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Miranda A, Rubovits E, Mudar R, Leung V, Raj M. Where are caregivers in the clinical trial? Evaluation of caregiver responsibilities in Alzheimer's disease and related dementias clinical trials. Alzheimers Dement 2023; 19:5316-5322. [PMID: 37594028 DOI: 10.1002/alz.13418] [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: 04/26/2023] [Revised: 06/20/2023] [Accepted: 07/12/2023] [Indexed: 08/19/2023]
Abstract
INTRODUCTION Family caregivers of persons with Alzheimer's disease and related dementias (ADRD) have significant responsibilities within health care. They may identify relevant clinical trials and support decision-making about their relative's participation. The objectives of this study were to (a) evaluate the responsibilities of caregivers related to their relative's participation in ADRD clinical trials and (b) examine how these responsibilities are communicated on clinicaltrials.gov. METHODS We reviewed ADRD clinical trials completed between 1990 and 2021 using clinicaltrials.gov. RESULTS Less than half of clinical trial study information pages included caregiver responsibilities. Nine caregiver responsibilities were provided among those with information (e.g., giving consent, caregiver training and education, monitoring patient's response to intervention, communicating with study team). DISCUSSION ADRD clinical trial study information pages should consistently include caregiver responsibilities to help caregivers better prepare for trial responsibilities. This enhanced engagement with caregivers could also facilitate recruitment and retention, including participants from diverse communities. HIGHLIGHTS Alzheimer's disease and related dementias (ADRD) clinical trial study information does not consistently include caregiver responsibilities. Caregiver responsibilities in clinical trials span communication, monitoring, and transportation. Robust information provision to caregivers could support participant recruitment and retention. Meaningfully engaging caregivers could support recruitment of diverse participants.
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Affiliation(s)
- Armando Miranda
- College of Applied Health Sciences, University of Illinois Urbana Champaign, Champaign, Illinois, USA
| | - Eve Rubovits
- College of Applied Health Sciences, University of Illinois Urbana Champaign, Champaign, Illinois, USA
| | - Raksha Mudar
- College of Applied Health Sciences, University of Illinois Urbana Champaign, Champaign, Illinois, USA
| | - Vania Leung
- Division of Geriatrics, University of Illinois Chicago, Chicago, Illinois, USA
| | - Minakshi Raj
- College of Applied Health Sciences, University of Illinois Urbana Champaign, Champaign, Illinois, USA
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2
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Park T, Pillemer K, Loeckenhoff C, Suitor JJ, Riffin C. What Motivates Physicians to Address Caregiver Needs? The Role of Experiential Similarity. J Appl Gerontol 2023; 42:1003-1012. [PMID: 36661199 PMCID: PMC10081953 DOI: 10.1177/07334648231151937] [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: 01/21/2023] Open
Abstract
Despite the significant stress of family caregiving, caregivers' needs and risks are often overlooked in healthcare settings. This study examined the factors associated with primary care physicians' perceived responsibility to identify and address caregiver needs and risks. Using a national random sample of U.S. primary care physicians (N = 106), multivariable logistic regression analyses were conducted to examine associations of physicians' perceived responsibility to assess caregivers' needs with experiential similarity (personal experience with caregiving), structural similarity (being older and female), and secondary exposure variables (time seeing older adults in the outpatient setting). Most (76.5%) physicians felt responsible for identifying caregivers' needs and risks. In multivariable models, physicians who had personal experience with caregiving were four times more likely than those without it to feel responsible for identifying caregivers' needs and risks and assessing caregivers' mental health concerns. Thus, physicians may benefit from educational interventions that immerse them in caregivers' lived experiences.
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Affiliation(s)
- Taeyoung Park
- Department of Medicine, Weill Cornell Medicine, New York, NY, 10065 USA
| | - Karl Pillemer
- Department of Psychology, Cornell University, Ithaca, NY, 14850 USA
| | | | - J. Jill Suitor
- Department of Sociology, Purdue University, West Lafayette, IN, 47907 USA
| | - Catherine Riffin
- Department of Medicine, Weill Cornell Medicine, New York, NY, 10065 USA
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3
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Williams AM, Theophanous C, Muir KW, Rosdahl JA, Woolson S, Olsen M, Bosworth HB, Hung A. Within-Trial Cost-Effectiveness of an Adherence-Enhancing Educational Intervention for Glaucoma. Am J Ophthalmol 2022; 244:216-227. [PMID: 36002073 PMCID: PMC10084845 DOI: 10.1016/j.ajo.2022.08.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Revised: 08/09/2022] [Accepted: 08/10/2022] [Indexed: 01/30/2023]
Abstract
PURPOSE To assess the within-trial cost-effectiveness of a behavioral intervention to improve glaucoma medication adherence. DESIGN Prospective cost-effectiveness analysis of randomized, controlled trial data. METHODS The study setting was a Veterans Affairs (VA) eye clinic. The patient population comprised veterans with medically treated glaucoma and self-reported poor adherence. Participants were randomized to a personalized educational session with a reminder bottle to promote medication adherence or to a control session on general eye health. Costs were assessed from the perspective of the VA payor at 6 months using the VA Managerial Cost Accounting System. Probabilistic sensitivity analyses were conducted using bootstrapped samples. The main outcome measures were the proportion of participants attaining ≥80% adherence as measured by electronic monitor, total intervention and medical resource costs, and incremental cost-effectiveness ratios comparing intervention to control at 6 months. RESULTS Of 200 randomized participants, 95 of 100 assigned to the intervention and 97 of 100 assigned to the control had adherence outcomes at 6 months, and the proportion of adherent patients was higher in the intervention group compared to control (0.78 vs 0.40, P < .0001). All participants had costs at 6 months. The total cost at 6 months was $1,149,600 in the intervention group (n = 100) compared to $1,298,700 in the control group (n = 100). Thus, in a hypothetical cohort of 100 patients, the intervention was associated with cost savings (-$149,100) and resulted in 38 additional patients achieving medication adherence. CONCLUSIONS An adherence-enhancing behavioral intervention was effective and cost saving at 6 months.
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Affiliation(s)
- Andrew M Williams
- From the Department of Ophthalmology (A.M.W., C.T., K.W.M., J.A.R., H.B.B.), Duke University School of Medicine, Durham, North Carolina, USA; Department of Ophthalmology (A.M.W.), University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Christos Theophanous
- From the Department of Ophthalmology (A.M.W., C.T., K.W.M., J.A.R., H.B.B.), Duke University School of Medicine, Durham, North Carolina, USA
| | - Kelly W Muir
- From the Department of Ophthalmology (A.M.W., C.T., K.W.M., J.A.R., H.B.B.), Duke University School of Medicine, Durham, North Carolina, USA; Durham Center of Innovation to Accelerate Discovery and Practice Transformation (K.W.M., S.W., M.O., H.B.B., A.H.), Durham Veterans Affairs Health Care System, Durham, North Carolina, USA.
| | - Jullia A Rosdahl
- From the Department of Ophthalmology (A.M.W., C.T., K.W.M., J.A.R., H.B.B.), Duke University School of Medicine, Durham, North Carolina, USA
| | - Sandra Woolson
- Durham Center of Innovation to Accelerate Discovery and Practice Transformation (K.W.M., S.W., M.O., H.B.B., A.H.), Durham Veterans Affairs Health Care System, Durham, North Carolina, USA
| | - Maren Olsen
- Durham Center of Innovation to Accelerate Discovery and Practice Transformation (K.W.M., S.W., M.O., H.B.B., A.H.), Durham Veterans Affairs Health Care System, Durham, North Carolina, USA
| | - Hayden B Bosworth
- From the Department of Ophthalmology (A.M.W., C.T., K.W.M., J.A.R., H.B.B.), Duke University School of Medicine, Durham, North Carolina, USA; Durham Center of Innovation to Accelerate Discovery and Practice Transformation (K.W.M., S.W., M.O., H.B.B., A.H.), Durham Veterans Affairs Health Care System, Durham, North Carolina, USA
| | - Anna Hung
- Durham Center of Innovation to Accelerate Discovery and Practice Transformation (K.W.M., S.W., M.O., H.B.B., A.H.), Durham Veterans Affairs Health Care System, Durham, North Carolina, USA; Department of Population Health Sciences (A.H.), Duke University School of Medicine, Durham, NC, United States; Duke-Margolis Center for Health Policy (A.H.), Duke University, Durham, NC, United States
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4
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Pérez-Milena A, Zafra-Ramírez N, Ramos-Ruiz JA, Rodríguez-Bayón A, Zafra-Ramírez J. [Influence of the companion in Primary Care consultations on communication skills and interview time]. Aten Primaria 2022; 54:102388. [PMID: 35779367 PMCID: PMC9253964 DOI: 10.1016/j.aprim.2022.102388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Revised: 04/28/2022] [Accepted: 05/04/2022] [Indexed: 11/27/2022] Open
Abstract
OBJETIVES To know the influence of the companion in triadic clinical encounter on the quality of doctor-patient communication and the duration of the interview. DESIGN Cross-sectional descriptive study. LOCATION 10 Primary Care Centers. PARTICIPANTS Resident doctors of Family and Community Medicine. INTERVENTIONS Peer review of video recordings of clinical demand consultations. MAIN MEASUREMENTS CICAA-2 questionnaire to assess communication skills (improvable, acceptable or adequate); age and sex, reasons for consultation and duration of the interview. Bivariate and multivariate analyses. Ethical authorization, oral informed consent and custody of the video recordings. RESULTS 73 RD (53.8% women, 32.9±7.7 years) participated with 260 interviews (60.3% women and 2.1±1.0 clinical demands). 27.7% of consultations with a companion (female sex 65.3%). The mean duration of the interviews was 8.5±4.0min. Clinical encounters lasted longer when a companion attended (2.7±0.5min more; p<.001 Student t) and with a greater number of clinical demands (40% with ≥3 reasons, p=0.048 X2). The mean value of the total score of the CICAA-2 scale (46.9±16.5; difference 4.6±2.3) and Task 2 (39.3±15.8 with difference 4.4±2.2) were higher when companion was present (p<.05 Student t). The model obtained with logistic regression shows a longer duration of the consultation with a companion (OR 1.2; CI [1.1-1.3]) and possibly a better score in Task 2 communication skills (OR 1.02; CI [0.99-1.1]). CONCLUSIONS Triadic communications challenge the clinician's communication skills, improving their abilities to identify and understand patient problems, albeit at the cost of a greater investment of time.
