Transcript Here is a sample of an Outstanding Qualifying Presentation

Tricia Richards
Marywood University
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Quantitative research course
Subtopic of cancer education and health
disparities emerged during literature review
focused on participation in mammography
screening
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Cancer patients want to learn more
 Malignancy, effects, treatment, rehabilitation,
and prognosis
 Physicians are the most trusted source of
information, followed by online information
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Online activity
 Third most common online activity is health
information seeking (first two are e-mail and
general searching)
 As health care shifts toward increased patient
participation in decision making, this activity is
expected to increase
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Associated with various positive outcomes
Improved physical function, better quality of
life, greater levels of self-care, more informed
decision making, better compliance with
treatment, and improved coping skills
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Effectiveness linked to socioeconomic status
(SES) and educational levels
Lower SES patients experience
communication and cancer education
disparities due to barriers in accessing,
understanding and using health information
Factors related to inequalities:
 Lack of access to primary care physicians
 English as a second language
 Limited literacy
 Reduced access to mainstream sources of
health information
Cancer education inequalities
Information gaps
Disparities in health, cancer
outcomes, and mortality
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Understanding relationship between cancer
education and health outcomes will inform
strategies to reach and educate cancer
patients across all SES populations
Data related to social, behavioral, and
cognitive factors that contribute to inequities
provide guidance for educational
interventions
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Educational interventions may occur through
healthcare providers, mass communication,
reliable Internet sources, and public libraries
"How can the delivery of cancer education be
improved to reduce health disparities between
high- and low-income populations?"
Examined through lens of communication arts,
health care and library science
Conclude with ethics considerations and
integrated summary
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Inequities in cancer education
Access and potential benefits are not equitable
across SES groups
Education among goals of Healthy People 2020
and the Patient Protection & Affordable Care Act
Communication about health disparities
delivered through mass media refer to
communication that highlights, brings attention
to, or explains variances in health outcomes
among groups
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Mass media refers to message channels that
reach wide audiences
Messages delivered through mass media shape
public opinion and policy-related outcomes
 Raise awareness of disparities
 Position health disparities as a topic of priority
 Raise beliefs that societal influences are directly
related to health disparities
 Generating public support for relevant policies
 Mobilize patient advocacy groups to call for change
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Knowledge Gap Hypothesis: concept that
individuals with higher SES will acquire
information from mass media faster than
those with lower SES
Lower SES populations
 Lower access to mass media
 Weaker comprehension
 Lower levels of exposure to health information
through providers, materials and Internet
 Increasing digital use
Lack of reliable cancer education, or disparities
in health communication, creates informational
gaps, affecting health outcomes and widening
health disparities
 Informational gaps refer to the differences
among groups related to accessing, using,
retaining, and acting on information
 Reduce potential for lower SES groups to lower
their personal cancer risk or make informed
decisions regarding treatment of existing cancer
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Mass media and interpersonal
communication influence health beliefs
Theory of Planned Behavior posits that
health beliefs are associated with intentions
to participate in specific health behaviors and
eventually engage in the behavior
In this way, mass media influences public
health
Exposure does not equal comprehension
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Cancer-related news announcements
Death of Steve Jobs from pancreatic cancer
and Angelina Jolie's voluntary prophylactic
double mastectomy generated heavy news
coverage and word-of-mouth exposure
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News provides opportunity for education
People access multiple channels to learn
more: mobile, Internet, newspaper,
television, magazine, interpersonal (including
health care providers)
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Paternalistic to partnership
Greater patient participation
Improved communication leads to better
education and outcomes
Cancer education helps patients manage
physical and psychological effects
Patients want information on illness,
treatment, side effects, prognosis,
rehabilitation, survivorship, end-of-life care
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Physicians are most trusted source
Providers aren’t always available
 Hectic schedules
 Questions outside of encounters
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Patients turn to Internet
Nearly 60% of American adults use Internet
for health information
Motivation influenced by: SES, health status,
access to Internet resources
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Lower SES and lower education associated
with lower self-efficacy
Differences in accessibility, use and
comprehension impact health outcomes
Motivation-contingency model suggests that
low-SES cancer patients seek and develop
knowledge when they have strong
motivation or interest
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Approximately two-thirds of cancer patients
use Internet resources for cancer information
Increasing trend
 Aging population
 Number of diagnoses and survivors
 Spike in awareness campaigns
 Situational factors
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Knowledge applied to decision making, so it
needs to be reliable
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Content varies in quality, accuracy and
reliability
Lack of regulation means much is incorrect
Patients want physicians to determine what
information is appropriate for them and what
resources they should use
National Library of Medicine and American
College of Physicians piloted a project to
meet health information needs; 2010 report
shows success
