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Baral A, Diggs BNA, Aka A, Williams R, Ortega NH, Fellah RME, Islam JY, Camacho-Rivera M, Penedo FJ, Vidot DC. Experiences and Comfort of Young Cancer Patients Discussing Cannabis with Their Providers: Insights from a Survey at an NCI-Designated Cancer Center. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2024:10.1007/s13187-024-02507-9. [PMID: 39294413 DOI: 10.1007/s13187-024-02507-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 09/10/2024] [Indexed: 09/20/2024]
Abstract
Cannabis use among cancer patients for managing treatment-related symptoms is increasing, yet little is known about patterns in patient-provider communication. This study examines demographic differences in cannabis use communication at a National Cancer Institute-designated cancer center. The analysis included cancer patients aged ≥ 18 years who self-reported current cannabis use (past 30 days) and had visited Sylvester Comprehensive Cancer Center within the past 5 years (N = 226). Data were collected via an anonymous electronic survey on REDCap. Responses on patients' disclosure of cannabis use to cancer doctor/care team and their comfort in discussing cannabis were analyzed. Chi-squared/Fisher's exact tests and t-tests were applied. Logistic regression estimated the associations between age and stage of cancer treatment with patients' comfort in discussing cannabis use with cancer doctor (oncologist). The sample was 51.8% male and 39.4% Hispanic (mean age, 45.9 years (SD = 15.1)); 41.1% were aged 20-39 years, 43.8% were undergoing treatment, and 35.4% were in follow-up/had finished treatment. Over half (50.4%) did not disclose cannabis use to their cancer doctor/care team. Non-disclosers were more often younger (20-39 years) than disclosers (52.6% vs. 29.5%, p < 0.01). Most patients (72.5%) felt comfortable discussing cannabis use with their oncologist; however, younger patients (20-39 years) were more often uncomfortable (40.8%). Logistic regression showed newly diagnosed patients had lower odds (aOR, 0.41; 95% CI, 0.12-0.98) of comfort discussing cannabis compared to those in follow-up/finished treatment. Younger patients (20-39 years) also had lower odds (aOR, 0.11; 95% CI, 0.03-0.40) of feeling comfortable discussing cannabis compared to older patients (≥ 60 years). Age and treatment stage significantly impact the cannabis use disclosure and comfort in discussing it with cancer doctor/care team. These findings underscore the importance of considering age-related factors and treatment status when addressing cannabis use discussions within oncology setting.
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Affiliation(s)
- Amrit Baral
- Division of Epidemiology, Department of Public Health Sciences, University of Miami Miller School of Medicine, 1120 NW 14 Street, Miami, FL, 33136, USA.
- Sylvester Comprehensive Cancer Center, Miami, FL, USA.
- School of Nursing and Health Studies, University of Miami, Coral Gables, FL, USA.
| | - Bria-Necole A Diggs
- Division of Epidemiology, Department of Public Health Sciences, University of Miami Miller School of Medicine, 1120 NW 14 Street, Miami, FL, 33136, USA
- Sylvester Comprehensive Cancer Center, Miami, FL, USA
- School of Nursing and Health Studies, University of Miami, Coral Gables, FL, USA
| | - Anurag Aka
- School of Nursing and Health Studies, University of Miami, Coral Gables, FL, USA
| | - Renessa Williams
- Division of Epidemiology, Department of Public Health Sciences, University of Miami Miller School of Medicine, 1120 NW 14 Street, Miami, FL, 33136, USA
- School of Nursing and Health Studies, University of Miami, Coral Gables, FL, USA
| | | | - Ranya Marrakchi El Fellah
- Sylvester Comprehensive Cancer Center, Miami, FL, USA
- School of Nursing and Health Studies, University of Miami, Coral Gables, FL, USA
| | - Jessica Y Islam
- H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | | | - Frank J Penedo
- Division of Epidemiology, Department of Public Health Sciences, University of Miami Miller School of Medicine, 1120 NW 14 Street, Miami, FL, 33136, USA
- Sylvester Comprehensive Cancer Center, Miami, FL, USA
| | - Denise C Vidot
- Division of Epidemiology, Department of Public Health Sciences, University of Miami Miller School of Medicine, 1120 NW 14 Street, Miami, FL, 33136, USA
- Sylvester Comprehensive Cancer Center, Miami, FL, USA
- School of Nursing and Health Studies, University of Miami, Coral Gables, FL, USA
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Okamura M, Fujimori M, Otsuki A, Saito J, Yaguchi-Saito A, Kuchiba A, Uchitomi Y, Shimazu T. Patients' perceptions of patient-centered communication with healthcare providers and associated factors in Japan - The INFORM Study 2020. PATIENT EDUCATION AND COUNSELING 2024; 122:108170. [PMID: 38308974 DOI: 10.1016/j.pec.2024.108170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Revised: 12/11/2023] [Accepted: 01/21/2024] [Indexed: 02/05/2024]
Abstract
OBJECTIVE To describe patients' perceptions of the patient-centeredness of their communication with healthcare providers in Japan, and to examine factors associated with these perceptions. METHODS We analyzed the cross-sectional data from the INFORM Study 2020, which is a nationwide survey on health information access in Japan. A total of 3605 respondents completed the survey. Our primary outcome was the nine elements of the patient-centered communication scale (PCCS), which was compiled from 2703 respondents (75.0%) reporting at least one provider visit within 12 months. It was rated on a four-point Likert scale: always, usually, sometimes, and never. We used binary logistic regression to examine the association between sociodemographic and health-related variables, and each element of the PCCS. RESULTS For all elements, the percentage of respondents who agreed that their healthcare providers always communicated in a patient-centered way was low (17-31%). Patients with higher age, higher education, poorer general health status and a larger number of visits to providers in the previous 12 months were more likely to have positive perception. CONCLUSION Patient-centered communication as reported in a national sample in Japan was low. CLINICAL IMPLICATIONS Efforts are needed to improve the patient-centeredness of patient-provider communication in Japan to optimize health outcomes.
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Affiliation(s)
- Masako Okamura
- Division of Survivorship, National Cancer Center Institute for Cancer Control, National Cancer Center, Tokyo, Japan
| | - Maiko Fujimori
- Division of Survivorship, National Cancer Center Institute for Cancer Control, National Cancer Center, Tokyo, Japan.
| | - Aki Otsuki
- Division of Behavioral Sciences, National Cancer Center Institute for Cancer Control, National Cancer Center, Tokyo, Japan; Division of Prevention, National Cancer Center Institute for Cancer Control, National Cancer Center, Tokyo, Japan
| | - Junko Saito
- Division of Behavioral Sciences, National Cancer Center Institute for Cancer Control, National Cancer Center, Tokyo, Japan
| | - Akiko Yaguchi-Saito
- Division of Behavioral Sciences, National Cancer Center Institute for Cancer Control, National Cancer Center, Tokyo, Japan; Faculty of Human Sciences, Tokiwa University, Mito, Japan
| | - Aya Kuchiba
- Division of Biostatistical Research, Institution for Cancer Control/ Biostatistics Division, Center for Administration and Support, National Cancer Center, Tokyo, Japan; Graduate School of Health Innovation, Kanagawa University of Human Services, Kawasaki, Japan
| | - Yosuke Uchitomi
- Division of Survivorship, National Cancer Center Institute for Cancer Control, National Cancer Center, Tokyo, Japan
| | - Taichi Shimazu
- Division of Behavioral Sciences, National Cancer Center Institute for Cancer Control, National Cancer Center, Tokyo, Japan.
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Bascom E, Casanova-Perez R, Tobar K, Bedmutha MS, Ramaswamy H, Pratt W, Sabin J, Wood B, Weibel N, Hartzler A. Designing Communication Feedback Systems To Reduce Healthcare Providers' Implicit Biases In Patient Encounters. PROCEEDINGS OF THE SIGCHI CONFERENCE ON HUMAN FACTORS IN COMPUTING SYSTEMS. CHI CONFERENCE 2024; 2024:452. [PMID: 38933286 PMCID: PMC11204363 DOI: 10.1145/3613904.3642756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/28/2024]
Abstract
Healthcare providers' implicit bias, based on patients' physical characteristics and perceived identities, negatively impacts healthcare access, care quality, and outcomes. Feedback tools are needed to help providers identify and learn from their biases. To incorporate providers' perspectives on the most effective ways to present such feedback, we conducted semi-structured design critique sessions with 24 primary care providers. We found that providers seek feedback designed with transparent metrics indicating the quality of their communication with a patient and trends in communication patterns across visits. Based on these metrics and trends, providers want this feedback presented in a dashboard paired with actionable, personalized tips about how to improve their communication behaviors. Our study provides new insights for interactive systems to help mitigate the impact of implicit biases in patient-provider communication. New systems that build upon these insights could support providers in making healthcare more equitable, particularly for patients from marginalized communities.
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Affiliation(s)
- Emily Bascom
- Information School, University of Washington, Seattle, Washington, USA
| | - Reggie Casanova-Perez
- Biomedical Informatics and Medical Education, University of Washington, Seattle, Washington, USA
| | - Kelly Tobar
- University of California, San Diego, San Diego, California, USA
| | | | | | - Wanda Pratt
- Information School, University of Washington, Seattle, Washington, USA
| | - Janice Sabin
- Biomedical Informatics and Medical Education, University of Washington, Seattle, Washington, USA
| | - Brian Wood
- University of Washington, Seattle, Washington, USA
| | - Nadir Weibel
- Computer Science and Engineering & Design Lab, University of California, San Diego, San Diego, California, USA
| | - Andrea Hartzler
- Biomedical Informatics and Medical Education, University of Washington, Seattle, Washington, USA
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Kim JHJ, Kagawa Singer M, Bang L, Ko A, Nguyen B, Chen Stokes S, Lu Q, Stanton AL. Supportive Care Needs in Chinese, Vietnamese, and Korean Americans With Metastatic Cancer: Mixed Methods Protocol for the DAWN Study. JMIR Res Protoc 2024; 13:e50032. [PMID: 38648633 PMCID: PMC11074895 DOI: 10.2196/50032] [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: 12/16/2023] [Revised: 02/06/2024] [Accepted: 03/11/2024] [Indexed: 04/25/2024] Open
Abstract
BACKGROUND Asian Americans with metastatic cancer are an understudied population. The Describing Asian American Well-Being and Needs in Cancer (DAWN) Study was designed to understand the supportive care needs of Chinese-, Vietnamese-, and Korean-descent (CVK) patients with metastatic cancer. OBJECTIVE This study aims to present the DAWN Study protocol involving a primarily qualitative, convergent, mixed methods study from multiple perspectives (patients or survivors, caregivers, and health care professionals). METHODS CVK Americans diagnosed with solid-tumor metastatic cancer and their caregivers were recruited nationwide through various means (registries, community outreach newsletters, newspapers, radio advertisements, etc). Potentially eligible individuals were screened and consented on the web or through a phone interview. The study survey and interview for patients or survivors and caregivers were provided in English, traditional/simplified Chinese and Cantonese/Mandarin, Vietnamese, and Korean, and examined factors related to facing metastatic cancer, including quality of life, cultural values, coping, and cancer-related symptoms. Community-based organizations assisted in recruiting participants, developing and translating study materials, and connecting the team to individuals for conducting interviews in Asian languages. Health care professionals who have experience working with CVK patients or survivors with metastatic solid cancer were recruited through referrals from the DAWN Study community advisory board and were interviewed to understand unmet supportive care needs. RESULTS Recruitment began in November 2020; data collection was completed in October 2022. A total of 66 patients or survivors, 13 caregivers, and 15 health care professionals completed all portions of the study. We completed data management in December 2023 and will submit results for patients or survivors and caregivers to publication outlets in 2024. CONCLUSIONS Future findings related to this protocol will describe and understand the supportive care needs of CVK patients or survivors with metastatic cancer and will help develop culturally appropriate psychosocial interventions that target known predictors of unmet supportive care needs in Chinese, Vietnamese, and Korean Americans with metastatic cancer. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/50032.
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Affiliation(s)
- Jacqueline H J Kim
- Department of Medicine, University of California, Irvine, Irvine, CA, United States
| | - Marjorie Kagawa Singer
- Department of Public Health, University of California, Los Angeles, Los Angeles, CA, United States
| | - Lisa Bang
- Department of Medicine, University of California, Irvine, Irvine, CA, United States
| | - Amy Ko
- Department of Medicine, University of California, Irvine, Irvine, CA, United States
| | - Becky Nguyen
- Vietnamese American Cancer Foundation, Fountain Valley, CA, United States
| | - Sandy Chen Stokes
- Chinese American Coalition for Compassionate Care, Cupertino, CA, United States
| | - Qian Lu
- Department of Health Disparities Research, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Annette L Stanton
- Department of Psychology, University of California, Los Angeles, Los Angeles, CA, United States
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5
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Nogueira LM, May FP, Yabroff KR, Siegel RL. Racial Disparities in Receipt of Guideline-Concordant Care for Early-Onset Colorectal Cancer in the United States. J Clin Oncol 2024; 42:1368-1377. [PMID: 37939323 DOI: 10.1200/jco.23.00539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Revised: 07/27/2023] [Accepted: 09/15/2023] [Indexed: 11/10/2023] Open
Abstract
PURPOSE Young individuals racialized as Black are more likely to die after a colorectal cancer (CRC) diagnosis than individuals racialized as White in the United States. This study examined racial disparities in receipt of timely and guideline-concordant care among individuals racialized as Black and White with early-onset CRC. METHODS Individuals age 18-49 years racialized as non-Hispanic Black and White (self-identified) and newly diagnosed with CRC during 2004-2019 were selected from the National Cancer Database. Patients who received recommended care (staging, surgery, lymph node evaluation, chemotherapy, and radiotherapy) were considered to have received guideline-concordant care. Odds ratios (ORs) were adjusted for age and sex. The decomposition method was used to estimate the relative contribution of demographic characteristics (age and sex), comorbidities, health insurance, and facility type to the racial disparity in receipt of guideline-concordant care. The product-limit method was used to evaluate differences in time to treatment between patients racialized as Black and White. RESULTS Of the 84,882 patients with colon cancer and 62,573 patients with rectal cancer, 20.8% and 14.5% were racialized as Black, respectively. Individuals racialized as Black were more likely to not receive guideline-concordant care for colon (adjusted OR [aOR], 1.18 [95% CI, 1.14 to 1.22]) and rectal (aOR, 1.27 [95% CI, 1.21 to 1.33]) cancers. Health insurance explained 28.2% and 21.6% of the disparity among patients with colon and rectal cancer, respectively. Individuals racialized as Black had increased time to adjuvant chemotherapy for colon cancer (hazard ratio [HR], 1.28 [95% CI, 1.24 to 1.32]) and neoadjuvant chemoradiation for rectal cancer (HR, 1.42 [95% CI, 1.37 to 1.47]) compared with individuals racialized as White. CONCLUSION Patients with early-onset CRC racialized as Black receive worse and less timely care than individuals racialized as White. Health insurance, a modifiable factor, was the largest contributor to racial disparities in receipt of guideline-concordant care in this study.
