Browsing by Author "Schwartz, Peter"

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    Development of a Computer-Tailored Intervention/Decision Aid To Increase Colorectal Cancer Screening in Health Systems
    (Cureus, 2022-03-21) Fatima, Hala; Wajid, Maryiam; Krier, Connie; Champion, Victoria; Carter-Harris, Lisa; Shedd-Steele, Rivienne; Imperiale, Thomas F.; Schwartz, Peter; Strom, Sylvia; Magnarella, Mark; Rawl, Susan M.; Medicine, School of Medicine
    Background: Non-compliance with scheduled colonoscopy is common among patients, especially in underserved populations. High no-show and late cancelation rates result in wasted resources, increased costs, and missed opportunities for colorectal cancer (CRC) screening. Among the barriers to colonoscopy is a lack of knowledge about the benefits, fears, and limited time for patient counseling. Methodology: We produced a digital video disc and a website program to enhance awareness about CRC screening and address patient barriers in a population with low screening adherence. Results: Patients can be educated via an interactive computer-tailored intervention with both DVD and web versions. It details the benefits and need for CRC screening, different methods of screening, and addresses patient-related barriers. Conclusions: Patient education is crucial to increase CRC screening among eligible individuals. Because online engagement is affected by attention, interest, and affect, content should be concise but comprehensive.
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    Participant experiences in phase I pediatric oncology clinical trials
    (2017-08-31) Crane, Stacey M.; Haase, Joan E.; Hickman, Susan; Carpenter, Janet S.; Schwartz, Peter
    Phase I clinical trials (P1Ts) are the first step in testing new medical therapies in humans, and are essential for developing new and innovative therapies for children with cancer. P1Ts are ethically controversial as they are not intended to directly benefit participants, but are particularly controversial for children with cancer who are only able to participate when there is no known curative therapy for their cancer. Benefits of pediatric oncology P1T participation may include improved quality of life (QOL) and hope. Risks may include fostering unrealistic hope, burdening children with additional medical procedures and toxicities, and limiting the opportunity for palliation. The goal of this dissertation was to investigate the P1T participation experience for children with cancer and their parents by: (1) assessing what is currently known about the participation experience, (2) exploring ways to understand and assess treatment burden and QOL during participation, and (3) interviewing parents about the experience of having a child participate in a P1T. Following a review of the literature, two studies were conducted: a longitudinal pilot study of 13 parent and child dyads who enrolled in a pediatric oncology early phase clinical trial at the recruiting institution, and a phenomenological study of 11 parents of children with cancer who participated in pediatric oncology P1Ts. Key findings included a dearth of research on the experiences of children and parents in pediatric oncology P1Ts. Instead, existing research has focused on consent processes. The longitudinal pilot study provided some insight into experiences of children and parents during trial participation, including that there may be time points when parents’ and children’s perceptions of the child’s quality of life substantively differ. Interviews with parents confirmed some of the anticipated benefits and risks of participation in P1Ts, and highlighted parents’ sense of running out of time to find an effective treatment and needing to use time they have with their child well. Specific challenges in conducting this research were participant attrition due to disease progression and the need for multi-site research to obtain an adequate sample.
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    The Person That Asks the Question Controls the Conversation: College Students' Privacy Management with Physicians about Sexual Behavior
    (2019-09) Hernandez, Rachael; Petronio, Sandra; Bute, Jennifer; Hoffman-Longtin, Krista; Schwartz, Peter
    College students demonstrate a persistent lack of knowledge about safe sexual practices and engage in sexual behavior that puts them at risk for preventable health issues, specifically, sexually transmitted infections and unplanned pregnancy. Fortunately, physicians have an opportunity to provide accurate and timely information about safe sexual behavior to individuals in their care. However, many young people, and in particular young women, are reticent to talk to their physicians about sexual behavior because they typically consider the information to be private. They draw thick privacy boundaries around this information, leading to a missed opportunity to communicate about sexual behavior with their healthcare provider. Exacerbating this issue is the fact that many physicians are also uncomfortable discussing sexual topics with their patients. In this dissertation, Communication Privacy Management (CPM) theory is used to investigate the criteria that female college students employ to negotiate the disclosure and concealment of information about sexual behavior to physicians. Qualitative analysis of open-ended interviews with female college students were used to describe and explain the way college students perceive issues concerning disclosure of sexual behaviors to their physician. These findings have the potential to improve communication interventions both for female college students and healthcare professionals.