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Physicians want patients to be active in their
cancer care
Education is encouraged to maximize
benefits of interaction
Physicians may share resources that are
linguistically sensitive, secure, beneficial
Library partnerships have shown success
because of physician referrals
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Some health education efforts shifted from
providers to libraries
President Obama called for public librarians
to advance consumer health literacy
Libraries offer accessibility, expertise and
resources for training and information
Inequalities in such access have historically
led to health inequities
Librarians viewed as trusted source
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Lower-income groups are using libraries
more than ever
Physicians are trusted referents
Librarian training on consumer health
information to assist patrons with barriers
Librarians help patrons determine reliability
of resources
Increased interest in topics informs collection
development
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Pilot study showed that consumer health
information was among top areas of interest
for public library visitors
Health literacy named national priority and
focus of public policy Institute of Medicine,
National Library of Medicine, and US
Department of Health and Human Services
Health literacy refers to skill to access health
information and capability to comprehend it
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Libraries positioned to help
Increased librarian education
 Assisting patrons with health information
 Tailoring information to diverse groups
 Increasing health literacy among users
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Collaborative efforts with health care
systems and providers
Partnerships continue to increase to meet
stronger consumer needs
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Library system improvements related to
consumer health information are part of
significant change in how librarians view their
role in public health
Result is greater appreciation of reference
services and increased usage
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Patients use information to participate more
actively and make informed decisions about
self-management and treatment options
Patient education is part of legal and ethical
obligation known as informed consent or
informed choice
Grew from movement toward patient selfdetermination and individual autonomy as
relationship model evolved
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Code of Ethics for the Health Education
Profession approved in 2011 by the Coalition
of National Health Education Organization
Upholds the rights of patients to make
informed decisions, provided decisions cause
no harm to others
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Health educators expected to accurately
educate patients about potential risks,
benefits, and outcomes
End goal of patient education is increased
autonomy
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Kantian theory identifies autonomy as the
ability to govern oneself using reason and
supports the ideal of respecting the dignity of
others
Reasonable patients typically choose care
Ethical implications arise when patients who
are educated about their illness decline care
Others choose not to be educated about
outcomes causing fear or anxiety
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Kant applies the idea of autonomy to
reasonable individuals who are worthy of
respect by others
Patients may not be reasonable or rational
A Kantian approach may carry the ethical
burden of determining what actions will
advance patients' free will and dignity
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Ethicists may see multiple physician choices
when a patient declines treatment:
 Implement care out of beneficence, respect for
others, and duty of care
 Delay treatment in expectation of greater patient
competence in the near future
 Honor the patient’s wishes out of respect for
patient free will and dignity
 Attempt persuasion to reconsider
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Choices guided by ethical behavior and law
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Cancer patients want to learn as much as
possible about all aspects of their illness
Patients educated about their illness have
 Improved physical function
 Greater self-efficacy
 More informed decision making
 Better compliance with treatment
 More positive outcomes than patients who are
not educated about their illness
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Lower SES populations have less ability to
access, use and understand cancer
information
Lack of information leads to gaps that affect
health outcomes
Patients need clear, relevant, useful
information from trusted resources
Physicians are most trusted referents
Patients want resource recommendations
Research has shown several methods to
improve delivery of cancer education to reduce
health disparities:
 Use of mass media
 Improved patient-physician communication
 Physician referrals to reliable resources
 Collaboration with medical and public librarians
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Little research on low-SES population’s use of
public libraries specifically for health
information
Many collaborative efforts among health care
providers and public libraries are still fairly
new and may not have longitudinal data
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General: Recommend research and
promotion of programs that enhance health
literacy among all populations
Personal: Incorporate these findings into
dissertation examining behavioral predictors
of participation in cancer screening activities
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Invitation for questions and comments
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Yes. Many health care organizations are using
physician extenders, such as physician
assistants, nurses, and health promotion
professionals, to educate cancer patients.
While there is much benefit to that, patients
name their physician as their most trusted
source of information and express desire to
receive more information directly from their
physician.
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There is no regulation on health information
online, but some organizations are working
on developing tools to measure the accuracy
and effectiveness of online information. In
the meantime, reliability is being determined
by the credibility of the organization that
publishes the information (JAMA, CDC, etc.).
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In consideration of varying literacy levels and
the readers’ potential distraction of
emotional distress related to health issues,
most health information is written at a sixth
grade level.
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