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Fereydooni S, Valdez C, William L, Malik D, Mehra S, Judson B. Predisposing, Enabling, and Need Factors Driving Palliative Care Use in Head and Neck Cancer. Otolaryngol Head Neck Surg 2024; 171:1069-1082. [PMID: 38796734 DOI: 10.1002/ohn.819] [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: 11/21/2023] [Revised: 04/10/2024] [Accepted: 04/27/2024] [Indexed: 05/28/2024]
Abstract
OBJECTIVE Characterizing factors associated with palliative care (PC) use in patients with stage III and VI head and neck cancer using Anderson's behavioral model of health service use. STUDY DESIGN A retrospective study of the 2004 to 2020 National Cancer Database.gg METHODS: We used multivariate logistic regression to assess the association of predisposing, enabling, and need factors with PC use. We also investigated the association of these factors with interventional PC type (chemotherapy, radiotherapy, surgery) and refusal of curative treatment in the last 6 months of life. RESULTS Five percent of patients received PC. "Predisposing factors" associated with less PC use include Hispanic ethnicity (adjusted odds ratio [aOR], 086; 95% confidence interval [CI], 0.76-0.97) and white and black race (vs white: aOR, 1.14; 95% CI, 1.07-1.22). "Enabling factors" associated with lower PC include private insurance (vs uninsured: aOR, 064; 95% CI, 0.53-0.77) and high-income (aOR, 078; 95% CI, 0.71-0.85). "Need factors" associated with higher PC use include stage IV (vs stage III cancer: aOR, 2.25; 95% CI, 2.11-2.40) and higher comorbidity index (vs Index 1: aOR, 1.58; 95% CI, 1.42-1.75). High-income (aOR, 0.78; 95% CI, 0.71-0.85) and private insurance (aOR, 0.6; 95% CI, 0.53, 0.77) were associated with higher interventional PC use and lower curative treatment refusal (insurance: aOR, 0.82; 95% CI, 0.55, 0.67; income aOR, 0.48; 95% CI, 0.44, 0.52). CONCLUSION Low PC uptake is attributed to patients' race/culture, financial capabilities, and disease severity. Culturally informed counseling, clear guidelines on PC indication, and increasing financial accessibility of PC may increase timely and appropriate use of this service.
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Affiliation(s)
- Soraya Fereydooni
- Department of Surgery, Division of Otolaryngology, Yale School of Medicine, New Haven, Connecticut, USA
| | - Caroline Valdez
- Department of Surgery, Division of Otolaryngology, Yale School of Medicine, New Haven, Connecticut, USA
| | | | - Devesh Malik
- Department of Surgery, Division of Otolaryngology, Yale School of Medicine, New Haven, Connecticut, USA
| | - Saral Mehra
- Department of Surgery, Division of Otolaryngology, Yale School of Medicine, New Haven, Connecticut, USA
| | - Benjamin Judson
- Department of Surgery, Division of Otolaryngology, Yale School of Medicine, New Haven, Connecticut, USA
- Otolaryngology Surgery, New Haven, Connecticut, USA
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Metlock FE, Hinneh T, Benjasirisan C, Alharthi A, Ogungbe O, Turkson-Ocran RAN, Himmelfarb CR, Commodore-Mensah Y. Impact of Social Determinants of Health on Hypertension Outcomes: A Systematic Review. Hypertension 2024; 81:1675-1700. [PMID: 38887955 DOI: 10.1161/hypertensionaha.123.22571] [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: 06/20/2024]
Abstract
Despite ample evidence linking social determinants of health (SDoH) and hypertension outcomes, efforts to address SDoH in the context of hypertension prevention and self-management are not commensurate with the burden and impact of hypertension. To provide valuable insights into the development of targeted and effective strategies for preventing and managing hypertension, this systematic review, guided by the Healthy People 2030 SDoH framework, aims to summarize the inclusion, measurement, and evaluation of SDoH in studies examining hypertension outcomes, with a focus on characterizing SDoH constructs and summarizing the current evidence of their influence on hypertension outcomes. Following Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines, a comprehensive search of electronic databases identified 10 608 unique records, from which 57 articles meeting inclusion criteria were analyzed. The studies, conducted nationally or regionally across the United States, revealed that higher educational attainment, health insurance coverage, income, and favorable neighborhood characteristics were associated with lower hypertension prevalence and better hypertension control among US adults. The findings underscore the importance of addressing SDoH such as education, health care access, economic stability, neighborhood environments, and social context to reduce hypertension disparities. Multilevel collaboration and community-engaged practices are necessary to tackle these disparities effectively.
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Affiliation(s)
- Faith E Metlock
- Johns Hopkins School of Nursing, Baltimore, MD (F.E.M., T.H., C.B., O.O., C.R.H., Y.C.-M.)
| | - Thomas Hinneh
- Johns Hopkins School of Nursing, Baltimore, MD (F.E.M., T.H., C.B., O.O., C.R.H., Y.C.-M.)
| | | | | | - Oluwabunmi Ogungbe
- Johns Hopkins School of Nursing, Baltimore, MD (F.E.M., T.H., C.B., O.O., C.R.H., Y.C.-M.)
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (C.R.H., O.O., Y.C.-M.)
| | - Ruth-Alma N Turkson-Ocran
- Department of Medicine, Research Section, Beth Israel Deaconess Medical Center, Boston, MA (R.-A.N.T.-O.)
- Harvard School of Medicine, Boston, MA (R.-A.N.T.-O.)
| | - Cheryl R Himmelfarb
- Johns Hopkins School of Nursing, Baltimore, MD (F.E.M., T.H., C.B., O.O., C.R.H., Y.C.-M.)
- Johns Hopkins School of Medicine, Baltimore, MD (C.R.H.)
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (C.R.H., O.O., Y.C.-M.)
| | - Yvonne Commodore-Mensah
- Johns Hopkins School of Nursing, Baltimore, MD (F.E.M., T.H., C.B., O.O., C.R.H., Y.C.-M.)
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (C.R.H., O.O., Y.C.-M.)
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Luck CC, Bass SB, Chertock Y, Kelly PJA, Singley K, Hoadley A, Hall MJ. Understanding perceptions of tumor genomic profile testing in Black/African American cancer patients in a qualitative study: the role of medical mistrust, provider communication, and family support. J Community Genet 2024; 15:281-292. [PMID: 38366313 PMCID: PMC11217212 DOI: 10.1007/s12687-024-00700-3] [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: 08/04/2023] [Accepted: 01/30/2024] [Indexed: 02/18/2024] Open
Abstract
Tumor genomic profiling (TGP) examines genes and somatic mutations specific to a patient's tumor to identify targets for cancer treatments but can also uncover secondary hereditary (germline) mutations. Most patients are unprepared to make complex decisions related to this information. Black/African American (AA) cancer patients are especially at risk because of lower health literacy, higher levels of medical mistrust, and lower awareness and knowledge of genetic testing. But little is known about their TGP attitudes or preferences. Five in-person focus groups were conducted with Black/AA cancer patients (N = 33) from an NCI-designated cancer center and an affiliated oncology unit in an urban safety-net hospital located in Philadelphia. Focus groups explored participants' understanding of TGP, cultural beliefs about genetics, medical mistrust, and how these perceptions informed decision-making. Participants were mostly female (81.8%), and one-third had some college education; mean age was 57 with a SD of 11.35. Of patients, 33.3% reported never having heard of TGP, and 48.5% were not aware of having had TGP as part of their cancer treatment. Qualitative analysis was guided by the principles of applied thematic analysis and yielded five themes: (1) mistrust of medical institutions spurring independent health-information seeking; (2) genetic testing results as both empowering and overwhelming; (3) how provider-patient communication can obviate medical mistrust; (4) how unsupportive patient-family communication undermines interest in secondary-hereditary risk communication; and (5) importance of developing centralized patient support systems outside of treatment decisions. Results improve understanding of how Black/AA patients perceive of TGP and how interventions can be developed to assist with making informed decisions about secondary hereditary results.
