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Arraras JI, Giesinger J, Shamieh O, Bahar I, Koller M, Bredart A, Costantini A, Greimel E, Sztankay M, Wintner LM, de Sousa MC, Ishiki H, Kontogianni M, Wolan M, Kikawa Y, Lanceley A, Gioulbasanis I, Harle A, Zarandona U, Kulis D, Kuljanic K. An international field study for the reliability and validity of the EORTC communication questionnaire EORTC QLQ-COMU26. Health Qual Life Outcomes 2024; 22:87. [PMID: 39385305 DOI: 10.1186/s12955-024-02298-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2024] [Accepted: 09/16/2024] [Indexed: 10/12/2024] Open
Abstract
BACKGROUND The EORTC Quality of Life Group has developed a questionnaire to evaluate cancer patients' perception of their communication with healthcare professionals (HCPs): the EORTC QLQ-COMU26. In this study we test the validity and reliability of this novel measure in an international and culturally diverse sample of cancer patients. METHODS Cancer patients completed the following EORTC questionnaires at two time points (before and during treatment): the QLQ-COMU26 (including a debriefing questionnaire), the QLQ-C30, and specific IN-PATSAT32 scales. These data were used to assess: the cross-cultural applicability, acceptability, scale structure, reliability, convergent/divergent validity, known-groups validity, and responsiveness to change of the QLQ-COMU26. RESULTS Data were collected from 498 patients with various cancer diagnoses in 10 European countries, Japan, Jordan and India (overall 5 cultural regions). At most, only 3% of patients identified an item as confusing and 0.6% as upsetting, which indicates that the questionnaire was clear and did not trigger negative emotional responses. Confirmatory factor analysis and multi-trait scaling confirmed the hypothesised QLQ-COMU26 scale structure comprising six multi-item scales and four single items (RMSEA = 0.025). Reliability was good for all scales (internal consistency > 0.70; test-retest reliability > 0.85). Convergent validity was supported by correlations of ≥ 0.50 with related scales of the IN-PATSAT32 and correlations < 0.30 with unrelated QLQ-C30 scales. Known-groups validity was shown according to sex, education, levels of anxiety and depression, satisfaction with communication, disease stage and treatment intention, professional evaluated, and having a companion during the visit. The QLQ-COMU26 captured changes over time in groups that were defined based on changes in the item of satisfaction with communication. CONCLUSION The EORTC QLQ-COMU26 is a reliable and valid measure of patients' perceptions of their communication with HCPs. The EORTC QLQ-COMU26 can be used in daily clinical practice and research and in various cancer patient groups from different cultures. This questionnaire can help to improve communication between patients and healthcare professionals.
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Affiliation(s)
- Juan Ignacio Arraras
- Oncology Departments, Hospital Universitario de Navarra, Navarra Institute for Health Research (IdiSNA), Irunlarrea 3, Pamplona, 31008, Spain.
| | - Johannes Giesinger
- University Hospital of Psychiatry II, Medical University of Innsbruck, Innsbruck, Austria
| | | | - Iqbal Bahar
- Cachar Cancer Hospital and Research Centre, Silchar, India
| | - Michael Koller
- Centre for Clinical Studies, University Hospital Regensburg, Regensburg, Germany
| | - Anne Bredart
- Psycho-Oncology Unit, SHARE - SHs And Outcome Research Team, Institut Curie and City University, Paris, France
| | - Anna Costantini
- S. Psycho-Oncology Service, Sant'Andrea Universitary Hospital, Rome, Italy
| | | | - Monika Sztankay
- University Hospital of Psychiatry II, Medical University of Innsbruck, Innsbruck, Austria
| | - Lisa M Wintner
- University Hospital of Psychiatry II, Medical University of Innsbruck, Innsbruck, Austria
| | - Marina Carreiro de Sousa
- Universidade Dos Açores, Ponta Delgada, Portugal
- Center for Research in Neuropsychology and Cognitive-Behavioral Intervention, Faculty of Psychology and Education Sciences, University of Coimbra, Coimbra, Portugal
| | | | | | | | | | - Anne Lanceley
- Department of Women's Cancer, UCL Elizabeth Garrett Anderson Institute for Women's Health, University College London, London, UK
| | - Ioannis Gioulbasanis
- Department of Medical Oncology, Animus Kyanus Stavros General Clinic, Larissa, Greece
| | | | - Uxue Zarandona
- Oncology Departments, Hospital Universitario de Navarra, Navarra Institute for Health Research (IdiSNA), Irunlarrea 3, Pamplona, 31008, Spain
| | - Dagmara Kulis
- European Organisation for Research and Treatment of Cancer, Brussels, Belgium
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Cortés DE, Progovac AM, Lu F, Lee E, Tran NM, Moyer MA, Odayar V, Rodgers CRR, Adams L, Chambers V, Delman J, Delman D, de Castro S, Sánchez Román MJ, Kaushal NA, Creedon TB, Sonik RA, Rodriguez Quinerly C, Nakash O, Moradi A, Abolaban H, Flomenhoft T, Nabisere R, Mann Z, Shu-Yeu Hou S, Shaikh FN, Flores MW, Jordan D, Carson N, Carle AC, Cook BL, McCormick D. Eliciting patient past experiences of healthcare discrimination as a potential pathway to reduce health disparities: A qualitative study of primary care staff. Health Serv Res 2024:e14373. [PMID: 39192536 DOI: 10.1111/1475-6773.14373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/29/2024] Open
Abstract
OBJECTIVE To understand whether and how primary care providers and staff elicit patients' past experiences of healthcare discrimination when providing care. DATA SOURCES/STUDY SETTING Twenty qualitative semi-structured interviews were conducted with healthcare staff in primary care roles to inform future interventions to integrate data about past experiences of healthcare discrimination into clinical care. STUDY DESIGN Qualitative study. DATA COLLECTION/EXTRACTION METHODS Data were collected via semi-structured qualitative interviews between December 2018 and January 2019, with health care staff in primary care roles at a hospital-based clinic within an urban safety-net health system that serves a patient population with significant racial, ethnic, and linguistic diversity. PRINCIPAL FINDINGS Providers did not routinely, or in a structured way, elicit information about past experiences of healthcare discrimination. Some providers believed that information about healthcare discrimination experiences could allow them to be more aware of and responsive to their patients' needs and to establish more trusting relationships. Others did not deem it appropriate or useful to elicit such information and were concerned about challenges in collecting and effectively using such data. CONCLUSIONS While providers see value in eliciting past experiences of discrimination, directly and systematically discussing such experiences with patients during a primary care encounter is challenging for them. Collecting this information in primary care settings will likely require implementation of multilevel systematic data collection strategies. Findings presented here can help identify clinic-level opportunities to do so.
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Affiliation(s)
- Dharma E Cortés
- Harvard Medical School, Boston, Massachusetts and Health Equity Research Lab, Cambridge Health Alliance, Cambridge, Massachusetts, USA
| | - Ana M Progovac
- Harvard Medical School, Boston, Massachusetts and Health Equity Research Lab, Cambridge Health Alliance, Cambridge, Massachusetts, USA
| | - Frederick Lu
- Warren Alpert Medical School of Brown University, Brown University Health, Providence, Rhode Island, USA
| | - Esther Lee
- University of Michigan, School of Public Health, Ann Arbor, Michigan, USA
| | | | | | - Varshini Odayar
- Health Equity Research Lab, Cambridge Health Alliance, Cambridge, Massachusetts, USA
| | - Caryn R R Rodgers
- Department of Pediatrics and Department of Psychiatry & Behavioral Sciences, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Leslie Adams
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Valeria Chambers
- Health Equity Research Lab, Cambridge Health Alliance, Cambridge, Massachusetts, USA
| | | | | | | | | | | | | | | | | | - Ora Nakash
- Smith College School for Social Work, Northampton, Massachusetts, USA
| | - Afsaneh Moradi
- Blair Athol Medical Clinic, Adelaide, South Australia, Australia
| | - Heba Abolaban
- Cambridge Health Alliance, Cambridge, Massachusetts, USA
| | | | - Ruth Nabisere
- Cambridge Health Alliance, Cambridge, Massachusetts, USA
| | - Ziva Mann
- Ascent Leadership Networks, New York, New York, USA
| | - Sherry Shu-Yeu Hou
- Public Policy and Population Health Observatory, McGill University, Montreal, Quebec, Canada
| | - Farah N Shaikh
- Cambridge Health Alliance, Cambridge, Massachusetts, USA
| | - Michael W Flores
- Harvard Medical School, Boston, Massachusetts and Health Equity Research Lab, Cambridge Health Alliance, Cambridge, Massachusetts, USA
| | - Dierdre Jordan
- Cambridge Health Alliance, Cambridge, Massachusetts, USA
| | - Nicholas Carson
- Harvard Medical School, Boston, Massachusetts and Health Equity Research Lab, Cambridge Health Alliance, Cambridge, Massachusetts, USA
| | - Adam C Carle
- James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, University of Cincinnati College of Arts and Sciences, Cincinnati, Ohio, USA
| | - Benjamin Lé Cook
- Harvard Medical School, Boston, Massachusetts and Health Equity Research Lab, Cambridge Health Alliance, Cambridge, Massachusetts, USA
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Hamilton KW, Hua E, Dutcher L, Fernandez Lynch H, Junker P, Doucette AG, Werner D, Kannel EZ, Civitello T, Gabriel P, Ahya VN, Jacobs DA, Garfall A, Pratz K, Degnan KO, Blumberg EA, Capozzi D, Craig E, Takach P, Payne AS, Geara A, Koenig H, Holzman L, Tebas P. Implementation of an Approach to Equitable Allocation of SARS-CoV-2 Monoclonal Antibodies for Preexposure Prophylaxis: Experience From a Single Medical Center. Open Forum Infect Dis 2024; 11:ofae388. [PMID: 39100528 PMCID: PMC11297503 DOI: 10.1093/ofid/ofae388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2024] [Accepted: 07/08/2024] [Indexed: 08/06/2024] Open
Abstract
Background During the COVID-19 pandemic, SARS-CoV-2 monoclonal antibodies for preexposure prophylaxis (SMA-PrEP) offered patients who were immunocompromised another option for protection. However, SMA-PrEP posed administrative, operational, and ethical challenges for health care facilities, resulting in few patients receiving them. Although the first SMA-PrEP medication, tixagevimab and cilgavimab, had its authorization revoked due to compromised in vitro efficacy, new SMA-PrEP medications are currently completing clinical trials. This article provides an operational framework for administrative organization, patient identification and prioritization, equitable medication allocation, medication ordering and administration, and patient tracking. Methods A retrospective cohort study evaluating our hospital's SMA-PrEP administration strategy was performed. Multivariable logistic regression was used to examine factors associated with receipt of SMA-PrEP. Results Despite the barriers in administering this medication and the scarcity of resources, our hospital was able to administer at least 1 dose of SMA-PrEP to 1359 of 5902 (23.0%) eligible patients. Even with the steps taken to promote equitable allocation, multivariable logistic regression demonstrated that there were still differences by race, ethnicity, and socioeconomic status. As compared with patients who identified as Black, patients who identified as White (odds ratio [OR], 1.85; 95% CI, 1.46-2.33), Asian (OR, 1.59; 95% CI, 1.03-2.46), and Hispanic (OR, 1.53; 95% CI, 1.02-2.44) were more likely to receive SMA-PrEP. When compared with patients with low socioeconomic status, patients with high socioeconomic status (OR, 1.37; 95% CI, 1.05-1.78) were more likely to be allocated SMA-PrEP. Conclusions Despite efforts to mitigate health care disparities, differences by race/ethnicity and socioeconomic status still arose in patients receiving SMA-PrEP.
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Affiliation(s)
- Keith W Hamilton
- Division of Infectious Diseases, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Elvis Hua
- Department of Pharmacy, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Lauren Dutcher
- Division of Infectious Diseases, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Holly Fernandez Lynch
- Department of Medical Ethics and Health Policy, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Paul Junker
- Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Abigail G Doucette
- Abramson Cancer Center, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Danielle Werner
- Clinical Practices of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Ethan Z Kannel
- University of Pennsylvania Health System, Philadelphia, Pennsylvania, USA
| | - Thomas Civitello
- University of Pennsylvania Health System, Philadelphia, Pennsylvania, USA
| | - Peter Gabriel
- Abramson Cancer Center, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Vivek N Ahya
- Clinical Practices of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Division of Pulmonary, Allergy, and Critical Care, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Dina A Jacobs
- Department of Neurology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Alfred Garfall
- Division of Hematology and Oncology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Keith Pratz
- Division of Hematology and Oncology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Kathleen O Degnan
- Division of Infectious Diseases, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Emily A Blumberg
- Division of Infectious Diseases, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Donna Capozzi
- Oncology Pharmacy and Investigational Drug Services, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Ethan Craig
- Division of Rheumatology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Corporal Michael J. Crescenz VA Medical Center, Philadelphia, Pennsylvania, USA
| | - Patricia Takach
- Section of Allergy and Immunology, Division of Pulmonary, Allergy, and Critical Care, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Aimee S Payne
- Department of Dermatology, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York, USA
| | - Abdallah Geara
- Division of Renal, Electrolyte, and Hypertension, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Helen Koenig
- Division of Infectious Diseases, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Lawrence Holzman
- Division of Renal, Electrolyte, and Hypertension, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Pablo Tebas
- Division of Infectious Diseases, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Ganta T, Kia A, Parchure P, Wang MH, Besculides M, Mazumdar M, Smith CB. Fairness in Predicting Cancer Mortality Across Racial Subgroups. JAMA Netw Open 2024; 7:e2421290. [PMID: 38985468 PMCID: PMC11238025 DOI: 10.1001/jamanetworkopen.2024.21290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2024] [Accepted: 05/10/2024] [Indexed: 07/11/2024] Open
Abstract
Importance Machine learning has potential to transform cancer care by helping clinicians prioritize patients for serious illness conversations. However, models need to be evaluated for unequal performance across racial groups (ie, racial bias) so that existing racial disparities are not exacerbated. Objective To evaluate whether racial bias exists in a predictive machine learning model that identifies 180-day cancer mortality risk among patients with solid malignant tumors. Design, Setting, and Participants In this cohort study, a machine learning model to predict cancer mortality for patients aged 21 years or older diagnosed with cancer between January 2016 and December 2021 was developed with a random forest algorithm using retrospective data from the Mount Sinai Health System cancer registry, Social Security Death Index, and electronic health records up to the date when databases were accessed for cohort extraction (February 2022). Exposure Race category. Main Outcomes and Measures The primary outcomes were model discriminatory performance (area under the receiver operating characteristic curve [AUROC], F1 score) among each race category (Asian, Black, Native American, White, and other or unknown) and fairness metrics (equal opportunity, equalized odds, and disparate impact) among each pairwise comparison of race categories. True-positive rate ratios represented equal opportunity; both true-positive and false-positive rate ratios, equalized odds; and the percentage of predictive positive rate ratios, disparate impact. All metrics were estimated as a proportion or ratio, with variability captured through 95% CIs. The prespecified criterion for the model's clinical use was a threshold of at least 80% for fairness metrics across different racial groups to ensure the model's prediction would not be biased against any specific race. Results The test validation dataset included 43 274 patients with balanced demographics. Mean (SD) age was 64.09 (14.26) years, with 49.6% older than 65 years. A total of 53.3% were female; 9.5%, Asian; 18.9%, Black; 0.1%, Native American; 52.2%, White; and 19.2%, other or unknown race; 0.1% had missing race data. A total of 88.9% of patients were alive, and 11.1% were dead. The AUROCs, F1 scores, and fairness metrics maintained reasonable concordance among the racial subgroups: the AUROCs ranged from 0.75 (95% CI, 0.72-0.78) for Asian patients and 0.75 (95% CI, 0.73-0.77) for Black patients to 0.77 (95% CI, 0.75-0.79) for patients with other or unknown race; F1 scores, from 0.32 (95% CI, 0.32-0.33) for White patients to 0.40 (95% CI, 0.39-0.42) for Black patients; equal opportunity ratios, from 0.96 (95% CI, 0.95-0.98) for Black patients compared with White patients to 1.02 (95% CI, 1.00-1.04) for Black patients compared with patients with other or unknown race; equalized odds ratios, from 0.87 (95% CI, 0.85-0.92) for Black patients compared with White patients to 1.16 (1.10-1.21) for Black patients compared with patients with other or unknown race; and disparate impact ratios, from 0.86 (95% CI, 0.82-0.89) for Black patients compared with White patients to 1.17 (95% CI, 1.12-1.22) for Black patients compared with patients with other or unknown race. Conclusions and Relevance In this cohort study, the lack of significant variation in performance or fairness metrics indicated an absence of racial bias, suggesting that the model fairly identified cancer mortality risk across racial groups. It remains essential to consistently review the model's application in clinical settings to ensure equitable patient care.
