Dr. Christine Gunn, PhD, and her lab conduct cancer-related research using mixed methods (combining qualitative and quantitative approaches) and patient engagement to understand health care delivery processes and create interventions that promote patient-centered decision-making. Major areas of interest include health literacy, shared decision-making, health equity, and cancer risk communication.

 

 

 

 

Ongoing Projects:

Feasibility of Measuring Affect in Rural Breast Cancer Survivors

This study seeks to learn about breast cancer survivors’ willingness to report their day-to-day feelings  to later measure how feelings over time relate to cancer screening behaviors.

We know little about how affect-based feeling states (worry, distress) influence breast cancer survivors’ participation in recommended cancer screenings. Measuring these feeling-states in-real-time as they are experienced may provide insights that are not evident when measuring feeling states on a traditional survey. Our study will test whether measuring In-real-time data about feeling states can be acceptably collected from survivors using a smartphone app. Data will be used to plan a longer term study to learn why rural women may not be having recommended cancer screenings during survivorship.

Funding Source: Dartmouth Cancer Center

Principal Investigator: Christine Gunn, PhD and Courtney Stevens, PhD

Research Team: Laura Beidler, Mia St. Angelo, Anna Tosteson, Jennifer Emond

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Creating a Breast Cancer Screening Decision Aid

This career development award supports Dr. Gunn to conduct a series of studies that engage patients, providers, and experts to develop a breast cancer screening decision aid created to meet the needs of women with limited health literacy. This study employs formative mixed-methods research to develop an online tool that incorporates risk assessment, education, and the elicitation of values and preferences, and then tests the tool in a clinical setting.

Funding Source: National Cancer Institute

Principal Investigators: Christine Gunn, PhD

Research Team: Laura Beidler, Anna Tosteson, Tracy Battaglia (Boston University), Nancy Kressin (Boston University), Mara Schonberg (Harvard), Michael Paasche-Orlow (Tufts)

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Genetic Testing in the Safety-Net: Improving Equity in Prostate Cancer Treatment

This mixed methods project characterizes the use of genetic testing in patients with prostate cancer treated at a safety-net hospital. Using both medical record data and qualitative interviews with clinicians, patients, and families, we aim to characterize how each group experiences access to genetic services to inform cancer decision-making.

 

Funding Source: Department of Defense

Principal Investigator: Christine Gunn, PhD

Research Team: Laura Beidler, Catharine Wang (Boston University), Gretchen Gignac (Boston University), Kimberly Zayhowski (Boston University)

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Adaptation of a breast cancer screening decision aid for a PFAS contaminated community

This project aims to adapt an existing decision aid to incorporate environmental risk messaging to increase informed breast cancer screening decisions for women 40-49 years of age living in the greater Merrimack, New Hampshire area, where known and ongoing PFAS contamination exists. This work will provide a critical foundation to achieve our long-term goal of incorporating environmental risks into risk prediction algorithms to improve the accuracy and scope of cancer risk assessment to guide screening decision-making.

Funding Source: Dartmouth Cancer Center

Principal Investigators: Christine Gunn, PhD and Megan Romano, PhD

Research Team: Mia St. Angelo, Merrimack Citizens for Clean Water (Community Partner)

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Select Publications:

2023

“Cancer Epidemiology in the Northeastern United States (2013-2017).” Rees JR, Weiss JE, Gunn CM, Carlos HA, Dragnev NC, Supattopone EY, Tosteson ANA, Kraft SA, Vahdat LT, Peacock JL.Cancer Research Communications. 2023. 

“A Survey of Cancer Risk Behaviors, Beliefs, and Social Drivers of Health in New Hampshire and Vermont.” Skipper TA, Weiss JE, Carlos HA, Gunn CM, Hasson RM, Peacock JL, Schiffelbein JE, Tosteson ANA, Langsigan F, Rees JR. Cancer Research Communications. 2023 

“Characterizing Referrals for Prostate Cancer Genetics Services in a Safety Net Hospital.” ‌ Gunn CM, Gignac G, Hardy B, Zayhowski K, Pankowska M, Loo S, Wang C. JCO Oncology Practice. 2023. doi: 10.1200/OP.23.00055. PMID: 37384869.   

