The advent of prostate-specific antigen (PSA) testing dramatically increased the diagnosis of prostate cancers in the United States. Many PSA-detected cancers are considered indolent, but men with these low-risk cancers usually opt for active treatments even though evidence suggests that these treatments offer no survival benefit and often adversely affect quality of life. Consequently, guidelines recommend offering these men active surveillance (AS), a strategy of
closely monitoring cancers with biopsies and PSA tests and offering active treatment only with biochemical or histological evidence of progression. However, decisions about treating prostate cancer often are not well informed, made with undue haste, and can be inconsistent with personal values. Men face particularly difficult decisions in selecting AS because they must weigh the anxiety of living with an untreated cancer and the complication risks of repeat biopsies against avoiding harm from potentially unnecessary treatment. Anxiety persists even after selecting AS, about 20% of the men who switch to active treatment do so in the absence of any clinical trigger. Understanding the decision factors influencing adherence to AS is crucial for developing interventions to reduce unnecessary treatments. The objective of this proposal is to conduct formative research identifying patient, provider, and decisional factors associated with adhering to AS.
The specific aims of the proposal are:
Aim 1. Conduct interviews with men on active surveillance to understand decision factors associated with selecting and adhering with active surveillance. We used information from the KPNC study and literature review to inform the interview guides. We interviewed men at the University of Iowa and Georgetown University with a low-risk prostate cancer who had initially selected active surveillance and had undergone surveillance monitoring.
Aim 2. Using the results from Aim 1, develop draft instruments to predict uptake and adherence with active surveillance. We conducted two rounds of cognitive interviews to evaluate the instruments.
Findings from this research could inform development of AS decision-support tools and strategies that could ultimately lead to reducing the burden of prostate cancer treatment in men with low-risk prostate cancer.
Seaman AT, Taylor KL, Davis K, Nepple KG, Lynch JH, Oberle AD, Hall IJ, Volk RJ, Reisinger HS, Hoffman RM: Why men with a low-risk prostate cancer select and stay on active surveillance: A qualitative study. PLoS One 2019, 14(11):e0225134.
Oral health is recognized as a critical requirement for overall health, sharing common risk factors with other chronic diseases. Accordingly, public health activities increasingly integrate dental services with primary health care. National public health priorities reflect the aim of medical and dental integration in order to optimize health outcomes. Notably, Healthy People 2020 objectives call for increasing the proportion of adults who receive chronic disease preventive services in dental settings, including tobacco screenings and cessation counseling, testing and referrals for glycemic control, screenings for oral and pharyngeal cancer, and dental visits for persons with diabetes. This project addresses integration of oral health and primary care. The objective of this project is to identify best practices for medical and dental integration in public health activities and to identify opportunities to include oral health in the ongoing climate of health care reform. In order to achieve this objective, this project will include an environmental scan of the role of public health in public health transformations. Results from this environmental scan will contribute to two of the four domains of the CDC’s Chronic Disease Prevention System, which aims to optimize public health efficiency and effectiveness through coordinated chronic disease prevention. Specifically, this project will address Domain 3, “Health Care System Interventions”, by identifying high-impact public health programs and policies that can improve delivery and use of evidence-based clinical services to prevent disease, detect diseases early, and manage risk factors. Outputs will also address Domain 4, “Community Programs Linked to Clinical Services”, by identifying
strategies that link high risk populations with existing public health services. Study aims include: 1) conducting an environmental scan for programs, services, and policies that link oral health and primary care; 2) analyzing collected data in order to identify programmatic gaps and opportunities; and 3) developing recommendations of best practices to integrate oral health and primary systems of care. Results from these activities will provide policy makers and public health officials with comprehensive information about what is currently occurring within state, tribal, and local governmental and non-profit public health entities surrounding oral health integration with chronic disease programs and health care reform. These efforts will allow future efforts by dental public health stakeholders to effectively and efficiently coordinate activities with primary care providers, based on recommended best practice approaches, in order to maximize chronic disease prevention and improve oral health alongside general health.
Medical-Dental Integration in Public Health Settings: An Environmental Scan. Iowa City, IA: University of Iowa Public Policy Center; 2018..