1
|
Hicks CL, Urbanek RE, Olfenbuttel C. Sociodemographic and regional determinants of rabies submission bias in North Carolina. WILDLIFE SOC B 2022. [DOI: 10.1002/wsb.1351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Carson L. Hicks
- Department of Environmental Sciences University of North Carolina Wilmington 601 S. College Avenue Wilmington North Carolina USA
| | - Rachael E. Urbanek
- Department of Environmental Sciences University of North Carolina Wilmington 601 S. College Avenue Wilmington North Carolina USA
| | - Colleen Olfenbuttel
- North Carolina Wildlife Resources Commission 1751 Varsity Drive Raleigh North Carolina USA
| |
Collapse
|
2
|
Adas MA, Norton S, Balachandran S, Alveyn E, Russell MD, Esterine T, Amlani-Hatcher P, Oyebanjo S, Lempp H, Ledingham J, Kumar K, Galloway JB, Dubey S. Worse outcomes linked to ethnicity for early inflammatory arthritis in England and Wales: a national cohort study. Rheumatology (Oxford) 2022; 62:169-180. [PMID: 35536178 PMCID: PMC9788810 DOI: 10.1093/rheumatology/keac266] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Revised: 04/01/2022] [Accepted: 04/19/2022] [Indexed: 01/01/2023] Open
Abstract
OBJECTIVE To assess variability in care quality and treatment outcomes across ethnicities in early inflammatory arthritis (EIA). METHODS We conducted an observational cohort study in England and Wales from May 2018 to March 2020, including patients with a suspected/confirmed EIA diagnosis. Care quality was assessed against six metrics defined by national guidelines. Clinical outcomes were measured using DAS28. Outcomes between ethnic groups ('White', 'Black', 'Asian', 'Mixed', 'Other') were compared, and adjusted for confounders. RESULTS A total of 35 807 eligible patients were analysed. Of those, 30 643 (85.6%) were White and 5164 (14.6%) were from ethnic minorities: 1035 (2.8%) Black; 2617 (7.3%) Asian; 238 (0.6%) Mixed; 1274 (3.5%) Other. In total, 12 955 patients had confirmed EIA, of whom 11 315 were White and 1640 were from ethnic minorities: 314 (2.4%) Black; 927 (7.1%) Asian; 70 (0.5%) Mixed; 329 (2.5%) Other. A total of 14 803 patients were assessed by rheumatology within three weeks, and 5642 started treatment within six weeks of referral. There were no significant differences by ethnicity. Ethnic minority patients had lower odds of disease remission at three months [adjusted odds ratio 0.79 (95% CI: 0.65, 0.96)] relative to White patients. Ethnic minorities were significantly less likely to receive initial treatment withMTX[0.68 (0.52, 0.90)] or with glucocorticoids [0.63 (0.49, 0.80)]. CONCLUSION We demonstrate that some ethnic minorities are less likely to achieve disease remission in three months following EIA diagnosis. This is not explained by delays in referral or time to treatment. Our data highlight the need for investigation into the possible drivers of these inequitable outcomes and reappraisal of EIA management pathways.
Collapse
Affiliation(s)
| | | | | | - Edward Alveyn
- Centre for Rheumatic Disease, Department of Inflammatory Biology
| | - Mark D Russell
- Centre for Rheumatic Disease, Department of Inflammatory Biology
| | | | | | | | - Heidi Lempp
- Centre for Rheumatic Disease, Department of Inflammatory Biology
| | - Joanna Ledingham
- Rheumatology Department, Portsmouth Hospitals University NHS Trust, Portsmouth
| | - Kanta Kumar
- Institute of Clinical Sciences, University of Birmingham, Birmingham
| | - James B Galloway
- Correspondence to: James Galloway, Weston Education Centre, 10 Cutcombe Road, SE5 9RJ London, UK. E-mail:
| | | |
Collapse
|
3
|
Hawkins JM, Bean RA, Smith TB, Sandberg JG. Representation of Race and Ethnicity in Counseling and Counseling Psychology Journals. COUNSELING PSYCHOLOGIST 2022. [DOI: 10.1177/00110000211041766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Literature reviews have concluded that People of Color are underrepresented in psychological literature; however, the fields of counseling and counseling psychology have taken a clear affirmative stance with respect to human diversity. This study sought to evaluate the representation of People of Color in four key journals across the 2000–2019 timespan: The Counseling Psychologist, Journal of Counseling Psychology, Journal of Counseling & Development, and Counselling Psychology Quarterly. Journal articles were coded for variables including focus on racial/ethnic minority (REM) groups and article content topics. Results indicated that 26.3% of the articles were coded as REM-focused (3.8% focused on African Americans, 4.1% on Asian Americans, 3.1% on Latinxs, and 0.7% on Native Americans). The need for additional research is especially notable in the case of Latinxs (the least represented REM group relative to United States Census estimates) and for several multicultural topics that remain underrepresented in the literature.
Collapse
Affiliation(s)
- Jared M. Hawkins
- Department of Community, Family, and Addiction Sciences, Texas Tech University, Lubbock, TX, USA
| | - Roy A. Bean
- School of Family Life, Brigham Young University, Provo, UT, USA
| | - Timothy B. Smith
- David O. McKay School of Education, Brigham Young University, Provo, UT, USA
| | | |
Collapse
|
4
|
Gillman AS, Ferrer RA. Opportunities for theory-informed decision science in cancer control. Transl Behav Med 2021; 11:2055-2064. [PMID: 34850928 DOI: 10.1093/tbm/ibab141] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Cancer prevention and control involves navigation of complex clinical decisions, often laden with uncertainty and/or intricate interpersonal dynamics, which have implications for both physical health and quality of life. Cancer decision-making research in recent decades has primarily focused on working to improve the quality of decisions by providing patients with detailed information about their choices and through an increased emphasis in medicine on the importance of shared decision making. This emphasis is reflective of a model of decision making that emphasizes knowledge, options, and deliberative synthesis of information as primary to decision making; yet, decades of research in psychology, decision science, and behavioral economics have taught us that our decisions are not influenced only by our objective knowledge of facts, but by our emotions, by the influence of others, and by biased cognitive processes. We present a conceptual framework for a future of research in decision science and cancer that is informed by decision science theories. Our framework incorporates greater recognition of the interpersonal dynamics of shared decision making, including the biases (including cognitive heuristics and race-based bias) that may affect multiple actors in the decision-making process, and emphasizes study of the interaction between deliberative and affective psychological processes as they relate to decision making. This work should be conducted with an eye toward informing efforts to improve decision making across the cancer care continuum, through interventions that are also informed by theory.
