Corresponding Author

Dannell Boatman, EdD, MS
West Virginia University (WVU) Cancer Institute
Cancer Prevention & Control
Morgantown, WV 26506

Author Affiliations

Dannell D. Boatman, EdD, MS
Cancer Prevention & Control, West Virginia University Cancer Institute
Morgantown WV
ORCID iD: 0000-0003-0219-0322

Stephenie K. Kennedy-Rea, EdD, MA
Cancer Prevention & Control, West Virginia University Cancer Institute
School of Medicine, West Virginia University,
Morgantown WV
ORCID iD: 0000-0001-7230-1484

Lesley Cottrell, PhD
Center for Excellence in Disabilities, West Virginia University
Department of Pediatrics, West Virginia University
Morgantown WV
ORCID iD: 0000-0001-9799-9727

Hannah W. Hazard-Jenkins, MD, FACS
West Virginia University Cancer Institute
Department of Surgery, West Virginia University
Morgantown WV

Author Area of Expertise

Dannell D. Boatman, EdD, MS
cancer prevention & control, health communication

Stephenie K. Kennedy-Rea, EdD, MA
cancer prevention & control, implementation science, health disparities

Lesley Cottrell, PhD
pediatrics, disabilities

Hannah W. Hazard-Jenkins, MD, FACS
breast cancer, surgery


Introduction: Adverse childhood experiences (ACEs) are associated with increased cancer risk. ACEs may affect this risk in a variety of ways, including cancer screening compliance. ACEs can contribute to mistrust in the medical profession, inhibit patient­–provider relationships and cause at-risk individuals to miss critical access points to preventive services. Protective factors may play an important role in mitigating ACE-related consequences by supporting resiliency.

Purpose: This study assesses the associations between ACEs, protective factors, patient–provider relationships, stage of cancer at diagnosis, and cancer screening behaviors for West Virginia (WV) cervical cancer survivors.

Methods: WV cervical cancer survivors diagnosed between 2000 and 2020 were mailed a survey which included questions on demographic information and cancer screening behaviors, alongside three scales to measure depth of patient–provider relationships, ACEs, and protective factors.

Results: Ninety participants completed the survey. ACEs were associated with weaker patient–provider relationships (p < .01) and fewer protective factors

(p < .01). More protective factors were associated with stronger patient–provider relationships (p < .01), earlier stage of cancer at diagnosis (p < .05) and positive cancer screening behaviors. Positive cancer screening behaviors were associated with deeper patient–provider relationships (p < .05). A statistically significant model (p = .004) using ACE and resilience scores was able to account for 13% of the explained variability in depth of patient–provider relationships.

Implications: These findings suggest an important interplay between ACEs, protective factors, and patient–provider relationships on cancer screening behaviors. Future studies should consider these variables in different populations. In addition, interventions focused on enhancing patient–provider relationships and supporting acquisition of protective factors should be considered.



Creative Commons License

Creative Commons Attribution 4.0 License
This work is licensed under a Creative Commons Attribution 4.0 License.

Recommended Citation

Boatman D, Kennedy-Rea S, Cottrell L, Hazard-Jenkins H. Cancer screening behaviors and associations with childhood trauma, resiliency, and patient–provider relationships: findings from an exploratory study of Appalachian cervical cancer survivors. J Appalach Health 2023;5(1):22–37. DOI: https://doi.org/10.13023/jah.0501.03.

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