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Wright KB, Bylund CL, Bagautdinova D, Vasquez TS, Sae-Hau M, S Weiss E, Rajotte M, Fisher CL. Caring for an Individual with Chronic Lymphocytic Leukemia (CLL): Understanding Family Caregivers' Perceptions of Social Support, Caregiver Burden, and Unmet Support Needs. J Cancer Educ 2024; 39:180-185. [PMID: 38049567 DOI: 10.1007/s13187-023-02392-8] [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] [Subscribe] [Scholar Register] [Accepted: 11/29/2023] [Indexed: 12/06/2023]
Abstract
Family caregivers (FCs) of a patient with chronic lymphocytic leukemia (CLL) can encounter unpredictable challenges and care demands. They can experience high levels of burden, a loss of self-care, and poor quality of life. Their receipt of social support and ability to communicate with clinicians may impact their burden. FCs would benefit from educational resources that teach them communication skills central to their ability to obtain the support they need-support that is imperative to reducing burden. To better target psychosocial educational interventions focused on social support and communication skills, we aimed to explore the relationship between social support, sources of support, and burden; the relationship between FCs' clinical communication and their perceptions of support and burden; and any unmet support needs. A total of 575 CLL FCs completed an online survey of validated scales about social support, burden, and clinical communication, as well as an open-ended item in which they reported any unmet support needs. Statistical analyses showed that FCs who perceived they were more supported reported less burden, and female FCs reported more burden than males. Support from family, friends, and professionals collectively contributed to FCs' support. FCs who perceived they had stronger communication skills with their loved one's clinicians reported more social support. FCs identified six areas of unmet support needs: financial, emotional, informational, instrumental, peer, and communication support. Collectively, findings show that increased social support can reduce FCs' burden and qualitative findings provide a roadmap of social support domains to target that could potentially improve the caregiving experience.
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Affiliation(s)
- Kevin B Wright
- College of Humanities and Social Sciences, George Mason University, Fairfax, VA, USA.
| | - Carma L Bylund
- College of Medicine, University of Florida, Gainesville, FL, USA
| | - Diliara Bagautdinova
- School of Medicine, Department of Oncology, Karmanos Cancer Institute, Wayne State University, Detroit, MI, USA
| | - Taylor S Vasquez
- College of Journalism and Communications, University of Florida, Gainesville, FL, USA
| | | | | | | | - Carla L Fisher
- College of Medicine, University of Florida, Gainesville, FL, USA
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Gutman CK, Fernandez R, McFarlane A, Krajewski JMT, Casey Lion K, Aronson PL, Bylund CL, Holmes S, Fisher CL. "Let us take care of the medicine": A qualitative analysis of physician communication when caring for febrile infants. Acad Pediatr 2024:S1876-2859(24)00070-6. [PMID: 38458491 DOI: 10.1016/j.acap.2024.03.002] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Revised: 02/27/2024] [Accepted: 03/01/2024] [Indexed: 03/10/2024]
Abstract
BACKGROUND Guidelines for the management of febrile infants emphasize patient-centered communication. Although patient-centeredness is central to high-quality healthcare, biases may impact physicians' patient-centeredness. We aimed to 1) identify physicians' assumptions that inform their communication with parents of febrile infants and 2) examine physicians' perceptions of bias. METHODS We recruited physicians from three academic pediatric emergency departments (EDs) for semi-structured interviews. We applied a constant comparative method approach to conduct a thematic analysis of interview transcripts. Two coders followed several analytical steps: 1) discovery of concepts and code assignment, 2) identification of themes by grouping concepts, 3) axial coding to identify thematic properties, and 4) identifying exemplar excerpts for rich description. Thematic saturation was based on repetition, recurrence, and forcefulness. RESULTS Fourteen physicians participated. Participants described making assumptions regarding three areas: 1) the parent's affect, 2) the parent's social capacity, and 3) the physician's own role in the parent-physician interaction. Thematic properties highlighted the importance of the physician's assumptions in guiding communication and decision-making. Participants acknowledged an awareness of bias, and specifically noted that language bias influenced the assumptions that informed their communication. CONCLUSIONS ED physicians described subjective assumptions about parents that informed their approach to communication when caring for febrile infants. Given the emphasis on patient-centered communication in febrile infant guidelines, future efforts are necessary to understand how assumptions are influenced by biases, the effect of such behaviors on health inequities, and how to combat this. WHAT'S NEW Physician communication drives health outcomes. In this qualitative investigation, physicians described making assumptions about parents, based on subjective assessments, which informed their communication and decision-making. This represents a step towards understanding how biases inform communication and result in health inequity.
