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Jain S, Bey GS, Forrester SN, Rahman-Filipiak A, Thompson Gonzalez N, Petrovsky DV, Kritchevsky SB, Brinkley TE. Aging, Race, and Health Disparities: Recommendations From the Research Centers Collaborative Network. J Gerontol B Psychol Sci Soc Sci 2024; 79:gbae028. [PMID: 38442186 PMCID: PMC11101762 DOI: 10.1093/geronb/gbae028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2023] [Indexed: 03/07/2024] Open
Abstract
Racial disparities in adverse health outcomes with aging have been well described. Yet, much of the research focuses on racial comparisons, with relatively less attention to the identification of underlying mechanisms. To address these gaps, the Research Centers Collaborative Network held a workshop on aging, race, and health disparities to identify research priorities and inform the investigation, implementation, and dissemination of strategies to mitigate disparities in healthy aging. This article provides a summary of the key recommendations and highlights the need for research that builds a strong evidence base with both clinical and policy implications. Successful execution of these recommendations will require a concerted effort to increase participation of underrepresented groups in research through community engagement and partnerships. In addition, resources to support and promote the training and development of health disparities researchers will be critical in making health equity a shared responsibility for all major stakeholders.
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Affiliation(s)
- Snigdha Jain
- Section of Pulmonary, Critical Care, and Sleep Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Ganga S Bey
- Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Sarah N Forrester
- Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA
| | - Annalise Rahman-Filipiak
- Department of Psychiatry—Neuropsychology Section, University of Michigan, Ann Arbor, Michigan, USA
| | - Nicole Thompson Gonzalez
- Department of Integrative Anthropological Sciences, University of California Santa Barbara, Santa Barbara, California, USA
| | - Darina V Petrovsky
- School of Nursing, Institute for Health, Health Care Policy, and Aging Research, Rutgers University, New Brunswick, New Jersey, USA
| | - Stephen B Kritchevsky
- Department of Internal Medicine, Section on Gerontology and Geriatric Medicine, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | - Tina E Brinkley
- Department of Internal Medicine, Section on Gerontology and Geriatric Medicine, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
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Burton L, Milad F, Janke R, Rush KL. The Landscape of Health Technology for Equity Deserving Groups in Rural Communities: A Systematic Review. COMMUNITY HEALTH EQUITY RESEARCH & POLICY 2024:2752535X241252208. [PMID: 38713914 DOI: 10.1177/2752535x241252208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/09/2024]
Abstract
BACKGROUND Equity-deserving groups face well-known health disparities that are exacerbated by rural residence. Health technologies have shown promise in reducing disparities among these groups, but there has been no comprehensive evidence synthesis of outcomes. PURPOSE The purpose of this systematic review was to examine the patient, healthcare, and economic outcomes of health technology applications with rural living equity-deserving groups. RESEARCH DESIGN The databases searched included Medline and Embase. Articles were assessed for bias using the McGill mixed methods appraisal tool. ANALYSIS Data were synthesized narratively using a convergent integrated approach for qualitative and quantitative findings. RESULTS This evidence synthesis includes papers (n = 21) that reported on health technologies targeting rural equity-deserving groups. Overall, patient outcomes - knowledge, self-efficacy, weight loss, and clinical indicators - improved. Healthcare access improved with greater convenience, flexibility, time and travel savings, though travel was still occasionally necessary. All studies reported satisfaction with health technologies. Technology challenges reported related to connectivity and infrastructure issues influencing appointment quality and modality options. While some studies reported additional costs, overall, studies indicated cost savings for patients. CONCLUSIONS There is a paucity of research on health technologies targeting rural equity-deserving groups, and the available research has primarily focused on women. While current evidence was primarily of high quality, research is needed inclusive of equity-deserving groups and interventions co-designed with users that integrate culturally sensitive approaches. Review registered with Prospero ID = CRD42021285994.
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Affiliation(s)
- Lindsay Burton
- School of Nursing, University of British Columbia-Okanagan, Kelowna, BC, Canada
| | - Fathi Milad
- School of Nursing, University of British Columbia-Okanagan, Kelowna, BC, Canada
| | - Robert Janke
- Department Of Library, University of British Columbia - Okanagan, Kelowna, BC, Canada
| | - Kathy L Rush
- School of Nursing, University of British Columbia-Okanagan, Kelowna, BC, Canada
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Sy M, Ritchie CS, Vranceanu AM, Bakhshaie J. Palliative Care Clinical Trials in Underrepresented Ethnic and Racial Minorities: A Narrative Review. J Palliat Med 2024; 27:688-698. [PMID: 38064535 DOI: 10.1089/jpm.2023.0124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2024] Open
Abstract
Introduction: A growing number of patients with serious illness who would benefit from palliative care are part of ethnoracial minority groups. Nevertheless, large disparities in provision of palliative services exist for minoritized populations. Furthermore, there is a relative dearth of palliative care research focused on minority groups and how best to provide high-quality, culturally tailored palliative care. The aim of this narrative review is to summarize the existing literature regarding palliative care clinical trials in underrepresented minority populations, describe methodological approaches, and provide guidance on future palliative care-focused clinical trials. Methods: We used the Scale for the Assessment of Narrative Review Articles (SANRA) and Cochrane's guidelines on conducting reviews. We used PubMed and Clinicaltrials.gov to review published, full-text articles or protocols (1950-2022), and limited to palliative care interventions focused on ethnoracial minority populations. We included randomized clinical trials (RCTs), including pilot and feasibility trials, protocols of RCTs, and studies that report RCT methodology. Two reviewers independently assessed eligibility. Results: Our search yielded 585 publications; of these, 30 met the full-text review criteria and 16 studies met our criteria for inclusion. We deemed nine articles as having low risk of bias and four as having high risk of bias. Discussion: Commonly used methodologic approaches for clinical trials in underrepresented minority populations included the following: the use of written and visual materials that were no higher than a sixth-grade reading level, the use of patient and lay health navigators, bilingual and multicultural study staff and study materials, race-concordant staff, the option of in-person and virtual visits that accommodated the patient and family's schedule, recruitment from faith communities, and the use of community-engaged research principles. Future palliative care clinical trials should expand on the strategies described in this article, adopt effective strategies currently used in nonpalliative care interventions, and innovate around the principles of community-engaged research.
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Affiliation(s)
- Maimouna Sy
- Center for Aging and Serious Illness, Department of Palliative Care and Geriatric Medicine, Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Christine Seel Ritchie
- Center for Aging and Serious Illness, Department of Palliative Care and Geriatric Medicine, Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Ana-Maria Vranceanu
- Center for Health Outcomes and Interdisciplinary Research, Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Jafar Bakhshaie
- Center for Health Outcomes and Interdisciplinary Research, Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, USA
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Madni A. Culturally Responsive Care for Patients With a Serious Illness #478. J Palliat Med 2024; 27:699-701. [PMID: 38728088 DOI: 10.1089/jpm.2024.0059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/12/2024] Open
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Patano A, Wyatt G, Lehto R. Palliative and End-of-Life Family Caregiving in Rural Areas: A Scoping Review of Social Determinants of Health and Emotional Well-Being. J Palliat Med 2024. [PMID: 38598274 DOI: 10.1089/jpm.2023.0566] [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: 04/11/2024] Open
Abstract
Introduction: Due to their remote location, rural-dwelling family caregivers (FCGs) experience geographic and psychosocial challenges when providing home-based palliative and end-of-life (PEOL) care for their care recipient. Limited research has evaluated the social and environmental factors that may compound FCG burden and contribute to adverse emotional health outcomes among rural-dwelling PEOL FCGs. Objective: To characterize the social determinants of health (SDOH) that affect the provision of PEOL care among rural-dwelling FCGs, along with symptoms of anxiety and depression. Methods: A scoping review was conducted using Arksey and O'Malley's Framework. Searches were conducted in PubMed, CINAHL, PsycINFO, and Cochrane, and 511 articles published between 2010 and 2023 were screened. Keywords included "rural," "PEOL care," and "FCG." Inclusion criteria included FCGs, ages ≥18 years; findings reported on SDOH, anxiety, and/or depressive symptoms; within a rural context; and U.S. based. Findings: In this review, 18 studies met eligibility and were included. Apart from six studies that specifically investigated Black and Latinx FCGs, most FCGs were middle-aged White female spouses. SDOH impacting PEOL care provision included: limited access to PEOL services due to remote distance and travel needs for services; low health literacy in medical terminology and patient symptom management; limited English-language proficiency; perceived clinician racial and ethnic discrimination; financial vulnerabilities affecting health care coverage; and underdeveloped infrastructure. These barriers negatively impacted decision making, communication with clinicians, and patient symptom management. FCGs reported emotional distress related to patients' symptom management and limited opportunities for respite. There was a limited investigation of emotional well-being and minimal interventions aimed toward improving rural-dwelling FCG emotional health. The presence of community support promoted hospice use and facilitated the provision of care. Conclusions: FCGs are vulnerable to adverse emotional health when providing home-based PEOL care. Research is needed to develop supportive interventions (e.g., digital health) for rural-dwelling FCGs.
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Affiliation(s)
- Arienne Patano
- College of Nursing, Michigan State University, East Lansing, Michigan, USA
| | - Gwen Wyatt
- College of Nursing, Michigan State University, East Lansing, Michigan, USA
| | - Rebecca Lehto
- College of Nursing, Michigan State University, East Lansing, Michigan, USA
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Fasolino T, Koci A, Huggins J, Lindell K. A Rapid Review of Uses and Outcomes of Telehealth Care in Rural and Remote Regions in the United States. J Hosp Palliat Nurs 2023; 25:239-248. [PMID: 37525370 DOI: 10.1097/njh.0000000000000964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/02/2023]
Abstract
As telehealth expands and becomes an increasingly important provision of palliative care and hospice services, the understanding of the uses and outcomes of this care delivery platform in rural communities is warranted. This rapid review aims to highlight the practice, policy, and research implications of telehealth in rural regions. Using a systematic approach for accessing and synthesizing available publications, this review included 22 articles published between January 2020 and January 2023. Telehealth was used with adult and pediatric populations diagnosed with serious illnesses. Acceptance of this type of care delivery was noted in adults and children, but not all found telehealth a valuable mechanism for care. Telehealth services included but were not limited to direct communication between the provider and the patient/caregiver, medication management, and a peer-to-peer consultant role for rural palliative care and hospice teams. Of those studies addressing provider-centered outcomes, noise level, interruptions, missed appointments, and challenges with providing emotional support were reported. Organizational barriers, such as the lack of financial support, were noted for pediatric hospices. Individuals living in rural communities require more frequent, immediate, and specialized attention over their illness trajectory. Practice, policy, and research implications are identified to consider the next steps for telehealth delivery of palliative care.
