Search

Introduction: Tumor genomic testing (TGT) is standard-of-care for most patients with advanced/metastatic cancer. Despite established guidelines, patient education prior to TGT is frequently omitted. The purpose of this study was to evaluate the impact of a concise 4 min video for patient education prior to TGT., Methods: Based on a quality improvement cycle, an animated video was created to be applicable to any cancer type, incorporating culturally diverse images, available in English and Spanish. Patients undergoing standard-of-care TGT were enrolled at a tertiary academic institution and completed survey instruments prior to video viewing (T1) and immediately post-viewing (T2). Instruments included: (1) 10-question objective genomic knowledge; (2) 10-question video message-specific knowledge; (3) 11-question Trust in Provider; (4) attitudes regarding TGT., Results: A total of 150 participants were enrolled. For the primary objective, there was a significant increase in video message-specific knowledge (median 10 point increase; p < 0.0001) with no significant change in genomic knowledge/understanding (p = 0.89) or trust in physician/provider (p = 0.59). Results for five questions significantly improved, including the likelihood of TGT impact on treatment decision, incidental germline findings, and cost of testing. Improvement in video message-specific knowledge was consistent across demographic groups, including age, income, and education., Conclusions: A concise, 3-4 min, broadly applicable video incorporating culturally diverse images administered prior to TGT significantly improved video message-specific knowledge across all demographic groups. This resource is publicly available at http://www.tumor-testing.com, with a goal to efficiently educate and empower patients regarding TGT while addressing guidelines within the flow of clinical practice., (© 2024 The Author(s). Cancer Medicine published by John Wiley & Sons Ltd.)

Background: Tumor genomic testing (TGT) has become standard-of-care for most patients with advanced/metastatic cancer. Despite established guidelines, patient education prior to TGT is variable or frequently omitted. The purpose of this study was to evaluate the impact of a concise (3-4 minute) video for patient education prior to TGT., Methods: Based on a quality improvement cycle, an animated video was created to be applicable to any cancer type, incorporating culturally diverse images, available in English and Spanish. Patients undergoing standard-of care TGT were enrolled at a tertiary academic institution and completed validated survey instruments immediately prior to video viewing (T1) and immediately post-viewing (T2). Instruments included: 1) 10-question objective genomic knowledge/understanding; 2) 10-question video message-specific knowledge/recall; 3) 11-question Trust in Physician/Provider; 4) attitudes regarding TGT. The primary objective was change in outcomes from before to after the video was assessed with Wilcoxon signed rank test., Results: From April 2022 to May 2023, a total of 150 participants were enrolled (MBC n=53, LC n=38, OC n=59). For the primary endpoint, there was a significant increase in video message-specific knowledge (median 10 point increase; p<0.0001) with no significant change in genomic knowledge/understanding (p=0.89) or Trust in Physician/Provider (p=0.59). Results for five questions significantly improved, including the likelihood of TGT impact on treatment decision, incidental germline findings, and cost of testing. Improvement in video message-specific knowledge was consistent across demographic groups, including age, income, and education. Individuals with less educational attainment had had greater improvement from before to after video viewing., Conclusions: A concise, 3-4 minute, broadly applicable video incorporating culturally diverse images administered prior to TGT significantly improved video message-specific knowledge across all demographic groups. This resource is publicly available at http://www.tumor-testing.com, with a goal to efficiently educate and empower patients regarding TGT while addressing guidelines within the flow of clinical practice., Clinical Trial Registration: ClinicalTrials.gov NCT05215769., Competing Interests: Conflict of interest disclosure statement: HH is on the scientific advisory board for Invitae Genetics, Genome Medical, and Promega. She has stock/stock options in Genome Medical and GI OnDemand. LS is a consultant and speaker for AstraZeneca. DS served on an advisory board for Novartis. CJP received payment for patient education material development through Jazz Pharmaceuticals.

An experimental study exposed participants ( N = 299) to different message frames to investigate whether Family Communication Patterns (FCP) and message characteristics influenced willingness to communicate about Family Health History (FHH). Message frames were either collective (our), individual (mine), or control (no pronouns). Afterward, participants were asked about their perceived collective psychological ownership of health information, attitudes, subjective norms, and FHH communication intentions. Although the message frames had no impact on perceived collective psychological ownership of health information, conversation orientation and conformity orientation (respecting parental authority) were positively associated with perceived collective psychological ownership of health information. Additionally, perceived collective psychological ownership, attitudes, and subjective norms were found to have indirect effects between FCP and FHH communication intentions. These findings provide further support that FCP influences how health message appeals are processed and suggest interventions could be tailored to FCP orientations for effective FHH behaviors.

While genetic testing for hereditary breast and ovarian cancer syndrome (HBOC) is well-established in the field of medicine, family members' uptake of cascade genetic testing for known familial pathogenic variants remains low. Probands often become responsible for initiating familial communication about their testing results, and barriers to communication may include difficulty in conveying information to relatives and a lack of communication resources for probands' use. In this study, we tested a two-minute animated digital message (ADM) intervention guided by the Health Belief Model (HBM) in an unselected sample to determine hypothetical individual perceptions of susceptibility and severity and behavioral intention to act on the information provided in the ADM. We recruited genetic testing naïve adults from the United States with no personal history of cancer through Amazon Mechanical Turk to participate in this study. Participants were presented a hypothetical scenario describing a relative's recent HBOC diagnosis, viewed the ADM, and answered a questionnaire assessing participants' perception of the HBM constructs in relation to the hypothetical scenario and participants' intentions to pursue cascade genetic testing, talk to a healthcare professional, or talk to family members after ADM viewing. Participants (n = 373) largely perceived HBOC as serious and believed that they could benefit from the information provided by genetic testing; 76% hypothetically intended to pursue genetic testing at a cost of $100 or less, and 90% intended to either pursue testing or talk to a healthcare provider or family members. This feasibility study in an unaffected population could mimic the experience of distant/less-engaged relatives in HBOC families after receiving unexpected information about cascade genetic testing. Most participants demonstrated behavioral intention toward cascade testing, at a rate higher than literature would suggest is typical in high-risk families, indicating that a theory-supported, simple to use intervention may be useful in clinical practice., (© 2022 The Authors. Journal of Genetic Counseling published by Wiley Periodicals LLC on behalf of National Society of Genetic Counselors.)