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Affiliation(s)
- Teja Ganta
- Division of Hematology and Medical Oncology, Icahn School of Medicine at Mount Sinai, New York, New York
- Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Arash Kia
- Department of Anesthesiology, Perioperative and Pain Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Prathamesh Parchure
- Institute for Healthcare Delivery Science, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Min-heng Wang
- Institute for Healthcare Delivery Science, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Melanie Besculides
- Institute for Healthcare Delivery Science, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Madhu Mazumdar
- Institute for Healthcare Delivery Science, Icahn School of Medicine at Mount Sinai, New York, New York
- Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Cardinale B. Smith
- Division of Hematology and Medical Oncology, Icahn School of Medicine at Mount Sinai, New York, New York
- Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, New York
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Broadbridge EA, Venetis MK. Examining the role of pre-visit anxiety on patient uncertainty and breast cancer patient-provider communication. Cancer Med 2024; 13:e70003. [PMID: 39031003 PMCID: PMC11258471 DOI: 10.1002/cam4.70003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Revised: 06/14/2024] [Accepted: 06/30/2024] [Indexed: 07/22/2024] Open
Abstract
OBJECTIVE Effective communication between cancer patients and providers is critical for addressing psychological distress, reducing uncertainty, and promoting patient well-being. This is particularly relevant during medical appointments that may elicit uncertainty, such as surgical consultations for newly diagnosed women with breast cancer. This study aimed to evaluate how pre-appointment anxiety and illness uncertainty affect patient-provider communication in breast cancer surgical consultations and subsequent post-appointment well-being. Breast cancer patient anxiety has been studied as an outcome of provider communication, though less is known about the extent to which preexisting anxiety or uncertainty act as antecedents to effective patient-provider communication. METHODS This study analyzed videorecorded breast cancer surgical consultations (N = 51) and corresponding patient surveys to understand how pre-appointment anxiety influences pre-appointment patient uncertainty, patient-provider communication during the appointment, and subsequent post-appointment uncertainty. RESULTS The proposed model achieved good fit to the data such that more pre-appointment anxiety was associated with more pre-appointment uncertainty, more pre-appointment anxiety was associated with more empathic opportunities per minute, and more empathic opportunities were associated with less post-appointment uncertainty. CONCLUSIONS Results indicate breast cancer patients with anxiety pre-appointment are at-risk for more illness uncertainty and are more likely to explicitly provide empathic opportunities. This supports the need for added attention to empathic opportunities to not only address patients emotionally but to also assess whether a patient may be at higher risk of having preexisting anxiety.
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Affiliation(s)
| | - Maria K. Venetis
- Department of CommunicationRutgers UniversityNew BrunswickNew JerseyUSA
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Bilotta I, Tonidandel S, Liaw WR, King E, Carvajal DN, Taylor A, Thamby J, Xiang Y, Tao C, Hansen M. Examining Linguistic Differences in Electronic Health Records for Diverse Patients With Diabetes: Natural Language Processing Analysis. JMIR Med Inform 2024; 12:e50428. [PMID: 38787295 PMCID: PMC11137426 DOI: 10.2196/50428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 09/26/2023] [Accepted: 04/23/2024] [Indexed: 05/25/2024] Open
Abstract
Background Individuals from minoritized racial and ethnic backgrounds experience pernicious and pervasive health disparities that have emerged, in part, from clinician bias. Objective We used a natural language processing approach to examine whether linguistic markers in electronic health record (EHR) notes differ based on the race and ethnicity of the patient. To validate this methodological approach, we also assessed the extent to which clinicians perceive linguistic markers to be indicative of bias. Methods In this cross-sectional study, we extracted EHR notes for patients who were aged 18 years or older; had more than 5 years of diabetes diagnosis codes; and received care between 2006 and 2014 from family physicians, general internists, or endocrinologists practicing in an urban, academic network of clinics. The race and ethnicity of patients were defined as White non-Hispanic, Black non-Hispanic, or Hispanic or Latino. We hypothesized that Sentiment Analysis and Social Cognition Engine (SEANCE) components (ie, negative adjectives, positive adjectives, joy words, fear and disgust words, politics words, respect words, trust verbs, and well-being words) and mean word count would be indicators of bias if racial differences emerged. We performed linear mixed effects analyses to examine the relationship between the outcomes of interest (the SEANCE components and word count) and patient race and ethnicity, controlling for patient age. To validate this approach, we asked clinicians to indicate the extent to which they thought variation in the use of SEANCE language domains for different racial and ethnic groups was reflective of bias in EHR notes. Results We examined EHR notes (n=12,905) of Black non-Hispanic, White non-Hispanic, and Hispanic or Latino patients (n=1562), who were seen by 281 physicians. A total of 27 clinicians participated in the validation study. In terms of bias, participants rated negative adjectives as 8.63 (SD 2.06), fear and disgust words as 8.11 (SD 2.15), and positive adjectives as 7.93 (SD 2.46) on a scale of 1 to 10, with 10 being extremely indicative of bias. Notes for Black non-Hispanic patients contained significantly more negative adjectives (coefficient 0.07, SE 0.02) and significantly more fear and disgust words (coefficient 0.007, SE 0.002) than those for White non-Hispanic patients. The notes for Hispanic or Latino patients included significantly fewer positive adjectives (coefficient -0.02, SE 0.007), trust verbs (coefficient -0.009, SE 0.004), and joy words (coefficient -0.03, SE 0.01) than those for White non-Hispanic patients. Conclusions This approach may enable physicians and researchers to identify and mitigate bias in medical interactions, with the goal of reducing health disparities stemming from bias.
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Affiliation(s)
| | - Scott Tonidandel
- Belk College of Business, University of North Carolina at Charlotte, Charlotte, NC, United States
| | - Winston R Liaw
- Department of Health Systems and Population Health Sciences, University of Houston Tilman J. Fertitta Family College of Medicine, Houston, TX, United States
| | - Eden King
- Department of Psychological Sciences, Rice University, Houston, TX, United States
| | - Diana N Carvajal
- Department of Family & Community Medicine, University of Maryland, Baltimore, MD, United States
| | - Ayana Taylor
- Department of Physical Medicine and Rehabilitation, University of California, Los Angeles, Los Angeles, CA, United States
| | - Julie Thamby
- Duke University School of Medicine, Durham, NC, United States
| | | | - Cui Tao
- Department of Artificial Intelligence and Informatics, Mayo Clinic, Jacksonville, FL, United States
| | - Michael Hansen
- Depatment of Family and Community Medicine, Baylor College of Medicine, Houston, TX, United States
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7
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Nogueira LM, May FP, Yabroff KR, Siegel RL. Racial Disparities in Receipt of Guideline-Concordant Care for Early-Onset Colorectal Cancer in the United States. J Clin Oncol 2024; 42:1368-1377. [PMID: 37939323 DOI: 10.1200/jco.23.00539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Revised: 07/27/2023] [Accepted: 09/15/2023] [Indexed: 11/10/2023] Open
Abstract
PURPOSE Young individuals racialized as Black are more likely to die after a colorectal cancer (CRC) diagnosis than individuals racialized as White in the United States. This study examined racial disparities in receipt of timely and guideline-concordant care among individuals racialized as Black and White with early-onset CRC. METHODS Individuals age 18-49 years racialized as non-Hispanic Black and White (self-identified) and newly diagnosed with CRC during 2004-2019 were selected from the National Cancer Database. Patients who received recommended care (staging, surgery, lymph node evaluation, chemotherapy, and radiotherapy) were considered to have received guideline-concordant care. Odds ratios (ORs) were adjusted for age and sex. The decomposition method was used to estimate the relative contribution of demographic characteristics (age and sex), comorbidities, health insurance, and facility type to the racial disparity in receipt of guideline-concordant care. The product-limit method was used to evaluate differences in time to treatment between patients racialized as Black and White. RESULTS Of the 84,882 patients with colon cancer and 62,573 patients with rectal cancer, 20.8% and 14.5% were racialized as Black, respectively. Individuals racialized as Black were more likely to not receive guideline-concordant care for colon (adjusted OR [aOR], 1.18 [95% CI, 1.14 to 1.22]) and rectal (aOR, 1.27 [95% CI, 1.21 to 1.33]) cancers. Health insurance explained 28.2% and 21.6% of the disparity among patients with colon and rectal cancer, respectively. Individuals racialized as Black had increased time to adjuvant chemotherapy for colon cancer (hazard ratio [HR], 1.28 [95% CI, 1.24 to 1.32]) and neoadjuvant chemoradiation for rectal cancer (HR, 1.42 [95% CI, 1.37 to 1.47]) compared with individuals racialized as White. CONCLUSION Patients with early-onset CRC racialized as Black receive worse and less timely care than individuals racialized as White. Health insurance, a modifiable factor, was the largest contributor to racial disparities in receipt of guideline-concordant care in this study.
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Affiliation(s)
- Leticia M Nogueira
- Surveillance and Health Equity Science, American Cancer Society, Atlanta, GA
| | - Folasade P May
- Department of Medicine, Vatche and Tamar Manoukian Division of Digestive Diseases, UCLA Kaiser Permanente Center for Health Equity, UCLA, Los Angeles, CA
| | - K Robin Yabroff
- Surveillance and Health Equity Science, American Cancer Society, Atlanta, GA
| | - Rebecca L Siegel
- Surveillance and Health Equity Science, American Cancer Society, Atlanta, GA
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Tenfelde K, Antheunis ML, Habibovic M, Widdershoven J, Bol N. Instrumental, Affective, and Patient-Centered Communication Between Cardiologists and Patients with Low Socioeconomic Status: An Observational Study. HEALTH COMMUNICATION 2024; 39:297-309. [PMID: 36628493 DOI: 10.1080/10410236.2023.2164955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
One of the essential elements in managing health is having adequate communication with health care providers. Unfortunately, patients with a low socioeconomic status (SES) often experience less adequate communication with their doctor. In the current study, we explore and compare the communication of both doctors and patients from lower and higher sociodemographic backgrounds on three factors: instrumental, affective, and patient-centered communication. In total, 45 cardiology consultations were observed, transcribed, and coded (16 low-SES, 16 middle-SES, 13 high-SES). Our analyses showed that, compared to higher-SES patients, low-SES patients voiced less of their concerns, answered questions of the doctor more often with one word, and expressed less utterances overall. Naturally, we found that doctors expressed more utterances overall toward low-SES patients. For doctors, no differences regarding instrumental, affective, or patient-centered communication were found. These findings suggest that low-SES patients are more passive communicators and communication differences based on SES exist predominantly for patients' communication. The revealed communication differences may lead to a less adequate interaction and potentially worse patient outcomes, further increasing the socioeconomic health gap. Hence, doctors should become even more aware of socioeconomic patient communication differences so that they can appropriately encourage low-SES patients to become more active communicators.
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Affiliation(s)
- Kim Tenfelde
- Department of Communication and Cognition, Tilburg University, Tilburg
| | | | - Mirela Habibovic
- Department of Medical and Clinical Psychology, Tilburg University, Tilburg
| | - Jos Widdershoven
- Department of Medical and Clinical Psychology, Tilburg University, Tilburg
- Department of Cardiology, Elisabeth-Tweesteden Hospital, Tilburg
| | - Nadine Bol
- Department of Communication and Cognition, Tilburg University, Tilburg
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Kabangu JLK, Fry L, Bhargav AG, Heskett C, Eden SV, Peterson JC, Camarata PJ, Ebersole K. Race and socioeconomic disparities in mortality and end-of-life care following aneurysmal subarachnoid hemorrhage. J Neurointerv Surg 2023:jnis-2023-020913. [PMID: 38123353 DOI: 10.1136/jnis-2023-020913] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2023] [Accepted: 11/21/2023] [Indexed: 12/23/2023]
Abstract
BACKGROUND This study explores racial and socioeconomic disparities in aneurysmal subarachnoid hemorrhage (aSAH) care, highlighting the impact on treatment and outcomes. The study aims to shed light on inequities and inform strategies for reducing disparities in healthcare delivery. METHODS In this cohort study the National Inpatient Sample database was queried for patient admissions with ruptured aSAH from 2016 to 2020. Multivariable analyses were performed estimating the impact of socioeconomic status and race on rates of acute treatment, functional outcomes, mortality, receipt of life-sustaining interventions (mechanical ventilation, tracheostomy, gastrostomy, and blood transfusions), and end-of-life care (palliative care and do not resuscitate). RESULTS A total of 181 530 patients were included. Minority patients were more likely to undergo treatment (OR 1.15, 95% CI 1.09 to 1.22, P<0.001) and were less likely to die (OR 0.89, 95% CI 0.84 to 0.95, P<0.001) than White patients. However, they were also more likely to have a tracheostomy (OR 1.47, 95% CI 1.33 to 1.62, P<0.001) and gastrostomy tube placement (OR 1.43, 95%CI 1.32 to 1.54, P<0.001), while receiving less palliative care (OR 0.75, 95% CI 0.70 to 0.80, P<0.001). This trend persisted when comparing minority patients from wealthier backgrounds with White patients from poorer backgrounds for treatment (OR 1.10, 95% CI 1.00 to 1.21, P=0.046), mortality (OR 0.82, 95% CI 0.74 to 0.89, P<0.001), tracheostomy tube (OR 1.27, 95% CI 1.07 to 1.48, P<0.001), gastrostomy tube (OR 1.34, 95% CI 1.18 to 1.52, P<0.001), and palliative care (OR 0.76, 95% CI 0.69 to 0.84, P<0.001). CONCLUSIONS Compared with White patients, minority patients with aSAH are more likely to undergo acute treatment and have lower mortality, yet receive more life-sustaining interventions and less palliation, even in higher socioeconomic classes. Addressing these disparities is imperative to ensure equitable access to optimal care and improve outcomes for all patients regardless of race or class.
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Affiliation(s)
- Jean-Luc K Kabangu
- Department of Neurosurgery, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Lane Fry
- Department of Neurosurgery, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Adip G Bhargav
- Department of Neurosurgery, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Cody Heskett
- Department of Neurosurgery, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Sonia V Eden
- Neurosurgery, Semmes-Murphey Neurologic and Spine Institute, Memphis, Tennessee, USA
| | - Jeremy C Peterson
- Department of Neurosurgery, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Paul J Camarata
- Department of Neurosurgery, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Koji Ebersole
- Department of Neurosurgery, University of Kansas Medical Center, Kansas City, Kansas, USA
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Langballe R, Svendsen L, Jakobsen E, Dalton SO, Karlsen RV, Iachina M, Freund KM, Leclair A, Jørgensen LB, Skou ST, Ehlers JH, Torenholt R, Svendsen MN, Envold Bidstrup P. Nurse navigation, symptom monitoring and exercise in vulnerable patients with lung cancer: feasibility of the NAVIGATE intervention. Sci Rep 2023; 13:22744. [PMID: 38123657 PMCID: PMC10733288 DOI: 10.1038/s41598-023-50161-w] [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] [Received: 08/14/2023] [Accepted: 12/15/2023] [Indexed: 12/23/2023] Open
Abstract
We developed the Navigate intervention to improve survival among vulnerable lung cancer patients. In this intervention-only study, we examined feasibility in terms of recruitment, retention, attendance, adherence, and acceptability to specify adjustments to study procedures and intervention components prior to a randomized trial. The Navigate intervention includes nurse navigation, patient-reported outcomes, and physical exercise. Patients ≥ 18 years old, diagnosed with non-small cell lung cancer at any stage, with performance status ≤ 2, eligible for cancer treatment and vulnerable according to a screening instrument were included. The recruitment goal of eligible patients was 40% while the retention goal was 85%. The predefined cut-offs for sufficient attendance and adherence were ≥ 75%. Acceptability was evaluated by semi-structured interviews with participants, nurse navigators, and physiotherapists. Seventeen (56%) out of 30 screened patients were considered vulnerable and eligible for the study, 14 (82%) accepted participation, and 3 (21%) were subsequently excluded due to ineligibility, leaving 11 patients. Four patients dropped out (36%) and four patients died (36%) during follow-up and 3 (27%) were retained. All 11 patients participated in nurse sessions (mean 16, range 1-36) with 88% attendance and dialogue tools being applied in 68% of sessions. Ninety-one percent of patients responded to PROs (mean of 9 PROs, range 1-24) with 76% of the PRO questionnaires used (attendance) and 100% adherence (completion of all questions in PRO questionnaires), and 55% participated in exercise sessions with 58% attendance and 85% adherence. We identified important barriers primarily related to transportation, but overall acceptability was high. The Navigate intervention was feasible with high participation, acceptability and satisfactory adherence. Retention and exercise attendance were low, which resulted in adjustments.Trial registration: The feasibility study was initiated prior to the multicenter randomized controlled trial registered by ClinicalTrials.gov (number: NCT05053997; date 23/09/2021).
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Affiliation(s)
- Rikke Langballe
- Psychological Aspects of Cancer, Cancer Survivorship, Danish Cancer Institute, Copenhagen, Denmark.