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Affiliation(s)
- Colleen K Gutman
- Departments of Emergency Medicine and Pediatrics, University of Florida College of Medicine, Gainesville, FL.
| | - Rosemarie Fernandez
- Department of Emergency Medicine and Center for Experiential Learning and Simulation, University of Florida College of Medicine, Gainesville, FL
| | - Antionette McFarlane
- Department of Emergency Medicine and Center for Experiential Learning and Simulation, University of Florida College of Medicine, Gainesville, FL
| | | | - K Casey Lion
- Department of Pediatrics, University of Washington School of Medicine, Seattle, WA; Center for Child Health, Behavior, and Development, Seattle Children's Research Institute, Seattle, WA
| | - Paul L Aronson
- Departments of Pediatrics and Emergency Medicine, Section of Pediatric Emergency Medicine, Yale School of Medicine, New Haven, CT
| | - Carma L Bylund
- Department of Health Outcomes & Biomedical Informatics, University of Florida College of Medicine, Gainesville, Fl
| | - Sherita Holmes
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA
| | - Carla L Fisher
- Departments of Pediatrics and Emergency Medicine, Section of Pediatric Emergency Medicine, Yale School of Medicine, New Haven, CT
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Mroz EL, Kastrinos A, Bacharz K, Fisher CL, Applebaum AJ. "A little bit different now": Impacts of caregiving for parent with cancer on psychosocial development in emerging and young adulthood. Death Stud 2024:1-12. [PMID: 38293809 DOI: 10.1080/07481187.2024.2309488] [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] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/01/2024]
Abstract
Serving as a family caregiver for, and ultimately losing, a parent with advanced cancer in emerging and young adulthood has substantial, life phase-specific implications for psychosocial development. This qualitative study characterizes domains of psychosocial development impacted by cancer caregiving and parental death in this life phase. As part of a larger study, 33 bereaved emerging/young adult caregivers of parents who died following advanced cancer completed semi-structured interviews. A thematic analysis leveraging the constant comparative method was conducted by two coders and generated three themes, which described impacts of caregiving on: identity, life path, and relational intimacy and roles. Analyses also defined specific outcomes within these domains. Findings suggest that cancer caregiving-loss experiences can greatly influence developmental pursuits in this life phase. Findings validate a range of possible psychosocial impacts these caregivers may experience and can guide development of supportive resources for this growing subgroup of bereaved family caregivers.
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Affiliation(s)
- Emily L Mroz
- Section of Geriatrics, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Amanda Kastrinos
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Kelsey Bacharz
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, Gainesville, Florida, USA
| | - Carla L Fisher
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, Gainesville, Florida, USA
| | - Allison J Applebaum
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, New York, USA
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Wollney EN, Bylund CL, Kastrinos AL, Campbell-Salome G, Sae-Hau M, Weiss ES, Fisher CL. Understanding parents uncertainty sources and management strategies while caring for a child diagnosed with a hematologic cancer. PEC Innov 2023; 3:100198. [PMID: 37662692 PMCID: PMC10468798 DOI: 10.1016/j.pecinn.2023.100198] [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] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 08/03/2023] [Accepted: 08/08/2023] [Indexed: 09/05/2023]
Abstract
Rationale Parents of a child or adolescent (CA) or young adult (YA) diagnosed with a hematologic cancer often face uncertainty. Managing uncertainty is critical to reduce the psychosocial burden of illness-related stressors. Objective This study sought to identify: 1) sources of uncertainty among parents of a child diagnosed with a hematologic cancer, 2) strategies used by parents to manage uncertainty, and 3) clinicians' responses to parents' online information-seeking approach to managing uncertainty. Methods Parents of CAs/YAs diagnosed with a hematologic cancer within the past 1-18 months and living in the U.S. participated in an in-depth, semi-structured phone interview (n = 20). Data were analyzed thematically. Results Parents reported uncertainty about treatment (options, efficacy, and side effects or risks) and uncertainty about the future (recurrence, whether worry would subside, and how to approach the child's future). Parents managed uncertainty by seeking information online, talking to clinicians, and joining support groups. Clinicians' responses to online information-seeking were described as supportive and unsupportive. Conclusion Parents described struggling with uncertainty across the cancer continuum (from primary treatment to survivorship). Parents' psychosocial health may benefit from individual and systems level interventions that help address and manage uncertainty, especially interventions focusing on parent caregiver-clinician communication.