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Affiliation(s)
- Alejandro Pérez-Milena
- Centro de Salud El Valle, Distrito Sanitario Jaén-Jaén Sur, Servicio Andaluz de Salud, Jaén, España.
| | - Natalia Zafra-Ramírez
- Unidad Docente Multiprofesional de Atención Familiar y Comunitaria del Distrito Sanitario Jaén-Jaén Sur, Servicio Andaluz de Salud, Jaén, España
| | - Juan Andrés Ramos-Ruiz
- Unidad Docente Multiprofesional de Atención Familiar y Comunitaria del Distrito Jaén Norte-Nordeste, Servicio Andaluz de Salud, Jaén, España
| | - Antonina Rodríguez-Bayón
- Unidad Docente Multiprofesional de Atención Familiar y Comunitaria del Distrito Jaén Norte-Nordeste, Servicio Andaluz de Salud, Jaén, España
| | - Javier Zafra-Ramírez
- Centro de Salud El Valle, Distrito Sanitario Jaén-Jaén Sur, Servicio Andaluz de Salud, Jaén, España
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Sheehan OC, Blinka MD, Roth DL. Can volunteer medical visit companions support older adults in the United States? BMC Geriatr 2021; 21:253. [PMID: 33863278 PMCID: PMC8052762 DOI: 10.1186/s12877-021-02162-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Accepted: 03/17/2021] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Older adults are encouraged to use Medical Visit Companions (MVCs) for routine medical encounters; however, many vulnerable older adults attend alone or fail to attend. In the absence of available family or friends, community volunteers could potentially fill this gap. We aimed to understand the role and acceptability of volunteer MVCs accompanying older adults to medical visits and explore potential barriers and facilitators of increasing MVC availability and expanding roles beyond transportation. METHODS Two moderators conducted 4 focus groups with 29 volunteers grouped by whether they provided (n = 15) or received (n = 14) rides to medical visits. All were members of Partners In Care (PIC), a community organization in Maryland, United States which offers a range of programs and services that support the independence of older adults including the provision of volunteer MVCs. Participants were asked to discuss why they were involved with PIC, and to describe their experiences with providing or receiving companionship during medical visits. Inductive thematic analysis was used to explore the views and experiences of participants, particularly around the roles played by MVCs and the feasibility of expanding these roles. RESULTS All participants reported benefits from their role whether that was giving or receiving rides. Many accompanied participants reported missing medical appointments prior to joining PIC and being able to avail of the services of a MVC. Volunteer roles varied and ranged from transportation only, help with care coordination and in some cases accompanying the person into their medical visit. A subgroup of volunteers expressed a willingness to take on additional roles during the physician visit following additional training and isolated older adults welcomed the prospect of their assistance. CONCLUSION Our qualitative data indicate that non-family, volunteer MVCs are willing and able to assist older people going to a medical visit. With appropriate training and support, volunteer companions could do much to improve the healthcare experience for those who otherwise would attend alone or would not attend medical visits.
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Affiliation(s)
- Orla C Sheehan
- Center on Aging and Health, Division of Geriatric Medicine and Gerontology, Johns Hopkins University School of Medicine, 2024 E. Monument Street, Suite 2-700, Baltimore, MD, 21205, USA.
| | - Marcela D Blinka
- Center on Aging and Health, Division of Geriatric Medicine and Gerontology, Johns Hopkins University School of Medicine, 2024 E. Monument Street, Suite 2-700, Baltimore, MD, 21205, USA
| | - David L Roth
- Center on Aging and Health, Division of Geriatric Medicine and Gerontology, Johns Hopkins University School of Medicine, 2024 E. Monument Street, Suite 2-700, Baltimore, MD, 21205, USA
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Rosdahl JA, Hein AM, Bosworth HB, Woolson S, Olsen M, Kirshner M, Hung A, Muir KW. Randomized controlled trial of an education-based intervention to improve medication adherence: Design considerations in the medication adherence in glaucoma to improve care study. Clin Trials 2021; 18:343-350. [PMID: 33487050 PMCID: PMC10048058 DOI: 10.1177/1740774520988291] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Glaucoma treatment requires patients to follow daily, often times complex, eye drop regimens, but adherence is poor for many patients, putting them at risk for irreversible vision loss. A comprehensive approach is needed to address the challenges in the self-management of glaucoma. The purpose of this study is to improve glaucoma medication adherence in Veterans with medically treated glaucoma using an education-based intervention. METHODS/DESIGN This study is a single-site randomized controlled trial enrolling 200 Veterans and their companions, if companions are involved in their care. It has two arms: an intervention group and a control group. Participants in the intervention group receive an educational session with a non-physician interventionist and are provided with an AdhereTech smart bottle with the reminder functions activated. The control group is designed as an attention control such that they have a session on general eye health and are provided with a smart bottle but without the reminder functions activated. The primary outcome is the proportion of prescribed doses taken on schedule over 6 months following randomization according to the smart bottle. Secondary outcomes include intensification of glaucoma treatment, cost of intervention delivery, and cost-effectiveness of the intervention over 12 months. DISCUSSION The education-based intervention that we are testing is comprehensive in scope, to encompass a variety of barriers to adherence that glaucoma patients encounter, but personalized to address issues facing individual patients. Particular attention was given to feasibility in the real-world setting, as the high throughput of patients and lack of reimbursement for educational encounters in ophthalmology would limit implementation of a resource-intensive intervention.
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Affiliation(s)
- Jullia A Rosdahl
- Department of Ophthalmology, Duke University School of Medicine, Durham, NC, USA
| | - Aaron M Hein
- Department of Medicine, Duke University School of Medicine, Durham, NC, USA
| | - Hayden B Bosworth
- Department of Medicine, Duke University School of Medicine, Durham, NC, USA.,Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA.,Durham Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Health Care System, Durham, NC, USA
| | - Sandra Woolson
- Durham Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Health Care System, Durham, NC, USA
| | - Maren Olsen
- Durham Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Health Care System, Durham, NC, USA
| | - Miriam Kirshner
- Durham Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Health Care System, Durham, NC, USA
| | - Anna Hung
- Durham Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Health Care System, Durham, NC, USA
| | - Kelly W Muir
- Department of Ophthalmology, Duke University School of Medicine, Durham, NC, USA.,Durham Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Health Care System, Durham, NC, USA
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7
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Reed NS, Assi L, Pedersen E, Alshabasy Y, Deemer A, Deal JA, Willink A, Swenor BK. Accompaniment to healthcare visits: the impact of sensory impairment. BMC Health Serv Res 2020; 20:990. [PMID: 33121483 PMCID: PMC7594990 DOI: 10.1186/s12913-020-05829-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Accepted: 10/19/2020] [Indexed: 11/18/2022] Open
Abstract
Background Millions of older adults in the United States experience hearing, vision, and dual sensory impairment (concurring hearing and vision impairment) yet little research exists on their needs in interactions with the healthcare system. This piece aims to determine the use of accompaniment in healthcare interactions by persons with sensory impairment. Methods These cross-sectional analyses included data from the 2015 Medicare Current Beneficiaries Survey and survey weighting provided by Centers for Medicare and Medicaid Services. Adjusted odds of reporting accompaniment to healthcare visits and given reasons for accompaniment among United States Medicare beneficiaries with self-reported sensory impairment (hearing, vision, and dual sensory impairment) were examined. Results After excluding observations with missing data, 10,748 Medicare beneficiaries remained representing a 46 million total weighted nationally representative sample, of which 88.9% reported no sensory impairment, 5.52% reported hearing impairment, 3.56% reported vision impairment, and 0.93% reported dual sensory impairment. Those with vision impairment and dual sensory impairment had 2.139 (95% confidence interval [CI] =1.605–2.850) and 2.703 (CI = 1.549–4.718) times the odds of reporting accompaniment to healthcare visits relative to those without sensory impairment. A secondary analysis suggests communication needs as the primary reason for accompaniment among persons with hearing loss, while those with vision impairment were more likely to indicate transportation needs. Conclusions Healthcare accompaniment is common for persons with sensory loss and healthcare systems should consider accommodations for and leveraging accompaniment to improve healthcare for persons with sensory impairments. In light of the current COVID-19 pandemic, as hospitals limit visitors to reduce the spread of infection, arrangements should be made to ensure that the communication and transportation needs of those with sensory impairment are not neglected.
