Projects | CHCR

Steven J. Katz, MD, MPH
University of Michigan

Some families are at a higher risk for cancer because of changes or mutations that can happen to certain genes. In these families, it is important for family members who are closely related to a person with cancer to consider genetic testing to learn if they do or do not have an increased genetic risk for cancer.

The Genetic Information and Family Testing (GIFT) Study is designed to:

Help families with a history of cancer more easily share important health information about hereditary cancer risk
Help interested family members get genetic testing for cancer risk

The GIFT Study includes two groups of people:

Men and women who were diagnosed with selected cancers in 2017 and who had genetic testing and were found to carry a gene variant that increases cancer risk
Their closely-related biological (blood) family members

Participants receive access to a secure website with personalized information about genetics, genetic cancer risk, and how genetic testing can be helpful to their family. A Family Health Navigator is available to help with outreach to family members and to answer questions. Participants in the “closely-related family members” group can opt to receive home-based genetic testing for cancer risk through the study.

Genetic testing services for the GIFT Study are provided by Color Health. The genetic testing process can be done entirely from home and involves spitting into a tube and mailing it back to the Color laboratory for processing. Color will provide results electronically along with access to a licensed genetic counselor to discuss the test results.

Investigator(s)
Lawrence C. An, MD
University of Michigan

Allison Kurian, MD, M.Sc
Stanford University

The SharES study recruited 700 newly diagnosed, early-stage breast cancer patients at 25 practices all over the US. Patients were given access to a mobile-responsive website that assisted in their decision to have a mastectomy or breast conserving surgery. Clinicians were given access to a clinician dashboard that provided the clinician with information about the patient gathered from the patient-facing website.

For this project, CHCR created a patient-facing decision aid, a clinician dashboard, and a study dashboard.

iCanDecide

iCanDecide was the patient-facing educational component of SharES. It provided educational content including key facts about surgery, key facts about systemic treatment, emotional-self care, and genetic testing.

Clinician Dashboard

The Clinician Dashboard provided clinicians with information about their breast cancer patients to better equip them to help their patients make an informed decision about treatment. This was studied using a stepped wedge cluster trial.

Study Dashboard

The Study Dashboard allowed the SharES Research Assistants to perform key study tasks such as monitor enrollment and track incentives.

Puedo Decidir: Spanish Version

The patient-facing iCanDecide educational site was also offered in Spanish.

Investigator(s)
Sarah T. Hawley, PhD, MPH
University of Michigan

Reshma Jagsi, MD, DPhil
University of Michigan

We partnered with the Michigan Primary Care Association (MPCA) and United Way to create COVID-19 vaccine communication trainings. These online trainings were focused on communication strategies for clinicians and community members to talk to people about the COVID-19 vaccines. Principals of motivational interviewing and background information about the vaccines were covered in the training. The training also included Interactive activities, animated example videos, and reference materials.

Investigator(s)
Lawrence C. An, MD
University of Michigan

Getting to Yes Michigan is a program that is designed to improve understanding and acceptance of COVID-19 vaccines in 4 Michigan counties (Genesee, Kent, Washtenaw and Wayne). We are particularly interested in helping people from under-represented communities of color get access to COVID-19 vaccines.

The program includes the following features:

Text messages that address common COVID-19 vaccine questions and concerns
A website with COVID-19 vaccine information and updates, messages from faith leaders, and links to helpful resources
Vaccine Champions who can help provide information and access to the vaccine
Communication training for participants who wish to become Vaccine Champions
Funded by the National Institutes of Health, the study is a partnership between faith leaders, Michigan CEAL, Michigan CIVIC, and researchers from the University of Michigan.

Investigator(s)
Ken Resnicow, PhD
University of Michigan

Barbara Israel, DrPH, MPH
University of Michigan

Susan Woolford, MD, MPH
University of Michigan

financial stress in breast cancer patient callout

To educate newly diagnosed breast cancer patients about financial toxicity, we developed a tool that can be given to patients to inform them about resources and action steps regarding financial stress. The tool was developed after conducting qualitative interviews with breast cancer patients. After the tool was developed, we conducted usability sessions with 4 breast cancer survivors who experienced financial stress during their treatment.

