Digestive System Diseases

All Conditions

Symptoms and General Pathology

Intestinal Diseases

Inflammatory Bowel Diseases

Diverticulum

Diverticular Diseases

Gastrointestinal Diseases

Gastroenteritis

Pathological Conditions, Anatomical

Study Population and Enrollment. To ensure survey feasibility and acceptability for our target population we will purposively recruit older African American patients at each of the three participating sites. Using conservative estimates of clinical volume as well as US county level census data we estimate enrolling 3 elderly (\>65 years of age) African American participants per site per week with a target enrollment of 12 patients per site.

To gain a broad understanding of barriers to surgical access and care in the Deep South, each study site will conduct key informant interviews. Participants will be recruited from five socioecological levels: patient, caregivers/provider, organizational, community, and policy-levels. At each site, two key informant interviews will be performed at each socioecological level (2 patients, 2 caregivers, 2 providers, 2 organizational leaders, 2 community leaders, and 2 policy leaders = 12 per site). We will purposively sample 100% of the participants at the patient and caregiver level (n=12) to be African American and \>65 years old.

Enrollment Process. Eligibility criteria for this phase of study enrollment will be broadened to include all English-speaking patients \>18 years of age undergoing or having recently undergone (\<7 days) an ACS-NSQIP defined surgical procedure. At each site, eligible participants will be approached by a trained research associate pre-operatively in clinic (for elective cases) or post-operatively in the hospital (for emergency cases \<7 days). Because each enrollment site has a unique schedule, site representatives will coordinate the most efficient weekly schedule.

We expect to reach our target enrollment (100 participants total, 33 at each site) in 1 year based on conservative estimates of clinical case volume. We expect to enroll at least 20% elderly participants (\>65 years of age) and between 30-50% African American participants based on county level (Greenville - Butler County, Demopolis - Marengo County, Alexander City - Tallapoosa County) census data.

This study will not involve an intervention of any sort. Participants will either take a survey or undergo an interview, and those taking the survey will have clinical data captured.

no intervention

Daniel I Chu, MD

Rationale: Older African Americans undergoing surgery are a vulnerable and growing population at high risk for poor surgical outcomes and disparities. Few programs have focused on this population due to a fragmented understanding of the needs of this population.

Objectives: While socioecological determinants of health (SEDOH) such as health literacy and socioeconomic status are known drivers of surgical disparities, an estimated 36-47% of surgical disparities remains unexplained. This gap results from limitations of current clinical datasets in capturing SEDOHs. This pilot study aims to fill this gap by (i) collecting granular SEDOH data, (ii) identifying barriers to surgical care for older African Americans, and (iii) establishing a multi-institutional clinical database through a socioecological context. These findings will help understand how SEDOHs drive surgical disparities and inform development of interventions to eliminate them in elderly African Americans.

Design and Methods: Guided by the socioecological model of health, the investigators will use mixed-methods to achieve the objectives. First, the investigators will assess the acceptability and feasibility of a 58-item SEDOH survey based on the NIH PhenX toolkit. After distributing this survey to 36 elderly (≥65 years) African American patients undergoing surgery at 3 rural, UAB-affiliated hospitals (Alex-City, Greenville, Demopolis) the investigators will conduct detailed theory guided assessments of acceptability and feasibility (SA1). Second, the investigators will conduct key informant interviews of individuals from all 5 socioecological levels at each rural hospital (n=10) to identify additional barriers and facilitators to surgical care. The investigators will purposively sample 100% of participants at the patient and caregiver level (n=12) to be elderly African Americans (SA2). Finally, the investigators will link measured SEDOH data with standardized clinical data at each hospital to establish a novel database (SA3). These findings will establish a process to measure SEDOHs across the Deep South and set the foundation for a unique database to study surgical disparities.

Significance: Development of effective multilevel interventions to eliminate surgical disparities in older African Americans is dependent on a clearer understanding of the contextual drivers of these disparities. This pilot study will accelerate understanding of these mechanism(s) through SEDOHs. It will establish a process to measure SEDOHs, identify additional barriers to surgical care not captured by NIH instruments, and build the database to study these relationships. Such findings will have the potential to impact vulnerable surgical populations in the Deep South and support the Deep South RCMAR mission to promote health and optimize health outcomes for older and rural African Americans.

The Deep South Surgical Equity Research Network: Addressing Socioecological Determinants of Health

Primary data acquired through the quantitative surveys and other demographics will be collected and managed using REDCap (Research Electronic Data Capture). As the host/coordinating center, UAB REDCap servers are secured through a virtualized environment behind an enterprise grade Palo Alto firewall. Only IRB-approved research team members will have access to the REDCap system through a secure and unique login. UAB REDCap is in compliance with NIST 800-53/800-171 (HIPAA) and FDA CFR21 part 11 guidelines, approved by all authorizing parties at UAB and authorized to operate (ATO) from NIH/NHLBI.