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Affiliation(s)
- Nicholas S Reed
- Cochlear Center for Hearing and Public Health, Johns Hopkins University Bloomberg School of Public Health, 2024 E. Monument Street, Baltimore, MD, 21205, USA. .,Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA.
| | - Lama Assi
- Cochlear Center for Hearing and Public Health, Johns Hopkins University Bloomberg School of Public Health, 2024 E. Monument Street, Baltimore, MD, 21205, USA.,Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Emily Pedersen
- Cochlear Center for Hearing and Public Health, Johns Hopkins University Bloomberg School of Public Health, 2024 E. Monument Street, Baltimore, MD, 21205, USA
| | - Yasmeen Alshabasy
- Cochlear Center for Hearing and Public Health, Johns Hopkins University Bloomberg School of Public Health, 2024 E. Monument Street, Baltimore, MD, 21205, USA
| | - Ashley Deemer
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Jennifer A Deal
- Cochlear Center for Hearing and Public Health, Johns Hopkins University Bloomberg School of Public Health, 2024 E. Monument Street, Baltimore, MD, 21205, USA.,Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | - Amber Willink
- Cochlear Center for Hearing and Public Health, Johns Hopkins University Bloomberg School of Public Health, 2024 E. Monument Street, Baltimore, MD, 21205, USA.,Department of Health Policy and Management, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | - Bonnielin K Swenor
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA.,Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Fabbri M, Finney Rutten LJ, Manemann SM, Boyd C, Wolff J, Chamberlain AM, Weston SA, Yost KJ, Griffin JM, Killian JM, Roger VL. Patient-centered communication and outcomes in heart failure. AMERICAN JOURNAL OF MANAGED CARE 2020; 26:425-430. [PMID: 33094937 DOI: 10.37765/ajmc.2020.88500] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVES To measure the impact of patient-centered communication on mortality and hospitalization among patients with heart failure (HF). STUDY DESIGN This was a survey study of 6208 residents of 11 counties in southeast Minnesota with incident HF (first-ever International Classification of Diseases, Ninth Revision code 428 or International Classification of Diseases, Tenth Revision code I50) between January 1, 2013, and March 31, 2016. METHODS Perceived patient-centered communication was assessed with the health care subscale of the Chronic Illness Resources Survey and measured as a composite score on three 5-point scales. We divided our cohort into tertiles and defined them as having fair/poor (score < 12), good (score of 12 or 13), and excellent (score ≥ 14) patient-centered communication. The survey was returned by 2868 participants (response rate: 45%), and those with complete data were retained for analysis (N = 2398). Cox and Andersen-Gill models were used to determine the association of patient-centered communication with death and hospitalization, respectively. RESULTS Among 2398 participants (median age, 75 years; 54% men), 233 deaths and 1194 hospitalizations occurred after a mean (SD) follow-up of 1.3 (0.6) years. Compared with patients with fair/poor patient-centered communication, those with good (HR, 0.70; 95% CI, 0.51-0.97) and excellent (HR, 0.70; 95% CI, 0.51-0.96) patient-centered communication experienced lower risks of death after adjustment for various confounders (Ptrend = .020). Patient-centered communication was not associated with hospitalization. CONCLUSIONS Among community patients living with HF, excellent and good patient-centered communication is associated with a reduced risk of death. Patient-centered communication can be easily assessed, and consideration should be given toward implementation in clinical practice.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | - Véronique L Roger
- Department of Health Sciences Research, Mayo Clinic, 200 First St SW, Rochester, MN 55905.
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Bayliss EA, Shetterly SM, Drace ML, Norton J, Green AR, Reeve E, Weffald LA, Wright L, Maciejewski ML, Sheehan OC, Wolff JL, Gleason KS, Kraus C, Maiyani M, Du Vall M, Boyd CM. The OPTIMIZE patient- and family-centered, primary care-based deprescribing intervention for older adults with dementia or mild cognitive impairment and multiple chronic conditions: study protocol for a pragmatic cluster randomized controlled trial. Trials 2020; 21:542. [PMID: 32552857 PMCID: PMC7301527 DOI: 10.1186/s13063-020-04482-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Accepted: 06/06/2020] [Indexed: 12/03/2022] Open
Abstract
Background Most individuals with dementia or mild cognitive impairment (MCI) have multiple chronic conditions (MCC). The combination leads to multiple medications and complex medication regimens and is associated with increased risk for significant treatment burden, adverse drug events, cognitive changes, hospitalization, and mortality. Optimizing medications through deprescribing (the process of reducing or stopping the use of inappropriate medications or medications unlikely to be beneficial) may improve outcomes for MCC patients with dementia or MCI. Methods With input from patients, family members, and clinicians, we developed and piloted a patient-centered, pragmatic intervention (OPTIMIZE) to educate and activate patients, family members, and primary care clinicians about deprescribing as part of optimal medication management for older adults with dementia or MCI and MCC. The clinic-based intervention targets patients on 5 or more medications, their family members, and their primary care clinicians using a pragmatic, cluster-randomized design at Kaiser Permanente Colorado. The intervention has two components: a patient/ family component focused on education and activation about the potential value of deprescribing, and a clinician component focused on increasing clinician awareness about options and processes for deprescribing. Primary outcomes are total number of chronic medications and total number of potentially inappropriate medications (PIMs). We estimate that approximately 2400 patients across 9 clinics will receive the intervention. A comparable number of patients from 9 other clinics will serve as wait-list controls. We have > 80% power to detect an average decrease of − 0.70 (< 1 medication). Secondary outcomes include the number of PIM starts, dose reductions for selected PIMs (benzodiazepines, opiates, and antipsychotics), rates of adverse drug events (falls, hemorrhagic events, and hypoglycemic events), ability to perform activities of daily living, and skilled nursing facility, hospital, and emergency department admissions. Discussion The OPTIMIZE trial will examine whether a primary care-based, patient- and family-centered intervention educating patients, family members, and clinicians about deprescribing reduces numbers of chronic medications and PIMs for older adults with dementia or MCI and MCC. Trial registration NCT03984396. Registered on 13 June 2019
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Affiliation(s)
- E A Bayliss
- Institute for Health Research, Kaiser Permanente Colorado, Aurora, CO, USA. .,Department of Family Medicine, University of Colorado School of Medicine, Aurora, CO, USA.
| | - S M Shetterly
- Institute for Health Research, Kaiser Permanente Colorado, Aurora, CO, USA
| | - M L Drace
- Institute for Health Research, Kaiser Permanente Colorado, Aurora, CO, USA
| | - J Norton
- Division of Geriatric Medicine and Gerontology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - A R Green
- Division of Geriatric Medicine and Gerontology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - E Reeve
- Quality Use of Medicines and Pharmacy Research Centre, UniSA: Clinical and Health Sciences, University of South Australia, Adelaide, SA, Australia.,Geriatric Medicine Research, Faculty of Medicine, and College of Pharmacy, Dalhousie University and Nova Scotia Health Authority, Halifax, NS, Canada
| | - L A Weffald
- Department of Clinical Pharmacy, Kaiser Permanente Colorado, Aurora, CO, USA
| | - L Wright
- Institute for Health Research, Kaiser Permanente Colorado, Aurora, CO, USA
| | - M L Maciejewski
- Durham Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham, Veterans Affairs Medical Center, Durham, NC, USA.,Department of Population Health Sciences, Duke University Medical Center, Durham, NC, USA
| | - O C Sheehan
- Division of Geriatric Medicine and Gerontology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - J L Wolff
- School of Public Health, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - K S Gleason
- Institute for Health Research, Kaiser Permanente Colorado, Aurora, CO, USA
| | - C Kraus
- Institute for Health Research, Kaiser Permanente Colorado, Aurora, CO, USA
| | - M Maiyani
- Institute for Health Research, Kaiser Permanente Colorado, Aurora, CO, USA
| | - M Du Vall
- Department of Clinical Pharmacy, Kaiser Permanente Colorado, Aurora, CO, USA
| | - C M Boyd
- Division of Geriatric Medicine and Gerontology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Riffin C, Wolff JL, Estill M, Prabhu S, Pillemer KA. Caregiver Needs Assessment in Primary Care: Views of Clinicians, Staff, Patients, and Caregivers. J Am Geriatr Soc 2020; 68:1262-1270. [PMID: 32167573 PMCID: PMC7325837 DOI: 10.1111/jgs.16401] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Revised: 01/22/2020] [Accepted: 01/23/2020] [Indexed: 01/07/2023]
Abstract
OBJECTIVES To understand current practices, challenges, and opportunities for a systematic assessment of family caregivers' needs and risks in primary care. DESIGN Qualitative study consisting of in-depth semi-structured interviews. SETTING Four primary care practices located in urban and rural settings. PARTICIPANTS Primary care clinicians, staff, and administrators (N = 30), as well as older adult patients and family caregivers (N = 40), recruited using purposive and maximum variation sampling. MEASUREMENTS Current experiences, challenges, and opportunities for integrating standardized caregiver assessment into primary care delivery. Interviews were audio-recorded and transcribed; transcripts were analyzed using the constant comparative method of data analysis. RESULTS Participating clinicians had been in practice for an average of 12.8 years (range = 1-36 y). Patients had a mean age of 84.0 years (standard deviation [SD] = 9.7); caregivers had a mean age of 67.0 years (SD = 9.3). There was wide variability in current practices for identifying caregivers' needs and risks, encompassing direct and indirect approaches, when such issues are considered. Participants posited that integrating standardized caregiver assessment into primary care delivery could help improve patient care, enhance clinician-caregiver communication, and validate caregivers' efforts. Barriers to assessment included insufficient time and reimbursement, liability concerns, lack of awareness of community resources, and concerns about patient autonomy. To facilitate future uptake of caregiver assessment, participants recommended brief self-administered assessment tools and post-screen discussions with practice staff. CONCLUSION Identification of caregivers' needs and risks in primary care is highly variable. Integration of standardized caregiver assessment into practice requires coordinated changes to policy, revision of practice workflows, and an interdisciplinary approach to the development of appropriate assessment tools. J Am Geriatr Soc 68:1262-1270, 2020.
