{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,6]],"date-time":"2026-04-06T05:31:13Z","timestamp":1775453473585,"version":"3.50.1"},"reference-count":37,"publisher":"Springer Science and Business Media LLC","issue":"4","license":[{"start":{"date-parts":[[2026,3,3]],"date-time":"2026-03-03T00:00:00Z","timestamp":1772496000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,3,3]],"date-time":"2026-03-03T00:00:00Z","timestamp":1772496000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/100006108","name":"National Center for Advancing Translational Sciences","doi-asserted-by":"publisher","award":["UL1TR002733"],"award-info":[{"award-number":["UL1TR002733"]}],"id":[{"id":"10.13039\/100006108","id-type":"DOI","asserted-by":"publisher"}]},{"name":"The Ohio State University (OSU) Graduate School 2021 Alumni Grant for Graduate Research Scholarship"},{"name":"The Ohio State University Internal Funds"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Cancer Causes Control"],"published-print":{"date-parts":[[2026,4]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Purpose<\/jats:title>\n                    <jats:p>Anxiety before a first-time screening colonoscopy is a commonly reported patient-level barrier to completing colorectal cancer (CRC) screening. This pilot study evaluated the feasibility, acceptability, and preliminary efficacy of \u201cFor peace of mind. Get Screened,\u201d a brief online mindfulness-based intervention (MBI) to reduce anxiety before a first-time screening colonoscopy.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Participants (n\u2009=\u2009100) were randomized (October 2023\u2014July 2024) to usual care or the MBI (daily CRC screening infographics guided by the Protection Motivation Theory, mindfulness infographics, and brief mindfulness meditations based on Monitor and Acceptance Theory) starting five days before their scheduled colonoscopy. Anxiety was assessed using the State-Trait Anxiety Inventory\u2014State Subscale (STAI-S) in the endoscopy suite\u2019s waiting room.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Participant retention was 83% due to patient and health system issues. Participant satisfaction with the MBI was high (mean: 6.40 out of 7). The MBI group had an average STAI-S score 2.54 points lower than the usual care group, though this difference was not statistically significant (32.24 vs. 34.78; p\u2009=\u20090.21). However, among participants not lost to follow up (n\u2009=\u200983), the MBI group had significantly lower waiting room STAI-S scores compared to the usual care group (31.52 vs. 35.21; p\u2009=\u20090.02). Clinical outcomes did not differ between groups.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Feasibility of the MBI was partially limited due to logistical issues. Findings support MBI acceptability and suggest that a brief MBI has the potential to decrease anxiety prior to a first-time colonoscopy. A larger randomized controlled trial is needed to further examine the efficacy of this intervention.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Clinical trial registration<\/jats:title>\n                    <jats:p>ClinicalTrials.gov NCT06233253.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s10552-026-02129-0","type":"journal-article","created":{"date-parts":[[2026,3,3]],"date-time":"2026-03-03T08:53:40Z","timestamp":1772528020000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["A pilot randomized controlled trial of an online mindfulness-based intervention to reduce patient anxiety before a first-time screening colonoscopy"],"prefix":"10.1007","volume":"37","clinical-trial-number":[{"clinical-trial-number":"nct06233253","registry":"10.18810\/clinical-trials-gov"}],"author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9343-4822","authenticated-orcid":false,"given":"Brent","family":"Emerson","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Paul L.","family":"Reiter","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Abigail B.","family":"Shoben","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Maryanna","family":"Klatt","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Subhankar","family":"Chakraborty","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mira