Stool DNA-based versus colonoscopy-based colorectal cancer screening: Patient perceptions and preferences

Objective:Stool DNA(sDNA)tests offer a noninvasive form of colon cancer screening for pa-tients,and although the test is expected to increase uptake of colon cancer screening,it is unknown if patients’perceptions of the sDNA test differ according to race and other patient characteristics.Methods:We conducted a self-administered survey of patients undergoing both a colonoscopy and an sDNA test to evaluate perceptions of sDNA testing.Results:Of the 613 participants who were sent surveys,423 responded(69%response rate).Respondents self-identified as African American(n=127,30%),Caucasian(n=284,67%),and other ethnicity(n=12,3%).In general,participants found the sDNA test more suitable than a colonos-copy(n=309,75%).In univariate analyses,a higher percentage of Caucasians as compared with African Americans found the sDNA test more suitable than a colonoscopy(89%vs.76%,p<0.01),and more Caucasians than African Americans preferred the sDNA test(43%vs.32%,p<0.05).Ad-justment for covariates reduced these racial differences to no significance.A family history of colo-rectal cancer remains a significant factor for patient’s preferences for screening regardless of race.Conclusions:Our study shows no racial differences in the perception of and preference for sDNA testing for colon screening.Intervention to increase the uptake of sDNA testing may help reduce racial disparities in colorectal cancer.

Assessment of Weight and Health in the Emergency Department: A Cross-Sectional Study

Introduction: The prevalence of obesity and obesity-related diseases continues to rise. A key aspect of prevention and treatment of these disorders requires clear communication about weight and health between patients and healthcare providers. Objective: We sought to examine the prevalence rate of obesity and associated comorbid illnesses in an emergency department (ED) population. A second aim was to assess patients’ perceptions of their weight and their overall health. Methods: This is a cross-sectional study performed in an academic tertiary-care center using a representative sample of patients (≥18 yr) who presented to the ED. Pregnant patients, patients who were medically unstable, cognitively impaired or who were unable or unwilling to provide informed consent were excluded. Anthropometric measurements were taken which include BMI (the ratio of a patient’s weight and height expressed as kg/m2) and waist circumference. In addition, the prevalence rates of all enrolled patients who 1) feel their health is affecting their weight and 2) who have had or recall discussions about their health and weight with their provider were examined by using a two-question validated survey. Results: The overall prevalence rate of obesity in this study was 38.6%. Only 71.8% (95% CI, 63.2% - 80.6%) of overweight patients (BMI = 25.0 - 29.9) and 28.4% (95% CI, 21.6% - 35.2%) of obese patients (BMI ≥ 30.0) believe their present weight is damaging to their health. Further, only 15.5% (95% CI, 8.5% - 22.6%) and 59.4% (95% CI, 53% - 67%) of those overweight and obese, respectively, recall being informed by their healthcare provider they are overweight. For morbidly obese patients (BMI ≥ 40.0), 79.6% (95% CI, 12.2 - 28.6) feel their weight is damaging their health and 83.7% (95% CI, 9.4 - 23.2) recall having a conversation about weight with their healthcare provider. Conclusion: Many obese and overweight patients believe their weight does not impact their health and have not had discussion about weight and health with their healthcare provider.

Deeper inside the Experience of Pediatric Headache: A Narrative Study

Objective: To explore meanings, perspectives and points of view of the subjective experience of paediatric patients with headache (PPwH) and create a first-person narrative for clinical practice. Methods: We conducted a qualitative, narrative research study with PPwH, 11 - 17 years old. Data were collected through narratives interviews and a twofold narrative analysis was performed: a narrative and a thematic analysis. Results: Twenty-three patients (14 girls;mean age 14.5;median duration of illness of 5.8 years) were recruited. Through narrative analysis and close reading, narratives revealed different ways to organize illness experience: PPwH can use 1) narrative sequences of recurrent events in order a) to describe the continuing living-through of the experience of headache, b) to define operative script or c) to characterize the illness experience generally as a “controlled” routine;or 2) a storied account of events, with well-defined characters, plot and evaluation of contingency and correlation between events to express a personal point of view and a moral standpoint about the illness experience. Through thematic analysis 5 main themes and 22 subthemes about the significance of being a PPwH emerged: a) disease dimension (description of pain), b) illness dimension, c) sickness, d) causality, e) coping and f) future perception. Then, a first-person narrative story was created as a tool enabling reflection and conversation during clinical consultation. Conclusions: Results suggest that promoting narrative dialogue can be an opportunity for the neurologist: the prototypical narrative developed from story analysis might be a tool to apply for the narrative-based medicine in the clinical setting.