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D C Iverson

Publications and source records attributed to D C Iverson.

At least 19 recordsLinked to original sources
PubMed1999

The Sociobehavioural Cancer Research Network: background and progress report.

The Sociobehavioural Cancer Research Network (SCRN) was established in 1994 by the National Cancer Institute of Canada (NCIC) with funding from the Canadian Cancer Society (CCS). The network was created to facilitate the development of behavioural science studies that would contribute to a fuller understanding of the cancer experience, from prevention through detection, treatment and post treatment (including palliative care). This article describes the nature of network research, the development and organization of the Sociobehavioural Cancer Research Network and the challenges it faces.

Adolescent↗
PubMed1997

Perspectives on Reach to Recovery and CanSurmount: informing the evaluation model.

The Canadian Cancer Society requested that the Centre for Behavioural Research and Program Evaluation of the National Cancer Institute of Canada evaluate Reach to Recovery and CanSurmount, 1-on-1 peer-support programs that provide information and support to individuals with cancer and their families. Key informant interviews (with program participants and volunteer visitors) were conducted to gather qualitative data and to help us develop a framework and tools to evaluate these programs. We found that 1) there are program objectives from the perspective of volunteers and participants in addition to those outlined in the program materials; 2) there are variations in how the programs are delivered and how patients or family members are recruited into the program; and 3) there is evidence that Reach to Recovery and CanSurmount volunteers are in a unique position to deliver the programs, either because they have personally experienced cancer or have family members who have had cancer. We describe the key informant exercise developed for this evaluation project and present the results of preliminary data-gathering activities.

Breast Neoplasms↗
PubMed1995

Charting the NCIC's future: stakeholder support for identified options.

The National Cancer Institute of Canada (NCIC) conducted a survey of representatives of its stakeholder populations (members of the cancer research and control communities, past and present NCIC grantees, senior administrators in academic institutions, NCIC governing committee representatives and major partners) to get input on proposals to restructure the NCIC's research programs. The survey results demonstrate support for changes that are likely to significantly alter how the NCIC operates as well as the programs it sponsors. The results suggest support for increasing the percentage of NCIC funds allocated to the Individual Operating Grants area and for changing the NCIC's programs and operating procedures. While there was widespread support for an NCIC-sponsored regional development initiative, many issues remain unresolved, such as what type of cancer research to develop within the provinces.

Academies and Institutes↗
PubMed1995

Issues for interpreting external stakeholder feedback on restructuring NCIC's research programs.

The National Cancer Institute of Canada surveyed members of its stakeholder groups on a number of issues pertaining to restructuring research programs. While it was hoped that the survey would ensure input from its primary stakeholder groups and thereby facilitate decision-making on critical issues like distribution of funds and research awards, there is reason to believe this may not have occurred. Some of the stakeholder groups seemed to be over-represented in the respondent population and the effect of this on the results was therefore examined. Analysis revealed several important issues: 1) a clear definition of who constitutes a "stakeholder" needs to be developed when stakeholder input-gathering is being contemplated; 2) multi-faceted strategies need to be developed to gain input from stakeholders; 3) potential sources of bias can emerge from the various techniques used to gather feedback from stakeholders; and 4) a clear outline of how the feedback is to be used in the decision-making process needs to be determined.

Academies and Institutes↗
PubMed1994

Preventing HIV infection among adolescents: evaluation of a school-based education program.

BACKGROUND: This article reports the results of the impact of a school-based HIV prevention intervention on students' knowledge, attitudes, and behavior related to HIV infection. METHODS: Seventeen schools within six Colorado school districts were assigned to either intervention or comparison conditions. Students in 10 schools received a 15-session, skills-based HIV prevention curriculum implemented by trained teachers. A total of 2,844 students completed at least one survey during the study period; surveys were matched using demographic questions, yielding a cohort of 979 students who had baseline and 6-month follow-up data. RESULTS: Intervention students exhibited greater knowledge about HIV and greater intent to engage in safer sexual practices than the comparison students. Among sexually active students at the 6-month follow-up, intervention students reported fewer sexual partners within the past 2 months, greater frequency of using condoms, and greater intentions to engage in sex less frequently and to use a condom when having sex. Intervention students were also more likely to believe that teens their age who engage in HIV risk behaviors are vulnerable to infection. The intervention neither delayed the onset nor decreased the frequency of sexual intercourse and the frequency of alcohol and other drug use before sex by the 6-month follow-up assessment. CONCLUSIONS: The results suggest that skills-based risk reduction programs can have an effect on student behavior. Among sexually active students, evidence suggests that school-based interventions can reduce behavior associated with risk of HIV infection.