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Rosa WE, McDarby M, Buller H, Ferrell BR. Palliative Care Clinician Perspectives on Person-Centered End-of-Life Communication for Racially and Culturally Minoritized Persons with Cancer. Cancers (Basel) 2023; 15:4076. [PMID: 37627105 PMCID: PMC10452546 DOI: 10.3390/cancers15164076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 07/28/2023] [Accepted: 08/07/2023] [Indexed: 08/27/2023] Open
Abstract
The aim of this study was to examine interdisciplinary clinicians' perceptions of priorities in serious illness communication and shared decision-making with racially and culturally minoritized persons at end of life. Clinicians (N = 152) read a detailed case study about a patient self-identifying as Black and American Indian who describes mistrust of the healthcare system. Participants then responded to three open-ended questions about communication strategies and approaches they would employ in providing care. We conducted a thematic analysis of participants' responses to questions using an iterative, inductive approach. Interdisciplinary clinicians from nursing (48%), social work (36%), and chaplaincy (16%), responded to the study survey. A total of four themes emerged: (1) person-centered, authentic, and culturally-sensitive care; (2) pain control; (3) approaches to build trust and connection; and (4) understanding communication challenges related to racial differences. Significant efforts have been made to train clinicians in culturally inclusive communication, yet we know little about how clinicians approach "real world" scenarios during which patients from structurally minoritized groups describe care concerns. We outline implications for identifying unconscious bias, informing educational interventions to support culturally inclusive communication, and improving the quality of end-of-life care for patients with cancer from minoritized groups.
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Affiliation(s)
- William E. Rosa
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY 10017, USA;
| | - Meghan McDarby
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY 10017, USA;
| | - Haley Buller
- City of Hope, Duarte, CA 91010, USA; (H.B.); (B.R.F.)
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Chen Y, Qiao C, Zhang X, Li W, Yang H. The Effect of Tele-palliative Care on Patient and Caregiver Outcomes: A Systematic Review. Am J Hosp Palliat Care 2023; 40:907-925. [PMID: 36113129 DOI: 10.1177/10499091221123566] [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: 07/20/2023] Open
Abstract
Objectives: To describe the use of tele-palliative care in patients with advanced disease and assess its effectiveness on quality of life (QOL), symptom burden and other outcomes for patients and their caregivers. Methods: We searched for randomised controlled trials to assess the outcomes of tele-palliative care on patients with advanced disease and their caregivers. Eight databases were searched for studies published in Chinese or English from inception to November 27, 2021. Data from the included trials were extracted independently by 2 reviewers and evaluated independently for methodological quality using the Cochrane Collaboration's tool. A narrative synthesis of the results of all trials was performed. Results: Thirty trials were included ultimately with more than one half of the studies were moderate to high quality, including, which involved 19 665 patients and 1153 caregivers. Results from 10/15 included trials (reporting patient QOL), 5/14 trials (reporting patient symptoms), 1/3 trials (reporting survival), 8/13 trials (reporting patient mood), 3/6 trials (reporting ACP related indicators), 3/7 trials (reporting resource utilization) showed statistically significant between tele-palliative care and control care groups. Of 30 trials, 8 measured caregiver outcomes, 1/4 trials (reporting caregiver QOL) showed statistically significant, and results from 3/3 trials (reporting caregiver mood), 3/4 trials (reporting caregiver burden) showed benefit in at least 1 domain at 1 or more time points. Conclusions: This systematic review suggests that although tele-palliative care can improve patient physical, patient and caregiver psychological health outcomes to some extent, there is still a lack of sufficient evidence to substantiate its application effects. Moreever, regional and cultural characteristics should also be taken into account when tele-palliative care interventions are carried out.
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Affiliation(s)
- Yiping Chen
- School of nursing, Shanxi Medical University, Shanxi Province, China
- Department of Neurology, First Hospital of Shanxi Medical University, Shanxi Province, China
| | - Caihong Qiao
- Department of Neurology, First Hospital of Shanxi Medical University, Shanxi Province, China
| | - Xianhui Zhang
- School of nursing, Shanxi Medical University, Shanxi Province, China
- Department of Neurology, First Hospital of Shanxi Medical University, Shanxi Province, China
| | - Wei Li
- International Medical Department, Peking Union Medical College Hospital, Beijing, China
| | - Hui Yang
- School of nursing, Shanxi Medical University, Shanxi Province, China
- Department of Neurology, First Hospital of Shanxi Medical University, Shanxi Province, China
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Rosa WE, Brown CE, Curtis JR. Race-conscious serious illness communication: An interpersonal tool to dismantle racism in practice and research. Palliat Support Care 2023; 21:492-497. [PMID: 37016914 PMCID: PMC10262215 DOI: 10.1017/s147895152300038x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/06/2023]
Abstract
BACKGROUND Racism significantly contributes to inequitable care quality and outcomes for people of color with serious illness, their families, and their communities. Clinicians use serious illness communication (SIC) to foster trust, elicit patients' needs and values, and deliver goal-concordant services. Current SIC tools do not actively guide users to incorporate patients' experiences with racism into care. OBJECTIVES 1) To explicitly address racism during SIC in the context of the patient's lived experience and 2) to provide race-conscious SIC recommendations for clinicians and researchers. METHODS Applying the conceptual elements of Public Health Critical Race Praxis to SIC practice and research through reflection on inclusive SIC approaches and a composite case. RESULTS Patients' historical and ongoing narratives of racism must be intentionally welcomed in physically and psychologically safe environments by leveraging empathic communication opportunities, forging antiracist palliative care practices, removing interpersonal barriers to promote transparent patient-clinician relationships, and strengthening organizational commitments to strategically dismantle racism. Race-conscious SIC communication strategies, skills, and examples of talking points are provided. DISCUSSION Race-conscious SIC practices may assist to acknowledge racial dynamics within the patient-clinician encounter. Furthermore, race-conscious SIC may help to mitigate implicit and explicit bias in clinical practices and the exclusionary research cultures that guide them.
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Affiliation(s)
- William E. Rosa
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Crystal E. Brown
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, University of Washington, Seattle, WA
- Cambia Palliative Care Center of Excellence, UW Medicine, Seattle WA
| | - J. Randall Curtis
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, University of Washington, Seattle, WA
- Cambia Palliative Care Center of Excellence, UW Medicine, Seattle WA
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Rosa WE, Grant L. Palliative Justice Post-COP27. THE YALE JOURNAL OF BIOLOGY AND MEDICINE 2023; 96:257-260. [PMID: 37396979 PMCID: PMC10303251 DOI: 10.59249/rtyb9681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 07/04/2023]
Abstract
The climate crisis is a planetary existential threat, disproportionately affecting the poorest populations worldwide. People in low- and middle-income countries (LMICs) experience the most detrimental consequences of climate injustice, endangering their livelihoods, safety, overall wellbeing, and survival. Although the 2022 United Nations Climate Change Conference (COP27) put forth several internationally salient recommendations, the outcomes fall short to efficiently tackle the suffering that exists at the intersection of social and climate injustice. Individuals with serious illness living in LMICs have the highest burden of health-related suffering globally. In fact, more than 61 million people experience serious health-related suffering (SHS) each year that is amenable to palliative care. Despite this well-documented burden of SHS, an estimated 88-90% of palliative care need is unmet, the majority in LMICs. To equitably address suffering at individual, population, and planetary levels in LMICs, a palliative justice approach is crucial. The interplay of human and planetary suffering requires that current planetary health recommendations be expanded to incorporate a whole-person and whole-people perspective that recognizes the need for environmentally conscious and community-based research and policy initiatives. Conversely, palliative care efforts should incorporate planetary health considerations to ensure sustainability in capacity building and service provision. In sum, the optimal health of the planet will remain elusive until we can holistically recognize the value of relieving all suffering due to life-limiting conditions, as well as the value in preserving the natural resources of countries in which all people are born, live, age, suffer, die, and grieve.
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Affiliation(s)
- William E. Rosa
- Department of Psychiatry and Behavioral Sciences,
Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Liz Grant
- Global Health Academy, University of Edinburgh,
Edinburgh, Scotland
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Gazaway S, Bakitas M, Underwood F, Ekelem C, Duffie M, McCormick S, Heard V, Colvin A, Elk R. Community Informed Recruitment: A Promising Method to Enhance Clinical Trial Participation. J Pain Symptom Manage 2023; 65:e757-e764. [PMID: 36871774 PMCID: PMC10192118 DOI: 10.1016/j.jpainsymman.2023.02.319] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Revised: 02/21/2023] [Accepted: 02/22/2023] [Indexed: 03/07/2023]
Abstract
CONTEXT Low recruitment rates in palliative care clinical trials amongst Black and rural individuals have been attributed to lack of trust and procedural barriers. Community engagement strategies have increased clinical trial participation of under-represented populations. OBJECTIVE Describe a successful community-engaged recruitment strategy in an ongoing multi-site randomized clinical trial (RCT). STUDY DESIGN AND METHODS Using community-based participatory research principles and input from a prior pilot study's community advisory group (CAG), we designed a novel recruitment strategy for Community Tele-Pal, a three-site, culturally based palliative care tele-consult RCT for Black and White seriously ill inpatients and their family caregivers. Local site CAGs helped design and implement a recruitment strategy in which a CAG member accompanied the study coordinators to introduce the study to eligible patients. Initially, CAG members could not accompany study coordinators in person due to pandemic restrictions. Hence, they created videos of themselves introducing the study, just as they would have done in person. We examined outcomes to date by the three recruitment methods and race. RESULTS Of the 2879 patients screened, 228 were eligible and approached. Overall, the proportions of patients who consented 102 (44.7%) vs. not consented 126 (55.3%) were similar by race- White (consented= 75 [44.1%]) vs; Black (consented = 27 [46.6%]). Proportionally, consent rates favored CAG-involved methods: coordinator only- 47 approached and 13 (12.7%) consented vs. coordinator/CAG video-105 approached and 60 (58.8%) consented. CONCLUSION A novel community-enhanced recruitment strategy demonstrated the potential to increase clinical trial participation from historically under-represented populations.