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Affiliation(s)
- Easton N. Wollney
- Department of Health Outcomes & Biomedical Informatics, University of Florida, Gainesville, FL, United States of America
| | - Carma L. Bylund
- Department of Health Outcomes & Biomedical Informatics, University of Florida, Gainesville, FL, United States of America
- Cancer Control and Population Sciences Program (CCPS), University of Florida Health Cancer Center, University of Florida, Gainesville, FL, United States of America
| | - Amanda L. Kastrinos
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, United States of America
| | - Gemme Campbell-Salome
- Genomic Medicine Institute, Department of Population Health Sciences, Geisinger, Danville, PA, United States of America
| | - Maria Sae-Hau
- The Leukemia & Lymphoma Society, Rye Brook, NY, United States of America
| | - Elisa S. Weiss
- The Leukemia & Lymphoma Society, Rye Brook, NY, United States of America
| | - Carla L. Fisher
- Department of Health Outcomes & Biomedical Informatics, University of Florida, Gainesville, FL, United States of America
- Cancer Control and Population Sciences Program (CCPS), University of Florida Health Cancer Center, University of Florida, Gainesville, FL, United States of America
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Wollney EN, Vasquez TS, Fisher CL, Armstrong MJ, Paige SR, Alpert J, Bylund CL. A systematic scoping review of patient and caregiver self-report measures of satisfaction with clinicians' communication. Patient Educ Couns 2023; 117:107976. [PMID: 37738791 DOI: 10.1016/j.pec.2023.107976] [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] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Revised: 09/05/2023] [Accepted: 09/07/2023] [Indexed: 09/24/2023]
Abstract
OBJECTIVE We conducted a systematic scoping review of self-report tools used to measure patient and/or caregiver satisfaction with clinician communication. Aims included identifying: 1) instruments that have been used to measure communication satisfaction, and 2) content of the communication items on measures. METHODS Two databases (PubMed and CINAHL) were searched for relevant studies. Eligibility included patient or caregiver self-report tools assessing satisfaction with clinicians' communication in a biomedical healthcare setting; and the stated purpose for using the measurement involved evaluating communication satisfaction and measures included more than one question about this. All data were charted in a form created by the authors. RESULTS Our search yielded a total of 4531 results screened as title and abstracts; 228 studies were screened in full text and 85 studies were included in the review. We found 53 different tools used to measure communication satisfaction among those 85 studies, including 29 previously used measures (e.g., FS-ICU-24, CAHPS), and 24 original measures developed by authors. Content of communication satisfaction items included satisfaction with content-specific communication, interpersonal communication skills of clinicians, communicating to set the right environment, and global communication satisfaction items. CONCLUSION There was high variability in the number of items and types of content on measures. Communication satisfaction should be better conceptualized to improve measurement, and more robust measures should be created to capture complex factors of communication satisfaction. PRACTICE IMPLICATIONS Creating a rigorous evaluation of satisfaction with clinician communication may help strengthen communication research and the assessment of communication interventions.
