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Gawel EM, DiNardo LA, Corbin AF, Friedel JE, Carr MM. Second opinions: Do otolaryngologist demographics matter? Am J Otolaryngol 2024; 45:104322. [PMID: 38692073 DOI: 10.1016/j.amjoto.2024.104322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2024] [Accepted: 04/18/2024] [Indexed: 05/03/2024]
Abstract
OBJECTIVE Pediatric patients and their caregivers may receive information from their primary care physician (PCP) that does not match current American Academy of Otolaryngology (AAO) guidelines. The purpose of this study is to evaluate the frequency of parents deciding to seek a second opinion based on the demographics of pediatric otolaryngologists who deliver guideline supported advice, contrary to advice from their child's PCP. METHODS A survey was distributed to parents in a pediatric otolaryngology clinic between June 2021 and July 2023. Demographics included parent age category, gender, race, and age of youngest child. The survey included a scenario depicting recurrent otitis media with clear ears and a suggestion to defer tympanostomy tube insertion per AAO guidelines after their child's PCP recommended tubes. Thirteen variations of otolaryngologist photos were used in the case, including a control case with no picture. RESULTS Of the 658 participants, 460 (69.9 %) were female. 551 (83.7 %) were aged 30-49 years, 70 (10.7 %) were younger, and 37 (5.6 %) were older. 545 (82.8 %) were White, 30 (4.6 %) were Black, 20 (3.0 %) were Asian, and 31 (4.7 %) were Hispanic. 39.9 % of parents would seek a second opinion if an otolaryngologist recommended watchful waiting following evaluation of their child's otitis media. Participants given the control case were 2.23 times more likely to listen to the otolaryngologist's advice (p = .025). If a picture was provided, respondents were more likely to follow advice given if the pictured otolaryngologist was female (p = .025, OR = 1.47) or Asian (p = .042, OR = 1.53). CONCLUSION In this group, there is evidence that physician race and gender may influence decision making when considering action versus monitoring in the context of recurrent otitis media.
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Affiliation(s)
- Erin M Gawel
- Jacobs School Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA.
| | - Lauren A DiNardo
- Jacobs School Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA.
| | - Alexandra F Corbin
- Jacobs School Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA.
| | - Jonathan E Friedel
- Department of Psychology, Georgia Southern University, Statesboro, GA, USA.
| | - Michele M Carr
- Department of Otolaryngology, Jacobs School Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA.
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Abrams LM, Look K, Shiyanbola O. Relationships Between Chronic Illness, Body Mass Index, and Patient-Provider Communication. HEALTH COMMUNICATION 2024; 39:1491-1498. [PMID: 37278049 DOI: 10.1080/10410236.2023.2218606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Little is known about how higher-weight patients experience patient-provider communication, particularly among those with chronic illness. This study uses quantitative analytical methods and nationally representative data to determine how patient-provider communication is affected when patients have one or more chronic illnesses, as well as if patient BMI has a moderating effect on this association. Pearson correlation and multivariate logistic regression were both used to determine the significance of these associations. A significant, negative, relationship was found between overall patient-provider communication and patient chronic illness status, but no significant relationship was found between respondent BMI and patient-provider communication. There was no observable moderation effect of respondent BMI on the relationship between their number of chronic illnesses and the perceived quality of the patient-provider communication they experienced. From this study there is evidence that patients with multiple chronic illness experience worse communication with their health care providers which could be due to numerous types of bias. More research is needed to better understand if and how weight and other bias affects outcomes for chronically ill patients. Research implications include improving the comprehensiveness of nation-wide surveys that measure health care quality to include improved measures of perceived bias, including weight bias, and patient-provider communication, as these are complex, multi-factorial concepts.
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Affiliation(s)
- Lucille M Abrams
- School of Pharmacy, Social and Administrative Sciences Division, University of Wisconsin-Madison
| | - Kevin Look
- School of Pharmacy, Social and Administrative Sciences Division, University of Wisconsin-Madison
| | - Olayinka Shiyanbola
- School of Pharmacy, Social and Administrative Sciences Division, University of Wisconsin-Madison
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Glauberman G, Kabua PM, Camba M, Dela Cruz M, Fontenot HB. Perspectives on Emergency Preparedness Among Indigenous Pacific People in Hawaii: A Qualitative Study. J Community Health Nurs 2024; 41:189-202. [PMID: 38334130 PMCID: PMC11128344 DOI: 10.1080/07370016.2024.2309375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/10/2024]
Abstract
PURPOSE This study sought an improved understanding of household emergency preparedness (EP) among Native Hawaiian, Pacific Islander, and Filipino (Indigenous Pacific People [IPP]) parents in Hawaii. DESIGN We conducted an exploratory qualitative descriptive study with 60-minute interviews occurring from October 2022 through March 2023. A semi-structured interview guide exploring participant household EP was employed. METHODS Prospective participants were females who identified as IPP, caregivers of a 0-12-year-old child, spoke English, and received health services at a federally qualified health center clinic. Two researchers conducted qualitative content analysis on interview transcripts. Initial coding of transcripts identified broad categories or themes. The process was reviewed continuously to verify data and coding procedures. Three investigators independently verified final themes and subthemes. FINDINGS Participants (N=25) were female, between 30-49 years of age (68%), had received some college education (60%), and were fully employed (68%). Major themes included: 1) Perceptions of family EP and current behaviors, 2) Barriers and challenges to family EP, and 3) Perspectives on strategies to improve family EP. Subthemes included risk perception for emergencies; family EP practices; health protection and pandemic preparedness; lack of knowledge and experience; social, cultural and economic barriers; and clinic-based, technology-driven, and community-based interventions. CONCLUSION Factors impeding access to healthcare services also impede family EP among IPP groups and their ability to mitigate the impact of future public health emergencies. CLINICAL EVIDENCE Targeted, innovative interventions, including ones led by health clinics and those that utilize technology, are needed to overcome common barriers faced and to facilitate the uptake of household EP behaviors among IPP families.
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Affiliation(s)
- Gary Glauberman
- University of Hawaii at Manoa School of Nursing, Honolulu, HI, USA
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Miller AN, Duvuuri VNS, Vishanagra K, Damarla A, Hsiao D, Todd A, Toledo R. The Relationship of Race/Ethnicity Concordance to Physician-Patient Communication: A Mixed-Methods Systematic Review. HEALTH COMMUNICATION 2024; 39:1543-1557. [PMID: 37338139 DOI: 10.1080/10410236.2023.2223402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/21/2023]
Abstract
The concept of race or ethnic concordance between health care provider and patient has emerged as a dimension of the patient-physician relationship that could influence health outcomes for patients from minoritized groups, particularly through differences in the way physicians communicate with patients based on race or ethnicity. However, two decades of study on concordance and physician-patient communication have produced contradictory results. Given the heightened societal awareness of racism and the persistence of health disparities, there is a need for a comprehensive review of the current state of knowledge. This review sets out to determine how communication patterns differ in race/ethnicity concordant versus discordant patient-physician medical encounters. Thirty-three studies employing a range of methodologies were identified. In most analyses, after accounting for covariates, no relationship was found between race/ethnicity concordance and communication variables. Race/ethnicity concordance with their physician does not appear to influence the quality of communication for most patients from minoritized groups. A number of methodological weaknesses were identified in existing research, among them: few studies investigated potential explanatory variables, the heterogeneity of ethnic and cultural experience was over-simplified, there was little consistency in operationalization of communication variables, and the physician-patient dynamic was inadequately conceptualized.
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Affiliation(s)
- Ann Neville Miller
- Nicholson School of Communication and Media, University of Central Florida
| | | | - Kishan Vishanagra
- Burnett School of Biomedical Sciences, University of Central Florida
| | - Akhila Damarla
- Burnett School of Biomedical Sciences, University of Central Florida
| | - Diana Hsiao
- College of Medicine, University of Central Florida
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Pollak KI, Davenport CA, Duck V, Falls A, Pepka S, Parente V, Jackson LR, Johnson KS. Discriminatory and valuing communication behaviors in cardiology encounters. PATIENT EDUCATION AND COUNSELING 2024; 123:108224. [PMID: 38395022 PMCID: PMC10997491 DOI: 10.1016/j.pec.2024.108224] [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: 10/16/2023] [Revised: 02/05/2024] [Accepted: 02/19/2024] [Indexed: 02/25/2024]
Abstract
OBJECTIVE Many have found racial differences in clinician-patient communication using validated codebooks that represent effective communication. No codebooks used for examining racial differences, however, have included patient input. In this paper, we describe creating codebook with Black patient advocates to determine if we could reliably code discriminatory/valuing communication and assess racial differences in these behaviors. METHODS We created a codebook for discriminatory/valuing communication behaviors with the input of Black patient advocates. We used the codebook to analyze data from 101 audio recorded encounters between White cardiologists and Black and White patients. We examined the differences in the prevalence of behaviors in cardiology encounters. RESULTS In comparison to White patients, cardiologists made fewer tailoring statements to their Black patients (68% vs. 49%, p = 0.07). Coders found 4 instances of stereotyping behaviors and only Black patients (p = 0.12). We found no significant associations between any of the other outcomes and patient race. Black patients had a lower incidence of tailoring statements (p = 0.13), lower incidence of interrupting statements (p = 0.16), and higher rushed global score (p = 0.14). CONCLUSION AND PRACTICE IMPLICATIONS We found that coders can reliably identify discriminatory/valuing behaviors in cardiology encounters. Future work should apply these codes to other datasets to assess their validity and generalizability.
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Affiliation(s)
- Kathryn I Pollak
- Cancer Prevention and Control, Duke Cancer Institute, Durham, NC, USA; Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA.
| | | | - Veronica Duck
- Cancer Prevention and Control, Duke Cancer Institute, Durham, NC, USA
| | - Allison Falls
- Department of Psychology, Duke University, Durham, NC, USA
| | - Sara Pepka
- Department of Psychology, Duke University, Durham, NC, USA
| | - Victoria Parente
- Department of Pediatrics, Duke University School of Medicine, Durham, NC, USA
| | - Larry R Jackson
- Department of Medicine, Duke University School of Medicine, Durham, NC, USA
| | - Kimberly S Johnson
- Department of Medicine, Duke University School of Medicine, Durham, NC, USA; Geriatric Research, Education, and Clinical Center (GRECC), Veterans Affairs Medical Center, Durham, NC, USA
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Mendez R, Velazquez E, Gimenez A, Michaud M, Mendez J, Wong M, Quesada J, Márquez-Magaña L, Samayoa C. The Impact of Insider Researcher Trainees in Recruiting and Retaining Latinx in an Outdoor Health Promotion Research Study. J Racial Ethn Health Disparities 2024; 11:1672-1684. [PMID: 37278955 PMCID: PMC10243238 DOI: 10.1007/s40615-023-01642-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 04/20/2023] [Accepted: 05/11/2023] [Indexed: 06/07/2023]
Abstract
Latinx represent the second largest ethnic group in the USA and remain significantly underrepresented in research studies. Efforts to better include Latinx make use of community-engaged research (CEnR) approaches, peer-navigators, and cultural humility training for research teams. While these efforts have led to slight increases in Latinx participation, studies to identify strategic practices for better inclusion of Latinx participants are needed. The objective of this study was to qualitatively examine factors leading to successful recruitment and retention of Latinx participants in the Promoting Activity and Stress Reduction in the Outdoors (PASITO) intervention. For this intervention, 99 low-income Latinx clients in a local community were contacted and 52 participants were recruited (53%). All were retained in the 3-month intervention. Of these, 12 were interviewed within 6 months of the close of PASITO by bi-cultural and bi-lingual non-research staff. They conducted one-on-one structured telephone interviews. Of the twelve participants, three (25%) were men, nine (75%) were women, and the mean age was 43.7 (SD = 8.7). Four critical themes for the recruitment and retention of Latinx populations emerged from the interviews: (1) importance of insider researchers; (2) sense of community and belonging; (3) responsive programming; and (4) health-promoting activities. These findings support the significant role insider researchers can play, and social identity theory provides a useful framework for understanding the role of insider researchers in recruiting and retaining Latinx, and likely other minoritized groups, in clinical studies. Insider researchers possess the skills, training, community cultural wealth, in-depth understanding of their communities, and structural competencies that position them to carry out more inclusive studies to address the needs of marginalized communities and advance science.
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Affiliation(s)
- Rebecca Mendez
- Department of Biology, San Francisco State University, Hensill Hall 665, 1600 Holloway Ave, San Francisco, CA, 94132, USA.
| | - Edgar Velazquez
- Internal Medicine, University of California San Francisco, San Francisco, CA, 94110, USA
| | - Alyssa Gimenez
- Department of Biology, San Francisco State University, Hensill Hall 665, 1600 Holloway Ave, San Francisco, CA, 94132, USA
| | - Midley Michaud
- Department of Biology, San Francisco State University, Hensill Hall 665, 1600 Holloway Ave, San Francisco, CA, 94132, USA
| | - Jaqueline Mendez
- Department of Biology, San Francisco State University, Hensill Hall 665, 1600 Holloway Ave, San Francisco, CA, 94132, USA
| | - Miriam Wong
- The Latina Center, 3701 Barrett Ave, Richmond, CA, 94805, USA
| | - James Quesada
- Department of Anthropology, San Francisco State University, 1600 Holloway Ave, San Francisco, CA, 94132, USA
| | - Leticia Márquez-Magaña
- Department of Biology, San Francisco State University, Hensill Hall 665, 1600 Holloway Ave, San Francisco, CA, 94132, USA
| | - Cathy Samayoa
- Department of Biology, San Francisco State University, Hensill Hall 665, 1600 Holloway Ave, San Francisco, CA, 94132, USA
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McFarlane SJ, Wright KO, Acheampong B, Francis DB, Callands T, Swartzendruber A, Adesina O. Reframing the experience of childbirth: Black doula communication strategies and client responses during delivery hospitalization. Soc Sci Med 2024; 351:116981. [PMID: 38781745 DOI: 10.1016/j.socscimed.2024.116981] [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: 10/21/2023] [Revised: 03/09/2024] [Accepted: 05/14/2024] [Indexed: 05/25/2024]
Abstract
Doulas, or birth coaches, are said to be "changing the world, one birth at a time." Black doulas have been suggested to mitigate against lack of representation in obstetric care, limited identity acknowledgement and accommodation, and obstetric racism. However, scientific inquiry into the specific communication strategies and messages used by Black doulas to advocate for clients was non-existent in extant literature. Guided by the Agency-Identity Model, we analyzed 20 diary-interviews of nine Black doulas who recently served Black clients. Specifically, we explored Black doulas' communication strategies and whether these strategies had an impact on client agency. We found that Black doulas prepare their clients for patient-provider interactions, including conversations about certain medical treatments and procedures and the risks for Black women and birthing people, the importance of informed consent, how to be heard, and how to resist neglect or abuse. We found that, in turn, most Black clients were able to enact agentic responses. We describe the specific doula messages, and contextualize our findings, considering how these collective interpersonal communication strategies of Black doulas, and their clients' agentic transformations, may index a sociopolitical movement to reframe the experience of childbirth in America.
