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Ebeid FSE, Mokhtar GM, Zaky EA, Abdelmageed RI, Elkamel NM, Ali HGA. Psychosocial and mental profile of children with sickle cell disease and their caregivers. Pediatr Hematol Oncol 2024; 41:15-29. [PMID: 37773584 DOI: 10.1080/08880018.2023.2261975] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Accepted: 08/22/2023] [Indexed: 10/01/2023]
Abstract
Sickle cell disease (SCD), a chronic debilitating disorder that may negatively affect health-related quality-of-life (HRQoL). In this observational, case-control study, we aim to assess the prevalence of impaired psychosocial profile and poor HRQoL among SCD patients and their caregivers as well as to determine the association of such impairment with parameters of disease severity. Sixty-five children and adolescents with SCD and 65 age- and sex-matched healthy controls and their caregivers were recruited. Demographic and clinical characteristics were collected, and a thorough clinical and psychiatric assessments and HR QoL were conducted. Recruited children and adolescents with SCD were 34 (52.3%) boys and 31 (47.7%) girls, and their mean age was 11.40 ± 3.55. Most of them (n = 44, 67.7%) had sickle HbSβ+, and vaso-occlusive crises were the most common causes for hospital admission (n = 24, 36.9%). Children with SCD and their caregivers had depression and anxiety symptoms scores higher than reported in the control group. Children with SCD had significantly less self-esteem and less QoL scores with the least scores were in the communication domain. This adverse psychological profile was significantly negatively correlated with the age of the child, duration of illness, number and duration of hospitalizations, disease severity score, and occurrence of complications. We conclude that HRQoL of children suffering from SCD, and their caregivers are adversely affected necessitating implementation of interventions which focus on reducing depressive symptoms, enhancing self-esteem and QoL.
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Affiliation(s)
- Fatma S E Ebeid
- Department of Pediatric Haematology Oncology and BMT, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Galila Mohamed Mokhtar
- Department of Pediatric Haematology Oncology and BMT, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Eman Ahmed Zaky
- Department of Paediatric Psychiatry, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | | | - Nermeen Mohamed Elkamel
- Department of Pediatric Haematology Oncology and BMT, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Heba G A Ali
- Department of Pediatric Haematology Oncology and BMT, Faculty of Medicine, Ain Shams University, Cairo, Egypt
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Kosoko AA, Alford YR, Upplegger KA, Stevens GS. Not Just a Pain: A Medical Simulation Case About Biased Communication and Osteomyelitis in Pediatric Sickle Cell Anemia. MEDEDPORTAL : THE JOURNAL OF TEACHING AND LEARNING RESOURCES 2023; 19:11335. [PMID: 37593566 PMCID: PMC10427742 DOI: 10.15766/mep_2374-8265.11335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/11/2022] [Accepted: 05/01/2023] [Indexed: 08/19/2023]
Abstract
Introduction Biases in communication can be harmful to patient perceptions of care and the medical team's decision-making. Optimal communication must be taught and practiced similarly to the optimal management of the complex medical conditions associated with sickle cell disease (SCD). This simulation is designed to teach about biases, optimizing communication to and about a patient with SCD, and appropriately diagnosing and managing pediatric osteomyelitis as a complication of SCD. Methods We designed and implemented a simulation case targeting emergency medicine residents and fellows to raise awareness about biases associated with SCD care and the complication of osteomyelitis in children with SCD. The case was delivered as a scheduled educational activity. Guided debriefing about optimizing care and communication for this patient population followed the simulation. We measured outcomes based on facilitator field notes and participant evaluations (Likert-scale and open-response questions). Results Forty learners of varying medical practice proficiencies, societal experiences, and demographics participated, with 30 completing the postsimulation feedback survey. A majority (97%) of participants indicated that the experience was useful and would improve their clinical performance. Participants learned from each other's language and communication styles and reflected on their own communication. Discussion Overall, participants found the simulation very useful as a review of the medical diagnosis and management of osteomyelitis in pediatric SCD. Moreover, they were very engaged and interested in the opportunity to learn about communication biases, particularly as these relate to SCD, to optimize their patient care.
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Affiliation(s)
- Adeola A. Kosoko
- Assistant Professor, Department of Emergency Medicine, McGovern Medical School at the University of Texas Health Science Center at Houston
| | - Yakira R. Alford
- Third-Year Resident, Department of Emergency Medicine, McGovern Medical School at the University of Texas Health Science Center at Houston
| | - Karl A. Upplegger
- Pediatric Emergency Medicine Fellow, Department of Emergency Medicine, McGovern Medical School at the University of Texas Health Science Center at Houston
| | - Gowri S. Stevens
- Assistant Professor, Department of Emergency Medicine, McGovern Medical School at the University of Texas Health Science Center at Houston
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Colton ZA, Stanek CJ, Liles SM, Baker C, Barnard-Kirk T, Chan P, McCorkle B, Quinn GP, Shen Y, Theroux CI, Creary SE, Nahata L. Study protocol for FUTURES: Testing a web-based reproductive health education program for adolescent and young adult males with sickle cell disease. PLoS One 2023; 18:e0289039. [PMID: 37494379 PMCID: PMC10370742 DOI: 10.1371/journal.pone.0289039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Accepted: 07/05/2023] [Indexed: 07/28/2023] Open
Abstract
Individuals with sickle cell disease are increasingly surviving into adulthood, many of whom have interest in future biological parenthood. Reproductive health knowledge is low among adolescent and young adult males and their caregivers. Their understanding of these topics is needed to optimize their reproductive health outcomes. As such, through collaboration with a community advisory board (adolescents and young adults with sickle cell disease and mothers of adolescent and young adult males with sickle cell disease) and digital design team, we developed a web-based sickle cell disease-focused reproductive health program entitled FUTURES to address these knowledge gaps. For phase I of this two phase feasibility and acceptability study, adolescent and young adult males and their caregivers will complete a pre- and post-program reproductive health knowledge and attitudes questionnaire to assess change in knowledge. In phase II, after learning about fertility testing as part of the FUTURES curriculum, adolescent and young adult male participants are given the option to pursue testing. The two-phase study aims to: 1) develop and test the feasibility, acceptability, and efficacy of a reproductive health web-based educational program at increasing reproductive health knowledge in male adolescent and young adult males with sickle cell disease and their caregivers, and 2) assess feasibility of fertility testing. The long-term goal is to improve reproductive and psychosocial outcomes among adolescent and young adult males with sickle cell disease.
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Affiliation(s)
- Zachary A Colton
- The Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, Ohio, United States of America
| | - Charis J Stanek
- The Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, Ohio, United States of America
| | - Sophia M Liles
- The Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, Ohio, United States of America
| | - Christian Baker
- The Ohio State University, Columbus, OH, United States of America
| | | | - Peter Chan
- The Ohio State University, Columbus, OH, United States of America
| | - Ben McCorkle
- The Ohio State University, Columbus, OH, United States of America
| | - Gwendolyn P Quinn
- New York University School of Medicine, New York, New York, United States of America
| | - Yvette Shen
- The Ohio State University, Columbus, OH, United States of America
| | - Charleen I Theroux
- The Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, Ohio, United States of America
| | - Susan E Creary
- The Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, Ohio, United States of America
- The Ohio State University, Columbus, OH, United States of America
- Nationwide Children's Hospital, Columbus, Ohio, United States of America
| | - Leena Nahata
- The Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, Ohio, United States of America
- The Ohio State University, Columbus, OH, United States of America
- Nationwide Children's Hospital, Columbus, Ohio, United States of America
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Jean-Baptiste DM, Wassef M, Bolyai SS, Jenerette C. Individuals with Sickle Cell Disease Using SBAR as a Communication Tool: A Pilot Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:13817. [PMID: 36360702 PMCID: PMC9655268 DOI: 10.3390/ijerph192113817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/25/2022] [Revised: 10/16/2022] [Accepted: 10/17/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND Sickle cell disease (SCD) is a hemoglobinopathy that causes debilitating pain. Patients often report dissatisfaction during care seeking for pain or a sickle cell crisis (SCC). The Theory of Self-Care Management for SCD conceptualizes assertive communication as a self-care management resource that improves healthcare outcomes. OBJECTIVES This pilot study aimed to determine whether adults with SCD could learn to use the Situation, Background, Assessment, Recommendation (SBAR) communication method using a web-based trainer, and it aimed to determine their perceptions of the training. METHODS The participants included n = 18 adults with SCD. Inter-rater reliability (IRR) among three reviewers was used to evaluate the participants' ability to respond as expected to prompts using SBAR communication within the web-based platform. Content analysis was used to describe the participants' perspectives of the acceptability of using the SBAR patient-HCP communication simulation. RESULTS The SBAR IRR ranged from 64 to 94%, with 72% to 94% of the responses being evaluated as the using of the SBAR component as expected. The predominant themes identified were (1) Patient-Provider Communication and Interaction; (2) Patients want to be Heard and Believed; (3) Accuracy of the ED Experience and Incorporating the Uniqueness of each Patient; and (4) the Overall Usefulness of the Video Trainer emerging. CONCLUSIONS This pilot study supported the usefulness and acceptability of a web-based intervention in training adults with SCD to use SBAR to enhance patient-HCP communication. Enhancing communication may mitigate the barriers that individuals with SCD encounter during care seeking and improve the outcomes. Additional studies with larger samples need to be conducted.