Collapse
Affiliation(s)
- Arielle S Gillman
- Basic Biobehavioral and Psychological Sciences Branch, Behavioral Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD 20892-9761, USA
| | - Rebecca A Ferrer
- Basic Biobehavioral and Psychological Sciences Branch, Behavioral Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD 20892-9761, USA
| |
Collapse
|
5
|
Vo JB, Gillman A, Mitchell K, Nolan TS. Health Disparities: Impact of Health Disparities and Treatment Decision-Making Biases on Cancer Adverse Effects Among Black Cancer Survivors. Clin J Oncol Nurs 2021; 25:17-24. [PMID: 34533532 DOI: 10.1188/21.cjon.s1.17-24] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND Health disparities affect cancer incidence, treatment decisions, and adverse effects. Oncology providers may hold biases in the decision-making process, which can perpetuate health disparities. OBJECTIVES The purpose of this article is to describe health disparities across treatment decisions and adverse effects, describe decision-making biases, and provide suggestions for nurses to mitigate adverse outcomes. METHODS A scoping review of the literature was conducted. FINDINGS Factors affecting health disparities stem, in part, from structural racism and decision-making biases, such as implicit bias, which occurs when individuals have unconscious negative thoughts or feelings toward a particular group. Other decision-making biases, seemingly unrelated to race, include default bias, delay discounting bias, and availability bias. Nurses and nurse navigators can mitigate health disparities by providing culturally appropriate care, assessing health literacy, providing education regarding adverse effects, serving as patient advocates, empowering patients, evaluating personal level of disease knowledge, and monitoring and managing cancer treatment adverse effects.
Collapse
Affiliation(s)
| | | | | | - Timiya S Nolan
- Arthur G. James Cancer Hospital and Richard J. Solove Research Institute
| |
Collapse
|
6
|
Michel J, Ballon J, Connor SE, Johnson DC, Bergman J, Saigal CS, Litwin MS, Alden DL. Improving Shared Decision Making in Latino Men With Prostate Cancer: A Thematic Analysis. MDM Policy Pract 2021; 6:23814683211014180. [PMID: 34104782 PMCID: PMC8165846 DOI: 10.1177/23814683211014180] [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: 10/19/2019] [Accepted: 04/04/2021] [Indexed: 11/25/2022] Open
Abstract
Background. Multiple studies have shown that digitally mediated decision aids help prepare patients for medical decision making with their providers. However, few studies have investigated whether decision-support preferences differ between non-English-speaking and English-speaking Latino men with limited literacy. Objective. To identify and compare health information seeking patterns, preferences for information presentation, and interest in digital decision aids in a sample of Southern Californian underserved Latino men with newly diagnosed prostate cancer at a county hospital. Methods. We conducted semistructured, in-depth telephone interviews with 12 Spanish-speaking and 8 English-speaking Latino men using a purposive sampling technique. Following transcription of taped interviews, Spanish interviews were translated. Using a coding protocol developed by the team, two bilingual members jointly analyzed the transcripts for emerging themes. Coder agreement exceeded 80%. Differences were resolved through discussion. Results. Thematic differences between groups with different preferred languages emerged. Most respondents engaged in online health information seeking using cellphones, perceived a paternalistic patient-provider relationship, and expressed willingness to use hypothetical digital decision aids if recommended by their provider. English speakers reported higher digital technology proficiency for health-related searches. They also more frequently indicated family involvement in digital search related to their condition and preferred self-guided, web-based decision aids. In comparison, Spanish speakers reported lower digital technology proficiency and preferred family-involved, coach-guided, paper and visual decision aids. English speakers reported substantially higher levels of formal education. Conclusion. Preferences regarding the use of digital technology to inform prostate cancer treatment decision making among underserved Latino men varied depending on preferred primary language. Effective preparation of underserved Latino men for shared decision making requires consideration of alternative approaches depending on level of education attainment and preferred primary language.
Collapse
Affiliation(s)
- Joaquin Michel
- Department of Urology, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Jorge Ballon
- Department of Urology, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Sarah E Connor
- Department of Urology, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - David C Johnson
- Department of Urology, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Jonathan Bergman
- Department of Urology, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Christopher S Saigal
- Department of Urology, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Mark S Litwin
- Department of Urology, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Dana L Alden
- Department of Marketing, Shidler College of Business, University of Hawai'i, Honolulu, Hawai'i
| |
Collapse
|
7
|
Londono Tobon A, Flores JM, Taylor JH, Johnson I, Landeros-Weisenberger A, Aboiralor O, Avila-Quintero VJ, Bloch MH. Racial Implicit Associations in Psychiatric Diagnosis, Treatment, and Compliance Expectations. ACADEMIC PSYCHIATRY : THE JOURNAL OF THE AMERICAN ASSOCIATION OF DIRECTORS OF PSYCHIATRIC RESIDENCY TRAINING AND THE ASSOCIATION FOR ACADEMIC PSYCHIATRY 2021; 45:23-33. [PMID: 33438155 PMCID: PMC7933096 DOI: 10.1007/s40596-020-01370-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Accepted: 11/04/2020] [Indexed: 05/04/2023]
Abstract
OBJECTIVE Racial and ethnic disparities are well documented in psychiatry, yet suboptimal understanding of underlying mechanisms of these disparities undermines diversity, inclusion, and education efforts. Prior research suggests that implicit associations can affect human behavior, which may ultimately influence healthcare disparities. This study investigated whether racial implicit associations exist among medical students and psychiatric physicians and whether race/ethnicity, training level, age, and gender predicted racial implicit associations. METHODS Participants completed online demographic questions and 3 race Implicit Association Tests (IATs) related to psychiatric diagnosis (psychosis vs. mood disorders), patient compliance (compliance vs. non-compliance), and psychiatric medications (antipsychotics vs. antidepressants). Linear and logistic regression models were used to identify demographic predictors of racial implicit associations. RESULTS The authors analyzed data from 294 medical students and psychiatric physicians. Participants were more likely to pair faces of Black individuals with words related to psychotic disorders (as opposed to mood disorders), non-compliance (as opposed to compliance), and antipsychotic medications (as opposed to antidepressant medications). Among participants, self-reported White race and higher level of training were the strongest predictors of associating faces of Black individuals with psychotic disorders, even after adjusting for participant's age. CONCLUSIONS Racial implicit associations were measurable among medical students and psychiatric physicians. Future research should examine (1) the relationship between implicit associations and clinician behavior and (2) the ability of interventions to reduce racial implicit associations in mental healthcare.