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Affiliation(s)
- Shena Gazaway
- School of Nursing, University of Alabama at Birmingham (S.G., M.B.,), Birmingham, AL, USA; Center for Palliative and Supportive Care, University of Alabama at Birmingham (S.G., M.B., F.U., C.E., M.D., S.M., V.H., R.E.), Birmingham, AL, USA.
| | - Marie Bakitas
- School of Nursing, University of Alabama at Birmingham (S.G., M.B.,), Birmingham, AL, USA; Center for Palliative and Supportive Care, University of Alabama at Birmingham (S.G., M.B., F.U., C.E., M.D., S.M., V.H., R.E.), Birmingham, AL, USA; Division of Geriatrics, School of Medicine, University of Alabama at Birmingham (M.B., F.U., C.E., R.E.), Birmingham, AL, USA
| | - Felicia Underwood
- Center for Palliative and Supportive Care, University of Alabama at Birmingham (S.G., M.B., F.U., C.E., M.D., S.M., V.H., R.E.), Birmingham, AL, USA; Division of Geriatrics, School of Medicine, University of Alabama at Birmingham (M.B., F.U., C.E., R.E.), Birmingham, AL, USA
| | - Christiana Ekelem
- Center for Palliative and Supportive Care, University of Alabama at Birmingham (S.G., M.B., F.U., C.E., M.D., S.M., V.H., R.E.), Birmingham, AL, USA; Division of Geriatrics, School of Medicine, University of Alabama at Birmingham (M.B., F.U., C.E., R.E.), Birmingham, AL, USA
| | - Marlee Duffie
- Center for Palliative and Supportive Care, University of Alabama at Birmingham (S.G., M.B., F.U., C.E., M.D., S.M., V.H., R.E.), Birmingham, AL, USA; Russell Medical Center (M.D., V.H.), Alexander City, AL, USA
| | - Sheila McCormick
- Center for Palliative and Supportive Care, University of Alabama at Birmingham (S.G., M.B., F.U., C.E., M.D., S.M., V.H., R.E.), Birmingham, AL, USA; Aiken Regional Medical Center (S.M.), Aiken, SC, USA
| | - Vantrice Heard
- Center for Palliative and Supportive Care, University of Alabama at Birmingham (S.G., M.B., F.U., C.E., M.D., S.M., V.H., R.E.), Birmingham, AL, USA; Russell Medical Center (M.D., V.H.), Alexander City, AL, USA
| | | | - Ronit Elk
- Center for Palliative and Supportive Care, University of Alabama at Birmingham (S.G., M.B., F.U., C.E., M.D., S.M., V.H., R.E.), Birmingham, AL, USA; Division of Geriatrics, School of Medicine, University of Alabama at Birmingham (M.B., F.U., C.E., R.E.), Birmingham, AL, USA
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Isaacson MJ, Duran T, Johnson GR, Soltoff A, Jackson SM, Purvis SJ, Sargent M, LaPlante JR, Petereit DG, Armstrong K, Daubman BR. Great Plains American Indians' Perspectives on Patient and Family Needs Throughout the Cancer Journey. Oncol Nurs Forum 2023; 50:279-289. [PMID: 37155972 PMCID: PMC10233750 DOI: 10.1188/23.onf.279-289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
PURPOSE To explore the perspectives on patient and family needs during cancer treatment and survivorship of American Indian (AI) cancer survivors, caregivers, Tribal leaders, and healers. PARTICIPANTS & SETTING 36 AI cancer survivors from three reservations in the Great Plains region. METHODOLOGIC APPROACH A community-based participatory research design was employed. Postcolonial Indigenous research techniques of talking circles and semistructured interviews were used to gather qualitative data. Data were analyzed using content analysis to identify themes. FINDINGS The overarching theme of accompaniment was identified. The following themes were intertwined with this theme: (a) the need for home health care, with the subthemes of family support and symptom management; and (b) patient and family education. IMPLICATIONS FOR NURSING To provide high-quality cancer care to AI patients in their home communities, oncology clinicians should collaborate with local care providers, relevant organizations, and the Indian Health Service to identify and develop essential services. Future efforts must emphasize culturally responsive interventions in which Tribal community health workers serve as navigators to accompany patients and families during treatment and in survivorship.
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Isaacson MJ, Duran T, Johnson G, Soltoff A, Jackson S, Petereit D, Armstrong K, Daubman BR. "Calling the Spirit Back:" Spiritual Needs Among Great Plains American Indians. J Pain Symptom Manage 2022; 64:268-275. [PMID: 35618248 PMCID: PMC9378634 DOI: 10.1016/j.jpainsymman.2022.05.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 05/06/2022] [Accepted: 05/09/2022] [Indexed: 11/17/2022]
Abstract
CONTEXT American Indians (AIs) are disproportionately affected by serious illness such as cancer. Colonization, cultural genocide, and trauma have adversely affected AIs' ability to attain health and well-being, and in many cases led to the loss of the right to practice traditional ceremonies and rituals. Still many AIs describe well-being as being rooted in spirituality. OBJECTIVES The purpose of this project was to learn about the perspectives of AI cancer survivors, caregivers, and Tribal leaders and healers specific to spirituality while on the cancer journey. METHODS Qualitative interviews and Indigenous talking circle methodologies were used to explore AIs cancer survivors, caregivers, and Tribal leaders and healers' perspectives on spirituality while on the cancer journey. A data analysis team consisting of AI and non-AI members analyzed the narrative data. RESULTS Qualitative analysis of interviews and talking circles revealed 4 major themes related to spirituality: the chasm of colonialism, coexistence of Traditional and Christian religions, calling the Spirit back, and prayer as sacred energy. CONCLUSION It is critical that clinicians caring for AIs with serious illness seek to understand their patients' spiritual beliefs about disease treatment and death and work with them and their families to support quality of life throughout their illness journey. In addition, clinicians must recognize the systemic racism inherent in our healthcare systems, and dismantle cultural clashes and bias for all patients, particularly AIs, who have long suffered from poorer health outcomes.
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Affiliation(s)
- Mary J Isaacson
- South Dakota State University, College of Nursing (M.J.I.), Rapid City, South Dakota, USA.
| | - Tinka Duran
- Great Plains Tribal Leaders Health Board (T.D., G.J., S.J.), Rapid City, South Dakota, USA
| | - Gina Johnson
- Great Plains Tribal Leaders Health Board (T.D., G.J., S.J.), Rapid City, South Dakota, USA
| | - Alexander Soltoff
- Department of Medicine (A.S.), Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Sean Jackson
- Great Plains Tribal Leaders Health Board (T.D., G.J., S.J.), Rapid City, South Dakota, USA
| | - Daniel Petereit
- Department of Radiation Oncology (D.P.), Monument Health Cancer Care Institute, Walking Forward, Avera Research Institute, Avera Health, Rapid City, South Dakota, USA
| | - Katrina Armstrong
- Dean, Vagelos College of Physicians and Surgeons, Columbia University, New York
| | - Bethany-Rose Daubman
- Division of Palliative Care and Geriatric Medicine (B.-R. D.), Massachusetts General Hospital, Boston, Massachusetts, USA
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14
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Soltoff A, Purvis S, Ravicz M, Isaacson MJ, Duran T, Johnson G, Sargent M, LaPlante JR, Petereit D, Armstrong K, Daubman BR. Factors Influencing Palliative Care Access and Delivery for Great Plains American Indians. J Pain Symptom Manage 2022; 64:276-286. [PMID: 35618250 PMCID: PMC10230738 DOI: 10.1016/j.jpainsymman.2022.05.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Revised: 05/06/2022] [Accepted: 05/09/2022] [Indexed: 11/22/2022]
Abstract
CONTEXT Despite the known importance of culturally tailored palliative care (PC), American Indian people (AIs) in the Great Plains lack access to such services. While clinicians caring for AIs in the Great Plains have long acknowledged major barriers to serious illness care, there is a paucity of literature describing specific factors influencing PC access and delivery for AI patients living on reservation land. OBJECTIVES This study aimed to explore factors influencing PC access and delivery on reservation land in the Great Plains to inform the development culturally tailored PC services for AIs. METHODS Three authors recorded and transcribed interviews with 21 specialty and 17 primary clinicians. A data analysis team of seven authors analyzed transcripts using conventional content analysis. The analysis team met over Zoom to engage in code negotiation, classify codes, and develop themes. RESULTS Qualitative analysis of interview data revealed four themes encompassing factors influencing palliative care delivery and access for Great Plains American Indians: health care system operations (e.g., hospice and home health availability, fragmented services), geography (e.g., weather, travel distances), workforce elements (e.g., care continuity, inadequate staffing, cultural familiarity), and historical trauma and racism. CONCLUSION Our findings emphasize the importance of addressing the time and cost of travel for seriously ill patients, increasing home health and hospice availability on reservations, and improving trust in the medical system. Strengthening the AI medical workforce, increasing funding for the Indian Health Service, and transitioning the governance of reservation health care to Tribal entities may improve the trustworthiness of the medical system.
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Affiliation(s)
- Alexander Soltoff
- Department of Medicine (A.S., S.P., M.R.), Massachusetts General Hospital, Boston, MA, USA.
| | - Sara Purvis
- Department of Medicine (A.S., S.P., M.R.), Massachusetts General Hospital, Boston, MA, USA
| | - Miranda Ravicz
- Department of Medicine (A.S., S.P., M.R.), Massachusetts General Hospital, Boston, MA, USA
| | - Mary J Isaacson
- College of Nursing South Dakota State University (M.J.I.), Rapid City, SD, USA
| | - Tinka Duran
- Community Health Prevention Programs (T.D., G.J.), Great Plains Tribal Leaders Health Board, Rapid City, SD, USA
| | - Gina Johnson
- Community Health Prevention Programs (T.D., G.J.), Great Plains Tribal Leaders Health Board, Rapid City, SD, USA
| | - Michele Sargent
- Walking Forward (M.S., D.P.), Avera Research Institute, Avera Health, Rapid City, SD, USA
| | - J R LaPlante
- American Indian Health Initiative (J.R.L.), Avera Health, Sioux Falls, SD, USA
| | - Daniel Petereit
- Walking Forward (M.S., D.P.), Avera Research Institute, Avera Health, Rapid City, SD, USA
| | | | - Bethany-Rose Daubman
- Massachusetts General Hospital, Division of Palliative Care and Geriatric Medicine (B.R.D.), Boston, MA, USA
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Gazaway S, Chuang E, Thompson M, White-Hammond G, Elk R. Respecting Faith, Hope, and Miracles in African American Christian Patients at End-of-Life: Moving from Labeling Goals of Care as "Aggressive" to Providing Equitable Goal-Concordant Care. J Racial Ethn Health Disparities 2022:10.1007/s40615-022-01385-5. [PMID: 35947300 PMCID: PMC10026148 DOI: 10.1007/s40615-022-01385-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Revised: 07/29/2022] [Accepted: 08/01/2022] [Indexed: 10/15/2022]
Abstract
In this article, we demonstrate first how the term "aggressive care," used loosely by clinicians to denote care that can negatively impact quality of life in serious illness, is often used to inappropriately label the preferences of African American patients, and discounts, discredits, and dismisses the deeply held beliefs of African American Christians. This form of biased communication results in a higher proportion of African Americans than whites receiving care that is non-goal-concordant and contributes to the prevailing lack of trust the African American community has in our healthcare system. Second, we invite clinicians and health care centers to make the perspectives of socially marginalized groups (in this case, African American Christians) the central axis around which we find solutions to this problem. Based on this, we provide insight and understanding to clinicians caring for seriously ill African American Christian patients by sharing their beliefs, origins, and substantive importance to the African American Christian community. Third, we provide recommendations to clinicians and healthcare systems that will result in African Americans, regardless of religious affiliation, receiving equitable levels of goal-concordant care if implemented. KEY MESSAGE: Labeling care at end-of-life as "aggressive" discounts the deeply held beliefs of African American Christians. By focusing on the perspectives of this group clinicians will understand the importance of respecting their religious values. The focus on providing equitable goal-concordant care is the goal.