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Affiliation(s)
- Leticia M Nogueira
- Surveillance and Health Equity Science, American Cancer Society, Atlanta, GA
| | - Folasade P May
- Department of Medicine, Vatche and Tamar Manoukian Division of Digestive Diseases, UCLA Kaiser Permanente Center for Health Equity, UCLA, Los Angeles, CA
| | - K Robin Yabroff
- Surveillance and Health Equity Science, American Cancer Society, Atlanta, GA
| | - Rebecca L Siegel
- Surveillance and Health Equity Science, American Cancer Society, Atlanta, GA
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6
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Tetteh DA, Dai Z. Making Sense of Gynecologic Cancer: A Relational Dialectics Approach. HEALTH COMMUNICATION 2024:1-13. [PMID: 38528375 DOI: 10.1080/10410236.2024.2333112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/27/2024]
Abstract
This study used the relational dialectics theory (RDT) as a theoretical lens to examine how the interplay of competing discourses shaped meaning making about gynecologic cancer. A reflexive thematic analysis of the narratives of 12 survivors of cervical cancer, ovarian cancer, and uterine cancer in Arkansas showed two discursive struggles at play, including continuity of care versus change, and voicing versus repressing of feelings. The findings showed that long history of care with physicians contributed to how participants privileged the discourse of continuity of care when faced with a decision to travel for care or receive care locally. We also found that cultural discourses about concealing women's cancer-afflicted bodies, lack of supportive spaces for women to discuss side effects of cancer treatments, and appropriate communication behavior between patients and physicians shaped the interplay of the discursive struggle of voicing versus repressing. The findings extend the RDT by showing that geographic location, disease characteristics, history of care between patients and physicians, and prevailing cultural discourses can contribute to the interplay of discursive struggles in the gynecologic cancer context. Further, the findings suggest to healthcare professionals to address harmful discourses about gynecologic cancer to help create support avenues for survivors.
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Affiliation(s)
| | - Zehui Dai
- School of Communication, Radford University
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7
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Aydın A, Savaş EH, Bingöl H, Kebudi R. Taboo words in pediatric oncology: Communication experiences of nurses and physicians with dying children and their families. Eur J Oncol Nurs 2024; 68:102466. [PMID: 38101245 DOI: 10.1016/j.ejon.2023.102466] [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: 05/09/2023] [Revised: 10/31/2023] [Accepted: 11/08/2023] [Indexed: 12/17/2023]
Abstract
PURPOSE Despite the numerous benefits of effective communication between patients, families, and healthcare professionals, there are still substantial barriers and communication challenges. This study investigated the experiences of nurses and doctors working in different pediatric hematology-oncology units in Turkey communicating with children and their parents about end-of-life issues. METHOD This qualitative study was conducted with twenty-four physicians and nurses. A descriptive phenomenological approach was used. Data were analyzed using Braun and Clarke's six-step reflexive thematic analysis. The MAXQDA software was used to facilitate data management. RESULTS The findings revealed three main themes describing end-of-life communication experiences of physicians and nurses: Avoiding communication with a dying child, Everyone knows but nobody talks, and Complicating aspects of the setting. CONCLUSIONS Communication with dying children and their families is essential. However, multiple barriers remain for healthcare providers to do so. That issue burdens the child and their family more during the end-of-life, which is already a challenging experience to handle. Healthcare professionals need urgent training in communication with the dying children and their families.
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Affiliation(s)
- Ayfer Aydın
- School of Nursing, Istanbul University, Istanbul, Turkey
| | | | - Hülya Bingöl
- Istanbul University, Oncology Institute, Istanbul, Turkey
| | - Rejin Kebudi
- Istanbul University, Oncology Institute, Istanbul, Turkey
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8
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Naamneh-Abuelhija B, Yogev-Seligmann G, Kafri M. Does affiliation with a minority group affect patient activation? PATIENT EDUCATION AND COUNSELING 2024; 118:108011. [PMID: 37866072 DOI: 10.1016/j.pec.2023.108011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Revised: 09/04/2023] [Accepted: 10/05/2023] [Indexed: 10/24/2023]
Abstract
OBJECTIVE To systematically review published studies assessing associations between ethnicity and patient activation (PA) among people with chronic conditions. METHODS A systematic review (PROSPERO-CRD42022320793) was performed by searching in PubMed, CINAHL, Scopus, and Google Scholar. Studies were included according to the following criteria: age > 18, diagnosis of at least one chronic condition, assessment of PA, report of ethnic minority group, and statistical analyses of PA scores include between-group comparisons or correlation or regression with ethnic group affiliation. Two reviewers conducted independent screening of records and full-text articles published until July 2021. Quality was evaluated using the National Institutes of Health study quality assessment tool. RESULTS From 197 records identified, 12 studies were included. The majority of studies focused on participants of White, Black and Hispanic ethnicity. Seven studies establish a significant association between ethnicity and PA, while the remainder of the studies found no association or inconclusive results. CONCLUSIONS The findings indicate that ethnicity is related to PA although additional, multiple explanatory variables other than ethnicity to PA were identified. Practice implications Programs to promote PA should be adjusted to participants' ethnic affiliation but consider differences in the barriers to PA and their magnitude that may differ across different ethnicities.
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Affiliation(s)
- Badera Naamneh-Abuelhija
- Department of Occupational Therapy, Faculty of Social Welfare & Health Sciences, University of Haifa, Mount Carmel, Haifa 3498838, Israel
| | - Galit Yogev-Seligmann
- Department of Occupational Therapy, Faculty of Social Welfare & Health Sciences, University of Haifa, Mount Carmel, Haifa 3498838, Israel
| | - Michal Kafri
- Department of Physical Therapy, Faculty of Social Welfare & Health Sciences, University of Haifa, Mount Carmel, Haifa 3498838, Israel.
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Wang JHY, Brown RL, Huang E, Schwartz MD. Mediational roles of stress-coping factors in the relationship between patient-perceived communication quality and physical functioning: racial difference between Chinese and Non-Hispanic White American breast cancer survivors. Qual Life Res 2024; 33:253-265. [PMID: 37589772 DOI: 10.1007/s11136-023-03501-2] [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] [Accepted: 07/30/2023] [Indexed: 08/18/2023]
Abstract
PURPOSE The assumption that patient-provider communication may mediate patients' sense of control over cancer to affect health outcomes has limited evidence. This study examines whether patient-perceived cancer care communication quality (PPCQ) mediates stress appraisal and coping behavior, affecting physical functioning across different racial groups. METHODS Two hundred and twenty Chinese American and 216 non-Hispanic White (NHW) women (ages 28-80) with stage 0-III breast cancer, 1-5 years post-diagnosis, and without recurrence, enrolled and completed a cross-sectional telephone survey. Physical functioning was measured by the NIH-PROMIS short form. Validated measures of PPCQ, patients' evaluation of their socioeconomic well-being, stress appraisal (perceived severity and control), use of coping strategies, treatment-related symptoms, and comorbidities were also assessed. Path analyses were used to examine the mediation for each racial group. RESULTS Regardless of race, treatment-related symptoms, comorbidities, and socioeconomic well-being were all directly related to physical functioning (p < 0.05). The impact of PPCQ on physical functioning was mediated by perceived control in the Chinese American group (p < 0.05), but not in the NHW group. Perceived severity and coping were not mediators of physical functioning in either group. CONCLUSIONS The mediational pathway from PPCQ to perceived control to physical functioning in Chinese American survivors may be partially explained by their lower socioeconomic well-being and culturally valued conformity to physicians as a medical authority. These sociocultural dynamics reinforce the importance of cancer care communication. For NHW survivors, the impact of treatment-related symptoms and socioeconomic well-being on physical functioning outweighed their PPCQ and perceived control.
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Affiliation(s)
- Judy Huei-Yu Wang
- Department of Oncology, Cancer Prevention and Control Program, Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, 2115 Wisconsin Avenue, N.W., Suite 300, Washington, DC, 20007, USA.
| | - Roger L Brown
- School of Medicine, Nursing and Public Health, University of Wisconsin-Madison, Madison, WI, USA
| | - Ellen Huang
- Department of Oncology, Cancer Prevention and Control Program, Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, 2115 Wisconsin Avenue, N.W., Suite 300, Washington, DC, 20007, USA
| | - Marc D Schwartz
- Department of Oncology, Cancer Prevention and Control Program, Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, 2115 Wisconsin Avenue, N.W., Suite 300, Washington, DC, 20007, USA
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Robison J, Shugrue N, Dillon E, Migneault D, Charles D, Wakefield D, Richards B. Racial and Ethnic Differences in Hospice Use Among Medicaid-Only and Dual-Eligible Decedents. JAMA HEALTH FORUM 2023; 4:e234240. [PMID: 38064239 PMCID: PMC10709774 DOI: 10.1001/jamahealthforum.2023.4240] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Accepted: 10/03/2023] [Indexed: 12/18/2023] Open
Abstract
Importance Hospice care enhances quality of life for people with terminal illness and is most beneficial with longer length of stay (LOS). Most hospice research focuses on the Medicare-insured population. Little is known about hospice use for the racially and ethnically diverse, low-income Medicaid population. Objective To compare hospice use and hospice LOS by race and ethnicity among Medicaid-only individuals and those with dual eligibility for Medicare and Medicaid (duals) in the Connecticut Medicaid program who died over a 4-year period. Design, Setting, and Participants This retrospective population-based cohort study used Medicaid and traditional Medicare enrollment and claims data for 2015 to 2020. The study included Connecticut Medicaid recipients with at least 1 of 5 most common hospice diagnoses who died from 2017 to 2020. Exposure Race and ethnicity. Main Outcomes and Measures Hospice use (yes/no) and hospice LOS (1-7 days vs ≥8 days.) Covariates included sex, age, and nursing facility stay within 60 days of death. Results Overall, 2407 and 23 857 duals were included. Medicaid-only decedents were younger (13.8% ≥85 vs 52.5%), more likely to be male (50.6% vs 36.4%), more racially and ethnically diverse (48.7% non-Hispanic White vs 79.9%), and less likely to have a nursing facility stay (34.9% vs 56.1%). Race and ethnicity were significantly associated with hospice use and LOS in both populations: non-Hispanic Black and Hispanic decedents had lower odds of using hospice than non-Hispanic White decedents, and Hispanic decedents had higher odds of a short LOS. In both populations, older age and female sex were also associated with more hospice use. For duals only, higher age was associated with lower odds of short LOS. For decedents with nursing facility stays, compared with those without, Medicaid-only decedents had higher odds of using hospice (odds ratio [OR], 1.49; 95% CI, 1.24-1.78); duals had lower odds (OR, 0.60; 95% CI, 0.57-0.63). Compared with decedents without nursing facility stays, duals with a nursing facility stay had higher odds of short LOS (OR, 2.63; 95% CI, 2.43-2.85). Conclusions and Relevance Findings raise concerns about equity and timing of access to hospice for Hispanic and non-Hispanic Black individuals in these understudied Medicaid populations. Knowledge about, access to, and acceptance of hospice may be lacking for these low-income individuals. Further research is needed to understand barriers to and facilitators of hospice use for people with nursing facility stays.
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Affiliation(s)
- Julie Robison
- UConn Health, Center on Aging, Farmington, Connecticut
| | | | - Ellis Dillon
- UConn Health, Center on Aging, Farmington, Connecticut
| | | | | | | | - Bradley Richards
- Connecticut Department of Social Services, Hartford, Connecticut
- Yale School of Medicine, New Haven, Connecticut
- Yale School of Management, New Haven, Connecticut
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11
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Torres TK, Hamann HA, Shen M, Stone J. Empathic Communication and Implicit Bias in the Context of Cancer Among a Medical Student Sample. HEALTH COMMUNICATION 2023:1-12. [PMID: 37906434 PMCID: PMC11058116 DOI: 10.1080/10410236.2023.2272359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/02/2023]
Abstract
Oncology clinicians often miss opportunities to communicate empathy to patients. The current study examined the relationship between implicit bias (based on cancer type and ethnicity) and medical students' empathic communication in encounters with standardized patients who presented as Hispanic (lung or colorectal) individuals diagnosed with cancer. Participants (101 medical students) completed the Implicit Association Test (IAT) to measure implicit bias based on cancer type (lung v. colorectal) and ethnicity (Hispanic v. non-Hispanic White). Empathic opportunities and responses (assessed by the Empathic Communication Coding System; ECCS) were evaluated in a mock consultation (Objective Structured Clinical Examination; OSCE) focused on smoking cessation in the context of cancer. Among the 241 empathic opportunities identified across the 101 encounters (M = 2.4), 158 (65.6%) received high empathy responses from the medical students. High empathy responses were most frequently used during challenge (73.2%) and emotion (77.3%) opportunities compared to progress (45.9%) opportunities. Higher levels of implicit bias against Hispanics predicted lower odds of an empathic response from the medical student (OR = 3.24, p = .04, 95% CI = 0.09-0.95). Further work is needed to understand the relationship between implicit bias and empathic communication and inform the development of interventions.
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Affiliation(s)
- Tara K. Torres
- Department of Psychology, University of Arizona, Tucson, AZ
| | - Heidi A. Hamann
- Department of Psychology, University of Arizona, Tucson, AZ
- University of Arizona Cancer Center, Tucson, AZ
| | - Megan Shen
- Fred Hutchinson Cancer Research Institute, Seattle, WA
| | - Jeff Stone
- Department of Psychology, University of Arizona, Tucson, AZ
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Canavan M, Wang X, Ascha M, Miksad R, Showalter TN, Calip G, Gross CP, Adelson K. End-of-Life Systemic Oncologic Treatment in the Immunotherapy Era: The Role of Race, Insurance, and Practice Setting. J Clin Oncol 2023; 41:4729-4738. [PMID: 37339389 PMCID: PMC10602547 DOI: 10.1200/jco.22.02180] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Revised: 02/15/2023] [Accepted: 04/25/2023] [Indexed: 06/22/2023] Open
Abstract
PURPOSE Receipt of antineoplastic systemic treatment near end of life (EOL) has been shown to harm patient and caregiver experience, increase hospitalizations, intensive care unit and emergency department use, and drive-up costs; yet, these rates have not declined. To understand factors contributing to use of antineoplastic EOL systemic treatment, we explored its association with practice- and patient-level factors. METHODS We included patients from a real-world electronic health record-derived deidentified database who received systemic therapy for advanced or metastatic cancer diagnosed starting in 2011 and died within 4 years between 2015 and 2019. We assessed use of EOL systemic treatment at 30 and 14 days before death. We divided treatments into three subcategories: chemotherapy alone, chemotherapy and immunotherapy in combination, and immunotherapy (with/without targeted therapy), and estimated conditional odds ratios (ORs) and 95% CIs for patient and practice factors using multivariable mixed-level logistic regression. RESULTS Among 57,791 patients from 150 practices, 19,837 received systemic treatment within 30 days of death. We observed 36.6% of White patients, 32.7% of Black patients, 43.3% of commercially insured patients, and 37.0% of Medicaid patients received EOL systemic treatment. White patients and those with commercial insurance were more likely to receive EOL systemic treatment than Black patients or those with Medicaid. Treatment at community practices was associated with higher odds of receiving 30-day systemic EOL treatment than treatment at academic centers (adjusted OR, 1.51). We observed large variations in EOL systemic treatment rates across practices. CONCLUSION In a large real-world population, EOL systemic treatment rates were related to patient race, insurance type, and practice setting. Future work should examine factors that contribute to this usage pattern and its impact on downstream care. [Media: see text].
