed a five-factor structure for former smokers (risk perceptions, worry, perceived severity, perceived benefits, and self-efficacy) and a six-factor structure for current smokers, such that absolute risk and comparative risk perceptions emerged as separate factors. A confirmatory factor analysis of 12-month follow-up responses revealed a good fit for the five latent constructs for former smokers and six latent constructs for current smokers. Longitudinal stability of these constructs was also demonstrated.
Conclusions:
This is the first study to examine tobacco-related health cognition and emotional constructs over time in current and former heavy smokers undergoing lung screening. This study found that the theoretical constructs were stable across time and that the factor structure differed based on smoking status (current vs. former).
doi:10.1093/ntr/ntv091
PMCID: PMC4757932  PMID: 25964503
12.  Racial Differences in Tobacco Cessation and Treatment Usage After Lung Screening: An Examination of the National Lung Screening Trial 
The Oncologist  2015;21(1):40-49.
Racial differences in smoking behavior and cessation among National Lung Screening Trial participants who were current smokers at screening using a follow-up survey were evaluated. Although blacks were more likely than whites to attempt to quit, the rates of continuous abstinence did not differ. Targeted interventions are needed at the time of lung cancer screening to promote abstinence among all smokers.
Background.
Black smokers have demonstrated greater lung cancer disease burden and poorer smoking cessation outcomes compared with whites. Lung cancer screening represents a unique opportunity to promote cessation among smokers; however, little is known about the differential impact of screening on smoking behaviors among black and white smokers. Using data from the National Lung Screening Trial (NLST), we examined the racial differences in smoking behaviors after screening.
Methods.
We examined racial differences in smoking behavior and cessation activity among 6,316 white and 497 black (median age, 60 and 59 years, respectively) NLST participants who were current smokers at screening using a follow-up survey on 24-hour and 7-day quit attempts, 6-month continuous abstinence, and the use of smoking cessation programs and aids at 12 months after screening. Using multiple regression analyses, we examined the predictors of 24-hour and 7-day quit attempts and 6-month continuous abstinence.
Results.
At 12 months after screening, blacks were more likely to report a 24-hour (52.7% vs. 41.2%, p < .0001) or 7-day (33.6% vs. 27.2%, p = .002) quit attempt. However, no significant racial differences were found in 6-month continuous abstinence (5.6% blacks vs. 7.2% whites). In multiple regression, black race was predictive of a higher likelihood of a 24-hour (odds ratio [OR], 1.6, 95% confidence interval [CI], 1.2–2.0) and 7-day (OR, 1.5, 95% CI, 1.1–1.8) quit attempt; however, race was not associated with 6-month continuous abstinence. Only a positive screening result for lung cancer was significantly predictive of successful 6-month continuous abstinence (OR, 2.3, 95% CI, 1.8–2.9).
Conclusion.
Although blacks were more likely than whites to have 24-hour and 7-day quit attempts, the rates of 6-month continuous abstinence did not differ. Targeted interventions are needed at the time of lung cancer screening to promote abstinence among all smokers.
Implications for Practice:
Among smokers undergoing screening for lung cancer, blacks were more likely than whites to have 24-hour and 7-day quit attempts; however, these attempts did not translate to increased rates of 6-month continuous abstinence among black smokers. Targeted interventions are needed at the time of lung cancer screening to convert quit attempts to sustained smoking cessation among all smokers.
doi:10.1634/theoncologist.2015-0325
PMCID: PMC4709215  PMID: 26712960
Smoking cessation; Tobacco cessation; Lung cancer; Cancer screening
13.  The Relations Between False Positive and Negative Screens and Smoking Cessation and Relapse in the National Lung Screening Trial: Implications for Public Health 
Nicotine & Tobacco Research  2015;18(1):17-24.
Introduction:
Lung screening is an opportunity for smoking cessation and relapse prevention, but smoking behaviors may differ across screening results. Changes in smoking were evaluated among 18 840 current and former smokers aged 55–74 scheduled to receive three annual lung screenings.
