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Gazaway S, Wells R, Haley J, Gutiérrez OM, Nix-Parker T, Martinez I, Lyas C, Lang-Lindsey K, Knight R, Crenshaw-Love R, Pazant A, Odom JN. Exploring the acceptability of a community-enhanced intervention to improve decision support partnership between patients with chronic kidney disease and their family caregivers. PLoS One 2024; 19:e0305291. [PMID: 38968287 PMCID: PMC11226109 DOI: 10.1371/journal.pone.0305291] [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: 10/31/2023] [Accepted: 05/27/2024] [Indexed: 07/07/2024] Open
Abstract
Patients face numerous health-related decisions once advanced chronic kidney disease (CKD) is diagnosed. Yet, when patients are underprepared to navigate and discuss health-related decisions, they can make choices inconsistent with their expectations for the future. This pilot study, guided by the multiphase optimization strategy and community-engaged research principles, aimed to explore the acceptability of a developed patient component to a decision-support training intervention called ImPart (Improving Decisional Partnership of CKD Dyads). CKD patients and their family caregivers were recruited from an urban, academic medical center. Eligibility criteria for patients included a diagnosis of stage 3 or higher CKD (on chart review), and caregivers participated in interview sessions only. Patients without a caregiver were not eligible. The intervention was lay coach, telephone-delivered, and designed to be administered in 1-2 week intervals for 4 sessions. An interview guide, developed in collaboration with an advisory group, was designed to ascertain participants' experiences with the intervention. Caregiver interviews focused on changes in the patient's decision ability or engagement. Thirteen patients and eleven caregivers were interviewed. The program was viewed as "good" or "beneficial." Three themes capture the intervention's impact- 1) Frequent and deliberate disease-focused communication, 2) Future planning activation, and 3) Coaching relationship. The piloted intervention was successfully delivered, acceptable to use, and found to promote enhanced disease and future planning communication. By undergoing this work, we ensure that the patient component is feasible to use and meets the needs of participants before implementation in a larger factorial trial.
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Affiliation(s)
- Shena Gazaway
- School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama, United States of America
- Center for Palliative and Supportive Care, University of Alabama at Birmingham, Birmingham, Alabama, United States of America
- Nephrology Training and Research Center, University of Alabama at Birmingham, Birmingham, Alabama, United States of America
| | - Rachel Wells
- School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama, United States of America
- Center for Palliative and Supportive Care, University of Alabama at Birmingham, Birmingham, Alabama, United States of America
| | - John Haley
- College of Nursing, Augusta University, Athens, Georgia, United States of America
| | - Orlando M. Gutiérrez
- Nephrology Training and Research Center, University of Alabama at Birmingham, Birmingham, Alabama, United States of America
- Heersink School of Medicine, Division of Nephrology, University of Alabama at Birmingham, Birmingham, Alabama, United States of America
| | - Tamara Nix-Parker
- School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama, United States of America
| | - Isaac Martinez
- Institute for Cancer Outcomes and Survivorship, University of Alabama at Birmingham, Birmingham, Alabama, United States of America
| | - Claretha Lyas
- Nephrology Training and Research Center, University of Alabama at Birmingham, Birmingham, Alabama, United States of America
- College of Nursing, Augusta University, Athens, Georgia, United States of America
| | - Katina Lang-Lindsey
- Department of Social Work, Psychology & Counseling, Alabama A & M University, Normal, Alabama, United States of America
| | - Richard Knight
- American Association of Kidney Patients, Tampa, Florida, United States of America
| | | | | | - J. Nicholas Odom
- School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama, United States of America
- Center for Palliative and Supportive Care, University of Alabama at Birmingham, Birmingham, Alabama, United States of America
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Thomas TH, Hadley ML, Nilsen ML. "I pretty much followed the law, and there weren't any decisions to make": A qualitative study of self-advocacy experiences of men with cancer. Nurs Health Sci 2022; 24:34-43. [PMID: 34850513 PMCID: PMC9169248 DOI: 10.1111/nhs.12909] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2021] [Revised: 11/16/2021] [Accepted: 11/16/2021] [Indexed: 11/28/2022]
Abstract
