Focus Area: Research

This project, led by Dr. Jennifer Weiss, aimed to characterize factors at the system, clinic, provider and patient levels that influence colorectal cancer (CRC) screening rates at rural and urban clinics. CRC is the second leading cause of cancer-related deaths for adults in Wisconsin, and it the most preventable yet least prevented cancer due to low uptake of screening. Recognizing that many rural, low-income, and racial/ethnically diverse communities have disproportionately low screening rates, the National Colorectal Cancer Roundtable announced a campaign to achieve screening rates of 80 percent and higher in every community. Wisconsin has a screening rate of 73.4 percent; however, there is wide geographic variation among rural and urban clinics. The research team successfully developed a novel rural-urban geodisparity model that revealed significant disparities in CRC screening rates between rural and urban clinics. High-performing clinics, particularly those serving subpopulations with historically low screening rates, utilized stool-based screening tests more frequently, likely due to fewer resources and less access to colonoscopy facilities in rural areas. Additionally, the research team conducted interviews with clinic staff who highlighted the critical roles of medical assistants and primary care providers, shared decision-making and the need for stratified screening rate information to inform interventions aimed at reducing disparities and improving CRC screening practices.

In Wisconsin, one in three older adults is admitted to an intensive care unit (ICU) at or near the end of their life despite the vast majority expressing preferences to avoid such care. Patients in the ICU are often too sick to speak for themselves, and family members are asked to make these difficult decisions on the patient’s behalf. As a result of these challenges, surviving family members experience psychological distress after the patients’ ICU stay and ICU clinicians experience moral distress and burnout. Previous efforts to improve end-of-life ICU care have utilized time-limited trials which are agreements among patients, their surrogate decision makers, and clinicians to attempt life-sustaining treatment for a predefined period before evaluating whether the treatment is helping the patient. The specific objective of this project is to optimize the time-limited trial model to meet the needs of older adults admitted to the ICU and their surrogate decision makers. Successful completion of this project will determine whether the time-limited trial model of care leads to better end-of-life outcomes for patients, families, and clinicians.

Estrogen receptor positive (ER+) breast cancer is the most prevalent subtype of breast cancer in Wisconsin. Importantly, more than 25 percent of ER+ cancers recur at distant sites, or metastasize, even 20 years after initial diagnosis. This makes ER+ breast cancer the primary cause of breast cancer-related deaths in Wisconsin women. The primary goal of this project was to investigate how factors of the tumor microenvironment, such as collagen stiffness and fiber alignment, regulate the spread of cancer cells and promote dormancy. By better understanding ER+ breast cancer recurrence, this project has the potential to improve breast cancer treatment and help reduce future recurrences for patients with ER+ breast cancer.

The incidence of obesity has rapidly increased in Wisconsin and across the United States, and more than 65 percent of adults are overweight. Obese individuals are at increased risk for severe diseases including obesity-induced type 2 diabetes, cardiovascular disease, stroke and cancer. Previous research has shown that low levels of ALAS1, an enzyme involved in making the iron-carrying molecule heme for hemoglobin (a process known as heme biosynthesis), correlates with high body mass index and higher risk of developing type 2 diabetes. For this project, researchers hypothesized that ALAS1 may function as a metabolic sink to control the breakdown of amino acids in brown fat tissue. This project gave researchers a better understanding of the role ALAS1 plays in energy expenditure as it relates to obesity.