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Martin KA, Mininger CN. Words Matter: a Call to Remove "Sickler" from Medical Lingo in the United States. J Gen Intern Med 2024:10.1007/s11606-024-09036-7. [PMID: 39302561 DOI: 10.1007/s11606-024-09036-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2024] [Accepted: 09/10/2024] [Indexed: 09/22/2024]
Affiliation(s)
- Karlyn A Martin
- Division of Hematology/Oncology, Larner College of Medicine, University of Vermont, 89 Beaumont Ave, Given E214, Burlington, VT, 05401, USA.
| | - Charles N Mininger
- Physician Assistant Program, Northwestern University Feinberg School of Medicine, McGaw Pavilion, Suite 1-203, 240 E. Huron Street, Chicago, IL, 60611, USA
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Baumann AA, Hankins JS, Hsu LL, Gibson RW, Richardson LD, Treadwell M, Glassberg JA, Bourne S, Luo L, Masese RV, Demartino T, Nocek J, Taaffe E, Gollan S, Ruiz OO, Nwosu C, Qashou N, James AS, Tanabe P, King AA. "The project did not come to us with a solution": Perspectives of research teams on implementing a study about electronic health record-embedded individualized pain plans for emergency department treatment of vaso-occlusive episodes in adults with sickle cell disease. BMC Health Serv Res 2023; 23:1245. [PMID: 37953236 PMCID: PMC10641983 DOI: 10.1186/s12913-023-10255-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Accepted: 10/30/2023] [Indexed: 11/14/2023] Open
Abstract
BACKGROUND This study aimed to capture the implementation process of the ALIGN Study, (An individualized Pain Plan with Patient and Provider Access for Emergency Department care of Sickle Cell Disease). ALIGN aimed to embed Individualized Pain Plans in the electronic health record (E-IPP) and provide access to the plan for both adult patients with sickle cell disease (SCD) and emergency department providers when a person with SCD comes to the emergency department in vaso-occlusive crises. METHODS Semi-structured interviews were conducted with research teams from the 8 participating sites from the ALIGN study. Seventeen participants (principal investigators and study coordinators) shared their perspectives about the implementation of ALIGN in their sites. Data were analyzed in three phases using open coding steps adapted from grounded theory and qualitative content analysis. RESULTS A total of seven overarching themes were identified: (1) the E-IPP structure (location and upkeep) and collaboration with the informatics team, (2) the role of ED champion, (3) the role of research coordinators, (4) research team communication, and communication between research team and clinical team, (5) challenges with the study protocol, (6) provider feedback: addressing over-utilizers, patient mistrust, and the positive feedback about the intervention, and (7) COVID-19 and its effects on study implementation. CONCLUSIONS Findings from this study contribute to learning how to implement E-IPPs for adult patients with SCD in ED. The study findings highlight the importance of early engagement with different team members, a champion from the emergency department, study coordinators with different skills and enhancement of communication and trust among team members. Further recommendations are outlined for hospitals aiming to implement E-IPP for patients with SCD in ED.
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Grants
- U24 HL133948 NHLBI NIH HHS
- U01 HL134042 NHLBI NIH HHS
- U01 HL133994 NHLBI NIH HHS
- U01 HL133964 NHLBI NIH HHS
- U01 HL134007 NHLBI NIH HHS
- U01 HL133997 NHLBI NIH HHS
- U24HL133948, U01HL133964, U01HL133990, U01HL133996, U01HL133994, U01HL133997, U01HL134004, U01HL134007, U01HL134042 NHLBI NIH HHS
- U01 HL134004 NHLBI NIH HHS
- U01 HL133990 NHLBI NIH HHS
- U01 HL133996 NHLBI NIH HHS
- National Heart, Lung, and Blood Institute
- National Institute on Minority Health and Health Disparities
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Affiliation(s)
- Ana A Baumann
- Division of Public Health Sciences, Department of Surgery, Washington University, Saint Louis, MO, USA.
