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CDA 13-025 – HSR&D Study

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CDA 13-025
Colorectal Cancer Survivorship Care in the Veterans Affairs Healthcare System
Leah L Zullig PhD MPH
Durham VA Medical Center, Durham, NC
Durham, NC
Funding Period: August 2014 - July 2019

BACKGROUND/RATIONALE:
Colorectal cancer (CRC) is the third most commonly diagnosed cancer in the US and among users of the VA health care system. Early detection and better treatment options have increased CRC survival, which has resulted in a large population of CRC survivors and the need for continuing survivorship care. With the increased survivability of CRC, many CRC survivors must also focus on chronic disease management. Thus, comprehensive survivorship care requires not only a focus on CRC related survivorship, but also self-management of multiple chronic comorbid conditions.

OBJECTIVE(S):
The overall goal of this research was to improve quality of care for VA CRC survivors through a self-management intervention bridging cancer surveillance and chronic disease management. Specific aims were to: (1) construct and characterize a national cohort of VA CRC survivors and their self-management behaviors along with a non-cancer comparison group; (2) assess VA CRC survivors' perceptions of self-management for survivorship care, including lifestyle choices, medication adherence, and healthcare utilization; and (3) design and pilot-test an intervention to motivate VA CRC survivors' adherence to a survivorship self-management plan.

METHODS:
Our initial study cohort was comprised of Veterans diagnosed with CRC in fiscal years 2009-2012 who were managed in the VA healthcare system. We obtained individual-level data including demographics, clinical information, and health services use for our study cohort and matched non-cancer controls from the VA Central Cancer Registry and administrative data sources. We conducted a matched-case control, retrospective analysis describing the composition of survivors receiving care in the VA. We described differences in likelihood of being diagnosed with cardiovascular disease (CVD)-related conditions including hypertension, hyperlipidemia, and diabetes, as well as achieving chronic disease control.

For a subset of the study cohort we used a mixed methods approach, encompassing quantitative surveys and qualitative interviews, to assess CRC survivors' perception of issues pertaining to self-management. We then developed and tested a self-management intervention to motivate VA cancer survivors' adherence to survivorship care and chronic disease self-management.

We then developed an intervention addressing unmet needs and chronic disease control among patients with cancer and pilot tested it in community-based clinics.

FINDINGS/RESULTS:
Not yet available.

IMPACT:
In the retrospective case-control study (Aim 1), we identified 9,758 non-metastatic CRC patients and matched them to 29,066 non-cancer controls. At baseline, 69.4% of CRC survivors and their matched controls were diagnosed with hypertension, 52.4% with hyperlipidemia, and 36.7% with diabetes. Compared to matched non-cancer controls, CRC survivors had 57% higher odds of being diagnosed with hypertension (OR=1.57, 95% CI=1.49-1.64) and 7% higher odds of controlled blood pressure (OR=1.07, 95% CI 1.02, 1.13) in the subsequent year. Compared to matched non-cancer control patients, CRC survivors had half the odds of being diagnosed with hyperlipidemia (OR=0.50, 95% CI=0.48-0.52) and lower odds of low-density lipoprotein (LDL) control (OR 0.88, 95% CI 0.81-0.94). There were no significant differences between groups for diabetes diagnoses or control.

In part of the qualitative study (Aim 2), we identified patients diagnosed with non-metastatic CRC between 10/1/2007 and 12/31/2015 at Veterans Affairs Medical Centers in North Carolina or Virginia. In 2016, we conducted telephone-based, semi-structured interviews to assess survivors' experiences with cancer survivorship and changes in health priorities. Interviews were conducted until thematic saturation was reached. Interviews were audio-recorded, transcribed, and coded. CRC survivors reported: (1) a shift in focus from surviving cancer to reducing cardiovascular disease risk (e.g., by managing weight); (2) challenges with taking medications for CVD-related conditions; (3) new recognition of the importance of engaging with primary care providers.
Chronic disease is common among CRC survivors receiving VA health care. Experiences with cancer shapes how survivors view their health. Management of cardiovascular-related chronic disease is important to veteran CRC survivors. There is a need to deliver cardiovascular disease risk reduction programs tailored for CRC survivors.

PUBLICATIONS:

Journal Articles

  1. Zullig LL, Drake C, Shahsahebi M, Avecilla RAV, Whitney C, Mills C, Oeffinger KC. Adherence to cardiovascular disease risk factor medications among patients with cancer: a systematic review. Journal of cancer survivorship : research and practice. 2023 Jun 1; 17(3):595-618.
  2. Schroeder K, Maiarana J, Gisiri M, Joo E, Muiruri C, Zullig L, Masalu N, Vasudevan L. Caregiver Acceptability of Mobile Phone Use for Pediatric Cancer Care in Tanzania: Cross-sectional Questionnaire Study. JMIR pediatrics and parenting. 2021 Dec 8; 4(4):e27988.
  3. Ballengee LA, Zullig LL, George SZ. Implementation of Psychologically Informed Physical Therapy for Low Back Pain: Where Do We Stand, Where Do We Go? Journal of pain research. 2021 Dec 7; 14:3747-3757.
  4. Zullig LL, Shahsahebi M, Neely B, Hyslop T, Avecilla RAV, Griffin BM, Clayton-Stiglbauer K, Coles T, Owen L, Reeve BB, Shah K, Shelby RA, Sutton L, Dinan MA, Zafar SY, Shah NP, Dent S, Oeffinger KC. Low-touch, team-based care for co-morbidity management in cancer patients: the ONE TEAM randomized controlled trial. BMC family practice. 2021 Nov 18; 22(1):234.
  5. Kostalova B, Ribaut J, Dobbels F, Gerull S, Mala-Ladova K, Zullig LL, De Geest S. Medication adherence interventions in transplantation lack information on how to implement findings from randomized controlled trials in real-world settings: A systematic review. Transplantation reviews (Orlando, Fla.). 2022 Jan 1; 36(1):100671.
  6. Drake C, Batchelder H, Lian T, Cannady M, Weinberger M, Eisenson H, Esmaili E, Lewinski A, Zullig LL, Haley A, Edelman D, Shea CM. Implementation of social needs screening in primary care: a qualitative study using the health equity implementation framework. BMC health services research. 2021 Sep 17; 21(1):975.
  7. Hung A, Blalock DV, Miller J, McDermott J, Wessler H, Oakes MM, Reed SD, Bosworth HB, Zullig LL. Impact of financial medication assistance on medication adherence: a systematic review. Journal of managed care & specialty pharmacy. 2021 Jul 1; 27(7):924-935.
  8. Siqeca F, Obas K, Yip O, Stenz S, Vounatsou P, Briel M, Schwenkglenks M, Quinto C, Blozik E, Zeller A, Zullig LL, De Geest S, Deschodt M. The INSPIRE Population Survey: development, dissemination and respondent characteristics. BMC medical research methodology. 2021 Jun 24; 21(1):131.
  9. Lewinski AA, Crowley MJ, Miller C, Bosworth HB, Jackson GL, Steinhauser K, White-Clark C, McCant F, Zullig LL. Applied Rapid Qualitative Analysis to Develop a Contextually Appropriate Intervention and Increase the Likelihood of Uptake. Medical care. 2021 Jun 1; 59(Suppl 3):S242-S251.
  10. Boucher NA, Zullig LL, Shepherd-Banigan M, Decosimo KP, Dadolf J, Choate A, Mahanna EP, Sperber NR, Wang V, Allen KA, Hastings SN, Van Houtven CH. Replicating an effective VA program to train and support family caregivers: a hybrid type III effectiveness-implementation design. BMC health services research. 2021 May 6; 21(1):430.
  11. Mielke J, Brunkert T, Zullig LL, Bosworth HB, Deschodt M, Simon M, De Geest S. Relevant Journals for Identifying Implementation Science Articles: Results of an International Implementation Science Expert Survey. Frontiers in public health. 2021 Apr 30; 9:639192.
  12. Yip O, Huber E, Stenz S, Zullig LL, Zeller A, De Geest SM, Deschodt M, INSPIRE consortium. A Contextual Analysis and Logic Model for Integrated Care for Frail Older Adults Living at Home: The INSPIRE Project. International journal of integrated care. 2021 Apr 23; 21(2):9.
  13. Jazowski SA, Sico IP, Lindquist JH, Smith VA, Bosworth HB, Danus S, Provenzale D, Kelley MJ, Zullig LL. Transportation as a barrier to colorectal cancer care. BMC health services research. 2021 Apr 13; 21(1):332.
  14. Sico IP, Oberle A, Thomas SM, Barsanti T, Egbuonu-Davis L, Kennedy DT, Zullig LL, Bosworth HB. Therapeutic Inertia in Prescribing Biologics for Patients with Moderate-to-Severe Asthma: Workshop Summary. Patient preference and adherence. 2021 Apr 7; 15(1):705-712.
  15. Lewinski AA, Bosworth HB, Goldstein KM, Gierisch JM, Jazowski S, McCant F, White-Clark C, Smith VA, Zullig LL. Improving cardiovascular outcomes by using team-supported, EHR-leveraged, active management: Disseminating a successful quality improvement project. Contemporary clinical trials communications. 2021 Mar 1; 21(1):100705.
  16. Vervloet M, Korevaar JC, Leemrijse CJ, Paget J, Zullig LL, van Dijk L. Interventions to Improve Adherence to Cardiovascular Medication: What About Gender Differences? A Systematic Literature Review. Patient preference and adherence. 2020 Oct 29; 14:2055-2070.
  17. Check DK, Zullig LL, Davis MM, Davies L, Chambers D, Fleisher L, Kaplan SJ, Proctor E, Ramanadhan S, Schroeck FR, Stover AM, Koczwara B. Improvement Science and Implementation Science in Cancer Care: Identifying Areas of Synergy and Opportunities for Further Integration. Journal of general internal medicine. 2021 Jan 1; 36(1):186-195.
  18. Bartlett DB, Broadwater G, White HK, Shelby R, Zullig LL, Robertson J, Kanesvaran R, Cohen HJ, Kimmick G. Factors associated with falls in older women with breast cancer: the use of a brief geriatric screening tool in clinic. Breast Cancer Research and Treatment. 2020 Nov 1; 184(2):445-457.
  19. Hastings SN, Zullig LL. Mobilizing Hospitals to Mobilize Patients. Journal of the American Geriatrics Society. 2020 Oct 1; 68(10):2202-2204.
  20. Munishi OM, McCormack V, Mchome B, Mangi G, Zullig LL, Bartlett J, Mapunda O, Nyindo P, Namwai T, Muiruri C, Kimaro F, Karia F, Mmbaga BT. Awareness of Cancer Risk Factors and Its Signs and Symptoms in Northern Tanzania: a Cross-Sectional Survey in the General Population and in People Living with HIV. Journal of Cancer Education : The Official Journal of The American Association For Cancer Education. 2020 Aug 1; 35(4):696-704.
  21. Zullig LL, Oakes MM, McCant F, Bosworth HB. Lessons learned from two randomized controlled trials: CITIES and STOP-DKD. Contemporary clinical trials communications. 2020 Sep 1; 19:100612.
  22. Jazowski SA, Bosworth HB, Goldstein KM, White-Clark C, McCant F, Gierisch JM, Zullig LL. Implementing a Population Health Management Intervention to Control Cardiovascular Disease Risk Factors. Journal of general internal medicine. 2020 Jun 1; 35(6):1931-1933.
  23. Muiruri C, Jazowski SA, Semvua SK, Karia FP, Knettel BA, Zullig LL, Ramadhani HO, Mmbaga BT, Bartlett JA, Bosworth HB. Does Antiretroviral Therapy Packaging Matter? Perceptions and Preferences of Antiretroviral Therapy Packaging for People Living with HIV in Northern Tanzania. Patient preference and adherence. 2020 Jan 23; 14:153-161.
  24. Perez Jolles M, Zullig LL, Lee PJ, Kolhatkar G. Disparities in Shared Decision Making and Service Receipt Among Children With Special Health Care Needs and Developmental Delay: A National Survey Analysis. Journal of primary care & community health. 2020 Jan 1; 11:2150132720924588.