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Affiliation(s)
- Catherine Riffin
- Division of Geriatrics & Palliative Medicine, Weill Cornell Medicine, New York, New York, USA
| | - Jennifer L Wolff
- Department of Health Policy & Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Matthew Estill
- Department of Internal Medicine, The Guthrie Clinic, Ithaca, New York, USA
| | - Sheela Prabhu
- Department of Internal Medicine, The Guthrie Clinic, Sayre, Pennsylvania, USA
| | - Karl A Pillemer
- Department of Human Development, Cornell University, Ithaca, New York, USA
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Bracher M, Stewart S, Reidy C, Allen C, Townsend K, Brindle L. Partner involvement in treatment-related decision making in triadic clinical consultations - A systematic review of qualitative and quantitative studies. PATIENT EDUCATION AND COUNSELING 2020; 103:245-253. [PMID: 31477515 DOI: 10.1016/j.pec.2019.08.031] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/09/2019] [Revised: 07/25/2019] [Accepted: 08/20/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVE Explore how partners are involved in treatment-related decision-making within triadic clinical encounters. METHODS Studies were identified via database searches and reference lists. One author assessed eligibility of studies, which were verified by an additional co-author. Data were extracted by one author and cross-checked for accuracy by a second. Quality of articles was assessed using Qualsyst. Retrieved studies were categorised by one author, and agreed through discussion. RESULTS From 2442 records, 14 studies were included and categorised as: (1) Descriptions of partner role and behaviour; (2) Role intentions of partners; (3) Relationship between partner and patient behaviour; (4) HCP-Partner interactions. CONCLUSION Partners are often involved in triadic clinical consultations that have implications for treatment-related decision making. Most studies offered general descriptions but lacked detailed investigation of communicative processes in triads and how these may operate with partners vs. other companions. PRACTICE IMPLICATIONS Existing studies lack detailed investigation through direct observation of the processes of partner involvement. Research in other areas of clinical communication suggests that future interventions could be informed by attention to the following areas: partner behaviour vs. other companion types in triads; relationships between partner involvement and decision-making processes; partner involvement in triads vs. other groups (e.g. quadratic).
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Affiliation(s)
- Mike Bracher
- School of Health Sciences, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, UK.
| | - Simon Stewart
- School of Health Sciences, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, UK.
| | - Claire Reidy
- School of Health Sciences, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, UK.
| | - Chris Allen
- School of Health Sciences, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, UK.
| | - Kay Townsend
- School of Health Sciences, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, UK.
| | - Lucy Brindle
- School of Health Sciences, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, UK.
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12
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Hao Z, Ruggiano N. Family-centeredness in dementia care: what is the evidence? SOCIAL WORK IN HEALTH CARE 2020; 59:1-19. [PMID: 31900066 DOI: 10.1080/00981389.2019.1690089] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Revised: 10/05/2019] [Accepted: 11/04/2019] [Indexed: 06/10/2023]
Abstract
Over the last decade, person-centered practices in care for adults with Alzheimer's disease and related dementias (AD/RD) has received significant attention from the health care and social service literature, though less attention has been paid to family-centered care (FCC). Initially conceptualized for application in pediatric care, FCC is an approach where clinicians develop partnerships with care recipients' family members and views family members as having expertise to contribute to the clinical team. More recently, FCC has been extended to the literature on AD/RD care, though little is known about the extent to which family-centered interventions have been developed for use in AD/RD clinical practice, or the effectiveness of family-centered care for this population. To contribute to gaps in scholarship, this systematic review identified and evaluated intervention studies examining FCC in AD/RD clinical care. Implications for research and practice are discussed.
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Affiliation(s)
- Zhichao Hao
- School of Social Work, The University of Alabama, Tuscaloosa, Alabama, USA
| | - Nicole Ruggiano
- School of Social Work, The University of Alabama, Tuscaloosa, Alabama, USA
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Peterson LJ, Hyer K, Meng H, Dobbs D, Gamaldo A, O’Neil K. Discussing End-of-Life Care Preferences With Family: Role of Race and Ethnicity. Res Aging 2019; 41:823-844. [DOI: 10.1177/0164027519858716] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
This study examined racial, ethnic, and other factors associated with whether older adults discussed their end-of-life (EOL) care wishes with family. A sample of 223 White, 95 African American, and 46 Hispanic adults aged 50 and older from a five-county area of Florida answered questions about sociodemographics, health, and preferences for involving family/friends in health-care decision-making. Analyses describe associations between whether discussions occurred and race/ethnicity and other factors, including preferences for family/friend involvement in health care. In descriptive analyses, one third ( n = 113) had not discussed EOL care. No differences were evident between African Americans and non-Hispanic Whites. In multivariate analyses, EOL care discussions were less likely for Hispanics. Further analysis showed this lower likelihood existed among Hispanics with lesser family/friend involvement. Ethnicity influences EOL care discussion, moderated by family/friend involvement, though results are considered preliminary. Knowing the involvement of patients’ family/friends could help providers initiate EOL care discussions.
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Affiliation(s)
| | - Kathryn Hyer
- School of Aging Studies, University of South Florida, Tampa, FL, USA
| | - Hongdao Meng
- School of Aging Studies, University of South Florida, Tampa, FL, USA
| | - Debra Dobbs
- School of Aging Studies, University of South Florida, Tampa, FL, USA
| | - Alyssa Gamaldo
- Department of Human Development and Family Studies, Pennsylvania State University, University Park, PA, USA
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Riffin C, Pillemer K, Reid MC, Tung J, L Ckenhoff CE. Decision Support for Joint Replacement: Implications for Decisional Conflict and Willingness to Undergo Surgery. J Gerontol B Psychol Sci Soc Sci 2019; 73:387-398. [PMID: 26968640 DOI: 10.1093/geronb/gbw023] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2015] [Accepted: 02/17/2016] [Indexed: 12/11/2022] Open
Abstract
Objectives The present study investigates age differences in the types of decision support that total joint replacement (TJR) candidates desire and receive when making the decision to pursue surgery. We consider the social structural (relationship to the patient) and experiential factors (network members' experience with TJR) that influence individuals' support preferences and the interactions of these factors with age. We also examine whether a lack of support is linked with increased decisional conflict and reduced willingness to undergo surgery. Method A telephone survey was conducted with 100 individuals (aged 40+) who were contemplating knee or hip replacement. Results TJR candidates desired and received decision support from health care providers, family members, and individuals who had previously undergone TJR. They reported higher deficits in informational and emotional support than in instrumental support. Overall, a lack of instrumental support was associated with greater decisional conflict; a lack of instrumental support and a lack of informational support were associated with reduced willingness to undergo TJR. Discussion Our findings point to the importance of involving both formal and informal network members in TJR discussions, and the need for informational guidance and practical assistance to reduce decisional conflict and uncertainty among individuals considering TJR.
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Affiliation(s)
- Catherine Riffin
- Division of Geriatrics, Yale School of Medicine, New Haven, Connecticut
| | - Karl Pillemer
- Department of Human Development, Cornell University, Ithaca, New York
| | - M Cary Reid
- Division of Geriatrics, Weill Cornell Medical College, New York
| | - Judy Tung
- Internal Medicine, Cornell Internal Medical Associates, New York
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Sheehan OC, Graham-Phillips AL, Wilson JD, Crews DC, Holt CL, Gabbard J, Smith KC, Wolff JL, Roth DL. Non-spouse companions accompanying older adults to medical visits: a qualitative analysis. BMC Geriatr 2019; 19:84. [PMID: 30876388 PMCID: PMC6419819 DOI: 10.1186/s12877-019-1098-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Accepted: 02/28/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Medical Visit Companions (MVCs) are encouraged for older adults' routine medical encounters. Little data exist on the experiences and contributions of non-spouse companions for the growing population of older adults without a living spouse. METHODS We conducted six focus groups with forty non-spouse MVCs identified through churches in Baltimore, Maryland. Thematic analysis was used to identify key issues before the visit, during the visit itself, after the visit, and in the overall companion experience. RESULTS MVCs described their experiences positively but also highlighted many challenges related to the role that extended far beyond the visit itself. These included scheduling, transportation, communication, and coordination of care expectations. CONCLUSION Our increasingly complex healthcare system can be challenging for older adults to navigate successfully. The diverse nature of tasks performed by companions in this study highlight the many benefits of having a companion accompany older patients to medical visits. The positive experience of the companions studied and their willingness to continue their role in the future highlights the untapped potential for increased social facilitation to improve the quality of healthcare visits and achieve patient-centered care for all older patients.