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Affiliation(s)
| | - Maureen Wassef
- Tan Chingfen Graduate School of Nursing, Umass Chan Medical School, Worcester, MA 01655, USA
| | - Susan Sullivan Bolyai
- Tan Chingfen Graduate School of Nursing, Umass Chan Medical School, Worcester, MA 01655, USA
| | - Coretta Jenerette
- College of Nursing, University of South Carolina, 1601 Greene Street, Columbia, SC 29208, USA
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Alavian S, Asare‐Agbo P, Chan TM. Systematic online academic resources (SOAR) review: Sickle cell disorders. AEM EDUCATION AND TRAINING 2022; 6:e10812. [PMID: 36258904 PMCID: PMC9562367 DOI: 10.1002/aet2.10812] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Revised: 09/10/2022] [Accepted: 09/20/2022] [Indexed: 06/16/2023]
Abstract
Background Free open-access medical education (FOAM) resources have become highly utilized resources in emergency medicine education. However, FOAM content often lacks the traditional peer review process, leaving quality assessment to the readers. In this systematic online academic resource (SOAR) review, we apply a systematic methodology to assess the quality of FOAM resources on sickle cell disease (SCD). Methods We searched keywords for SCD using FOAM Search and the top 50 FOAM websites listed on the Social Media Index. Resources found were screened using inclusion/exclusion criteria, and a total of 53 resources underwent full-text quality assessment using the revised Medical Education Translational Resources Impact and Quality (rMETRIQ) tool. Results The search yielded 520 resources, of which 53 met the criteria for quality assessment. A total of eight posts (15.1% of posts) were identified as high quality (rMETRIQ ≥ 16). The most commonly addressed topics within SCD topics included acute chest syndrome, acute pain crisis and general review of SCD. A total of 11 posts (21% of posts) were found to have an rMETRIQ score of less than 7, which may indicate poor quality. The most commonly identified type of resource was personalized reading (64%) and a number of posts were deemed to not have an appropriate use due to poor quality (15%). Conclusions We were able to systematically search a wide range of resources to identify, appraise, and organize FOAM resources on the topic of SCD. A final list of eight high-quality resources can guide trainees, educator recommendations, and FOAM authors.
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Affiliation(s)
- Sara Alavian
- Royal College Emergency Medicine Training Program, Division of Emergency Medicine, Department of MedicineMcMaster UniversityHamiltonOntarioCanada
| | - Prince Asare‐Agbo
- Department of Emergency Medicine, The Ottawa HospitalUniversity of OttawaOttawaOntarioCanada
| | - Teresa M. Chan
- Department of Medicine, Division of Emergency Medicine McMaster ClinicsMcMaster UniversityHamiltonOntarioCanada
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Phillips S, Chen Y, Masese R, Noisette L, Jordan K, Jacobs S, Hsu LL, Melvin CL, Treadwell M, Shah N, Tanabe P, Kanter J. Perspectives of individuals with sickle cell disease on barriers to care. PLoS One 2022; 17:e0265342. [PMID: 35320302 PMCID: PMC8942270 DOI: 10.1371/journal.pone.0265342] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Accepted: 03/01/2022] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Sickle cell disease (SCD) is an inherited hemoglobinopathy that predominantly affects African Americans in the United States. The disease is associated with complications leading to high healthcare utilization rates, including emergency department (ED) visits and hospitalizations. Optimal SCD care requires a multidisciplinary approach involving SCD specialists to ensure preventive care, minimize complications and prevent unnecessary ED visits and hospitalizations. However, most individuals with SCD receive sub-optimal care or are unaffiliated with care (have not seen an SCD specialist). We aimed to identify barriers to care from the perspective of individuals with SCD in a multi-state sample. METHODS We performed a multiple methods study consisting of surveys and interviews in three comprehensive SCD centers from March to June 2018. Interviews were transcribed and coded, exploring themes around barriers to care. Survey questions on the specific themes identified in the interviews were analyzed using summary statistics. RESULTS We administered surveys to 208 individuals and conducted 44 in-depth interviews. Barriers to care were identified and classified according to ecological level (i.e., individual, family/interpersonal, provider, and socio-environmental/organizational level). Individual-level barriers included lack of knowledge in self-management and disease severity. Family/interpersonal level barriers were inadequate caregiver support and competing life demands. Provider level barriers were limited provider knowledge, provider inexperience, poor provider-patient relationship, being treated differently, and the provider's lack of appreciation of the patient's SCD knowledge. Socio-environmental/organizational level barriers included limited transportation, lack of insurance, administrative barriers, poor care coordination, and reduced access to care due to limited clinic availability, services provided or clinic refusal to provide SCD care. CONCLUSION Participants reported several multilevel barriers to SCD care. Strategies tailored towards reducing these barriers are warranted. Our findings may also inform interventions aiming to locate and link unaffiliated individuals to care.