  25. Zullig LL, Deschodt M, De Geest S. Embracing Implementation Science: A Paradigm Shift for Nursing Research. Journal of nursing scholarship : an official publication of Sigma Theta Tau International Honor Society of Nursing. 2020 Jan 1; 52(1):3-5.
  26. Zullig LL, Jazowski SA, Davenport CA, Diamantidis CJ, Oakes MM, Patel S, Moaddeb J, Bosworth HB. Primary Care Providers' Acceptance of Pharmacists' Recommendations to Support Optimal Medication Management for Patients with Diabetic Kidney Disease. Journal of general internal medicine. 2020 Jan 1; 35(1):63-69.
  27. Muiruri C, Manavalan P, Jazowski SA, Knettel BA, Vilme H, Zullig LL. Opportunities to Leverage Telehealth Approaches Along the Hypertension Control Cascade in Sub-Saharan Africa. Current Hypertension Reports. 2019 Aug 26; 21(10):75.
  28. Zullig LL, Jazowski SA, Wang TY, Hellkamp A, Wojdyla D, Thomas L, Egbuonu-Davis L, Beal A, Bosworth HB. Novel application of approaches to predicting medication adherence using medical claims data. Health services research. 2019 Dec 1; 54(6):1255-1262.
  29. van Eikenhorst L, Taxis K, Rademakers J, Zullig LL, de Gier H, van Dijk L. How are medication related problems managed in primary care? An exploratory study in patients with diabetes and primary care providers. Research in social & administrative pharmacy : RSAP. 2020 May 1; 16(5):646-653.
  30. Zullig LL, Bhatia HL, Gellad ZF, Eatherly M, Henderson R, Bosworth HB. Adoption of direct-acting antiviral medications for hepatitis C: a retrospective observational study. BMC health services research. 2019 Jul 25; 19(1):521.
  31. Zullig LL, Smith VA, Lindquist JH, Williams CD, Weinberger M, Provenzale D, Jackson GL, Kelley MJ, Danus S, Bosworth HB. Cardiovascular disease-related chronic conditions among Veterans Affairs nonmetastatic colorectal cancer survivors: a matched case-control analysis. Cancer management and research. 2019 Jul 22; 11:6793-6802.
  32. Zullig LL, Ramos K, Berkowitz C, Miller JJ, Dolor RJ, Koontz BF, Yousuf Zafar S, Hutch Allen D, Tenhover JA, Bosworth HB. Assessing Key Stakeholders' Knowledge, Needs, and Preferences for Head and Neck Cancer Survivorship Care Plans. Journal of Cancer Education : The Official Journal of The American Association For Cancer Education. 2019 Jun 1; 34(3):584-591.
  33. De Geest S, Zullig LL, Dunbar-Jacob J, Hughes D, Wilson IB, Vrijens B. Improving Medication Adherence Research Reporting: European Society for Patient Adherence, Compliance and Persistence Medication Adherence Reporting Guideline. The Journal of cardiovascular nursing. 2019 May 1; 34(3):199-200.
  34. Zullig LL, Granger BB, Vilme H, Oakes MM, Bosworth HB. Potential impact of pharmaceutical industry rebates on medication adherence. The American journal of managed care. 2019 May 1; 25(5):e135-e137.
  35. Zullig LL, Granger BB, Vilme H, Oakes MM, Bosworth HB. Medication rebates and health disparities: Mind the gap. Research in social & administrative pharmacy : RSAP. 2020 Mar 1; 16(3):431-433.
  36. Kikuchi R, Broadwater G, Shelby R, Robertson J, Zullig LL, Maloney B, Meyer C, Mungal D, Marcom PK, Kanesvaran R, White H, Kimmick G. Detecting geriatric needs in older patients with breast cancer through use of a brief geriatric screening tool. Journal of geriatric oncology. 2019 Nov 1; 10(6):968-972.
  37. Blalock DV, Zullig LL, Bosworth HB, Taylor SS, Voils CI. Self-reported medication nonadherence predicts cholesterol levels over time. Journal of psychosomatic research. 2019 Mar 1; 118:49-55.
  38. Berkowitz C, Allen DH, Tenhover J, Zullig LL, Ragsdale J, Fischer JE, Pollak KI, Koontz BF. Knowledge and Preferences of Primary Care Providers in Delivering Head and Neck Cancer Survivorship Care. Journal of Cancer Education : The Official Journal of The American Association For Cancer Education. 2018 Dec 1; 33(6):1323-1327.
  39. Oshotse C, Zullig LL, Bosworth HB, Tu P, Lin C. Self-Efficacy and Adherence Behaviors in Rheumatoid Arthritis Patients. Preventing chronic disease. 2018 Oct 18; 15:E127.
  40. Goldstein KM, Zullig LL, Dedert EA, Alishahi Tabriz A, Brearly TW, Raitz G, Sata SS, Whited JD, Bosworth HB, Gordon AM, Nagi A, Williams JW, Gierisch JM. Telehealth Interventions Designed for Women: an Evidence Map. Journal of general internal medicine. 2018 Dec 1; 33(12):2191-2200.
  41. Berkowitz CM, Allen DH, Tenhover J, Zullig LL, Fischer JE, Pollak KI, Hicks MR, Hillson JV, Koontz BF. Head and Neck Cancer Survivors: Specific Needs and Their Implications for Survivorship Care Planning. Clinical Journal of Oncology Nursing. 2018 Oct 1; 22(5):523-528.
  42. Zullig LL, Egbuonu-Davis L, Trasy A, Oshotse C, Goldstein KM, Bosworth HB. Countering clinical inertia in lipid management: Expert workshop summary. American heart journal. 2018 Dec 1; 206:24-29.
  43. Zullig LL, Deschodt M, Liska J, Bosworth HB, De Geest S. Moving from the Trial to the Real World: Improving Medication Adherence Using Insights of Implementation Science. Annual review of pharmacology and toxicology. 2019 Jan 6; 59:423-445.
  44. Zullig LL, Blalock DV, Dougherty S, Henderson R, Ha CC, Oakes MM, Bosworth HB. The new landscape of medication adherence improvement: where population health science meets precision medicine. Patient preference and adherence. 2018 Jul 13; 12:1225-1230.
  45. Zullig LL, Kimmick G, Smith V, Little K, Bosworth HB, Gonzales S, Oakes MM, Shelby RA, Owen L, Altomare IP. Using a geriatric oncology assessment to link with services (GOAL). Journal of geriatric oncology. 2019 Jan 1; 10(1):164-168.
  46. De Geest S, Zullig LL, Dunbar-Jacob J, Helmy R, Hughes DA, Wilson IB, Vrijens B. ESPACOMP Medication Adherence Reporting Guideline (EMERGE). Annals of internal medicine. 2018 Jul 3; 169(1):30-35.
  47. Zullig LL, Goldstein KM, Sims KJ, Williams CD, Chang M, Provenzale D, Kelley MJ. Cancer Among Women Treated in the Veterans Affairs Healthcare System. Journal of women's health (2002). 2019 Feb 1; 28(2):268-275.
  48. Koczwara B, Stover AM, Davies L, Davis MM, Fleisher L, Ramanadhan S, Schroeck FR, Zullig LL, Chambers DA, Proctor E. Harnessing the Synergy Between Improvement Science and Implementation Science in Cancer: A Call to Action. Journal of oncology practice. 2018 Jun 1; 14(6):335-340.
  49. Goldstein KM, Zullig LL, Oddone EZ, Andrews SM, Grewe ME, Danus S, Heisler M, Bastian LA, Voils CI. Understanding women veterans' preferences for peer support interventions to promote heart healthy behaviors: A qualitative study. Preventive medicine reports. 2018 Jun 1; 10:353-358.
  50. Zullig LL, Goldstein KM, Bosworth HB, Andrews SM, Danus S, Jackson GL, Provenzale D, Weinberger M, Kelley MJ, Voils CI. Chronic disease management perspectives of colorectal cancer survivors using the Veterans Affairs healthcare system: a qualitative analysis. BMC health services research. 2018 Mar 9; 18(1):171.
  51. Bosworth HB, Ngouyombo B, Liska J, Zullig LL, Atlani C, Beal AC. The importance of cholesterol medication adherence: the need for behavioral change intervention programs. Patient preference and adherence. 2018 Mar 6; 12:341-348.
