Implications for improving risk communication through various channels: a discussion

The news media need to improve their coverage of new and old cancer risks, avoiding sensational reporting of minor risks and underreporting of major ones. However, efforts to communicate about cancer risk to the general public need to go far beyond the traditional print and broadcast outlets into more innovative, personalized channels that can better educate individuals about the risks they face and what they can do about them.     

Cancer Risk Factors in Korean News Media: a Content Analysis

Background: Little is known about the news coverage of cancer risk factors in Korea. This study aimed toexamine how the news media encompasses a wide array of content regarding cancer risk factors and relatedcancer sites, and investigate whether news coverage of cancer risk factors is congruent with the actual prevalenceof the disease. Materials and Methods: A content analysis was conducted on 1,138 news stories covered duringa 5-year period between 2008 and 2012. The news stories were selected from nationally representative mediain Korea. Information was collected about cancer risk factors and cancer sites. Results: Of various cancer riskfactors, occupational and environmental exposures appeared most frequently in the news. Breast cancer wasmentioned the most in relation to cancer sites. Breast, cervical, prostate, and skin cancer were overrepresentedin the media in comparison to incidence and mortality cases, whereas lung, thyroid, liver, and stomach cancerwere underrepresented. Conclusions: To our knowledge, this research is the first investigation dealing with newscoverage about cancer risk factors in Korea. The study findings show occupational and environmental exposuresare emphasized more than personal lifestyle factors; further, more prevalent cancers in developed countrieshave greater media coverage, not reflecting the realities of the disease. The findings may help health journalistsand other health storytellers to develop effective ways to communicate cancer risk factors.     

Coverage of cancer in local television news

Background. The news media provide significant health information to the American public. Although the public turns to and trusts local television news, news about cancer has not been systematically examined. Methods. In this content analysis, we examined 40,112 news stories aired in the 3rd, 25th, 87th, and 150th sized market in the country, all located in the Midwest. Results. In total, 386 stories focused on cancer. News stories about cancer were short and occurred less than once for every 30 minutes of news. The amount of news coverage of specific cancer sites was not consistent with cancer incidence rates. Similarly, the demography of cancer patients featured in the news differed from that in real life. Few stories provided follow-up information. The average story required a 10th-grade education to be understood. Differences across markets were not systematically related to market size. Conclusions. Cancer coverage was scattered and abbreviated. For both cancer practitioners as well as the general public, local television news cannot be counted on as a primary vehicle for cancer information.     

Fears and Misperceptions of Radiation Therapy: Sources and Impact on Decision-Making and Anxiety

Recent media attention about radiation has led to heightened public awareness and concern about radiation therapy (RT). An understanding of concerns and their potential role in patient decision-making can inform education efforts. A multiphase needs assessment survey was designed to ascertain broad public perceptions of radiation (phase I) and the more in-depth cancer patient perceptions of RT (phase II). One hundred forty-six phase I and 111 phase II surveys were completed. Data suggested a prevalence of negative connotations of the word “radiation,” often associated with information from the media or secondhand experience. Side effects during and after RT were reported as concerns, including misperceptions about becoming radioactive and impact on fertility. Rankings of quality and safety perceptions suggested confidence in staff training and equipment, though concerns regarding overdoses and protection of healthy tissue were higher amongst those who refused RT. In deciding whether or not to undergo RT, high value was placed on the reputation of the cancer centre and the expected effectiveness of RT. The importance of understanding RT was more highly regarded by those who underwent RT than those who refused it. Perceptions of RT should thus be addressed amongst those in a position to consider RT, to maximize RT utilization where appropriate.     

Risk Messages about HPV, Cervical Cancer, and the HPV Vaccine Gardasil in North American News Magazines

The human papillomavirus (HPV) vaccine (Gardasil) is a significant advancement in reducing women’s risk for cervical cancer. Public opinion of the vaccine can be influenced by the mass media. We used content analysis to assess the discussion of risks, fear-inducing messages about HPV, cervical cancer, and the HPV vaccine in four high circulating North American news magazines from January 2006 to December 2007. Risk messages about HPV and cervical cancer focused on threatening illness or injury. Reporting on the HPV vaccine emphasized it being poorly understood by science. News magazine articles on the HPV vaccine and cervical cancer included fear-inducing messages. Cancer educators need to be aware of media reporting in order to alleviate fears that the public may experience about the HPV vaccine.     

