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Peeler A, Nelson K, Agrawalla V, Badawi S, Moore R, Li D, Street L, Hager DN, Dennison Himmelfarb C, Davidson PM, Koirala B. Living with multimorbidity: A qualitative exploration of shared experiences of patients, family caregivers, and healthcare professionals in managing symptoms in the United States. J Adv Nurs 2024. [PMID: 38197539 DOI: 10.1111/jan.15998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 11/12/2023] [Accepted: 11/19/2023] [Indexed: 01/11/2024]
Abstract
AIMS To elicit experiences of patients, family caregivers, and healthcare professionals in intermediate care units (IMCUs) in an academic medical centre in Baltimore, MD related to the challenges and intricacies of multimorbidity management to inform development of a multimorbidity symptom management toolkit. DESIGN Experience-based co-design. METHODS Between July and October 2021, patients aged 55 years and older with multimorbidity admitted to IMCUs at an academic medical centre in Baltimore, Maryland, USA were recruited and interviewed in person. Interdisciplinary healthcare professionals working in the IMCU were interviewed virtually. Participants were asked questions about their role in recognizing and treating symptoms, factors affecting the quality of life, symptom burden and trajectory over time, and strategies that have and have not worked for managing symptoms. An inductive thematic analysis approach was used for analysis. RESULTS Twenty-three interviews were conducted: 9 patients, 2 family caregivers, and 12 healthcare professionals. Patients' mean age was 67.5 (±6.5) years, over half (n = 5) were Black or Hispanic, and the average number of comorbidities was 3.67. Five major themes that affect symptom management emerged: (1) the patient-provider relationship; (2) open and honest communication; (3) accessibility of resources during hospitalization and at discharge; (4) caregiver support, training, and education; and (5) care coordination and follow-up care. CONCLUSION Patients, caregivers, and healthcare professionals often have similar goals but different priorities for multimorbidity management. It is imperative to identify shared priorities and target holistic interventions that consider patient and caregiver experiences to improve outcomes. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE AND IMPACT This paper addresses the paucity of research related to the shared experience of disease trajectory and symptom management for people living with multimorbidity. We found that patients, caregivers, and healthcare professionals often have similar goals but different care and communication priorities. Understanding differing priorities will help better design interventions to support symptom management so people with multimorbidity can have the best possible quality of life. REPORTING METHOD We have adhered to the Consolidated Criteria for Reporting Qualitative Studies (COREQ) guidelines in our reporting. PATIENT OR PUBLIC CONTRIBUTION This study has been designed and implemented with patient and public involvement throughout the process, including community advisory board engagement in the project proposal phase and interview guide development, and member checking in the data collection and analysis phases. The method we chose, experience-based co-design, emphasizes the importance of engaging members of a community to act as experts in their own life challenges. In the coming phases of the study, the public will be involved in developing and testing a new intervention, informed by these qualitative interviews and co-design events, to support symptom management for people with multimorbidity.
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Affiliation(s)
- Anna Peeler
- Cicely Saunders Institute of Palliative Care, Policy, and Rehabilitation, King's College London, London, England
| | - Katie Nelson
- Johns Hopkins School of Nursing, Baltimore, Maryland, USA
| | | | - Sarah Badawi
- Johns Hopkins School of Nursing, Baltimore, Maryland, USA
| | - Robyn Moore
- Johns Hopkins School of Nursing, Baltimore, Maryland, USA
| | - David Li
- Johns Hopkins School of Nursing, Baltimore, Maryland, USA
| | - Lara Street
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - David N Hager
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | | | | | - Binu Koirala
- Johns Hopkins School of Nursing, Baltimore, Maryland, USA
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Miller HN, Stevens SC, Young D, Lacanienta CT, Tomiwa T, Vazquez MG, Olawole W, Zhu T, Lewis-Land C, Clark R, Peeler A, Byiringiro S, Cook B, Weston C, Bronner Y, Rich T, Himmelfarb CR. Grassroots and Digital Outreach Strategies Raise Awareness of COVID-19 Information and Research in Baltimore City. Am J Public Health 2024; 114:S69-S73. [PMID: 38207261 PMCID: PMC10785161 DOI: 10.2105/ajph.2023.307492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/04/2023] [Indexed: 01/13/2024]
Abstract
We aimed to disseminate reliable COVID-19 information to the Black and Latino communities of Baltimore City, Maryland, between July 2020 and December 2022. With community partners, we disseminated evidence-based COVID-19 information via grassroots and digital strategies, including Hopkins Opportunity for Participant Engagement, and connected volunteers to COVID-19 research. Using a multimodal approach facilitated dissemination of reliable information and raised awareness of research; evaluation of trust is ongoing. Robust, multimodal strategies are needed to foster trust and equity among diverse communities. (Am J Public Health. 2024;114(S1):S69-S73. https://doi.org/10.2105/AJPH.2023.307492).
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Affiliation(s)
- Hailey N Miller
- Hailey N. Miller, Donald Young, Wura Olawole, Trinity Zhu, Samuel Byiringiro, Brittany Cook, and Cheryl R. Himmelfarb are with the Johns Hopkins School of Nursing, Johns Hopkins University, Baltimore, MD. Sarah C. Stevens, Cyd T. Lacanienta, Tosin Tomiwa, Cassie Lewis-Land, and Anna Peeler are with the Johns Hopkins Institute for Clinical and Translational Research, Johns Hopkins University. Monica Guerrero Vazquez is with Centro SOL, Baltimore, MD. Roger Clark is with the Community Research Advisory Council, Johns Hopkins University. Christine Weston is with Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University. Yvonne Bronner is with the Morgan State University School of Community Health and Policy, Baltimore, MD. Tim Rich is with Reaching Innocent Children Hearts Foundation, Baltimore, MD
| | - Sarah C Stevens
- Hailey N. Miller, Donald Young, Wura Olawole, Trinity Zhu, Samuel Byiringiro, Brittany Cook, and Cheryl R. Himmelfarb are with the Johns Hopkins School of Nursing, Johns Hopkins University, Baltimore, MD. Sarah C. Stevens, Cyd T. Lacanienta, Tosin Tomiwa, Cassie Lewis-Land, and Anna Peeler are with the Johns Hopkins Institute for Clinical and Translational Research, Johns Hopkins University. Monica Guerrero Vazquez is with Centro SOL, Baltimore, MD. Roger Clark is with the Community Research Advisory Council, Johns Hopkins University. Christine Weston is with Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University. Yvonne Bronner is with the Morgan State University School of Community Health and Policy, Baltimore, MD. Tim Rich is with Reaching Innocent Children Hearts Foundation, Baltimore, MD
| | - Donald Young
- Hailey N. Miller, Donald Young, Wura Olawole, Trinity Zhu, Samuel Byiringiro, Brittany Cook, and Cheryl R. Himmelfarb are with the Johns Hopkins School of Nursing, Johns Hopkins University, Baltimore, MD. Sarah C. Stevens, Cyd T. Lacanienta, Tosin Tomiwa, Cassie Lewis-Land, and Anna Peeler are with the Johns Hopkins Institute for Clinical and Translational Research, Johns Hopkins University. Monica Guerrero Vazquez is with Centro SOL, Baltimore, MD. Roger Clark is with the Community Research Advisory Council, Johns Hopkins University. Christine Weston is with Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University. Yvonne Bronner is with the Morgan State University School of Community Health and Policy, Baltimore, MD. Tim Rich is with Reaching Innocent Children Hearts Foundation, Baltimore, MD
| | - Cyd T Lacanienta
- Hailey N. Miller, Donald Young, Wura Olawole, Trinity Zhu, Samuel Byiringiro, Brittany Cook, and Cheryl R. Himmelfarb are with the Johns Hopkins School of Nursing, Johns Hopkins University, Baltimore, MD. Sarah C. Stevens, Cyd T. Lacanienta, Tosin Tomiwa, Cassie Lewis-Land, and Anna Peeler are with the Johns Hopkins Institute for Clinical and Translational Research, Johns Hopkins University. Monica Guerrero Vazquez is with Centro SOL, Baltimore, MD. Roger Clark is with the Community Research Advisory Council, Johns Hopkins University. Christine Weston is with Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University. Yvonne Bronner is with the Morgan State University School of Community Health and Policy, Baltimore, MD. Tim Rich is with Reaching Innocent Children Hearts Foundation, Baltimore, MD
| | - Tosin Tomiwa
