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Pavon JM, Fish LJ, Colón-Emeric CS, Hall KS, Morey MC, Pastva AM, Hastings SN. Towards "mobility is medicine": Socioecological factors and hospital mobility in older adults. J Am Geriatr Soc 2021; 69:1846-1855. [PMID: 33755991 DOI: 10.1111/jgs.17109] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Revised: 02/11/2021] [Accepted: 02/19/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Understanding the factors that influence hospital mobility, especially in the context of a heightened focus on falls prevention, is needed to improve care. OBJECTIVE This qualitative study uses a socioecological framework to explore factors that influence hospital mobility in older adults. DESIGN Qualitative research PARTICIPANTS: Semi-structured interviews and focus groups were conducted with medically-ill hospitalized older adults (n = 19) and providers (hospitalists, nurses, and physical and occupational therapists (n = 48) at two hospitals associated with an academic health system. APPROACH Interview and focus group guides included questions on perceived need for mobility, communication about mobility, hospital mobility culture, and awareness of patients' walking activity. Data were analyzed thematically and mapped onto the constructs of the socioecological model. KEY RESULTS A consistent theme among patients and providers was that "mobility is medicine." Categories of factors reported to influence hospital walking activity included intrapersonal factors (patients' health status, fear of falls), interpersonal factors (patient-provider communication about mobility), organizational factors (clarity about provider roles and responsibilities, knowledge of safe patient handling, reliance on physical therapy for mobility), and environmental factors (falls as a never event, patient geographical locations on hospital units). Several of these factors were identified as potentially modifiable targets for intervention. Patients and providers offered recommendations for improving awareness of patient's ambulatory activity, assigning roles and responsibility for mobility, and enhancing education and communication between patients and providers across disciplines. CONCLUSION Patients and providers identified salient factors for future early mobility initiatives targeting hospitalized older adults. Consideration of these factors across all stages of intervention development and implementation will enhance impact and sustainability.
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Pollak KI, Oliver JA, Pieper C, Davis JM, Gao X, Noonan D, Kennedy D, Granados I, Fish LJ. Cue-based treatment for light smokers: A proof of concept pilot. Addict Behav 2021; 114:106717. [PMID: 33109394 DOI: 10.1016/j.addbeh.2020.106717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 10/13/2020] [Accepted: 10/14/2020] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Light smoking (smoking ≤ 10 cigarettes per day or on some days) has become increasingly prevalent in the US and increases morbidity and mortality. Many light smokers do not experience significant nicotine withdrawal but instead smoke in response to cues. Minimal evidence exists supporting interventions to help light smokers quit smoking. METHODS We present results from a proof-of-concept pilot study designed to evaluate the feasibility and acceptability of a cue-based smoking cessation intervention targeted to light daily and intermittent smokers. Participants were randomized to one of two arms: Arm 1) standard smoking cessation treatment or Arm 2) standard smoking cessation treatment + enhanced cue-based treatment that included interactive texting to extend cue exposure treatment to real-world settings and cue management counseling.Outcomes included feasibility (number of participants who were recruited and who completed the intervention), acceptability (intervention ratings), and preliminary efficacy (7-day point prevalence abstinence). RESULTS We randomized 24 English and Spanish-speaking light smokers, 13 to the treatment arm and 11 to the control arm. Across both arms, 77% attended all counseling sessions, 90% rated these sessions as very useful and 100% said that they would recommend the intervention to a friend. 15% in the treatment arm had biochemically-validated smoking abstinence compared to 0% in the standard counseling arm. CONCLUSIONS Results from this proof-of-concept study demonstrated that a cue-based intervention is feasible and acceptable among light smokers and suggests the need for a fully powered study to assess this approach. TRIAL REGISTRATION This study is registered at www.clinicaltrials.gov NCT03416621.
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Oshima SM, Tait SD, Rushing C, Lane W, Hyslop T, Offodile AC, Wheeler SB, Zafar SY, Greenup R, Fish LJ. Patient Perspectives on the Financial Costs and Burdens of Breast Cancer Surgery. JCO Oncol Pract 2021; 17:e872-e881. [PMID: 33566677 DOI: 10.1200/op.20.00780] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Although financial toxicity is a well-documented aspect of cancer care, little is known about how patients narratively characterize financial experiences related to breast cancer treatment. We sought to examine these patient experiences through mixed methods analysis. METHODS Women (≥ 18 years old) with a history of breast cancer were recruited from the Love Research Army and Sisters Network to complete an 88-item electronic survey including an open-ended response. Quantitative data were used to sort and stratify responses to the open-ended question, which comprised the qualitative data evaluated here. Descriptive statistics and qualitative content analysis were used to evaluate the financial costs and other burdens resulting from breast cancer surgery. RESULTS In total, 511 respondents completed the survey in its entirety and wrote an open-ended response. Participants reported significant financial burden in different categories including direct payments for medical care and indirect costs such as lost wages and travel expenses. Treatment-related costs burdened participants for years after diagnosis, forming a financial arc for many participants. Discrepancies existed between the degree of financial burden reported on multiple-choice questions and participants' corresponding open-ended descriptions of financial burden. Participants described a lack of communication surrounding costs with their providers and difficulty negotiating payments with insurance. CONCLUSION Breast cancer care can result in ongoing financial burden years after diagnosis among all patients, even those with adequate insurance patient populations.