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Affiliation(s)
- Caseem C Luck
- Risk Communication Laboratory, Department of Social and Behavioral Sciences, Temple University College of Public Health, 1301 Cecil B Moore Ave, Rm 947, Philadelphia, PA, 19122, USA.
| | - Sarah Bauerle Bass
- Risk Communication Laboratory, Department of Social and Behavioral Sciences, Temple University College of Public Health, 1301 Cecil B Moore Ave, Rm 947, Philadelphia, PA, 19122, USA
| | - Yana Chertock
- Department of Clinical Genetics, Cancer Prevention and Control Program, Fox Chase Cancer Center, 333 Cottman Avenue, Philadelphia, PA, 19111, USA
| | - Patrick J A Kelly
- Department of Behavioral and Social Sciences, Brown University School of Public Health, 121 South Main Street, Providence, RI, 02903, USA
| | - Katie Singley
- Risk Communication Laboratory, Department of Social and Behavioral Sciences, Temple University College of Public Health, 1301 Cecil B Moore Ave, Rm 947, Philadelphia, PA, 19122, USA
| | - Ariel Hoadley
- Risk Communication Laboratory, Department of Social and Behavioral Sciences, Temple University College of Public Health, 1301 Cecil B Moore Ave, Rm 947, Philadelphia, PA, 19122, USA
| | - Michael J Hall
- Department of Clinical Genetics, Cancer Prevention and Control Program, Fox Chase Cancer Center, 333 Cottman Avenue, Philadelphia, PA, 19111, USA
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Izumi S(S, Garcia E, Kualaau A, Sloan DE, DeSanto-Madeya S, Candrian C, Anderson E, Sanders J. Advance care planning as perceived by marginalized populations: Willing to engage and facing obstacles. PLoS One 2024; 19:e0301426. [PMID: 38557983 PMCID: PMC10984538 DOI: 10.1371/journal.pone.0301426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Accepted: 03/17/2024] [Indexed: 04/04/2024] Open
Abstract
BACKGROUND Health disparities exist in end-of-life (EOL) care. Individuals and communities that are marginalized due to their race, ethnicity, income, geographic location, language, or cultural background experience systemic barriers to access and receive lower quality EOL care. Advance care planning (ACP) prepares patients and their caregivers for EOL decision-making for the purpose of promoting high-quality EOL care. Low engagement in ACP among marginalized populations is thought to have contributed to disparity in EOL care. To advance health equity and deliver care that aligns with the goals and values of each individual, there is a need to improve ACP for marginalized populations. AIM To describe how patients from marginalized populations experience and perceive ACP. METHODS We used an interpretive phenomenological approach with semi-structured qualitative interviews. Participants were recruited from four primary care clinics and one nursing home in a US Pacific Northwest city. Thirty patients from marginalized populations with serious illness participated in individual interviews between January and December 2021. Participants were asked to describe their experiences and perceptions about ACP during the interviews. RESULTS The mean age of 30 participants was 69.5; 19 (63%) were women; 12 (40%) identified as Asian/Pacific Islanders, 10 (33%) as Black; and 9 (30%) were non-native English speakers. Our three key findings were: 1) patients from marginalized populations are willing to engage in ACP; 2) there were multiple obstacles to engaging in ACP; and 3) meaningful ACP conversations could happen when clinicians listen. Although participants from marginalized populations were willing to engage in ACP, a fragmented and restrictive healthcare system and clinicians' biased behaviors or lack of interest in knowing their patients were obstacles. Participants who felt their clinicians took time and listened were encouraged to engage in ACP. CONCLUSION Patients from marginalized populations are willing to engage in ACP conversations despite a common belief otherwise. However, obstacles to meaningful ACP conversations with healthcare providers exist. Clinicians need to be aware of these obstacles and listen to build trust and engage marginalized patients in mutually meaningful ACP conversations.
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Affiliation(s)
- Shigeko (Seiko) Izumi
- School of Nursing, Oregon Health & Science University, Portland, Oregon, United States of America
| | - Ellen Garcia
- School of Nursing, Oregon Health & Science University, Portland, Oregon, United States of America
| | - Andrew Kualaau
- School of Nursing, Oregon Health & Science University, Portland, Oregon, United States of America
| | - Danetta E. Sloan
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, United States of America
| | - Susan DeSanto-Madeya
- College of Nursing, University of Rhode Island, Providence, Rhode Island, United States of America
| | - Carey Candrian
- School of Medicine, University of Colorado, Aurora, Colorado, United States of America
| | - Elizabeth Anderson
- Pacific Institute for Research and Evaluation, Louisville, Kentucky, United States of America
| | - Justin Sanders
- Department of Family Medicine, McGill University, Montreal, Quebec, Canada
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Murrar S, Baqai B, Padela AI. Predictors of Perceived Discrimination in Medical Settings Among Muslim Women in the USA. J Racial Ethn Health Disparities 2024; 11:150-156. [PMID: 36622571 DOI: 10.1007/s40615-022-01506-0] [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: 08/30/2022] [Revised: 12/21/2022] [Accepted: 12/22/2022] [Indexed: 01/10/2023]
Abstract
Minority groups based on immigration status, gender, or religion often face discrimination in healthcare settings. Muslim women, especially those who wear hijab, are more likely to experience stereotyping and discrimination in and outside of healthcare, but little is known about the sociodemographic predictors of this discrimination. We examined sociodemographic factors and religiosity as predictors of discrimination in medical settings among Muslim American women. Muslim women (n = 254) were recruited from Muslim organizations in Chicago to self-administer a survey on perceived discrimination, religiosity, and sociodemographic characteristics. Many participants reported that they were treated with less courtesy than non-Muslims (25.4%) and that a doctor or nurse did not listen to them (29.8%) or acted as though they were not smart (24.3%). A multivariable regression model revealed that self-rated religiosity was negatively associated with discrimination. Race/ethnicity trended towards predicting perceived discrimination such that Arabs and South Asians reported less discrimination than African Americans. The current study sheds light on the important role of religiosity in shaping Muslim women's experiences in medical settings and points to the buffering effect of religiosity and the additive consequences of racial/ethnic identity in experiences of religious discrimination.
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Affiliation(s)
- Sohad Murrar
- Department of Emergency Medicine, Medical College of Wisconsin, Milwaukee, WI, USA.
- Department of Psychology, University of Illinois at Chicago, Chicago, IL, USA.
- Initiative On Islam and Medicine, Brookfield, WI, USA.
| | - Benish Baqai
- Initiative On Islam and Medicine, Brookfield, WI, USA
- Medical College of Wisconsin, Milwaukee, WI, USA
| | - Aasim I Padela
- Department of Emergency Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
- Initiative On Islam and Medicine, Brookfield, WI, USA
- Medical College of Wisconsin, Milwaukee, WI, USA
- Center for Bioethics and the Medical Humanities, Institute for Health and Equity, Medical College of Wisconsin, Milwaukee, WI, USA
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6
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Jiménez AL, Cruz-Gonzalez M, Forsyth Calhoun T, Cohen L, Alegría M. Late life anxiety and depression symptoms, and suicidal behaviors in racial/ethnic minority older adults in community-based organizations and community clinics in the U.S. CULTURAL DIVERSITY & ETHNIC MINORITY PSYCHOLOGY 2024; 30:22-34. [PMID: 35113605 PMCID: PMC9519187 DOI: 10.1037/cdp0000524] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/09/2023]
Abstract
OBJECTIVE Late life anxiety and depression represent a significant source of disability, with racial/ethnic minority older adults in the U.S. showing marked disparities in healthy aging. Community-based organizations (CBOs) and community clinics serve these populations for preventive care, yet few identify their mental health service needs. We examine the association between race/ethnicity and risk of mild-to-severe symptoms of anxiety and depression, and suicidal behaviors in minority older adults. METHOD Data come from the multisite randomized controlled trial Building Community Capacity for Disability Prevention for Minority Elders, which screened 1,057 adults (45.5% Asian, 26.8% Latinx, 15.0% non-Latinx Black, 8.5% non-Latinx White, and 4.2% American Indian) aged 60 + years at CBOs and clinics in Massachusetts, New York, Florida, and Puerto Rico. Screened participants completed the Generalized Anxiety Disorder-7 (GAD-7) for anxiety symptoms, the Geriatric Depression Scale-15 (GDS-15) for depression symptoms, and the Paykel Suicide Risk Questionnaire for suicidal behaviors. RESULTS 28.1% of older adults reported mild-to-severe anxiety symptoms, 30.1% reported mild-to-severe depression symptoms, and 4.3% reported at least one suicidal behavior. Compared to non-Latinx Whites, Latinxs had higher odds of mild-to-severe anxiety and depression symptoms and one or more suicidal behaviors, and Asians had higher odds of mild-to-severe depression symptoms only. CONCLUSIONS There is an urgent need to improve outreach for screening and preventive mental health care for minority older adults. Expanding outreach and community-based capacity to identify and treat minority older adults with mental health conditions represents an opportunity to prevent disability. (PsycInfo Database Record (c) 2024 APA, all rights reserved).