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Affiliation(s)
- Shena Gazaway
- Department of Family, School of Nursing, University of Alabama Birmingham, Community, and Health Systems 1720 2nd Avenue South, AB, N485C,35294-1210, Birmingham, USA.
| | | | | | | | - Ronit Elk
- School of Medicine, UAB, Birmingham, AL, USA
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Hutchinson RN, Anderson EC, Ruben MA, Manning N, John L, Daruvala A, Rizzo DM, Eppstein MJ, Gramling R, Han PK. A Formative Mixed-Methods Study of Emotional Responsiveness in Telepalliative Care. J Palliat Med 2022; 25:1258-1267. [PMID: 35417249 PMCID: PMC9347382 DOI: 10.1089/jpm.2021.0589] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/15/2022] [Indexed: 11/13/2022] Open
Abstract
Background: It is unknown whether telemedicine-delivered palliative care (tele-PC) supports emotionally responsive patient-clinician interactions. Objectives: We conducted a mixed-methods formative study at two academic medical centers in rural U.S. states to explore the acceptability, feasibility, and emotional responsiveness of tele-PC. Design: We assessed clinicians' emotional responsiveness through questionnaires, qualitative interviews, and video coding. Results: We completed 11 tele-PC consultations. Mean age was 71 years, 30% did not complete high school, 55% experienced at least moderate financial insecurity, and 2/3 rated their overall health poorly. All patients rated tele-PC as equal to, or better than, in-person PC at providing emotional support. There was a tendency toward higher positive and lower negative emotions following the consultation. Video coding identified 114 instances of patients expressing emotions, and clinicians detected and responded to 98% of these events. Conclusion: Tele-PC appears to support emotionally responsive patient-clinician interactions. A mixed-methods approach to evaluating tele-PC yields useful, complementary insights.
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Affiliation(s)
- Rebecca N. Hutchinson
- Center for Outcomes Research and Evaluation, Maine Medical Center Research Institute, Portland, Maine, USA
- Tufts University School of Medicine, Boston, Massachusetts, USA
- Division of Palliative Medicine, Maine Medical Center, Portland, Maine, USA
| | - Eric C. Anderson
- Center for Outcomes Research and Evaluation, Maine Medical Center Research Institute, Portland, Maine, USA
- Tufts University School of Medicine, Boston, Massachusetts, USA
| | | | - Noah Manning
- Tufts University School of Medicine, Boston, Massachusetts, USA
| | - Liam John
- Department of Family Medicine, Larner College of Medicine, and University of Vermont, Burlington, Vermont, USA
| | - Ava Daruvala
- Tufts University School of Medicine, Boston, Massachusetts, USA
| | - Donna M. Rizzo
- College of Engineering and Mathematical Sciences, University of Vermont, Burlington, Vermont, USA
| | - Margaret J. Eppstein
- College of Engineering and Mathematical Sciences, University of Vermont, Burlington, Vermont, USA
| | - Robert Gramling
- Department of Family Medicine, Larner College of Medicine, and University of Vermont, Burlington, Vermont, USA
| | - Paul K.J. Han
- Center for Outcomes Research and Evaluation, Maine Medical Center Research Institute, Portland, Maine, USA
- Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, Maryland, USA
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17
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Choi A, Sanft T. Establishing Goals of Care. Med Clin North Am 2022; 106:653-662. [PMID: 35725231 DOI: 10.1016/j.mcna.2022.01.007] [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: 11/16/2022]
Abstract
Establishing goals of care (GOC) is a crucial component of a patient's treatment plan. The need for better physician-patient communication in this area has been recognized for decades, yet several gaps remain. Challenges exist for both physician and patient. Physicians should pursue a patient-led approach, exercise cultural competency, and use various communication techniques to guide patients when establishing GOC.
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Affiliation(s)
- Alex Choi
- Yale Palliative Care Program, Yale New Haven Hospital, New Haven, CT, USA.
| | - Tara Sanft
- Survivorship Clinic, Yale New Haven Hospital, New Haven, CT, USA
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18
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Needle JS, Friebert S, Thompkins JD, Grossoehme DH, Baker JN, Jiang J, Wang J, Lyon ME. Effect of the Family-Centered Advance Care Planning for Teens with Cancer Intervention on Sustainability of Congruence About End-of-Life Treatment Preferences: A Randomized Clinical Trial. JAMA Netw Open 2022; 5:e2220696. [PMID: 35819787 PMCID: PMC9277499 DOI: 10.1001/jamanetworkopen.2022.20696] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
IMPORTANCE The effect of pediatric advance care planning (pACP) on the sustainability of end-of-life treatment preference congruence between adolescents with cancer and their families has not been examined. OBJECTIVE To evaluate the longitudinal efficacy of the Family-Centered Advance Care Planning for Teens with Cancer (FACE-TC) intervention to sustain adolescent-family congruence about end-of-life treatment preferences. DESIGN, SETTING, AND PARTICIPANTS This multisite, assessor-blinded, randomized clinical trial enrolled adolescents with cancer (aged 14-21 years) and their family members from 4 pediatric hospitals between July 16, 2016, and April 30, 2019. Participants were randomized 2:1 to FACE-TC (intervention group) or treatment as usual (control group) and underwent 5 follow-up visits over an 18-month postintervention period. Intention-to-treat analyses were conducted from March 9, 2021, to April 14, 2022. EXPOSURES Adolescent-family dyads randomized to the FACE-TC group received 3 weekly 60-minute sessions consisting of the discussion and/or completion of the Lyon Family-Centered Advance Care Planning Survey (session 1), Respecting Choices Next Steps pACP conversation (session 2), and Five Wishes advance directive (session 3). Dyads in the control group received treatment as usual. Both groups received pACP information. MAIN OUTCOMES AND MEASURES Congruence was measured by completion of the Statement of Treatment Preferences (a document that discusses 4 hypothetical clinical situations and treatment choices for each scenario: continue all treatments, stop all efforts to keep me alive, or unsure) after session 2 (time 1) and at 3 months (time 2), 6 months (time 3), 12 months (time 4), and 18 months (time 5) after intervention. The influence of FACE-TC on the trajectory of congruence over time was measured by longitudinal latent class analysis. RESULTS A total of 252 participants (126 adolescent-family dyads) were randomized. Adolescents (mean [SD] age, 17 [1.9] years) and family members (mean [SD] age, 46 [8.3] years) were predominantly female (72 [57%] and 104 [83%]) and White individuals (100 [79%] and 103 [82%]). There was an 83% (104 of 126) retention at the 18-month assessment. Two latent classes of congruence over time were identified: high-congruence latent class (69 of 116 [60%]) and low-congruence latent class (47 of 116 [41%]). The dyads in the FACE-TC group had a 3-fold odds of being in the high-congruence latent class (odds ratio [OR], 3.22; 95% CI, 1.09-9.57) compared with the control group. Statistically significant differences existed at 12 months (β [SE] = 1.17 [0.55]; P = .03]) but not at 18 months (OR, 2.08; 95% CI, 0.92-4.69). In the high-congruence latent class, good agreement (agreement on 2 or 3 of 4 situations) increased over 12 months. White adolescents and families had significantly greater odds of congruence than a small population of American Indian or Alaska Native, Asian, Black or African American, Hispanic or Latino, or multiracial adolescents and families (OR, 3.97; 95% CI, 1.07-14.69). CONCLUSIONS AND RELEVANCE Results of this trial showed that, for those who received the FACE-TC intervention, the families' knowledge of their adolescents' end-of-life treatment preferences was sustained for 1 year, suggesting yearly follow-up sessions. Race and ethnicity-based differences in the sustainability of this knowledge reflect a difference in the effect of the intervention and require further study. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT02693665.
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Affiliation(s)
- Jennifer Susan Needle
- Department of Pediatrics and Center for Bioethics, University of Minnesota, Minneapolis
| | - Sarah Friebert
- Haslinger Family Pediatric Palliative Care Center, Akron Children’s Hospital, Akron, Ohio
- Rebecca D. Considine Research Institute, Akron Children’s Hospital, Akron, Ohio
| | - Jessica D. Thompkins
- Division of Allergy and Immunology, Children’s National Hospital, Washington, DC
| | - Daniel H. Grossoehme
- Haslinger Family Pediatric Palliative Care Center, Akron Children’s Hospital, Akron, Ohio
- Rebecca D. Considine Research Institute, Akron Children’s Hospital, Akron, Ohio
| | - Justin N. Baker
- Division of Quality of Life and Palliative Care, St Jude Children’s Research Hospital, Memphis, Tennessee
| | - JiJi Jiang
- Henry M Jackson Foundation for the Advancement of Military Medicine, Bethesda, Maryland
| | - Jichuan Wang
- Division of Biostatistics and Study Methodology, Center for Translational Research/Children’s National Research Institute, Children’s National Hospital, Washington, DC
- Center for Translational Research/Children’s National Research Institute, Children’s National Hospital, Washington, DC
| | - Maureen E. Lyon
- Center for Translational Research/Children’s National Research Institute, Children’s National Hospital, Washington, DC
- Department of Pediatrics, George Washington University School of Medicine and Health Sciences, Washington, DC
- Division of Adolescent and Young Adult Medicine, Children’s National Hospital, Washington, DC
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Gazaway S, Bakitas MA, Elk R, Eneanya ND, Dionne-Odom JN. Engaging African American family Caregivers in Developing a Culturally-responsive Interview Guide: A Multiphase Process and Approach. J Pain Symptom Manage 2022; 63:e705-e711. [PMID: 35247583 PMCID: PMC9133041 DOI: 10.1016/j.jpainsymman.2022.02.331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Revised: 02/11/2022] [Accepted: 02/18/2022] [Indexed: 11/21/2022]
Abstract
Qualitatively eliciting historically marginalized populations' beliefs, values, and preferences is critical to capturing information that authentically characterizes their experiences and can be used to develop culturally-responsive interventions. Eliciting these rich perspectives requires researchers to have highly effective qualitative interviewing guides, which can be optimized through community engagement. However, researchers have had little methodological guidance on how community member engagement can aid development of interview guides. The purpose of this article is to provide a series of steps, each supported by a case example from our work with African American family caregivers, for developing an interview guide through community engagement. We conclude by highlighting how involving historically marginalized community members in these early stages of research study development can build trust, research partnerships, and acknowledge their contribution to the development of new knowledge.
