Low awareness of and referral to National Cancer Information Resources among physicians.
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ABSTRACT: PURPOSE: The concept of providing personalised care plans for cancer survivors is receiving increasing attention; a recognised element of a care plan is to provide an indication of the risks and consequences of treatment. This paper reports health care professional (HCP) response to providing cancer survivors with information on potential late effects of their cancer treatment. METHODS: Eighteen HCPs from five cancer centres and three general practices in the UK completed semi-structured interviews which were digitally recorded, transcribed and qualitatively analysed using framework analysis. RESULTS: HCPs' view of health care was that it is currently focused on acute care and needs are responded to as they may arise, including those which are late effects of cancer treatments. The concept of pre-empting a discussion of potential late effects during the survivorship phase was felt to be discordant with this approach and could impact on adjustment to life after cancer treatment. CONCLUSION: Providing cancer survivors with information on potential late effects requires further consideration. Evidence for survivor preference for late effect information and the benefit afforded to survivors who receive it could inform the practice of HCPs. If a culture of proactivity is to be encouraged regarding discussions of future potential risk, HCPs may need support in considering ways of presenting survivors with reality whilst being mindful of their need to retain hope during the survivorship phase.Supportive Care in Cancer 04/2013; · 2.09 Impact Factor
1206 Correspondence | JNCI Vol. 102, Issue 15 | August 4, 2010
Low Awareness of and
Referral to National Cancer
There are currently more than 11 million
cancer survivors in the United States ( 1 ).
With improvements in cancer screening
technology and treatment, this number is
likely to increase. The information needs
of cancer patients and survivors could strain
an already burdened health-care system,
underscoring the need for reliable cancer
information from credible sources ( 2 – 4 ).
Although many quality cancer informa-
tion resources are available, recent data ( 5 )
indicate that health-care professionals are the
most trusted source for health information,
followed by US government health agencies
that produce and scientifi cally vet materials
for patients and health-care professionals,
such as the National Institutes of Health
(NIH) and the Centers for Disease Control
and Prevention (CDC). The National Cancer
Institute’s Web site ( www . cancer . gov ) and
the Cancer Information Service (1-800-4-
CANCER) serve as NIH’s primary cancer
information resources. The CDC Web site
( www . cdc . gov ) also serves as a cancer infor-
To assess the awareness of and referral
to national cancer information resources
among primary care physicians, we ana-
lyzed data from the National Survey of
Primary Care Physicians ’ Recommendations
and Practice for Breast, Cervical, Colorectal,
and Lung Cancer Screening. The survey
was fi elded in 2006 and 2007 as a mailed
questionnaire. The sample was drawn from
the American Medical Association Physician
Masterfi le by using a systematic sample
design that was stratifi ed by medical spe-
cialty type. Eligible respondents were non-
federal offi ce-based family physicians,
general practitioners, general internists,
and obstetricians and gynecologists aged
75 years or younger. A total of 1212 physi-
cians completed the survey for a 73.4%
cooperation rate and a 67.5% response rate.
Details about sampling and survey method-
ology are published elsewhere ( 6 ).
Respondents were asked “Are you aware
of, and have you ever referred a patient to,
any of the following services for cancer in-
formation: 1-800-4-CANCER; www . cancer
. gov ; and www.cdc.gov?” Response options
were “aware and referred,” “aware of it,
never referred,” and “not aware of it.”
Awareness and referral were assessed by phy-
sician and practice characteristics.
(Research Triangle Institute, Research
Triangle Park, NC), was used to calculate
weighted percentages and 95% confi dence
intervals (CIs). Cross tabulations with
two-sided ? 2 and t tests and a multinomial
regression analysis were conducted to dis-
cern physician and practice characteristics
associated with awareness and referral.
