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Masterman C, Mendlowitz AB, Capraru C, Campbell K, Eastabrook G, Yudin MH, Kushner T, Flemming JA, Feld JJ, Babenko-Mould Y, Tryphonopoulos P, Biondi M. An evolutionary concept analysis: stigma among women living with hepatitis C. BMC Public Health 2024; 24:2660. [PMID: 39342214 PMCID: PMC11439273 DOI: 10.1186/s12889-024-20131-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2024] [Accepted: 09/19/2024] [Indexed: 10/01/2024] Open
Abstract
BACKGROUND Stigma is a complex social phenomenon that leads to marginalization and influences the course of illness. In the context of hepatitis C virus (HCV), stigma is a well-documented barrier to accessing care, treatment, and cure. In recent years, HCV rates among women have increased, resulting in an urgent need to address stigma and its harmful effects. The purpose of this concept analysis was to investigate stigma in the context of women living with HCV using Rodgers' evolutionary method. METHODS PubMed, CINAHL, Scopus, Medline, PsycINFO, and Nursing and Allied Health were used to identify articles describing HCV stigma among women. Articles from peer-reviewed journals and geographic locations, published between 2002-2023, were included in the analysis. As specified in Rodgers' evolutionary method, articles were analyzed with a focus on the concept's context, surrogate and related terms, antecedents, attributes, examples, and consequences. RESULTS Following screening, 33 articles were selected for inclusion in the analysis. Discrimination and marginalization were identified as surrogate and related terms to stigma; and antecedents of stigma were identified as limited knowledge, fear of diagnosis, and disclosure. Prevalent attributes of stigma in the literature were described as feelings of decreased self-worth, negative stereotyping, and fear of transmission. Importantly, HCV stigma among women is unique in comparison to other forms of infectious disease-related stigma, primarily due its impact on women's identity as mothers and caregivers. Stigmatization of women living with HCV resulted in negative consequences to personal relationships and healthcare access due to decreased health-seeking behaviours. Although access to HCV treatment has changed considerably over time, a temporal analysis could not be completed due to the limited number of articles. CONCLUSIONS Stigma in the context of women living with HCV has its own unique antecedents, attributes, and consequences. This enhanced understanding of stigma among women living with HCV has the potential to inform improved and more effective approaches to care, which will be required to reach HCV elimination. Furthermore, this analysis identifies stigma layering and stigma in the direct-acting antiviral treatment era as areas for more in-depth future inquiry.
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Affiliation(s)
- Chelsea Masterman
- Arthur Labatt Family School of Nursing, Western University, London, ON, Canada
| | - Andrew B Mendlowitz
- Viral Hepatitis Care Network (VIRCAN) Study Group, Toronto Centre for Liver Disease, Toronto, ON, Canada
| | - Camelia Capraru
- Viral Hepatitis Care Network (VIRCAN) Study Group, Toronto Centre for Liver Disease, Toronto, ON, Canada
| | | | | | - Mark H Yudin
- Department of Obstetrics and Gynecology, University of Toronto, Toronto, ON, Canada
| | - Tatyana Kushner
- Division of Liver Diseases, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Jennifer A Flemming
- Department of Medicine and Public Health Sciences, Queen's University, Kingston, ON, Canada
| | - Jordan J Feld
- Viral Hepatitis Care Network (VIRCAN) Study Group, Toronto Centre for Liver Disease, Toronto, ON, Canada
| | | | | | - Mia Biondi
- Arthur Labatt Family School of Nursing, Western University, London, ON, Canada.
- Viral Hepatitis Care Network (VIRCAN) Study Group, Toronto Centre for Liver Disease, Toronto, ON, Canada.
- School of Nursing, York University, Toronto, ON, Canada.