Using a theory guided framework and previously published measures of acceptability and feasibility, a post survey will be administered to all participants in specific aim 1. Feasibility and acceptability scores will be calculated, with positive acceptability and feasibility being indicated by scores of 4 or greater on a likert scale. The investigators will ensure that the survey is found to be acceptable and feasible to \>70% of the target population, and will have areas for qualitative feedback and comments to adapt the survey as needed.

To identify barriers to surgical care for older African American patients in the Deep South the investigators will conduct qualitative interviews of participants at all socioecological levels at each site. These interviews will be transcribed and coded using NVivo software, and themes from this analysis will be compared with the domains assessed in the survey used in specific aim 1 in order to ensure that all relevant domains are captured and assessed.

To establish a database linking socioecological determinants of health with nationally validated surgical outcomes the investigators will pair data obtained from the previously developed survey with chart abstracted clinical outcomes data. All data will be stored in a secure RedCap database, and entered only by trained abstractors.

University of Alabama at Birmingham

Associate Professor

AYA will complete questionnaires assessing peer versus family connectedness, peer/romantic competence, coping, distress, social support, and quality of life.A study-specific needs assessment regarding interest in social functioning interventions will also be completed.

Participants (30 on-therapy) will be interviewed to further explore aspects of peer/family connectedness and intervention interest.

AYA will complete questionnaires assessing peer versus family connectedness, peer/romantic competence, coping, distress, social support, and quality of life.A study-specific needs assessment regarding interest in social functioning interventions will also be completed.

Participants (20 off-therapy) will be interviewed to further explore aspects of peer/family connectedness and intervention interest.

Victoria W. Willard, PhD

Participants are being asked to take part in this clinical trial, a type of research study, because investigators want to learn more about the social experiences adolescents and young adults who are being treated or have been treated for cancer.

Primary Objectives

* Describe differences in social experience variables (peer connectedness, perceived social competence, parent versus peer attachment) based on treatment status: on versus off therapy.
* In on-therapy patients, describe differences in social experience variables (peer connectedness, perceived social competence, parent versus peer attachment) based on developmental stage: high school versus post-high school.

Secondary Objectives

* Assess the social support and peer interaction needs of AYA with cancer as a means of determining stakeholder interest and need for psychosocial interventions targeting social experiences.
* Using qualitative interviews, explore patient perceptions of the impact of cancer on social experiences among AYA, particularly with regards to changes in friendships as a result of the cancer diagnosis and the role of the hospital in helping or hindering friendship maintenance/development.

Exploratory Objectives

* Explore differences in social experience by demographic, disease and treatment factors, including: gender, diagnostic category (brain tumor, leukemia/lymphoma, solid tumor), late effects/symptom burden, and treatment (e.g., treatment intensity, serious medical events).
* Explore associations between perceived impact of cancer and social experience in AYA.
* Explore associations between use of social media and social experience.
* Explore associations between social experiences and overall functioning (quality of life, distress, coping).
* Explore the possibility of subclasses of AYA by using person-centered analyses to empirically derive profiles of social experience.

A mixed-methods design involving questionnaires and interviews will be used to evaluate the study objectives. AYA ages 15 to 22 will be recruited to participate. Two cohorts will be enrolled: AYA who are on-treatment, 2-12 months post-diagnosis; and AYA who are off-therapy 1 to 4 years. AYA will complete questionnaires assessing peer versus family connectedness, peer/romantic competence, coping, distress, social support, and quality of life. A study-specific needs assessment regarding interest in social functioning interventions will also be completed. If a caregiver is available, they will be asked to complete questionnaires regarding family functioning and quality of life. A subset of 50 AYA (30 on-therapy/20 off-therapy) will be interviewed to further explore aspects of peer/family connectedness and intervention interest. Analyses will focus on describing how aspects of social experiences (peer connectedness, social competence, peer versus parent attachment) differ based on treatment status (on versus off therapy) and developmental stage (high school versus post-high school), as well as potential moderators.

Two cohorts of AYA with cancer, ages 15-22, will be identified and recruited for the study: 1) patients on-therapy, 2-12 months from diagnosis; and 2) patients off- therapy 1-4 years, and ≥13 years of age at diagnosis. AYA from all diagnostic groups - brain tumor, solid tumor, leukemia/lymphoma - and developmental periods - high school, post-high school - will be targeted, and care will be taken to ensure a representative sample.

Social Experiences of Adolescents and Young Adults With Cancer

This is a self-report measure of perceptions of the relationship between an individual and their mother, father and close friends.

This 20-item self-report questionnaire assesses perceptions of peer connectedness over the past month. Items assess feelings of social connectedness, loneliness, and social isolation. Questions are answered on a 4-point Likert scale from "never" to "often," and a total score is calculated.