- Hailey N. Miller, Donald Young, Wura Olawole, Trinity Zhu, Samuel Byiringiro, Brittany Cook, and Cheryl R. Himmelfarb are with the Johns Hopkins School of Nursing, Johns Hopkins University, Baltimore, MD. Sarah C. Stevens, Cyd T. Lacanienta, Tosin Tomiwa, Cassie Lewis-Land, and Anna Peeler are with the Johns Hopkins Institute for Clinical and Translational Research, Johns Hopkins University. Monica Guerrero Vazquez is with Centro SOL, Baltimore, MD. Roger Clark is with the Community Research Advisory Council, Johns Hopkins University. Christine Weston is with Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University. Yvonne Bronner is with the Morgan State University School of Community Health and Policy, Baltimore, MD. Tim Rich is with Reaching Innocent Children Hearts Foundation, Baltimore, MD
| | - Monica Guerrero Vazquez
- Hailey N. Miller, Donald Young, Wura Olawole, Trinity Zhu, Samuel Byiringiro, Brittany Cook, and Cheryl R. Himmelfarb are with the Johns Hopkins School of Nursing, Johns Hopkins University, Baltimore, MD. Sarah C. Stevens, Cyd T. Lacanienta, Tosin Tomiwa, Cassie Lewis-Land, and Anna Peeler are with the Johns Hopkins Institute for Clinical and Translational Research, Johns Hopkins University. Monica Guerrero Vazquez is with Centro SOL, Baltimore, MD. Roger Clark is with the Community Research Advisory Council, Johns Hopkins University. Christine Weston is with Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University. Yvonne Bronner is with the Morgan State University School of Community Health and Policy, Baltimore, MD. Tim Rich is with Reaching Innocent Children Hearts Foundation, Baltimore, MD
| | - Wura Olawole
- Hailey N. Miller, Donald Young, Wura Olawole, Trinity Zhu, Samuel Byiringiro, Brittany Cook, and Cheryl R. Himmelfarb are with the Johns Hopkins School of Nursing, Johns Hopkins University, Baltimore, MD. Sarah C. Stevens, Cyd T. Lacanienta, Tosin Tomiwa, Cassie Lewis-Land, and Anna Peeler are with the Johns Hopkins Institute for Clinical and Translational Research, Johns Hopkins University. Monica Guerrero Vazquez is with Centro SOL, Baltimore, MD. Roger Clark is with the Community Research Advisory Council, Johns Hopkins University. Christine Weston is with Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University. Yvonne Bronner is with the Morgan State University School of Community Health and Policy, Baltimore, MD. Tim Rich is with Reaching Innocent Children Hearts Foundation, Baltimore, MD
| | - Trinity Zhu
- Hailey N. Miller, Donald Young, Wura Olawole, Trinity Zhu, Samuel Byiringiro, Brittany Cook, and Cheryl R. Himmelfarb are with the Johns Hopkins School of Nursing, Johns Hopkins University, Baltimore, MD. Sarah C. Stevens, Cyd T. Lacanienta, Tosin Tomiwa, Cassie Lewis-Land, and Anna Peeler are with the Johns Hopkins Institute for Clinical and Translational Research, Johns Hopkins University. Monica Guerrero Vazquez is with Centro SOL, Baltimore, MD. Roger Clark is with the Community Research Advisory Council, Johns Hopkins University. Christine Weston is with Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University. Yvonne Bronner is with the Morgan State University School of Community Health and Policy, Baltimore, MD. Tim Rich is with Reaching Innocent Children Hearts Foundation, Baltimore, MD
| | - Cassie Lewis-Land
- Hailey N. Miller, Donald Young, Wura Olawole, Trinity Zhu, Samuel Byiringiro, Brittany Cook, and Cheryl R. Himmelfarb are with the Johns Hopkins School of Nursing, Johns Hopkins University, Baltimore, MD. Sarah C. Stevens, Cyd T. Lacanienta, Tosin Tomiwa, Cassie Lewis-Land, and Anna Peeler are with the Johns Hopkins Institute for Clinical and Translational Research, Johns Hopkins University. Monica Guerrero Vazquez is with Centro SOL, Baltimore, MD. Roger Clark is with the Community Research Advisory Council, Johns Hopkins University. Christine Weston is with Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University. Yvonne Bronner is with the Morgan State University School of Community Health and Policy, Baltimore, MD. Tim Rich is with Reaching Innocent Children Hearts Foundation, Baltimore, MD
| | - Roger Clark
- Hailey N. Miller, Donald Young, Wura Olawole, Trinity Zhu, Samuel Byiringiro, Brittany Cook, and Cheryl R. Himmelfarb are with the Johns Hopkins School of Nursing, Johns Hopkins University, Baltimore, MD. Sarah C. Stevens, Cyd T. Lacanienta, Tosin Tomiwa, Cassie Lewis-Land, and Anna Peeler are with the Johns Hopkins Institute for Clinical and Translational Research, Johns Hopkins University. Monica Guerrero Vazquez is with Centro SOL, Baltimore, MD. Roger Clark is with the Community Research Advisory Council, Johns Hopkins University. Christine Weston is with Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University. Yvonne Bronner is with the Morgan State University School of Community Health and Policy, Baltimore, MD. Tim Rich is with Reaching Innocent Children Hearts Foundation, Baltimore, MD
| | - Anna Peeler
- Hailey N. Miller, Donald Young, Wura Olawole, Trinity Zhu, Samuel Byiringiro, Brittany Cook, and Cheryl R. Himmelfarb are with the Johns Hopkins School of Nursing, Johns Hopkins University, Baltimore, MD. Sarah C. Stevens, Cyd T. Lacanienta, Tosin Tomiwa, Cassie Lewis-Land, and Anna Peeler are with the Johns Hopkins Institute for Clinical and Translational Research, Johns Hopkins University. Monica Guerrero Vazquez is with Centro SOL, Baltimore, MD. Roger Clark is with the Community Research Advisory Council, Johns Hopkins University. Christine Weston is with Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University. Yvonne Bronner is with the Morgan State University School of Community Health and Policy, Baltimore, MD. Tim Rich is with Reaching Innocent Children Hearts Foundation, Baltimore, MD
| | - Samuel Byiringiro
- Hailey N. Miller, Donald Young, Wura Olawole, Trinity Zhu, Samuel Byiringiro, Brittany Cook, and Cheryl R. Himmelfarb are with the Johns Hopkins School of Nursing, Johns Hopkins University, Baltimore, MD. Sarah C. Stevens, Cyd T. Lacanienta, Tosin Tomiwa, Cassie Lewis-Land, and Anna Peeler are with the Johns Hopkins Institute for Clinical and Translational Research, Johns Hopkins University. Monica Guerrero Vazquez is with Centro SOL, Baltimore, MD. Roger Clark is with the Community Research Advisory Council, Johns Hopkins University. Christine Weston is with Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University. Yvonne Bronner is with the Morgan State University School of Community Health and Policy, Baltimore, MD. Tim Rich is with Reaching Innocent Children Hearts Foundation, Baltimore, MD
| | - Brittany Cook
- Hailey N. Miller, Donald Young, Wura Olawole, Trinity Zhu, Samuel Byiringiro, Brittany Cook, and Cheryl R. Himmelfarb are with the Johns Hopkins School of Nursing, Johns Hopkins University, Baltimore, MD. Sarah C. Stevens, Cyd T. Lacanienta, Tosin Tomiwa, Cassie Lewis-Land, and Anna Peeler are with the Johns Hopkins Institute for Clinical and Translational Research, Johns Hopkins University. Monica Guerrero Vazquez is with Centro SOL, Baltimore, MD. Roger Clark is with the Community Research Advisory Council, Johns Hopkins University. Christine Weston is with Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University. Yvonne Bronner is with the Morgan State University School of Community Health and Policy, Baltimore, MD. Tim Rich is with Reaching Innocent Children Hearts Foundation, Baltimore, MD
| | - Christine Weston
- Hailey N. Miller, Donald Young, Wura Olawole, Trinity Zhu, Samuel Byiringiro, Brittany Cook, and Cheryl R. Himmelfarb are with the Johns Hopkins School of Nursing, Johns Hopkins University, Baltimore, MD. Sarah C. Stevens, Cyd T. Lacanienta, Tosin Tomiwa, Cassie Lewis-Land, and Anna Peeler are with the Johns Hopkins Institute for Clinical and Translational Research, Johns Hopkins University. Monica Guerrero Vazquez is with Centro SOL, Baltimore, MD. Roger Clark is with the Community Research Advisory Council, Johns Hopkins University. Christine Weston is with Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University. Yvonne Bronner is with the Morgan State University School of Community Health and Policy, Baltimore, MD. Tim Rich is with Reaching Innocent Children Hearts Foundation, Baltimore, MD
| | - Yvonne Bronner
- Hailey N. Miller, Donald Young, Wura Olawole, Trinity Zhu, Samuel Byiringiro, Brittany Cook, and Cheryl R. Himmelfarb are with the Johns Hopkins School of Nursing, Johns Hopkins University, Baltimore, MD. Sarah C. Stevens, Cyd T. Lacanienta, Tosin Tomiwa, Cassie Lewis-Land, and Anna Peeler are with the Johns Hopkins Institute for Clinical and Translational Research, Johns Hopkins University. Monica Guerrero Vazquez is with Centro SOL, Baltimore, MD. Roger Clark is with the Community Research Advisory Council, Johns Hopkins University. Christine Weston is with Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University. Yvonne Bronner is with the Morgan State University School of Community Health and Policy, Baltimore, MD. Tim Rich is with Reaching Innocent Children Hearts Foundation, Baltimore, MD
| | - Tim Rich
- Hailey N. Miller, Donald Young, Wura Olawole, Trinity Zhu, Samuel Byiringiro, Brittany Cook, and Cheryl R. Himmelfarb are with the Johns Hopkins School of Nursing, Johns Hopkins University, Baltimore, MD. Sarah C. Stevens, Cyd T. Lacanienta, Tosin Tomiwa, Cassie Lewis-Land, and Anna Peeler are with the Johns Hopkins Institute for Clinical and Translational Research, Johns Hopkins University. Monica Guerrero Vazquez is with Centro SOL, Baltimore, MD. Roger Clark is with the Community Research Advisory Council, Johns Hopkins University. Christine Weston is with Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University. Yvonne Bronner is with the Morgan State University School of Community Health and Policy, Baltimore, MD. Tim Rich is with Reaching Innocent Children Hearts Foundation, Baltimore, MD
