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Associations were found among TV viewing, energy-dense snack consumption, and snacking behavior, and between TV viewing and body weight status.

Background Less than 5% of all adult patients with cancer enter clinical trials. These rates are lower in racial/ethnic minority populations, negatively affecting the generalizability and validity of trial results. Many studies have identified barriers to minority enrolment, yet few have gathered in-depth insights into minority patients’ reasons for trial refusal. We aimed to (1) explore trial refusal reasons in a sample of African American (AA) patients with cancer who declined trial participation and (2) gather patients’ perceptions of the potential benefit of an array of decision support tools. Methods Participants were 22 consecutively recruited AA patients with cancer who had declined participation in a therapeutic clinical trial. Within 3 months of the trial refusal decision, participants completed an audio-recorded semistructured interview that asked about demographic and disease information, psychosocial factors, and patients’ experience with clinical trials. Two months later, participants completed a questionnaire that asked about their trial decision. Results Few patients received positive recommendations about joining a trial. Patients gave multiple refusal reasons. Only two participants refused to join a clinical trial as a result of issues of mistrust. Most participants refused as a result of fears of additional burdens and adverse effects. Many patients and family members misunderstood trial information. Family members mostly recommended against trial participation. Most patients felt that question prompt lists or decision aids would assist information seeking and decision making. Conclusion Low rates of physician recommendations for clinical trial participation of AA patients with cancer warrant further investigation. Interventions to reduce misunderstandings and aid decision making, both within and external to the clinical interaction, need to target both patients and family members.

Objective To examine the influence of patient and physician communication factors on diagnostic delay (DD). Methods 242 patients diagnosed with colorectal cancer (CRC) in the past 6 months who experienced symptoms prior to diagnosis were administered a 2-hour semi-structured qualitative interview to assess communication with health care provider and ease of access to care, among other factors. Patient-provided information was verified via review of medical records. Results The factors associated with DD > 2 months included lower income (OR=0.56, p=0.03), having regular physician prior to receiving a cancer diagnosis (OR=2.52, p=0.03), having a physician who used temporizing communication strategies during the consultation (OR=2.41, p=0.02), receiving an initial alternate diagnosis (OR=3.36, p=0.02), experiencing referral delay (OR=3.61, p=<0.001), and experiencing follow-up delay of any kind (OR=3.32, p=0.01). Conclusion Excellent communication skills that appropriately probe for relevant social and economic patient information, assist patients in distinguishing and elaborating on symptoms, and provide clear rationale and instructions for future steps, will speed along the diagnosis process and could be the difference between early and late stage CRC. Practice Implications Increased understanding of physician communication and practice styles that contribute to DD could have a positive impact on decreasing the morbidity and mortality from this disease.

BackgroundThere is often a lack of transparency in research using online panels related to recruitment methods and sample derivation. The purpose of this study was to describe the recruitment and participation of respondents from two disparate surveys derived from the same online research panel using quota sampling. MethodsA commercial survey sampling and administration company, Qualtrics, was contracted to recruit participants and implement two internet-based surveys. The first survey targeted adults aged 50-75 years old and used sampling quotas to obtain diversity with respect to household income and race/ethnicity. The second focused on women aged 18-49 years and utilized quota sampling to achieve a geographically balanced sample. ResultsA racially and economically diverse sample of older adults (n=419) and a geographically diverse sample of younger women (n=530) were acquired relatively quickly (within 12 and 4 days, respectively). With exception of the highest income level, quotas were implemented as requested. Recruitment of older adults took longer (vs. younger female adults). Although survey completion rates were reasonable in both studies, there were inconsistencies in the proportion of incomplete survey responses and quality fails. ConclusionsCancer researchersand researchers in generalshould consider ways to leverage the use of online panels for future studies. To optimize novel and innovative strategies, researchers should proactively ask questions about panels and carefully consider the strengths and drawbacks of online survey features including quota sampling and forced response. ImpactResults provide practical insights for cancer researchers developing future online surveys and recruitment protocols.

