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Fridman I, Ubel PA, Blumenthal-Barby J, England CV, Currier JS, Eyal N, Freedberg KA, Halpern SD, Kelley CF, Kuritzkes DR, Le CN, Lennox JL, Pollak KI, Zikmund-Fisher BJ, Scherr KA. "Cure" Versus "Clinical Remission": The Impact of a Medication Description on the Willingness of People Living with HIV to Take a Medication. AIDS Behav 2020; 24:2054-2061. [PMID: 31900813 DOI: 10.1007/s10461-019-02769-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Many people living with HIV (PLWHIV) state that they would be willing to take significant risks to be "cured" of the virus. However, how they interpret the word "cure" in this context is not clear. We used a randomized survey to examine whether PLWHIV had a different willingness to take a hypothetical HIV medication if it causes flu-like symptoms, but provides: (a) cure, (b) remission that was labeled "cure", or (c) remission. PLWHIV (n = 454) were more willing to take a medication that provided a "cure" versus a "remission" if the side effects lasted less than 1 year. PLWHIV were more willing to take a medication that provided a remission that was labeled "cure" versus a "remission" (p = 0.01) if the side effects lasted 2 weeks. Clinicians and researchers should be aware of the impact of the word "cure" and ensure that PLWHIV fully understand the possible outcomes of their treatment options.
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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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Tarnasky A, Tran GN, Nicolla J, Friedman FAP, Wolf S, Troy JD, Sung AD, Shah K, Oury J, Thompson JC, Gagosian B, Pollak KI, Manners I, Zafar Y. A randomized controlled trial (RCT) testing a mobile application (app) to identify cancer treatment-related financial assistance. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.15_suppl.7073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
7073 Background: Insured cancer patients face high treatment-related, out-of-pocket costs. While philanthropic- and pharmaceutical-sponsored financial assistance programs exist, patients are often unaware of them. We developed “Bridge”, a patient-facing app that identified financial assistance programs for which a patient might be eligible based on treatment, disease, insurance, and financial characteristics. We hypothesized that patients in the Bridge study arm would be more likely than controls to apply for and receive financial assistance. Methods: We enrolled patients at a single institution from January 2018-March 2019. Patients were receiving treatment for any cancer, had a life expectancy of ≥6 months, and self-reported out-of-pocket costs. We randomized patients 1:1 to intervention (Bridge) vs. control (financial assistance educational websites). We assessed subjective financial distress with the validated COST measure. Outcomes included application for and receipt of financial assistance. Data on outcomes was collected from the medical record, institutional pharmacy database, and Bridge. We compared patient characteristics between study arms using chi-square and Mann-Whitney-Wilcoxon tests. We used an unadjusted logistic regression model to compare differences in outcomes. Results: We randomized 200 patients and found no significant differences between arms in baseline characteristics (Table). At 6 months from enrollment, patients in the Bridge arm were more likely than controls to apply for financial assistance [35% Bridge vs. 10% control, OR 3.53, 95%CI 1.69-7.34, p < 0.01]. Bridge patients were also more likely than controls to receive financial assistance (30% Bridge vs. 9% control, OR 3.39, 95%CI 1.78-6.46, p < 0.01). Conclusions: Among patients with treatment-related out-of-pocket costs, those who interacted with a financial assistance app were significantly more likely to apply for and receive treatment-related financial assistance. [Table: see text]
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Brannen EN, Pollak KI, Farrell D, Baranowski RA, Arnold GK, Rohowyj N, Goldman JL, Tulsky JA. When worlds collide: Challenges to implementing communication research in community oncology practices. PATIENT EDUCATION AND COUNSELING 2020; 103:1057-1063. [PMID: 31866193 DOI: 10.1016/j.pec.2019.12.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Revised: 12/11/2019] [Accepted: 12/12/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVE During a recent trial assessing the effectiveness of an online communication training for community practice oncologists, we encountered multiple barriers. METHODS We asked oncologists to participate through the American Board of Internal Medicine (ABIM) Maintenance of Certification program. Oncologists collected 25 Clinician and Group Consumer Assessment of Healthcare Providers (CAHPS) surveys from patients and 4 audio-recorded clinic encounters. They then completed either the ABIM Action Plan (control) or the online Study of Communication in Oncologist Patient Encounters (SCOPE) program (intervention). Oncologists collected another 25 CAHPS surveys and 4 audio-recorded encounters as follow-up. RESULTS We enrolled 146 oncologists in the study. Only 27 completed the study; another 27 actively withdrew, and 94 did not complete the study. We identified four main challenges to participation: commitment discrepancies, burden of research, informed consent, and technology. We introduced efforts to overcome these barriers with success limited by time and resources. CONCLUSION When conducting research in community practices, investigators must provide significant support, limit burden, increase flexibility, and conduct thorough pilot testing. PRACTICE IMPLICATIONS To improve patient care, research must translate well into the workflow of actual practices. Assessing our experience, we identified challenges and effective solutions to be used by investigators as they plan and implement future communication interventions.