Is public communication about end‐of‐life care helping to inform all? Cancer news coverage in African American versus mainstream media

BACKGROUND:

Because cancers are a leading cause of death, these diseases receive a great deal of news attention. However, because news media frequently target specific racial or ethnic audiences, some populations may receive different information, and it is unknown whether reporting equally informs all audiences about the options for care at the end of life. This study of news reporting compared “mainstream” (general market) media with African American media, which serves the largest minority group. The specific goal of this study was to determine whether these news media communicate differently about cure‐directed cancer treatment and end‐of‐life alternatives.

METHODS:

This content analysis included 660 cancer news stories from online and print media that targeted either African American or mainstream audiences. The main outcome measures included whether reporting discussed adverse events of cancer treatment, cancer treatment failure, cancer death/dying, and end‐of‐life palliative or hospice care.

RESULTS:

Unadjusted and adjusted analyses indicated that the news stories in the African American media are less likely than those in mainstream media to discuss each of the topics studied. Comparing the proportions of news stories in mainstream versus African American media, 31.6% versus 13.6% discussed adverse events (odds ratio [OR], 2.92; 95% confidence interval [CI], 1.51‐5.66; P = .001); 14.1% versus 4.2% mentioned treatment failure (OR, 3.79; 95% CI, 1.45‐9.88; P = .006); and 11.9% versus 3.8% focused on death/dying (OR, 3.42; 95% CI, 1.39‐8.38; P = .007). Finally, although very few news stories discussed end‐of‐life hospice or palliative care, all were found in mainstream media (7/396 vs 0/264).

CONCLUSION:

The African American news media sampled are less likely than mainstream news media to portray negative cancer outcomes and end‐of‐life care. Given media's segmented audiences, these findings raise concerns that not all audiences are being informed equally well. Because media content is modifiable, there may be opportunities to improve public cancer communication. Cancer 2012. © 2011 American Cancer Society.     

Radio frequency radiation (RFR): the nature of exposure and carcinogenic potential

Epidemiologic evidence on the relation between radio-frequency radiation (RFR) and cancer is reviewed. Radio-wave communications are used extensively in modern society; thus, we are all subject to RFR created by radio, television, wireless telephony, emergency communications, radar, etc. Interest in the health effects of RFR has been motivated by the rapid growth in wireless communications and by media reports expressing concern that specific diseases may be caused by RFR exposure, e.g., from cellular telephone handsets. Due to the ubiquitous presence of RFR, the public health implication of any connection between RFR and cancer risk is potentially significant. (It is important to keep RFR distinct from power-line electromagnetic fields.) Comparison of potential risks from RFR exposure with other occupational and environmental health risks requires evaluating the level of support from available epidemiology, from studies with laboratory animals, and from mechanistic or biophysical information about the interaction of RFR with living tissues. A large number of studies have been done with laboratory animals and with in vitro systems; a more limited set of epidemiologic studies is available. Effects from RFR exposure that lead to temperature increases have been consistently reported, but 'non-thermal' effects have not been substantiated. Also, there are no mechanistic theories that support 'non-thermal' interactions with biology. Evidence to support a causal relationship between exposure to RFR and human cancers is scant. Our present state of knowledge about exposure, mechanisms, epidemiology, and animal studies does not identify significant cancer risks.     

Breast Cancer Information Behaviours and Needs among Singapore Women: A Qualitative Study

Background: There is growing evidence on cancer communication and its impact on cancer-related health outcomes; however, little is known about how women gain access to and use breast cancer information in the multi-ethnic Asian context. This paper aimed to explore the breast cancer information acquisition behaviours and needs among Singapore women who attended a community-based health organisation for mammography screening. Methods, design and setting: Qualitative data were collected through semi-structured interviews with 37 racially diverse, aged 50 and above women, who have received mammography screening within the past two years. The interviews were conducted at either the Singapore Cancer Society Clinic or participant’s home. Results: Although cancer information scanning was more prevalent than information seeking (91.9% vs. 62.2%), those who purposively seek information exhibited a higher knowledge level of breast cancer. The most commonly cited sources for information scanning were friends, television and family, and for information seeking were the Internet, pamphlets from a healthcare organisation/ public authority, and healthcare providers. Singapore women were well-informed about the benefits of mammogram; however, specific knowledge, such as modifiable risk factors, reasons for different screening options and the trade-off between harm and benefit, was still lacking which led to confusion about screening. Conclusion: Breast cancer health educational materials should provide clear and balanced information to give women a more accurate or realistic expectation about mammography screening. Study findings provide important implications for breast cancer education and programs to move beyond simply raising awareness and craft specific informative messages addressing the needs of the target group.     

