Nancy Janz | University of Michigan (original) (raw)

Papers by Nancy Janz

BMC Medical Informatics and Decision Making

Background Breast cancer patients face several preference-sensitive treatment decisions. Feelings... more Background Breast cancer patients face several preference-sensitive treatment decisions. Feelings such as regret or having had inadequate information about these decisions can significantly alter patient perceptions of recovery and recurrence. Numerous objective measures of decision quality (e.g., knowledge assessments, values concordance measures) have been developed; there are far fewer measures of subjective decision quality and little consensus regarding how the construct should be assessed. The current study explores the psychometric properties of a new subjective quality decision measure for breast cancer treatment that could be used for other preference sensitive decisions. Methods320 women aged 20¿79 diagnosed with AJCC stage 0 ¿ III breast cancer were surveyed at two cancer specialty centers. Decision quality was assessed with single items representing six dimensions: regret, satisfaction, and fit as well as perceived adequacy of information, time, and involvement. Women ra...

American Journal of Preventive Medicine

Although breast self-examination (BSE) continues to be recommended as an adjunct to clinical scre... more Although breast self-examination (BSE) continues to be recommended as an adjunct to clinical screening techniques for the early detection of breast cancer, little is known about events that might negatively influence long-term adherence. The primary aim of this investigation was to determine if regularity of BSE would decline after a benign breast biopsy. Analyses are based on 655 women: 83 women who self-discovered the breast problem by BSE, 179 women in whom the problem was discovered by the health care system, and a control group of 393 women who had no history of breast problems. Frequency of BSE was assessed over two six-month periods and collapsed into three categories--nonpractitioner, irregular practitioner, and regular practitioner. Results indicated that the percentage of women in the self-discovered group who reported decreased regularity of BSE was over three times higher than that found in the control group. The largest percentage increase in BSE frequency was evidenced...

and the CIGTS Study Group 6 PURPOSE. To compare the baseline Collaborative Initial Glaucoma Treat... more and the CIGTS Study Group 6 PURPOSE. To compare the baseline Collaborative Initial Glaucoma Treatment Study (CIGTS) visual field (VF) score and mean deviation (MD), investigate test-retest variability, and identify variables associated with VF loss and VF measurement variability. METHODS. Baseline data from a randomized clinical trial of 607 patients with newly diagnosed open-angle glaucoma were collected at 14 clinical centers. The CIGTS VF score and MD were obtained from 24-2 VF tests (Zeiss-Humphrey Systems, Dublin, CA) at two visits approximately 2 weeks apart. RESULTS. Although most baseline CIGTS VF scores showed limited field loss, 15% (91/607) of patients showed a substantial deficit (VF score Ͼ10 on a 0 -20 scale). A small but significant learning effect was seen over the two baseline measures for CIGTS VF score and MD. CIGTS VF score and MD correlate highly (r ϭ Ϫ0.93); both have high test-retest correlation (0.83 and 0.91, respectively). Variables associated with greater baseline VF loss for both CIGTS VF score and MD include (probabilities for VF only): male sex (P ϭ 0.018), black race (P Յ 0.0001), lower visual acuity (P Յ 0.0001), higher intraocular pressure if more than 30 mm Hg (P ϭ 0.0034), poor field reliability score (P Յ 0.0001), cardiovascular disease (P ϭ 0.015), reduced patient-reported alertness (P ϭ 0.023), and CIGTS clinical center (P Յ 0.0001). Predictors of increased CIGTS VF score variability include a midrange VF score (P Յ 0.0001), first-tested eye (P ϭ 0.0027), reduced patient-reported alertness (P ϭ 0.0177), increasing age (P ϭ 0.0040), current smoker (P ϭ 0.0014), and CIGTS clinical center (P ϭ 0.0215). CONCLUSIONS. The CIGTS VF score provides a measure of VF strikingly similar to the MD. Variables associated with VF loss and VF variability may help identify patients who need greater clinical scrutiny. (Invest Ophthalmol Vis Sci.

Investigative ophthalmology & visual science, 2014

To estimate minimally important differences (MIDs) for the Visual Activities Questionnaire (VAQ) ... more To estimate minimally important differences (MIDs) for the Visual Activities Questionnaire (VAQ) and the National Eye Institute-Visual Function Questionnaire (NEI-VFQ). A total of 607 subjects with newly-diagnosed open-angle glaucoma (OAG) was enrolled in the Collaborative Initial Glaucoma Treatment Study (CIGTS) and randomized to initial treatment with medications or surgery. Subjects underwent an ophthalmic examination and telephone-administered quality of life (QOL) interview before randomization and every six months thereafter. The VAQ and NEI-VFQ were used to assess participants' perceptions of their visual function. Clinical measures included the mean deviation (MD) from Humphrey 24-2 full threshold visual field (VF) testing, and best-corrected visual acuity (VA) measured using the Early Treatment Diabetic Retinopathy Study (ETDRS) protocol. Anchor-based (using MD and VA) and distribution-based methods were used to estimate MIDs. Anchor-based cross-sectional analyses at 66...