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Nicolla J, Bosworth HB, Docherty SL, Pollak KI, Powell J, Sellers N, Reeve BB, Samsa G, Sutton L, Kamal AH. The need for a Serious Illness Digital Ecosystem (SIDE) to improve outcomes for patients receiving palliative and hospice care. AMERICAN JOURNAL OF MANAGED CARE 2020; 26:SP124-SP126. [PMID: 32286036 DOI: 10.37765/ajmc.2020.42960] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Palliative and hospice care services produce immense benefits for patients living with serious illness and for their families. Due to the national shift toward value-based payment models, health systems and payers share a heightened awareness of the need to incorporate palliative and hospice services into their service mix for seriously ill patient populations. During the last decade, a tremendous amount of capital has been invested to better integrate information technology into healthcare. This includes development of technologies to promote utilization of palliative and hospice services. However, no coordinated strategy exists to link such efforts together to create a cohesive strategy that transitions from identification of patients through receipt of services. A Serious Illness Digital Ecosystem (SIDE) is the intentional aggregation of disparate digital and mobile health technologies into a single system that connects all of the actors involved in serious illness patient care. A SIDE leverages deployed health technologies across disease continuums and geographic locations of care to facilitate the flow of information among patients, providers, health systems, and payers. Five pillars constitute a SIDE, and each one is critical to the success of the system. The 5 pillars of a SIDE are: Identification, Education, Engagement, Service Delivery, and Remote Monitoring. As information technology continues to evolve and becomes a part of the care delivery landscape, it is necessary to develop cohesive ecosystems that inform all parts of the serious illness patient experience and identifies patients for the right services, at the right time.
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Pollak KI, Gao X, Arnold RM, Arnett K, Felton S, Fairclough DL, Kutner JS. Feasibility of Using Communication Coaching to Teach Palliative Care Clinicians Motivational Interviewing. J Pain Symptom Manage 2020; 59:787-793. [PMID: 31765759 DOI: 10.1016/j.jpainsymman.2019.11.010] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Revised: 11/07/2019] [Accepted: 11/08/2019] [Indexed: 10/25/2022]
Abstract
CONTEXT Palliative care clinicians often have challenging conversations with patients or family caregivers who express ambivalence about goals or feel reluctant to discuss topics. Motivational Interviewing (MI) has tools to address ambivalence and reluctance. OBJECTIVE The aim of this pilot study was to test the feasibility, acceptability, and preliminary efficacy of an MI communication coaching intervention. METHODS We enrolled 22 palliative care clinicians and randomly assigned half to receive communication coaching versus wait-list control. The coaching entailed a lecture on MI, a 1:1 session to discuss applying MI, and audio recording and receiving feedback on four encounters (two separate times). Palliative care clinicians in the wait-list control arm audio-recorded four encounters. Coders blinded to study arm coded MI behaviors. We surveyed patients, caregivers, and clinicians after all audio-recorded encounters to assess perceptions of the encounter. The analyses were performed using a repeated-measures mixed model. RESULTS We found the intervention to be feasible and acceptable. Eighty-six percent of those enrolled completed all study activities including coaching sessions, audio-recording encounters, and completing surveys. Of those in the intervention arm, 88% rated the intervention as helpful and 100% would recommend it to a colleague. Compared to control clinicians, intervention clinicians had higher ratings of their MI skills after intervention, higher objectively rated communication skills, and slightly better burnout scores. We found no arm differences in patient, caregiver, or clinician ratings of satisfaction. CONCLUSION This pilot study indicates that coaching palliative care clinicians is feasible and shows promise that coaching can improve palliative care clinician communication.