Adolescent↗
PubMed1994

The danger of applying uniform clinical policies across populations: the case of breast cancer in American Indians.

OBJECTIVES: This study examined the implications of annual screening mammography for cost and mortality in American Indian populations with differing baseline breast cancer rates. METHODS: A decision tree compared annual screening mammography and screening clinical breast examination with referral for diagnostic mammography when appropriate. The decision tree was constructed to examine the effect of different base-line cancer rates, stage at diagnosis, and stage-specific survival. Outcomes included 5-year relative survival, deaths prevented at 5 years, cost per death prevented, and total costs. RESULTS: The findings suggest that the total cost of breast cancer is 3.6 times higher with the screening mammography program but results in a 27.9% reduction in breast cancer deaths over the first 5 years of the program. Both costs and deaths prevented are sensitive to the incidence of breast cancer in the population and are less favorable in the range of incidence seen in American Indians. CONCLUSIONS: The cost and impact of a given strategy for cancer screening vary among communities with different disease incidence, stage at diagnosis, and stage-specific survival, as seen in American Indian populations.

Adult↗
PubMed1994

The NCIC/CCS behavioral initiative. National Cancer Institute of Canada Canadian Cancer Society.

The NCIC's behavioral initiative is comprised of three pillars, each of which is designed to make an important independent contribution toward a reduction in cancer incidence, morbidity or mortality rates. It is also expected that the activities in one area will complement those in the other areas, thereby creating a synergistic effect. To determine if the objectives of the Centre for Behavioral Research and Program Evaluation (CBRPE) are being met, the NCIC has committed to an ongoing assessment of the CBRPE's performance, including an independent review of its scientific merit by a site visit conducted at the end of the second year of the CBRPE's operation. Thus, while the behavioral initiative represents a different type of investment by the NCIC, its contributions will be judged via a process that is central to all NCIC activities--the assessment of scientific merit by teams of persons recognized nationally and internationally for their expertise in social and behavioral research as it pertains to cancer.

Behavioral Sciences↗
PubMed1994

Carpal tunnel syndrome in primary care: a report from ASPN. Ambulatory Sentinel Practice Network.

BACKGROUND: Carpal tunnel syndrome (CTS) is a common condition in primary care, yet little is known about its presentation and management. This study was designed to provide a better understanding of the frequency of CTS in a primary care population, and its presentation, diagnosis, and management. METHODS: Clinicians in 74 Ambulatory Sentinel Practice Network (ASPN) practices from 30 states and three Canadian provinces collected data on all patients presenting with symptoms of CTS during a 30-month period. RESULTS: The adjusted frequencies of all visits and of first visits for symptoms of CTS were 1.01 and 0.68 per 1000 patient visits, respectively. Women visited more frequently than men with new onset symptoms of CTS (0.81 vs 0.55 per 1000 visits), and homemakers accounted for 15.9% of all new cases. Clinicians judged 43.1% of all CTS incident visits to be job-related. The diagnostic evaluation of patients seldom included nerve conduction studies (12.9%) or electromyography (11.8%). The most frequent treatments were splints (56.3%) and nonsteroidal anti-inflammatory agents (50.8%). Four-month follow-up data were obtained for 68.5% of the patients, and symptom relief was reported by 55.2% of patients. Ninety percent of patients were able to continue working at the same job, and 96% were able to continue their usual activities. CONCLUSIONS: Carpal tunnel syndrome symptoms are common in primary care, and most cases occur among women, many of whom are homemakers. Most patients with CTS symptoms are treated conservatively by their primary care clinicians with minimal testing or referral, and most patients report improvement or resolution of symptoms at 4 months.