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Affiliation(s)
- Aida L. Jiménez
- Department of Psychology, University of Puerto Rico, San
Juan, Puerto Rico
| | - Mario Cruz-Gonzalez
- Disparities Research Unit, Department of Medicine,
Massachusetts General Hospital
| | | | - Lauren Cohen
- Disparities Research Unit, Department of Medicine,
Massachusetts General Hospital
| | - Margarita Alegría
- Disparities Research Unit, Department of Medicine,
Massachusetts General Hospital
- Departments of Medicine and Psychiatry, Harvard Medical
School
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Antoine-LaVigne D, Hayes T, Fortenberry M, Ohikhuai E, Addison C, Mozee S, McGill D, Shanks ML, Roby C, Jenkins BWC, Tchounwou PB. Trust and Biomedical Research Engagement of Minority and Under-Represented Communities in Mississippi, USA. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:1592. [PMID: 36674346 PMCID: PMC9860548 DOI: 10.3390/ijerph20021592] [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] [Received: 12/08/2022] [Revised: 12/30/2022] [Accepted: 01/04/2023] [Indexed: 06/17/2023]
Abstract
Trust is critical to the development and maintenance of effective research collaborations and community engagement. The purpose of this study was to assess the current attitudes and level of trust pertaining to health research among residents of Central Mississippi, the priority health region for the Research Centers in Minority Institutions (RCMI) Center for Health Disparities Research (RCHDR) at Jackson State University. The cross-sectional study was conducted from November 2021 to April 2022. The data were analyzed using descriptive statistics carried out by SPSS statistical software. A total of 146 participants responded to the survey. The participants were predominately African American (99%) and female (75%). Historical research studies, the researchers' qualities, and potential benefits from participation were factors affecting the level of trust in the research process. Ninety percent (n = 131) expressed that it was important to be involved in the research process, and 98.5% (n = 144) agreed that discussing the research findings with the participants was important for establishing trust in the research process. While trust in the research process does not guarantee participation, trust is a precursor for those who decide to engage in health disparities research. Key findings will be integrated into the RCHDR research agenda to foster further development and implementation of innovative community-based participatory research toward the control and/or prevention of diseases that disproportionately affect minority and under-represented populations in Mississippi.
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Affiliation(s)
- Donna Antoine-LaVigne
- RCMI Center for Health Disparities Research, Jackson State University, Jackson, MS 39217, USA
| | - Traci Hayes
- School of Health Professions, University of Southern Mississippi, Hattiesburg, MS 39406, USA
| | - Marty Fortenberry
- RCMI Center for Health Disparities Research, Jackson State University, Jackson, MS 39217, USA
| | - Evidence Ohikhuai
- RCMI Center for Health Disparities Research, Jackson State University, Jackson, MS 39217, USA
| | - Clifton Addison
- Jackson Heart Study Graduate Training and Education Center, School of Public Health, Jackson State University, Jackson, MS 39213, USA
| | - Sam Mozee
- Mississippi Urban Research Center, Jackson State University, Jackson, MS 39201, USA
| | - Dorothy McGill
- Innovative Behavioral Services, Ridgeland, MS 39157, USA
| | - Mangle L. Shanks
- Shanks Health Housing, Employment, Education & Training Services, Inc., Jackson, MS 39289, USA
| | | | - Brenda W. Campbell Jenkins
- Jackson Heart Study Graduate Training and Education Center, School of Public Health, Jackson State University, Jackson, MS 39213, USA
| | - Paul B. Tchounwou
- RCMI Center for Health Disparities Research, Jackson State University, Jackson, MS 39217, USA
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Breaux RD, Rooks RN. The intersectional importance of race/ethnicity, disability, and age in flu vaccine uptake for U.S. adults. SSM Popul Health 2022; 19:101211. [PMID: 36052156 PMCID: PMC9425074 DOI: 10.1016/j.ssmph.2022.101211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Revised: 08/11/2022] [Accepted: 08/14/2022] [Indexed: 10/31/2022] Open
Abstract
Improving vaccination rates among marginalized populations is an important priority among public policy makers and healthcare providers in the United States of America (U.S.). Racial/ethnic minorities have a long history of reduced vaccination rates relative to white Americans (Khan, Hall, Tanner, & Marlow, 2018), while people with disabilities (PWD) have varied rates of vaccine use (Diab & Johnston, 2004; O'Neill, Newall, Antolovich, Lima, & Danchin, 2019). Yet, little is known about vaccine use among individuals who belong to both groups. This study examines the intersectional effects of race/ethnicity and disability on flu vaccine use. We used the 2015-2018 National Health Interview Survey to examine the odds of flu vaccine use by race/ethnicity, disability, and their interaction among adults aged 18+ in the U.S. non-institutionalized, civilian population stratified by age groups. For each unit increase in disability scores, we found a significant race-by-disability interaction for young black adults (18-39 years) who had higher odds of getting the flu vaccine compared to white adults in the same age group. A significant interaction occurred for middle-aged Hispanic vs. white adults (40-64 years) who had higher odds of getting the flu vaccine as their disability scores increased. Black vs. white adults were less likely to get the flu vaccine across all age groups irrespective of disability and other covariates, while results were more mixed among other racial/ethnic groups. Additionally, people with disabilities had higher odds of flu vaccination. Further, race/ethnicity had a moderating effect on the relationship between disability and flu vaccination and an interaction effect occurred between disability and certain racial/ethnic groups when stratified by age.
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Affiliation(s)
- Rebecca D Breaux
- University of Colorado Denver, 1224 5th Street, HUB, Denver, CO, 80204, USA
| | - Ronica N Rooks
- University of Colorado Denver, 3023C North Classroom, P.O. Box 173364, Campus Box 188, Denver, CO, 80217-3364, USA
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McBride CM, Pathak S, Johnson CE, Alberg AJ, Bandera EV, Barnholtz‐Sloan JS, Bondy ML, Cote ML, Moorman PG, Peres LC, Peters ES, Schwartz AG, Terry PD, Schildkraut JM. Psychosocial factors associated with genetic testing status among African American women with ovarian cancer: Results from the African American Cancer Epidemiology Study. Cancer 2022; 128:1252-1259. [PMID: 34882782 PMCID: PMC9300067 DOI: 10.1002/cncr.34053] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Revised: 10/25/2021] [Accepted: 10/27/2021] [Indexed: 12/29/2022]
Abstract
BACKGROUND Racial disparities in the uptake of cancer genetic services are well documented among African American (AA) women. Understanding the multiple social and psychological factors that can influence the uptake of genetic testing among AA women is needed. METHODS Data came from 270 AA women diagnosed with ovarian cancer and participating in a population-based, case-control study of ovarian cancer who were asked about genetic testing. Logistic regression analyses tested the associations of predisposing, enabling, and need factors with reported genetic testing uptake. RESULTS One-third of the sample (35%) reported having had genetic testing. In the multivariable model, AA women with higher incomes had more than double the odds of being tested than those with the lowest income (odds ratio [OR] for $25,000-$74,999, 2.04; 95% confidence interval [CI], 1.06-3.99; OR for ≥$75,000, 2.32; 95% CI, 0.92-5.94). AA women who reported employment discrimination were significantly less likely to report genetic testing than those who did not report job discrimination (OR, 0.39; 95% CI, 0.14-0.95). Marital status, Medicaid versus other insurance, prayer frequency, and perceived social support were significantly associated with genetic testing uptake in bivariate analyses but were not significant contributors in multivariable analyses. CONCLUSIONS Consistent with other studies of AA women, a minority of African American Cancer Epidemiology Study participants had undergone genetic testing. Having a lower income and experiencing job discrimination decreased the likelihood of testing. These results provide foundational evidence supporting the need for interventions to improve the uptake of genetic testing among AA women by reducing cost barriers and providing credible assurances that genetic results will be kept private and not affect social factors such as employability.