- Department of Clinical Oncology and Palliative Care, Zealand University Hospital, Næstved, Denmark.
| | - Lukas Svendsen
- Psychological Aspects of Cancer, Cancer Survivorship, Danish Cancer Institute, Copenhagen, Denmark
| | - Erik Jakobsen
- Department of Thoracic Surgery, Odense University Hospital, Odense, Denmark
- The Danish Lung Cancer Registry, Odense University Hospital, Odense, Denmark
| | - Susanne Oksbjerg Dalton
- Cancer Survivorship, Danish Cancer Institute, Copenhagen, Denmark
- Institute of Clinical Medicine, Faculty of Health, University of Copenhagen, Copenhagen, Denmark
- Danish Research Center for Equality in Cancer, Department of Clinical Oncology & Palliative Care, Zealand University Hospital, Næstved, Denmark
| | - Randi Valbjørn Karlsen
- Psychological Aspects of Cancer, Cancer Survivorship, Danish Cancer Institute, Copenhagen, Denmark
| | - Maria Iachina
- Center for Clinical Epidemiology and Research Unit of Clinical Epidemiology, Odense University Hospital, Odense, Denmark
| | - Karen M Freund
- Department of Medicine, Tufts Medical Center, Tufts University School of Medicine, Boston, USA
| | - Amy Leclair
- Department of Medicine, Tufts Medical Center, Tufts University School of Medicine, Boston, USA
| | - Lars Bo Jørgensen
- The Research and Implementation Unit PROgrez, Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospitals, Slagelse, Denmark
- Research Unit for Musculoskeletal Function and Physiotherapy, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
- Department of Physiotherapy and Occupational Therapy, Zealand University Hospital, Roskilde, Denmark
| | - Søren T Skou
- The Research and Implementation Unit PROgrez, Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospitals, Slagelse, Denmark
- Research Unit for Musculoskeletal Function and Physiotherapy, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Jeanette Haar Ehlers
- Department of Clinical Oncology and Palliative Care, Zealand University Hospital, Næstved, Denmark
| | - Rikke Torenholt
- Psychological Aspects of Cancer, Cancer Survivorship, Danish Cancer Institute, Copenhagen, Denmark
| | - Mads Nordahl Svendsen
- Department of Clinical Oncology and Palliative Care, Zealand University Hospital, Næstved, Denmark
| | - Pernille Envold Bidstrup
- Psychological Aspects of Cancer, Cancer Survivorship, Danish Cancer Institute, Copenhagen, Denmark
- Institute of Psychology, University of Copenhagen, Copenhagen, Denmark
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Wohlmann A. Critique and Postcritique: Analyzing Age Stereotypes in Literary Studies and Health Care. THE GERONTOLOGIST 2023; 63:1638-1644. [PMID: 37279539 DOI: 10.1093/geront/gnad059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Indexed: 06/08/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Gerontological research shows that stereotypes about older people negatively impact the quality of health care they receive. Therefore, knowledge of ageism is particularly relevant for medical students. Narrative Medicine draws on theory and methods from literary studies to interlace the humanities and medical studies. RESEARCH DESIGN AND METHODS This paper first describes a Narrative Medicine intervention at the University of Southern Denmark where medical students learn about ageism and stereotypes through a presentation of gerontological research results. In addition, literary texts and methods of close reading and reflective writing are employed to help students identify problematic stereotypes. The results of a survey conducted during the intervention suggest that students' awareness about ageism increased. Yet, rather than exploring the results of the survey, this paper's second part uses the intervention as a springboard to self-critically ask what type of humanities approaches, methods and theories are best suited to convey knowledge about ageist stereotypes. The paper sketches 2 approaches within literary studies-critique and postcritique-and applies them to a poem about an older man. RESULTS The paper discusses the gains and limitations of each approach and makes suggestions for how they can be joined with research about age stereotypes. DISCUSSION AND IMPLICATIONS To create productive pathways between the humanities and gerontology, the heterogeneity of the humanities-with literary studies as the example-need to be acknowledged. That is, clarity about the differences in humanities-based methods is crucial to establish a firmer ground for their usability in interdisciplinary contexts.
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Affiliation(s)
- Anita Wohlmann
- Department of Language, Culture, History and Communication, University of Southern Denmark, Odense, Denmark
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12
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Carlisle EM, Shinkunas LA, Lieberman MT, Hoffman RM, Reisinger HS. Evaluation of a Novel Question Prompt List in Pediatric Surgical Oncology. J Surg Res 2023; 292:44-52. [PMID: 37579715 PMCID: PMC10592310 DOI: 10.1016/j.jss.2023.07.029] [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] [Received: 02/28/2023] [Revised: 05/25/2023] [Accepted: 07/12/2023] [Indexed: 08/16/2023]
Abstract
INTRODUCTION Parents of children with cancer describe interactions with clinicians as emotionally distressing. Patient engagement in treatment discussions decreases decisional conflict and improves decision quality which may limit such distress. We have shown that parents prefer to engage surgeons by asking questions, but parents may not know what to ask. Question Prompt Lists (QPLs), structured lists of questions designed to help patients ask important questions, have not been studied in pediatric surgery. We developed a QPL designed to empower parents to ask meaningful questions during pediatric surgical oncology discussions. We conducted a mixed methods analysis to assess the acceptability, appropriateness, and feasibility of using the QPL. METHODS Key stakeholders at an academic children's hospital participated in focus groups to discuss the QPL. Focus groups were recorded and transcribed. Participants were surveyed regarding QPL acceptability, appropriateness, and feasibility. Thematic content analysis of transcripts was performed. RESULTS Four parents, five nurses, five nurse practitioners, five oncologists, and four surgeons participated. Seven key themes were identified: (1) QPL as a tool of empowerment; (2) stick to the surgical details; (3) QPLs can impact discussion quality; (4) time consuming, but not overly disruptive; (5) parental emotion may impact QPL use; (6) provide QPLs prior to surgical consultation in both print and digital formats; and (7) expansion of QPLs to other disciplines. Over 70% of participants agreed that the QPL was acceptable, appropriate, and feasible. CONCLUSIONS Our novel QPL is acceptable, appropriate, and feasible to use with parents of pediatric surgical oncology patients.
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Affiliation(s)
- Erica M Carlisle
- Division of Pediatric Surgery, Department of Surgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa; Program in Bioethics and Humanities, University of Iowa Carver College of Medicine, Iowa City, Iowa.
| | - Laura A Shinkunas
- Program in Bioethics and Humanities, University of Iowa Carver College of Medicine, Iowa City, Iowa
| | | | - Richard M Hoffman
- Department of Internal Medicine, University of Iowa Hospitals and Clinics, Iowa City, Iowa
| | - Heather Schacht Reisinger
- Program in Bioethics and Humanities, University of Iowa Carver College of Medicine, Iowa City, Iowa; Department of Internal Medicine, University of Iowa Hospitals and Clinics, Iowa City, Iowa; Institute for Clinical and Translational Science, University of Iowa, Iowa City, Iowa
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13
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Reeder-Hayes K, Roberson ML, Wheeler SB, Abdou Y, Troester MA. From Race to Racism and Disparities to Equity: An Actionable Biopsychosocial Approach to Breast Cancer Outcomes. Cancer J 2023; 29:316-322. [PMID: 37963365 PMCID: PMC10651167 DOI: 10.1097/ppo.0000000000000677] [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: 11/16/2023]
Abstract
PURPOSE Racial disparities in outcomes of breast cancer in the United States have widened over more than 3 decades, driven by complex biologic and social factors. In this review, we summarize the biological and social narratives that have shaped breast cancer disparities research across different scientific disciplines in the past, explore the underappreciated but crucial ways in which these 2 strands of the breast cancer story are interwoven, and present 5 key strategies for creating transformative interdisciplinary research to achieve equity in breast cancer treatment and outcomes. DESIGN We first review the key differences in tumor biology in the United States between patients racialized as Black versus White, including the overrepresentation of triple-negative breast cancer and differences in tumor histologic and molecular features by race for hormone-sensitive disease. We then summarize key social factors at the interpersonal, institutional, and social structural levels that drive inequitable treatment. Next, we explore how biologic and social determinants are interwoven and interactive, including historical and contemporary structural factors that shape the overrepresentation of triple-negative breast cancer among Black Americans, racial differences in tumor microenvironment, and the complex interplay of biologic and social drivers of difference in outcomes of hormone receptor positive disease, including utilization and effectiveness of endocrine therapies and the role of obesity. Finally, we present 5 principles to increase the impact and productivity of breast cancer equity research. RESULTS We find that social and biologic drivers of breast cancer disparities are often cyclical and are found at all levels of scientific investigation from cells to society. To break the cycle and effect change, we must acknowledge and measure the role of structural racism in breast cancer outcomes; frame biologic, psychosocial, and access factors as interwoven via mechanisms of cumulative stress, inflammation, and immune modulation; take responsibility for the impact of representativeness (or the lack thereof) in genomic and decision modeling on the ability to accurately predict the outcomes of Black patients; create research that incorporates the perspectives of people of color from inception to implementation; and rigorously evaluate innovations in equitable cancer care delivery and health policies. CONCLUSIONS Innovative, cross-disciplinary research across the biologic and social sciences is crucial to understanding and eliminating disparities in breast cancer outcomes.
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Affiliation(s)
| | | | | | - Yara Abdou
- From the Division of Oncology, School of Medicine
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14
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Hagiwara N, Harika N, Carmany EP, Shin Y, Eggly S, Jones SCT, Quillin J. Racial disparities in cancer genetic counseling encounters: study protocol for investigating patient-genetic counselor communication in the naturalistic clinical setting using a convergent mixed methods design. BMC Cancer 2023; 23:983. [PMID: 37845629 PMCID: PMC10578042 DOI: 10.1186/s12885-023-11486-x] [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] [Received: 09/15/2023] [Accepted: 10/06/2023] [Indexed: 10/18/2023] Open
Abstract
BACKGROUND Despite decades of effort to reduce racial cancer disparities, Black people continue to die at higher rates from cancer than any other U.S. racial group. Because prevention is a key to the cost-effective and long-term control of cancer, the potential for cancer genetic counseling to play a central role in reducing racial cancer disparities is high. However, the benefits of genetic counseling are not equitable across race. Only 2% of genetic counselors self-identify as Black/African American, so most genetic counseling encounters with Black patients are racially discordant. Patients in racially discordant medical interactions tend to have poorer quality patient-provider communication and receive suboptimal clinical recommendations. One major factor that contributes to these healthcare disparities is racial bias. Drawing on findings from prior research, we hypothesize that genetic counselor providers' implicit racial prejudice will be associated negatively with the quality of patient-provider communication, while providers' explicit negative racial stereotypes will be associated negatively with the comprehensiveness of clinical discussions of cancer risk and genetic testing for Black (vs. White) patients. METHODS Using a convergent mixed methods research design, we will collect data from at least 15 genetic counseling providers, from two different institutions, and their 220 patients (approximately equal number of Black and White patients per provider) whose appointments are for a hereditary cancer condition. The data sources will include two provider surveys, two patient surveys, video- and/or audio-recordings of genetic counseling encounters, and medical chart reviews. The recorded cancer genetic counseling in-person and telehealth encounters will be analyzed both qualitatively and quantitatively to assess the quality of patient-provider communication and the comprehensiveness of clinical discussion. Those data will be linked to pre- and post-encounter survey data and data from medical chart reviews to test our hypotheses. DISCUSSION Findings from this multi-site study will highlight specific aspects of cancer genetic counseling encounters (patient-provider communication and clinical recommendations) that are directly associated with patient-centered outcomes (e.g., satisfaction, trust, genetic testing completion). Patient-provider communication and clinical recommendations are modifiable factors that can be integrated into current genetic counseling training curricula and thus can have immediate impact on genetic counseling training and practice.
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Affiliation(s)
- Nao Hagiwara
- Department of Public Health Sciences, University of Virginia, 200 Jeanette Lancaster Way, Charlottesville, VA, 22903, USA.
| | - Nadia Harika
- Department of Pediatrics, Virginia Commonwealth University, 1008 East Clay Street, B-011 Box 980270, Richmond, VA, 23219, USA
| | - Erin P Carmany
- Center for Molecular Medicine and Genetics, Wayne State University, 3127 Scott Hall, 540 E. Canfield Ave, Detroit, MI, 48201, USA
| | - Yongyun Shin
- Department of Biostatistics, Virginia Commonwealth University, 830 East Main Street, One Capitol Square 718, Richmond, VA, 23298, USA
| | - Susan Eggly
- Department of Oncology, Wayne State University, Karmanos Cancer Institute, 4100 John R, Detroit, MI, 48201, USA
| | - Shawn C T Jones
- Department of Psychology, Virginia Commonwealth University, 806 West Franklin Street, 23284, Richmond, VA, USA
| | - John Quillin
- Department of Pediatrics, Virginia Commonwealth University, 1008 East Clay Street, B-011 Box 980270, Richmond, VA, 23219, USA
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15
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Durand MA, Bannier M, Aim MA, Mancini J. Adaptation and Implementation of Pictorial Conversation Aids for Early-Stage Breast Cancer Surgery and Reconstruction: A Quality Improvement Study. Patient Prefer Adherence 2023; 17:2463-2474. [PMID: 37817892 PMCID: PMC10560627 DOI: 10.2147/ppa.s421695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Accepted: 09/23/2023] [Indexed: 10/12/2023] Open
Abstract
Purpose After a diagnosis of early-stage breast cancer, women of lower socioeconomic position (SEP) report worse outcomes than women of higher SEP. A pictorial conversation aid was shown to improve decision outcomes in controlled contexts. No such intervention existed in France. In Phase 1, our aim was to adapt, for use in France, two pictorial conversation aids for breast cancer surgery and reconstruction. In Phase 2, our aim was to implement them in a regional cancer center serving a diverse population. Patients and Methods In phase 1, we used iterative qualitative methods to adapt the conversation aids with a convenience sample of patients and health professionals. In phase 2, we tested their implementation using PDSA cycles with volunteer surgeons. Results In phase 1, we interviewed 10 health professionals and 5 patients to reach thematic data saturation. They found the conversation aids usable and very acceptable (especially patients) and suggested small changes to further simplify the layout and content (including a glossary). In phase 2, three surgeons started the first PDSA cycle, for 4 weeks. Only one additional surgeon agreed to take part in the second cycle. The third cycle was cancelled since no new surgeon agreed to take part. Time was a barrier for 2 out of 4 surgeons, potentially explaining the difficulty recruiting for the third cycle. The evaluation was otherwise positive. The surgeons found the conversation aids very useful during their consultations and all intended to continue using them in the future. Conclusion It was possible to adapt, for use in France, pictorial conversation aids proven to be effective elsewhere. While the adapted conversation aids were deemed usable by health professionals and very acceptable to patients, their implementation using PDSA cycles proved slow.
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Affiliation(s)
- Marie-Anne Durand
- CERPOP, Université de Toulouse, Inserm, Université Toulouse III Paul Sabatier, Toulouse, France
- The Dartmouth Institute for Health Policy & Clinical Practice, Dartmouth College Lebanon, Lebanon, NH, USA
- Unisanté, Centre universitaire de médecine générale et santé publique, Lausanne, Switzerland
| | | | - Marie-Anastasie Aim
- AP-HM, Délégation à la Recherche Clinique et à l’Innovation, Marseille, France
- Aix-Marseille Univ, LPS, Aix-en-Provence, France
| | - Julien Mancini
- Aix-Marseille Univ, APHM, INSERM, IRD, ISSPAM, SESSTIM, “Cancer, Biomedicine & Society” Group, Equipe Labellisée LIGUE, Hop Timone, Marseille, France
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Langballe R, Jakobsen E, Iachina M, Karlsen RV, Ehlers JH, Svendsen MN, Bodtger U, Hilberg O, Dalton SO, Bidstrup PE. Who are the vulnerable lung cancer patients at risk for not receiving first-line curative or palliative treatment? Acta Oncol 2023; 62:1301-1308. [PMID: 37656828 DOI: 10.1080/0284186x.2023.2252581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Accepted: 08/21/2023] [Indexed: 09/03/2023]
Abstract
BACKGROUND To identify non-small-cell lung cancer (NSCLC) patients in need of comprehensive support, we examined the association between patient and disease-related factors of vulnerability related to not receiving guideline-recommended treatment. MATERIAL AND METHODS We identified 14,597 non-small-cell lung cancer (NSCLC) patients with performance status <3 during 2013-2018 in the Danish Lung Cancer Registry. Multivariate logistic regression models were used to estimate Odds Ratios (ORs) and 95% confidence intervals (CIs) for receiving guideline-recommended treatment according to stage, comorbidities, age, performance status, long distance to hospital, cohabitation status, education and alcohol abuse. RESULTS 21% of stage I-IIIA NSCLC patients did not receive curative treatment while 10% with stage IIIB-IV did not receive any oncological therapy. Factors associated with reduced likelihood of receiving curative treatment included: advanced stage (OR = 0.45; 95% CI = 0.42-0.49), somatic comorbidity (OR = 0.72; 95% CI = 0.63-0.83), age ≥ 80 years (OR = 0.59; 95% CI = 0.55-0.64), performance status = 2 (OR = 0.33; 95% CI = 0.28-0.39) and living alone (OR = 0.79; 95% CI = 0.69-0.90). Results were similar for stage IIIB-IV NSCLC patients, although a statistically significant association was also seen for long distances to the hospital (OR = 0.71; 95% CI = 0.58-0.86). CONCLUSIONS Several factors are associated with not receiving guideline-recommended NSCLC treatment with age, performance status, comorbidity and stage being most predictive of no treatment receipt. Efforts should be made to develop support for vulnerable lung cancer patients to improve adherence to optimal first-line therapy.
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Affiliation(s)
- Rikke Langballe
- Psychological Aspects of Cancer, the Danish Cancer Society Research Center, Copenhagen, Denmark
- Department of Clinical Oncology and Palliative Care, Zealand University Hospital, Roskilde, Denmark
| | - Erik Jakobsen
- Department of Thoracic surgery, Odense University Hospital, Odense C, Denmark
- The Danish Lung Cancer Registry, Odense University Hospital, Odense C, Denmark
| | - Maria Iachina
- Center for Clinical Epidemiology and Research Unit of Clinical Epidemiology, Odense University Hospital, Odense C, Denmark
| | - Randi Valbjørn Karlsen
- Psychological Aspects of Cancer, the Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Jeanette Haar Ehlers
- Department of Clinical Oncology and Palliative Care, Zealand University Hospital, Roskilde, Denmark
| | - Mads Nordahl Svendsen
- Department of Clinical Oncology and Palliative Care, Zealand University Hospital, Roskilde, Denmark
| | - Uffe Bodtger
- Respiratory Research Unit PLUZ, Department of Respiratory Medicine, Zealand University Hospital Roskilde/Næstved, Næstved, Denmark
- Institute for Regional Health Research, University of Southern Denmark, Odense C, Denmark
| | - Ole Hilberg
- Institute for Regional Health Research, University of Southern Denmark, Odense C, Denmark
- Department of Respiratory Disease, Vejle Hospital, Vejle, Denmark
| | - Susanne Oksbjerg Dalton
- Survivorship and Inequality in Cancer, the Danish Cancer Society Research Center, Copenhagen, Denmark
- Department of Clinical Oncology and Palliative Care, Zealand University Hospital, Næstved, Denmark
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Levinsen AKG, Kjaer TK, Thygesen LC, Maltesen T, Jakobsen E, Gögenur I, Borre M, Christiansen P, Zachariae R, Christensen P, Laurberg S, de Nully Brown P, Hölmich LR, Johansen C, Kjær SK, van de Poll‐Franse L, Saltbæk L, Dalton SO. Social inequality in cancer survivorship: Educational differences in health-related quality of life among 27,857 cancer survivors in Denmark. Cancer Med 2023; 12:20150-20162. [PMID: 37772475 PMCID: PMC10587985 DOI: 10.1002/cam4.6596] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Revised: 08/30/2023] [Accepted: 09/16/2023] [Indexed: 09/30/2023] Open
Abstract
BACKGROUND With a growing population of cancer survivors in Denmark, the evaluation of health-related quality of life (HRQoL) has become increasingly important. We describe variations in HRQoL between educational groups in a national population of cancer survivors. METHODS We conducted a cross-sectional questionnaire study among breast, prostate, lung, and colon cancer survivors diagnosed in 2010-2019 in Denmark. We used the EORTC QLQ-C30 to assess HRQoL including physical, role, emotional, cognitive, social functioning, and symptoms (fatigue, nausea and vomiting, pain, dyspnea, insomnia, appetite loss, constipation, diarrhea, and financial difficulties). Information on educational level and clinical data were extracted from national registers and clinical databases. Levels of impaired functioning and severe symptoms were identified using newly established thresholds for clinical importance. Multivariate logistic regression was used to examine associations between education and HRQoL. All statistical tests were 2-sided. RESULTS In total, 27,857 (42%) participated in the study. Up to 72% and 75% of cancer survivors with short education (≤9 years) reported impaired functioning and severe symptoms, respectively. Cancer survivors with short compared to long education (>12 years) were more likely to report impaired functioning and severe symptoms, with for example significantly higher odds ratios (ORs) for impaired physical function (breast OR = 2.41, 99% CI = 2.01-2.89; prostate OR = 1.81, 99% CI = 1.48-2.21; lung OR = 2.97, 99% CI = 1.95-4.57; and colon cancer OR = 1.69, 99% CI = 1.28-2.24). CONCLUSIONS Cancer survivors with short education are at greater risk of impaired HRQoL than survivors with long education 2-12 years after diagnosis. This underscores the need for systematic screening and symptom management in cancer aftercare, in order to reach all cancer survivors, also cancer survivors with short education.