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Affiliation(s)
- Shannon Phillips
- College of Nursing, Medical University of South Carolina, Charleston, SC, United States of America
| | - Yumei Chen
- Department of Hematology/Oncology, UCSF Benioff Children’s Hospital Oakland, Oakland, CA, United States of America
| | - Rita Masese
- School of Nursing, Duke University, Durham, NC, United States of America
| | - Laurence Noisette
- Department of Pediatrics, Medical University of South Carolina, Charleston, SC, United States of America
| | - Kasey Jordan
- College of Nursing, Medical University of South Carolina, Charleston, SC, United States of America
| | - Sara Jacobs
- Translational Health Research Division, RTI International, Research Triangle Park, NC, United States of America
| | - Lewis L. Hsu
- Department of Pediatrics, Comprehensive Sickle Cell Center, University of Illinois at Chicago, Chicago, IL, United States of America
| | - Cathy L. Melvin
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC, United States of America
| | - Marsha Treadwell
- Department of Pediatrics/Division of Hematology, UCSF Benioff Children’s Hospital Oakland, Oakland, CA, United States of America
| | - Nirmish Shah
- School of Medicine, Duke University, Durham, NC, United States of America
| | - Paula Tanabe
- School of Nursing, Duke University, Durham, NC, United States of America
| | - Julie Kanter
- Division of Hematology & Oncology, University of Alabama at Birmingham, Birmingham, AL, United States of America
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Emerson AJ, Chandler LE, Oxendine RH, Huff CM, Harris GM, Baxter GD, Wonsetler Jones EC. Systematic review of clinical decision-makers’ attitudes, beliefs, and biases that contribute to a marginalized process of care in persistent musculoskeletal pain. Part II: case vignettes. PHYSICAL THERAPY REVIEWS 2021. [DOI: 10.1080/10833196.2021.2000289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Alicia J. Emerson
- Department of Physical Therapy, Congdon School of Health Sciences, High Point University, High Point, NC, USA
- Centre for Health, Activity, and Rehabilitation Research, University of Otago, Dunedin, New Zealand
| | - Lauren E. Chandler
- Department of Physical Therapy, Congdon School of Health Sciences, High Point University, High Point, NC, USA
| | - Riley H. Oxendine
- Department of Physical Therapy, Congdon School of Health Sciences, High Point University, High Point, NC, USA
| | - Corey M. Huff
- Department of Physical Therapy, Congdon School of Health Sciences, High Point University, High Point, NC, USA
| | - Gabrielle M. Harris
- Department of Physical Therapy, Congdon School of Health Sciences, High Point University, High Point, NC, USA
| | - G. David Baxter
- Centre for Health, Activity, and Rehabilitation Research, University of Otago, Dunedin, New Zealand
| | - Elizabeth C. Wonsetler Jones
- Department of Physical Therapy, Congdon School of Health Sciences, High Point University, High Point, NC, USA
- Department of Public Health and Community Medicine, Tufts University, Boston, MA, USA
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Reflections of Healthcare Experiences of African Americans With Sickle Cell Disease or Cancer: A Qualitative Study. Cancer Nurs 2021; 44:E53-E61. [PMID: 31743153 DOI: 10.1097/ncc.0000000000000750] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
BACKGROUND The experiences of African American adult patients before, during, and after acute care utilization are not well characterized for individuals with sickle cell disease (SCD) or cancer. OBJECTIVE To describe the experiences of African Americans with SCD or cancer before, during, and after hospitalization for pain control. METHODS We conducted a qualitative study among African American participants with SCD (n = 15; 11 male; mean age, 32.7 ± 10.9 years; mean pain intensity, 7.8 ± 2.6) or cancer (n = 15; 7 male; mean age, 53.7 ± 15.2 years; mean pain intensity, 4.9 ± 3.7). Participants completed demographic questions and pain intensity using PAINReportIt and responded to a 7-item open-ended interview, which was recorded and transcribed verbatim. We used content analysis to identify themes in the participants' responses. RESULTS Themes identified included reason for admission, hospital experiences, and discharge expectations. Pain was the primary reason for admission for participants with SCD (n = 15) and for most participants with cancer (n = 10). Participants of both groups indicated that they experienced delayed treatment and a lack of communication. Participants with SCD also reported accusations of drug-seeking behavior, perceived mistreatment, and feeling of not being heard or believed. Participants from both groups verbalized concerns about well-being after discharge and hopeful expectations. CONCLUSIONS Race-concordant participants with SCD but not with cancer communicated perceived bias from healthcare providers. IMPLICATIONS FOR PRACTICE Practice change interventions are needed to improve patient-provider interactions, reduce implicit bias, and increase mutual trust, as well as facilitate more effective pain control, especially for those who with SCD.
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Let Their Voices Be Seen. Ann Emerg Med 2020; 76:S73-S77. [PMID: 32928466 DOI: 10.1016/j.annemergmed.2020.08.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
STUDY OBJECTIVE The mutual distrust, in part caused by misunderstanding and bias, between sickle cell disease (SCD) patients and their emergency department (ED) providers has been widely documented in the SCD literature. This study seeks to illustrate the perceptions and experiences of adult sickle cell patients who have had at least 1 ED experience in the last 2 years. METHODS Qsource, a nonprofit health care consultancy based in Tennessee, used photovoice, a qualitative research method, to facilitate the representation of patients' experiences in living with SCD. Photovoice has participants document their experiences through photography and then, as a group, discuss and analyze the emotional state behind the photographs. Eight participants with SCD took 25 photographs during 4 weeks. Then, in a 2-hour critical dialogue, participants identified recurring themes through consensus. RESULTS Participants identified 6 themes that emerged from their discussion: unpredictability of SCD, fickleness of time, coping with pain, proximity to death, avoidance of the ED, and need for improved communication. They expressed their wish to be active participants in their care, and many described a fear of death, which is exacerbated by a lack of control in the ED setting. CONCLUSION Factors such as poor patient experience and misunderstanding may contribute to delays in seeking care for SCD patients. This may, in turn, escalate pain crises and increase the likelihood of hospital admission. We believe that photovoice may be a new means to educate ED providers on SCD patient perceptions, ultimately resulting in better ED care.
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Park J, Beach MC, Han D, Moore RD, Korthuis PT, Saha S. Racial disparities in clinician responses to patient emotions. PATIENT EDUCATION AND COUNSELING 2020; 103:1736-1744. [PMID: 32253063 PMCID: PMC7423722 DOI: 10.1016/j.pec.2020.03.019] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Revised: 02/26/2020] [Accepted: 03/18/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVE In a previous study of patients newly enrolled in HIV care, we observed that clinicians were less likely to address emotional issues expressed by African-American patients compared to whites. We sought to verify and expand these findings in a larger group of patients established in HIV care. METHODS We used VR-CoDES to analyze transcripts from 342 audio-recorded medical visits in the United States. We used random intercept multilevel logistic regression to assess associations between patient and clinician characteristics and patterns of emotional talk. RESULTS African-American patients were less likely than others to spontaneously express emotions (OR 0.50; 95 % CI 0.29-0.85). Clinicians, who were predominantly white, were more likely to respond to emotional expressions by African-American patients explicitly (OR 1.56; 95 % CI 1.11-2.20) but less likely to offer neutral/passive responses that provide space for emotional conversation (OR 0.56; 95 % CI 0.37-0.84) and more likely to block discussion of the emotional issue (OR 2.20; 95 % CI 1.05-4.63). Emotional talk did not vary by patient age or gender. CONCLUSION These results confirm our prior findings, demonstrating less open emotional communication between African-American patients and their providers. PRACTICE IMPLICATIONS Addressing racial differences in communicating about emotions may reduce disparities in patient-clinician relationships.
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Affiliation(s)
- Jenny Park
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Mary Catherine Beach
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Berman Institute of Bioethics, Johns Hopkins University, Baltimore, MD, USA
| | - Dingfen Han
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Richard D Moore
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - P Todd Korthuis
- Department of Medicine, Oregon Health and Science University, Portland, OR, USA
| | - Somnath Saha
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Department of Medicine, Oregon Health and Science University, Portland, OR, USA; Center to Improve Veteran Involvement in Care, VA Portland Health Care System, Portland, OR, USA.
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Wilson JD, Lanzkron S, Pecker LH, Bediako SM, Han D, Beach MC. Psychosocial and Clinical Risk Factors Associated with Substance Use in Observational Cohort of Patients with Sickle Cell Disease. Subst Use Misuse 2020; 55:2205-2212. [PMID: 32762425 PMCID: PMC8208322 DOI: 10.1080/10826084.2020.1797807] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND Patients with sickle cell disease (SCD) experience high rates of chronic pain, and have a high burden of mental health comorbidities shown to negatively influence health. There is limited research on substance use among individuals with SCD. Objective: The aim of this study is to measure the prevalence of substance use in patients with SCD and determine whether psychosocial or clinical risk factors are associated with substance use. Methods: This study was conducted as part of an observational study of patients with SCD at two academic medical centers. We asked participants (ages 15 and older) about the lifetime use of heroin, cocaine, amphetamines, and marijuana/cannabis. We measured stigma, depression, urban life stress, pain catastrophizing, and asked about a brief pain inventory. Results: Of 258 participants, 24.9% (n = 71) reported substance use. Marijuana was the most common substance used (22.5%; n = 65). The mean depressive score met criteria for positive screen amongst individuals who reported a history of substance use (mean 10.7(5.76)). Adjusting for age, sex, yearly family income, and education level, odds of substance use increased with higher levels of internalized stigma (aOR: 1.38; 95% CI: 1.07, 1.77; p = 0.012); higher urban life stress scores (aOR 1.06; 95% CI: 1.01, 1.12; p = 0.017) and higher pain catastrophizing scores (aOR: 1.03; 95% CI: 1.01, 1.06; p = 0.008). Conclusions: Among individuals with SCD who endorse substance use, there was markedly more stress and distress with higher rates of depression and poorer quality of life. Interventions focusing on improving distress tolerance and coping to not only pain, but also social stressors, might reduce substance use.