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Affiliation(s)
- Colleen M. McBride
- Department of Behavioral, Social, and Health Education SciencesEmory University Rollins School of Public HealthAtlantaGeorgia
| | - Sarita Pathak
- Department of Behavioral, Social, and Health Education SciencesEmory University Rollins School of Public HealthAtlantaGeorgia
| | - Courtney E. Johnson
- Department of EpidemiologyEmory University Rollins School of Public HealthAtlantaGeorgia
| | - Anthony J. Alberg
- Department of Epidemiology and BiostatisticsUniversity of South Carolina Arnold School of Public HealthColumbiaSouth Carolina
| | - Elisa V. Bandera
- Cancer Prevention and Control ProgramRutgers Cancer Institute of New JerseyNew BrunswickNew Jersey
| | - Jill S. Barnholtz‐Sloan
- Department of Population and Quantitative Health SciencesCase Western Reserve University School of MedicineClevelandOhio
- University HospitalsClevelandOhio
| | - Melissa L. Bondy
- Department of Epidemiology and Population HealthStanford UniversityStanfordCalifornia
| | - Michele L. Cote
- Department of OncologyWayne State University School of Medicine and Karmanos Cancer InstituteDetroitMichigan
| | - Patricia G. Moorman
- Department of Community and Family MedicineDuke University Medical CenterDurhamNorth Carolina
| | - Lauren C. Peres
- Department of Cancer EpidemiologyH. Lee Moffitt Cancer Center and Research InstituteTampaFlorida
| | - Edward S. Peters
- Epidemiology ProgramLouisiana State University Health Sciences Center School of Public HealthNew OrleansLouisiana
| | - Ann G. Schwartz
- Department of OncologyWayne State University School of Medicine and Karmanos Cancer InstituteDetroitMichigan
| | - Paul D. Terry
- Department of MedicineUniversity of Tennessee Medical Center–KnoxvilleKnoxvilleTennessee
| | - Joellen M. Schildkraut
- Department of EpidemiologyEmory University Rollins School of Public HealthAtlantaGeorgia
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Ma A, Sanchez A, Ma M. Racial disparities in health care utilization, the affordable care act and racial concordance preference. INTERNATIONAL JOURNAL OF HEALTH ECONOMICS AND MANAGEMENT 2022; 22:91-110. [PMID: 34427837 DOI: 10.1007/s10754-021-09311-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Accepted: 08/17/2021] [Indexed: 06/13/2023]
Abstract
The Affordable Care Act was implemented with the aim of increasing coverage and affordable access with hopes of improving health outcomes and reducing costs. Yet, disparities persist. Coverage and affordable access alone cannot explain the health care gap between racial/ethnic minorities and white patients. Instead, the focus has turned to other factors affecting utilization rates such as the patient-provider relationship. Data from nationally represented U.S. households in 2009-2017 were used to study the association between patient-provider social distance as measured by "racial/ethnic concordance" and health care utilization rates for periods covering pre- and post-ACA. Despite the reduction in financial barriers to health access with the implementation of the ACA, the correlation between racial/ethnic concordance and utilization remains positive and significant. The results suggest that while the ACA may have improved coverage and affordability, other dimensions of access, particularly acceptability, as measured by patient-provider clinical interaction experience, remains a factor in the decision to utilize care.
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Affiliation(s)
- Alyson Ma
- Department of Economics, University of San Diego School of Business, 5998 Alcala Park, San Diego, CA, 92110, USA
| | - Alison Sanchez
- Department of Economics, University of San Diego School of Business, 5998 Alcala Park, San Diego, CA, 92110, USA.
| | - Mindy Ma
- Department of Psychology and Neuroscience, Nova Southeastern University, 3301 College Avenue, Fort Lauderdale, FL, 33314, USA
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Pugh M, Perrin PB, Rybarczyk B, Tan J. Racism, Mental Health, Healthcare Provider Trust, and Medication Adherence Among Black Patients in Safety-Net Primary Care. J Clin Psychol Med Settings 2021; 28:181-190. [PMID: 32008136 DOI: 10.1007/s10880-020-09702-y] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
There has been a growing research focus on social determinants to health disparities in general and medication adherence more specifically in low-income Black populations. The purpose of this study was to examine whether prior experiences of racism among Black patients in safety-net primary care indirectly predicts poor medication adherence through increased mental health symptoms and low healthcare provider trust. Two competing models were run whereby mental health leads to provider trust or provider trust leads to mental health in this multiple mediational chain. A group of 134 Black patients (76 men, average age 45.39 years) in a safety-net primary care clinic completed measures of these constructs. Results revealed that in the first model, mental health mediated the relationship between racism and provider trust, and provider trust mediated the relationship between mental health and medication adherence. All paths within this model were statistically significant, except the path between provider trust and medication adherence which approached significance. In the second model, provider trust and mental health significantly mediated the relationship between racism and medication adherence, and all direct and indirect paths were statistically significant, though the path between provider trust and medication adherence was omitted. These results may serve as catalysts to assess and attempt to mitigate specific minority-based stressors and associated outcomes within safety-net primary care settings.
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Affiliation(s)
- Mickeal Pugh
- Department of Psychology, Virginia Commonwealth University, Richmond, VA, USA
| | - Paul B Perrin
- Department of Psychology, Virginia Commonwealth University, Richmond, VA, USA.
- Departments of Psychology, Physical Medicine and Rehabilitation, Virginia Commonwealth University, 800 West Franklin St., Room 201, Box 842018, Richmond, VA, 23284-2018, USA.
| | - Bruce Rybarczyk
- Department of Psychology, Virginia Commonwealth University, Richmond, VA, USA
- Department of Psychiatry, Virginia Commonwealth University School of Medicine, Richmond, VA, USA
| | - Joseph Tan
- Department of Psychology, Virginia Commonwealth University, Richmond, VA, USA
- Hunter Holmes McGuire VA Medical Center, Richmond, VA, USA
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12
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Han SD, Lamar M, Fleischman D, Kim N, Bennett DA, Lewis TT, Arfanakis K, Barnes LL. Self-reported experiences of discrimination in older black adults are associated with insula functional connectivity. Brain Imaging Behav 2021; 15:1718-1727. [PMID: 32720182 PMCID: PMC7854830 DOI: 10.1007/s11682-020-00365-9] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Self-reported experiences of discrimination are associated with a number of negative health outcomes. However, the neurobiological correlates of discrimination remain elusive. Recent neuroimaging work suggests that the amygdala is sensitive to forms of social adversity and the insula is involved in assessments of trust. We hypothesized that functional connectivity (FC) of these brain regions may be associated with discrimination in older Black adults. One-hundred and twenty-four nondemented older Black adults participating in the Minority Aging Research Study or the Clinical Core study of the Rush Alzheimer's Disease Center completed a measure of self-reported experiences of discrimination and a 3T MRI brain scan including structural T1 and resting-state fMRI EPIBOLD sequences. The right and left amygdala and insula regions were anatomically delineated as ROIs according to the Harvard-Oxford Brain Atlas and whole-brain voxelwise FC analyses were conducted using default parameters in the CONN toolbox. In regression analyses controlling for demographics and global cognition, self-reported experiences of discrimination were associated with greater FC between the left insula and the bilateral intracalcarine cortex, weaker FC between the left insula and the left dorsolateral prefrontal cortex, and weaker FC between the right insula and the left supplementary motor area. Amygdala analyses yielded no significant findings. Greater self-reported experiences of discrimination are associated with differential insula functional connectivity in older adults. More specifically, results suggest that discrimination is associated with differential connectivity of a key region (the insula) involved in trust perception.
