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Borelli JL, Zhou E, Russo LN, Li FH, Tironi M, Yamashita KS, Smiley PA, Campos B. Culturally adapting relational savoring: A therapeutic approach to improve relationship quality. FAMILY PROCESS 2024. [PMID: 38533758 DOI: 10.1111/famp.12989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Revised: 02/23/2024] [Accepted: 02/29/2024] [Indexed: 03/28/2024]
Abstract
Relational savoring (RS) is a brief, strengths-based approach to heightening attentional focus to moments of positive connectedness within relationships. RS can be administered preventatively or within an intervention context when a therapist aspires to foster more optimal relational functioning. Typically administered within a one-on-one therapy setting, RS has demonstrated efficacy in enhancing intra- and interpersonal outcomes. To increase access to mental health services, the developers of RS are committed to engaging in an iterative approach of enhancing the cultural congruence and accessibility of this intervention within various cultural contexts, beginning with Latine groups in Southern California. In this article, we describe relational savoring and its theoretical and empirical support, including the process of culturally adapting the intervention within the context of three major studies, each with a distinct focus on Latine groups, a community that is underserved in mental health care settings. We then provide a vision for future research to improve upon the intervention's compatibility for Latine families and other populations.
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Affiliation(s)
- Jessica L Borelli
- Department of Psychological Science, University of California, Irvine, California, USA
| | - Elayne Zhou
- Department of Psychology, University of Southern California, California, Los Angeles, USA
| | - Lyric N Russo
- Department of Social Ecology, University of California, Irvine, California, USA
| | - Frances H Li
- Department of Psychological Science, University of California, Irvine, California, USA
| | - Marta Tironi
- Department of Educational Sciences, University of Genoa, Genoa, Italy
| | - Ken S Yamashita
- Department of Psychological Science, University of California, Irvine, California, USA
| | - Patricia A Smiley
- Department of Psychological Science, Pomona College, Pomona, California, USA
| | - Belinda Campos
- Department of Psychological Science, University of California, Irvine, California, USA
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Suntai Z, Laha-Walsh K, Albright DL. Perspectives on a good death: A comparative study of veterans and civilians. DEATH STUDIES 2023; 48:276-285. [PMID: 37288754 DOI: 10.1080/07481187.2023.2219641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
This study aimed to identify any differences between veterans and non-veterans in the importance of domains of the Good Death Inventory. Participants were recruited from Amazon Mechanical Turk to complete a Qualtrics survey on the importance of the 18 domains of the Good Death Inventory scale. Logistic regression models were then used to analyze any differences between veterans (n = 241) and nonveterans (n = 1151). Results showed that veterans (mostly aged 31-50, men, and White) were more likely to indicate that pursuing all treatment possible and maintaining their pride were important aspects of a good death. The results support other studies that have found military culture to be a significant factor in the way veterans view preferences at the end of life. Interventions may include increasing access to palliative care and hospice services for military members and veterans and providing education/training on end-of-life care for healthcare providers who work with this population.
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Affiliation(s)
- Zainab Suntai
- Diana R. Garland School of Social Work, Baylor University, Waco, Texas, USA
| | | | - David L Albright
- School of Social Work, University of Alabama, Tuscaloosa, Alabama, USA
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Swankoski KE, Reddy A, Grembowski D, Chang ET, Wong ES. Intensive care management for high-risk veterans in a patient-centered medical home - do some veterans benefit more than others? HEALTHCARE (AMSTERDAM, NETHERLANDS) 2023; 11:100677. [PMID: 36764053 DOI: 10.1016/j.hjdsi.2023.100677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Revised: 11/30/2022] [Accepted: 01/22/2023] [Indexed: 02/11/2023]
Abstract
BACKGROUND Primary care intensive management programs utilize interdisciplinary care teams to comprehensively meet the complex care needs of patients at high risk for hospitalization. The mixed evidence on the effectiveness of these programs focuses on average treatment effects that may mask heterogeneous treatment effects (HTEs) among subgroups of patients. We test for HTEs by patients' demographic, economic, and social characteristics. METHODS Retrospective analysis of a VA randomized quality improvement trial. 3995 primary care patients at high risk for hospitalization were randomized to primary care intensive management (n = 1761) or usual primary care (n = 1731). We estimated HTEs on ED and hospital utilization one year after randomization using model-based recursive partitioning and a pre-versus post-with control group framework. Splitting variables included administratively collected demographic characteristics, travel distance, copay exemption, risk score for future hospitalizations, history of hospital discharge against medical advice, homelessness, and multiple residence ZIP codes. RESULTS There were no average or heterogeneous treatment effects of intensive management one year after enrollment. The recursive partitioning algorithm identified variation in effects by risk score, homelessness, and whether the patient had multiple residences in a year. Within each distinct subgroup, the effect of intensive management was not statistically significant. CONCLUSIONS Primary care intensive management did not affect acute care use of high-risk patients on average or differentially for patients defined by various demographic, economic, and social characteristics. IMPLICATIONS Reducing acute care use for high-risk patients is complex, and more work is required to identify patients positioned to benefit from intensive management programs.
