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Olson SM, Muñoz EG, Solis EC, Bradford HM. Mitigating Weight Bias in the Clinical Setting: A New Approach to Care. J Midwifery Womens Health 2024; 69:180-190. [PMID: 38087862 DOI: 10.1111/jmwh.13578] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/06/2024]
Abstract
Weight bias toward patients in larger bodies is pervasive among health care providers and can negatively influence provider-patient communication, as well as patients' behavior and health outcomes. Weight bias has historical roots that perpetuate thinness and Whiteness as the cultural norm. Although weight bias remains socially acceptable in US culture, contributing factors to an individual's body size are complex and multifactorial. Providers and health care systems also consistently use body mass index (BMI) as an indicator of health status, despite its limitations and harmful effects in the clinical setting. This state of the science review presents 8 evidence-based strategies that demonstrate how to mitigate harm from weight bias and improve quality of care and health outcomes for patients living in larger bodies. Person-centered approaches to care include (1) eliminating clinical recommendations to lose weight; (2) shifting from a focus on weight to health; (3) implementing a size and weight-inclusive approach; (4) engaging in weight bias self-evaluation; (5) creating a welcoming environment for patients of all sizes; (6) seeking permission and learning the patient's story; (7) using weight-inclusive language; and (8) re-evaluating clinical guidelines and policies based on BMI. Midwives and other health care providers may benefit from training that re-imagines the delivery of health care to patients in larger bodies.
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Affiliation(s)
- Signey M Olson
- Georgetown University School of Nursing, Washington, District of Columbia
| | - Elizabeth G Muñoz
- University of Alabama at Birmingham School of Nursing, Birmingham, Alabama
| | - Ellen C Solis
- University of Washington School of Nursing, Seattle, Washington
| | - Heather M Bradford
- Georgetown University School of Nursing, Washington, District of Columbia
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2
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Pozzar RA, Tulsky JA, Berry DL, Batista J, Yackel HD, Phan H, Wright AA. Developing a Collaborative Agenda-Setting Intervention (CASI) to promote patient-centered communication in ovarian cancer care: A design thinking approach. PATIENT EDUCATION AND COUNSELING 2024; 120:108099. [PMID: 38086227 DOI: 10.1016/j.pec.2023.108099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 12/01/2023] [Accepted: 12/05/2023] [Indexed: 01/29/2024]
Abstract
OBJECTIVES Patient-centered communication (PCC) occurs when clinicians respond to patients' needs, preferences, and concerns. While PCC is associated with better health-related quality of life in patients with cancer, patients with ovarian cancer have reported unmet communication needs. We used design thinking to develop an intervention to promote PCC in ovarian cancer care. METHODS Following the steps of design thinking, we empathized with stakeholders by reviewing the literature, then created stakeholder and journey maps to define the design challenge. To ideate solutions, we developed a challenge map. Finally, we developed wireframe prototypes and tested them with stakeholders. RESULTS Empathizing revealed that misaligned visit priorities precipitated suboptimal communication. Defining the design challenge and ideating solutions highlighted the need to normalize preference assessments, promote communication self-efficacy, and enhance visit efficiency. The Collaborative Agenda-Setting Intervention (CASI) elicits patients' needs and preferences and delivers communication guidance at the point of care. Stakeholders approved of the prototype. CONCLUSION Design thinking provided a systematic approach to empathizing with stakeholders, identifying challenges, and innovating solutions. PRACTICE IMPLICATIONS To our knowledge, the CASI is the first intervention to set the visit agenda and support communication from within the electronic health record. Future research will assess its usability and acceptability.
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Affiliation(s)
- Rachel A Pozzar
- Dana-Farber Cancer Institute, 450 Brookline Ave., Boston, MA 02215, USA; Harvard Medical School, 25 Shattuck St., Boston, MA 02115, USA.