Methods:
Participants were randomized to low-dose computed tomography or single-view chest radiography in the American College of Radiology/National Lung Screening Trial. Outcome measures included point and sustained (6-month) abstinence and motivation to quit among smokers; and relapse among smokers who quit during follow-up, recent quitters (quit < 6 months), and long-term former smokers (quit ≥ 6 months).
Results:
During five years of follow-up, annual point prevalence quit rates ranged from 11.6%–13.4%; 48% of current smokers reported a quit attempt and 7% of long-term former smokers relapsed. Any false positive screening result was associated with subsequent increased point (multivariable hazard ratio HR = 1.23, 95% CI = 1.13, 1.35) and sustained (HR = 1.28, 95% CI = 1.15, 1.43) abstinence among smokers. Recent quitters with ≥1 false positive screen were less likely to relapse (HR = 0.72, 95% CI = 0.54, 0.96). Screening result was not associated with relapse among long-term former smokers or among baseline smokers who quit during follow-up.
Conclusions:
A false positive screen was associated with increased smoking cessation and less relapse among recent quitters. Consistently negative screens were not associated with greater relapse among long-term former smokers. Given the Affordable Care Act requires most health plans to cover smoking cessation and lung screening, the impact and cost-effectiveness of lung screening could be further enhanced with the addition of smoking cessation interventions.
doi:10.1093/ntr/ntv037
PMCID: PMC4881825  PMID: 25746779
14.  Integrating Tobacco Treatment into Thoracic Oncology Settings: Lessons Learned 
Journal of health psychology  2015;21(12):2813-2823.
Clinical practice guidelines recommend tobacco treatment for all cancer patients. However, little is known about how to integrate tobacco treatment into cancer care. The results of our pilot study of an evidence-based tobacco treatment integrated into a thoracic oncology clinic demonstrated good feasibility and efficacy, providing an opportunity to inform future tobacco treatment integration efforts. Here we describe the process of intervention development, clinic integration, patient identification, and patient enrollment. We report on the intervention content and delivery, patterns of quitting for participants in the tobacco treatment group, and changes in smoking-related psychosocial variables. Clinical implications and suggestions for future research are discussed.
doi:10.1177/1359105315587136
PMCID: PMC4738162  PMID: 26044717
Cancer; intervention; smoking cessation; lung cancer; methodology
15.  Primary Care Provider-Delivered Smoking Cessation Interventions and Smoking Cessation Among Participants in the National Lung Screening Trial 
JAMA internal medicine  2015;175(9):1509-1516.
Importance
The National Lung Screening Trial (NLST) found a reduction in lung cancer mortality among participants screened with low-dose computed tomography vs chest radiography. In February 2015, Medicare announced its decision to cover annual lung screening for patients with a significant smoking history. These guidelines promote smoking cessation treatment as an adjunct to screening, but the frequency and effectiveness of clinician-delivered smoking cessation interventions delivered after lung screening are unknown.
Objective
To determine the association between the reported clinician-delivered 5As (ask, advise, assess, assist [talk about quitting or recommend stop-smoking medications or recommend counseling], and arrange follow-up) after lung screening and smoking behavior changes.
Design, Setting, and Participants
A matched case-control study (cases were quitters and controls were continued smokers) of 3336 NLST participants who were smokers at enrollment examined participants' rates and patterns of 5A delivery after a lung screen and reported smoking cessation behaviors.
Main outcomes and Measures
Prevalence of the clinician-delivered 5As and associated smoking cessation after lung screening.
Results
Delivery of the 5As 1 year after screening were as follows: ask, 77.2%; advise, 75.6%; assess, 63.4%; assist, 56.4%; and arrange follow-up, 10.4%. Receipt of ask, advise, and assess was not significantly associated with quitting in multivariate models that adjusted for sociodemographic characteristics, medical history, screening results, nicotine dependence, and motivation to quit. Assist was associated with a 40% increase in the odds of quitting (odds ratio, 1.40; 95% CI, 1.21-1.63), and arrange was associated with a 46% increase in the odds of quitting (odds ratio, 1.46; 95% CI, 1.19-1.79).