This is a 53-item measure for parents designed to assess the impact of a child's health condition on the family system. Six subscales are derived, including measures of the child's daily life, the parent's perceived ability to manage the condition, and, for partnered parents, how the parents work together to manage the condition.

The SPPA/EA is a self-report measure of self-competence. Multiple constructs are assessed, including social, romantic, physical, and academic competence, as well as global self-worth. Subscales assessing Social Competence, Romantic Competence and Physical Appearance are of primary interest.

This is a 5- (ages 15-17) or 8-item (ages 18+) self- report questionnaire that assesses aspects of friendship. Questions assess perceived ability to access friend and participation in activities with friends over the past month on a 5-point Likert scale from never to always. Five items are similar across the two age groups. Raw scores are converted to T-scores (M = 50, SD = 10), with higher scores indicative of more perceived friends to interact with.

This is a 5-item self-report measure that assesses an individual's perception of the impact of cancer on relevant domains: education, social interaction, career goals, romantic relationships and independent living. Items are rated on a 1-10 scale from "did not interfere/affect" to "extremely interfered/affected." The social interaction and romantic relationship items are of primary interest.

The COE is a 20-item self-report measure that assesses an individual's perception of the impact that a traumatic or significant event as had on their identity development. Participants will be asked to complete the COE based on their experiences with cancer.

The two part OSSS assesses the role of online apps or websites in an individual's perception of the support they receive from others. In the first part, participants rate the frequency that they use specific online spaces (e.g., Instagram, Twitter, Facebook) to interact with others. Space is also provided for participants to free text additional sites. In the second part, 40 items assess the types of social support individuals receive from these spaces, with four subscales derived: Esteem/Emotional Support, Social Companionship, Informational Support, and Instrumental Support. Oneline Social Support Scale-scores could range from 0 to 160 with higher scores indicating receipt of more support.

The MSPSS is a 12-item self-report questionnaire that assesses perceived reception of support from important persons - friends, family, and significant other. Questions are answered on 7-item Likert scale from "very strong disagree" to "very strongly agree." Higher scores are indicative of more social support.

The RSQ is a 57-item self-report questionnaire assessing an individual's coping with an identified stressor. For this study, cancer will be the identified stressor and separate versions of the RSQ are available for those on treatment and off treatment. Responses to Stress Questionnaire - scores range from 0 to 4 with higher scores indicating more use of that coping mechanism

Three brief self-report measures will assess symptoms of anxiety, depression, and fatigue over the past 7 days. Measures will be completed by both AYA and their caregivers, with each respondent providing indicators of their own level of distress. Raw scores are converted to T- scores (M = 50, SD = 10) with higher scores indicating greater symptoms.

The PedsQL Cancer Module is a 27-item self-report measure that assesses symptom burden and quality of life as related to cancer-specific factors, including pain, nausea, procedural anxiety, and physical appearance. AYA will complete this measure as an indicator of current cancer- related symptoms. PedsQL - scores range 0 to 100 with higher scores indicating better functioning

The PedsQL Core Module is a 23-item measure of quality of life, with both self- and proxy-report versions available. Four subscales provide two broad domains - Physical and Psychosocial Functioning - and an overall quality of life score. Raw scores undergo a linear transformation. AYA and their participating caregiver will complete this measure.

The ITR-3 is a clinician-completed rating form that provides a means of classifying the intensity of pediatric cancer treatment. Four categories are elicited: Least, Moderately, Very, and Most Intensive. This will be completed for each participant using information gathered from the medical record.

This is a new questionnaire developed specifically for this study. Participants will answer questions about their participation in current hospital activities and events as well as their interest in and feedback on future interventions. It will be analyzed at the individual item level.

A subsample of participants will complete an interview to further assess aspects of friendships and intervention interest. Participant responses will be transcribed and analyzed for themes.

Study title	NCT ID	Conditions	Interventions	Eligibility	Organization
The Deep South Surgical Equity Research Network: Addressing Socioecological Determinants of Health	NCT05345054	Colorectal Canc... Inflammatory Bo... Diverticular Di... Social Behavior	no intervention	18 Years -	University of Alabama at Birmingham
Social Experiences of Adolescents and Young Adults With Cancer	NCT04328350	Childhood Cance... Social Behavior Social Competen...		15 Years - 22 Years	St. Jude Children's Research Hospital
The Deep South Surgical Equity Research Network: Addressing Socioecological Determinants of Health	NCT05345054	Colorectal Canc... Inflammatory Bo... Diverticular Di... Social Behavior	no intervention	18 Years -	University of Alabama at Birmingham
Social Experiences of Adolescents and Young Adults With Cancer	NCT04328350	Childhood Cance... Social Behavior Social Competen...		15 Years - 22 Years	St. Jude Children's Research Hospital

Spots Global Cancer Trial Database for social behavior