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Affiliation(s)
| | | | | | - Rebecca Miksad
- Flatiron Health, Inc, New York, NY
- Department of Hematology and Oncology, Boston Medical Center, Boston, MA
| | | | - Gregory Calip
- Flatiron Health, Inc, New York, NY
- Program on Medicines and Public Health, Titus Family Department of Clinical Pharmacy, University of Southern California School of Pharmacy, Los Angeles, CA
| | | | - Kerin Adelson
- Yale School of Medicine, New Haven, CT
- MD Anderson Cancer Center, University of Texas, Houston, TX
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13
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Sanders JJ, Durieux BN, Cannady K, Johnson KS, Ford DW, Block SD, Paladino J, Sterba KR. Acceptability of a Serious Illness Conversation Guide to Black Americans: Results from a focus group and oncology pilot study. Palliat Support Care 2023; 21:788-797. [PMID: 36184937 DOI: 10.1017/s1478951522001298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVES Serious illness conversations (SICs) can improve the experience and well-being of patients with advanced cancer. A structured Serious Illness Conversation Guide (SICG) has been shown to improve oncology patient outcomes but was developed and tested in a predominantly White population. To help address disparities in advanced cancer care, we aimed to assess the acceptability of the SICG among African Americans with advanced cancer and their clinicians. METHODS A two-phase study conducted in Charleston, SC, included focus groups to gather perspectives on the SICG in Black Americans and a single-arm pilot study of a revised SICG with surveys and qualitative exit interviews to evaluate patient and clinician perspectives. We used descriptive analysis of survey results and thematic analysis of qualitative data. RESULTS Community-based and patient focus group participants (N = 20) reported that a simulated conversation using an adapted SICG built connection, promoted control, and fostered consideration of religious faith and family. Black patients with advanced cancer (N = 23) reported that SICG-guided conversations were acceptable, helpful, and promoted conversations with loved ones. Oncologists found conversations feasible to implement and skill-building, and also identified opportunities for training and implementation that could support meeting the needs of their patients with low health literacy. An adapted SICG includes language to assess the strength and affirm the clinician-patient relationship. SIGNIFICANCE OF RESULTS An adapted structured communication tool to facilitate SIC, the SICG, appears acceptable to Black Americans with advanced cancer and seems feasible for use by oncology clinicians working with this population. Further testing in other marginalized populations may address disparities in advanced cancer care.
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Affiliation(s)
- Justin J Sanders
- Department of Family Medicine, McGill University, Montreal, QC, Canada
- Ariadne Labs, Boston, MA, USA
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Brigitte N Durieux
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Kimberly Cannady
- Department of Medicine (Ford) Department of Public Health Sciences (Cannady and Sterba), Medical University of South Carolina, Charleston, SC, USA
| | - Kimberly S Johnson
- Department of Medicine, Division of Geriatrics, Duke University School of Medicine, Durham, NC, USA
- Geriatrics Research Education and Clinical Center, Durham Veterans Affairs Medical Center, Durham, NC, USA
| | - Dee W Ford
- Department of Medicine (Ford) Department of Public Health Sciences (Cannady and Sterba), Medical University of South Carolina, Charleston, SC, USA
| | - Susan D Block
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Joanna Paladino
- Ariadne Labs, Boston, MA, USA
- Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Katherine R Sterba
- Department of Medicine (Ford) Department of Public Health Sciences (Cannady and Sterba), Medical University of South Carolina, Charleston, SC, USA
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14
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Wang Y, Zhang Q, Wang X, Yan D, Yin J, Zhuang S, Qiang W. Current status and influencing factors of participating satisfaction during surgical treatment decision-making among breast cancer patients with immediate breast reconstruction. Eur J Oncol Nurs 2023; 66:102402. [PMID: 37738841 DOI: 10.1016/j.ejon.2023.102402] [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: 05/31/2023] [Accepted: 07/22/2023] [Indexed: 09/24/2023]
Abstract
OBJECTIVE Breast reconstruction (BR) is a positive contribution to aesthetic effect among breast cancer patients. Identification of influenced factors for participating satisfaction may provide insights on the decision-making theory to promote patient's autonomy in surgical choice. The purpose of this study was to examine the level of participating satisfaction with surgical treatment decision-making and its predictors among breast cancer patients with immediate BR. METHODS A cross-sectional study was conducted including 163 breast cancer patients with immediate BR in Mainland China. Data was collected using patients' participation satisfaction in medical decision-making scale (PSMDS), Big five Short-Form (BFI) Scale, Patient Participation Competence Scale(PPCS) and Patients' Preference (MPP) scale. Descriptive, bivariate, and multivariate regression analyses were used. RESULTS Scores of PSMD were 86.38 ± 15.74. Multiple regression analyses indicated autonomous decision-making, marital statue, information acquisition competence, agreeableness, and decision-making preferences as indicators, explaining 29.6% of the response variation (P < 0.05). CONCLUSIONS The level of PSMD in breast cancer patients with immediate BR need to be improved. Patients with greater autonomous decision-making, married, higher information acquisition competence, agreeableness, and collaborative role are more likely to have an preferable PSMD. A comprehensive assessment and effective decision-making support are needed initially for BC patients to promote positive participation when making surgical decision.
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Affiliation(s)
- Yan Wang
- Department of Breast Oncoplastic Surgery, Tianjin Medical University Cancer Institute & Hospital, National Clinical Research Center for Cancer, Tianjin's Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin, 300060, China
| | - Qingyue Zhang
- Department of Breast Oncoplastic Surgery, Tianjin Medical University Cancer Institute & Hospital, National Clinical Research Center for Cancer, Tianjin's Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin, 300060, China
| | - Xiaoyuan Wang
- Department of Breast Oncoplastic Surgery, Tianjin Medical University Cancer Institute & Hospital, National Clinical Research Center for Cancer, Tianjin's Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin, 300060, China
| | - Di Yan
- Department of Breast Oncoplastic Surgery, Tianjin Medical University Cancer Institute & Hospital, National Clinical Research Center for Cancer, Tianjin's Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin, 300060, China
| | - Jian Yin
- Department of Breast Oncoplastic Surgery, Tianjin Medical University Cancer Institute & Hospital, National Clinical Research Center for Cancer, Tianjin's Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin, 300060, China
| | | | - Wanmin Qiang
- Department of Breast Oncoplastic Surgery, Tianjin Medical University Cancer Institute & Hospital, National Clinical Research Center for Cancer, Tianjin's Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin, 300060, China.
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15
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Sardessai-Nadkarni AA, Street RL. Understanding the pathways linking patient-centered communication to cancer survivors' emotional health: examining the mediating roles of self-efficacy and cognitive reappraisal. J Cancer Surviv 2023; 17:1266-1275. [PMID: 35167049 DOI: 10.1007/s11764-022-01170-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Accepted: 01/10/2022] [Indexed: 12/30/2022]
Abstract
PURPOSE Many cancer survivors commonly face psychological health issues upon cancer diagnosis, both during and after treatment. Patient-centered communication can play an important role in improving health outcomes among cancer survivors across the cancer continuum. The current study examined the influence of patient-centered communication on self-efficacy in managing health, cognitive reappraisal, and emotional distress among cancer survivors. METHODS The analysis was conducted on a subsample of 809 cancer survivors acquired from a nationally representative 2019 Health Information National Trends Survey 5 (Cycle 3). Multivariate regression analysis was conducted to explore the pathways through which patient-centered communication can be associated with cancer survivors' emotional distress, mediated by self-efficacy and cognitive reappraisal. RESULTS The results indicated that effective patient-centered provider communication led to higher self-efficacy in managing health, greater involvement in cognitive reappraisal, and decreased emotional distress among cancer survivors. Additionally, the results revealed that the effect of patient-centered communication that led to decreased emotional distress was fully mediated through self-efficacy and cognitive reappraisal. CONCLUSIONS Although patient-centered communication positively relates to various emotional health outcomes among cancer survivors, it does not affect their emotional health directly. Self-efficacy and cognitive reappraisal play a crucial role in explaining the underlying mechanisms of such effects. IMPLICATIONS FOR CANCER SURVIVORS Future interventions to promote patient-centered communication in cancer care should give more emphasis to managing patients' emotions. Providers should not only recognize, elicit, and respond to patient's emotions, but also develop emotional regulation skills among patients, and improve their ability to cope with emotional distress.
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Affiliation(s)
| | - Richard L Street
- Department of Communication, Texas A&M University, College Station, TX, USA
- Department of Medicine, Baylor College of Medicine, Houston, TX, USA
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16
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Tsai W, Wang JHY. Fatalism and Psychological Distress Among Chinese American Breast Cancer Survivors: Mediating Role of Perceived Self-control and Fear of Cancer Recurrence. Int J Behav Med 2023; 30:705-713. [PMID: 36333553 PMCID: PMC10494707 DOI: 10.1007/s12529-022-10136-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/08/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND Extant literature on the relationship between cancer fatalism and psychological distress among Chinese American breast cancer survivors has been mixed, and few studies have examined potential mediators of this relationship. The current study examined how cancer fatalism is associated with psychological distress by investigating perceived personal control and fear of cancer recurrence as mediators, and acculturation as a moderator of these relationships. METHOD A total of 220 Chinese American women diagnosed with stage 0-III breast cancer were recruited from California cancer registries and completed a telephone survey. The measurement of cancer fatalism examined one's view of health as a result of destiny. Validated measures of psychological distress (i.e., depressive and anxiety symptoms), fear of cancer recurrence, and perceived personal control were used. Acculturation was defined by English proficiency, preferred interview language, and number of years lived in the USA. RESULTS Higher cancer fatalism was directly associated with greater depressive and anxiety symptoms after controlling for covariates. This association was also mediated by higher fear of cancer recurrence, but not by perceived control. The mediation was not moderated by acculturation. CONCLUSION Our findings suggest that Chinese American breast cancer survivors' fatalistic beliefs may exacerbate fear of cancer recurrence, and, in turn, depressive and anxiety symptoms. Fear of recurrence was more salient than perceived control in their associations with psychological distress among Chinese American cancer survivors. Future intervention research may adopt cognitive approaches to alter Chinese survivors' fatalistic views of health outcomes to reduce their psychological distress.
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Affiliation(s)
- William Tsai
- Department of Applied Psychology, New York University, New York City, USA
| | - Judy Huei-Yu Wang
- Department of Oncology, Lombardi Comprehensive Cancer Center, Cancer Prevention and Control Program, Georgetown University, 2115 Wisconsin Ave. Suite 300 DC, N.W., 20007, Washington, USA.
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17
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Oh KM, An K, Lee M, Shin C, Steves SL. Colorectal cancer screening disparities in Asian Americans: the influences of patient-provider communication and social media use. Cancer Causes Control 2023:10.1007/s10552-023-01720-z. [PMID: 37266764 PMCID: PMC10237058 DOI: 10.1007/s10552-023-01720-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2022] [Accepted: 05/16/2023] [Indexed: 06/03/2023]
Abstract
PURPOSE We examined the role of patient-provider communication (PPC) during in-person visits and via electronic communication and social media use on colorectal cancer (CRC) screening among Asian Americans (AAs) and Non-Hispanic Whites (NHWs) aged 50 and older. METHODS Health Information National Trends Survey 2017-2020 data were analyzed. RESULTS AAs tended to evaluate the quality of PPC during their in-person visits to a health care provider lower than NHWs. AAs' CRC screening rate was lower than the rate of NHWs (78.8% vs. 84.4%). After adjusting for sociodemographics, healthcare access, and health status, the quality of PPC was the only significant predictor associated with a lower probability of CRC screening among AAs (Adjusted OR 0.74; 95% CI 0.56, 0.96); while the Internet to communicate with a health care provider was the only significant predictor of CRC screening among NHWs (Adjusted OR 1.76; CI 1.11, 2.79). AAs were more likely to use YouTube to watch a health-related video than NHWs (43.5% vs, 24%). However, social media use was not associated with CRC screening in both AAs and NHWs. CONCLUSION Use of electronic communication technology may contribute to improve health information literacy and reduce the disparity. On-line communication may empower the culturally and linguistically diverse AAs by improving their confidence in communication with health care providers. Thus, communication technologies need to be strategically utilized and tailored to better meet the communication needs of racial/ethnic minorities. Online communication technologies may reduce the disparities in PPC related to cancer screening and cancer burden experienced by AAs.
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Affiliation(s)
- Kyeung Mi Oh
- School of Nursing, George Mason University, Fairfax, VA, USA.
| | - Kyungeh An
- Graduate School of Biomedical Sciences & School of Nursing, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Moonju Lee
- School of Nursing, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Chanam Shin
- College of Nursing, Texas Woman's University, Denton, TX, USA
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18
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Pawloski KR, Srour MK, Moo TA, Sevilimedu V, Nelson JA, Garcia P, Kirstein LJ, Morrow M, Tadros AB. Timing of Chemotherapy and Patient-Reported Outcomes After Breast-Conserving Surgery and Mastectomy with Immediate Reconstruction. Ann Surg Oncol 2023; 30:2897-2909. [PMID: 36737530 PMCID: PMC11110643 DOI: 10.1245/s10434-023-13148-5] [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: 10/20/2022] [Accepted: 01/09/2023] [Indexed: 02/05/2023]
Abstract
INTRODUCTION Receipt of chemotherapy is associated with decreased satisfaction after breast surgery, but whether timing as adjuvant versus neoadjuvant (NAC) affects patient-reported outcomes (PROs) is unclear. We examined associations between chemotherapy timing and PROs after breast-conserving surgery (BCS) and mastectomy with immediate reconstruction (M-IR). METHODS In this retrospective cohort study of patients with stage I-III breast cancer undergoing chemotherapy between January 2017 and December 2019, we compared satisfaction with breasts (SABTR) and chest physical well-being (PWB-CHEST) between chemotherapy groups in BCS and M-IR cohorts. Median SABTR and PWB-CHEST scores (scale 0-100) were compared between chemotherapy groups at baseline and for 3 years postoperatively. Factors associated with SABTR and PWB-CHEST at 1 and 2 years were assessed with multivariable linear regression. RESULTS Overall, 640 patients had BCS and 602 had M-IR; 210 (33%) BCS patients and 294 (49%) M-IR patients had NAC. Following BCS, SABTR was higher than baseline at all postoperative timepoints, whereas 3-year SABTR remained similar to baseline following M-IR, independent of chemotherapy timing. In both surgical cohorts, PWB-CHEST was lowest after NAC at 6 months compared with baseline but was similar to adjuvant counterparts by 3 years. NAC was not a statistically significant predictor of SABTR or PWB-CHEST in either surgical cohort on multivariable analysis. CONCLUSIONS For patients with breast cancer who require chemotherapy, neoadjuvant versus adjuvant timing does not impact long-term PROs in this study. These findings may inform shared decision making regarding the sequence of treatment in patients with operable disease.