Background: Based on the integrative model of behavioral prediction, we examined predictors of heart disease information seeking. We also examined demographic and individual factors associated with seeking-related perceived norms, attitudes, and perceived behavioral control., Methods: Non-Hispanic White and Black participants, aged 45 and older, completed a cross sectional online survey (N = 383). Stepwise logistic and multiple linear regression models were tested to assess study hypotheses, as well as tests of indirect effects., Results: Perceived norms, attitudes and perceived behavioral control were positively associated with heart disease information seeking, but when controlling for distal variables only the perceived norm-behavior association remained significant ( p <.05). Indirect effects of distal variables (race, heart disease risk, perceived heart disease susceptibility and information engagement orientation) on information seeking were also detected via perceived norms., Conclusions: Our results provide support for the integrative model as a framework for predicting information seeking, but further highlight the important role of distal predictors and perceived norms on heart disease seeking intentions. When communicating to promote heart disease information acquisition, communicators should pay particular attention to promoting information seeking as a normative behavior, particularly among those who perceive a lower risk of heart disease and who may be less engaged with health information more generally.

Purpose: Tumor genomic testing (TGT) has become increasingly adopted as part of standard cancer care for many cancers. Despite national guidelines around patient education before TGT, available evidence suggests that most patients' understanding of genomics remains limited, particularly lower-income and minority patients, and most patients are not informed regarding potential incidental germline findings., Methods: To investigate and address limitations in patient understanding of TGT results, a Plan-Do-Study-Act (PDSA) approach is being used to assess needs, identify opportunities for improvement, and implement approaches to optimize patient education. We reviewed published guidelines related to pre-TGT provider-patient education and to identify key points (Plan). A provider quality improvement survey was completed (Do), which highlighted inconsistency in pre-TGT discussion practice across providers and minimal discussion with patients regarding the possibility of incidental germline findings., Results: Patient focus groups and interviews (N = 12 patients) were completed with coding of each transcript (Study), which revealed themes including trouble differentiating TGT from other forms of testing, yet understanding that results could tailor therapy. The integration of data across this initial PDSA cycle identified consistent themes and opportunities, which were incorporated into a patient-directed, concise animated video for pre-TGT education (Act), which will form the foundation of a subsequent PDSA cycle. The video addresses how TGT may/may not inform treatment, the process for TGT using existing tissue or liquid biopsy, insurance coverage, and the potential need for germline genetics follow-up because of incidental findings., Conclusion: This PDSA cycle reveals key gaps and opportunities for improvement in patient education before TGT.

Communicating complex information about environmental health risks in a single message is impossible. Thus, message designers hope that risk messages encourage people to think more about the message and risks, look for more information, and ultimately make behavior changes. The presentation of information about environmental risks using threat appeals is a common message design strategy thought to increase message engagement and influence attitudes, information seeking, and risk reduction behaviors. We compared lower threat messages, which did not include explicit statements about susceptibility and severity of a risk, to higher threat messages, which did. We combined predictions from the extended parallel process model with dual-process theories of persuasion to examine whether people respond to these types of messages differently. In an online experiment, participants (N = 892) were randomly assigned to a message condition (higher or lower threat) and topic condition (arsenic, bisphenol A, or volatile organic compounds). Overall, participants exposed to higher threat messages (regardless of risk topic) reported experiencing higher levels of fear. Higher levels of fear were associated with more positive thoughts about the message (in alignment with the message advocacy) and fewer negative thoughts about the message (against the message advocacy), both of which influenced message attitudes. Finally, message attitudes were associated with increased information seeking and intentions to engage in risk reduction behaviors., (© 2021 Society for Risk Analysis.)

This study explores the effects of exposure to a reality television narrative depicting genetic testing on attitudes and intentions, looking particularly at the effects of narratives containing elements of misinformation on genetics-related knowledge accuracy. In an experiment, participants completed a baseline survey, viewed a high versus low-accuracy narrative, then completed a follow-up survey. Exposure to a low-accuracy narrative was associated with lower knowledge accuracy. Indirect effects of identification and transportation on intentions to talk to a doctor about genetic testing also were detected via attitudes and reduced message counterarguing. Results illustrate the negative implications of inaccurate narratives on knowledge, which is concerning given the public's low level of genetic literacy, as well as the critical role narrative engagement may play in shaping public attitudes and intentions regarding genetic testing.

Background: Assuring that relatives are informed about a genetic diagnosis and have appropriate medical follow-up can be challenging. We hypothesize that communal coping (CC)-an approach in which a group views a stressor (such as a new genetic diagnosis) as our problem, versus my or your problem, and takes joint action to address it-can help families to address this challenge. A better understanding of CC could also inform counseling interventions to promote CC and family follow-up., Methods: In the Dilated Cardiomyopathy (DCM) PM study (Precision Medicine), living first-degree relatives of DCM probands were invited to undergo clinical screening; 31% of these did so. This research program offers the opportunity to determine the frequency of CC in DCM families, assess whether CC attitudes and actions occurred more commonly among families in which family members participated, and conduct prospective follow-up to evaluate family coping and counseling needs over time., Results: The proposed studies will provide evidence about the frequency of CC attitudes and actions among DCM families, assess the association of CC with increased family follow-up, and identify counseling needs related to family follow-up., Conclusions: The DCM PM study offers an opportunity to test the hypothesis that CC contributes to increased family follow-up and generate evidence to inform counseling interventions to encourage such follow-up.