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Affiliation(s)
- Shena Gazaway
- School of Nursing (S.G., M.A.B., J.N.D.-O.), University of Alabama at Birmingham, Birmingham, Alabama, USA; Center for Palliative and Supportive Care (S.G., M.A.B., R.E., J.N.D.-O.), University of Alabama at Birmingham, Birmingham, Alabama, USA.
| | - Marie A Bakitas
- School of Nursing (S.G., M.A.B., J.N.D.-O.), University of Alabama at Birmingham, Birmingham, Alabama, USA; Center for Palliative and Supportive Care (S.G., M.A.B., R.E., J.N.D.-O.), University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Ronit Elk
- Center for Palliative and Supportive Care (S.G., M.A.B., R.E., J.N.D.-O.), University of Alabama at Birmingham, Birmingham, Alabama, USA; School of Medicine (R.E.), Division of Geriatrics, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Nwamaka D Eneanya
- Perelman School of Medicine (N.D.E.), University of Pennsylvania, Philadelphia, Pennsylvania, USA; Palliative and Advanced Illness Research (PAIR) Center (N.D.E.), University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - J Nicholas Dionne-Odom
- School of Nursing (S.G., M.A.B., J.N.D.-O.), University of Alabama at Birmingham, Birmingham, Alabama, USA; Center for Palliative and Supportive Care (S.G., M.A.B., R.E., J.N.D.-O.), University of Alabama at Birmingham, Birmingham, Alabama, USA
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20
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Rosa WE, Pandey S, Epstein AS, Connor SR, Andersen LJ, Applebaum AJ, Blackler L, Koranteng LA, Breitbart WS, Nelson JE. The 2nd Annual US Celebration of World Hospice and Palliative Care Day: A virtual coming together to support equity in palliative care access. Palliat Support Care 2022; 20:307-312. [PMID: 35241195 PMCID: PMC9232874 DOI: 10.1017/s147895152200013x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE On October 5-6, 2021, the Memorial Sloan Kettering Cancer Center Supportive Care Service and Department of Psychiatry and Behavioral Sciences hosted the 2nd Annual United States (US) Celebration of World Hospice and Palliative Care Day (WHPCD). The purpose of this article is to describe the event within the broader context of the international WHPCD theme: "Leave No One Behind - Equity in Access to Palliative Care." We reflect on lessons learned in anticipation of the 3rd annual conference to be held October 3-4, 2022. METHODS Description of the 2nd annual event, conference planning team reflection, and attendee evaluation responses. RESULTS The Worldwide Hospice Palliative Care Alliance launched WHPCD in 2005 as an annual unified day of action to celebrate and support hospice and palliative care around the world. The 2021 US-based innovative virtual conference featured 37 interprofessional hospice and palliative care specialists and patient and family caregiver speakers across 11 diverse sessions with a focus on health equity and COVID-19 considerations. Two primary aims continue to guide the event: community building and wisdom sharing at the intersection of art and science. 278 registrants from at least 14 countries and 21 different states across the US joined the program, which served as a global debriefing for hospice and palliative care workers from diverse settings, contexts, and disciplines. SIGNIFICANCE OF RESULTS The US WHPCD Celebration creates a virtual coming together for collective reflection on hospice and palliative care delivery amid vast changes in clinical practice, research, and policy, both locally and globally. In addition, our goal to ensure an internationally relevant, culturally inclusive, and multidisciplinary agenda will continue to draw increased participation worldwide during future annual events.
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Affiliation(s)
- William E Rosa
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Shila Pandey
- Supportive Care Service, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Andrew S Epstein
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | | | - Laurie J Andersen
- Supportive Care Service, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Allison J Applebaum
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY
- Weill Cornell Medical College, New York, NY
| | - Liz Blackler
- Ethics Committee, Memorial Sloan Kettering Cancer Center, New York, NY
| | | | - William S Breitbart
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY
- Weill Cornell Medical College, New York, NY
| | - Judith E Nelson
- Supportive Care Service, Memorial Sloan Kettering Cancer Center, New York, NY
- Weill Cornell Medical College, New York, NY
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21
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Rosa WE, Elk R, Tucker RO. Community-based participatory research in palliative care: a social justice imperative. Lancet Public Health 2022; 7:e104. [PMID: 35122757 PMCID: PMC9260493 DOI: 10.1016/s2468-2667(21)00305-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Accepted: 12/10/2021] [Indexed: 11/17/2022]
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Mahilall R, Swartz L. 'I am Dying a Slow Death of White Guilt': Spiritual Carers in a South African Hospice Navigate Issues of Race and Cultural Diversity. Cult Med Psychiatry 2022; 46:779-797. [PMID: 34510312 PMCID: PMC8435180 DOI: 10.1007/s11013-021-09750-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/26/2021] [Indexed: 12/04/2022]
Abstract
Culturally appropriate spiritual care is increasingly recognised as a crucial component of spiritual care. As part of a larger study, we were interested in cultural and racial issues as experienced by spiritual carers in a hospice in Cape Town, South Africa. We conducted one-on-one interviews and focus group discussions with a cohort of spiritual care workers, who, being volunteers and relatively privileged South Africans, discussed their sensitivity to cultural issues, but also mentioned a host of political, racial and identity issues which profoundly affect their work. The data suggest that the concept of culturally appropriate care must be understood and acted on contextually. We note that the work of transformation of care cannot be separated from broader questions of social inequality and change.
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Affiliation(s)
- Ronita Mahilall
- Department of Psychology, Stellenbosch University, Stellenbosch, Private Bag X4, Cape Town, 7745, South Africa.
| | - Leslie Swartz
- grid.11956.3a0000 0001 2214 904XDepartment of Psychology, Stellenbosch University, Stellenbosch, Private Bag X4, Cape Town, 7745 South Africa
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Aaron SP, Gazaway SB, Harrell ER, Elk R. Disparities and Racism Experienced Among Older African Americans Nearing End of Life. CURRENT GERIATRICS REPORTS 2021; 10:157-166. [PMID: 34956825 PMCID: PMC8685164 DOI: 10.1007/s13670-021-00366-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/02/2021] [Indexed: 11/23/2022]
Abstract
Purpose of Review The purpose of this review is to examine racism in healthcare as it relates to older African American adults. We focus on health disparities in old age and medical mismanagement throughout their lifespan. Recent Findings In the United States there have been extensive medical advances over the past several decades. Individuals are living longer, and illnesses that were deemed terminal in the past are now considered chronic illnesses. While most individuals living with chronic illness have experienced better quality of life, this is not the case for many African American older adults. Summary Older African American adults are less likely to have their chronic illness sufficiently managed and are more likely to die from chronic illnesses that are well controlled in Whites. African American older adults also continue to suffer from poorer healthcare outcomes throughout the lifespan to end-of-life.
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Affiliation(s)
- Siobhan P Aaron
- College of Nursing, University of Utah, 10 2000 E, Salt Lake City, UT 84112 U.S.A
| | - Shena B Gazaway
- School of Nursing, University of Alabama Birmingham, Birmingham, AL U.S.A
| | - Erin R Harrell
- Department of Psychology, University of Alabama, Tuscaloosa, AL U.S.A
| | - Ronit Elk
- Department of Medicine, University of Alabama Birmingham, Birmingham, AL U.S.A
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Jia Z, Yeh IM, Lee CH, Yeung AS, Tulsky JA, Leiter RE. Barriers and Facilitators to Advance Care Planning among Chinese Patients with Advanced Cancer and Their Caregivers. J Palliat Med 2021; 25:774-782. [PMID: 34847732 DOI: 10.1089/jpm.2021.0404] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
Background: Chinese American adults experience health disparities at the end of life. Culturally tailored advance care planning (ACP) may promote goal-concordant care across the continuum of serious illness. However, seriously ill Chinese Americans' preferences for ACP remain unknown. Objective: To explore barriers and facilitators to ACP among Chinese patients with advanced cancer and their caregivers. Design: Informed by socioecological theory, we conducted an exploratory qualitative study using semistructured interviews that were thematically analyzed. Setting/Participants: We recruited participants at one U.S. comprehensive cancer center. Of 27 eligible patients approached, we recruited 20 patients (74.1%) and 8 accompanying caregivers. Overall, participants were middle aged (55.6 ± 13.5 years), 60.7% female, 85.7% partnered/married, 89.3% college educated, and had low acculturation (mean Suinn-Lew Asian Self-Identify Acculturation = 2.0 ± 1.6/5.0). More patients were privately insured (35%) than self-pay (30%), Medicare (25%), and Medicaid (10%). Caregivers were split between "spouse" and "child." Results: Findings highlight participants' trust in their clinicians and the study institution as primary supports for clinicians to lead ACP. However, participants' preconceptions of clinicians' professional responsibilities and participants' belief in an uncertain future may hinder an open discussion of goals and values for future medical care. A key moderating factor in how participants view ACP may be their level of acculturation to local care, behavioral, and communication norms. Conclusions: Chinese patients may prefer a routinized clinician-led ACP approach that supports their actionable priorities in the present by leveraging patient-clinician trust, gauging acculturation level, and using indirect communication strategies. Future studies should investigate preferred communication strategies to support in-the-moment care planning.