L.","family":"Katz","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2026,3,3]]},"reference":[{"key":"2129_CR1","doi-asserted-by":"publisher","first-page":"10","DOI":"10.3322\/caac.21871","volume":"75","author":"RL Siegel","year":"2025","unstructured":"Siegel RL, Kratzer TB, Giaquinto AN, Sung H, Jemal A (2025) Cancer statistics, 2025. CA Cancer J Clin 75:10\u201345. https:\/\/doi.org\/10.3322\/caac.21871","journal-title":"CA Cancer J Clin"},{"key":"2129_CR2","doi-asserted-by":"publisher","first-page":"2308","DOI":"10.1002\/cncr.28724","volume":"120","author":"GP Guy Jr.","year":"2014","unstructured":"Guy GP Jr., Richardson LC, Pignone MP, Plescia M (2014) Costs and benefits of an organized fecal immunochemical test-based colorectal cancer screening program in the United States. Cancer 120:2308\u20132315. https:\/\/doi.org\/10.1002\/cncr.28724","journal-title":"Cancer"},{"key":"2129_CR3","doi-asserted-by":"publisher","first-page":"88","DOI":"10.1093\/epirev\/mxr004","volume":"33","author":"I Lansdorp-Vogelaar","year":"2011","unstructured":"Lansdorp-Vogelaar I, Knudsen AB, Brenner H (2011) Cost-effectiveness of colorectal cancer screening. Epidemiol Rev 33:88\u2013100. https:\/\/doi.org\/10.1093\/epirev\/mxr004","journal-title":"Epidemiol Rev"},{"key":"2129_CR4","doi-asserted-by":"publisher","first-page":"2281","DOI":"10.1002\/cncr.29336","volume":"121","author":"RGS Meester","year":"2015","unstructured":"Meester RGS, Doubeni CA, Zauber AG et al (2015) Public health impact of achieving 80% colorectal cancer screening rates in the United States by 2018. Cancer 121:2281\u20132285. https:\/\/doi.org\/10.1002\/cncr.29336","journal-title":"Cancer"},{"key":"2129_CR5","doi-asserted-by":"publisher","first-page":"330","DOI":"10.1002\/cncr.34622","volume":"129","author":"MB Nierengarten","year":"2023","unstructured":"Nierengarten MB (2023) Colonoscopy remains the gold standard for screening despite recent tarnish. Cancer 129:330\u2013331. https:\/\/doi.org\/10.1002\/cncr.34622","journal-title":"Cancer"},{"key":"2129_CR6","doi-asserted-by":"publisher","first-page":"1965","DOI":"10.1001\/jama.2021.6238","volume":"325","author":"KW Davidson","year":"2021","unstructured":"Davidson KW, Barry MJ, Mangione CM et al (2021) Screening for colorectal cancer: US preventive services task force recommendation statement. JAMA 325:1965\u20131977. https:\/\/doi.org\/10.1001\/jama.2021.6238","journal-title":"JAMA"},{"key":"2129_CR7","unstructured":"American Cancer Society (2023) Colorectal cancer facts & figures 2023\u20132025."},{"key":"2129_CR8","doi-asserted-by":"publisher","first-page":"1810","DOI":"10.1038\/s41395-018-0398-8","volume":"113","author":"C Yang","year":"2018","unstructured":"Yang C, Sriranjan V, Abou-Setta AM, Poluha W, Walker JR, Singh H (2018) Anxiety associated with colonoscopy and flexible sigmoidoscopy: a systematic review. Am J Gastroenterol 113:1810\u20131818. https:\/\/doi.org\/10.1038\/s41395-018-0398-8","journal-title":"Am J Gastroenterol"},{"key":"2129_CR9","doi-asserted-by":"publisher","first-page":"781","DOI":"10.1097\/MEG.0b013e328352deff","volume":"24","author":"Y Niv","year":"2012","unstructured":"Niv Y, Bogolavski I, Ilani S et al (2012) Impact of colonoscopy on quality of life. Eur J Gastroenterol Hepatol 24:781\u2013786. https:\/\/doi.org\/10.1097\/MEG.0b013e328352deff","journal-title":"Eur J Gastroenterol Hepatol"},{"key":"2129_CR10","doi-asserted-by":"publisher","first-page":"366","DOI":"10.3109\/00365521.2012.758768","volume":"48","author":"J McEntire","year":"2013","unstructured":"McEntire J, Sahota J, Hydes T, Trebble TM (2013) An evaluation of patient attitudes to colonoscopy and the importance of endoscopist interaction and the endoscopy environment to satisfaction and value. Scand J Gastroenterol 48:366\u2013373. https:\/\/doi.org\/10.3109\/00365521.2012.758768","journal-title":"Scand J Gastroenterol"},{"key":"2129_CR11","doi-asserted-by":"publisher","first-page":"1853","DOI":"10.1007\/s10620-016-4096-3","volume":"61","author":"V Bhise","year":"2016","unstructured":"Bhise V, Modi V, Kalavar A et al (2016) Patient-reported attributions for missed colonoscopy appointments in two large healthcare systems. Dig