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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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Pollak KI, Gao X, Chung RJ, Farrell D, Bravender T. Feasibility of a clinic-delivered adolescent and pediatrician communication intervention on patient participatory behaviors and behavior change: TIC TAC pilot study. PATIENT EDUCATION AND COUNSELING 2020; 103:414-417. [PMID: 31455566 DOI: 10.1016/j.pec.2019.08.025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/29/2018] [Revised: 05/23/2019] [Accepted: 08/17/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVES Pediatrician-adolescent communication can improve adolescent health. We conducted a two-arm design to pilot-test an intervention that randomized adolescents to receive a Feedback Guide to promote engaged conversations. We hypothesized that adolescents who received the Guide would be more participatory. METHODS We recruited 12 pediatricians and 29 adolescents. Clinic staff enrolled adolescents using a tablet that enabled consenting, assessment of high-risk behaviors, and audio recording of encounters. We surveyed adolescents immediately and two months after the encounter. RESULTS Adolescents who received the intervention were more participatory than adolescents who did not. Pediatricians counseled on 20 of 32 high-risk behaviors with no significant arm differences. At follow-up, adolescents changed 9 of 32 behaviors; 6 were among 4 of adolescents in the intervention arm. Adolescents in the intervention arm were also more likely to report that counseling would help them change their behavior; these encounters were slightly longer than control arm encounters. CONCLUSIONS We confirmed feasibility of a streamlined approach to enrolling and audio recording encounters. The Feedback Guide improved adolescent participation and might have helped them adopt healthier behaviors. PRACTICE IMPLICATIONS Adolescents can be primed to be participatory and can change their behaviors after a meaningful encounter with their pediatrician.
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Pollak KI. Teaching effective communication by modeling effective communication: Experiences of a communication coach for clinicians. PATIENT EDUCATION AND COUNSELING 2020; 103:423-427. [PMID: 31519462 DOI: 10.1016/j.pec.2019.08.024] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/03/2019] [Revised: 08/13/2019] [Accepted: 08/17/2019] [Indexed: 06/10/2023]
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Kutner JS, Ritchie CS, Pollak KI. Better Together: The Palliative Care Research Cooperative Group as a Model for Increasing Equity in the Science of Hospice and Palliative Care. J Palliat Med 2020; 23:601-602. [PMID: 31977271 DOI: 10.1089/jpm.2019.0684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Malhotra C, Rajasekaran T, Kanesvaran R, Yee A, Bundoc FG, Singh R, Tulsky JA, Pollak KI. Pilot Trial of a Combined Oncologist-Patient-Caregiver Communication Intervention in Singapore. JCO Oncol Pract 2019; 16:e190-e200. [PMID: 31880975 DOI: 10.1200/jop.19.00412] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
PURPOSE High-quality end-of-life cancer care requires oncologists to communicate effectively and patients/caregivers to be participatory. However, most communication interventions target either but not both. We aimed to pilot a potentially disseminable combined oncologist-patient/caregiver intervention to improve oncologist empathic responses, discussions of prognosis and goals of care, and patient/caregiver participation. We assessed its feasibility, acceptability, and preliminary efficacy. METHODS Between June 2018 and January 2019, we conducted a pilot 2-arm cluster trial in Singapore, randomly assigning 10 oncologists in a 1:1 ratio to receive the combined intervention or usual care. Intervention arm oncologists received online communication skills training, and their patients received a brief prompt sheet before consultations. We audio recorded consultations with 60 patients with stage IV solid malignancy and analyzed 30 in the postintervention phase. The study was not powered for statistical significance. RESULTS Participation rates for oncologists and patients were 100% and 63%, respectively. All oncologists completed the online training within an average of 4.5 weeks; 73% of the patients selected at least 1 question in the prompt sheet. Compared with the control arm, intervention arm oncologists had more empathic responses in total (relative risk [RR], 1.66) and for every patient/caregiver negative emotion (RR, 2.01). Their consultations were more likely to involve discussions of prognosis (RR, 3.00) and goals of care, and their patients were more likely to ask a prognosis-related question (RR, 2.00; P > .05 for all). CONCLUSION The combined oncologist-patient/caregiver intervention is feasible and acceptable and has the potential to improve communication within consultations.
