Kathleen Ell DSW

Publications (2)4.77 Total impact

• Article: Cancer treatment adherence among low‐income women with breast or gynecologic cancer

  Kathleen Ell DSW, Betsy Vourlekis PhD, Bin Xie PhD, Frances R. Nedjat-Haiem MSW, Pey-Jiuan Lee MS, Laila Muderspach MD, Christy Russell MD, Lawrence A. Palinkas PhD
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  ABSTRACT: BACKGROUND:The authors implemented a controlled, randomized trial that compared 2 interventions: the provision of written resource navigation information (enhanced usual care [EUC]) versus written information plus patient navigation (TPN) aimed at improving adjuvant treatment adherence and follow-up among 487 low-income, predominantly Hispanic women with breast cancer or gynecologic cancer.METHODS:Women were randomized to receive either TPN or EUC; and chemotherapy, radiation therapy, hormone therapy, and follow-up were assessed over 12 months. Patients with breast cancer were analyzed separately from patients with gynecologic cancer.RESULTS:Overall adherence rates ranged from 87% to 94%, and there were no significant differences between the TPN group and the EUC group. Among women with breast cancer, 90% of the EUC group and 88% of the TPN group completed chemotherapy (14% of the EUC group and 26% of the TPN group delayed the completion of chemotherapy), 2% of the EUC group and 4% of the TPN group failed to complete chemotherapy, and 8% of the EUC group and 7% of the TPN group refused chemotherapy. Radiation treatment adherence was similar between the groups: Ninety percent of patients completed radiation (40% of the EUC group and 42% of the TPN group delayed the completion of radiation); in both groups, 2% failed to complete radiation, and 8% refused radiation. Among gynecologic patients, 87% of the EUC group and 94% of the TPN group completed chemotherapy (41% of the EUC group and 31% of the TPN group completed it with delays), 7% of the EUC group and 6% of the TPN group failed to complete chemotherapy, 6% of the EUC refused chemotherapy, 87% of the EUC group and 84% of the TPN group completed radiation (51% of the EUC group and 42% of the TPN with delays), 5% of the EUC group and 8% of the TPN group failed to complete radiation, and 8% of the EUC group and 5% of the TPN group refused radiation.CONCLUSIONS:Treatment adherence across randomized groups was notably higher than reported in previous studies, suggesting that active telephone patient navigation or written resource informational materials may facilitate adherence among low-income, predominantly Hispanic women. Adherence also may have be facilitated by federal-state breast and cervical cancer treatment funding. Cancer 2009. © 2009 American Cancer Society.
  Cancer 09/2009; 115(19):4606 - 4615. · 4.77 Impact Factor
• Article: Abnormal Mammogram Follow‐up

  Kathleen Ell dsw, Deborah Padgett phd, Betsy Vourlekis phd, Jan Nissly msw, Diana Pineda msw, Olga Sarabia msw, Virginia Walther msw, Susan Blumenfield dsw, Pey-Jiuan Lee ms
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  ABSTRACT: purpose: The purpose of this study was to test an intervention (the Screening Adherence Follow-up Program [SAFe]) that was designed to reduce the number of known barriers to diagnostic follow-up adherence and initiation of treatment among women with low incomes who had abnormal mammogram findings.description of program: The investigators developed and implemented a highly structured, theory- and evidence-based intervention that combined health education, counseling, and systems navigation, which was delivered by a team consisting of a peer counselor and a social worker who held a masters degree. A scripted baseline telephone interview identified potential barriers to follow-up adherence and provided counseling interventions for each patient. Patients were assigned to different service intensities based on the level of risk for nonadherence. Patients with significant mental health symptoms, psychosocial stressors, or who had received a diagnosis of cancer were referred to the team social worker for further assessment and intervention. Patients also received reinforcing telephone follow-up calls at 6 and 12 months.results: An observational pilot study of SAFe (N = 605) in two large urban diagnostic centers showed that 71% of women receiving SAFe were Hispanic, 18% were Black, and 11% were from other ethnic backgrounds. Adherence rates through diagnostic resolution and the initiation of treatment for women who had received a diagnosis of cancer were 93% and 90%, respectively, at the two study sites. Rates of adherence among women who could not be located or who refused study consent were significantly lower (72% and 69%, respectively). The rate of timely adherence was also higher among the women served. Patient satisfaction with SAFe was generally high.clinical implications: Study results support the combining of interventions and the practical utility of a clinical decision-making algorithm to determine individualized nonadherence risk and to assign service intensity based on individual need. Problems in locating women for enrollment were experienced.
  Cancer Practice 04/2002; 10(3):130 - 138.