Collapse
Affiliation(s)
| | - José M Flores
- Yale University School of Medicine, New Haven, CT, USA
| | - Jerome H Taylor
- Children's Hospital of Philadelphia & University of Pennsylvania School of Medicine, Philadelphia, PA, USA
| | - Isaac Johnson
- Yale University School of Medicine, New Haven, CT, USA
| | | | | | | | | |
Collapse
|
8
|
Matthews EB, Savoy M, Paranjape A, Washington D, Hackney T, Galis D, Zisman-Ilani Y. Shared Decision Making in Primary Care Based Depression Treatment: Communication and Decision-Making Preferences Among an Underserved Patient Population. Front Psychiatry 2021; 12:681165. [PMID: 34322040 PMCID: PMC8310927 DOI: 10.3389/fpsyt.2021.681165] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Accepted: 06/15/2021] [Indexed: 12/19/2022] Open
Abstract
Objectives: Although depression is a significant public health issue, many individuals experiencing depressive symptoms are not effectively linked to treatment by their primary care provider, with underserved populations have disproportionately lower rates of engagement in depression care. Shared decision making (SDM) is an evidence-based health communication framework that can improve collaboration and optimize treatment for patients, but there is much unknown about how to translate SDM into primary care depression treatment among underserved communities. This study seeks to explore patients' experiences of SDM, and articulate communication and decision-making preferences among an underserved patient population receiving depression treatment in an urban, safety net primary care clinic. Methods: Twenty-seven patients with a depressive disorder completed a brief, quantitative survey and an in-depth semi-structured interview. Surveys measured patient demographics and their subjective experience of SDM. Qualitative interview probed for patients' communication preferences, including ideal decision-making processes around depression care. Interviews were transcribed verbatim and analyzed using thematic analysis. Univariate statistics report quantitative findings. Results: Overall qualitative and quantitative findings indicate high levels of SDM. Stigma related to depression negatively affected patients' initial attitude toward seeking treatment, and underscored the importance of patient-provider rapport. In terms of communication and decision-making preferences, patients preferred collaboration with doctors during the information sharing process, but desired control over the final, decisional outcome. Trust between patients and providers emerged as a critical precondition to effective SDM. Respondents highlighted several provider behaviors that helped facilitated such an optimal environment for SDM to occur. Conclusion: Underserved patients with depression preferred taking an active role in their depression care, but looked for providers as partner in this process. Due to the stigma of depression, effective SDM first requires primary care providers to ensure that they have created a safe and trusting environment where patients are able to discuss their depression openly.
Collapse
Affiliation(s)
- Elizabeth B Matthews
- Graduate School of Social Service, Fordham University, New York, NY, United States
| | - Margot Savoy
- Lewis Katz School of Medicine, Temple University, Philadelphia, PA, United States
| | - Anuradha Paranjape
- Lewis Katz School of Medicine, Temple University, Philadelphia, PA, United States
| | - Diana Washington
- College of Public Health, Temple University, Philadelphia, PA, United States
| | - Treanna Hackney
- College of Public Health, Temple University, Philadelphia, PA, United States
| | - Danielle Galis
- Graduate School of Social Service, Fordham University, New York, NY, United States
| | - Yaara Zisman-Ilani
- College of Public Health, Temple University, Philadelphia, PA, United States
| |
Collapse
|
9
|
Kim H, Anhang Price R, Bunker JN, Bradley M, Schlang D, Bandini JI, Teno JM. Racial Differences in End-of-Life Care Quality between Asian Americans and Non-Hispanic Whites in San Francisco Bay Area. J Palliat Med 2020; 24:1147-1153. [PMID: 33326317 DOI: 10.1089/jpm.2020.0627] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: Little is known about end-of-life care experiences of Asian Americans and gaps in end-of-life care quality between Asians and non-Hispanic whites. Objective: Compare the perceptions of next-of-kin of Asian and non-Hispanic white decedents on end-of-life care quality. Design: Mortality follow-back survey. Setting/Subjects: Population-based sample of 108 Asian and 414 non-Hispanic white bereaved family members or close friends of adult, nontraumatic deaths in the San Francisco Bay area in 2018. Measurements: Survey items examined whether health care professionals treated the dying person with respect and dignity, respected their cultural traditions, respected their religious or spiritual beliefs, provided enough information about what to expect during the last month of life, provided emotional support to the family after the patient's death, and whether the dying person and the family received the needed help after work hours. Results: Of the 623 surveys (weighted n = 6513), 108 (weighted percentage = 17.6%) were from caregivers of Asian decedents. Almost half of these respondents indicated that they did not always experience respect for their cultural traditions (45.9% vs. 21.8%, p = 0.00) or respect for their religious and spiritual beliefs (42.2% vs. 24.5%, p = 0.01). With the exception of two outcomes, worse caregiver-reported care quality for Asian decedents persisted after adjustment for cause of death, site of death, type of health insurance, respondent's relationship to decedent, decedent age, and respondent education. Conclusions: Compared with caregivers of non-Hispanic whites, caregivers of Asian decedents reported unmet needs for caregiver support and lack of respect for cultural traditions and religious/spiritual beliefs.
Collapse
Affiliation(s)
- Hyosin Kim
- Division of General Internal Medicine and Geriatrics, School of Medicine, Oregon Health and Science University, Portland, Oregon, USA
| | | | - Jennifer N Bunker
- Division of General Internal Medicine and Geriatrics, School of Medicine, Oregon Health and Science University, Portland, Oregon, USA
| | | | | | | | - Joan M Teno
- Division of General Internal Medicine and Geriatrics, School of Medicine, Oregon Health and Science University, Portland, Oregon, USA
| |
Collapse
|
10
|
Lamb CC, Wang Y. PHYSICIAN CHARACTERISTICS THAT INFLUENCE PATIENT PARTICIPATION IN THE TREATMENT OF PRIMARY IMMUNODEFICIENCY. PATIENT EDUCATION AND COUNSELING 2020; 103:2280-2289. [PMID: 32475713 DOI: 10.1016/j.pec.2020.05.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Revised: 05/15/2020] [Accepted: 05/16/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVE Shared decision making (SDM) is recommended to improve healthcare quality. Physicians who use a rational decision-making style and patient-centric approach are more likely to incorporate SDM into clinical practice. This paper explores how certain physician characteristics such as gender, age, race, experience, and specialty explain patient participation. METHODS A multi-group structural equation model tested the relationship between physician decision-making styles, patient-centered care, physician characteristics, and patient participation in clinical treatment decisions. A survey was completed by 330 physicians who treat primary immunodeficiency. Sample group responses were compared between groups across specialty, age, race, experience, or gender. RESULTS A patient-centric approach was the main factor that encouraged SDM independent of physician decision-making style with both treatment protocols and product choices. The positive effect of patient-centrism is stronger for immunologists, more experienced physicians, or male physicians. A rational decision-making style increases participation for non-immunologists, older physicians, white physicians, less-experienced physicians and female physicians. CONCLUSION A patient-centric approach, rational decision-making and certain physician characteristics help explain patient participation in clinical decisions. Practice Implications Future SDM research and policy initiatives should focus on physician adoption of patient-centric approaches to chronic care diseases and the potential bias associated with physician characteristics and decision-making style.
