Gaining numbers, gaining strength
They say that there’s strength in numbers. When it comes to cancer treatment, the numbers and strength are growing, as researchers pursue new treatment strategies and students pursue careers in oncology. But in cancer prevention, the numbers aren’t as large and the effect isn’t as strong.
“Cancer prevention research, as compared to research on cancer treatment, has received very little attention. This is unfortunate, as research suggests that nearly two-thirds of cancer is largely attributable to smoking, lack of exercise, and diet,” says Jakob D. Jensen, assistant professor of communication and an RCHE faculty affiliate. In fact, research estimates that for both cancers in general as well as breast cancer, which is one of the better-studied cancers, anywhere from 50 to 75 percent of cancer is preventable.
This led a group of Purdue researchers in the Oncological Sciences Center at Discovery Park to launch a new initiative to attract students to cancer prevention and then train them for the challenges they will face. The result has been not only a prevention-focused training program but a campus conversation on the opportunities for preventing cancer.
CPIP: The Future of Prevention
“The program is designed to be broadly interdisciplinary, bringing together researchers from the social sciences, including communication and education, to the basic scientists, including engineering, nutrition and other basic sciences, to optimize our ability to identify and develop strategies for prevention of cancer,” says Dorothy Teegarden, professor of Foods and Nutrition and director of the Cancer Prevention Internship Program. Purdue is the first to design and implement a curriculum that includes this broad of a range of researchers to train students.
“We do a great job of training researchers in cancer treatment. Our goal, and the goal of the program, is to train high-quality cancer prevention researchers as well,” he said.
CPIP takes about a year to complete, with tracks for both undergraduate and graduate students. In both cases, students are required to take cancer prevention-related courses, including a CPIP seminar, and participate in research.
ndergraduates go through the Discovery Park Undergraduate Research Internship (DURI) program; graduate students are placed directly into labs. Undergraduates are also required to participate in EPICS, a service-learning program through the College of Engineering. The program exposes students to cancer prevention from the laboratory, classroom, and community standpoints.
Like the faculty, students in the program come from a variety of disciplines, something the team feels is essential. “By exposing them to a variety of themes from across disciplines, we can create a new pool of scientists who are trained to work together, drawing from many areas of study, to develop new prevention techniques and possibly save many lives.”
A Campus Conversation
Recently, the CPIP team launched a “campus conversation” to focus attention on cancer prevention. Breast Cancer Prevention 2020, or BCP2020, asks the Purdue community, “What can we accomplish in the next 10 years of breast cancer research?” The first event, Breast Cancer Awareness Day, was held this month to coincide with national Breast Cancer Awareness Month.
“Breast cancer is one of the five most common cancers in the U.S. We also have a very active group of researchers studying breast cancer at Purdue, which made breast cancer a logical first site for us,” says Jensen. The conversation on breast cancer will culminate in an international symposium in October 2010.
Students interested in the cancer prevention program should contact Professor Jensen at firstname.lastname@example.org. For more information about the BCP 2020 campaign, please visit www.purdue.edu/hicc/bcp2020.html.
The BCP 2020 campaign focuses attention on breast cancer and prevention and treatment research at Purdue. The Purdue community is encouraged to participate in the campaign through attending or facilitating discussions on breast cancer prevention, and cancer prevention activities, among others.
For more information about the BCP 2020 campaign and to download logos to show your support, please visit www.purdue.edu/hicc/bcp2020.html.
Professor talks health policy with PBS viewers
George Avery, assistant professor of health and kinesiology, joined a panel of experts to discuss healthcare policy and reform with Northern Indiana PBS viewers. The program, We the People: Health Reform, included questions from both a studio audience and an online chat after the program. Other panelists included Dr. Tom Vidic, Indiana State Medical Association; Martin de Agostino, AARP Indiana; and David A. Roos, Covering Kids & Families of Indiana Inc.
“[The questions] were across the board and ranged from quality to access, etc.” said Avery. Many commented on the lack of system integration or coordination. This is particularly evident with patients who have more than one chronic condition, as they often see multiple specialists in addition to their primary care provider. Another common concern expressed was the setup of the current system, fee-for-service. The PBS audience questioned whether fee-for-service creates the wrong incentives, encouraging providers to do more tests and procedures because that is how they get paid more, rather than being paid for helping patients to better health outcomes regardless of the number of procedures necessary to do so.
As Harvey Fineberg, president of the Institute of Medicine, said at RCHE’s spring 2009 conference, “when you pay for units of service, what you get are more units of service.” By contrast, there are select medical systems around the country where providers receive a specified salary regardless of the number of procedures performed or tests run.
We the People: Health Reform ran on October 18, on WNIT in Northern Indiana. Currently, a transcript is not available. Future We the People episodes will focus on other pressing topics in the news.
Avery’s areas of specialization include public health, healthcare quality management and regulation, and public health preparedness.
RCHE welcomes new faculty and research affiliates
RCHE faculty and research affiliates share research interests with RCHE. More than 60 Purdue faculty are RCHE affiliates, and the number grows each month. New this quarter are:
A full list of affiliates is available at www.purdue.edu/rche, under “About Us.”
RCHE, HEA conference draws diverse audience to discuss key delivery issues
With healthcare again at the forefront of the political world, it has rarely been clearer how important collaboration and partnerships are in finding the best solutions. In support of these partnerships, RCHE and the Healthcare Engineering Alliance (HEA) teamed up for the RCHE fall conference and HEA 2009 meeting at the end of September. The events brought together researchers from several universities to discuss healthcare issues and partnership possibilities.