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Racioppi A, Dalton T, Ramalingam S, Romero K, Ren Y, Bohannon L, Arellano C, Jonassaint J, Miller H, Barak I, Fish LJ, Choi T, Gasparetto C, Long GD, Lopez RD, Rizzieri DA, Sarantopoulos S, Horwitz ME, Chao NJ, Shah NR, Sung AD. Assessing the Feasibility of a Novel mHealth App in Hematopoietic Stem Cell Transplant Patients. Transplant Cell Ther 2021; 27:181.e1-181.e9. [PMID: 33830035 PMCID: PMC10522407 DOI: 10.1016/j.jtct.2020.10.017] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Revised: 10/23/2020] [Accepted: 10/25/2020] [Indexed: 12/22/2022]
Abstract
Hematopoietic stem cell transplantation (HCT) is a curative treatment option for patients with hematologic conditions but presents many complications that must be managed as a complex, chronic condition. Mobile health applications (mHealth apps) may permit tracking of symptoms in HCT. In seeking strategies to manage the complexities of HCT, our team collaborated with Sicklesoft, Inc., to develop an mHealth app specifically for HCT patients to allow for daily evaluation of patient health, Technology Recordings to better Understand Bone Marrow Transplantation (TRU-BMT). The primary value of this application is that of potentially enhancing the monitoring of symptoms and general health of patients undergoing HCT, with the ultimate goal of allowing earlier detection of adverse events, earlier intervention, and improving outcomes. To first evaluate patient interest in mHealth apps, we designed and administered an interest survey to patients at the 2017 BMT-InfoNet reunion. As a follow-up to the positive feedback received, we began testing the TRU-BMT app in a Phase 1 pilot study. Thirty patients were enrolled in this single-arm study and were given the TRU-BMT mHealth app on a smartphone device in addition to a wearable activity tracker. Patients were followed for up to 180 days, all the while receiving daily app monitoring. Adherence to TRU-BMT was approximately 30% daily and 44% weekly, and greater adherence was associated with increased meal completion, decreased heart rate, and shorter hospital stay. TRU-BMT assessments of symptom severity were significantly associated with duration of hospital stay and development of chronic graft-versus-host disease. Our findings suggest that using TRU-BMT throughout HCT is feasible for patients and established a proof-of-concept for a future randomized control trial of the TRU-BMT application in HCT. © 2021 American Society for Blood and Marrow Transplantation. Published by Elsevier Inc. All rights reserved.
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Biederman DJ, Hartman AM, Felsman IC, Mountz H, Jacobs T, Rich N, Fish LJ, Noonan D. Improving the Health of Public Housing Residents Through a Housing Authority and Nursing School Partnership. Prog Community Health Partnersh 2021; 15:59-64. [PMID: 33775961 DOI: 10.1353/cpr.2021.0005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The connection between health and housing is well-established. People who are precariously housed have worse health than those who have stable housing arrangements.- Persons moving into public housing have a higher illness burden than the general population, and public housing residents engage in less healthy behaviors, which contribute to public housing residents having poorer health than persons living in other housing situations. Public housing authorities and residents can benefit from authentic and constructive relationships with academic partners; academicians and students can benefit from engaging in partnerships with housing authorities and residents to better understand the connection between housing and health. This article describes the well-established relationship between the Duke University School of Nursing (DUSON) and the Durham Housing Authority (DHA), the evolution of that relationship, our collaborative work in improving the health of DHA residents while advancing nursing education and science, and lessons learned.