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Affiliation(s)
- S Duke Han
- Department of Family Medicine, Keck School of Medicine of the University of Southern California, Los Angeles, CA, 90089, USA.
- Department of Neurology, Keck School of Medicine of the University of Southern California, Los Angeles, CA, 90089, USA.
- Department of Psychology, University of Southern California, Los Angeles, CA, 90089, USA.
- School of Gerontology, University of Southern California, Los Angeles, CA, 90089, USA.
| | - Melissa Lamar
- Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, Chicago, IL, 60612, USA
- Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, IL, 60612, USA
| | - Debra Fleischman
- Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, Chicago, IL, 60612, USA
- Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, IL, 60612, USA
- Department of Neurological Sciences, Rush University Medical Center, Chicago, IL, 60612, USA
| | - Namhee Kim
- Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, IL, 60612, USA
- Department of Neurological Sciences, Rush University Medical Center, Chicago, IL, 60612, USA
| | - David A Bennett
- Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, IL, 60612, USA
- Department of Neurological Sciences, Rush University Medical Center, Chicago, IL, 60612, USA
| | - Tené T Lewis
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, 30322, USA
| | - Konstantinos Arfanakis
- Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, IL, 60612, USA
- Department of Biomedical Engineering, Illinois Institute of Technology, Chicago, IL, 60616, USA
- Department of Diagnostic Radiology and Nuclear Medicine, Rush University Medical Center, Chicago, IL, 60612, USA
| | - Lisa L Barnes
- Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, Chicago, IL, 60612, USA
- Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, IL, 60612, USA
- Department of Neurological Sciences, Rush University Medical Center, Chicago, IL, 60612, USA
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13
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Sutton AL, Hagiwara N, Perera RA, Sheppard VB. Assessing Perceived Discrimination as Reported by Black and White Women Diagnosed with Breast Cancer. J Racial Ethn Health Disparities 2021; 8:589-595. [PMID: 32808196 PMCID: PMC7962667 DOI: 10.1007/s40615-020-00817-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Revised: 07/01/2020] [Accepted: 07/05/2020] [Indexed: 01/13/2023]
Abstract
OBJECTIVE Although a number of factors contribute to racial disparities in breast cancer outcomes, perceived discrimination in healthcare may be a key factor that hinders positive interactions and negatively impacts patient outcomes. The goals of our study were to (1) assess the prevalence of perceived discrimination as reported by breast cancer patients and (2) identify factors related to discrimination in women overall as well as by race. DESIGN This study is a secondary analysis of a larger study, "Narrowing the Gaps in Adjuvant Therapy," where a convenience sample of 359 women completed one telephone survey assessing sociodemographics, and attitudes and beliefs concerning breast cancer treatments and care. Chi-square analysis was used to assess the relationship of categorical variables with perceived discrimination, while the F-test was employed for continuous variables. Logistic regression determined predictors of perceived discrimination, a dichotomous variable (none vs. any). RESULTS A majority of women were Black (58%), privately insured (85%), and had at least a Bachelor's degree (48%). Discrimination was reported by 32.4% of women, with significantly more Black women reporting discrimination than White women. Insurance status, attitudes toward treatment, and distress factors were significantly related to perceived discrimination. In the logistic model, women who were less trusting of their providers (OR = 0.863 [0.751, 0.993], p = .021) and Black women (OR = 7.241 [0.751, 0.993], p = .039) were more likely to report incidences of discrimination. CONCLUSIONS Our findings suggest a need to understand Black survivor's experiences with healthcare. Similarly, future work must focus on identifying ways to improve provider trust amongst breast cancer survivors.
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Affiliation(s)
- Arnethea L Sutton
- Department of Health Behavior and Policy, Virginia Commonwealth University School of Medicine, P.O. Box 980149, Richmond, VA, 23219, USA.
| | - Nao Hagiwara
- Department of Psychology, Virginia Commonwealth University, Richmond, VA, USA
| | - Robert A Perera
- Department of Biostatistics, Virginia Commonwealth University School of Medicine, Richmond, VA, USA
| | - Vanessa B Sheppard
- Department of Health Behavior and Policy, Virginia Commonwealth University School of Medicine, P.O. Box 980149, Richmond, VA, 23219, USA
- Office of Health Equity and Disparities Research, Virginia Commonwealth University Massey Cancer Center, Richmond, VA, USA
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14
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Oyesanya TO, Harris G, Yang Q, Byom L, Cary MP, Zhao AT, Bettger JP. Inpatient rehabilitation facility discharge destination among younger adults with traumatic brain injury: differences by race and ethnicity. Brain Inj 2021; 35:661-674. [PMID: 33779428 PMCID: PMC8122065 DOI: 10.1080/02699052.2021.1895317] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Revised: 02/21/2021] [Accepted: 02/22/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVE : To determine the association of race and ethnicity with discharge destination among patients with traumatic brain injury (TBI) receiving inpatient rehabilitation facility (IRF) care. DESIGN Secondary analysis using Uniform Data System for Medical Rehabilitation data. METHODS : Patients (N = 99,614) diagnosed with TBI, age 18-64, admitted for IRF care between 2002 and 2018. Logistic regression was used to analyze data. OUTCOME : Discharge destination (home/community vs. subacute settings). RESULTS : Most younger adults (age 18-64) with TBI were discharged home (89.24%) after IRF care vs. subacute (10.76%). Of those discharged home, 63.16% were white, 10.42% Black, 8.94% Hispanic/Latino, and 6.72% other races/ethnicities. After adjusting for covariates, patients who were Hispanic/Latino [OR = 1.26; 95% CI: 1.15, 1.37] and other race/ethnicities [OR = 1.10; 95% CI: 1.00, 1.21] (vs. White) had higher odds of discharge home vs. subacute. There was no difference in discharge destination for Black patients (vs. white). Predictors of discharge destination for groups stratified by race/ethnicity varied. CONCLUSIONS : Younger patients with TBI who were Hispanic/Latino or other races/ethnicities (vs. white) were more likely to go home vs. subacute. Findings can be used to inform IRF planning, resource allocation, and transitional care planning.
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Affiliation(s)
| | | | | | - Lindsey Byom
- University of North Carolina-Chapel Hill, Department of Allied Health Sciences
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15
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Pollard JD, Haq KT, Lutz KJ, Rogovoy NM, Paternostro KA, Soliman EZ, Maher J, Lima JAC, Musani SK, Tereshchenko LG. Electrocardiogram machine learning for detection of cardiovascular disease in African Americans: the Jackson Heart Study. EUROPEAN HEART JOURNAL. DIGITAL HEALTH 2021; 2:137-151. [PMID: 34048510 PMCID: PMC8139412 DOI: 10.1093/ehjdh/ztab003] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Revised: 12/10/2020] [Accepted: 01/12/2021] [Indexed: 01/31/2023]
Abstract
AIMS Almost half of African American (AA) men and women have cardiovascular disease (CVD). Detection of prevalent CVD in community settings would facilitate secondary prevention of CVD. We sought to develop a tool for automated CVD detection. METHODS AND RESULTS Participants from the Jackson Heart Study (JHS) with analysable electrocardiograms (ECGs) (n=3679; age, 6212 years; 36% men) were included. Vectorcardiographic (VCG) metrics QRS, T, and spatial ventricular gradient vectors magnitude and direction, and traditional ECG metrics were measured on 12-lead ECG. Random forests, convolutional neural network (CNN), lasso, adaptive lasso, plugin lasso, elastic net, ridge, and logistic regression models were developed in 80% and validated in 20% samples. We compared models with demographic, clinical, and VCG input (43 predictors) and those after the addition of ECG metrics (695 predictors). Prevalent CVD was diagnosed in 411 out of 3679 participants (11.2%). Machine learning models detected CVD with the area under the receiver operator curve (ROC AUC) 0.690.74. There was no difference in CVD detection accuracy between models with VCG and VCG + ECG input. Models with VCG input were better calibrated than models with ECG input. Plugin-based lasso model consisting of only two predictors (age and peak QRS-T angle) detected CVD with AUC 0.687 [95% confidence interval (CI) 0.6250.749], which was similar (P=0.394) to the CNN (0.660; 95% CI 0.5970.722) and better (P<0.0001) than random forests (0.512; 95% CI 0.4930.530). CONCLUSIONS Simple model (age and QRS-T angle) can be used for prevalent CVD detection in limited-resources community settings, which opens an avenue for secondary prevention of CVD in underserved communities.
