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Saketkoo LA, Russell AM, Jensen K, Mandizha J, Tavee J, Newton J, Rivera F, Howie M, Reese R, Goodman M, Hart P, Strookappe B, De Vries J, Rosenbach M, Scholand MB, Lammi MR, Elfferich M, Lower E, Baughman RP, Sweiss N, Judson MA, Drent M. Health-Related Quality of Life (HRQoL) in Sarcoidosis: Diagnosis, Management, and Health Outcomes. Diagnostics (Basel) 2021; 11:1089. [PMID: 34203584 PMCID: PMC8232334 DOI: 10.3390/diagnostics11061089] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 05/30/2021] [Accepted: 06/02/2021] [Indexed: 02/06/2023] Open
Abstract
Health-related quality of life (HRQoL), though rarely considered as a primary endpoint in clinical trials, may be the single outcome reflective of patient priorities when living with a health condition. HRQoL is a multi-dimensional concept that reflects the degree to which a health condition interferes with participation in and fulfillment of important life areas. HRQoL is intended to capture the composite degree of physical, physiologic, psychological, and social impairment resulting from symptom burden, patient-perceived disease severity, and treatment side effects. Diminished HRQoL expectedly correlates to worsening disability and death; but interventions addressing HRQoL are linked to increased survival. Sarcoidosis, being a multi-organ system disease, is associated with a diffuse array of manifestations resulting in multiple symptoms, complications, and medication-related side effects that are linked to reduced HRQoL. Diminished HRQoL in sarcoidosis is related to decreased physical function, pain, significant loss of income, absence from work, and strain on personal relationships. Symptom distress can result clearly from a sarcoidosis manifestation (e.g., ocular pain, breathlessness, cough) but may also be non-specific, such as pain or fatigue. More complex, a single non-specific symptom, e.g., fatigue may be directly sarcoidosis-derived (e.g., inflammatory state, neurologic, hormonal, cardiopulmonary), medication-related (e.g., anemia, sleeplessness, weight gain, sub-clinical infection), or an indirect complication (e.g., sleep apnea, physical deconditioning, depression). Identifying and distinguishing underlying causes of impaired HRQoL provides opportunity for treatment strategies that can greatly impact a patient's function, well-being, and disease outcomes. Herein, we present a reference manual that describes the current state of knowledge in sarcoidosis-related HRQoL and distinguish between diverse causes of symptom distress and other influences on sarcoidosis-related HRQoL. We provide tools to assess, investigate, and diagnose compromised HRQoL and its influencers. Strategies to address modifiable HRQoL factors through palliation of symptoms and methods to improve the sarcoidosis health profile are outlined; as well as a proposed research agenda in sarcoidosis-related HRQoL.
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Affiliation(s)
- Lesley Ann Saketkoo
- New Orleans Scleroderma and Sarcoidosis Patient Care and Research Center, New Orleans, LA 70112, USA; (K.J.); (M.R.L.)
- Comprehensive Pulmonary Hypertension Center and Interstitial Lung Disease Clinic Programs, University Medical Center, New Orleans, LA 70112, USA
- Section of Pulmonary Medicine, Louisiana State University School of Medicine, New Orleans, LA 70112, USA
- Tulane University School of Medicine, Tulane University, New Orleans, LA 70112, USA
| | - Anne-Marie Russell
- College of Medicine and Health, University of Exeter, Devon EX1 2LU, UK
- Imperial College Healthcare NHS Foundation Trust, London W2 1NY, UK
| | - Kelly Jensen
- New Orleans Scleroderma and Sarcoidosis Patient Care and Research Center, New Orleans, LA 70112, USA; (K.J.); (M.R.L.)
- Tulane University School of Medicine, Tulane University, New Orleans, LA 70112, USA
- Department of Internal Medicine, Oregon Health and Science University, Portland, OR 97239, USA
| | - Jessica Mandizha
- Respiratory Medicine, Royal Devon and Exeter Hospital NHS Foundation Trust, Exeter EX2 5DW, UK;
| | - Jinny Tavee
- Department of Neurology, National Jewish Health, Denver, CO 80206, USA;
| | - Jacqui Newton
- Sarcoidosis UK, China Works, Black Prince Road, London SE1 7SJ, UK; (J.N.); (M.H.)
| | - Frank Rivera
- Foundation for Sarcoidosis Research, Chicago, IL 60614, USA; (F.R.); (R.R.)