Dis Sci 61:1853\u20131861. https:\/\/doi.org\/10.1007\/s10620-016-4096-3","journal-title":"Dig Dis Sci"},{"key":"2129_CR12","doi-asserted-by":"publisher","first-page":"541","DOI":"10.1370\/afm.123","volume":"2","author":"NL Lacy","year":"2004","unstructured":"Lacy NL, Paulman A, Reuter MD, Lovejoy B (2004) Why we don\u2019t come: patient perceptions on no-shows. Ann Fam Med 2:541\u2013545. https:\/\/doi.org\/10.1370\/afm.123","journal-title":"Ann Fam Med"},{"key":"2129_CR13","doi-asserted-by":"publisher","first-page":"e580","DOI":"10.1016\/j.crohns.2013.04.011","volume":"7","author":"T Bessissow","year":"2013","unstructured":"Bessissow T, Van Keerberghen C-A, Van Oudenhove L et al (2013) Anxiety is associated with impaired tolerance of colonoscopy preparation in inflammatory bowel disease and controls. J Crohns Colitis 7:e580\u2013e587. https:\/\/doi.org\/10.1016\/j.crohns.2013.04.011","journal-title":"J Crohns Colitis"},{"key":"2129_CR14","doi-asserted-by":"publisher","first-page":"368","DOI":"10.47717\/turkjsurg.2020.4532","volume":"36","author":"M Sarg\u0131n","year":"2020","unstructured":"Sarg\u0131n M, Uluer M (2020) The effect of pre-procedure anxiety on sedative requirements for sedation during upper gastrointestinal endoscopy. Turk J Surg 36:368\u2013373. https:\/\/doi.org\/10.47717\/turkjsurg.2020.4532","journal-title":"Turk J Surg"},{"key":"2129_CR15","doi-asserted-by":"publisher","first-page":"5336","DOI":"10.3748\/wjg.14.5336","volume":"14","author":"WW Tam","year":"2008","unstructured":"Tam WW, Wong EL, Twinn SF (2008) Effect of music on procedure time and sedation during colonoscopy: a meta-analysis. World J Gastroenterol 14:5336\u20135343. https:\/\/doi.org\/10.3748\/wjg.14.5336","journal-title":"World J Gastroenterol"},{"key":"2129_CR16","doi-asserted-by":"publisher","first-page":"710","DOI":"10.1055\/s-2007-966718","volume":"39","author":"P Bytzer","year":"2007","unstructured":"Bytzer P, Lindeberg B (2007) Impact of an information video before colonoscopy on patient satisfaction and anxiety - a randomized trial. Endoscopy 39:710\u2013714. https:\/\/doi.org\/10.1055\/s-2007-966718","journal-title":"Endoscopy"},{"key":"2129_CR17","doi-asserted-by":"publisher","DOI":"10.1097\/jnr.0000000000000112","author":"F-C Hsueh","year":"2016","unstructured":"Hsueh F-C, Chen C-M, Sun C-A, Chou Y-C, Hsiao S-M, Yang T (2016) A study on the effects of a health education intervention on anxiety and pain during colonoscopy procedures. J Nurs Res. https:\/\/doi.org\/10.1097\/jnr.0000000000000112","journal-title":"J Nurs Res"},{"key":"2129_CR18","doi-asserted-by":"publisher","first-page":"314","DOI":"10.1093\/abm\/kaae013","volume":"58","author":"SM Rawl","year":"2024","unstructured":"Rawl SM, Perkins SM, Tong Y et al (2024) Patient navigation plus tailored digital video disc increases colorectal cancer screening among low-income and minority patients who did not attend a scheduled screening colonoscopy: a randomized trial. Ann Behav Med 58:314\u2013327. https:\/\/doi.org\/10.1093\/abm\/kaae013","journal-title":"Ann Behav Med"},{"key":"2129_CR19","doi-asserted-by":"publisher","first-page":"507","DOI":"10.1055\/s-2007-966362","volume":"39","author":"D Rudin","year":"2007","unstructured":"Rudin D, Kiss A, Wetz RV, Sottile VM (2007) Music in the endoscopy suite: a meta-analysis of randomized controlled studies. Endoscopy 39:507\u2013510. https:\/\/doi.org\/10.1055\/s-2007-966362","journal-title":"Endoscopy"},{"key":"2129_CR20","doi-asserted-by":"publisher","first-page":"e634","DOI":"10.1097\/meg.0000000000002186","volume":"33","author":"S Albashir","year":"2021","unstructured":"Albashir S, Durepos P, Causada Calo N et al (2021) Psychological interventions for reducing anxiety in patients undergoing first-time colonoscopy: a pilot and feasibility study. Eur J Gastroenterol Hepatol 33:e634\u2013e641. https:\/\/doi.org\/10.1097\/meg.0000000000002186","journal-title":"Eur J Gastroenterol Hepatol"},{"key":"2129_CR21","first-page":"1082","volume":"57","author":"PH Hu","year":"2010","unstructured":"Hu PH, Peng YC, Lin YT, Chang CS, Ou MC (2010) Aromatherapy for reducing colonoscopy related procedural anxiety and physiological parameters: a randomized controlled