Collapse
Affiliation(s)
- Christopher C Lamb
- BioSolutions Services, Englewood Cliffs, New Jersey, United States; Department of Management and Entrepreneurship, Silberman College of Business, Fairleigh Dickinson University, Teaneck, New Jersey, United States; Weatherhead School of Management, Case Western Reserve University, Cleveland, Ohio, USA.
| | - Yunmei Wang
- Case Cardiovascular Research Institute, Case Western Reserve University School of Medicine and Harrington Heart &Vascular Institute, University Hospitals Cleveland Medical Center, Cleveland, Ohio 44106, USA
| |
Collapse
|
11
|
Shannon EM, Schnipper JL, Mueller SK. Identifying Racial/Ethnic Disparities in Interhospital Transfer: an Observational Study. J Gen Intern Med 2020; 35:2939-2946. [PMID: 32700216 PMCID: PMC7572909 DOI: 10.1007/s11606-020-06046-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Accepted: 07/07/2020] [Indexed: 01/26/2023]
Abstract
BACKGROUND Interhospital transfer (IHT) is often performed to provide patients with specialized care. Racial/ethnic disparities in IHT have been suggested but are not well-characterized. OBJECTIVE To evaluate the association between race/ethnicity and IHT. DESIGN Cross-sectional analysis of 2016 National Inpatient Sample data. PATIENTS Patients aged ≥ 18 years old with common medical diagnoses at transfer, including acute myocardial infarction, congestive heart failure, arrhythmia, stroke, sepsis, pneumonia, and gastrointestinal bleed. MAIN MEASURES We performed a series of logistic regression models to estimate adjusted odds of transfer by race/ethnicity controlling for patient demographics, clinical variables, and hospital characteristics and to identify potential mediators. In secondary analyses, we estimated adjusted odds of transfer among patients at community hospitals (those more likely to transfer patients) and performed subgroup analyses by region and primary medical diagnosis. KEY RESULTS Of 5,774,175 weighted hospital admissions, 199,015 (4.5%) underwent IHT, including 4.7% of White patients, compared with 3.9% of Black patients and 3.8% of Hispanic patients. Black (OR 0.83, 95% CI 0.78-0.89) and Hispanic (OR 0.81, 95% CI 0.75-0.87) patients had lower crude odds of transfer compared with White patients, but this became non-significant after adjusting for hospital-level characteristics. In secondary analyses among patients hospitalized at community hospitals, Hispanic patients had lower adjusted odds of transfer (aOR 0.89, 95% CI 0.79-0.98). Disparities in IHT by race/ethnicity varied by region and medical diagnosis. CONCLUSIONS Black and Hispanic patients had lower odds of IHT, largely explained by a higher likelihood of being hospitalized at urban teaching hospitals. Racial/ethnic disparities in transfer were demonstrated at community hospitals, in certain geographic regions and among patients with specific diseases.
Collapse
Affiliation(s)
- Evan Michael Shannon
- Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital, Boston, MA, USA.
- Harvard Medical School, Boston, MA, USA.
| | - Jeffrey L Schnipper
- Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Stephanie K Mueller
- Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| |
Collapse
|
12
|
Timely Care is Patient-Centered Care for Patients with Acute Cholecystitis at a Safety-Net Hospital. World J Surg 2020; 45:72-78. [PMID: 32915281 DOI: 10.1007/s00268-020-05764-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/16/2020] [Indexed: 12/24/2022]
Abstract
BACKGROUND Multiple strategies exist to improve the timeliness and efficiency of surgical care at safety-net hospitals (SNH), such as acute care surgery models and nighttime surgery. However, the patient-centeredness of such approaches is unknown. METHODS Adults ( ≥18 years) with acute cholecystitis were interviewed upon admission to a SNH. Interviews were semi-structured and designed to obtain both exploratory qualitative data and ratings of patient-centered outcomes, ranked by importance to the patient. Outcomes included for rating were general health, symptom status, quality of life, and return to prior functional status. Latent content analysis applying inductive coding methods were used to code and condense raw qualitative data from interview transcripts. RESULTS Thematic saturation was reached with a sample size of 15 patients. Most participants were female (87%), Hispanic (87%), and had prior diagnosis of benign biliary disease (60%). Patients identified symptom resolution as the highest-ranked outcome in their treatment. Themes expressed by patients during the exploratory segments of the interview included: desire for pain alleviation, frustration with delays to both symptom resolution and surgical intervention, lack of perceived control over their health care, and reticence in discussing preferences with physicians. All patients preferred to have surgical treatment as soon as possible, even if that meant having nighttime surgery. CONCLUSIONS Effective and timely resolution of symptoms is of utmost importance to patients with acute cholecystitis at a SNH. Efforts to improve timeliness of surgical care are also perceived as patient-centered.
Collapse
|
13
|
Dijkstra HP, Ergen E, Holtzhausen L, Beasley I, Alonso JM, Geertsema L, Geertsema C, Nelis S, Ngai ASH, Stankovic I, Targett S, Andersen TE. Remote assessment in sport and exercise medicine (SEM): a narrative review and teleSEM solutions for and beyond the COVID-19 pandemic. Br J Sports Med 2020; 54:1162-1167. [PMID: 32605933 PMCID: PMC7513251 DOI: 10.1136/bjsports-2020-102650] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/21/2020] [Indexed: 12/12/2022]
Abstract
Background The COVID-19 pandemic forces sport and exercise medicine (SEM) physicians to think differently about the clinical care of patients. Many rapidly implement eHealth and telemedicine solutions specific to SEM without guidance on how best to provide these services. Aim The aim of this paper is to present some guiding principles on how to plan for and perform an SEM consultation remotely (teleSEM) based on a narrative review of the literature. A secondary aim is to develop a generic teleSEM injury template. Results eHealth and telemedicine are essential solutions to effective remote patient care, also in SEM. This paper provides guidance for wise planning and delivery of teleSEM. It is crucial for SEM physicians, technology providers and organisations to codesign teleSEM services, ideally involving athletes, coaches and other clinicians involved in the clinical care of athletes, and to gradually implement these services with appropriate support and education. Conclusion teleSEM provides solutions for remote athlete clinical care during and after the COVID-19 pandemic. We define two new terms—eSEM and teleSEM and discuss guiding principles on how to plan for and perform SEM consultations remotely (teleSEM). We provide an example of a generic teleSEM injury assessment guide.