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Affiliation(s)
- Soroya Julian McFarlane
- University of Georgia, Department of Communication Studies, 602 Caldwell Hall, GeorgiaAthens, GA, 30606, USA.
| | - Kallia O Wright
- University of Miami, School of Communication, 5100 Brunson Drive, Coral Gables, FL, 33146, USA.
| | - Beauty Acheampong
- University of Georgia, Department of Communication Studies, 602 Caldwell Hall, GeorgiaAthens, GA, 30606, USA.
| | - Diane B Francis
- Northeastern University, College of Arts, Media and Design, Ryder Hall, 11 Leon St #102, Boston, MA, 02115, USA.
| | - Tamora Callands
- University of Georgia, College of Public Health, 231 Wright Hall, Health Sciences Campus, 100 Foster Road, Athens, GA, 30602, USA.
| | - Andrea Swartzendruber
- University of Georgia, College of Public Health, 231 Wright Hall, Health Sciences Campus, 100 Foster Road, Athens, GA, 30602, USA.
| | - Oyinade Adesina
- University of Georgia, Department of Communication Studies, 602 Caldwell Hall, GeorgiaAthens, GA, 30606, USA.
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Ogunsanya ME, Kaninjing E, Ellis TN, Bamidele OO, Morton DJ, McIntosh AG, Dickey SL, Kendzor DE, Dwyer K, Young ME, Odedina FT. Quality of life assessment among ethnically diverse Black prostate cancer survivors: a constructivist grounded theory approach. J Cancer Surviv 2024:10.1007/s11764-024-01619-x. [PMID: 38805150 DOI: 10.1007/s11764-024-01619-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2024] [Accepted: 05/17/2024] [Indexed: 05/29/2024]
Abstract
PURPOSE Prostate cancer (CaP) is the most common cancer in Black men (BM), and the number of Black CaP survivors is rapidly increasing. Although Black immigrants are among the fastest-growing and most heterogeneous ethnic groups in the USA, limited data exist regarding their CaP experiences. Therefore, this study aimed to explore and model the experiences of ethnically diverse Black men with CaP. METHODS In-depth interviews were conducted with 34 participants: native-born BM (NBBM) (n = 17), African-born BM (ABBM) (n = 11), and Caribbean-born BM (CBBM) (n = 6) CaP survivors recruited through QR code-embedded flyers posted in Black businesses, clinics, social media platforms, and existing research networks within the USA. Guided by Charmaz's constructivist grounded theory methodology, the interviews were analyzed using constant comparison following key stages of initial, focused, and theoretical coding using Atlas.ti v23. RESULTS Participants were thirty-four men aged 49-84 years (mean ± SD, 66 ± 8). Most were married (77%), likely to be diagnosed at stage I (35%), and treated with radiotherapy (56%). Our study findings explored the complex trajectory of Black prostate cancer (CaP) survivors, unveiling a comprehensive model termed "Journeying through Unfamiliar Terrain." Comprising three phases and 11 sub-phases, this model uniquely captures the pre-diagnosis awareness and post-treatment adaptation among survivors. CONCLUSION The resulting theoretical model delineates the entire CaP survivorship process among BM, providing contextual and conceptual understanding for developing interventions and enhancing patient-centered care for ethnically diverse CaP survivors, pivotal in bridging the gaps in survivorship research and healthcare practices. IMPLICATIONS FOR CANCER SURVIVORS Black CAP survivors experience significant burdens and challenges that impact their overall quality of life. Understanding the factors that impact the complex survivorship journey can inform design and implementation of interventions to address the multiple challenges and thus improve quality of life.
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Affiliation(s)
- Motolani E Ogunsanya
- Department of Pharmacy, Clinical & Administrative Sciences, College of Pharmacy, University of Oklahoma Health Sciences Center, 655 Research Parkway, Suite 400, Oklahoma City, OK, 73104, USA.
- TSET Health Promotion Research Center, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA.
- OU Health Stephenson Cancer Center, University of Oklahoma Health Sciences Center, Oklahoma City, USA.
| | - Ernest Kaninjing
- School of Health and Human Performance, Georgia College & State University, Milledgeville, GA, USA
| | - Tanara N Ellis
- Department of Pharmacy, Clinical & Administrative Sciences, College of Pharmacy, University of Oklahoma Health Sciences Center, 655 Research Parkway, Suite 400, Oklahoma City, OK, 73104, USA
| | - Olufikayo O Bamidele
- Hull York Medical School, University of Hull, Cottingham Road, Hull, HU6 7RX, UK
| | - Daniel J Morton
- Department of Pediatrics, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
- OU Health Stephenson Cancer Center, University of Oklahoma Health Sciences Center, Oklahoma City, USA
| | - Andrew G McIntosh
- Department of Urology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
- OU Health Stephenson Cancer Center, University of Oklahoma Health Sciences Center, Oklahoma City, USA
| | - Sabrina L Dickey
- College of Nursing, Florida State University, Tallahassee, FL, USA
| | - Darla E Kendzor
- TSET Health Promotion Research Center, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
- Department of Family and Preventive Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
- OU Health Stephenson Cancer Center, University of Oklahoma Health Sciences Center, Oklahoma City, USA
| | - Kathleen Dwyer
- Fran and Earl Ziegler College of Nursing, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
- OU Health Stephenson Cancer Center, University of Oklahoma Health Sciences Center, Oklahoma City, USA
| | - Mary Ellen Young
- Prevention, Symptom Control and Survivorship, and Care Delivery Transformation (CPSD) Program, Mayo Clinic Comprehensive Cancer Center, Mayo Clinic, Jacksonville, FL, USA
| | - Folakemi T Odedina
- Prevention, Symptom Control and Survivorship, and Care Delivery Transformation (CPSD) Program, Mayo Clinic Comprehensive Cancer Center, Mayo Clinic, Jacksonville, FL, USA
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Munro C. Role models help to progress gender parity, but we mustn't forget the personal cost. BMJ 2024; 385:q1033. [PMID: 38724098 DOI: 10.1136/bmj.q1033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/15/2024]
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10
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Noureldin M, Rubenstein JH, Urias E, Berinstein JA, Cohen-Mekelburg S, Saini SD, Higgins PD, Waljee AK. Racial Disparity in Esophageal Squamous Cell Carcinoma Treatment and Survival in the United States. Am J Gastroenterol 2024; 119:830-836. [PMID: 37975573 DOI: 10.14309/ajg.0000000000002606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Accepted: 11/07/2023] [Indexed: 11/19/2023]
Abstract
INTRODUCTION Esophageal squamous cell carcinoma (ESCC) has a higher incidence and prevalence than esophageal adenocarcinoma among Black individuals in the United States. Black individuals have lower ESCC survival. These racial disparities have not been thoroughly investigated. We examined the disparity in treatment and survival stratified by ESCC stage at diagnosis. METHODS The Surveillance, Epidemiology, and End Results database was queried to identify patients with ESCC between 2000 and 2019. The identified cohort was divided into subgroups by race. Patient and cancer characteristics, treatment received, and survival rates were compared across the racial subgroups. RESULTS A total of 23,768 patients with ESCC were identified. Compared with White individuals, Black individuals were younger and had more distant disease during diagnosis (distant disease: 26.7% vs 23.8%, P < 0.001). Black individuals had lower age-standardized 5-year survival for localized (survival % [95% confidence interval]: 19.3% [16-22.8] vs 27.6% [25.1-30.2]), regional (14.3% [12-16.7] vs 21.1% [19.6-22.7]), and distant (2.9% [1.9-4.1] vs 6.5% [5.5-7.5]) disease. Black individuals were less likely to receive chemotherapy (54.7% vs 57.5%, P = 0.001), radiation (58.5% vs 60.4%, P = 0.03), and surgery (11.4% vs 16.3%, P < 0.0001). DISCUSSION Black individuals with ESCC have a lower survival rate than White individuals. This could be related to presenting at a later stage but also disparities in which treatments they receive even among individuals with the same stage of disease. To what extent these disparities in receipt of treatment is due to structural racism, social determinants of health, implicit bias, or patient preferences deserves further study.
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Affiliation(s)
- Mohamed Noureldin
- Division of Gastroenterology, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Joel H Rubenstein
- Division of Gastroenterology, University of Michigan Medical School, Ann Arbor, Michigan, USA
- Center for Clinical Management Research, LTC Charles S. Kettles Veterans Affairs Medical Center, Ann Arbor, Michigan, USA
- Cancer Control and Population Sciences Program, Rogel Cancer Center, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Esteban Urias
- Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Jeffrey A Berinstein
- Division of Gastroenterology, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Shirley Cohen-Mekelburg
- Division of Gastroenterology, University of Michigan Medical School, Ann Arbor, Michigan, USA
- Center for Clinical Management Research, LTC Charles S. Kettles Veterans Affairs Medical Center, Ann Arbor, Michigan, USA
| | - Sameer D Saini
- Division of Gastroenterology, University of Michigan Medical School, Ann Arbor, Michigan, USA
- Center for Clinical Management Research, LTC Charles S. Kettles Veterans Affairs Medical Center, Ann Arbor, Michigan, USA
| | - Peter D Higgins
- Division of Gastroenterology, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Akbar K Waljee
- Division of Gastroenterology, University of Michigan Medical School, Ann Arbor, Michigan, USA
- Department of Learning Health Sciences, University of Michigan Medical School, Ann Arbor, Michigan, USA
- Center for Global Health Equity, University of Michigan, Ann Arbor, Michigan, USA
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Magura CM, Rubino MS, Bolaji T, Goldberg MB. Increasing Underrepresented Minority Representation in a General Surgery Residency Program Utilizing a 3-Phase Strategy. Am Surg 2024:31348241248687. [PMID: 38631332 DOI: 10.1177/00031348241248687] [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: 04/19/2024]
Abstract
BACKGROUND Underrepresented minority groups (URMs) in surgery are not significantly increasing despite evidence suggesting that diversity in health care providers leads to excellent patient outcomes and care. Efforts to increase URM representation in surgical residency programs are essential for addressing disparities and improving health care delivery. METHODS This retrospective study outlines a three-phase strategy implemented at a large academic-affiliated hospital to increase URM representation in its general surgery residency program. The strategy encompassed interview selection with a holistic review and implicit bias training for interviewers, modification of the interview scoring rubric, and post-interview recruitment efforts, including a virtual second look event for URM applicants. RESULTS Following the implementation of these strategies, the URM match rate improved from 0 to 33.3% in the first year and was sustained at 33.3% in the subsequent year. Consequently, the representation of URMs in the residency program rose from 6.7% before our intervention to 13.3% afterwards. DISCUSSION This structured approach successfully increased URM representation in a surgical residency program, affirming the success of targeted recruitment strategies. By promoting a diverse and inclusive environment, the program better reflects the community it serves, with aims at improved patient care and patient satisfaction.
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Affiliation(s)
- Connor M Magura
- Department of Surgery, ChristianaCare Health System, Newark, DE, USA
| | - Matthew S Rubino
- Department of Surgery, ChristianaCare Health System, Newark, DE, USA
| | - Toba Bolaji
- Department of Surgery, ChristianaCare Health System, Newark, DE, USA
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Brandt J, Ramly E, Lim SS, Bao G, Messina ML, Piper ME, Bartels CM. Implementing a Staff-Led Smoking Cessation Intervention in a Diverse Safety-Net Rheumatology Clinic: A Pre-Post Scalability Study in a Low-Resource Setting. Arthritis Care Res (Hoboken) 2024. [PMID: 38622089 DOI: 10.1002/acr.25349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Revised: 03/21/2024] [Accepted: 04/11/2024] [Indexed: 04/17/2024]
Abstract
OBJECTIVE Quit Connect (QC), our specialty clinic smoking cessation intervention, supports clinic staff to check, advise, and connect willing patients to a state quit line or class. QC improved tobacco screening and quit line referrals 26-fold in a predominantly White academic health care system population. Implementing QC includes education, electronic health record (EHR) reminders, and periodic audit feedback. This study tested QC's feasibility and impact in a safety-net rheumatology clinic with a predominantly Black population. METHODS In this pre-post study, adult rheumatology visits were analyzed 12 months before through 18 months after QC intervention (November 2019 through November 2021, omitting COVID-19 peak April through November 2020). EHR data compared process and clinical outcomes, including offers, referrals to resources, completed referrals, and documented cessation. Clinic staff engaged in pre-post focus groups and questionnaires regarding intervention feasibility and acceptability. Cost-effectiveness was also assessed. RESULTS Visit-level patients who smoked were 89.8% Black and 69.5% women (n = 550). Before intervention, clinic staff rarely asked patients about readiness to cut back smoking (<10% assessment). After QC intervention, staff assessed quit readiness in 31.8% of visits with patients who smoked (vs 8.1% before); 58.9% of these patients endorsed readiness to cut back or quit. Of 102 accepting cessation services, 37% (n = 17) of those reached set a quit date. Staff found the intervention feasible and acceptable. Each quit attempt cost approximately $4 to $10. CONCLUSION In a safety-net rheumatology clinic with a predominantly Black population, QC improved tobacco screening, readiness-to-quit assessment, and referrals and was also feasible and cost-effective.
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Affiliation(s)
- Jennifer Brandt
- Emory University School of Medicine and Grady Health System, Atlanta, Georgia
| | - Edmond Ramly
- University of Wisconsin School of Medicine and Public Health and University of Wisconsin College of Engineering, Madison
- Indiana University School of Public Health, Bloomington, Indiana
| | - S Sam Lim
- Emory University School of Medicine and Grady Health System, Atlanta, Georgia
| | - Gaobin Bao
- Emory University School of Medicine, Atlanta, Georgia
| | | | - Megan E Piper
- UW Center for Tobacco Research and Intervention, Madison, Wisconsin
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13
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Hauc SC, Rivera JC, Pondugula N, Febre-Alemañy DA, Jayaraj C, Goss JA, Butler PD. A 10-year analysis of the racial distribution of authors in plastic surgery research and the impact of minority mentorship. Am J Surg 2024:S0002-9610(24)00232-0. [PMID: 38658268 DOI: 10.1016/j.amjsurg.2024.04.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Revised: 03/24/2024] [Accepted: 04/10/2024] [Indexed: 04/26/2024]
Abstract
BACKGROUND This study evaluates the racial distribution in Plastic and Reconstructive Surgery (PRS) publication authorship and illustrates the impact underrepresented in medicine (URiM) mentorship has on increasing diverse trainee contributions to the PRS peer-reviewed literature. METHODS Articles published in the seven highest-impact PRS peer-reviewed journals within the last 10 years (2012-2022) were reviewed and analyzed for first and senior authors' race and ethnicity, publication year, and citation count. RESULTS A total of 23,549 publications were identified of which 8250 were from the US-based institutions. A random sampling of 778 publications (∼10 %) were scrutinized for first and senior author race and ethnicity. Across all journals, 64.5 % of senior authors were White, 29.9 % Asian, 4.6 % Hispanic, and 1.0 % Black. First authors were 59.5 % White, 32.8 % Asian, 5.2 % Hispanic, and 2.6 % Black (p=<0.0001). The presence of a URiM senior author increased the likelihood of a URiM first author 7-fold (p=<0.0001); 95 % CI [3.5-14.0]). There was no statistically significant difference in the total citation count relative to author race or ethnicity. The Aesthetic Surgery Journal had the greatest proportion of White senior authors (73.6 %), while Microsurgery had the highest percentage of URiM senior authors (8.7 %). CONCLUSIONS URiM authorship of PRS publications is limited and mentorship is essential to improve underrepresented perspectives in the PRS peer-reviewed literature.