American Journal of Public Health, 2005

We examined breast cancer treatment experiences of and outcomes for Latinas in Los Angeles County... more We examined breast cancer treatment experiences of and outcomes for Latinas in Los Angeles County. We conducted a population-based survey of women who were diagnosed with breast cancer between December 2001 and November 2002 (n=910) to evaluate the types of treatments received, communication with clinicians, and satisfaction. About two thirds were non-Latina White, 18.8% were African American, and 18.9% were Latina (with 11.0% preferring English and 7.9% preferring Spanish). The rest indicated other ethnic groups. Latinas who preferred Spanish were more likely to experience a delay of 3 months or more from diagnosis to surgical treatment (36.4% vs 9.1% for non-Latina Whites, 18.6% for African Americans, and 12.7%, for other Latinas, P<.001). African Americans and Latinas who preferred Spanish had very low rates of reconstruction (13.8% and 9.2%, respectively, compared with 42.1% for Whites and 34.5% for Latinas who preferred English, P=.009). Latinas who preferred Spanish had the highest odds ratio for low satisfaction. Latinas who preferred Spanish received different treatments and perceived a different treatment experience than did other cultural groups.

Preventive Medicine, 2003

Background. Even though colorectal cancer (CRC) screening tests for persons 50 years of age or ov... more Background. Even though colorectal cancer (CRC) screening tests for persons 50 years of age or over are recommended to reduce colorectal cancer mortality, screening rates remain disturbingly low.

Psycho-Oncology, 2014

Although worry about recurrence is a persistent concern among breast cancer survivors, little is ... more Although worry about recurrence is a persistent concern among breast cancer survivors, little is known about physicians' confidence about presenting recurrence risk information, identifying women with considerable worry, and helping women manage worry. Between January and June 2012, we surveyed 750 surgeons and 750 medical oncologists randomly sampled from the American Medical Association Physician Masterfile. We tested differences between surgeons and medical oncologists on confidence of presenting risk, identifying and managing worry using chi-square statistic and Student's t-tests and developed multiple variable logistic regression models to explain odds regarding confidence and use of different strategies for managing worry. The analytic sample included 403 surgeons and 363 medical oncologists (n = 766; response rate = 60%). Compared with surgeons, medical oncologists were significantly more likely to report confidence in: presenting risk information (87.5% vs 73.2%), identifying women who are worried (74.1% vs 63.9%), and managing worry (66.9% vs 52.4%). Confidence in managing worry was associated with more regular inquiry about worry (p = 0.009). Models of the likelihood of using different management strategies varied by provider type (e.g., surgeons more likely than medical oncologists to recommend support group or online resources, oncologists more likely to refer to psychologist or use medications, all p < 0.05). Cancer providers, particularly surgeons, may benefit from educational training to raise confidence in identifying women with high levels of worry and managing women with considerable worry. Communication between specialties and primary care physicians on efforts to manage worry is necessary for coordinated, quality care for women with breast cancer. Copyright © 2014 John Wiley & Sons, Ltd.

Objectives. This study involving 570 women aged 60 years or older with heart disease, assessed th... more Objectives. This study involving 570 women aged 60 years or older with heart disease, assessed the effects of a disease management program on physical functioning, symptom experience, and psychosocial status. Methods. Women were randomly assigned to control or program groups. Six to eight women met weekly with a health educator and peer leader over 4 weeks to learn self-regulation skills

Female pelvic medicine & reconstructive surgery

Surgical pain scales (SPS) consist of 4 items that measure pain at rest, during normal activities... more Surgical pain scales (SPS) consist of 4 items that measure pain at rest, during normal activities, and during work/exercise and quantify unpleasantness of worst pain, which are valid and responsive in men undergoing hernia repair. Our objective was to evaluate the psychometric properties of SPS in women undergoing vaginal surgery for pelvic organ prolapse and stress urinary incontinence. We modified SPS by converting original response scales from a visual analog scale to numerical rating scales. Numerical rating scales have lower error rates and higher validity than visual analog scale. The sample included 169 women with stage II to IV pelvic organ prolapse and stress urinary incontinence in a randomized trial comparing sacrospinous ligament fixation to uterosacral vault suspension with and without pelvic floor muscle training. Participants completed SPS and SF-36 at baseline, and 2 weeks and 6 months after surgery. Construct validity and responsiveness were examined in cross-sectio...

Journal of Women & Aging, 2001

This study explored and compared the role of self esteem, stress and social support in maintenanc... more This study explored and compared the role of self esteem, stress and social support in maintenance or improvement in physical and psychosocial functioning over 12 months in older men and women with cardiovascular disease. Data from 502 adults over 60 years of age showed that self esteem and stress were both significantly associated with functioning when demographic and clinical factors

