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Lisa Carter-Harris
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The decision to screen for lung cancer is difficult. Lung cancer screening can reduce lung cancer mortality in high-risk populations. Still, there are potential harms associated with lung cancer screening that includes false-positive results, over-diagnosis, radiation exposure, and incidental findings. The decision to screen for lung cancer is best made in the context of shared decision making, where clinicians and patients weigh the benefits and risks of screening and make informed decisions together. This critical patient-clinician communication is challenged by low levels of awareness about lung cancer screening among high-risk populations.
Dr. Lisa Carter-Harris and her team have developed LungTalk, a computer-tailored decision support tool, to help prepare high-risk patients to engage in a discussion about lung health and screening with their clinician, make a decision about lung cancer screening, and intervene with current smokers to consider cessation.
LungTalk is unique in that content is tailored by smoking status, and includes key information in the form of a tailored print-out to help the patient initiate this important conversation with their clinician. LungTalk also includes a cognitive embodiment game meant to increase negative perceptions toward cigarettes and smoking to promote cessation.
Dr. Carter-Harris’ work to improve patient-clinician communication and shared decision-making in the complex decision of lung cancer screening is another example of how IUPUI faculty are TRANSLATING RESEARCH INTO PRACTICE.
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Browsing Lisa Carter-Harris by Author "Carter-Harris, Lisa"
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Item Beyond Traditional Newspaper Advertisement: Leveraging Facebook-Targeted Advertisement to Recruit Long-Term Smokers for Research(JMIR Publications, 2016) Carter-Harris, Lisa; Bartlett Ellis, Rebecca J.; Warrick, Adam; Rawl, Susan; IU School of NursingBACKGROUND: Smokers are a stigmatized population, but an important population to reach for the purpose of research. Therefore, innovative recruitment methods are needed that are both cost-effective and efficacious in recruiting this population. OBJECTIVE: The aim of the present article was to evaluate the feasibility of Facebook-targeted advertisement to recruit long-term smokers eligible for lung cancer screening for a descriptive, cross-sectional survey. METHODS: A social media recruitment campaign was launched using Facebook-targeted advertisement to target age and keywords related to tobacco smoking in the Facebook users profile, interests, and likes. A 3-day newspaper advertisement recruitment campaign was used as a comparison. The study that used both recruitment methods aimed to test the psychometric properties of 4 newly developed lung cancer screening health belief scales. Data were collected via cross-sectional survey methodology using an Web-based survey platform. RESULTS: The Facebook-targeted advertisements were viewed 56,621 times over an 18-day campaign in 2015 in the United States. The advertisement campaign yielded 1121 unique clicks to the Web-based survey platform at a cost of $1.51 per completed survey. Of those who clicked through to the study survey platform, 423 (37.7%) consented to participate; 92 (8.2%) dropped out during completion of the survey yielding a final study pool of 331 completed surveys. Recruitment by newspaper advertisement yielded a total of 30 participants in response to a 3-day advertisement campaign; recruitment efficacy resulted in 10 participants/day at $40.80 per completed survey. Participants represented current (n=182; 51%) and former smokers (n=178; 49%) with a mean age of 63.4 years (SD 6.0). Cost of the advertisement campaign was $500 total for the 18-day campaign. CONCLUSIONS: Recruitment by Facebook was more efficacious and cost-effective compared with newspaper advertisement. Facebook offers a new venue for recruitment into research studies that offer the potential for wider reach at a lower cost while providing privacy and flexibility for potential study participants. The study's findings extend recent work of other researchers who have demonstrated Facebook's utility with younger smokers, and Facebook is an effective tool to recruit older smokers. Furthermore, Facebook is a cost-effective alternative to traditional newspaper advertisement offering a new, affordable venue to recruit large numbers of older smokers efficiently.Item Current Smokers’ Preferences for Receiving Cessation Information in a Lung Cancer Screening Setting(Springer, 2017) Carter-Harris, Lisa; Schwindt, Rhonda; Bakkoyannis, Giorgos; Ceppa, DuyKhanh Pham; School of NursingThe purpose of this study was to identify current smokers’ communication format preferences for receiving smoking cessation information in a lung cancer screening setting. A cross-sectional correlational design using survey methodology with 159 screening-eligible current smokers was the method used. Data was dichotomized (digital versus traditional preference) and analyzed using Pearson’s chi-squared test, Mann-Whitney