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Affiliation(s)
- Orla C Sheehan
- Johns Hopkins University School of Medicine, Division of Geriatrics and Gerontology, Baltimore, MD, USA. .,Center on Aging and Health, Johns Hopkins University, 2024 E. Monument Street, Suite 2-700, Baltimore, MD, 21205, USA.
| | | | - John D Wilson
- THREAD Community Research Institute, Baltimore, MD, USA
| | - Deidra C Crews
- Johns Hopkins University School of Medicine, Division of Nephrology, Baltimore, MD, USA
| | - Cheryl L Holt
- Department of Behavioral and Community Health, School of Public Health, University of Maryland, College Park, MD, USA
| | - Jennifer Gabbard
- Wake Forest University, Section of Gerontology and Geriatrics, Winston-Salem, North Carolina, USA
| | - Katherine C Smith
- Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Jennifer L Wolff
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - David L Roth
- Johns Hopkins University School of Medicine, Division of Geriatrics and Gerontology, Baltimore, MD, USA.,Center on Aging and Health, Johns Hopkins University, 2024 E. Monument Street, Suite 2-700, Baltimore, MD, 21205, USA
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Pine J, Steffen AM. Intergenerational Ambivalence and Dyadic Strain: Understanding Stress in Family Care Partners of Older Adults. Clin Gerontol 2019; 42:90-100. [PMID: 28960145 DOI: 10.1080/07317115.2017.1356894] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVES The present study used Pearlin, Mullan, Semple & Skaff's (1990) caregiving stress process model as a framework to examine the comparative influence of two stressors: (a) intergenerational ambivalence as a unified construct and (b) dyadic strain, which is one isolated component of intergenerational ambivalence. METHODS Participants were 120 women providing healthcare and medication assistance to an earlier generation family member with physical and/or cognitive impairments. RESULTS Hierarchical regression confirmed that intergenerational ambivalence explained perceived stress in family care partners, beyond the variance accounted for by other commonly reported stressors such as length of caregiving experience, memory/cognitive and functional impairments of the care recipient, caregiver overload, family conflict and financial strain. Further analyses revealed that examining dyadic strain apart from intergenerational ambivalence may more accurately explain the influence of ambivalence scores on care partners' perceived stress. CONCLUSIONS AND CLINICAL IMPLICATIONS The comparative influence of dyadic strain versus ambivalence suggests that stress-reducing interventions may benefit from a focus on reducing care partners' experiences of negative strain in the dyadic relationship rather than managing ambivalence.
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Affiliation(s)
- Jillian Pine
- a Psychological Sciences , University of Missouri-St. Louis , St. Louis , Missouri , USA
| | - Ann M Steffen
- b Department of Psychological Services , University of Missouri-St. Louis , St. Louis , Missouri , USA
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17
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Helping Older Adults Improve Their Medication Experience (HOME) by Addressing Medication Regimen Complexity in Home Healthcare. Home Healthc Now 2018; 36:10-19. [PMID: 29298192 DOI: 10.1097/nhh.0000000000000632] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
In skilled home healthcare (SHHC), communication between nurses and physicians is often inadequate for medication reconciliation and needed changes to the medication regimens are rarely made. Fragmentation of electronic health record (EHR) systems, transitions of care, lack of physician-nurse in-person contact, and poor understanding of medications by patients and their families put patients at risk for serious adverse outcomes. The aim of this study was to develop and test the HOME tool, an informatics tool to improve communication about medication regimens, share the insights of home care nurses with physicians, and highlight to physicians and nurses the complexity of medication schedules. We used human computer interaction design and evaluation principles, automated extraction from standardized forms, and modification of existing EHR fields to highlight key medication-related insights that had arisen during the SHHC visit. Separate versions of the tool were developed for physicians/nurses and patients/caregivers. A pilot of the tool was conducted using 20 SHHC encounters. Home care nurses and physicians found the tool useful for communication. Home care nurses were able to implement the HOME tool into their clinical workflow and reported improved communication with physicians about medications. This simple and largely automated tool improves understanding and communication around medications in SHHC.
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18
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Sentell TL, Shen C, Landsittel D, Mays MH, Southerland J, King MH, Taira DA. Racial/Ethnic Differences in Those Accompanying Medicare Patients to the Doctor: Insights from the 2013 Medicare Current Beneficiary's Survey. J Immigr Minor Health 2018; 20:776-783. [PMID: 28405871 PMCID: PMC5656534 DOI: 10.1007/s10903-017-0582-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Surprisingly little current, population-level detail exists regarding companion accompaniment for health care among Medicare beneficiaries, particularly by race/ethnicity. For respondents in the 2013 Medicare Current Beneficiary's Survey Access to Care public use data (N = 12,253), multivariable models predicted accompaniment to the doctor by race/ethnicity, adjusting for confounders. Chi square analyses compared, by race/ethnicity, who was accompanying and why. Overall, 37.5% of beneficiaries had accompaniment. In multivariable analyses, non-Hispanic blacks (OR 1.18; 95% CI 1.03-1.36) and Hispanics (OR 1.47; 95% CI 1.25-1.74) were significantly more likely than non-Hispanic whites to have accompaniment. Over 35% of all three groups had someone to "take notes," "ask questions," and/or "explain things," which did not vary by race/ethnicity; significant differences were seen for "explain instructions," "translate," and "moral support." Hispanics had the highest percentages for all three. Many Medicare beneficiaries have accompaniment to doctors' appointments, particularly in minority racial/ethnic groups, which should be considered in policy and practice.
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Affiliation(s)
- Tetine Lynn Sentell
- Office of Public Health Studies, University of Hawai'i at Manoa, 1960 East-West Road, Biomed D104-G, Honolulu, HI, 96821, USA.
| | - Chengli Shen
- Section on Biomarkers and Prediction Modeling, Department of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Doug Landsittel
- Section on Biomarkers and Prediction Modeling, Department of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Mary Helen Mays
- Puerto Rico Clinical and Translational Research Consortium, University of Puerto Rico Medical Sciences Campus, San Juan, PR, USA
| | | | | | - Deborah A Taira
- Daniel K. Inouye College of Pharmacy, University of Hawai'i at Hilo, Hilo, HI, USA
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Isenberg SR, Aslakson RA, Dionne-Odom JN, Clegg Smith K, Singh S, Larson S, Bridges JFP, Smith TJ, Wolff JL, Roter DL. Family companions' involvement during pre-surgical consent visits for major cancer surgery and its relationship to visit communication and satisfaction. PATIENT EDUCATION AND COUNSELING 2018; 101:1066-1074. [PMID: 29402574 DOI: 10.1016/j.pec.2018.01.011] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/23/2017] [Revised: 01/16/2018] [Accepted: 01/17/2018] [Indexed: 06/07/2023]
Abstract
OBJECTIVE To examine the association between family companion presence during pre-surgical visits to discuss major cancer surgery and patient-provider communication and satisfaction. METHODS Secondary analysis of 61 pre-surgical visit recordings with eight surgical oncologists at an academic tertiary care hospital using the Roter Interaction Analysis System (RIAS). Surgeons, patients, and companions completed post-visit satisfaction questionnaires. Poisson and logistic regression models assessed differences in communication and satisfaction when companions were present vs. absent. RESULTS There were 46 visits (75%) in which companions were present, and 15 (25%) in which companions were absent. Companion communication was largely emotional and facilitative, as measured by RIAS. Companion presence was associated with more surgeon talk (IRR 1.29, p = 0.006), and medical information-giving (IRR 1.41, p = 0.001). Companion presence was associated with less disclosure of lifestyle/psychosocial topics by patients (IRR 0.55, p = 0.037). In adjusted analyses, companions' presence was associated with lower levels of patient-centeredness (IRR 0.77, p 0.004). There were no differences in patient or surgeon satisfaction based on companion presence. CONCLUSION Companions' presence during pre-surgical visits was associated with patient-surgeon communication but was not associated with patient or surgeon satisfaction. PRACTICE IMPLICATIONS Future work is needed to develop interventions to enhance patient-companion-provider interactions in this setting.
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Affiliation(s)
- Sarina R Isenberg
- Temmy Latner Centre for Palliative Care and Lunenfeld-Tanenbaum Research Institute, Sinai Health System, 60 Murray Street, 4th floor, Box 13, Toronto, Ontario, M5T 3L9, Canada.
| | - Rebecca A Aslakson
- Department of Anesthesiology, Johns Hopkins Hospital, 600 N Wolfe St, Baltimore, MD 21205, United States.
| | - James N Dionne-Odom
- School of Nursing, University of Alabama at Birmingham, 1720 2nd Avenue South, Birmingham, AL MT412 K, United States.
| | - Katherine Clegg Smith
- Department of Health, Behavior and Society, Johns Hopkins School of Public Health, 624 N Broadway, Baltimore, MD 21205, United States.
| | - Sarabdeep Singh
- Department of Anesthesiology and Critical Care Medicine, The Johns Hopkins School of Medicine, 401 N. Broadway, Baltimore, MD, 21287, United States.
| | - Susan Larson
- Department of Health, Behavior and Society, Johns Hopkins School of Public Health, 624 N Broadway, Baltimore, MD 21205, United States.
| | - John F P Bridges
- Department of Health, Policy and Management, Johns Hopkins School of Public Health, 624 N Broadway, Baltimore, MD 21205, United States.
| | - Thomas J Smith
- Departments of Medicine and Oncology, Johns Hopkins Hospital, 601 N. Caroline Street, Baltimore, MD 21287, United States.
| | - Jennifer L Wolff
- Department of Health, Policy and Management, Johns Hopkins School of Public Health, 624 N Broadway, Baltimore, MD 21205, United States.
| | - Debra L Roter
- Department of Health, Behavior and Society, Johns Hopkins School of Public Health, 624 N Broadway, Baltimore, MD 21205, United States.