  52. Zullig LL, McCant F, Silberberg M, Johnson F, Granger BB, Bosworth HB. Changing CHANGE: adaptations of an evidence-based telehealth cardiovascular disease risk reduction intervention. Translational behavioral medicine. 2018 Mar 1; 8(2):225-232.
  53. Bosworth HB, Olsen MK, McCant F, Stechuchak KM, Danus S, Crowley MJ, Goldstein KM, Zullig LL, Oddone EZ. Telemedicine cardiovascular risk reduction in veterans: The CITIES trial. American heart journal. 2018 May 1; 199:122-129.
  54. Zullig LL, Bosworth HB. Importance and Challenges of Moving Stroke Prevention into the Community. Circulation. Cardiovascular quality and outcomes. 2018 Jan 1; 11(1):e004513.
  55. Berkowitz CM, Zullig LL, Koontz BF, Smith SK. Prescribing an App? Oncology Providers' Views on Mobile Health Apps for Cancer Care. JCO clinical cancer informatics. 2017 Nov 1; 1:1-7.
  56. Zullig LL, Curtis LH. A population health perspective on a claims and electronic health record-based tool to screen for suboptimal medication adherence. American heart journal. 2018 Mar 1; 197:150-152.
  57. Zullig LL, Ramos K, Bosworth HB. Improving Medication Adherence in Coronary Heart Disease. Current Cardiology Reports. 2017 Sep 22; 19(11):113.
  58. Zullig LL, Goldstein KM, Bosworth HB. Changes in the Delivery of Veterans Affairs Cancer Care: Ensuring Delivery of Coordinated, Quality Cancer Care in a Time of Uncertainty. Journal of oncology practice. 2017 Nov 1; 13(11):709-711.
  59. Bosworth HB, Brown JN, Danus S, Sanders LL, McCant F, Zullig LL, Olsen MK. Evaluation of a packaging approach to improve cholesterol medication adherence. The American journal of managed care. 2017 Sep 1; 23(9):e280-e286.
  60. Zullig LL, Diamantidis CJ, Bosworth HB, Bhapkar MV, Barnhart H, Oakes MM, Pendergast JF, Miller JJ, Patel UD. Racial differences in nocturnal dipping status in diabetic kidney disease: Results from the STOP-DKD (Simultaneous Risk Factor Control Using Telehealth to Slow Progression of Diabetic Kidney Disease) study. Journal of clinical hypertension (Greenwich, Conn.). 2017 Dec 1; 19(12):1327-1335.
  61. Zullig LL, Sims KJ, McNeil R, Williams CD, Jackson GL, Provenzale D, Kelley MJ. Cancer Incidence Among Patients of the U.S. Veterans Affairs Health Care System: 2010 Update. Military medicine. 2017 Jul 1; 182(7):e1883-e1891.
  62. Whalley Buono E, Vrijens B, Bosworth HB, Liu LZ, Zullig LL, Granger BB. Coming full circle in the measurement of medication adherence: opportunities and implications for health care. Patient preference and adherence. 2017 Jun 2; 11:1009-1017.
  63. Lin C, Clark R, Tu P, Bosworth HB, Zullig LL. Breast cancer oral anti-cancer medication adherence: a systematic review of psychosocial motivators and barriers. Breast Cancer Research and Treatment. 2017 Sep 1; 165(2):247-260.
  64. Zullig LL, Liang Y, Vale Arismendez S, Trevino A, Bosworth HB, Turner BJ. Trajectory of systolic blood pressure in a low-income, racial-ethnic minority cohort with diabetes and baseline uncontrolled hypertension. Journal of clinical hypertension (Greenwich, Conn.). 2017 Jul 1; 19(7):722-730.
  65. Zullig LL, Wolf S, Vlastelica L, Shankaran V, Zafar SY. The Role of Patient Financial Assistance Programs in Reducing Costs for Cancer Patients. Journal of managed care & specialty pharmacy. 2017 Apr 1; 23(4):407-411.
  66. Goldstein KM, Stechuchak KM, Zullig LL, Oddone EZ, Olsen MK, McCant FA, Bastian LA, Batch BC, Bosworth HB. Impact of Gender on Satisfaction and Confidence in Cholesterol Control Among Veterans at Risk for Cardiovascular Disease. Journal of women's health (2002). 2017 Jul 1; 26(7):806-814.
  67. Helmy R, Zullig LL, Dunbar-Jacob J, Hughes DA, Vrijens B, Wilson IB, De Geest S. ESPACOMP Medication Adherence Reporting Guidelines (EMERGE): a reactive-Delphi study protocol. BMJ open. 2017 Feb 10; 7(2):e013496.
  68. Zullig LL, Mendys P, Bosworth HB. Medication adherence: A practical measurement selection guide using case studies. Patient education and counseling. 2017 Jul 1; 100(7):1410-1414.
  69. Bosworth HB, Fortmann SP, Kuntz J, Zullig LL, Mendys P, Safford M, Phansalkar S, Wang T, Rumptz MH. Recommendations for Providers on Person-Centered Approaches to Assess and Improve Medication Adherence. Journal of general internal medicine. 2017 Jan 1; 32(1):93-100.
  70. Check DK, Reeder-Hayes KE, Zullig LL, Weinberger M, Basch EM, Dusetzina SB. Examining racial variation in antiemetic use and post-chemotherapy health care utilization for nausea and vomiting among breast cancer patients. Supportive Care in Cancer : Official Journal of The Multinational Association of Supportive Care in Cancer. 2016 Dec 1; 24(12):4839-4847.
  71. Zullig LL, Smith VA, Jackson GL, Danus S, Schnell M, Lindquist J, Provenzale D, Weinberger M, Kelley MJ, Bosworth HB. Colorectal Cancer Statistics From the Veterans Affairs Central Cancer Registry. Clinical Colorectal Cancer. 2016 Dec 1; 15(4):e199-e204.
  72. Goldstein KM, Zullig LL, Bastian LA, Bosworth HB. Statin Adherence: Does Gender Matter? Current Atherosclerosis Reports. 2016 Nov 1; 18(11):63.
  73. Williams CD, Grady WM, Zullig LL. Use of NCCN Guidelines, Other Guidelines, and Biomarkers for Colorectal Cancer Screening. Journal of the National Comprehensive Cancer Network : JNCCN. 2016 Nov 1; 14(11):1479-1485.
  74. Zullig LL, Granger BB, Bosworth HB. A renewed Medication Adherence Alliance call to action: harnessing momentum to address medication nonadherence in the United States. Patient preference and adherence. 2016 Jul 7; 10:1189-95.
  75. Nipp RD, Zullig LL, Samsa G, Peppercorn JM, Schrag D, Taylor DH, Abernethy AP, Zafar SY. Identifying cancer patients who alter care or lifestyle due to treatment-related financial distress. Psycho-oncology. 2016 Jun 1; 25(6):719-25.
  76. Shaw RJ, Pollak K, Zullig LL, Bennett G, Hawkins K, Lipkus I. Feasibility and Smokers' Evaluation of Self-Generated Text Messages to Promote Quitting. Nicotine & tobacco research : official journal of the Society for Research on Nicotine and Tobacco. 2016 May 1; 18(5):1206-9.
  77. Zullig LL, Sanders LL, Thomas S, Brown JN, Danus S, McCant F, Bosworth HB. Health beliefs and desire to improve cholesterol levels among patients with hyperlipidemia. Patient education and counseling. 2016 May 1; 99(5):830-5.
  78. Koczwara B, Birken SA, Perry CK, Cragun D, Zullig LL, Ginossar T, Nodora J, Chawla N, Ramanadhan S, Kerner J, Brownson RC. How Context Matters: A Dissemination and Implementation Primer for Global Oncologists. Journal of global oncology. 2016 Apr 1; 2(2):51-55.
  79. Bosworth HB, Zullig LL, Mendys P, Ho M, Trygstad T, Granger C, Oakes MM, Granger BB. Health Information Technology: Meaningful Use and Next Steps to Improving Electronic Facilitation of Medication Adherence. JMIR medical informatics. 2016 Mar 15; 4(1):e9.
  80. Zullig LL, Whitson HE, Hastings SN, Beadles C, Kravchenko J, Akushevich I, Maciejewski ML. A Systematic Review of Conceptual Frameworks of Medical Complexity and New Model Development. Journal of general internal medicine. 2016 Mar 1; 31(3):329-37.