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Affiliation(s)
- J. Deanna Wilson
- Division of General Internal Medicine, University of Pittsburgh, PA
| | - Sophie Lanzkron
- Department of Hematology, Johns Hopkins University School of Medicine
| | - Lydia H. Pecker
- Department of Pediatric Hematology, Johns Hopkins University School of Medicine
| | - Shawn M. Bediako
- Department of Psychology, University of Maryland, Baltimore County, MD
| | - Dingfen Han
- Division of General Internal Medicine, Johns Hopkins University School of Medicine
| | - Mary Catherine Beach
- Division of General Internal Medicine, Johns Hopkins University School of Medicine
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Cronin RM, Yang M, Hankins JS, Byrd J, Pernell BM, Kassim A, Adams-Graves P, Thompson AA, Kalinyak K, DeBaun M, Treadwell M. Association between hospital admissions and healthcare provider communication for individuals with sickle cell disease. ACTA ACUST UNITED AC 2020; 25:229-240. [PMID: 32552526 DOI: 10.1080/16078454.2020.1780737] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Objective: To test the hypothesis that caregivers' or adult participants' low ratings of provider communication are associated with more hospital admissions among adults and children with sickle cell disease (SCD), respectively. Secondarily, we determined whether there was an association between the caregivers' or participants' health literacy and rating of providers' communication. Methods: Primary data were collected from participants through surveys between 2014 and 2016, across six sickle cell centers throughout the U.S. In this cross-sectional cohort study, 211 adults with SCD and 331 caregivers of children with SCD completed surveys evaluating provider communication using the Consumer Assessment of Healthcare Providers and Systems (CAHPS), healthcare utilization, health literacy, and other sociodemographic and behavioral variables. Analyses included descriptive statistics, bivariate analyses, and logistic regression. Results: Participants with better ratings of provider communication were less likely to be hospitalized (odds ratio (OR) = 0.54, 95% confidence interval (CI) = [0.35, 0.83]). Positive ratings of provider communication were associated with fewer readmissions for children (OR = 0.23, 95% CI = [0.09, 0.57]). Participants with better ratings of provider communication were less likely to rate their health literacy as lower (regression coefficient (B) = -0.28, 95% CI = [-0.46, -0.10]). Conclusions: Low ratings of provider communication were associated with more hospitalizations and readmissions in SCD, suggesting the need for interventions targeted at improving patient-provider communication which could decrease hospitalizations for this population.
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Affiliation(s)
- Robert M Cronin
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN, USA.,Department of Internal Medicine, Vanderbilt University Medical Center, Nashville, TN, USA.,Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Manshu Yang
- Department of Psychology, University of Rhode Island, Kingston, RI, USA.,American Institutes for Research, Chapel Hill, NC, USA
| | - Jane S Hankins
- Department of Hematology, St Jude Children's Research Hospital, Memphis, TN, USA
| | - Jeannie Byrd
- Department of Pediatrics, Division of Hematology/Oncology, Vanderbilt-Meharry Center for Excellence in Sickle Cell Disease, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Brandi M Pernell
- Department of Pediatrics, Division of Hematology/Oncology, Vanderbilt-Meharry Center for Excellence in Sickle Cell Disease, Vanderbilt University Medical Center, Nashville, TN, USA.,Department of Pediatrics, Division of Hematology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Adetola Kassim
- Department of Hematology/Oncology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Patricia Adams-Graves
- Department of General Internal Medicine and Hematology, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Alexis A Thompson
- Department of Pediatrics, Department of Medicine, Northwestern University, Chicago, IL, USA
| | - Karen Kalinyak
- Division of Hematology in Cancer and Blood Diseases Institute, University of Cincinnati, Cincinnati, OH, USA
| | - Michael DeBaun
- Department of Pediatrics, Division of Hematology/Oncology, Vanderbilt-Meharry Center for Excellence in Sickle Cell Disease, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Marsha Treadwell
- Department of Hematology/Oncology, UCSF Benioff Children's Hospital Oakland, Oakland, CA, USA
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13
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Blake A, Guthrie-Dixon N, Grindley M, Barton-Gooden A, Knight-Madden J, Asnani M. Level of agreement between adolescents' self-assessment and parent proxy report of health-related quality of life in adolescents with sickle cell disease. Pediatr Blood Cancer 2020; 67:e28198. [PMID: 32020725 DOI: 10.1002/pbc.28198] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Revised: 01/08/2020] [Accepted: 01/12/2020] [Indexed: 11/07/2022]
Abstract
BACKGROUND We aim to assess the levels of agreement between parents, as proxies, and Jamaican adolescents living with sickle cell disease (SCD) in the reporting of the adolescent's quality of life. PROCEDURES This cross-sectional study assessed 102 patient/proxy pairs on quality of life of adolescents with SCD using the PedsQL-SCD module. The level of agreement among pairs was assessed starting with broad group-level approaches (the Wilcoxon signed-rank test augmented by exploring percentage agreement) tapering to individual-level approaches (intraclass correlation coefficients [ICCs] supplemented with Bland-Altman plots). RESULTS Most patients (76.5%) had homozygous SS disease (45.1% females; mean age 15.2 ± 1.5 years). Median total pediatric quality of life (PedsQL) scores were 79.1 (adolescent report) and 80.2 (parental report) (P = .60). There were 11.8% underestimation and 12.7% overestimation of overall health-related quality of life (HRQOL) by parents. The highest perfect agreement existed on the "pain and hurt" domain for both male and female adolescents (85.7% and 84.4%, respectively). Overestimation was highest on the "social communication" domain for both male and female adolescents (19.6% and 34.8%, respectively). Parents exhibited good agreement on total PedsQL scores in male adolescents (ICC = 0.70), but moderate agreement (ICC = 0.43) in female adolescents. Generally, parents underestimated their male child's functioning and overestimated the female child's functioning on the various domains. CONCLUSIONS Parents and adolescents exhibit fair agreement in assessment of the adolescent's overall HRQOL but differ on subjective domains. Agreement varies by sex of the affected teen where girls' HRQOL is generally overestimated by the parental proxy. Interventions to improve parents' understanding of their children's psychosocial needs are needed.
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Affiliation(s)
- Alphanso Blake
- Caribbean Institute for Health Research-Sickle Cell Unit, The University of the West Indies, Kingston 7, Jamaica
| | - Natalie Guthrie-Dixon
- Caribbean Institute for Health Research-Epidemiology Research Unit, The University of the West Indies, Kingston 7, Jamaica
| | - Marlyn Grindley
- Caribbean Institute for Health Research-Sickle Cell Unit, The University of the West Indies, Kingston 7, Jamaica
| | | | - Jennifer Knight-Madden
- Caribbean Institute for Health Research-Sickle Cell Unit, The University of the West Indies, Kingston 7, Jamaica
| | - Monika Asnani
- Caribbean Institute for Health Research-Sickle Cell Unit, The University of the West Indies, Kingston 7, Jamaica
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14
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Issom DZ, Henriksen A, Woldaregay AZ, Rochat J, Lovis C, Hartvigsen G. Factors Influencing Motivation and Engagement in Mobile Health Among Patients With Sickle Cell Disease in Low-Prevalence, High-Income Countries: Qualitative Exploration of Patient Requirements. JMIR Hum Factors 2020; 7:e14599. [PMID: 32207692 PMCID: PMC7139429 DOI: 10.2196/14599] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2019] [Revised: 12/29/2019] [Accepted: 01/24/2020] [Indexed: 12/20/2022] Open
Abstract
Background Sickle cell disease (SCD) is a hematological genetic disease affecting over 25 million people worldwide. The main clinical manifestations of SCD, hemolytic anemia and vaso-occlusion, lead to chronic pain and organ damages. With recent advances in childhood care, high-income countries have seen SCD drift from a disease of early childhood mortality to a neglected chronic disease of adulthood. In particular, coordinated, preventive, and comprehensive care for adults with SCD is largely underresourced. Consequently, patients are left to self-manage. Mobile health (mHealth) apps for chronic disease self-management are now flooding app stores. However, evidence remains unclear about their effectiveness, and the literature indicates low user engagement and poor adoption rates. Finally, few apps have been developed for people with SCD and none encompasses their numerous and complex self-care management needs. Objective This study aimed to identify factors that may influence the long-term engagement and user adoption of mHealth among the particularly isolated community of adult patients with SCD living in low-prevalence, high-income countries. Methods Semistructured interviews were conducted. Interviews were audiotaped, transcribed verbatim, and analyzed using thematic analysis. Analysis was informed by the Braun and Clarke framework and mapped to the COM-B model (capability, opportunity, motivation, and behavior). Results were classified into high-level functional requirements (FRs) and nonfunctional requirements (NFRs) to guide the development of future mHealth interventions. Results Overall, 6 males and 4 females were interviewed (aged between 21 and 55 years). Thirty FRs and 31 NFRs were extracted from the analysis. Most participants (8/10) were concerned about increasing their physical capabilities being able to stop pain symptoms quickly. Regarding the psychological capability aspects, all interviewees desired to receive trustworthy feedback on their self-care management practices. About their physical opportunities, most (7/10) expressed a strong desire to receive alerts when they would reach their own physiological limitations (ie, during physical activity). Concerning social opportunity, most (9/10) reported wanting to learn about the self-care practices of other patients. Relating to motivational aspects, many interviewees (6/10) stressed their need to learn how to avoid the symptoms and live as normal a life as possible. Finally, NFRs included inconspicuousness and customizability of user experience, automatic data collection, data shareability, and data privacy. Conclusions Our findings suggest that motivation and engagement with mHealth technologies among the studied population could be increased by providing features that clearly benefit them. Self-management support and self-care decision aid are patients’ major demands. As the complexity of SCD self-management requires a high cognitive load, pervasive health technologies such as wearable sensors, implantable devices, or inconspicuous conversational user interfaces should be explored to ease it. Some of the required technologies already exist but must be integrated, bundled, adapted, or improved to meet the specific needs of people with SCD.