The use of messaging features within online patient portals could be beneficial to patients, but many patients do not utilize these features. Furthermore, it remains uncertain the reasons why patients may (or may not) use messaging features to communicate with a care provider. This study proposes and tests an extended Technology Acceptance Model (TAM), which incorporated perceived affordances (editability and persistence) and communication efficacy. An online survey was conducted with a sample of 525 young adults. Results showed that the editability affordance was conducted with perceived usefulness, while communication efficacy was associated with perceived ease of use of messaging. Editability and communication efficacy also were positively associated intention to use online patient portal messaging features, whereas persistence was negatively associated. Results suggest practitioners should emphasize editability and communication efficacy to increase patient intentions to use messaging features to communicate with a care provider.

Importance: COVID-19 has disproportionately affected Black individuals in the US; however, vaccination rates among Black individuals trail those among other racial groups. This disparity is often attributed to a high level of vaccine hesitancy among Black individuals, but few studies have examined changes in vaccine hesitancy over time., Objectives: To compare changes in vaccine hesitancy between Black and White individuals in the US and to examine mechanisms that might help explain the observed differences., Design, Setting, and Participants: This survey study used 7 waves of data collected using a panel design. A total of 1200 English-speaking adults in the US were recruited from a nonprobability online panel to construct a census-matched sample. Participants were contacted monthly between December 9, 2020, and June 16, 2021., Main Outcomes and Measures: The main outcome of interest was self-reported vaccination intention, measured on a 6-point scale (where 1 indicates extremely unlikely and 6 indicates extremely likely). Beliefs about the safety, effectiveness, and necessity of COVID-19 vaccines were measured on a 5-point Likert scale, with higher scores denoting greater agreement., Results: The baseline data included 1200 participants (693 women [52.0%; weighted]; 921 White individuals [64.0%; weighted], 107 Black individuals [12.2%; weighted]; weighted mean [SD] age, 49.5 [17.6] years). The survey participation rate was 57.0% (1264 of 2218). Black and White individuals had comparable vaccination intentions in December 2020, but Black individuals experienced larger increases in vaccination intention than White individuals relative to baseline in March 2021 (b = 0.666; P < .001), April 2021 (b = 0.890; P < .001), May 2021 (b = 0.695; P < .001), and June 2021 (b = 0.709; P < .001). The belief that the vaccines are necessary for protection also increased more among Black than White individuals in March 2021 (b = 0.221; P = .01) and April 2021 (b = 0.187; P = .04). Beliefs that the vaccines are safe and effective (b = 0.125; P < .001) and necessary (b = 0.405; P < .001) were positively associated with vaccination intention. There was no evidence that these associations varied by race., Conclusions and Relevance: This survey study suggests that the intention of Black individuals to be vaccinated was initially comparable to that of White individuals but increased more rapidly. There is some evidence that this increase is associated with changes in beliefs about the vaccine. Vaccination rates continue to be lower among Black individuals than White individuals, but these results suggest that this might be less likely the result of vaccine hesitancy than other factors.

This study tests the effects of environmental health risk messages on perceived risk, information needs and decisions to seek information, testing a reduced risk information seeking and processing model (R-RISP). Participants ( N = 1,823) were randomized to one of three risk conditions (arsenic, bisphenol A [BPA] or volatile organic compounds [VOCs]) and one of the three message conditions (high threat, low threat or no message); participants in the high and low threat message conditions were also randomly assigned to a seeking cue to action condition (with or without seeking cue). Overall, the results support the R-RISP model, demonstrating the importance of current knowledge perceptions and informational subjective norms in information acquisition decisions. In addition, the results also provide initial evidence that environmental health risk messages can prompt information seeking and increase intentions to seek information in the future. Avenues for future research are discussed.

Cascade genetic testing is essential to clarify cancer risk in families with hereditary breast and ovarian cancer syndrome (HBOC) due to pathogenic variants (PVs) in BRCA1 or BRCA2. To date, data suggest that family communication of genetic testing results, with or without the aid of clinical resources such as a provider-written family letter, is impacted by multiple barriers. These barriers eventually lead to sub-optimal uptake of cascade genetic testing. We designed a 2-min animated video that a proband can share with relatives to notify them that the proband has tested positive for a pathogenic variant in BRCA1 or BRCA2. We studied the video via hypothetical scenario in an unselected population to simulate the process by which a relative receives unsolicited genetics information about their family member. We assessed the impact of the video on three specific domains: knowledge, cognitive message processing, and affective reactions. A total of 399 participants recruited through Amazon Mechanical Turk completed the study, and 373 were analyzed. The video significantly improved content knowledge/recall (p < .0001) from pre- to post-video viewing, indicating effective message communication. Items used to measure cognitive processing showed preliminary tendencies toward systematic message processing, which could be desired in familial communication aimed at initiating a specific action-in this case, cascade genetic testing. A majority of participants (66%) reported positive affective reaction as they indicated that they would feel gratitude if they received the video message from a relative, and did not evidence a negative affective reaction to receiving the information. Our data suggest that a video message can effectively communicate information about cascade genetic testing to potential relatives with as little as two minutes of content. Our data suggest that video messaging to assist family communication is a reasonable approach that increases understanding and is unlikely to cause harm., (© 2020 National Society of Genetic Counselors.)