“If you’re strung out and female, they will take advantage of you”: A qualitative study exploring drug use and substance use service experiences among women in Boston and San Francisco. Harris MHH, Maschke A, Laks J, Jain J, Bagley SM, Walley AY, Hurstak E, Farley J, Keller SG, Gunn CM. J Subst Abuse Treat. 2023 

“Women’s Reactions to Breast Density Information Vary by Sociodemographic Characteristics.” Kressin NR, Wormwood JB, Battaglia TA, Slanetz PJ, Gunn CM. WHI. 2023.doi: 10.1016/j.whi.2023.03.002 

“Delivering Genetic Testing for Patients with Prostate Cancer: Moving Beyond Provider Knowledge as a Barrier to Care.” Gunn CM, Li EX, Gignac GA, Pankowska M, Loo SS, Zayhowski K, Wang C. Cancer Control. 2023;30. doi: 10.1177/10732748221143884   

Perceptions of Breast Cancer Risks Among Women Receiving Mammograph Screening. Beidler LB, Kressin NR, Wormwood JB, Battaglia TA, Slanetz PJ, Gunn CM. JAMA Netw Open. 2023;6(1):e2252209. doi: 10.1001/jamanetw 

“Ensuring Clarity and Understandability of the FDA’s Breast Density Notifications.” Kressin NR, Slanetz P, Gunn CM. JAMA. 2022. doi: 10.1001/jama.2022.22753 

“Delivering Genetic Testing for Patients with Prostate Cancer: Moving Beyond Provider Knowledge as a Barrier to Care.” Gunn CM, Li EX, Gignac GA, Pankowska M, Loo SS, Zayhowski K, Wang C. Cancer Control. 2023; 30. PMID: 36946278

2022

Ensuring Clarity and Understandability of the FDA’s Breast Density Notifications.; Kressin NR, Slanetz PJ, Gunn CM. JAMA. 2022. doi:10.1001/jama.2022.22753. PMID: 36508205 

“More than just giving them a piece of paper”: Interviews with Primary Care on Social Needs Referrals to Community-Based Organizations. Beidler LB, Razon N, Lang H, Fraze TK. J Gen Intern Med. 2022;37(16):4160-4167. doi:10.1007/s11606-022-07531-3. PMID: 35426010; PMCID: PMC9708990 

The representation of females in clinical trials for substance use disorder conducted in the United States (2010-19).; Gunn CM, Pankowska M, Harris M, Helsing E, Battaglia TA, Bagley SM. Addiction. 2022;117(10):2583-2590. doi:10.1111/add.15842. PMID: 35165969 

“It’s Not Just the Right Thing . . . It’s a Survival Tactic”: Disentangling Leaders’ Motivations and Worries on Social Care. Fraze TK, Beidler LB, Savitz LA. Med Care Res Rev. 2022;79(5):701-716. doi: 10.1177/10775587211057673. PMID: 34906013; PMCID: PMC9397397 

A Missed Opportunity? How Health Care Organizations Engage Primary Care Clinicians in Formal Social Care Efforts. Fraze TK, Beidler LB, Gottlieb LM. Popul Health Manag. 2022;25(4):509-516. doi:10.1089/pop.2021.0306. PMID: 35196116; PMCID: PMC9419929 

Integrating community engagement with implementation science to advance the measurement of translational science.; Gunn CM, Sprague Martinez LS, Battaglia TA, Lobb R, Chassler D, Hakim D, Drainoni ML. J Clin Transl Sci. 2022;6(1):e107. doi:10.1017/cts.2022.433. PMID: 36285013 

“Patient Navigator Team Perceptions on the Implementation of a Citywide Breast Cancer Patient Navigation Protocol: A Qualitative Study.” Loo S, Mullikin K, Robbins C, Xiao V, Battaglia TA, Lemon SC, Gunn CM. BMC Health Services Research. 2022. 22, 683. PMCID: 9123866 

Patient navigation to address sociolegal barriers for patients with cancer: A comparative-effectiveness study. Battaglia TA, Gunn CM, Bak SM, Flacks J, Nelson KP, Wang N, Ko NY, Morton SJ. Cancer. 2022;128 Suppl 13:2623-2635. doi:10.1002/cncr.33965. PMID: 35699610 