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Affiliation(s)
- Kate R Pawloski
- Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Marissa K Srour
- Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Tracy-Ann Moo
- Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Varadan Sevilimedu
- Biostatistics Service, Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Jonas A Nelson
- Plastic and Reconstructive Surgical Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Paula Garcia
- Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Laurie J Kirstein
- Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Monica Morrow
- Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Audree B Tadros
- Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
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19
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Davis-Ajami ML, Lu ZK, Wu J. US Older Adults with Multiple Chronic Conditions Perceptions of Provider-Patient Communication: Trends and Racial Disparities from MEPS 2013-2019. J Gen Intern Med 2023; 38:1459-1467. [PMID: 36352202 PMCID: PMC10160303 DOI: 10.1007/s11606-022-07899-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Accepted: 10/26/2022] [Indexed: 11/10/2022]
Abstract
BACKGROUND Multiple chronic conditions (MCC) require complex patient-centered approaches with effective provider-patient communication. OBJECTIVE To describe trends in patient perceptions of provider-patient communication during non-emergency care and identify associated racial disparities in US older adults with MCC. DESIGN, SETTING, PARTICIPANTS Observational study using pooled US Medical Expenditure Panel Survey (2013-2019) data included adults > 65 with two or more chronic conditions. MAIN MEASURES Provider-patient communication was measured by four indicators (how often their doctor explained things clearly, listened carefully, showed respect, and spent enough time with them). The primary outcomes were the annual rates of reporting "always" for the communication indicators. Cochran-Armitage trend tests examined the trends of reporting "always" and associated racial disparities. Multivariable logistic regression identified racial and other factors associated with respondents choosing "always" for one or more categories for provider-patient communication, defined as positive communication. RESULTS Among 9758 older adults with MCC, declining trends for positive communication were shown across all provider-patient communication categories during 2013 to 2019 (p<0.001). The greatest decrease occurred in "always listening carefully", from 68.6% in 2013 to 59.1% in 2019 (p<0.001). The declining trends of four communication measures in non-Hispanic Whites with MCC were significant (p<0.001). Older adults from Hispanic or Non-Hispanic Black racial backgrounds were 28 to 51% more likely to report "always" for the four indicators of provider-patient communication than non-Hispanic Whites after adjusting for respondents' characteristics. CONCLUSION The rates of "always" reporting positive communication with providers significantly declined from 2013 to 2019 in older adults with MCC, particularly in non-Hispanic Whites. Hispanics and non-Hispanic Blacks were more likely to report positive communication with providers than other races.
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Affiliation(s)
| | - Zhiqiang K Lu
- University of South Carolina College of Pharmacy, Columbia, SC, USA
| | - Jun Wu
- Presbyterian College School of Pharmacy, Clinton, SC, USA.
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20
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Iguina MM, Danyalian AM, Luque I, Shaikh U, Kashan SB, Morgan D, Heller D, Danckers M. Characteristics, ICU Interventions, and Clinical Outcomes of Patients With Palliative Care Triggers in a Mixed Community-Based Intensive Care Unit. J Palliat Care 2023; 38:126-134. [PMID: 36632687 DOI: 10.1177/08258597221145326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Objective: Integration of palliative care initiatives in the intensive care unit (ICU) benefit patients and improve outcomes. Palliative care triggers (PCTs) is a screening tool that aides in stratifying patients who would benefit most from an early palliative care approach. There is no consensus on PCT selection or best timing for implementation. We evaluated the clinical characteristics, ICU and palliative care interventions, and clinical outcomes of critically ill patients with PCT in a community-based mixed ICU. Methods: This retrospective study was conducted in a 44-bed adult, mixed ICU in a 407-bed community-based teaching hospital in Florida. Eleven PCTs were used as a screening tool during multidisciplinary rounds (MDRs). Patients were analyzed based on presence or absence of PCT as well as having met high (>2) versus low (<2) PCT. Data collected included patient demographics, ICU resource utilization and clinical outcomes. We considered a two-sided P value of less than .05 to indicate statistical significance with a 95% confidence interval. Results: Of 388 ICU patients, 189 (48.7%) met at least 1 PCT and 199 (51.3%) did not. The trigger group had higher Acute Physiology and Chronic Evaluation (APACHE) and Sequential Organ Failure Assessment (SOFA) scores within 24 h of ICU admission. The most common PCTs identified were ICU length of stay greater than 7 days or readmission to ICU, terminal prognosis and assisting family in transitioning goals of care. There were statistically significant differences in ICU resource utilization, palliative care interventions, and overall worse clinical outcomes in the trigger-detected group. Similar findings were seen in the cohort with high PCT (>2). Conclusions: Our study supports the implementation of a tailored 11-item palliative care screening tool to effectively identify ICU patients with high ICU and palliative care interventions and worse clinical outcomes.
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Affiliation(s)
- Michele M Iguina
- Department of Medicine, HCA Florida Aventura Hospital, Aventura, FL, USA
- Division of Critical Care, HCA Florida Aventura Hospital, Aventura, FL, USA
| | - Aunie M Danyalian
- Department of Medicine, HCA Florida Aventura Hospital, Aventura, FL, USA
- Division of Critical Care, HCA Florida Aventura Hospital, Aventura, FL, USA
| | - Ilko Luque
- Research Department, Graduate Medical Education, HCA East Florida Division, 23686Aventura Hospital and Medical Center, Aventura, FL, USA
| | - Umair Shaikh
- Department of Medicine, Piedmont Eastside Medical Center, Snellville, GA, USA
| | - Sanaz B Kashan
- Department of Medicine, HCA Florida Aventura Hospital, Aventura, FL, USA
| | - Dionne Morgan
- Department of Medicine, HCA Florida Aventura Hospital, Aventura, FL, USA
- Division of Critical Care, HCA Florida Aventura Hospital, Aventura, FL, USA
| | - Daniel Heller
- Department of Medicine, HCA Florida Aventura Hospital, Aventura, FL, USA
- Division of Critical Care, HCA Florida Aventura Hospital, Aventura, FL, USA
| | - Mauricio Danckers
- Department of Medicine, HCA Florida Aventura Hospital, Aventura, FL, USA
- Division of Critical Care, HCA Florida Aventura Hospital, Aventura, FL, USA
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21
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Turner K, Brownstein NC, Whiting J, Arevalo M, Vadaparampil S, Giuliano AR, Islam JY, Meade CD, Gwede CK, Kasting ML, Head KJ, Christy SM. Impact of the COVID-19 pandemic on human papillomavirus (HPV) vaccination among a national sample of United States adults ages 18-45: A cross-sectional study. Prev Med Rep 2023; 31:102067. [PMID: 36439896 PMCID: PMC9677560 DOI: 10.1016/j.pmedr.2022.102067] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Revised: 10/24/2022] [Accepted: 11/20/2022] [Indexed: 11/23/2022] Open
Abstract
To assess how the COVID-19 pandemic affected catch-up HPV vaccination among age-eligible adults (ages 18-45). The current study leverages a national, cross-sectional sample of US adults ages 18-45 years to assess the prevalence and determinants of COVID-19 pandemic-related disruptions to catch-up HPV vaccination in 2021. The sample was restricted to adults intending to receive the HPV vaccine. Multinomial logistic regression analysis was conducted to assess the probability of 1) pandemic-related HPV vaccination disruption and 2) uncertainty about pandemic-related HPV vaccination disruption. Report of 'no pandemic-related HPV vaccination disruption' served as the reference category. Among adults intending to get the HPV vaccine (n = 1,683), 8.6 % reported pandemic-related HPV vaccination disruption, 14.7 % reported uncertainty about vaccination disruption, and 76.7 % reported no disruption. Factors associated with higher odds of pandemic-related vaccination disruption included non-English language preference (OR: 3.20; 95 % CI: 1.99-5.13), being a parent/guardian (OR: 1.77; 95 % CI: 1.18-2.66), having at least one healthcare visit in the past year (OR: 1.97; 95 % CI: 1.10-3.53), being up-to-date on the tetanus vaccine (OR: 1.81; 95 % CI: 1.19-2.75), and being a cancer survivor (OR: 2.57; 95 % CI: 1.52-4.34). Catch-up HPV vaccination for age-eligible adults is a critical public health strategy for reducing HPV-related cancers. While a small percentage of adults reported pandemic-related disruptions to HPV vaccination, certain adults (e.g., individuals with a non-English language preference and cancer survivors) were more likely to report a disruption. Interventions may be needed that increase accessibility of catch-up HPV vaccination among populations with reduced healthcare access during the pandemic.
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Affiliation(s)
- Kea Turner
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, 12902 USF Magnolia Drive, Tampa, FL 33612, USA
- Department of Gastrointestinal Oncology, Moffitt Cancer Center, 12902 USF Magnolia Drive, Tampa, FL 33612, USA
- Department of Oncological Sciences, University of South Florida, 12901 Bruce B. Downs Blvd., Tampa, FL 33612, USA
| | - Naomi C. Brownstein
- Department of Public Health Sciences, Medical University of South Carolina, 96 Jonathan Lucas Street, Charleston, SC 29425, USA
| | - Junmin Whiting
- Department of Biostatistics and Bioinformatics, Moffitt Cancer Center, 12902 USF Magnolia Drive, Tampa, FL 33612, USA
| | - Mariana Arevalo
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, 12902 USF Magnolia Drive, Tampa, FL 33612, USA
| | - Susan Vadaparampil
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, 12902 USF Magnolia Drive, Tampa, FL 33612, USA
- Department of Oncological Sciences, University of South Florida, 12901 Bruce B. Downs Blvd., Tampa, FL 33612, USA
| | - Anna R. Giuliano
- Department of Oncological Sciences, University of South Florida, 12901 Bruce B. Downs Blvd., Tampa, FL 33612, USA
- Department of Cancer Epidemiology, Moffitt Cancer Center, 12902 USF Magnolia Drive, Tampa, FL 33612, USA
- Center for Immunization and Infection Research in Cancer, Moffitt Cancer Center, 12902 USF Magnolia Drive, Tampa, FL 33612, USA
| | - Jessica Y. Islam
- Department of Oncological Sciences, University of South Florida, 12901 Bruce B. Downs Blvd., Tampa, FL 33612, USA
- Department of Cancer Epidemiology, Moffitt Cancer Center, 12902 USF Magnolia Drive, Tampa, FL 33612, USA
- Center for Immunization and Infection Research in Cancer, Moffitt Cancer Center, 12902 USF Magnolia Drive, Tampa, FL 33612, USA
| | - Cathy D. Meade
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, 12902 USF Magnolia Drive, Tampa, FL 33612, USA
- Department of Oncological Sciences, University of South Florida, 12901 Bruce B. Downs Blvd., Tampa, FL 33612, USA
- Department of Genitourinary Oncology, Moffitt Cancer Center, 12902 USF Magnolia Drive, Tampa, FL 33612, USA
| | - Clement K. Gwede
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, 12902 USF Magnolia Drive, Tampa, FL 33612, USA
- Department of Gastrointestinal Oncology, Moffitt Cancer Center, 12902 USF Magnolia Drive, Tampa, FL 33612, USA
- Department of Oncological Sciences, University of South Florida, 12901 Bruce B. Downs Blvd., Tampa, FL 33612, USA
- Department of Genitourinary Oncology, Moffitt Cancer Center, 12902 USF Magnolia Drive, Tampa, FL 33612, USA
| | - Monica L. Kasting
- Department of Public Health, Purdue University, 812 W. State Street, Room 216, West Lafayette, IN 47907, USA
| | - Katharine J. Head
- Department of Communication Studies, Indiana University-Purdue University Indianapolis, 425 University Blvd., Indianapolis, IN 46202, USA
| | - Shannon M. Christy
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, 12902 USF Magnolia Drive, Tampa, FL 33612, USA
- Department of Gastrointestinal Oncology, Moffitt Cancer Center, 12902 USF Magnolia Drive, Tampa, FL 33612, USA
- Department of Oncological Sciences, University of South Florida, 12901 Bruce B. Downs Blvd., Tampa, FL 33612, USA
- Center for Immunization and Infection Research in Cancer, Moffitt Cancer Center, 12902 USF Magnolia Drive, Tampa, FL 33612, USA
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22
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Huang ER, Longcoy J, Shen J, Hsiao SC, Hsiao HY, Isaacs C, Sheppard VB, Wang JHY. Exploring Racial Differences in Treatment Decision-making in Chinese Immigrant and White American Breast Cancer Patients: the Role of Patient-Provider Communication. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2023; 38:66-73. [PMID: 34392497 PMCID: PMC9165569 DOI: 10.1007/s13187-021-02079-y] [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] [Accepted: 08/06/2021] [Indexed: 06/13/2023]
Abstract
Chinese immigrant cancer patients report suboptimal patient-provider communication, which increases the likelihood of decisional conflict and unsatisfactory treatment decision-making (TDM) outcomes (e.g., low satisfaction and perceived control over cancer care). This cross-sectional study explored whether (1) communication and decisional conflict factors associated with TDM outcomes differed between Chinese immigrant and non-Hispanic White breast cancer patients, and (2) the association between patient-provider communication and the outcomes were mediated by TDM factors, regardless of race. Ninety-eight breast cancer patients, diagnosed at stage I-III participated in cross-sectional survey interviews. TDM outcomes and possible predictors of the outcomes (e.g., patient-provider communication, decisional conflict, preference for who makes the treatment decision) were assessed. Linear regression and mediational testing were performed to examine associations among variables of interest. Of the 98, 85 were included for analysis. Chinese patients with limited English proficiency (n = 37) had poorer patient-provider communication, higher decisional conflict, and preferred providers to make decisions than non-Hispanic White patients (n = 48; all p < .05). They also had lower satisfaction with their TDM process after controlling for predictors (e.g., patient-provider communication) (p < .001). There were no significant racial differences in perceived control, controlling for covariates. Regardless of race, patients who reported quality patient-provider communication reported less decisional conflict. These patients also reported increased satisfaction and perceived control. The disparities Chinese immigrant cancer patients experienced in the TDM process may be related to their cultural communication style with providers. Facilitating Chinese patients' communication and partnership with providers may reduce decisional conflicts and increase their TDM outcomes.
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Affiliation(s)
- Ellen R Huang
- Department of Oncology, Lombardi Comprehensive Cancer Center, Cancer Prevention and Control Program, Georgetown University Medical Center, Washington, DC, USA
| | - Joshua Longcoy
- Department of Oncology, Lombardi Comprehensive Cancer Center, Cancer Prevention and Control Program, Georgetown University Medical Center, Washington, DC, USA
- Department of Biostatistics, Epidemiology, and Environmental Health Sciences, Jiann-Ping Hsu College of Public Health, Georgia Southern University, Statesboro, GA, USA
| | | | - Suh-Chen Hsiao
- University of Southern California Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, CA, USA
| | - Hsin-Yi Hsiao
- Department of Social Work, Tzu Chi University, Hualien, Taiwan
| | - Claudine Isaacs
- Department of Oncology, Fisher Center for Hereditary Cancer and Clinical Genomics Research, Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC, USA
| | - Vanessa B Sheppard
- Department of Health Behavior and Policy, Massey Cancer Center Office of Health Equity Disparities Research, Virginia Commonwealth University School of Medicine, Richmond, VA, USA
| | - Judy Huei-Yu Wang
- Department of Oncology, Lombardi Comprehensive Cancer Center, Cancer Prevention and Control Program, Georgetown University Medical Center, Washington, DC, USA.