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Watson CH, Fish LJ, Falkovic M, Monuszko K, Lorenzo A, Havrilesky LJ, Secord AA, Davidson BA. Adherence to Oral Anticancer Therapeutics in the Gynecologic Oncology Population. Obstet Gynecol 2020; 136:1145-1153. [DOI: 10.1097/aog.0000000000004170] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Hall R, Rutledge J, Colón-Emeric C, Fish LJ. Unmet Needs of Older Adults Receiving In-Center Hemodialysis: A Qualitative Needs Assessment. Kidney Med 2020; 2:543-551.e1. [PMID: 33094273 PMCID: PMC7568084 DOI: 10.1016/j.xkme.2020.04.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Rationale & Objective Attention to geriatric impairments is not routinely provided to older adults receiving dialysis. Our objective was to identify patient and personnel perspectives on experiences with geriatric problems, unmet needs that may affect a patient’s ability to maintain his or her functional status, and preferences for design of a geriatric model of care tailored to address the unmet needs. Study Design Qualitative study using semi-structured interviews and focus groups. Setting & Participants 14 hemodialysis patients 55 years and older and 24 dialysis unit personnel (eg, nephrologists, nurses, patient care technicians, and social workers) representing 5 dialysis units. Analytical Approach Content analysis to identify themes reflecting unmet needs and design considerations for a geriatric model of care for older adults receiving dialysis. Results 4 themes (or unmet needs) identified from both patient and personnel transcripts were: (1) mobility, which referred to the insufficient mobility assessment and transportation services; (2) medications, which referred to insufficient attention to appropriate prescribing and medication self-management; (3) social support, which referred to insufficient support for activities of daily living and emotional problems; and (4) communication, which referred to insufficient patient-provider and interprofessional communication, including data transfer across separate health systems. Although participants generally acknowledged that an integrated model of care could result in benefits across all 4 areas of unmet need, they noted that the program design would need to minimize disruption of current workflow and practices in dialysis units. Limitations The findings may not be broadly representative of all older adults receiving dialysis and dialysis unit personnel. Conclusions There is insufficient attention to mobility, medication management, social support, and communication needs for older adults receiving in-center hemodialysis. Addressing these unmet needs in a geriatric model of care and measuring its effectiveness are areas of future research.
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Hofacker SA, Fish LJ, Blewer AL, Pun PH. Barriers and Facilitators to Performing Cardiopulmonary Resuscitation During Treatment in Outpatient Hemodialysis Clinics: A Qualitative Study. Nephrol Nurs J 2020; 47:401-411. [PMID: 33107712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Cardiac arrest is the leading cause of death among patients receiving hemodialysis, and major deficiencies exist in hemodialysis staff-provided cardiopulmonary resuscitation (CPR). Our study aimed to identify factors influencing CPR delivery in the outpatient hemodialysis clinic. Through content analysis of in-depth interviews with 10 staff members of a hemodialysis clinic, we identified three broad themes regarding barriers and facilitators to performing CPR in the hemodialysis clinic: 1) physical and environmental challenges regarding the layout of the clinic; 2) uncertainty about optimal in-clinic CPR procedures, particularly concerning patient positioning and dealing with the hemodialysis machine; and 3) benefit of continuous improvement programs, including hemodialysis-specific protocols, hands-on training, and pre-defined team roles. Our findings call for further investigation of optimal in-clinic resuscitation procedures to inform hemodialysis clinic CPR protocols and hemodialysis staff training.
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Noonan D, Silva S, Fish LJ, Peter K, Conley C, Simmons LA, Severson H, Pollak KI. Feasibility of a text-based reduction intervention in helping rural and underserved smokeless tobacco users quit. Addict Behav 2020; 108:106434. [PMID: 32361367 PMCID: PMC7337980 DOI: 10.1016/j.addbeh.2020.106434] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2019] [Revised: 03/29/2020] [Accepted: 04/06/2020] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Smokeless tobacco (ST) use significantly affects morbidity and mortality and remains disproportionally prevalent in rural and medically underserved communities. Few programs exist for rural smokeless tobacco users. Text-based interventions may increase the reach of cessation interventions; yet, none has tested them in ST users. We evaluated the feasibility, acceptability, and preliminary efficacy of a text-based Scheduled Gradual Reduction (SGR) intervention in rural and underserved ST users. METHODS ST users were randomized in 2:1 fashion to the SGR group (N = 65), a text-based reduction program plus text-based support counseling messages or text-based support messages only group (N = 33). We surveyed participants at 30-days post intervention initiation to assess feasibility and acceptability and examined self-report 7-day point prevalence cessation at 30-days and 6-months post intervention initiation in the two arms. RESULTS We achieved benchmarks for feasibility and acceptability. Among the SGR participants 51% (n = 48) reported that intervention was useful in helping them quit, 83% (n = 48) indicated that they would recommend the intervention to a friend. Over 95% (n = 39) of SGR participants said that they read all alert texts. The SGR participants had a higher quit rate at 30-days compared to support messages alone (SGR = 21.5%, Control = 9.1%, p = 0.1627, Cohen's d equivalent = 0.56, medium effect). However, the quit rate at 6-months was 21% (p = 0.9703) for both groups. CONCLUSIONS A text-based intervention was feasible and acceptable among underserved ST users. SGR helped promote short-term cessation. The text-based interventions both had long-term efficacy. Given that text-based interventions have the potential to increase reach in underserved ST users, further testing is warranted.