“Beyond Just a Supplement”: Administrators’ Visions for the Future of Virtual Primary Care Services. Fraze TK, Beidler LB, De Marchis EH, Gottlieb LM, Potter MB. J Am Board Fam Med. 2022;35(3):527-536. doi:10.3122/jabfm.2022.03.210479. PMID: 35641035; PMCID: PMC9726205 

A letter is not enough: Women’s preferences for and experiences of receiving breast density information.; Kressin NR, Wormwood JB, Battaglia TA, Slanetz PJ, Gunn CM. Patient Educ Couns. 2022;105(7):2450-2456. doi:10.1016/j.pec.2022.03.014. PMID: 35534300 

Women’s Understandings and Misunderstandings of Breast Density and Related Concepts: A Mixed Methods Study.; Kressin NR, Wormwood JB, Battaglia TA, Maschke AD, Slanetz PJ, Pankowska M, Gunn CM. J Womens Health. 2022;31(7):983-990. doi:10.1089/jwh.2021.0343. PMID: 35230164 

Limited English Proficiency and Clinical Outcomes After Hospital-Based Care in English-Speaking Countries: a Systematic Review. Woods AP, Alonso A, Duraiswamy S, Ceraolo C, Feeney T, Gunn CM, Burns WR, Segev DL, Drake FT. J Gen Intern Med. 2022;37(8):2050-2061. doi:10.1007/s11606-021-07348-6. PMID: 35112283 

Differences in Breast Cancer Screening Practices by Diabetes Status and Race/Ethnicity in the United States.; Kim SE, Bachorik AE, Bertrand KA, Gunn CM. J Womens Health. 2022;31(6):848-855. doi:10.1089/jwh.2021.0396. PMID: 34935471 

“No home to take methadone to”: Experiences with addiction services during the COVID-19 pandemic among survivors of opioid overdose in Boston. Harris MTH, Lambert AM, Maschke AD, Bagley SM, Walley AY, Gunn CM. J Subst Abuse Treat. 2022;135:108655. Doi:10.1016/j.jsat.2021.108655. PMID: 34772604 

2021

Resource Brokering: Efforts to Assist Patients With Housing, Transportation, and Economic Needs in Primary Care Settings. Fraze TK, Beidler LB, Fichtenberg C, Brewster AL, Gottlieb LM. Ann Fam Med. 2021;19(6):507-514. doi:10.1370/afm.2739. PMID: 34750125; PMCID: PMC8575510 

Using Mixed Methods With Multiple Stakeholders to Inform Development of a Breast Cancer Screening Decision Aid for Women With Limited Health Literacy.; Gunn CM, Maschke A, Paasche-Orlow MK, Housten AJ, Kressin NR, Schonberg MA, Battaglia TA. MDM Policy Pract. 2021;6(2):23814683211033249. doi: 10.1177/23814683211033249. PMID: 34350361 

“‘I’m a Survivor:’ Perceptions of Chronic Disease and Survivorship Among Individuals in Long-term remission from Opioid Use Disorder.” Pytell JD, Sklar MD, Carrese J, Rastegar DA, Gunn C, Chander G. J Gen Intern Med. 2021; 1-8. PMCID:  PMC8141362.   

Competing risks of women and men who use fentanyl: “The number one thing I worry about would be my safety and number two would be overdose”.; Harris MTH, Bagley SM, Maschke A, Schoenberger SF, Sampath S, Walley AY, Gunn CM. J Subst Abuse Treat. 2021;125:108313. doi:10.1016/j.jsat.2021.108313. PMID: 34016300 

Dense Breast Notification Laws’ Association With Outcomes in the US Population: A Cross-Sectional Study.; Kressin NR, Battaglia TA, Wormwood JB, Slanetz PJ, Gunn CM. J Am Coll Radiol. 2021;18(5):685-695. doi:10.1016/j.jacr.2020.11.012. PMID: 33358722 

Postpartum Analgesia in New Mothers (PAIN) Study: A Survey of Canadian Obstetricians’ Post-Delivery Opioid-Prescribing Practices.; Harris M, McDonald EG, Marrone E, El-Messidi A, Girard T, Gosselin S, Gunn CM, Shapiro GD, Longo C, Dayan N. J Obstet Gynaecol Can. 2021;43(8):957-966.e9. doi:10.1016/j.jogc.2020.11.018. PMID: 33321248 