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Affiliation(s)
- Kaylyn E Swankoski
- Department of Health Systems and Population Health, University of Washington, Seattle, WA, USA; VA Puget Sound Health Care System, Center of Innovation for Veteran-Centered and Value- Driven Care, Seattle, WA, USA.
| | - Ashok Reddy
- Department of Health Systems and Population Health, University of Washington, Seattle, WA, USA; VA Puget Sound Health Care System, Center of Innovation for Veteran-Centered and Value- Driven Care, Seattle, WA, USA; Division of General Internal Medicine, Department of Medicine, University of Washington, Seattle, WA, USA
| | - David Grembowski
- Department of Health Systems and Population Health, University of Washington, Seattle, WA, USA
| | - Evelyn T Chang
- VA Center for the Study of Healthcare Innovation, Implementation and Policy (CSHIIP), Los Angeles, CA, USA; Department of Medicine, VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA; Department of Medicine, Geffen School of Medicine, University of California at Los Angeles, Los Angeles, CA, USA
| | - Edwin S Wong
- Department of Health Systems and Population Health, University of Washington, Seattle, WA, USA; VA Puget Sound Health Care System, Center of Innovation for Veteran-Centered and Value- Driven Care, Seattle, WA, USA
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Conard PL, Keller MJ, Armstrong ML. Military Veterans' End of Life: Supporting Them in Their Last Deployment. Home Healthc Now 2023; 41:28-35. [PMID: 36607207 DOI: 10.1097/nhh.0000000000001138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
More than 600,000 U.S. Veterans die from illness each year. Clinicians in civilian settings are increasingly providing care to Veterans at end of life. Veteran care should be distinctive and individualized to meet their unique needs. There is limited information to guide civilian clinicians in providing care to Veterans at end of life. This article provides bio-psycho-social information to holistically guide Veteran healthcare and assist them with solace, respect, and serenity at end of life. Various options for end-of-life care are discussed, as well as specific concerns of women, lesbian, gay, bisexual, and transgender Veterans. Some end-of-life entitlements for all Veterans and sometimes their spouses/children are included.
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Plys E, Vaughan CL, Kutner JS, Berk J, Kolva E. Interdisciplinary neuropalliative care: A unique and valuable clinical training experience for geropsychology trainees. GERONTOLOGY & GERIATRICS EDUCATION 2022; 43:551-563. [PMID: 34044751 PMCID: PMC8626543 DOI: 10.1080/02701960.2021.1925891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
To address workforce issues in professional geropsychology, clinical training sites must offer opportunities to build skills for working with older adults and aging families. Neuropalliative care (NPC) may offer a valuable learning environment for geropsychology trainees to develop professional competencies, while positively contributing to patient care. This article describes a novel clinical rotation for an advanced geropsychology trainee in an interdisciplinary specialty NPC clinic. A co-assessment model emerged as a useful strategy for integrating the trainee into the established NPC team. Two case examples illustrate the co-assessment's ability to enhance: collaboration within the clinic; psychological care for patients and care partners; and opportunities for the trainee to build competencies related to assessment, intervention, teams, and consultation. This paper concludes with a discussion of the benefits of NPC as a clinical training rotation for geropsychology trainees, as well as practical considerations for implementation in other clinics.