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Noonan D, Lyna P, Simmons LA, Gordon KC, Pollak KI. The Co-occurrence of Daily Smoking, Binge Drinking and IPV Among Latino Expectant Fathers. J Immigr Minor Health 2019; 22:639-643. [PMID: 31811613 DOI: 10.1007/s10903-019-00950-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Many Latino men have multiple risk factors that predispose them to chronic disease morbidity and mortality, yet few have examined patterns in this population. We describe the co-occurrence of daily smoking, binge drinking, and intimate partner violence (IPV) behaviors among Latino expectant fathers and examine factors associated with the co-occurrence of these behaviors. We conducted a secondary analysis of baseline data from the Parejas Trial, a randomized controlled trial testing a culturally tailored couples-based smoking cessation intervention. We used Kruskal-Wallis test statistics to explore the relationship of the co-occurring behavior and demographic and cultural factors. All participants smoked as was a requirement of being in the trial, but only 39% smoked daily. Forty three percent of the participants engaged in one behavior, 32% engaged in two behaviors, and 5% engaged in three behaviors, with binge drinking being the most common co-occurring behavior. In the bivariate analysis, higher stress (p = 0.01) and having more children (p = 0.003) were found to be positively significantly associated with the number of behaviors. Helping Latino expectant fathers manage with their stress may serve as tailoring points for future interventions to reduce risk behaviors.
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LeBlanc MR, LeBlanc TW, Ashley BL, Pollak KI, Bailey DE, Smith SK. LIVING WITH MULTIPLE MYELOMA: SELF-MANAGEMENT STRATEGIES. Innov Aging 2019. [PMCID: PMC6845531 DOI: 10.1093/geroni/igz038.3379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Multiple myeloma (myeloma), is an incurable cancer of the plasma cells that affects many older adults. Over 30,000 new diagnoses and over 12,000 deaths are attributed to myeloma annually in the United States, where the median age of diagnosis is 69 years old. Dramatic improvements in survival over the past fifteen years have transformed myeloma into a chronic disease for many. The disease and its toxic, ongoing treatment lead to significant challenges for patients. In this study we explore the self-management strategies patients use to address the challenges of living with myeloma through semi-structured one-on-one interviews with myeloma patients and clinicians. Fifteen myeloma patients and ten myeloma clinicians were interviewed between September 2017 and September 2018. Self-management strategies emerged in five major categories; managing uncertainty, finding emotional strength, seeking support, medication management, and activity management. The care of MM patients has made great strides as new and more effective treatments have extended survival for many patients. Effective self-management strategies are critical in addressing the challenges of this increasingly chronic disease. Our study explores the ways myeloma patients address the many challenges they face due to their disease and its’ treatment. Findings from this study could inform the development of interventions to optimize and support patients living with myeloma self-management.
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Malhotra C, Kanesvaran R, Barr Kumarakulasinghe N, Tan SH, Xiang L, Tulsky JA, Pollak KI. Oncologist-patient-caregiver decision-making discussions in the context of advanced cancer in an Asian setting. Health Expect 2019; 23:220-228. [PMID: 31682064 PMCID: PMC6978867 DOI: 10.1111/hex.12994] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Revised: 09/24/2019] [Accepted: 10/09/2019] [Indexed: 11/30/2022] Open
Abstract
Objective Patient involvement in treatment decisions is recommended in clinician‐patient encounters. Little is known about how oncologists engage patients in shared decision making in non‐Western countries. We assessed the prevalence of shared decision making among Singaporean oncologists and analysed how they discussed prognosis. Methods We audio‐recorded 100 consultations between advanced cancer patients and their oncologists. We developed a coding system to assess oncologist encouragement of patient participation in decision making and disclosure of an explicit prognosis. We assessed patient and oncologist characteristics that predicted these behaviours. Results Forty‐one consultations involved treatment discussions. Oncologists almost always listed more than one treatment option (90%). They also checked patient understanding (34%), discussed pros and cons (34%) and addressed uncertainty (29%). Oncologists discussed prognosis mostly qualitatively (34%) rather than explicitly (17%). They were more likely to give an explicit prognosis when patients/caregivers asked questions related to prognosis. Conclusion Oncologists in our sample engaged their patients in decision making. They have areas in which they can improve to involve patients at a deeper level to ensure shared decision making. Findings will be used to develop an intervention targeting oncologists and patients to promote patient involvement in decision making.