| | - Jane S Hankins
- Department of Global Pediatric Medicine, St. Jude Children's Research Hospital, Memphis, TN, USA
- Center for Sickle Cell Disease, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Lewis L Hsu
- Sickle Cell Center, University of Illinois at Chicago, Chicago, IL, USA
| | | | - Lynne D Richardson
- Icahn School of Medicine at Mount Sinai, Institute for Health Equity Research, New York City, NY, USA
| | - Marsha Treadwell
- Department of Pediatrics, Division of Hematology, University of California San Francisco, San Francisco, CA, USA
| | - Jeffrey A Glassberg
- Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Sarah Bourne
- Addiction Sciences Division, Medical University of South Carolina, Charleston, SC, USA
| | - Lingzi Luo
- School of Global Public Health, New York University, New York City, NY, USA
| | | | | | - Judith Nocek
- Sickle Cell Center, University of Illinois at Chicago, Chicago, IL, USA
| | - Elizabeth Taaffe
- Department of Pediatrics, Washington University in St. Louis, St Louis, MO, USA
| | | | - Ome-Ollin Ruiz
- Department of Pediatrics, Division of Hematology, University of California San Francisco, San Francisco, CA, USA
| | - Chinonyelum Nwosu
- Department of Global Pediatric Medicine, St. Jude Children's Research Hospital, Memphis, TN, USA
- Department of Hematology, St. Jude, Memphis, TN, USA
| | - Nai Qashou
- Department of Pediatrics, Washington University in St. Louis, St Louis, MO, USA
| | - Aimee S James
- Division of Public Health Sciences, Department of Surgery, Washington University, Saint Louis, MO, USA
| | - Paula Tanabe
- Duke University School of Nursing, Durham, NC, USA
| | - Allison A King
- Division of Public Health Sciences, Department of Surgery, Washington University, Saint Louis, MO, USA
- Department of Pediatrics, Washington University in St. Louis, St Louis, MO, USA
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Rodrigues CFDA, Rodrigues TA, de Oliveira EJSG, Garcia JBS, Cartágenes MDSDS. Prejudice impairing quality of life in sickle cell disease patients in a developing country: faces of suffering. Hematol Transfus Cell Ther 2023; 45 Suppl 2:S3-S10. [PMID: 34294599 PMCID: PMC10433304 DOI: 10.1016/j.htct.2021.06.002] [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: 03/30/2021] [Revised: 05/17/2021] [Accepted: 06/13/2021] [Indexed: 11/27/2022] Open
Abstract
INTRODUCTION The perception of prejudice against, and stigmatization of, sickle cell disease (SCD) leads the patient to perceive a different treatment, due to the disease stigma and may be related to a worse quality of life (QoL). OBJECTIVES Describe and evaluate the perception of the prejudice against the disease and its impact on the quality of life of patients with sickle cell disease. METHODS This is a cross-sectional study conducted between March 2019 and February 2020, with patients diagnosed with SCD. Patients were questioned about the perception of prejudice in any kind of situation, choosing between "Yes" or "No", not differentiating situations related to prejudice. To assess the QoL and impact of the disease, the volunteers answered a version of the SF-36 questionnaire translated and validated into Brazilian Portuguese. RESULTS In this study, 113 patients with SCD were followed up, 92% were classified as HbSS and the rest, divided between HbSC and HbS-β-0. Regarding the SF-36, the worst scores were in the summary of the physical components (mean 48.19 ± 21.51) and the physical aspect had the lowest mean (30.75 ±€42.65). When questioned if they had already perceived any kind of prejudice, including the SCD, 32.74% answered "Yes". For this comparison, there was a significant difference in the summary of the physical and mental components, with worse QoL for those who had already suffered prejudice. CONCLUSION Patients diagnosed with SCD who reported perception of prejudice had statistically significant worse QoL, revealing the negative impact, that might lead to sadness and social isolation.
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Affiliation(s)
| | - Thiago Alves Rodrigues
- Centro de Ciências Biológicas e da Saúde, Universidade Federal Universal do Maranhão (CCBS UFMA), São Luís, MA, Brazil
| | | | - João Batista Santos Garcia
- Centro de Ciências Biológicas e da Saúde, Universidade Federal Universal do Maranhão (CCBS UFMA), São Luís, MA, Brazil
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De D, Thakur I. Assessing and managing people with sickle cell disease presenting with vaso-occlusive crisis in the emergency department. Emerg Nurse 2022; 30:33-40. [PMID: 35018749 DOI: 10.7748/en.2022.e2117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/24/2021] [Indexed: 11/09/2022]
Abstract
Sickle cell disease is a group of inherited blood disorders characterised by atypical haemoglobin molecule structures (haemoglobin S) which can manifest as painful vaso-occlusive crises, chronic anaemia and progressive organ damage. This article aims to raise greater awareness of sickle cell disease, its acute manifestations and the potential for rapid clinical deterioration that can occur in patients with this condition. The article outlines the main aspects of the assessment and management of patients presenting to the emergency department (ED) with vaso-occlusive crisis, describes the barriers to effective care that they commonly experience and explains how their care could be improved. The authors emphasise the importance of timely management of these patients by ED staff, including emergency nurses.