Conclusions and Relevance
Assist and arrange follow-up delivered by primary care providers to smokers who were participating in the NLST were associated with increased quitting; less intensive interventions (ask, advise, and assess) were not. However, rates of assist and arrange follow-up were relatively low. Our findings confirm the need for and benefit of clinicians taking more active intervention steps in helping patients who undergo screening to quit smoking.
doi:10.1001/jamainternmed.2015.2391
PMCID: PMC5089370  PMID: 26076313
16.  Oncologists' and Cancer Patients' Views on Whole-Exome Sequencing and Incidental Findings: Results from The CanSeq Study 
Purpose
While targeted sequencing improves outcomes for many cancer patients, how somatic and germline whole-exome sequencing (WES) will integrate into care remains uncertain.
Methods
We conducted surveys and interviews, within a study of WES integration at an academic center, to determine oncologists' attitudes about WES and to identify lung and colorectal cancer patients' preferences for learning WES findings.
Results
167 patients (85% white, 58% female, mean age 60) and 27 oncologists (22% female) participated. Although oncologists had extensive experience ordering somatic tests (median 100/year), they had little experience ordering germline tests. Oncologists intended to disclose most WES results to patients but anticipated numerous challenges in using WES. Patients had moderately low levels of genetic knowledge (mean 4 correct of 7). Most patients chose to learn results that could help select a clinical trial, pharmacogenetic and positive prognostic results, and results suggesting inherited predisposition to cancer and treatable non-cancer conditions (all ≥95%). Fewer chose to receive negative prognostic results (84%) and results suggesting predisposition to untreatable non-cancer conditions (85%).
Conclusion
The majority of patients want most cancer-related and incidental WES results. Patients' low levels of genetic knowledge and oncologists' inexperience with large-scale sequencing presage challenges to implementing paired WES in practice.
doi:10.1038/gim.2015.207
PMCID: PMC4981555  PMID: 26866579
sequencing; cancer; incidental findings; return of results
17.  An exploratory mixed methods analysis of adherence predictors following acute coronary syndrome 
Psychology, health & medicine  2014;20(5):541-550.
Adherence to cardiac health behaviors is a critical predictor of prognosis in the months following an acute coronary syndrome (ACS). However, there has been minimal concomitant study of multiple nonadherence risk factors, as assessed via record review, structured assessments, and qualitative interviews, among hospitalized ACS patients. Accordingly, we completed an exploratory mixed methods study with 22 individuals who were admitted for ACS and had suboptimal pre-ACS adherence to physical activity, heart-healthy diet, and/or medications, defined by a Medical Outcomes Study Specific Adherence Scale (MOS SAS) score <15/18. During hospitalization, participants underwent quantitative assessments of sociodemographic, medical, and psychological variables, followed by in-depth semi-structured interviews to explore intentions, plans, and perceived barriers related to post-discharge health behavior changes. The MOS SAS was readministered at 3 months and participants were designated as persistently nonadherent (MOS SAS<15; n=9) or newly adherent (n=13). Interviews were transcribed and coded by trained raters via content analysis, and quantitative variables were compared between groups using chi-square analysis and independent-samples t-tests. On our primary qualitative analysis, we found that participants with vaguely described intentions/plans regarding health behavior change, and those who focused on barriers to change that were perceived as static, were more likely to be persistently nonadherent. On exploratory quantitative analyses, greater medical burden, diabetes, depressive symptoms, and low optimism/positive affect at baseline were associated with subsequent post-ACS nonadherence (all p<.05). In conclusion, this appears to be the first study to prospectively examine all of these constructs in hospitalized ACS patients, and we found that specific factors were associated with nonadherence to key health behaviors 3 months later. It may therefore be possible to predict future nonadherence in ACS patients, even during hospitalization, and specific interventions during admission may be indicated to prevent adverse outcomes among patients at highest risk for post-ACS nonadherence.
doi:10.1080/13548506.2014.989531
PMCID: PMC4426849  PMID: 25495864
acute coronary syndrome; health behavior; mixed methods; optimism; positive affect
18.  Age and Gender Moderate the Impact of Early Palliative Care in Metastatic Non-Small Cell Lung Cancer 
The Oncologist  2015;21(1):119-126.