| | - James A Tulsky
- Dana-Farber Cancer Institute, 450 Brookline Ave., Boston, MA 02215, USA; Harvard Medical School, 25 Shattuck St., Boston, MA 02115, USA
| | - Donna L Berry
- University of Washington, 1959 NE Pacific St., Seattle, WA 98195, USA
| | - Jeidy Batista
- Dana-Farber Cancer Institute, 450 Brookline Ave., Boston, MA 02215, USA
| | | | - Hang Phan
- Dana-Farber Cancer Institute, 450 Brookline Ave., Boston, MA 02215, USA
| | - Alexi A Wright
- Dana-Farber Cancer Institute, 450 Brookline Ave., Boston, MA 02215, USA; Harvard Medical School, 25 Shattuck St., Boston, MA 02115, USA
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3
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Anandarajah G, Mennillo MR, Wang S, DeFries K, Gottlieb JL. Trust as a Central Factor in Hospice Enrollment Disparities Among Ethnic and Racial Minority Patients: A Qualitative Study of Interrelated and Compounding Factors Impacting Trust. J Palliat Med 2023; 26:1488-1500. [PMID: 37379486 DOI: 10.1089/jpm.2023.0090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/30/2023] Open
Abstract
Background: Disparities in end-of-life (EOL) care remain among ethnic/racial minority populations. Choosing hospice care in the United States depends on goals-of-care discussions founded on trust. While studies examine hospice enrollment disparities and others explore trust in hospice settings in general, very few explicitly examine the role of trust in hospice enrollment disparities. Objectives: To explore factors impacting trust and how these might contribute to disparities in hospice enrollment. Design: A qualitative, individual interview study, based on grounded theory. Setting/Subjects: Setting: Rhode Island, USA. Participants: Multiple stakeholders in EOL care, with diverse professional and personal backgrounds. Measurements: In-depth semistructured individual interviews were audio-recorded and transcribed as part of a broader study of hospice enrollment barriers in diverse patients. Analysis: Five researchers did a secondary data analysis, focusing on trust as the central phenomenon of interest. Researchers independently analyzed transcripts, then held iterative group analysis meetings until they reached consensus regarding themes, subthemes, and relationships. Results: Twenty-two participants included five physicians, five nurses, three social workers, two chaplains, one nursing assistant, three administrators, and three patient caregivers/family. Interviews reveal that trust is multidimensional, involving personal- and systems-level trust, and both locus and degree of trust. Factors impacting trust include: fear; communication/relationships; knowledge of hospice; religious/spiritual beliefs; language; and cultural beliefs/experiences. While some are common across groups, several are more prevalent in minority populations. These factors appear to interact in complex ways, unique to individual patients/families, compounding their impact on trust. Conclusions: While gaining patient/family trust regarding EOL decision making is challenging across all groups, minority patients often experience additional compounding factors impacting trust building. More research is needed to mitigate the negative ways these interacting factors impact trust.
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Affiliation(s)
- Gowri Anandarajah
- Department of Family Medicine and Medical Science, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Meera R Mennillo
- Department of English, University of Rhode Island, Kingston, Rhode Island, USA
| | - Sophie Wang
- Department of Medical Sciences, Brown University Graduate School, Providence, Rhode Island, USA
| | - Kai'olu DeFries
- Department of Medical Sciences, Brown University Graduate School, Providence, Rhode Island, USA
| | - Jaya L Gottlieb
- Department of Biology, University of Massachusetts-Amherst, Amherst, Massachusetts, USA
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4
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Paladino J, Fromme EK, Kilpatrick L, Dingfield L, Teuteberg W, Bernacki R, Jackson V, Sanders JJ, Jacobsen J, Ritchie C, Mitchell S. Lessons Learned About System-Level Improvement in Serious Illness Communication: A Qualitative Study of Serious Illness Care Program Implementation in Five Health Systems. Jt Comm J Qual Patient Saf 2023; 49:620-633. [PMID: 37537096 DOI: 10.1016/j.jcjq.2023.06.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Revised: 06/26/2023] [Accepted: 06/26/2023] [Indexed: 08/05/2023]
Abstract
BACKGROUND Serious illness communication is a key element of high-quality care, but it is difficult to implement in practice. The Serious Illness Care Program (SICP) is a multifaceted intervention that contributes to more, earlier, and better serious illness conversations and improved patient outcomes. This qualitative study examined the organizational and implementation factors that influenced improvement in real-world contexts. METHODS The authors performed semistructured interviews of 30 health professionals at five health systems that adopted SICP as quality improvement initiatives to investigate the organizational and implementation factors that appeared to influence improvement. RESULTS After SICP implementation across the organizations studied, approximately 4,661 clinicians have been trained in serious illness communication and 56,712 patients had had an electronic health record (EHR)-documented serious illness conversation. Facilitators included (1) visible support from leaders, who financially invested in an implementation team and champions, expressed the importance of serious illness communication as an institutional priority, and created incentives for training and documenting serious illness conversations; (2) EHR and data infrastructure to foster performance improvement and accountability, including an accessible documentation template, a reporting system, and customized data feedback for clinicians; and (3) communication skills training and sustained support for clinicians to problem-solve communication challenges, reflect on communication experiences, and adapt the intervention. Inhibitors included leadership inaction, competing priorities and incentives, variable clinician acceptance of EHR and data tools, and inadequate support for clinicians after training. CONCLUSION Successful implementation appeared to rely on multilevel organizational strategies to prioritize, reward, and reinforce serious illness communication. The insights derived from this research may function as an organizational road map to guide implementation of SICP or related quality initiatives.
