Current Departmental Research:

• Levent Dumenci, Ph.D.
• May Kennedy, Ph.D.
• Robin Matsuyama, Ph.D.
• Laura A. Siminoff, Ph.D.
• Amy Sullivan, Ph.D.

Levent Dumenci, Ph.D.

Title: Model-based integraion of multi-informant symptom data
Funder:  NIMH

Summary.  This study is designed to test (a) the incremental validity of mother, teacher, and youth informants for obtaining clinical information, (b) the conditions under which, given reports from two informants, the third informant contributes to the understanding of youths’ emotional and behavioral problems, (c) the cross-cultural generalizability of model-based methods for integrating multi-informant data on youth psychopathology, and (d) the equality of predictive relations between cultures.  This project capitalizes on recent advances in statistical modeling of multi-informant data (the Psychometric Latent Agreement Model) developed through a grant from the NIMHby Dr. Dumenci.

Title: Assessment of Parental Help-Seeking Behavior
Funder:  Pending

Summary.  This study is designed to (a) develop a method for measuring the multidimensional construct of problem recognition,(b)identify factors that predict initial awareness and service need, and (c) assess reliability and predictive validity of the Parental Problem Recognition Questionnaire.

Title: Behavioral treatment of adolescent marijuana use
Funder:  Pending

Summary.  This research is a Stage IIA clinical trial designed to (a) replicate initial findings demonstrating the efficacy of combined voucher and parent-directed contingency management (CM), (b) systematically extend these findings by isolating the effects of the two CM components, (c) determine if the interventions change parental and adolescent risk factors for ongoing substance abuse and whether such changes are associated with better outcomes across conditions, and (d) extend assessment of risk and protective factors related to outcomes by including laboratory measures of risk taking and delay discounting.

Title: Family Based Contingency Management for Adolescent Alcohol Abuse
Funder:  Pending

Summary.  This study is designed to (a) provide a preliminary demonstration of the efficacy of a family-based CM intervention to treat adolescent alcohol abuse and dependence, (b) determine whether and how treatment interventions modify parental and adolescent risk and protective factors using observational and laboratory measures (parenting practices, family functioning, risk taking, delay discounting), and child and parent psychopathology, and (c) determine whether these factors are associated with outcomes over time. (top of page)

May Kennedy, Ph.D.

Title:  Effects of viewing a television show on knowledge about outcomes of exposure to hazardous chemicals
Funder:  Hollywood, Health and Society Program, Norman Lear Center, USC

Summary.  Placing health messages in broadcast media has been shown to increase health information-seeking behavior and the psychosocial predictors of other health-relevant behaviors.  This study is examining the impact of several levels of dosage of exposure to environmental health messages in popular primetime network dramas.  CDC and EPA experts consulted with scriptwriters on two storylines about toxic substance exposure that aired on NUMB3RS(CBS)and Law & Order: SVU(NBC).  The first storyline concerned children who had been exposed to hazardous chemicals buried under school playgrounds and the second was about unregulated pesticide use in an apartment building.  A 3-wave online survey (baseline, after show #1, and after show #2) was conducted to evaluate storyline effects.  Respondents were drawn from a Nielson Media Research panel of regular primetime TV viewers. 

Title:  Refining Entertainment Education for Cancer Literacy in African American Women
Funder: Pending

Summary.  African Americans suffer negative health disparities compared with whites in mortality and morbidity from colorectal and breast cancer.  Dispite this higher risk, African Americans are less likely to be screened for these diseases on schedule.  Embedding educational messages in entertainment media offerings has been shown to be effective in prompting health behavior change, but little is known about the mechanisms through which such changes come about.  This 3-year study would use audio narratives to study the roles of health literacy and several narrative variables in the promotion of colorectal and breast cancer screening among African American women over 50.  It would involve the creation of various versions of audio soap operas and would employ a factorial experimental design.  Initial pre-exposure and post-exposure data would be collected from face-to-face, forced-exposure groups and group members would receive a one-month follow-up mailed survey. 

Title:  Diffusing Effective Social Marketing through Distance-Based Technical Assistance
Funding:  Pending

Summary.  This 3-year study would build on the translation and diffusion efforts of a national collaborative network created by the Turning Point Initiative that was funded by the Robert Wood Johnson Foundation.  The study would create and pilot-test a triaged, distance-based network of providers of technical assistance in social marketing.  It would then contrast outcomes of on-demand, recipient-paced technical assistance with those of provider-paced technical assistance.  Six community-based organizations from around the country would be randomly assigned to one of these conditions and provided financial support in replicating an evidence-based model social marketing program.  The technical assistance would rely heavily on the Social Marketing Edition of CDCynergy, version 2, an interactive performance support tool.   