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Affiliation(s)
- Easton N Wollney
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, Gainesville, FL, USA.
| | - Taylor S Vasquez
- College of Journalism & Communications, University of Florida, Gainesville, FL, USA
| | - Carla L Fisher
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, Gainesville, FL, USA; Cancer Control and Population Sciences Program (CCPS), UF Health Cancer Center, Gainesville, FL, USA
| | - Melissa J Armstrong
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, Gainesville, FL, USA; Department of Neurology, College of Medicine, University of Florida, Gainesville, FL, USA; Norman Fixel Institute for Neurological Diseases, UF Health, Gainesville, FL, USA
| | - Samantha R Paige
- Health & Wellness Solutions, Johnson & Johnson, Inc., New Brunswick, NJ, USA
| | - Jordan Alpert
- Internal Medicine and Geriatrics, Cleveland Clinic, Cleveland, OH, USA
| | - Carma L Bylund
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, Gainesville, FL, USA; Cancer Control and Population Sciences Program (CCPS), UF Health Cancer Center, Gainesville, FL, USA
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Kastrinos A, Bylund CL, Bacharz K, Applebaum AJ, Fisher CL. Understanding the role of parents' information sharing and withholding on emerging and young adults' caregiving and coping during their parents' advanced cancer. J Psychosoc Oncol 2023:1-15. [PMID: 37929571 DOI: 10.1080/07347332.2023.2276940] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2023]
Abstract
Emerging and young adult caregivers (EYACs) who provide care to their parents are a hidden, unsupported population of caregivers. Research identifies information sharing or withholding as a key aspect of caregivers' ability to cope and adjust, which may be especially critical when a parent is diagnosed with advanced cancer. The goal of this study was to examine the impact of parent information sharing/withholding on EYACs' caregiving and coping experiences. We conducted in-depth, semi-structured interviews with 33 EYACs between the ages of 18-35 who cared for a parent that died of advanced cancer. Interview transcripts were thematically analyzed. Three factors played a role in how parents' information sharing/withholding affected EYACs' caregiving/coping: 1) topic, 2) timing, and 3) who is included. Findings highlight the adaptive functioning of parents' information sharing and negative outcomes associated with information withholding, illustrating how parents' disclosure decisions function to promote or inhibit EYACs' care involvement and coping.
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Affiliation(s)
- Amanda Kastrinos
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Carma L Bylund
- Department of Health Outcomes and Biomedical Informatics, University of Florida College of Medicine, Gainesville, Florida, USA
| | - Kelsey Bacharz
- Department of Clinical and Health Psychology, University of Florida, Gainesville, Florida, USA
| | - Allison J Applebaum
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Carla L Fisher
- Department of Health Outcomes and Biomedical Informatics, University of Florida College of Medicine, Gainesville, Florida, USA
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Parker ND, Wollney EN, Bylund CL, Amin TB, Mullis MD, Bagautdinova D, Sae-Hau M, Weiss ES, Thomas LA, Fisher CL. Living with a blood cancer in later life: The complex challenges and related support needs of adults aged 75 and older. Palliat Support Care 2023:1-7. [PMID: 37606295 DOI: 10.1017/s1478951523001219] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/23/2023]
Abstract
OBJECTIVES This study investigated the challenges and support needs of adults aged 75 and older during and after treatment for a blood cancer to aid targeted supportive resource development. METHODS Adults aged 75 and older with a blood cancer participated in in-depth, semi-structured interviews about challenges and unmet support needs. Participants recruited through The Leukemia & Lymphoma Society were (1) in treatment or previously in treatment for a blood cancer at age 75 or older and (2) living in the United States or its territories. A thematic analysis was conducted with findings compared between 2 groups: (1) chronic -living with a chronic blood cancer; (2) acute -living with an acute blood cancer or both an acute and chronic blood cancer. RESULTS Participants (n = 50) ranged from 75 to 91 years old. Both groups described similar experiences and identified 5 challenges and support needs: (1) socioemotional impact, (2) activities of daily living and instrumental activities of daily living (ADLs/iADLs), (3) uncertainty management, (4) treatment-related stressors, and (5) COVID-19-related strain. Properties for these themes illustrate challenges and support needs, with some differences between groups. For instance, those living with a chronic blood cancer highlighted financial strain with treatment-related stressors, while those with an acute blood cancer focused more on iADLs. SIGNIFICANCE OF RESULTS Findings inform an agenda for targeted resource development for older adults with a blood cancer nearing the end of the life span. Results demonstrate the need for supportive services and family communication interventions to help patients manage iADLs and navigate socioemotional needs and challenges.