Awareness and referral to national in-
formation resources was low: 6.2% of phy-
sicians reported awareness and referral to
1-800-4CANCER, 14.0% reported aware-
ness and referral to www . cancer . gov , and
23.1% reported awareness and referral to
www . cdc . gov ( Table 1 ). Greater awareness
of and referral to at least one of these re-
sources was associated with more time
spent teaching ( P = .046 [ t test]) and con-
ducting administrative duties ( P = .046
[ t test]). Lower awareness and referral was
observed among physicians who were in
private practice ( P = .001 [ ? 2 test]), had
larger patient loads ( P = .015 [ ? 2 test]), or
had a higher percentage of uninsured
patients ( P = .015 [ ? 2 test]). A multinomial
logistic regression analysis revealed that
compared with physicians in university
Table 1 . Physician awareness of and referral to national cancer information resources
Resource Sample size
Aware and did
not referNot aware
www . cancer . gov
www . cdc . gov
At least one resource
settings, those in private practice were less
likely to be aware of and refer to national
cancer information resources (odds ratio =
0.50, 95% CI = 0.34 to 0.74) and less likely
to report awareness and no referral (odds
ratio = 0.49, 95% CI = 0.32 to 0.74).
Low levels of awareness of and referral to
national cancer information resources were
observed across physician and practice char-
acteristics. Efforts to raise awareness and use
of these resources could improve informa-
tional support to health-care providers, can-
cer patients, and survivors.
LILA FINNEY RUTTEN
KELLY D. BLAKE
1. Horner MJ , Ries LAG , Krapcho M , et al ., eds.
SEER Cancer Statistics Review, 1975 – 2006 .
Bethesda, MD : National Cancer Institute ;
2009 . Based on November 2008 SEER data
submission, posted to the SEER Web site. http
:// seer . cancer . gov / csr / 1975_2006 / . Accessed
May 21, 2010 .
2. Arora NK . Interacting with cancer patients:
the signifi cance of physicians ’ communication
behavior . Soc Sci Med . 2003 ; 57 ( 5 ): 791 – 806 .
3. Hesse BW , Arora NK , Burke Beckjord E ,
Finney Rutten LJ . Information support for
cancer survivors . Cancer . 2008 ; 112 ( 11 suppl ):
2529 – 2540 .
4. Finney Rutten LJ , Arora NK . Provider-patient
communication across the cancer care con-
tinuum . In: O’Hair HD , Kreps GL , Sparks L ,
eds. Communication and Cancer Care . Cresskill,
NJ : Hampton Press ; 2007 : 13 – 36 .
5. Hesse BW , Moser RP , Rutten LJ . Surveys of
physicians and electronic health information .
N Engl J Med . 2010 ; 362 ( 9 ): 859 – 860 .
6. Yabroff KR , Saraiya M , Meissner HI , et al .
Specialty differences in primary care physician
reports of papanicolaou test screening prac-
tices: a national survey, 2006 to 2007 . Ann
Intern Med . 2009 ; 151 ( 9 ): 602 – 611 .
This project was funded in part with fed-
eral funds from the National Cancer Institute,
National Institutes of Health, under contract
The content of this publication does not neces-
sarily reflect the views or policies of the
Department of Health and Human Services, nor
does mention of trade names, commercial prod-
ucts, or organizations imply endorsement by the
by guest on April 13, 2012
JNCI | Correspondence 1207
Affiliations of authors: Clinical Monitoring
Research Program, SAIC-Frederick, Inc, National
Cancer Institute-Frederick, Frederick, MD (LFR,
KD); Health Communication and Marketing,
Research Triangle Institute, Research Triangle
Park, NC (LS); Health Communication and
Informatics Research Branch, Behavioral Research
Program, Division of Cancer Control and
Population Sciences, National Cancer Institute,
Bethesda, MD (KDB) .
Correspondence to: Lila Finney Rutten, PhD,
MPH, Clinical Monitoring Research Program,
SAIC-Frederick, Inc, National Cancer Institute-
Frederick, Frederick, MD 21704 (e-mail: finneyl
@mail.nih.gov ) .
Published by Oxford University Press 2010.
Advance Access publication on June 25, 2010.
by guest on April 13, 2012