Collapse
Affiliation(s)
- H Paul Dijkstra
- Department of Medical Education, Aspetar Qatar Orthopaedic and Sports Medicine Hospital, Doha, Ad Dawhah, Qatar .,Department for Continuing Education, University of Oxford, Oxford, UK
| | - Emin Ergen
- Sports Medicine Department, Aspetar Qatar Orthopaedic and Sports Medicine Hospital, Doha, Ad Dawhah, Qatar
| | - Louis Holtzhausen
- Sports Medicine Department, Aspetar Qatar Orthopaedic and Sports Medicine Hospital, Doha, Ad Dawhah, Qatar.,Section Sports Medicine, University of Pretoria Faculty of Health Sciences, Pretoria, South Africa
| | - Ian Beasley
- Sports Medicine Department, Aspetar Qatar Orthopaedic and Sports Medicine Hospital, Doha, Ad Dawhah, Qatar.,The Royal Ballet, London, UK
| | - Juan Manuel Alonso
- Sports Medicine Department, Aspetar Qatar Orthopaedic and Sports Medicine Hospital, Doha, Ad Dawhah, Qatar
| | - Liesel Geertsema
- Sports Medicine Department, Aspetar Qatar Orthopaedic and Sports Medicine Hospital, Doha, Ad Dawhah, Qatar
| | - Celeste Geertsema
- Sports Medicine Department, Aspetar Qatar Orthopaedic and Sports Medicine Hospital, Doha, Ad Dawhah, Qatar
| | - Sofie Nelis
- Department of Medical Education, Aspetar Qatar Orthopaedic and Sports Medicine Hospital, Doha, Ad Dawhah, Qatar
| | - Aston Seng Huey Ngai
- Sports Medicine Department, Aspetar Qatar Orthopaedic and Sports Medicine Hospital, Doha, Ad Dawhah, Qatar
| | - Ivan Stankovic
- Department of Medical Education, Aspetar Qatar Orthopaedic and Sports Medicine Hospital, Doha, Ad Dawhah, Qatar
| | - Stephen Targett
- Sports Medicine Department, Aspetar Qatar Orthopaedic and Sports Medicine Hospital, Doha, Ad Dawhah, Qatar
| | - Thor Einar Andersen
- Sports Medicine Department, Aspetar Qatar Orthopaedic and Sports Medicine Hospital, Doha, Ad Dawhah, Qatar.,Department of Sports Medicine, Oslo Sports Trauma Research Center, Norwegian School of Sport Sciences, Oslo, Norway
| |
Collapse
|
14
|
Lee YK, Chor YY, Tan MY, Ngio YC, Chew AW, Tiew HW, Syahirah MR, Ng CJ. Factors associated with level of shared decision making in Malaysian primary care consultations. PATIENT EDUCATION AND COUNSELING 2020; 103:1049-1051. [PMID: 31866195 DOI: 10.1016/j.pec.2019.12.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Revised: 11/27/2019] [Accepted: 12/09/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVE To measure the level of shared decision-making (SDM) in primary care consultations in Malaysia, a multicultural, middle-income developing country. METHODS A cross-sectional study was conducted in an urban, public primary care clinic. Convenience sampling was used to recruit participants, and audio-recorded consultations were scored for SDM levels by two independent raters using the OPTION tool. Univariate and multivariate analysis was conducted to determine factors significantly associated with SDM levels. RESULTS 199 patients and 31 doctors participated. Mean consultation time was 14.3 min (+ SD 5.75). Patients' age ranged from 18 to 87 years (median age of 57.5 years). 52.8 % of patients were female, with three main ethnicities (Malay, Chinese, Indian). The mean OPTION score was found to be 7.8 (+ SD 3.31) out of 48. After a multivariate analysis, only patient ethnicity (β= -0.142, p < 0.05) and increased consultation time (β = 0.407, p < 0.01) were associated with higher OPTION scores. CONCLUSIONS Patients in Malaysia experience extremely poor levels of SDM in general practice. Higher scores were associated with increased consultation time and patient ethnicity. PRACTICE IMPLICATIONS Malaysian general practitioners should aim to develop and practice cultural competency skills to avoid biased SDM practice towards certain ethnicities.
Collapse
Affiliation(s)
- Yew Kong Lee
- Department of Primary Care, University of Malaya, Kuala Lumpur, Malaysia.
| | - Yee Yang Chor
- Department of Primary Care, University of Malaya, Kuala Lumpur, Malaysia
| | - Mae-Yen Tan
- School of Medicine, University of Glasgow, Glasgow, UK
| | - Yi Chen Ngio
- Department of Primary Care, University of Malaya, Kuala Lumpur, Malaysia
| | - Ai Wie Chew
- Department of Primary Care, University of Malaya, Kuala Lumpur, Malaysia
| | - Han Wei Tiew
- Department of Primary Care, University of Malaya, Kuala Lumpur, Malaysia
| | | | - Chirk Jenn Ng
- Department of Primary Care, University of Malaya, Kuala Lumpur, Malaysia
| |
Collapse
|
15
|
Attanasio LB, Hardeman RR. Declined care and discrimination during the childbirth hospitalization. Soc Sci Med 2019; 232:270-277. [DOI: 10.1016/j.socscimed.2019.05.008] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Revised: 05/06/2019] [Accepted: 05/09/2019] [Indexed: 01/04/2023]
|
16
|
Discussion: Decline in Racial Disparities in Postmastectomy Breast Reconstruction: A Surveillance, Epidemiology, and End Results Analysis from 1998 to 2014. Plast Reconstr Surg 2019; 143:1571-1572. [PMID: 31136469 DOI: 10.1097/prs.0000000000005612] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
17
|
Grabinski VF, Myckatyn TM, Lee CN, Philpott-Streiff SE, Politi MC. Importance of Shared Decision-Making for Vulnerable Populations: Examples from Postmastectomy Breast Reconstruction. Health Equity 2018; 2:234-238. [PMID: 30283872 PMCID: PMC6167005 DOI: 10.1089/heq.2018.0020] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
Shared decision-making (SDM) is a process through which patients and providers collaborate to select a treatment option that aligns with patients' preferences and clinical context. SDM can improve patients' decision quality and satisfaction. However, vulnerable populations face barriers to participation in SDM, which exacerbates disparities in decision quality. This perspective article discusses SDM with vulnerable patients, using examples from patients who made decisions about postmastectomy breast reconstruction. We offer several strategies for clinical practice, medical education, and research to ensure that movements to engage patients in SDM do not exclude already marginalized groups.