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Affiliation(s)
- Naomi D Parker
- College of Journalism and Communications, University of Florida, Gainesville, FL, USA
| | - Easton N Wollney
- Department of Health Outcomes and Biomedical Informatics, University of Florida College of Medicine, Gainesville, FL, USA
| | - Carma L Bylund
- Department of Health Outcomes and Biomedical Informatics, University of Florida College of Medicine, Gainesville, FL, USA
| | - Tithi B Amin
- Department of Health Outcomes and Biomedical Informatics, University of Florida College of Medicine, Gainesville, FL, USA
| | - M Devyn Mullis
- Department of Health Outcomes and Biomedical Informatics, University of Florida College of Medicine, Gainesville, FL, USA
| | - Diliara Bagautdinova
- College of Journalism and Communications, University of Florida, Gainesville, FL, USA
| | | | | | - Lyndsey A Thomas
- Department of Health Outcomes and Biomedical Informatics, University of Florida College of Medicine, Gainesville, FL, USA
| | - Carla L Fisher
- Department of Health Outcomes and Biomedical Informatics, University of Florida College of Medicine, Gainesville, FL, USA
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Fisher CL, Campbell-Salome G, Bagautdinova D, Wright KB, Forthun LF, Bacharz KC, Mullis MD, Wolf B, Pereira DB, Spiguel L, Bylund CL. Young Adult Caregiving Daughters and Diagnosed Mothers Navigating Breast Cancer Together: Open and Avoidant Communication and Psychosocial Outcomes. Cancers (Basel) 2023; 15:3864. [PMID: 37568680 PMCID: PMC10417340 DOI: 10.3390/cancers15153864] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 01/01/1970] [Accepted: 07/26/2023] [Indexed: 08/13/2023] Open
Abstract
For many diagnosed mothers and their daughters, breast cancer is a shared experience. However, they struggle to talk about cancer. This is particularly true when the daughter is in adolescence or young adulthood, as they tend to be more avoidant, which is associated with poorer biopsychosocial outcomes. When daughters are their mother's caregivers, daughters' burden and distress are heightened. Young adult caregiving daughters (YACDs) are the second most common family caregiver and encounter more distress and burden than other caregiver types. Yet, YACDs and their diagnosed mothers receive no guidance on how to talk about cancer. Thirty-nine mother/YACD pairs participated in an online survey to identify challenging topics and strategies for talking about cancer, and to explore associations between openness/avoidance and psychosocial outcomes. YACDs and mothers reported the same challenging topics (death, treatment-related issues, negative emotions, relational challenges, YACDs' disease risk) but differed on why they avoided the topic. YACDs and mothers identified the same helpful approaches to navigate conversations (openness, staying positive, third-party involvement, avoidance). Avoidance was correlated with more distress whereas openness was correlated with better psychosocial outcomes. These results provide a psychosocial map for a mother-YACD communication skills intervention, which is key to promoting healthy outcomes.
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Affiliation(s)
- Carla L. Fisher
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, Gainesville, FL 32610, USA; (M.D.M.); (C.L.B.)
| | | | - Diliara Bagautdinova
- Department of Advertising, College of Journalism and Communications, University of Florida, Gainesville, FL 32611, USA;
| | - Kevin B. Wright
- Department of Communication, College of Humanities and Social Sciences, George Mason University, Fairfax, VA 22030, USA;
| | - Larry F. Forthun
- Department of Family, Youth and Community Sciences, University of Florida, Gainesville, FL 32611, USA;
| | - Kelsey C. Bacharz
- Department of Clinical and Health Psychology, College of Public Health and Health Professions, University of Florida, Gainesville, FL 32610, USA; (K.C.B.); (D.B.P.)
| | - M. Devyn Mullis
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, Gainesville, FL 32610, USA; (M.D.M.); (C.L.B.)