The current study extends family communication patterns (FCP) research to assess how family communication schemata (conversation and conformity orientation dimensions) influence systematic processing of health appeals intended to persuade individuals to seek family health history information, emphasizing an updated conceptualization of family conformity (i.e., the expanded conformity orientation scale). Our results suggest that conversation orientation and the conformity dimension of parental control are the primary drivers of systematic processing of family health history messages. Systematic processing, in turn, was significantly associated with more positive attitudes and greater intentions to seek health information from family members. Our results suggest family communication patterns may impact individual engagement with family health history campaign messages, thus campaign designers may want to consider how best to tailor messages to match family communication characteristics.

Family communication patterns (FCP) are relational schema theorized to influence behaviors indirectly via cognitive processes, including perceived norms. However, relatively little is known about the indirect effect of FCP on health self-disclosure via perceived norms. We examine FCP's associations with young adults' health self-disclosure to their parents, assessing the theory of normative social behavior and the integrative model of behavioral prediction. Young adults ( N = 504) completed a cross-sectional survey. Mediation analysis showed the effect of conversation orientation on health self-disclosure via communication efficacy and descriptive norms. Injunctive norms moderated the indirect effect of descriptive norms on self-disclosure. Results suggest conversation, but not conformity orientation, influenced young adults' self-disclosure, while norms and efficacy act as predominant drivers of disclosure behavior., Competing Interests: Disclosure statement No potential conflict of interest was reported by authors.

Purpose: Although the literature establishes a link between health consciousness (HC) and prevention behavior, less explored are the individual, social, and health characteristics that are associated with increased HC. Similarly, underexamined is the influence of race and ethnicity on the relationship of these characteristics to higher levels of HC., Design: This cross-sectional study aims to identify and assess the relative importance of factors associated with higher levels of HC, highlighting the role of race and ethnicity., Participants: Participants came from a national research panel survey (N = 1007)., Measures: Participants completed a 4-item scale capturing key concepts of HC as well as questionnaires capturing demographic profiles, social support, social networking activities, and health status., Analysis: A stepwise multiple regression was used to identify significant predictors of HC., Results: Female and more educated participants report higher levels of HC. African American and Hispanic participants report higher levels of HC compared to white participants. Findings indicate social support, social network participation, education, cancer survivorship, and health status were positively associated with higher HC for the collective sample. However, results revealed variations in factors associated with higher HC when stratified by race/ethnicity., Conclusion: Findings suggest that interventions aiming to motivate cancer prevention behaviors within at-risk communities may find more success by incorporating factors that are aligned with increased HC among culturally diverse populations.

This study draws on the Planned Risk Information Seeking Model (PRISM) to assess Zika virus information seeking and systematic processing, paying particular attention to the relationship between perceived knowledge and knowledge insufficiency. Novel risks, such as Zika, provide an interesting context for examining whether information-seeking models, such as PRISM, are able to predict information seeking when available information is limited or scarce. A cross-sectional, online study of men and women of childbearing age (N = 494) residing in the state of Florida was conducted. Our results provide some support for the PRISM for predicting Zika information seeking intention, as well as systematic processing of information. We also found that individuals with high levels of perceived knowledge were more likely to report high level of knowledge insufficiency, illustrating that contextual factors may impact the fit of risk information seeking models., (© 2020 Society for Risk Analysis.)

Studies have shown that patients with hypertrophic cardiomyopathy (HCM) may misinterpret the meaning of uninformative genetic testing results to mean that a genetic etiology and family members' risk is ruled out. We hypothesized that poor comprehension of the laboratory genetic test report may contribute to this misunderstanding. We conducted a qualitative study to examine patient understanding of uninformative laboratory results and reports and elicit suggestions for an improved report. Fifteen participants with HCM were interviewed after undergoing genetic testing and receiving their report. While all patients read the report, most participants reported only partially reading it. Most reported not understanding the report at all or only partially understanding it because a provider explained it to them. Some participants said that the report was helpful for understanding their result, but there was evidence of misunderstanding; most participants stated that specific aspects of the report were unhelpful. While most of our participants communicated risk with relatives, none said that the report helped with the communication. Most participants did not recall or find the accompanying physician-directed result letter useful for their understanding or familial communication. Many participants expressed need for a supplemental report that illustrates a personalized clinical 'action plan' that could summarize clinical and familial implications of the result for the patient and their family. We conclude that laboratory reports and physician-directed result letters did not help participants understand their results or their familial implications. Our results suggest opportunities for research to explore the utility of a patient-directed result supplement to improve patient comprehension of genetic test results and outline clinical recommendations via a patient action plan., (© 2019 National Society of Genetic Counselors.)

Objective : "Consent is Sexy" (CIS) is a poster campaign incorporating sex-positive messages to promote consent and increase sexual communication among college students. We assess reactions to the campaign and associations between campaign recall and communication attitudes and behaviors. Participants: Male and female undergraduates at a Midwestern university were recruited ( N  = 284). Methods: A cross-sectional survey was conducted. t -Tests, logistic and multiple linear regressions were used to analyze the data. Results: Over half (56%) of participants recalled the campaign and reactions were positive. Students who recalled CIS had more positive attitudes towards sexual communication ( p  = .04) and greater perceived behavioral control (PBC; p  < .01). Conclusions: Results show many students paid attention and reacted positively to CIS posters and results offer dissemination insights. Consent campaigns should continue to cultivate positive attitudes and PBC in regards to sexual communication.