This study analyzed data from a randomized controlled trial of patients with metastatic non-small cell lung cancer who received either early palliative care (EPC) integrated with oncology care or oncology care alone. Males and younger patients who received EPC had better quality of life and mood than those who received oncology care alone. However, these outcomes did not differ significantly between treatment groups for females or older patients.
Background.
Studies demonstrate that early palliative care (EPC) improves advanced cancer patients’ quality of life (QOL) and mood. However, it remains unclear whether the role of palliative care differs based upon patients’ demographic characteristics. We explored whether age and gender moderate the improvements in QOL and mood seen with EPC.
Methods.
We performed a secondary analysis of data from a randomized controlled trial of patients with metastatic non-small cell lung cancer. Patients received either EPC integrated with oncology care or oncology care alone. We assessed the degree to which QOL (Trial Outcome Index [TOI]) and mood (Hospital Anxiety and Depression Scale [HADS] and Patient Health Questionnaire 9 [PHQ-9]) outcomes at week 12 varied by patient age (<65) and gender. The week 12 data of 107 patients are included in this analysis.
Results.
At 12 weeks, younger patients receiving EPC reported better QOL (TOI mean = 62.04 vs. 49.43, p = .001) and lower rates of depression (HADS–Depression = 4.0% vs. 52.4%, p < .001; PHQ-9 = 0.0% vs. 28.6%, p = .006) than younger patients receiving oncology care alone. Males receiving EPC reported better QOL (TOI mean = 58.81 vs. 48.30, p = .001) and lower rates of depression (HADS–Depression = 18.5% vs. 60.9%, p = .002; PHQ-9 = 3.8% vs. 34.8%, p = .008) than males receiving oncology care alone. At 12 weeks, QOL and mood did not differ between study groups for females and older patients.
Conclusion.
Males and younger patients who received EPC had better QOL and mood than those who received oncology care alone. However, these outcomes did not differ significantly between treatment groups for females or older patients.
Implications for Practice:
This study found that early palliative care improves patients’ quality of life and mood differentially based on their age and gender. Specifically, males and younger patients receiving early palliative care experienced better quality of life and mood than those receiving oncology care alone. Conversely, females and older patients did not experience this treatment effect. Thus, palliative care interventions may need to be tailored to patients’ age- and gender-specific care needs. Studying how patients’ demographic characteristics affect their experience with palliative care will enable the development of interventions targeted to the distinct supportive care needs of patients with cancer.
doi:10.1634/theoncologist.2015-0232
PMCID: PMC4709206  PMID: 26621041
Palliative care; Quality of life; Mood; Advanced cancer; Gender; Geriatrics
19.  Accuracy of Race, Ethnicity, and Language Preference in an Electronic Health Record 
BACKGROUND
Collection of data on race, ethnicity, and language preference is required as part of the “meaningful use” of electronic health records (EHRs). These data serve as a foundation for interventions to reduce health disparities.
OBJECTIVE
Our aim was to compare the accuracy of EHR-recorded data on race, ethnicity, and language preference to that reported directly by patients.
DESIGN/SUBJECTS/MAIN MEASURES
Data collected as part of a tobacco cessation intervention for minority and low-income smokers across a network of 13 primary care clinics (n = 569).