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Affiliation(s)
- Diana De
- College of Biomedical and Life Sciences, Cardiff University, Wales
| | - Indu Thakur
- lead for red blood cell disorders, Noah's Ark Children's Hospital, Cardiff, Wales
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Morse BL, Carmichael AE, Bradford VA, Pollard AL. Sickle Cell Disease Care Planning for School Nurses. NASN Sch Nurse 2021; 37:48-54. [PMID: 34292091 DOI: 10.1177/1942602x211025079] [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: 11/15/2022]
Abstract
Schoolchildren with sickle cell disease (SCD) experience physiologic and psychologic stress that can affect school functioning, mental well-being, and physical health. Student needs are unique and individualized; however, school nurses can support students and families with SCD through comprehensive and thorough care planning efforts. In addition to components specific to individual prescriptions and other nonpharmacological therapies, school nurses should consider school access and inclusion, pain management, racism, and disease self-management when care planning. As a healthcare provider who may have several continuous years of near-daily contact with students, the school nurse is an imperative provider, educator, and advocate for students learning to manage their SCD and avoid the related complications and challenges.
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Maddray AB, Phillips SM. Instruments to Measure Perceptions in the Emergency Department Provider-Patient with Sickle Cell Disease Interaction: Findings of an Integrative Review from a Ph.D. Project. Open Nurs J 2020. [DOI: 10.2174/1874434602014010263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background & Purpose:
The purpose of this review is to examine instruments that measure providers' perceptions of adult patients with Sickle Cell Disease (SCD), examine instruments that measure adult patients with SCD perceptions of providers' behaviors, and determine optimal instruments to use in evaluating the perceptions of Emergency Department (ED) providers and adult patients with SCD of one another's behaviors after an interaction in the ED.
Methods:
An integrative review was conducted searching EBSCOhost and PubMed databases using the keywords: measure [OR] measure* [OR] assess* [OR] scale [OR] survey [OR] tool [AND] stigma* [OR] stereotype [OR] prejudice [OR] bias [OR] perception [OR] attitude [OR] discrimination [OR] racism [OR] behavior [AND] interaction [OR] relationship [OR] communication [AND] sickle cell. Initial search located 256 articles, but only 15 articles were included in the final review.
Results:
Fifteen articles reporting six instruments were reviewed. Four instruments evaluated a provider’s perceptions of patients with SCD behaviors, and two instruments evaluated how patients with SCD perceived provider behaviors. The two patient-focused instruments and three provider-focused instruments were found to be adequately reliable and valid according to the Psychometric Grading Framework (PGF).
Conclusions:
The findings suggest that the General Perceptions About Sickle Cell Disease Patients Scale would be an optimal instrument to evaluate ED providers' perceptions of adult patients with SCD behaviors. One patient-focused instrument, The Sickle Cell Health-Related Stigma Scale (SCD-HRSS), reported adequate reliability and validity but was not specific to measuring the patient's perceptions of ED providers' behaviors, nor was it administered in the ED environment. The SCD-HRSS Doctors subscale has potential adaptability for use in measuring patients with SCD perceptions of ED provider behaviors in the ED environment.
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Affiliation(s)
- Alexandra Power-Hays
- From the Department of Pediatrics, Boston Medical Center, and the Department of Medicine, Boston Children's Hospital - both in Boston (A.P.-H.); and the Division of Hematology, Cincinnati Children's Hospital Medical Center, and the Department of Pediatrics, University of Cincinnati College of Medicine - both in Cincinnati (P.T.M.)
| | - Patrick T McGann
- From the Department of Pediatrics, Boston Medical Center, and the Department of Medicine, Boston Children's Hospital - both in Boston (A.P.-H.); and the Division of Hematology, Cincinnati Children's Hospital Medical Center, and the Department of Pediatrics, University of Cincinnati College of Medicine - both in Cincinnati (P.T.M.)