study. Hepatogastroenterology 57:1082\u20131086","journal-title":"Hepatogastroenterology"},{"key":"2129_CR22","doi-asserted-by":"publisher","first-page":"416","DOI":"10.1080\/00207140600856780","volume":"54","author":"G Elkins","year":"2006","unstructured":"Elkins G, White J, Patel P, Marcus J, Perfect MM, Montgomery GH (2006) Hypnosis to manage anxiety and pain associated with colonoscopy for colorectal cancer screening: case studies and possible benefits. Int J Clin Exp Hypn 54:416\u2013431. https:\/\/doi.org\/10.1080\/00207140600856780","journal-title":"Int J Clin Exp Hypn"},{"key":"2129_CR23","doi-asserted-by":"publisher","DOI":"10.1016\/j.jopan.2023.08.017","author":"S Lazar Barzegar","year":"2023","unstructured":"Lazar Barzegar S, Mohammadi S, Shamsalinia A, Saberifar M (2023) The effects of white noise on preprocedural anxiety and vital signs among older adults undergoing colonoscopy. J Perianesth Nurs. https:\/\/doi.org\/10.1016\/j.jopan.2023.08.017","journal-title":"J Perianesth Nurs"},{"key":"2129_CR24","first-page":"73","volume":"8","author":"J Kabat-Zinn","year":"2003","unstructured":"Kabat-Zinn J (2003) Mindfulness-based stress reduction (MBSR). Constr Hum Sci 8:73\u2013107","journal-title":"Constr Hum Sci"},{"key":"2129_CR25","doi-asserted-by":"publisher","first-page":"571","DOI":"10.1002\/pon.1400","volume":"18","author":"D Ledesma","year":"2009","unstructured":"Ledesma D, Kumano H (2009) Mindfulness-based stress reduction and cancer: a meta-analysis. Psycho-Oncol 18:571\u2013579. https:\/\/doi.org\/10.1002\/pon.1400","journal-title":"Psycho-Oncol"},{"key":"2129_CR26","doi-asserted-by":"publisher","first-page":"560","DOI":"10.1177\/08901171241227316","volume":"38","author":"B Emerson","year":"2024","unstructured":"Emerson B, Reddy M, Reiter PL et al (2024) Mindfulness-based interventions across the cancer continuum in the United States: a scoping review. Am J Health Promot 38:560\u2013575. https:\/\/doi.org\/10.1177\/08901171241227316","journal-title":"Am J Health Promot"},{"key":"2129_CR27","doi-asserted-by":"publisher","DOI":"10.1007\/s13187-025-02608-z","author":"B Emerson","year":"2025","unstructured":"Emerson B, Reiter PL, Klatt M et al (2025) Development of a brief online mindfulness-based intervention to reduce patient anxiety before a first-time screening colonoscopy. J Cancer Educ. https:\/\/doi.org\/10.1007\/s13187-025-02608-z","journal-title":"J Cancer Educ"},{"key":"2129_CR28","doi-asserted-by":"publisher","first-page":"21","DOI":"10.1186\/1471-2296-7-21","volume":"7","author":"NS Morris","year":"2006","unstructured":"Morris NS, MacLean CD, Chew LD, Littenberg B (2006) The single item literacy screener: evaluation of a brief instrument to identify limited reading ability. BMC Fam Pract 7:21. https:\/\/doi.org\/10.1186\/1471-2296-7-21","journal-title":"BMC Fam Pract"},{"key":"2129_CR29","volume-title":"Manual for the state-trait anxiety inventory","author":"CD Spielberger","year":"1983","unstructured":"Spielberger CD, Gorsuch RL, Lushene R, Vagg PR, Jacobs GA (1983) Manual for the state-trait anxiety inventory. Consulting Psychologists Press, Palo Alto"},{"key":"2129_CR30","doi-asserted-by":"publisher","first-page":"153","DOI":"10.1093\/her\/1.3.153","volume":"1","author":"S Prentice-Dunn","year":"1986","unstructured":"Prentice-Dunn S, Rogers RW (1986) Protection motivation theory and preventive health: beyond the health belief model. Health Educ Res 1:153\u2013161. https:\/\/doi.org\/10.1093\/her\/1.3.153","journal-title":"Health Educ Res"},{"key":"2129_CR31","doi-asserted-by":"publisher","first-page":"204","DOI":"10.1177\/1073191107311467","volume":"15","author":"L Cardaciotto","year":"2008","unstructured":"Cardaciotto L, Herbert JD, Forman EM, Moitra E, Farrow V (2008) The assessment of present-moment awareness and acceptance: the Philadelphia mindfulness scale. Assessment 15:204\u2013223. https:\/\/doi.org\/10.1177\/1073191107311467","journal-title":"Assessment"},{"key":"2129_CR32","doi-asserted-by":"publisher","first-page":"48","DOI":"10.1016\/j.cpr.2016.10.011","volume":"51","author":"EK Lindsay","year":"2017","unstructured":"Lindsay EK, Creswell JD (2017) Mechanisms of mindfulness training: monitor and acceptance theory (MAT). Clin