Collapse
Affiliation(s)
- Victoria F Grabinski
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St. Louis, Missouri
| | - Terence M Myckatyn
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, Missouri
| | - Clara N Lee
- Department of Plastic and Reconstructive Surgery, College of Medicine, The Ohio State University, Columbus, Ohio.,Division of Health Services Management and Policy, College of Public Health, The Ohio State University, Columbus, Ohio
| | - Sydney E Philpott-Streiff
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St. Louis, Missouri
| | - Mary C Politi
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St. Louis, Missouri
| |
Collapse
|
18
|
Attanasio LB, Kozhimannil KB, Kjerulff KH. Factors influencing women's perceptions of shared decision making during labor and delivery: Results from a large-scale cohort study of first childbirth. PATIENT EDUCATION AND COUNSELING 2018; 101:1130-1136. [PMID: 29339041 PMCID: PMC5977392 DOI: 10.1016/j.pec.2018.01.002] [Citation(s) in RCA: 58] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/15/2017] [Revised: 11/30/2017] [Accepted: 01/04/2018] [Indexed: 06/07/2023]
Abstract
OBJECTIVE To examine correlates of shared decision making during labor and delivery. METHODS Data were from a cohort of women who gave birth to their first baby in Pennsylvania, 2009-2011 (N = 3006). We used logistic regression models to examine the association between labor induction and mode of delivery in relation to women's perceptions of shared decision making, and to investigate race/ethnicity and SES as potential moderators. RESULTS Women who were Black and who did not have a college degree or private insurance were less likely to report high shared decision making, as well as women who underwent labor induction, instrumental vaginal or cesarean delivery. Models with interaction terms showed that the reduction in odds of shared decision making associated with cesarean delivery was greater for Black women than for White women. CONCLUSIONS Women in marginalized social groups were less likely to report shared decision making during birth and Black women who delivered by cesarean had particularly low odds of shared decision making. PRACTICE IMPLICATIONS Strategies designed to improve the quality of patient-provider communication, information sharing, and shared decision making must be attentive to the needs of vulnerable groups to ensure that such interventions reduce rather than widen disparities.
Collapse
Affiliation(s)
- Laura B Attanasio
- Health Policy and Management, University of Minnesota School of Public Health, Minneapolis, MN, USA.
| | - Katy B Kozhimannil
- Health Policy and Management, University of Minnesota School of Public Health, Minneapolis, MN, USA
| | - Kristen H Kjerulff
- Department of Public Health Sciences and Department of Obstetrics and Gynecology, College of Medicine, Penn State University, Hershey, PA, USA
| |
Collapse
|
19
|
Leal IM, Kao LS, Karanjawala B, Escamilla RJ, Ko TC, Millas SG. Understanding Patients' Experiences of Diagnosis and Treatment of Advanced Colorectal Cancer in a Safety-Net Hospital System: A Qualitative Study. Dis Colon Rectum 2018. [PMID: 29521833 DOI: 10.1097/dcr.0000000000000967] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
BACKGROUND Greater understanding of barriers to screening of colorectal cancer among lower socioeconomic, particularly Hispanic, patients is needed to improve disparities in care. OBJECTIVE This study aimed to explore patients' perceptions and experiences of care seeking for colorectal cancer to identify barriers to early diagnosis and treatment. DESIGN This explorative qualitative study was conducted as a focused ethnography of patients diagnosed with advanced-stage colorectal cancer. SETTINGS This study was conducted at an urban safety-net hospital. PARTICIPANTS Thirty lower-income, primarily minority, patients diagnosed with stage III and IV colorectal cancer without prior colorectal cancer screening were selected. MAIN OUTCOME MEASURES The primary outcomes measured were participants' perceptions and experiences of colorectal cancer and barriers they faced in seeking diagnosis and treatment RESULTS:: Data analysis yielded 4 themes consistently influencing participants' decisions to seek diagnosis and treatment: 1) limited resources for accessing care (structural barriers, including economic, health care and health educational resources); 2) (mis)understanding of symptoms by patients; misdiagnosis of symptoms, by physicians; 3) beliefs about illness and health, such as relying on faith, or self-care when symptoms developed; and 4) reactions to illness, including maintenance of masculinity, confusing interactions with physicians, embarrassment, and fear. These 4 themes describe factors on the structural, health care system, provider and patient level, that interact to make engaging in prevention foreign among this population, thus limiting early detection and treatment of colorectal cancer. LIMITATIONS This study was limited by selection bias and the lack of generalizability. CONCLUSION Improving screening rates among lower-income populations requires addressing barriers across the multiple levels, structural, personal, health care system, that patients encounter in seeking care for colorectal cancer. Acknowledging the complex, multilevel influences impacting patient health care choices and behaviors allows for the development of culturally tailored interventions, and educational, financial, and community resources to decrease disparities in cancer screening and care and improve outcomes for these at-risk patients. See Video Abstract at http://links.lww.com/DCR/A473.
Collapse
Affiliation(s)
- Isabel M Leal
- Department of General Surgery, The University of Texas Health Science Center, Houston, Texas.,Department of Psychological, Health and Learning Sciences, University of Houston, Houston, Texas
| | - Lillian S Kao
- Department of General Surgery, The University of Texas Health Science Center, Houston, Texas.,Center for Surgical Trials and Evidence-based Practice, The University of Texas Health Science Center, Houston, Texas
| | - Burzeen Karanjawala
- Department of General Surgery, The University of Texas Health Science Center, Houston, Texas
| | - Richard J Escamilla
- Department of General Surgery, The University of Texas Health Science Center, Houston, Texas
| | - Tien C Ko
- Department of General Surgery, The University of Texas Health Science Center, Houston, Texas
| | - Stefanos G Millas
- Department of General Surgery, The University of Texas Health Science Center, Houston, Texas
| |
Collapse
|
20
|
Jongen C, McCalman J, Bainbridge R, Clifford A. Cultural Competence Strengths, Weaknesses and Future Directions. SPRINGERBRIEFS IN PUBLIC HEALTH 2018. [DOI: 10.1007/978-981-10-5293-4_8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
|
21
|
Thareja S, Fink M, Chen KH, Liu Y, Chen SC, Stoff BK. Race as a predictor of patient preferences for biopsy result communication. J Am Acad Dermatol 2017; 78:1223-1225.e1. [PMID: 29223577 DOI: 10.1016/j.jaad.2017.11.054] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2017] [Revised: 11/21/2017] [Accepted: 11/24/2017] [Indexed: 11/24/2022]
Affiliation(s)
- Shalini Thareja
- Department of Internal Medicine, Emory University, Atlanta, Georgia
| | - Matthew Fink
- Department of Dermatology, Emory University, Atlanta, Georgia
| | - Kuang-Ho Chen
- School of Medicine, Emory University, Atlanta, Georgia
| | - Yuan Liu
- Department of Biostatistics and Bioinformatics, Emory University, Atlanta, Georgia
| | - Suephy C Chen
- Department of Dermatology, Emory University, Atlanta, Georgia
| | - Benjamin K Stoff
- Department of Dermatology, Emory University, Atlanta, Georgia; Center for Ethics, Emory University, Atlanta, Georgia.