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5
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Wu W, He X, Li S, Jin M, Ni Y. Pain nursing for gynecologic cancer patients. Front Oncol 2023; 13:1205553. [PMID: 37564934 PMCID: PMC10410261 DOI: 10.3389/fonc.2023.1205553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Accepted: 07/11/2023] [Indexed: 08/12/2023] Open
Abstract
Gynecological malignancy remains a prevalent cause of mortality among women. Chronic cancer pain, as a severe complication of malignancy and its therapies, accounts for a substantial burden of physical and psychological distress in affected patients. Accordingly, early identification, assessment, and standardized management of such pain are crucial in the prevention or delay of its progression. In the present review, we provide a comprehensive overview of the pathological factors that contribute to pain in patients with gynecological malignancy while highlighting the underlying mechanisms of pain in this population. In addition, we summarize several treatment modalities targeting pain management in gynecologic cancer patients, including surgery, radiotherapy, and chemotherapy. These interventions are crucial for tumor elimination and patient survival. Chronic cancer pain exerts a significant impact on wellbeing and quality of life for patients with gynecologic cancer. Therefore, our review emphasizes the importance of addressing this pain and its psychological sequelae and advocates for a multidisciplinary approach that encompasses nursing and psychological support. In summary, this review offers valuable insights into the pathological factors underlying pain, reviews pain management modalities, and stresses the critical role of early intervention and comprehensive care in enhancing the quality of life of these patients.
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Affiliation(s)
| | - Xiaodan He
- Department of Gynecology, Cancer Hospital of China Medical University, Liaoning Cancer Hospital and Institute, Shenyang, Liaoning, China
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6
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Peters PN, Havrilesky LJ, Davidson BA. Guidelines for goals of care discussions in patients with gynecologic cancer. Gynecol Oncol 2023; 174:247-252. [PMID: 37243995 DOI: 10.1016/j.ygyno.2023.05.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 05/07/2023] [Accepted: 05/15/2023] [Indexed: 05/29/2023]
Abstract
This article represents a distillation of literature to provide guidance for goals of care discussions with patients who have gynecologic malignancies. As clinicians who provide surgical care, chemotherapy, and targeted therapeutics, gynecologic oncology clinicians are uniquely positioned to form longitudinal relationships with patients that can enable patient-centered decision making. In this review, we describe optimal timing, components, and best practices for goals of care discussions in gynecologic oncology.
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Affiliation(s)
- Pamela N Peters
- Division of Gynecologic Oncology, Department of Obstetrics & Gynecology, Duke University Health System, Durham, NC 27710, United States of America.
| | - Laura J Havrilesky
- Division of Gynecologic Oncology, Department of Obstetrics & Gynecology, Duke University Health System, Durham, NC 27710, United States of America
| | - Brittany A Davidson
- Division of Gynecologic Oncology, Department of Obstetrics & Gynecology, Duke University Health System, Durham, NC 27710, United States of America
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7
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Güler B, Mete S. Effects of Relaxation-Focused Nursing Program in Women with Ovarian Cancer: A Randomized Controlled Trial. Pain Manag Nurs 2023:S1524-9042(23)00074-7. [PMID: 37045690 DOI: 10.1016/j.pmn.2023.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Revised: 02/26/2023] [Accepted: 03/11/2023] [Indexed: 04/14/2023]
Abstract
BACKGROUND Surgical treatment is a major cause of hospitalization in ovarian cancer. In this process, physical problems, such as pain and changes in respiratory functions, and psychological problems, such as anxiety and stress, may develop. AIM This study aims to investigate the effects of the Relaxation-Focused Nursing Program on pain, anxiety, lung volume, level of knowledge, and nursing care satisfaction in ovarian cancer surgery. METHOD A randomized controlled trial in which participants were randomly assigned to either the experimental (preoperative relaxation exercises and education; n = 24) or control (usual nursing care; n =22) groups. The intervention consisted of practicing four sessions of relaxation exercises and education in the hospital for two days before surgery. Data were collected using the Trait and State Anxiety Inventory, Surgical Information Form, and Perioperative Assessment Form. The results were analyzed using the Friedman and Wilcoxon tests. RESULTS The findings showed significant reductions in pain (p = .045) and anxiety scores (p < .001). The level of knowledge means scores were higher in the experimental group, but there was no significant difference between mean scores of spirometer volume and care satisfaction. CONCLUSIONS The program was more effective than usual nursing care in preoperative anxiety, pain, and level of knowledge. Although there was no difference between the care satisfaction scores of the patients, the reasons for care satisfaction were different in the program. Developing and implementing care that combines stress reduction interventions and preoperative education can improve the preoperative outcomes of patients.
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Affiliation(s)
- Buse Güler
- From the Dokuz Eylul University Faculty of Nursing, İzmir, Turkey.