Psychol 51:48\u201359. https:\/\/doi.org\/10.1016\/j.cpr.2016.10.011","journal-title":"Clin Psychol"},{"key":"2129_CR33","doi-asserted-by":"publisher","first-page":"620","DOI":"10.1016\/j.gie.2008.05.057","volume":"69","author":"EJ Lai","year":"2009","unstructured":"Lai EJ, Calderwood AH, Doros G, Fix OK, Jacobson BC (2009) The Boston bowel preparation scale: a valid and reliable instrument for colonoscopy-oriented research. Gastrointest Endosc 69:620\u2013625. https:\/\/doi.org\/10.1016\/j.gie.2008.05.057","journal-title":"Gastrointest Endosc"},{"key":"2129_CR34","doi-asserted-by":"publisher","first-page":"531","DOI":"10.4097\/kja.23278","volume":"76","author":"E Ahn","year":"2023","unstructured":"Ahn E, Kang H (2023) Intention-to-treat versus as-treated versus per-protocol approaches to analysis. Korean J Anesthesiol 76:531\u2013539. https:\/\/doi.org\/10.4097\/kja.23278","journal-title":"Korean J Anesthesiol"},{"key":"2129_CR35","doi-asserted-by":"publisher","first-page":"c2697","DOI":"10.1136\/bmj.c2697","volume":"340","author":"I Abraha","year":"2010","unstructured":"Abraha I, Montedori A (2010) Modified intention to treat reporting in randomised controlled trials: systematic review. BMJ 340:c2697. https:\/\/doi.org\/10.1136\/bmj.c2697","journal-title":"BMJ"},{"key":"2129_CR36","doi-asserted-by":"publisher","first-page":"414","DOI":"10.1016\/j.cct.2010.06.006","volume":"31","author":"AT Langford","year":"2010","unstructured":"Langford AT, Resnicow K, Davis RE et al (2010) Ethnic identity predicts loss-to-follow-up in a health promotion trial. Contemp Clin Trials 31:414\u2013418. https:\/\/doi.org\/10.1016\/j.cct.2010.06.006","journal-title":"Contemp Clin Trials"},{"key":"2129_CR37","doi-asserted-by":"publisher","first-page":"61","DOI":"10.1016\/j.cct.2013.05.014","volume":"36","author":"J Butler","year":"2013","unstructured":"Butler J, Quinn SC, Fryer CS, Garza MA, Kim KH, Thomas SB (2013) Characterizing researchers by strategies used for retaining minority participants: results of a national survey. Contemp Clin Trials 36:61\u201367. https:\/\/doi.org\/10.1016\/j.cct.2013.05.014","journal-title":"Contemp Clin Trials"}],"container-title":["Cancer Causes &amp; Control"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s10552-026-02129-0.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s10552-026-02129-0","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s10552-026-02129-0.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,6]],"date-time":"2026-04-06T04:11:41Z","timestamp":1775448701000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s10552-026-02129-0"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,3,3]]},"references-count":37,"journal-issue":{"issue":"4","published-print":{"date-parts":[[2026,4]]}},"alternative-id":["2129"],"URL":"https:\/\/doi.org\/10.1007\/s10552-026-02129-0","relation":{},"ISSN":["0957-5243","1573-7225"],"issn-type":[{"value":"0957-5243","type":"print"},{"value":"1573-7225","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,3,3]]},"assertion":[{"value":"3 October 2025","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"6 January 2026","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"3 March 2026","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"This manuscript is part of Brent Emerson\u2019s (first author) dissertation research.","order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The authors have no competing interests to declare that are relevant to the content of this article.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}},{"value":"Approval was granted by the Institutional Review Board at The Ohio State University.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethical approval"}},{"value":"Informed consent and HIPAA research authorization was obtained from all individual participants included in the study.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent to participate"}},{"value":"All participants provided informed consent for the publication of anonymized data and findings derived from this research. No personally identifiable information is included in this article.","order":5,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}}],"article-number":"55"}}