| | - Cheryl R Himmelfarb
- Hailey N. Miller, Donald Young, Wura Olawole, Trinity Zhu, Samuel Byiringiro, Brittany Cook, and Cheryl R. Himmelfarb are with the Johns Hopkins School of Nursing, Johns Hopkins University, Baltimore, MD. Sarah C. Stevens, Cyd T. Lacanienta, Tosin Tomiwa, Cassie Lewis-Land, and Anna Peeler are with the Johns Hopkins Institute for Clinical and Translational Research, Johns Hopkins University. Monica Guerrero Vazquez is with Centro SOL, Baltimore, MD. Roger Clark is with the Community Research Advisory Council, Johns Hopkins University. Christine Weston is with Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University. Yvonne Bronner is with the Morgan State University School of Community Health and Policy, Baltimore, MD. Tim Rich is with Reaching Innocent Children Hearts Foundation, Baltimore, MD
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Saylor MA, Pavlovic N, DeGroot L, Peeler A, Nelson KE, Perrin N, Gilotra NA, Wolff JL, Davidson PM, Szanton SL. Feasibility of a Multi-Component Strengths-Building Intervention for Caregivers of Persons With Heart Failure. J Appl Gerontol 2023; 42:2371-2382. [PMID: 37707361 PMCID: PMC10840901 DOI: 10.1177/07334648231191595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/15/2023] Open
Abstract
Caregivers of persons with heart failure (HF) navigate complex care plans, yet support strategies often focus solely on meeting the needs of patients. We conducted a randomized waitlist control trial (N = 38) to test the feasibility and gauge initial effect size of the Caregiver Support intervention on quality of life, caregiver burden, and self-efficacy among HF caregivers. The intervention includes up to five remote, nurse-facilitated sessions. Components address: holistic caregiver assessment, life purpose, action planning, resources, and future planning. Caregivers were 93.3% female, 60% White, and 63.3% spouses. Average age was 59.4. Participants who completed the intervention reported high satisfaction and acceptability of activities. Between-group effect sizes at 16 and 32 weeks suggest improvement in quality of life (mental health) (.88; 1.08), caregiver burden (.31; .37), and self-efficacy (.63; .74). Caregivers found Caregiver Support acceptable and feasible. Findings contribute evidence that this intervention can enhance caregiver outcomes. Clinicaltrials.gov Identifier NCT04090749.
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Affiliation(s)
| | - Noelle Pavlovic
- Johns Hopkins School of Nursing, Baltimore, Maryland, United States
| | - Lyndsay DeGroot
- Johns Hopkins School of Nursing, Baltimore, Maryland, United States
| | - Anna Peeler
- King’s College London, Cicely Saunders Institute, London, United Kingdom
| | - Katie E. Nelson
- Johns Hopkins School of Nursing, Baltimore, Maryland, United States
| | - Nancy Perrin
- Johns Hopkins School of Nursing, Baltimore, Maryland, United States
| | - Nisha A. Gilotra
- Johns Hopkins School of Medicine, Baltimore, Maryland, United States
| | - Jennifer L. Wolff
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States
| | | | - Sarah L. Szanton
- Johns Hopkins School of Nursing, Baltimore, Maryland, United States
- King’s College London, Cicely Saunders Institute, London, United Kingdom
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Hansford L, Wyatt K, Creanor S, Davies J, Horne G, Lynn A, McCready S, Pearce S, Peeler A, Rhys A, Sallnow L, Harding R. Engaging with communities in rural, coastal and low-income areas to understand barriers to palliative care and bereavement support: reflections on a community engagement programme in South-west England. Palliat Care Soc Pract 2023; 17:26323524231212514. [PMID: 38044933 PMCID: PMC10693214 DOI: 10.1177/26323524231212514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Accepted: 10/19/2023] [Indexed: 12/05/2023] Open
Abstract
Background England's South-west Peninsula is largely rural, has a high proportion of over 65s, and has areas of rural and coastal deprivation. Rural and low-income populations face inequities at end of life and little is known about the support needs of rural, coastal and low-income communities. Objectives To understand how to foster community support for dying and grieving well, a regional, multi-sectoral research partnership developed a community engagement programme to explore experiences of seeking support, issues important to people and the community support they valued. This article shares what people told us about the role that communities can play at end of life, and reflects on learning from our process of engaging communities in conversations about dying. Design and methods A programme of varied community engagement which included: the use of the 'Departure Lounge' installation and four focus groups with interested individuals in a range of community settings; the co-creation of a 'Community Conversation' toolkit to facilitate conversations with individuals with experience of end-of-life care and their carers with Community Builders; a focus group with Community Builders and a storytelling project with three bereaved individuals. Results People valued community support at the end of life or in bereavement that offered connection with others, peer support without judgement, responded to their individual needs and helped them to access services. Creative methods of engagement show potential to help researchers and practitioners better understand the needs and priorities of underserved populations. Collaboration with existing community groups was key to engagement, and contextual factors influenced levels of engagement. Conclusion Local community organizations are well placed to support people at end of life. This work highlighted the potential for partnership with palliative care and bereavement organizations, who could offer opportunities to develop people's knowledge and skills, and together generate sustainable solutions to meet local need.
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Affiliation(s)
- Lorraine Hansford
- Department of Health and Community Sciences, University of Exeter, South Cloisters, St Luke’s Campus, Queen’s Building, Exeter EX1 2LU, UK
| | - Katrina Wyatt
- Department of Health and Community Sciences, University of Exeter, Exeter, UK
| | - Siobhan Creanor
- Department of Health and Community Sciences, University of Exeter, Exeter, UK
| | | | | | - Amanda Lynn
- Torbay Community Development Trust, Torquay, UK
| | | | - Susie Pearce
- School of Nursing and Midwifery, University of Plymouth, Plymouth, UK Torbay and South Devon NHS Foundation Trust, Torquay, UK
| | - Anna Peeler
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, King’s College London, London, UK
| | | | - Libby Sallnow
- St Christopher’s Hospice, London, UK
- Marie Curie Palliative Care Research Department, University College London, London, UK
| | - Richard Harding
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, King’s College London, London, UK
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Peeler A, Davidson PM, Gleason KT, Stephens RS, Ferrell B, Kim BS, Cho SM. Palliative Care Utilization in Patients Requiring Extracorporeal Membrane Oxygenation: An Observational Study. ASAIO J 2023; 69:1009-1015. [PMID: 37549652 PMCID: PMC10615693 DOI: 10.1097/mat.0000000000002021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/09/2023] Open
Abstract
Palliative care (PC) is a model of care centered around improving the quality of life for individuals with life-limiting illnesses. Few studies have examined its impact in patients on extracorporeal membrane oxygenation (ECMO). We aimed to describe demographics, clinical characteristics, and complications associated with PC consultation in adult patients requiring ECMO support. We analyzed data from an ECMO registry, including patients aged 18 years and older who have received either venoarterial (VA)- or venovenous (VV)-ECMO support between July 2016 and September 2021. We used analysis of variance and Fisher exact tests to identify factors associated with PC consultation. Of 256, 177 patients (69.1%) received VA-ECMO support and 79 (30.9%) received VV-ECMO support. Overall, 115 patients (44.9%) received PC consultation while on ECMO. Patients receiving PC consultation were more likely to be non-white (47% vs. 53%, p = 0.016), have an attending physician from a medical versus surgical specialty (65.3% vs. 39.6%), have VV-ECMO (77.2% vs. 30.5%, p < 0.001), and have longer ECMO duration (6.2 vs. 23.0, p < 0.001). Patients were seen by the PC team on an average of 7.6 times (range, 1-35), with those who died having significantly more visits (11.2 vs. 5.6, p < 0.001) despite the shorter hospital stay. The average time from cannulation to the first PC visit was 5.3 ± 5 days. Congestive heart failure in VA-ECMO, coronavirus disease 2019 infection in VV-ECMO, and non-white race and longer ECMO duration for all patients were associated with PC consultation. We found that despite the benefits of PC, it is underused in this population.
