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Cancer Communication Research Center
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Given my growing interest in long-term cancer survivors, I was excited to see the announcement for the 2012 Biennial Cancer Survivorship Research Conference "Cancer Survivorship Research: Translating Science to Care". The large number of cancer survivors in the U.S. (approximately 11.7 million) is reflective of the strides that have been made in the "war against cancer," due to factors such as early detection and effective treatment. In one sense, effective treatment of cancer marks an endpoint, but in another it represents a new beginning for survivors. We are now faced with the challenge of meeting the unique needs of cancer survivors. Cancer survivors have ongoing needs due to the long-term physical and psychological effects of cancer diagnosis and treatment, as well as other issues related to successful reintegration into society (e.g., workplace discrimination).

I am currently involved in a project exploring the promotion of lifestyle behavior change (e.g., dietary changes) in the care of cancer survivors. Although we are still in the early stages of the project, it is already evident that there is a lack of clarity regarding who is "responsible" for cancer survivors once they have completed active treatment. As Richard Wood discusses in his Nov. 23 blog, mandated cancer survivorship care plans will play an essential role in ensuring coordination of survivor care. I believe that the research discussed during the Cancer Survivorship Research Conference will inform efforts to develop cancer survivorship care plans that best address the needs of cancer survivors. I look forward to attending this conference to learn about both the scientific and programmatic work being conducted to enhance the care of cancer survivors.

Kisha Coa
2011 CCRC Doctoral Fellow
Johns Hopkins Bloomberg School of Public Health

Written by CCRC at 12:56

I currently take a Health Informatics course and I've been noticing some interesting trends in health information seeking behaviors within non-traditional contexts of new media and technology; particularly, social media and mobile phone use.

Social media is such a hot topic right now and the healthcare industry is still findings its place to fit in. Social media has shaped the way patients, physicians, care providers, and other medical professionals engage with health information and resources. The simple absorption of information is replaced by engagement with information. We can see from the literature that information-seeking behavior trends head towards personalization and tailored information (e.g., PatientsLikeMe, DiabetesMine, i[2]y), where everyday individuals are empowered with the tools to research, generate and share their own content. Sarasohn-Kahn (2008) describes this as Health 2.0, social software to promote collaboration between patients and other health stakeholders to create and consume information related to health. As Ginossar (2008) found, patients are not limited to seeking personal information, but they also offer information to others and demonstrate "information reply" helping behaviors more often than family members. Hawn (2009) also confirms the idea of a participatory health care system with Hello Health utilizing technology to benefit both the patient and the physician.

I wonder how much the attainment of personalized and tailored information affects information-seeking expectations as a whole in our everyday lives. A search for cancer information, for example, can yield "relevant" results within Google. However, this idea of "relevant" disease information really means "relevant information to me." I also think that this means new things for information competency. That is, finding information is no longer an issue; rather, sorting through information and determining personal relevance requires much higher-level skill and competency. Sorting through data means having at least some pre-existing knowledge or idea of what is relevant or not relevant to a health condition.

Additionally, mobile technology certainly perpetuates a phenomenon of ubiquitous computing. Personalization and tailored patterns also include preferred modes of delivery and media. Consumers desire information at their fingertips and mobile phones are especially powerful means of obtaining such information.

Undoubtedly, technology has influenced time expectations. "Waiting" to fill prescriptions, to book an appointment, or to communicate with one's physician are considered inconvenient and poor service. However, what sacrifices are individuals making by obtaining information and resources in the "now"? Is efficiency and convenience taking place of quality and efficacy? Hawn (2009) describes social media as "changing the locus of control to the patient," (p. 368) but are patients adequately informed or qualified to take the control? What things need to be done for them to be informed or qualified to take control?

References
Ginossar, T. (2008). Online participation: a content analysis of differences in utilization of two online cancer communities by men and women, patients and family members. Health Communication, 23(1), 1-12.

Hawn, C. (2009). Take two aspirin and tweet me in the morning: How Twitter, Facebook, and other social media are reshaping health care. Health Affairs, 28(2), 361-368.