  81. Zullig LL, Fortune-Britt AG, Rao S, Tyree SD, Godley PA, Carpenter WR. Enrollment and Racial Disparities in Cancer Treatment Clinical Trials in North Carolina. North Carolina Medical Journal. 2016 Jan 1; 77(1):52-8.
  82. Goldstein KM, Zullig LL, Bosworth HB, Oddone EZ. Consideration of Out-of-Office Blood Pressure Monitoring in Hypertension Management. Journal of clinical hypertension (Greenwich, Conn.). 2016 May 1; 18(5):381-2.
  83. Ramalingam S, Pollak KI, Zullig LL, Harrison MR. What Should We Tell Patients About Physical Activity After a Prostate Cancer Diagnosis? Oncology (Williston Park, N.Y.). 2015 Sep 1; 29(9):680-5, 687-8, 694.
  84. Shaw RJ, Zullig LL, Crowley MJ, Grambow SC, Lindquist JH, Shah BR, Peterson E, Bosworth HB. Willingness of Patients to Use Computers for Health Communication and Monitoring Following Myocardial Infarction. Computers, Informatics, Nursing : CIN. 2015 Sep 1; 33(9):384-9.
  85. Zullig LL, Bosworth HB, Jeffreys AS, Corsino L, Coffman CJ, Oddone EZ, Yancy WS, Allen KD. The association of comorbid conditions with patient-reported outcomes in Veterans with hip and knee osteoarthritis. Clinical Rheumatology. 2015 Aug 1; 34(8):1435-41.
  86. Jackson GL, Zullig LL, Phelan SM, Provenzale D, Griffin JM, Clauser SB, Haggstrom DA, Jindal RM, van Ryn M. Patient characteristics associated with the level of patient-reported care coordination among male patients with colorectal cancer in the Veterans Affairs health care system. Cancer. 2015 Jul 1; 121(13):2207-13.
  87. Zullig LL, Stechuchak KM, Goldstein KM, Olsen MK, McCant FM, Danus S, Crowley MJ, Oddone EZ, Bosworth HB. Patient-reported medication adherence barriers among patients with cardiovascular risk factors. Journal of managed care & specialty pharmacy. 2015 Jun 1; 21(6):479-85.
  88. Zullig LL, Bosworth HB. Selecting, adapting, and sustaining programs in health care systems. Journal of multidisciplinary healthcare. 2015 Apr 16; 8:199-203.
  89. Zullig LL, Shaw RJ, Shah BR, Peterson ED, Lindquist JH, Crowley MJ, Grambow SC, Bosworth HB. Patient-provider communication, self-reported medication adherence, and race in a postmyocardial infarction population. Patient preference and adherence. 2015 Feb 19; 9:311-8.
  90. Zullig LL, Gellad WF, Moaddeb J, Crowley MJ, Shrank W, Granger BB, Granger CB, Trygstad T, Liu LZ, Bosworth HB. Improving diabetes medication adherence: successful, scalable interventions. Patient preference and adherence. 2015 Jan 23; 9:139-49.
  91. Zullig LL, Williams CD, Fortune-Britt AG. Lung and colorectal cancer treatment and outcomes in the Veterans Affairs health care system. Cancer management and research. 2015 Jan 14; 7:19-35.
  92. Crowley MJ, Zullig LL, Shah BR, Shaw RJ, Lindquist JH, Peterson ED, Bosworth HB. Medication non-adherence after myocardial infarction: an exploration of modifying factors. Journal of general internal medicine. 2015 Jan 1; 30(1):83-90.
  93. Bestvina CM, Zullig LL, Yousuf Zafar S. The implications of out-of-pocket cost of cancer treatment in the USA: a critical appraisal of the literature. Future oncology (London, England). 2014 Nov 1; 10(14):2189-99.
  94. Shaw RJ, Steinberg DM, Zullig LL, Bosworth HB, Johnson CM, Davis LL. mHealth interventions for weight loss: a guide for achieving treatment fidelity. Journal of the American Medical Informatics Association : JAMIA. 2014 Nov 1; 21(6):959-63.
  95. Zullig LL, Bosworth HB. Behavioral interventions to improve hypertension control in the Veterans Affairs healthcare system. Journal of clinical hypertension (Greenwich, Conn.). 2014 Nov 1; 16(11):827-37.
  96. Goldstein KM, Melnyk SD, Zullig LL, Stechuchak KM, Oddone E, Bastian LA, Rakley S, Olsen MK, Bosworth HB. Heart matters: Gender and racial differences cardiovascular disease risk factor control among veterans. Women's health issues : official publication of the Jacobs Institute of Women's Health. 2014 Sep 1; 24(5):477-83.
  97. Zullig LL, Pathman J, Melnyk SD, Brown JN, Sanders LL, Koropchak C, Howard T, Danus S, McCant F, Bosworth HB. A protocol to evaluate the efficacy, perceptions, and cost of a cholesterol packaging approach to improve medication adherence. Contemporary clinical trials. 2014 Sep 1; 39(1):106-12.
  98. Mendys P, Zullig LL, Burkholder R, Granger BB, Bosworth HB. Medication adherence: process for implementation. Patient preference and adherence. 2014 Jul 28; 8:1025-34.
  99. Bestvina CM, Zullig LL, Rushing C, Chino F, Samsa GP, Altomare I, Tulsky J, Ubel P, Schrag D, Nicolla J, Abernethy AP, Peppercorn J, Zafar SY. Patient-oncologist cost communication, financial distress, and medication adherence. Journal of oncology practice / American Society of Clinical Oncology. 2014 May 1; 10(3):162-7.
  100. Zullig LL, McCant F, Melnyk SD, Danus S, Bosworth HB. A health literacy pilot intervention to improve medication adherence using Meducation technology. Patient education and counseling. 2014 May 1; 95(2):288-91.
  101. Zullig LL, Jackson GL, Provenzale D, Griffin JM, Phelan S, Nieuwsma JA, van Ryn M. Utilization of hospital-based chaplain services among newly diagnosed male Veterans Affairs colorectal cancer patients. Journal of Religion and Health. 2014 Apr 1; 53(2):498-510.
  102. Zullig LL, Sanders LL, Shaw RJ, McCant F, Danus S, Bosworth HB. A randomised controlled trial of providing personalised cardiovascular risk information to modify health behaviour. Journal of telemedicine and telecare. 2014 Apr 1; 20(3):147-52.
  103. Zullig LL, Melnyk SD, Stechuchak KM, McCant F, Danus S, Oddone E, Bastian L, Olsen M, Edelman D, Rakley S, Morey M, Bosworth HB. The Cardiovascular Intervention Improvement Telemedicine Study (CITIES): rationale for a tailored behavioral and educational pharmacist-administered intervention for achieving cardiovascular disease risk reduction. Telemedicine journal and e-health : the official journal of the American Telemedicine Association. 2014 Feb 1; 20(2):135-43.
  104. Zullig LL, Jackson GL, Weinberger M, Provenzale D, Reeve BB, Carpenter WR. An examination of racial differences in process and outcome of colorectal cancer care quality among users of the veterans affairs health care system. Clinical Colorectal Cancer. 2013 Dec 1; 12(4):255-60.
  105. Zullig LL, Shaw RJ, Crowley MJ, Lindquist J, Grambow SC, Peterson E, Shah BR, Bosworth HB. Association between perceived life chaos and medication adherence in a postmyocardial infarction population. Circulation. Cardiovascular quality and outcomes. 2013 Nov 12; 6(6):619-25.
  106. Shaw RJ, Kaufman MA, Bosworth HB, Weiner BJ, Zullig LL, Lee SY, Kravetz JD, Rakley SM, Roumie CL, Bowen ME, Del Monte PS, Oddone EZ, Jackson GL. Organizational factors associated with readiness to implement and translate a primary care based telemedicine behavioral program to improve blood pressure control: the HTN-IMPROVE study. Implementation science : IS. 2013 Sep 8; 8(1):106.
Journal Other