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Affiliation(s)
- David-Zacharie Issom
- Division of Medical Information Sciences, Geneva University Hospitals, Geneva, Switzerland.,Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - André Henriksen
- Department of Community Medicine, UiT - The Arctic University of Norway, Tromsø, Norway
| | | | - Jessica Rochat
- Division of Medical Information Sciences, Geneva University Hospitals, Geneva, Switzerland.,Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Christian Lovis
- Division of Medical Information Sciences, Geneva University Hospitals, Geneva, Switzerland.,Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Gunnar Hartvigsen
- Department of Computer Science, UiT - The Arctic University of Norway, Norway, Tromsø, Norway
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15
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Clayton-Jones D, Matthie N, Treadwell M, Field JJ, Mager A, Sawdy R, George Dalmida S, Leonard C, Koch KL, Haglund K. Social and Psychological Factors Associated With Health Care Transition for Young Adults Living With Sickle Cell Disease. J Transcult Nurs 2019; 32:21-29. [PMID: 31889479 DOI: 10.1177/1043659619896837] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Introduction: Due to advances in disease management, mortality rates in children with sickle cell disease (SCD) have decreased. However, mortality rates for young adults (YA) increased, and understanding of social and psychological factors is critical. The aim of this study was to explore factors associated with health care transition experiences for YA with SCD. Method: This was a qualitative descriptive study. A 45-minute semistructured interview was conducted with 13 YA (M = 21.5 years, SD = 1.73). Results: Results suggest that social and psychological factors and self-management experiences influence health care transition. Eight themes emerged: "need for accessible support"; "early assistance with goal setting"; "incongruence among expectations, experiences, and preparation"; "spiritual distress"; "stigma"; "need for collaboration"; "appreciation for caring providers"; and "feeling isolated." Discussion: Consideration of cultural contexts will guide nurses in supporting health care transition. Designing culturally relevant interventions that address unique needs for YA living with SCD is warranted.
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Affiliation(s)
- Dora Clayton-Jones
- Marquette University College of Nursing, Milwaukee, WI, USA.,Medical College of Wisconsin, Milwaukee, WI, USA
| | - Nadine Matthie
- Emory University, Nell Hodgson Woodruff School of Nursing, Atlanta, GA, USA
| | | | | | - Amy Mager
- Medical College of Wisconsin, Milwaukee, WI, USA
| | - Rachel Sawdy
- Marquette University College of Nursing, Milwaukee, WI, USA
| | - Safiya George Dalmida
- Christine E. Lynn College of Nursing, Florida Atlantic University, Boca Raton, FL, USA
| | - Cynthia Leonard
- Froedtert Hospital Sickle Cell Disease Clinic, Milwaukee, WI, USA
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16
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Lee L, Smith-Whitley K, Banks S, Puckrein G. Reducing Health Care Disparities in Sickle Cell Disease: A Review. Public Health Rep 2019; 134:599-607. [PMID: 31600481 DOI: 10.1177/0033354919881438] [Citation(s) in RCA: 116] [Impact Index Per Article: 23.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Sickle cell disease (SCD) is an inherited blood disorder most common among African American and Hispanic American persons. The disease can cause substantial, long-term, and costly health problems, including infections, stroke, and kidney failure, many of which can reduce life expectancy. Disparities in receiving health care among African Americans and other racial/ethnic minority groups in the United States are well known and directly related to poor outcomes associated with SCD. As an orphan disease-one that affects <200 000 persons nationwide-SCD does not receive the research funding and pharmaceutical investment directed to other orphan diseases. For example, cystic fibrosis affects fewer than half the number of persons but receives 3.5 times the funding from the National Institutes of Health and 440 times the funding from national foundations. In this review, we discuss the health inequities affecting persons with SCD, describe programs intended to improve their care, and identify actions that could be taken to further reduce these inequities, improve care, control treatment costs, and ease the burden of disease.
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Affiliation(s)
- LaTasha Lee
- Department of Clinical Research & Leadership, School of Medicine and Health Sciences, George Washington University, Washington, DC, USA
| | - Kim Smith-Whitley
- Comprehensive Sickle Cell Center, Children's Hospital of Philadelphia, Philadelphia, PA, USA.,Perlman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Sonja Banks
- Sickle Cell Disease Association of America, Baltimore, MD, USA
| | - Gary Puckrein
- National Minority Quality Forum, Washington, DC, USA
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17
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Jabour SM, Beachy S, Coburn S, Lanzkron S, Eakin MN. The Role of Patient-Physician Communication on the Use of Hydroxyurea in Adult Patients with Sickle Cell Disease. J Racial Ethn Health Disparities 2019; 6:1233-1243. [PMID: 31410784 DOI: 10.1007/s40615-019-00625-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Revised: 07/26/2019] [Accepted: 07/29/2019] [Indexed: 12/22/2022]
Abstract
OBJECTIVE This qualitative study analyzed the perspective of patients living with sickle cell disease (SCD) on their process of deciding whether to take hydroxyurea (HU), and the role of physician communication in patients' decision-making process. METHODS From October 2015 to July 2016, we conducted semi-structured interviews among patients with SCD (N = 20) that were audio-recorded and transcribed. Participants were ≥ 18 years old, a patient of an urban adult sickle cell center, able to provide informed consent, and English-speaking. We iteratively developed codes and used thematic analysis to organize the key themes. RESULTS Most participants were female (65%), middle aged (M = 44, SD = 12.2), and 55% were prescribed HU for an average of 10.4 (SD = 4.7) years. Participants described 3 key factors that influenced their decision regarding HU treatment: (1) lifestyle, (2) health status, and (3) HU characteristics. Four themes emerged about provider communication and HU treatment decisions: (1) provider's advisement, (2) shared decision-making, (3) "wrestled," and (4) not feeling heard. CONCLUSION Providers who engaged in shared decision-making empowered participants to decide whether to start HU treatment. Participants who felt their providers were not listening to their concerns expressed disengaging from HU treatment. During discussions about HU with patients living with SCD, providers must understand the multi-faceted aspects that impact patients' decision and empower patients to engage in such discussions. Further research is needed to understand the role of shared decision-making among patients with SCD to improve management of SCD.
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Affiliation(s)
- Sarah M Jabour
- Division of General Internal Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Sara Beachy
- Department of Education and Health Services, Lehigh University, Bethlehem, PA, USA
| | - Shayna Coburn
- Children's National Health System, Washington, D.C., USA.,The George Washington University, Washington, D.C., USA
| | - Sophie Lanzkron
- Division of Hematology, Johns Hopkins University, Baltimore, MD, USA
| | - Michelle N Eakin
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, 5501 Hopkins Bayview Blvd., Room 4B.74, Baltimore, MD, 21224, USA.