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Pollak KI, Lyna P, Gao X, Noonan D, Bejarano Hernandez S, Subudhi S, Swamy GK, Fish LJ. Efficacy of a Texting Program to Promote Cessation Among Pregnant Smokers: A Randomized Control Trial. Nicotine Tob Res 2020; 22:1187-1194. [PMID: 31647564 PMCID: PMC7291805 DOI: 10.1093/ntr/ntz174] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Accepted: 09/10/2019] [Indexed: 12/29/2022]
Abstract
INTRODUCTION Smoking during pregnancy poses serious risks to baby and mother. Few disseminable programs exist to help pregnant women quit or reduce their smoking. We hypothesized that an SMS text-delivered scheduled gradual reduction (SGR) program plus support texts would outperform SMS support messages alone. METHODS We recruited 314 pregnant women from 14 prenatal clinics. Half of the women received theory-based support messages throughout their pregnancy to promote cessation and prevent relapse. The other half received the support messages plus alert texts that gradually reduced their smoking more than 3-5 weeks. We conducted surveys at baseline, end of pregnancy, and 3 months postpartum. Our primary outcome was biochemically validated 7-day point prevalence abstinence at late pregnancy. Our secondary outcome was reduction in cigarettes per day. RESULTS Adherence to the SGR was adequate with 70% responding to alert texts to smoke within 60 minutes. Women in both arms quit smoking at the same rate (9%-12%). Women also significantly reduced their smoking from baseline to the end of pregnancy from nine cigarettes to four; we found no arm differences in reduction. CONCLUSIONS Support text messages alone produced significant quit rates above naturally occurring quitting. SGR did not add significantly to helping women quit or reduce. Sending support messages can reach many women and is low-cost. More obstetric providers might consider having patients who smoke sign up for free texting programs to help them quit. IMPLICATIONS A disseminable texting program helped some pregnant women quit smoking.Clinical Trial Registration number: NCT01995097.
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Barrett NJ, Ingraham KL, Bethea K, Hwa-Lin P, Chirinos M, Fish LJ, Randolph S, Zhang P, Le P, Harvey D, Godbee RL, Patierno SR. Project PLACE: Enhancing community and academic partnerships to describe and address health disparities. Adv Cancer Res 2020; 146:167-188. [PMID: 32241388 DOI: 10.1016/bs.acr.2020.01.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Achieving cancer health equity is a national imperative. Cancer is the second leading cause of death in the United States and in North Carolina (NC), where the disease disproportionately impacts traditionally underrepresented race and ethnic groups, those who live in rural communities, the impoverished, and medically disenfranchised and/or health-disparate populations at high-risk for cancer. These populations have worse cancer outcomes and are less likely to be participants in clinical research and trials. It is critical for cancer centers and other academic health centers to understand the factors that contribute to poor cancer outcomes, the extent to which they impact the cancer burden, and develop effective interventions to address them. Key to this process is engaging diverse stakeholders in the development and execution of community and population health assessments, and the subsequent programs and interventions designed to address the need across the catchment area. This chapter describes the processes and lessons learned of the Duke Cancer Institute's (DCI) long standing community partnerships that led to Project PLACE (Population Level Approaches to Cancer Elimination), a National Cancer Institute (NCI)-funded community health assessment reaching 2315 respondents in 7 months, resulting in a community partnered research agenda to advance cancer equity within the DCI catchment area. We illustrate the application of a community partnered health assessment and offer examples of strategic opportunities, successes, lessons learned, and implications for practice.
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Pollak KI, Lyna P, Gao X, Noonan D, Hernandez SB, Subudhi S, Kennedy D, Farrell D, Swamy GK, Fish LJ. Pilot Test of Connecting Pregnant Women who Smoke to Short Message Service (SMS) Support Texts for Cessation. Matern Child Health J 2020; 24:419-422. [PMID: 32026323 DOI: 10.1007/s10995-020-02893-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Most pregnant women know that smoking poses serious risks to baby and mother, yet many still smoke. We conducted a large randomized controlled trial and found that an SMS text-delivered program helped about 10% of these women quit smoking. In this paper, we describe the feasibility of disseminating a text-based intervention to pregnant women who smoke. METHODS We tested dissemination in two ways from prenatal clinics and compared recruitment rates to those found in our large randomized controlled trial. The first method involved "direct texting" where study staff identified women who smoked and sent them a text asking them to text back if they wanted to receive texts to help them quit. The second involved "nurse screening" where clinic staff from county health departments screened women for smoking and asked them to send a text to the system if they wanted to learn more about the program. Our primary outcome was feasibility assessed by the number of women who texted back their baby's due date, which served as "enrolling" in the texting program, which we compared to the recruitment rate we found in our large trial. RESULTS Over 4 months, we texted 91 women from the academic health system. Of those, 17 texted back and were counted as "enrolled." In the health departments, across the 4 months, 12 women texted the system initially. Of those, 10 were enrolled. This rate was similar to the rate enrolled in the randomized controlled trial. DISCUSSION Two different methods connected pregnant women who smoke to a texting program. One of these methods can be automated further and have the potential of helping many women quit smoking with minimal effort. Clinical Trial # NCT01995097.
