Lisa Carter-Harris

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https://hdl.handle.net/1805/14108

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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Lung cancer stigma predicts timing of medical help-seeking in individuals with lung cancer
(2014-05) Carter-Harris, Lisa; Hermann, Carla P.; Schreiber, Judith A.; Weaver, Michael T.; Rawl, Susan M.; IU School of Nursing
Purpose/Objectives To examine relationships among demographic variables, healthcare system distrust, lung cancer stigma, smoking status, and timing of medical help–seeking behavior in individuals with symptoms suggestive of lung cancer after controlling for ethnicity, socioeconomic status, and social desirability. Design Descriptive, cross-sectional, correlational study. Setting Outpatient oncology clinics in Louisville, KY. Sample 94 patients diagnosed in the past three weeks to six years with all stages of lung cancer. Methods Self-report, written survey packets were administered in person followed by a semistructured interview to assess symptoms and timing characteristics of practice-identified patients with lung cancer. Main Research Variables Timing of medical help–seeking behavior, healthcare system distrust, lung cancer stigma, and smoking status. Findings Lung cancer stigma was independently associated with timing of medical help–seeking behavior in patients with lung cancer. Healthcare system distrust and smoking status were not independently associated with timing of medical help–seeking behavior. Conclusions Findings suggest that stigma influences medical help–seeking behavior for lung cancer symptoms, serving as a barrier to prompt medical help–seeking behavior. Implications for Nursing When designing interventions to promote early medical help–seeking behavior in individuals with symptoms suggestive of lung cancer, methods that consider lung cancer stigma as a barrier that can be addressed through public awareness and patient-targeted interventions should be included.
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 Nursing
Lung 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.
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 Medicine
Objective 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.
Pathways to a Lung Cancer Diagnosis
(Wiley, 2015-03) Carter-Harris, Lisa; Hermann, Carla P.; Burke Draucker, Claire; School of Nursing
Purpose The purpose of this qualitative descriptive study was to identify and describe pathways to a lung cancer diagnosis based on narratives of persons diagnosed with the disease. Data sources Eleven adults with lung cancer were recruited from an academic thoracic oncology clinic in a large city in the southeastern United States. Moderately structured interviews were conducted by an experienced nurse practitioner (NP) to obtain information regarding the participants’ experiences leading to their diagnosis. Qualitative content analysis was used to develop a typology of pathways. Conclusions Findings revealed four distinct pathways: missing opportunities, waiting and seeing, being alarmed, and being blindsided. Implications for practice The Pathways to a Lung Cancer Diagnosis Typology has important implications for clinical practice and can be used to inform NPs and other healthcare providers who provide care for patients at risk for or diagnosed with lung cancer.
Lung cancer stigma as a barrier to medical help-seeking behavior: Practice implications
(John Wiley & Sons, Inc., 2015-03-03) Carter-Harris, Lisa; School of Nursing, Indiana University
Purpose The purpose of this study was to examine the relationship of perceived lung cancer stigma and timing of medical help-seeking behavior in symptomatic individuals. Data sources A convenience sample was recruited from an academic thoracic oncology clinic and community hospital-based outpatient radiation center in a large city in the southeastern United States. This descriptive, cross-sectional study used survey methodology and semi-structured interviews to examine the relationship of perceived lung cancer stigma and delayed medical help-seeking finding a statistically significant positive correlation. Additional examination revealed positive correlations between the stigma and shame, social isolation, and smoking-related stigma subscales and delay. The discrimination-related subscale was not associated with delay. In addition, smoking status was not related to perceived lung cancer stigma. Conclusions Findings support an association between lung cancer stigma and delayed medical help-seeking behavior. Therefore, lung cancer stigma is a potential barrier to timely medical help-seeking behavior in lung cancer symptoms, which can have important patient outcome implications. Implications for practice As primary care nurse practitioners, awareness that lung cancer stigma exists for patients is essential regardless of smoking status and efforts to decrease this barrier to timely healthcare are important.
An introduction to key event mapping: A primer for nurse researchers
(Elsevier, 2015-05) Carter-Harris, Lisa; Indiana University School of Nursing
To 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.
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 Nursing
BACKGROUND: 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.
Preparing Students for Success on Examinations: Readiness Assurance Tests in a Graduate-Level Statistics Course
(Healio, 2016-01) Bartlett Ellis, Rebecca J.; Carter-Harris, Lisa; MacLaughlin, Pam; School of Nursing
Formative feedback is one way to foster students' readiness for statistics examinations. The use of Readiness Assurance Tests was examined as an educational intervention in which feedback was provided for both correct and incorrect responses in a graduate-level statistics course. Examination scores in the intervention group ( n = 56) were compared with those in a control group ( n = 42). Intervention group examination scores significantly improved from 75.92 ± 14.52 on the Readiness Assurance Test to 90.06 ± 7.06, p < .001, on the midterm, and final examination scores improved from 78.23 ± 17.29 to 85.6 ± 6.98, p = .002. Intervention group midterm scores were significantly higher than those of the control group (90.06 ± 7.06 versus 79.7 ± 11.6, p < .001); however, no differences were found between the groups on the final examination (85.35 ± 9.46 versus 85.6 ± 6.98, p = .91). Use of Readiness Assurance Tests was an effective modality to increase student self-efficacy, learning experience, and, relative to a control group, midterm examination performance in statistics
Stigma, Smoking and Social Influence in Health Beliefs about Lung Cancer Screening
(Office of the Vice Chancellor for Research, 2016-04-08) Randle, Alexxis; Carter-Harris, Lisa
Background: Lung cancer is the leading cause of all cancer-related deaths in the United States. 158,080 people are expected to die from lung cancer in 2016. Most people are diagnosed at an advanced stage. Lung cancer screening, a recent recommendation by the United States Preventive Services Task Force, is associated with a 20% decreased relative mortality risk secondary to finding lung cancer at an earlier stage. Lung cancer screening is affected by patient, provider, and healthcare system variables. From the patient perspective, individual health beliefs have been shown to predict cancer screening participation in other cancers and are likely associated with lung cancer screening participation. In order for lung cancer screening to be effective, we must first understand what factors affect individual health beliefs about screening. The purpose of this study was to examine the association of social influence and cigarette smoking on individual health beliefs related to lung cancer screening and identify variables associated with stigma in screening-eligible current and former smokers. Methods: Descriptive, cross-sectional design using survey methodology (N=497). Convenience sample of lung cancer screening-eligible smokers. Data collected online measuring sociodemographic variables and lung cancer screening health beliefs. Results: We tested for associations between various variables and perceived smoking-related stigma, along with associations between number of cigarette pack-years, social influence and individual health beliefs (perceived risk, perceived benefits, perceived barriers, self-efficacy). Higher number of cigarette pack-years was associated with perceived barriers to lung cancer screening (p=.022). Higher levels of social influence were associated with perceived benefits of (p<.001) and self-efficacy for (p<.001) lung cancer screening. Conclusions: Results from this study indicate higher pack-year cigarette smoking history, social influence, and stigma may be important components to health beliefs and lung cancer screening participation. Future research is needed to explore the relationships more fully.
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 Nursing
Background: 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.

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