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Guan Y, Roter DL, Wolff JL, Gitlin LN, Christensen KD, Roberts JS, Green RC, Erby LH. The impact of genetic counselors' use of facilitative strategies on cognitive and emotional processing of genetic risk disclosure for Alzheimer's disease. PATIENT EDUCATION AND COUNSELING 2018; 101:817-823. [PMID: 29203084 PMCID: PMC5911203 DOI: 10.1016/j.pec.2017.11.019] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Revised: 11/22/2017] [Accepted: 11/27/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVES To determine the impact of genetic counselor (GC) communication on cognitive and emotional processing of Alzheimer's disease (AD) risk information during discussions with patients with clinical diagnoses of mild cognitive impairment and their companion. METHODS 79 recordings and transcripts of AD risk disclosure sessions collected as part of the fourth REVEAL Trial were coded using the Roter Interaction Analysis System (RIAS) and the Linguistic Inquiry Word Count (LIWC). Multilevel analyses were used to determine the association between GCs' use of communication facilitation strategies and patient and companion use of words indicative of cognitive and emotional processing. RESULTS GC used somewhat more cognitive (14%) than emotional (10%) facilitation strategies. Both patients and companions used more words indicative of cognitive (18% and 17%) than emotional (6% and 5%) processing. GC use of facilitative strategies and patient and companion use of cognitive and emotional processing words were significantly associated in both unadjusted and adjusted models (all p-values<0.01). CONCLUSIONS GCs' use of facilitative strategies assist in cognitive and emotional processing in a way that may be linked to therapeutic benefit. PRACTICE IMPLICATIONS These findings highlight mechanisms through which GCs may assist patients and companions to better understand and cope with risk information.
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Affiliation(s)
- Yue Guan
- Department of Medicine, University of Maryland School of Medicine, Baltimore, MD, USA.
| | - Debra L Roter
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Jennifer L Wolff
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Laura N Gitlin
- Department of Community Public Health, School of Nursing, Center for Innovative Care in Aging, Johns Hopkins University, Baltimore, MD, USA
| | - Kurt D Christensen
- Division of Genetics, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| | - J Scott Roberts
- Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor, MI, USA
| | - Robert C Green
- Division of Genetics, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA; Broad Institute of MIT and Harvard, Cambridge, MA, USA; Partners Personalized Medicine, Boston, MA, USA
| | - Lori H Erby
- Social and Behavioral Research Branch, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD, USA
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Cené CW, Haymore B, Laux JP, Lin FC, Carthron D, Roter D, Cooper LA, Chang PP, Jensen BC, Miller PF, Corbie-Smith G. Family presence and participation during medical visits of heart failure patients: An analysis of survey and audiotaped communication data. PATIENT EDUCATION AND COUNSELING 2017; 100:250-258. [PMID: 27609321 PMCID: PMC5322738 DOI: 10.1016/j.pec.2016.09.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/24/2015] [Revised: 08/31/2016] [Accepted: 09/02/2016] [Indexed: 06/06/2023]
Abstract
OBJECTIVE To describe the frequency, roles, and utility of family companion involvement in the care of patients with Heart Failure (HF) care and to examine the association between audiotaped patient, companion, and provider communication behaviors. METHODS We collected survey data and audiotaped a single medical visit for 93 HF patients (36 brought a companion into the examination room) and their cardiology provider. Communication data was analyzed using the Roter Interaction Analysis System. RESULTS There were 32% more positive rapport-building statements (p<0.01) and almost three times as many social rapport-building statements (p<0.01) from patients and companions in accompanied visits versus unaccompanied patient visits. There were less psychosocial information giving statements in accompanied visits compared to unaccompanied patient visits (p<0.01.) Providers made 25% more biomedical information giving statements (p=0.04) and almost three times more social rapport-building statements (p<0.01) in accompanied visits. Providers asked fewer biomedical and psychosocial questions in accompanied versus unaccompanied visits. Providers made 16% fewer partnership-building statements in accompanied versus unaccompanied visits (p=0.01). CONCLUSIONS Our findings are mixed regarding the benefits of accompaniment for facilitating patient-provider communication based on survey and audiotaped data. PRACTICE IMPLICATIONS Strategies to enhance engagement during visits, such as pre-visit question prompt lists, may be beneficial.
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Affiliation(s)
- Crystal W Cené
- Department of Medicine, Division of General Internal Medicine, University of North Carolina at Chapel Hill, Chapel Hill School of Medicine, NC, USA; Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, USA.
| | - Beth Haymore
- Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, USA
| | - Jeffrey P Laux
- North Carolina Translational & Clinical Sciences Institute, University of North Carolina at Chapel Hill School, Chapel Hill, NC, USA; Department of Biostatistics, UNC Gillings School of Global Public Health, Chapel Hill, NC, USA
| | - Feng-Chang Lin
- North Carolina Translational & Clinical Sciences Institute, University of North Carolina at Chapel Hill School, Chapel Hill, NC, USA; Department of Biostatistics, UNC Gillings School of Global Public Health, Chapel Hill, NC, USA
| | - Dana Carthron
- College of Nursing, Michigan State University, East Lansing, Michigan, USA
| | - Debra Roter
- Department of Health Behavior and Society, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | - Lisa A Cooper
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Patricia P Chang
- Department of Medicine, Division of Cardiology, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, USA
| | - Brian C Jensen
- Department of Medicine, Division of Cardiology, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, USA
| | - Paula F Miller
- Department of Social Medicine, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, USA
| | - Giselle Corbie-Smith
- Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, USA; Department of Social Medicine, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, USA; Center for Health Equity Research, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, USA
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Patient and family empowerment as agents of ambulatory care safety and quality. BMJ Qual Saf 2016; 26:508-512. [DOI: 10.1136/bmjqs-2016-005489] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2016] [Revised: 07/24/2016] [Accepted: 08/06/2016] [Indexed: 11/03/2022]
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Sivananthan SN, McGrail KM. Diagnosis and Disruption: Population-Level Analysis Identifying Points of Care at Which Transitions Are Highest for People with Dementia and Factors That Contribute to Them. J Am Geriatr Soc 2016; 64:569-77. [PMID: 27000330 DOI: 10.1111/jgs.14033] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To examine transitions that individuals with dementia experience longitudinally and to identify points of care when transitions are highest and the factors that contribute to those transitions. DESIGN Population-based 10-year retrospective cohort study from 2000 to 2011. SETTING General community. PARTICIPANTS All individuals aged 65 and older newly diagnosed with dementia in British Columbia, Canada. MEASUREMENTS The frequency and timing of transitions over 10 years, participant characteristics associated with greater number of transitions, and the influence of recommended dementia care and high-quality primary care on number of transitions. RESULTS Individuals experience a spike in transitions during the year of diagnosis, driven primarily by hospitalizations, despite accounting for end of life or newly moving to a long-term care facility (LTCF). This occurs regardless of survival time or care location. Regardless of survival time, individuals not in LTCFs experience a marked increase in hospitalizations in the year before and the year of death, often exceeding hospitalizations in the year of diagnosis. Receipt of recommended dementia care and receipt of high-quality primary care were independently associated with fewer transitions across care settings. CONCLUSION The spike in transitions in the year of diagnosis highlights a distressing period for individuals with dementia during which unwanted or unnecessary transitions might occur and suggests a useful target for interventions. There is an association between recommended dementia care and outcomes and evidence of the continued value of high-quality primary care in a complex population at a critical point when gaps in continuity are especially likely.
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Affiliation(s)
- Saskia N Sivananthan
- Centre for Health Services and Policy Research, University of British Columbia, Vancouver, British Columbia, Canada
| | - Kimberlyn M McGrail
- Centre for Health Services and Policy Research, University of British Columbia, Vancouver, British Columbia, Canada
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Wolff JL, Spillman BC, Freedman VA, Kasper JD. A National Profile of Family and Unpaid Caregivers Who Assist Older Adults With Health Care Activities. JAMA Intern Med 2016; 176:372-9. [PMID: 26882031 PMCID: PMC4802361 DOI: 10.1001/jamainternmed.2015.7664] [Citation(s) in RCA: 331] [Impact Index Per Article: 41.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
IMPORTANCE Family and unpaid caregivers commonly help older adults who are at high risk for poorly coordinated care. OBJECTIVE To examine how caregivers' involvement in older adults' health care activities relates to caregiving responsibilities, supportive services use, and caregiving-related effects. DESIGN, SETTING, AND PARTICIPANTS A total of 1739 family and unpaid caregivers of 1171 community-dwelling older adults with disabilities who participated in the 2011 National Health and Aging Trends Study (NHATS) and National Study of Caregiving (NSOC). MAIN OUTCOMES AND MEASURES Caregiving-related effects, including emotional, physical, and financial difficulty; participation restrictions in valued activities; and work productivity loss. EXPOSURES Caregivers assisting older adults who provide substantial, some, or no help with health care, defined by coordinating care and managing medications (help with both, either, or neither activity, respectively). RESULTS Based on NHATS and NSOC responses from 1739 family and unpaid caregivers of 1171 older adults with disabilities, weighted estimates were produced that accounted for the sampling designs of each survey. From these weighted estimates, 14.7 million caregivers assisting 7.7 million older adults, 6.5 million (44.1%) provided substantial help, 4.4 million (29.8%) provided some help, and 3.8 million (26.1%) provided no help with health care. Almost half (45.5%) of the caregivers providing substantial help with health care assisted an older adult with dementia. Caregivers providing substantial help with health care provided more hours of assistance per week than caregivers providing some or no help (28.1 vs 15.1 and 8.3 hours, P < .001 for both). The use of supportive services was low but was greater among caregivers providing substantial vs some or no help (26.7% vs 15.5% and 7.6%, P < .001 for both). In multivariable regression models adjusting for older adults' function and caregivers' sociodemographic and health characteristics, caregivers providing substantial help with health care were significantly more likely to experience emotional difficulty (adjusted odds ratio [aOR], 1.79; 95% CI, 1.20-2.66), physical difficulty (aOR, 2.03; 95% CI, 1.39-2.97), and financial difficulty (aOR, 2.21; 95% CI, 1.52-3.22) than caregivers providing no help. Compared with caregivers providing no help with health care activities, caregivers providing substantial help with health care activities were more than 5 times as likely to experience participation restrictions in valued activities (aOR, 5.32; 95% CI, 3.31-8.59) and more than 3 times as likely to experience work productivity loss (aOR, 3.14; 95% CI, 1.40-7.02). CONCLUSIONS AND RELEVANCE Family caregivers providing substantial assistance with health care experience significant emotional difficulty and role-related effects, yet only one-quarter use supportive services.