  1. Silva A, Henry E, Zullig LL, Crawford R, Faircy-Anderson K, Klein MA, Houraneih J. Treatment Patterns Among Men with Metastatic Castrate-Resistant Prostate Cancer in the United States Veterans Affairs Health System. [Abstract]. Federal practitioner : for the health care professionals of the VA, DoD, and PHS. 2017 Aug 3; 33(8):27S-28S.
  2. Zullig LL, Carpenter WR, Williams CD. Next steps to improve disparities in lung cancer treatment clinical trial enrollment. [Editorial]. Annals of translational medicine. 2017 Mar 1; 5(5):118.
  3. Check DK, Reeder-Hayes KE, Basch EM, Zullig LL, Weinberger M, Dusetzina SB. Investigating racial disparities in use of NK1 receptor antagonists to prevent chemotherapy-induced nausea and vomiting among women with breast cancer. [Abstract]. Breast Cancer Research and Treatment. 2016 Apr 1; 156(2):351-9.
  4. Zullig LL, Smith V, Danus SM, Schnell M, Lindquist JH, Provenzale D, Jackson GL, Weinberger M, Kelley MJ, Bosworth HB. Colorectal cancer survivorship statistics: A Veterans Affairs Central Cancer Registry analysis. [Abstract]. Journal of clinical oncology : official journal of the American Society of Clinical Oncology. 2016 Jan 1;(3S):e267.
  5. Zullig LL, Peterson ED, Bosworth HB. Strategies to overcome medication nonadherence--reply. JAMA : the journal of the American Medical Association. 2014 Apr 1; 311(16):1693-4.
  6. Zullig LL, Peterson ED, Bosworth HB. Ingredients of successful interventions to improve medication adherence. JAMA : the journal of the American Medical Association. 2013 Dec 25; 310(24):2611-2.
Online News Media Articles