KEY RESULTS
Patients were more likely to self-report Hispanic ethnicity (19.6 % vs. 16.6 %, p < 0.001) and African American race (27.0 % vs. 20.4 %, p < 0.001) than was reported in the EHR. Conversely, patients were less likely to complete the survey in Spanish than the language preference noted in the EHR suggested (5.1 % vs. 6.3 %, p < 0.001). Thirty percent of whites self-reported identification with at least one other racial or ethnic group, as did 37.0 % of Hispanics, and 41.0 % of African Americans. Over one-third of EHR-documented Spanish speakers elected to take the survey in English. One-fifth of individuals who took the survey in Spanish were recorded in the EHR as English-speaking.
CONCLUSION
We demonstrate important inaccuracies and the need for better processes to document race/ ethnicity and language preference in EHRs.
doi:10.1007/s11606-014-3102-8
PMCID: PMC4441665  PMID: 25527336
disparities; race; ethnicity; health information technology
20.  Supplemental Security Income and Social Security Disability Insurance Coverage Among Long-term Childhood Cancer Survivors 
Supplemental security income (SSI) and social security disability insurance (DI) are federal programs that provide disability benefits. We report on SSI/DI enrollment in a random sample of adult, long-term survivors of childhood cancer (n = 698) vs a comparison group without cancer (n = 210) from the Childhood Cancer Survivor Study who completed a health insurance survey. A total of 13.5% and 10.0% of survivors had ever been enrolled on SSI or DI, respectively, compared with 2.6% and 5.4% of the comparison group. Cranial radiation doses of 25 Gy or more were associated with a higher risk of current SSI (relative risk [RR] = 3.93, 95% confidence interval [CI] = 2.05 to 7.56) and DI (RR = 3.65, 95% CI = 1.65 to 8.06) enrollment. Survivors with severe/life-threatening conditions were more often enrolled on SSI (RR = 3.77, 95% CI = 2.04 to 6.96) and DI (RR = 2.73, 95% CI = 1.45 to 5.14) compared with those with mild/moderate or no health conditions. Further research is needed on disability-related financial challenges after childhood cancer.
doi:10.1093/jnci/djv057
PMCID: PMC4650970  PMID: 25770148
21.  Processes of Discontinuing Chemotherapy for Metastatic Non–Small-Cell Lung Cancer at the End of Life 
Journal of Oncology Practice  2015;11(3):e405-e412.
The authors conclude that date of last chemotherapy is not a proxy for when a decision to stop treatment is made.
Purpose:
Administration of chemotherapy close to death is widely recognized as poor-quality care. Prior research has focused on predictors and outcomes of chemotherapy administration at the end of life. This study describes processes of chemotherapy discontinuation and examines their relationships with timing before death, hospice referral, and hospital death.
Patients and Methods:
We reviewed health records of a prospective cohort of 151 patients with newly diagnosed metastatic non–small-cell lung cancer who participated in a trial of early palliative care. Chemotherapy treatments during final regimen were qualitatively analyzed to identify categories of discontinuation processes. We then quantitatively compared predictors and outcomes of the process categories.
Results:
A total of 144 patients died, with 81 and 48 receiving intravenous (IV) and oral chemotherapies as their final regimen, respectively. Five processes were identified for IV chemotherapy: definitive decisions (19.7%), deferred decisions or breaks (22.2%), disruptions for radiation therapy (22.2%), disruptions resulting from hospitalization (27.2%), and no decisions (8.6%). The five processes occurred at significantly different times before death and, except for definitive decisions, ultimate decisions for no further chemotherapy and referral to hospice were often made months later. Among patients receiving oral chemotherapy, 83.3% (40 of 48) were switched from IV to oral delivery as their final regimen, sometimes concurrent with or even after hospice referral.
Conclusion:
Date of last chemotherapy is not a proxy for when a decision to stop treatment is made. Patients with metastatic non–small-cell lung cancer stop their final chemotherapy regimen via different processes, which significantly vary in time before death and subsequent end-of-life care.
doi:10.1200/JOP.2014.002428
PMCID: PMC4438117  PMID: 25829525
22.  Childhood Cancer Survivor Study Participants' Perceptions and Understanding of the Affordable Care Act 
Journal of Clinical Oncology  2015;33(7):764-772.