Disparities in precision medicine-Examining germline genetic counseling and testing patterns among men with prostate cancer.; Borno HT, Odisho AY, Gunn CM, Pankowska M, Rider JR. Urol Oncol. 2021;39(4):233.e9-233.e14. doi:10.1016/j.urolonc.2020.10.014. PMID: 33158741 

“Narratives of Gestational Diabetes Provide a Lens to Tailor Post-Partum Prevention and Monitoring Counseling.” Gunn CM, Bernstein J, Bokhour B, McCloskey L. JMWH. 2020;65(5); 681-687. doi: 10.1111/jmwh.13122. PMID: 32568461 

Health Literacy Interventions in Cancer: a Systematic Review.; Housten AJ, Gunn CM, Paasche-Orlow MK, Basen-Engquist KM. J Cancer Educ. 2021;36(2):240-252. doi:10.1007/s13187-020-01915-x. PMID: 33155097 

Age-based preferences for risk communication in the fentanyl era: ‘A lot of people keep seeing other people die and that’s not enough for them’.; Gunn CM, Maschke A, Harris M, Schoenberger SF, Sampath S, Walley AY, Bagley SM. Addiction. 2021;116(6):1495-1504. doi: 10.1111/add.15305. PMID: 33119196 

Engaging Women with Limited Health Literacy in Mammography Decision-Making: Perspectives of Patients and Primary Care Providers.; Gunn CM, Maschke A, Paasche-Orlow MK, Kressin NR, Schonberg MA, Battaglia TA. J Gen Intern Med. 2021;36(4):938-945. doi:10.1007/s11606-020-06213-2. PMID: 32935318

2020

Discussions of Potential Mammography Benefits and Harms among Patients with Limited Health Literacy and Providers: “Oh, There are Harms?”.; Maschke A, Paasche-Orlow MK, Kressin NR, Schonberg MA, Battaglia TA, Gunn CM. J Health Commun. 2020;25(12):951-961. doi:10.1080/10810730.2020.1845256. PMID: 33455518 

Differences in Breast Density Awareness, Knowledge, and Plans.; Kressin NR, Wormwood JB, Battaglia TA, Gunn CM. J Gen Intern Med. 2020;35(8):2473. doi:10.1007/s11606-020-05840-z. PMID: 32394138 

Health Literacy, Language, and Cancer-Related Needs in the First 6 Months After a Breast Cancer Diagnosis.; Gunn CM, Paasche-Orlow MK, Bak S, Wang N, Pamphile J, Nelson K, Morton S, Battaglia TA.JCO Oncol Pract. 2020;16(8):e741-e750. doi:10.1200/JOP.19.00526. PMID: 32216715 

The Ethics of Delivering Precision Medicine-Pretest Counseling and Somatic Genomic Testing.; Borno HT, Rider JR, Gunn CM. JAMA Oncol. 2020;6(6):815-816. doi:10.1001/jamaoncol.2020.0016. PMID: 32163096 

“Health Literacy, Language, and Cancer Related Needs in the First Six Months after a Breast Cancer Diagnosis.” Gunn CM, Paasche-Orlow MK, Bak S, Wang N, Pamphile J, Nelson K, Morton S, Battaglia TA. Journal of Oncology Practice. 2020; 16(8): e741-e750. PMID: 32216715 

Differences in Breast Density Awareness, Knowledge, and Plans Based on State Legislation Status and Sociodemographic Characteristics.; Kressin NR, Wormwood JB, Battaglia TA, Gunn CM. J Gen Intern Med. 2020;35(6):1923-1925. doi:10.1007/s11606-019-05578-3. PMID: 31845108 

“Acceptability of an Interactive Computer-Animated Agent to Promote Patient-Provider Communication about Breast Density: A Mixed Method Pilot Study.” Gunn CM, Maschke A, Bickmore T, Kennedy M, Hopkins MF, Fishman M, Paasche-Orlow MK, Warner ET. J Gen Intern Med. 2020;35(4):1069-1077. PMID: 31919723 

Evaluation of existing patient educational materials and development of a brochure for women with dense breasts.; Warner ET, Kennedy M, Maschke A, Hopkins MF, Wernli K, Gunn CM. Breast. 2020;50:81-84. doi:10.1016/j.breast.2020.02.001. PMID: 32086135