| |
Collapse
|
22
|
Mueck KM, Leal IM, Wan CC, Goldberg BF, Saunders TE, Millas SG, Liang MK, Ko TC, Kao LS. Shared decision-making during surgical consultation for gallstones at a safety-net hospital. Surgery 2017; 163:680-686. [PMID: 29223328 DOI: 10.1016/j.surg.2017.10.043] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2017] [Revised: 09/04/2017] [Accepted: 10/18/2017] [Indexed: 12/17/2022]
Abstract
BACKGROUND Understanding patient perspectives regarding shared decision-making is crucial to providing informed, patient-centered care. Little is known about perceptions of vulnerable patients regarding shared decision-making during surgical consultation. The purpose of this study was to evaluate whether a validated tool reflects perceptions of shared decision-making accurately among patients seeking surgical consultation for gallstones at a safety-net hospital. METHODS A mixed methods study was conducted in a sample of adult patients with gallstones evaluated at a safety-net surgery clinic between May to July 2016. Semi-structured interviews were conducted after their initial surgical consultation and analyzed for emerging themes. Patients were administered the Shared Decision-Making Questionnaire and Autonomy Preference Scale. Univariate analyses were performed to identify factors associated with shared decision-making and to compare the results of the surveys to those of the interviews. RESULTS The majority of patients (N = 30) were female (90%), Hispanic (80%), Spanish-speaking (70%), and middle-aged (45.7 ± 16 years). The proportion of patients who perceived shared decision-making was greater in the Shared Decision-Making Questionnaire versus the interviews (83% vs 27%, P < .01). Age, sex, race/ethnicity, primary language, diagnosis, Autonomy Preference Scale score, and decision for operation was not associated with shared decision-making. Contributory factors to this discordance include patient unfamiliarity with shared decision-making, deference to surgeon authority, lack of discussion about different treatments, and confusion between aligned versus shared decisions. CONCLUSION Available questionnaires may overestimate shared decision-making in vulnerable patients suggesting the need for alternative or modifications to existing methods. Furthermore, such metrics should be assessed for correlation with patient-reported outcomes, such as satisfaction with decisions and health status.
Collapse
Affiliation(s)
- Krislynn M Mueck
- Department of Surgery, University of Texas Health Science Center, Houston, TX; Center for Surgical Trials and Evidence-based Practice (CSTEP), University of Texas Health Science Center, Houston, TX.
| | - Isabel M Leal
- Department of Surgery, University of Texas Health Science Center, Houston, TX
| | - Charlie C Wan
- Department of Surgery, University of Texas Health Science Center, Houston, TX
| | - Braden F Goldberg
- Department of Surgery, University of Texas Health Science Center, Houston, TX
| | - Tamara E Saunders
- Department of Surgery, University of Texas Health Science Center, Houston, TX
| | - Stefanos G Millas
- Department of Surgery, University of Texas Health Science Center, Houston, TX
| | - Mike K Liang
- Department of Surgery, University of Texas Health Science Center, Houston, TX; Center for Surgical Trials and Evidence-based Practice (CSTEP), University of Texas Health Science Center, Houston, TX
| | - Tien C Ko
- Department of Surgery, University of Texas Health Science Center, Houston, TX
| | - Lillian S Kao
- Department of Surgery, University of Texas Health Science Center, Houston, TX; Center for Surgical Trials and Evidence-based Practice (CSTEP), University of Texas Health Science Center, Houston, TX
| |
Collapse
|
23
|
Attanasio LB, Hardeman RR, Kozhimannil KB, Kjerulff KH. Prenatal attitudes toward vaginal delivery and actual delivery mode: Variation by race/ethnicity and socioeconomic status. Birth 2017; 44:306-314. [PMID: 28887835 PMCID: PMC5687997 DOI: 10.1111/birt.12305] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVES Researchers documenting persistent racial/ethnic and socioeconomic status disparities in chances of cesarean delivery have speculated that women's birth attitudes and preferences may partially explain these differences, but no studies have directly tested this hypothesis. We examined whether women's prenatal attitudes toward vaginal delivery differed by race/ethnicity or socioeconomic status, and whether attitudes were differently related to delivery mode depending on race/ethnicity or socioeconomic status. METHODS Data were from the First Baby Study, a cohort of 3006 women who gave birth to a first baby in Pennsylvania between 2009 and 2011. We used regression models to examine (1) predictors of prenatal attitudes toward vaginal delivery, and (2) the association between prenatal attitudes and actual delivery mode. To assess moderation, we estimated models adding interaction terms. RESULTS Prenatal attitudes toward vaginal delivery were not associated with race/ethnicity or socioeconomic status. Positive attitudes toward vaginal delivery were associated with lower odds of cesarean delivery (AOR=0.60, P < .001). However, vaginal delivery attitudes were only related to delivery mode among women who were white, highly educated, and privately insured. CONCLUSIONS There are racial/ethnic differences in chances of cesarean delivery, and these differences are not explained by birth attitudes. Furthermore, our findings suggest that white and high-socioeconomic status women may be more able to realize their preferences in childbirth.