Pathogenic germline mutations in the BRCA1 or BRCA2 genes are associated with an elevated lifetime risk for breast (50%-85% risk) and ovarian cancer (20%-40% risk). Genome-wide association studies have identified over 100 genetic variants associated with modified breast and/or ovarian cancer risk in BRCA1 and BRCA2 carriers. Risk models generated based on these variants have shown that these genetic modifiers strongly influence absolute risk of developing breast or ovarian cancer in BRCA mutation carriers. There is a lack of understanding, however, about the clinical applicability and utility of these risk models. To investigate this gap, we collected survey data from 274 cancer genetic counselors (GCs) through the National Society of Genetic Counselors Cancer Special Interest Group. Questions assessed perceptions of usefulness and intentions of genetic counselors to use these refined risk models in clinical care based on the Technology Acceptance Model (TAM). We found that GCs' reactions to the estimates were largely positive, though they thought the possibility of changing management based on results was unlikely. Additionally, we found that more experienced GCs were more likely to consider refined risk estimates in clinic. Support also was provided for core predictions within the TAM, whereby the perceived usefulness (indirect effect est. = 0.08, 95% CI: [0.04, 0.13]) and perceived ease of use (indirect effect est. = 0.078, 95% CI: [0.04, 0.13]) of refined risk estimates were indirectly associated with intentions to use via attitudes., (© 2019 National Society of Genetic Counselors.)

Refined estimates of risk based on genetic risk modifiers could assist BRCA mutation carriers in understanding their risk, but it is not clear whether carriers are interested in receiving these estimates or how they might benefit from them. Using qualitative interviews, we investigated female BRCA 1 and BRCA 2 mutation carriers' (N = 20) reactions to numerical and verbal presentations of breast cancer risk based on risk modifiers and assessed women's preferences regarding visual formats for communicating risk. Our results show carriers are interested in receiving refined risk estimates and suggest the estimates may influence decision-making regarding cancer prevention, depending on the nature of the risk assessment. Although accurate and precise estimates of breast cancer risk are most important to women, they preferred quantitative risk estimates expressed as a proportion with or without a population comparison; however, women noted that comparisons to other BRCA mutation carriers were less useful given their high risk. Participants also preferred communication of a risk as a specific percentage versus a range of risk, but a clear preference regarding visual displays was not expressed. Results support many existing recommendations for genetic risk communication and provide guidance for the development of tools incorporating genetic risk modifiers.

This study examined proposed direct and mediating relationships in the Structural Influence Model (SIM) of Communication within the chronic disease context. Using data from the Annenberg National Health Communication Survey (N = 14,472), we tested the potential mediating roles of information seeking, information scanning, and social capital between social determinants of health and four chronic disease risk behaviors: exercise level, fruit and vegetable intake, cigarette smoking, and excessive alcohol use. Information seeking, information scanning, and social capital received support as potential mediators. Our results are largely consistent with predictions of the SIM and highlight the important role of communication in reducing health risks and increasing healthy behaviors.

Background: Family health history tools have the ability to improve health outcomes and promote patient-provider communication, but some research suggests their effectiveness is limited. Tool design features may heavily influence users' perceptions of the tools., Aims: This study provides a summative evaluation of the Family HealthLink tool, which assesses cancer and coronary heart disease risk based on personal and family health history, to better understand how tool design and message content impact user perceptions., Method: User observations and semi-structured interviews were conducted with breast cancer patients (n = 16) and support persons (n = 18) at an academic comprehensive breast center., Results: The users responded positively to many of Family HealthLink's features, but they noted that it lacked a modern design. The participants felt much of the risk information was too generic and did not account for lifestyle factors. The users also did not consistently interpret the qualitative risk assessments provided by Family HealthLink., Conclusion: Our data analysis suggests that certain aspects of the Family HealthLink tool could be executed more effectively to take fuller advantage of opportunities for online personalization., (© 2018 S. Karger AG, Basel.)

This study aims to examine the influence of rape myth acceptance (RMA) and the perceived salience of sexual violence on the cognitive processing of an affirmative consent campaign active on the campus where research was conducted. As part of a midcourse evaluation of the Consent is Sexy (CIS) campaign (N = 285), a subsample of participants who reported prior exposure to campaign posters (N = 182) was asked to review four campaign posters and indicate the extent to which they processed the message in the posters systematically. Robust gender differences in perceived salience of sexual violence, supportive attitudes, and perceived behavioral control (PBC) toward establishing consent were mediated by RMA. Moreover, robust gender differences in the systematic processing of the campaign were mediated by RMA and perceived salience in serial. Implications of the influence of rape myths and perceived salience on the cognitive processing of affirmed consent campaigns are discussed with respect to both campaign message design and implementation.

Online cancer risk assessment tools, which provide personalized cancer information and recommendations based on personal data input by users, are a promising cancer education approach; however, few tools have been evaluated. A randomized controlled study was conducted to compare user impressions of one tool, Cancer Risk Check (CRC), to non-personalized educational information delivered online as series of self-advancing slides (the control). CRC users (N = 1452) rated the tool to be as interesting as the control (p > .05), but users were more likely to report that the information was difficult to understand and not applicable to them (p < .05). Information seeking and sharing also were lower among CRC users; thus, although impressions of CRC were favorable, it was not shown to be superior to existing approaches. We hypothesized CRC was less effective because it contained few visual and graphical elements; therefore, CRC was compared to a text-based control (online PDF file) post hoc. CRC users rated the information to be more interesting, less difficult to understand, and better able to hold their attention (p < .05). Post hoc results suggest the visual presentation of risk is critical to tool success.