Current conceptualizations of patient self-advocacy focus on women with cancer, leaving knowledge of male self-advocacy deficient. The purpose of this study is to describe the key components of self-advocacy among men with cancer. Adult (≥18 years old) men with a history of invasive cancer were recruited from cancer clinics and registries. Trained researchers led individual semi-structured interviews regarding participants' challenges, how they overcame those challenges, and barriers and facilitators to their self-advocacy. All interviews were analyzed using descriptive content analysis methods and synthesized into major themes. These themes were refined after receiving feedback from key stakeholders. Participants (N = 28) reported three major self-advocacy themes: (i) managing through information and planning; (ii) finding the best team and falling in line; and (iii) strategic social connections. These themes are richly described with representative quotations for each theme and subtheme. Based on these findings, existing models of patient self-advocacy should be adjusted to encompass how men self-advocate. Clinicians should consider how gender may impact how and why patients with cancer self-advocate so that they can best support their patients in achieving patient-centered care.
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Affiliation(s)
- Teresa Hagan Thomas
- School of Nursing, University of Pittsburgh, Pittsburgh, Pennsylvania, USA,Palliative Research Center (PaRC), University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Makenna L. Hadley
- School of Nursing, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Marci Lee Nilsen
- School of Nursing, University of Pittsburgh, Pittsburgh, Pennsylvania, USA,Department of Otolaryngology, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
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Alkureishi MA, Johnson T, Nichols J, Dhodapkar M, Czerwiec MK, Wroblewski K, Arora VM, Lee WW. Impact of an Educational Comic to Enhance Patient-Physician-Electronic Health Record Engagement: Prospective Observational Study. JMIR Hum Factors 2021; 8:e25054. [PMID: 33908891 PMCID: PMC8116991 DOI: 10.2196/25054] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Revised: 02/06/2021] [Accepted: 03/18/2021] [Indexed: 01/16/2023] Open
Abstract
Background Electronic health record (EHR) use can impede or augment patient-physician communication. However, little research explores the use of an educational comic to improve patient-physician-EHR interactions. Objective To evaluate the impact of an educational comic on patient EHR self-advocacy behaviors to promote patient engagement with the EHR during clinic visits. Methods We conducted a prospective observational study with adult patients and parents of pediatric patients at the University of Chicago General Internal Medicine (GIM) and Pediatric Primary Care (PPC) clinics. We developed an educational comic highlighting EHR self-advocacy behaviors and distributed it to study participants during check-in for their primary care visits between May 2017 and May 2018. Participants completed a survey immediately after their visit, which included a question on whether they would be interested in a follow-up telephone interview. Of those who expressed interest, 50 participants each from the adult and pediatric parent cohorts were selected at random for follow-up telephone interviews 8 months (range 3-12 months) post visit. Results Overall, 71.0% (115/162) of adult patients and 71.6% (224/313) of pediatric parents agreed the comic encouraged EHR involvement. African American and Hispanic participants were more likely to ask to see the screen and become involved in EHR use due to the comic (adult P=.01, P=.01; parent P=.02, P=.006, respectively). Lower educational attainment was associated with an increase in parents asking to see the screen and to be involved (ρ=−0.18, P=.003; ρ=−0.19, P<.001, respectively) and in adults calling for physician attention (ρ=−0.17, P=.04), which was confirmed in multivariate analyses. Female GIM patients were more likely than males to ask to be involved (median 4 vs 3, P=.003). During follow-up phone interviews, 90% (45/50) of adult patients and all pediatric parents (50/50) remembered the comic. Almost half of all participants (GIM 23/50, 46%; PPC 21/50, 42%) recalled at least one best-practice behavior. At subsequent visits, adult patients reported increases in asking to see the screen (median 3 vs 4, P=.006), and pediatric parents reported increases in asking to see the screen and calling for physician attention (median 3 vs 4, Ps<.001 for both). Pediatric parents also felt that the comic had encouraged them to speak up and get more involved with physician computer use since the index visit (median 4 vs 4, P=.02) and that it made them feel more empowered to get involved with computer use at future visits (median 3 vs 4, P<.001). Conclusions Our study found that an educational comic may improve patient advocacy for enhanced patient-physician-EHR engagement, with higher impacts on African American and Hispanic patients and patients with low educational attainment.