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Affiliation(s)
- Jennifer L Wolff
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | | | - Vicki A Freedman
- Institute for Social Research, University of Michigan, Ann Arbor
| | - Judith D Kasper
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
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Goldman AW, Cornwell B. Social network bridging potential and the use of complementary and alternative medicine in later life. Soc Sci Med 2015; 140:69-80. [PMID: 26207353 PMCID: PMC4697732 DOI: 10.1016/j.socscimed.2015.07.003] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2015] [Revised: 06/12/2015] [Accepted: 07/05/2015] [Indexed: 11/26/2022]
Abstract
The use of complementary/alternative medicine (CAM) is typically modeled as a function of individual health beliefs, including changes in perceptions of conventional medicine, an orientation toward more holistic care, and increasing patient involvement in health care decision-making. Expanding on research that shows that health-related behavior is shaped by social networks, this paper examines the possibility that CAM usage is partly a function of individuals' social network structure. We argue that people are more likely to adopt CAM when they function as bridges between network members who are otherwise not (or poorly) connected to each other. This circumstance not only provides individuals with access to a wider range of information about treatment options, it also reduces the risk of sanctioning by network members if one deviates from conventional forms of treatment. We test this idea using data from the National Social Life, Health, and Aging Project (NSHAP), a nationally representative study of older Americans. Analyses of egocentric social network data show that older adults with bridging potential in their networks are significantly more likely to engage in a greater number of types of CAM. We close by discussing alternative explanations of these findings and their potential implications for research on CAM usage.
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Affiliation(s)
- Alyssa W Goldman
- Department of Sociology, Cornell University, 333 Uris Hall, Ithaca, NY 14853, USA.
| | - Benjamin Cornwell
- Department of Sociology, Cornell University, 342 Uris Hall, Ithaca, NY 14853, USA.
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Wolff JL, Spillman B. Older adults receiving assistance with physician visits and prescribed medications and their family caregivers: prevalence, characteristics, and hours of care. J Gerontol B Psychol Sci Soc Sci 2015; 69 Suppl 1:S65-72. [PMID: 25342825 DOI: 10.1093/geronb/gbu119] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
OBJECTIVES To profile older adults receiving assistance with physician visits and prescribed medications and the time demands associated with their care. METHODS Observational study of 7,197 community-dwelling adults ages 65+ responding to the 2011 National Health and Aging Trends Study. RESULTS More than one third of older adults receive assistance with either physician visits or prescribed medications (26.3%), or both (9.9%). The 3.3 million older adults who receive assistance with both physician visits and prescribed medications are a high-need subgroup: 3 in 5 have possible (16.5%) or probable (46.1%) dementia and three quarters (76.6%) receive help with mobility, self-care, or household activities. These 3.3 million older adults receive more than twice as many weekly hours of help with all activities (60.5 hr) as those receiving help with either physician visits or prescribed medications (26.5 hr), or neither (18.6 hr). Older adults receiving help with both physician visits and prescribed medications are assisted by 7.2 million helpers, most often adult children (46.6%), or spouses (23.6%). The 3.1 million helpers who assist with both physician visits and prescribed medications provide an average of 45.4 hr of help per week; nearly two thirds (64.3%) also assist with mobility or self-care. DISCUSSION Older adults receiving help with both physician visits and prescribed medications typically have high health and functioning needs that involve significant time demands for caregivers.
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Affiliation(s)
- Jennifer L Wolff
- Department of Health Policy & Management and Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland. Division of Geriatric Medicine and Gerontology, Johns Hopkins University School of Medicine, Baltimore, Maryland.
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Does spouse participation influence quality of life reporting in patients with Parkinson’s disease? Qual Life Res 2014; 24:245-9. [DOI: 10.1007/s11136-014-0744-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/17/2014] [Indexed: 10/25/2022]
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Personality facets and all-cause mortality among Medicare patients aged 66 to 102 years: a follow-on study of Weiss and Costa (2005). Psychosom Med 2014; 76:370-8. [PMID: 24933014 PMCID: PMC4096682 DOI: 10.1097/psy.0000000000000070] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
OBJECTIVE To investigate associations between personality facets and survival during an 8-year follow-up. METHODS In 597 Medicare recipients (age, 66-102 years) followed up for approximately 8 years, personality domains and facets were assessed using the Revised NEO Personality Inventory (NEO-PI-R). This study builds on a previous study which used proportional hazards regression to test whether the NEO-PI-R factor and selected facet scores were associated with mortality risk. That study revealed that the neuroticism facet impulsiveness, agreeableness facet straightforwardness, and conscientiousness facet self-discipline were related to lower risk during 4 years of follow-up. We extended the follow-up period by 4 years, examined all 30 facets, and used accelerated failure time modeling as an additional analytic approach. Unlike proportional hazards regression, accelerated failure time modeling permits inferences about the median survival length conferred by predictors. Each facet was tested in a model that included health-related covariates and NEO-PI-R factor scores for dimensions that did not include that facet. RESULTS Over the 8-year follow-up period, impulsiveness was not significant, each standard deviation of straightforwardness was associated with an 11% increase in median survival time and, when dichotomized, higher self-discipline was associated with a 34% increase in median survival time. Each standard deviation of altruism, compliance, tender-mindedness, and openness to fantasy was associated with a 9% to 11% increase in median survival time. CONCLUSIONS After extending the follow-up period from 4 to 8 years, self-discipline remained a powerful predictor of survival and facets associated with imagination, generosity, and higher-quality interpersonal interactions become increasingly important.
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Wolff JL, Roter DL, Barron J, Boyd CM, Leff B, Finucane TE, Gallo JJ, Rabins PV, Roth DL, Gitlin LN. A tool to strengthen the older patient-companion partnership in primary care: results from a pilot study. J Am Geriatr Soc 2014; 62:312-9. [PMID: 24417565 DOI: 10.1111/jgs.12639] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To determine the acceptability of a pre-consultation checklist for older adults who attend medical visits with an unpaid companion and to evaluate its effects on visit communication. DESIGN Randomized controlled pilot study. SETTING Academic geriatrics ambulatory clinic. PARTICIPANTS Thirty-two individuals aged 65 and older and their unpaid companions. INTERVENTION A self-administered checklist was compared with usual care. The checklist was designed to elicit and align patient and companion perspectives regarding health concerns to discuss with the doctor and stimulate discussion about the companion's role in the visit. MEASUREMENT PRIMARY OUTCOME ratio of patient-centered communication, coded from visit audiotapes. SECONDARY OUTCOMES checklist acceptability; visit duration; patient-companion verbal activity; patient- and physician-reported perspectives of the visit. RESULTS All intervention patients and companions (n = 17) completed the checklist, and all participants (n = 32 dyads) completed the study. Patients and companions stated that the checklist was easy to complete (88%) and useful (91%), and they uniformly (100%) recommended it to other patients. Communication was significantly more patient-centered in intervention group visits (ratio of 1.22 vs 0.71; P = .03). Visit duration (35.0 and 30.6 minutes; P = .34) and percentage of total verbal activity contributed by patients and companions (58.2% and 56.3% of visit statements; P = .50) were comparable in the intervention and control groups, respectively. Physicians were more likely to indicate that intervention companions "helped them provide good care to the patient" (94% vs 60%; P = .02). Intervention patients were more likely to indicate that they "better understood their doctor's advice and explanations" because their companion was present (82% vs 47%; P = .03). CONCLUSION A checklist to elicit and align perspectives of older adults and their companions resulted in enhanced patient-centered medical visit communication.