Investigator(s)
Laila A. Gharzai, MD, LLM
Northwestern University

This project is testing the efficacy of a 12-week remote therapy intervention (RTI) to decrease aggression and victimization behaviors among violently injured youth (age 14-20) seeking treatment in the emergency department (ED) in Detroit or Flint.

Study Design

The intervention has 3 study arms:

S-RTI: Standard ED counseling session + 5 post-ED remote therapy sessions
AI-RTI: An adaptive artificial intelligence (AI) supported RTI package that optimizes therapeutic intensity using reinforcement learning. Participants are assigned to varying therapy conditions based on their risk status each week. Therapies in this arm include:
- 30-minute telephone-based remote therapy session;
- Automated electronic tailored therapy (chatbot); or,
- Assessment only without intervention (i.e., none)
Standard care

Randomization is stratified by age (14-17; 18-20) and sex.

Chatbot

CHCR leveraged our MTS system to create highly tailored, interactive chatbot interactions in the AI-RTI arm for automated electronic tailored therapy. The chatbot was also designed to show different emotions to help build empathy and rapport with participants. Participants saw relevant testimonials, infographics and behavioral tips within the chatbot as well. The chatbot was delivered on a personalized website that also included links to community resources.

Therapist MI Dashboard

CHCR also created a therapist dashboard to guide the ED counseling session based on principles of motivational interviewing (MI). Data from a participant surveys and chatbot responses was fed into this feature in order to produce tailored summary screens to help guide the counselor’s MI session with that participant. The therapist dashboard also records all relevant data for each counseling session.

Investigator(s)
Patrick Carter, MD
University of Michigan

Expressive writing is an evidence-based practice that been shown to reduce stress and improve coping for people facing a wide range of health and social challenges.

Because of the coronavirus crisis, people are facing serious health challenges and extremely difficult circumstances. This unprecedented, anxious time has enormous impact — not only on our way of operating, but also on our well-being.

The University of Michigan Rogel Cancer Center’s Office of Patient Experience and Center for Health Communications Research partnered with health psychologist James Pennebaker and his team at the University of Texas at Austin to build this website. The writing feedback that is provided is powered by the Receptiviti natural language platform.

Investigator(s)
Lawrence C. An, MD
University of Michigan

James W. Pennebaker, PhD
University of Texas - Austin

Investigator(s)
Christine M. Veenstra, MD, MSHP
University of Michigan

The University of Michigan and its partners wanted to understand if messages created by the community could protect people from COVID-19. Community Engagement Alliance (CEAL) is a national, NIH-funded program working toward a goal of reducing the burden of COVID-19 on the hardest hit communities.

Online surveys to assess a range of individual and household characteristics, attitudes, and behaviors related to the COVID-19 pandemic.

Survey #1 - May 2020

We conducted an online survey of a representative sample of over 1,000 US adults to assess social distance attitudes, COVID-19 related beliefs and behaviors, and demographics. Surveys were completed through the Qualtrics online platform using a sample provided by Dynata.

Investigator(s)
Lawrence C. An, MD
University of Michigan

Laila A. Gharzai, MD, LLM
Northwestern University

Investigator(s)
Reshma Jagsi, MD, DPhil
University of Michigan

Guys/Girls Opt for Activities for Life (GOAL) intervention includes and after school GOAL club to incorporate physical activity and health eating, parent-child meetings, and a social networking website for parents to motivate each other.

Guided by Self-Determination Theory and the Information-Motivation-Behavioral Skills Model, the novel 16-week Guys/Girls Opt for Activities for Life (GOAL) intervention includes 3 components:

After-school GOAL Club: 26 120-minute events (2 days/week) for boys and girls that incorporate physical activity and healthy eating and cooking;
Three parent-adolescent dyad meetings to empower dyads about physical activity and healthy eating and cooking; and
GOAL social networking website so parents can motivate each other to help their adolescents increase physical activity and diet quality.

Investigator(s)
Lorraine Robbins, PhD, RN, FNP-BC
Michigan State University

This study aims to test and compare two methods for educating parents/caregivers of children ages 6 months to 10 years about child passenger safety. The study will help determine how best to deliver this information in a way that appeals to parents/caregivers.