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Aimono Y, Kohyama N, Kamoshida T, Yamamoto T, Kogo M. [QOL Assessment in Chronic Hepatitis C Patients Receiving Ledipasvir/ Sofosbuvir or Simeprevir/Peginterferon/Ribavirin in Clinical Practice]. YAKUGAKU ZASSHI 2020; 139:1427-1434. [PMID: 31685739 DOI: 10.1248/yakushi.19-00019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Recently, a clinical study using a Chronic Liver Disease Questionnaire (CLDQ) showed that ledipasvir/sofosbuvir (LDV/SOF)-treated patients' QOL was more favorable than that of IFN/ribavirin (RBV)-treated patients. However, no study has reported QOL assessment in clinical practice. In this study, we compared the QOL between patients treated with LDV/SOF and those treated with simeprevir (SMV)/peginterferon (Peg-IFN)/RBV to provide QOL information in clinical practice. The subjects were 169 patients with type I chronic hepatitis C or compensated cirrhosis C (Child-Pugh Grade A) who were treated with SMV/Peg-IFN/RBV or LDV/SOF in Hitachi General Hospital. The QOL was assessed ≥2 weeks after the start of administration using the Japanese version of the CLDQ (Kida et al., 2008 version). The total CLDQ score in the LDV/SOF group was significantly higher than in the SMV/Peg-IFN/RBV group (6.59 vs. 6.38, respectively, p=0.007). In particular, the scores for 4 domains (abdominal symptoms, systemic symptoms, activity, and emotional function) in the former were significantly higher than in the latter (p<0.05). Furthermore, the rates of patients scoring 7 (no symptom) on 8 items in the former were significantly higher than in the latter (p<0.05). In clinical practice, LDV/SOF-treated patients' QOL was more favorable than that of those receiving conventional treatment with IFN and RBV. This study may make it possible for health care professionals to provide clinical QOL information on LDV/SOF therapy to patients. Furthermore, QOL information may promote decision-making for treatment, leading to effective treatment.
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Affiliation(s)
- Yuka Aimono
- Division of Pharmacotherapeutics, Department of Clinical Pharmacy, School of Pharmacy, Showa University.,Department of Clinical Pharmacy, Hitachi, Ltd., Hitachi General Hospital
| | - Noriko Kohyama
- Division of Pharmacotherapeutics, Department of Clinical Pharmacy, School of Pharmacy, Showa University
| | - Toshiro Kamoshida
- Department of Medical Gastroenterology, Hitachi, Ltd., Hitachi General Hospital
| | | | - Mari Kogo
- Division of Pharmacotherapeutics, Department of Clinical Pharmacy, School of Pharmacy, Showa University
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Finley EP, Schneegans S, Tami C, Pugh MJ, McGeary D, Penney L, Sharpe Potter J. Implementing prescription drug monitoring and other clinical decision support for opioid risk mitigation in a military health care setting: a qualitative feasibility study. J Am Med Inform Assoc 2019; 25:515-522. [PMID: 29025024 DOI: 10.1093/jamia/ocx075] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2017] [Accepted: 06/16/2017] [Indexed: 11/12/2022] Open
Abstract
Objective Chronic noncancer pain is a highly prevalent condition among service members returning from deployment overseas. The US Army has a higher rate of opioid misuse than the civilian population. Although most states and many health care systems have implemented prescription drug monitoring programs (PDMPs) or other clinician decision support (CDS) to aid providers in delivering guideline-recommended opioid therapy, similar tools are lacking in military health settings. Materials and Methods We conducted a pre-implementation feasibility and needs assessment guided by the Promoting Action Research in Health Services framework. Twenty-six semistructured interviews were conducted with providers from a large military health system (MHS) to assess baseline knowledge and practices in opioid risk mitigation and providers' preferences and needs for a military-based PDMP or other CDS. Results Military health care providers reported complex decision-making around opioid prescribing and monitoring, varied knowledge and use of existing clinical informatics, and concerns about the feasibility of implementing a military-based PDMP in their context. However, providers indicated a need for training and CDS to support opioid risk mitigation for their patients. Discussion This article describes providers' knowledge and behaviors around opioid risk mitigation in the MHS, and views on the potential usefulness of a military-based PDMP or other CDS. This pre-implementation study provides a model for using qualitative methods to assess feasibility and inform planning and development of CDS in complex health care settings. Conclusion Military providers were skeptical regarding the feasibility of MHS-based PDMP implementation, but provided important recommendations for CDS to support safe and appropriate opioid prescribing in military health care.