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Barrett NJ, Rodriguez EM, Iachan R, Hyslop T, Ingraham KL, Le GM, Martin K, Haring RC, Rivadeneira NA, Erwin DO, Fish LJ, Middleton D, Hiatt RA, Patierno SR, Sarkar U, Gage-Bouchard EA. Factors associated with biomedical research participation within community-based samples across 3 National Cancer Institute-designated cancer centers. Cancer 2020; 126:1077-1089. [PMID: 31909824 DOI: 10.1002/cncr.32487] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2018] [Revised: 05/21/2019] [Accepted: 05/27/2019] [Indexed: 12/17/2022]
Abstract
BACKGROUND Engaging diverse populations in biomedical research, including biospecimen donation, remains a national challenge. This study examined factors associated with an invitation to participate in biomedical research, intent to participate in biomedical research in the future, and participation in biomedical research and biospecimen donation among a diverse, multilingual, community-based sample across 3 distinct geographic areas. METHODS Three National Cancer Institute-designated cancer centers engaged in community partnerships to develop and implement population health assessments, reaching a convenience sample of 4343 participants spanning their respective catchment areas. Data harmonization, multiple imputation, and multivariable logistic modeling were used. RESULTS African Americans, Hispanic/Latinos, and other racial minority groups were more likely to be offered opportunities to participate in biomedical research compared to whites. Access to care, history of cancer, educational level, survey language, nativity, and rural residence also influenced opportunity, intent, and actual participation in biomedical research. CONCLUSIONS Traditionally underserved racial and ethnic groups reported heightened opportunity and interest in participating in biomedical research. Well-established community partnerships and long-standing community engagement around biomedical research led to a diverse sample being reached at each site and may in part explain the current study findings. However, this study illustrates an ongoing need to establish trust and diversify biomedical research participation through innovative and tailored approaches. National Cancer Institute-designated cancer centers have the potential to increase opportunities for diverse participation in biomedical research through community partnerships and engagement. Additional work remains to identify and address system-level and individual-level barriers to participation in both clinical trials and biospecimen donation for research.
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Hofacker SA, Fish LJ, Blewer AL, Pun PH. Barriers and Facilitators to Performing Cardiopulmonary Resuscitation During Treatment in Outpatient Hemodialysis Clinics: A Qualitative Study. Nephrol Nurs J 2020. [DOI: 10.37526/1526-744x.2020.47.5.401] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Greenup RA, Rushing CN, Fish LJ, Lane WO, Peppercorn JM, Bellavance E, Tolnitch L, Hyslop T, Myers ER, Zafar SY, Hwang ES. Perspectives on the Costs of Cancer Care: A Survey of the American Society of Breast Surgeons. Ann Surg Oncol 2019; 26:3141-3151. [PMID: 31342390 DOI: 10.1245/s10434-019-07594-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Indexed: 12/17/2022]
Abstract
BACKGROUND Cancer treatment costs are not routinely addressed in shared decisions for breast cancer surgery. Thus, we sought to characterize cost awareness and communication among surgeons treating breast cancer. METHODS We conducted a self-administered, confidential electronic survey among members of the American Society of Breast Surgeons from 1 July to 15 September 2018. Questions were based on previously published or validated survey items, and assessed surgeon demographics, cost sensitivity, and communication. Descriptive summaries and cross-tabulations with Chi-square statistics were used, with exact tests where warranted, to assess findings. RESULTS Of those surveyed (N = 2293), 598 (25%) responded. Surgeons reported that 'risk of recurrence' (70%), 'appearance of the breast' (50%), and 'risks of surgery' (47%) were the most influential on patients' decisions for breast cancer surgery; 6% cited out-of-pocket costs as significant. Over half (53%) of the surgeons agreed that doctors should consider patient costs when choosing cancer treatment, yet the majority of surgeons (58%) reported 'infrequently' (43%) or 'never' (15%) considering patient costs in medical recommendations. The overwhelming majority (87%) of surgeons believed that patients should have access to the costs of their treatment before making medical decisions. Surgeons treating a higher percentage of Medicaid or uninsured patients were more likely to consistently consider costs (p < 0.001). Participants reported that insufficient knowledge or resources (61%), a perceived inability to help with costs (24%), and inadequate time (22%) impeded cost discussions. Notably, 20% of participants believed that discussing costs might impact the quality of care patients receive. CONCLUSIONS Cost transparency remains rare, however in shared decisions for breast cancer surgery, improved cost awareness by surgeons has the potential to reduce financial hardship.
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Pollak KI, Fish LJ, Sutton LM, Gao X, Lyna P, Owen L, Patel ML, Somers TJ. A smoking cessation and pain management program for cancer survivors. J Cancer Surviv 2018; 12:821-827. [PMID: 30328056 DOI: 10.1007/s11764-018-0719-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2018] [Accepted: 09/24/2018] [Indexed: 11/29/2022]
Abstract
PURPOSE Many cancer survivors continue to smoke. Further, most survivors also report high levels of persistent pain and smoke in response to pain. The investigators tested the feasibility, acceptability, and preliminary efficacy of a smoking cessation program paired with a pain management program for cancer survivors. METHODS The investigators conducted a two-arm, wait-list randomized controlled pilot study in which they delivered a combined smoking cessation and pain management intervention. RESULTS The investigators randomized 30 survivors (14 intervention and 16 wait-list control). Seventy-one percent of the survivors who received the intervention rated it as extremely useful (5 out of 5) in helping them quit smoking. Further, 86% would recommend the program to other survivors. Although we could not conduct inferential statistics, 14% of those in the intervention arm, compared to 6% in the control condition had biochemically validated cessation at 2-months post-randomization. Survivors in the intervention also reported less pain, had improvements in depressive symptoms, and better physical function than those in the control arm. CONCLUSIONS Our pilot data suggest the feasibility, acceptability, and preliminary efficacy of this approach. The next step is to conduct a large randomized controlled trial to fully test the efficacy of the intervention. IMPLICATIONS FOR CANCER SURVIVORS A combined smoking cessation and pain program might help improve both issues simultaneously.