U test, and logistic regression. Race was a statistically significant predictor with White participants having four times greater odds of reporting preference for a digital format for receiving smoking cessation information such as social media and/or supportive text messages (OR: 4.06; p = 0.004). Lung cancer screening is a new venue where current long-term smokers can be offered information about smoking cessation while they are engaging in a health-promoting behavior and potentially more likely to contemplate quitting. It is important to consider the communication format preference of current smokers to support cessation uptake. This study is the first to examine communication format preference of current smokers in the context of the lung cancer screening venue. Key differences noted by race support the need for further research examining multiple formats of communication with efforts to maximize options in the cancer screening setting.Item Development and Psychometric Evaluation of the Lung Cancer Screening Health Belief Scales(Lippincott, Williams, and Wilkins, 2016-05) Carter-Harris, Lisa; Slaven, James E., II; Monohan, Patrick; Rawl, Susan M.; IU School of NursingBackground: Lung cancer screening is a recent recommendation for long-term smokers. Understanding individual health beliefs about screening is a critical component in future efforts to facilitate patient-provider conversations about screening participation. Objective: The aim of this study was to describe the development and psychometric testing of 4 new scales to measure lung cancer screening health beliefs (perceived risk, perceived benefits, perceived barriers, self-efficacy). Methods: In phase I, 4 scales were developed from extensive literature review, item modification from existing Breast and Colorectal Cancer Screening Health Belief Scales, focus groups with long-term smokers, and evaluation/feedback from a panel of 10 content experts. In phase II, we conducted a survey of 497 long-term smokers to assess the final scales’ reliability and validity. Results: Phase I: content validity was established with the content expert panel. Phase II: internal consistency reliability of the scales was supported with Cronbach’s α’s ranging from .88 to .92. Construct validity was established with confirmatory factor analysis and testing for differences between screeners and nonscreeners in theoretically proposed directions. Conclusions: Initial testing supports the scales are valid and reliable. These new scales can help investigators identify long-term smokers more likely to screen for lung cancer and are useful for the development and testing of behavioral interventions regarding lung cancer screening. Implications for Practice: Development of effective interventions to enhance shared decision making about lung cancer screening between patients and providers must first identify factors influencing the individual’s screening participation. Future efforts facilitating patient-provider conversations are better informed by understanding the perspective of the individual making the decision.Item Development and Usability Testing of a Computer-Tailored Decision Support Tool for Lung Cancer Screening: Study Protocol(JMIR, 2017) Carter-Harris, Lisa; Comer, Robert Skipworth; Goyal, Anurag; Vode, Emilee Christine; Hanna, Nasser; Ceppa, DuyKhanh; Rawl, Susan M.; School of NursingBackground: Awareness of lung cancer screening remains low in the screening-eligible population, and when patients visit their clinician never having heard of lung cancer screening, engaging in shared decision making to arrive at an informed decision can be a challenge. Therefore, methods to effectively support both patients and clinicians to engage in these important discussions are essential. To facilitate shared decision making about lung cancer screening, effective methods to prepare patients to have these important discussions with their clinician are needed. Objective: Our objective is to develop a computer-tailored decision support tool that meets the certification criteria of the International Patient Decision Aid Standards instrument version 4.0 that will support shared decision making in lung cancer screening decisions. Methods: Using a 3-phase process, we will develop and test a prototype of a computer-tailored decision support tool in a sample of lung cancer screening-eligible individuals. In phase I, we assembled a community advisory board comprising 10 screening-eligible individuals to develop the prototype. In phase II, we recruited a sample of 13 screening-eligible individuals to test the prototype for usability, acceptability, and satisfaction. In phase III, we are conducting a pilot randomized controlled trial (RCT) with 60 screening-eligible participants who have never been screened for lung cancer. Outcomes tested include lung cancer and screening knowledge, lung cancer screening health beliefs (perceived risk, perceived benefits, perceived barriers, and self-efficacy), perception of being prepared to engage in a patient-clinician discussion about lung cancer screening, occurrence of a patient-clinician discussion about lung cancer screening, and stage of adoption for lung cancer screening. Results: Phases I