Over the course of 1 year, participants receive 8 requests to share pictures of their child as they usually ride in cars with the research team via text message. There are also 2 in-person visits with the research team to assess the appropriateness and fit of the child's current vehicle restraint.

Administrative Dashboard

CHCR created an administrative dashboard that allowed the research team to manage study participants, as well as handle the complex process of photo request submissions, organization, and replies. The dashboard shows a comprehensive participant list with study status and upcoming events for each individual. Photo submissions are also logged in each participant’s record along with all other message history and ability to send custom text responses.

Car Seat Compass Website

CHCR also created the participant-facing Car Seat Compass website. This website included:

Tailored road map based on child’s height, weight, and age to give an accurate car seat recommendations
Car seat calculator to recommend a seat type based on child’s age and weight, with answers to common questions
Educational information about proper car seat fit, including diagrams and videos
Personalized summary and feedback based on survey data about child’s car seat

Investigator(s)
Michelle Macy, MD, MS
Northwestern University

The Sleep Coach app provides access to evidence-based CBT-I strategies for insomnia. It engages users with a computerized dialogue agent to support adoption and adherence to these evidence-based strategies.

Sleep disturbance is one of the most common problems among cancer patients and cancer survivors. Sleep disturbance negatively impacts quality of life across multiple dimensions. Cognitive behavioral therapy for insomnia (CBT-I), an evidence-based psychoeducational intervention, is considered a first line treatment; however, access to CBT-I is severely limited. We therefore formed a multidisciplinary collaboration to address this critical gap in survivorship care through the development and evaluation of a mobile CBT-I Sleep Coach app.

Innovative features of this app include incorporation and integration of:

Evidence-based CBT-I strategies and interactive activities
A computerized dialogue agent to engage users in the adoption of and adherence to CBT-I strategies

Investigator(s)
Lawrence C. An, MD
University of Michigan

Tiffany Braley, MD, MS
University of Michigan

Deirdre Conroy, PhD
University of Michigan

Debra L. Barton, PhD, FAAN, RN
University of Michigan

The Cancer Support Community (CSC) created the Open to Options® program to help newly diagnosed cancer patients as they prepare to make an upcoming treatment decision.

The program involves talking with a trained specialist in-person or via phone who guides the patient through a structured, non-directive interaction to elicit their questions, concerns and priorities. At the end of the session, patients have a curated list of questions prepared for their upcoming medical appointment to make an informed treatment decision. Open to Options® has been validated in clinical studies, including a CDC-sponsored study, that showed the program is effective at lowering distress and improving self-efficacy among cancer patients when making a treatment decision.

In an effort to reach a wider audience, CSC partnered with the Center for Health Communications Research at the University of Michigan Rogel Cancer Center to create an interactive chatbot experience that simulates the in-person experience of Open to Options®. The chatbot is currently being tested in newly diagnosed cancer patients as a pilot study at the cancer center.

Following the same structure as the in-person interaction, the Open to Options® chatbot provides an engaging conversational experience that involves the exchange of information, the opportunity for reflection, and the expression of emotional support.

Investigator(s)
Daniela A Wittmann, PhD, LMSW
University of Michigan

Investigator(s)
Paul Reiter, PhD, MPH
The Ohio State University

We have determined racial disparities in cancer incidence and mortality within the Rogel Cancer Center catchment area, however, we know less about the underlying sociodemographic, psychosocial, and behavioral factors driving these disparities. Obtaining these data in a manner that is both cost effective and scientifically rigorous is a critical step in planning effective strategies to reduce disparities.

We responded to this need by conducting survey research that appropriately sampled our catchment area, and collected information to understand and decrease cancer disparities.

Understanding & Reducing Disparities

The overall objective of this work was to generate data to help us better understand, and thereby reduce, health disparities within the University of Michigan Rogel Cancer Center catchment area.

We conducted a new survey in our catchment area, oversampling key demographic groups. We also compared three methods of survey data collection in our catchment area to inform similar surveys for other cancer centers.

This included two non-random (and less costly) sampling strategies:

In-person community events using paper and online surveys
An online listed panel through Dynata

As well as a “gold standard:”

Population probability telephone survey conducted by Harris Insights and Analytics.