Tobacco-Related Chronic Illnesses: A Public Health Concern for Jamaica

Background: Tobacco use is a leading cause of preventable morbidity and mortality from non-communicablediseases. The objectives of the study were to determine the percentage of annual income used to purchasetobacco-related products and treat tobacco-related illnesses, and assess the characteristics of smokers and theirawareness of the health-related risks of smoking. Method: Stratified and snowball sampling methods were usedto obtain information (via a 17-item, close-ended questionnaire) from 85 adult respondents (49 males and 36females). The instrument comprised of demographic characteristics, smoking behavioural/lifestyle, health, andmicro socio-economics. Results: There were no significant differences between individuals who were affectedby chronic obstructive pulmonary disorder (COPD) (14.1%) and cardiovascular disease (18.8%). It was foundthat respondents spend 30-39% of their annual income on tobacco-related products. Forty percent (40.0%) and41.7% of respondents with lung cancer and COPD respectively spend more than 50% of their annual incometo treat these diseases. The majority (80%) of those who continues to consume tobacco-related products wereuncertain as to why they were doing it. Not all the smokers were aware of the dangers of tobacco consumptiondespite their level of education. Conclusion: The majority of the respondents who had tobacco-related illnessessuch as lung cancer and COPD spend a significant amount of their income on their health care. Not all thesmokers were aware of the dangers of tobacco consumption despite their level of education. This suggests theneed for increase public awareness where both smokers and non smokers are being fully or adequately informedabout the dangers or health risks of tobacco consumption.     

Communicating cancer risk in print journalism

The current barrage of information about real and potential cancer risks has created undue fears and misplaced concerns about cancer hazards faced by Americans. Most members of the general public are far more worried about minuscule, hypothetical risks presented by environmental contaminants than about the far greater well-established hazards that they inflict on themselves, for example, through smoking, dietary imbalance, and inactivity. It is the job of the print media to help set the record straight and to help place in perspective the myriad cancer risks that are aired almost weekly in 30-second radio and television broadcasts.     

Follow-up Care Education and Information: Identifying Cancer Survivors in Need of More Guidance

Cancer survivors engage in cancer screenings and protective health behaviors at suboptimal rates despite their increased risk for future illness. Survivorship care plans and other educational strategies to prepare cancer survivors to adopt engaged roles in managing long-term follow-up care and health risks are needed. In a sample of cancer survivors, we identified patient characteristics and psychosocial predictors associated with increased follow-up care informational needs. Cross-sectional surveys were administered to early-stage breast and prostate survivors (N?=?278; 68 % breast) at least 2 years post treatment from four community hospital programs in New Jersey between May 2012 and July 2013. Patient demographics, medical history, psychosocial characteristics (i.e., worries about the future, fear of disease recurrence, and patient activation), and perceptions of oncology and primary care were assessed. African-American survivors (AOR?=?2.69, 95 % confidence interval [CI] 1.27–5.68) and survivors with higher comorbidity (AOR?=?1.16, CI 1.01-1.33) were more likely to want additional information to guide follow-up care. Adjusting for race and comorbidities, survivors who wanted more information to guide their follow-up care reported greater worries about the future (p?<?0.05) and fears about disease recurrence (p?<?0.05) compared to those who did not want additional information. Results emphasize the need to develop cancer survivorship educational strategies that are both responsive to the needs of specific populations (e.g., African-American survivors and patients with multiple comorbidities) and the psychosocial profiles that motivate requests for more extensive follow-up guidance.     

Impact of information about risks and benefits of cancer screening on intended participation

BackgroundProviding comprehensive information about the risks and benefits of cancer screening is ethically necessary, but information about risks may decrease participation. This study explored the impact of information on intended participation using a randomised factorial design.MethodsWe conducted a mail survey of 2333 adults living in Geneva, Switzerland. Each participant was given one randomly chosen version of a scenario that described a hypothetical cancer screening test, and was asked whether he or she would accept to undergo screening. The versions varied in terms of the amount of information about risks and benefits.ResultsRespondents who received information about risks associated with screening were more likely to refuse participation (odds ratio 2.6 (95% confidence interval (CI) 2.0–3.5)) than those who received minimal information. In contrast, information about benefits had no impact on intended participation (odds ratio 1.0 (95% CI 0.8–1.2)). The impact of information about risks was significantly stronger in women than in men, in respondents who were in poorer health, who have had a doctor visit in the past 6 months, those who have had a cancer screening test in the past 3 years, and those who reported a high desire for autonomy in medical decisions.ConclusionsInforming potential participants about the risks of screening may reduce participation rates. Enhanced information about the benefits of screening does not counterbalance this effect.     