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8
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Sun Y, Ma Y, Li Q, Ge J. Supportive care needs of women with gynaecological cancer: A systematic review and synthesis of qualitative studies. J Adv Nurs 2023. [PMID: 36811244 DOI: 10.1111/jan.15614] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Revised: 01/23/2023] [Accepted: 02/11/2023] [Indexed: 02/24/2023]
Abstract
AIMS To synthesize existing qualitative research evidence on the supportive care needs of women with gynaecological cancer. DESIGN Qualitative systematic review. DATA SOURCES A comprehensive literature search was performed using nine databases (PubMed, Web of Science, PsycINFO, CINAHL, Embase, CBM, CNKI, VIP and WanFang) without restrictions regarding publication date; qualitative studies published in English or Chinese were included. Initial search in December 2021 and updated in October 2022. REVIEW METHODS This study was conducted according to the Enhancing Transparency in Reporting the Synthesis of Qualitative Research (ENTREQ) guidelines. The Critical Appraisal Skills Programme tool for qualitative research was used to assess the quality of all included papers. Finally, we adopted a thematic synthesis method, synthesized the main findings, and constructed themes. RESULTS Eleven studies published between 2010 and 2021 were included in the review. Based on the thematic synthesis method, 10 descriptive themes were generated and five analytical themes were derived: psychological support, information support, social support, disease-specific symptom management and form of care. Women with gynaecological cancer expressed a desire for psychological support from empathetic healthcare professionals; information support included access to adequate and appropriate information, as well as communication and involvement; social support highlighted women's desire for peer support, family-related support and financial support; disease-specific symptom management described women's desire for support in coping with reproduction/sexual issues and form of care highlighted the need for continuity of care and holistic care. CONCLUSION The supportive care needs of women with gynaecological cancer are multidimensional and complex. The future care practice should take women's needs as a starting point and provide ongoing holistic and individualized support. Healthcare providers' understanding and support of these needs are critical to improving women's clinical outcomes and quality of care. IMPACT The present findings can help further develop supportive care programmes and make nursing interventions more targeted and effective. PATIENT OR PUBLIC CONTRIBUTION No patient or public contribution.
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Affiliation(s)
- Yue Sun
- School of Nursing, China Medical University, Shenyang, China.,Department of Gynaecology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Yanling Ma
- Department of Orthopedics, West China Hospital of Sichuan University, Chengdu, China
| | - Qiaoran Li
- School of Nursing, China Medical University, Shenyang, China.,Department of Gynaecology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Jingling Ge
- Department of Gynaecology, Shengjing Hospital of China Medical University, Shenyang, China
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9
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Pozzar RA, Xiong N, Hong F, Wright AA, Goff BA, Underhill-Blazey ML, Tulsky JA, Hammer MJ, Berry DL. How does patient-centered communication in ovarian cancer care enhance patient well-being? A mixed methods study. Gynecol Oncol 2022; 167:261-268. [PMID: 36057465 DOI: 10.1016/j.ygyno.2022.08.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 07/15/2022] [Accepted: 08/24/2022] [Indexed: 11/27/2022]
Abstract
OBJECTIVE Greater perceived patient-centered communication (PCC) is associated with better health-related quality of life (HRQoL) in patients with ovarian cancer. Quantitative measures of PCC and HRQoL do little to explain this association. We interviewed patients with high and low ratings of PCC to understand how it is associated with HRQoL. METHODS Explanatory sequential mixed methods study. Participants were English-speaking U.S. adults with ovarian cancer. We assessed PCC with the Patient-Centered Communication - Cancer (PCC-Ca)-36 (possible score range 1-5; higher scores represent greater patient-centeredness), and purposively sampled 14 participants with total scores in the top and bottom quartiles. Participants completed individual, semi-structured interviews about their communication experiences. Guided by the National Cancer Institute Framework for PCC in Cancer Care, we analyzed interview transcripts using directed content analysis. We integrated survey and interview findings in a joint display. RESULTS Among 176 survey respondents, PCC-Ca-36 total scores ranged from 1.7 to 5.0. Participants with scores in the top quartile (4.8-5.0) perceived clinicians as proactive and attentive to psychosocial concerns. Those with scores in the bottom quartile (1.7-3.5) described not feeling known as an individual and receiving limited support for self-management. CONCLUSIONS The association between PCC and QoL may be partially explained by differences in perceived support for psychosocial concerns and self-management. PCC may facilitate receipt of proactive, personalized care.