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Noonan D, Silva S, Njuru J, Bishop T, Fish LJ, Simmons LA, Choi SH, Pollak KI. Feasibility of a text-based smoking cessation intervention in rural older adults. HEALTH EDUCATION RESEARCH 2018; 33:81-88. [PMID: 29309599 PMCID: PMC6279146 DOI: 10.1093/her/cyx080] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/21/2016] [Accepted: 11/30/2017] [Indexed: 05/10/2023]
Abstract
Text-based interventions are effective for smoking cessation, but have not been tested in rural older adults. The purpose of this study was to compare the feasibility, acceptability and preliminary efficacy of a text-based Scheduled Gradual Reduction (SGR) program to a non-SGR text messaging support condition among rural older adults. Adults over 60 years were randomized to either: (i) the SGR program (n = 20), a text-based program to reduce smoking over 4-weeks plus text-based support messages; or (ii) control (n = 20), receipt of text-based support messages only. Participants completed surveys at baseline and end of program to assess feasibility and acceptability of the intervention, and biochemically validated 7-day point prevalence cessation was assessed at end of treatment. Most participants (81%) reported reading all the messages they received. Participants found both interventions useful in quitting smoking (SGR = 57%, Control = 63%) and would recommend it to a friend (SGR = 72%, Control = 79%). Although not statically significant, the SGR group had a higher rate of biochemically validated cessation (SGR = 15%, Control = 5%, Cohen d = 0.67). Among those still smoking, the median percent reduction in cigarettes was 33.3% for both groups. Text-based cessation interventions are feasible, acceptable and can be easily disseminated to rural older adult tobacco users.
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Freel SA, Fish LJ, Mirman B, Sudan R, Devi GR. Advancement of multidisciplinary education and research in translational sciences: MERITS program development at Duke University. J Clin Transl Sci 2018; 2:57-62. [PMID: 31660219 PMCID: PMC6799111 DOI: 10.1017/cts.2018.17] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2017] [Revised: 03/01/2018] [Accepted: 03/12/2018] [Indexed: 11/06/2022] Open
Abstract
INTRODUCTION The Duke Multidisciplinary Education and Research in Translational Sciences Program provides educational resources for faculty and trainees in translational research. METHODS To aid in program development, we assessed perceptions of translational science through focus groups targeting different career stages. RESULTS In total, 3 essential themes emerged: collaboration, movement toward application, and public health impact. Facilitators and barriers varied among groups. CONCLUSION Training programs must provide specific strategies for collaboration and selectively accelerating discoveries to therapies.
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LeBlanc TW, Fish LJ, Bloom CT, El-Jawahri A, Davis DM, Locke SC, Steinhauser KE, Pollak KI. Patient experiences of acute myeloid leukemia: A qualitative study about diagnosis, illness understanding, and treatment decision-making. Psychooncology 2016; 26:2063-2068. [DOI: 10.1002/pon.4309] [Citation(s) in RCA: 58] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2016] [Revised: 10/24/2016] [Accepted: 11/11/2016] [Indexed: 11/11/2022]
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Noonan D, Lyna P, Fish LJ, Bilheimer AK, Gordon KC, Roberson P, Gonzalez A, Pollak KI. Unintended Effects of a Smoking Cessation Intervention on Latino Fathers' Binge Drinking In Early Postpartum. Ann Behav Med 2016; 50:622-7. [PMID: 26868270 PMCID: PMC6087664 DOI: 10.1007/s12160-016-9781-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Background Research suggests that when smokers reduce their smoking, they also reduce their alcohol consumption. Purpose To examine the effects of a smoking cessation intervention and actual quitting smoking on binge drinking behavior among Latino expectant and new fathers. Methods Logistic regression models were used to examine the effect of intervention arm and quitting smoking on past 30-day binge drinking measured at 3-months and 12-months postpartum while controlling for known covariates. Results Fathers in the intervention arm were significantly more likely to decrease their binge drinking at the 12-month follow-up (OR=0.57, 95% CI=0.35–0.93). Quitting smoking, measured by both 7-day and 30-day point prevalence, was positively associated with reduced binge drinking at 3-months (OR=0.25, 95% CI=0.14–0.45; OR=0.44, 95% CI= 0.26–0.75) and 12-months (OR=0.22, 95% CI=0.11–0.42; OR=0.43, 95% CI= 0.24–0.77). Conclusions The results of this study support the positive effects of a smoking cessation intervention on decreasing binge drinking behavior among Latino fathers in the postpartum period.