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Affiliation(s)
- Anna Peeler
- Cicely Saunders Institute of Palliative Care, Policy, and Rehabilitation, King’s College London, London, United Kingdom
| | | | | | - R. Scott Stephens
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Johns Hopkins University, Baltimore, MD
| | | | - Bo Soo Kim
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Johns Hopkins University, Baltimore, MD
| | - Sung-Min Cho
- Division of Neuroscience Critical Care, Departments of Neurology and Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
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Kaur A, Kim A, Yanek LR, Liu Y, Tao X, Peeler A, Mogul D, Adam Hamilton JP, Mullin GE. Trends in the Utilization of Herbal and Dietary Supplements in Patients with Chronic Liver Disease During the SARS-CoV2 Pandemic. Integr Med (Encinitas) 2023; 22:14-17. [PMID: 38144166 PMCID: PMC10734968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2023]
Abstract
Background We studied the pattern of herbal and dietary supplement (HDS) use in patients with chronic liver disease (CLD) during the first year of the COVID-19 pandemic. Methods A questionnaire/survey was sent to hepatology patients with CLD under the care of hepatologists at Johns Hopkins University School of Medicine. Results The 5 most taken dietary supplements during the pandemic included vitamin B12 (27.7%), vitamin C (32.4%), vitamin D (54.6%), zinc (25.4%) and green tea extract (20.8%). Most participants (82.3%) did not discuss their HDS use with their hepatology providers. Conclusions Healthcare providers should be mindful of potential HDS use in patients with CLD.
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Affiliation(s)
- Avleen Kaur
- Maimonides Medical Center, Brooklyn, New York, USA
| | - Ahyoung Kim
- Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Lisa R. Yanek
- Johns Hopkins University School of Medicine, Baltimore, Maryland, USA; Biostatistics, Epidemiology, and Data Management (BEAD) Core, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Yisi Liu
- Johns Hopkins University School of Medicine, Baltimore, Maryland, USA; Biostatistics, Epidemiology, and Data Management (BEAD) Core, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Xueting Tao
- Johns Hopkins University School of Medicine, Baltimore, Maryland, USA; Biostatistics, Epidemiology, and Data Management (BEAD) Core, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Anna Peeler
- Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Douglas Mogul
- Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | | | - Gerard E. Mullin
- Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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Horst G, Miller H, Peeler A, Charleston J, Dell T, Juraschek SP, Brady TM. Experiences with recruitment and retention of adolescents and emerging adults in a weight loss intervention trial. Clin Trials 2023; 20:536-545. [PMID: 37106576 PMCID: PMC10523837 DOI: 10.1177/17407745231167090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/29/2023]
Abstract
BACKGROUND/AIMS Efficient and effective participant recruitment is key for successful clinical research. Adolescent and emerging adult recruitment into clinical trials can be particularly challenging, especially when targeting underrepresented groups. This study aimed to determine the most successful recruitment strategies from those employed during a pediatric trial testing the efficacy of a behavioral intervention on adiposity and cardiovascular disease risk. METHODS We determined the effectiveness, cost, and diversity of the final research population by each recruitment method utilized in the EMPower trial, a randomized clinical trial designed to test the effect of a technology-delivered behavioral Healthy Lifestyle intervention on adiposity, blood pressure, and left ventricular mass among adolescents and emerging adults with overweight or obesity. Effectiveness was determined by respondent yield (RY; number of respondents/number contacted), scheduled yield (SY; number scheduled for a baseline visit/number of respondents), enrollment yield (EY; number enrolled/number of respondents), and retention (number completed/number enrolled). Cost-effectiveness of each recruitment method was calculated and demographics of participants recruited via each method was determined. RESULTS A minimum of 109,314 adolescents and emerging adults were contacted by at least one recruitment method (clinic, web-based, postal mailing, electronic medical record (EMR) messaging) leading to 429 respondents. The most successful strategies in terms of RY were clinic-based recruitment (n = 47, 61% RY), community web-postings (n = 109, 5.33% RY), and EMR messaging (n = 163, 0.99% RY); however, website, postal mailings, and EMR recruitment led to more successful SY and EY. Postal mailings were the most costly strategy to employ (US$3261/completed participant) with EMR messaging the second most costly (US$69/completed participant). Community web-postings were free of charge. Clinic-based recruitment did not add additional costs, per se, but did require a substantial amount of personnel time (63.6 h/completed participant). Final cohort diversity primarily came from postal mailings (57% Black) and EMR messages (50% female). CONCLUSION Electronic medical record messaging and web-based recruitment were highly successful and cost-effective strategies in a pediatric clinical trial targeting adolescents and emerging adults, but was less successful in recruiting a diverse cohort. Clinic recruitment and postal mailings, despite being costly and time-consuming, were the strategies that enrolled a greater proportion of underrepresented groups. While online forms of trial recruitment are growing in popularity, clinic-based recruitment and non-web-based strategies may be required to ensure participant diversity and representation.
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Affiliation(s)
| | | | - Anna Peeler
- Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, King's College, London, UK
| | | | - Thomas Dell
- Johns Hopkins University, Baltimore, MD, USA
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Peeler A, Doran A, Winter-Dean L, Ijaz M, Brittain M, Hansford L, Wyatt K, Sallnow L, Harding R. Public health palliative care interventions that enable communities to support people who are dying and their carers: a scoping review of studies that assess person-centered outcomes. Front Public Health 2023; 11:1180571. [PMID: 37564426 PMCID: PMC10410270 DOI: 10.3389/fpubh.2023.1180571] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 07/05/2023] [Indexed: 08/12/2023] Open
Abstract
Background Public health palliative care views communities as an integral part of care delivery at the end of life. This community-provider partnership approach has the potential to improve end-of-life care for people who are dying and their carers. Objective To identify and appraise the current literature related to public health interventions that enable communities to support people who are dying and their carers. Methods A scoping review was conducted, applying Arksey and O'Malley's methods. Data was extracted and synthesized using narrative techniques, and results are reported using PRISMA guidelines. Results The search yielded 2,902 results. Eighteen met inclusion criteria and were included in the analysis. Interventions were categorized according to their target population: people with life-limiting illness (ex. facilitated social interaction, helplines and guided discussions about death and dying); carers (ex. social support mapping, psychoeducation, and community resource identification and facilitation); or dyads (ex. reminiscence activities, practical and emotional support from volunteers, online modules to bolster coping mechanisms). Public health palliative care approaches were delivered by key community stakeholders such as community health workers, volunteers, peer mentors, and pre-established support groups. Despite reported challenges in identifying appropriate tools to measure effectiveness, studies report improvement in quality of life, loneliness, social support, stress and self-efficacy. Conclusion We found that community-engaged palliative care interventions can lead to appreciable changes in various outcomes, though it was difficult to determine in which contexts this approach works best because of the dearth of contextual information reported. Based on the varied design and implementation strategies, it is clear that no one method for enhancing end of life care will benefit all communities and it is crucial to engage community members at all stages of the design and implementation process. Future research should be grounded in appropriate theory, describe contextual differences in these communities, and should specifically examine how demographics, resource availability, and social capital might impact the design, implementation, and results of public health palliative care interventions.