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    The Relationship Between Dementia Severity & Caregiver Preferences for Decision Making Role Regarding Mammography
    (Oxford University Press, 2021-12-17) Frank, Molly; Park, Seho; Lane, Kathleen; Torke, Alexia; Schonberg, Mara; Sachs, Greg; Schwartz, Peter; Fowler, Nicole; Biostatistics, School of Public Health
    The incidence of Alzheimer’s disease and related dementias (ADRD) and breast cancer increases with age. Despite being one of the most effective ways to diagnose breast cancer early, mammography in ADRD patients comes with an increased risk of treatment complications and false-positive results. Family caregivers are often involved in the decision-making process, and this study evaluates the relationship between dementia severity and caregiver preferences when making decisions about mammography with the patient alone, and with the patient and doctor. We included 181 caregivers from the Decisions about Cancer screening in Alzheimer’s Disease trial, which uses the Dementia Severity Rating Scale (DSRS) to assess dementia severity and a modified Control Preferences Scale (CPS) to assess each caregiver’s preferred decision-making approach. Multinomial logistic regression models evaluated the relationship between DSRS and CPS categories (active, passive, and collaborative), while controlling for the caregivers’ age, sex, race, education, and relationship to patient. Model 1 examined the caregivers’ preferred role with the patient, and it found a significant association between increased dementia severity and preference for a collaborative approach (p<0.001) or passive approach (p<0.05) compared to an active approach. Model 2 did not find a significant association between dementia severity and the caregivers’ preferred role when making decisions with the patient and doctor; however, those with increased age and education were more likely to prefer an active role. The association between dementia severity, caregiver characteristics, and decision-making preferences supports the need for approaches to support ADRD caregivers with medical decision making.
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    To Know and Be Known: Commercial Surrogacy and the Subordination of Children's Rights to the Desires of Adults
    (2024-05) McNally, Emily Brooke; Gunderman , Richard; Schwartz, Peter; Kahn, Samuel
    When Russia invaded Ukraine in February 2022, hundreds of couples around the world feared for the safety of their children—children they had never met. These couples are the intended parents to unborn children being carried by Ukrainian women in commercial surrogacy contracts. These surrogates are financially compensated for delivering a healthy infant, a job that becomes fraught with decision in the middle of a war zone. Staying put risks the perils of war but relocating to a safer jurisdiction may endanger the legal parenthood of the child. Most neighboring countries do not permit or even recognize surrogacy contracts. An estimated 2,000 babies are born through commercial surrogacy in Ukraine annually, mostly to foreign couples. Ukraine is a popular destination for “surrogacy tourism” because of its cost-effectiveness compared to other jurisdictions and because it is one of the few countries where the intended parents are named on the birth certificate without the need for a court order. The surrogacy industry in Ukraine is booming, with Kiev recognized as the global hub. There are over 50 reproductive clinics in the country, as well as many agencies and untold numbers of middlemen who match intended parents to prospective surrogates. On the surface, surrogacy seems like a win-win scenario for all parties involved. Surrogate women earn passive income, and an infertile couple receives a much-wanted and long-desired child. However, whenever technology advances to allow humanity to circumvent a natural process, bioethical questions need to be raised. This thesis will give a history of surrogacy and the broader world of assisted reproductive technologies (ART). I argue that surrogacy, even altruistic surrogacy, presents ethical dilemmas that ultimately cannot be resolved. To satisfy the advanced writing requirement for my J.D., I examine the comparative surrogacy laws of various jurisdictions to show that this unethical practice is made even more complicated due to a lack of a multi-state convention governing the practice. I conclude by offering recommendations for laws to be adopted in the United States that protect the rights and interests of children.