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Affiliation(s)
- Maria A Alkureishi
- Department of Academic Pediatrics, University of Chicago, Chicago, IL, United States
| | - Tyrone Johnson
- Department of Internal Medicine, University of California, San Francisco, San Francisco, CA, United States
| | - Jacqueline Nichols
- Department of Obstetrics and Gynecology, University of Washington, Seattle, WA, United States
| | - Meera Dhodapkar
- Yale University School of Medicine, New Haven, CT, United States
| | - M K Czerwiec
- Center for Medical Humanities & Bioethics, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Kristen Wroblewski
- Department of Public Health Sciences, University of Chicago, Chicago, IL, United States
| | - Vineet M Arora
- Department of Medicine, University of Chicago, Chicago, IL, United States
| | - Wei Wei Lee
- Department of Medicine, University of Chicago, Chicago, IL, United States
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Thomas TH, Donovan HS, Rosenzweig MQ, Bender CM, Schenker Y. A Conceptual Framework of Self-advocacy in Women With Cancer. ANS Adv Nurs Sci 2021; 44:E1-E13. [PMID: 33181568 PMCID: PMC7894983 DOI: 10.1097/ans.0000000000000342] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Researchers define self-advocacy as the ability of an individual with cancer to overcome challenges in getting their preferences, needs, and values met. While imperative in all health care settings, self-advocacy is especially important in cancer care. The goal of this article is to present a conceptual framework for self-advocacy in cancer. We review foundational studies in self-advocacy, define the elements of the conceptual framework, discuss underlying assumptions of the framework, and suggest future directions in this research area. This framework provides an empirical and conceptual basis for studies designed to understand and improve self-advocacy among women with cancer.
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Affiliation(s)
- Teresa H Thomas
- School of Nursing, University of Pittsburgh, Pennsylvania (Drs Thomas, Donovan, Rosenzweig, and Bender); and Palliative Research Center (PaRC), Section of Palliative Care and Medical Ethics, Division of General Internal Medicine, University of Pittsburgh, Pennsylvania (Dr Schenker)
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Hagan TL, Gilbertson-White S, Cohen SM, Temel JS, Greer JA, Donovan HS. Symptom Burden and Self-Advocacy: Exploring the Relationship Among Female Cancer Survivors. Clin J Oncol Nurs 2019; 22:E23-E30. [PMID: 29350706 DOI: 10.1188/18.cjon.e23-e30] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Although patient self-advocacy is a critical component of patient-centered care, the association between symptom burden and self-
advocacy has received little attention.
. OBJECTIVES This analysis evaluates the degree to which self-advocacy is associated with symptom burden among women with a history of cancer.
. METHODS Participants completed online or paper questionnaires. Descriptive statistics and ordinary least squares regression models were used to analyze the association between the three dimensions of self-advocacy and two dimensions of symptom burden. FINDINGS Participants reported moderate levels of symptom burden. Fatigue, disturbed sleep, and memory problems were most common. Informed decision making was positively associated with symptom burden and participants' burden across the three most severe symptoms. Effective communication was negatively associated with total symptom burden and the degree to which symptoms interfered with daily life.