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18
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Bulgin D, Tanabe P, Asnani M, Royal CDM. Twelve tips for teaching a comprehensive disease-focused course with a global perspective: A sickle cell disease example. MEDICAL TEACHER 2019; 41:275-281. [PMID: 29334305 PMCID: PMC6046270 DOI: 10.1080/0142159x.2017.1420151] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
A disease-focused course entitled "Understanding Sickle Cell Disease: A Biopsychosocial Approach" addressed the complex nature of SCD using patient-centered, global and interdisciplinary approaches. Sickle cell disease (SCD) is a rare inherited blood disorder that requires multidisciplinary care. Worldwide 20-25 million individuals have SCD, which is associated with a shortened lifespan due to many medical complications and social and behavioral health challenges. Health care professionals often have limited knowledge of SCD as they typically learn about it within the context of their own disciplines. This article provides twelve tips for educators that can be used to develop a similar course on any disease, with considerations for both low- and high-resource countries. The tips were devised from personal experience and available literature. Through these twelve tips, we provide a practical framework for increasing knowledge of complex diseases like SCD using a comprehensive elective course.
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Affiliation(s)
| | - Paula Tanabe
- School of Nursing, Duke University, Durham, NC, USA
| | - Monika Asnani
- Caribbean Institute for Health Research-Sickle Cell Unit, The University of the West Indies, Kingston, Jamaica
| | - Charmaine D. M. Royal
- Departments of African and African American Studies, Biology, and Community & Family Medicine, Duke University, Durham, NC, USA
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19
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Taylor JL, Roberts L, Hladek MD, Liu M, Nkimbeng M, Boyd CM, Szanton SL. Achieving self-management goals among low income older adults with functional limitations. Geriatr Nurs 2019; 40:424-430. [PMID: 30799154 DOI: 10.1016/j.gerinurse.2019.01.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2018] [Revised: 01/20/2019] [Accepted: 01/25/2019] [Indexed: 11/29/2022]
Abstract
Although self-management interventions can improve symptoms and disease among older adults, there is a dearth of literature on how self-management behaviors may improve factors related to the older adults' physical function. To fill this gap in the literature, we describe the patient-directed self-management goals in nursing visits that relate to physical function as part of a multi-component program. We analyze the self-management goals and outcomes of 367 low- income older adults with functional limitations who participated in the CAPABLE program: a program to reduce the health effects of impaired physical function in low-income older adults. We focus on the following self-management goals that participants chose with the nurses: pain management, depressive symptoms, incontinence, fall prevention, and communication with healthcare providers. The majority of participants chose pain (50%) or fall prevention (51%) as goals and partially or fully met their goals. Improvements across these areas may lead to improved physical function.
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Affiliation(s)
- Janiece L Taylor
- Johns Hopkins School of Nursing, USA; Johns Hopkins School of Nursing Center of Innovative Care in Aging, USA.
| | | | | | - Minhui Liu
- Johns Hopkins School of Nursing, USA; Johns Hopkins School of Nursing Center of Innovative Care in Aging, USA
| | | | | | - Sarah L Szanton
- Johns Hopkins School of Nursing, USA; Johns Hopkins School of Nursing Center of Innovative Care in Aging, USA
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20
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Wehrens R, Walters BH. Understanding each other in the medical encounter: Exploring therapists' and patients' understanding of each other's experiential knowledge through the Imitation Game. Health (London) 2018; 22:558-579. [PMID: 28770633 PMCID: PMC6168741 DOI: 10.1177/1363459317721100] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The ability of health-care professionals to understand the lived experiences of their patients has become increasingly important but has been a difficult topic to investigate empirically because it involves two distinctive research strands: interpretative phenomenological analysis and patient-provider communication. While interpretative phenomenological analysis focuses on experiences and illness narratives of patients, but not on therapist's understanding of those, patient-provider communication surveys focus primarily on effective forms of communication without addressing the actual illness experiences of patients. There is a need for empirical research that combines both strands to investigate not only the experiences of patients but also whether professionals are able to understand these. This study combined both strands by means of a novel research method called the Imitation Game (combined with other qualitative methods). This sociological method was developed to investigate what different social groups know of each other's lifeworld. It focused on the important domain of eating disorder treatment to investigate whether therapists were able to understand the experiences of their patients and vice versa. This study provides insights into the domains in which therapists and patients were able to develop insights into each other's experiential knowledge (and where they had difficulties in doing so). The findings also implicate the high potential of the Imitation Game as an interdisciplinary research method. We propose that the Imitation Game may be particularly valuable as a 'can opener' that enables the development of in-depth, qualitative insights into the substantive themes that matter in the lifeworlds of patients and therapists.
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Affiliation(s)
- Rik Wehrens
- Erasmus University Rotterdam, The Netherlands
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21
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Barriers to Care for Persons With Sickle Cell Disease: The Case Manager's Opportunity to Improve Patient Outcomes. Prof Case Manag 2018; 23:213-219. [PMID: 29846351 DOI: 10.1097/ncm.0000000000000260] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE AND OBJECTIVES The purpose of this discussion is to review the barriers to care for patients with sickle cell disease (SCD). Chronic pain and the perception of addiction, implicit bias, frequent hospitalizations and emergency department visits, clinician and patient knowledge deficits, and SCD stigma all impede the ability to provide evidence-based care for patients with SCD. Case managers can coordinate and advocate for appropriate care that improves patient outcomes. PRIMARY PRACTICE SETTING This discussion is relevant to case managers working with patients with SCD in the clinic, hospital, and emergency department. FINDINGS/CONCLUSIONS Case managers can serve an important advocacy role and intervene to improve the coordination of services and efficient use of resources. This will lead to improved quality of life and optimal health care utilization for persons with SCD. IMPLICATIONS FOR CASE MANAGEMENT PRACTICE As a constant member of the health care team, the case manager may be the only health care team member who has a broad knowledge of the patient's experience of acute and chronic pain, usual state of health, social behavioral health needs, and how these factors may affect both inpatient and outpatient health care use and health outcomes. This article explores the barriers to care and suggests specific interventions within the role of the case manager that can improve care delivered and ultimately contribute to improved patient outcomes. Specifically, these interventions can improve communication among members of the health care team. Case manager interventions can guide coordination, prevent hospital readmissions, reduce health care utilization, and contribute to overall improved patient quality of life and health outcomes.
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22
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From trust to skepticism: An in-depth analysis across age groups of adults with sickle cell disease on their perspectives regarding hydroxyurea. PLoS One 2018; 13:e0199375. [PMID: 29949647 PMCID: PMC6021071 DOI: 10.1371/journal.pone.0199375] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2017] [Accepted: 06/06/2018] [Indexed: 12/04/2022] Open
Abstract
Despite its efficacy, the uptake of HU in adults with sickle cell disease (SCD) is poor likely due to a combination of system, provider, and patient-related factors. We investigated attitudes of adult patients towards HU by conducting qualitative interviews with 95 adult SCD patients (age 18 to 67 years old, 71 were female). While 53% of all participants reported that they were currently taking HU, patients ranging in age 18–30 years (Group 1) were more likely to report current HU use as compared to those (Group 2) ranging in age 31–67 years (65% vs. 41% P = 0.01). Most Group 1 participants who reported currently taking HU indicated that the decision to start HU was made by a parent, though some made the decision themselves as a young adult. Group 1 participants expressed trust in the efficacy of HU as well as trust that their physician adequately shared risks and benefits for the medication. The Group 2 participants, who were not currently on HU, were skeptical that all the risks and benefits of HU were known, were concerned that the efficacy of HU was not proven, and that they were not receiving complete information about its potential side effects. Of Group 2 participants who reported currently being on HU, 25% were concerned about the side effects and efficacy of HU and reported continuing HU because of a lack of effective alternatives. These data suggest that there are significant differences by age in adult SCD patients’ attitudes towards, utilization and understanding of the risks and benefits of HU.