Sarasohn-Kahn, J. (April 2008). The Wisdom of Patients: Health Care Meets Online Social Media. Oakland, CA: California Health Care Foundation.
(http://www.chcf.org/publications/2008/04/the-wisdom-of-patients-health-care-meets-online-social-media)

Rannie Teodoro
2011 CCRC Doctoral Fellow
Rutgers, The State University of New Jersey

Written by CCRC at 12:57

Missouri is unofficially referred to as the Show-Me State. As a native of the nation's 24th state, I was glad to go home to attend the annual Centers of Excellence in Cancer Communication (CECCR) meeting on the campus of Washington University in St. Louis, Missouri on October 10-12. As a (relatively) new Senior Research Assistant at KPCO, I was ready to learn more about each CECCR and to meet many of the people I only knew through e-mails. After two days of posters, presentations, and panels, Washington University and the other four CECCRs really showed me the amazing work that is being done in the field of cancer communication, and made me excited to be a part of it.

The first night was the poster presentation. I was immediately impressed by the quantity of posters that were submitted, not to mention the quality. On the final day of the meeting, the winners of the top three posters were announced. Rui Shi, a 2011 CCRC Doctoral Fellow and a PhD student at the University of Pennsylvania, took top prize. I was thrilled for her accomplishment.

The annual CECCR meeting consisted of members of the five centers: The Cancer Research Network-Cancer Communication Research Center (which Kaiser Permanente Colorado is a member), University of Michigan, University of Wisconsin, University of Pennsylvania, and Washington University. On the first full day, each CECCR presented the work being conducted at their location. While I was familiar with some of the studies the other CECCRs were doing, it was great to get a more in-depth analysis of the variety of work being done; from smoking cessation and media messages, to evaluating psychosocial factors in elderly cancer patients and using online support with CHESS, to studying referral systems and publishing newspapers with targeted and tailored health messages. Since some of the studies involve more than one CECCR site, I also saw the importance of collaboration. Each CECCR brings something different to the research table, which definitely strengthens a study.

In addition to the CECCR presentations, there were also three panels. Each panel comprised of individuals from different agencies and institutions who discussed topics which directly related to cancer communication, namely policy, cost of care, and challenges. One intriguing panel presentation was from Dr. Christine Berg from the National Cancer Institute. She discussed one study, the National Lung Screening Trial (NLST), which compared lung cancer deaths of those who were screened with chest X-rays with those screened with a low-dose helical CT. In sum, they found that current or former heavy smokers screened with the low-dose helical CT scan resulted in 20 percent fewer deaths from lung cancer than those screened with a chest X-ray. This is an important study and a valuable finding for the future of cancer detection. However, as it was noted throughout the meeting, smoking prevention and cessation are key to decreasing lung cancer rates.

Overall, the CECCR meeting was a great success. Though there are some challenges ahead, I'm optimistic about the contributions the great minds within the CECCR have on the future of cancer communication research. I'm looking forward to meeting with everyone again next year in Wisconsin.

Michelle Henton
Senior Research Assistant, CCRC
KPCO

Written by CCRC at 12:58

In the last decade, and especially after 2005 with the Institute of Medicine report From Cancer Patient to Cancer Survivor: Lost in Transition, a greater consensus has formed around the need for cancer survivorship care plans. (See the related IOM Fact Sheet.) This year the American College of Surgeons Commission on Cancer (CoC) decided to integrate survivorship care plans into their accreditation program standards. The CoC accreditation process will phase in requirements for survivorship care plans starting in 2015. These requirements are as follows:

(a) A survivorship care plan is prepared by the principal provider(s) who coordinated the oncology treatment for the patient with input from the patient's other providers.

(b) The survivorship care plan is given to the patient on completion of treatment.

(c) The written or electronic survivorship care plan contains a record of care received, important disease characteristics, and a follow-up care plan incorporating available and recognized evidence-based standards of care, when available. The minimum care plan standards are included in the Fact Sheet: Cancer Survivorship Care Planning, from the IOM.

Compliance with the new CoC survivorship care plan standards requires programs to fulfill two criteria:

1. The cancer committee has developed a process to disseminate a comprehensive care summary and follow-up plan to patients with cancer who are completing treatment.