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Pollak KI, Fish LJ, Lyna P, Peterson BL, Myers ER, Gao X, Swamy GK, Brown-Johnson A, Whitecar P, Bilheimer AK, Pletsch PK. Efficacy of a Nurse-Delivered Intervention to Prevent and Delay Postpartum Return to Smoking: The Quit for Two Trial. Nicotine Tob Res 2016; 18:1960-6. [PMID: 27091830 DOI: 10.1093/ntr/ntw108] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2016] [Accepted: 04/08/2016] [Indexed: 11/12/2022]
Abstract
INTRODUCTION Most pregnant women who quit smoking return to smoking postpartum. Trials to prevent this return have been unsuccessful. We tested the efficacy of a nurse-delivered intervention in maintaining smoking abstinence after delivery among pregnant women who quit smoking that was tailored on their high risk of relapse (eg, had strong intentions to return). METHODS We recruited 382 English-speaking spontaneous pregnant quitters from 14 prenatal clinics and randomized them to receive either a smoking abstinence booklet plus newsletters about parenting and stress (control) or a nurse-delivered smoking abstinence intervention that differed in intensity for the high and low risk groups. Our primary outcome was smoking abstinence at 12 months postpartum. RESULTS Using intent-to-treat analyses, there was a high rate of biochemically validated smoking abstinence at 12 months postpartum but no arm differences ( CONTROL 36% [95% confidence interval [CI]: 29-43] vs. INTERVENTION 35% [95% CI: 28-43], P = .81). Among women at low risk of returning to smoking, the crude abstinence rate was significantly higher in the control arm (46%) than in the intervention arm (33%); among women at high risk of returning to smoking, the crude abstinence rate was slightly lower but not different in the control arm (31%) than in the intervention arm (37%). CONCLUSIONS Low-risk women fared better with a minimal intervention that focused on parenting skills and stress than when they received an intensive smoking abstinence intervention. The opposite was true for women who were at high risk of returning to smoking. Clinicians might need to tailor their approach based on whether women are at high or low risk of returning to smoking. IMPLICATIONS Results suggest that high-risk and low-risk women might benefit from different types of smoking relapse interventions. Those who are lower risk of returning to smoking might benefit from stress reduction that is devoid of smoking content, whereas those who are higher risk might benefit from smoking relapse prevention.
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Bastian LA, Fish LJ, Gierisch JM, Stechuchak KM, Grambow SC, Keefe FJ. Impact of Smoking Cessation on Subsequent Pain Intensity Among Chronically Ill Veterans Enrolled in a Smoking Cessation Trial. J Pain Symptom Manage 2015. [PMID: 26210348 DOI: 10.1016/j.jpainsymman.2015.06.012] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
CONTEXT Prior cross-sectional studies have reported greater pain intensity among persistent smokers compared with nonsmokers or former smokers; yet, few prospective studies have examined how smoking abstinence affects pain intensity. OBJECTIVES To determine the impact of smoking cessation on subsequent pain intensity in smokers with chronic illness enrolled in a smoking cessation trial. METHODS We recruited veteran smokers with chronic illness (heart disease, cancer, chronic obstructive pulmonary disease, diabetes, or hypertension) for a randomized controlled smoking cessation trial and prospectively examined pain intensity and smoking status. Participants (n = 380) were asked to rate their pain in the past week from 0 to 10 at baseline and the five-month follow-up. The primary outcome measure was self-reported pain intensity at the five-month follow-up survey. Self-reported smoking status was categorized as an abstainer if patients reported no cigarettes in the seven days before the follow-up survey. RESULTS In unadjusted analyses, abstainers reported significantly lower pain levels at the five-month follow-up compared with patients who continued to smoke (parameter estimate = -1.07; 95% CI = -1.77, -0.36). In multivariable modeling, abstaining from cigarettes was not associated with subsequent pain intensity at five-month follow-up (parameter estimate = -0.27; 95% CI = -0.79, 0.25). CONCLUSION Participants who were classified as abstainers did not report significantly different levels of pain intensity than patients who continued to smoke. Future studies should expand on our findings and monitor pain intensity in smoking cessation trials. TRIAL REGISTRATION ClinicalTrials.govNCT00448344.