Title:  Refining Entertainment Education Approaches to the Promotion of Breast Cancer Screening
Funding: Pending

Summary.  A greater proportion of African American women than white women report that they learn health information from soap operas.  This 5-year study would leverage the cultural acceptability of the soap opera genre in an attempt to increase breast cancer screening rates among African American women over 40.  It would begin with formative research on the benefits of and barriers to breast cancer screening among members of the target audience in in Richmond and Petersburg Virginia.  The findings of that qualitative work would guide the creation of several versions of an audio soap opera which would be efficacy-tested in small groups and then broadcast in a random sample of top African American media markets around the country.  Outcomes such as screening efficacy, information-seeking, appointment-making, and reported screening would be studied in a wait-list control design. (top of page)

Robin Matsuyama, Ph.D.

Title: Cultural Perceptions and Disparities in Cancer Care.
Funder: Massey Cancer Center.

Summary. This exploratory study uses qualitative and quantitative measures to identify cultural perceptions and expectations of African-American and Caucasian patients related to cancer treatment and care. First we employed focus groups to explore patients’ experiences. Using the findings, we developed two cross-sectional surveys to examine: (1) information needs and preferred information sources related to cancer care; and (2) awareness of hospice care and palliative care.

Title: Health Literacy and Information Needs of Colorectal Cancer Patients: A Study to Assess Disparities.
Funder: pending

Summary. Patients are increasingly called upon to be responsible for self-care and to make complicated health care decisions that require ever-higher levels of health literacy. Because of the complexity of cancer treatment, the disadvantages of low health literacy are substantial. However, there are few health literacy studies in cancer. Unlike most other research to date, this is a prospective study over time (rather than cross-sectional survey) and it measures adherence to treatment and not just patient knowledge. It responds to the IOM suggestion that studies should address causal relationships and examines associations between health literacy, race, SES, expressed information needs and information receipt, and treatment adherence. (top of page)

Laura A. Siminoff, Ph.D.

Title: Testing the Early Referral and Request Approach Model
Funder: HRSA

Summary. There is a critical need for transplantable organs and tissues.  Over 95,000 Americans are now waiting to receive a transplant.  The goal of this project is to increase organ and tissue donation using the early referral and request approach (ERRA) intervention.  This intervention aims to increase referral of potential donor patients to the Organ Procurement Organizations (OPO) from target hospitals and evaluating the overall impact of the ERRA intervention on family consent rates to organ donation in acute care hospital settings.

Title: Understanding Consent to Tissue Donation
Funder: AHRQ

Summary. This project is examining why most requests for tissue donation are refused, while consent rates for requests for solid organ donations average 50% by directly examining the tissue request process by describing the approaches taken by Tissue Bank staff requesting donation and assess the adequacy of the informed consent process, assessing the determinants of the families’ willingness to donate tissue, including the incentives and disincentives associated with the donation decision, recommending ways in which the current request process might be modified, and suggesting education measures that might help to increase the numbers of tissue procured and ensure that consent to tissue donation is based on informed decision making.

Title: Family Conflict and Decision Making for Advanced Cancer
Funder: NCI

Summary. A diagnosis of cancer frequently leads to an increased involvement of family members as caregivers and, ultimately, decision makers.  The care of these patients has shifted from in-patient to mostly outpatient settings and the home. This has increased the complexity and significance of the dynamics between cancer patients and their family caregivers. While some families are well suited and prepared to assume new responsibilities for the patient, others lack the social, emotional, and economic resources to do so.

Communication between cancer patients and their family caregivers is often suboptimal. Caregivers and patients frequently have conflicting and unmet communication needs. Studies indicate that the quality of communication and emotional support provided in interactions among family members are strong predictors of family and patient adjustment to cancer and healthcare outcomes. Regular communication significantly predicts the extent to which they can cope with the tremendous stressors of living with cancer. Disputes over treatment decisions and patients’ deteriorating conditions can further strain family caregivers and make treatment planning difficult. The Cancer Communication Assessment Tool for Patients and Families (CCAT-PF) is a valid and reliable 18-item scale developed to measure congruence in patient- family caregiver communication. A copy of this tool is available upon request.

Title: Family-Patient Communication and Cancer Outcomes
Funder: Pending

Summary. This study examines whether and how communication between cancer patients and family caregivers has an impact on patients’ outcomes. This study is important because much of the treatment and care of cancer patients has shifted from the hospital to outpatient settings where family caregivers play a crucial role. This study examines hematological cancer patients and their family caregivers to better understand how congruence in communication is associated with patients’ short and long-term outcomes including quality of life and functional status with the ultimate goal of developing interventions to improve outcomes. Using a longitudinal study design, 250 patients, together with their primary family caregivers, will be followed for 2 years from onset of the patient’s first treatment, to assess how patients and caregivers communicate about treatment and care decisions. We measure communication using the Cancer Communication assessment Tool for Patients and Families (CCAT-PF), a new instrument that can validly and reliably assess the level of family – patient communication conflict and concordance concerning cancer treatment and care decisions. The main goal of this study is to assess whether communication congruence between caregivers and patients is an important and independent factor in cancer care outcomes.