- National Sarcoidosis Support Group, Stronger than Sarcoidosis, New York, NY 11727, USA
| | - Mike Howie
- Sarcoidosis UK, China Works, Black Prince Road, London SE1 7SJ, UK; (J.N.); (M.H.)
- CGI UK, Space Defense & Intelligence (Cyber Security Operations), London EC3M 3BY, UK
| | - Rodney Reese
- Foundation for Sarcoidosis Research, Chicago, IL 60614, USA; (F.R.); (R.R.)
- National Sarcoidosis Support Group, Stronger than Sarcoidosis, New York, NY 11727, USA
- Sarcoidosis Awareness Foundation of Louisiana, Baton Rouge, LA 70812, USA
| | - Melanie Goodman
- New Orleans Sarcoidosis Support Group, New Orleans, LA 70112, USA;
| | - Patricia Hart
- iHart Wellness Holistic Approach to Sarcoidosis Certified Health & Wellness Coach, International Association of Professionals, New York, NY 11727, USA;
| | - Bert Strookappe
- Department of Physiotherapy, Gelderse Vallei Hospital, 10, 6716 RP Ede, The Netherlands; (B.S.); (M.E.)
- ildcare Foundation Research Team, 6711 NR Ede, The Netherlands; (M.D.)
| | - Jolanda De Vries
- Admiraal de Ruyter Hospital (Adrz), 114, 4462 RA Goes, The Netherlands;
- Department of Medical and Clinical Psychology, Tilburg University, 5037 AB Tilburg, The Netherlands
| | - Misha Rosenbach
- Cutaneous Sarcoidosis Clinic, Department of Dermatology, University of Pennsylvania, Philadelphia, PA 19104, USA;
| | - Mary Beth Scholand
- Division of Pulmonary Medicine, Interstitial Lung Disease Center, University of Utah, Salt Lake City, UT 84132, USA;
| | - Mathew R. Lammi
- New Orleans Scleroderma and Sarcoidosis Patient Care and Research Center, New Orleans, LA 70112, USA; (K.J.); (M.R.L.)
- Comprehensive Pulmonary Hypertension Center and Interstitial Lung Disease Clinic Programs, University Medical Center, New Orleans, LA 70112, USA
- Section of Pulmonary Medicine, Louisiana State University School of Medicine, New Orleans, LA 70112, USA
| | - Marjon Elfferich
- Department of Physiotherapy, Gelderse Vallei Hospital, 10, 6716 RP Ede, The Netherlands; (B.S.); (M.E.)
- ildcare Foundation Research Team, 6711 NR Ede, The Netherlands; (M.D.)
| | - Elyse Lower
- Department of Medicine, University of Cincinnati Medical Center, Cincinnati, OH 45267, USA; (E.L.); (R.P.B.)
| | - Robert P. Baughman
- Department of Medicine, University of Cincinnati Medical Center, Cincinnati, OH 45267, USA; (E.L.); (R.P.B.)
| | - Nadera Sweiss
- Division of Rheumatology, Department of Medicine, University of Illinois at Chicago, Chicago, IL 60612, USA;
| | - Marc A. Judson
- Division of Pulmonary Medicine and Critical Care, Albany Medical College, Albany, NY 12208, USA;
| | - Marjolein Drent
- ildcare Foundation Research Team, 6711 NR Ede, The Netherlands; (M.D.)