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Affiliation(s)
- Zhimeng Jia
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Irene M Yeh
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts, USA.,Division of Palliative Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA
| | | | - Albert S Yeung
- Harvard Medical School, Boston, Massachusetts, USA.,Depression Clinical and Research Program, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - James A Tulsky
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts, USA.,Division of Palliative Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA
| | - Richard E Leiter
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts, USA.,Division of Palliative Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA
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Reeves TJ, Mathis TJ, Bauer HE, Hudson MM, Robison LL, Wang Z, Baker JN, Huang IC. Racial and Ethnic Disparities in Health Outcomes Among Long-Term Survivors of Childhood Cancer: A Scoping Review. Front Public Health 2021; 9:741334. [PMID: 34778176 PMCID: PMC8586515 DOI: 10.3389/fpubh.2021.741334] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Accepted: 09/30/2021] [Indexed: 11/30/2022] Open
Abstract
The five-year survival rate of childhood cancer has increased substantially over the past 50 yr; however, racial/ethnic disparities in health outcomes of survival have not been systematically reviewed. This scoping review summarized health disparities between racial/ethnic minorities (specifically non-Hispanic Black and Hispanic) and non-Hispanic White childhood cancer survivors, and elucidated factors that may explain disparities in health outcomes. We used the terms “race”, “ethnicity”, “childhood cancer”, “pediatric cancer”, and “survivor” to search the title and abstract for the articles published in PubMed and Scopus from inception to February 2021. After removing duplicates, 189 articles were screened, and 23 empirical articles were included in this review study. All study populations were from North America, and the mean distribution of race/ethnicity was 6.9% for non-Hispanic Black and 4.5% for Hispanic. Health outcomes were categorized as healthcare utilization, patient-reported outcomes, chronic health conditions, and survival status. We found robust evidence of racial/ethnic disparities over four domains of health outcomes. However, health disparities were explained by clinical factors (e.g., diagnosis, treatment), demographic (e.g., age, sex), individual-level socioeconomic status (SES; e.g., educational attainment, personal income, health insurance coverage), family-level SES (e.g., family income, parent educational attainment), neighborhood-level SES (e.g., geographic location), and lifestyle health risk (e.g., cardiovascular risk) in some but not all articles. We discuss the importance of collecting comprehensive social determinants of racial/ethnic disparities inclusive of individual-level, family-level, and neighborhood-level SES. We suggest integrating these variables into healthcare systems (e.g., electronic health records), and utilizing information technology and analytics to better understand the disparity gap for racial/ethnic minorities of childhood cancer survivors. Furthermore, we suggest national and local efforts to close the gap through improving health insurance access, education and transportation aid, racial-culture-specific social learning interventions, and diversity informed training.
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Affiliation(s)
- Tegan J Reeves
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN, United States
| | - Taylor J Mathis
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN, United States
| | - Hailey E Bauer
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN, United States
| | - Melissa M Hudson
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN, United States.,Department of Oncology, St. Jude Children's Research Hospital, Memphis, TN, United States
| | - Leslie L Robison
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN, United States
| | - Zhaoming Wang
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN, United States.,Department of Computational Biology, St. Jude Children's Research Hospital, Memphis, TN, United States
| | - Justin N Baker
- Department of Oncology, St. Jude Children's Research Hospital, Memphis, TN, United States
| | - I-Chan Huang
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN, United States
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Ebneter AS, Fliedner M, Trapp D, Ramseier F, Sauter TC, Eychmüller S. [Telemedicine in Palliative Care: Digital Communication in a Relationship-Based Speciality - Does It Make Sense?]. PRAXIS 2021; 110:845-850. [PMID: 34814716 DOI: 10.1024/1661-8157/a003781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Telemedicine in Palliative Care: Digital Communication in a Relationship-Based Speciality - Does It Make Sense? Abstract. Telemedicine in palliative care is established especially in countries with large geographical distances. Digital forms of communication (virtual consultations) are most frequently used and well-accepted by patients and caregivers. The main benefit lies in the reduction of the access barrier in the outpatient setting. Advantages are stress reduction for patients (travel, accessibility) and reduction in the care burden for relatives. Additional benefits compared to the physical visit for symptom-control, quality of life and costs are unclear. Risks are influenced by the lack of physical interaction and data security. To what extent telepalliative care makes sense in a high-density health system is difficult to predict. It is therefore important to use these new tools in a carefully adapted and scientifically verified way.
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Affiliation(s)
| | - Monica Fliedner
- Universitäres Zentrum für Palliative Care, Inselspital, Bern
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Rosa WE, Buck HG, Squires AP, Kozachik SL, Huijer HAS, Bakitas M, Boit JM, Bradley PK, Cacchione PZ, Chan GK, Crisp N, Dahlin C, Daoust P, Davidson PM, Davis S, Doumit MAA, Fink RM, Herr KA, Hinds PS, Hughes TL, Karanja V, Kenny DJ, King CR, Klopper HC, Knebel AR, Kurth AE, Madigan EA, Malloy P, Matzo M, Mazanec P, Meghani SH, Monroe TB, Moreland PJ, Paice JA, Phillips JC, Rushton CH, Shamian J, Shattell M, Snethen JA, Ulrich CM, Wholihan D, Wocial LD, Ferrell BR. American Academy of Nursing Expert Panel consensus statement on nursing's roles in ensuring universal palliative care access. Nurs Outlook 2021; 69:961-968. [PMID: 34711419 PMCID: PMC8717680 DOI: 10.1016/j.outlook.2021.06.011] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 05/26/2021] [Accepted: 06/12/2021] [Indexed: 01/19/2023]
Abstract
The purpose of this consensus paper was to convene leaders and scholars from eight Expert Panels of the American Academy of Nursing and provide recommendations to advance nursing's roles and responsibility to ensure universal access to palliative care. Part I of this consensus paper herein provides the rationale and background to support the policy, education, research, and clinical practice recommendations put forward in Part II. On behalf of the Academy, the evidence-based recommendations will guide nurses, policy makers, government representatives, professional associations, and interdisciplinary and community partners to integrate palliative nursing services across health and social care settings. The consensus paper's 43 authors represent eight countries (Australia, Canada, England, Kenya, Lebanon, Liberia, South Africa, United States of America) and extensive international health experience, thus providing a global context for the subject matter. The authors recommend greater investments in palliative nursing education and nurse-led research, nurse engagement in policy making, enhanced intersectoral partnerships with nursing, and an increased profile and visibility of palliative nurses worldwide. By enacting these recommendations, nurses working in all settings can assume leading roles in delivering high-quality palliative care globally, particularly for minoritized, marginalized, and other at-risk populations.
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Affiliation(s)
- William E Rosa
- Palliative Care & End-of-Life Expert Panel; Global Nursing & Health Expert Panel; Lesbian, Gay, Bisexual, Transgender, Queer (LGBTQ) Health Expert Panel.
| | - Harleah G Buck
- Palliative Care & End-of-Life Expert Panel; Expert Panel on Aging
| | | | | | - Huda Abu-Saad Huijer
- Palliative Care & End-of-Life Expert Panel; Global Nursing & Health Expert Panel
| | | | | | | | | | | | | | | | | | - Patricia M Davidson
- Palliative Care & End-of-Life Expert Panel; Global Nursing & Health Expert Panel
| | | | | | | | - Keela A Herr
- Palliative Care & End-of-Life Expert Panel; Expert Panel on Aging
| | | | - Tonda L Hughes
- Global Nursing & Health Expert Panel; Lesbian, Gay, Bisexual, Transgender, Queer (LGBTQ) Health Expert Panel
| | | | | | | | | | | | | | | | | | | | | | | | - Todd B Monroe
- Palliative Care & End-of-Life Expert Panel; Expert Panel on Aging
| | - Patricia J Moreland
- Palliative Care & End-of-Life Expert Panel; Global Nursing & Health Expert Panel
| | | | - J Craig Phillips
- Lesbian, Gay, Bisexual, Transgender, Queer (LGBTQ) Health Expert Panel
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Bazargan M, Bazargan-Hejazi S. Disparities in Palliative and Hospice Care and Completion of Advance Care Planning and Directives Among Non-Hispanic Blacks: A Scoping Review of Recent Literature. Am J Hosp Palliat Care 2021; 38:688-718. [PMID: 33287561 PMCID: PMC8083078 DOI: 10.1177/1049909120966585] [Citation(s) in RCA: 63] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVES Published research in disparities in advance care planning, palliative, and end-of-life care is limited. However, available data points to significant barriers to palliative and end-of-life care among minority adults. The main objective of this scoping review was to summarize the current published research and literature on disparities in palliative and hospice care and completion of advance care planning and directives among non-Hispanc Blacks. METHODS The scoping review method was used because currently published research in disparities in palliative and hospice cares as well as advance care planning are limited. Nine electronic databases and websites were searched to identify English-language peer-reviewed publications published within last 20 years. A total of 147 studies that addressed palliative care, hospice care, and advance care planning and included non-Hispanic Blacks were incorporated in this study. The literature review include manuscripts that discuss the intersection of social determinants of health and end-of-life care for non-Hispanic Blacks. We examined the potential role and impact of several factors, including knowledge regarding palliative and hospice care; healthcare literacy; communication with providers and family; perceived or experienced discrimination with healthcare systems; mistrust in healthcare providers; health care coverage, religious-related activities and beliefs on palliative and hospice care utilization and completion of advance directives among non-Hispanic Blacks. DISCUSSION Cross-sectional and longitudinal national surveys, as well as local community- and clinic-based data, unequivocally point to major disparities in palliative and hospice care in the United States. Results suggest that national and community-based, multi-faceted, multi-disciplinary, theoretical-based, resourceful, culturally-sensitive interventions are urgently needed. A number of practical investigational interventions are offered. Additionally, we identify several research questions which need to be addressed in future research.
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Affiliation(s)
- Mohsen Bazargan
- Department of Family Medicine, Charles R. Drew University of Medicine and Science (CDU), Los Angeles, CA, USA
- Department of Family Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Shahrzad Bazargan-Hejazi
- Department of Psychiatry, Charles R. Drew University of Medicine and Science (CDU), Los Angeles, CA, USA
- Department of Psychiatry, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
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Hutchinson RN, Han PKJ, Lucas FL, Black A, Sawyer D, Fairfield K. Rural disparities in end-of-life care for patients with heart failure: Are they due to geography or socioeconomic disparity? J Rural Health 2021; 38:457-463. [PMID: 34043838 DOI: 10.1111/jrh.12597] [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: 02/02/2023]
Abstract
PURPOSE The impact of rurality and socioeconomic deprivation on end-of-life (EOL) care for patients with heart failure (HF) is unknown. We analyzed claims to describe the prevalence and predictors of EOL health care utilization for patients dying with HF in a predominantly rural state. METHODS We used the MaineHealth Data Organization's All-Payer Claims Data to identify 15,168 patients ≥35 who died with HF between 2012 and 2017. The primary outcome was health care utilization during the last 180 days of life (EOL definition for this analysis), including emergency department (ED) visits, hospitalizations, intensive care unit (ICU) admissions, and hospice utilization. Patient characteristics analyzed included age, gender, comorbidities, area deprivation index (ADI), and rurality. FINDINGS Among 15,168 patients ≥35 who died with HF, 48% had ≥2 hospitalizations, 72% had ≥2 ED visit, 29% had an ICU stay, 2% initiated dialysis during EOL, and 64% received hospice. Rural patients were more likely to have an ICU admission and have ≥2 hospitalizations. Patients residing in areas with higher ADI were more likely to be hospitalized, admitted to the ICU, and started on dialysis. Both rural patients and those living in higher ADI areas were less likely to receive hospice. After multivariable adjustment, rurality and ADI were independently associated with a decreased likelihood of receiving hospice (OR 0.62 [95% CI: 0.53-0.72] for the most rural patients and OR 0.64 [95% CI: 0.57-0.72] for the highest ADI). CONCLUSION Both rurality and local area deprivation drive disparities in EOL care for patients dying with heart failure.