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Kang HA, Barner JC. The association between hydroxyurea adherence and opioid utilization among Texas Medicaid enrollees with sickle cell disease. J Manag Care Spec Pharm 2020; 26:1412-1422. [PMID: 33119448 PMCID: PMC10391267 DOI: 10.18553/jmcp.2020.26.11.1412] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND: Individuals with sickle cell disease (SCD) suffer from recurrent catastrophic pain crises that are often managed by opioid analgesics. Being adherent to hydroxyurea has been associated with decreased health care resource use for pain; however, evidence of its association with opioid use is limited. OBJECTIVE: To determine if adherence to hydroxyurea is associated with opioid use among patients with SCD. METHODS: This retrospective study used Texas Medicaid data from September 1, 2011, to August 31, 2016 (study period). The index date was the date of hydroxyurea initiation. Patients who were aged 2-63 years at the index date, had ≥ 1 inpatient or ≥ 2 outpatient SCD diagnoses during the study period, had ≥ 1 hydroxyurea prescription during the identification period (September 1, 2011-August 31, 2015), had no diagnosis of other indications for hydroxyurea during the study period, and were continuously enrolled for at least 12 months after the index date were included. Hydroxyurea adherence was measured using medication possession ratio (MPR). The study outcomes (measured 1-year post-index) were (a) opioid use; (b) number of opioid prescriptions; (c) strong opioid use (morphine, hydromorphone, fentanyl, and methadone); (d) number of strong opioid prescriptions; (e) high-dose opioid use (≥ 50 mg morphine milligram equivalent [MME]); and (f) days supply for opioid prescriptions. Covariates included demographic (age and gender) and clinical (vaso-occlusive crisis [VOC], avascular necrosis, iron overload, acute chest syndrome, and blood transfusion) characteristics. Descriptive, bivariate (chi-square and Wilcoxon-Mann-Whitney tests), multiple logistic regression, and negative binomial regression analyses were performed. RESULTS: 1,146 patients (18.3 [12.3] years) met the inclusion criteria. Of these, 19.6% were adherent to hydroxyurea (defined as MPR ≥ 80%) and mean (SD) MPR was 48.3% (29.7%). In the 1 year following hydroxyurea initiation, 923 (80.5%) patients had ≥ 1 opioid prescription with 7.6 (9.4) opioid prescriptions per patient, while 259 (22.6%) patients had ≥ 1 strong opioid prescription with 1.5 (4.4) strong opioid prescriptions per patient. Average (SD) opioid dose was 41.7 (74.3) mg MME, and 27.1% had high daily MME doses (≥ 50 mg MME). Average (SD) opioid days supply was 83.1 (112.2) days. After adjusting for covariates, compared with being nonadherent, being adherent to hydroxyurea was associated with a 50.5% decreased risk of having strong opioids (OR = 0.495, 95% CI = 0.278-0.879, P = 0.0165). Additionally, SCD-related complications (VOC, avascular necrosis, and iron overload) and older age were significant factors associated with opioid use and higher MME. Post hoc analyses showed that being adherent to hydroxyurea was significantly associated with lower probabilities of experiencing SCD-related complications. CONCLUSIONS: Results showed that patients with SCD are moderately adherent to hydroxyurea. Being adherent to hydroxyurea was found to be associated with a lower risk of receiving a prescription for strong opioids. Findings suggest that close monitoring and interventions to improve adherence may help mitigate strong opioid use among these patients. DISCLOSURES: This research did not receive any specific funding. Barner and Kang report grants from Novartis Pharmaceuticals, unrelated to this work. A part of this study was presented as a poster at the American Pharmacists Association (APhA) 2019 Annual Meeting and Exposition (March 22-25, 2019, Seattle, WA) and received the 2019 APhA-APRS Presentation Award in the APhA-APRS Contributed Research Paper, Graduate Student/Fellow/Postdoctoral Scholar category.
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Affiliation(s)
- Hyeun Ah Kang
- The University of Texas at El Paso School of Pharmacy
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Ballas SK, Dampier C. Risk factors associated with increased emergency department utilization in patients with sickle cell disease: a systematic literature review. Ann Hematol 2020; 99:2483-2495. [PMID: 32852615 DOI: 10.1007/s00277-020-04205-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Accepted: 07/27/2020] [Indexed: 10/23/2022]
Abstract
Sickle cell disease (SCD), a genetic disorder affecting up to 100,000 patients in the USA, impacts multiple organ systems. The emergency department (ED) is frequently utilized by patients with SCD who have severe pain from vaso-occlusive crises. The goal of this systematic literature review is to identify predictors for ED use among patients with SCD in the USA, as high ED reliance is not ideal because of the potential for discontinuity of care as well as higher costs. PubMed and Embase were searched for articles containing the keywords "sickle cell disease" AND ("emergency" OR "acute care") AND ("utilization" OR "health care") published between 2000 and 26 September 2019. A total of 26 publications were identified meeting the following inclusion criteria: report of ED or acute care clinic use; report of health care utilization for SCD; and report of ED visits independent of hospital admission, ED revisits, inpatient care visits, and SCD care unit visits. Articles unavailable in English or those focused on populations outside the USA were excluded. Of the 26 articles included, 4 were prospective and the remainder were retrospective. Qualitative analysis of the articles revealed a higher rate of ED utilization among adults than children, patients with public insurance than private insurance, and patients with more comorbidities, complications, or pain. Age and pain levels were both commonly cited as predictors of ED utilization. Additional prospective and interventional studies are needed to further define predictors of ED utilization and to uncover treatments that decrease ED visits.