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Affiliation(s)
- Rachel A Pozzar
- Dana-Farber Cancer Institute, Boston, MA, USA; Harvard Medical School, Boston, MA, USA.
| | - Niya Xiong
- Dana-Farber Cancer Institute, Boston, MA, USA
| | - Fangxin Hong
- Dana-Farber Cancer Institute, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| | - Alexi A Wright
- Dana-Farber Cancer Institute, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| | | | | | - James A Tulsky
- Dana-Farber Cancer Institute, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| | - Marilyn J Hammer
- Dana-Farber Cancer Institute, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
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10
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Zanolli NC, Gatta LA, Fish L, Falkovic M, Lorenzo A, Puechl AM, Havrilesky LJ, Davidson B. A Qualitative Assessment of Patient Experience following Systematic Implementation of Goals of Care Conversations in the Ambulatory Gynecologic Oncology Setting. Palliat Med Rep 2022; 3:308-315. [DOI: 10.1089/pmr.2022.0040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/03/2022] [Indexed: 11/24/2022] Open
Affiliation(s)
- Nicole C. Zanolli
- Department of Obstetrics and Gynecology, Duke University School of Medicine, Durham, North Carolina, USA
| | - Luke A. Gatta
- Department of Obstetrics and Gynecology, Duke University Medical Center, Durham, North Carolina, USA
| | - Laura Fish
- Duke Cancer Institute Behavioral Health and Survey Research Core, Durham, North Carolina, USA
| | - Margaret Falkovic
- Department of Population Health Sciences, Durham, North Carolina, USA
| | - Amelia Lorenzo
- Division of Gynecologic Oncology, Duke University Medical Center, Durham, North Carolina, USA
| | - Allison M. Puechl
- Department of Obstetrics and Gynecology, Duke University Medical Center, Durham, North Carolina, USA
- Division of Gynecologic Oncology, Duke University Medical Center, Durham, North Carolina, USA
| | - Laura J. Havrilesky
- Department of Obstetrics and Gynecology, Duke University Medical Center, Durham, North Carolina, USA
- Division of Gynecologic Oncology, Duke University Medical Center, Durham, North Carolina, USA
| | - Brittany Davidson
- Department of Obstetrics and Gynecology, Duke University Medical Center, Durham, North Carolina, USA
- Division of Gynecologic Oncology, Duke University Medical Center, Durham, North Carolina, USA
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11
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Dillon EC, Chopra V, Mesghina E, Milki A, Chan A, Reddy R, Kapp DS, Silver BA, Chan JK. The Healthcare Journey of Women With Advanced Gynecological Cancer From Diagnosis Through Terminal Illness: Qualitative Analysis of Progress Note Data. Am J Hosp Palliat Care 2021; 39:1090-1097. [PMID: 34951820 DOI: 10.1177/10499091211064242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE To examine women's journeys with gynecologic cancer from before diagnosis through death and identify elements of their healthcare experience that warrant improvement. METHODS This exploratory study used longitudinal progress notes data from a multispecialty practice in Northern California. The sample included women with stage IV gynecological cancer diagnosed after 2011 and who died before 2018. Available progress notes from prior to diagnosis to death were qualitatively analyzed. RESULTS We identified 32 women, (median age 61 years) with mostly uterine (n=17) and ovarian (n=9) cancers and median survival of 9.2 months (min:2.9 and max:47.5). Sixteen (50%) received outpatient palliative care and 18 (56%) received hospice care. The analysis found wide variation in documentation about communication about diagnosis, prognosis, goals of care, stopping treatment, and starting hospice care. Challenges included escalating/severe symptoms, repeated urgent care/emergency department/hospital encounters, and lack of or late access to palliative and hospice care. Notes also illustrated how patient background and goals influenced care trajectory and communication. Documentation styles varied substantially, with palliative care notes more consistently documenting conversations about goals of care and psychosocial needs. CONCLUSION This analysis of longitudinal illness experience of women with advanced gynecological cancer suggests that clinicians may want to (1) prioritize earlier discussion about goals of care; (2) provide supplemental support to patients with higher needs, possibly through palliative care or navigation; and (3) write notes to enhance patient understanding now that patients may access all notes.