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Affiliation(s)
- Sacha C Hauc
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Yale School of Medicine, New Haven, CT, USA
| | - Jean Carlo Rivera
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Yale School of Medicine, New Haven, CT, USA
| | - Nishita Pondugula
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Yale School of Medicine, New Haven, CT, USA
| | - David A Febre-Alemañy
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Yale School of Medicine, New Haven, CT, USA
| | - Christina Jayaraj
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Yale School of Medicine, New Haven, CT, USA
| | - Jeremy A Goss
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Yale School of Medicine, New Haven, CT, USA
| | - Paris D Butler
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Yale School of Medicine, New Haven, CT, USA.
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14
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Watanabe M, Kato M, Matsuda YT, Taniguchi K, Itakura S. The infant-doctor relationship: an examination of infants' distress reactions in the presence of a doctor. Sci Rep 2024; 14:7968. [PMID: 38575648 PMCID: PMC10994921 DOI: 10.1038/s41598-024-58677-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Accepted: 04/02/2024] [Indexed: 04/06/2024] Open
Abstract
Fear of doctors is a common source of distress among infants; however, the underlying sources of this distress are unknown. To investigate the doctor-infant relationship, the behaviors of 61 healthy infants (176-617 days old) were observed in a simulated examination room. Their behaviors and electrocardiograms were recorded. Two groups of infants were analyzed: those who cried and those who did not. When an experimenter dressed in the doctor's attire entered the room, all 9 infants who were crying (14.8% of all infants) stopped crying, all infants gazed at the experimenter, and their mean heart rate (HR) decreased. After the auscultation started, 29.5% of all infants cried, and the HRs of infants who cried were higher than those of infants who did not cry. During the auscultation, 80.0% of infants who cried averted from the experimenter, while 34.4% of infants who did not cry. Within 5 s of gazing at the stethoscope, the number of infants who cried increased from 3 to 12, and their mean HR also increased. Our findings suggest that the fear of doctors is not due to the appearance of doctors but rather to specific actions performed by doctors, such as auscultation. Infants may regard a doctor's appearance as a source of interest. Furthermore, a stethoscope is a possible trigger for infants' crying. These behavioral observations suggest the potential for patient-centered care for infants.
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Affiliation(s)
- Motonobu Watanabe
- Center for Baby Science, Doshisha University, 4-1-1 Kizugawadai, Kizugawa City, Kyoto, 619-0225, Japan.
- Department of Pediatrics, NHO Minami Kyoto Hospital, Joyo, Kyoto, Japan.
| | - Masaharu Kato
- Center for Baby Science, Doshisha University, 4-1-1 Kizugawadai, Kizugawa City, Kyoto, 619-0225, Japan
| | - Yoshi-Taka Matsuda
- Center for Baby Science, Doshisha University, 4-1-1 Kizugawadai, Kizugawa City, Kyoto, 619-0225, Japan
- Department of Child Studies, Shiraume Gakuen University, Kodaira, Tokyo, Japan
| | - Kosuke Taniguchi
- Center for Baby Science, Doshisha University, 4-1-1 Kizugawadai, Kizugawa City, Kyoto, 619-0225, Japan
- Department of Psychology, Kyoto University of Advanced Science, Ukyo-ku, Kyoto, Japan
| | - Shoji Itakura
- Center for Baby Science, Doshisha University, 4-1-1 Kizugawadai, Kizugawa City, Kyoto, 619-0225, Japan
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15
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Middleton KK, Turner A. Racial and Ethnic Disparities in Sports Medicine and the Importance of Diversity. Clin Sports Med 2024; 43:233-244. [PMID: 38383106 DOI: 10.1016/j.csm.2023.07.005] [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: 02/23/2024]
Abstract
Within orthopedics surgery as a specialty, sports medicine is one of the least diverse surgical subspecialties. Differences in minority representation between patient and provider populations are thought to contribute to disparities in care, access, and outcomes.
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Affiliation(s)
| | - Alex Turner
- University of Texas Southwestern Medical School, Dallas, TX, USA
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16
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Hamilton RH. Building an ethnically and racially diverse neurology workforce. Nat Rev Neurol 2024; 20:222-231. [PMID: 38388568 DOI: 10.1038/s41582-024-00941-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/02/2024] [Indexed: 02/24/2024]
Abstract
As diversity among patient populations continues to grow, racial and ethnic diversity in the neurology workforce is increasingly essential to the delivery of culturally competent care and for enabling inclusive, generalizable clinical research. Unfortunately, diversity in the workforce is an area in which the field of neurology has historically lagged and faces formidable challenges, including an inadequate number of trainees entering the field, bias experienced by trainees and faculty from minoritized racial and ethnic backgrounds, and 'diversity tax', the disproportionate burden of service work placed on minoritized people in many professions. Although neurology departments, professional organizations and relevant industry partners have come to realize the importance of diversity to the field and have taken steps to promote careers in neurology for people from minoritized backgrounds, additional steps are needed. Such steps include the continued creation of diversity leadership roles in neurology departments and organizations, the creation of robust pipeline programmes, aggressive recruitment and retention efforts, the elevation of health equity research and engagement with minoritized communities. Overall, what is needed is a shift in culture in which diversity is adopted as a core value in the field.
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Affiliation(s)
- Roy H Hamilton
- Department of Neurology, University of Pennsylvania, Philadelphia, PA, USA.
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17
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Eggermont D, Kunst AE, Groenewegen PP, Verheij RA. Social concordance and patient reported experiences in countries with different gender equality: a multinational survey. BMC PRIMARY CARE 2024; 25:97. [PMID: 38521895 PMCID: PMC10960425 DOI: 10.1186/s12875-024-02339-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 03/11/2024] [Indexed: 03/25/2024]
Abstract
BACKGROUND Patient reported experiences (PREMs) are important indices of quality of care. Similarities in demography between patient and doctor, known as social concordance, can facilitate patient-doctor interaction and may be associated with more positive patient experiences. The aim of this research is to study associations between gender concordance, age concordance and PREMs (doctor-patient communication, involvement in decision making, comprehensiveness of care and satisfaction) and to investigate whether these associations are dependent on a countries' Gender Equality Index (GEI). METHODS Secondary analysis on a multinational survey (62.478 patients, 7.438 GPs from 34 mostly European countries) containing information on general practices and the patient experiences regarding their consultation. Multi-level analysis is used to calculate associations of both gender and age concordance with four PREMs. RESULTS The female/female dyad was associated with better experienced doctor-patient communication and patient involvement in decision making but not with patient satisfaction and experienced comprehensiveness of care. The male/male dyad was not associated with more positive patient experiences. Age concordance was associated with more involvement in decision making, more experienced comprehensiveness, less satisfaction but not with communication. No association was found between a country's level of GEI and the effect of gender concordance. CONCLUSION Consultations in which both patient and GP are female are associated with higher ratings of communication and involvement in decision making, irrespective of the GEI of the countries concerned. Age concordance was associated with all PREMs except communication. Although effect sizes are small, social concordance could create a suggestion of shared identity, diminish professional uncertainty and changes communication patterns, thereby enhancing health care outcomes.
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Affiliation(s)
- D Eggermont
- School of Social and Behavioral Sciences, Tranzo Tilburg University, Heidelberglaan 1, Utrecht, 3584 CS, the Netherlands.
- Department of Public Health, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, Amsterdam, 1105 AZ, the Netherlands.
- Nivel, Netherlands Institute for Health Services Research, Otterstraat 118-124, Utrecht, 3513 CR, The Netherlands.
| | - A E Kunst
- Department of Public Health, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, Amsterdam, 1105 AZ, the Netherlands
| | - P P Groenewegen
- Nivel, Netherlands Institute for Health Services Research, Otterstraat 118-124, Utrecht, 3513 CR, The Netherlands
| | - R A Verheij
- School of Social and Behavioral Sciences, Tranzo Tilburg University, Heidelberglaan 1, Utrecht, 3584 CS, the Netherlands
- Nivel, Netherlands Institute for Health Services Research, Otterstraat 118-124, Utrecht, 3513 CR, The Netherlands
- National Health Care Institute, Willem Dudokhof 1, 1112 ZA, Diemen, the Netherlands
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18
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Kipp C, Wilson DK, Brown A, Quattlebaum M, Loncar H, Sweeney AM, Abshire DA. Compounding effects of stress on diet, physical activity, and wellbeing among African American parents: a qualitative study to inform the LEADS health promotion trial. J Behav Med 2024:10.1007/s10865-024-00477-3. [PMID: 38460063 DOI: 10.1007/s10865-024-00477-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Accepted: 02/01/2024] [Indexed: 03/11/2024]
Abstract
The purpose of the study was to conduct in-depth qualitative interviews to understand the lived experiences of African American parents of overweight adolescents who had previously participated in a family-based weight loss program and to utilize these insights to inform the essential elements of the LEADS trial, an integrated resilience stress management and health promotion intervention. Participants (N = 30) were African American parents and/or caregivers (96.7% female; Mage = 49.73, SD = 10.88; MBMI = 37.63, SD = 8.21) of adolescents with overweight and/or obesity. Interviews were transcribed and coded using inductive and deductive approaches for themes by two independent coders. Inter-rater reliability was acceptable (r = 0.70-0.80) and discrepancies were resolved to 100% agreement. Prominent stress themes included caregiver responsibilities, work, interpersonal family conflict, and physical and emotional consequences of chronic stress. Participants also noted decreases in physical activity and poor food choices due to stress. Coping mechanisms included prayer/meditation, church social support, and talking with family/partner. Results highlight the importance of mitigating stress among African American parents through stress management and cultural/familial resilience approaches to increase the likelihood of engagement in behavioral strategies in health promotion programs. Future studies should assess the utility of incorporating stress management components and health promotion techniques to improve health outcomes among African American families.
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Affiliation(s)
- Colby Kipp
- Department of Psychology, University of South Carolina, Columbia, SC, USA.
| | - Dawn K Wilson
- Department of Psychology, University of South Carolina, Columbia, SC, USA
| | - Asia Brown
- Department of Psychology, University of South Carolina, Columbia, SC, USA
| | - Mary Quattlebaum
- Department of Psychology, University of South Carolina, Columbia, SC, USA
| | - Haylee Loncar
- Department of Psychology, University of South Carolina, Columbia, SC, USA
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Baker O, Horvitz-Lennon M, Yu H. Racial and Ethnic Concordance Between National Health Service Corps Clinicians and Underserved Populations. JAMA Netw Open 2024; 7:e242961. [PMID: 38506809 PMCID: PMC10955390 DOI: 10.1001/jamanetworkopen.2024.2961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Accepted: 01/25/2024] [Indexed: 03/21/2024] Open
Abstract
Importance Despite the widely recognized importance of racial and ethnic concordance between patients and clinicians, there is a lack of studies on clinician diversity in medically underserved areas and whether it aligns with the changing demographic landscape. Objective To assess trends in National Health Services Corps (NHSC) clinician diversity and racial and ethnic concordance between NHSC clinicians and the populations in underserved areas from before to after the 2009 NHSC expansion. Design, Setting, and Participants This cross-sectional, population-based study compared trends in the diversity of NHSC clinicians practicing in health professional shortage areas (HPSAs) and the HPSA populations during 2003 to 2019 using the Health Resources and Services Administration's NHSC Field Strength Database and Area Health Resources Files. The analysis was performed from February through May 2023. Main Outcomes and Measures Concordance was measured with an annual community representativeness ratio defined as the ratio of the proportions of same race or ethnicity NHSC clinicians to HPSA population. Results There were a total of 41 180 clinicians practicing in HPSAs from 2003 to 2019; the median (IQR) age was 34 (30-41) years. Among 38 569 NHSC clinicians who reported gender, 28 444 (73.7%) identified as female and 10 125 (26.3%) identified as male. The average annual number of NHSC clinicians increased from 3357 in 2003 to 2008 to 9592 in 2009 to 2019. Before 2009, 1076 clinicians (5.3%) identified as Black, 9780 (48.6%) as Hispanic, 908 (4.5%) as other, and 8380 (41.6%) as White. During this period, concordance was low among non-Hispanic White and Black individuals due to clinician underrepresentation relative to the population, yet Hispanic clinicians were overrepresented. Following the 2009 NHSC expansion, the main change was the sharp decline in the proportion of Hispanic clinicians, to 1601 (13%) by 2019; while concordance was achieved for non-Hispanic White and Black individuals, Hispanic clinicians became underrepresented relative to population. The results held across 3 specialties: primary care, mental health care, and dental care. Conclusions and Relevance This cross-sectional study of trends in racial and ethnic concordance found that while the NHSC expansion starting in 2009 improved clinician-population concordance for non-Hispanic White and Black individuals, it reversed a prior trend for Hispanic individuals among whom clinicians became underrepresented relative to the population. Targeted NHSC clinician recruitment efforts are needed to improve concordance for Hispanic individuals in underserved areas, especially given Hispanics' projected growth in the US.
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Affiliation(s)
- Olesya Baker
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts
| | | | - Hao Yu
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts
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20
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Dmowska A, Fielding-Singh P, Halpern J, Prata N. The intersection of traumatic childbirth and obstetric racism: A qualitative study. Birth 2024; 51:209-217. [PMID: 37849421 PMCID: PMC10922554 DOI: 10.1111/birt.12774] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Revised: 06/02/2023] [Accepted: 09/12/2023] [Indexed: 10/19/2023]
Abstract
BACKGROUND Traumatic childbirth experiences are common in the United States - affecting a third to a fourth of mothers - with significant negative impacts on maternal health. Yet most research on traumatic childbirth focuses on white mothers' experiences. Drawing on a racially and ethnically diverse sample of mothers who experienced traumatic childbirth, this exploratory qualitative study examined Black, Latina, and Asian mothers' traumatic birth experiences and the role of obstetric racism in shaping these experiences. METHODS In-depth, semi-structured interviews were conducted in 2019-2020 with 30 mothers who identified as women of color (37% Black, 40% Latina, and 23% Asian) who gave birth in the US and self-identified as having experienced a traumatic childbirth. Data were analyzed using qualitative content analysis. RESULTS Mothers reported obstetric racism as core to their traumatic birth experiences. This racism manifested through practitioners' use of gendered and racialized stereotypes, denying and delegitimizing mothers' needs. Mothers shared key consequences of the obstetric racism they experienced, including postpartum anxiety and depression, increased medical mistrust, and decreased desire for future children. CONCLUSIONS Mothers' reports suggest that obstetric racism played a role in their traumatic birth experiences. Particularly, practitioners' deployment of gendered and racialized stereotypes influenced mothers' treatment during birth. These findings point to opportunities to address obstetric racism during childbirth and improve patients' experiences through enhancing their agency and empowerment. The findings, in addition, highlight the need for increased practitioner training in anti-racist practice and cultural humility.