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Affiliation(s)
- Rebecca N Hutchinson
- Division of Palliative Medicine, Maine Medical Center, Portland, Maine, USA.,Center for Outcomes Research and Evaluation, Maine Medical Center Research Institute, Portland, Maine, USA
| | - Paul K J Han
- Center for Outcomes Research and Evaluation, Maine Medical Center Research Institute, Portland, Maine, USA
| | - F Lee Lucas
- Center for Outcomes Research and Evaluation, Maine Medical Center Research Institute, Portland, Maine, USA
| | - Adam Black
- Center for Outcomes Research and Evaluation, Maine Medical Center Research Institute, Portland, Maine, USA
| | - Douglas Sawyer
- Division of Academic Affairs, Maine Medical Center, Portland, Maine, USA
| | - Kathleen Fairfield
- Department of Internal Medicine, Maine Medical Center, Portland, Maine, USA
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31
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Bakitas M, Cheville AL, Mulvey TM, Peppercorn J, Watts K, Dionne-Odom JN. Telehealth Strategies to Support Patients and Families Across the Cancer Trajectory. Am Soc Clin Oncol Educ Book 2021; 41:413-422. [PMID: 34010046 DOI: 10.1200/edbk_320979] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Effective delivery of cancer care via telehealth requires a planned care system that accounts for myriad patient, provider, and practice/cancer center resources before, during, and after the care episode. Telehealth is broadly defined as a method to have virtual, bidirectional communication between patients and providers. Telehealth can include methods such as audio-only, video-consultation, and tele-monitoring, which can occur in a synchronous, asynchronous, or blended format. The purpose of this review is to present common foundational principles for providing clinical cancer care via telehealth, followed by an overview of three distinct examples of comprehensive telehealth programs that have been developed to meet the needs of patients and families across the cancer trajectory, including survivorship, rehabilitation, and palliative care phases. The programs described are exemplars that were developed and implemented prior to the coronavirus pandemic, so they reflect many years of planning and evidence. Lessons learned include the need for ongoing patient support, clinician training, and cancer health system/practice programmatic considerations such as billing, scheduling, reimbursement, software, and hardware/platform security. Although the COVID-19 pandemic produced an explosive shift in regulations and implementation, sustainability of these changes may not be long-term. Nevertheless, a permanent shift in cancer care to include telehealth is likely here to stay.
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Affiliation(s)
- Marie Bakitas
- School of Nursing, Center for Palliative and Supportive Care, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL
| | | | | | | | | | - J Nicholas Dionne-Odom
- School of Nursing, Center for Palliative and Supportive Care, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL
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32
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The "Good" Home Death in Pulmonary Disease: Avoiding the "Bad" and the "Ugly". Chest 2021; 158:449-450. [PMID: 32768060 DOI: 10.1016/j.chest.2020.04.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Accepted: 04/06/2020] [Indexed: 11/21/2022] Open
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O'Mahony S, Kittelson S, Barker PC, Delgado Guay MO, Yao Y, Handzo GF, Chochinov HM, Fitchett G, Emanuel LL, Wilkie DJ. Association of Race with End-of-Life Treatment Preferences in Older Adults with Cancer Receiving Outpatient Palliative Care. J Palliat Med 2021; 24:1174-1182. [PMID: 33760658 DOI: 10.1089/jpm.2020.0542] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background: End-of-life discussions and documentation of preferences are especially important for older cancer patients who are at high risk of morbidity and mortality. Objective: To evaluate influence of demographic factors such as religiosity, education, income, race, and ethnicity on treatment preferences for end-of-life care. Methods: A retrospective observational study was performed on baseline data from a multisite randomized clinical trial of Dignity Therapy in 308 older cancer patients who were receiving outpatient palliative care (PC). Interviews addressed end-of-life treatment preferences, religion, religiosity and spirituality, and awareness of prognosis. End-of-life treatment preferences for care were examined, including preferences for general treatment, cardiopulmonary resuscitation (CPR), and mechanical ventilation (MV). Bivariate associations and multiple logistic regression analysis of treatment preferences with demographic and other baseline variables were conducted. Results: Our regression models demonstrated that race was a significant predictor for CPR preference and preferences for MV, although not for general treatment goals. Minority patients were more likely to want CPR and MV than whites. Men were more likely to opt for MV, although not for CPR or overall aggressive treatment, than women. Higher level of education was a significant predictor for preferences for less aggressive care at the end-of-life but not for CPR or MV. Higher level of terminal illness awareness was also a significant predictor for preferences for CPR, but not MV or aggressive care at the end-of-life. Discussion: Race was significantly associated with all three markers for aggressive care in bivariate analysis and with two out of three markers in multiple regression analysis, with minorities preferring aggressive care and whites preferring less aggressive care. Contrary to our hypothesis, income was not significantly associated with treatment preferences, whereas religion was significantly associated with all markers for aggressive care in bivariate models, but not in multiple regression models. Clinical Trial Registration Number NCT03209440.
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Affiliation(s)
- Sean O'Mahony
- Department of Medicine, Rush University, Chicago, Illinois, USA
| | - Sheri Kittelson
- Department of Medicine, University of Florida, Gainesville, Florida, USA
| | - Paige C Barker
- Department of Medicine, University of Florida, Gainesville, Florida, USA
| | - Marvin O Delgado Guay
- Department of Palliative Care and Rehabilitation Medicine, MD Anderson Cancer Center, Houston, Texas, USA
| | - Yingwei Yao
- Department of Medicine, University of Florida, Gainesville, Florida, USA
| | - George F Handzo
- CSSBB Health Care Chaplaincy Network, New York, New York, USA
| | - Harvey M Chochinov
- Department of Psychiatry, FRSC University of Manitoba, Winnipeg, Manitoba, Canada
| | - George Fitchett
- Department of Medicine, Rush University, Chicago, Illinois, USA
| | - Linda L Emanuel
- Department of Medicine, Northwestern University, Evanston, Illinois, USA
| | - Diana J Wilkie
- Department of Medicine, University of Florida, Gainesville, Florida, USA
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Allen Watts K, Malone E, Dionne-Odom JN, McCammon S, Currie E, Hicks J, Tucker RO, Wallace E, Elk R, Bakitas M. Can you hear me now?: Improving palliative care access through telehealth. Res Nurs Health 2021; 44:226-237. [PMID: 33393704 PMCID: PMC7958991 DOI: 10.1002/nur.22105] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Revised: 12/10/2020] [Accepted: 12/20/2020] [Indexed: 12/24/2022]
Abstract
Telehealth has been increasingly used to expand healthcare access over the last two decades. However, this had not been the case for palliative care (PC), because telehealth was considered nontraditional and impractical due to the sensitive nature of conversations and a "high touch" philosophy. Motivated by limited PC access to rural and underserved populations and positive PC telehealth studies, clinical PC telehealth models have been developing. However, nearly overnight, the COVID-19 pandemic accelerated the use and uptake of telehealth across health care and especially in PC. As a result, clinicians, administrators, and others agree that telehealth is "here to stay," and will likely maintain widespread use and refinement beyond rural areas. The purpose of this review is to describe exemplar PC telehealth programs in research and clinical practice, including pros and cons, lessons learned, and future directions for the ongoing development and expansion of PC via telehealth across diseases and the lifespan.
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Affiliation(s)
- Kristen Allen Watts
- Department of Medicine, Division of Gerontology, Geriatrics, and Palliative Care, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Emily Malone
- Department of Medicine, Division of Gerontology, Geriatrics, and Palliative Care, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | | | - Susan McCammon
- Department of Medicine, Division of Gerontology, Geriatrics, and Palliative Care, University of Alabama at Birmingham, Birmingham, Alabama, USA
- Department of Otolaryngology, School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Erin Currie
- School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Jennifer Hicks
- School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Rodney O Tucker
- Department of Medicine, Division of Gerontology, Geriatrics, and Palliative Care, University of Alabama at Birmingham, Birmingham, Alabama, USA
- Center for Palliative and Supportive Care, Schools of Medicine and Nursing, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Eric Wallace
- Department of Medicine, Division of Nephrology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Ronit Elk
- Department of Medicine, Division of Gerontology, Geriatrics, and Palliative Care, University of Alabama at Birmingham, Birmingham, Alabama, USA
- Center for Palliative and Supportive Care, Schools of Medicine and Nursing, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Marie Bakitas
- Department of Medicine, Division of Gerontology, Geriatrics, and Palliative Care, University of Alabama at Birmingham, Birmingham, Alabama, USA
- School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama, USA
- Center for Palliative and Supportive Care, Schools of Medicine and Nursing, University of Alabama at Birmingham, Birmingham, Alabama, USA
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Mahilall R, Swartz L. Spiritual care practices in hospices in the Western cape, South Africa: the challenge of diversity. BMC Palliat Care 2021; 20:9. [PMID: 33423672 PMCID: PMC7797180 DOI: 10.1186/s12904-020-00704-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Accepted: 12/28/2020] [Indexed: 12/21/2022] Open
Abstract
Background South Africa is a very diverse middle-income country, still deeply divided by the legacy of its colonial and apartheid past. As part of a larger study, this article explored the experiences and views of representatives of hospices in the Western Cape province of South Africa on the provision of appropriate spiritual care, given local issues and constraints. Methods Two sets of focus group discussions, with 23 hospice participants, were conducted with 11 of the 12 Hospice Palliative Care Association registered hospices in the Western Cape, South Africa, to understand what spiritual care practices existed in their hospices against the backdrop of multifaceted diversities. The discussions were analysed using thematic analysis. Results Two prominent themes emerged: the challenges of providing relevant spiritual care services in a religiously, culturally, linguistically and racially diverse setting, and the organisational context impacting such a spiritual care service. Participants agreed that spiritual care is an important service and that it plays a significant role within the inter-disciplinary team. Participants recognised the need for spiritual care training and skills development, alongside the financial costs of employing dedicated spiritual care workers. In spite of the diversities and resource constraints, the approach of individual hospices to providing spiritual care remained robust. Discussion Given the diversities that are largely unique to South Africa, shaped essentially by past injustices, the hospices have to navigate considerable hurdles such as cultural differences, religious diversity, and language barriers to provide spiritual care services, within significant resource constraints. Conclusions While each of the hospices have established spiritual care services to varying degrees, there was an expressed need for training in spiritual care to develop a baseline guide that was bespoke to the complexities of the South African context. Part of this training needs to focus on the complexity of providing culturally appropriate services.