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Affiliation(s)
- James D Pollard
- University of Mississippi Medical Center, 2500 N State St, Jackson, MS 39216, USA
| | - Kazi T Haq
- Department of Medicine, Knight Cardiovascular Institute, Oregon Health & Science University, 3181 SW Sam Jackson Park Rd, UHN62, Portland, OR 97239, USA
| | - Katherine J Lutz
- Department of Medicine, Knight Cardiovascular Institute, Oregon Health & Science University, 3181 SW Sam Jackson Park Rd, UHN62, Portland, OR 97239, USA
| | - Nichole M Rogovoy
- Department of Medicine, Knight Cardiovascular Institute, Oregon Health & Science University, 3181 SW Sam Jackson Park Rd, UHN62, Portland, OR 97239, USA
| | - Kevin A Paternostro
- Department of Medicine, Knight Cardiovascular Institute, Oregon Health & Science University, 3181 SW Sam Jackson Park Rd, UHN62, Portland, OR 97239, USA
| | - Elsayed Z Soliman
- Division of Public Health Sciences and Department of Medicine, Cardiology Section, Epidemiological Cardiology Research Center, Wake Forest School of Medicine, 475 Vine St, Winston-Salem, NC 27101, USA
| | - Joseph Maher
- University of Mississippi Medical Center, 2500 N State St, Jackson, MS 39216, USA
| | - João A C Lima
- Cardiovascular Division, Department of Medicine, Johns Hopkins School of Medicine, 733 N Broadway, Baltimore, MD 21205, USA
| | - Solomon K Musani
- University of Mississippi Medical Center, 2500 N State St, Jackson, MS 39216, USA
| | - Larisa G Tereshchenko
- Department of Medicine, Knight Cardiovascular Institute, Oregon Health & Science University, 3181 SW Sam Jackson Park Rd, UHN62, Portland, OR 97239, USA
- Cardiovascular Division, Department of Medicine, Johns Hopkins School of Medicine, 733 N Broadway, Baltimore, MD 21205, USA
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16
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Goldstein P, Losin EAR, Anderson SR, Schelkun VR, Wager TD. Clinician-Patient Movement Synchrony Mediates Social Group Effects on Interpersonal Trust and Perceived Pain. THE JOURNAL OF PAIN 2020; 21:1160-1174. [PMID: 32544602 PMCID: PMC7722052 DOI: 10.1016/j.jpain.2020.03.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Revised: 02/24/2020] [Accepted: 03/22/2020] [Indexed: 12/19/2022]
Abstract
Pain is an unfortunate consequence of many medical procedures, which in some patients becomes chronic and debilitating. Among the factors affecting medical pain, clinician-patient (C-P) similarity and nonverbal communication are particularly important for pain diagnosis and treatment. Participants (N = 66) were randomly assigned to clinician and patient roles and were grouped into C-P dyads. Clinicians administered painful stimuli to patients as an analogue of a painful medical procedure. We manipulated the perceived C-P similarity of each dyad using groups ostensibly based on shared beliefs and values, and each patient was tested twice: Once with a same group clinician (concordant, CC) and once with a clinician from the other group (discordant, DC). Movement synchrony was calculated as a marker of nonverbal communication. We tested whether movement synchrony mediated the effects of group concordance on patients' pain and trust in the clinician. Movement synchrony was higher in CC than DC dyads. Higher movement synchrony predicted reduced pain and increased trust in the clinician. Movement synchrony also formally mediated the group concordance effects on pain and trust. These findings increase our understanding of the role of nonverbal C-P communication on pain and related outcomes. Interpersonal synchrony may be associated with better pain outcomes, independent of the specific treatment provided. PERSPECTIVE: This article demonstrates that movement synchrony in C-P interactions is an unobtrusive measure related to their relationship quality, trust toward the clinician, and pain. These findings suggest that interpersonal synchrony may be associated with better patient outcomes, independent of the specific treatment provided.
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Affiliation(s)
- Pavel Goldstein
- Institute of Cognitive Science, University of Colorado, Boulder, Colorado; The School of Public Health, University of Haifa, Israel
| | | | | | - Victoria R Schelkun
- Department of Psychological and Brain Sciences, Dartmouth College, Hanover, New Hampshire
| | - Tor D Wager
- Department of Psychological and Brain Sciences, Dartmouth College, Hanover, New Hampshire; Department of Psychology and Neuroscience, University of Colorado, Boulder, Colorado.
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17
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Putturaj M, Van Belle S, Criel B, Engel N, Krumeich A, B Nagendrappa P, Prashanth NS. Towards a multilevel governance framework on the implementation of patient rights in health facilities: a protocol for a systematic scoping review. BMJ Open 2020; 10:e038927. [PMID: 33060087 PMCID: PMC7566736 DOI: 10.1136/bmjopen-2020-038927] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2020] [Revised: 08/24/2020] [Accepted: 09/06/2020] [Indexed: 12/30/2022] Open
Abstract
INTRODUCTION Patient rights are "those rights that are attributed to a person seeking healthcare". Patient rights have implications for quality of healthcare and acts as a key accountability tool. It can galvanise structural improvements in the health system and reinforces ethical healthcare. States are duty bound to respect, protect and promote patient rights. The rhetoric on patient rights is burgeoning across the globe. With changing modes of governance arrangements, a number of state and non-state actors and institutions at various levels play a role in the design and implementation of (patient rights) policies. However, there is limited understanding on the multilevel institutional mechanisms for patient rights implementation in health facilities. We attempt to fill this gap by analysing the available scholarship on patient rights through a critical interpretive synthesis approach in a systematic scoping review. METHODS The review question is 'how do the multilevel actors, institutional structures, processes interact and influence the patient rights implementation in healthcare facilities? How do they work at what level and in which contexts?" Three databases PubMed, LexisNexis and Web of Science will be systematically searched until 30 th April 2020, for empirical and non-empirical literature in English from both lower middle-income countries and high-income countries. Targeted search will be performed in grey literature and through citation and reference tracking of key records. Using the critical interpretive synthesis approach, a multilevel governance framework on the implementation of patient rights in health facilities which is grounded in the data will be developed. ETHICS AND DISSEMINATION The review uses published literature hence ethics approval is not required. The findings of the review will be published in a peer-reviewed journal. REGISTRATION NUMBER PROSPERO 2020 CRD42020176939.
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Affiliation(s)
- Meena Putturaj
- Centre for Local Health Traditions and Policy, The University of Trans-disciplinary Health Sciences and Technology, Bengaluru, India
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
- Department of Health, Ethics and Society, Maastricht University, Maastricht, Netherlands
- Health Equity Cluster, Institute of Public Health, Bengaluru, India
| | - Sara Van Belle
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | - Bart Criel
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | - Nora Engel
- Department of Health, Ethics and Society, Maastricht University, Maastricht, Netherlands
| | - Anja Krumeich
- Department of Health, Ethics and Society, Maastricht University, Maastricht, Netherlands
| | - Prakash B Nagendrappa
- Centre for Local Health Traditions and Policy, The University of Trans-disciplinary Health Sciences and Technology, Bengaluru, India
| | - N S Prashanth
- Health Equity Cluster, Institute of Public Health, Bengaluru, India
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18
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Gupta A, Bahl B, Rabadi S, Mebane A, Levey R, Vasudevan V. Value of Advance Care Directives for Patients With Serious Illness in the Era of COVID Pandemic: A Review of Challenges and Solutions. Am J Hosp Palliat Care 2020; 38:191-198. [PMID: 33021094 DOI: 10.1177/1049909120963698] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Advance care directives (ACDs) are instructions regarding what types of medical treatments a patient desires and/or who they would like to designate as a healthcare surrogate to make important healthcare decisions when the patient is mentally incapacitated. At end-of-life, when faced with poor prognosis for a meaningful health-related quality of life, most patients indicate their preference to abstain from aggressive, life-sustaining treatments. Patients whose wishes are left unsaid often receive burdensome life sustain therapy by default, prolonging patient suffering. The CoVID pandemic has strained our healthcare resources and raised the need for prioritization of life-sustaining therapy. This highlights the urgency of ACDs more than ever. Despite ACDs' potential to provide patients with care that aligns with their values and preferences and reduce resource competition, there has been relatively little conversation regarding the overlap of ACDs and CoVID-19. There is low uptake among patients, lack of training for healthcare professionals, and inequitable adoption in vulnerable populations. However, solutions are forthcoming and may include electronic medical record completion, patient outreach efforts, healthcare worker programs to increase awareness of at-risk minority patients, and restructuring of incentives and reimbursement policies. This review carefully describes the above challenges and unique opportunities to address them in the CoVID-19 era. If solutions are leveraged appropriately, ACDs have the potential to address the described challenges and ethically resolve resource conflicts during the current crisis and beyond.