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Affiliation(s)
- Ellis C Dillon
- Center for Health Systems Research, 33314Sutter Health and Palo Alto Medical Foundation Research Institute, Palo Alto, CA, USA
| | - Vidita Chopra
- Center for Health Systems Research, 33314Sutter Health and Palo Alto Medical Foundation Research Institute, Palo Alto, CA, USA
| | - Elizabeth Mesghina
- Center for Health Systems Research, 7024Sutter Health, Palo Alto, CA, USA
| | - Anthony Milki
- 43989The George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Ava Chan
- Division of Gynecologic Oncology, Sutter Research Institute, 204799California Pacific-Palo Alto Medical Foundation, San Francisco, CA, USA
| | - Ravali Reddy
- Department of Obstetrics and Gynecology, 10624Stanford University School of Medicine, Stanford, CA, USA
| | - Daniel S Kapp
- Department of Radiation Oncology, 10624Stanford University School of Medicine, Stanford, CA, USA
| | - Barbara A Silver
- The Ovarian and Reproductive Cancer Recovery Program at The Women's Health Resource Center, 7153California Pacific Medical Center, San Francisco, CA, USA
| | - John K Chan
- Division of Gynecologic Oncology, Sutter Research Institute, 204799California Pacific-Palo Alto Medical Foundation, San Francisco, CA, USA
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Davidson BA, Havrilesky LJ, Lefkowitz C. Opportunities to Advance the Delivery of High-Quality, Goal-Concordant End-of-Life Care in Ovarian Cancer. JCO Oncol Pract 2021; 18:161-163. [PMID: 34748389 DOI: 10.1200/op.21.00699] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | | | - Carolyn Lefkowitz
- Division of Gynecologic Oncology, University of Colorado, Aurora, CO
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13
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Pozzar RA, Xiong N, Hong F, Wright AA, Goff BA, Underhill-Blazey ML, Tulsky JA, Hammer MJ, Berry DL. Perceived patient-centered communication, quality of life, and symptom burden in individuals with ovarian cancer. Gynecol Oncol 2021; 163:408-418. [PMID: 34454724 DOI: 10.1016/j.ygyno.2021.08.007] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Revised: 08/09/2021] [Accepted: 08/10/2021] [Indexed: 12/22/2022]
Abstract
OBJECTIVE To describe perceptions of patient-centered communication (PCC); assess whether physician specialty, patient characteristics, or health system characteristics are associated with PCC; and identify associations between PCC, health-related quality of life (HRQoL), and symptom burden among individuals with ovarian cancer. METHODS Cross-sectional, descriptive survey of English-speaking adults with ovarian cancer. PCC, HRQoL, and ovarian cancer symptom burden were assessed with the PCC-Ca-36, the FACT-G, and the FOSI-18, respectively. PCC-Ca-36 scores were summarized using descriptive statistics. Predictors of PCC-Ca-36, FACT-G, and FOSI-18 scores were identified using multiple linear regression. RESULTS Participants (n = 176) had a mean age of 59.4 years (SD = 12.1). The majority (65.9%) had advanced-stage disease, while 42.0% were receiving treatment. The mean PCC-Ca-36 total score was 4.09 (SD = 0.78) out of a possible 5, indicating participants often perceived that clinicians engaged in PCC. Among the PCC functions, participants reported that clinicians least often enabled patient self-management (M = 3.65, SD = 0.99), responded to emotions (M = 3.84, SD = 1.04), and managed uncertainty (M = 3.91, SD = 0.93). In multivariable analyses, neither physician specialty nor patient and health system characteristics were significantly associated with overall PCC. Greater overall PCC predicted better overall HRQoL; better social/family, emotional, and functional well-being; and lower overall and physical symptom burden (all p ≤ 0.05). CONCLUSION Greater PCC is significantly associated with better HRQoL and lower symptom burden among individuals with ovarian cancer. PRACTICE IMPLICATIONS Promotion of PCC is a promising strategy to improve patient-reported outcomes in the ovarian cancer care setting.
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Affiliation(s)
- Rachel A Pozzar
- Dana-Farber Cancer Institute, 450 Brookline Ave., Boston, MA 02215, United States.