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Affiliation(s)
- Samir K Ballas
- Cardeza Foundation for Hematologic Research, Department of Medicine, Sidney Kimmel Medical College, Thomas Jefferson University, 1020 Locust Street Suite 394, Philadelphia, PA, 19107, USA.
| | - Carlton Dampier
- Division of Hematology/Oncology/BMT, Department of Pediatrics, Emory University School of Medicine, Children's Healthcare of Atlanta, Emory Healthcare, Atlanta, GA, USA.,AFLAC Cancer and Blood Disorders Center, Atlanta, GA, USA
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Wakefield EO, Pantaleao A, Popp JM, Dale LP, Santanelli JP, Litt MD, Zempsky WT. Describing Perceived Racial Bias Among Youth With Sickle Cell Disease. J Pediatr Psychol 2019; 43:779-788. [PMID: 29562253 DOI: 10.1093/jpepsy/jsy015] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Accepted: 03/07/2018] [Indexed: 11/13/2022] Open
Abstract
Objectives Sickle cell disease (SCD) predominately affects Black Americans. This is the first study of its kind to describe the racial bias experiences of youth with SCD and their reactions to these experiences. Methods Participants were 20 youth with SCD (ages 13-21 years) who were asked to describe any racial bias events they experienced, as recorded on the Perception of Racism in Children and Youth measure (PRaCY). Interviews were recorded, transcribed, and analyzed by two independent raters using a conventional content analysis approach. Results All participants reported at least one incident of racial bias. Content analysis of racial bias events (n = 104) yielded 4 categories and 12 subcategories as follows: Perpetrator (Peers, Authority Figures, and General Public), Type of Racial Bias (Explicit, Implicit), Behavioral Reaction (Approach, Avoidant), and Emotional Response (Dysphoria, Anger, Unconcerned, Inferior, Anxious). Discussion This study provides a description of racial bias experiences within community and medical settings and highlights the need for further evaluation of the impact of racial bias among youth with SCD.
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Affiliation(s)
- Emily O Wakefield
- Department of Psychology, University of Hartford.,Division of Pain and Palliative Medicine, Connecticut Children's Medical Center, University of Connecticut School of Medicine
| | - Ashley Pantaleao
- Division of Pain and Palliative Medicine, Connecticut Children's Medical Center
| | - Jill M Popp
- Department of Research, Connecticut Children's Medical Center
| | | | - James P Santanelli
- Division of Pain and Palliative Medicine, Connecticut Children's Medical Center
| | - Mark D Litt
- Division of Behavioral Sciences and Community Health, University of Connecticut Health Center
| | - William T Zempsky
- Division of Pain and Palliative Medicine, Connecticut Children's Medical Center, University of Connecticut School of Medicine
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Jabour SM, Beachy S, Coburn S, Lanzkron S, Eakin MN. The Role of Patient-Physician Communication on the Use of Hydroxyurea in Adult Patients with Sickle Cell Disease. J Racial Ethn Health Disparities 2019; 6:1233-1243. [PMID: 31410784 DOI: 10.1007/s40615-019-00625-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Revised: 07/26/2019] [Accepted: 07/29/2019] [Indexed: 12/22/2022]
Abstract
OBJECTIVE This qualitative study analyzed the perspective of patients living with sickle cell disease (SCD) on their process of deciding whether to take hydroxyurea (HU), and the role of physician communication in patients' decision-making process. METHODS From October 2015 to July 2016, we conducted semi-structured interviews among patients with SCD (N = 20) that were audio-recorded and transcribed. Participants were ≥ 18 years old, a patient of an urban adult sickle cell center, able to provide informed consent, and English-speaking. We iteratively developed codes and used thematic analysis to organize the key themes. RESULTS Most participants were female (65%), middle aged (M = 44, SD = 12.2), and 55% were prescribed HU for an average of 10.4 (SD = 4.7) years. Participants described 3 key factors that influenced their decision regarding HU treatment: (1) lifestyle, (2) health status, and (3) HU characteristics. Four themes emerged about provider communication and HU treatment decisions: (1) provider's advisement, (2) shared decision-making, (3) "wrestled," and (4) not feeling heard. CONCLUSION Providers who engaged in shared decision-making empowered participants to decide whether to start HU treatment. Participants who felt their providers were not listening to their concerns expressed disengaging from HU treatment. During discussions about HU with patients living with SCD, providers must understand the multi-faceted aspects that impact patients' decision and empower patients to engage in such discussions. Further research is needed to understand the role of shared decision-making among patients with SCD to improve management of SCD.