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Affiliation(s)
- Amol Gupta
- 24508The Brooklyn Hospital Center, NY, USA
| | | | - Saher Rabadi
- 12340University of Texas Health Sciences Center, Houston, TX, USA
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19
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Patneaude A, Kett J. Cultural Responsiveness and Palliative Care during the COVID-19 Pandemic. Palliat Med Rep 2020; 1:171-173. [PMID: 34223473 PMCID: PMC8241343 DOI: 10.1089/pmr.2020.0049] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/13/2020] [Indexed: 11/15/2022] Open
Abstract
During the COVID-19 pandemic, much has changed in the delivery of palliative care (PC). However, cultural responsiveness remains critical to our mission. It is essential to our aims of identifying individual goals of care and providing relief of suffering for our patients. Cultural responsiveness may also enhance trust and could be a mitigating factor in the staggering health care disparities unmasked during this pandemic. In this study, the authors outline the rationale for renewed focus on this issue, and offer some initial suggestions for how culturally responsive PC can be provided even in this extraordinary time.
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Affiliation(s)
- Arika Patneaude
- Division of Bioethics and Palliative Care, Treuman Katz Center for Pediatric Bioethics, Seattle Children's Hospital and Research Institute, Seattle, Washington, USA
| | - Jennifer Kett
- Division of Bioethics and Palliative Care, Treuman Katz Center for Pediatric Bioethics, Seattle Children's Hospital and Research Institute, Seattle, Washington, USA
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20
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Payton Foh E, Echeverria SE. Incorporating Health Equity and Community Perspectives During COVID-19: Commonalities with Cardiovascular Health Equity Research. Ethn Dis 2020; 30:421-424. [PMID: 32742144 DOI: 10.18865/ed.30.3.421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
The COVID-19 pandemic is revealing the deeply entrenched structural inequities in health that exist in the United States. We draw parallels between the COVID-19 pandemic and our cardiovascular health equity research focused on physical activity and diabetes to highlight three common needs: 1) access to timely and disaggregated data; 2) how to integrate community-engaged approaches in telehealth; and 3) policy initiatives that explicitly integrate health equity and social justice principles and action. We suggest that a similar sense of urgency regarding COVID-19 should be applied to slow the burgeoning costs and suffering associated with cardiovascular disease overall and in marginalized communities specifically. We remain hopeful that the current crisis can serve as a guide for aligning our principles as a just and democratic society with a health agenda that explicitly recognizes that social inequities in health for some impacts all members of society.
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Affiliation(s)
- Erica Payton Foh
- Department of Public Health Education, University of North Carolina at Greensboro, NC
| | - Sandra E Echeverria
- Department of Public Health Education, University of North Carolina at Greensboro, NC
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21
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Cardel MI, Chi X, Min YI, Sims M, Musani SK, Dulin A, Gravlee CC, Smith SM, DeBoer MD, Gurka MJ. Experiences of Discrimination Are Associated With Worse Metabolic Syndrome Severity Among African Americans in the Jackson Heart Study. Ann Behav Med 2020; 55:266-279. [PMID: 32686818 DOI: 10.1093/abm/kaaa050] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Metabolic syndrome (MetS) is a risk factor for the development of cardiovascular disease and type 2 diabetes. Although the development of MetS is attributed to known lifestyle factors, perceived discrimination may also contribute to MetS development and severity. PURPOSE We examined the associations of perceived discrimination with MetS severity among African American adults at baseline and 8-year follow-up. METHODS Three thousand eight hundred and seventy participants (mean age 53.8 ± 13.0; 63.1% female) without diabetes and no missing MetS severity scores at baseline were included. Each self-reported measure of discrimination at baseline (everyday, lifetime, and burden of lifetime) was classified into tertiles (low, medium, high). After adjustment for demographics and MetS risk factors, associations of discrimination were examined with a sex- and race/ethnicity-specific MetS severity Z-score. We employed a mixed model approach that allowed for the assessment of an overall association between reported discrimination at baseline and MetS severity, and for the possible change over time. RESULTS Sex and age differences were observed in experiences with discrimination, such that men reported higher levels of all aspects of discrimination relative to women. Everyday discrimination decreased with age, whereas lifetime discrimination increased with age (p < .05). Independent of lifestyle and demographic factors, everyday and lifetime discrimination were significantly associated with MetS severity (p = .003 and p = .017, respectively) and the associations remained constant over the 8 years (i.e., no interaction with time). CONCLUSIONS Our results suggest that, in a large community-based sample of African Americans, discrimination is a salient psychosocial risk factor for severity of MetS.
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Affiliation(s)
- Michelle I Cardel
- Department of Health Outcomes and Biomedical Informatics, University of Florida, Gainesville, FL, USA
| | - Xiaofei Chi
- Department of Health Outcomes and Biomedical Informatics, University of Florida, Gainesville, FL, USA
| | - Yuan-I Min
- Department of Medicine, University of Mississippi Medical Center, Jackson, MS, USA
| | - Mario Sims
- Department of Medicine, University of Mississippi Medical Center, Jackson, MS, USA
| | - Solomon K Musani
- Department of Medicine, University of Mississippi Medical Center, Jackson, MS, USA
| | - Akilah Dulin
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, USA
| | - Clarence C Gravlee
- Department of Anthropology, University of Florida, Turlington Hall, Gainesville, FL, USA
| | - Steven M Smith
- Department of Pharmacotherapy and Translational Research, University of Florida, Gainesville, FL, USA
| | - Mark D DeBoer
- Department of Pediatrics, University of Virginia Health System, Charlottesville, VA, USA
| | - Matthew J Gurka
- Department of Health Outcomes and Biomedical Informatics, University of Florida, Gainesville, FL, USA
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22
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Interactive Relations Across Dimensions of Interpersonal-Level Discrimination and Depressive Symptoms to Carotid Intimal-Medial Thickening in African Americans. Psychosom Med 2020; 82:234-246. [PMID: 31738316 PMCID: PMC9513678 DOI: 10.1097/psy.0000000000000765] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
OBJECTIVE This study aimed to examine within-race interactions of multiple dimensions of self-reported discrimination with depressive symptoms in relation to carotid intimal-medial thickness (IMT), a subclinical marker of atherosclerosis prospectively implicated in stroke incidence, in middle-aged to older African American and white adults. METHODS Participants were a socioeconomically diverse group of 1941 African Americans (56.5%) and whites from the Healthy Aging in Neighborhoods of Diversity across the Life Span study (30-64 years old, 47% men, 45.2% with household income <125% federal poverty threshold) who underwent carotid IMT measurement. Discrimination was assessed across four dimensions (everyday, frequency across various social statuses, racial, and lifetime burden). The Center for Epidemiologic Studies Depression scale was used to assess depressive symptoms. RESULTS In cross-sectional hierarchical regression analyses, two interactions were observed in African Americans: more frequent discrimination across various social statuses (b < 0.001, p = .006) and a higher lifetime discrimination burden (b < 0.001, p = .02) were each related to thicker carotid IMT in those with greater depressive symptoms. No significant findings were observed within whites. CONCLUSIONS Among African Americans, those reporting high levels of discrimination and depressive symptoms have increased carotid atherosclerosis and may be at greater risk for clinical end points compared with those reporting one or neither of these risk factors. Findings suggest that assessment of interactive relationships among social and psychological factors may elucidate novel pathways for cardiovascular disease, including stroke, among African Americans.