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Affiliation(s)
- Erin P Finley
- University of Texas Health Science Center San Antonio, San Antonio, TX, USA.,South Texas Veterans Healthcare System, San Antonio, TX, USA
| | - Suyen Schneegans
- University of Texas Health Science Center San Antonio, San Antonio, TX, USA
| | - Claudina Tami
- University of Texas Health Science Center San Antonio, San Antonio, TX, USA
| | - Mary Jo Pugh
- University of Texas Health Science Center San Antonio, San Antonio, TX, USA.,South Texas Veterans Healthcare System, San Antonio, TX, USA
| | - Don McGeary
- University of Texas Health Science Center San Antonio, San Antonio, TX, USA
| | - Lauren Penney
- University of Texas Health Science Center San Antonio, San Antonio, TX, USA.,South Texas Veterans Healthcare System, San Antonio, TX, USA
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Garvey CM, Jones R. The role of stigma and trauma in hepatitis C virus treatment in veterans: Applying the common-sense model. Public Health Nurs 2019; 36:829-835. [PMID: 31583773 DOI: 10.1111/phn.12665] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Revised: 08/19/2019] [Accepted: 08/28/2019] [Indexed: 01/16/2023]
Abstract
Hepatitis C Virus (HCV), a blood borne pathogen capable of causing severe liver disease, disproportionately affects veterans in the United States. While there are antiviral medications to treat HCV, stigma and trauma in this population may lead to avoidance of care. Those veterans who do undergo treatment have certain illness representations about HCV and its treatment. They undergo treatment even while facing stigma and trauma. The Common-Sense Model may be useful in elucidating how such representations, when matched to an appropriate illness prototype, may inform an action plan of how to respond to HCV. An exploration of the illness representations among veterans with HCV, and the effects of stigma and trauma on these representations, may help to explain how they exercise the choice to undergo treatment and may inform interventions to encourage treatment in veterans who have yet to do so.
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Affiliation(s)
- Casey M Garvey
- School of Nursing, Northeastern University, Boston, Massachusetts
| | - Rachel Jones
- School of Nursing, Northeastern University, Boston, Massachusetts
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Welzel TM, Yang M, Sajeev G, Chen YJ, Pinsky B, Bao Y, Wu EQ, Dieterich D. Assessing Patient Preferences for Treatment Decisions for New Direct Acting Antiviral (DAA) Therapies for Chronic Hepatitis C Virus Infections. Adv Ther 2019; 36:2475-2486. [PMID: 31240629 PMCID: PMC6822851 DOI: 10.1007/s12325-019-01012-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2019] [Indexed: 01/27/2023]
Abstract
INTRODUCTION The new direct acting antiviral (DAA) therapies are able to effectively treat chronic hepatitis C (CHC). This study elicited the preferences of CHC patients for treatment attributes of new DAAs. METHODS An online discrete choice experiment survey was designed to collect data from adult CHC patients in the USA, UK, France, Germany, Spain, and Italy. Patients were asked to choose from alternative hypothetical DAA options, defined by differing levels of nine attributes [i.e., treatment duration, tablet count and packaging, cure rate, required office visits when on treatment, modifications to statins or to proton pump inhibitors (PPIs), and risks of diarrhea, headache and nausea]. Logistic regression was used to assess preference for the treatment options. RESULTS A total of 328 patients with CHC completed the survey (USA, n = 227; European countries, n = 101), with a mean age of 47.7 years (SD = 14.4) and an average 11.2 years since CHC diagnosis; 51% of patients were female. More than half (60%) of the patients had treatment for CHC. Patients significantly preferred a DAA regimen with higher cure rate, shorter treatment duration, lower risks of diarrhea, headache, and nausea (all p < 0.001), reduced need for office visits when on treatment (p = 0.044), and without requiring dose reduction or timing change in PPIs (p = 0.032). Tablet counts were not found to be statistically significant. CONCLUSION Given the overall high cure rates of new DAAs, CHC patients' preferences for therapy may be influenced by treatment attributes other than cure rates and tolerability. Treatments that are more convenient and require less disruption to their daily life (e.g., shorter treatment duration, no modification in PPI use, and fewer office visits when on treatment) are important to patients with CHC and should be considered when making treatment decisions. FUNDING AbbVie.