Collapse
Affiliation(s)
- Laura B Attanasio
- Department of Health Promotion and Policy, School of Public Health and Health Sciences, University of Massachusetts Amherst, Amherst, MA, USA
| | - Rachel R Hardeman
- Division of Health Policy and Management, University of Minnesota School of Public Health, Minneapolis, MN, USA
| | - Katy B Kozhimannil
- Division of Health Policy and Management, University of Minnesota School of Public Health, Minneapolis, MN, USA
| | - Kristen H Kjerulff
- Department of Public Health Sciences and Department of Obstetrics and Gynecology, College of Medicine, Penn State University, Hershey, PA, USA
| |
Collapse
|
24
|
Molokwu JC, Penaranda E, Shokar N. Decision-Making Preferences Among Older Hispanics Participating in a Colorectal Cancer (CRC) Screening Program. J Community Health 2017; 42:1027-1034. [DOI: 10.1007/s10900-017-0352-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
25
|
Castaneda-Guarderas A, Glassberg J, Grudzen CR, Ngai KM, Samuels-Kalow ME, Shelton E, Wall SP, Richardson LD. Shared Decision Making With Vulnerable Populations in the Emergency Department. Acad Emerg Med 2016; 23:1410-1416. [PMID: 27860022 DOI: 10.1111/acem.13134] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2016] [Accepted: 11/02/2016] [Indexed: 01/19/2023]
Abstract
The emergency department (ED) occupies a unique position within the healthcare system, serving as a safety net for vulnerable patients, regardless of their race, ethnicity, religion, country of origin, sexual orientation, socioeconomic status, or medical diagnosis. Shared decision making (SDM) presents special challenges when used with vulnerable population groups. The differing circumstances, needs, and perspectives of vulnerable groups invoke issues of provider bias, disrespect, judgmental attitudes, and lack of cultural competence, as well as patient mistrust and the consequences of their social and economic disenfranchisement. A research agenda that includes community-engaged approaches, mixed-methods studies, and cost-effectiveness analyses is proposed to address the following questions: 1) What are the best processes/formats for SDM among racial, ethnic, cultural, religious, linguistic, social, or otherwise vulnerable groups who experience disadvantage in the healthcare system? 2) What organizational or systemic changes are needed to support SDM in the ED whenever appropriate? 3) What competencies are needed to enable emergency providers to consider patients' situation/context in an unbiased way? 4) How do we teach these competencies to students and residents? 5) How do we cultivate these competencies in practicing emergency physicians, nurses, and other clinical providers who lack them? The authors also identify the importance of using accurate, group-specific data to inform risk estimates for SDM decision aids for vulnerable populations and the need for increased ED-based care coordination and transitional care management capabilities to create additional care options that align with the needs and preferences of vulnerable populations.
Collapse
Affiliation(s)
- Ana Castaneda-Guarderas
- Department of Emergency Medicine Aventura Hospital and Medical Center; Miami FL
- Department of Emergency Medicine and Knowledge & Evaluation Research Unit; Mayo Clinic; Rochester MN
| | - Jeffrey Glassberg
- Department of Emergency Medicine; The Icahn School of Medicine at Mount Sinai; New York NY
- Center for Health Equity and Community Engaged Research; Department of Population Health Science & Policy; The Icahn School of Medicine at Mount Sinai; New York NY
- Department of Medicine; Division Hematology & Medical Oncology; The Icahn School of Medicine at Mount Sinai; New York NY
| | - Corita R. Grudzen
- Department of Emergency Medicine and the Department of Population Health; New York University; New York NY
| | - Ka Ming Ngai
- Department of Emergency Medicine; The Icahn School of Medicine at Mount Sinai; New York NY
| | | | - Erica Shelton
- Department of Emergency Medicine; Johns Hopkins University; Baltimore MD
| | - Stephen P. Wall
- Department of Emergency Medicine and the Department of Population Health; New York University; New York NY
- Bellevue Hospital Center; New York NY
| | - Lynne D. Richardson
- Department of Emergency Medicine; The Icahn School of Medicine at Mount Sinai; New York NY
- Center for Health Equity and Community Engaged Research; Department of Population Health Science & Policy; The Icahn School of Medicine at Mount Sinai; New York NY
- Department of Population Health Science & Policy; The Icahn School of Medicine at Mount Sinai; New York NY
| |
Collapse
|
26
|
Spring LM, Marshall MR, Warner ET. Mammography decision making: Trends and predictors of provider communication in the Health Information National Trends Survey, 2011 to 2014. Cancer 2016; 123:401-409. [PMID: 27727457 DOI: 10.1002/cncr.30378] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2016] [Revised: 08/01/2016] [Accepted: 09/14/2016] [Indexed: 01/20/2023]
Abstract
BACKGROUND In 2009, the US Preventive Services Task Force recommended that the decision to initiate screening mammography before age 50 years should be individualized. Herein, the authors examined whether health care providers are communicating regarding mammography decision making with women and whether communication is associated with screening behavior. METHODS Data were drawn from the 2011 to 2014 Health Information National Trends Survey (HINTS). A total of 5915 female respondents aged ≥ 40 years who responded to the following question were included: "Has a doctor or other health professional ever told you that you could choose whether or not to have a mammogram?" We used logistic regression to generate odds ratios (ORs) and 95% confidence intervals (95% CIs) for predictors of provider communication and assessed whether provider communication was associated with mammography in the previous 2 years overall and stratified by age. RESULTS Fewer than 50% of the women reported provider communication regarding mammogram choice. Women who reported provider communication were not found to be more likely to report no mammogram within the past 2 years (OR, 1.07; 95% CI, 0.87-1.31) compared with those who did not. When stratified by 10-year age group, provider communication was associated with a higher likelihood of no mammogram only among women age ≥70 years (OR, 1.64; 95% CI, 1.15-2.34), and was associated with a lower likelihood of no mammogram only among women aged 40 to 49 years (OR, 0.63; 95% CI, 0.43-0.92). CONCLUSIONS Between 2011 and 2014, less than one-half of women received communication regarding mammogram choice despite recommendations from the US Preventive Services Task Force. Provider communication regarding mammogram choice can influence screening behavior, particularly for younger and older women. Cancer 2017;123:401-409. © 2016 American Cancer Society.
Collapse
Affiliation(s)
- Laura M Spring
- Breast Medical Oncology, Massachusetts General Hospital, Boston, Massachusetts
| | - Megan R Marshall
- Department of Orthopedics, Massachusetts General Hospital, Boston, Massachusetts
| | - Erica T Warner
- Clinical Translational Epidemiology Unit, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts
| |
Collapse
|
27
|
Abstract
The annual National Healthcare Quality and Disparities Reports document widespread and persistent racial and ethnic disparities. These disparities result from complex interactions between patient factors related to social disadvantage, clinicians, and organizational and health care system factors. Separate and unequal systems of health care between states, between health care systems, and between clinicians constrain the resources that are available to meet the needs of disadvantaged groups, contribute to unequal outcomes, and reinforce implicit bias. Recent data suggest slow progress in many areas but have documented a few notable successes in eliminating these disparities. To eliminate these disparities, continued progress will require a collective national will to ensure health care equity through expanded health insurance coverage, support for primary care, and public accountability based on progress toward defined, time-limited objectives using evidence-based, sufficiently resourced, multilevel quality improvement strategies that engage patients, clinicians, health care organizations, and communities.
Collapse
Affiliation(s)
- Kevin Fiscella
- Departments of Family Medicine and Public Health Sciences, University of Rochester Medical Center, Rochester, New York 14620;
| | - Mechelle R Sanders
- Departments of Family Medicine and Public Health Sciences, University of Rochester Medical Center, Rochester, New York 14620;
| |
Collapse
|