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Pollak KI, Gao X, Beliveau J, Griffith B, Kennedy D, Casarett D. Pilot Study to Improve Goals of Care Conversations Among Hospitalists. J Pain Symptom Manage 2019; 58:864-870. [PMID: 31422103 DOI: 10.1016/j.jpainsymman.2019.06.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Revised: 06/05/2019] [Accepted: 06/06/2019] [Indexed: 10/26/2022]
Abstract
CONTEXT Many hospitalized patients receive care that is not concordant with their goals. Teaching communication skills that better align goals and treatment can improve the care that patients receive. OBJECTIVE To develop and test an innovative approach that encourages hospitalists to engage in goals of care (GOC) conversations with their patients. METHODS We recruited 14 hospitalists and randomized half to receive electronic health record alerts for patients who might benefit most from a goals-of-care conversation, as well as communication coaching. The coaching required an initial meeting, then audio recording of two GOC conversations and feedback from the coach. Outcomes were the presence of GOC conversations (primary), the quality of the GOC conversations, physician perceptions of the intervention, and hospital metrics (e.g., 30-day readmissions, referrals to palliative care). RESULTS We did not increase the frequency of GOC conversations but did improve the quality of the conversations. Patients of physicians who received the intervention had fewer 30-day readmission rates and were less likely to die 90 days after admission than patients of physicians in the control arm. Patients of intervention physicians also had fewer palliative care consults than patients of control physicians. CONCLUSIONS Teaching hospitalists to have GOC conversations translated into better skills and outcomes for patients. This pilot study shows promise and should be tested in a larger trial.
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Oliver JA, Pacek LR, Locey EN, Fish LM, Hendricks PS, Pollak KI. Lack of utility of cigarettes per day cutoffs for clinical and laboratory smoking research. Addict Behav 2019; 98:106066. [PMID: 31386967 DOI: 10.1016/j.addbeh.2019.106066] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Revised: 06/19/2019] [Accepted: 07/29/2019] [Indexed: 12/31/2022]
Abstract
BACKGROUND Most clinical and laboratory smoking research studies require that participants smoke at a certain level to be eligible for enrollment. However, there is limited evidence that use of these cutoffs differentiates groups of smokers along clinically meaningful criteria. METHODS Using receiver operating characteristic curves, we analyzed data from daily smokers in the National Epidemiologic Study of Alcohol Use and Related Conditions - III (NESARC-III) to examine the utility of smoking rates for determining whether participants met DSM-5 criteria for tobacco use disorder, experienced nicotine withdrawal or had a history of failed quit attempts. We also examined whether relationships between these variables differed as a function of key sample characteristics. RESULTS Smoking rate exhibited a weak relationship with the presence of tobacco use disorder (AUC = 0.664), whether individuals experience nicotine withdrawal (AUC = 0.672) and whether individuals had a history of failed quit attempts (AUC = 0.578). The relationship between smoking rate and a history of failed quit attempts was weaker for women than men (p < .05). Otherwise, utility did not differ as a function of sex, race/ethnicity, education, income, or use of multiple tobacco products. Optimal cutoffs varied somewhat across indices, but the largest number of correct classifications occurred at very low smoking rates. CONCLUSIONS Researchers should consider abandoning the use of smoking rate cutoffs to determine study eligibility. If smoking rate cutoffs are used, a rationale should be presented along with justification for the specific cutoff chosen.