2019

“An innovation in patient navigation: Background, methods, and measures.” Ko NY, Bak S, Gunn C, Nelson KP, Bowen D, Flacks J, Morton S, Parker V, Mendez J, Battaglia TA. JONS. 2019 10(6). doi: 10.1001/jamanetworkopen.2019.11514. PMID: 31532515; PMCID: PMC6752088 

Prevalence of Screening for Food Insecurity, Housing Instability, Utility Needs, Transportation Needs, and Interpersonal Violence by US Physician Practices and Hospitals. Fraze TK, Brewster AL, Lewis VA, Beidler LB, Murray GF, Colla CH. JAMA Netw Open. 2019;2(9):e1911514. doi:10.1001/jamanetworkopen.2019.11514. PMID: 31532515; PMCID: PMC6752088 

The FDA-Approved Essure Device Counseling Order Fails to Promote Patient Empowerment.; Gunn CM, Paasche-Orlow MK. Health Lit Res Pract. 2019;3(2):e70-e73. doi:10.3928/24748307-20190306-01. PMID: 31289791 

“Connecting Community to Research: A Training Program to Increase Community Partnership in Research.” Battaglia, TB, Pamphile J, Spencer N, Bak S, Gunn CM. Prog. 2019;13(2):209-217. doi: 10.1353/cpr.2019.0021. PMID: 31178456 

Understanding Decision Making about Breast Cancer Prevention in Action: The Intersection of Perceived Risk, Perceived Control, and Social Context: NRG Oncology/NSABP DMP-1.; Gunn CM, Bokhour BG, Parker VA, Battaglia TA, Parker PA, Fagerlin A, McCaskill-Stevens W, Bandos H, Blakeslee SB, Holmberg C. Med Decis Making. 2019;39(3):217-227. doi:10.1177/0272989X19827258. PMID: 30803311 

A Qualitative Study of Spanish-Speakers’ Experience with Dense Breast Notifications in a Massachusetts Safety-Net Hospital.; Gunn CM, Fitzpatrick A, Waugh S, Carrera M, Kressin NR, Paasche-Orlow MK, Battaglia TA. J Gen Intern Med. 2019;34(2):198-205. doi:10.1007/s11606-018-4709-y. PMID: 30350031 

Exploring Explanatory Models of Risk in Breast Cancer Risk Counseling Discussions: NSABP/NRG Oncology Decision-Making Project 1.; Gunn CM, Bokhour B, Parker VA, Parker PA, Blakeslee S, Bandos H, Holmberg C. Cancer Nurs. 2019;42(1):3-11. doi:10.1097/NCC.0000000000000517. PMID: 28661894

2018

High-frequency greenhouse gas flux measurement system detects winter storm surge effects on salt marsh.; Diefenderfer HL, Cullinan VI, Borde AB, Gunn CM, Thom RM. Glob Chang Biol. 2018;24(12):5961-5971. doi:10.1111/gcb.14430. PMID: 30152082  

Women’s perceptions of dense breast notifications in a Massachusetts safety net hospital: “So what is that supposed to mean?”.; Gunn CM, Battaglia TA, Paasche-Orlow MK, West AK, Kressin NR. Patient Educ Couns. 2018;101(6):1123-1129. doi:10.1016/j.pec.2018.01.017. PMID: 29426765 

Primary Care Provider Experience with Breast Density Legislation in Massachusetts.; Gunn CM, Kressin NR, Cooper K, Marturano C, Freund KM, Battaglia TA. J Womens Health. 2018;27(5):615-622. doi:10.1089/jwh.2017.6539. PMID: 29338539 

False-positive mammography and its association with health service use.; Gunn CM, Bokhour B, Battaglia TA, Silliman RA, Hanchate A. Am J Manag Care. 2018;24(3):131-138. PMID: 29553275 

Challenges in Recruiting, Retaining and Promoting Racially and Ethnically Diverse Faculty.; Kaplan SE, Gunn CM, Kulukulualani AK, Raj A, Freund KM, Carr PL. J Natl Med Assoc. 2018;110(1):58-64. doi:10.1016/j.jnma.2017.02.001. PMID: 29510845

2017

Deciding on breast cancer risk reduction: The role of counseling in individual decision-making – A qualitative study.; Blakeslee SB, McCaskill-Stevens W, Parker PA, Gunn CM, Bandos H, Bevers TB, Battaglia TA, Fagerlin A, Müller-Nordhorn J, Holmberg C. Patient Educ Couns. 2017;100(12):2346-2354. doi:10.1016/j.pec.2017.06.033. PMID: 28734560  