JAMA Surgery, 2014

IMPORTANCE The growing rate of contralateral prophylactic mastectomy (CPM) among women diagnosed ... more IMPORTANCE The growing rate of contralateral prophylactic mastectomy (CPM) among women diagnosed as having breast cancer has raised concerns about potential for overtreatment. Yet, there are few large survey studies of factors that affect women's decisions for this surgical treatment option. OBJECTIVE To determine factors associated with the use of CPM in a population-based sample of patients with breast cancer. DESIGN, SETTING, AND PARTICIPANTS A longitudinal survey of 2290 women newly diagnosed as having breast cancer who reported to the Detroit and Los Angeles Surveillance, Epidemiology, and End Results registries from June 1, 2005, to February 1, 2007, and again 4 years later (June 2009 to February 2010) merged with Surveillance, Epidemiology, and End Results registry data (n = 1536). Multinomial logistic regression was used to evaluate factors associated with type of surgery. Primary independent variables included clinical indications for CPM (genetic mutation and/or strong family history), diagnostic magnetic resonance imaging, and patient extent of worry about recurrence at the time of treatment decision making. MAIN OUTCOMES AND MEASURES Type of surgery received from patient self-report, categorized as CPM, unilateral mastectomy, or breast conservation surgery. RESULTS Of the 1447 women in the analytic sample, 18.9% strongly considered CPM and 7.6% received it. Of those who strongly considered CPM, 32.2% received CPM, while 45.8% received unilateral mastectomy and 22.8% received breast conservation surgery (BCS). The majority of patients (68.9%) who received CPM had no major genetic or familial risk factors for contralateral disease. Multivariate regression showed that receipt of CPM (vs either unilateral mastectomy or breast conservation surgery) was significantly associated with genetic testing (positive or negative) (vs UM, relative risk ratio [RRR]: 10.48; 95% CI, 3.61-3.48 and vs BCS, RRR: 19.10; 95% CI, 5.67-56.41; P < .001), a strong family history of breast or ovarian cancer (vs UM, RRR: 5.19; 95% CI, 2.34-11.56 and vs BCS, RRR: 4.24; 95% CI, 1.80-9.88; P = .001), receipt of magnetic resonance imaging (vs UM RRR: 2.07; 95% CI, 1.21-3.52 and vs BCS, RRR: 2.14; 95% CI, 1.28-3.58; P = .001), higher education (vs UM, RRR: 5.04; 95% CI, 2.37-10.71 and vs BCS, RRR: 4.38; 95% CI, 2.07-9.29; P < .001), and greater worry about recurrence (vs UM, RRR: 2.81; 95% CI, 1.14-6.88 and vs BCS, RRR: 4.24; 95% CI, 1.80-9.98; P = .001). CONCLUSIONS AND RELEVANCE Many women considered CPM and a substantial number received it, although few had a clinically significant risk of contralateral breast cancer. Receipt of magnetic resonance imaging at diagnosis contributed to receipt of CPM. Worry about recurrence appeared to drive decisions for CPM although the procedure has not been shown to reduce recurrence risk. More research is needed about the underlying factors driving the use of CPM.

To review the potential health risks associated with bioengineered ocular surface tissue, which s... more To review the potential health risks associated with bioengineered ocular surface tissue, which serves as a bellwether for other tissues. All clinical trials using bioengineered ocular surface tissue published between July 1, 1996, and June 30, 2005, were reviewed with respect to materials used and statements of risk assessment, risk remediation, adverse events, manufacturing standards, and regulatory oversight. Ninety-five percent of investigational protocols used 1 or more animal-derived products and an overlapping 95% used 1 or more donor human tissues. Consideration of risks reveals a very low probability of potential harm but a significant risk of disability or death if such an event were to occur. Details of ethics approval, patient consent, and donor serologic test results were not consistently provided. No references were made to risk assessment or to codes of manufacturing and clinical practice. While a degree of risk is associated with bioengineered ocular surface tissue, investigational reports of this new technology have yet to address issues of risk management and regulatory oversight. Attention to risk and codes of manufacturing and clinical practice will be required for advancement of the technology. We suggest the adoption of international standards to address these issues.

number of problems per person ranged from 13.5 for those with diabetic retinopathy to 7.9 for per... more number of problems per person ranged from 13.5 for those with diabetic retinopathy to 7.9 for persons with glau- coma. For the sample overall, reading problems were men- tioned most frequently, followed by driving, general prob- lems with seeing clearly, and mental health complaints caused by vision. Although the proportion of persons who reported each problem varied by condition, at least some persons with each eye disease reported each problem. The 3 most common descriptors associated with each prob- lem were difficulty or ease of performance (13%), psy- chological distress associated with performance of the ac- tivity (11%), and complete inability to participate in a visual activity (11%). Conclusion: An item-generation strategy for a new questionnaire using a standardized focus group method identified content areas and aspects of visual disability that are not included in currently available vision-specific instruments that assess the impact of common eye diseases on visual func...

Women & Health, 1991

Findings are presented from an exploratory study of differences in the impact and management of h... more Findings are presented from an exploratory study of differences in the impact and management of heart disease between men and women aged 60 and over (N = 323). The sample consisted of ambulatory, non-institutionalized, cardiac patients who had agreed to participate in a self-management intervention study. Differences between men and women were found regarding symptom experience, physical functioning, exercise compliance, use of prescribed drugs, and physician/clinic visits. Differences in emotional well-being and psychosocial functioning were not found; however, women reported more stress and limitation in the area of household management. Implications for future research and practice are discussed.