- Interstitial Lung Diseases (ILD) Center of Excellence, Department of Pulmonology, St. Antonius Hospital, Koekoekslaan 1, 3435 CM Nieuwegein, The Netherlands
- Department of Pharmacology and Toxicology, Faculty of Health and Life Sciences, Maastricht University, 40, 6229 ER Maastricht, The Netherlands
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Siler S, Arora K, Doyon K, Fischer SM. Spirituality and the Illness Experience: Perspectives of African American Older Adults. Am J Hosp Palliat Care 2021; 38:618-625. [PMID: 33461330 DOI: 10.1177/1049909120988280] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Disparities in hospice and palliative care (PC) for African Americans have been linked to mistrust toward the healthcare system, racial inequalities, and cultural preferences. Spirituality has been identified as important to African Americans in general. Less is known about the influence of spirituality on African American illness experiences. OBJECTIVE The goal of this study was to understand older African Americans' perspectives on how spirituality influences chronic illness experiences to inform the development of a culturally tailored PC intervention. METHODS In partnership with 5 churches in the Denver metropolitan area, we conducted focus groups with African American older adults (n = 50) with chronic health conditions and their family caregivers. Transcripts were analyzed using a deductive approach. The theoretical framework for this study draws on psychology of religion research. RESULTS Themes referenced participants' spiritual orienting systems, spiritual coping strategies, and spiritual coping styles. Psycho-spiritual struggles, social struggles, and sources of social support were also identified. Findings suggest African Americans' spirituality influences chronic illness experiences. Participants relied on their spirituality and church community to help them cope with illness. In addition, social struggles impacted the illness experience. Social struggles included mistrust toward the healthcare system and not being connected to adequate resources. Participants expressed a need to advocate for themselves and family members to receive better healthcare. Churches were referred to as a trusted space for health resources, as well as spiritual and social support.
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Affiliation(s)
- Shaunna Siler
- School of Medicine, 12225University of Colorado, Anschutz Medical Campus, CO, USA
| | - Kelly Arora
- University of Colorado, Anschutz Medical Campus, CO, USA
| | - Katherine Doyon
- School of Medicine, 12225University of Colorado, Anschutz Medical Campus, CO, USA
| | - Stacy M Fischer
- Division of General Internal Medicine, Department of Medicine, 12225University of Colorado, Anschutz Medical Campus, CO, USA
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Davaro FM, Weinstein D, Siddiqui SA, Hamilton ZA. A Lack of Palliative Therapy Use in Patients With Advanced Penile Cancer. J Palliat Care 2020; 36:98-104. [PMID: 32752928 DOI: 10.1177/0825859720946887] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
OBJECTIVES Advanced penile cancer is associated with a poor prognosis; therefore, providing patients with realistic expectations, addressing goals of care and offering palliative therapy when appropriate is critical. Our goal was to investigate the National Cancer Database (NCDB) and analyze the role and trends in use of palliative therapy in patients with advanced penile cancer. METHODS The NCDB 2004-2015 penile cancer data set was queried for patients with locally advanced, defined as cT4NanyM0 and cTanyN3M0, or metastatic disease regardless of tumor or nodal stage. Patients were categorized based on whether they did or did not receive palliative care. Palliative care was cataloged as pain management therapy, surgery, radiation or systemic treatment, any combination therapy or not otherwise specified (NOS). Our primary outcome was receiving palliative therapy. Secondary outcome was the temporal trends in palliative care. Logistic regression (LR) was performed. RESULTS OBTAINED 385 and 279 patients were identified with locally advanced and metastatic penile cancer respectively. 27 (7.1%) and 49 (17.6%) patients received palliative care. Average age of patients accepting palliative care was 61.9 years old, about 5 years younger than their counterparts who declined therapy (p < 0.011) in the metastatic cohort. Other patient specific demographics and clinical tumor characteristics were not significantly different in either population. Of patients with locally advanced disease pursuing palliative therapy, radiation (29.6%), surgery (14.8%), systemic treatment (14.8%) and combination treatment (22.2%) were the more popular choices. In the metastatic population, radiation (32.7%) and systemic therapy (24.5%) were the most prevalent choices for palliative treatment followed by combination treatment (16.3%), surgery (12.2%), pain management (10.2%), or NOS (4.1%). LR for the receipt of "any palliative therapy" revealed that increasing age (OR 0.971, p = 0.032) decreased the likelihood of accepting palliative therapy in the metastatic population but not in the locally advanced group. Charlson score of 2 (OR 5.966, p = 0.025) and low income (OR 3.968, p = 0.002) predicted receipt of palliative therapy in the locally advanced group. In patients with metastatic disease, African-American race (OR 2.502, p = 0.025), Charlson score 1 (2.175, p = 0.047) and 3+ (5.386, p = 0.020) predicted an increased predilection for receiving palliative therapy. Interestingly, no statistically significant difference in mortality was noted in either cohort. No significant increase in the trend of palliative care administration was seen in locally advanced and metastatic penile cancer between 2004 to 2015 (p = 0.078 and p = 0.942, respectively). CONCLUSION Locally advanced and metastatic penile cancer carry a high mortality rate yet only 11.4% of all patients studied received palliative care. Its use is more common in younger patients, those with co-morbidities and/or those of black race in the metastatic group. Locally advanced patients with low income or comorbidities were also more likely to opt for palliative therapy. Receipt of palliative care did not affect mortality. No increase in frequency of palliative therapy was seen, suggesting much improvement needs to be done in adopting and implementing palliative care in this patient population.