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Affiliation(s)
- Jennifer L Wolff
- Department of Health Policy & Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland; Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland; Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland; Division of Geriatric Medicine and Gerontology and Department of Psychiatry, Johns Hopkins University School of Medicine, Baltimore, Maryland
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Aschbrenner KA, Pepin R, Mueser KT, Naslund JA, Rolin SA, Faber MJ, Bartels SJ. A mixed methods exploration of family involvement in medical care for older adults with serious mental illness. Int J Psychiatry Med 2014; 48:121-33. [PMID: 25377153 PMCID: PMC4825808 DOI: 10.2190/pm.48.2.e] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Many older persons with serious mental illness (SMI) suffer from high rates of comorbid medical conditions. Although families play a critical role in psychiatric illness management among adults with SMI, their contributions to improving health outcomes in this population has received little attention. This study explored family involvement in medical care for older adults with SMI. METHODS This mixed methods study involved analysis of quantitative data collected from older adults with SMI and cardiovascular risk (n = 28) participating in a pilot study of an intervention designed to improve patient-centered primary care augmented by qualitative interviews with their relatives (n = 13) to explore family involvement in medical care. RESULTS Approximately 89% of older adults with SMI reported family involvement in at least one aspect of their medical care (e.g., medication reminders, medical decision making). However, many family members reported that they were rarely involved in their relative's medical visits, and most did not perceive a need to be involved during routine care. Family members identified obesity as their relative's primary health concern and many wanted guidance from providers on effective strategies for supporting weight loss. CONCLUSIONS Although many family members did not perceive a need to be involved in their relative's routine medical visits, they expressed interest in talking with providers about how to help their relative change unhealthy behaviors. Educating patients, families, and providers about the potential benefits of family involvement in medical care, including routine medical visits for persons with SMI and cardiovascular health risk may promote patient- and family-centered collaboration in this high-risk population.
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Affiliation(s)
- Kelly A. Aschbrenner
- Dartmouth Centers for Aging Research, 46 Centerra Parkway, Suite 200, Lebanon NH 03766
| | - Renee Pepin
- Dartmouth Centers for Aging Research, 46 Centerra Parkway, Suite 200, Lebanon NH 03766
| | - Kim T. Mueser
- Boston University Center for Psychiatric Rehabilitation, 940 Commonwealth Avenue West, Boston , MA 02215
| | - John A. Naslund
- Dartmouth Centers for Aging Research, 46 Centerra Parkway, Suite 200, Lebanon NH 03766
| | - Stephanie A. Rolin
- Dartmouth Centers for Aging Research, 46 Centerra Parkway, Suite 200, Lebanon NH 03766
| | - Marjan J. Faber
- Dartmouth Centers for Aging Research, 46 Centerra Parkway, Suite 200, Lebanon NH 03766
| | - Stephen J. Bartels
- Dartmouth Centers for Aging Research, 46 Centerra Parkway, Suite 200, Lebanon NH 03766
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Shin DW, Cho J, Roter DL, Kim SY, Sohn SK, Yoon MS, Kim YW, Cho B, Park JH. Preferences for and experiences of family involvement in cancer treatment decision-making: patient-caregiver dyads study. Psychooncology 2013; 22:2624-31. [PMID: 23893390 DOI: 10.1002/pon.3339] [Citation(s) in RCA: 101] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2013] [Revised: 05/24/2013] [Accepted: 05/27/2013] [Indexed: 12/20/2022]
Abstract
BACKGROUND Despite the important role that family caregivers play in providing emotional and practical support to cancer patients, relatively little is known about the family caregiver's role in treatment decision-making (TDM). We sought to investigate patients' and family caregivers' preferences for and experiences of family involvement in TDM and factors associated with preference concordance. METHOD A national survey was performed with 990 patient-caregiver dyads (participation rate:76.2%). Questions examining preferences for and experiences of family involvement in TDM were administered independently to patients and family caregivers. Concordance was calculated with weighted kappa. Logistic regression analyses were used to identify predictors of patients' and caregivers' preferences for family involvement in TDM and concordance between them. RESULTS Few patients or family caregivers expressed a preference for unilateral decision-making; however, there was considerable variation and poor agreement within dyads in regard to whether the patient or family caregivers should take the lead in decision-making with input from the other (weighted kappa between respondents for TDM preferences and experiences = 0.10 and κ = 0.18, respectively). Greater TDM preference concordance was associated with higher patient education, whereas lower levels of concordance were evident for younger patients, less educated caregivers, adult child patient dyads (as opposed to a spouse-patient dyads) and problematic family communication about cancer. CONCLUSIONS Most patients and family caregivers valued and expected family involvement in TDM. However, there is little explicit agreement in regard to which party in the dyad should take decisional leadership and who should play a supporting role.
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Affiliation(s)
- Dong Wook Shin
- Department of Family Medicine & Health Promotion Center, Seoul National University Hospital, Seoul, Korea; Cancer Survivorship Clinic, Seoul National University Cancer Hospital, Seoul, Korea
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Schulz R. Research priorities in geriatric palliative care: informal caregiving. J Palliat Med 2013; 16:1008-12. [PMID: 23883146 DOI: 10.1089/jpm.2013.9483] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Informal care provided by family members is an essential feature of health care systems worldwide. Although caregiving often begins early in the disease process, over time informal caregivers must deal with chronic, debilitating, and life-threatening illnesses. Despite thousands of published studies on informal care, little is known about the intersection of informal caregiving and formal palliative care. OBJECTIVE The goal of this review is to identify research priorities that would enhance our understanding of the relationship between informal caregiving and palliative care. DESIGN To better understand palliative care in the context of caregiving, we provide an overview of the nature of a caregiving career from inception to care recipient placement and death and the associated tasks, challenges, and health effects at each stage of a caregiving career. This in turn leads to key unanswered questions designed to advance research in caregiving and palliative care. RESULTS Little is known about the extent to which and how palliative care uniquely affects the caregiving experience. This suggests a need for more fine-grained prospective studies that attempt to clearly delineate the experience of caregivers during palliative and end-of-life phases, characterize the transitions into and out of these phases from both informal and formal caregiver perspectives, identify caregiver needs at each phase, and identify effects on key caregiver and patient outcomes. CONCLUSIONS Inasmuch as most caregivers must deal with chronic, debilitating, and often life-threatening conditions, it is essential that we advance a research agenda that addresses the interplay between informal care and formal palliative care.
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Affiliation(s)
- Richard Schulz
- Department of Psychiatry, University of Pittsburgh , Pittsburgh, Pennsylvania
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Clayman ML, Morris MA. Patients in context: recognizing the companion as part of a patient-centered team. PATIENT EDUCATION AND COUNSELING 2013; 91:1-2. [PMID: 23465692 DOI: 10.1016/j.pec.2013.02.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
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Abstract
Older adults with multiple chronic conditions (MCCs) require considerable health services and complex care. Because the persistence and progression of diseases and courses of treatments affect health status in multiple dimensions, well-validated universal outcome measures across diseases are needed for research, clinical care, and administrative purposes. An expert panel meeting held by the National Institute on Aging in September 2011 recommends that older persons with MCCs complete a brief initial composite measure that includes general health; pain; fatigue; and physical health, mental health, and social role function, along with gait speed measurement. Suitable composite measures include the Medical Outcomes Study 8 (SF-8) and 36 (SF-36) -item Short-Form Survey and the Patient Reported Outcomes Measurement Information System 29-item Health Profile. Based on responses to items in the initial measure, short follow-on measures should be selectively targeted to symptom burden, depression, anxiety, and daily activities. Persons unable to walk a short distance to assess gait speed should be assessed using a physical function scale. Remaining gaps to be considered for measure development include disease burden, cognitive function, and caregiver burden. Routine outcome assessment of individuals with MCCs could facilitate system-based care improvement and clinical effectiveness research.
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Guiding principles for the care of older adults with multimorbidity: an approach for clinicians: American Geriatrics Society Expert Panel on the Care of Older Adults with Multimorbidity. J Am Geriatr Soc 2012; 60:E1-E25. [PMID: 22994865 DOI: 10.1111/j.1532-5415.2012.04188.x] [Citation(s) in RCA: 452] [Impact Index Per Article: 37.7] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
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Clayman ML, Makoul G, Harper MM, Koby DG, Williams AR. Development of a shared decision making coding system for analysis of patient-healthcare provider encounters. PATIENT EDUCATION AND COUNSELING 2012; 88:367-72. [PMID: 22784391 PMCID: PMC3417351 DOI: 10.1016/j.pec.2012.06.011] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/02/2012] [Revised: 05/08/2012] [Accepted: 06/12/2012] [Indexed: 05/22/2023]
Abstract
OBJECTIVES To describe the development and refinement of a scheme, detail of essential elements and participants in shared decision making (DEEP-SDM), for coding shared decision making (SDM) while reporting on the characteristics of decisions in a sample of patients with metastatic breast cancer. METHODS The evidence-based patient choice instrument was modified to reflect Makoul and Clayman's integrative model of SDM. Coding was conducted on video recordings of 20 women at the first visit with their medical oncologists after suspicion of disease progression. Noldus Observer XT v.8, a video coding software platform, was used for coding. RESULTS The sample contained 80 decisions (range: 1-11), divided into 150 decision making segments. Most decisions were physician-led, although patients and physicians initiated similar numbers of decision-making conversations. CONCLUSION DEEP-SDM facilitates content analysis of encounters between women with metastatic breast cancer and their medical oncologists. Despite the fractured nature of decision making, it is possible to identify decision points and to code each of the essential elements of shared decision making. Further work should include application of DEEP-SDM to non-cancer encounters. PRACTICE IMPLICATIONS A better understanding of how decisions unfold in the medical encounter can help inform the relationship of SDM to patient-reported outcomes.
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Affiliation(s)
- Marla L Clayman
- Division of General Internal Medicine, Northwestern University, Chicago, IL, USA.
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