Women & Health, 2000

This study describes the symptom experience of 570 older women with heart disease and evaluates a... more This study describes the symptom experience of 570 older women with heart disease and evaluates a disease-management program's impact on symptoms over time. Women were randomly assigned to either usual care or a 4-week program ("Women take PRIDE") designed to improve self-regulation skills by focusing on increasing physical activity. At 4 months follow-up, program women, compared to controls, reported fewer total symptoms (p = 0.01) and decreased symptom frequency (p = 0.02) and bothersomeness (p = 0.02). By 12 months, positive intervention effects emerged within the common cardiac and sleep and rest symptom categories. Program group women reported more improvements in symptoms likely to be affected by increasing physical activity at both follow-ups (p < 0.05).

Social Science & Medicine, 2003

Quality of Life Research, 2005

Objective: To examine the relationship between cancer stage, surgical treatment and chemotherapy ... more Objective: To examine the relationship between cancer stage, surgical treatment and chemotherapy on quality of life (QOL) after breast cancer and determine if sociodemographic characteristics modify the observed relationships. Methods: A population-based sample of women with Stages 0-II breast cancer in the United States (N ¼ 1357) completed surveys including the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30), and the Breast Cancer-Specific Quality of Life Questionnaire (QLQ BR-23). Regression models calculated mean QOL scores across primary surgical treatment and chemotherapy. Clinically significant differences in QOL were defined as P10 point difference (out of 100) between groups. Results: Meaningful differences in QOL by surgical treatment were limited to body image with women receiving mastectomy with reconstruction reporting lower scores than women receiving breast conserving surgery (p < 0.001). Chemotherapy lowered QOL scores overall across four QOL dimensions (p values < 0.001), with a disproportionately greater impact on those with lower levels of education. Younger women reported lower QOL scores for seven of nine QOL dimensions (p values < 0.001). Conclusions: Women should be reassured that few QOL differences exist based on surgical treatment, however, clinicians should recognize that the impact of treatment on QOL does vary by a woman's age and educational level.

Public Health Nursing, 1996

The number of adolescent females between the ages of 13 and 19 who are contracting sexually trans... more The number of adolescent females between the ages of 13 and 19 who are contracting sexually transmitted diseases (STDs) is rising at an alarming rate. Although the issue of STDs has been overshadowed by continued public debate over adolescent pregnancy and childbearing, it demands attention. Particularly concerning is the fact that STDs increase the likelihood of transmitting HIV (N.E. MacDonald et al., 1990). To offset the growing incidences of STDs among female adolescents, genderspecific interventions are needed. Following is a description of the theoretical underpinnings that informed and guided the development of a gender-specific intervention titled Girl Talk. A twostage creation and review process was used to design this 2.5-hr, four-session intervention. An overview of the quasi-experimental design that compared a nonequivalent comparison and two intervention groups (peer led and adult led) is presented. Baseline

Psycho-Oncology, 2005

The purpose of the study was to develop and evaluate Taking CHARGE, a self-management interventio... more The purpose of the study was to develop and evaluate Taking CHARGE, a self-management intervention designed to facilitate successful transitions to survivorship after breast cancer treatment. The Taking CHARGE intervention involves a two-pronged approach building on self-regulation principles to (1) equip women with self-management skills to address concerns following breast cancer treatment, and (2) provide information about common survivorship topics. The program involved four intervention contacts, two small group meetings and two individualized telephone sessions, delivered by nurse/health educators. This paper focuses on the process evaluation findings from a preliminary test of the Taking CHARGE intervention conducted with 25 women, aged 34-66 years, completing breast cancer treatment, who were randomly assigned to the intervention group. The process evaluation was conducted to obtain systematic information about the relevance and usefulness of the self-regulation approach, informational aspects, and program delivery. The findings indicated that intervention group participants found the Taking CHARGE program to be timely, relevant, and to have high utility in dealing with concerns that exist following breast cancer treatment. The process evaluation findings provide early evidence of the usefulness of the Taking CHARGE intervention for successful transition to survivorship following breast cancer treatment.

Psychology & Health, 2007

Previous studies examining decision making in the context of genetic testing for BRCA1/2 gene mut... more Previous studies examining decision making in the context of genetic testing for BRCA1/2 gene mutations have been limited in their reliance on cross-sectional designs, lack of theoretical guidance, and focus on measures of intention rather than actual behavior. Informed by the Health Belief Model and other theories of self-regulation, the present study set out to examine the role of cognitive appraisal and worry in BRCA1/2 testing decisions. A total of 205 women completed baseline questionnaires prior to their genetic counselling appointment. Medical charts were audited to determine testing decisions. Bivariate analyses indicated that perceived severity of being a carrier and perceived benefits and barriers to testing were significantly associated with testing decisions. Perceived benefits remained significant in multivariate analyses. Moreover, multivariate analyses revealed a significant three-way interaction between perceived susceptibility, perceived severity, and worry about being a mutation carrier and testing decisions. Among women high in baseline worry, those high in perceived susceptibility but low in perceived severity were significantly more likely to undergo genetic testing than all other susceptibility/severity combinations (80% vs. 36.2-42.9% range; Wald test ¼ 8.79, p < 0.01). These results support the need for researchers and practitioners to consider how interactions between cognition and worry may influence genetic testing decisions.