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Affiliation(s)
| | | | - Lau Caspar Thygesen
- National Institute of Public HealthUniversity of Southern DenmarkCopenhagenDenmark
| | - Thomas Maltesen
- Statistics and Data AnalysisDanish Cancer InstituteCopenhagenDenmark
| | - Erik Jakobsen
- Department of Thoracic surgeryOdense University hospitalOdenseDenmark
| | - Ismail Gögenur
- Dept. Surgery, Center for Surgical ScienceZealand University HospitalKøgeDenmark
- Institute for Clinical MedicineCopenhagen UniversityCopenhagenDenmark
| | - Michael Borre
- Department of UrologyAarhus University HospitalAarhusDenmark
| | - Peer Christiansen
- Danish Breast Cancer Group Center and Clinic for Late EffectsAarhusDenmark
- Department of Plastic and Breast SurgeryAarhus University HospitalAarhusDenmark
| | - Robert Zachariae
- Danish Breast Cancer Group Center and Clinic for Late EffectsAarhusDenmark
| | - Peter Christensen
- Danish Cancer Society Centre for Research on Survivorship and Late Adverse Effects After Cancer in the Pelvic Organs, Department of SurgeryAarhus University HospitalAarhusDenmark
| | - Søren Laurberg
- Danish Cancer Society Centre for Research on Survivorship and Late Adverse Effects After Cancer in the Pelvic Organs, Department of SurgeryAarhus University HospitalAarhusDenmark
| | | | | | | | - Susanne K. Kjær
- Unit of Virus, Lifestyle and GenesDanish Cancer InstituteCopenhagenDenmark
- Department of Gynecology, RigshospitaletUniversity of CopenhagenCopenhagenDenmark
| | - Lonneke van de Poll‐Franse
- Department of Psychosocial Research and EpidemiologyThe Netherlands Cancer InstituteAmsterdamThe Netherlands
- Center of Research on Psychology in Somatic diseases, Department of Medical and Clinical PsychologyTilburg UniversityTilburgThe Netherlands
| | - Lena Saltbæk
- Survivorship and Inequality in CancerDanish Cancer InstituteCopenhagenDenmark
- Danish Research Center for Equality in Cancer, Department of Clinical Oncology & Palliative CareZealand University HospitalNæstvedDenmark
| | - Susanne Oksbjerg Dalton
- Survivorship and Inequality in CancerDanish Cancer InstituteCopenhagenDenmark
- Danish Research Center for Equality in Cancer, Department of Clinical Oncology & Palliative CareZealand University HospitalNæstvedDenmark
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18
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Weidler EM, Suorsa-Johnson KI, Baskin AS, Fagerlin A, Gardner MD, Rutter MM, Schafer-Kalkhoff T, van Leeuwen K, Sandberg DE. "It became easier once I knew": Stakeholder perspectives for educating children and teenagers about their difference of sex development. PATIENT EDUCATION AND COUNSELING 2023; 113:107763. [PMID: 37087875 PMCID: PMC10268945 DOI: 10.1016/j.pec.2023.107763] [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: 09/12/2022] [Revised: 04/05/2023] [Accepted: 04/15/2023] [Indexed: 05/03/2023]
Abstract
OBJECTIVE Secrecy about a child's difference of sex development (DSD) can lead to internalized shame and stigma. We explored how teenagers and adults with DSD, parents, healthcare providers, and allied professionals value and perceive patient education. METHODS Stakeholders (n = 110) completed qualitative semi-structured interviews. Relevant themes for educational content were queried and organized. RESULTS Education was consistently identified as essential to successful outcomes. There was less consistency in how to educate patients. Disagreement existed regarding who should champion the education process. Participants believed medically relevant information should be shared gradually with attention to developmental capacity. Details were lacking regarding how much or what information to share. Participants noted that vetted resources were helpful. Benefits of sharing condition-specific information with patients included supporting their psychosocial development. Barriers included parental resistance to sharing information due to shame/stigma, and cultural and/or family dynamics. CONCLUSIONS Stakeholders' different perspectives regarding patient DSD education warrant future research to focus on the design, evaluation, and implementation of education-focused interventions. PRACTICE IMPLICATIONS Healthcare providers are responsible for supporting the education of children and teenagers with DSD about their condition. When considering barriers, adopting a cultural or family systems framework can reduce parental resistance and promote open dialogue.
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Affiliation(s)
- Erica M Weidler
- Division of Pediatric Surgery, Phoenix Children's Hospital, Phoenix, USA; Accord Alliance, USA
| | - Kristina I Suorsa-Johnson
- Division of Psychiatry and Behavioral Health, Department of Pediatrics, University of Utah Spencer Fox Eccles School of Medicine, Salt Lake City, USA.
| | - Alison S Baskin
- Department of Surgery, University of California San Francisco School of Medicine, San Francisco, USA
| | - Angela Fagerlin
- Department of Population Health Sciences, University of Utah Spencer Fox Eccles School of Medicine, Salt Lake City, USA; Veterans Administration Health Services Research and Development Informatics, Decision-Enhancement and Analytic Sciences Center, Veterans Administration Salt Lake City Health Care System, Salt Lake City, USA
| | - Melissa D Gardner
- Susan B. Meister Child Health Evaluation & Research (CHEAR) Center, University of Michigan, Ann Arbor, USA
| | - Meilan M Rutter
- Accord Alliance, USA; Division of Endocrinology, Cincinnati Children's Hospital Medical Center, Cincinnati, USA; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, USA
| | - Tara Schafer-Kalkhoff
- Division of Endocrinology, Cincinnati Children's Hospital Medical Center, Cincinnati, USA
| | - Kathleen van Leeuwen
- Division of Pediatric Surgery, Phoenix Children's Hospital, Phoenix, USA; Accord Alliance, USA
| | - David E Sandberg
- Accord Alliance, USA; Susan B. Meister Child Health Evaluation & Research (CHEAR) Center, University of Michigan, Ann Arbor, USA; Division of Pediatric Psychology, Department of Pediatrics, University of Michigan Medical School, Ann Arbor, MI, USA
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19
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Canzona MR, Murphy K, Victorson D, Harry O, Clayman ML, McLean TW, Golden SL, Patel B, Strom C, Little-Greene D, Saker S, Salsman JM. Fertility Preservation Decisional Turning Points for Adolescents and Young Adults With Cancer: Exploring Alignment and Divergence by Race and Ethnicity. JCO Oncol Pract 2023; 19:509-515. [PMID: 37058685 PMCID: PMC10337714 DOI: 10.1200/op.22.00613] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 01/06/2023] [Accepted: 03/01/2023] [Indexed: 04/16/2023] Open
Abstract
PURPOSE For adolescents and young adults (AYAs) with cancer, fertility preservation (FP) decision making is complex and distressing. Racial/ethnic minority (REM) AYAs experience disparities in FP awareness, uptake, and outcomes. A turning point (TP) is a point of reflection, change, or decisive moment(s) resulting in changes in perspectives or trajectories. To enhance understanding of AYAs' diverse experiences, this study examined alignment and/or divergence of FP decisional TPs among non-Hispanic White (NHW) AYAs and REM AYAs. METHODS Qualitative semistructured interviews were conducted in person, by video, or phone with 36 AYAs (20 NHW and 16 REM [nine Hispanic and seven Black/multiracial Black). The constant comparative method was used to identify and analyze themes illustrating participants' conceptualization and/or experience of FP decisional TPs. RESULTS Seven thematic TPs emerged: (1) emotional reaction to discovering FP procedures exist; (2) encountering unclear or dismissive communication during initial fertility conversations with health care providers; (3) encountering direct and supportive communication during initial fertility conversations with health care providers; (4) participating in critical family conversations about pursuing FP; (5) weighing personal desire for a child against other priorities/circumstances; (6) realizing FP is not feasible, and (7) experiencing unanticipated changes in cancer diagnosis or treatment plans/procedures. TP variations include REM participants reported dismissive communication and suggested cost was prohibitive. NHW participants emphasized more forcefully that biological children may become a future priority. CONCLUSION Understanding how clinical communication and priorities/resources may vary for NHW and REM AYAs can inform future interventions aimed at reducing health disparities and enhancing patient-centered care.
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Affiliation(s)
- Mollie R. Canzona
- Department of Communication, Wake Forest University, Winston-Salem, NC
- Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Winston-Salem, NC
| | - Karly Murphy
- Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Winston-Salem, NC
| | - David Victorson
- Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Onengiya Harry
- Pediatrics—Rheumatology, Wake Forest Baptist Health, Winston-Salem, NC
| | - Marla L. Clayman
- Department of Population and Quantitative Research, UMass Chan School of Medicine, Worcester, MA
| | - Thomas W. McLean
- Pediatrics—Hematology/and Oncology, Wake Forest Baptist Health, Winston-Salem, NC
| | | | - Bonnie Patel
- Obstetrics and Gynecology, Reproductive Medicine, Wake Forest Baptist Health, Winston-Salem, NC
| | - Carla Strom
- Operations, Office of Cancer Health Equity, Wake Forest Baptist Comprehensive Cancer Center, Winston-Salem, NC
| | | | - Siba Saker
- Department of Pathology, Beth Israel Deaconess Medical Center, Boston, MA
| | - John M. Salsman
- Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Winston-Salem, NC
- Clinical Research in Adolescent and Young Adult Oncology, Wake Forest Baptist Comprehensive Cancer Center, Winston-Salem, NC
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20
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Smith AJB, Alvarez R, Heintz J, Simpkins F, Ko EM. Disparities in clinical trial participation in ovarian cancer: A real-world analysis. Gynecol Oncol 2023; 175:25-31. [PMID: 37300995 DOI: 10.1016/j.ygyno.2023.05.066] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Revised: 05/13/2023] [Accepted: 05/24/2023] [Indexed: 06/12/2023]
Abstract
BACKGROUND Significant disparities exist in clinical trial participation in non-gynecologic cancers, but little is known about disparities in ovarian cancer trial participation. Our objective was to examine patient, sociodemographic (race/ethnicity, insurance), cancer, and health system factors associated with clinical trial participation in ovarian cancer. METHODS We conducted a retrospective cohort study of patients with epithelial ovarian cancer diagnosed from 2011 to 2021, using a real-world electronic health record derived database, representing around 800 sites of care in US academic and community practices. We used multivariable Poisson regression modeling to analyze the association of ever participating in an ovarian cancer clinical drug trial with patient, sociodemographic, health system, and cancer factors. RESULTS Of the 7540 patients with ovarian cancer, 5.0% (95% CI 4.5-5.5) ever participated in a clinical drug trial. Patients of Hispanic or Latino ethnicity were 71% less likely to participate in clinical trials (RR 0.29, 95% CI 0.13-0.61) than non-Hispanic patients, and patients whose race was unknown or other than Black or White were 40% less likely to participate in clinical trials (RR 0.68, 95% CI 0.52-0.89). Patients who had Medicaid insurance were 51% less likely (RR 0.49, 95% CI 0.28-0.87) and those with Medicare were 32% (RR 0.48-0.97) less likely to participate in clinical trials than privately-insured patients. CONCLUSION In this national cohort study, only 5% of patients with ovarian cancer participated in clinical drug trials. Interventions are needed to decrease race, ethnicity, and insurance disparities in clinical trial participation.
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Affiliation(s)
- Anna Jo Bodurtha Smith
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Pennsylvania Health Systems, Philadelphia, PA, USA; Department of Obstetrics and Gynecology, University of Pennsylvania Health Systems, Philadelphia, PA, USA; Leonard Davis Institute of Health Economics, University of Pennsylvania Health Systems, Philadelphia, PA, USA; Penn Center for Cancer Care Innovation, Abramson Cancer Center, University of Pennsylvania Health Systems, Philadelphia, PA, USA.
| | | | - Jonathan Heintz
- Biostatistics Analysis Center, Perelman School of Medicine, University of Pennsylvania Health Systems, Philadelphia, PA, USA
| | - Fiona Simpkins
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Pennsylvania Health Systems, Philadelphia, PA, USA; Department of Obstetrics and Gynecology, University of Pennsylvania Health Systems, Philadelphia, PA, USA
| | - Emily M Ko
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Pennsylvania Health Systems, Philadelphia, PA, USA; Department of Obstetrics and Gynecology, University of Pennsylvania Health Systems, Philadelphia, PA, USA; Leonard Davis Institute of Health Economics, University of Pennsylvania Health Systems, Philadelphia, PA, USA; Penn Center for Cancer Care Innovation, Abramson Cancer Center, University of Pennsylvania Health Systems, Philadelphia, PA, USA
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21
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Hu X. Becoming a Physician Who is a Good Communicator to Patients. Health Serv Insights 2023; 16:11786329231177799. [PMID: 37256094 PMCID: PMC10226321 DOI: 10.1177/11786329231177799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023] Open
Affiliation(s)
- Xiaojing Hu
- VXiaojing Hu, Human Resources Department, Peking
University First Hospital, No. 8 Xishiku Street, Xicheng District, Beijing 100034, China.
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22
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Waltz M, Yan H, Cadigan RJ, Canter C, Bain L, Bensen JT, Conway C, Haldeman-Englert C, Farnan L, M Foreman AK, Grant TL, Leach B, Lin FC, Mahla M, O'Daniel JM, O'Neill SC, Smith G, Powell BC, Berg JS, Rini CM. Question prompt lists and caregiver question asking in pediatric specialty appointments: A randomized controlled trial. PATIENT EDUCATION AND COUNSELING 2023; 109:107620. [PMID: 36689884 PMCID: PMC9931668 DOI: 10.1016/j.pec.2022.107620] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Revised: 12/09/2022] [Accepted: 12/30/2022] [Indexed: 06/17/2023]
Abstract
OBJECTIVE Question prompt lists (QPLs) have been effective at increasing patient involvement and question asking in medical appointments, which is critical for shared decision making. We investigated whether pre-visit preparation (PVP), including a QPL, would increase question asking among caregivers of pediatric patients with undiagnosed, suspected genetic conditions. METHODS Caregivers were randomized to receive the PVP before their appointment (n = 59) or not (control, n = 53). Appointments were audio-recorded. Transcripts were analyzed to determine questions asked. RESULTS Caregivers in the PVP group asked more questions (MeanPVP = 4.36, SDPVP = 4.66 vs. Meancontrol = 2.83, SDcontrol = 3.03, p = 0.045), including QPL questions (MeanPVP = 1.05, SDPVP = 1.39 vs. Meancontrol = 0.36, SDcontrol = 0.81, p = 0.002). Caregivers whose child had insurance other than Medicaid in the PVP group asked more total and QPL questions than their counterparts in the control group (ps = 0.005 and 0.002); there was no intervention effect among caregivers of children with Medicaid or no insurance (ps = 0.775 and 0.166). CONCLUSION The PVP increased question asking but worked less effectively among traditionally underserved groups. Additional interventions, including provider-focused efforts, may be needed to promote engagement of underserved patients. PRACTICE IMPLICATIONS Patient/family-focused interventions may not be beneficial for all populations. Providers should be aware of potential implicit and explicit biases and encourage question asking to promote patient/family engagement.