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Affiliation(s)
- Anna Peeler
- Cicely Saunders Institute of Palliative Care, Policy, and Rehabilitation, King's College London, London, United Kingdom
| | - Alexandra Doran
- GKT School of Medical Education, King's College London, London, United Kingdom
| | - Lee Winter-Dean
- Cicely Saunders Institute of Palliative Care, Policy, and Rehabilitation, King's College London, London, United Kingdom
| | - Mueed Ijaz
- GKT School of Medical Education, King's College London, London, United Kingdom
| | - Molly Brittain
- Cicely Saunders Institute of Palliative Care, Policy, and Rehabilitation, King's College London, London, United Kingdom
| | - Lorraine Hansford
- Wellcome Centre for Cultures and Environments of Health, University of Exeter, Exeter, United Kingdom
| | - Katrina Wyatt
- Department of Health and Community Sciences, University of Exeter Medical School, Exeter, United Kingdom
| | - Libby Sallnow
- St Christopher's Hospice, London, United Kingdom
- End-of-Life Care Research Group, Vrije Universiteit Brussel, Brussels, Belgium
- Marie Curie Palliative Care Research Group, University College London, London, United Kingdom
| | - Richard Harding
- Cicely Saunders Institute of Palliative Care, Policy, and Rehabilitation, King's College London, London, United Kingdom
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Sun PYW, Fanning J, Peeler A, Shou B, Lindsley J, Caturegli G, Whitman G, Cha S, Kim BS, Cho SM. Characteristics of delirium and its association with sedation and in-hospital mortality in patients with COVID-19 on veno-venous extracorporeal membrane oxygenation. Front Med (Lausanne) 2023; 10:1172063. [PMID: 37305142 PMCID: PMC10248255 DOI: 10.3389/fmed.2023.1172063] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Accepted: 04/25/2023] [Indexed: 06/13/2023] Open
Abstract
Background Veno-venous extracorporeal membrane oxygenation (VV-ECMO) has been used in patients with COVID-19 acute respiratory distress syndrome (ARDS). We aim to assess the characteristics of delirium and describe its association with sedation and in-hospital mortality. Methods We retrospectively reviewed adult patients on VV-ECMO for severe COVID-19 ARDS in the Johns Hopkins Hospital ECMO registry in 2020-2021. Delirium was assessed by the Confusion Assessment Method for the ICU (CAM-ICU) when patients scored-3 or above on the Richmond Agitation-Sedation Scale (RASS). Primary outcomes were delirium prevalence and duration in the proportion of days on VV-ECMO. Results Of 47 patients (median age = 51), 6 were in a persistent coma and 40 of the remaining 41 patients (98%) had ICU delirium. Delirium in the survivors (n = 21) and non-survivors (n = 26) was first detected at a similar time point (VV-ECMO day 9.5(5,14) vs. 8.5(5,21), p = 0.56) with similar total delirium days on VV-ECMO (9.5[3.3, 16.8] vs. 9.0[4.3, 28.3] days, p = 0.43). Non-survivors had numerically lower RASS scores on VV-ECMO days (-3.72[-4.42, -2.96] vs. -3.10[-3.91, -2.21], p = 0.06) and significantly prolonged delirium-unassessable days on VV-ECMO with a RASS of -4/-5 (23.0[16.3, 38.3] vs. 17.0(6,23), p = 0.03), and total VV-ECMO days (44.5[20.5, 74.3] vs. 27.0[21, 38], p = 0.04). The proportion of delirium-present days correlated with RASS (r = 0.64, p < 0.001), the proportions of days on VV-ECMO with a neuromuscular blocker (r = -0.59, p = 0.001), and with delirium-unassessable exams (r = -0.69, p < 0.001) but not with overall ECMO duration (r = 0.01, p = 0.96). The average daily dosage of delirium-related medications on ECMO days did not differ significantly. On an exploratory multivariable logistic regression, the proportion of delirium days was not associated with mortality. Conclusion Longer duration of delirium was associated with lighter sedation and shorter paralysis, but it did not discern in-hospital mortality. Future studies should evaluate analgosedation and paralytic strategies to optimize delirium, sedation level, and outcomes.
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Affiliation(s)
- Philip Young-woo Sun
- Division of Neurosciences Critical Care, Departments of Neurology, Neurosurgery, and Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Jonathon Fanning
- Division of Cardiothoracic Surgery, Department of Surgery, Johns Hopkins Hospital, Baltimore, MD, United States
| | - Anna Peeler
- King's College London, Cicely Saunders Institute of Palliative Care, Policy, and Rehabilitation, London, United Kingdom
| | - Benjamin Shou
- Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - John Lindsley
- Department of Pharmacy, Johns Hopkins Hospital, Baltimore, MD, United States
| | - Giorgio Caturegli
- Department of Surgery, Yale School of Medicine, New Haven, CT, United States
| | - Glenn Whitman
- Division of Cardiothoracic Surgery, Department of Surgery, Johns Hopkins Hospital, Baltimore, MD, United States
| | - Stephanie Cha
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University, Baltimore, MD, United States
| | - Bo Soo Kim
- Department of Pulmonary Critical Care Medicine, Johns Hopkins University, Baltimore, MD, United States
| | - Sung-Min Cho
- Division of Neurosciences Critical Care, Departments of Neurology, Neurosurgery, and Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States
- Division of Cardiothoracic Surgery, Department of Surgery, Johns Hopkins Hospital, Baltimore, MD, United States
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10
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Wu Y, Prasanna A, Miller HN, Ogungbe O, Peeler A, Juraschek SP, Turkson-Ocran RA, Plante TB. Female Recruitment Into Cardiovascular Disease Trials. Am J Cardiol 2023; 198:88-91. [PMID: 37210978 DOI: 10.1016/j.amjcard.2023.03.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Revised: 03/21/2023] [Accepted: 03/31/2023] [Indexed: 05/23/2023]
Affiliation(s)
- Yingfei Wu
- Department of Medicine, New York University Langone Health, New York, New York.
| | | | - Hailey N Miller
- School of Nursing, Duke University, Durham, North Carolina; Institute for Clinical and Translational Research and
| | - Oluwabunmi Ogungbe
- Institute for Clinical and Translational Research and; School of Nursing, Johns Hopkins University, Baltimore, Maryland
| | - Anna Peeler
- Institute for Clinical and Translational Research and; School of Nursing, Johns Hopkins University, Baltimore, Maryland
| | - Stephen P Juraschek
- Division of General Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | | | - Timothy B Plante
- Department of Medicine, Larner College of Medicine at the University of Vermont, Colchester, Vermont
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Koirala B, Peeler A, Dennison Himmelfarb C, Davidson PM. Living with multiple chronic conditions: How we achieve holistic care and optimize health outcomes. J Adv Nurs 2023; 79:e7-e9. [PMID: 36062872 PMCID: PMC9877113 DOI: 10.1111/jan.15433] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Revised: 08/16/2022] [Accepted: 08/20/2022] [Indexed: 01/28/2023]
Abstract
Editorials are opinion pieces. This piece has not been subject to peer review and the opinions expressed are those of the authors. None of the authors have relevant political or other affiliations to declare.
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Affiliation(s)
- Binu Koirala
- Johns Hopkins University School of Nursing, Baltimore, Maryland, USA
| | - Anna Peeler
- Johns Hopkins University School of Nursing, Baltimore, Maryland, USA
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12
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Peeler A, Nelson K, Badawi S, Street L, Hager D, Davidson P, Koirala B. LIVING WITH MULTIMORBIDITY: SHARED EXPERIENCES OF PATIENTS, FAMILY CAREGIVERS, AND HEALTHCARE PROFESSIONALS. Innov Aging 2022. [PMCID: PMC9770664 DOI: 10.1093/geroni/igac059.1854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Over 50% of patients in intermediate care units (IMCU) present with multimorbidity, two or more chronic conditions. Balancing the effects of multimorbidity and their treatments with quality-of-life can be a challenge. This experience-based co-design project aimed to elicit experiences of patients, family caregivers, and healthcare professionals in IMCU, in the context of challenges and intricacies of multimorbidity management, to inform the development of a symptom management toolkit. Patients aged 55 years and older were recruited and interviewed in person. Healthcare professionals working in IMCU (i.e., physicians, nurses, respiratory therapists, social workers, etc.) were recruited and interviewed virtually. Participants were asked questions about their role in recognizing and treating symptoms, factors affecting quality of life, symptom burden and trajectory over time, and symptom management strategies that have and have not worked. An inductive thematic analysis approach was used for data analysis. Twenty-three interviews were conducted: 9 patients, 2 family-caregivers, and 12 healthcare professionals. Patients’ mean age was 67.5 (± 6.5) years, over half (n=5) were Black or Hispanic, and average number of multimorbidity was 3.67. Five major themes emerged: 1) importance of patient-provider relationship; 2) open and honest communication; 3) accessibility of resources during hospitalization and at discharge; 4) caregiver support, training, and education; and 5) care-coordination and follow-up care. Patients, caregivers, and healthcare professionals often have different priorities for multimorbidity management, treatment, and education. However, given the growing population of patients experiencing multimorbidity, it is imperative to identify shared priorities and target holistic interventions considering their experiences to enhance outcomes.