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Glover LM, Cain-Shields LR, Wyatt SB, Gebreab SY, Diez-Roux AV, Sims M. Life Course Socioeconomic Status and Hypertension in African American Adults: The Jackson Heart Study. Am J Hypertens 2020; 33:84-91. [PMID: 31420642 PMCID: PMC6931894 DOI: 10.1093/ajh/hpz133] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Revised: 06/23/2019] [Accepted: 08/12/2019] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Limited research has examined the association of life-course socioeconomic status (SES) with hypertension prevalence and incidence in a large cohort of African Americans. METHODS Among 4,761 participants from the Jackson Heart Study (JHS), we examined the association of SES indicators with prevalent and incident hypertension. We used multivariable Poisson regression to estimate prevalence ratios (PR, 95% confidence interval-CI) of baseline (2000-2004) hypertension by adult (education, income, occupation, wealth) and childhood (mother's education) SES. Cox proportional hazards regression was used to estimate hazard ratios (HR, 95% CI) of incident hypertension by adult and childhood SES (2005-2013; 7.21 median years of follow-up). We also examined the association of childhood-to-adult SES mobility (parent-to-adult education) with prevalent and incident hypertension. Model 1 adjusted for age and sex. Model 2 added waist circumference, behaviors (smoking, alcohol, physical activity, diet), and diabetes prevalence. RESULTS High (vs. low) adult SES measures were associated with a lower prevalence of hypertension, with the exception of having a college degree and upper-middle income (PR: 1.04, 95% CI: 1.01, 1.07; PR: 1.05, 95% CI: 1.01, 1.09, respectively). Higher childhood SES was associated with a lower prevalence and risk of hypertension (PR: 0.83, 95%: CI 0.75, 0.91; HR: 0.76, 95% CI: 0.65, 0.89, respectively). Upward mobility and consistent high SES (vs. consistent low SES) from childhood to adulthood was associated with a greater prevalence, but lower incidence of hypertension. CONCLUSION Efforts to prevent hypertension among African Americans should consider childhood and current SES status.
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Affiliation(s)
- Láshauntá M Glover
- Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill North Carolina, USA
| | - Loretta R Cain-Shields
- Department of Medicine, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - Sharon B Wyatt
- Department of Medicine, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | | | - Ana V Diez-Roux
- Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, Pennsylvania, USA
| | - Mario Sims
- Department of Medicine, University of Mississippi Medical Center, Jackson, Mississippi, USA
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Sutton AL, He J, Edmonds MC, Sheppard VB. Medical Mistrust in Black Breast Cancer Patients: Acknowledging the Roles of the Trustor and the Trustee. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2019; 34:600-607. [PMID: 29552705 PMCID: PMC7061268 DOI: 10.1007/s13187-018-1347-3] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
Studies indicate that Black patients report higher medical mistrust compared to their White counterparts. However, little is known about factors associated with higher medical mistrust among Black breast cancer patients. We examined predictors of medical mistrust and relationships between medical mistrust, subscales of mistrust, and process of care factors to identify opportunities to promote positive healthcare interactions between the trustees (e.g., providers) and Black breast cancer patients, or the trustors. A secondary analysis was conducted of survey data from 210 Black women with confirmed diagnosis of invasive breast cancer. Participants completed telephone surveys consisting of questions pertaining to sociodemographics, attitudes, and beliefs about medical care and breast cancer treatments. Multiple linear regression determined factors associated with medical mistrust and mistrust subscales. Most participants (61%) were over the age of 50 and currently single (64.8%). Women with greater medical mistrust reported less satisfaction with the trustee's technical ability (p < 0.0001) and greater satisfaction with their own propensity to access care (p < 0.05). Additionally, women with public insurance demonstrated greater mistrust (p < 0.01) and suspicion (p < 0.05) than women with private insurance, and women with less education reported greater perceived discrimination than women who have at least a bachelor's degree. Findings from this study may inform future endeavors to educate providers on ways to effectively interact with and treat Black breast cancer patients. Opportunities to develop interventions that address and tackle issues of mistrust as reported by Black patients may contribute to ongoing efforts to reduce health disparities.
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Affiliation(s)
- Arnethea L Sutton
- Department of Health Behavior and Policy, Virginia Commonwealth University School of Medicine, 830 East Main Street, 9th Floor, Suite 919, Richmond, VA, 23219, USA.
| | - Jun He
- Department of Health Behavior and Policy, Virginia Commonwealth University School of Medicine, 830 East Main Street, 9th Floor, Suite 919, Richmond, VA, 23219, USA
| | - Megan C Edmonds
- Department of Health Behavior and Policy, Virginia Commonwealth University School of Medicine, 830 East Main Street, 9th Floor, Suite 919, Richmond, VA, 23219, USA
| | - Vanessa B Sheppard
- Department of Health Behavior and Policy, Virginia Commonwealth University School of Medicine, 830 East Main Street, 9th Floor, Suite 919, Richmond, VA, 23219, USA
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Qadri S, Langefeld CD, Milligan C, Caress JB, Cartwright MS. Racial differences in intervention rates in individuals with ALS: A case-control study. Neurology 2019; 92:e1969-e1974. [PMID: 30918092 DOI: 10.1212/wnl.0000000000007366] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Accepted: 01/02/2019] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE This study was conducted to determine whether longer lifespans in African Americans with amyotrophic lateral sclerosis (ALS), compared to white non-Hispanics, are secondary to higher rates of tracheostomy and invasive ventilation (TIV) in African Americans. METHODS A retrospective case-control study was conducted with 49 African Americans with ALS matched by age, gender, and site of onset to 137 white persons with ALS. RESULTS African Americans had longer survival than whites when the outcome was death (p = 0.016), but this was no longer significant when the outcome was death or TIV (p = 0.100). African Americans also had a lower rate of noninvasive ventilation use compared to whites (27 [55%] vs 96 [70%], p = 0.015) and a higher rate of TIV (8 [16%] vs 7 [5%], p = 0.016), but after controlling for baseline severity, only the noninvasive ventilation difference (p = 0.036), and not the TIV difference (p = 0.115), remained significant. CONCLUSION African Americans with ALS live longer than white persons with ALS, and this may be secondary to higher rates of TIV use among African Americans.
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Affiliation(s)
- Saman Qadri
- From the Department of Neurosciences, Health Disparities in Neuroscience-related Disorders Program (S.Q., C.M.), and Departments of Biostatistics and Data Science (C.D.L.) and Neurology (J.B.C., M.S.C.), Wake Forest School of Medicine, Winston-Salem, NC
| | - Carl D Langefeld
- From the Department of Neurosciences, Health Disparities in Neuroscience-related Disorders Program (S.Q., C.M.), and Departments of Biostatistics and Data Science (C.D.L.) and Neurology (J.B.C., M.S.C.), Wake Forest School of Medicine, Winston-Salem, NC
| | - Carol Milligan
- From the Department of Neurosciences, Health Disparities in Neuroscience-related Disorders Program (S.Q., C.M.), and Departments of Biostatistics and Data Science (C.D.L.) and Neurology (J.B.C., M.S.C.), Wake Forest School of Medicine, Winston-Salem, NC
| | - James B Caress
- From the Department of Neurosciences, Health Disparities in Neuroscience-related Disorders Program (S.Q., C.M.), and Departments of Biostatistics and Data Science (C.D.L.) and Neurology (J.B.C., M.S.C.), Wake Forest School of Medicine, Winston-Salem, NC
| | - Michael S Cartwright
- From the Department of Neurosciences, Health Disparities in Neuroscience-related Disorders Program (S.Q., C.M.), and Departments of Biostatistics and Data Science (C.D.L.) and Neurology (J.B.C., M.S.C.), Wake Forest School of Medicine, Winston-Salem, NC.
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