and II are complete. Phase III is underway. As of July 15, 2017, 60 participants have been enrolled into the study, and have completed the baseline survey, intervention, and first follow-up survey. We expect to have results by December 31, 2017 and to have data analysis completed by March 1, 2018. Conclusions: Results from usability testing indicate that the computer-tailored decision support tool is easy to use, is helpful, and provides a satisfactory experience for the user. At the conclusion of phase III (pilot RCT), we will have preliminary effect sizes to inform a future fully powered RCT on changes in (1) knowledge about lung cancer and screening, (2) perceived risk of lung cancer, (3) perceived benefits of lung cancer screening, (4) perceived barriers to lung cancer screening, (5) self-efficacy for lung cancer screening, and (6) perceptions of being adequately prepared to engage in a discussion with their clinician about lung cancer screening.Item Development of a Short Version of the Cataldo Lung Cancer Stigma Scale(Taylor and Francis, 2015) Carter-Harris, Lisa; Hall, Lynne A.; IU School of NursingLung cancer stigma is an important phenomenon experienced by many lung cancer patients that can be a barrier to medical help-seeking behavior. The purpose of this study was to shorten the Cataldo Lung Cancer Stigma Scale (CLCSS). The original 31-item scale had excellent internal consistency reliability but item redundancy. The majority of lung cancer patients are diagnosed at an advanced stage, and patient burden with survey completion may be higher in this population. To reduce patient burden with participation in lung cancer stigma-related research, a psychometrically sound short measure of lung cancer stigma is valuable. Factor analysis was used to evaluate the dimensionality of the CLCSS. Results were used to shorten the measure to 21 items. The shortened scale showed strong evidence of internal consistency reliability (Cronbach's alpha =.93). Results also indicate the scale is three dimensional with reliable subscales: stigma and blame, social isolation, and discrimination.Item Impact of smoke-free ordinance strength on smoking prevalence and lung cancer incidence(PLOS, 2021-04-16) Nguyen, Ryan H.; Vater, Laura B.; Timsina, Lava R.; Durm, Gregory A.; Rupp, Katelin; Wright, Keylee; Spitznagle, Miranda H.; Paul, Brandy; Jalal, Shadia I.; Carter-Harris, Lisa; Hudmon, Karen S.; Hanna, Nasser H.; Loehrer, Patrick J.; Ceppa, DuyKhanh P.; Surgery, School of MedicineBackground: Smoke-free ordinances (SFO) have been shown to be effective public health interventions, but there is limited data on the impact SFO on lung cancer outcomes. We explored the effect of county-level SFO strength with smoking prevalence and lung cancer incidence in Indiana. Methods: We obtained county-level lung cancer incidence from the Indiana State Cancer Registry and county-level characteristics from the Indiana Tobacco Prevention and Cessation Commission's policy database between 1995 and 2016. Using generalized estimating equations, we performed multivariable analyses of smoking prevalence and age-adjusted lung cancer rates with respect to the strength of smoke-free ordinances at the county level over time. Results: Of Indiana's 92 counties, 24 had a SFO by 2011. In 2012, Indiana enacted a state-wide SFO enforcing at least moderate level SFO protection. Mean age-adjusted lung cancer incidence per year was 76.8 per 100,000 population and mean smoking prevalence per year was 25% during the study period. Counties with comprehensive or moderate SFO had a smoking prevalence 1.2% (95% CI [-1.88, -0.52]) lower compared with counties with weak or no SFO. Counties that had comprehensive or moderate SFO also had an 8.4 (95% CI [-11.5, -5.3]) decrease in new lung cancer diagnosis per 100,000 population per year compared with counties that had weak or no SFO. Conclusion: Counties with stronger smoke-free air ordinances were associated with decreased smoking prevalence and fewer new lung cancer cases per year. Strengthening SFO is paramount to decreasing lung cancer incidence.Item An introduction to key event mapping: A primer for nurse researchers(Elsevier, 2015-05) Carter-Harris, Lisa; Indiana University School of NursingTo fully understand the events leading to a diagnosis, retrospective recall can help nurse researchers reconstruct important health behavior-related events. However, retrospective recall can be a challenge. Key event mapping offers nurse researchers a method beyond retrospective chart review to elicit date data to explore the pre-diagnosis time frame of an illness. The purpose of this paper is to introduce the key event mapping method to nurse researchers in search of a method of eliciting date data from participants when designing research studies that include a retrospective recall component.Item Lung cancer screening and stigma: Do smoking-related differences in perceived lung cancer stigma emerge prior to diagnosis?