BMC Medical Informatics and Decision Making

Background Breast cancer patients face several preference-sensitive treatment decisions. Feelings... more Background Breast cancer patients face several preference-sensitive treatment decisions. Feelings such as regret or having had inadequate information about these decisions can significantly alter patient perceptions of recovery and recurrence. Numerous objective measures of decision quality (e.g., knowledge assessments, values concordance measures) have been developed; there are far fewer measures of subjective decision quality and little consensus regarding how the construct should be assessed. The current study explores the psychometric properties of a new subjective quality decision measure for breast cancer treatment that could be used for other preference sensitive decisions. Methods320 women aged 20¿79 diagnosed with AJCC stage 0 ¿ III breast cancer were surveyed at two cancer specialty centers. Decision quality was assessed with single items representing six dimensions: regret, satisfaction, and fit as well as perceived adequacy of information, time, and involvement. Women ra...

American Journal of Preventive Medicine

Although breast self-examination (BSE) continues to be recommended as an adjunct to clinical scre... more Although breast self-examination (BSE) continues to be recommended as an adjunct to clinical screening techniques for the early detection of breast cancer, little is known about events that might negatively influence long-term adherence. The primary aim of this investigation was to determine if regularity of BSE would decline after a benign breast biopsy. Analyses are based on 655 women: 83 women who self-discovered the breast problem by BSE, 179 women in whom the problem was discovered by the health care system, and a control group of 393 women who had no history of breast problems. Frequency of BSE was assessed over two six-month periods and collapsed into three categories--nonpractitioner, irregular practitioner, and regular practitioner. Results indicated that the percentage of women in the self-discovered group who reported decreased regularity of BSE was over three times higher than that found in the control group. The largest percentage increase in BSE frequency was evidenced...

and the CIGTS Study Group 6 PURPOSE. To compare the baseline Collaborative Initial Glaucoma Treat... more and the CIGTS Study Group 6 PURPOSE. To compare the baseline Collaborative Initial Glaucoma Treatment Study (CIGTS) visual field (VF) score and mean deviation (MD), investigate test-retest variability, and identify variables associated with VF loss and VF measurement variability. METHODS. Baseline data from a randomized clinical trial of 607 patients with newly diagnosed open-angle glaucoma were collected at 14 clinical centers. The CIGTS VF score and MD were obtained from 24-2 VF tests (Zeiss-Humphrey Systems, Dublin, CA) at two visits approximately 2 weeks apart. RESULTS. Although most baseline CIGTS VF scores showed limited field loss, 15% (91/607) of patients showed a substantial deficit (VF score Ͼ10 on a 0 -20 scale). A small but significant learning effect was seen over the two baseline measures for CIGTS VF score and MD. CIGTS VF score and MD correlate highly (r ϭ Ϫ0.93); both have high test-retest correlation (0.83 and 0.91, respectively). Variables associated with greater baseline VF loss for both CIGTS VF score and MD include (probabilities for VF only): male sex (P ϭ 0.018), black race (P Յ 0.0001), lower visual acuity (P Յ 0.0001), higher intraocular pressure if more than 30 mm Hg (P ϭ 0.0034), poor field reliability score (P Յ 0.0001), cardiovascular disease (P ϭ 0.015), reduced patient-reported alertness (P ϭ 0.023), and CIGTS clinical center (P Յ 0.0001). Predictors of increased CIGTS VF score variability include a midrange VF score (P Յ 0.0001), first-tested eye (P ϭ 0.0027), reduced patient-reported alertness (P ϭ 0.0177), increasing age (P ϭ 0.0040), current smoker (P ϭ 0.0014), and CIGTS clinical center (P ϭ 0.0215). CONCLUSIONS. The CIGTS VF score provides a measure of VF strikingly similar to the MD. Variables associated with VF loss and VF variability may help identify patients who need greater clinical scrutiny. (Invest Ophthalmol Vis Sci.

Investigative ophthalmology & visual science, 2014

To estimate minimally important differences (MIDs) for the Visual Activities Questionnaire (VAQ) ... more To estimate minimally important differences (MIDs) for the Visual Activities Questionnaire (VAQ) and the National Eye Institute-Visual Function Questionnaire (NEI-VFQ). A total of 607 subjects with newly-diagnosed open-angle glaucoma (OAG) was enrolled in the Collaborative Initial Glaucoma Treatment Study (CIGTS) and randomized to initial treatment with medications or surgery. Subjects underwent an ophthalmic examination and telephone-administered quality of life (QOL) interview before randomization and every six months thereafter. The VAQ and NEI-VFQ were used to assess participants' perceptions of their visual function. Clinical measures included the mean deviation (MD) from Humphrey 24-2 full threshold visual field (VF) testing, and best-corrected visual acuity (VA) measured using the Early Treatment Diabetic Retinopathy Study (ETDRS) protocol. Anchor-based (using MD and VA) and distribution-based methods were used to estimate MIDs. Anchor-based cross-sectional analyses at 66...