| | - Niya Xiong
- Dana-Farber Cancer Institute, 450 Brookline Ave., Boston, MA 02215, United States
| | - Fangxin Hong
- Dana-Farber Cancer Institute, 450 Brookline Ave., Boston, MA 02215, United States
| | - Alexi A Wright
- Dana-Farber Cancer Institute, 450 Brookline Ave., Boston, MA 02215, United States
| | - Barbara A Goff
- University of Washington, 1959 NE Pacific St., Seattle, WA 98115, United States
| | - Meghan L Underhill-Blazey
- Dana-Farber Cancer Institute, 450 Brookline Ave., Boston, MA 02215, United States; University of Rochester, 255 Crittenden Blvd., Rochester, NY 14642, United States
| | - James A Tulsky
- Dana-Farber Cancer Institute, 450 Brookline Ave., Boston, MA 02215, United States
| | - Marilyn J Hammer
- Dana-Farber Cancer Institute, 450 Brookline Ave., Boston, MA 02215, United States
| | - Donna L Berry
- Dana-Farber Cancer Institute, 450 Brookline Ave., Boston, MA 02215, United States; University of Washington, 1959 NE Pacific St., Seattle, WA 98115, United States
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Pozzar RA, Hong F, Xiong N, Stopfer JE, Nayak MM, Underhill-Blazey M. Knowledge and psychosocial impact of genetic counseling and multigene panel testing among individuals with ovarian cancer. Fam Cancer 2021; 21:35-47. [PMID: 33751319 DOI: 10.1007/s10689-021-00240-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Accepted: 02/25/2021] [Indexed: 11/29/2022]
Abstract
In a sample of individuals with ovarian cancer, we aimed to (a) identify factors associated with the psychosocial impact of genetic counseling and multigene panel testing, (b) identify factors associated with cancer genetics knowledge, and (c) summarize patient-reported recommendations to improve the genetic counseling and multigene panel testing process. Eligible participants in this secondary analysis of quantitative and qualitative survey data were English-speaking adults with ovarian cancer. Psychosocial impact was assessed using the Multidimensional Impact of Cancer Risk Assessment (MICRA) questionnaire. Knowledge of cancer genetics was assessed using the KnowGene scale. Significant predictors of MICRA and KnowGene scores were identified using multiple regression. Open-ended survey item responses were analyzed using conventional content analysis. Eighty-seven participants met eligibility criteria. A positive genetic test result was associated with greater adverse psychosocial impact (B = 1.13, p = 0.002). Older age (B = - 0.07, p = 0.044) and being a member of a minority racial or ethnic group (B = - 3.075, p = 0.033) were associated with lower knowledge, while a personal history of at least one other type of cancer (B = 1.975, p = 0.015) was associated with higher knowledge. In open-ended item responses, participants wanted clinicians to assist with family communication, improve result disclosure, and enhance patient and family understanding of results. A subset of individuals with ovarian cancer who receive a positive genetic test result may be at risk for adverse psychosocial outcomes. Tailored cancer genetics education is necessary to promote the equitable uptake of targeted ovarian cancer treatment and risk-reducing therapies. Interventions to enhance patient-clinician communication in this setting are a research priority.
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Affiliation(s)
- Rachel A Pozzar
- Dana-Farber Cancer Institute, 450 Brookline Ave., Boston, MA, 02215, USA.
| | - Fangxin Hong
- Dana-Farber Cancer Institute, 450 Brookline Ave., Boston, MA, 02215, USA
| | - Niya Xiong
- Dana-Farber Cancer Institute, 450 Brookline Ave., Boston, MA, 02215, USA
| | - Jill E Stopfer
- Dana-Farber Cancer Institute, 450 Brookline Ave., Boston, MA, 02215, USA
| | - Manan M Nayak
- Dana-Farber Cancer Institute, 450 Brookline Ave., Boston, MA, 02215, USA
| | - Meghan Underhill-Blazey
- Dana-Farber Cancer Institute, 450 Brookline Ave., Boston, MA, 02215, USA.,University of Rochester, 601 Elmwood Ave., Rochester, NY, 14642, USA
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15
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Ferriss JS, Rose S, Rungruang B, Urban R, Spencer R, Uppal S, Sinno AK, Duska L, Walsh C. Society of Gynecologic Oncology recommendations for fellowship education during the COVID-19 pandemic and beyond: Innovating programs to optimize trainee success. Gynecol Oncol 2020; 160:271-278. [PMID: 33077260 PMCID: PMC7568037 DOI: 10.1016/j.ygyno.2020.10.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Accepted: 10/09/2020] [Indexed: 12/19/2022]
Abstract
In approximately ten months' time, the novel coronavirus, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has infected over 34 million people and caused over one million deaths worldwide. The impact of this virus on our health, relationships, and careers is difficult to overstate. As the economic realities for academic medical centers come into focus, we must recommit to our core missions of patient care, education, and research. Fellowship education programs in gynecologic oncology have quickly adapted to the “new normal” of social distancing using video conferencing platforms to continue clinical and didactic teaching. United in a time of crisis, we have embraced systemic change by developing and delivering collaborative educational content, overcoming the limitations imposed by institutional silos. Additional innovations are needed in order to overcome the losses in program surgical volume and research opportunities. With the end of the viral pandemic nowhere in sight, program directors can rethink how education is best delivered and potentially overhaul aspects of fellowship curriculum and content. Similarly, restrictions on travel and the need for social distancing has transformed the 2020 fellowship interview season from an in-person to a virtual experience. During this time of unprecedented and rapid change, program directors should be particularly mindful of the needs and health of their trainees and consider tailoring their educational experiences accordingly. The novel coronavirus pandemic has disrupted medical education at all levels. Fellowship programs must adapt to the realities of social distancing, workforce redeployments, and laboratory closures. The integration of teleconferencing into clinical practice and learning provides both challenges and growth opportunities. Program directors should be aware of new stressors our fellows, particularly underrepresented minorities, are facing. Programs should take advantage of the opportunity to rethink fellowship education and the needs of our recent graduates.