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Affiliation(s)
- Anna Peeler
- Johns Hopkins University School of Nursing, Baltimore, Maryland, United States
| | - Katie Nelson
- Johns Hopkins University, Baltimore, Maryland, United States
| | - Sarah Badawi
- Johns Hopkins University, Baltimore, Maryland, United States
| | - Lara Street
- Johns Hopkins Hospital, Baltimore, Maryland, United States
| | - David Hager
- Johns Hopkins Hospital, Baltimore, Maryland, United States
| | | | - Binu Koirala
- Johns Hopkins University, Baltimore, Maryland, United States
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Moser CH, Peeler A, Long R, Schoneboom B, Budhathoki C, Pelosi PP, Brenner MJ, Pandian V. Prevention of Tracheostomy-Related Pressure Injury: A Systematic Review and Meta-analysis. Am J Crit Care 2022; 31:499-507. [PMID: 36316177 DOI: 10.4037/ajcc2022659] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND In the critical care environment, individuals who undergo tracheostomy are highly susceptible to tracheostomy-related pressure injuries. OBJECTIVE To evaluate the effectiveness of interventions to reduce tracheostomy-related pressure injury in the critical care setting. METHODS MEDLINE, Embase, CINAHL, and the Cochrane Library were searched for studies of pediatric or adult patients in intensive care units conducted to evaluate interventions to reduce tracheostomy-related pressure injury. Reviewers independently extracted data on study and patient characteristics, incidence of tracheostomy-related pressure injury, characteristics of the interventions, and outcomes. Study quality was assessed using the Cochrane Collaboration's risk-of-bias criteria. RESULTS Ten studies (2 randomized clinical trials, 5 quasi-experimental, 3 observational) involving 2023 critically ill adult and pediatric patients met eligibility criteria. The incidence of tracheostomy-related pressure injury was 17.0% before intervention and 3.5% after intervention, a 79% decrease. Pressure injury most commonly involved skin in the peristomal area and under tracheostomy ties and flanges. Interventions to mitigate risk of tracheostomy-related pressure injury included modifications to tracheostomy flange securement with foam collars, hydrophilic dressings, and extended-length tracheostomy tubes. Interventions were often investigated as part of care bundles, and there was limited standardization of interventions between studies. Meta-analysis supported the benefit of hydrophilic dressings under tracheostomy flanges for decreasing tracheostomy-related pressure injury. CONCLUSIONS Use of hydrophilic dressings and foam collars decreases the incidence of tracheostomy-related pressure injury in critically ill patients. Evidence regarding individual interventions is limited by lack of sensitive measurement tools and by use of bundled interventions. Further research is necessary to delineate optimal interventions for preventing tracheostomy-related pressure injury.
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Affiliation(s)
- Chandler H Moser
- Chandler H. Moser is a PhD candidate, School of Nursing, Johns Hopkins University, Baltimore, Maryland
| | - Anna Peeler
- Anna Peeler is a PhD candidate, School of Nursing, Johns Hopkins University, Baltimore, Maryland
| | - Robert Long
- Robert Long is chief of anesthesia nursing, Walter Reed National Military Medical Center, Bethesda, Maryland
| | - Bruce Schoneboom
- Bruce Schoneboom (retired) was associate dean for Practice, Innovation, and Leadership, School of Nursing, Johns Hopkins University, Baltimore, Maryland
| | - Chakra Budhathoki
- Chakra Budhathoki is a biostatistician, School of Nursing and Biostatistics Core, Johns Hopkins University
| | - Paolo P Pelosi
- Paolo P. Pelosi is a chief professor, Anaesthesia and Intensive Care, and director, Specialty School in Anaesthesiology, University of Genoa, and head of the Anaesthesia and Intensive Care Unit at IRCCS San Martino-IST Hospital, Genoa, Italy
| | - Michael J Brenner
- Michael J. Brenner is an associate professor, Department of Otolaryngology-Head and Neck Surgery, University of Michigan, Ann Arbor, and President, Global Tracheostomy Collaborative, Raleigh, North Carolina
| | - Vinciya Pandian
- Vinciya Pandian is an associate professor, School of Nursing and Outcomes After Critical Illness and Surgery (OACIS) Research Group, Johns Hopkins University
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Moser CH, Peeler A, Long R, Schoneboom B, Budhathoki C, Pelosi PP, Brenner MJ, Pandian V. Prevention of Endotracheal Tube-Related Pressure Injury: A Systematic Review and Meta-analysis. Am J Crit Care 2022; 31:416-424. [PMID: 36045034 DOI: 10.4037/ajcc2022644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
BACKGROUND Hospital-acquired pressure injuries, including those related to airway devices, are a significant source of morbidity in critically ill patients. OBJECTIVE To determine the incidence of endotracheal tube-related pressure injuries in critically ill patients and to evaluate the effectiveness of interventions designed to prevent injury. METHODS MEDLINE, Embase, CINAHL, and the Cochrane Library were searched for studies of pediatric or adult patients in intensive care units that evaluated interventions to reduce endotracheal tube-related pressure injury. Reviewers extracted data on study and patient characteristics, incidence of pressure injury, type and duration of intervention, and outcomes. Risk of bias assessment followed the Cochrane Collaboration's criteria. RESULTS Twelve studies (5 randomized clinical trials, 3 quasi-experimental, 4 observational) representing 9611 adult and 152 pediatric patients met eligibility criteria. The incidence of pressure injury was 4.2% for orotracheal tubes and 21.1% for nasotracheal tubes. Interventions included anchor devices, serial endotracheal tube assessment or repositioning, and barrier dressings for nasotracheal tubes. Meta-analysis revealed that endotracheal tube stabilization was the most effective individual intervention for preventing pressure injury. Nasal alar barrier dressings decreased the incidence of skin or mucosal injury in patients undergoing nasotracheal intubation, and data on effectiveness of serial assessment and repositioning were inconclusive. CONCLUSIONS Airway device-related pressure injuries are common in critically ill patients, and patients with nasotracheal tubes are particularly susceptible to iatrogenic harm. Fastening devices and barrier dressings decrease the incidence of injury. Evidence regarding interventions is limited by lack of standardized assessments.
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Affiliation(s)
- Chandler H Moser
- Chandler H. Moser is a PhD candidate, School of Nursing, Johns Hopkins University, Baltimore, Maryland
| | - Anna Peeler
- Anna Peeler is a PhD candidate, School of Nursing, Johns Hopkins University, Baltimore, Maryland
| | - Robert Long
- Robert Long is chief of anesthesia nursing, Walter Reed National Military Medical Center, Bethesda, Maryland
| | - Bruce Schoneboom
- Bruce Schoneboom (retired) was associate dean for Practice, Innovation, and Leadership, School of Nursing, Johns Hopkins University, Baltimore, Maryland
| | - Chakra Budhathoki
- Chakra Budhathoki is a biostatistician, School of Nursing and Biostatistics Core, Johns Hopkins University
| | - Paolo P Pelosi
- Paolo P. Pelosi is a chief professor, Anaesthesia and Intensive Care, and director, Specialty School in Anaesthesiology, University of Genoa, and head of the Anaesthesia and Intensive Care Unit at IRCCS San Martino-IST Hospital, Genoa, Italy
| | - Michael J Brenner
- Michael J. Brenner is an associate professor, Department of Otolaryngology-Head and Neck Surgery, University of Michigan, Ann Arbor, and President, Global Tracheostomy Collaborative, Raleigh, North Carolina
| | - Vinciya Pandian
- Vinciya Pandian is an associate professor, School of Nursing and Outcomes After Critical Illness and Surgery (OACIS) Research Group, Johns Hopkins University
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Peeler A, Gleason KT, Ferrell B, Battista V, Klinedinst R, Cho SM, Davidson PM. Extracorporeal Membrane Oxygenation: Opportunities for Expanding Nurses' Roles. AACN Adv Crit Care 2021; 32:341-345. [PMID: 34490441 DOI: 10.4037/aacnacc2021862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Affiliation(s)
- Anna Peeler
- Anna Peeler is a PhD student, Johns Hopkins University School of Nursing, 525 N Wolfe St, Baltimore, MD 21205
| | - Kelly T Gleason
- Kelly T. Gleason is Assistant Professor, Johns Hopkins University School of Nursing, Baltimore, Maryland
| | - Betty Ferrell
- Betty Ferrell is Professor, City of Hope National Medical Center, Duarte, California
| | - Vanessa Battista
- Vanessa Battista is Nurse Practitioner, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Rachel Klinedinst
- Rachel Klinedinst is Nurse Practitioner, Hospital of University of Pennsylvania, Philadelphia, Pennsylvania
| | - Sung-Min Cho
- Sung-Min Cho is Neuro Intensivist and Assistant Professor, Division of Neuroscience Critical Care, Departments of Neurology and Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Patricia M Davidson
- Patricia M. Davidson is Vice-Chancellor, University of Wollongong, Wollongong NSW, Australia
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Prasanna A, Miller HN, Wu Y, Peeler A, Ogungbe O, Plante TB, Juraschek SP. Recruitment of Black Adults into Cardiovascular Disease Trials. J Am Heart Assoc 2021; 10:e021108. [PMID: 34431310 PMCID: PMC8649250 DOI: 10.1161/jaha.121.021108] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Accepted: 06/01/2021] [Indexed: 11/21/2022]
Abstract
Background Although disproportionately affected by cardiovascular disease, Black adults remain underrepresented in clinical trials. The National Institutes of Health recommends that studies define goals for recruitment of underrepresented populations. However, the extent to which cardiovascular trials incorporate evidence-based recruitment strategies in their protocols is understudied. Methods and Results We systematically reviewed National Institutes of Health-funded cardiovascular clinical trials registered in ClinicalTrials.gov between 2000 and 2019. Based on publicly available or requested protocols, we focused on enrollment of Black adults as well as the following recruitment strategies: community-based, electronic medical record-based, and provider-based recruitment. A total of 100 clinical trials focused on cardiovascular disease were included in our analysis, of which 62% had published protocols, and 46% of trials had enrolled populations that were <25% Black. In our analysis of available trial protocols, 21% of trials defined a recruitment target for underrepresented groups; however, only one study reported achieving its enrollment goal. While 13% of trial protocols referenced community-based recruitment strategies, 5% explicitly mentioned involving community members in the trial design process. Defining recruitment targets was associated with higher enrollment of Black participants. Conclusions Black adults are underrepresented in National Institutes of Health-funded cardiovascular trials, and the majority of these trials did not specify a Black enrollment target, did not meet targets, and largely did not report specific plans to enroll Black adults in their studies. Future interventions should target trial design and planning phases before study initiation to address these enrollment disparities.