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Khaddouma A, Gordon KC, Fish LJ, Bilheimer A, Gonzalez A, Pollak KI. Relationships among spousal communication, self-efficacy, and motivation among expectant Latino fathers who smoke. Health Psychol 2015; 34:1038-42. [PMID: 25844907 PMCID: PMC4579045 DOI: 10.1037/hea0000224] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Cigarette smoking is a prevalent problem among Latinos, yet little is known about what factors motivate them to quit smoking or make them feel more confident that they can. Given cultural emphases on familial bonds among Latinos (e.g., familismo), it is possible that communication processes among Latino spouses play an important role. The present study tested a mechanistic model in which perceived spousal constructive communication patterns predicted changes in level of motivation for smoking cessation through changes in self-efficacy among Latino expectant fathers. METHODS Latino males (n = 173) and their pregnant partners participated in a couple-based intervention targeting males' smoking. Couples completed self-report measures of constructive communication, self-efficacy (male partners only), and motivation to quit (male partners only) at 4 time points throughout the intervention. RESULTS Higher levels of perceived constructive communication among Latino male partners predicted subsequent increases in male partners' self-efficacy and, to a lesser degree, motivation to quit smoking; however, self-efficacy did not mediate associations between constructive communication and motivation to quit smoking. Furthermore, positive relationships with communication were only significant at measurements taken after completion of the intervention. Female partners' level of perceived constructive communication did not predict male partners' outcomes. CONCLUSION These results provide preliminary evidence to support the utility of couple-based interventions for Latino men who smoke. Findings also suggest that perceptions of communication processes among Latino partners (particularly male partners) may be an important target for interventions aimed at increasing desire and perceived ability to quit smoking among Latino men. (PsycINFO Database Record
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Pollak KI, Fish LJ, Lyna P, Peterson BL, Swamy GK, Levine MD. Predictors of pregnant quitters' intention to return to smoking postpartum. Nicotine Tob Res 2014; 17:742-5. [PMID: 25542912 DOI: 10.1093/ntr/ntu270] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2014] [Accepted: 11/27/2014] [Indexed: 11/12/2022]
Abstract
INTRODUCTION Although many pregnant women quit smoking, most return to smoking postpartum. Returning to smoking is strongly related to women's stated intention about smoking during pregnancy. We examined factors related to women's intention to return to smoking to improve intervention trials. METHODS We report cross-sectional baseline data from a randomized controlled trial to prevent postpartum return to smoking. Women (n = 382; 98% consent rate) were English-speaking women who smoked at least 100 cigarettes in their lifetimes and at least 5 cigarettes a day prior to becoming pregnant. We fit logistic regression models to test whether women's intention to return to smoking was associated with demographic and smoking factors such as race, parity, and smoker self-identity. RESULTS Forty-three percent of women had a strong intention of returning to smoking. Factors independently associated with intending to return to smoking were: stating they did not want to be currently pregnant (OR = 2.1, CI = 1.1-3.9), reporting being abstinent for fewer days (OR = 0.8, CI = 0.7-0.9), being less concerned about the harmful effects of smoking to themselves (OR = 1.6, CI = 0.9-2.8), viewing quit as temporary (OR = 2.1, CI = 1.2-3.6), and self-identifying selves as smokers (OR = 8.7, CI = 5.0-15.2). CONCLUSIONS Although some factors related to intention to return to smoking were unchangeable, it might be possible to attempt to change women's attribution of why they quit to be more permanent and to have them change their self-identity to be a "nonsmoker" from a "smoker who is not currently smoking." Helping women have stronger intentions to stay quit could promote less return to smoking postpartum.
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Pollak KI, Lyna P, Bilheimer AK, Gordon KC, Peterson BL, Gao X, Swamy GK, Denman S, Gonzalez A, Rocha P, Fish LJ. Efficacy of a couple-based randomized controlled trial to help Latino fathers quit smoking during pregnancy and postpartum: the Parejas trial. Cancer Epidemiol Biomarkers Prev 2014; 24:379-85. [PMID: 25406226 DOI: 10.1158/1055-9965.epi-14-0841] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Although many Latinos in the United States smoke, they receive assistance to quit less often than non-Latinos. To address this disparity, we recruited Latino couples into a randomized controlled trial and provided a smoking cessation program during a teachable moment, when men's partners were pregnant. METHODS We compared two interventions: (i) written materials plus nicotine replacement therapy (NRT) to (ii) materials, NRT, and couple-based counseling that addressed smoking cessation and couples communication. We recruited 348 expectant fathers who smoked via their pregnant partners from county health departments. Our primary outcome was 7-day point prevalence smoking abstinence and was collected from November 2010 through April 2013 and analyzed in February 2014. RESULTS We found high rates of cessation but no arm differences in smoking rates at the end of pregnancy (0.31 vs. 0.30, materials only vs. counseling, respectively) and 12 months after randomization (postpartum: 0.39 vs. 0.38). We found high quit rates among nondaily smokers but no arm differences (0.43 vs. 0.46 in pregnancy and 0.52 vs. 0.48 postpartum). Among daily smokers, we found lower quit rates with no arm differences but effects favoring the intervention arm (0.13 vs. 0.16 in pregnancy and 0.17 vs. 0.24 postpartum). CONCLUSIONS A less intensive intervention promoted cessation equal to more intensive counseling. Postpartum might be a more powerful time to promote cessation among Latino men. IMPACT Less intensive interventions when delivered during teachable moments for Latino men could result in a high smoking cessation rate and could reduce disparities.
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