Adult↗
PubMed1993

Involving providers and patients in cancer control and prevention efforts. Barriers to overcome.

Although progress has been made in providing cancer prevention and control services to the population, there remain sizeable segments of the population that are either uninvolved or underinvolved with national and state efforts. One method of reaching most of the population, including those segments currently not involved or underinvolved, is through primary care clinicians. Effective, albeit imperfect, strategies to increase the involvement of primary care clinicians in cancer prevention and control are available, and there is emerging evidence that these strategies are making a difference. Unfortunately, the progress made to date is at risk of being lost because of economic barriers that can be expected to reduce the likelihood of persons, especially low-income and minority persons, having regular access to cancer prevention and control services through their primary care clinicians.

Breast Neoplasms↗
PubMed1993

How representative of typical practice are practice-based research networks? A report from the Ambulatory Sentinel Practice Network Inc (ASPN)

OBJECTIVE: To evaluate the patients and practices of family physicians in a national practice-based research network to understand whether results from practice-based research networks are likely to be relevant to other practicing clinicians. STUDY DESIGN: Survey focused on family physicians that replicated the National Ambulatory Medical Care Survey (NAMCS). SETTING: The Ambulatory Sentinel Practice Network Inc (ASPN), a practice-based research network, consisting of volunteer primary care practices that serve approximately 350,000 patients. OUTCOME MEASURES: Comparison of visits reported in ASPN with the visits reported in the 1990 NAMCS in terms of patient demographics, reasons for visit, diagnostic and therapeutic services, diagnoses, disposition, and amount of time spent with patients. RESULTS: Overall, the two samples differed with respect to demographic characteristics of patients, while problems, diagnoses, services, disposition, and time spent with patients were similar. Specific pair-wise comparisons identified areas of difference. CONCLUSION: The ASPN and possibly other similar practice-based research networks are sufficiently representative of family practice to serve as useful laboratories in which family practice and primary care can be explored.

Adolescent↗
PubMed1993

Does family practice at residency teaching sites reflect community practice?

BACKGROUND: Family medicine has aspired to train residents and conduct research in settings that closely resemble community practice. The purpose of this study was to compare the patient characteristics of the ambulatory teaching centers of a consortium of seven community-based university-affiliated family practice residency programs in northeast Ohio with the National Ambulatory Medical Care Survey (NAMCS) results for family physicians (FPs) and general practitioners (GPs). METHODS: Ninety-eight faculty and resident physicians at the residency training site of the Northeastern Ohio Universities College of Medicine collected data on all ambulatory patient visits (N = 1498) for one randomly chosen week between July 1, 1991, and June 30, 1992. We compared these data with patient visits reported in the 1990 NAMCS for FPs and GPs. RESULTS: The residency training sites saw slightly more children, women, blacks, and Medicare and Medicaid patients. The most common reason for an office visit in both populations was an undifferentiated symptom. Fifteen of the top 20 "reason for visit" codes were identical, as were 14 of the top 20 diagnoses. More preventive and therapeutic services were offered or performed at our residency training sites but fewer diagnostic services were performed. There were fewer consultations requested at our residency training sites but similar hospitalization rates for patients. The mean duration of visit differed by only 1 minute. CONCLUSIONS: The residency training sites of the Northeastern Ohio Universities College of Medicine provide patient care opportunities similar to those found in a national survey of family and general practitioners.

Adolescent↗
PubMed1993

Factors influencing mammogram ordering at the time of the office visit.