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Affiliation(s)
| | - Min Yang
- Analysis Group, Inc., Boston, MA, USA
| | | | | | | | | | - Eric Q Wu
- Analysis Group, Inc., Boston, MA, USA
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Evon DM, Golin CE, Stoica T, Jones RE, Willis SJ, Galanko J, Fried MW. What's Important to the Patient? Informational Needs of Patients Making Decisions About Hepatitis C Treatment. PATIENT-PATIENT CENTERED OUTCOMES RESEARCH 2018; 10:335-344. [PMID: 27882509 DOI: 10.1007/s40271-016-0207-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND OBJECTIVES Multiple treatment options with direct-acting antivirals are now available for hepatitis C virus (HCV). Study aims were to understand (1) the informational topics patients want to have to make informed treatment decisions; (2) the importance patients place on each topic; and (3) the topics patients prioritize as most important. METHODS We used a mixed-methods study of two samples recruited from an academic liver center. Participants were not currently on treatment. Sample I (n = 45) free listed all informational topics deemed important to decision making. Raw responses were coded into several broad and subcategories. Sample II (n = 38) rated the importance of the subcategories from Sample I and ranked their highest priorities on two surveys, one containing topics for which sufficient research existed to inform patients ('static'), and the other containing topics that would require additional research. RESULTS The topics listed by Sample I fell into six broad categories with 17 total subcategories. The most oft-cited informational topics were harms of treatment (100%), treatment benefits (62%), and treatment regimen details (84%). Sample II rated 16 of 17 subcategories as "pretty important' or "extremely important". Sample II prioritized (1) viral cure, (2) long-term survival, and (3) side effects on the survey of topics requiring additional research, and (1) liver disease, (2) lifestyle changes, and (3) medication details on the second survey of the most important static topics patients needed. CONCLUSIONS Patients weighed several informational topics to make an informed decision about HCV treatment. These findings lay the groundwork for future patient-centered outcomes research in HCV and patient-provider communication to enhance patients' informed decision making regarding direct-acting antiviral treatment options.
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Affiliation(s)
- Donna M Evon
- Division of Gastroenterology and Hepatology, University of North Carolina, CB# 7584, 8010 Burnett-Womack, Chapel Hill, NC, 27599, USA.
| | - Carol E Golin
- Department of Medicine, Department of Health Behavior, University of North Carolina, Chapel Hill, NC, USA
| | - Teodora Stoica
- Division of Gastroenterology and Hepatology, University of North Carolina, CB# 7584, 8010 Burnett-Womack, Chapel Hill, NC, 27599, USA
| | - Rachel E Jones
- Division of Gastroenterology and Hepatology, University of North Carolina, CB# 7584, 8010 Burnett-Womack, Chapel Hill, NC, 27599, USA
| | - Sarah J Willis
- Department of Epidemiology, University of North Carolina, Chapel Hill, NC, USA
| | - Joseph Galanko
- Division of Gastroenterology and Hepatology, University of North Carolina, CB# 7584, 8010 Burnett-Womack, Chapel Hill, NC, 27599, USA
| | - Michael W Fried
- Division of Gastroenterology and Hepatology, University of North Carolina, CB# 7584, 8010 Burnett-Womack, Chapel Hill, NC, 27599, USA
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A Qualitative Study on Marital Challenges of Chronic Hepatitis B Patients. IRANIAN RED CRESCENT MEDICAL JOURNAL 2017. [DOI: 10.5812/ircmj.55577] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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