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Hoerger M, Ramos K, Ellington L, Perry LM, Pollak KI, Porter LS. Organizing Psychologists, Behavioral Scientists, and Allied Professionals: Formation of the Society of Behavioral Medicine's Palliative Care Special Interest Group. J Pain Symptom Manage 2019; 58:e10-e11. [PMID: 31200013 DOI: 10.1016/j.jpainsymman.2019.06.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2019] [Revised: 05/31/2019] [Accepted: 06/03/2019] [Indexed: 11/20/2022]
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Kamal AH, Docherty SL, Reeve BB, Samsa GP, Bosworth HB, Pollak KI. Helping the Demand Find the Supply: Messaging the Value of Specialty Palliative Care Directly to Those With Serious Illnesses. J Pain Symptom Manage 2019; 57:e6-e7. [PMID: 30853550 DOI: 10.1016/j.jpainsymman.2019.02.026] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Accepted: 02/20/2019] [Indexed: 11/18/2022]
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LeBlanc TW, Locke SC, Herring K, Davis DM, Troy JD, Steinhauser KE, Pollak KI, Ubel PA. A video decision aid to improve acute myeloid leukemia patients’ illness understanding: Results of a pilot trial. J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.15_suppl.7040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
7040 Background: Many acute myeloid leukemia (AML) patients harbor misunderstandings about their illness, overestimating both their likelihood of cure and risks of intensive therapies. Decision aids (DA) can improve illness understanding and reduce decisional conflict, but are not routinely used in AML. Methods: We developed an AML DA with input from patients, caregivers, clinicians, and laypersons, via the International Patient Decision Aids Standards (IPDAS) process. It includes 10 short animated videos with voiceovers, covering AML basics, etiology, outcomes, treatment paradigms, and risks/benefits of various treatment approaches. We enrolled 20 patients in a pilot feasibility and efficacy trial, with pre/post survey assessments of AML knowledge via an 18-item questionnaire, decisional conflict (Decisional Conflict Scale; DCS), anxiety (State Trait Anxiety Inventory, Short Form; STAI-6), and measures of DA usability and satisfaction. Results: Participants were a mean of 62.4 years old, 12 (60%) were male, 17 (85%) white, and 15 (75%) had newly-diagnosed disease. Mean time since AML diagnosis was 145 days (median 31; range 2-1092). 16 (80%) exhibited high-school-level understanding of medical terms per the REALM-SF, and participants on average exhibited moderate numeracy (mean score of 4.1 on the Subjective Numeracy Scale). All participants completed the study, exceeding our pre-determined feasibility threshold. AML knowledge scores generally improved, from a mean of 11.8 correct items on pre-test, to 15.2 on post-test assessment (p < 0.0001), with 80% of participants achieving improved scores. Struggles remained regarding patients’ understanding of the role that genetic tests play in AML care. There was no increase in anxiety after watching the videos, but decisional conflict was significantly reduced, from a mean of 28.5 at baseline to 22 in the post-test (p = .019). Participants reported high satisfaction and usability scores for the DA. Conclusions: Our AML decision aid exhibits favorable performance characteristics, with high satisfaction and usability, a marked increase in patient knowledge, and reduced decisional conflict. Further testing is warranted in a randomized trial. Clinical trial information: NCT03442452.
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Murray BR, Kratka A, Scherr KA, Eyal N, Blumenthal-Barby J, Freedberg KA, Kuritzkes DR, Hammitt JK, Edifor R, Katz MN, Pollak KI, Zikmund-Fisher BJ, Halpern SD, Barks MC, Ubel PA. What risk of death would people take to be cured of HIV and why? A survey of people living with HIV. J Virus Erad 2019. [DOI: 10.1016/s2055-6640(20)30052-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Murray BR, Kratka A, Scherr KA, Eyal N, Blumenthal-Barby J, Freedberg KA, Kuritzkes DR, Hammitt JK, Edifor R, Katz MN, Pollak KI, Zikmund-Fisher BJ, Halpern SD, Barks MC, Ubel PA. What risk of death would people take to be cured of HIV and why? A survey of people living with HIV. J Virus Erad 2019; 5:109-115. [PMID: 31191914 PMCID: PMC6543487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
People living with HIV (PLWHIV) can reasonably expect near-normal longevity, yet many express a willingness to assume significant risks to be cured. We surveyed 200 PLWHIV who were stable on antiretroviral therapy (ART) to quantify associations between the benefits they anticipate from a cure and their risk tolerance for curative treatments. Sixty-five per cent expected their health to improve if cured of HIV, 41% predicted the virus would stop responding to medications over the next 20 years and 54% predicted experiencing serious medication side effects in the next 20 years. Respondents' willingness to risk death for a cure varied widely (median 10%, 75th percentile 50%). In multivariate analyses, willingness to risk death was associated with expected long-term side effects of ART, greater financial resources and being employed (all P < 0.05) but was not associated with perceptions of how their health would improve if cured.