Two key issues
The conference highlighted two key issues that emerged from RCHE’s spring 2009 conference — care coordination and population health.
Better care coordination can not only decrease errors and increase good outcomes but can also be less expensive. However the current medical system encourages aspiring physicians to choose specialties over primary care and practicing physicians to run many tests, said speakers Mark Braunstein, professor of the practice at Georgia Institute of Technology’s Health Systems Institute, and Peter J. Fabri, professor of surgery at University of South Florida. One opportunity on the horizon is electronic or personal health records, which would allow physicians to know what other care a patient is receiving. Bill Cast highlighted NoMoreClipboard.com, one company offering personal health records.
In contrast with care coordination, population health focuses on impacting the health outcomes of an entire group. Glen Mays, associate professor and chair, Department of Health Policy and Management, University of Arkansas for Medical Sciences, noted that only three percent of national health spending is on prevention and public health services; the rest is treatment, rehabilitation, and long-term care. Per capita spending in the U.S. is among the highest in the world, yet more than 25 countries have higher life expectancies than the U.S.
While personal health records may be a good start, it is critical that the system begin to use that information to create this continuity. Other technologies, either placed in the home or worn, may also be able to provide information that helps patients and physicians better understand and manage health outcomes. While the system is not perfect, noted Vinod Sahney, Blue Cross Blue Shield of Massachusetts, we must also take a certain amount of responsibility for making better food choices and exercising regularly. Patients must become involved in their treatment, either on their own, with a friend or family member, or another health advocate.
Cancer Prevention and Healthcare Retreat and Poster Competition
Graduate and undergraduate students across campus are invited to participate in a poster competition co-sponsored by RCHE, the Department of Foods and Nutrition, and the Oncological Sciences Center.
December 4, 2009
Eligibility: All Purdue undergraduate and graduate students are eligible to present. Faculty advisors will be contacted to confirm poster registration.
Topic: All posters must represent research being done to advance the healthcare systems, delivery, care, products, or advancements.
Deadlines: Posters must be registered by November 20. Posters must be submitted to suite 225 Mann Hall by December 1 and will be hung on December 2. Judging will be December 3 and 4.
Registration: All posters must be registered at www.purdue.edu/rche/education/postercompetition.php.
Patient-Centered Communication with Cancer Patients
Shields, C. G., Coker, C. J., Poulsen, S. S., Doyle, J. M., Fiscella, K., Epstein, R. M., & Griggs, J. J. (In Press) Patient-Centered Communication and Prognosis Discussions with Cancer Patients. Patient Education and Counseling.
Objective & Methods
To examine physician communication associated with prognosis discussion with cancer patients. We conducted a study of physician–patient communication using trained actors. Thirty-nine physicians, including 19 oncologists and 20 family physicians participated in the study. Actors carried two hidden digital recorders to unannounced visits. We coded recordings for eliciting and validating patient concerns, attentive voice tone, and prognosis talk.
Actor adherence to role averaged 92% and the suspected detection rate was 14%. In a multiple regression, eliciting and validating patient concerns (β = .40, C.I. = 0.11–0.68) attentiveness (β = .32, C.I. = 0.06–0.58) and being an oncologist vs. a family physician (β = .33, C.I. = 0.33–1.36) accounted for 46% of the variance in prognosis communication.
Conclusion & Practice Implications
Eliciting and validating patient concerns and attentiveness voice tone is associated with increased discussion of cancer patient prognosis as is physician specialty. Eliciting and validating patient concerns and attentive voice tone may be markers of physician willingness to discuss emotionally difficult topics. Educating physicians about mindful practice may increase their ability to collect important information and to attend to patient concerns.
Let us help your project grow: Announcing two RFP opportunities for 2010
RCHE’s third annual research RFP dates and criteria are now available. This year, RCHE is also announcing the addition of a new funding opportunity, the implementation RFP.
RCHE will award six seed grants of up to $40,000 each to projects with the potential to improve healthcare delivery. The grants are designed to enable projects to become competitive for external funding by the end of the one year seed grant period.
Faculty and researchers from all Purdue campuses are eligible to submit proposals. The topic range is open; however, preference will be given to projects that improve delivery in care coordination or population health, two key areas in which RCHE has chosen to focus research activity based on this year’s conferences. More information about these topics is available through the RCHE website and by viewing the archived pages of past conferences.
RCHE will award up to three grants of up to $40,000 each to projects taking research results into a clinical or “real world” setting to demonstrate the impact of the research on the healthcare system.
Faculty and researchers from all Purdue campuses are eligible to submit proposals. Topics are open. Preference will be given to projects in which the initial research was completed through RCHE.
Both RFPs require use of the RCHE proposal template, available on the website. Please visit www.purdue.edu/rche/research/funding.php for more information about each RFP process and requirements.
Please note that all deadlines are in 2010.
January 20: Letter of intent due
February 17: Proposal due
April 2: Grant recipients notified
July 1: Funding begins
PROPOSAL TEMPLATE AND EVALUATION CRITERIA
Both RFPs must use the RCHE proposal template, which is available online as a Word document.
Visit www.purdue.edu/rche/research/funding.php for the template and other important evaluation criteria.
Winter 2009 Events
Joint Retreat on Cancer Prevention Poster Competition
December 4, 2009
Peyton Manning Children’s Hospital Toy Drive
Submit by December 7, 2009
Deliver donations to Mann Hall, suite 225
RCHE will collect toys for patients from toddlers through teens. Suggestions for donations include toys, books, video games (Wii, Nintendo DS, X box, PSP), DVDs, and character pillowcases. A complete wish list is included on the RCHE website.
All items must be new, no food, and contain no latex.