Arab and Chaldean Community Health Survey

Our catchment area includes southeast Michigan, which is home to some of the largest Middle Eastern and North African populations in the US.

We partnered with the Dearborn-based organization ACCESS – the largest Arab American community nonprofit in the US – to create a version of the Community Health Survey specifically geared towards the Arab and Chaldean communities. This version included extra questions about cultural identity, discrimination, and healthcare attitudes. In order to better meet the needs of this population, we also translate the survey into Arabic for paper or online completion.

Investigator(s)
Ken Resnicow, PhD
University of Michigan

Pancreatic cancer risk assessment poster

This pancreatic cancer screening education tool is targeted to people visiting the New York University Pancreatic Cancer Center website who might be interested in learning more about their risk factors for pancreatic cancer (including patients, future patients, family members of patients).

Investigator(s)
Diane M. Simeone, MD
New York University

Surrogate decision makers of stroke patients are often unprepared to make critical decisions on life-sustaining treatments. This web-based, patient-centered, tailored decision aid includes general information about stroke, outcomes (prognostic information and recovery), in-hospital and life-sustaining treatments, decision making and values clarification, post-hospital care, tips for talking to the health care team, and a summary report. Preliminary usability testing received generally favorable feedback.

Investigator(s)
Darin Zahuranec, MD, MS
University of Michigan

Investigator(s)
Michael Dorsch, PharmD, MS
University of Michigan

Scott Hummel, MD, MS
University of Michigan

Todd Michael Koelling, MD
University of Michigan

Investigator(s)
Edwin Grant Wilkins, MD
University of Michigan

Investigator(s)
Michael Dorsch, PharmD, MS
University of Michigan

Scott Hummel, MD, MS
University of Michigan

An interactive, personalized, text-messaging program to help participants prevent cancer and lead a healthy life.

T4H is a nationally available resource that was created by the National Cancer Institute (NCI) and the CHCR. Participants get several texts per week for about 6 weeks. Text messages include healthy tips, strategies to stay on track, and check-ins.

T4H Programs

There are 4 programs to choose from and participants can enroll in as many as they want:

Eat healthier
Be more active
Quit smoking
Get screened for colorectal cancer (CRC)

Version 1 - 2016

The first version of T4H included the 3 primary programs:

Eating healthy
Exercising more
Quitting smoking

Version 2 - 2017

The second version of T4H added a new program to promote screening for colorectal cancer (CRC). It targets people age 50 and older at average risk for developing colon cancer and encourages them to get a colonoscopy or complete a home stool test.

The CRC program includes interactive text messages and additional educational components on a dedicated website. The website contains information and video stories related to:

Getting checked
What tests are available
How to pay for testing
How to overcome barriers to getting tested

The text messages and website content were highly tailored to each participant’s testing preference, as well as their barriers and motivators to getting tested.

The CRC screening program was built on findings from an earlier project called Inside Health led by Dr. Ken Resnicow. Inside Health used a tailored print newsletter to encourage CRC screening in an African Americans in Detroit.

Read more about Inside Health: Resnicow, K., Zhou, Y., Hawley, S., Jimbo, M., Ruffin, M. T., Davis, R. E., Shires, D., & Lafata, J. E. (2014). Communication preference moderates the effect of a tailored intervention to increase colorectal cancer screening among African Americans. Patient education and counseling, 97(3), 370–375. https://doi.org/10.1016/j.pec.2014.08.013

Version 3 - 2019

The third version of T4H included a few updates:

Text messages for the healthy eating, exercise, and quit smoking programs was updated to align with new messages released by NCI
Created 2 new versions of the quit smoking program:
- 1 focused on patients in the University of Medicine system
- 1 focused on patients in rural clinics in Michigan
- These versions are very similar to the original program, with modifications to deliver these patients more relevant resources and follow-up
Added a new feature to allow healthcare providers or clinic staff to send a welcome text directly to potential patient participants inviting them to enroll
CHCR redesigned the T4H website for easier dissemination among healthcare providers and patients, as well as more efficient enrollment

Yallah Quit - 2020

This version of T4H uses culturally specific, bilingual messaging to help the Muslim community quit smoking during Ramadan. Southeast Michigan is home to some of the largest Middle Eastern and North African populations in the US.