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23
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Pantaleao A, DiPlacido J, Guite JW, Zempsky WT. Caregiver factors related to emergency department utilization for youth with sickle cell disease. CHILDRENS HEALTH CARE 2018. [DOI: 10.1080/02739615.2018.1454838] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
- Ashley Pantaleao
- Department of Family Science, School of Public Health, University of Maryland, College Park, MD, USA
| | - Joanne DiPlacido
- Department of Psychological Science, Central Connecticut State University, New Britain, CT, USA
| | - Jessica W. Guite
- The Center for Behavioral Health, Connecticut Children’s Medical Center, Hartford, CT, USA
| | - William T. Zempsky
- Division of Pain & Palliative Medicine, Connecticut Children’s Medical Center, Hartford, CT, USA
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24
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Abstract
Using descriptive case studies, this paper describes a short-term mentoring program using goal attainment scaling for young adults with sickle cell disease (SCD). Two participants received three and seven visits, respectively, before dropping out of the program with no significant change in goal attainment scores. Although the program supported meaningful individualized goals, repeated and cumulative effects of hospitalizations, sickle cell pain episodes, family health issues, unsafe location of residence, and transportation appeared to remain significant barriers for to achieve stated goals. While the value of an individualized, community-based mentoring experience that addresses goal attainment remains unanswered, this project documents the complex and health barriers of young adults living with SCD.
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Affiliation(s)
- Christine Berg
- a Program in Occupational Therapy , Washington University School of Medicine , St. Louis , Missouri , USA
| | - Allison King
- b Program in Occupational Therapy , Washington University School of Medicine , St. Louis , Missouri , USA
| | - Dorothy Farrar Edwards
- c Department of Kinesiology and Medicine, Core Leader Wisconsin Alzheimer's Disease Research Center Outreach Education and Recruitment and Minority Recruitment Cores, Director, Collaborative Center for Health Equity , University ofWisconsin, Madison , Madison , Wisconsin , USA
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25
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Patient, Provider, and System Factors Contributing to Patient Safety Events During Medical and Surgical Hospitalizations for Persons With Serious Mental Illness. J Nerv Ment Dis 2017; 205:495-501. [PMID: 28557885 PMCID: PMC5559891 DOI: 10.1097/nmd.0000000000000675] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
This study aimed to explore patient-, provider-, and system-level factors that may contribute to elevated risk of patient safety events among persons with serious mental illness (SMI). We conducted a medical record review of medical/surgical admissions in Maryland hospitals from 1994 to 2004 for a community-based sample of adults with SMI (N = 790 hospitalizations). We estimated the prevalence of multiple patient, provider, and system factors that could influence patient safety among persons with SMI. We conducted a case crossover analysis to examine the relationship between these factors and adverse patient safety events. Patients' mental status, level of consciousness, disease severity, and providers' lack of patient monitoring, delay/failure to seek consultation, lack of trainee supervision, and delays in care were positively associated with adverse patient safety events (p < 0.05). Efforts to reduce SMI-related patient safety risks will need to be multifaceted and address both patient- and provider-level factors.
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26
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Shift in Emergency Department Provider Attitudes Toward Patients With Sickle Cell Disease. Adv Emerg Nurs J 2017; 38:199-212. [PMID: 27482992 DOI: 10.1097/tme.0000000000000106] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Patients with sickle cell disease frequently seek care in the emergency department. They have reported experiencing negative attitudes from emergency providers. This study was undertaken to evaluate change in emergency provider attitudes toward patients with sickle cell disease over a 2.5-year time period when several educational efforts were ongoing. The General Perceptions about Sickle Cell Disease Patients Scale was used to measure emergency provider attitudes at 2 emergency departments at baseline, 6 months, and 30 months into the project. Analyses of covariance were used to test for effects of site, time, and provider type, as well as their interactions, on Negative attitudes, Uneasiness With Care, and Positive Attitudes subscale scores, after controlling for years of provider experience. The number of surveys returned at the 3 time points was 216, 182, and 113, respectively. The mean Negative Attitudes subscale scores decreased significantly over time, with significantly higher mean Negative Attitudes subscale scores reported by nurses than by physicians. The mean Uneasiness With Care subscale scores did not differ significantly over time, but the mean score was significantly higher for physicians than for nurses. The mean Positive Attitudes subscale scores significantly improved over time, with physicians tending to have a higher mean Positive Attitudes subscale scores than nurses. During the observation period, there was improvement in attitudes, with a decline in mean Negative Attitudes subscale scores and increase in mean Positive Attitudes subscale scores. Physicians reported better attitudes than nurses.
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27
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Cronin RM, Hankins JS, Adams-Graves P, Thompson AA, Kalinyak K, Byrd J, McClain B, Kassim A, DeBaun M, Treadwell M. Barriers and facilitators to research participation among adults, and parents of children with sickle cell disease: A trans-regional survey. Am J Hematol 2016; 91:E461-2. [PMID: 27421796 DOI: 10.1002/ajh.24483] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2016] [Revised: 07/12/2016] [Accepted: 07/13/2016] [Indexed: 11/05/2022]
Affiliation(s)
- Robert M. Cronin
- Department of Biomedical Informatics; Vanderbilt University Medical Center; Nashville Tennessee
- Department of Internal Medicine; Vanderbilt University Medical Center; Nashville Tennessee
- Department of Pediatrics; Vanderbilt University Medical Center; Nashville Tennessee
| | - Jane S. Hankins
- Department of Hematology; St Jude Children's Research Hospital; Memphis Tennessee
| | - Patricia Adams-Graves
- Department of General Internal Medicine; University of Tennessee Health Science Center; Memphis Tennessee
| | - Alexis A. Thompson
- Department of Pediatrics; Department of Medicine; Northwestern University; Chicago Illinois
| | - Karen Kalinyak
- Division of Hematology in Cancer and Blood Disease Institute; Cincinnati Children's Hospital; Cincinnati Ohio
| | - Jeannie Byrd
- Department of Pediatrics; Division of Hematology/Oncology; Vanderbilt-Meharry Center for Excellence in Sickle Cell Disease, Vanderbilt University Medical Center; Nashville Tennessee
| | - Brandi McClain
- Department of Pediatrics; Division of Hematology/Oncology; Vanderbilt-Meharry Center for Excellence in Sickle Cell Disease, Vanderbilt University Medical Center; Nashville Tennessee
| | - Adetola Kassim
- Department of Medicine; Division of Hematology/Oncology; Vanderbilt-Meharry Center for Excellence in Sickle Cell Disease, Vanderbilt University Medical Center; Nashville Tennessee
| | - Michael DeBaun
- Department of Pediatrics; Division of Hematology/Oncology; Vanderbilt-Meharry Center for Excellence in Sickle Cell Disease, Vanderbilt University Medical Center; Nashville Tennessee
| | - Marsha Treadwell
- Department of Hematology/Oncology; UCSF Benioff Children's Hospital Oakland; Oakland California
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Daumit GL, McGinty EE, Pronovost P, Dixon LB, Guallar E, Ford DE, Cahoon EK, Boonyasai RT, Thompson D. Patient Safety Events and Harms During Medical and Surgical Hospitalizations for Persons With Serious Mental Illness. Psychiatr Serv 2016; 67:1068-1075. [PMID: 27181736 PMCID: PMC5048490 DOI: 10.1176/appi.ps.201500415] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE This study explored the risk of patient safety events and associated nonfatal physical harms and mortality in a cohort of persons with serious mental illness. This group experiences high rates of medical comorbidity and premature mortality and may be at high risk of adverse patient safety events. METHODS Medical record review was conducted for medical-surgical hospitalizations occurring during 1994-2004 in a community-based cohort of Maryland adults with serious mental illness. Individuals were eligible if they died within 30 days of a medical-surgical hospitalization and if they also had at least one prior medical-surgical hospitalization within five years of death. All admissions took place at Maryland general hospitals. A case-crossover analysis examined the relationships among patient safety events, physical harms, and elevated likelihood of death within 30 days of hospitalization. RESULTS A total of 790 hospitalizations among 253 adults were reviewed. The mean number of patient safety events per hospitalization was 5.8, and the rate of physical harms was 142 per 100 hospitalizations. The odds of physical harm were elevated in hospitalizations in which 22 of the 34 patient safety events occurred (p<.05), including medical events (odds ratio [OR]=1.5, 95% confidence interval [CI]=1.3-1.7) and procedure-related events (OR=1.6, CI=1.2-2.0). Adjusted odds of death within 30 days of hospitalization were elevated for individuals with any patient safety event, compared with those with no event (OR=3.7, CI=1.4-10.3). CONCLUSIONS Patient safety events were positively associated with physical harm and 30-day mortality in nonpsychiatric hospitalizations for persons with serious mental illness.