Explaining Breast Density Recommendations: An Introductory Workshop for Breast Health Providers.; Casas RS, Ramachandran A, Gunn CM, Weinberg JM, Shaffer K. MedEdPORTAL. 2017;13:10654. doi:10.15766/mep_2374-8265.10654. PMID: 30800855 

“What Makes Patient Navigation Most Effective: Defining Useful Tasks and Networks.” Gunn CM, Battaglia TA, Parker VA, Clark JA, Paskett ED, Calhoun E, Snyder FR, Bergling E, Freund KM, and the Patient Navigation Research Group. J Health Care Poor Underserved. 2017;28(2): 663-676. PMID: 28529216.   

Social Network Structures of Breast Cancer Patients and the Contributing Role of Patient Navigators.; Gunn CM, Parker VA, Bak SM, Ko N, Nelson KP, Battaglia TA. Oncologist. 2017;22(8):918-924. doi:10.1634/theoncologist.2016-0440. PMID: 28559408 

“Recruitment, Promotion and Retention of Women in Academic Medicine: How Institutions Are Addressing Gender Disparities Women’s Health Issues.” Carr PL, Gunn CM, Raj A, Kaplan S, Freund KM. WHI. 2017;27(3): 374-381. doi: 10.1016/j.whi.2016.11.003 PMID: 28063849

2016

Content, Readability, and Understandability of Dense Breast Notifications by State.; Kressin NR, Gunn CM, Battaglia TA. JAMA. 2016;315(16):1786-8. doi:10.1001/jama.2016.1712. PMID: 27115382 

“Burden of Socio-Legal Concerns Among Vulnerable Patients Seeking Cancer Care Services at An Urban Safety-Net Hospital: A Cross-Sectional Survey.” Ko NY, Battaglia TA, Gupta-Lawrence R, Schiller J, Gunn C, Festa K, Nelson K, Flacks J, Morton S, Rosen J. BMC Health Services Research. 2016;196. doi:10.1186/s12913-016-1443-1 PMID: 27296566 

2015

Beliefs About Anal Cancer among HIV-Infected Women: Barriers and Motivators to Participation in Research. Battaglia TA, Gunn CM, McCoy ME, Mu HH, Baranoski AS, Chiao EY, Kachnic LA, Stier EA. WHI. 2015;25(6):720-6. doi:10.1016/j.whi.2015.06.008. PMID: 26253825 

Shared Decision Making and the Use of Screening Mammography in Women Younger Than 50 Years of Age.; Gunn CM, Soley-Bori M, Battaglia TA, Cabral H, Kazis L. J Health Commun. 2015;20(9):1060-6. doi:10.1080/10810730.2015.1018628. PMID: 26091367 

Inadequate progress for women in academic medicine: findings from the National Faculty Study.; Carr PL, Gunn CM, Kaplan SA, Raj A, Freund KM. J Womens Health. 2015;24(3):190-9. doi:10.1089/jwh.2014.4848. PMID: 25658907

2014

An assessment of patient navigator activities in breast cancer patient navigation programs using a nine-principle framework.; Gunn CM, Clark JA, Battaglia TA, Freund KM, Parker VA. Health Serv Res. 2014;49(5):1555-77. doi:10.1111/1475-6773.12184. PMID: 24820445 

Knowledge and perceptions of family leave policies among female faculty in academic medicine.; Gunn CM, Freund KM, Kaplan SA, Raj A, Carr PL. WHI. 2014;24(2):e205-10. doi:10.1016/j.whi.2013.12.008. PMID: 24533979

2011

“Phase II Study of Abiraterone Acetate in Chemotherapy-Naive Metastatic Castration-Resistant Prostate Cancer Displaying Bone Flare Discordant with Serologic Response.” Ryan CJ, Shah S, Efstathiou E, Smith MR, Taplin ME, Bubley GJ, Logothetis CJ, Kheoh T, Kilian C, Haqq CM, Molina A, Small EJ. Clinical Cancer Research. 2011; 17(14):4854-61. doi: 10.1158/1078-0432.CCR-11-0815. PMID: 21632851