We partnered with the Dearborn-based organization ACCESS – the largest Arab American community nonprofit in the US – to update T4H smoking cessation messages to create a campaign called Yallah Quit. Yallah is Arabic for “Let’s go!” We worked closely with community stakeholders at ACCESS to modify messaging to ensure relevance and cultural humility. For example, smoking hookah is a social activity that is sometimes considered less dangerous than smoking cigarettes, though both increase cancer risk significantly.

Investigator(s)
Lawrence C. An, MD
University of Michigan

Dawn K. Wilson, PhD
University of South Carolina

PAVE is a peer support program that connects incoming student veterans on college campuses with student veterans who are trained as Peer Advisors to help them navigate college life, address challenges, refer them to appropriate resources on and off campus, and provide ongoing support.

This project created a technology platform to expand the reach of the PAVE program by converting the in-person training materials to a robust online training site. In addition, a mobile tracking system for Peer Advisors and a management console were created to support the program's rollout.

Investigator(s)
Michelle Kees, PhD
University of Michigan

We sought to develop and evaluate an intervention for military spouses that would enhance individual resilience and improve psychological functioning, in part by identifying and changing negative thoughts specific to military life and deployment experiences. Thus began the development of Home Front Strong (HFS), an 8 week group grounded in evidence-based components of positive psychology, cognitive behavioral therapy and dialectical behavior therapy, tailored for military spouses.

Investigator(s)
Michelle Kees, PhD
University of Michigan

Investigator(s)
Michael Sabel, MD
University of Michigan

Investigator(s)
Ken Resnicow, PhD
University of Michigan

Investigator(s)
Kevin Kerber, MD, MS
University of Michigan

William Meurer, MD
University of Michigan

Angela Fagerlin, PhD
University of Utah

Investigator(s)
José A. Bauermeister, PhD, MPH
University of Pennsylvania

Investigator(s)
Victor J. Strecher, PhD
University of Michigan

Brian Zikmund-Fisher, PhD
University of Michigan

Angela Fagerlin, PhD
University of Utah

Investigator(s)
Michael L. Volk, MD, MSc, AGAF
Loma Linda University

Sheryl L. Catz, PhD
University of California - Davis

Investigator(s)
Jennifer McClure, PhD
Kaiser Permanente

Simon Hambidge, MD, PhD
University of Colorado

Investigator(s)
Amanda F. Dempsey, MD, PhD, MPH
University of Colorado

Karen Albright, PhD

Miriam Dickinson, PhD

Sean T. O’Leary, MD
University of Colorado

Investigator(s)
Paula Anne Newman-Casey, MD, MS
University of Michigan

Investigator(s)
Nancy J. Birkmeyer, PhD

Angela Fagerlin, PhD
University of Utah

Edward C. Norton, PhD
University of Michigan

M. E. Michele Heisler, MD, MPA
University of Michigan

Lisa Prosser, PhD
University of Michigan

Mousumi Banerjee, PhD
University of Michigan

Amir Abbas Ghaferi, MD
University of Michigan

Investigator(s)
M. E. Michele Heisler, MD, MPA
University of Michigan

Investigator(s)
Yuh-Pey Anne Buu, PhD

As part of the 30-minute intervention, participants are guided to explore their goals and values, how risky behaviors could affect their goals, and positive ways to resolve conflict. Afterwards, participants receive booster text messages for two months to reinforce intervention content. Previous studies led by our team with teens recruited from the emergency department have found that patients who receive the SafER Teens program are less likely to report involvement in violence and violence-related consequences at follow-up.

Investigator(s)
Maureen A. Walton, PhD, MPH
University of Michigan

Rebecca Cunningham, MD
University of Michigan

Investigator(s)
Sara Konrath, PhD
Indiana University

Investigator(s)
Shawna J. Lee, PhD
University of Michigan

John C. Krauss, MD
University of Michigan

Investigator(s)
John C. Krauss, MD
University of Michigan

Investigator(s)
Lawrence C. An, MD
University of Michigan

Investigator(s)
Debbie Sue Gipson, MD
University of Michigan