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Affiliation(s)
- Margaret Waltz
- Department of Social Medicine, University of North Carolina, Chapel Hill, Chapel Hill, NC, USA.
| | - Haoyang Yan
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - R Jean Cadigan
- Department of Social Medicine, University of North Carolina, Chapel Hill, Chapel Hill, NC, USA
| | - Courtney Canter
- Department of Anthropology, University of North Carolina, Chapel Hill, Chapel Hill, NC, USA
| | | | - Jeannette T Bensen
- Department of Epidemiology, University of North Carolina, Chapel Hill, Chapel Hill, NC, USA
| | - Carol Conway
- Parent/Advocate, Parent Advocates for Adult Children with Intellectual &/or Developmental Disabilities in NC, Chapel Hill, NC, USA
| | | | - Laura Farnan
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, USA
| | | | - Tracey L Grant
- Department of Genetics, University of North Carolina, Chapel Hill, Chapel Hill, NC, USA
| | - Barbara Leach
- Parent/Advocate, Family Support Program, School of Social Work, UNC Chapel Hill, Chapel Hill, NC, USA
| | - Feng-Chang Lin
- Department of Biostatistics, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Madeline Mahla
- Department of Genetics, University of North Carolina, Chapel Hill, Chapel Hill, NC, USA
| | - Julianne M O'Daniel
- Department of Genetics, University of North Carolina, Chapel Hill, Chapel Hill, NC, USA
| | | | | | - Bradford C Powell
- Department of Genetics, University of North Carolina, Chapel Hill, Chapel Hill, NC, USA
| | - Jonathan S Berg
- Department of Genetics, University of North Carolina, Chapel Hill, Chapel Hill, NC, USA
| | - Christine M Rini
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA; Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL, USA
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23
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Saeed F, Ladwig S, Allen RJ, Eneanya ND, Tamura MK, Fiscella KA. Racial Disparities in Health Beliefs and Advance Care Planning Among Patients Receiving Maintenance Dialysis. J Pain Symptom Manage 2023; 65:318-325. [PMID: 36521766 PMCID: PMC10103744 DOI: 10.1016/j.jpainsymman.2022.12.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Revised: 11/30/2022] [Accepted: 12/02/2022] [Indexed: 12/14/2022]
Abstract
CONTEXT Among people receiving maintenance dialysis, little is known about racial disparities in the occurrence of prognostic discussions, beliefs about future health, and completion of advance care planning (ACP) documents. OBJECTIVES We examined whether Black patients receiving maintenance dialysis differ from White patients in prognostic discussions, beliefs about future health, and completion of ACP-related documents. METHODS We surveyed adult patients receiving maintenance dialysis from seven dialysis units in Cleveland, Ohio, and hospitalized patients at a tertiary care hospital in Cleveland. Of the 450 patients who were asked to participate in the study, 423 (94%) agreed. We restricted the current secondary analyses to include only Black (n=285) and White (n=114) patients. The survey assessed patients' knowledge of their kidney disease, attitudes toward chronic kidney disease (CKD) treatment, preferences for end-of-life (EoL) care, the patient-reported occurrence of prognostic discussions, experiences with kidney therapy decision making, sentiments of dialysis regret, beliefs about health over the next 12 months, and advance care planning. We used stepwise logistic regression to determine if race was associated with the occurrence of prognostic discussions, beliefs about future health, and completion of an ACP-related document, while controlling for potential confounders. RESULTS We found no significant difference in the frequency of prognostic discussions between Black (11.9%) versus White patients (7%) (P=0.15). However, Black patients (19%) had lower odds of believing that their health would worsen over the next 12 months (OR 0.22, CI 0.12, 0.44) and reporting completion of any ACP-related document (OR 0.5, CI 0.32, 0.81) compared to White patients CONCLUSION: Racial differences exist in beliefs about future health and completion of ACP-related documents. Systemic efforts to investigate differences in health beliefs and address racial disparities in the completion of ACP-related documents are needed.
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Affiliation(s)
- Fahad Saeed
- Department of Medicine, Division of Nephrology (F.S.), University of Rochester School of Medicine and Dentistry, Rochester, New York, USA; Division of Palliative Care (F.S., S.L.), University of Rochester School of Medicine and Dentistry, Rochester, New York, USA.
| | - Susan Ladwig
- Division of Palliative Care (F.S., S.L.), University of Rochester School of Medicine and Dentistry, Rochester, New York, USA
| | - Rebecca Jane Allen
- Mount St. Joseph University, School of Behavior and Natural Science (R.J.A.), Cincinnati, Ohio, USA
| | - Nwamaka D Eneanya
- Fresenius Medical Care, Global Medical Office, Philadelphia, Pennsylvania, USA
| | - Manjula Kurella Tamura
- Division of Nephrology (MKT), Stanford University and Geriatric Research and Education Clinical Center Veterans Affairs Palo Alto, Palo Alto, California, USA
| | - Kevin A Fiscella
- Department of Family Medicine and Center for Center for Communication and Disparities Research (K.A.F.), University of Rochester School of Medicine and Dentistry, Rochester, New York, USA
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24
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Yilmaz S, Koita F, Zittel J, Wells M, Mohile S, Wittink M, Kelly JM, Sedrak M, DeCaporale-Ryan L, DiGiovanni G, Magnuson A. The role of self-perceived age in older adults considering adjuvant chemotherapy. J Geriatr Oncol 2023; 14:101429. [PMID: 36682217 PMCID: PMC9974899 DOI: 10.1016/j.jgo.2023.101429] [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] [Received: 06/22/2022] [Revised: 11/21/2022] [Accepted: 01/12/2023] [Indexed: 01/22/2023]
Abstract
INTRODUCTION Aging-related concerns can increase the risk of treatment toxicities among older adults considering adjuvant chemotherapy. We previously demonstrated that older adults with cancer who reported feeling older than their chronological age (i.e., self-perceived age) were more likely to have aging-related concerns identified during a geriatric assessment. We explored how decisions about adjuvant chemotherapy vary with or are related to older adults' self-perceived age. MATERIALS AND METHODS We conducted a secondary analysis of a multi-phased feasibility pilot using semi-structured interviews that were conducted to explore the patient decision-making process for adjuvant chemotherapy. Interviews incorporated questions about chronological and perceived age as factors for decision-making. Patient eligibility for the study included (1) age ≥ 70 years and older, (2) a diagnosis of breast, colon, or lung cancer and considering adjuvant chemotherapy, and (3) able to read size 18 font in English. Interview data were analyzed using constant comparative method. RESULTS Twenty-one patients were enrolled. The mean chronological age was 78 years (range 71-91). The average perceived age of patients was 57 years (range 21-80). Eleven patients chose to receive treatment while ten patients did not. Aging-related themes illustrated that self-perceived age plays an important role when patients make decisions about adjuvant chemotherapy. More specifically, patients who reported their self-perceived age as younger than their chronological age also reported better perceived health status and chose to receive adjuvant chemotherapy. DISCUSSION Patients' experiences of aging and self-perceived age may have different implications for decision-making.
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Affiliation(s)
- Sule Yilmaz
- University of Rochester, Rochester, NY, United States of America.
| | - Fatoumata Koita
- State University of New York at Albany, Albany, NY, United States of America
| | - Jason Zittel
- University of Rochester, Rochester, NY, United States of America
| | - Megan Wells
- University of Rochester, Rochester, NY, United States of America
| | - Supriya Mohile
- University of Rochester, Rochester, NY, United States of America
| | - Marsha Wittink
- University of Rochester, Rochester, NY, United States of America
| | - J MacLaren Kelly
- University of Rochester, Rochester, NY, United States of America
| | - Mina Sedrak
- City of Hope, Duarte, CA, United States of America
| | | | - Grace DiGiovanni
- University of Rochester, Rochester, NY, United States of America
| | - Allison Magnuson
- University of Rochester, Rochester, NY, United States of America
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25
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Streid JL, Lee KC, Bader AM, Jarman MP, Rosenthal RA, Cooper Z, Lindvall C. Shared Decision Making in the Geriatric Surgery Verification Program: Assessing Baseline Performance. J Pain Symptom Manage 2023; 65:510-520.e3. [PMID: 36736861 DOI: 10.1016/j.jpainsymman.2023.01.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Revised: 01/19/2023] [Accepted: 01/24/2023] [Indexed: 02/04/2023]
Abstract
CONTEXT As part of the launch of the Geriatric Surgery Verification program in 2019, the American College of Surgeons issued care standards for older patients, including requirements for preoperative documentation of patients' goals. Hospital performance on these standards prior to the Geriatric Surgery Verification program is unknown. OBJECTIVES To assess baseline performance of the Geriatric Surgery Verification (GSV) standard for documentation of preoperative goals for older patients, and to determine factors associated with standard adherence. METHODS Using natural language processing, this study examines the electronic health records of patients aged 65 years or older who underwent coronary artery bypass grafts (CABG) or colectomies in 2017 or 2018 at three hospitals. The primary outcome was adherence to at least one of the three components of GSV Standard 5.1, which requires preoperative documentation of overall health goals, treatment goals, and patient-centered outcomes. RESULTS A total of 2630 operations and 2563 patients were included. At least one component of the standard was met in 307 (11.7%) operations and all three components were met in 5 (0.2%). Higher likelihood of meeting the standard was demonstrated for patients who were female (odds ratio [OR] 1.30; 95% CI 1.00-1.68), undergoing colectomy (OR 2.82; 95% CI 2.15-3.72), or with more comorbidities (Charlson scores >3 [OR 1.55; 95% CI 1.14-2.09]). CONCLUSION Before GSV program implementation, clinicians for two major operations almost never met the GSV standard for preoperative discussion of patient goals. Interdisciplinary teams will need to adjust clinical practice to meet best-practice communication standards for older patients.
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Affiliation(s)
- Jocelyn L Streid
- Center for Surgery and Public Health (J.L.S., K.C.L., A.M.B., M.P.J., Z.C.), Brigham and Women's Hospital, Boston, Massachusetts; Department of Anesthesiology, Perioperative and Pain Medicine (J.L.S., A.M.B.), Brigham and Women's Hospital, Boston, Massachusetts.
| | - Katherine C Lee
- Center for Surgery and Public Health (J.L.S., K.C.L., A.M.B., M.P.J., Z.C.), Brigham and Women's Hospital, Boston, Massachusetts; Department of Surgery (K.C.L.), University of California, San Diego, La Jolla, California
| | - Angela M Bader
- Center for Surgery and Public Health (J.L.S., K.C.L., A.M.B., M.P.J., Z.C.), Brigham and Women's Hospital, Boston, Massachusetts; Department of Anesthesiology, Perioperative and Pain Medicine (J.L.S., A.M.B.), Brigham and Women's Hospital, Boston, Massachusetts
| | - Molly P Jarman
- Center for Surgery and Public Health (J.L.S., K.C.L., A.M.B., M.P.J., Z.C.), Brigham and Women's Hospital, Boston, Massachusetts
| | | | - Zara Cooper
- Center for Surgery and Public Health (J.L.S., K.C.L., A.M.B., M.P.J., Z.C.), Brigham and Women's Hospital, Boston, Massachusetts; Department of Surgery (Z.C.), Brigham and Women's Hospital, Boston, Massachusetts
| | - Charlotta Lindvall
- Division of Palliative Medicine, Department of Medicine (C.L.), Brigham and Women's Hospital, Boston, Massachusetts; Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute (C.L.), Boston, Massachusetts
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Derricks V, Johnson IR, Pietri ES. Black (patients') lives matter: Exploring the role of identity-safety cues in healthcare settings among Black Americans. J Health Psychol 2023; 28:30-47. [PMID: 35570659 DOI: 10.1177/13591053221090850] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Two online experiments investigated whether hypothetical physicians' use of an identity-safety cue acknowledging systemic injustice (a Black Lives Matter pin) improves Black Americans' evaluations of the physician and feelings of identity-safety. Across studies, findings showed that when a White physician employed the identity-safety cue, Black Americans reported stronger perceptions of physician allyship and increased identity-safety (e.g. trust). As predicted, use of the identity-safety cue produced smaller or non-significant effects when employed by a Black physician. These benefits emerged regardless of physicians' perceived motivation for employing the cue (e.g. whether the physician was personally motivated to employ the cue or his medical practice encouraged use of the cue; Study 2). Furthermore, analyses revealed that exposure to the identity-safety cue promoted a greater sense of identity-safety for Black Americans due to increased perceptions that the physician is an ally for Black individuals. Implications of identity-safety cues for racially discordant medical interactions are discussed.
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Affiliation(s)
- Veronica Derricks
- Department of Psychology, Indiana University - Purdue University Indianapolis, Indianapolis, IN, USA
| | - India R Johnson
- Department of Psychology, Butler University, Indianapolis, IN, USA
| | - Evava S Pietri
- Department of Psychology and Neuroscience, University of Colorado Boulder, Boulder, CO, USA
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Louis K, Crum AJ, Markus HR. Negative consequences of self-presentation on disclosure of health information: A catch-22 for Black patients? Soc Sci Med 2023; 316:115141. [PMID: 35778285 DOI: 10.1016/j.socscimed.2022.115141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2021] [Revised: 05/19/2022] [Accepted: 06/10/2022] [Indexed: 01/11/2023]
Abstract
RATIONALE Most patients assume that it is adaptive to present oneself in a positive light when interacting with medical professionals. Here in two studies focused on Black patients we ask: might this desire to present oneself well inhibit the disclosure of health-relevant information when patients are concerned about negative and stereotypic evaluations by their health care providers? OBJECTIVE Specifically, we explore three important questions: First, whether self-presentational efforts (e.g., working hard to sound knowledgeable or "smart") are negatively associated with disclosure of health information (e.g., not taking certain medications); Second, whether patient-provider racial congruence (e.g. Black patients interacting with a Black vs. a White doctor) moderates that relationship; and third, more broadly, what factors promote or inhibit disclosure of health information for Black patients in medical interactions. METHODS These questions were investigated using mixed methodology (survey, experimental, qualitative) studies on CloudResearch and Prolific. RESULTS We found a potential catch-22: participants who spend more effort self-presenting tend to be less comfortable disclosing health information to their healthcare providers. Moreover, Study 1 (N = 321) indicated that the negative relationship between self-presentation and disclosure was significant in Black-incongruent (i.e., Black patient and White provider) and White-congruent (i.e., White patient and White provider) medical interactions. Study 2 (N = 361) did not find a significant moderation by race of the provider but instead suggested that the relationship between self-presentation and disclosure was moderated by expectations of unfair treatment. Exploratory qualitative analyses suggested that some Black participants face a dilemma when deciding whether to disclose information to their healthcare providers. They weigh the kind of information they will share, and how sharing some information might lead to embarrassment and judgment. CONCLUSION Mitigating the potentially counteractive effects of self-presentation on disclosure and working to foster contexts that encourage honest disclosure of health information may help to reduce health care inequalities.
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Affiliation(s)
| | - Alia J Crum
- Department of Psychology, Stanford University, United States
| | - Hazel R Markus
- Department of Psychology, Stanford University, United States
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McDonnell S, Breslin T, Mascan B, Shahruddin NS, Elnour M, Fanning M, Galvin A, Moore J, Ravi N, Reynolds JV, Donohoe CL. Translating evidence in a priority setting partnership: knowledge gaps between healthcare providers and oesophageal cancer patients. Support Care Cancer 2023; 31:126. [PMID: 36680653 PMCID: PMC9860237 DOI: 10.1007/s00520-022-07523-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Accepted: 11/26/2022] [Indexed: 01/22/2023]
Abstract
INTRODUCTION Despite the fact that health information is now more accessible than ever, knowledge gaps remain between patients and healthcare providers (HCPs). To date, the patients' need for information following a diagnosis of oesophageal cancer has not been adequately met. PURPOSE The purpose of this study was to identify why knowledge gaps exist between oesophageal cancer patients and HCPs and how to address them. METHODS Purposive sampling of a group of people living with and after oesophageal cancer who had participated in a priority-setting partnership where 45% of questions from patients had existing evidence-based answers. A 7-set question series was developed for use in a patient/HCP focus group in addition to 11 individual phone interviews with survivors of oesophageal cancer. Qualitative semistructured interviews were conducted to explore oesophageal cancer patients' access to information. The data was analysed thematically, which involved coding all patient transcripts before identifying and reviewing key themes. RESULTS The three primary themes that emerged were as follows: opportunity (HCP team factors and relationship development), ability (patient factors) and priority (pacing of information delivery). CONCLUSION Effective communication between patients and HCPs was identified as an integral component of the enhancement of patient knowledge. HCPs should continue to refine and improve methods of information delivery and encourage conversations regarding information preferences.
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Affiliation(s)
- Sarah McDonnell
- grid.8217.c0000 0004 1936 9705School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - Tara Breslin
- grid.8217.c0000 0004 1936 9705School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - Bianca Mascan
- grid.8217.c0000 0004 1936 9705School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - Nur Shuhada Shahruddin
- grid.8217.c0000 0004 1936 9705School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - Mawaheb Elnour
- grid.8217.c0000 0004 1936 9705School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - Michelle Fanning
- Department of Clinical Nutrition and Dietetics, Trinity St James Cancer Institute, Dublin, Ireland
| | - Anthony Galvin
- Department of Surgery, National Centre for Oesophageal and Gastric Cancer, Trinity St James Cancer Institute, Dublin, Ireland
| | - Jennifer Moore
- Department of Surgery, National Centre for Oesophageal and Gastric Cancer, Trinity St James Cancer Institute, Dublin, Ireland
| | - Narayansamy Ravi
- Department of Surgery, National Centre for Oesophageal and Gastric Cancer, Trinity St James Cancer Institute, Dublin, Ireland
| | - John V. Reynolds
- Department of Surgery, National Centre for Oesophageal and Gastric Cancer, Trinity St James Cancer Institute, Dublin, Ireland
| | - Claire L. Donohoe
- Department of Surgery, National Centre for Oesophageal and Gastric Cancer, Trinity St James Cancer Institute, Dublin, Ireland
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Iachina M, Anru PL, Jakobsen E. Effects of Demographic and Socio-Economic Factors on Investigation Time of Lung Cancer Patients in Denmark: A Retrospective Cohort Study. Health Serv Res Manag Epidemiol 2023; 10:23333928231206627. [PMID: 37901611 PMCID: PMC10605680 DOI: 10.1177/23333928231206627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2023] Open
Abstract
Background Lung cancer is one of the most common cancer types worldwide. The significance of the individual socio-economic position on the delay in lung cancer diagnosis has not been properly investigated. The purpose of this nationwide population-based study is to examine the association between position and the length of the primary investigation for lung cancer. Materials and Methods This register study was based on all lung cancer patients in Denmark who were diagnosed in 2012 to 2017, in total 28,431 patients. We used a multivariate logistic regression model and multivariate zero-inflated negative binomial model to estimate the effect of education level, family income, difficulty of transport, and cohabitation status on the length of the primary investigation. Results We found that the patients' income, difficulty of transport, and cohabitation status were associated with the length of the primary investigation. The chance of carrying out the investigation process within 24 days is higher for patients with a high income (adjusted OR = 0.86 with 95% CI (0.81; 0.91)), lower for patients with troublesome transport (adjusted OR = 0.67 with 95% CI (0.61; 0.72)), and lower for patients living alone (adjusted OR = 0.93 with 95% CI (0.88; 0.99)). Conclusion Several socio-economic factors are associated with the length of the primary lung cancer investigation. To ensure that all patients receive the most appropriate health care and to avoid extra investigation time, clinicians may pay extra attention to patients who are less fortunate due to low income, troublesome transport to the hospital, or living alone.