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Thomas TH, McLaughlin M, Hayden M, Shumaker E, Trybus J, Myers E, Zabiegalski A, Cohen SM. Teaching Patients with Advanced Cancer to Self-Advocate: Development and Acceptability of the Strong Together™ Serious Game. Games Health J 2019; 8:55-63. [DOI: 10.1089/g4h.2018.0021] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Teresa Hagan Thomas
- Department of Health Promotion & Development, University of Pittsburgh School of Nursing, Pittsburgh, Pennsylvania
| | - Mary McLaughlin
- University of Pittsburgh Medical Center Passavant, Pittsburgh, Pennsylvania
| | - Margaret Hayden
- University of Pittsburgh Medical Center Passavant, Pittsburgh, Pennsylvania
| | - Elizabeth Shumaker
- University of Pittsburgh Medical Center Passavant, Pittsburgh, Pennsylvania
| | - Jessica Trybus
- Simcoach Games, Pittsburgh, Pennsylvania
- Entertainment Technology Center, Carnegie Mellon University, Pittsburgh, Pennsylvania
| | - Eben Myers
- Simcoach Games, Pittsburgh, Pennsylvania
| | | | - Susan M. Cohen
- Department of Health Promotion & Development, University of Pittsburgh School of Nursing, Pittsburgh, Pennsylvania
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Hagan TL, Cohen SM, Rosenzweig MQ, Zorn K, Stone CA, Donovan HS. The Female Self-Advocacy in Cancer Survivorship Scale: A validation study. J Adv Nurs 2017; 74:976-987. [PMID: 29117439 DOI: 10.1111/jan.13498] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/24/2017] [Indexed: 11/28/2022]
Abstract
AIM To develop and psychometrically test the validity of the Female Self-Advocacy in Cancer Survivorship Scale. BACKGROUND Female cancer survivors need to self-advocate to overcome challenges associated with cancer yet no valid measure of self-advocacy exists. DESIGN Instrument development. Mixed-mode cross-sectional survey design. PARTICIPANTS We recruited adult females (18+ years; N = 317) with a history of invasive cancer from local and national tumour registries and advocacy organizations to complete online or paper questionnaires. METHODS Between July 2014 - March 2015 to evaluate the construct validity based on evidence of the scale's: (1) internal structure consistent with the underlying model of self-advocacy; (2) sensitivity to differences between groups known to differ in self-advocacy skills; (3) relationships between self-advocacy and key potential predictors (openness and conscientiousness; information engagement; social support) and outcomes (symptom burden and healthcare utilization); (4) relationships between self-advocacy and related concepts (patient activation; self-advocacy within another patient population); and (5) relationships between self-advocacy and criterion measures. Analyses included an exploratory factor analysis, t tests, and bivariate correlations using validated, reliable measures for constructs. RESULTS Evidence from all five hypotheses supported the construct validity of the Female Self-Advocacy in Cancer Survivorship Scale. The factor analysis confirmed the three underlying dimensions of self-advocacy resulting in a 20-item measure with strong internal consistency that explained almost half of response variance. CONCLUSION The Female Self-Advocacy in Cancer Survivorship Scale is a valid, reliable measure of how well adult female cancer survivors can get their needs met in the face of adversity.
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Affiliation(s)
- Teresa L Hagan
- Center for Psychiatric Oncology and Behavioral Sciences, Massachusetts General Hospital/Harvard Medical School, Boston, MA, USA
| | - Susan M Cohen
- Department of Health Promotion and Development, University of Pittsburgh School of Nursing, Pittsburgh, PA, USA
| | - Margaret Q Rosenzweig
- Department of Acute and Tertiary Care, University of Pittsburgh School of Nursing, Pittsburgh, PA, USA
| | - Kristin Zorn
- Department of Obstetrics & Gynecology, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Clement A Stone
- Department of Psychology in Education, University of Pittsburgh School of Education, Pittsburgh, PA, USA
| | - Heidi S Donovan
- Department of Health & Community Systems, University of Pittsburgh School of Nursing, Pittsburgh, PA, USA
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