  1. Zullig LL. How can research impact patients' health in the "real world"? OUP Blog: Oxford University Press's Academic Insights for the Thinking World [Internet]. 2018 May 25. Available from: https://blog.oup.com/2018/05/research-impact-patients-health-real-world/.
  2. Zullig LL, Bosworth HB. Engaging Patients to Optimize Medication Adherence. NEJM Catalyst [Internet]. 2017 May 14: Available from: http://catalyst.nejm.org/optimize-patients-medication-adherence/.
Reports

  1. Goldstein KM, Gierisch JM, Zullig LL, Alishahi A, Brearly T, Dedert EA, Raitz G, Sata SS, Whited JD, Bosworth HB, McDuffie J, Williams JW. Telehealth Services Designed for Women: An Evidence Map. VA ESP #09-010. Department of Veterans Affairs; 2017 Nov 1. 86 p.
VA Cyberseminars

  1. Zullig LL. Cancer Epidemiology and Cancer Care Quality Among VA Health Care System Patients. Cancer Epidemiologic Research in Understudied Populations Webinar Series [Cyberseminar]. National Cancer Institute, Division of Cancer Control and Population Sciences. 2018 Sep 19.
  2. Bosworth HB, Zullig LL. Cancer Survivorship & Cardiovascular Disease. HSR&D Career Development Award Enhancement Initiative [Cyberseminar]. HSR&D. 2017 Nov 14.
Conference Presentations