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Affiliation(s)
| | - Hailey N. Miller
- School of NursingDuke UniversityDurhamNC
- Institute for Clinical and Translational ResearchJohns Hopkins UniversityBaltimoreMD
| | | | - Anna Peeler
- Institute for Clinical and Translational ResearchJohns Hopkins UniversityBaltimoreMD
- School of NursingJohns Hopkins UniversityBaltimoreMD
| | - Oluwabunmi Ogungbe
- Institute for Clinical and Translational ResearchJohns Hopkins UniversityBaltimoreMD
- School of NursingJohns Hopkins UniversityBaltimoreMD
| | - Timothy B. Plante
- Department of MedicineLarner College of Medicine at the University of VermontColchesterVT
| | - Stephen P. Juraschek
- Department of MedicineBeth Israel Deaconess Medical CenterHarvard Medical SchoolBostonMA
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Peeler A, Miller H, Ogungbe O, Lewis Land C, Martinez L, Guerrero Vazquez M, Carey S, Murli S, Singleton M, Lacanienta C, Gleason K, Ford D, Himmelfarb CR. Centralized registry for COVID-19 research recruitment: Design, development, implementation, and preliminary results. J Clin Transl Sci 2021; 5:e152. [PMID: 34462668 PMCID: PMC8387691 DOI: 10.1017/cts.2021.819] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 06/30/2021] [Accepted: 07/08/2021] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND The Coronavirus Disease 2019 (COVID-19) pandemic has had substantial global morbidity and mortality. Clinical research related to prevention, diagnosis, and treatment of COVID-19 is a top priority. Effective and efficient recruitment is challenging even without added constraints of a global pandemic. Recruitment registries offer a potential solution to slow or difficult recruitment. OBJECTIVES The purpose of this paper is to describe the design and implementation of a digital research recruitment registry to optimize awareness and participant enrollment for COVID-19-related research in Baltimore and to report preliminary results. METHODS Planning began in March 2020, and the registry launched in July 2020. The primary recruitment mechanisms include electronic medical record data, postcards distributed at testing sites, and digital advertising campaigns. Following consent in a Research Electronic Data Capture survey, participants answer questions related to COVID-19 exposure, testing, and willingness to participate in research. Branching logic presents participants with studies they might be eligible for. RESULTS As of March 24, 2021, 9010 participants have enrolled, and 64.2% are female, 80.6% are White, 9.4% are Black or African American, and 6% are Hispanic or Latino. Phone outreach has had the highest response rate (13.1%), followed by email (11.9%), text (11.4%), and patient portal message (9.4%). Eleven study teams have utilized the registry, and 4596 matches have been made between study teams and interested volunteers. CONCLUSION Effective and efficient recruitment strategies are more important now than ever due to the time-limited nature of COVID-19 research. Pilot efforts have been successful in connecting interested participants with recruiting study teams.
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Affiliation(s)
- Anna Peeler
- Johns Hopkins University School of Nursing, Baltimore, MD, USA
- Johns Hopkins University Institute for Clinical and Translational Research, Baltimore, MD, USA
| | - Hailey Miller
- Johns Hopkins University Institute for Clinical and Translational Research, Baltimore, MD, USA
- Duke University School of Nursing, Durham, NC, USA
| | - Oluwabunmi Ogungbe
- Johns Hopkins University School of Nursing, Baltimore, MD, USA
- Johns Hopkins University Institute for Clinical and Translational Research, Baltimore, MD, USA
| | - Cassia Lewis Land
- Johns Hopkins University Institute for Clinical and Translational Research, Baltimore, MD, USA
| | - Liz Martinez
- Johns Hopkins University Institute for Clinical and Translational Research, Baltimore, MD, USA
| | - Monica Guerrero Vazquez
- Johns Hopkins School of Medicine, Baltimore, MD, USA
- Center for Salud/Health and Opportunity for Latinos, Baltimore, MD, USA
| | - Scott Carey
- Johns Hopkins University Institute for Clinical and Translational Research, Baltimore, MD, USA
| | - Sumati Murli
- Johns Hopkins University Institute for Clinical and Translational Research, Baltimore, MD, USA
| | - Megan Singleton
- Johns Hopkins University Institute for Clinical and Translational Research, Baltimore, MD, USA
| | - Cyd Lacanienta
- Johns Hopkins University Institute for Clinical and Translational Research, Baltimore, MD, USA
| | - Kelly Gleason
- Johns Hopkins University School of Nursing, Baltimore, MD, USA
- Johns Hopkins University Institute for Clinical and Translational Research, Baltimore, MD, USA
| | - Daniel Ford
- Johns Hopkins University Institute for Clinical and Translational Research, Baltimore, MD, USA
- Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Cheryl R. Himmelfarb
- Johns Hopkins University School of Nursing, Baltimore, MD, USA
- Johns Hopkins University Institute for Clinical and Translational Research, Baltimore, MD, USA
- Johns Hopkins School of Medicine, Baltimore, MD, USA
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18
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Ogungbe O, Miller H, Peeler A, Cassie LL, Carey S, Lacanienta C, Martinez E, Singleton M, Gleason KT, Keruly J, Ford D, Dennison Himmelfarb CR. Abstract MP36: The Development Of A Centralized Recruitment Process For Covid-19 Research: Hopkins Opportunity For Participant Engagement Registry. Circulation 2021. [DOI: 10.1161/circ.143.suppl_1.mp36] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Introduction:
The COVID-19 pandemic has required urgent scientific response to investigate the disease, its prevention and treatment and interactions with cardiovascular conditions. Consequently, a centralized workflow was needed to effectively recruit, screen and connect volunteers to COVID-19 research opportunities.
Objective:
To create a centralized registry to match eligible and interested volunteers ≥18 years with COVID-19 outpatient research studies at an academic health system.
Methods:
Key stakeholders, including researchers and participant advocates, collaborated to build the Hopkins Opportunity for Participant Engagement (HOPE) Registry in English and Spanish. REDCap, a secure web-based application, served as the Registry platform. Study teams recruiting for outpatient studies were invited to present their studies through the Registry. Study volunteers were recruited using multiple methods, including patient portal messages, email, social media, and online advertisement. The Registry included COVID testing results and participant survey of demographic and COVID-19 related questions. Branching logic was used to pre-screen and present participating studies for which the person was eligible. The individual then selected which studies, if any, they were interested in. Study teams received an automatic notification and reached out directly to individuals expressing interest in their study (
Figure
).