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23
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Thanabalasingam SJ, Ranawaka SS, Gunarathna SSC, Yathev B, Booth CM, Seneviratne S, Gunasekera S, Wijeratne DT. Patient Satisfaction With Breast Cancer Care Delivery at the National Cancer Institute of Sri Lanka: Does Language Play a Role? JCO Glob Oncol 2023; 9:e2200366. [PMID: 36821801 PMCID: PMC10166464 DOI: 10.1200/go.22.00366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/25/2023] Open
Abstract
PURPOSE This study sought to examine whether there was an association between language barriers and patient satisfaction with breast cancer care in Sri Lanka. METHODS A telephone-based survey was conducted in the three official languages (Sinhala, Tamil, or English) among adult women (older than 18 years) who had been treated for breast cancer within 6-12 months of diagnosis at the National Cancer Institute of Sri Lanka. The European Organisation for Research and Treatment of Cancer Satisfaction with Cancer Care core questionnaire was adapted to assess three main domains (physicians, allied health care professionals, and the organization). All scores were linearly transformed to a 0-100 scale, and subscores for domains were summarized using means and standard deviations. These were also calculated for the Sinhalese and Tamil groups and compared. RESULTS The study included 72 participants (32 ethnically Tamil and 40 Sinhalese, with 100% concordance with preferred language). The most commonly reported best aspect of care (n = 25) involved affective behaviors of the physicians and nurses. Ease of access to the hospital performed poorest overall, with a mean satisfaction score of 54 (30.5). Clinic-related concerns were highlighted as the worst aspect of the care (n = 10), including long waiting times during clinic visits. Sixty-three percent of Tamil patients reported receiving none of their care in Tamil and 18% reported experiencing language barriers during their care. Tamil patients were less satisfied overall and reported lower satisfaction with care coordination (P = .005) and higher financial burden (P = 0.014). CONCLUSION Ethnically Tamil patients were significantly less satisfied than their Sinhalese counterparts and experienced more language barriers, suggesting there is a need to improve access to language-concordant care in Sri Lanka.
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Affiliation(s)
- Susan J Thanabalasingam
- Kingston Health Sciences Centre, Kingston, ON, Canada.,Department of Medicine, Queen's University, Kingston, ON, Canada
| | | | | | - Bala Yathev
- Faculty of Medicine, University of Colombo, Colombo, Sri Lanka
| | | | - Sanjeewa Seneviratne
- Faculty of Medicine, University of Colombo, Colombo, Sri Lanka.,National Cancer Institute, Colombo, Sri Lanka
| | | | - Don Thiwanka Wijeratne
- Kingston Health Sciences Centre, Kingston, ON, Canada.,Department of Medicine, Queen's University, Kingston, ON, Canada
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24
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Eysenbach G, Goldsack JC, Cordovano G, Downing A, Fields KK, Geoghegan C, Grewal U, Nieva J, Patel N, Rollison DE, Sah A, Said M, Van De Keere I, Way A, Wolff-Hughes DL, Wood WA, Robinson EJ. Advancing Digital Health Innovation in Oncology: Priorities for High-Value Digital Transformation in Cancer Care. J Med Internet Res 2023; 25:e43404. [PMID: 36598811 PMCID: PMC9850283 DOI: 10.2196/43404] [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: 10/11/2022] [Revised: 11/17/2022] [Accepted: 11/30/2022] [Indexed: 01/05/2023] Open
Abstract
Although health care delivery is becoming increasingly digitized, driven by the pursuit of improved access, equity, efficiency, and effectiveness, progress does not appear to be equally distributed across therapeutic areas. Oncology is renowned for leading innovation in research and in care; digital pathology, digital radiology, real-world data, next-generation sequencing, patient-reported outcomes, and precision approaches driven by complex data and biomarkers are hallmarks of the field. However, remote patient monitoring, decentralized approaches to care and research, "hospital at home," and machine learning techniques have yet to be broadly deployed to improve cancer care. In response, the Digital Medicine Society and Moffitt Cancer Center convened a multistakeholder roundtable discussion to bring together leading experts in cancer care and digital innovation. This viewpoint highlights the findings from these discussions, in which experts agreed that digital innovation is lagging in oncology relative to other therapeutic areas. It reports that this lag is most likely attributed to poor articulation of the challenges in cancer care and research best suited to digital solutions, lack of incentives and support, and missing standardized infrastructure to implement digital innovations. It concludes with suggestions for actions needed to bring the promise of digitization to cancer care to improve lives.
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Affiliation(s)
| | | | | | | | - Karen K Fields
- Center for Digital Health, Moffitt Cancer Center, Tampa, FL, United States
| | | | | | - Jorge Nieva
- Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA, United States
| | - Nikunj Patel
- AstraZeneca PLC, Gaithersburg, MD, United States
| | - Dana E Rollison
- Center for Digital Health, Moffitt Cancer Center, Tampa, FL, United States
| | - Archana Sah
- AS Pharma Advisors, Inc, San Francisco, CA, United States
| | - Maya Said
- Outcomes4Me Inc, Boston, MA, United States
| | | | - Amanda Way
- Jazz Venture Partners, San Francisco, CA, United States
| | - Dana L Wolff-Hughes
- Division of Cancer Control and Populations Sciences, National Cancer Institute, Bethesda, MD, United States
| | - William A Wood
- Lineberger Comprehensive Cancer Center, University of North Carolina Chapel Hill, Chapel Hill, NC, United States
| | - Edmondo J Robinson
- Center for Digital Health, Moffitt Cancer Center, Tampa, FL, United States
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25
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Callinan K, Grube D, Ramirez V. Medical Aid in Dying. Cancer Treat Res 2023; 187:347-360. [PMID: 37851240 DOI: 10.1007/978-3-031-29923-0_26] [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: 10/19/2023]
Abstract
As the nation's 75 million baby boomers enter into a new phase of their life, care for their aging parents, and contemplate their own mortality, many have come to realize that our end-of-life care system is hamstrung by outdated modes of dying. This chapter discusses the current status of medical aid in dying in the United States as a legal and medically recognized medical option for supporting patients at life's end.
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Affiliation(s)
- Kim Callinan
- Compassion and Choices, Portland, Oregon, United States.
| | - David Grube
- Compassion and Choices, Portland, Oregon, United States
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26
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Mavragani A, Yin C, Meno M, Abe J, Pagano I, Tamashiro S, Fujinaga K, Braun-Inglis C, Fukui J. Racial Disparities in Patient-Provider Communication During Telehealth Visits Versus Face-to-face Visits Among Asian and Native Hawaiian and Other Pacific Islander Patients With Cancer: Cross-sectional Analysis. JMIR Cancer 2022; 8:e37272. [PMID: 36485021 PMCID: PMC9789492 DOI: 10.2196/37272] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2022] [Revised: 07/21/2022] [Accepted: 08/10/2022] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Telehealth visits increase patients' access to care and are often rated as "just as good" as face-to-face visits by oncology patients. Telehealth visits have become increasingly more common in the care of patients with cancer since the advent of the COVID-19 pandemic. Asians and Pacific Islanders are two of the fastest growing racial groups in the United States, but there are few studies assessing patient satisfaction with telemedicine among these two racial groups. OBJECTIVE Our objective was to compare satisfaction with communication during telehealth visits versus face-to-face visits among oncology patients, with a specific focus on Asian patients and Native Hawaiian and other Pacific Islander (NHOPI) patients. METHODS We surveyed a racially diverse group of patients who were treated at community cancer centers in Hawaii and had recently experienced a face-to-face visit or telehealth visit. Questions for assessing satisfaction with patient-physician communication were adapted from a previously published study of cancer survivors. Variables that impact communication, including age, sex, household income, education level, and cancer type and stage, were captured. Multivariable logistic models for patient satisfaction were created, with adjustments for sociodemographic factors. RESULTS Participants who attended a face-to-face visit reported higher levels of satisfaction in all communication measures than those reported by participants who underwent a telehealth encounter. The univariate analysis revealed lower levels of satisfaction during telehealth visits among Asian participants and NHOPI participants compared to those among White participants for all measures of communication (eg, when asked to what degree "[y]our physician listened carefully to you"). Asian patients and NHOPI patients were significantly less likely than White patients to strongly agree with the statement (P<.004 and P<.007, respectively). Racial differences in satisfaction with communication persisted in the multivariate analysis even after adjusting for sociodemographic factors. There were no significant racial differences in communication during face-to-face visits. CONCLUSIONS Asian patients and NHOPI patients were significantly less content with patient-physician communication during telehealth visits when compared to White patients. This difference among racial groups was not seen in face-to-face visits. The observation that telehealth increases racial disparities in health care satisfaction should prompt further exploration.
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Affiliation(s)
| | - Chelsea Yin
- Kaiser Permanente, Oakland, CA, United States
| | - Michael Meno
- University of Washington, Seattle, WA, United States
| | - Justin Abe
- University of Southern California, Los Angeles, CA, United States
| | - Ian Pagano
- University of Hawaii Cancer Center, Honolulu, HI, United States
| | | | | | | | - Jami Fukui
- University of Hawaii Cancer Center, Honolulu, HI, United States
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27
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Shore S, O'Leary M, Kamdar N, Harrod M, Silveira MJ, Hummel SL, Nallamothu BK. Do Not Attempt Resuscitation Order Rates in Hospitalized Patients With Heart Failure, Acute Myocardial Infarction, Chronic Obstructive Pulmonary Disease, and Pneumonia. J Am Heart Assoc 2022; 11:e025730. [PMID: 36382963 PMCID: PMC9851455 DOI: 10.1161/jaha.122.025730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Background Descriptions of do not attempt resuscitation (DNAR) orders in heart failure (HF) are limited. We describe use of DNAR orders in HF hospitalizations relative to other common conditions, focusing on race. Methods and Results This was a retrospective study of all adult hospitalizations for HF, acute myocardial infarction (AMI), chronic obstructive pulmonary disease (COPD), and pneumonia from 2010 to 2016 using the California State Inpatient Dataset. Using a hierarchical multivariable logistic regression model with random effects for the hospital, we identified factors associated with DNAR orders for each condition. For racial variation, hospitals were divided into quintiles based on proportion of Black patients cared for. Our cohort comprised 399 816 HF, 190 802 AMI, 192 640 COPD, and 269 262 pneumonia hospitalizations. DNAR orders were most prevalent in HF (11.9%), followed by pneumonia (11.1%), COPD (7.9%), and AMI (7.1%). Prevalence of DNAR orders did not change from 2010 to 2016 for each condition. For all conditions, DNAR orders were more common in elderly people, women, and White people with significant site-level variation across 472 hospitals. For HF and COPD, hospitalizations at sites that cared for a higher proportion of Black patients were less likely associated with DNAR orders. For AMI and pneumonia, conditions such as dementia and malignancy were strongly associated with DNAR orders. Conclusions DNAR orders were present in 12% of HF hospitalizations, similar to pneumonia but higher than AMI and COPD. For HF, we noted significant variability across sites when stratified by proportion of Black patients cared for, suggesting geographic and racial differences in end-of-life care.
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Affiliation(s)
- Supriya Shore
- Division of Internal MedicineUniversity of MichiganAnn ArborMI,Institute of Healthcare Policy and Innovation, University of MichiganAnn ArborMI
| | - Michael O'Leary
- Division of Internal MedicineUniversity of MichiganAnn ArborMI,Institute of Healthcare Policy and Innovation, University of MichiganAnn ArborMI
| | - Neil Kamdar
- Division of Internal MedicineUniversity of MichiganAnn ArborMI,Institute of Healthcare Policy and Innovation, University of MichiganAnn ArborMI
| | - Molly Harrod
- Veterans Affairs Ann Arbor Center for Clinical Management ResearchAnn ArborMI
| | - Maria J. Silveira
- Division of Internal MedicineUniversity of MichiganAnn ArborMI,Veterans Affairs Geriatric Research Education and Clinical CenterAnn ArborMI
| | - Scott L. Hummel
- Division of Internal MedicineUniversity of MichiganAnn ArborMI,Institute of Healthcare Policy and Innovation, University of MichiganAnn ArborMI,Veterans Affairs Ann Arbor Center for Clinical Management ResearchAnn ArborMI
| | - Brahmajee K. Nallamothu
- Division of Internal MedicineUniversity of MichiganAnn ArborMI,Institute of Healthcare Policy and Innovation, University of MichiganAnn ArborMI,Veterans Affairs Ann Arbor Center for Clinical Management ResearchAnn ArborMI
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28
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Pandit AA, Gressler LE, Halpern MT, Kamel M, Payakachat N, Li C. Racial/Ethnic Disparities in Patient Care Experiences among Prostate Cancer Survivors: A SEER-CAHPS Study. Curr Oncol 2022; 29:8357-8373. [PMID: 36354719 PMCID: PMC9689524 DOI: 10.3390/curroncol29110659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Revised: 10/24/2022] [Accepted: 10/29/2022] [Indexed: 11/06/2022] Open
Abstract
PURPOSE To evaluate racial/ethnic disparities in patient care experiences (PCEs) among prostate cancer (PCa) survivors. METHODS This retrospective study used 2007-2015 National Cancer Institute Surveillance, Epidemiology and End Results registry data linked to Consumer Assessment of Healthcare Providers and Systems surveys. First survey ≥ 6 months post-PCa diagnosis was analyzed. We performed multivariable linear regression, adjusting for demographic and clinical covariates, to evaluate the association of race/ethnicity (non-Hispanic Whites (NHWs), non-Hispanic Black (NHBs), Hispanic, non-Hispanic Asian (NHAs), and other races) with PCE composite measures: getting needed care, doctor communication, getting care quickly, getting needed prescription drugs (Rx), and customer service. RESULTS Among 7319 PCa survivors, compared to NHWs, Hispanics, NHBs and NHAs reported lower scores for getting care quickly (ß = -3.69; p = 0.002, ß = -2.44; p = 0.021, and ß = -6.44; p < 0.001, respectively); Hispanics scored worse on getting needed care (ß = -2.16; p = 0.042) and getting needed Rx (ß = -2.93; p = 0.009), and NHAs scored worse on customer service (ß = -7.60; p = 0.003), and getting needed Rx (ß = -3.08; p = 0.020). However, NHBs scored better than NHWs on doctor communication (ß = 1.95, p = 0.006). No statistically significant differences were found between other races and NHWs. CONCLUSIONS Comparing to NHWs, Hispanics and NHAs reported worse experiences on several PCE composite measures, while NHBs reported worse scores on one but better scores on another PCE composite measure. Further research is needed to understand the reasons behind these disparities and their influence on healthcare utilization and health outcomes among PCa survivors.
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Affiliation(s)
- Ambrish A. Pandit
- Department of Pharmacy Practice, University of Arkansas for Medical Sciences, Little Rock, AR 72211, USA
| | - Laura E. Gressler
- Department of Pharmacy Practice, University of Arkansas for Medical Sciences, Little Rock, AR 72211, USA
| | - Michael T. Halpern
- Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD 20892, USA
| | - Mohamed Kamel
- College of Medicine, University of Cincinnati, Cincinnati, OH 45267, USA
- Department of Urology, Ain Shams University, Cairo 11566, Egypt
| | - Nalin Payakachat
- Department of Pharmacy Practice, University of Arkansas for Medical Sciences, Little Rock, AR 72211, USA
| | - Chenghui Li
- Department of Pharmacy Practice, University of Arkansas for Medical Sciences, Little Rock, AR 72211, USA
- Correspondence: ; Tel.: +1-(501)-686-6298
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29
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Li CC, Matthews AK, Yen PS, Chen YF, Dong X. The influence of perceived discrimination in healthcare settings on psychological distress among a diverse sample of older Asian Americans. Aging Ment Health 2022; 26:1874-1881. [PMID: 34319179 DOI: 10.1080/13607863.2021.1958146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVES The purpose of this study was to determine the relationship between discrimination in healthcare settings and psychological distress. METHOD This study utilized a retrospective cross-sectional study design. The dataset was obtained from 2015-2017 California Health Interview Survey (CHIS). Healthcare discrimination experience (yes, no) was measured using the following question "Over your entire lifetime, how often have you been treated unfairly when getting medical care (never, rarely, sometimes, often)?". Psychological distress was the study outcome and was measured using the Kessler Psychological Distress Scale. A composite score (0-24) was created for psychological distress for the prior 30 days and for the worse most in the past 12 months. A hierarchical multivariate linear regression was conducted to examine the influence of healthcare discrimination experience on psychological distress after adjusting for other covariates. RESULTS Study participants (weighted N = 1,360,487) had a mean age of 64.35 years (SD = 0.61), were primarily female (54.93%), heterosexual (96.61%), and married or living with a partner (73.37%). About 10.00% of older Asian Americans ever perceived healthcare discrimination over their entire lifetime. Perceived discrimination was associated with higher levels of psychological distress for the past 30 days (beta= 2.107, SE = 0.662, p < 0.05) and for the worst month in the past year (beta= 2.099, SE = 0.697, p < 0.05) after controlling for covariates. CONCLUSION Self-reported discrimination was relatively low in this sample of older Asian American adults. However, consistent with prior research, perceived discrimination in the healthcare setting was associated with increased psychological distress. The findings have implications for improving the quality of health care services received.