  1. Oakes MM, Zullig LL, Davenport CA, Grambow SC, Bosworth HB. Evaluating a Cardiovascular Disease Medication Adherence Program Among Individuals with Low Socioeconomic Status (SES): Study Design and Methodology. Poster session presented at: European Society for Patient Adherence, Compliance and Persistence European Symposium; 2016 Nov 17; Lisbon, Portugal.
  2. Henry E, Silva A, Zullig LL, Crawford RB, Faircy-Anderson K, Klein M, Houranieh J, Tarlov E. AVAHO Health Services Research Subcommittee: A Productive Inter-Institutional Partnership. Poster session presented at: Association of VA Hematology/Oncology Annual Meeting; 2016 Sep 23; Dallas, TX.
  3. Silva A, Henry E, Zullig LL, Crawford RB, Faircy-Anderson K, Klein M, Houranieh J, Tarlov E. Treatment Patterns Among Men with Metastatic Castrate-Resistant Prostate Cancer in the United States Veterans Affairs Health System. Poster session presented at: Association of VA Hematology/Oncology Annual Meeting; 2016 Sep 23; Dallas, TX.
  4. Zullig LL, Sims KJ, McNeil RB, Williams C, Jackson GL, Provenzale D, Kelley MJ. Cancer Incidence in the Veterans Affairs Health Care System: A Veterans Affairs Central Cancer Registry Analysis. Poster session presented at: Association of VA Hematology/Oncology Annual Meeting; 2016 Sep 23; Dallas, TX.
  5. McNeil RB, Sims KJ, Zullig LL, Jackson GL, Provenzale D. Statistical Learning of Healthcare Systems. Presented at: Joint Statistical Annual Meeting; 2016 Jul 31; Chicago, IL.
  6. McNeil RB, Sims KJ, Zullig LL, Jackson GL, Provenzale D. Two case studies of statistical approaches that simplify the VHA learning healthcare system. Paper presented at: Joint Statistical Annual Meeting; 2016 Jul 8; Chicago, IL.
  7. Zullig LL, Liang Y, Arismendez SV, Bosworth HB, Turner BJ. Factors Associated with Sustained Uncontrolled Hypertension in a Low-Income, Largely Hispanic Primary Care Cohort with Diabetes. Poster session presented at: Society of General Internal Medicine Annual Meeting; 2016 May 13; Hollywood, FL.
  8. Zullig LL, Whitson H, Hastings SN, Beadles CA, Kravchenko J, Akushevich I, Maciejewski ML. A Systematic Review of Conceptual Frameworks of Medical Complexity and New Model Development. Poster session presented at: Health Care Systems Research Network Annual Conference; 2016 Apr 13; Atlanta, GA.
  9. Check DK, Reeder-Hayes KE, Basch EM, Zullig LL, Weinberger M, Dusetzina SB. Investigating racial disparities in use of NK1 receptor antagonists to prevent chemotherapy-induced nausea and vomiting among women with breast cancer. Poster session presented at: American Society of Clinical Oncology Quality Care Symposium; 2016 Feb 26; Phoenix, AZ.
  10. Zullig LL, Lindquist JH, Smith V, Danus SM, Weinberger M, Jackson GL, Provenzale D, Kelley MJ, Bosworth HB. Cardiovascular and Personal Characteristics Among Veterans Affairs Colorectal Cancer Survivors: A Retrospective Matched Case Control Analysis. Poster session presented at: VA HSR&D Career Development Annual Meeting; 2016 Feb 8; Arlington, VA.
  11. Goldstein K, Stechuchak KM, Zullig LL, Oddone EZ, Olsen MK, McCant FA, Batch B, Bosworth HB. Gender differences in satisfaction and confidence in lipid control among high risk individuals. Paper presented at: Society for Women's Health Research Annual Conference; 2015 Oct 7; Winston Salem, NC.
  12. Zullig LL, Smith V, Danus SM, Schnell M, Lindquist JH, Provenzale D, Jackson GL, Weinberger M, Kelley MJ, Bosworth HB. Colorectal Cancer Statistics among Patients Reported in the Veterans Affairs Central Cancer Registry. Presented at: Association of VA Hematology/Oncology Annual Meeting; 2015 Oct 3; Washington, DC.
  13. Goldstein K, Stechuchak KM, Zullig LL, Oddone EZ, Olsen MK, McCant FA, Batch B, Bosworth HB. Gender differences in satisfaction and confidence in lipid control among high risk Veterans. Poster session presented at: VA HSR&D / QUERI National Meeting; 2015 Jul 9; Philadelphia, PA.
  14. Zullig LL, Stechuchak KM, Goldstein K, Olsen MK, McCant FA, Danus SM, Crowley M, Oddone EZ, Bosworth HB. Patient-Reported Medication Adherence Barriers among Veterans Affairs Patients with Cardiovascular Risk Factors. Poster session presented at: Society of General Internal Medicine Annual Meeting; 2015 Apr 23; Toronto, Canada.
  15. Zullig LL, Rushing C, Chino FL, Samsa G, Altomare I, Tulsky JA, Ubel PA, Nicolla J, Abernethy AP, Peppercorn JM, Zafar Y. Can We Identify Patients At Risk for Discordance in Preferred and Actual Role In Cancer Treatment Decision-Making? Paper presented at: Duke University Comprehensive Cancer Center Annual Meeting; 2014 Nov 10; Durham, NC.
  16. Nipp RD, Zullig LL, Samsa G, Peppercorn JM, Schrag D, Taylor DH, Abernathy AP, Zafar SY. Coping with Cancer Treatment-Related Financial Burden. Poster session presented at: American Society of Clinical Oncology Palliative Care In Oncology Annual Symposium; 2014 Oct 5; Boston, MA.
  17. Zullig LL, Faricy-Anderson K, Crawford R, Klein MA, Cosgriff S, Henry E, Mobarek D, Aggarwal A, Haggstorm D, Bhoopalam N. Protocol to Evaluate Medication Non-Adherence Among Patients with Metastatic Prostate Cancer. Poster session presented at: Association of VA Hematology/Oncology Annual Meeting; 2014 Sep 18; Portland, OR.
  18. Zullig LL, Faircy-Anderson K, Crawford R, Klein MA, Cosgriff S, Henry E, Mobarek D, Aggarwal A, Haggstrom D, Bhoopalam N. Protocol to Evaluate Medication Non-Adherence Among Patients With Metastatic Prostate Cancer. Poster session presented at: Association of VA Hematology/Oncology Annual Meeting; 2014 Sep 5; Portland, OR.
  19. Zullig LL, Rushing C, Chino F, Samsa G, Altomare I, Tulsky JA, Ubel P, Nicolla J, Abernethy AP, Peppercorn J, Zafar SY. Can We Identify Patients At Risk for Discordance in Preferred and Actual Role in Cancer Treatment Decision Making? Poster session presented at: American Society of Clinical Oncology Annual Meeting; 2014 Jun 15; Chicago, IL.
  20. Zullig LL, McCant FA, Melnyk SD, Danus SM, Bosworth HB. Improving Medication Adherence Using a Medication Health Literacy Intervention. Poster session presented at: VA Durham VAMC Annual Research Week; 2014 May 18; Durham, NC.
  21. Zullig LL, Bosworth HB, Jeffreys AL, Corsino L, Coffman CJ, Oddone EZ, Yancy WS, Allen KD. The Association of Comorbid Conditions with Patient Reported Outcomes among Patients with Osteoarthritis. Poster session presented at: VA Durham VAMC Annual Research Week; 2014 May 15; Durham, NC.
  22. Kirshner M, Bosworth HB, Roumie CL, Rakley SM, Kravetz JD, Del Monte PS, Bowen ME, Oddone EZ, Weiner BJ, Shaw R, Zullig LL, Jackson GL. Challenges and Opportunities Encountered Conducting Partnered Research in Organizational Readiness to Change and Implementation of HTN-IMPROVE. Poster session presented at: VA Durham VAMC Annual Research Week; 2014 May 13; Durham, NC.
  23. Goldstein K, Melnyk SD, Zullig LL, Stechuchak KM, Oddone EZ, Bastian L, Rakley S, Olsen MK, Bosworth HB. Gender and Racial Differences in Control of Cardiovascular Disease Risk Factors Among Veterans. Poster session presented at: Society of General Internal Medicine Midwest Regional Annual Meeting; 2014 Apr 23; San Diego, CA.
  24. Zullig LL, Bosworth HB, Jeffreys AL, Corsino F, Coffman C, Oddone EZ, Yancy WS, Allen KD. The Association of Comorbid Conditions with Patient Reported Outcomes Among Patients with Osteoarthritis. Poster session presented at: Osteoarthritis Research Society International World Congress on Osteoarthritis; 2014 Apr 18; Paris, France.
  25. Zullig LL, McCant FA, Melnyk SD, Danus SM, Bosworth HB. A Health Literacy Intervention to Improve Medication Adherence Using Meducation Technology. Poster session presented at: Society of General Internal Medicine Annual Meeting; 2014 Apr 12; San Diego, CA.


DRA: Aging, Older Veterans' Health and Care, Cancer
DRE: Treatment - Observational, Prevention, Technology Development and Assessment
Keywords: Career Development
MeSH Terms: none

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