American Journal of Public Health, 2005

We examined breast cancer treatment experiences of and outcomes for Latinas in Los Angeles County... more We examined breast cancer treatment experiences of and outcomes for Latinas in Los Angeles County. We conducted a population-based survey of women who were diagnosed with breast cancer between December 2001 and November 2002 (n=910) to evaluate the types of treatments received, communication with clinicians, and satisfaction. About two thirds were non-Latina White, 18.8% were African American, and 18.9% were Latina (with 11.0% preferring English and 7.9% preferring Spanish). The rest indicated other ethnic groups. Latinas who preferred Spanish were more likely to experience a delay of 3 months or more from diagnosis to surgical treatment (36.4% vs 9.1% for non-Latina Whites, 18.6% for African Americans, and 12.7%, for other Latinas, P&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;.001). African Americans and Latinas who preferred Spanish had very low rates of reconstruction (13.8% and 9.2%, respectively, compared with 42.1% for Whites and 34.5% for Latinas who preferred English, P=.009). Latinas who preferred Spanish had the highest odds ratio for low satisfaction. Latinas who preferred Spanish received different treatments and perceived a different treatment experience than did other cultural groups.

Preventive Medicine, 2003

Background. Even though colorectal cancer (CRC) screening tests for persons 50 years of age or ov... more Background. Even though colorectal cancer (CRC) screening tests for persons 50 years of age or over are recommended to reduce colorectal cancer mortality, screening rates remain disturbingly low.

Psycho-Oncology, 2014

Although worry about recurrence is a persistent concern among breast cancer survivors, little is ... more Although worry about recurrence is a persistent concern among breast cancer survivors, little is known about physicians&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; confidence about presenting recurrence risk information, identifying women with considerable worry, and helping women manage worry. Between January and June 2012, we surveyed 750 surgeons and 750 medical oncologists randomly sampled from the American Medical Association Physician Masterfile. We tested differences between surgeons and medical oncologists on confidence of presenting risk, identifying and managing worry using chi-square statistic and Student&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s t-tests and developed multiple variable logistic regression models to explain odds regarding confidence and use of different strategies for managing worry. The analytic sample included 403 surgeons and 363 medical oncologists (n = 766; response rate = 60%). Compared with surgeons, medical oncologists were significantly more likely to report confidence in: presenting risk information (87.5% vs 73.2%), identifying women who are worried (74.1% vs 63.9%), and managing worry (66.9% vs 52.4%). Confidence in managing worry was associated with more regular inquiry about worry (p = 0.009). Models of the likelihood of using different management strategies varied by provider type (e.g., surgeons more likely than medical oncologists to recommend support group or online resources, oncologists more likely to refer to psychologist or use medications, all p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.05). Cancer providers, particularly surgeons, may benefit from educational training to raise confidence in identifying women with high levels of worry and managing women with considerable worry. Communication between specialties and primary care physicians on efforts to manage worry is necessary for coordinated, quality care for women with breast cancer. Copyright © 2014 John Wiley &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp; Sons, Ltd.

Objectives. This study involving 570 women aged 60 years or older with heart disease, assessed th... more Objectives. This study involving 570 women aged 60 years or older with heart disease, assessed the effects of a disease management program on physical functioning, symptom experience, and psychosocial status. Methods. Women were randomly assigned to control or program groups. Six to eight women met weekly with a health educator and peer leader over 4 weeks to learn self-regulation skills

Female pelvic medicine & reconstructive surgery

Surgical pain scales (SPS) consist of 4 items that measure pain at rest, during normal activities... more Surgical pain scales (SPS) consist of 4 items that measure pain at rest, during normal activities, and during work/exercise and quantify unpleasantness of worst pain, which are valid and responsive in men undergoing hernia repair. Our objective was to evaluate the psychometric properties of SPS in women undergoing vaginal surgery for pelvic organ prolapse and stress urinary incontinence. We modified SPS by converting original response scales from a visual analog scale to numerical rating scales. Numerical rating scales have lower error rates and higher validity than visual analog scale. The sample included 169 women with stage II to IV pelvic organ prolapse and stress urinary incontinence in a randomized trial comparing sacrospinous ligament fixation to uterosacral vault suspension with and without pelvic floor muscle training. Participants completed SPS and SF-36 at baseline, and 2 weeks and 6 months after surgery. Construct validity and responsiveness were examined in cross-sectio...

Journal of Women & Aging, 2001

This study explored and compared the role of self esteem, stress and social support in maintenanc... more This study explored and compared the role of self esteem, stress and social support in maintenance or improvement in physical and psychosocial functioning over 12 months in older men and women with cardiovascular disease. Data from 502 adults over 60 years of age showed that self esteem and stress were both significantly associated with functioning when demographic and clinical factors