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Affiliation(s)
- Facundo M Davaro
- Division of Urology, Department of Surgery, xxxSaint Louis University Hospital, St. Louis MO, USA
| | - David Weinstein
- Division of Urology, Department of Surgery, xxxSaint Louis University Hospital, St. Louis MO, USA
| | - Sameer A Siddiqui
- Division of Urology, Department of Surgery, xxxSaint Louis University Hospital, St. Louis MO, USA
| | - Zachary A Hamilton
- Division of Urology, Department of Surgery, xxxSaint Louis University Hospital, St. Louis MO, USA
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Coats H, Rosenfeld AG, Crist JD, Sternberg E, Berger A. Using cognitive interviews to improve a Psychological-Social-Spiritual Healing instrument: Voices of aging African Americans with serious illness. Appl Nurs Res 2017; 39:109-114. [PMID: 29422143 DOI: 10.1016/j.apnr.2017.11.019] [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: 05/10/2017] [Revised: 10/17/2017] [Accepted: 11/02/2017] [Indexed: 11/17/2022]
Abstract
AIM The purpose of this study was to contribute to content validity, by providing input into the linguistic and pragmatic validities, of a 53 item Psychological-Social-Spiritual Healing instrument. BACKGROUND Discovery of cultural values and beliefs from African American elders' experiences of illness provides insight for development of more culturally sensitive instruments. METHODS Through an exploratory descriptive design, this study used cognitive interviewing methods to examine linguistic and pragmatic validity of the Psychological-Social-Spiritual Healing instrument, from the perspectives of aging seriously ill AAs. Participants were recruited from urban Jackson, MS from community settings from October 2014 to January 2015. With a purposefully chosen sample of seriously ill African Americans elders (N=15), and using the method of cognitive interviewing, responses related to cultural relevance, clarity and meaning of the 53 items of the instrument were collected. This in-depth query of items was accomplished through the use of both verbal probing and think aloud methods of cognitive interviewing. RESULTS Thirty-seven items were retained. Eight items were revised. Eight items were deleted. CONCLUSIONS From the expert input of seriously ill African American elders, a systematic decision-making process of item retention, revision or deletion led to the development of a more culturally sensitive Psychological-Social-Spiritual Healing instrument.
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Affiliation(s)
- Heather Coats
- University of Colorado, Anschutz Medical Campus, College of Nursing, 13120 E. 19th Avenue Aurora, CO 80045, United States.
| | - Anne G Rosenfeld
- The University of Arizona, College of Nursing, 1305 N. Martin Avenue, Tucson, AZ 85721-0203, United States.
| | - Janice D Crist
- The University of Arizona, College of Nursing, 1305 N. Martin Avenue, Tucson, AZ 85721-0203, United States.
| | - Esther Sternberg
- University of Arizona, College of Medicine, P.O. Box 245153, Tucson, AZ 85724-5153, United States.
| | - Ann Berger
- NIH Clinical Center, 10 Center Dr, Bethesda, MD 20814, United States.
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