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Affiliation(s)
- Sarah M Jabour
- Division of General Internal Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Sara Beachy
- Department of Education and Health Services, Lehigh University, Bethlehem, PA, USA
| | - Shayna Coburn
- Children's National Health System, Washington, D.C., USA.,The George Washington University, Washington, D.C., USA
| | - Sophie Lanzkron
- Division of Hematology, Johns Hopkins University, Baltimore, MD, USA
| | - Michelle N Eakin
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, 5501 Hopkins Bayview Blvd., Room 4B.74, Baltimore, MD, 21224, USA.
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Abstract
The aim of this systematic review was to synthesize the literature regarding health-related stigma in adolescents and adults living with sickle cell disease (SCD). Four domains were identified from 27 studies: (1) social consequences of stigma; (2) the effect of stigma on psychological well-being; (3) the effect of stigma on physiological well-being; and (4) the impact of stigma on patient-provider relationships and care-seeking behaviors. Current literature revealed that SCD stigma has detrimental consequences. Methodological issues as well as research and practice implications were identified. Future research should further examine the impact of health-related stigma on self-management of SCD.
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Affiliation(s)
- Dominique Bulgin
- a Duke University School of Nursing, Durham, North Carolina, USA
| | - Paula Tanabe
- a Duke University School of Nursing, Durham, North Carolina, USA
| | - Coretta Jenerette
- b University of North Carolina at Chapel Hill, School of Nursing, Chapel Hill, North Carolina, USA
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Abstract
OBJECTIVE Little is known about the role of perceived racial bias and health-related stigma on the health of youth with sickle cell disease (SCD). The purpose of this study was to investigate the occurrence of perceived racial bias and health-related stigma among youth with SCD and its relationship with psychological and physical well-being. METHODS Twenty-eight youth with SCD, ages 13 to 21, were recruited from outpatient and inpatient settings at an urban children's medical center. Participants completed measures of perceived racial bias, perceived health-related stigma, depression, quality of life, and pain burden. RESULTS Most participants endorsed occurrences of racial bias and health-related stigma. The findings indicate that greater perceived racial bias was associated with greater pain burden, and greater perceived health-related stigma was related to lower quality of life. CONCLUSION Perceived racial bias and health-related stigma may be important to consider for future research investigating the psychological and physiological features of SCD for youth.
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Benenson I, Jadotte Y, Echevarria M. Factors influencing utilization of hospital services by adult sickle cell disease patients: a systematic review. JBI DATABASE OF SYSTEMATIC REVIEWS AND IMPLEMENTATION REPORTS 2017; 15:765-808. [PMID: 28267033 DOI: 10.11124/jbisrir-2016-002983] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND Painful vaso-occlusive crisis is a hallmark of sickle cell disease (SCD) that commonly results in utilization of hospital services. Recurrent use of hospital services by SCD patients is associated with high healthcare costs and adverse clinical outcomes. Understanding the factors influencing the pattern of utilization is a first step in improving medical care of this patient population while reducing healthcare expenditures. OBJECTIVES The primary objective of this systematic review was to determine what modifiable and non-modifiable factors influence utilization of hospital services by adult SCD patients. INCLUSION CRITERIA TYPES OF PARTICIPANTS Adult SCD patients of both sexes who utilized hospital services for acute or emergency care. TYPES OF FACTORS/EXPOSURE Non-modifiable and modifiable factors influencing utilization of hospital services. TYPES OF STUDIES Prospective and retrospective cohort studies, case-control and analytical cross-sectional studies. OUTCOMES The primary outcome of interest was high utilization of hospital services by adult SCD patients based on non-modifiable and modifiable factors measured as an odds ratio (analytical outcome). The secondary outcome was the prevalence of non-modifiable and modifiable factors among SCD patients who utilized hospital services measured as an event rate (descriptive outcome). SEARCH STRATEGY A comprehensive multi-step search was undertaken to find both published and unpublished studies. Only studies published in the English language were included. The search was not limited by year of publication. METHODOLOGICAL QUALITY Retrieved papers were assessed for methodological quality using standardized critical appraisal instruments from the Joanna Briggs Institute Meta Analysis of Statistics Assessment and Review Instrument. DATA EXTRACTION Data were extracted using a researcher-developed tool. DATA SYNTHESIS Included studies were combined in a statistical meta-analysis. The meta-analysis was based on a random effect model. For studies that did not allow statistical pooling, the findings have been presented in a narrative form. RESULTS Fourteen studies were included in this review. The analysis demonstrated that male patients accounted for 40.8% (95% confidence interval [CI] 0.370-0.447) of all utilizing patients. Sickle cell disease patients who were publically insured accounted for 76.5% (95% CI 0.632-0.861) of all patients who had hospital encounters. Patients aged 25-35 years had the highest rate of utilization, and the rate of utilization declined in patients older than 50 years. High utilizing patients had more diagnoses of acute chest syndrome and sepsis than patients who were moderate or low utilizers. CONCLUSION The majority of SCD patients who utilized hospital services were women, young people and publically insured individuals. Patients with particularly high level of utilization had more frequent diagnoses of acute chest syndrome and sepsis.
