Wendy Birmingham, Psychology
Review of Research Study and Academic Objectives
Colorectal cancer (CRC) is the third most common cancer and the second leading cause of cancer death in the U.S. A family history of CRC is one of the strongest risk factors for the disease; those with a first-degree relative (i.e., a parent, sibling or child) with CRC have a two- to four-fold increased risk of CRC compared to the general population. A large literature indicates CRC screening can significantly reduce risk of CRC, yet screening rates remain less than optimal in those at increased risk. Some literature suggests that social influence and greater family support for screening and lower levels of social isolation are associated with increased CRC screening. However, much of the work on social relationships has focused on broader health behavior or the effect of social networks on individuals who have already been diagnosed with cancer, while relatively little has examined the effect of social relationships in preventing cancer occurrence, specifically the quality of the marital relationship and communication processes on spousal influence in CRC screening decision-making and lifestyle behaviors that can reduce risk. This study represented an innovative partnership between BYU, the University of Utah and Huntsman Cancer Institute. The primary goal of this project is to examine the effect of spousal influence, spousal communication patterns, and spousal relationship quality on cancer screening decision making in at-risk individuals and on lifestyle behaviors that can reduce cancer risk.
There were four primary academic and research outcomes we expected students would develop while participating in this study. First, students will learn to actively recruit participants from a cancer patient population, and gain an understanding of the ethical considerations and sensitivity to confidentiality inherent in recruiting from such a population, including HIPPA considerations. Second, students will assist with the genetic counseling sessions and participate in training sessions to develop understanding of direct-to-consumer genetic testing, and the risks and benefits associated with such testing. Third, students will be trained in behavioral coding through Noldus Observer, and will code and disseminate data, and assist in data analysis. Fourth, students will present findings and assist in manuscript preparation.
Evaluation of Academic Objectives and Specific Products of MEG
Overall the project has gone extremely well. Students have been able to recruit from a cancer population at Huntsman Cancer Institute, learning the difficulties of recruitment from such a population. They have had the opportunity to participate in the genetic counseling sessions, be trained through specialized training seminars with our licensed, certified genetic counselor in direct-to-consumer testing, and in genetic evaluations of CRC risk. Students were thoroughly trained in coding with Noldus Observer, including weekly meetings centering on coding proficiency and accuracy. They participated in analyzing the data, and in presenting findings at both international research conferences and at local undergraduate research conferences.
Students participated in presenting both a paper presentation on our findings, and a poster presentation at the 2015 International Association for Relational Research annual research meeting at Rutgers University in New Jersey in June 2015. Two students attended the conference and it was a wonderful experience participating in an international conference and hearing first hand from international experts in the field. We also presented our findings in one paper and one poster presentation at the 2015 World Congress of Psycho-Oncology meeting in Washington, DC in July 2015 and a paper presentation at the 2015 International Conference on Communication in Healthcare in New Orleans, LA in October 2015. Students also presented our findings at local undergraduate conferences, giving them an opportunity to be first-author presenters. Six students were involved and four students traveled to St. George, Utah to present at the Utah Conference on Undergraduate Research. Six students also were involved and presented findings at the Mary Lou Fulton Mentored Student Research conference in April, 2015. These were great experiences for students to first-author a presentation and present in a conference.
For 2016 we have a paper accepted at the Utah Conference on Undergraduate Research in Salt Lake City. Two students were involved and will present the finding. We are very excited about these conferences we have presented at, and upcoming opportunities for students to present research findings in these venues. We have now submitted one manuscript, which is currently under review, and are preparing several manuscripts for publication based on these presentations and findings. In addition, we have been invited to write a book chapter on our spousal influence findings from this study based on our presentation delivered at IARR.
Description of the results/findings of the project
We have begun basic analysis of the data and presented initial findings at three international conferences and three undergraduate conferences discussed above. We have also submitted a manuscript to Patient Education and Counseling and it is currently under review. The findings so far indicate that spousal influence does impact behavior, although spouses report more influencing than their partners’ report, indicating that not all influence is recognized. Spouses also engage in several strategies to reduce their CRC risk, and problem-solve together, including problem solving diet and exercise issues, however, other risk factors received far less attention and spouses also minimized or negated the importance of some health behaviors. Negation was quite common. Of particular interest: our at-risk partners report that their spouses did not encourage or influence their cancer screening behavior or self-examination screening behavior. And overall, self-examination behavior for cancer (while not related to CRC) was very low. Our next analysis will be to examine interest in genetic testing and the effects of relationship quality on spousal influence and communication patterns.
Evaluation of the Mentoring Environment
Both Dr. Birmingham and Dr. Reblin (from the U of U; and now Moffitt Cancer Center in Tampa, Florida) led weekly research team meetings that are attended by all undergraduate lab members. Dr. Reblin provided initial extensive training sessions on coding with students and then led weekly Skype meetings, assessing the quality and accuracy of the students coding. This hands-on experience helped students to become proficient in such behavioral coding.
Most students were involved on this project for a year, allowing them to develop professional relationships with both researchers and with other students, and to present research findings at local and international research conferences. Students played a large role in all phases of the research—from recruitment to scheduling, to assisting with the genetic counseling sessions, data entry, data coding, data analysis, abstract writing, presenting at conferences, and working on manuscripts, enabling them to gain experience not possible in classroom settings. This experience provided students the opportunity to develop strong resumes and graduate school applications; in fact, several students have already gone on to strong graduate school programs. Overall, it has been a wonderful experience.
List of Students Mentored and Outcomes
We (the students and I) continue to work on the data, which will lead to future publications and presentations. However, student outcomes and participation are as follows:
- Chelsea Romney: 4 conference presentations
- Emily Hartung: one paper in preparation; 6 total conference presentations
- Sarah Higbee: one paper in preparation; 4 total conference presentations
- Jordan Sgro: one paper in review; one paper in preparation; 7 total conference presentations
- Spencer Nielson: 1 conference presentation; currently helping with analysis for a manuscript
- Sarah Hanni: 3 total conference presentations Kathleen Willoughby: 4 total conference presentations
- Erin Kaseda: lab participant, currently helping with analysis
- Nathan Gardner: lab participant; data transcribing
- Phillip Smith: lab participant; data transcribing
This MEG grant received $18,000 in total funding. The $10,400 that was requested for wages for research assistants participating in the research project was used to pay student wages. We requested $5,400 to help students pay for conference travel and attendance. This was spent on conference travel for two students to the IARR conference and for 4 students to the Utah Conference on Undergraduate Research. We requested $1,800 for the PI to travel and supervise the conference and this was spent on the IARR conference. We also requested and spent $2,000 on newspaper advertising for the project. We requested and spent $400 for mailings and supplies.