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Affiliation(s)
- J Stuart Ferriss
- Kelly Gynecologic Oncology Service, Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
| | - Steve Rose
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Wisconsin, Madison, WI, USA
| | - Bunja Rungruang
- Medical College of Georgia at Augusta University, Augusta, GA, USA
| | - Renata Urban
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Washington School of Medicine, Seattle, WA, USA
| | - Ryan Spencer
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Wisconsin, Madison, WI, USA
| | - Shitanshu Uppal
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI, USA
| | - Abdulrahman K Sinno
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Miami, Miami, FL, USA
| | - Linda Duska
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Virginia, Charlottesville, VA, USA
| | - Christine Walsh
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Cedars Sinai Medical Center, Los Angeles, CA, USA
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Shalowitz DI, Lefkowits C, Landrum LM, von Gruenigen VE, Spillman MA. Principles of ethics and critical communication during the COVID-19 pandemic. Gynecol Oncol 2020; 158:526-530. [PMID: 32622474 PMCID: PMC7315948 DOI: 10.1016/j.ygyno.2020.06.494] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
•During the COVID-19 pandemic, the primary clinical emphasis has shifted to optimizing community health. •Scarce resources should be allocated to maximize benefit without unfairly affecting any group. •Healthcare systems should consider adopting a formal, tier-based response to COVID-19 related demand on resources. •Clinicians should use principles of high-stakes communication to guide care planning during the pandemic.
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Affiliation(s)
- David I Shalowitz
- Section on Gynecologic Oncology, Department of Obstetrics and Gynecology, Wake Forest School of Medicine, Winston-Salem, NC, United States of America.
| | - Carolyn Lefkowits
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Colorado, Denver, CO, United States of America
| | - Lisa M Landrum
- Section of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States of America
| | - Vivian E von Gruenigen
- Division of Gynecologic Oncology, University Hospitals Medical Center, Beachwood, OH, United States of America
| | - Monique A Spillman
- Division of Gynecologic Oncology, Texas Oncology, Baylor University Medical Center, Dallas, TX, United States of America
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Monchis M, Martin C, DiDiodato G. Evaluation of a program using a physician assistant and an electronic patient-provider communication tool to facilitate discussions about goals of care in older adults in hospital: a pilot study. CMAJ Open 2020; 8:E577-E584. [PMID: 32928879 PMCID: PMC7505521 DOI: 10.9778/cmajo.20200022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Many patients receive unwanted, low-value, high-intensity care at the end of life because of poor communication with health care providers. Our aim was to evaluate the feasibility of using a physician assistant and an electronic tool to facilitate discussions about goals of care. METHOD We conducted a pilot study for the intervention (physician assistant-led discussion using an electronic tool) from Apr. 1 to Aug. 31, 2019. Patients aged 79 years or older admitted to the Royal Victoria Hospital (Barrie, Ontario) with either (i) no documented resuscitation preferences or (ii) a request for life-sustaining treatments in the event of a life-threatening illness were eligible for the intervention. The goal of this study was to complete more than 30 interventions. The primary outcomes included the proportion of consenting eligible patients, the time required and the proportion of patients changing their resuscitation preferences. RESULTS A total of 763 patients met the inclusion criteria, with 337 eligible for the intervention. Of these, 49 cases were contacted for consent, and 37 interventions were completed (75.5%, 95% confidence interval [CI] 61.1%-86.6%). On average, the intervention required 50 minutes (standard deviation 21) to complete. Overall, 31 interventions resulted in a change in resuscitation preferences (83.7%, 95% CI 68.0%-93.8%), with 22 patients choosing to forgo any access to life-sustaining treatments in the event of a life-threatening illness (59.4%, 95% CI 42.1%-75.2%). INTERPRETATION In this pilot study, the intervention was completed in a minority of eligible patients and required substantial time; however, it led to many changes in resuscitation preferences. Before designing a study to evaluate its impact, the intervention needs to be revised to make it more efficient to administer.
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Affiliation(s)
- Monica Monchis
- Department of Critical Care Medicine (Monchis, Martin, DiDiodato), Royal Victoria Regional Health Centre, Barrie, Ont.; Department of Health Research Methods, Evidence and Impact (DiDiodato), McMaster University, Hamilton, Ont
| | - Chris Martin
- Department of Critical Care Medicine (Monchis, Martin, DiDiodato), Royal Victoria Regional Health Centre, Barrie, Ont.; Department of Health Research Methods, Evidence and Impact (DiDiodato), McMaster University, Hamilton, Ont
| | - Giulio DiDiodato
- Department of Critical Care Medicine (Monchis, Martin, DiDiodato), Royal Victoria Regional Health Centre, Barrie, Ont.; Department of Health Research Methods, Evidence and Impact (DiDiodato), McMaster University, Hamilton, Ont.
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