Health-related information needs in a large and diverse sample of adult cancer survivors: implications for cancer care

Background  This study describes the information needs of adult cancer survivors, identifies sociodemographic, health, and healthcare-related factors associated with information needs, and examines the relationship between information needs and survivors’ perceived mental and physical health. Methods  One thousand forty survivors 2–5 years post-diagnosis who were identified via two cancer registries were included in the present analysis. Self-report questionnaires assessed six categories of information needs, sociodemographic, health, and healthcare-related variables, and perceived mental and physical health. Results  Information needs were prevalent and varied; most survivors need more information about tests and treatments, health promotion, side effects and symptoms, and interpersonal and emotional issues. Multivariate analyses suggested that survivors who were younger, who reported non-White race/ethnicity, who reported less than excellent quality of follow-up cancer care, and who had more comorbid health conditions had more information needs. After adjustment for sociodemographic and health-related variables, more information needs were associated with worse perceived mental and physical health. Conclusions  Most cancer survivors needed more information about maintaining good health outcomes during survivorship. Health communication interventions, such as Survivorship Care Plans, have excellent potential to address survivors’ information needs while improving quality of follow-up cancer care and health-related quality of life.     

The use of video-based patient education for shared decision-making in the treatment of prostate cancer

Increased consumerism, patient empowerment, and autonomy are creating a health care revolution. In recent years, the public has become better informed and more sophisticated. An extraordinary amount of treatment advice from books, the media, and the Internet is available to patients today, although much of it is confusing or conflicting. Consequently, the traditional, paternalistic doctor-patient relationship is yielding to a more consumerist one. The new dynamic is based on a participatory ethic and a change in the balance of power. This shared decision-making creates a true partnership between professionals and patients, in which each contributes equally to decisions about treatment or care. Evidence suggests that in diseases such as prostate cancer, where there may be a number of appropriate treatment options for a particular patient, shared decision-making may lead to improved clinical and quality-of-life outcomes. This article explores the evolving relationship between the physician and patient, the pros and cons of shared decision-making, and the use of video technology in the clinical setting. The authors review the use of medical decision aids, including a video-based educational program called CHOICES, in the treatment of prostate cancer and other diseases.     

Perceptions of cancer-related information among cancer survivors: a report from the American Cancer Society's Studies of Cancer Survivors

BACKGROUND.: Sources of cancer-related information are rapidly increasing, but little is known about whether the health information available to cancer survivors meets their needs. METHODS.: The authors surveyed 778 Massachusetts cancer survivors 3, 6, or 11 years after their diagnosis for 6 common cancers. They analyzed their views about 5 types of cancer-related information, the quality of that information, barriers to getting it, their experiences with physicians providing cancer care, and the quality of their cancer care. RESULTS.: Among 462 (61%) respondents who reported needing cancer information, many gave unfavorable ratings (fair or poor) of the quality of cancer information regarding cancer support groups (38%), long-term side effects (36%), experiences of other cancer patients (26%), and cancer physicians (26%). About 20% of respondents reported sometimes experiencing barriers to obtaining cancer information, although fewer than 10% usually or always experienced barriers. For both men and women, worse physical and mental functioning was associated with greater need for information, worse ratings of information quality, and more barriers to obtaining information (all P<.01). Cancer survivors who were black or had lower incomes reported more problems obtaining needed information, and younger women had greater information needs than older women (all P <.01). CONCLUSIONS.: Opportunities exist to improve the quality, content and delivery of cancer-related information to survivors, especially for those who are racial/ethnic minorities, have low incomes, or are in worse physical or mental health. Providing information more effectively to cancer survivors may improve their care and health outcomes. Cancer 2008. (c) 2008 American Cancer Society.     

Oral cancer and dentists: knowledge, attitudes, and practices in Italy

The purpose of the survey was to assess through a mailed questionnaire the knowledge, attitudes, and behaviors regarding oral cancer and their relationship with different indicators in a random sample of 1000 dentists in Italy. Respondents know the major risk factors and only half identify the diagnostic procedures. One-third indicated the most common form and the early lesions and this knowledge was more likely in those graduated from dental school and attended a course on oral cancer in the previous year. Approximately two-thirds (64.8%) believed that they were prepared to perform an oral cancer examination and to palpate lymph nodes in patients' necks. Multiple logistic regression revealed that this positive attitude was significantly higher for those who graduated from medical school and for those who have attended a course on oral cancer in the previous year. Half of the dentists routinely perform an oral cancer examination on all patients and it was more likely by those graduated from dental school, those who know that squamous cell is the most common form of oral cancer and that an early oral cancer lesion usually is a small, painless red area, those who believed that they are prepared to perform an oral cancer examination and to palpate lymph nodes in patients' necks, those who have attended a course on oral cancer in the previous year, and those who claim they need information. The importance of health care professionals as communicators of public health messages should be emphasized.     