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Affiliation(s)
- Amelia Dmowska
- Medical Student, University of California Berkeley and University of California San Francisco Joint Medical Program
| | | | - Jodi Halpern
- Professor of Bioethics and Medical Humanities, University of California Berkeley and University of California San Francisco Joint Medical Program
| | - Ndola Prata
- Professor of Maternal, Child and Adolescent Health, University of California Berkeley School of Public Health
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21
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Buck DiSilvestro J, Ulmer KK, Hedges M, Kardonsky K, Bruegl AS. Cervical Cancer: Preventable Deaths Among American Indian/Alaska Native Communities. Obstet Gynecol Clin North Am 2024; 51:125-141. [PMID: 38267123 DOI: 10.1016/j.ogc.2023.11.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2024]
Abstract
American Indian/Alaska Native (AI/AN) individuals have twice the mortality rate of cervical cancer than the general US population. Participation in prevention programs such as cervical cancer screening and human papillomavirus (HPV) vaccination are under-utilized in this population. There are high rates of established cervical cancer risk factors among this community, with AI/AN people having a higher likelihood of infection with high-risk HPV strains not included in the 9-valent vaccine. There is a need for more robust and urgent prevention and treatment efforts in regard to cervical cancer in the AI/AN community.
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Affiliation(s)
- Jessica Buck DiSilvestro
- Brown University, Providence, RI, USA; Women & Infants Hospital, 101 Dudley Street, Providence, RI 02905, USA.
| | - Keely K Ulmer
- University of Iowa Hospitals and Clinics, 200 Hawkins Drive, Iowa City, IA 52242, USA
| | | | - Kimberly Kardonsky
- Department of Family Medicine, University of Washington School of Medicine, Heath Sciences Center, E-304 Box 356391, Seattle, WA 98195, USA
| | - Amanda S Bruegl
- Division of Gynecologic Oncology, Oregon Health and Science University, 3181 SW Sam Jackson Park Road, Mailstop L466, Portland, OR 97239, USA
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22
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Zelin NS, Scott C, Avila-Quintero VJ, Curlin K, Flores JM, Bloch MH. Sexual Orientation and Racial Bias in Relation to Medical Specialty. JOURNAL OF HOMOSEXUALITY 2024; 71:574-599. [PMID: 36269161 DOI: 10.1080/00918369.2022.2132441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Physician explicit and implicit biases involving race and sexual orientation (SO) affect patient and provider experiences in healthcare settings. An anonymous survey was disseminated nationally to graduating medical students, residents, and practicing physicians to evaluate SO and racial biases across medical specialties. SO explicit and implicit bias were measured with the Attitudes toward Lesbians and Gay Men Scale, short form (ATLG-S) and Gay-Straight Implicit Association Test (IAT). Racial explicit and implicit bias were measured with the Quick Discrimination Index (QDI) and the Black-White IAT. Medical specialty was associated with racial explicit bias and specialty prestige with Black-White IAT score. Medical specialty and specialty prestige were not associated with SO bias. Female sex, sexual and gender minority (SGM) identity, and decreased religiosity were associated with reduced SO and racial bias. Provider race was associated with racial implicit and explicit bias.
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Affiliation(s)
| | - Carter Scott
- Washington University School of Medicine, St. Louis, Missouri, USA
| | | | - Kaveri Curlin
- Irvine School of Medicine, University of California, Irvine, California, USA
| | - Jose M Flores
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut, USA
| | - Michael H Bloch
- Child Study Center, Yale School of Medicine, New Haven, Connecticut, USA
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut, USA
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23
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Waselewski M, Amaro X, Huerto R, Berger J, Spinelli da Silva M, Siroky K, Torres A, Chang T. Youth preferences for healthcare providers and healthcare interactions: a qualitative study. BMC PRIMARY CARE 2024; 25:63. [PMID: 38383303 PMCID: PMC10882742 DOI: 10.1186/s12875-024-02300-z] [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: 04/14/2023] [Accepted: 02/08/2024] [Indexed: 02/23/2024]
Abstract
BACKGROUND Patient-physician relationships in healthcare can influence healthcare provision, patient engagement, and health outcomes. Little is known about youth preferences on types and characteristics of their healthcare providers. The aim of this study was to assess youth perspectives on preferences for and interactions with their healthcare providers. METHODS We posed 5 open-ended questions to 1,163 MyVoice participants, a nationwide text message cohort of United States youth aged 14-24, on April 10, 2020 related to youth preferences for healthcare providers. Content analysis was used to develop a codebook. Responses were independently coded by two reviewers with discrepancies discussed to reach consensus. Descriptive statistics were calculated for demographics and frequency of codes. RESULTS 944 (81%) participants responded to at least one question. Respondents had a mean age of 18.9 years (SD: 2.8) and were a majority female (53.6%) and White (56.3%). Youth reported "kindness" or other personality traits (31%) and education (30%) as important in choosing their doctor. Patient-physician concordance was not important to many youths (44%) and among those who reported concordance as important (55%), having the same gender was the most noted (68%). Youth suggested respect, open conversation, and addressing issues directly to help alleviate uncomfortable situations, though some would simply switch providers. CONCLUSION Personality and empathy are important provider characteristics valued by youth. Female respondents preferred gender concordant providers, particularly for sexual health-related issues, and non-white respondents were more likely to prefer racial concordance. Strengthening professional and interpersonal skills among youth-serving providers may improve healthcare engagement and satisfaction among youth.
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Affiliation(s)
- Marika Waselewski
- Department of Family Medicine, University of Michigan, 2800 Plymouth Road, Building 14 G128, Ann Arbor, MI, 48109, USA
| | | | - Ryan Huerto
- Department of Adult and Family Medicine, Kaiser Permanente Northern California, Oakland, CA, USA
| | - Jessica Berger
- Department of Family Medicine, University of Michigan, 2800 Plymouth Road, Building 14 G128, Ann Arbor, MI, 48109, USA
- University of Michigan, Ann Arbor, MI, USA
| | | | - Kate Siroky
- School of Medicine, University of Michigan, Ann Arbor, MI, USA
| | | | - Tammy Chang
- Department of Family Medicine, University of Michigan, 2800 Plymouth Road, Building 14 G128, Ann Arbor, MI, 48109, USA.
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA.
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24
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Ogunsanya M, Kaninjing E, Ellis T, Bamidele O, Morton D, McIntosh A, Dickey S, Kendzor D, Dwyer K, Young ME, Odedina F. Quality of Life Assessment Among Ethnically Diverse Black Prostate Cancer Survivors: A Constructivist Grounded Theory Approach. RESEARCH SQUARE 2024:rs.3.rs-3941497. [PMID: 38464107 PMCID: PMC10925397 DOI: 10.21203/rs.3.rs-3941497/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/12/2024]
Abstract
Purpose Prostate cancer (CaP) is the most common cancer in Black men (BM), and the number of Black CaP survivors is rapidly increasing. Although Black immigrants are among the fastest-growing and most heterogeneous ethnic groups in the US, limited data exist regarding their CaP experiences. Therefore, this study aimed to explore and model the experiences of ethnically diverse Black men with CaP. Methods In-depth interviews were conducted with 34 participants: Native-born BM (NBBM) (n=17), African-born BM (ABBM) (n=11), and Caribbean-born BM (CBBM) (n=6) CaP survivors recruited through QR-code embedded flyers posted in Black businesses, clinics, social media platforms, and existing research networks within the US. Guided by Charmaz's constructivist grounded theory methodology, the interviews were analyzed using constant comparison following key stages of initial, focused, and theoretical coding using Atlas.ti v23. Results Participants were thirty-four men aged 49-84 years (mean±SD, 66±8). Most were married (77%), likely to be diagnosed at Stage I (35%), and treated with radiotherapy (56%). Our study findings explored the complex trajectory of Black prostate cancer (CaP) survivors, unveiling a comprehensive model termed "Journeying through Unfamiliar Terrain." Comprising three phases and 11 sub-phases, this model uniquely captures the pre-diagnosis awareness and post-treatment adaptation among survivors. Conclusion The resulting theoretical model delineates the entire CaP survivorship process among BM, providing contextual and conceptual understanding for developing interventions and enhancing patient-centered care for ethnically diverse CaP survivors, pivotal in bridging the gaps in survivorship research and healthcare practices.
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Barylski N, Henson P, Verduzco-Gutierrez M, Escalon MX. Examining Diversity Recruitment Efforts in US-Based Physical Medicine and Rehabilitation Residencies: A Survey of Program Directors on Gender, Ethnic and Racial Diversity, and Implications for Recruitment Efforts. Am J Phys Med Rehabil 2024; 103:166-171. [PMID: 37752670 DOI: 10.1097/phm.0000000000002342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/28/2023]
Abstract
As the population of the United States continues to grow and diversify, it is critical that the medical profession follows. This study aimed to evaluate aspects of the current landscape of diversity within physical medicine and rehabilitation by surveying program directors of US-based physical medicine and rehabilitation residencies. The secondary aim was to identify program characteristics that correlate with more diverse residency classes. An online, cross-sectional 17-question survey was distributed to program directors of all US-based physical medicine and rehabilitation residencies with known contact information (95/100), with a completed survey response rate of 53% (50/95). Race and ethnicity categories of the survey were based on those used by the US Census. The percentages of individuals identifying as women or those underrepresented in medicine in this survey were below those of the general US population, a trend also seen within the field of physical medicine and rehabilitation overall. Linear regression revealed no statistically significant association between the percentage of underrepresented in medicine residents and commonly used diversity recruitment initiatives. There was a significant association between the presence of a departmental role for diversity, equity and inclusion and the percentage of women residents (odds ratio, 1.13; P = 0.017). Continued research is required to identify additional strategies with demonstrated efficacy in recruiting diverse residency applicants.
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Affiliation(s)
- Nicole Barylski
- From the Department of Rehabilitation and Human Performance, Icahn School of Medicine at Mount Sinai, New York, New York (NB); Icahn School of Medicine at Mount Sinai, New York, New York (PH); Department of Rehabilitation Medicine, University of Texas Health Science Center at San Antonio, San Antonio, Texas (MV); and Department of Rehabilitation and Human Performance, Icahn School of Medicine at Mount Sinai, New York, New York (MXE)
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Müller-Hilke B, Finger C, Hampe W. [Novel admission procedure for medical students leads to equal opportunities for the individuals-but may aggravate the shortage of rural doctors]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2024; 67:225-232. [PMID: 38197927 PMCID: PMC10834559 DOI: 10.1007/s00103-023-03825-x] [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: 07/20/2023] [Accepted: 12/11/2023] [Indexed: 01/11/2024]
Abstract
BACKGROUND In 2017, the Federal Constitutional Court ruled several aspects of the German student admission process unconstitutional. Consequently, the waiting time quota was replaced by an aptitude quota in 2020. Students are now allowed to simultaneously apply to all German medical faculties and an adjustment algorithm for school leaving grades from different federal states was introduced. The present study investigates the impact of these changes on the new study cohorts. METHODS Records from the federal admission trust were used to compare the final two winter semesters before the change to the first three thereafter. RESULTS AND DISCUSSION The impact of the new procedure on students with previous medical training cannot yet be conclusively assessed. While grade point average (GPA) and sex of the students remained comparable and students still prefer to study close to home; however, they have become younger. The adjustment for school leaving grades indeed led to equal opportunities for the individual applicant; however, this may aggravate the shortage of rural doctors. The current adjustment mechanism considers applicant numbers, yet less people apply from rural areas while at the same time these areas suffer from a shortage of physicians. As rural upbringing and education are the best predictors of rural practice after licensing, the shortage may worsen. To counteract this, the compensation mechanism for the school leaving grades could easily be adjusted.
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Affiliation(s)
- Brigitte Müller-Hilke
- Core Facility für Zellsortierung und Zellanalyse & Institut für Immunologie, Universitätsmedizin Rostock, Schillingallee 70, 18057, Rostock, Deutschland.
| | - Claudia Finger
- Wissenschaftszentrum Berlin für Sozialforschung, Berlin, Deutschland
| | - Wolfgang Hampe
- Zentrum für Experimentelle Medizin, Institut für Biochemie und Molekulare Zellbiologie, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Deutschland
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Herndon S, Corneli A, Dombeck C, Swezey T, Clowse M, Rogers JL, Criscione-Schreiber LG, Sadun RE, Doss J, Eudy AM, Bosworth HB, Sun K. A qualitative study of facilitators of medication adherence in systemic lupus erythematosus: Perspectives from rheumatology providers/staff and patients. Lupus 2024; 33:137-144. [PMID: 38164913 PMCID: PMC10922388 DOI: 10.1177/09612033231225843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2024]
Abstract
OBJECTIVE Systemic lupus erythematosus (SLE) disproportionately affects patients from racial and ethnic minority groups. Medication adherence is lower among these patient populations, and nonadherence is associated with worse health outcomes. We aimed to identify factors that enable adherence to immunosuppressive medications among patients with SLE from racial and ethnic minority groups. METHODS Using a qualitative descriptive study design, we conducted in-depth interviews with purposefully selected (1) patients with SLE from racial and ethnic minority groups who were taking immunosuppressants and (2) lupus providers and staff. We focused on adherence facilitators, asking patients to describe approaches supporting adherence and for overcoming common adherence challenges and providers and staff to describe actions they can take to foster patient adherence. We used applied thematic analysis and categorized themes using the Capability, Opportunity, Motivation, Behavior (COM-B) model. RESULTS We interviewed 12 patients (4 adherent and 8 nonadherent based on medication possession ratio) and 12 providers and staff. Although each patient described a unique set of facilitators, patients most often described social support, physical well-being, reminders, and ability to acquire medications as facilitators. Providers also commonly mentioned reminders and easy medication access as facilitators as well as patient education/communication and empowerment. CONCLUSION Using an established behavioral change model, we categorized a breadth of adherence facilitators within each domain of the COM-B model while highlighting patients' individual approaches. Our findings suggest that an optimal adherence intervention may require a multi-modal and individually tailored approach including components from each behavioral domain-ensuring medication access (Capability) and utilizing reminders and social support (Opportunity), while coupled with internal motivation through improved communication and empowerment (Motivation).