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Affiliation(s)
- Evan Plys
- Division of General Internal Medicine, Department of Medicine, University of Colorado School of Medicine
- Department of Psychiatry, University of Colorado School of Medicine
| | - Christina L. Vaughan
- Division of General Internal Medicine, Department of Medicine, University of Colorado School of Medicine
- Department of Neurology, University of Colorado School of Medicine
| | - Jean S. Kutner
- Division of General Internal Medicine, Department of Medicine, University of Colorado School of Medicine
| | - Julie Berk
- Department of Neurology, University of Colorado School of Medicine
| | - Elissa Kolva
- Division of Medical Oncology, Department of Medicine, University of Colorado School of Medicine
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Johnson-Koenke R, Horton-Deutsch S, Pratt-Hopp F, Jones J, Oman KS. Stories of the Heart: Illness Narratives of Veterans Living With Heart Failure. Fed Pract 2022; 39:237-243. [PMID: 35935926 PMCID: PMC9351735 DOI: 10.12788/fp.0260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
BACKGROUND Illness narratives for veterans living with heart failure (HF) have been largely unexplored, yet HF is a significant and impactful illness affecting the lives of many veterans. METHODS This study used narrative inquiry to explore the domains of psychosocial adjustments using the model of adjustment to illness, including self-schema, world schema, and meaning. RESULTS Five illness narratives of veterans living with HF were cocreated and explored domains which were found across all the narratives explored in this study. Emergent themes included: uniqueness of the veteran experience and the social, historical, and cultural context of narrator and researcher. CONCLUSIONS Veterans living with HF are a unique population who experience changes in their self-schema, world schema, and meaning through their illness experience. These findings have important implications for interdisciplinary health care research and clinical practice, providing important insight into how people live with chronic illness.
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Affiliation(s)
- Rachel Johnson-Koenke
- University of Colorado Anschutz Medical Campus, College of Nursing, Aurora
- Rocky Mountain Regional Veterans Affairs Medical Center, Aurora, Colorado
| | - Sara Horton-Deutsch
- University of Colorado Anschutz Medical Campus, College of Nursing, Aurora
- University of San Francisco, San Francisco, California
| | | | - Jacqueline Jones
- University of Colorado Anschutz Medical Campus, College of Nursing, Aurora
| | - Kathleen S. Oman
- University of Colorado Anschutz Medical Campus, College of Nursing, Aurora
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Care-seeking and delay of care during COPD exacerbations. NPJ Prim Care Respir Med 2022; 32:7. [PMID: 35169140 PMCID: PMC8847354 DOI: 10.1038/s41533-022-00269-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Accepted: 12/22/2021] [Indexed: 11/29/2022] Open
Abstract
Patients who receive earlier treatment for acute exacerbations of chronic obstructive pulmonary disease (COPD) have a better prognosis, including earlier symptom resolution and reduced risk of future emergency-department visits (ED) or hospitalizations. However, many patients delay seeking care or do not report worsening symptoms to their healthcare provider. In this study, we aimed to understand how patients perceived their breathing symptoms and identify factors that led to seeking or delaying care for an acute exacerbation of COPD. We conducted semistructured interviews with 60 individuals following a recent COPD exacerbation. Participants were identified from a larger study of outpatients with COPD by purposive sampling by exacerbation type: 15 untreated, 15 treated with prednisone and/or antibiotics in the outpatient setting, 16 treated in an urgent care or ED setting, and 14 hospitalized. Data were analyzed using inductive content analysis. Participants were primarily male (97%) with a mean age of 69.1 ± 6.9 years, mean FEV1 1.42 (±0.63), and mean mMRC dyspnea of 2.7 (±1.1). We identified 4 primary themes: (i) access and attitudinal barriers contribute to reluctance to seek care, (ii) waiting is a typical response to new exacerbations, (iii) transitioning from waiting to care-seeking: the tipping point, and (iv) learning from and avoiding worse outcomes. Interventions to encourage earlier care-seeking for COPD exacerbations should consider individuals’ existing self-management approaches, address attitudinal barriers to seeking care, and consider health-system changes to increase access to non-emergent outpatient treatment for exacerbations. Clinical Trial Registration NCT02725294
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Collett G, Young WR, Martin W, Anderson RM. Exposure Worry: The Psychological Impact of Perceived Ionizing Radiation Exposure in British Nuclear Test Veterans. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182212188. [PMID: 34831944 PMCID: PMC8617632 DOI: 10.3390/ijerph182212188] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Revised: 11/15/2021] [Accepted: 11/17/2021] [Indexed: 11/17/2022]
Abstract
Potential psychological issues faced by British nuclear test veterans have been under-researched. This study assessed the prevalence of clinically relevant anxiety in British nuclear test veterans and aimed to explore experiences of worry and the broader psychological impact of the British nuclear weapons testing programme. The Geriatric Anxiety Inventory (Short-Form) was completed by 89 British nuclear test veterans (33.7% met the criteria for clinically relevant anxiety). Nineteen veterans then participated in semi-structured interviews. Thematic analysis of the data generated three themes. The first theme highlighted how worry was relevant only in a few cases (four) generally regarding their grandchildren’s health, but the guilt in those who perceive responsibility for family health conditions also appeared to be a pertinent issue. The second theme highlighted the anger towards authorities resulting from perceived negligence and deception. The third theme highlighted the relevance of how certain life events across the life course influence the potential psychological impact. This study suggests that guilt must be considered in (potentially) exposed individuals whose family members experience health conditions, which may exacerbate distress. It also suggests the importance that authorities ensure transparency when dealing with any radiological exposure scenario to reduce the potential for anger.