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Affiliation(s)
- Gail L Daumit
- Dr. Daumit, Dr. Ford, and Dr. Boonyasai are with the Department of Internal Medicine, and Dr. Pronovost and Dr. Thompson are with the Department of Anesthesiology and the Department of Critical Care Medicine, all at Johns Hopkins University School of Medicine, Baltimore. Dr. Daumit is also with the Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, where Dr. McGinty is affiliated. Dr. Dixon is with the New York State Psychiatric Institute and the Department of Psychiatry, Columbia University College of Physicians and Surgeons, New York City. Dr. Guallar is with the Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore. Dr. Cahoon is with the Radiation Epidemiology Branch, National Cancer Institute, Bethesda, Maryland. Send correspondence to Dr. McGinty (e-mail: )
| | - Emma E McGinty
- Dr. Daumit, Dr. Ford, and Dr. Boonyasai are with the Department of Internal Medicine, and Dr. Pronovost and Dr. Thompson are with the Department of Anesthesiology and the Department of Critical Care Medicine, all at Johns Hopkins University School of Medicine, Baltimore. Dr. Daumit is also with the Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, where Dr. McGinty is affiliated. Dr. Dixon is with the New York State Psychiatric Institute and the Department of Psychiatry, Columbia University College of Physicians and Surgeons, New York City. Dr. Guallar is with the Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore. Dr. Cahoon is with the Radiation Epidemiology Branch, National Cancer Institute, Bethesda, Maryland. Send correspondence to Dr. McGinty (e-mail: )
| | - Peter Pronovost
- Dr. Daumit, Dr. Ford, and Dr. Boonyasai are with the Department of Internal Medicine, and Dr. Pronovost and Dr. Thompson are with the Department of Anesthesiology and the Department of Critical Care Medicine, all at Johns Hopkins University School of Medicine, Baltimore. Dr. Daumit is also with the Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, where Dr. McGinty is affiliated. Dr. Dixon is with the New York State Psychiatric Institute and the Department of Psychiatry, Columbia University College of Physicians and Surgeons, New York City. Dr. Guallar is with the Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore. Dr. Cahoon is with the Radiation Epidemiology Branch, National Cancer Institute, Bethesda, Maryland. Send correspondence to Dr. McGinty (e-mail: )
| | - Lisa B Dixon
- Dr. Daumit, Dr. Ford, and Dr. Boonyasai are with the Department of Internal Medicine, and Dr. Pronovost and Dr. Thompson are with the Department of Anesthesiology and the Department of Critical Care Medicine, all at Johns Hopkins University School of Medicine, Baltimore. Dr. Daumit is also with the Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, where Dr. McGinty is affiliated. Dr. Dixon is with the New York State Psychiatric Institute and the Department of Psychiatry, Columbia University College of Physicians and Surgeons, New York City. Dr. Guallar is with the Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore. Dr. Cahoon is with the Radiation Epidemiology Branch, National Cancer Institute, Bethesda, Maryland. Send correspondence to Dr. McGinty (e-mail: )
| | - Eliseo Guallar
- Dr. Daumit, Dr. Ford, and Dr. Boonyasai are with the Department of Internal Medicine, and Dr. Pronovost and Dr. Thompson are with the Department of Anesthesiology and the Department of Critical Care Medicine, all at Johns Hopkins University School of Medicine, Baltimore. Dr. Daumit is also with the Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, where Dr. McGinty is affiliated. Dr. Dixon is with the New York State Psychiatric Institute and the Department of Psychiatry, Columbia University College of Physicians and Surgeons, New York City. Dr. Guallar is with the Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore. Dr. Cahoon is with the Radiation Epidemiology Branch, National Cancer Institute, Bethesda, Maryland. Send correspondence to Dr. McGinty (e-mail: )
| | - Daniel E Ford
- Dr. Daumit, Dr. Ford, and Dr. Boonyasai are with the Department of Internal Medicine, and Dr. Pronovost and Dr. Thompson are with the Department of Anesthesiology and the Department of Critical Care Medicine, all at Johns Hopkins University School of Medicine, Baltimore. Dr. Daumit is also with the Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, where Dr. McGinty is affiliated. Dr. Dixon is with the New York State Psychiatric Institute and the Department of Psychiatry, Columbia University College of Physicians and Surgeons, New York City. Dr. Guallar is with the Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore. Dr. Cahoon is with the Radiation Epidemiology Branch, National Cancer Institute, Bethesda, Maryland. Send correspondence to Dr. McGinty (e-mail: )
| | - Elizabeth K Cahoon
- Dr. Daumit, Dr. Ford, and Dr. Boonyasai are with the Department of Internal Medicine, and Dr. Pronovost and Dr. Thompson are with the Department of Anesthesiology and the Department of Critical Care Medicine, all at Johns Hopkins University School of Medicine, Baltimore. Dr. Daumit is also with the Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, where Dr. McGinty is affiliated. Dr. Dixon is with the New York State Psychiatric Institute and the Department of Psychiatry, Columbia University College of Physicians and Surgeons, New York City. Dr. Guallar is with the Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore. Dr. Cahoon is with the Radiation Epidemiology Branch, National Cancer Institute, Bethesda, Maryland. Send correspondence to Dr. McGinty (e-mail: )
| | - Romsai T Boonyasai
- Dr. Daumit, Dr. Ford, and Dr. Boonyasai are with the Department of Internal Medicine, and Dr. Pronovost and Dr. Thompson are with the Department of Anesthesiology and the Department of Critical Care Medicine, all at Johns Hopkins University School of Medicine, Baltimore. Dr. Daumit is also with the Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, where Dr. McGinty is affiliated. Dr. Dixon is with the New York State Psychiatric Institute and the Department of Psychiatry, Columbia University College of Physicians and Surgeons, New York City. Dr. Guallar is with the Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore. Dr. Cahoon is with the Radiation Epidemiology Branch, National Cancer Institute, Bethesda, Maryland. Send correspondence to Dr. McGinty (e-mail: )
| | - David Thompson
- Dr. Daumit, Dr. Ford, and Dr. Boonyasai are with the Department of Internal Medicine, and Dr. Pronovost and Dr. Thompson are with the Department of Anesthesiology and the Department of Critical Care Medicine, all at Johns Hopkins University School of Medicine, Baltimore. Dr. Daumit is also with the Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, where Dr. McGinty is affiliated. Dr. Dixon is with the New York State Psychiatric Institute and the Department of Psychiatry, Columbia University College of Physicians and Surgeons, New York City. Dr. Guallar is with the Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore. Dr. Cahoon is with the Radiation Epidemiology Branch, National Cancer Institute, Bethesda, Maryland. Send correspondence to Dr. McGinty (e-mail: )
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Adams-Graves P, Bronte-Jordan L. Recent treatment guidelines for managing adult patients with sickle cell disease: challenges in access to care, social issues, and adherence. Expert Rev Hematol 2016; 9:541-52. [DOI: 10.1080/17474086.2016.1180242] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Ajayi TA, Edmonds KP, Thornberry K, Atayee RA. Palliative Care Teams as Advocates for Adults with Sickle Cell Disease. J Palliat Med 2016; 19:195-201. [DOI: 10.1089/jpm.2015.0268] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Toluwalase A. Ajayi
- Department of Pediatrics, Rady Children's Hospital, San Diego, California
- Scripps Translational Science Institute, La Jolla, California
| | - Kyle P. Edmonds
- Doris A. Howell Palliative Care Service, University of California San Diego, La Jolla, California
| | - Kathryn Thornberry
- Doris A. Howell Palliative Care Service, University of California San Diego, La Jolla, California
| | - Rabia A. Atayee
- Doris A. Howell Palliative Care Service, University of California San Diego, La Jolla, California
- Skaggs School of Pharmacy and Pharmaceutical Sciences, University of California San Diego, La Jolla, California
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Finset A. An unequal burden. PATIENT EDUCATION AND COUNSELING 2014; 96:143. [PMID: 25017609 DOI: 10.1016/j.pec.2014.06.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
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