There is a growing body of evidence linking childhood exposure to environmental toxins and a range of adverse health outcomes, including preterm birth, cognitive deficits, and cancer. Little is known, however, about what drives mothers to engage in health behaviors to reduce such risks. Guided by the integrative model of behavioral prediction, this study surveyed women who were pregnant and/or had children younger than 7 years (N = 819) to identify the factors that determine engagement in behaviors to reduce childhood exposure to toxic chemicals in the environment. Structural equation modeling pertaining to three different environmental toxins-bisphenol A, arsenic, and pesticides-demonstrated that perceived normative pressure was the primary determinant of behavior across all three models. Additionally, we identified two key distal variables-perceived risk and information seeking-that not only increased the model's predictive power but also consistently and positively predicted perceived social norms regarding exposure reduction behaviors. Findings also suggest important differences across these behaviors. Implications for health communication researchers and practitioners developing interventions, communication campaigns, and persuasive messages to promote prenatal and pediatric environmental health are discussed., (© 2016 Society for Public Health Education.)

Background: Understanding patients' knowledge and prior information-seeking regarding personalized cancer therapy (PCT) may inform future patient information systems, consent for molecular testing and PCT protocols. We evaluated breast cancer patients' knowledge and information-seeking behaviors regarding PCT., Methods: Newly registered female breast cancer patients (n=100) at a comprehensive cancer center completed a self-administered questionnaire prior to their first clinic visit., Results: Knowledge regarding cancer genetics and PCT was moderate (mean 8.7±3.8 questions correct out of 16). A minority of patients (27%) indicated that they had sought information regarding PCT. Higher education (p=0.009) and income levels (p=0.04) were associated with higher knowledge scores and with seeking PCT information (p=0.04). Knowledge was not associated with willingness to participate in PCT research., Conclusion: Educational background and financial status impact patient knowledge as well as information-seeking behavior. For most patients, clinicians are likely to be patients' initial source of information about PCT. Understanding patients' knowledge deficits at presentation may help inform patient education efforts., (Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.)

Despite their understanding of the links between (a) information seeking and scanning and (b) health outcomes, researchers still know relatively little about the impact of information behaviors on people's disease-related beliefs and attitudes. The goal of this study was to validate findings linking information and health behaviors and to assess whether information seeking and scanning are associated with beliefs about the effectiveness of heart disease and colon cancer risk prevention behaviors (in regard to exercise, controlling one's diet to prevent overweight/obesity, and daily fruit and vegetable intake), as well as determine whether the effects of seeking versus scanning on these beliefs differ. Data from the Annenberg National Health Communication Survey were analyzed (N = 3,212). For colon cancer, significant main effects were detected for information scanning for each of the 3 beliefs assessed (p < .05). For heart disease, both information scanning and heart disease media exposure (p < .05) were associated with stronger beliefs. Information seeking was not associated with beliefs for either disease (p > .05). Our results suggest that disease-related cognitions and beliefs, which ultimately impact decisions to engage in prevention behaviors, may be influenced most by less purposeful forms of information acquisition.

Within the health communication literature there has been an increased focus on the use of cultural and identity-based message tailoring to enhance the effectiveness of messages and interventions, particularly among minority and underserved populations. Although this approach may be promising, little is known about the effect of ethnic identity on health behaviors and beliefs or how the effects of ethnic identity differ from those of race or ethnicity. This study is among the first to explore relationships between ethnic identity and cancer-related risk factors, knowledge characteristics, and cognitive and affective appraisals. This study utilized a national online sample of Whites, Blacks, and Hispanics (N = 1,452). Higher ethnic identity was associated with increased physical activity and fruit and vegetable intake and decreased body mass index among Whites (p < .05). Higher ethnic identity was also associated with increased cancer risk knowledge (p < .05) but not cancer risk perceptions or self-efficacy (p > .05). Hispanics and Blacks with higher ethnic identity had greater cancer worry. Our results suggest that the effect of ethnic identity is often distinct from that of race/ethnicity and that health communication interventions based solely on race/ethnicity may not be as effective as those that also take ethnic identity into account.

Studies on health behaviors have observed several barriers to breast cancer screening, including lack of breast cancer knowledge, distrust of health care providers, and long waiting times to be screened or to receive screening results. We conducted a nested case-control study among a subsample of 200 women 21 years of age and older [100 patients (cases)], who had been diagnosed with breast cancer, and 100 controls, who were screened and found to be free of breast cancer), all residing in the Toluca metropolitan area in central Mexico. We examined how knowledge of breast cancer screening guidelines, perceptions of screening methods, and quality of health care influenced the use of breast cancer screening among study participants. Our study found that the most important factor associated with the decision to have breast cancer screenings was having a positive perception of the quality of care provided by the local health care centers, such as having competent clinic personnel, sufficient screening equipment, and reasonable waiting times to receive screening and to receive the screening results. Therefore, individual health care centers need to focus on the patients' perception of the services received by optimizing the care provided and, in so doing, increase the rates of early diagnosis and reduce the rate of mortality from breast cancer as well as its associated treatment costs.

Purpose: Latino Medicare enrollees report suboptimal rates of colorectal cancer screening (CRCS) despite Medicare policies designed to improve CRCS access for older persons. Patient navigation (PN) may address many underlying barriers to CRCS, yet little is known about the effectiveness of PN to increase CRCS adherence among Latino Medicare enrollees., Methods: Using a randomized controlled trial study design, we evaluated tailored PN delivered outside of primary care settings as an intervention to increase CRCS adherence in this population. Intervention participants (n = 135) received tailored PN services which included education, counseling, and logistical support administered in their language of choice. Comparison participants (n = 168) received mailed cancer education materials. We compared CRCS rates between interventions and used multivariable logistic regression to assess the odds of CRCS adherence for PN versus comparison groups after adjusting for covariates of interest., Results: More navigated than non-navigated participants became CRCS adherent during the study period (43.7 vs. 32.1%, p = 0.04). The odds of CRCS adherence were significantly higher for PN relative to comparison participants before and after adjusting for covariates (unadjusted OR 1.64, p = 0.04; adjusted OR 1.82, p = 0.02). Higher CRCS adherence rates were observed primarily in the uptake of endoscopic screening methods., Conclusion: This study demonstrates that PN delivered outside of the primary care environment is modestly effective in increasing CRCS adherence among Latino Medicare enrollees. This intervention strategy should be further evaluated as a complement to primary care-based PN and other care coordination strategies to increase adherence with CRCS and other evidence-based screenings among older Latinos., Competing Interests: The authors declare that they have no conflict of interest.