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Affiliation(s)
- George Collett
- Centre for Health Effects of Radiological and Chemical Agents, Institute of Health, Medicine and Environments, College of Health, Medicine and Life Sciences, Brunel University London, Uxbridge UB8 3PH, UK; (W.M.); (R.M.A.)
- Correspondence:
| | - William R. Young
- Sport and Health Sciences, College of Life and Environmental Sciences, University of Exeter, Exeter EX1 2LU, UK;
| | - Wendy Martin
- Centre for Health Effects of Radiological and Chemical Agents, Institute of Health, Medicine and Environments, College of Health, Medicine and Life Sciences, Brunel University London, Uxbridge UB8 3PH, UK; (W.M.); (R.M.A.)
| | - Rhona M. Anderson
- Centre for Health Effects of Radiological and Chemical Agents, Institute of Health, Medicine and Environments, College of Health, Medicine and Life Sciences, Brunel University London, Uxbridge UB8 3PH, UK; (W.M.); (R.M.A.)
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Schwartz C, Winchester DE. Discrepancy between patient-reported and clinician-documented symptoms for myocardial perfusion imaging: initial findings from a prospective registry. Int J Qual Health Care 2021; 33:6258102. [PMID: 33913488 DOI: 10.1093/intqhc/mzab076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Revised: 04/05/2021] [Accepted: 04/28/2021] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Occasionally, the symptoms reported by patients disagree with those documented in the medical record. We designed the Patient Centered Assessment of Symptoms (PCAS) registry to measure discrepancies between patient-reported and clinician-documented symptoms. OBJECTIVE Use patient-derived symptoms data to measure discrepancies with clinical documentation. METHODS The PCAS registry captured data from a prospective cohort of patients undergoing myocardial perfusion imaging (MPI) and includes free response and structured questions to gauge symptoms. Clinician-documented symptoms were extracted from the patients' medical records. The appropriateness of testing was determined twice: once using the patient-reported symptoms and once using the clinician-documented symptoms. RESULTS A total of 90 subjects were enrolled, among whom diabetes (36.7%), prior coronary disease (28.9%), hypertension (80.0%) and hyperlipidemia (85.6%) were common. Percentage of patient-reported symptoms compared to clinician-documented symptoms and agreement were as follows: chest pain (patient 29.0%, clinician 36.6%, moderate [kappa = 0.54]), chest pressure (patient 18.3%, clinician 10.8%, fair [kappa = 0.27]), dyspnea (patient 41.0%, clinician 36.6%, fair [kappa = 0.28]), onset with exertion (patient 61.7%, clinician 59.6%, slight [kappa = 0.17]), symptoms same as prior coronary artery disease (patient 46.2%, clinician 15.3%, slight [kappa = 0.01]). As a result of these inconsistencies, appropriateness ratings were different for 13.3% (n = 12) subjects. CONCLUSION In this prospective registry of patients undergoing MPI, we observed substantial disagreements between patient-reported and clinician-documented symptoms. Disagreement resulted in a considerable proportion of MPI appropriateness ratings also being incongruous.
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Affiliation(s)
- Cody Schwartz
- Department of Medicine, University of Florida, 1600 SW Archer Road Gainesville, Gainesville, FL 32610, USA
| | - David E Winchester
- Medical Service, Malcom Randall VA Medical Center, 1601 SW Archer Road, Box 111-D, Gainesville, FL 32608, USA.,Division of Cardiology, University of Florida, 1600 SW Archer Road Gainesville, Gainesville, FL 32610, USA
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