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Affiliation(s)
- Ronita Mahilall
- Department of Psychology, Stellenbosch University, Private Bag X4, Matieland, Stellenbosch, 7745, South Africa.
| | - Leslie Swartz
- Department of Psychology, Stellenbosch University, Private Bag X1, Matieland, Stellenbosch, 7602, South Africa
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36
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Elk R, Gazaway S. Engaging Social Justice Methods to Create Palliative Care Programs That Reflect the Cultural Values of African American Patients with Serious Illness and Their Families: A Path Towards Health Equity. THE JOURNAL OF LAW, MEDICINE & ETHICS : A JOURNAL OF THE AMERICAN SOCIETY OF LAW, MEDICINE & ETHICS 2021; 49:222-230. [PMID: 34924058 DOI: 10.1017/jme.2021.32] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Cultural values influence how people understand illness and dying, and impact their responses to diagnosis and treatment, yet end-of-life care is rooted in white, middle class values. Faith, hope, and belief in God's healing power are central to most African Americans, yet life-preserving care is considered "aggressive" by the healthcare system, and families are pressured to cease it.
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Cross SH, Lakin JR, Mendu M, Mandel EI, Warraich HJ. Trends in Place of Death for Individuals With Deaths Attributed to Advanced Chronic or End-Stage Kidney Disease in the United States. J Pain Symptom Manage 2021; 61:112-120.e1. [PMID: 32791183 DOI: 10.1016/j.jpainsymman.2020.08.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 06/29/2020] [Accepted: 08/05/2020] [Indexed: 12/30/2022]
Abstract
CONTEXT An important aspect of end-of-life care, place of death is understudied in advanced chronic (CKD) and end-stage kidney disease (ESKD). OBJECTIVE We sought to examine trends and factors associated with where advanced CKD/ESKD patients die. METHODS We conducted a retrospective cross-sectional study using mortality data from 2003 to 2017 for deaths attributed primarily to advanced CKD/ESKD in the United States. RESULTS Between 2003 and 2017, 222,247 deaths were attributed to advanced CKD/ESKD. From 2003 to 2017, deaths occurring in hospitals declined from 56.0% (n = 5356) to 35.6% (n = 7764), whereas increases occurred in deaths at home (13.5% [n = 1292] to 24.3% [n = 5306]), nursing facilities (18.6% [n = 1776] to 19.3% [n = 4221]), and hospice facilities (0.3% [n = 29] to 13.4% [n = 2917]). Nonwhite race was associated with increased odds of hospital death (Black [OR = 1.59; 95% CI = 1.55, 1.62]; Native American [OR = 1.47; 95% CI = 1.32, 1.63]; Asian [OR = 1.43; 95% CI = 1.32, 1.55] and reduced odds of nursing facility (Black [OR = 0.622; 95% CI = 0.600, 0.645]; Native American [OR = 0.638; 95% CI = 0.572, 0.712]; Asian [OR = 0.574; 95% CI = 0.533, 0.619], or hospice facility death (Black [OR = 0.843; 95% CI = 0.773, 0.918]; Native American [OR = 0.380; 95% CI = 0.289, 0.500]; Asian [OR = 0.609; 95% CI = 0.502, 0.739]). Older age was associated with reduced odds of hospital death (≥85 [OR = 0.334; 95% CI = 0.312, 0.358]) and increased odds of home (≥85 [OR = 1.55; 95% CI = 1.43, 1.68]), nursing facility (≥85 [OR = 3.09; 95% CI = 2.76, 3.45]) or hospice facility death (≥85 [OR = 1.60; 95% CI = 1.49, 1.72]). CONCLUSIONS Hospitals remain the most common place of death from advanced CKD/ESKD; however, the proportion of home, nursing facility, and hospice facility deaths have increased.
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Affiliation(s)
- Sarah H Cross
- Sanford School of Public Policy, Duke University, Durham, North Carolina, USA.
| | - Joshua R Lakin
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts, USA; Division of Palliative Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA; Harvard Medical School, Boston, Massachusetts, USA
| | - Mallika Mendu
- Harvard Medical School, Boston, Massachusetts, USA; Renal Division, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA; Department of Quality and Safety, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Ernest I Mandel
- Harvard Medical School, Boston, Massachusetts, USA; Renal Division, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Haider J Warraich
- Harvard Medical School, Boston, Massachusetts, USA; Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA; Cardiology Section, Department of Medicine, Boston VA Healthcare System, Boston, Massachusetts, USA
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Watts KA, Gazaway S, Malone E, Elk R, Tucker R, McCammon S, Goldhagen M, Graham J, Tassin V, Hauser J, Rhoades S, Kagawa-Singer M, Wallace E, McElligott J, Kennedy R, Bakitas M. Community Tele-pal: A community-developed, culturally based palliative care tele-consult randomized controlled trial for African American and White Rural southern elders with a life-limiting illness. Trials 2020; 21:672. [PMID: 32703245 PMCID: PMC7376880 DOI: 10.1186/s13063-020-04567-w] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Accepted: 06/29/2020] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Patients living in rural areas experience a variety of unmet needs that result in healthcare disparities. The triple threat of rural geography, racial inequities, and older age hinders access to high-quality palliative care (PC) for a significant proportion of Americans. Rural patients with life-limiting illness are at risk of not receiving appropriate palliative care due to a limited specialty workforce, long distances to treatment centers, and limited PC clinical expertise. Although culture strongly influences people's response to diagnosis, illness, and treatment preferences, culturally based care models are not currently available for most seriously ill rural patients and their family caregivers. The purpose of this randomized clinical trial (RCT) is to compare a culturally based tele-consult program (that was developed by and for the rural southern African American (AA) and White (W) population) to usual hospital care to determine the impact on symptom burden (primary outcome) and patient and care partner quality of life (QOL), care partner burden, and resource use post-discharge (secondary outcomes) in hospitalized AA and White older adults with a life-limiting illness. METHODS Community Tele-pal is a three-site RCT that will test the efficacy of a community-developed, culturally based PC tele-consult program for hospitalized rural AA and W older adults with life-limiting illnesses (n = 352) and a care partner. Half of the participants (n = 176) and a care partner (n = 176) will be randomized to receive the culturally based palliative care consult. The other half of the patient participants (n = 176) and care partners (n = 176) will receive usual hospital care appropriate to their illness. DISCUSSION This is the first community-developed, culturally based PC tele-consult program for rural southern AA and W populations. If effective, the tele-consult palliative program and methods will serve as a model for future culturally based PC programs that can reduce patients' symptoms and care partner burden. TRIAL REGISTRATION ClinicalTrials.gov NCT03767517 . Registered on 27 December 2018.
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Affiliation(s)
- Kristen Allen Watts
- School of Medicine, Division of Gerontology, Geriatrics, and Palliative Care, University of Alabama at Birmingham, Birmingham, USA
| | - Shena Gazaway
- College of Nursing, Augusta University, Augusta, USA
| | - Emily Malone
- School of Medicine, Division of Gerontology, Geriatrics, and Palliative Care, University of Alabama at Birmingham, Birmingham, USA
| | - Ronit Elk
- School of Medicine, Division of Gerontology, Geriatrics, and Palliative Care, University of Alabama at Birmingham, Birmingham, USA
- Center for Palliative and Supportive Care, University of Alabama at Birmingham, Birmingham, USA
| | - Rodney Tucker
- School of Medicine, Division of Gerontology, Geriatrics, and Palliative Care, University of Alabama at Birmingham, Birmingham, USA
- Center for Palliative and Supportive Care, University of Alabama at Birmingham, Birmingham, USA
| | - Susan McCammon
- Center for Palliative and Supportive Care, University of Alabama at Birmingham, Birmingham, USA
- School of Medicine, Department of Otolaryngology, University of Alabama at Birmingham, Birmingham, USA
| | | | | | | | - Joshua Hauser
- Department of Medical Education at Northwestern University, Chicago, USA
| | | | - Marjorie Kagawa-Singer
- Fielding School of Public Health, Department of Community Health Sciences, University of California Los Angeles, Los Angeles, USA
| | - Eric Wallace
- Department of Medicine, Division of Nephrology, University of Alabama at Birmingham, Birmingham, USA
| | - James McElligott
- College of Medicine, The Medical University of South Carolina, Charleston, USA
| | - Richard Kennedy
- School of Medicine, Division of Gerontology, Geriatrics, and Palliative Care, University of Alabama at Birmingham, Birmingham, USA
| | - Marie Bakitas
- School of Nursing, University of Alabama at Birmingham, Birmingham, USA.
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Núñez A, Madison M, Schiavo R, Elk R, Prigerson HG. Responding to Healthcare Disparities and Challenges With Access to Care During COVID-19. Health Equity 2020; 4:117-128. [PMID: 32368710 PMCID: PMC7197255 DOI: 10.1089/heq.2020.29000.rtl] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Affiliation(s)
- Ana Núñez
- College of Medicine, Drexel University, Philadelphia, Pennsylvania, USA
| | - Maria Madison
- Heller School for Social Policy and Management, Brandeis University, Waltham, Massachusetts, USA
| | - Renata Schiavo
- Mailman School of Public Health, Department of Sociomedical Sciences, Columbia University, New York, New York, USA.,Founder and Board President, Health Equity Initiative, New York, New York, USA
| | - Ronit Elk
- Department of Medicine, Division of Geriatrics, Gerontology and Palliative Care; University of Alabama at Birmingham, Birmingham, Alabama, USA.,Center of the Southeast Institute for Innovation in Palliative Care, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Holly G Prigerson
- Cornell Center for Research on End-of-Life Care; Weill Cornell Medicine, New York, New York, USA.,Sociology in Medicine, Weill Cornell Medicine, New York, New York, USA
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