Risk perception and concern among brothers of men with prostate carcinoma

BACKGROUND: It is important for clinicians, researchers, and others who shape public health policy to understand the demographic correlates and psychologic factors that drive health behaviors, such as screening for early detection of cancer, particularly among individuals at high risk for developing the disease. METHODS: One-hundred eleven men whose brothers were diagnosed with prostate carcinoma completed a computer-assisted telephone interview aimed to assess their perception of absolute risk and concern about developing prostate carcinoma over the next 10 years and across their lifetime. Comparisons were made between selected demographic, behavioral, family pedigree characteristics, and measures of perceived risk and concern. RESULTS: The majority of men perceived their personal risk of developing prostate carcinoma to be > or =50%. Men who at the time of the interview were younger than their affected brother were significantly more concerned about prostate carcinoma and perceived their risk to be higher than men who were older than their brother. Estimates of personal risk and concern were also uniformly higher among men with more than one first-degree relative affected with prostate carcinoma compared to men with only one affected first-degree relative. Risk perception and concern about an impending prostate carcinoma diagnosis were associated with the use of supplements marketed for prostate health. CONCLUSIONS: The findings indicated that birth order in relation to a brother diagnosed with prostate carcinoma is significantly associated with risk perception and concern in unaffected family members. These results highlight the need for further study of the familial dynamics and characteristics that drive health behaviors and stress importance of public health education to inform men of personal risk assessment as well as the risks and benefits of screening. These studies ultimately can contribute to the success of strategies for the primary prevention and early detection of cancer.     

Postmastectomy educational needs and social support

Due to shorter hospitalization periods and changes in surgical procedures, breast cancer patients have less inpatient contact with rehabilitation resources. A questionnaire related to educational needs and social support was mailed statewide to 2,000 postmastectomy women who had received a Reach to Recovery visit. The findings are based on quantitative data reported by 933 women and from 27 women in follow-up interviews. Respondents ranked their educational needs in six categories from greatest to least importance as follows: (1) information about breast cancer, (2/3) personal hygiene/exercise and nutrition/weight control (both ranked of equal importance), (4) prosthesis/clothing information, (5) social support, and (6) sexual issues. Performance on the knowledge assessment correlated directly with the amount of educational experience and inversely with age. Respondents who lived in communities of less than 2,500 were less informed than those from other locations. Participation in formalized support groups was infrequent (11%). The major source of information was the media, with 88% indicating they would watch television programs about breast cancer. Thirty-three percent of the respondents indicated they owned a video cassette recorder (VCR); about 93% said VCRs were available for rent in their community. Work associates were identified as a group that encouraged information seeking; health care professionals were the most successful in motivating women to participate in support groups.     

Beliefs,Attitudes, and Behavior of Turkish Women about Breast Cancer and Breast Self-Examination According to a Turkish Version of the Champion Health Belief Model Scale

Background: Breast cancer (BC) is one of the most common cancer affecting women worldwide. Although agreat deal of progress has been made in the health sciences, early diagnosis, and increasing community awareness,breast cancer remains a life-threatening illness. In order to reduce this threat, breast cancer screening needs tobe implemented in all communities where possible. Objective: The purpose of this study was to examine healthbeliefs, attitudes and behaviors about breast cancer and breast self-examination of Turkish women. Methods:Data were collected from a sample of 656 women, using an adapted Turkish version of Champion’s Health BeliefModel Scale (CHBMS), between January and May 2011, in Ordu province of Turkey. Results: The results showedthat 67.7% of women had knowledge about and 55.8% performed BSE, however 60.6% of those who indicatedthey practiced BSE reported they did so at irregular intervals. CHBMS subscales scores of women accordingto women’s age, education level, occupation, family income and education level of the women’s mothers, familyhistory of breast cancer, friend and an acquaintance with breast cancer, knowledge about breast cancer, BSEand mammography were significantly different. Conclusion: Knowledge of women about the risks and benefitsof early detection of breast cancer positively affect their health beliefs, attitudes, and behaviors. Health careprofessionals can develop effective breast health programs and can help women to gain good health behaviorand to maintain health.