2. Each year, the process is implemented, monitored, evaluated, and presented to the cancer committee.

From now to 2015 (and beyond) we have an opportunity to measure uptake as accredited cancer centers move from a current best practice to a future mandate. How exactly will this occur? Who are the agents of change? What are the barriers and facilitators? Perhaps by studying dissemination of survivorship care planning, we can learn something useful about transforming the standard of cancer care for the future.

The CoC standards point to care planning templates available from several sources such as the American Society of Clinical Oncology, National Coalition for Cancer Survivorship, and the Lance Armstrong Foundation (Livestrong). How will these templates differ? Will we see differences as drastic as those seen in the standards for mammography screening from the U.S. Preventive Services Task Force and the American Cancer Society? Livestrong has already taken initiative in defining what their survivorship care planning template(s) will consist of. In September 2011, a hundred leaders, stakeholders, and experts met with Livestrong to determine what elements are essential in survivorship care. (See both Livestrong Blog and Dr. Len's Cancer Blog for further details.) Other organizations such as UT MD Anderson Cancer Center have constructed long-term clinical practice algorithms around survivorship. Will these algorithms, or others like them, diffuse through organizations across the country as the 2015 CoC requirements for survivorship care planning draw closer? Will organizations create their own algorithms and templates?

There is currently quite a lot of flexibility for implementation of survivorship care plans both across and within healthcare organizations. This flexibility presents many opportunities for study. What will survivorship care plans look like? Will there be one standard template in an organization, or will there be multiple templates? Will the specifics of implementation be left up to each individual oncologist? Will survivorship care plans be updated? How often? Will they be utilized? Will the care plans be effective?

As we learn more about the needs of cancer survivors, we will continue to adapt our clinical standards and practices to better serve this emerging population. Our healthcare system can greatly benefit by learning how to best go about such a complex and dynamic process of change.

Richard Wood
2011 CCRC Doctoral Fellow
Texas A&M Health Science Center (TAMHSC) School of Rural Public Health

Written by CCRC at 12:58

Advertising Campaign and Organizational Identification in Health Care Organizations

Today, managed care, which developed from the need to reduce medical costs, has spawned new concerns about the quality of care Americans will receive from health care organizations. The challenge to provide patients with excellent and affordable health care is a challenge worthy of health care professionals' best efforts.

Facing the challenge, health care organizations may have difficulties in maintaining a clearly defined identity as other service organizations in terms of its complexity and unique physician-organizational relationship. In addition, given the recent struggles of policy makers in the United States to reform the U.S. health care system to balance issues of quality, access, and cost, understanding and managing organizational identity well has ever-increasing practical relevance. This relevance is especially clear given that any restructuring of health care will certainly have unanticipated consequences for the day-to-day provision and management of care. In this case, health care managers are increasingly aware that organizational identification influence key outcomes at work, including effort, cooperation, organizational support, and citizenship behaviors.

Existing research concludes that external communication aiming to build perceived external prestige for the organization helps to foster organizational identification. As an important form of external communication in organizations, advertising campaign is increasingly being used both externally and internally to influence health care consumers and stakeholders today. Besides sending messages externally to the public, advertising is also utilized by health care organizations as a self-enhancing tool to enhance their own values.

I've been working on a research project with my advisor for the past academic year on the possible effects of advertising campaigns on employees' organization identification in health care organizations. Through interview-based qualitative method, my project looked at employees' perceptions of advertising campaigns in a health care organization locally in Albany, and how their perceptions suggest that advertising campaigns can help to promote their identification with the organization. Analysis on the interview data found that the advertising campaigns in the health care organization does affect employees' sense of identification with it. Interestingly, some findings in the employees' evaluation of the campaigns are beyond my expectation. I was delighted to see that both health care professionals and non health care professional identify not only with the whole organization, but also with multiple targets such as their professional medical specialty as well as their work unit in the hospital.

However, due to strategy of recruitment, all of the interviewees in my sample are directly employed by the organization. As the problem of competing identifications to multiple identities becomes a challenge for health care organizations to promote employees' organization identification, future research may examine whether forms of external communication may affect health care providers' organization identification while they are having multiple identities, such as professional and organizational identities.

Sunny Zhao
2011 CCRC Doctoral Fellow
Department of Communication, University at Albany, State University of New York

Written by CCRC at 12:59

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