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Affiliation(s)
- Maria Iachina
- Center for Clinical Epidemiology, Odense University Hospital, Odense, Denmark
- Research Unit of Clinical Epidemiology, University of Southern Denmark, Odense, Denmark
| | - Pavithra Laxsen Anru
- Center for Clinical Epidemiology, Odense University Hospital, Odense, Denmark
- Research Unit of Clinical Epidemiology, University of Southern Denmark, Odense, Denmark
| | - Erik Jakobsen
- Department of Thoracic Surgery, Odense University Hospital, Odense, Denmark
- Odense Patient Data Exploratory Network (OPEN), Institute of Clinical Research, University of Southern Denmark, Odense, Denmark
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Neal D, Morgan JL, Kenny R, Ormerod T, Reed MW. Is there evidence of age bias in breast cancer health care professionals' treatment of older patients? EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2022; 48:2401-2407. [PMID: 35871030 DOI: 10.1016/j.ejso.2022.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Revised: 07/01/2022] [Accepted: 07/04/2022] [Indexed: 12/14/2022]
Abstract
OBJECTIVES Despite NICE (2009; 2018) guidelines to treat breast cancer patients 'irrespective of age', older women experience differential treatment and worse outcomes beyond that which can be explained by patient health or patient choice. Research has evidenced the prevalence of ageism and identified the role of implicit bias in reflecting and perhaps perpetuating disparities across society, including in healthcare. Yet age bias has rarely been considered as an explanatory factor in poorer outcomes for older breast cancer patients. METHODS This mixed methods study explored age bias amongst breast cancer HCPs through four components: 1) An implicit associations test (31 HCPs) 2) A treatment recommendations questionnaire (46 HCPs). 3) An attitudes about older patients questionnaire (31 HCPs). 4) A treatment recommendations interview (20 HCPs). RESULTS This study showed that breast cancer HCPs held negative implicit associations towards older women; HCPs were less likely to recommend surgery for older patients; some HCPs held assumptions that older patients are more afraid, less willing and able to be involved in decision-making, and are less willing and able to cope with being informed of a poor treatment prognosis; and conditions which disproportionately affect older patients, such as dementia, are not always well understood by breast cancer HCPs. CONCLUSIONS These results indicate that there are elements of age bias present amongst breast cancer HCPs. The study's findings of age-based assumptions and a poorer understanding of conditions which disproportionately affect older patients align with patterns of differential treatment towards older breast cancer patients suggesting that age bias may be, at least in part, driving differential treatment.
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Affiliation(s)
- Daisy Neal
- Brighton and Sussex Medical School. Brighton, UK.
| | | | - Ross Kenny
- Department of Breast Surgery, Surrey and Sussex NHS Trust, UK
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Parente VM, Reid HW, Robles J, Johnson KS, Svetkey LP, Sanders LL, Olsen MK, Pollak KI. Racial and Ethnic Differences in Communication Quality During Family-Centered Rounds. Pediatrics 2022; 150:e2021055227. [PMID: 36345704 PMCID: PMC9724176 DOI: 10.1542/peds.2021-055227] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/29/2022] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVES To evaluate racial and ethnic differences in communication quality during family centered rounds. METHODS We conducted an observational study of family-centered rounds on hospital day 1. All enrolled caregivers completed a survey following rounds and a subset consented to audio record their encounter with the medical team. We applied a priori defined codes to transcriptions of the audio-recorded encounters to assess objective communication quality, including medical team behaviors, caregiver participatory behaviors, and global communication scores. The surveys were designed to measure subjective communication quality. Incident Rate Ratios (IRR) were calculated with regression models to compare the relative mean number of behaviors per encounter time minute by race and ethnicity. RESULTS Overall, 202 of 341 eligible caregivers completed the survey, and 59 had accompanying audio- recorded rounds. We found racial and ethnic differences in participatory behaviors: English-speaking Latinx (IRR 0.5; 95% confidence interval [CI] 0.3-0.8) Black (IRR 0.6; 95% CI 0.4-0.8), and Spanish-speaking Latinx caregivers (IRR 0.3; 95% CI 0.2-0.5) participated less than white caregivers. Coder-rated global ratings of medical team respect and partnership were lower for Black and Spanish-speaking Latinx caregivers than white caregivers (respect 3.1 and 2.9 vs 3.6, P values .03 and .04, respectively: partnership 2.4 and 2.3 vs 3.1, P values .03 and .04 respectively). In surveys, Spanish-speaking caregivers reported lower subjective communication quality in several domains. CONCLUSIONS In this study, Black and Latinx caregivers were treated with less partnership and respect than white caregivers.
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Affiliation(s)
| | - Hadley W. Reid
- Duke University School of Medicine, Durham, North Carolina
| | - Joanna Robles
- Hematology/Oncology, Department of Pediatrics
- Cancer Prevention and Control, Duke Cancer Institute, Durham, North Carolina
| | - Kimberly S. Johnson
- Division of Geriatrics, Department of Medicine
- Center for Aging and Human Development
- Geriatrics Research Education and Clinical Center, Durham Veterans Affairs Medical Center, Durham, North Carolina
| | | | | | - Maren K. Olsen
- Durham Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Health Care System, Durham, North Carolina
- Departments of Biostatistics and Bioinformatics
| | - Kathryn I. Pollak
- Population Health Sciences, Duke University, Durham, North Carolina
- Cancer Prevention and Control, Duke Cancer Institute, Durham, North Carolina
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Identifying the Predictors of Patient-Centered Communication by Machine Learning Methods. Processes (Basel) 2022. [DOI: 10.3390/pr10122484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Patient-centered communication (PCC) quality is critical to increasing the quality of patient-centered care. Based on the nationally representative data of the Health Information National Trends Survey (HINTS) 2019–2020 (N = 4593), this study combined four machine learning methods, namely, Generalized Linear Models (GLM), Random Forests (Random Forests), Deep Neural Networks (Deep Learning), and Gradient Boosting Machines (GBM), to identify important PCC predictors through variable importance metrics. Fifteen variables were identified as important predictors, involving multiple dimensions, such as individual sociodemographic characteristics, health-related factors, and individual living habits. Among them, four novel potential associated variables are included, an individual’s level of verbal expression, exercise habits, etc., which significantly impacted respondents’ perceived PCC quality. This study revealed the value of combining feature selection with machine learning approaches to identify broad variables that could enhance PCC prediction and clinical decision-making, influence future PCC prediction research, and improve patient-centered care. In the future, other easy-to-interpret models can be combined to conduct further research on the impact direction and mechanism of important predictors on PCC.
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Fenton A, Stevens S, Cost Z, Bickford J, Kohut M, Jacobs EA, Hutchinson RN. Patients' and caregivers' experiences of hospitalization under COVID-19 visitation restrictions. J Hosp Med 2022; 17:819-826. [PMID: 35920080 PMCID: PMC9538139 DOI: 10.1002/jhm.12924] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Revised: 07/06/2022] [Accepted: 07/11/2022] [Indexed: 11/10/2022]
Abstract
BACKGROUND During the COVID-19 pandemic, hospitals did not allow caregiver visitation. Little is known about how caregivers' absence affected patients' care. OBJECTIVE This study aimed to describe visitation restrictions' impact on patients and their caregivers experiences. DESIGN We used a sequential explanatory mixed-methods study design. First, we randomly selected 200 adult patients with cancer or heart failure hospitalized before (n = 100) and during visitor restrictions (n = 100) and abstracted data from the electronic medical record on communication between medical teams and caregivers and the topics discussed. Results from the quantitative analysis guided our thematic analysis of semi-structured interviews conducted with a subsample of patients hospitalized during visitor restrictions and their caregivers to understand the impact of visitor restrictions on their experiences. RESULTS Compared to prerestrictions, caregivers under visitation restrictions communicated less frequently with the medical team (29% vs. 37% of hospitalized days; p = .04), fewer received discharge counseling (37% vs. 52%; p = .04), and disproportionately more had no contact with the medical team (36% vs. 17%; p < .01). Video conferencing was documented for caregivers of only five patients. Qualitative analysis revealed that both caregivers and patients experienced emotional distress, increased conflict, and decreased perception of quality of care because of visitation restrictions. CONCLUSIONS Hospital visitor restrictions significantly reduced caregivers' communication with patients' medical team, causing caregivers and patients emotional distress. Protocols that facilitate communication between caregivers and care teams may benefit caregivers who cannot be physically present at care facilities, including distance caregivers.
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Affiliation(s)
- Anny Fenton
- Division of Population SciencesDana Farber Cancer InstituteBostonMassachusettsUSA
| | - Sandra Stevens
- Maine Medical CenterDivision of Palliative MedicinePortlandMaineUSA
| | - Zachary Cost
- Tufts University School of MedicineBostonMassachusettsUSA
| | - Jaime Bickford
- Maine Medical CenterDivision of Palliative MedicinePortlandMaineUSA
| | - Michael Kohut
- MaineHealth Center for Interdisciplinary Population Health ResearchPortlandMaineUSA
| | - Elizabeth A. Jacobs
- Tufts University School of MedicineBostonMassachusettsUSA
- MaineHealth Center for Interdisciplinary Population Health ResearchPortlandMaineUSA
| | - Rebecca N. Hutchinson
- Maine Medical CenterDivision of Palliative MedicinePortlandMaineUSA
- Tufts University School of MedicineBostonMassachusettsUSA
- MaineHealth Center for Interdisciplinary Population Health ResearchPortlandMaineUSA
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Blease C. Sharing online clinical notes with patients: implications for nocebo effects and health equity. JOURNAL OF MEDICAL ETHICS 2022; 49:medethics-2022-108413. [PMID: 35918134 DOI: 10.1136/jme-2022-108413] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Accepted: 07/22/2022] [Indexed: 06/15/2023]
Abstract
Patients in around 20 countries worldwide are now offered online access to at least some of their medical records. Access includes test results, medication lists, referral information, and/or the very words written by clinicians (so-called 'open notes'). In this paper, I discuss the possibility of one unintended negative consequence of patient access to their clinical notes-the potential to increase 'nocebo effects'. A growing body of research shows that nocebo effects arise by engaging perceptual and cognitive processes that influence negative expectancies, and as a consequence, adverse health effects. Studies show that increased awareness about the side effects of medications, the framing of information and the socioemotional context of care can increase the risk of nocebo effects. Connecting research into the nocebo effect with open notes provides preliminary support for the hypothesis that patient access to clinical notes might be a forum for facilitating unwanted nocebo effects. Furthermore, current findings indicate that we might expect to see systematic differences in how nocebo effects are experienced among different patient populations. The ethical implications of the tension between transparency and the potential for harm are discussed, with an emphasis on what open notes might mean for justice and equity in clinical care for a range of already marginalised patient populations. I argue that to resolve these challenges does not thereby justify 'closed notes', and conclude with suggestions for how health systems and clinicians might adapt to this innovation to reduce the risk of potential nocebo effects arising via this novel route.
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Affiliation(s)
- Charlotte Blease
- Division of General Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts 02115, USA
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35
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Glaucoma Treatment Outcomes in Open Angle Glaucoma Patients of African Descent. J Glaucoma 2022; 31:479-487. [PMID: 35353787 PMCID: PMC9246921 DOI: 10.1097/ijg.0000000000002027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Accepted: 03/19/2022] [Indexed: 01/31/2023]
Abstract
Open angle glaucoma (OAG), characterized by structural changes to the optic nerve head and retinal nerve fiber layer, is a progressive multifactorial optic neuropathy and a leading cause of irreversible blindness globally. Currently, intraocular pressure is the only modifiable risk factor; however, others have been identified, including genetics and race. Importantly, OAG is much more prevalent in persons of African descent (AD) compared with those of European descent (ED). OAG patients of AD are also known to have a more severe course of the disease, a finding potentially explained by structural and/or vascular differences within eye tissues. In addition, disparities in treatment outcomes have been identified in OAG patients of AD. Specifically, prostaglandin analogues have been suggested to be more effective in patients of AD than in those ED, while beta-adrenergic receptors have been suggested to be less effective, although the evidence is inconsistent. AD has also been identified as a risk factor for trabeculectomy failure while laser trabeculoplasty has been conversely found to be very effective in lowering intraocular pressure in patients of AD. Alternative surgical options, including Ex-Press shunt implantation, viscocanalostomy, and canaloplasty are promising in equivalence but require further research to evaluate disparity in outcome properly. In addition to treatment outcomes, social disparities affecting clinical care also exist for AD persons in the form of reduced adherence, access, and choice. Overall, data suggest the need for properly designed prospective trials with AD populations as a primary focus to identify the potential mechanisms driving disparities in treatment and address overall potential bias in glaucoma management.
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Riccetti N, Hempler I, Hermes-Moll K, Heidt V, Bayer O, Walawgo T, Merbach M, Singer S. Linguistic barriers in communication between oncologists and cancer patients with migration background in Germany: an explorative analysis based on the perspective of the oncologists from the mixed-methods study POM. RESEARCH IN HEALTH SERVICES & REGIONS 2022; 1:3. [PMID: 39177829 PMCID: PMC11264866 DOI: 10.1007/s43999-022-00001-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/20/2021] [Accepted: 05/02/2022] [Indexed: 08/24/2024]
Abstract
OBJECTIVE We aimed at investigating the predictors of linguistic barriers among office-based haemato-oncologists during consultation with migrant cancer patients in Germany. METHODS Physicians from haemato-oncological practices were invited to participate in a cross-sectional study. Linguistic barriers and family factors were ascertained using a newly developed online-questionnaire with the scales "Overall linguistic barriers", "Self-perceived linguistic barriers" and "Family factors - antagonistic behaviour". Predictors of linguistic barriers were identified using multivariate ANOVA via step-wise backwards selection. RESULTS Fifty-five physicians participated in the study. Treating patients from Sub-Saharan Africa predicted higher overall and self-perceived linguistic barriers (F [2,46] = 4.51, p = .04; and F [3,45] = 5.44, p = .02, respectively). Working in an single practice (F [3,45] = 4.19; p = .05) predicted higher self-perceived linguistic barriers. Employees who could act as translators predicted lower barriers in form of antagonistic behaviour from relatives (F [2,48] = 6.12; p = .02). CONCLUSIONS The results indicate that linguistic barriers are affected by the level of linguistic concordance between patients and medical personnel. A temporary solution might be the presence of linguistically competent personnel in the practice. However, the results of this study highlight the need for greater availability of linguistic competent translators for consultations in haemato-oncological practices.
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Affiliation(s)
- Nicola Riccetti
- University Medical Centre, Institute of Medical Biostatistics, Epidemiology and Informatics (IMBEI), Mainz, Germany.
- University Cancer Centre Mainz, Mainz, Germany.
| | - Isabelle Hempler
- Scientific Institute of Office-Based Haematologists and Oncologists (WINHO GmbH), Cologne, Germany
| | - Kerstin Hermes-Moll
- Scientific Institute of Office-Based Haematologists and Oncologists (WINHO GmbH), Cologne, Germany
| | - Vitali Heidt
- Scientific Institute of Office-Based Haematologists and Oncologists (WINHO GmbH), Cologne, Germany
| | - Oliver Bayer
- University Medical Centre, Institute of Medical Biostatistics, Epidemiology and Informatics (IMBEI), Mainz, Germany
- University Cancer Centre Mainz, Mainz, Germany
| | - Thomas Walawgo
- Scientific Institute of Office-Based Haematologists and Oncologists (WINHO GmbH), Cologne, Germany
| | - Martin Merbach
- Evangelisches Zentralinstitut Für Familienberatung, Berlin, Germany
| | - Susanne Singer
- University Medical Centre, Institute of Medical Biostatistics, Epidemiology and Informatics (IMBEI), Mainz, Germany
- University Cancer Centre Mainz, Mainz, Germany
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Schuller BW, Burch C, Casterton T, Crowther C, Fowler J, Stenmark MH. Precision patient education using a "flipped classroom" approach. J Appl Clin Med Phys 2022; 23:e13601. [PMID: 35482549 PMCID: PMC9121034 DOI: 10.1002/acm2.13601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 03/05/2022] [Accepted: 03/16/2022] [Indexed: 11/22/2022] Open
Abstract
Objectives To improve patient education delivered over telemedicine by using a “flipped classroom”‐inspired approach. Methods A “flipped classroom” is an education strategy used to engage active learning by sending students home with lecture material and reserving classroom time for collaborative learning. To adapt this approach for use in radiation oncology patient education, three pieces of written education material were created: introduction to radiation oncology, treatment planning scan, and treatment delivery. An automated system was created to deliver precisely timed emails at three time points ahead of appointments. Appointment time was then used for collaborative learning with our staff. As a primary endpoint, email engagement metrics were tracked via the automated system. Secondarily, enrolled patients were surveyed to assess level of understanding (before vs. after intervention), anxiety (before vs. after intervention), and satisfaction. Additionally, email delivery timing, clarity, relevance, and patient support were evaluated. Data analyses test the impact of active learning against our existing education approaches. Results Overall, 77.1% of the emails were opened, and of those, patients accessed 72.2% of the education material. Patients re‐read the education material 4.6 times on average. Active learning increased patient understanding regarding the purpose of the treatment planning scan (p = 0.031) and increased patient understanding of what to expect during daily radiation treatments (p = 0.0078). Patients reported reduced anxiety (p = 0.031) and high scores for satisfaction, timing, clarity, relevance, and overall support. Conclusions Patient engagement with the education material was high, and they continued to access it many times. Active learning enhances patient comprehension of complex treatment information leading to decreased anxiety. Furthermore, this technique can be incorporated into existing telemedicine with basic technology.