Background: Nutrition literacy (NL) and food literacy (FL) have emerged as key components in the promotion and maintenance of healthy dietary practices. However, a critical appraisal of existing tools is required to advance the operationalization and measurement of these constructs using instruments that demonstrate sound validity and reliability. Methods: Electronic databases were searched in January and July 2016, January 2017, and March 2018 for publications detailing the development and/or testing of NL or FL instruments. Instruments' psychometric properties were assessed using a structured methodological framework. We identified 2,563 new titles and abstracts, and short-listed 524 for full review. The extent to which key domains of NL were included in each measure was examined. Key Results: Thirteen instruments assessing NL underwent full evaluation; seven from the United States, and one each from Australia, Norway, Switzerland, Italy, Hong Kong, and Japan. Measures targeted general Spanish-, Italian-, or Cantonese-speaking adults; primary care patients, parent, and populations with breast cancer. Instruments ranged from 6 to 64 items, and they predominantly assessed functional NL rather than broader domains of NL. Substantial variation in methodological rigor was observed across measures. Discussion: Multidimensional and psychometrically sound measures that capture broader domains of NL and assess FL are needed. Plain Language Summary: This review systemically compiles, and critically appraises 13 existing measures that assess nutrition literacy and food literacy in an adult population. Substantial variation in methodological rigor was found across the measures, and most tools assessed nutrition literacy rather than food literacy. Findings from this current review may be useful to guide development of future measures that comprehensively capture nutrition literacy and food literacy. [ HLRP: Health Literacy Research and Practice . 2018;2(3):e134–e160.]

Patient portals are becoming widespread throughout health-care systems. Initial research has demonstrated that they positively impact patient-provider communication and patients' health knowledge, but little is known about the impact of patient portals in the cancer setting, where highly complex and uncertain medical data are available for patients to view. To better understand communicative behaviors and perceptions of the patient portal and how it is utilized in oncology, in-depth, semi-structured interviews were conducted with 48 participants: 35 patients and 13 oncologists. Thematic analysis identified that portals help to enhance participation during in-person consultations, increase patients' self-advocacy, and build rapport with providers. However, patients' comfort level with reviewing information via the portal depended upon the severity of the test. Oncologists worried about patient anxiety and widening health disparities, but acknowledged that the portal can motivate them to expedite communication about laboratory and scan results. As patient portals become more widely used in all medical settings, oncologists should become more engaged with how patients are viewing their medical information and consider the portal within the framework of patient-centered care by valuing patients' communication preferences.

Decision aids (DA) can inform cancer screening. We conducted a systematic review of web-based, cancer DA to evaluate their appropriateness for use with low literacy and diverse culture groups. Eighty-one Internet DA were found searching five databases (Pubmed-Medline; Web of Science/SSCI; Cancerlit; CINAHL; and Google) and the Cochrane decision aid inventory. Twenty-three met key inclusion criteria of (1) informing cancer screening or treatment decisions, (2) being patient or consumer oriented, and (3) conforming to the Cochrane definition of DA. DA were evaluated using the International Patient Decision Aid Standards checklist, the Cultural Sensitivity Assessment Tool (CSAT), the Cultural Sensitivity Assessment Checklist (CSAC), and the SMOG readability formula. DA had a high readability with 74% (n = 17) written at the grade 10 - 13, 22% (n = 5) at the grade 9, and 4% (n = 1) at the grade 8 level. Visual aids were used in 35% (n = 8) to present probability information. Written information was complemented with video or audio components in 35% (n = 8). Most (91%, n = 21) were developed for generic audiences, while 9% (n = 2) specified a cultural group. Although DA enabled a step-by-step movement through the website, none allowed key word searches and only 65% permitted document printing. Most DA included difficult texts and were not focused for specific cultural groups.