BACKGROUND: Breast cancer is the second most common cause of cancer death in women, with mammographic screening the only modality shown to decrease the death rate. However, only 17% to 41% of women have ever been screened, and multiple barriers to screening have been identified. This study examined physician and patient factors at a single encounter to explore components influencing mammography ordering. METHODS: Ten family physicians in a primary care research network completed daily data cards on encounters with women presenting for annual examinations, chronic problems, or breast-related complaints. Information collected included patient age, personal or family history of breast cancer, physician's perception of expected compliance, previous mammogram results, breast examination, physician's perception of need for a mammogram, whether the mammogram was ordered, and the patient's method of payment for the test. RESULTS: Eight hundred thirty-nine patients were entered into the study, and 277 mammograms were ordered. Mammograms were ordered for a greater percentage of patients with insurance (36%) than for those without insurance (26%) (P < .001). A multivariate analysis indicated that several factors helped to correctly classify 90% of mammogram ordering: the patient was making a first visit, a breast-related visit, or a visit for an annual examination; the patient had had a previous mammogram; had a breast examination at the current visit or within the past year; and the physician believed the patient would comply and believed that a mammogram was indicated. CONCLUSIONS: Factors unique to a physician-patient visit influence the physician with regard to ordering a mammogram, including the type of visit, whether the physician believes a mammogram is indicated, and the cost.

Adult↗
PubMed1992

Family practice residents' identification and management of obesity.

This study, involving 25 family practice residents and 2746 patients in a family practice residency programme, addressed four hypotheses regarding the identification and management of obesity in the primary care setting: (i) the physician-identified prevalence of obesity is significantly lower than the actual prevalence in the population, (ii) obesity is more likely to be addressed with management actions when it is recorded on the medical record problem list than when it is not recorded, (iii) physician actions dealing with obesity are influenced by the patient's age, sex, level of motivation, and body mass index (BMI) value, and (iv) the type of physician management actions taken are affected by the patient's age, sex, level of motivation, and level of BMI value. Obesity was identified as a risk factor by physicians for 51.6% of all patients with a BMI greater than or equal to 30. Obesity was recorded on the medical record problem list for 70.6% of the physician-identified obese patients. When obesity was recorded on the problem list, management actions were taken for 92.9% of patients. However, when obesity was recorded on a risk factor evaluation form but not on the problem list, management actions were taken for only 56.6% of patients. Self-care strategies were selected as the management strategy more frequently than return visits. Demographic characteristics, BMI value and level of patient motivation did not influence the selection of follow-up management strategies. Given the potential for significant improvement in a patient's health status through early recognition and aggressive management of obesity, the barriers to physician identification and involvement in clinical management of obesity deserve further investigation.

Adult↗
PubMed1988

Patients with new headache in primary care: a report from ASPN.

From a consecutive series of 3,847 headache patients, 1,331 patients who made first visits for new headache to 120 primary care physicians were studied for usual care over a 14-month period. Either tension or vascular headache was the initial diagnosis in 23.8 percent and 12.8 percent of patients, respectively. Nearly one half (47.8 percent) were classified as having headaches other than tension or vascular. A total of 15.3 percent of headaches were undiagnosed or were regarded as a mixture of traditional diagnostic designations. At first visit, most patients (76.6 percent) were managed without diagnostic tests. Drugs were prescribed for 73.6 percent, and advice was given for 58.6 percent. Only 2.0 percent of patients had computerized tomographic scanning ordered at first visit, although at least 46 percent met National Institutes of Health criteria, a finding with potential economic consequences of at least $2 billion. These findings suggest the need for reevaluation of diagnostic categories for headache, reevaluation of strategies for headache management, and further investigations of headache in primary care patients.

Headache↗
PubMed1987

Health behavior models compared.

This study compares the health belief, Fishbein/Ajzen, and PRECEDE models to predict changes in smoking, exercise, and consumption of sweet and fried foods over an eight-month interval. Data were collected from a panel of 326 adults in two large cities of the western United States. The PRECEDE model accounted for more variance in behavior than both the Fishbein/Ajzen and health belief models, but it required far more questions. Fishbein/Ajzen and PRECEDE provide a limited theoretical basis for selecting specific types of beliefs or predisposing factors without turning to the health belief model, making the health belief model complementary to either Fishbein/Ajzen or PRECEDE.

Adolescent↗