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Affiliation(s)
- Irina Benenson
- 1School of Nursing, Rutgers University, Newark, USA 2The Northeast Institute for Evidence Synthesis and Translation (NEST): a Joanna Briggs Institute Center of Excellence 3Division of Nursing Science, School of Nursing, Rutgers University, Newark, USA 4Department of Quantitative Methods, Epidemiology and Biostatistics, School of Public Health, Rutgers University, Newark, USA 5Division of Advanced Nursing Practice, School of Nursing, Rutgers University, Newark, USA
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Mathur VA, Kiley KB, Haywood C, Bediako SM, Lanzkron S, Carroll CP, Buenaver LF, Pejsa M, Edwards RR, Haythornthwaite JA, Campbell CM. Multiple Levels of Suffering: Discrimination in Health-Care Settings is Associated With Enhanced Laboratory Pain Sensitivity in Sickle Cell Disease. Clin J Pain 2016; 32:1076-1085. [PMID: 26889615 PMCID: PMC5045821 DOI: 10.1097/ajp.0000000000000361] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2015] [Revised: 02/23/2016] [Accepted: 01/17/2016] [Indexed: 12/11/2022]
Abstract
OBJECTIVE People living with sickle cell disease (SCD) experience severe episodic and chronic pain and frequently report poor interpersonal treatment within health-care settings. In this particularly relevant context, we examined the relationship between perceived discrimination and both clinical and laboratory pain. METHODS Seventy-one individuals with SCD provided self-reports of experiences with discrimination in health-care settings and clinical pain severity, and completed a psychophysical pain testing battery in the laboratory. RESULTS Discrimination in health-care settings was correlated with greater clinical pain severity and enhanced sensitivity to multiple laboratory-induced pain measures, as well as stress, depression, and sleep. After controlling for relevant covariates, discrimination remained a significant predictor of mechanical temporal summation (a marker of central pain facilitation), but not clinical pain severity or suprathreshold heat pain response. Furthermore, a significant interaction between experience with discrimination and clinical pain severity was associated with mechanical temporal summation; increased experience with discrimination was associated with an increased correlation between clinical pain severity and temporal summation of pain. DISCUSSION Perceived discrimination within health-care settings was associated with pain facilitation. These findings suggest that discrimination may be related to increased central sensitization among SCD patients, and more broadly that health-care social environments may interact with pain pathophysiology.