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Affiliation(s)
- Shannon Herndon
- Department of Medicine, Duke University School of Medicine, Durham, NC
| | - Amy Corneli
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC
- Clinical Research Institute, Duke University, Durham, NC
| | - Carrie Dombeck
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC
| | - Teresa Swezey
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC
| | - Megan Clowse
- Department of Medicine, Duke University School of Medicine, Durham, NC
| | | | | | - Rebecca E. Sadun
- Department of Medicine, Duke University School of Medicine, Durham, NC
| | - Jayanth Doss
- Department of Medicine, Duke University School of Medicine, Durham, NC
| | - Amanda M. Eudy
- Department of Medicine, Duke University School of Medicine, Durham, NC
| | - Hayden B. Bosworth
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC
| | - Kai Sun
- Department of Medicine, Duke University School of Medicine, Durham, NC
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Alsan M, Eichmeyer S. Experimental Evidence on the Effectiveness of Nonexperts for Improving Vaccine Demand. AMERICAN ECONOMIC JOURNAL. ECONOMIC POLICY 2024; 16:394-414. [PMID: 38433953 PMCID: PMC10907065 DOI: 10.1257/pol.20210393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/05/2024]
Abstract
We experimentally vary signals and senders to identify which combination will increase vaccine demand among a disadvantaged population in the United States-Black and White men without a college education. Our main finding is that laypeople (nonexpert concordant senders) are most effective at promoting vaccination, particularly among those least willing to become vaccinated. This finding points to a trade-off between the higher qualifications of experts on the one hand and the lower social proximity to low-socioeconomic-status populations on the other hand, which may undermine credibility in settings of low trust.
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Hantzmon SV, Davenport CA, Das Gupta MN, Adekunle TA, Gaither SE, Olsen MK, Pinheiro SO, Johnson KS, Mahoney H, Falls A, Lloyd L, Pollak KI. Race differences in patient trust and distrust from audio-recorded cardiology encounters. PATIENT EDUCATION AND COUNSELING 2024; 119:108083. [PMID: 37989068 PMCID: PMC10842896 DOI: 10.1016/j.pec.2023.108083] [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: 08/16/2023] [Revised: 11/06/2023] [Accepted: 11/16/2023] [Indexed: 11/23/2023]
Abstract
OBJECTIVE Many have reported racial disparities in self-reported trust in clinicians but have not directly assessed expressions of trust and distrust in physician-patient encounters. We created a codebook to examine racial differences in patient trust and distrust through audio-recorded cardiologist-patient interactions. METHODS We analyzed data from a randomized controlled trial of audio-recorded outpatient cardiology encounters (50 White and 51 Black patients). We created a codebook for trust and distrust that was applied to recordings between White cardiologists and White and Black patients. We assessed differences in trust, distrust, and guardedness while adjusting for patient age, sex, and first appointment with the cardiologist. RESULTS Compared to White patients, Black patients had significantly lower expressions of trust ([IRR] [95 % CI]: 0.59 [0.41, 0.84]) and a significantly lower mean guarded/open score ([β] [95 % CI] -0.38 [-0.71, -0.04]). There was no statistically significant association between race and odds of at least one distrustful expression (OR [95 % CI] 1.36 [0.37, 4.94]). CONCLUSION AND PRACTICE IMPLICATIONS We found that coders can reliably identify patient expressions of trust and distrust rather than relying on problematic self-reported measures. Results suggest that White clinicians can improve their communication with Black patients to increase expressions of trust.
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Affiliation(s)
- Sarah V Hantzmon
- Cancer Prevention and Control Program, Duke Cancer Institute, Durham, NC, USA
| | | | - Maya N Das Gupta
- Cancer Prevention and Control Program, Duke Cancer Institute, Durham, NC, USA
| | - Temi A Adekunle
- Department of Psychology and Neuroscience, Duke University Trinity College of Arts and Sciences, Durham, NC, USA
| | - Sarah E Gaither
- Department of Psychology and Neuroscience, Duke University Trinity College of Arts and Sciences, Durham, NC, USA; Samuel DuBois Cook Center on Social Equity, Duke University, Durham, NC, USA
| | - Maren K Olsen
- Department of Biostatistics and Bioinformatics, Duke University, Durham, NC, USA; Durham Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Health Care System, Durham, NC, USA
| | - Sandro O Pinheiro
- Department of Medicine, Duke University School of Medicine, Durham, NC, USA
| | - Kimberly S Johnson
- Department of Medicine, Duke University School of Medicine, Durham, NC, USA; Geriatric Research, Education, and Clinical Center (GRECC), Veterans Affairs Medical Center, Durham, NC, USA
| | - Hannah Mahoney
- Department of Population Health Sciences, Duke University, Durham, NC, USA
| | - Allison Falls
- Department of Psychology and Neuroscience, Duke University Trinity College of Arts and Sciences, Durham, NC, USA
| | - Lauren Lloyd
- Department of Psychology and Neuroscience, Duke University Trinity College of Arts and Sciences, Durham, NC, USA
| | - Kathryn I Pollak
- Cancer Prevention and Control Program, Duke Cancer Institute, Durham, NC, USA; Department of Population Health Sciences, Duke University, Durham, NC, USA.
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Jackson T, Wahab RA, Bankston K, Mehta TS. Raising Cultural Awareness and Addressing Barriers to Breast Imaging Care for Black Women. JOURNAL OF BREAST IMAGING 2024; 6:72-79. [PMID: 38142231 DOI: 10.1093/jbi/wbad091] [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: 08/09/2022] [Indexed: 12/25/2023]
Abstract
Health care disparities, which are differences in the attainment of full health potential among population groups, have been documented across medical conditions, clinical settings, and diagnostic and treatment modalities. Deeply rooted health care disparities due to many factors have affected how Black women (BW) view medical care including screening mammography. This article explores health care disparities around breast cancer in BW and how patient distrust, provider biases, race, and social determinants of health continue to have negative effects on breast cancer outcomes in BW, despite medical advances in breast cancer detection and management. In addition, this article addresses the importance of culturally competent care for BW around breast cancer awareness, screening, and treatment, and offers strategies to address disparities and rebuild trust.
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Affiliation(s)
- Tatianie Jackson
- Department of Radiology, Geisinger Wyoming Valley Medical Center, Wilkes-Barre, PA, USA
| | - Rifat A Wahab
- Department of Radiology, University of Cincinnati Medical Center, Cincinnati, OH, USA
| | - Karen Bankston
- College of Nursing, University of Cincinnati, Cincinnati, OH, USA
| | - Tejas S Mehta
- Department of Radiology, UMass Memorial Medical Center/UMass Chan Medical School, Worcester, MA, USA
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Duveau C, Wets C, Delaruelle K, Demoulin S, Dauvrin M, Lepièce B, Ceuterick M, De Maesschalck S, Bracke P, Lorant V. Individual, interpersonal, and organisational factors associated with discrimination in medical decisions affecting people with a migration background with mental health problems: the case of general practice. ETHNICITY & HEALTH 2024; 29:126-145. [PMID: 37936401 DOI: 10.1080/13557858.2023.2279476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Accepted: 10/31/2023] [Indexed: 11/09/2023]
Abstract
OBJECTIVES Although people with a migration background (MB) have more unmet mental health needs than the general population, patients with a MB are still underrepresented in mental health care services. Provider bias towards these patients has been evidenced repeatedly but its driving factors remain elusive. We assessed the moderating effect of the individual (e.g. age and ethnicity), interpersonal (e.g. healthcare provider trust), and organisational (e.g. perceived workload) factors on general practitioners (GPs) differential decision-making regarding diagnosis, treatment, and referral for a depressed patient with or without a MB. DESIGN An experimental study was carried out in which GPs were shown one of two video vignettes featuring adult male depressed patients, one with a MB and the other without. Belgian GPs (n = 797, response rate was 13%) had to decide on their diagnosis, treatment, and referral. Analysis of variance and logistic regression were used to analyse the effect of a MB, adding interaction terms for the explanatory variables. RESULTS Overall, we found that there were ethnic differences in GPs' decisions regarding diagnosis and treatment recommendations. GPs perceived the symptoms of the patient with a MB as less severe (F = 7.68, p < 0.01) and demonstrated a reduced likelihood to prescribe a combination of medical and non-medical treatments (F = 11.55, p < 0.001). Those differences increased in accordance with the GP's age and perceived workload; at an interpersonal level, we found that differences increased when the GP thought the patient was exaggerating his distress. CONCLUSION This paper showed that lower levels of trust among GPs' towards their migrant patients and high GP workloads contribute to an increased ethnic bias in medical decision-making. This may perpetuate ethnic inequalities in mental health care. Future researchers should develop an intervention to decrease the ethnic inequities in mental health care by addressing GPs' trust in their migrant and ethnic minority patients.
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Affiliation(s)
- Camille Duveau
- Institute of Health and Society, Université catholique de Louvain, Brussels, Belgium
| | - Camille Wets
- Health and Demographic Research, Ghent University, Ghent, Belgium
| | | | - Stéphanie Demoulin
- Psychological Sciences Research Institute, Université catholique de Louvain, Louvain-la-Neuve, Belgium
| | - Marie Dauvrin
- Institute of Health and Society, Université catholique de Louvain, Brussels, Belgium
- Belgian Health Care Knowledge Centre, KCE, Brussels, Belgium
| | - Brice Lepièce
- Institute of Health and Society, Université catholique de Louvain, Brussels, Belgium
| | | | | | - Piet Bracke
- Health and Demographic Research, Ghent University, Ghent, Belgium
| | - Vincent Lorant
- Institute of Health and Society, Université catholique de Louvain, Brussels, Belgium
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Frego N, Beatrici E, Labban M, Stone BV, Filipas DK, Koelker M, Lughezzani G, Buffi NM, Osman NY, Lipsitz SR, Sammon JD, Kibel AS, Trinh QD, Cole AP. Racial Disparities in Prostate Cancer Screening: The Role of Shared Decision Making. Am J Prev Med 2024; 66:27-36. [PMID: 37567369 DOI: 10.1016/j.amepre.2023.08.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 08/04/2023] [Accepted: 08/04/2023] [Indexed: 08/13/2023]
Abstract
INTRODUCTION The 2018 U.S. Preventive Services Task Force recommendations endorsed shared decision making for men aged 55-69 years, encouraging consideration of patient race/ethnicity for prostate-specific antigen screening. This study aimed to assess whether a proxy shared decision-making variable modified the impact of race/ethnicity on the likelihood of prostate-specific antigen screening. METHODS A cross-sectional analysis of men aged between 55 and 69 years, who responded to the prostate-specific antigen screening portions of the 2020 U.S.-based Behavioral Risk Factor Surveillance System survey, was performed between September and December 2022. Complex sample multivariable logistic regression models with an interaction term combining race and estimated shared decision making were used to test whether shared decision making modified the impact of race/ethnicity on screening. RESULTS Of a weighted sample of 26.8 million men eligible for prostate-specific antigen screening, 25.7% (6.9 million) reported for prostate-specific antigen screening. In adjusted analysis, estimated shared decision making was a significant predictor of prostate-specific antigen screening (AOR=2.65, 95% CI=2.36, 2.98, p<0.001). The interaction between race/ethnicity and estimated shared decision making on the receipt of prostate-specific antigen screening was significant (pint=0.001). Among those who did not report estimated shared decision making, both non-Hispanic Black (OR=0.77, 95% CI=0.61, 0.97, p=0.026) and Hispanic (OR=0.51, 95% CI=0.39, 0.68, p<0.001) men were significantly less likely to undergo prostate-specific antigen screening than non-Hispanic White men. On the contrary, among respondents who reported estimated shared decision making, no race-based differences in prostate-specific antigen screening were found. CONCLUSIONS Although much disparities research focuses on race-based differences in prostate-specific antigen screening, research on strategies to mitigate these disparities is needed. Shared decision making might attenuate the impact of race/ethnic disparities on the likelihood of prostate-specific antigen screening.
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Affiliation(s)
- Nicola Frego
- Division of Urological Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts; Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts; Department of Urology, Humanitas Research Hospital - IRSSC, Milan, Italy
| | - Edoardo Beatrici
- Division of Urological Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts; Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts; Department of Urology, Humanitas Research Hospital - IRSSC, Milan, Italy
| | - Muhieddine Labban
- Division of Urological Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts; Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Benjamin V Stone
- Division of Urological Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts; Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Dejan K Filipas
- Division of Urological Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts; Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts; Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Mara Koelker
- Division of Urological Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts; Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts; Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | | | - Nicolò M Buffi
- Department of Urology, Humanitas Research Hospital - IRSSC, Milan, Italy
| | - Nora Y Osman
- Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Stuart R Lipsitz
- Division of Urological Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts; Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts; Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Jesse D Sammon
- Division of Urology, Maine Medical Center, Portland, Maine; Center for Outcomes Research & Evaluation (CORE), Maine Medical Center, Portland, Maine
| | - Adam S Kibel
- Division of Urological Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts; Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Quoc-Dien Trinh
- Division of Urological Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts; Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Alexander P Cole
- Division of Urological Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts; Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
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Koppel PD, Park HYK, Ledbetter LS, Wang EJ, Rink LC, De Gagne JC. Rapport between nurses and adult patients with cancer in ambulatory oncology care settings: A scoping review. Int J Nurs Stud 2024; 149:104611. [PMID: 37879272 DOI: 10.1016/j.ijnurstu.2023.104611] [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: 11/02/2022] [Revised: 09/13/2023] [Accepted: 09/19/2023] [Indexed: 10/27/2023]
Abstract
BACKGROUND Although the importance of the nurse-patient relationship in oncology is established, a consolidated body of research describing nurse-patient rapport, especially in ambulatory care, is lacking. OBJECTIVES This scoping review aimed to explore knowledge about rapport between adult patients with cancer and their nurses in ambulatory oncology care, including nurse, patient, nurse-patient dyad, and system-level factors that influence rapport. METHODS A scoping review was conducted to explore sources of evidence and gaps in knowledge pertinent to future research. The Joanna Briggs Institute methodology for Systematic Reviews was used with searches in MEDLINE, CINAHL, and ProQuest Dissertations and Theses Global databases. Experimental, descriptive observational, and qualitative study designs that focused on patients with cancer and their nurses within an ambulatory care setting were included. Results were reported using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews. RESULTS The search strategy collected 4538 studies of which 10 met study criteria after screening. Forward and backward citation tracking of included articles resulted in 4 additional studies. In total, 14 studies were extracted and analyzed. Synthesis of results from the individual sources resulted in three key observations: (a) there is an absence of studies that focus directly on nurse-patient rapport; (b) the majority of extracted data on rapport-related factors described aspects of nurses' attitudes; and (c) there was minimal information on patient, nurse-patient dyad, and system-level factors reported in these studies. CONCLUSIONS The lack of studies focused specifically on nurse-patient rapport in oncology ambulatory care indicates a notable gap in our empirical understanding of relationship-based care, a hallmark of cancer care provision. TWEETABLE ABSTRACT Nurse-patient rapport in oncology ambulatory care requires additional research @paula_koppel.