Background: This study assessed attitudes of breast cancer patients toward molecular testing for personalized therapy and research., Methods: A questionnaire was given to female breast cancer patients presenting to a cancer center. Associations between demographic and clinical variables and attitudes toward molecular testing were evaluated., Results: Three hundred eight patients were approached, and 100 completed the questionnaire (a 32% response rate). Most participants were willing to undergo molecular testing to assist in the selection of approved drugs (81%) and experimental therapy (59%) if testing was covered by insurance. Most participants were white (71%). Even if testing was financially covered, nonwhite participants were less willing to undergo molecular testing for the selection of approved drugs (54% of nonwhites vs 90% of whites, odds ratio [OR] = 0.13, P = .0004) or experimental drugs (35% vs 68%, OR = 0.26, P = .0072). Most participants (75%) were willing to undergo a biopsy to guide therapy, and 46% were willing to undergo research biopsies. Nonwhite participants were less willing to undergo research biopsies (17% vs 55%, OR = 0.17, P = .0033). Most participants wanted to be informed when research results had implications for treatment (91%), new cancer risk (90%), and other preventable/treatable diseases (87%)., Conclusions: Most patients were willing to undergo molecular testing and minimally invasive procedures to guide approved or experimental therapy. There were significant differences in attitudes toward molecular testing between racial groups; nonwhites were less willing to undergo testing even if the results would guide their own therapy. Novel approaches are needed to prevent disparities in the delivery of genomically informed care and to increase minority participation in biomarker-driven trials. Cancer 2015;121:243-50. © 2014 American Cancer Society., (© 2014 American Cancer Society.)

Given the importance of family health history and the pivotal role of older adults in communicating it, this study examines how African American older adults (a) characterize their understandings of health-related conditions in their family histories and (b) rationalize their motivations and constraints for sharing this information with current family members. Using narrative theory as a framework, we illustrate how the participants reflect on prior health-related experiences within the family to respond to moral and practical calls for communicating family health information to current relatives. Specifically, our analysis highlights how storied family secrets--as constructed by 28 participants in group and individual interviews--reveal and inform shifting cultural and generational practices that shape the lived health behaviors and communication of older adults at greater risk for health disparities.

This qualitative study examined patterns of communication regarding family health history among older African American adults. The authors conducted 5 focus groups and 6 semi-structured interviews with African Americans aged 60 years and older (N = 28). The authors identified 4 distinct patterns of family health history communication: noncommunication, open communication, selective communication (communication restricted to certain people or topics), and one-way communication (communication not reciprocated by younger family members). In general, participants favored open family health history communication, often resulting from desires to change patterns of noncommunication in previous generations regarding personal and family health history. Some participants indicated that they were selective about what and with whom they shared health information in order to protect their privacy and not worry others. Others described family health history communication as one-way or unreciprocated by younger family members who appeared uninterested or unwilling to share personal and family health information. The communication patterns that the authors identified are consistent with communication privacy management theory and with findings from studies focused on genetic testing results for hereditary conditions, suggesting that individuals are consistent in their communication of health and genetic risk information. Findings may guide the development of health message strategies for African Americans to increase family health history communication.

Objective: To evaluate attitudes regarding privacy of genomic data in a sample of patients with breast cancer., Methods: Female patients with breast cancer (n=100) completed a questionnaire assessing attitudes regarding concerns about privacy of genomic data., Results: Most patients (83%) indicated that genomic data should be protected. However, only 13% had significant concerns regarding privacy of such data. Patients expressed more concern about insurance discrimination than employment discrimination (43% vs 28%, p<0.001). They expressed less concern about research institutions protecting the security of their molecular data than government agencies or drug companies (20% vs 38% vs 44%; p<0.001). Most did not express concern regarding the association of their genomic data with their name and personal identity (49% concerned), billing and insurance information (44% concerned), or clinical data (27% concerned). Significantly fewer patients were concerned about the association with clinical data than other data types (p<0.001). In the absence of direct benefit, patients were more willing to consent to sharing of deidentified than identified data with researchers not involved in their care (76% vs 60%; p<0.001). Most (85%) patients were willing to consent to DNA banking., Discussion: While patients are opposed to indiscriminate release of genomic data, privacy does not appear to be their primary concern. Furthermore, we did not find any specific predictors of privacy concerns., Conclusions: Patients generally expressed low levels of concern regarding privacy of genomic data, and many expressed willingness to consent to sharing their genomic data with researchers., (Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.)

We evaluated knowledge of gynecologic cancer screening recommendations, screening behaviors, and communication with providers among women with Lynch syndrome (LS). Women aged ≥25 years who were at risk for LS-associated cancers completed a semi-structured interview and a questionnaire. Of 74 participants (mean age 40 years), 61% knew the appropriate age to begin screening, 75-80% correctly identified the recommended screening frequency, and 84% reported no previous screening endometrial biopsy. Women initiated discussions with their providers about their LS cancer risks, but many used nonspecific terms or relied on family history. Most were not offered high-risk screening options. While many women were aware of risk-appropriate LS screening guidelines, adherence was suboptimal. Improving communication between women and their providers regarding LS-related gynecologic cancer risk and screening options may help improve adherence., (© 2013 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

This study retested PRISM, a model of risk information seeking, and found that it is applicable to the context of cancer risk communication. The study, which used an online sample of 928 U.S. adults, also tested the effect of additional variables on that model and found that the original model better fit the data. Among the strongest predictors of cancer information seeking were seeking-related subjective norms, attitude toward seeking, perceived knowledge insufficiency, and affective risk response. Furthermore, risk perception was a strong predictor of an affective risk response. The authors suggest that, given the robustness across studies, the path between seeking-related subjective norms and seeking intention is ready to be implemented in communication practice.