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Affiliation(s)
- Vani A. Mathur
- Johns Hopkins University School of Medicine, Department of Psychiatry & Behavioral Sciences, Baltimore, MD
- Texas A&M University, Department of Psychology, College Station, TX
| | - Kasey B. Kiley
- Johns Hopkins University School of Medicine, Department of Psychiatry & Behavioral Sciences, Baltimore, MD
| | - Carlton Haywood
- Johns Hopkins University School of Medicine, Division of Hematology
| | - Shawn M. Bediako
- University of Maryland, Baltimore County, Department of Psychology, Baltimore, MD
| | - Sophie Lanzkron
- Johns Hopkins University School of Medicine, Division of Hematology
| | - C. Patrick Carroll
- Johns Hopkins University School of Medicine, Department of Psychiatry & Behavioral Sciences, Baltimore, MD
| | - Luis F. Buenaver
- Johns Hopkins University School of Medicine, Department of Psychiatry & Behavioral Sciences, Baltimore, MD
| | - Megan Pejsa
- Johns Hopkins University School of Medicine, Department of Psychiatry & Behavioral Sciences, Baltimore, MD
| | - Robert R. Edwards
- Harvard Medical School, Departments of Anesthesiology, Perioperative, Pain Medicine, and Psychiatry; Brigham and Women's Hospital, Pain Management Center, Harvard Medical School, Chestnut Hill, MA
| | | | - Claudia M. Campbell
- Johns Hopkins University School of Medicine, Department of Psychiatry & Behavioral Sciences, Baltimore, MD
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Irvin R, Wilton L, Scott H, Beauchamp G, Wang L, Betancourt J, Lubensky M, Wallace J, Buchbinder S. A study of perceived racial discrimination in Black men who have sex with men (MSM) and its association with healthcare utilization and HIV testing. AIDS Behav 2014; 18:1272-8. [PMID: 24569888 PMCID: PMC4161025 DOI: 10.1007/s10461-014-0734-y] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
In HPTN 061, a study of Black men who have sex with men (MSM), we evaluated the association of healthcare-specific racial discrimination with healthcare utilization and HIV testing among 1167 HIV-negative participants. Median age was 38 years, 41 % were uninsured, and 38 % had an annual household income <$10,000. Overall, 19 % reported healthcare-specific racial discrimination directed toward family, friend, or self; 61 % saw a healthcare provider in the previous 6 months and 81 % HIV tested within the past year. Healthcare-specific racial discrimination was positively associated with seeing a provider [adjusted odds ratio (AOR) = 1.4 (1.0, 2.0)] and HIV testing [AOR = 1.6 (1.1, 2.4)] suggesting that barriers other than racial discrimination may be driving health disparities related to access to medical care and HIV testing among Black MSM. These results contrast with previous studies, possibly due to measurement or cohort differences, strategies to overcome discrimination, or because of greater exposure to healthcare.
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Affiliation(s)
- R Irvin
- Division of Infectious Diseases, Johns Hopkins University, 725 N. Wolfe Street, Suite 218A, Baltimore, MD, 21205, USA,
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EDWARDS CHRISTOPHERL, KILLOUGH ALVIN, WOOD MARY, DOYLE TODD, FELIU MIRIAM, BARKER CAMELAS, UPPAL PRIYANKA, DeCASTRO LAURA, WELLINGTON CHANTÉ, WHITFIELD KEITHE, TRAMBADIA JAY, GUINYARD DARIENE, MUHAMMAD MALIK, O’GARO KEISHAGAYEN, MORGAN KAI, EDWARDS ALESII LEKISHAY, BYRD GOLDIES, McCABE MELANIE, GOLI VEERAINDAR, KEYS ABIGAIL, HILL LABARRON, COLLINS-McNEIL JANICE, McDONALD PATRICIA, SCHMECHEL DONALDE, ROBINSON ELWOOD. Emotional reactions to pain predict psychological distress in adult patients with Sickle Cell Disease (SCD). Int J Psychiatry Med 2014; 47:1-16. [PMID: 24956913 PMCID: PMC4444040 DOI: 10.2190/pm.47.1.a] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Differentiating somatic from emotional influences on the experience of chronic pain has been of interest to clinicians and researchers for many years. Although prior research has not well specified these pathways at the anatomical level, some evidence, both theoretical and empirical, suggest that emotional reactions influence the experience of disease and non-disease-related pains. Other studies suggest that treatments directed at negative emotional responses reduce suffering associated with pain. The current study was conducted to explore the influence of emotional reactions to pain as a predictor of psychological distress in a sample of adult Blacks with Sickle Cell Disease (SCD). Using cross-sectional survey data, we evaluated whether negative emotional reactions to the experience of pain were predictive of psychological distress after controlling for the somatic dimension of pain and age in n = 67 Black patients with Sickle Cell Disease (SCD). Results showed that greater negative emotion associated with pain predicted Somatization (p < .01), Anxiety (p < .05), Phobic Anxiety (p < .05), and Psychoticism (p < .05). Increased negative emotion associated with pain was also predictive of the General Symptoms Index (p < .05) and the Positive Symptoms Total from the SCL-90-R (p < .01). We believe the current study demonstrates that negative emotional reactions to the experience of pain in adults with SCD are predictive of psychological distress above and beyond the influences of age and the direct nociceptive experience. We also believe these data to be valuable in conceptualizing the allocation of treatment resources toward a proactive approach with early identification of patients who are responding poorly for the purpose of potentially reducing later psychopathology. A deeper understanding of the ways that subpopulations cope with chronic disease-related pain may produce models that can be ultimately generalized to the consumers of the majority of healthcare resources.
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