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Affiliation(s)
| | | | | | - Emily J Wang
- School of Nursing, Duke University, Durham, NC, USA
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Alexander SM, Gilleskie D, Díaz-González de Ferris M. Changing the Clock in Medical Education: Addressing Physician Shortages and Patient Outcomes. JOURNAL OF MEDICAL EDUCATION AND CURRICULAR DEVELOPMENT 2024; 11:23821205241264692. [PMID: 38894718 PMCID: PMC11185009 DOI: 10.1177/23821205241264692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Accepted: 06/09/2024] [Indexed: 06/21/2024]
Abstract
Despite the shortage of physicians in the United States, there is no consensus among medical educators as to how to address the nation's unmet needs. A growing but unfulfilled argument is to revisit the configuration of medical education and the time required to complete medical training. Pilot programs, such as shortened programs or advancement-in-place structures to accelerate the practice capability of trainees, have been attempted. This manuscript addresses underlying economic and human considerations that medical educators must reconcile, drawing on lessons from international educational structures, as we advance toward a system that supports the needs of the communities that our graduates will serve.
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Affiliation(s)
- Seth McKenzie Alexander
- Department of Pediatrics, UNC School of Medicine, Chapel Hill, NC, USA
- Department of Medicine, UNC School of Medicine, Chapel Hill, NC, USA
- Department of Health Sciences, UNC School of Medicine, Chapel Hill, NC, USA
| | - Donna Gilleskie
- Department of Economics, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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Anderson JN, Paladino AJ, Blue R, Dangerfield DT, Eggly S, Martin MY, Schwartzberg LS, Vidal GA, Graetz I. Silent suffering: the impact of sexual health challenges on patient-clinician communication and adherence to adjuvant endocrine therapy among Black women with early-stage breast cancer. J Cancer Surviv 2023:10.1007/s11764-023-01511-0. [PMID: 38114711 DOI: 10.1007/s11764-023-01511-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Accepted: 12/05/2023] [Indexed: 12/21/2023]
Abstract
PURPOSE Adjuvant endocrine therapy (AET) increases sexual health challenges for women with early-stage breast cancer. Black women are more likely than women of other racial/ethnic groups to report adverse symptoms and least likely to initiate and maintain AET. Little is known about how sexual health challenges influence patient-clinician communication and treatment adherence. This study explores facilitators of and barriers to patient-clinician communication about sexual health and how those factors might affect AET adherence among Black women with early-stage breast cancer. METHODS We conducted 32 semi-structured, in-depth interviews among Black women with early-stage breast cancer in the U.S. Mid-South region. Participants completed an online questionnaire prior to interviews. Data were analyzed using thematic analysis. RESULTS Participants' median age was 59 (range 40-78 years, SD = 9.0). Adverse sexual symptoms hindered participants' AET adherence. Facilitators of patient-clinician communication about sexual health included female clinicians and peer support. Barriers included perceptions of male oncologists' disinterest in Black women's sexual health, perceptions of male oncologists' biased beliefs about sexual activity among older Black women, cultural norms of sexual silence among Southern Black women, and medical mistrust. CONCLUSIONS Adverse sexual symptoms and poor patient-clinician communication about sexual health contribute to lower AET adherence among Black women with early-stage breast cancer. New interventions using peer support models and female clinicians trained to discuss sexual health could ameliorate communication barriers and improve treatment adherence. IMPLICATIONS FOR CANCER SURVIVORS Black women with early-stage breast cancer in the U.S. Mid-South may require additional resources to address sociocultural and psychosocial implications of cancer survivorship to enable candid discussions with oncologists.
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Affiliation(s)
- Janeane N Anderson
- College of Nursing, University of Tennessee Health Science Center, 874 Union Avenue, Memphis, TN, 38163, USA.
| | - Andrew J Paladino
- College of Medicine, University of Tennessee Health Science Center, 910 Madison Avenue, Memphis, TN, 38103, USA
| | - Ryan Blue
- College of Nursing, University of Tennessee Health Science Center, 874 Union Avenue, Memphis, TN, 38163, USA
| | - Derek T Dangerfield
- Department of Prevention and Community Health, Milken Institute School of Public Health, The George Washington University, 950 New Hampshire Ave. NW #308, Washington, D.C, 20037, USA
| | - Susan Eggly
- Department of Oncology, School of Medicine, Wayne State University, 87 E. Canfield, Detroit, MI, 48201, USA
| | - Michelle Y Martin
- Department of Preventive Medicine, College of Medicine, University of Tennessee Health Science Center, 66 N. Pauline Street, Memphis, TN, 38163, USA
| | | | - Gregory A Vidal
- West Cancer Center Research Institute, 7945 Wolf River Blvd, Germantown, TN, 38138, USA
| | - Ilana Graetz
- Department of Health Policy and Management, Rollins School of Public Health, Emory University, 1518 Clifton Road NE, Atlanta, GA, 30322, USA
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Didier AJ, Fang L, Stiene J, Spencer CT, Hamouda DM. Evaluation of the Quality and Comprehensiveness of YouTube Videos Discussing Pancreatic Cancer. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2023; 38:1894-1900. [PMID: 37606727 DOI: 10.1007/s13187-023-02355-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 08/13/2023] [Indexed: 08/23/2023]
Abstract
Pancreatic cancer is one of the most lethal diseases worldwide and incidence continues to rise, resulting in increased deaths each year. In the modern era, patients often turn to online sources like YouTube for information regarding their disease, which may be subject to a high degree of bias and misinformation; previous analyses have demonstrated low quality of other cancer-related YouTube videos. Thus, we sought to determine if patients can rely on educational YouTube videos for accurate and comprehensive information about pancreatic cancer diagnosis and treatment. We designed a search query and inclusion/exclusion criteria based on published studies evaluating YouTube user tendencies, which were used to identify videos most likely watched by patients. Videos were evaluated based on two well-known criteria, the DISCERN and JAMA tools, as well as a tool published by Sahin et al. to evaluate the comprehensiveness of YouTube videos. Statistical analyses were performed using Chi-square analysis to compare categorical variables. We used linear regression to assess for correlations between quantitative variables. Kruskal-Wallis and independent samples t-test were used to compare means between groups. We assessed inter-rater reliability using Cronbach's alpha. After the initial search query, 39 videos were retrieved that met inclusion criteria. The comprehensiveness and quality of these materials was generally low to moderate, with only 7 videos being considered comprehensive. Pearson's R demonstrated strong correlations between video length and both comprehensiveness and quality. Higher-quality videos also tended to be newer. YouTube videos regarding pancreatic cancer are generally of low to moderate quality and lack comprehensiveness, which could affect patients' perceptions of their disease or understanding of treatment options. These videos, which have collectively been viewed over 6 million times, should be subject to some form of expert review before upload, and producers of this content should consider citing the sources used in the video.
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Affiliation(s)
- Alexander J Didier
- University of Toledo College of Medicine and Life Sciences, 3000 Arlington Ave., OH, 43606, Toledo, USA.
| | - Lauren Fang
- University of Toledo College of Medicine and Life Sciences, 3000 Arlington Ave., OH, 43606, Toledo, USA
| | - Jennifer Stiene
- University of Toledo College of Medicine and Life Sciences, 3000 Arlington Ave., OH, 43606, Toledo, USA
| | - Caleb T Spencer
- University of Toledo College of Medicine and Life Sciences, 3000 Arlington Ave., OH, 43606, Toledo, USA
| | - Danae M Hamouda
- Division of Hematology & Oncology, Department of Medicine, The University of Toledo Medical Center, Toledo, OH, USA
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Mulder L, Wouters A, Akwiwu EU, Koster AS, Ravesloot JH, Peerdeman SM, Salih M, Croiset G, Kusurkar RA. Diversity in the pathway from medical student to specialist in the Netherlands: a retrospective cohort study. THE LANCET REGIONAL HEALTH. EUROPE 2023; 35:100749. [PMID: 37860636 PMCID: PMC10583163 DOI: 10.1016/j.lanepe.2023.100749] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Revised: 09/20/2023] [Accepted: 09/25/2023] [Indexed: 10/21/2023]
Abstract
Background Medical specialist workforces are not representative of the society they serve, partially due to loss of diversity in the path from student to specialist. We investigated which demographic characteristics of bachelor students of medicine (BSM) are associated with becoming a physician and (particular type of) medical specialist; and whether this suggests 'cloning' (reproduction of sameness) of the existing workforce. Methods We used a retrospective cohort design, based on Statistics Netherlands data of all first-year BSM in 2002-2004 in The Netherlands (N = 4503). We used logistic regression to analyze the impact of sex, migration background, urbanity of residence, parental income and assets categories, and having healthcare professional parents, on being registered as physician or medical specialist in 2021. We compared our results to the national pool of physicians (N = 76,845) and medical specialists (N = 49,956) to identify cloning patterns based on Essed's cultural cloning theory. Findings Female students had higher odds of becoming a physician (OR 1.87 [1.53-2.28], p < 0.001). Physicians with a migration background other than Turkish, Moroccan, Surinamese, Dutch Caribbean or Indonesian (TMSDI) had lower odds of becoming a specialist (OR 0.55 [0.43-0.71], p < 0.001). This was not significant for TMSDI physicians (OR 0.74 [0.54-1.03], p = 0.073). We found a cloning pattern with regard to sex and migration background. Nationwide, physicians with a Turkish or Moroccan migration background, and female physicians with other migration backgrounds, are least likely to be a medical specialist. Interpretation In light of equity in healthcare systems, we recommend that every recruitment body increases the representativeness of their particular specialist workforce. Funding ODISSEI.
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Affiliation(s)
- Lianne Mulder
- Amsterdam UMC Location Vrije Universiteit Amsterdam, Research in Education, De Boelelaan 1118, Amsterdam, the Netherlands
- LEARN! Research Institute for Learning and Education, Faculty of Psychology and Education, VU University Amsterdam, the Netherlands
| | - Anouk Wouters
- Amsterdam UMC Location Vrije Universiteit Amsterdam, Research in Education, De Boelelaan 1118, Amsterdam, the Netherlands
- LEARN! Research Institute for Learning and Education, Faculty of Psychology and Education, VU University Amsterdam, the Netherlands
| | - Eddymurphy U. Akwiwu
- Amsterdam UMC, Vrije Universiteit Amsterdam, Epidemiology and Data Science, Amsterdam Public Health, De Boelelaan 1117, Amsterdam, the Netherlands
| | - Andries S. Koster
- Department of Pharmaceutical Sciences, Utrecht University, David de Wied Building, Universiteitsweg 99, Utrecht, the Netherlands
| | - Jan Hindrik Ravesloot
- Amsterdam UMC Location University of Amsterdam, Faculty of Medicine, Department of Medical Biology, Meibergdreef 9, Amsterdam, the Netherlands
| | - Saskia M. Peerdeman
- Amsterdam UMC Location University of Amsterdam, Department Neurosurgery, Meibergdreef 9, Amsterdam, the Netherlands
- Amsterdam UMC Location University of Amsterdam, Faculty of Medicine, Teaching and Learning Centre, Meibergdreef 9, Amsterdam, the Netherlands
- Amsterdam Public Health, Quality of Care, Amsterdam, the Netherlands
| | - Mahdi Salih
- Erasmus MC, Division of Nephrology and Transplantation, Department of Internal Medicine, Dr. Molewaterplein 40, Rotterdam, The Netherlands
| | - Gerda Croiset
- University Medical Center Groningen, Wenckebach Institute for Education and Training, Hanzeplein 1, Groningen, the Netherlands
| | - Rashmi A. Kusurkar
- Amsterdam UMC Location Vrije Universiteit Amsterdam, Research in Education, De Boelelaan 1118, Amsterdam, the Netherlands
- LEARN! Research Institute for Learning and Education, Faculty of Psychology and Education, VU University Amsterdam, the Netherlands
- Amsterdam Public Health, Quality of Care, Amsterdam, the Netherlands
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Hill AJ, Jones DB, Woodworth L. Physician-patient race-match reduces patient mortality. JOURNAL OF HEALTH ECONOMICS 2023; 92:102821. [PMID: 37871470 DOI: 10.1016/j.jhealeco.2023.102821] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Revised: 07/27/2023] [Accepted: 09/23/2023] [Indexed: 10/25/2023]
Abstract
This paper assesses the impacts of physician-patient race-match, especially Black patients paired with Black physicians, on patient mortality. We draw on administrative data from Florida, linking hospital encounters from mid-2011 through 2014 to information from the Florida Physician Workforce Survey. Focusing on uninsured patients experiencing unscheduled hospital admissions who are conditionally randomly assigned to physicians, we find that physician-patient race-match for Black patients reduces the likelihood of within-hospital mortality by 0.28 percentage points, a 27 % reduction relative to the overall mortality rate. An alternative identification strategy relying on instrumental variables provides a similar finding.
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Affiliation(s)
- Andrew J Hill
- Montana State University, Department of Agricultural Economics and Economics, P.O. Box 172920, Bozeman, MT 59717, United States of America.
| | - Daniel B Jones
- University of Pittsburgh, Graduate School of Public and International Affairs, 230 S. Bouquet St., Pittsburgh, PA 15213, United States of America
| | - Lindsey Woodworth
- University of South Carolina, Darla Moore School of Business, Department of Economics, 1014 Greene St., Columbia, SC 29208, United States of America
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Maisner RS, Silva I, Biswas S, Jolibois M, Segal RM, Laurent C, Chen W. TimesUpPRS: A Social Media Movement for Promoting Diversity, Equity, and Inclusion in Plastic Surgery. JOURNAL OF SURGICAL EDUCATION 2023; 80:1818-1825. [PMID: 37775357 DOI: 10.1016/j.jsurg.2023.08.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 08/17/2023] [Accepted: 08/27/2023] [Indexed: 10/01/2023]
Abstract
OBJECTIVE Minority representation and promotion in medicine is lacking. Social media can facilitate change by raising awareness of biases, empowering others, and cultivating connections. The TimesUpPRS Instagram account was created in March 2020 to foster diversity, equity, and inclusion (DEI) in plastic surgery by celebrating surgeons of diverse identities and emphasizing the need to create safe, fair, and equitable workplaces. We aim to characterize its content, audience demographics, engagement, and impact. METHODS All TimesUpPRS posts published until March 2022 were reviewed for content analysis. Audience demographics were assessed through Instagram Insights. Engagement was assessed through likes, comments, and posts tagging @TimesUpPRS. RESULTS Three hundred fifty-five posts have been published, with 45.9% original content. These posts discuss representation or treatment of women (39.7%), Black (24.2%), Asian and Pacific Islander (14.4%), LGBTQ+ (12.7%), LatinX (6.5%), people of color overall (4.8%), first generation-low income (1.7%), and Native American (1.1%) individuals. 45.1% aimed to raise social awareness, 19.4% spotlighted plastic surgery figures, 16.3% highlighted research, and 5.6% advertised opportunities for community involvement. The mean (SE) number of hashtags utilized was 10.9 (0.6), with #ilooklikeasurgeon used most. There were 2052 followers, but 10,025 accounts reached. Of reached accounts, 66.8% were women, 71.8% were from the U.S., and 55% were aged 25 to 34. The mean (SE) number of likes and comments per post was 62.2 (3.4) and 2.6 (0.2). 85.0% of comments were supportive. Three hundred sixty-six posts tagged @TimesUpPRS. TimesUpPRS has also garnered industry and private sponsorship, inspired DEI programming, and collaborated with multiple other organizations. CONCLUSIONS In 2 years, TimesUpPRS has generated 350+ posts and reached 10,000+ accounts. Content highlighted figures of diverse identities and cultivated high, positive engagement. Now with 20 content creators, TimesUpPRS will continue increasing content, expanding its audience, and fostering impactful discussion that helps shift the existing culture to one of inclusivity and equity.