JAMA Surgery, 2014

IMPORTANCE The growing rate of contralateral prophylactic mastectomy (CPM) among women diagnosed ... more IMPORTANCE The growing rate of contralateral prophylactic mastectomy (CPM) among women diagnosed as having breast cancer has raised concerns about potential for overtreatment. Yet, there are few large survey studies of factors that affect women&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s decisions for this surgical treatment option. OBJECTIVE To determine factors associated with the use of CPM in a population-based sample of patients with breast cancer. DESIGN, SETTING, AND PARTICIPANTS A longitudinal survey of 2290 women newly diagnosed as having breast cancer who reported to the Detroit and Los Angeles Surveillance, Epidemiology, and End Results registries from June 1, 2005, to February 1, 2007, and again 4 years later (June 2009 to February 2010) merged with Surveillance, Epidemiology, and End Results registry data (n = 1536). Multinomial logistic regression was used to evaluate factors associated with type of surgery. Primary independent variables included clinical indications for CPM (genetic mutation and/or strong family history), diagnostic magnetic resonance imaging, and patient extent of worry about recurrence at the time of treatment decision making. MAIN OUTCOMES AND MEASURES Type of surgery received from patient self-report, categorized as CPM, unilateral mastectomy, or breast conservation surgery. RESULTS Of the 1447 women in the analytic sample, 18.9% strongly considered CPM and 7.6% received it. Of those who strongly considered CPM, 32.2% received CPM, while 45.8% received unilateral mastectomy and 22.8% received breast conservation surgery (BCS). The majority of patients (68.9%) who received CPM had no major genetic or familial risk factors for contralateral disease. Multivariate regression showed that receipt of CPM (vs either unilateral mastectomy or breast conservation surgery) was significantly associated with genetic testing (positive or negative) (vs UM, relative risk ratio [RRR]: 10.48; 95% CI, 3.61-3.48 and vs BCS, RRR: 19.10; 95% CI, 5.67-56.41; P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; .001), a strong family history of breast or ovarian cancer (vs UM, RRR: 5.19; 95% CI, 2.34-11.56 and vs BCS, RRR: 4.24; 95% CI, 1.80-9.88; P = .001), receipt of magnetic resonance imaging (vs UM RRR: 2.07; 95% CI, 1.21-3.52 and vs BCS, RRR: 2.14; 95% CI, 1.28-3.58; P = .001), higher education (vs UM, RRR: 5.04; 95% CI, 2.37-10.71 and vs BCS, RRR: 4.38; 95% CI, 2.07-9.29; P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; .001), and greater worry about recurrence (vs UM, RRR: 2.81; 95% CI, 1.14-6.88 and vs BCS, RRR: 4.24; 95% CI, 1.80-9.98; P = .001). CONCLUSIONS AND RELEVANCE Many women considered CPM and a substantial number received it, although few had a clinically significant risk of contralateral breast cancer. Receipt of magnetic resonance imaging at diagnosis contributed to receipt of CPM. Worry about recurrence appeared to drive decisions for CPM although the procedure has not been shown to reduce recurrence risk. More research is needed about the underlying factors driving the use of CPM.

To review the potential health risks associated with bioengineered ocular surface tissue, which s... more To review the potential health risks associated with bioengineered ocular surface tissue, which serves as a bellwether for other tissues. All clinical trials using bioengineered ocular surface tissue published between July 1, 1996, and June 30, 2005, were reviewed with respect to materials used and statements of risk assessment, risk remediation, adverse events, manufacturing standards, and regulatory oversight. Ninety-five percent of investigational protocols used 1 or more animal-derived products and an overlapping 95% used 1 or more donor human tissues. Consideration of risks reveals a very low probability of potential harm but a significant risk of disability or death if such an event were to occur. Details of ethics approval, patient consent, and donor serologic test results were not consistently provided. No references were made to risk assessment or to codes of manufacturing and clinical practice. While a degree of risk is associated with bioengineered ocular surface tissue, investigational reports of this new technology have yet to address issues of risk management and regulatory oversight. Attention to risk and codes of manufacturing and clinical practice will be required for advancement of the technology. We suggest the adoption of international standards to address these issues.

number of problems per person ranged from 13.5 for those with diabetic retinopathy to 7.9 for per... more number of problems per person ranged from 13.5 for those with diabetic retinopathy to 7.9 for persons with glau- coma. For the sample overall, reading problems were men- tioned most frequently, followed by driving, general prob- lems with seeing clearly, and mental health complaints caused by vision. Although the proportion of persons who reported each problem varied by condition, at least some persons with each eye disease reported each problem. The 3 most common descriptors associated with each prob- lem were difficulty or ease of performance (13%), psy- chological distress associated with performance of the ac- tivity (11%), and complete inability to participate in a visual activity (11%). Conclusion: An item-generation strategy for a new questionnaire using a standardized focus group method identified content areas and aspects of visual disability that are not included in currently available vision-specific instruments that assess the impact of common eye diseases on visual func...

Women & Health, 1991

Findings are presented from an exploratory study of differences in the impact and management of h... more Findings are presented from an exploratory study of differences in the impact and management of heart disease between men and women aged 60 and over (N = 323). The sample consisted of ambulatory, non-institutionalized, cardiac patients who had agreed to participate in a self-management intervention study. Differences between men and women were found regarding symptom experience, physical functioning, exercise compliance, use of prescribed drugs, and physician/clinic visits. Differences in emotional well-being and psychosocial functioning were not found; however, women reported more stress and limitation in the area of household management. Implications for future research and practice are discussed.