Purpose
The Patient Protection and Affordable Care Act (ACA) established provisions intended to increase access to affordable health insurance and thus increase access to medical care and long-term surveillance for populations with pre-existing conditions. However, childhood cancer survivors' coverage priorities and familiarity with the ACA are unknown.
Methods
Between May 2011 and April 2012, we surveyed a randomly selected, age-stratified sample of 698 survivors and 210 siblings from the Childhood Cancer Survivor Study.
Results
Overall, 89.8% of survivors and 92.1% of siblings were insured. Many features of insurance coverage that survivors considered “very important” are addressed by the ACA, including increased availability of primary care (94.6%), no waiting period before coverage initiation (79.0%), and affordable premiums (88.1%). Survivors were more likely than siblings to deem primary care physician coverage and choice, protections from costs due to pre-existing conditions, and no start-up period as “very important” (P < .05 for all). Only 27.3% of survivors and 26.2% of siblings reported familiarity with the ACA (12.1% of uninsured v 29.0% of insured survivors; odds ratio, 2.86; 95% CI, 1.28 to 6.36). Only 21.3% of survivors and 18.9% of siblings believed the ACA would make it more likely that they would get quality coverage. Survivors' and siblings' concerns about the ACA included increased costs, decreased access to and quality of care, and negative impact on employers and employees.
Conclusion
Although survivors' coverage preferences match many ACA provisions, survivors, particularly uninsured survivors, were not familiar with the ACA. Education and assistance, perhaps through cancer survivor navigation, are critically needed to ensure that survivors access coverage and benefits.
doi:10.1200/JCO.2014.58.0993
PMCID: PMC4334780  PMID: 25646189
23.  Reflections on living with HIV over time: Exploring the perspective of HIV-infected women over 50 
Aging & mental health  2014;19(2):121-128.
Objectives
Approximately 32.7% of people living with HIV/AIDS (PLWHA) in the U.S. are now over the age of 50. Women comprise a significant percentage of the U.S. HIV epidemic and the percentage of women diagnosed with HIV continues to grow; however, little is known about women’s experiences living and coping with HIV over time. The goal of this study was to explore experiences of U.S. women over 50 living with HIV to better understand how they make sense of their diagnosis and cope with their illness over time, and during the aging process.
Method
Nineteen women (mean age = 56.79, SD=4.63) referred from Boston-area organizations and hospitals completed one-time, in-depth individual interviews. 47% of participants identified as Black/African American, and 37% as White. Average time since diagnosis was 16.32 years (SD=5.70). Inclusion criteria included: female sex; aged 50 or older; HIV diagnosis; and English speaking. Transcribed interviews were analyzed using a grounded theory approach and NVivo 9 software.
Results
Findings are described across the following themes: 1) experiences at diagnosis, 2) uncertainty of disease course, 3) acceptance, 4) living “well” with HIV. Participants appeared to be well-adjusted to their HIV diagnosis and described a progression to acceptance and survivorship; they identified strategies to “live well” in the context of HIV. For some, health-related uncertainty about the future remained. These findings were organized into a model of coping with HIV.
Conclusions
Themes and issues identified by this study may help guide interventions across the lifespan for women with HIV.
doi:10.1080/13607863.2014.917608
PMCID: PMC4245325  PMID: 24903460
HIV/AIDS; women; aging; adjustment; coping
24.  Proactive tobacco cessation outreach to smokers of low socioeconomic status: a randomized clinical trial 
JAMA internal medicine  2015;175(2):218-226.
Importance
Widening socioeconomic disparities in mortality in the United States are largely explained by slower declines in tobacco use between low- and high-socioeconomic status (SES) groups, suggesting the need for targeted tobacco cessation interventions. Documentation of smoking status in electronic health records (EHRs), provides health systems with an opportunity to proactively offer tobacco treatment to disadvantaged smokers.