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Affiliation(s)
- Chien-Ching Li
- Department of Health Systems Management, Rush University, Chicago, Illinois, USA
| | - Alicia K Matthews
- Department of Population Health Nursing Science, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Pei-Shan Yen
- Center for Clinical Translational Science, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Yi-Fan Chen
- Center for Clinical Translational Science, University of Illinois at Chicago, Chicago, Illinois, USA
| | - XinQi Dong
- Institute for Health, Health Care Policy and Aging Research, Rutgers University, New Brunswick, New Jersey, USA
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30
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Ponce SEB, Thomas CR, Diaz DA. Social determinants of health, workforce diversity, and financial toxicity: A review of disparities in cancer care. Curr Probl Cancer 2022; 46:100893. [DOI: 10.1016/j.currproblcancer.2022.100893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Accepted: 05/11/2022] [Indexed: 11/26/2022]
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Sanford K, Pizzuto AE. The Healthcare Discrimination Experience Scale: Assessing a Variable Crucial for Explaining Racial/Ethnic Inequities in Patient Activation and Health. J Racial Ethn Health Disparities 2022:10.1007/s40615-022-01350-2. [PMID: 35731463 DOI: 10.1007/s40615-022-01350-2] [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: 04/01/2022] [Revised: 05/23/2022] [Accepted: 06/14/2022] [Indexed: 11/26/2022]
Abstract
Healthcare discrimination experience is expected to be a consequential variable that explains racial/ethnic inequities in patient activation and health; however, existing scales assessing healthcare discrimination experience are limited by insufficient psychometric development and overly narrow construct definitions. A new Healthcare Discrimination Experience Scale was developed, validated, compared to an existing scale, and used to estimate effects in explaining racial/ethnic health inequities. Across two studies, 975 patients with hypertension or diabetes (43% Black, 10% other Persons of Color, 47% White, 53% having household incomes < 40 thousand dollars) were recruited through marketing research panels to complete online questionnaires. Compared to an existing measure, the new scale better detected differences between People of Color and White people. It produced good results in confirmatory factor analysis and item response theory analysis, and it mediated the effects of racial/ethnic identity on eight variables regarding patient-practitioner relationships, treatment adherence, general health, blood pressure, and life stress. The new scale is valid for assessing a broadly defined healthcare discrimination experience construct in diverse patients with chronic medical conditions, and it is more sensitive to group differences than the best existing alternative scale. Compared to research using unvalidated scales, the results of this study demonstrate that healthcare discrimination experience plays a larger role in explaining racial/ethnic inequities in patient activation and health.
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Affiliation(s)
- Keith Sanford
- Department of Psychology and Neuroscience, Baylor University, One Bear Place #97334, Waco, TX, 76798-7334, USA.
| | - Alexandra E Pizzuto
- Department of Psychology and Neuroscience, Baylor University, One Bear Place #97334, Waco, TX, 76798-7334, USA
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32
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Riccetti N, Hempler I, Hermes-Moll K, Heidt V, Bayer O, Walawgo T, Merbach M, Singer S. Linguistic barriers in communication between oncologists and cancer patients with migration background in Germany: an explorative analysis based on the perspective of the oncologists from the mixed-methods study POM. RESEARCH IN HEALTH SERVICES & REGIONS 2022; 1:3. [PMID: 39177829 PMCID: PMC11264866 DOI: 10.1007/s43999-022-00001-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/20/2021] [Accepted: 05/02/2022] [Indexed: 08/24/2024]
Abstract
OBJECTIVE We aimed at investigating the predictors of linguistic barriers among office-based haemato-oncologists during consultation with migrant cancer patients in Germany. METHODS Physicians from haemato-oncological practices were invited to participate in a cross-sectional study. Linguistic barriers and family factors were ascertained using a newly developed online-questionnaire with the scales "Overall linguistic barriers", "Self-perceived linguistic barriers" and "Family factors - antagonistic behaviour". Predictors of linguistic barriers were identified using multivariate ANOVA via step-wise backwards selection. RESULTS Fifty-five physicians participated in the study. Treating patients from Sub-Saharan Africa predicted higher overall and self-perceived linguistic barriers (F [2,46] = 4.51, p = .04; and F [3,45] = 5.44, p = .02, respectively). Working in an single practice (F [3,45] = 4.19; p = .05) predicted higher self-perceived linguistic barriers. Employees who could act as translators predicted lower barriers in form of antagonistic behaviour from relatives (F [2,48] = 6.12; p = .02). CONCLUSIONS The results indicate that linguistic barriers are affected by the level of linguistic concordance between patients and medical personnel. A temporary solution might be the presence of linguistically competent personnel in the practice. However, the results of this study highlight the need for greater availability of linguistic competent translators for consultations in haemato-oncological practices.
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Affiliation(s)
- Nicola Riccetti
- University Medical Centre, Institute of Medical Biostatistics, Epidemiology and Informatics (IMBEI), Mainz, Germany.
- University Cancer Centre Mainz, Mainz, Germany.
| | - Isabelle Hempler
- Scientific Institute of Office-Based Haematologists and Oncologists (WINHO GmbH), Cologne, Germany
| | - Kerstin Hermes-Moll
- Scientific Institute of Office-Based Haematologists and Oncologists (WINHO GmbH), Cologne, Germany
| | - Vitali Heidt
- Scientific Institute of Office-Based Haematologists and Oncologists (WINHO GmbH), Cologne, Germany
| | - Oliver Bayer
- University Medical Centre, Institute of Medical Biostatistics, Epidemiology and Informatics (IMBEI), Mainz, Germany
- University Cancer Centre Mainz, Mainz, Germany
| | - Thomas Walawgo
- Scientific Institute of Office-Based Haematologists and Oncologists (WINHO GmbH), Cologne, Germany
| | - Martin Merbach
- Evangelisches Zentralinstitut Für Familienberatung, Berlin, Germany
| | - Susanne Singer
- University Medical Centre, Institute of Medical Biostatistics, Epidemiology and Informatics (IMBEI), Mainz, Germany
- University Cancer Centre Mainz, Mainz, Germany
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Pratt-Chapman ML. Learning Outcomes of Diverse Oncology Professionals After the TEAM Cultural Competency Training. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2022; 37:662-667. [PMID: 32902787 PMCID: PMC9205792 DOI: 10.1007/s13187-020-01865-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 09/02/2020] [Indexed: 05/29/2023]
Abstract
Racial, ethnic, sexual, and gender minorities are more likely to report challenges with oncology provider communication and quality of care. The Together-Equitable-Accessible-Meaningful (TEAM) training was developed to improve health equity across cancer care organizations by guiding teams of interprofessional learners through planning and implementation of quality improvements to advance equitable, accessible, and patient-centered cancer care. This study compared changes to self-reported cultural competence as measured by the Cultural Competency Assessment (CCA); Lesbian, Gay, Bisexual, and Transgender Development of Clinical Skills Scale (LGBT-DOCSS); and Interprofessional Socialization and Valuing Scale (ISVS). The primary aim of the study was to assess changes to self-reported cultural competence; the secondary aim was to examine changes to interprofessional valuation from baseline to post-intervention. Results indicated statistically significant improvements in self-reported Cultural Competency Behaviors (p = .055), a subscale of the CCA, and Attitudinal Awareness toward sexual and gender minorities (p = .046), a subscale of the LGBT-DOCSS, using p < .10 as statistically significant. These subscale results drove statistically significant improvements for their respective composite scales. No other statistically significant results were found. This study suggests that cultural competency training among interprofessional oncology health care professionals can be effective. Given the growing diversity within the USA, additional opportunities for cultural competency training are needed.
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Affiliation(s)
- Mandi L Pratt-Chapman
- The George Washington University School of Medicine and Health Sciences, Washington, DC, USA.
- The GW Cancer Center, The George Washington University, 2600 Virginia Ave, #324, Washington, DC, 20037, USA.
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Cho G, Chang VW. Patient-Provider Communication Quality, 2002-2016: A Population-based Study of Trends and Racial Differences. Med Care 2022; 60:324-331. [PMID: 35180718 DOI: 10.1097/mlr.0000000000001694] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Effective patient-provider communication (PPC) can improve clinical outcomes and therapeutic alliance. While PPC may have improved over time due to the implementation of various policies for patient-centered care, its nationwide trend remains unclear. OBJECTIVE The objective of this study was to examine trends in PPC quality among US adults and whether trends vary with race-ethnicity. RESEARCH DESIGN A repeated cross-sectional study. PARTICIPANTS We examine noninstitutionalized civilian adults who made 1 or more health care visits in the last 12 months and self-completed the mail-back questionnaire in the Medical Expenditure Panel Survey, 2002-2016. MEASURES Outcomes include 4 top-box measures, each representing the odds of patients reporting that their providers always (vs. never, sometimes, usually) used a given communication behavior in the past 12 months regarding listening carefully, explaining things understandably, showing respect, and spending enough time. A linear mean composite score (the average of ordinal responses for the behaviors above) is also examined as an outcome. Exposures include time period and race-ethnicity. RESULTS Among 124,158 adults (181,864 observations), the quality of PPC increases monotonically between 2002 and 2016 for all outcomes. Between the first and last periods, the odds of high-quality PPC increase by 37% [95% confidence interval (CI)=32%-43%] for listen, 25% (95% CI=20%-30%) for explain, 41% (95% CI=35%-47%) for respect, and 37% (95% CI=31%-43%) for time. The composite score increases by 3.24 (95% CI=2.87-3.60) points. While increasing trends are found among all racial groups, differences exist at each period. Asians report the lowest quality throughout the study period for all outcomes, while Blacks report the highest quality. Although racial differences narrow over time, most changes are not significant. CONCLUSIONS Our findings suggest that providers are increasingly likely to use patient-centered communication strategies. While racial differences have narrowed, Asians report the lowest quality throughout the study period, warranting future research.
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Affiliation(s)
- Gawon Cho
- Department of Social and Behavioral Sciences, School of Global Public Health, New York University
| | - Virginia W Chang
- Department of Social and Behavioral Sciences, School of Global Public Health, New York University
- Department of Population Health, Grossman School of Medicine, New York University, New York, NY
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Yilmaz S, Sanapala C, Schiaffino MK, Schumacher JR, Wallington SF, McKoy JM, Canin B, Tang W, Tucker-Seeley RD, Simmons J, Gilmore N. Social Justice and Equity: Why Older Adults With Cancer Belong-A Life Course Perspective. Am Soc Clin Oncol Educ Book 2022; 42:1-13. [PMID: 35649203 PMCID: PMC11070065 DOI: 10.1200/edbk_349825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The population of older adults with cancer in the United States is rapidly increasing, which will have a substantial impact on the oncology and public health workforces across the cancer continuum, from prevention to end of life. Unfortunately, inequities in existing social structures that cause increased psychosocial stressors have led to disparities in the incidence of cancer and the morbidity and mortality of cancer for individuals from marginalized backgrounds. It is imperative that older adults, especially those from historically marginalized backgrounds, be adequately represented in all stages of cancer research to address health inequities. Continued efforts and progress toward achieving social justice and health equity require a deeper commitment to and better understanding of the impact of social determinants of health within the cancer domain. Undoubtedly, a more holistic and integrated view that extends beyond the biologic and genetic factors of health must be adopted for health entities to recognize the critical role of environmental, behavioral, and social determinants in cancer health disparities. Against this backdrop, this paper uses a life course approach to present a multifactorial framework for understanding and addressing cancer disparities in an effort to advance social justice and health equity for racially and ethnically diverse older adults.
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Affiliation(s)
- Sule Yilmaz
- Division of Supportive Care in Cancer, Department of Surgery, University of Rochester Medical Center, Rochester, NY
| | - Chandrika Sanapala
- James P. Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, NY
| | | | - Jessica R Schumacher
- Wisconsin Surgical Outcomes Research Program, Department of Surgery, School of Medicine and Public Health, University of Wisconsin, Madison, WI
| | - Sherrie F Wallington
- The George Washington School of Nursing & Milken Institute School of Public Health, Washington, DC
| | - June M McKoy
- Robert H. Lurie Comprehensive Cancer Center, Chicago, IL
| | | | - Weizhou Tang
- Leonard Davis School of Gerontology, University of Southern California, Los Angeles, CA
| | - Reginald D Tucker-Seeley
- Leonard Davis School of Gerontology, University of Southern California, Los Angeles, CA
- ZERO-The End of Prostate Cancer, Alexandria, VA
| | - John Simmons
- Cancer and Aging Research Group, City of Hope, CA
- Ethnic Health Institute, Center for Community Engagement, Samuel Merritt University, Oakland, CA
| | - Nikesha Gilmore
- Division of Supportive Care in Cancer, Department of Surgery, University of Rochester Medical Center, Rochester, NY
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LeBaron V, Boukhechba M, Edwards J, Flickinger T, Ling D, Barnes LE. Exploring the use of wearable sensors and natural language processing technology to improve patient-clinician communication: Protocol for a feasibility study (Preprint). JMIR Res Protoc 2022; 11:e37975. [PMID: 35594139 PMCID: PMC9166632 DOI: 10.2196/37975] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 03/24/2022] [Accepted: 03/30/2022] [Indexed: 11/13/2022] Open
Affiliation(s)
- Virginia LeBaron
- School of Nursing, University of Virginia, Charlottesville, VA, United States
| | - Mehdi Boukhechba
- School of Engineering & Applied Science, University of Virginia, Charlottesville, VA, United States
| | - James Edwards
- School of Nursing, University of Virginia, Charlottesville, VA, United States
| | - Tabor Flickinger
- School of Medicine, University of Virginia, Charlottesville, VA, United States
| | - David Ling
- School of Medicine, University of Virginia, Charlottesville, VA, United States
| | - Laura E Barnes
- School of Engineering & Applied Science, University of Virginia, Charlottesville, VA, United States
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Czerwinski F, Link E, Rosset M, Baumann E, Suhr R. Correlates of the perceived quality of patient-provider communication among German adults. Eur J Public Health 2021; 31:979-984. [PMID: 34363672 DOI: 10.1093/eurpub/ckab131] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Since a higher perceived quality of patient-provider communication is known to be associated with improved health outcomes, it is essential to analyze determinants influencing patients' perceived quality of patient-provider communication. Due to the limited knowledge about patient-related influencing factors of quality perception available so far, the objective of this study is to explore and assess determinants of the perceived quality of patient-provider communication with regards to sociodemographic, health-related, healthcare-specific and information-related factors. METHODS Linear regression of cross-sectional data from the first wave of Health Information National Trends Survey Germany (n = 2902) was conducted. Independent variables were sociodemographic, health-, healthcare- and information-related factors; the dependent variable was the perceived quality of patient-provider communication. RESULTS Results show that age, migration background, the perceived quality of healthcare, health-related self-efficacy and trust in health information from health professionals are significantly associated with the perceived quality of patient-provider communication. CONCLUSIONS Sociodemographic, healthcare- and health information-related factors influence the perceived quality of patient-provider communication. In particular, patients having a migration background and patients reporting low self-efficacy showed significant lower levels of their perceived patient-provider communication quality. With the aim to improve quality issues, patients of both target groups should be empowered and supported.