Little is known about the effect of personalized risk information on risk perceptions over time, particularly among ethnically diverse subpopulations. The present study examines Mexican American's (MAs) risk perceptions for heart disease and diabetes at baseline and following receipt of risk feedback based on family health history. Participants comprising 162 households received a pedigree or personalized risk feedback, with or without behavioral risk reduction recommendations. Multiple logistic regression analyses were used to assess lifetime perceived risk (LPR) at baseline, 3 months and 10 months following the receipt of risk feedback. Having an elevated familial risk of heart disease or diabetes increased the odds of an elevated LPR for both diseases at baseline. At 3 months, compared with receipt of a pedigree only, MAs receiving elevated risk feedback for both diseases were more likely to have an elevated LPR for both diseases. At 10 months, participants receiving weak risk feedback for both diseases indicated an adjustment to a lower LPR for heart disease only. Results suggest that communicating risk for multiple diseases may be more effective than a single disease, with responses to increased risk feedback more immediate than to weak risk feedback.

This study tests an expanded Structural Influence Model (SIM) to gain a greater understanding of the social and cognitive factors that contribute to disparities in cancer risk knowledge and information seeking. At the core of this expansion is the planned risk information seeking model (PRISM). This study employed an online sample (N = 1,007) of African American, Hispanic, and non-Hispanic White adults. The addition of four cognitive predictors to the SIM substantially increased variance explained in cancer risk knowledge (R(2) = .29) and information seeking (R(2) = .56). Health literacy mediated the effects of social determinants (socioeconomic status [SES] and race/ethnicity) on cancer risk knowledge, while subjective norms mediated their effects on cancer risk information seeking. Social capital and perceived seeking control were also shown to be important mediators of the relationships between SES and cancer communication outcomes. Our results illustrate the social and cognitive mechanisms by which social determinants impact cancer communication outcomes, as well as several points of intervention to reduce communication disparities.

Although a family health history can be used to assess disease risk and increase health prevention behaviors, research suggests that few people have collected family health information. Guided by the Theory of Motivated Information Management, this study seeks to understand the barriers to and facilitators of interpersonal information seeking about family health history. Individuals who were engaged to be married (N = 306) were surveyed online and in person to understand how factors such as uncertainty, expectations for an information search, efficacy, and anxiety influence decisions and strategies for obtaining family health histories. The results supported the Theory of Motivated Information Management by demonstrating that individuals who experienced uncertainty discrepancies regarding family heath history had greater intention to seek information from family members when anxiety was low, outcome expectancy was high, and communication efficacy was positive. Although raising uncertainty about family health history may be an effective tool for health communicators to increase communication among family members, low-anxiety situations may be optimal for information seeking. Health communication messages must also build confidence in people's ability to communicate with family to obtain the needed health information.

It is estimated that 5 to 10% of all colorectal cancer (CRC) cases are attributed to a hereditary cause. The primary hereditary cancer syndromes that confer an increased risk for colorectal cancers are Lynch syndrome/hereditary nonpolyposis colorectal cancer (HNPCC) and familial adenomatous polyposis (FAP). Through genetic testing, health care providers can identify patients and families who carry gene mutations and subsequently are at a substantially greater risk for developing colorectal cancer than the general population. Genetic testing provides risk information not only about an individual patient, but also his or her biological relatives. A variety of risk-reduction behaviors (including screening, surgery, and health and lifestyle behaviors) have been examined in Lynch syndrome and FAP populations. The research indicates that screening behaviors are less than optimal, although the rates vary from study to study. Prophylactic colectomy is the primary course of treatment for individuals who test positive for a FAP mutation, but the results are inconclusive for cancer-unaffected Lynch syndrome mutation carriers. Although research suggests that the adoption of healthy lifestyles and behaviors (e.g., diet, physical activity, weight control, smoking cessation, limited alcohol consumption) could have a favorable impact on colon cancer burden, there is minimal data on how these behaviors may moderate cancer risk among those at risk of hereditary colon cancer. To date, we know very little about the actual health and lifestyle behaviors of those at risk of hereditary colon cancer. Genetic testing and counseling at risk individuals may resolve uncertainty about their personal and familial cancer risk and provide information to guide and personalize decisions about their future health care.

We investigated the risk-information-processing behaviors of people living at or near the poverty line. Because significant gaps in health and communication exist among high- and low-income groups, increasing the information seeking and knowledge of poor individuals may help them better understand risks to their health and increase their engagement in health-protective behaviors. Most earlier studies assessed only a single health risk selected by the researcher, whereas we listed 10 health risks and allowed the respondents to identify the one that they worried about most but took little action to prevent. Using this risk, we tested one pathway inspired by the risk information seeking and processing model to examine predictors of information insufficiency and of systematic processing and extended this pathway to include health-protective action. A phone survey was conducted of African Americans and whites living in the southern United States with an annual income of ≤$35,000 (N= 431). The results supported the model pathway: worry partially mediated the relationship between perceived risk and information insufficiency, which, in turn, increased systematic processing. In addition, systematic processing increased health-protective action. Compared with whites and better educated respondents, African Americans and respondents with little education had significantly higher levels of information insufficiency but higher levels of systematic processing and health-protective action. That systematic processing and knowledge influenced health behavior suggests a potential strategy for reducing health disparities., (© 2011 Society for Risk Analysis.)