Title: Appraisal and Diagnostic Delay in Colon Cancer
Funder:  Pending

Summary.  Disparities in cancer incidence, prevalence, and mortality have been well-documented for racial/ethnic minorities. These disparities persist despite widespread and targeted cancer education, screening campaigns, and advancements in cancer therapy. Diagnostic delay is significantly and negatively associated with cancer patient outcomes. Substantial barriers to early detection and diagnosis include lower rates of screening by minorities and access issues due to lack of health insurance. Later detection of cancer, however, is not solely explained by structural barriers to obtaining health care. Evidence has accumulated that cultural and communication factors may play a role in outcome disparities caused by late detection. 

Two important factors that are likely to contribute to a delay in the diagnosis of cancer are examined. First, ‘appraisal delay’, defined as patients’ inability to identify, interpret, and bring symptoms to the attention of their physicians. Second, 'diagnostic delay', defined as physicians’ inaction or incorrect actions to make a diagnosis. The study examines how diagnostic delay may be associated with an inability to understand, interpret, and communicate effectively with patients. The overall goal of this study is to understand how these factors contribute to delay in detecting cancers in African-Americans, using colon cancer as a paradigm for this phenomenon. (top of page)

Amy Sullivan, Ph.D.

Title: Diagnosing and Discussing Imminent Death in the Hospital
Funder:  NINR

Summary.  Many clinicians are inadequately prepared to effectively “diagnose dying” or to discuss the likelihood of imminent death with patients and families.  For the approximately 53% of all Americans who die in the hospital, studies also suggest that these patients may be at risk for overly aggressive care, may not receive adequate pain and symptom management, and clinical and family caregivers may not be fully informed about patients’ wishes for care at the end of life.  Understanding facilitators and obstacles to clinicians’ recognition of and communication about the imminence of death is key to the design of effective interventions to improve care for imminently dying patients in the hospital and their families.
 
The aim of this study is to use qualitative and quantitative methods of analysis to (1) identify, among physicians (n=158) and nurses (n=18) who cared for patients (n=59) who died in the hospital, systematic and modifiable factors associated with recognizing and communicating (with patients, families, and the medical team) imminent patient death, (2) explore the ways in which recognition and communication of impending death are related to clinician reports of end-of-life care provided to patients and families, and (3) assess the extent to which multiple accounts of care provided for the same patient are similar or different.  We will address these aims through a secondary analysis of a unique dataset (response rate 80%) containing semi-structured and structured interviews and surveys with clinicians about their experiences and behaviors related to care for a random sample of patients who died in the hospital.  Findings will be used to develop a prospective study that includes patient, family, and clinician perspectives to explore key variables identified here, and to include clinician, patient, and family perspectives simultaneously, and subsequently to design a pilot intervention to enhance physician and nurse clinical practice with hospital patients near the end of life.

Title: The Impact and Mechanisms of Gender Differences at the End of Life. 
Funder: NCI

Summary.  Being female or male is a fundamental category in human life and contributes to variation in social roles and responsibilities, communication and relationships, economic status, mental and physical health care, and health outcomes.  Although patient gender would be expected to play a similarly important role in experiences for cancer patients at the end of life, surprisingly little research has focused on this issue.  Preliminary analyses carried out for this proposal suggest the presence of important gender differences in cancer patients’ preferences and physician practices related to communication about the end of life, with women being less likely than men to want prognostic information and, when death is imminent, less likely to be told they are dying.  In addition, this preliminary evidence suggests having dependent children is an important moderator of the relationship between gender and preferences for prognostic information, with women with children least likely, and men with children most likely, to want to know their life expectancy.  Understanding the specific impact and mechanisms of these gender differences, and how they vary by patient ethnicity, will be important in designing effective interventions and determining best practices of care.  The purpose of this study is to use an existing dataset and generate new data to document the presence and impact of gender differences in prognostic communication among an ethnically diverse group of cancer patients at the end of life, and to identify potential mechanisms that underlie these differences. 

This study draws on data from an ongoing, multisite NCI- and NIMH-funded study of ethnic differences among cancer patients with a prognosis of 6-months or less and their caregivers (n=800 patient-caregiver pairs, P.I. Prigerson), and includes an analysis of existing survey data as well as primary data collection through the addition of new items to surveys of newly-enrolled patients and caregivers (estimated n=100 pairs).  The study will address three aims: (1) To identify the presence and impact of gender differences in preferences for physician-patient communication about prognosis; (2) (a) To examine whether and how the effect of gender varies by patient ethnicity, socioeconomic status, and parental status, and (b) To determine whether there are gender differences in coping styles, family support, and psychosocial distress, and whether these account for expected differences in communication preferences; and (3) To explore whether there are differences by patient gender in whether physicians tell patients when death is imminent.  The statistical method of structural equations modeling will be used to analyze these data.  Findings will contribute to the understanding of clinically important gender differences at the end of life, and provide the evidence base for a long-term program of research in gender differences at the end of life. (top of page)