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Affiliation(s)
- Fabian Czerwinski
- Hanover Center for Health Communication, University of Music, Drama & Media, Hanover, Germany
| | - Elena Link
- Hanover Center for Health Communication, University of Music, Drama & Media, Hanover, Germany
| | - Magdalena Rosset
- Hanover Center for Health Communication, University of Music, Drama & Media, Hanover, Germany
| | - Eva Baumann
- Hanover Center for Health Communication, University of Music, Drama & Media, Hanover, Germany
| | - Ralf Suhr
- Stiftung Gesundheitswissen, Berlin, Germany
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Sanders JJ, Dubey M, Hall JA, Catzen HZ, Blanch-Hartigan D, Schwartz R. What is empathy? Oncology patient perspectives on empathic clinician behaviors. Cancer 2021; 127:4258-4265. [PMID: 34351620 DOI: 10.1002/cncr.33834] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Revised: 02/04/2021] [Accepted: 02/11/2021] [Indexed: 12/30/2022]
Abstract
BACKGROUND Oncology patients and physicians value empathy because of its association with improved health outcomes. Common measures of empathy lack consistency and were developed without direct input from patients. Because of their intense engagement with health care systems, oncology patients may have unique perspectives on what behaviors signal empathy in a clinical setting. METHODS As part of a cross-sectional study of patient perspectives on clinician empathy at an academic cancer center in the northeastern United States, the authors solicited up to 10 free-text responses to an open-ended question about what clinician behaviors define empathy. RESULTS The authors categorized open-ended responses from 89 oncology patients into 5 categories representing 14 themes. These categories were relationship sensitivity, focus on the whole person, communication, clinician attributes, and institutional resources and care processes. Frequently represented themes, including listening, understanding, and attention to emotions and what matters most, aligned with existing measures of empathy; behaviors that were not well represented among existing measures included qualities of information sharing and other communication elements. Patients also associated clinician demeanor, accessibility, and competence with empathy. CONCLUSIONS Oncology patients' perspectives on empathy highlight clinician behaviors and attributes that may help to refine patient experience measures and may be adopted by clinicians and cancer centers to enhance patient care and outcomes. High-quality communication skills training can promote active listening and paying attention to the whole person. A system-level focus on delivering empathic care may improve patients' experiences and outcomes. LAY SUMMARY Oncology patients' responses to an open-ended question about empathic clinician behavior have revealed insights into a variety of behaviors that are perceived as demonstrative of empathy. These include behaviors that imply sensitivity to the clinician-patient relationship, such as listening and understanding and attention to the whole person. Participants valued caring communication and demeanor and clinician accessibility. Perspective taking was not common among answers. Many existing measures of clinical care quality do not include the behaviors cited by patients as empathic. These results can inform efforts to refine quality measures of empathy-associated behaviors in clinical practice. Cancer centers can use skills training to improve elements of communication.
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Affiliation(s)
- Justin J Sanders
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts.,Harvard Medical School, Boston, Massachusetts
| | - Manisha Dubey
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Judith A Hall
- Department of Psychology, Northeastern University, Boston, Massachusetts
| | - Hannah Z Catzen
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts.,University of Michigan School of Medicine, Ann Arbor, Michigan
| | | | - Rachel Schwartz
- WellMD and WellPhD Center, Stanford University School of Medicine, Palo Alto, California
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Meno M, Abe J, Fukui J, Braun-Inglis C, Pagano I, Acoba J. Telehealth amid the COVID-19 pandemic: perception among Asian, Native Hawaiian and Pacific Islander cancer patients. Future Oncol 2021; 17:3077-3085. [PMID: 34102878 PMCID: PMC8202507 DOI: 10.2217/fon-2021-0136] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Accepted: 04/12/2021] [Indexed: 12/26/2022] Open
Abstract
Aim: To assess the perception of telehealth visits among a multiracial cancer population during the coronavirus disease 2019 pandemic. Methods: This cross-sectional study was conducted at outpatient cancer clinics in Hawaii between March and August 2020. Patients were invited to participate in the survey either by phone or email. Results: Of the 212 survey respondents, 61.3% were Asian, 23.6% were White and 15.1% were Native Hawaiians or Pacific Islanders. Asians, Native Hawaiians and Pacific Islanders were less likely to desire future telehealth visits compared with Whites. Predictors with regard to preferring future telehealth visits included lower income and hematopoietic cancers. Conclusion: The authors found racial differences in preference for telehealth. Future studies aimed at overcoming these racial disparities are needed to provide equitable oncology care.
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Affiliation(s)
- Michael Meno
- Department of Medicine, John A. Burns School of Medicine, University of Hawaii, Honolulu, HI 96813, Hawaii
| | - Justin Abe
- University of Southern California, Los Angeles, CA 90007, USA
| | - Jami Fukui
- University of Hawaii Cancer Center, Honolulu, HI 96813, Hawaii
| | | | - Ian Pagano
- University of Hawaii Cancer Center, Honolulu, HI 96813, Hawaii
| | - Jared Acoba
- Department of Medicine, John A. Burns School of Medicine, University of Hawaii, Honolulu, HI 96813, Hawaii
- University of Hawaii Cancer Center, Honolulu, HI 96813, Hawaii
- Queen's Medical Center, Honolulu, HI 96813, Hawaii
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40
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Palmer Kelly E, McGee J, Obeng-Gyasi S, Herbert C, Azap R, Abbas A, Pawlik TM. Marginalized patient identities and the patient-physician relationship in the cancer care context: a systematic scoping review. Support Care Cancer 2021; 29:7195-7207. [PMID: 34195857 DOI: 10.1007/s00520-021-06382-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Accepted: 06/21/2021] [Indexed: 11/25/2022]
Abstract
PURPOSE We sought to examine and categorize the current evidence on patient-physician relationships among marginalized patient populations within the context of cancer care using a systemic scoping review approach. METHODS Web-based discovery services (e.g., Google Scholar) and discipline-specific databases (e.g., PubMed) were queried for articles on the patient-physician relationship among marginalized cancer patients. The marginalized populations of interest included (1) race and ethnicity, (2) gender, (3) sexual orientation and gender identity, (4) age, (5) disability, (6) socioeconomic status, and (7) geography (rural/urban). Study screening and data extraction were facilitated through the Covidence software platform. RESULTS Of the 397 screened studies, 37 met study criteria-most articles utilized quantitative methodologies (n = 28). The majority of studies focused on racial and ethnic cancer disparities (n = 27) with breast cancer (n = 20) as the most common cancer site. Trust and satisfaction with the provider were the most prevalent issues cited in the patient-physician relationship. Differences in patient-physician communication practices and quality were also frequently discussed. Overall, studies highlighted the need for increased culturally congruent care among providers. CONCLUSION Results from this review suggest marginalized cancer patients face significant barriers in establishing culturally and linguistically congruent patient-physician relationships. Future studies should focus on the intersectionality of multiple marginalized identities and optimization of the patient-physician relationship.
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Affiliation(s)
| | - Julia McGee
- The Ohio State University, Columbus, OH, USA
| | - Samilia Obeng-Gyasi
- Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Chelsea Herbert
- Ohio University Heritage College of Osteopathic Medicine, Athens, OH, USA
| | - Rosevine Azap
- Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Alizeh Abbas
- Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Timothy M Pawlik
- Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA.
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Horicks F, Coppieters Y. [Current challenges in cancer care in Brussels-capital region: A qualitative study]. Bull Cancer 2021; 108:705-717. [PMID: 34127254 DOI: 10.1016/j.bulcan.2021.04.016] [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: 12/14/2020] [Revised: 04/20/2021] [Accepted: 04/23/2021] [Indexed: 11/29/2022]
Abstract
Cancer is a disease with multidimensional consequences accompanied by new challenges in order to guarantee optimal care involving physical, psychological and social consequences of the disease and his treatments. The objective of this study is to identify the main challenges encountered by different stakeholders around cancer, including patients, in Brussels. This qualitative study was carried out with various stakeholders in the field of oncology. The semi-structured interviews and focus groups were transcribed directly and the data collected was analysed manually. Healthcare professionals and patients face many challenges in the current context of oncology care. Communication difficulties can affect the therapeutic relationship and the sharing of complex information. The increasing complexity of therapeutic strategies complicates interprofessional collaborations and care coordination. In a context of early return home and home hospitalization in particular, continuity in care and collaboration between the different lines of care are crucial. Patients face a variety of challenges, such as managing long-term side effects and post-cancer difficulties, including redefining their social and professional identities. Finally, cancer involves financial toxicity and social inequalities in health are particularly marked. Cancer is a complex disease which management involves a growing number of caretakers. It is also frequently synonymous with disruption in the personal, social and professional life of patients. The emerging themes of this study are closely interconnected and communication seems to occupy a central place. A holistic approach to the individual and inter-professional interactions could guide future prospects for the overall management of this constantly changing field.
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Affiliation(s)
- Florence Horicks
- Centre de recherche Politiques et systèmes de santé, École de Santé Publique, Université libre de Bruxelles (ULB), route de Lennik 808, 1070 Bruxelles, Belgique.
| | - Yves Coppieters
- Centre de recherche Politiques et systèmes de santé, École de Santé Publique, Université libre de Bruxelles (ULB), route de Lennik 808, 1070 Bruxelles, Belgique
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Bandera EV, Alfano CM, Qin B, Kang DW, Friel CP, Dieli-Conwright CM. Harnessing Nutrition and Physical Activity for Breast Cancer Prevention and Control to Reduce Racial/Ethnic Cancer Health Disparities. Am Soc Clin Oncol Educ Book 2021; 41:1-17. [PMID: 33989021 DOI: 10.1200/edbk_321315] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
There are well-known racial/ethnic disparities in the prevalence of obesity and physical inactivity, as well as breast cancer risk and survival. However, most of the current scientific evidence that serves as a foundation for nutrition and physical activity guidelines is based on studies conducted in predominantly non-Hispanic White populations. Similarly, exercise, diet, or lifestyle intervention trials for breast cancer prevention and survivorship are scarce in racial/ethnic minority populations. We review the current evidence for racial/ethnic disparities in obesity and breast cancer risk and survival (we are focusing on obesity, because this is considered an ASCO priority, and studies conducted in the United States), discuss the evolution of nutrition/physical activity guidelines for cancer prevention and control, and provide an overview of lifestyle interventions, including barriers and facilitators in implementation and dissemination science among minority populations underrepresented in research. There is a critical need to include racially/ethnically diverse populations in cancer prevention and control research or to specifically target minority populations in which disparities are known to exist to achieve much needed health equity.
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Affiliation(s)
- Elisa V Bandera
- Cancer Epidemiology and Health Outcomes, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ
| | - Catherine M Alfano
- Center for Personalized Health, Feinstein Institutes for Medical Research, Northwell Health, New York, NY.,Northwell Health Cancer Institute, New York, NY.,Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New York, NY
| | - Bo Qin
- Cancer Epidemiology and Health Outcomes, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ
| | - Dong-Woo Kang
- Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA
| | - Ciarán P Friel
- Center for Personalized Health, Feinstein Institutes for Medical Research, Northwell Health, New York, NY
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43
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Zheng LF, Ngoh SHA, Ng JYX, Tan NC. Clinician perspectives on a culturally adapted patient decision aid concerning maintenance therapy for asthma. J Asthma 2021; 59:1463-1472. [PMID: 33926335 DOI: 10.1080/02770903.2021.1923736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND AND OBJECTIVE Patients with persistent asthma often show poor adherence to inhaled corticosteroids (ICS). Shared decision-making can improve adherence rates in this population. Patient decision aids (PDAs) are tools to facilitate shared decision-making. To date, only one PDA, developed in a Canadian French-speaking population, exists for patients considering ICS maintenance therapy. This PDA has been culturally adapted in this study to contextualize to the needs of multi-ethnic Asian patients in Singapore. This study explored the views of local clinicians on the content, design and implementation of this newly-adapted PDA. METHODS 24 clinicians, who were purposively sampled from polyclinics and a tertiary institution, were interviewed on the content, design and implementation of the PDA. The interviews were audio-recorded, transcribed and analyzed via thematic analysis. RESULTS Clinicians generally accepted the design of the PDA. They suggested for the target users to be patients on Step 2 of GINA guidelines and the number of options to be reduced from four to two (do nothing or start inhaled corticosteroids). Moreover, they supported including a list of values for patients to select from given that Asian patients often do not articulate their values readily. The addition of more visual aids, the production of multilingual Asian editions and the involvement of nurses to administer the PDA was also suggested. CONCLUSION The PDA was culturally-adapted with local clinicians' perspectives to target multi-ethnic Asian patients with persistent asthma (Step 2 GINA guidelines). The main changes include a list of values and addition of visual aids.
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Affiliation(s)
- L F Zheng
- SingHealth Polyclinics, Singapore, Singapore.,SingHealth-Duke NUS Family Medicine Academic Clinical Programme, Singapore, Singapore
| | - S H A Ngoh
- SingHealth Polyclinics, Singapore, Singapore
| | - J Y X Ng
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - N C Tan
- SingHealth Polyclinics, Singapore, Singapore.,SingHealth-Duke NUS Family Medicine Academic Clinical Programme, Singapore, Singapore
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Kirby JB, Berdahl TA, Torres Stone RA. Perceptions of Patient-Provider Communication Across the Six Largest Asian Subgroups in the USA. J Gen Intern Med 2021; 36:888-893. [PMID: 33559065 PMCID: PMC8041938 DOI: 10.1007/s11606-020-06391-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Accepted: 12/03/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND Asians are the fastest-growing racial/ethnic minority group in the USA and many face communication barriers when seeking health care. Given that a high proportion of Asians are immigrants and have limited English proficiency, poor patient-provider communication may explain Asians' relatively low ratings of care. Though Asians are linguistically, economically, and culturally heterogeneous, research on health care disparities typically combines Asians into a single racial/ethnic category. OBJECTIVES To estimate racial/ethnic differences in perceptions of provider communication among the six largest Asian subgroups. DESIGN AND PARTICIPANTS Using a nationally representative sample of adults from the 2014-2017 Medical Expenditure Panel Survey (N = 136,836, round-specific response rates range from 72% to 98%), we estimate racial/ethnic differences in perceptions of provider communication, adjusted for English proficiency, immigration status, and sociodemographic characteristics. MAIN MEASURES The main dependent variable is a 4-item scale ranging from 0 to 100 measuring how positively patients view their health care providers' communication, adapted from the Consumer Assessment of Healthcare Providers and Systems (CAHPS©) program. Respondents report how often their providers explain things clearly, show respect, listen carefully, and spend enough time with them. KEY RESULTS Asians, overall, had less positive perceptions of their providers' communication than either Whites or Latinxs. However, only Chinese-White differences remained after differences in English proficiency and immigration status were controlled (difference = - 2.67, 95% CI - 4.83, - 0.51). No other Asian subgroup differed significantly from Whites. CONCLUSIONS Negative views of provider communication are not pervasive among all Asians but, rather, primarily reflect the perceptions of Chinese and, possibly, Vietnamese patients. Researchers, policymakers, health plan executives, and others who produce or use data on patients' experiences with health care should, if possible, avoid categorizing all Asians into a single group.