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Affiliation(s)
- Rose S Maisner
- Division of Plastic Surgery, Department of Surgery, University of Wisconsin, Madison, Wisconsin.
| | - Isabel Silva
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Rutgers New Jersey Medical School, Newark, New Jersey
| | - Sonali Biswas
- Division of Plastic, Maxillofacial, and Oral Surgery, Department of Surgery, Duke University School of Medicine, Durham, North Carolina
| | - Marah Jolibois
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Albany Medical Center, Albany, New York
| | - Rachel M Segal
- Division of Plastic Surgery, Department of Surgery, University of California San Diego, San Diego, California
| | - Christian Laurent
- Section of Plastic Surgery, Department of Surgery, Medical College of Georgia, Augusta University, Augusta, Georgia
| | - Wendy Chen
- Division of Plastic and Reconstructive Surgery, Department of Surgery, McGovern Medical School at UT Health Houston, Houston, Texas
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Blalock AE, Miao S, Wentworth C. Envisioning future roles: How women medical students navigate the figured world of medical school. CLINICAL TEACHER 2023; 20:e13617. [PMID: 37550894 DOI: 10.1111/tct.13617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Accepted: 07/09/2023] [Indexed: 08/09/2023]
Abstract
BACKGROUND Women medical students experience tensions as they learn to become doctors. These tensions reflect the cultural world of medical school and clinical medicine, spaces that are highly gendered, racist and exclusionary. This study describes how women medical students are envisioning themselves as future doctors during their first 2 years of medical school while experiencing these tensions. METHODS Using Figured Worlds theory, this qualitative study focused on four participants from a larger longitudinal study. Each participant was interviewed four times over a 2-year period using narrative methodology and provided multiple written reflections during their first year of medical school. Analysis was performed using deductive methods reflecting Figured Worlds theory. RESULTS Participants offered storied experiences about how they understood their place in the figured world, ways they enacted agency and how they responded to contradictions they encountered in medical school as they learned to become doctors. These three findings reflect concepts of Figured Worlds theory: positionality and discourse, power and agency, and improvisation. These findings also illuminate ways women medical students are navigating gendered and hierarchical structures of medical school to reimagine their roles in medicine. CONCLUSION Participants' stories illuminate that woman medical students' lived experiences shaped their decision to enter medical school and continue to shape how they navigate their educational experience. These interactions have implications for their future roles as physicians and how medical schools respond to cultures of teaching and learning that may not recognise these students' positionality and potential agency in medical school and clinical medicine.
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Affiliation(s)
- A Emiko Blalock
- Department of Family Medicine, College of Human Medicine, Michigan State University, East Lansing, Michigan, USA
| | - Sanfeng Miao
- Higher, Adult, and Lifelong Education, College of Education, Michigan State University, East Lansing, Michigan, USA
| | - Chelsea Wentworth
- Office of Medical Education Research and Development, College of Human Medicine, Michigan State University, East Lansing, Michigan, USA
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Engel-Rebitzer E, Dolan A, Shofer FS, Schapira MM, Hess EP, Rhodes KV, Bellamkonda VR, Msw EG, Bell J, Schwarz L, Schiller E, Lewis-Salley D, McCollum S, Zyla M, Becker LB, Graves RL, Meisel ZF. The association between specific narrative elements and patient perspectives on acute pain treatment. Am J Emerg Med 2023; 74:84-89. [PMID: 37797399 PMCID: PMC10924766 DOI: 10.1016/j.ajem.2023.09.016] [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: 04/03/2023] [Revised: 09/05/2023] [Accepted: 09/12/2023] [Indexed: 10/07/2023] Open
Abstract
BACKGROUND Narratives are effective tools for communicating with patients about opioid prescribing for acute pain and improving patient satisfaction with pain management. It remains unclear, however, whether specific narrative elements may be particularly effective at influencing patient perspectives. METHODS This study was a secondary analysis of data collected for Life STORRIED, a multicenter RCT. Participants included 433 patients between 18 and 70 years-old presenting to the emergency department (ED) with renal colic or musculoskeletal back pain. Participants were instructed to view one or more narrative videos during their ED visit in which a patient storyteller discussed their experiences with opioids. We examined associations between exposure to individual narrative features and patients' 1) preference for opioids, 2) recall of opioid-related risks and 3) perspectives about the care they received. RESULTS Participants were more likely to watch videos featuring storytellers who shared their race or gender. We found that participants who watched videos that contained specific narrative elements, for example mention of prescribed opioids, were more likely to recall having received information about pain treatment options on the day after discharge (86.3% versus 72.9%, p = 0.02). Participants who watched a video that discussed family history of addiction reported more participation in their treatment decision than those who did not (7.6 versus 6.8 on a ten-point scale, p = 0.04). CONCLUSIONS Participants preferentially view narratives featuring storytellers who share their race or gender. Narrative elements were not meaningfully associated with patient-centered outcomes. These findings have implications for the design of narrative communication tools.
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Affiliation(s)
- Eden Engel-Rebitzer
- Center for Emergency Care Policy and Research, University of Pennsylvania, Philadelphia, PA, USA; Brigham and Women's Hospital, Boston, MA, USA.
| | - Abby Dolan
- Center for Emergency Care Policy and Research, University of Pennsylvania, Philadelphia, PA, USA; Urban Health Lab at the Penn Medicine Center for Health Justice, Perelman School of Medicine at the University of Pennsylvania, USA; Department of Emergency Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Frances S Shofer
- Center for Emergency Care Policy and Research, University of Pennsylvania, Philadelphia, PA, USA; Department of Emergency Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Marilyn M Schapira
- Center for Health Equity Research and Promotion (CHERP), Philadelphia VA Medical Center, Philadelphia, PA, USA; Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, USA; University of Pennsylvania Department of General and Internal Medicine, Philadelphia, PA, USA
| | - Erik P Hess
- Department of Emergency Medicine, Mayo Clinic College of Medicine and Science, Rochester, MN, USA; Vanderbilt University School of Medicine, Department of Emergency Medicine, Nashville, TN, USA
| | - Karin V Rhodes
- Department of Emergency Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
| | - Venkatesh R Bellamkonda
- Department of Emergency Medicine, Mayo Clinic College of Medicine and Science, Rochester, MN, USA
| | - Erica Goldberg Msw
- Center for Emergency Care Policy and Research, University of Pennsylvania, Philadelphia, PA, USA
| | - Jeffrey Bell
- Center for Emergency Care Policy and Research, University of Pennsylvania, Philadelphia, PA, USA
| | - Linda Schwarz
- Center for Emergency Care Policy and Research, University of Pennsylvania, Philadelphia, PA, USA
| | - Elise Schiller
- Center for Emergency Care Policy and Research, University of Pennsylvania, Philadelphia, PA, USA
| | - Dena Lewis-Salley
- Center for Emergency Care Policy and Research, University of Pennsylvania, Philadelphia, PA, USA
| | - Sharon McCollum
- Center for Emergency Care Policy and Research, University of Pennsylvania, Philadelphia, PA, USA
| | - Michael Zyla
- Center for Emergency Care Policy and Research, University of Pennsylvania, Philadelphia, PA, USA
| | - Lance B Becker
- Department of Emergency Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
| | - Rachel Lynn Graves
- Center for Emergency Care Policy and Research, University of Pennsylvania, Philadelphia, PA, USA
| | - Zachary F Meisel
- Center for Emergency Care Policy and Research, University of Pennsylvania, Philadelphia, PA, USA; Department of Emergency Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA; Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, USA; Penn Injury Science Center, University of Pennsylvania, Philadelphia, PA 19104, USA
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Anderson A. "Messengers matter": Assessing the impact of racially concordant care on vaccine hesitation. Soc Sci Med 2023; 338:116335. [PMID: 37913746 DOI: 10.1016/j.socscimed.2023.116335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Revised: 10/01/2023] [Accepted: 10/11/2023] [Indexed: 11/03/2023]
Abstract
With the rise in COVID-related deaths among the unvaccinated, understanding coronavirus vaccine hesitancy is critical to maintaining public health. Previous research has shown that sociodemographic factors, such as race, are essential for understanding vaccine hesitancy; yet, the specific factors driving racial disparities in vaccination continue to be a matter of intense debate. This study uses a novel survey experiment to uncover the linkages between race, physician trust, and vaccine hesitancy. Using a standard prompt on the release of the COVID-19 vaccine, it tests whether patient-physician race concordance affects the likelihood of vaccine uptake among US citizens. Analyses reveal that racially concordant care has a negligible effect on vaccine hesitancy, but does ameliorate other harmful beliefs regarding one's likelihood of experiencing discrimination and racism in healthcare more generally. These findings suggest that increasing diversity in the medical field should be paired with efforts to address systemic inequalities to promote increased vaccination.
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Affiliation(s)
- Ashley Anderson
- University of North Carolina at Chapel Hill, 205 South Building, Chapel Hill, NC, 27599, USA.
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Abujaradeh H, O'Brien J, Mazanec SR, Bender CM, Schlemmer IM, Brufsky AM, Nasrollahi E, Rosenzweig M. The Effect of Race and Area Deprivation on Symptom Profiles over the Course of Early-Stage Breast Cancer. RESEARCH SQUARE 2023:rs.3.rs-3649299. [PMID: 38076798 PMCID: PMC10705700 DOI: 10.21203/rs.3.rs-3649299/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2023]
Abstract
Purpose This study compared common symptoms (fatigue, pain), overall physical functioning and changes over time between Black and White women receiving early-stage breast cancer (ESBC) chemotherapy. Methods A longitudinal, repeated measures comparative design was employed. Time points of symptom measurement (PROMIS domains) at baseline, mid and end point were adjusted as per patient chemotherapy schedule. Analyses Linear mixed models were applied. Results There were 147 patients, 36% Black 64% White (54±12 years) recommended to receive early-stage breast cancer chemotherapy with adequate data for symptom analysis. Pain Main effect of race was significant (F(1, 390) = 29.43, p<.001) for pain with Black patients experiencing significantly higher pain scores compared to White patients at pretherapy (Mean Difference; MD=3.7, p=.034), midpoint (MD=5.8, p=.002), and endpoint (MD=7.8, p<.001). Fatigue Fatigue significantly increased (deteriorated) at endpoint (MDT1-T3= 8.7, p<.001) for Black patients. Among White patients, fatigue significantly increased at midpoint (MDT1-T2= 5.7) and at endpoint (MDT1-T3=10.1, p<.001; MDT2-T3=4.3, p= .017). Physical function: Black patients had significantly lower physical function scores compared to White patients at midpoint (MD=4.0, p=.027). Physical function decreased by endpoint in Black (MDT1-T3=7.8, p<.001), and White patients (MDT1-T3=7.7, p<.001). Conclusion Symptom burden significantly increased over the course of chemotherapy for all patients. Scores for pain and physical function were higher overall for Black patients and deteriorated at a greater rate for Black vs. White women over the course of chemotherapy. This assessment holds implication for proactive assessment and mitigation strategies.
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Hennein R, Tiako MJN, Bonumwezi J, Tineo P, Boatright D, Crusto C, Lowe SR. Vicarious Racism, Direct Racism, and Mental Health Among Racialized Minority Healthcare Workers. J Racial Ethn Health Disparities 2023:10.1007/s40615-023-01844-7. [PMID: 37935947 DOI: 10.1007/s40615-023-01844-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Revised: 10/03/2023] [Accepted: 10/17/2023] [Indexed: 11/09/2023]
Abstract
BACKGROUND Racism-related stress is a root cause of racial and ethnic disparities in mental health outcomes. An individual may be exposed to racism directly or vicariously by hearing about or observing people of the same racial and/or ethnic group experience racism. Although the healthcare setting is a venue by which healthcare workers experience both direct and vicarious racism, few studies have assessed the associations between direct and vicarious racism and mental health outcomes among healthcare workers. METHODS In this cross-sectional study, we assessed the relationships between direct and vicarious racism and symptoms of posttraumatic stress, depression, and anxiety among healthcare workers in the USA in 2022. RESULTS Our sample consisted of 259 healthcare workers identifying as a racialized minority, including 68 (26.3%) who identified as mixed-race, 61 (23.6%) East Asian, 36 (13.9%) Black, 33 (12.7%) South Asian, 22 (8.5%) Southeast Asian, 21 (8.1%) Middle Eastern/North African, and 18 (6.9%) another race. The mean age was 37.9 years (SD 10.1). In multivariable linear regression models that adjusted for demographics, work stressors, and social stressors, we found that increased reporting of vicarious racism was associated with greater symptoms of anxiety (B = 0.066, standard error = 0.034, p = .049). We did not identify significant relationships between vicarious and direct racism and symptoms of posttraumatic stress or depression in the fully adjusted models. CONCLUSIONS Our findings should be considered by academic health systems to mitigate the negative impact of racism on healthcare workers' mental health.
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Affiliation(s)
- Rachel Hennein
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, 60 College St, New Haven, CT, USA.