(APA, 2021) Williamson, Timothy J.; Rawl, Susan M.; Kale, Minal S.; Carter-Harris, Lisa; School of NursingBackground: Most lung cancer patients report experiencing stigma (i.e., devaluation based on one’s lung cancer diagnosis), which is associated with adverse health outcomes. Lung cancer is stigmatized due to its robust association with smoking and the perception of the disease as self inflicted. Purpose: Identifying sociodemographic and smoking-related correlates of perceived stigma among lung cancer screening-eligible adults (early in the cancer care trajectory) is needed to guide proactive psycho social interventions to reduce stigma and improve health for patients newly diagnosed with lung cancer. Methods: A national sample of lung cancer screening eligible adults (N = 515; 64.9% female) completed questionnaires on sociodemographic information, smoking-related characteristics, and perceived smoking-related lung cancer stigma. Zero-order and multivariate relationships between sociodemographic variables, smoking-related characteristics, and stigma were evaluated using Pearson’s correlations, t-tests, ANOVAs, and multivariable regression. Results: The multivariable regression demonstrated that younger age (b = -0.05, p = .047) was associated significantly with higher stigma. Additionally, women (b = 0.63, p = .015), participants who reported Hispanic/Latino ethnicity (b = 1.07, p = .049), and those with a college degree or higher (all p < .029) reported significantly higher stigma, compared to men, those who did not report Hispanic/Latino ethnicity, and other education categories, respectively. None of the smoking-related characteristics were associated significantly with perceived stigma (all p > .12). Conclusions: Sociodemographic variables (rather than smoking-related characteristics) significantly and uniquely differentiated lung cancer screening-eligible adults’ perception of lung cancer stigma. Smoking-related differences in lung cancer stigma may emerge following rather than prior to diagnosis.Item Lung Cancer Screening Participation: Developing a Conceptual Model to Guide Research(Springer, 2016-11-01) Carter-Harris, Lisa; Davis, Lorie L.; Rawl, Susan M.; School of NursingPurpose: To describe the development of a conceptual model to guide research focused on lung cancer screening participation from the perspective of the individual in the decision-making process. Methods: Based on a comprehensive review of empirical and theoretical literature, a conceptual model was developed linking key psychological variables (stigma, medical mistrust, fatalism, worry, and fear) to the health belief model and precaution adoption process model. Results: Proposed model concepts have been examined in prior research of either lung or other cancer screening behavior. To date, a few studies have explored a limited number of variables that influence screening behavior in lung cancer specifically. Therefore, relationships among concepts in the model have been proposed and future research directions presented. Conclusion: This proposed model is an initial step to support theoretically based research. As lung cancer screening becomes more widely implemented, it is critical to theoretically guide research to understand variables that may be associated with lung cancer screening participation. Findings from future research guided by the proposed conceptual model can be used to refine the model and inform tailored intervention development.Item Lung cancer screening: what do long-term smokers know and believe?(Wiley, 2015) Carter-Harris, Lisa; Ceppa, DuyKhanh Pham; Hanna, Nasser; Rawl, Susan M.; Department of Surgery, IU School of MedicineObjective To explore knowledge and beliefs of long-term smokers about lung cancer, associated risk factors and lung cancer screening. Design Qualitative study theoretically framed by the expanded Health Belief Model based on four focus group discussions. Content analysis was performed to identify themes of knowledge and beliefs about lung cancer, associated risk factors and lung cancer screening among long-term smokers' who had and had not been screened for lung cancer. Methods Twenty-six long-term smokers were recruited; two groups (n = 9; n = 3) had recently been screened and two groups (n = 7; n = 7) had never been screened. Results While most agreed lung cancer is deadly, confusion or inaccurate information exists regarding the causes and associated risk factors. Knowledge related to lung cancer screening and how it is performed was low; awareness of long-term smoking's association with lung cancer risk remains suboptimal. Perceived benefits of screening identified include: (i) finding lung cancer early; (ii) giving peace of mind; and (iii) motivation to quit smoking. Perceived barriers to screening identified include: (i) inconvenience; (ii) distrust; and (iii) stigma. Conclusions Perceived barriers to lung cancer screening, such as distrust and stigma, must be addressed as lung cancer screening becomes more widely implemented. Heightened levels of health-care system distrust may impact successful implementation of screening programmes. Perceived smoking-related stigma may lead to low levels of patient engagement with medical care and decreased cancer screening participation. It is also important to determine modifiable targets for intervention to enhance the shared decision-making process between health-care providers and their high-risk patients.
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