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Affiliation(s)
- James B Kirby
- Agency for Healthcare Research and Quality, Center for Financing, Access and Cost Trends, Rockville, MD, USA.
| | - Terceira A Berdahl
- Agency for Healthcare Research and Quality, Center for Financing, Access and Cost Trends, Rockville, MD, USA
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45
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Williamson TJ, Ostroff JS, Martin CM, Banerjee SC, Bylund CL, Hamann HA, Shen MJ. Evaluating relationships between lung cancer stigma, anxiety, and depressive symptoms and the absence of empathic opportunities presented during routine clinical consultations. PATIENT EDUCATION AND COUNSELING 2021; 104:322-328. [PMID: 32859447 PMCID: PMC7855769 DOI: 10.1016/j.pec.2020.08.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Revised: 06/26/2020] [Accepted: 08/03/2020] [Indexed: 05/03/2023]
Abstract
OBJECTIVE Empathic communication in clinical consultations is mutually constructed, with patients first presenting empathic opportunities (statements communicating emotions, challenges, or progress) to which clinicians can respond. We hypothesized that lung cancer patients who did not present empathic opportunities during routine consultations would report higher stigma, anxiety, and depressive symptoms than patients who presented at least one. METHODS Audio-recorded consultations between lung cancer patients (N = 56) and clinicians were analyzed to identify empathic opportunities. Participants completed questionnaires measuring sociodemographic and psychosocial characteristics. RESULTS Twenty-one consultations (38 %) did not contain empathic opportunities. Unexpectedly, there was a significant interaction between presenting empathic opportunities and patients' race on disclosure-related stigma (i.e., discomfort discussing one's cancer; F = 4.49, p = .041) and anxiety (F = 8.03, p = .007). Among racial minority patients (self-identifying as Black/African-American, Asian/Pacific Islander, or other race), those who did not present empathic opportunities reported higher stigma than those who presented at least one (t=-5.47, p = .038), but this difference was not observed among white patients (t = 0.38, p = .789). Additional statistically significant findings emerged for anxiety. CONCLUSION Disclosure-related stigma and anxiety may explain why some patients present empathic opportunities whereas others do not. PRACTICE IMPLICATIONS Clinicians should intentionally elicit empathic opportunities and encourage open communication with patients (particularly from diverse racial backgrounds).
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Affiliation(s)
- Timothy J Williamson
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
| | - Jamie S Ostroff
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Chloé M Martin
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Smita C Banerjee
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Carma L Bylund
- College of Journalism and Communications, University of Florida, Gainesville, FL, USA; College of Medicine, University of Florida, Gainesville, FL, USA
| | - Heidi A Hamann
- Department of Psychology, University of Arizona, Tucson, AZ, USA
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Jun J. Cancer/health communication and breast/cervical cancer screening among Asian Americans and five Asian ethnic groups. ETHNICITY & HEALTH 2020; 25:960-981. [PMID: 29792075 DOI: 10.1080/13557858.2018.1478952] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/30/2017] [Accepted: 05/03/2018] [Indexed: 06/08/2023]
Abstract
Objectives: This paper is an examination of cancer/health communication factors (i.e. cancer/health information seeking, patient-provider communication (PPC), cancer screening information from providers) and screening for breast and cervical cancer among Asian Americans and five Asian ethnic groups (Chinese, Filipinos, Japanese, Koreans, Vietnamese) in comparison to Whites. Additionally, the relationship between cancer/health communication disparity and cancer screening gaps between Asian Americans and Whites was investigated. Design: Data comes from a nationally representative sample of 2011-2014 Health Information National Trends Surveys (HINTS). Results: Asian Americans and most Asian ethnic-groups reported significantly lower rates of cancer/health information seeking and lower evaluations for PPC as compared to Whites, though differences within Asian ethnic groups were observed (Koreans' greater cancer/health information seeking, Japanese' higher PPC evaluation). When the cancer/health communication factors were controlled, Asian Americans' odds of cancer screening were increased. Especially, Asian Americans' odds of adhering to the breast cancer screening guideline became nearly 1.4 times greater than Whites. Conclusion: This research demonstrates that health organizations, providers, and Asian American patients' collaborative efforts to increase the access to quality cancer information, to make culturally competent but straightforward screening recommendations, and to practice effective communication in medical encounters will contribute to diminishing cancer disparities among Asian Americans.
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Affiliation(s)
- Jungmi Jun
- The School of Journalism and Mass Communications, University of South Carolina, Columbia, SC, USA
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Hirsh AT, Anastas TM, Miller MM, Quinn PD, Kroenke K. Patient race and opioid misuse history influence provider risk perceptions for future opioid-related problems. AMERICAN PSYCHOLOGIST 2020; 75:784-795. [PMID: 32915023 PMCID: PMC7490831 DOI: 10.1037/amp0000636] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
In response to the dual public health crises of chronic pain and opioid use, providers have become more vigilant about assessing patients for risk of opioid-related problems. Little is known about how providers are making these risk assessments. Given previous studies indicating that Black patients are at increased risk for suboptimal pain care, which may be related to stereotypes about drug abuse, the current study examined how patient race and previous opioid misuse behaviors impact providers' risk assessments for future prescription opioid-related problems. Physician residents and fellows (N = 135) viewed videos and read vignettes about 8 virtual patients with chronic pain who varied by race (Black/White) and history of prescription opioid misuse (absent/present). Providers rated patients' risk for future prescription opioid-related adverse events, misuse/abuse, addiction, and diversion, and also completed measures of implicit racial attitudes and explicit beliefs about race differences in pain. Two significant interactions emerged indicating that Black patients were perceived to be at greater risk for future adverse events (when previous misuse was absent) and diversion (when previous misuse was present). Significant main effects indicated that Black patients and patients with previous misuse were perceived to be at greater risk for future misuse/abuse of prescription opioids, and that patients with previous misuse were perceived to be at greater risk of addiction. These findings suggest that racial minorities and patients with a history of prescription opioid misuse are particularly vulnerable to any unintended consequences of efforts to stem the dual public health crises of chronic pain and opioid use. (PsycInfo Database Record (c) 2020 APA, all rights reserved).
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Affiliation(s)
- Adam T. Hirsh
- Department of Psychology, Indiana University – Purdue University Indianapolis
| | - Tracy M. Anastas
- Department of Psychology, Indiana University – Purdue University Indianapolis
| | - Megan M. Miller
- Department of Psychology, Indiana University – Purdue University Indianapolis
| | - Patrick D. Quinn
- Department of Applied Health Science, Indiana University, Bloomington
| | - Kurt Kroenke
- Department of Medicine, Indiana University School of Medicine
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Boehmer U, Clark MA, Ozonoff A, Winter M, Potter J. Survivors' Perceptions of Quality of Colorectal Cancer Care by Sexual Orientation. Am J Clin Oncol 2020; 43:660-666. [PMID: 32889837 PMCID: PMC8011297 DOI: 10.1097/coc.0000000000000732] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
OBJECTIVE The objective of this study was to assess sexual minority and heterosexual survivors' perceived quality of cancer care and identify demographic, clinical, and psychosocial characteristics associated with patient-centered quality of care. MATERIALS AND METHODS Four cancer registries provided data on 17,849 individuals who were diagnosed with stage I, II, or III colorectal cancer an average of 3 years prior and resided in predetermined diverse geographic areas. A questionnaire, which queried about sexual orientation and other eligibility criteria was mailed to all cancer survivors. Of these, 480 eligible survivors participated in a telephone survey. Quality of cancer care was defined by 3 measures of interpersonal care (physician communication, nursing care, and coordination of care) and by rating cancer care as excellent. We used generalized linear models and logistic regression with forward selection to obtain models that best explained each quality of care measure. RESULTS Sexual minority survivors rated physician communication, nursing care, and coordination of care similarly to heterosexual survivors, yet a significantly higher percentage of sexual minority survivors rated the overall quality of their cancer care as excellent (59% vs. 49%). Sexual minority survivors' greater likelihood of reporting excellent care remained unchanged after adjusting for demographic, clinical, and psychosocial characteristics. CONCLUSIONS Sexual minority survivors' ratings of quality of colorectal cancer care were comparable or even higher than heterosexual survivors. Sexual minority survivors' reports of excellent care were not explained by their interpersonal care experiences.
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Affiliation(s)
- Ulrike Boehmer
- Department of Community Health Sciences, Boston University School of Public Health, Boston, MA
| | - Melissa A. Clark
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA
| | - Al Ozonoff
- Harvard Medical School, Boston, MA
- Boston Children’s Hospital, Boston, MA
| | - Michael Winter
- Biostatistics and Epidemiology Data Analytics Center, Boston University School of Public Health, Boston, MA
| | - Jennifer Potter
- Harvard Medical School, Boston, MA
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA
- The Fenway Institute, Boston, MA
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Ornstein KA, Roth DL, Huang J, Levitan EB, Rhodes JD, Fabius CD, Safford MM, Sheehan OC. Evaluation of Racial Disparities in Hospice Use and End-of-Life Treatment Intensity in the REGARDS Cohort. JAMA Netw Open 2020; 3:e2014639. [PMID: 32833020 PMCID: PMC7445597 DOI: 10.1001/jamanetworkopen.2020.14639] [Citation(s) in RCA: 92] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Accepted: 06/12/2020] [Indexed: 01/08/2023] Open
Abstract
Importance Although hospice use is increasing and patients in the US are increasingly dying at home, racial disparities in treatment intensity at the end of life, including hospice use, remain. Objective To examine differences between Black and White patients in end-of-life care in a population sample with well-characterized causes of death. Design, Setting, and Participants This study used data from the Reasons for Geographic and Racial Differences in Stroke (REGARDS) study, an ongoing population-based cohort study with enrollment between January 25, 2003, and October 3, 2007, with linkage to Medicare claims data. Multivariable logistic regression models were used to examine racial and regional differences in end-of-life outcomes and in stroke mortality among 1212 participants with fee-for-service Medicare who died between January 1, 2013, and December 31, 2015, owing to natural causes and excluding sudden death, with oversampling of Black individuals and residents of Southeastern states in the United States. Initial analyses were conducted in March 2019, and final primary analyses were conducted in February 2020. Main Outcomes and Measures The primary outcomes of interest were hospice use of 3 or more days in the last 6 months of life derived from Medicare claims files. Other outcomes included multiple hospitalizations, emergency department visits, and use of intensive procedures in the last 6 months of life. Cause of death was adjudicated by an expert panel of clinicians using death certificates, proxy interviews, autopsy reports, and medical records. Results The sample consisted of 1212 participants (630 men [52.0%]; 378 Black individuals [31.2%]; mean [SD] age at death, 81.0 [8.6] years) of 2542 total deaths. Black decedents were less likely than White decedents to use hospice for 3 or more days (132 of 378 [34.9%] vs 385 of 834 [46.2%]; P < .001). After stratification by cause of death, substantial racial differences in treatment intensity and service use were found among persons who died of cardiovascular disease but not among patients who died of cancer. In analyses adjusted for cause of death (dementia, cancer, cardiovascular disease, and other) and clinical and demographic variables, Black decedents were significantly less likely to use 3 or more days of hospice (odds ratio [OR], 0.72; 95% CI, 0.54-0.96) and were more likely to have multiple emergency department visits (OR, 1.35; 95% CI, 1.01-1.80) and hospitalizations (OR, 1.39; 95% CI, 1.02-1.89) and undergo intensive treatment (OR, 1.94; 95% CI, 1.40-2.70) in the last 6 months of life compared with White decedents. Conclusions and Relevance Despite the increase in the use of hospice care in recent decades, racial disparities in the use of hospice remain, especially for noncancer deaths. More research is required to better understand racial disparities in access to and quality of end-of-life care.
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Affiliation(s)
- Katherine A. Ornstein
- Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| | - David L. Roth
- Center on Aging and Health, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Jin Huang
- Center on Aging and Health, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Emily B. Levitan
- Department of Epidemiology, University of Alabama at Birmingham School of Public Health, Birmingham
| | - J. David Rhodes
- Department of Epidemiology, University of Alabama at Birmingham School of Public Health, Birmingham
| | - Chanee D. Fabius
- Department of Health Policy and Management, Johns Hopkins School of Public Health, Baltimore, Maryland
| | - Monika M. Safford
- Division of General Internal Medicine, Weill Cornell Medicine, New York, New York
| | - Orla C. Sheehan
- Center on Aging and Health, Johns Hopkins School of Medicine, Baltimore, Maryland
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50
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Arabandi P, Slade AN, Sutton AL, McGuire KP, Sheppard V. Racial differences in the relationship between surgical choice and subsequent patient-reported satisfaction outcomes among women with early-stage hormone-positive breast cancer. Breast Cancer Res Treat 2020; 183:459-466. [PMID: 32676991 DOI: 10.1007/s10549-020-05784-2] [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: 10/23/2019] [Accepted: 07/02/2020] [Indexed: 11/29/2022]
Abstract
PURPOSE The last fifteen years has seen a rising proportion of women who are eligible for breast conserving therapy (BCT) choosing mastectomy despite equivalent survival in early-stage breast cancer. We aim to explore potential racial differences in the association of surgical choice with subsequent patient-reported satisfaction outcomes. METHODS Women who were within one year of diagnosis with hormone receptor (HR)-positive breast cancer were asked the Short Version of Patient Satisfaction Questionnaire (PSQ-18), which assesses their overall satisfaction with their medical care. We conducted bivariate analyses, including paired t-tests, to clarify differences in these patient-reported factors by surgical choice and race. Multivariable linear regression models were used to adjust for clinical and demographic control variables. RESULTS For the sample of 279 women who underwent definitive surgery, women who received a mastectomy had lower levels of overall satisfaction, 71 vs. 75 (out of 90) (p = .001). In stratifying this relationship by race, the difference in total satisfaction score was largest among Black women (69 among mastectomy patients vs. 75 among BCT patients; p = 0.016). On multivariable linear regression, Black race and mastectomy status (together) exhibited a significantly large negative association with total satisfaction score, with negative associations across all domains of the PSQ-18. CONCLUSION Despite the high prevalence of mastectomy among Black women with early-stage, HR-positive breast cancer, this population is more likely to report lower levels of patient satisfaction compared to patients receiving BCT. These findings suggest there may be potential racial differences in the psychosocial consequences of surgical choice.
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Affiliation(s)
- Prudvi Arabandi
- Massey Cancer Center, Virginia Commonwealth University Health System, Richmond, VA, USA
| | - Alexander N Slade
- Massey Cancer Center, Virginia Commonwealth University Health System, Richmond, VA, USA.
| | - Arnethea L Sutton
- Department of Health Behavior & Policy, Virginia Commonwealth University, Richmond, VA, USA
| | - Kandace P McGuire
- Massey Cancer Center, Virginia Commonwealth University Health System, Richmond, VA, USA
| | - Vanessa Sheppard
- Department of Health Behavior & Policy, Virginia Commonwealth University, Richmond, VA, USA
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