- Yale School of Medicine, New Haven, CT, USA.
| | | | - Jessica Bonumwezi
- Department of Psychology, University of Maryland, College Park, MD, USA
| | - Petty Tineo
- Department of Psychology, Montclair State University, Montclair, NJ, USA
| | - Dowin Boatright
- Department of Emergency Medicine, New York University Grossman School of Medicine, New York, NY, USA
| | - Cindy Crusto
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
- Department of Psychology, University of Pretoria, Pretoria, South Africa
| | - Sarah R Lowe
- Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, CT, USA
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Carey C, Silvestrini M, Callegari LS, Katon JG, Bossick AS, Doll KM, Christy A, Washington DL, Owens S. "I Wasn't Presented With Options": Perspectives of Black Veterans Receiving Care for Uterine Fibroids in the Veterans Health Administration. Womens Health Issues 2023; 33:652-660. [PMID: 37689493 DOI: 10.1016/j.whi.2023.07.006] [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: 09/07/2022] [Revised: 07/17/2023] [Accepted: 07/24/2023] [Indexed: 09/11/2023]
Abstract
INTRODUCTION Black women with uterine fibroids experience greater symptom severity and worse treatment outcomes compared with their White counterparts. Black veterans who use Veterans Health Administration (VA) health care experience similar disparities. This study investigated the experiences of Black veterans receiving care for uterine fibroids at VA. METHODS We identified Black veterans aged 18 to 54 years with newly diagnosed symptomatic uterine fibroids between the fiscal years 2010 and 2012 using VA medical record data, and we recruited participants for interviews in 2021. We used purposive sampling by the last recorded fibroid treatment in the data (categorized as hysterectomy, other uterine-sparing treatments, and medication only/no treatment) to ensure diversity of treatment experiences. In-depth semistructured interviews were conducted to gather rich narratives of veterans' uterine fibroid care experiences. Transcribed interviews were analyzed using content analysis. RESULTS Twenty Black veterans completed interviews. Key themes that emerged included the amplified impact of severe fibroid symptoms in male-dominated military culture; the presence of multilevel barriers, from individual to health care system factors, that delayed access to high-quality treatment; insufficient treatments offered; experiences of interpersonal racism and provider bias; and the impact of fertility loss related to fibroids on mental health and intimate relationships. Veterans with positive experiences stressed the importance of finding a trustworthy provider and self-advocacy. CONCLUSIONS System-level interventions, such as race-conscious and person-centered care training, are needed to improve care experiences and outcomes of Black veterans with fibroids.
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Affiliation(s)
- Cathea Carey
- Health Services Research and Development (HSR&D) Center of Innovation for Veteran-Centered and Value-Driven Care, U.S. Department of Veterans Affairs, VA Puget Sound Healthcare System, Seattle, Washington
| | - Molly Silvestrini
- Health Services Research and Development (HSR&D) Center of Innovation for Veteran-Centered and Value-Driven Care, U.S. Department of Veterans Affairs, VA Puget Sound Healthcare System, Seattle, Washington
| | - Lisa S Callegari
- Health Services Research and Development (HSR&D) Center of Innovation for Veteran-Centered and Value-Driven Care, U.S. Department of Veterans Affairs, VA Puget Sound Healthcare System, Seattle, Washington; Department of Health Systems and Population Health, University of Washington, Seattle, Washington; Department of Obstetrics and Gynecology, University of Washington, Seattle, Washington.
| | - Jodie G Katon
- Health Services Research and Development (HSR&D) Center of Innovation for Veteran-Centered and Value-Driven Care, U.S. Department of Veterans Affairs, VA Puget Sound Healthcare System, Seattle, Washington
| | - Andrew S Bossick
- Department of Public Health Sciences, Henry Ford Health, Detroit, Michigan; Department of Obstetrics, Gynecology, and Reproductive Biology, College of Human Medicine, Michigan State University, East Lansing, Michigan
| | - Kemi M Doll
- Department of Health Systems and Population Health, University of Washington, Seattle, Washington; Department of Obstetrics and Gynecology, University of Washington, Seattle, Washington
| | - Alicia Christy
- Women's Health Services, Veterans Administration, U.S. Department of Veterans Affairs, Washington, District of Columbia
| | - Donna L Washington
- VA HSR&D Center for the Study of Healthcare Innovation, Implementation and Policy, VA Greater Los Angeles Healthcare System, Los Angeles, California; Division of General Internal Medicine and Health Services Research, Department of Medicine, University of California, Los Angeles, Los Angeles, California
| | - Shanise Owens
- Department of Health Systems and Population Health, University of Washington, Seattle, Washington
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Butler C. The Role of Diversity, Equity, and Inclusion Principles in Enhancing the Quality of Urologic Resident Education and Advancing Gender Diverse Care. Urol Clin North Am 2023; 50:541-547. [PMID: 37775213 DOI: 10.1016/j.ucl.2023.06.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/01/2023]
Abstract
This article will review the history of trans and gender diverse individuals in the medical field and suggest relevant content and methods to include in a diversity, equity, and inclusion curriculum. The hope is that the inclusion of these methods will help combat the barriers in place to receiving equitable and fair urologic care.
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Affiliation(s)
- Christi Butler
- University of California San Francisco, 400 Parnassus Avenue, 6th Floor, San Francisco, CA 94143, USA.
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Zimmermann M, Peacock-Chambers E, Merton C, Pasciak K, Thompson A, Mackie T, Clare CA, Lemon SC, Byatt N. Equitable reach: Patient and professional recommendations for interventions to prevent perinatal depression and anxiety. Gen Hosp Psychiatry 2023; 85:95-103. [PMID: 37862962 PMCID: PMC11056209 DOI: 10.1016/j.genhosppsych.2023.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 07/14/2023] [Accepted: 10/06/2023] [Indexed: 10/22/2023]
Abstract
OBJECTIVE Perinatal depression and anxiety are the most common complications in the perinatal period and disproportionately affect those experiencing economic marginalization. Fewer than 15% of individuals at risk for perinatal depression are referred for preventative counseling. The goal of this study was to elicit patient and perinatal care professionals' perspectives on how to increase the reach of interventions to prevent perinatal depression and anxiety among economically marginalized individuals. METHODS We conducted qualitative interviews with perinatal individuals with lived experience of perinatal depression and/or anxiety who were experiencing economic marginalization (n = 12) and perinatal care professionals and paraprofessionals (e.g., obstetrician/gynecologists, midwives, doulas; n = 12) serving this population. Three study team members engaged a "a coding consensus, co-occurrence, and comparison," approach to code interviews. RESULTS Perinatal individuals and professionals identified prevention intervention delivery approaches and content to facilitate equitable reach for individuals who are economically marginalized. Factors influential included availability of mental health counselors, facilitation of prevention interventions by a trusted professional, digital health options, and options for mental health intervention delivery approaches. Content that was perceived as increasing equitable intervention reach included emphasizing stigma reduction, using cultural humility and inclusive materials, and content personalization. CONCLUSIONS Leveraging varied options for mental health intervention delivery approaches and content could reach perinatal individuals experiencing economic marginalization and address resource considerations associated with preventative interventions.
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Affiliation(s)
- Martha Zimmermann
- UMass Chan Medical School, 222 Maple Avenue - Chang Building Shrewsbury, MA 01545, United States of America.
| | - Elizabeth Peacock-Chambers
- UMass Chan Medical School, 222 Maple Avenue - Chang Building Shrewsbury, MA 01545, United States of America
| | - Catherine Merton
- UMass Chan Medical School, 222 Maple Avenue - Chang Building Shrewsbury, MA 01545, United States of America
| | - Katarzyna Pasciak
- UMass Chan Medical School, 222 Maple Avenue - Chang Building Shrewsbury, MA 01545, United States of America
| | - Azure Thompson
- SUNY Downstate Health Sciences University, 450 Clarkson Avenue, Brooklyn, NY 11203, United States of America
| | - Thomas Mackie
- SUNY Downstate Health Sciences University, 450 Clarkson Avenue, Brooklyn, NY 11203, United States of America
| | - Camille A Clare
- SUNY Downstate Health Sciences University, 450 Clarkson Avenue, Brooklyn, NY 11203, United States of America
| | - Stephenie C Lemon
- UMass Chan Medical School, 222 Maple Avenue - Chang Building Shrewsbury, MA 01545, United States of America
| | - Nancy Byatt
- UMass Chan Medical School, 222 Maple Avenue - Chang Building Shrewsbury, MA 01545, United States of America
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Ajayi PT, Murdock CJ, Destine H, Trenchfield D, Aiyer A, Oni J. Trends in Racial, Ethnic, and Gender Diversity in Orthopaedic Surgery Adult Reconstruction Fellowships From 2007 to 2021. J Arthroplasty 2023; 38:2232-2236. [PMID: 37271237 DOI: 10.1016/j.arth.2023.05.048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/25/2022] [Revised: 05/17/2023] [Accepted: 05/20/2023] [Indexed: 06/06/2023] Open
Abstract
BACKGROUND Orthopaedic surgery has seen improvement in its representation of women, whereas the representation of racial/ethnic minorities has remained stagnant over the past decade. Overall, the surgical field lags behind other specialties in sex and racial/ethnic parity. Although demographic disparities within orthopaedics have been analyzed for both residents and faculty members, information for adult reconstruction fellows remains limited. METHODS Sex and race/ethnicity demographics for adult reconstruction orthopaedic fellowship matriculants were collected via a database published by the Accreditation Council for Graduate Medical Education (ACGME) from 2007 to 2021. Statistical analyses, including descriptive statistics and significance testing, were performed. RESULTS During the 14-year time frame, men trainees remained high with an overall average percentage of 88% and demonstrated increasing representation (P trend = .012). White non-Hispanics, Asians, Blacks, and Hispanics represented on average 54%, 11%, 3%, and 4%, respectively. White non-Hispanics (P trend = .039) and Asians (P trend = .030) saw increasing and decreasing representation, respectively. Women, Blacks, and Hispanics remained relatively stagnant throughout the observation period as no trends were appreciable (P trend >.05, each). CONCLUSION Using publicly available demographic data from the Accreditation Council for Graduate Medical Education (ACGME) from 2007 to 2021, we found relatively limited progress in the representation of women and those from traditionally marginalized groups seeking additional training in adult reconstruction. Our findings mark an initial step in measuring the demographic diversity among adult reconstruction fellows. Further research is needed to ascertain specific factors likely to attract and retain members from minoritized groups into orthopaedics.
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Affiliation(s)
- Peter T Ajayi
- Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | | | - Henson Destine
- University of Miami Miller School of Medicine, Miami, Florida
| | | | - Amiethab Aiyer
- Johns Hopkins University Orthopaedic Surgery, Baltimore, Maryland
| | - Julius Oni
- Johns Hopkins University Orthopaedic Surgery, Baltimore, Maryland
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Ganguli I, Mackwood MB, Yang CWW, Crawford M, Mulligan KL, O'Malley AJ, Fisher ES, Morden NE. Racial differences in low value care among older adult Medicare patients in US health systems: retrospective cohort study. BMJ 2023; 383:e074908. [PMID: 37879735 PMCID: PMC10599254 DOI: 10.1136/bmj-2023-074908] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/14/2023] [Indexed: 10/27/2023]
Abstract
OBJECTIVE To characterize racial differences in receipt of low value care (services that provide little to no benefit yet have potential for harm) among older Medicare beneficiaries overall and within health systems in the United States. DESIGN Retrospective cohort study SETTING: 100% Medicare fee-for-service administrative data (2016-18). PARTICIPANTS Black and White Medicare patients aged 65 or older as of 2016 and attributed to 595 health systems in the United States. MAIN OUTCOME MEASURES Receipt of 40 low value services among Black and White patients, with and without adjustment for patient age, sex, and previous healthcare use. Additional models included health system fixed effects to assess racial differences within health systems and separately, racial composition of the health system's population to assess the relative contributions of individual patient race and health system racial composition to low value care receipt. RESULTS The cohort included 9 833 304 patients (6.8% Black; 57.9% female). Of 40 low value services examined, Black patients had higher adjusted receipt of nine services and lower receipt of 20 services than White patients. Specifically, Black patients were more likely to receive low value acute diagnostic tests, including imaging for uncomplicated headache (6.9% v 3.2%) and head computed tomography scans for dizziness (3.1% v 1.9%). White patients had higher rates of low value screening tests and treatments, including preoperative laboratory tests (10.3% v 6.5%), prostate specific antigen tests (31.0% v 25.7%), and antibiotics for upper respiratory infections (36.6% v 32.7%; all P<0.001). Secondary analyses showed that these differences persisted within given health systems and were not explained by Black and White patients receiving care from different systems. CONCLUSIONS Black patients were more likely to receive low value acute diagnostic tests and White patients were more likely to receive low value screening tests and treatments. Differences were generally small and were largely due to differential care within health systems. These patterns suggest potential individual, interpersonal, and structural factors that researchers, policy makers, and health system leaders might investigate and address to improve care quality and equity.
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Affiliation(s)
- Ishani Ganguli
- Harvard Medical School and Brigham and Women's Hospital, Boston, MA, USA
| | - Matthew B Mackwood
- Department of Community & Family Medicine, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA
- The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA
| | - Ching-Wen Wendy Yang
- The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA
| | - Maia Crawford
- The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA
| | | | - A James O'Malley
- The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA
- Department of Biomedical Data Science, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA
| | - Elliott S Fisher
- Department of Community & Family Medicine, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA
- The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA
- Department of Medicine, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA
| | - Nancy E Morden
- The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA
- UnitedHealthcare, Minnetonka, MN, USA
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Llaneza AJ, Holt A, Stephens L, Seward J. Native American Community Perspectives on Oral Health Access: Understanding the Impact of Rurality. Healthcare (Basel) 2023; 11:2788. [PMID: 37893863 PMCID: PMC10606298 DOI: 10.3390/healthcare11202788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Revised: 10/10/2023] [Accepted: 10/18/2023] [Indexed: 10/29/2023] Open
Abstract
PURPOSE Oral health disparities related to access persist for American Indian/Alaska Native (AI/AN) communities compared to the general population, especially in rural areas of the United States. The objective of this study was to better understand community perspectives of oral health, how rurality impacts access to care, and attitudes towards the implementation of dental therapists in Oklahoma, particularly among the AI/AN population. METHODS A descriptive, observational study design was utilized. An exploratory survey was conducted online and comprised of qualitative and quantitative data. The total frequencies and percentages were evaluated for the quantitative questions. The qualitative data was analyzed using thematic analysis. Utilizing descriptive and qualitative research methods, the focus was to describe the experiences of the respondents and their characteristics related to oral health in Oklahoma. RESULTS A total of 201 responses were obtained, where 65% (n = 131) identified as an enrolled member or employee of a tribe represented in Oklahoma. Key qualitative themes included community access to care, community concerns, and community motivated solutions. CONCLUSIONS AI/AN communities are an underserved group in healthcare. Although communities in rural areas face major barriers to oral health services, evidence-based solutions can be implemented.
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Affiliation(s)
- Amanda J. Llaneza
- Southern Plains Tribal Health Board, Oklahoma City, OK 73114, USA; (A.J.L.); (A.H.)
| | - Alex Holt
- Southern Plains Tribal Health Board, Oklahoma City, OK 73114, USA; (A.J.L.); (A.H.)
| | - Lancer Stephens
- Health Promotion Sciences, Hudson College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City, OK 73104, USA;
- Oklahoma Shared Clinical and Translational Resources, University of Oklahoma Health Sciences Center, Oklahoma City, OK 73104, USA
| | - Julie Seward
- Southern Plains Tribal Health Board, Oklahoma City, OK 73114, USA; (A.J.L.); (A.H.)
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