Women & Health, 2000

This study describes the symptom experience of 570 older women with heart disease and evaluates a... more This study describes the symptom experience of 570 older women with heart disease and evaluates a disease-management program&#39;s impact on symptoms over time. Women were randomly assigned to either usual care or a 4-week program (&quot;Women take PRIDE&quot;) designed to improve self-regulation skills by focusing on increasing physical activity. At 4 months follow-up, program women, compared to controls, reported fewer total symptoms (p = 0.01) and decreased symptom frequency (p = 0.02) and bothersomeness (p = 0.02). By 12 months, positive intervention effects emerged within the common cardiac and sleep and rest symptom categories. Program group women reported more improvements in symptoms likely to be affected by increasing physical activity at both follow-ups (p &lt; 0.05).

Social Science & Medicine, 2003

Quality of Life Research, 2005

Objective: To examine the relationship between cancer stage, surgical treatment and chemotherapy ... more Objective: To examine the relationship between cancer stage, surgical treatment and chemotherapy on quality of life (QOL) after breast cancer and determine if sociodemographic characteristics modify the observed relationships. Methods: A population-based sample of women with Stages 0-II breast cancer in the United States (N ¼ 1357) completed surveys including the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30), and the Breast Cancer-Specific Quality of Life Questionnaire (QLQ BR-23). Regression models calculated mean QOL scores across primary surgical treatment and chemotherapy. Clinically significant differences in QOL were defined as P10 point difference (out of 100) between groups. Results: Meaningful differences in QOL by surgical treatment were limited to body image with women receiving mastectomy with reconstruction reporting lower scores than women receiving breast conserving surgery (p < 0.001). Chemotherapy lowered QOL scores overall across four QOL dimensions (p values < 0.001), with a disproportionately greater impact on those with lower levels of education. Younger women reported lower QOL scores for seven of nine QOL dimensions (p values < 0.001). Conclusions: Women should be reassured that few QOL differences exist based on surgical treatment, however, clinicians should recognize that the impact of treatment on QOL does vary by a woman's age and educational level.

Public Health Nursing, 1996

The number of adolescent females between the ages of 13 and 19 who are contracting sexually trans... more The number of adolescent females between the ages of 13 and 19 who are contracting sexually transmitted diseases (STDs) is rising at an alarming rate. Although the issue of STDs has been overshadowed by continued public debate over adolescent pregnancy and childbearing, it demands attention. Particularly concerning is the fact that STDs increase the likelihood of transmitting HIV (N.E. MacDonald et al., 1990). To offset the growing incidences of STDs among female adolescents, genderspecific interventions are needed. Following is a description of the theoretical underpinnings that informed and guided the development of a gender-specific intervention titled Girl Talk. A twostage creation and review process was used to design this 2.5-hr, four-session intervention. An overview of the quasi-experimental design that compared a nonequivalent comparison and two intervention groups (peer led and adult led) is presented. Baseline

Psycho-Oncology, 2005

The purpose of the study was to develop and evaluate Taking CHARGE, a self-management interventio... more The purpose of the study was to develop and evaluate Taking CHARGE, a self-management intervention designed to facilitate successful transitions to survivorship after breast cancer treatment. The Taking CHARGE intervention involves a two-pronged approach building on self-regulation principles to (1) equip women with self-management skills to address concerns following breast cancer treatment, and (2) provide information about common survivorship topics. The program involved four intervention contacts, two small group meetings and two individualized telephone sessions, delivered by nurse/health educators. This paper focuses on the process evaluation findings from a preliminary test of the Taking CHARGE intervention conducted with 25 women, aged 34-66 years, completing breast cancer treatment, who were randomly assigned to the intervention group. The process evaluation was conducted to obtain systematic information about the relevance and usefulness of the self-regulation approach, informational aspects, and program delivery. The findings indicated that intervention group participants found the Taking CHARGE program to be timely, relevant, and to have high utility in dealing with concerns that exist following breast cancer treatment. The process evaluation findings provide early evidence of the usefulness of the Taking CHARGE intervention for successful transition to survivorship following breast cancer treatment.

Psychology & Health, 2007

Previous studies examining decision making in the context of genetic testing for BRCA1/2 gene mut... more Previous studies examining decision making in the context of genetic testing for BRCA1/2 gene mutations have been limited in their reliance on cross-sectional designs, lack of theoretical guidance, and focus on measures of intention rather than actual behavior. Informed by the Health Belief Model and other theories of self-regulation, the present study set out to examine the role of cognitive appraisal and worry in BRCA1/2 testing decisions. A total of 205 women completed baseline questionnaires prior to their genetic counselling appointment. Medical charts were audited to determine testing decisions. Bivariate analyses indicated that perceived severity of being a carrier and perceived benefits and barriers to testing were significantly associated with testing decisions. Perceived benefits remained significant in multivariate analyses. Moreover, multivariate analyses revealed a significant three-way interaction between perceived susceptibility, perceived severity, and worry about being a mutation carrier and testing decisions. Among women high in baseline worry, those high in perceived susceptibility but low in perceived severity were significantly more likely to undergo genetic testing than all other susceptibility/severity combinations (80% vs. 36.2-42.9% range; Wald test ¼ 8.79, p < 0.01). These results support the need for researchers and practitioners to consider how interactions between cognition and worry may influence genetic testing decisions.