Results:
The HOPE Registry includes 7 studies and has enrolled 4186 people. Over half (55%) were >55 years and the majority were female (64%). Racial/ethnic groups represented were Whites (80%), Black s (9%), Asians (4.7%), Hispanics (5%), and American Indian (0.3%). Participants were interested in: 29%, treatment study; 37%, vaccine study; and 66%, donating plasma. Within 10 weeks, 585 persons were matched with an actively recruiting study.
Conclusions:
The ongoing HOPE registry has shown promise in engaging individuals with COVID-19 research and improving research recruitment workflow.
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Affiliation(s)
| | | | | | | | - Scott Carey
- Johns Hopkins Univ Sch of Medicine, Baltimore, MD
| | | | | | | | | | | | - Daniel Ford
- Johns Hopkins Univ Sch of Medicine, Baltimore, MD
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19
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Carlson JM, Etchill EW, Enriquez CAG, Peeler A, Whitman GJ, Choi CW, Geocadin RG, Cho SM. Population Characteristics and Markers for Withdrawal of Life-Sustaining Therapy in Patients on Extracorporeal Membrane Oxygenation. J Cardiothorac Vasc Anesth 2021; 36:833-839. [PMID: 34088552 DOI: 10.1053/j.jvca.2021.04.040] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 04/20/2021] [Accepted: 04/24/2021] [Indexed: 11/11/2022]
Abstract
OBJECTIVE As survival with extracorporeal membrane oxygenation (ECMO) therapy improves, it is important to study patients who do not survive secondary to withdrawal of life-sustaining therapy (WLST). The purpose of the present study was to determine the population and clinical characteristics of those who experienced short latency to WLST. DESIGN Retrospective cohort study. SETTING Single academic hospital center. PARTICIPANTS Adult ECMO patients. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS During the study period, 150 patients (mean age 54.8 ± 15.9 y, 43.3% female) underwent ECMO (80% venoarterial ECMO and 20% venovenous ECMO). Seventy-three (48.7%) had WLST from ECMO support (median five days), and 33 of those (45.2%) had early WLST (≤five days). Patients who underwent WLST were older (60.3 ± 15.3 y v 49.6 ± 14.7 y; p < 0.001) than those who did not undergo WLST and had greater body mass index (31.7 ± 7.6 kg/m2v 28.3 ± 5.5 kg/m2; p = 0.002), longer ECMO duration (six v four days; p = 0.01), and higher Acute Physiology and Chronic Health Evaluation (25 v 21; p < 0.001) and Sequential Organ Failure Assessment (12 v 11; p = 0.037) scores. Family request frequently (91.7%) was cited as part of the WLST decision. WLST patients experienced more chaplaincy (89% v 65%; p < 0.001), palliative care consults (53.4% v 29.9%; p = 0.003), and code status change (do not resuscitate: 83.6% v 7.8%; p < 0.001). CONCLUSIONS Nearly 50% of ECMO patients underwent WLST, with approximately 25% occurring in the first 72 hours. These patients were older, sicker, and experienced a different clinical context. Unlike with other critical illnesses, neurologic injury was not a primary reason for WLST in ECMO patients.
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Affiliation(s)
- Julia M Carlson
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Eric W Etchill
- Division of Cardiac Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Clare Angeli G Enriquez
- Department of Neurosciences, University of the Philippines Manila-Philippine General Hospital, Manila, Philippines
| | - Anna Peeler
- Johns Hopkins University School of Nursing, Baltimore, MD
| | - Glenn J Whitman
- Division of Cardiac Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Chun Woo Choi
- Division of Cardiac Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Romergryko G Geocadin
- Division of Neuroscience Critical Care, Departments of Neurology and Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Sung-Min Cho
- Division of Neuroscience Critical Care, Departments of Neurology and Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD.
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20
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Peeler A, Gleason KT, Cho SM, Davidson PM. Extracorporeal Membrane Oxygenation in Acute Respiratory Distress Syndrome: How Do We Expand Capacity in the COVID-19 Era? Heart Lung Circ 2021; 30:623-625. [PMID: 33707137 PMCID: PMC7927577 DOI: 10.1016/j.hlc.2021.03.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Anna Peeler
- Johns Hopkins School of Nursing, Baltimore, MD, USA.
| | - Kelly T Gleason
- Johns Hopkins School of Nursing, Baltimore, MD, USA. https://twitter.com/KTG_RN
| | - Sung-Min Cho
- Division of Neuroscience Critical Care, Departments of Neurology and Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Patricia M Davidson
- Johns Hopkins School of Nursing, Baltimore, MD, USA. https://twitter.com/nursingdean
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21
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Racy S, Davidson PM, Peeler A, Hager DN, Street L, Koirala B. A review of inpatient nursing workload measures. J Clin Nurs 2021; 30:1799-1809. [PMID: 33503306 DOI: 10.1111/jocn.15676] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Revised: 01/12/2021] [Accepted: 01/18/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND Fiscal constraints, an ageing populations and the increasing burden of chronic conditions are stressing health systems internationally. Nurses are the linchpin of effective healthcare delivery and their success is dependent on adequate staffing models, which must align knowledge, skills and competencies with workload. OBJECTIVES To compare measures of nursing workload in adult inpatient settings. DESIGN, DATA SOURCES AND REVIEW METHOD A review of published studies characterising nursing workload measures was undertaken. Databases-PubMed and CINHAL-were used to identify published studies. A description of the psychometric properties of each measure and its use in an inpatient setting was required for inclusion. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement was used to guide and report the review. RESULTS Of the 1,422 studies identified, 15 met the inclusion criteria. Nursing workload was measured in the intermediate care unit (n = 6), overall hospital (n = 7), emergency department (n = 1) and burn unit (n = 1) settings and also by mailed survey (n = 1). Eleven different workload measures were identified. The National Aeronautics and Space Administration Task Load Index (n = 3), Therapeutic Intervention Scoring System (n = 3) and Nursing Activities Score (n = 2) were the most common nursing workload measures identified with reported psychometric properties. CONCLUSION Researchers, clinicians and hospital administrators should carefully identify and assess the psychometric properties of nursing workload measures before using these in routine practice. RELEVANCE TO CLINICAL PRACTICE Gaining a consensus on effective nursing workload measures is a crucial step in designing appropriate staffing models and policies, improving nurse productivity and well-being, as well as enhancing patient health outcomes in inpatient settings.
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Affiliation(s)
- Stepney Racy
- Johns Hopkins University School of Nursing, Baltimore, MD, USA
| | | | - Anna Peeler
- Johns Hopkins University School of Nursing, Baltimore, MD, USA
| | - David N Hager
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | | | - Binu Koirala
- Johns Hopkins University School of Nursing, Baltimore, MD, USA
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22
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Nelson KE, Wright R, Peeler A, Brockie T, Davidson PM. Sociodemographic Disparities in Access to Hospice and Palliative Care: An Integrative Review. Am J Hosp Palliat Care 2021; 38:1378-1390. [PMID: 33423532 DOI: 10.1177/1049909120985419] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND There is growing evidence of disparities in access to hospice and palliative care services to varying degrees by sociodemographic groups. Underlying factors contributing to access issues have received little systematic attention. OBJECTIVE To synthesize current literature on disparities in access to hospice and palliative care, highlight the range of sociodemographic groups affected by these inequities, characterize the domains of access addressed, and outline implications for research, policy, and clinical practice. DESIGN An integrative review comprised a systematic search of PubMed, Embase, and CINAHL databases, which was conducted from inception to March 2020 for studies outlining disparities in hospice and palliative care access in the United States. Data were analyzed using critical synthesis within the context of a health care accessibility conceptual framework. Included studies were appraised on methodological quality and quality of reporting. RESULTS Of the articles included, 80% employed non-experimental study designs. Study measures varied, but 70% of studies described differences in outcomes by race, ethnicity, or socioeconomic status. Others revealed disparate access based on variables such as age, gender, and geographic location. Overall synthesis highlighted evidence of disparities spanning 5 domains of access: Approachability, Acceptability, Availability, Affordability, and Appropriateness; 60% of studies primarily emphasized Acceptability, Affordability, and Appropriateness. CONCLUSIONS This integrative review highlights the need to consider various stakeholder perspectives and attitudes at the individual, provider, and system levels going forward, to target and address access issues spanning all domains.
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Affiliation(s)
- Katie E Nelson
- Johns Hopkins University School of Nursing, Baltimore, MD, USA
| | - Rebecca Wright
- Johns Hopkins University School of Nursing, Baltimore, MD, USA
| | - Anna Peeler
- Johns Hopkins University School of Nursing, Baltimore, MD, USA
| | - Teresa Brockie
- Johns Hopkins University School of Nursing, Baltimore, MD, USA
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