Objective
To evaluate a proactive strategy to provide tobacco treatment that addresses socio-contextual mediators of tobacco use for low-SES smokers.
Design, Setting, Participants
Prospective, randomized controlled trial for low-SES adult smokers who described their race/ethnicity as black, Hispanic or white and received primary care at one of 13 practices in greater-Boston (intervention n=399, control n=308).
Intervention
We used interactive voice response (IVR)-facilitated outreach to eligible individuals using EHR-coded smoking status. Consenting patients were randomized to a control group which received usual care from their health care team or to an intervention group that included a treatment program of: (1) telephone-based motivational counseling, (2) 6-weeks of free nicotine replacement therapy (NRT), (3) access to community-based referrals to address socio-contextual mediators of tobacco use, and (4) integration of this program with an individual’s care team through the EHR.
Main Outcome
Self-reported past 7-day tobacco abstinence 9-months after randomization (“quitting”), assessed by automated caller or blinded study staff.
Results
The intervention group had a higher quit rate than the usual care group (17.8% vs. 8.1%, odds ratio 2.5, 95% confidence interval 1.5-4.0, number-needed-to-treat=10). We examined whether use of intervention components was associated with quitting among individuals in the intervention group; individuals who participated in the telephone counseling were more likely to quit compared to those who did not (21.2% vs. 10.4%, p=0.0009). There was no difference in quitting by use of NRT. Quitting did not differ by a request for a community referral, but individuals who used their referral were more likely to quit than those who did not (43.6% vs. 15.3%, p<0.0001).
Conclusions and Relevance
Proactive, IVR-facilitated outreach enables engagement with low-SES smokers. Providing counseling, nicotine replacement therapy, and access to community-based resources to address socio-contextual mediators among smokers reached in this setting is effective.
doi:10.1001/jamainternmed.2014.6674
PMCID: PMC4590783  PMID: 25506771
tobacco control; surveillance; health disparities
25.  Childhood Cancer Survivor Study participants’ perceptions and knowledge of health insurance coverage: implications for the Affordable Care Act 
Introduction
Childhood cancer survivors face long-term health consequences, and comprehensive health insurance is critical. However, childhood cancer survivors may face barriers in accessing medical services due to being uninsured or underinsured. Little is known about the quality of survivors’ health insurance coverage, and improving health insurance within the context of changes mandated by the 2010 Affordable Care Act requires understanding survivors’ coverage. The current study explored adult childhood cancer survivors’ quality of health insurance coverage.
Methods
From 9/09 to 2/10, we conducted in-depth, semi-structured qualitative interviews with 39 adult participants from the Childhood Cancer Survivor Study, a cohort of 5-year survivors of cancers diagnosed before age 21. Interviews were recorded and transcribed; content analyses were conducted by two coders (kappa00.88) using NVivo 8.
Results
Most insured survivors reported satisfaction with the quality of their coverage; however, they expressed low expectations. Almost half reported annual out-of-pocket costs exceeding $2,000, yet most felt fortunate to simply have coverage. One third of insured survivors had difficulty obtaining coverage, and many had difficulties understanding how to utilize it. Most uninsured survivors minimized their need for care. Worry about future health care costs seemed inevitable among insured and uninsured survivors. Almost all participants lacked knowledge about existing health insurance-related laws.
Conclusions and implications for cancer survivors
Insured survivors had low coverage expectations, and uninsured survivors avoided care. Childhood cancer survivors will likely benefit from assistance in how to access and utilize the new health care reform provisions (e.g., Medicaid expansion, expansion of parents’ insurance, and mandatory primary care coverage).
doi:10.1007/s11764-012-0225-y
PMCID: PMC4706983  PMID: 22592507
Childhood cancer; Childhood Cancer Survivor Study; Health insurance; Affordable Care Act

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