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Affiliation(s)
- Bradley W Schuller
- SCL Health, St. Joseph Hospital, Radiation Oncology, Denver, Colorado, USA
| | - Christina Burch
- SCL Health, St. Joseph Hospital, Radiation Oncology, Denver, Colorado, USA
| | | | | | - Jordan Fowler
- SCL Health, St. Joseph Hospital, Radiation Oncology, Denver, Colorado, USA
| | - Matthew H Stenmark
- Kaiser Permanente, St. Joseph Hospital, Radiation Oncology, Denver, Colorado, USA
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Chen AT, Tsui S, Sharma RK. Characterizing uncertainty in goals-of-care discussions among black and white patients: a qualitative study. Palliat Care 2022; 21:24. [PMID: 35177049 PMCID: PMC8851788 DOI: 10.1186/s12904-022-00912-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2021] [Accepted: 02/01/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Uncertainty has been associated with distress and poorer quality of life in patients with advanced cancer. Prior studies have focused on prognostic uncertainty; little is known about other types of uncertainty that patients and family members experience when discussing goals of care. Understanding the types of uncertainty expressed and differences between Black and White patients can inform the development of uncertainty management interventions. METHODS This study sought to characterize the types of uncertainty expressed by Black and White patients and family members within the context of information needs during inpatient goals-of-care discussions. We performed a secondary analysis of transcripts from 62 recorded goals-of-care discussions that occurred between 2012 and 2014 at an urban, academic medical center in the United States. We applied an adapted taxonomy of uncertainty to data coded as describing information needs and used an inductive qualitative analysis method to analyze the discussions. We report the types of uncertainty expressed in these discussions. RESULTS Fifty discussions included patient or family expressions of information needs. Of these, 40 discussions (n=16 Black and n=24 White) included statements of uncertainty. Black and White patients and families most frequently expressed uncertainty related to processes and structures of care (system-centered uncertainty) and to treatment (scientific uncertainty). Statements of prognostic uncertainty focused on quantitative information among Whites and on qualitative information and expectations for the future among Blacks. CONCLUSIONS Black and White patients and families frequently expressed system-centered uncertainty, suggesting this may be an important target for intervention. Addressing other sources of uncertainty, such as prognostic uncertainty, may need more tailored approaches.
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Affiliation(s)
- Annie T Chen
- Department of Biomedical Informatics and Medical Education, University of Washington School of Medicine, 850 Republican St, Box 358047, 98109, Seattle, WA, United States.
| | - Shelley Tsui
- University of Washington, WA, Seattle, United States
| | - Rashmi K Sharma
- Division of General Internal Medicine, University of Washington School of Medicine, Seattle, WA, United States
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Kwon DH, Karthikeyan S, Chang A, Borno HT, Koshkin VS, Desai A, Bose R, Friedlander T, Rodvelt T, Li P, Small EJ, Aggarwal RR, Belkora J. Mobile Audio Recording Technology to Promote Informed Decision Making in Advanced Prostate Cancer. JCO Oncol Pract 2021; 18:e648-e658. [PMID: 34932386 DOI: 10.1200/op.21.00480] [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
PURPOSE Men with metastatic castration-resistant prostate cancer increasingly encounter complex treatment decisions. Consultation audio recordings and summaries promote patient informed decision making but are underutilized. Mobile recording software applications may increase access. Little is known regarding the feasibility of implementation in clinical encounters. METHODS We conducted a mixed-methods pilot study in men with progressive metastatic castration-resistant prostate cancer. We instructed patients to use a mobile software application to record an oncology visit. Patients could share the recording with our patient scribing program to receive a written summary. We assessed feasibility and acceptability with postvisit surveys. We measured patient-reported helpfulness of the intervention in decision making and change in Decisional Conflict Scale-informed subscale. We conducted semistructured interviews to explore implementation and analyzed transcripts using thematic analysis. RESULTS Across 20 patients, 18 (90%) recorded their visits. Thirteen of 18 (72%) listened to the recording, and 14 of 18 (78%) received a summary. Eighteen of 20 (90%) visits were telehealth. Fourteen patients (70% of all 20; 78% of 18 question respondents) found the application easy to use. Nine patients (50% of 18 recording patients; 90% of 10 question respondents) reported that the recording helped treatment decision making. Decisional conflict decreased from baseline to 1-week postvisit (47.4-28.5, P < .001). Interviews revealed benefits, facilitators, contextual factors, and technology and patient-related barriers to recordings and summaries. CONCLUSION In this single-institution academic setting, a mobile application for patients to record consultations was a feasible, acceptable, and potentially valued intervention that improved decision making in the telehealth setting. Studies in larger, diverse populations are needed.
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Affiliation(s)
- Daniel H Kwon
- Division of Hematology/Oncology, Department of Medicine, University of California, San Francisco, San Francisco, CA
| | - Sneha Karthikeyan
- Department of Surgery, University of California, San Francisco, San Francisco, CA
| | - Alison Chang
- Department of Surgery, University of California, San Francisco, San Francisco, CA
| | - Hala T Borno
- Division of Hematology/Oncology, Department of Medicine, University of California, San Francisco, San Francisco, CA.,Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, San Francisco, CA
| | - Vadim S Koshkin
- Division of Hematology/Oncology, Department of Medicine, University of California, San Francisco, San Francisco, CA.,Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, San Francisco, CA
| | - Arpita Desai
- Division of Hematology/Oncology, Department of Medicine, University of California, San Francisco, San Francisco, CA.,Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, San Francisco, CA
| | - Rohit Bose
- Division of Hematology/Oncology, Department of Medicine, University of California, San Francisco, San Francisco, CA.,Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, San Francisco, CA
| | - Terence Friedlander
- Division of Hematology/Oncology, Department of Medicine, University of California, San Francisco, San Francisco, CA.,Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, San Francisco, CA
| | - Tammy Rodvelt
- Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, San Francisco, CA
| | - Patricia Li
- Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, San Francisco, CA
| | - Eric J Small
- Division of Hematology/Oncology, Department of Medicine, University of California, San Francisco, San Francisco, CA.,Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, San Francisco, CA
| | - Rahul R Aggarwal
- Division of Hematology/Oncology, Department of Medicine, University of California, San Francisco, San Francisco, CA.,Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, San Francisco, CA
| | - Jeffrey Belkora
- Department of Surgery, University of California, San Francisco, San Francisco, CA.,Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, San Francisco, CA.,Institute for Health Policy Studies, University of California, San Francisco, San Francisco, CA
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Gautier G, Lucas M, Vermeulin T, Di Fiore F, Merle V. Deprived social status is associated with decreased use of oral chemotherapy in patients with metastatic colorectal cancer: A retrospective cohort study on administrative databases in a French University Hospital. Pharmacol Res Perspect 2021; 9:e00888. [PMID: 34766736 PMCID: PMC8587174 DOI: 10.1002/prp2.888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Accepted: 10/02/2021] [Indexed: 11/15/2022] Open
Abstract
Factors associated with the choice of oral versus intravenous CT are not clearly established. Our purpose was to evaluate the influence of social status and home distance to hospital on the use of oral CT in patients with metastatic colorectal cancer (mCRC). This retrospective single-center study included mCRC patients between 2011 and 2017. Patient social status was assessed by European Deprivation Index (EDI) and home distance to the hospital was calculated. Univariable and multivariable logistic regression analyses were performed. One hundred and seventy-five mCRC patients were included, with 71 receiving oral CT. Most deprived patients received less oral CT (OR 0.5 [0.26, 0.96], p = .039). No association was found for road distance. Previous use of adjuvant oral CT was associated with oral CT in mCRC (OR 2.65 [1.06, 6.66], p = .038). Our results suggest that deprived social status is a factor associated with decreased use of oral CT in patients with mCRC. Clinical trial registration: no registration.
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Affiliation(s)
- Gwendoline Gautier
- Department of HepatogastroenterologyRouen University HospitalUNIROUENRouenFrance
| | - Mélodie Lucas
- Department of Medical InformationLe Havre HospitalLe HavreFrance
- Dynamiques et Evènements des Soins et des Parcours Research GroupRouen University HospitalUNIROUENRouenFrance
| | - Thomas Vermeulin
- Dynamiques et Evènements des Soins et des Parcours Research GroupRouen University HospitalUNIROUENRouenFrance
- CLCC H. BecquerelUnicancerRouenFrance
- LEDA‐LEGOSUniversité Paris‐DauphineParisFrance
| | - Frederic Di Fiore
- Department of HepatogastroenterologyRouen University HospitalUNIROUENRouenFrance
- CLCC H. BecquerelUnicancerRouenFrance
| | - Veronique Merle
- Dynamiques et Evènements des Soins et des Parcours Research GroupRouen University HospitalUNIROUENRouenFrance
- Inserm U1086 ANTICIPECaenFrance
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Burkhardt J, DesJardins S, Gruppen L. Diversity of the physician workforce: Specialty choice decisions during medical school. PLoS One 2021; 16:e0259434. [PMID: 34735513 PMCID: PMC8568153 DOI: 10.1371/journal.pone.0259434] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Accepted: 10/20/2021] [Indexed: 12/04/2022] Open
Abstract
Background Despite efforts to increase the overall diversity of the medical student body, some medical specialties have a less diverse applicant pool based on both gender and race than would be expected based on medical graduate demographics. Objectives To identify whether women and Underrepresented in Medicine (URiM) medical students have baseline differences in their career interests or if their career plans change more during medical school when compared to men and non-URIM students. Methods Secondary data analyses of all medical students who applied through ERAS from 2005–2010 was conducted. Binary logistic regression models with the response being a planned career in one of four medical specialties (internal medicine, pediatrics, OB/GYN, and general surgery/surgical specialties) at medical school entry and graduation. Regression models included demographics, student attitudes, debt, academic metrics, and medical school experiences. Results Comparatively, women were less likely to be interested in internal medicine and surgery and more interested in pediatrics and OB/GYN at matriculation. URiM students expressed more interest in OB/GYN and surgery when starting medical school. At graduation, women were less likely to plan for internal medicine and surgery and were more interested in pursuing OB/GYN and pediatrics. URiM students were more likely to plan for a career in internal medicine and less likely to choose pediatrics. Conclusions From matriculation to graduation, women have relatively stable preferences regarding planned medical specialties. In contrast, URiM students’ specialty plans shifted over time among the four specialties, with variation in preferences occurring between matriculation and graduation.
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Affiliation(s)
- John Burkhardt
- Department of Emergency Medicine and Learning Health Sciences at the University of Michigan Medical School, Ann Arbor, Michigan, United States of America
- * E-mail:
| | - Stephen DesJardins
- Center for the Study of Higher and Postsecondary Education at the University of Michigan School of Education and Gerald Ford School of Public Policy, Ann Arbor, Michigan, United States of America
| | - Larry Gruppen
- Department of Learning Health Sciences at the University of Michigan Medical School, Ann Arbor, Michigan, United States of America
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Abstract
Drawing on recent experiences as a Chief Resident, the author proposes several strategies for promoting health equity. Challenges to this task are highlighted. The Chief Resident's ability to bypass these obstacles and construct experiences that promote long-term change is explored through the framework of the formal, informal, and hidden curricula. The strategic use of didactic conferences, role-modeling, and personnel decisions are emphasized.
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Anderson JN, Graff C, Krukowski RA, Schwartzberg L, Vidal GA, Waters TM, Paladino AJ, Jones TN, Blue R, Kocak M, Graetz I. "Nobody Will Tell You. You've Got to Ask!": An Examination of Patient-Provider Communication Needs and Preferences among Black and White Women with Early-Stage Breast Cancer. HEALTH COMMUNICATION 2021; 36:1331-1342. [PMID: 32336140 PMCID: PMC7606266 DOI: 10.1080/10410236.2020.1751383] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/20/2023]
Abstract
Patient-provider communication is a critical component of healthcare and is associated with treatment quality and outcomes for women with breast cancer. This qualitative study examines similarities and differences in patient perspectives of communication needs between Black and White breast cancer survivors. We conducted four focus groups (N = 28) involving women with early-stage breast cancer on adjuvant endocrine therapy (AET), stratified by race and length of time on AET (< 6 months and >6 months). Each group was moderated by a race-concordant moderator and analyzed by emergent themes. Participants expressed common patient-provider communication needs, namely increased sensitivity from oncologists during the initial cancer diagnosis, personalized information to facilitate treatment decisions, emotional support during the transition from active treatment to maintenance, and rapid provider responses to mobile app-based queries. Communication differences by race also emerged. Black women were less likely than White women to describe having their informational needs met. White women praised longstanding relationships with providers, while Black women shared personal stories of disempowered interactions and noted the importance of patient advocates. White women more often reported privacy concerns about technology use. Unlike White women, Black women reported willingness to discuss sensitive topics, both online and offline, but believed those discussions made their providers feel uncomfortable. Early-stage breast cancer patients on AET, regardless of race, have similar needs for patient-centered communication with their oncologists. However, Black women were more likely to report experiencing poorer communication with providers than White women, which may be improved by technology and advocates.
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Affiliation(s)
- Janeane N. Anderson
- University of Tennessee Health Science Center, College of Medicine, Department of Preventive Medicine, 66 N. Pauline St., Ste. 633, Memphis, TN 38163
- University of Tennessee Health Science Center, College of Nursing, Department of Health Promotion and Disease Prevention, 920 Madison Avenue; Memphis, TN 38163
| | - Carolyn Graff
- University of Tennessee Health Science Center, College of Nursing, Department of Health Promotion and Disease Prevention, 920 Madison Avenue; Memphis, TN 38163
| | - Rebecca A. Krukowski
- University of Tennessee Health Science Center, College of Medicine, Department of Preventive Medicine, 66 N. Pauline St., Ste. 633, Memphis, TN 38163
| | - Lee Schwartzberg
- West Cancer Center Research Institute, 7945 Wolf River Blvd, Germantown, TN 38138
- University of Tennessee Health Science Center, College of Medicine, Division of Hematology/Oncology; 956 Court Avenue, Memphis, TN 38163
| | - Gregory A. Vidal
- West Cancer Center Research Institute, 7945 Wolf River Blvd, Germantown, TN 38138
- University of Tennessee Health Science Center, College of Medicine, Division of Hematology/Oncology; 956 Court Avenue, Memphis, TN 38163
| | - Teresa M. Waters
- University of Tennessee Health Science Center, College of Medicine, Department of Preventive Medicine, 66 N. Pauline St., Ste. 633, Memphis, TN 38163
- University of Kentucky, College of Public Health, Department of Health Management and Policy, 111 Washington Ave., Lexington, KY 40536
| | - Andrew J. Paladino
- University of Tennessee Health Science Center, College of Medicine, Department of Preventive Medicine, 66 N. Pauline St., Ste. 633, Memphis, TN 38163
- West Cancer Center Research Institute, 7945 Wolf River Blvd, Germantown, TN 38138
| | - Tameka N. Jones
- West Cancer Center Research Institute, 7945 Wolf River Blvd, Germantown, TN 38138
| | - Ryan Blue
- University of Tennessee Health Science Center, College of Nursing, Department of Health Promotion and Disease Prevention, 920 Madison Avenue; Memphis, TN 38163
| | - Mehmet Kocak
- University of Tennessee Health Science Center, College of Medicine, Department of Preventive Medicine, 66 N. Pauline St., Ste. 633, Memphis, TN 38163
| | - Ilana Graetz
- University of Tennessee Health Science Center, College of Medicine, Department of Preventive Medicine, 66 N. Pauline St., Ste. 633, Memphis, TN 38163
- Emory University, Rollins School of Public Health, Department of Health Policy and Management; 1518 Clifton Road NE, Atlanta, GA 30322
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Yen RW, Smith J, Engel J, Muscat DM, Smith SK, Mancini J, Perestelo-Pérez L, Elwyn G, O'Malley AJ, Leyenaar JK, Mac O, Cadet T, Giguere A, Housten AJ, Langford A, McCaffery K, Durand MA. A Systematic Review and Meta-Analysis of Patient Decision Aids for Socially Disadvantaged Populations: Update from the International Patient Decision Aid Standards (IPDAS). Med Decis Making 2021; 41:870-896. [PMID: 34151614 PMCID: PMC8763253 DOI: 10.1177/0272989x211020317] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
BACKGROUND The effectiveness of patient decision aids (PtDAs) and other shared decision-making (SDM) interventions for socially disadvantaged populations has not been well studied. PURPOSE To assess whether PtDAs and other SDM interventions improve outcomes or decrease health inequalities among socially disadvantaged populations and determine the critical features of successful interventions. DATA SOURCES MEDLINE, CINAHL, Cochrane, PsycINFO, and Web of Science from inception to October 2019. Cochrane systematic reviews on PtDAs. STUDY SELECTION Randomized controlled trials of PtDAs and SDM interventions that included socially disadvantaged populations. DATA EXTRACTION Independent double data extraction using a standardized form and the Template for Intervention Description and Replication checklist. DATA SYNTHESIS Twenty-five PtDA and 13 other SDM intervention trials met our inclusion criteria. Compared with usual care, PtDAs improved knowledge (mean difference = 13.91, 95% confidence interval [CI] 9.01, 18.82 [I2 = 96%]) and patient-clinician communication (relative risk = 1.62, 95% CI 1.42, 1.84 [I2 = 0%]). PtDAs reduced decisional conflict (mean difference = -9.59; 95% CI -18.94, -0.24 [I2 = 84%]) and the proportion undecided (relative risk = 0.39; 95% CI 0.28, 0.53 [I2 = 75%]). PtDAs did not affect anxiety (standardized mean difference = 0.02, 95% CI -0.22, 0.26 [I2 = 70%]). Only 1 trial looked at clinical outcomes (hemoglobin A1C). Five of the 12 PtDA studies that compared outcomes by disadvantaged standing found that outcomes improved more for socially disadvantaged participants. No evidence indicated which intervention characteristics were most effective. Results were similar for SDM intervention trials. LIMITATIONS Sixteen PtDA studies had an overall unclear risk of bias. Heterogeneity was high for most outcomes. Most studies only had short-term follow-up. CONCLUSIONS PtDAs led to better outcomes among socially disadvantaged populations but did not reduce health inequalities. We could not determine which intervention features were most effective.[Box: see text].