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Kross EK, Pollak KI, Curtis JR. Addressing the Psychological Symptoms of Critical Illness: The Importance of "Negative" Trials in Guiding Next Steps. JAMA 2019; 321:649-650. [PMID: 30776299 DOI: 10.1001/jama.2019.0072] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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Berkowitz C, Allen DH, Tenhover J, Zullig LL, Ragsdale J, Fischer JE, Pollak KI, Koontz BF. Knowledge and Preferences of Primary Care Providers in Delivering Head and Neck Cancer Survivorship Care. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2018; 33:1323-1327. [PMID: 28707205 DOI: 10.1007/s13187-017-1250-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
Long-term care for head and neck cancer (HNC) survivors is complex and requires coordination among multiple providers. Clinical practice guidelines highlight the role of primary care providers (PCPs) in screening for secondary cancer/recurrence, assessment of late/long-term side effects, and referrals for appropriate specialty management of toxicity. However, these responsibilities may be difficult to meet within the scope of primary care practice. We conducted this study to explore preferences, comfort, and knowledge of PCPs in the care of HNC survivors. We piloted a 40-item web-based survey developed with oncologist and PCP input targeted for family medicine and internal medicine providers. Responses were collected within a single university health system over 2 months. PCPs (n = 28; RR = 11.3%) were interested in learning about health promotion after cancer treatment (89%) and generally agree that their current practice patterns address healthy lifestyle behaviors (82%). However, only 32% of PCPs felt confident they could manage late/long-term side effects of chemotherapy, radiation, or surgery. Only 29% felt confident they could provide appropriate cancer screening. Looking at shared care responsibilities with oncology providers, PCPs perceived being responsible for 30% of care in the first year after treatment and 81% of care after 5 years. Seventy-one percent of PCPs agreed that oncologists provided them necessary information, yet 32% of PCPs found it difficult to coordinate with cancer providers. While these PCPs perceive increased care responsibility for long-term survivors, most are uncomfortable screening for recurrence and managing late/long-term side effects. Education and mutual coordination between PCPs and oncology providers may improve survivor care.
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Bodner ME, Lyna P, Østbye T, Bravender T, Alexander SC, Tulsky JA, Lin PH, Pollak KI. Accuracy and congruence of physician and adolescent patient weight-related discussions: Teen CHAT (Communicating health: Analyzing talk). PATIENT EDUCATION AND COUNSELING 2018; 101:2105-2110. [PMID: 30115415 PMCID: PMC6478386 DOI: 10.1016/j.pec.2018.07.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/22/2017] [Revised: 06/08/2018] [Accepted: 07/25/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVE We assessed the accuracy and congruence of recall of weight topics during clinical encounters between adolescent patients with overweight/obesity and physicians (randomized to Motivational Interviewing education vs. control arm). METHODS We audio recorded 357 clinic encounters and coded topics of weight, physical activity (PA), breakfast, and fast food. We assessed recall accuracy/congruence. Generalized estimation equation modeling assessed associations between selected factors and recall accuracy. RESULTS Accuracy for physicians was: weight (90%), PA (88%), breakfast (77%) and fast food (70%). Patient accuracy was: weight (94%), PA (94%), breakfast (73%) and fast food (61%). Physician/patient congruence was: weight (89%), PA (90%), breakfast (71%) and fast food (67%). Use of a reminder report indicating adolescent's weight behaviors in the physician control group resulted in increased adolescent (p = 0.02) and physician accuracy (p = 0.05) for fast food. Adolescents were more likely to recall discussions of fast food (odds ratio, 0.87; 95% CI, 0.77-0.97) as encounter time decreased; male adolescents were less likely to recall breakfast than females (odds ratio, 0.52; 95% CI, 0.28-0.95). CONCLUSION Adolescents and physicians recall weight and PA more often, perhaps indicating greater engagement in these topics. PRACTICE IMPLICATIONS Reminder reports might possibly enhance discussion and recall of diet related messages.
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Pollak KI, Ashton-James C. Empathy is not empathy is not empathy in the management of chronic pain. PATIENT EDUCATION AND COUNSELING 2018; 101:2045-2046. [PMID: 30342890 DOI: 10.1016/j.pec.2018.10.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/04/2018] [Accepted: 10/04/2018] [Indexed: 06/08/2023]
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