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Affiliation(s)
- Renata W Yen
- The Dartmouth Institute for Health Policy & Clinical Practice, Dartmouth College, Lebanon, NH, USA
| | - Jenna Smith
- Sydney Health Literacy Lab, School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Jaclyn Engel
- The Dartmouth Institute for Health Policy & Clinical Practice, Dartmouth College, Lebanon, NH, USA
| | - Danielle Marie Muscat
- Sydney Health Literacy Lab, School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Sian K Smith
- University of Bath, School of Management, Bath, Somerset, UK
| | - Julien Mancini
- Aix-Marseille Université, APHM, INSERM, IRD, SESSTIM, Marseille, Provence-Alpes-Cote d'Azu, France
| | | | - Glyn Elwyn
- The Dartmouth Institute for Health Policy & Clinical Practice, Dartmouth College, Lebanon, NH, USA
| | - A James O'Malley
- The Dartmouth Institute for Health Policy & Clinical Practice, Dartmouth College, Lebanon, NH, USA
- Department of Biomedical Sciences, Dartmouth College, Lebanon, NH, USA
| | - JoAnna K Leyenaar
- The Dartmouth Institute for Health Policy & Clinical Practice, Dartmouth College, Lebanon, NH, USA
- Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
| | - Olivia Mac
- Sydney Health Literacy Lab, School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Tamara Cadet
- School of Social Work, Simmons University, Boston, MA, USA
- Harvard School of Dental Medicine, Boston, MA, USA
| | - Anik Giguere
- Department of Family Medicine and Emergency Medicine, Laval University, Quebec, Canada
| | | | - Aisha Langford
- New York University School of Medicine, Division of Comparative Effectiveness and Decision Science, Department of Population Health, NYU Langone Medical Centre, New York, NY, USA
| | - Kirsten McCaffery
- Sydney Health Literacy Lab, School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Marie-Anne Durand
- The Dartmouth Institute for Health Policy & Clinical Practice, Dartmouth College, Lebanon, NH, USA
- Faculté de Médecine, Université Toulouse III Paul Sabatier, Toulouse, France
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Reeder-Hayes KE, Troester MA, Wheeler SB. Adherence to Endocrine Therapy and Racial Outcome Disparities in Breast Cancer. Oncologist 2021; 26:910-915. [PMID: 34582070 DOI: 10.1002/onco.13964] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Accepted: 09/02/2021] [Indexed: 11/10/2022] Open
Abstract
The disparity in outcomes of breast cancer for Black compared with White women in the U.S. is well known and persistent over time, with the largest disparities appearing among women with hormone receptor-positive (HR+) cancers. The racial gap in breast cancer survival first emerged in the 1980s, a time of significantmen treatment advances in early-stage breast cancer, including the introduction of adjuvant endocrine therapy. Since that time, the gap has continued to widen despite steady advances in treatment and survival of breast cancer overall. Although advanced stage at presentation and unfavorable biology undoubtedly contribute to racial differences in survival of HR+ breast, treatment disparities are increasingly acknowledged to play a key role as well. The recent recognition of racial differences in endocrine therapy use may be a key explanatory factor in the persistent racial gap in mortality of HR+ disease, and may be a key focus of intervention to improve breast cancer outcomes for Black women. IMPLICATIONS FOR PRACTICE: Black women with hormone receptor-positive breast cancer experience the greatest racial disparity in survival among all breast cancer subtypes. This survival gap appears consistently across studies and is not entirely explained by differences in presenting stage, tumor biology as assessed by genomic risk scores, or receipt of chemotherapy. Recent research highlights lower adherence to endocrine therapy (ET) for Black women. Health systems and individual providers should focus on improving communication about the importance of ET use, sharing decisions around ET, providing appropriate support for side effects and other ET-related concerns, and equitably delivering survivorship care, including ET adherence assessment.
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Affiliation(s)
- Katherine E Reeder-Hayes
- Division of Oncology, University of North Carolina-Chapel Hill School of Medicine, Chapel Hill, North Carolina, USA.,University of North Carolina Lineberger Comprehensive Cancer Center, Chapel Hill, North Carolina, USA
| | - Melissa A Troester
- Department of Epidemiology, UNC Gillings School of Global Public Health, Chapel Hill, North Carolina, USA.,University of North Carolina Lineberger Comprehensive Cancer Center, Chapel Hill, North Carolina, USA
| | - Stephanie B Wheeler
- Department of Health Policy, UNC Gillings School of Global Public Health, Chapel Hill, North Carolina, USA.,University of North Carolina Lineberger Comprehensive Cancer Center, Chapel Hill, North Carolina, USA
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46
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Roe AK, Eppler SL, Shapiro LM, Satteson ES, Yao J, Kamal RN. Engaging Patients to Ask More Questions: What's the Best Way? A Pragmatic Randomized Controlled Trial. J Hand Surg Am 2021; 46:818.e1-818.e6. [PMID: 33775464 PMCID: PMC8429060 DOI: 10.1016/j.jhsa.2021.02.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Revised: 11/23/2020] [Accepted: 02/03/2021] [Indexed: 02/02/2023]
Abstract
PURPOSE Hand conditions are common, and often require a discussion of the tradeoffs of different treatment options. Our goal was to evaluate whether providing patients with a Question Prompt List (QPL) for common hand conditions improves their perceived involvement in care compared with providing patients with 3 generic questions. METHODS We performed a prospective, single-center, pragmatic randomized controlled trial. We created a QPL pamphlet for patients with common hand conditions. New patients with common hand conditions were enrolled between April 2019 and July 2019 and were randomized into either the QPL group (with 35 hand-specific questions) or the AskShareKnow group (3 generic questions: [1] What are my options? [2] What are the possible benefits and harms of those options? [3] How likely are each of these benefit and harms to happen to me?). Both groups received the questions prior to meeting with their surgeon. We used the Perceived Involvement in Care Scale (PICS), a validated instrument designed to evaluate patient participation in decision-making, as our primary outcome. The maximum PICS score is 13, and a higher score indicates higher perceived involvement. RESULTS One hundred twenty-six patients participated in the study, with 63 patients in the QPL group and 63 patients in the AskShareKnow group. The demographic characteristics were similar in the 2 groups. The mean AskShareKnow group PICS score was 8.3 ± 2.2 and the mean QPL PICS score was 7.5 ± 2.8, which was not deemed clinically significant. CONCLUSIONS The QPLs do not increase perceived involvement in care in patients with hand conditions compared with providing patients with 3 generic questions. CLINICAL RELEVANCE Various approaches have been evaluated to help improve patient involvement in their care. In hand surgery, 3 generic questions were no different than a lengthy QPL with respect to patient involvement in their care.
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Affiliation(s)
- Allison K Roe
- Department of Orthopaedic Surgery, VOICES Health Policy Research Center, Stanford University, Redwood City, CA
| | - Sara L Eppler
- Department of Orthopaedic Surgery, VOICES Health Policy Research Center, Stanford University, Redwood City, CA
| | - Lauren M Shapiro
- Department of Orthopaedic Surgery, VOICES Health Policy Research Center, Stanford University, Redwood City, CA
| | - Ellen S Satteson
- Department of Orthopaedic Surgery, VOICES Health Policy Research Center, Stanford University, Redwood City, CA
| | - Jeffrey Yao
- Department of Orthopaedic Surgery, VOICES Health Policy Research Center, Stanford University, Redwood City, CA
| | - Robin N Kamal
- Department of Orthopaedic Surgery, VOICES Health Policy Research Center, Stanford University, Redwood City, CA.
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Dencker A, Tjørnhøj-Thomsen T, Pedersen PV. A qualitative study of mechanisms influencing social inequality in cancer communication. Psychooncology 2021; 30:1965-1972. [PMID: 34278655 DOI: 10.1002/pon.5767] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 06/23/2021] [Accepted: 06/23/2021] [Indexed: 11/12/2022]
Abstract
OBJECTIVE To understand and describe mechanisms influencing social inequality in cancer communication between patients, companions and healthcare professionals. METHODS The study was based on observations of 104 encounters and 30 semi-structured interviews with nurses and medical doctors on three Danish oncology wards. Observations, interviews and subsequent analysis were guided by the theoretical framework of cultural health capital developed by Shim to investigate mechanisms that may generate social inequality in cancer communication. The analysis addressed both interactive processes and interpretative meanings. RESULTS Information exchange was affected by (1) patient insight and preparation, (2) the presence of companions, and (3) communicating on patients' "home ground." Patients who, on the basis of language and hygiene, were assessed to have low capacity, received less information. Lack of mutual exchange of information left healthcare professionals and patients with fewer opportunities to provide-or receive-the best treatment. CONCLUSION Exchange of information between patients, companions and healthcare professionals is co-constructed in a mutual dynamic. To avoid social inequality in cancer communication, it is crucial that questions and answers allow proportionate insight into disease and treatment both for patients and for healthcare professionals.
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Affiliation(s)
- Annemarie Dencker
- Research Department for Health and Social Context, National Institute of Public Health, University of Southern Denmark, København, Denmark.,Department for Research, The Danish National Center for Grief, København, Denmark
| | - Tine Tjørnhøj-Thomsen
- Research Department for Health and Social Context, National Institute of Public Health, University of Southern Denmark, København, Denmark
| | - Pia Vivian Pedersen
- Research Department for Health and Social Context, National Institute of Public Health, University of Southern Denmark, København, Denmark
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48
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Vigier M, Thorson KR, Andritsch E, Stoeger H, Suerth L, Farkas C, Schwerdtfeger AR. Physiological linkage during interactions between doctors and cancer patients. Soc Sci Med 2021; 284:114220. [PMID: 34273870 DOI: 10.1016/j.socscimed.2021.114220] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Revised: 07/03/2021] [Accepted: 07/09/2021] [Indexed: 02/06/2023]
Abstract
INTRODUCTION Doctors and patients influence each other when interacting and, as a result, can become similar to each other in affect and behavior. In the current work, we examine whether they also become similar to each other on a moment-to-moment basis in their physiological responses. Specifically, we examine physiological linkage-how much a doctor's (or patient's) physiological response predicts a patient's (or doctor's) response at a subsequent time interval-and whether this changes over the course of doctor-patient relationships (measured as the number of consultations held for each unique doctor-patient dyad). METHODS We collected interbeat interval responses (IBI) continuously during consultations between oncologists and patients undergoing cancer treatment (N = 102 unique doctor-patient interactions) at a hospital in Austria. RESULTS Physiological linkage varied by an interaction between role (doctor vs. patient) and relationship length (in a non-linear, quadratic pattern). Patients showed significant positive linkage to their doctors (i.e., doctors' physiological responses positively, significantly predicted patients' responses) in relationships that spanned three to eight consultations together. Patients were not linked to their doctors in shorter or longer relationships. Doctors were never significantly linked to their patients, meaning that patients' physiological responses never predicted doctors' responses. CONCLUSION These results reveal that, by influencing patients' physiological responses on a moment-to-moment basis, doctors may have even more influence over patients' physiology than previously known.
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Affiliation(s)
- Marta Vigier
- Division of Oncology, Medical University of Graz, Graz, Austria; Department of Psychology, University of Graz, Graz, Austria.
| | - Katherine R Thorson
- Department of Psychology, Barnard College of Columbia University, New York, USA.
| | | | - Herbert Stoeger
- Division of Oncology, Medical University of Graz, Graz, Austria
| | - Leonie Suerth
- Department of Psychology, University of Graz, Graz, Austria
| | - Clemens Farkas
- Division of Oncology, Medical University of Graz, Graz, Austria
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Palmer Kelly E, McGee J, Obeng-Gyasi S, Herbert C, Azap R, Abbas A, Pawlik TM. Marginalized patient identities and the patient-physician relationship in the cancer care context: a systematic scoping review. Support Care Cancer 2021; 29:7195-7207. [PMID: 34195857 DOI: 10.1007/s00520-021-06382-8] [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: 02/01/2021] [Accepted: 06/21/2021] [Indexed: 11/25/2022]
Abstract
PURPOSE We sought to examine and categorize the current evidence on patient-physician relationships among marginalized patient populations within the context of cancer care using a systemic scoping review approach. METHODS Web-based discovery services (e.g., Google Scholar) and discipline-specific databases (e.g., PubMed) were queried for articles on the patient-physician relationship among marginalized cancer patients. The marginalized populations of interest included (1) race and ethnicity, (2) gender, (3) sexual orientation and gender identity, (4) age, (5) disability, (6) socioeconomic status, and (7) geography (rural/urban). Study screening and data extraction were facilitated through the Covidence software platform. RESULTS Of the 397 screened studies, 37 met study criteria-most articles utilized quantitative methodologies (n = 28). The majority of studies focused on racial and ethnic cancer disparities (n = 27) with breast cancer (n = 20) as the most common cancer site. Trust and satisfaction with the provider were the most prevalent issues cited in the patient-physician relationship. Differences in patient-physician communication practices and quality were also frequently discussed. Overall, studies highlighted the need for increased culturally congruent care among providers. CONCLUSION Results from this review suggest marginalized cancer patients face significant barriers in establishing culturally and linguistically congruent patient-physician relationships. Future studies should focus on the intersectionality of multiple marginalized identities and optimization of the patient-physician relationship.
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Affiliation(s)
| | - Julia McGee
- The Ohio State University, Columbus, OH, USA
| | - Samilia Obeng-Gyasi
- Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Chelsea Herbert
- Ohio University Heritage College of Osteopathic Medicine, Athens, OH, USA
| | - Rosevine Azap
- Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Alizeh Abbas
- Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Timothy M Pawlik
- Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA.
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Black KZ, Lightfoot AF, Schaal JC, Mouw MS, Yongue C, Samuel CA, Faustin YF, Ackert KL, Akins B, Baker SL, Foley K, Hilton AR, Mann-Jackson L, Robertson LB, Shin JY, Yonas M, Eng E. 'It's like you don't have a roadmap really': using an antiracism framework to analyze patients' encounters in the cancer system. ETHNICITY & HEALTH 2021; 26:676-696. [PMID: 30543116 PMCID: PMC6565499 DOI: 10.1080/13557858.2018.1557114] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/20/2017] [Accepted: 11/23/2018] [Indexed: 06/09/2023]
Abstract
Background: Cancer patients can experience healthcare system-related challenges during the course of their treatment. Yet, little is known about how these challenges might affect the quality and completion of cancer treatment for all patients, and particularly for patients of color. Accountability for Cancer Care through Undoing Racism and Equity is a multi-component, community-based participatory research intervention to reduce Black-White cancer care disparities. This formative work aimed to understand patients' cancer center experiences, explore racial differences in experiences, and inform systems-level interventions.Methods: Twenty-seven breast and lung cancer patients at two cancer centers participated in focus groups, grouped by race and cancer type. Participants were asked about what they found empowering and disempowering regarding their cancer care experiences. The community-guided analysis used a racial equity approach to identify racial differences in care experiences.Results: For Black and White patients, fear, uncertainty, and incomplete knowledge were disempowering; trust in providers and a sense of control were empowering. Although participants denied differential treatment due to race, analysis revealed implicit Black-White differences in care.Conclusions: Most of the challenges participants faced were related to lack of transparency, such that improvements in communication, particularly two-way communication could greatly improve patients' interaction with the system. Pathways for accountability can also be built into a system that allows patients to find solutions for their problems with the system itself. Participants' insights suggest the need for patient-centered, systems-level interventions to improve care experiences and reduce disparities.
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Affiliation(s)
- Kristin Z. Black
- Department of Health Education and Promotion, East Carolina University, Greenville, North Carolina, USA,
| | - Alexandra F. Lightfoot
- Department of Health Behavior, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA, ,
- Center for Health Promotion and Disease Prevention, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA,
| | | | - Mary S. Mouw
- Division of Geriatrics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA,
| | - Christina Yongue
- Department of Public Health Education, University of North Carolina at Greensboro, Greensboro, North Carolina, USA,
| | - Cleo A. Samuel
- Department of Health Policy and Management, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA,
| | - Yanica F. Faustin
- Department of Maternal and Child Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA,
| | | | - Barbara Akins
- Behavioral Health, Cone Health System, Greensboro, North Carolina, USA,
| | - Stephanie L. Baker
- Public Health Studies Program, Elon University, Elon, North Carolina, USA,
| | - Karen Foley
- University of Pittsburgh Cancer Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA,
| | - Alison R. Hilton
- Durham County Department of Public Health, Durham, North Carolina, USA,
| | - Lilli Mann-Jackson
- Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA,
| | - Linda B. Robertson
- University of Pittsburgh, UPMC Hillman Cancer Center, Pittsburgh, Pennsylvania, USA,
| | - Janet Y. Shin
- Georgia Department of Public Health, Atlanta, Georgia, USA,
| | - Michael Yonas
- Social Innovation, Research and Special Initiatives, The Pittsburgh Foundation, Pittsburgh, Pennsylvania, USA,
| | - Eugenia Eng
- Department of Health Behavior, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA, ,
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