| | - Bianca Wolf
- Department of Communication Studies, University of Puget Sound, Tacoma, WA 98416, USA;
| | - Deidre B. Pereira
- Department of Clinical and Health Psychology, College of Public Health and Health Professions, University of Florida, Gainesville, FL 32610, USA; (K.C.B.); (D.B.P.)
| | - Lisa Spiguel
- Department of Surgery, College of Medicine, University of Florida, Gainesville, FL 32610, USA;
| | - Carma L. Bylund
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, Gainesville, FL 32610, USA; (M.D.M.); (C.L.B.)
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Mullis MD, Fisher CL, Kastrinos AL, Sae-Hau M, Weiss ES, Rajotte M, Bylund CL. Survivorship transitions in blood cancer: Identifying experiences and supportive care needs for caregivers. J Cancer Surviv 2023:10.1007/s11764-023-01422-0. [PMID: 37420150 PMCID: PMC11024982 DOI: 10.1007/s11764-023-01422-0] [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: 05/05/2023] [Accepted: 06/21/2023] [Indexed: 07/09/2023]
Abstract
PURPOSE Survivorship care often refers to continued healthcare after cancer treatment. Jacobsen and colleagues advocated to expand this to include patients on extended treatments and maintenance/prophylactic therapies, recognizing the care continuum as more complex. Transitions of care for individuals diagnosed with a blood cancer can be complicated. We sought to better understand blood cancer caregivers' experiences as their diagnosed family member encountered "survivorship transitions" across the continuum. METHODS We conducted semi-structured interviews with adults caring for a parent or a child with a blood cancer. Caregivers were segmented into survivorship groups based on two transitional contexts: (1) when patients transitioned to a new line of therapy (active treatment or maintenance therapy); (2) when patients ended treatment. We conducted a thematic analysis and triangulated findings to compare transitional experiences. RESULTS Caregivers in both groups reported experiencing a "new normal," which included personal, relational, and environmental adjustments. Caregivers in the treatment transitions group (n = 23) also described uncertainty challenges (e.g., losing their "safety net") and disrupted expectations (e.g., feeling "caught off guard" by challenges). Whereas caregivers in the end-of-treatment transitions group (n = 15) described relief coupled with worry (e.g., feeling hopeful yet worried). CONCLUSIONS Survivorship transitions for caregivers are riddled with challenges that include difficult readjustments, uncertainty/worry, and unmet expectations. While there seems to be a cohesive experience of "survivorship transitions," each transition group revealed nuanced distinctions. IMPLICATIONS FOR CANCER SURVIVORS Tailored supportive resources are needed for caregivers throughout survivorship transitions.
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Affiliation(s)
- M Devyn Mullis
- College of Medicine, University of Florida, Gainesville, FL, USA.
| | - Carla L Fisher
- College of Medicine, University of Florida, Gainesville, FL, USA
| | | | | | | | | | - Carma L Bylund
- College of Medicine, University of Florida, Gainesville, FL, USA
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Wright KB, Bylund CL, Vasquez TS, Mullis MD, Sae-Hau M, Weiss ES, Bagautdinova D, Fisher CL. Adult-Child Caregivers' Family Communication Experiences after an Older Parent's Blood Cancer Diagnosis: A Survey Exploring Their Openness, Avoidance, and Social Support. Cancers (Basel) 2023; 15:3177. [PMID: 37370787 DOI: 10.3390/cancers15123177] [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: 05/13/2023] [Revised: 06/06/2023] [Accepted: 06/12/2023] [Indexed: 06/29/2023] Open
Abstract
Adult-child caregivers of an aging parent living with a blood cancer describe struggling to communicate with one another and within the family system. They may avoid critical care conversations, which may impede care and their ability to receive social support. We examined what approaches adult-child caregivers of a parent diagnosed with a blood cancer use to enhance their family communication, the topics they find most challenging to discuss, and the roles of openness and support. We used qualitative and quantitative approaches to analyze data from a larger online survey study. In partnership with the Leukemia & Lymphoma Society, we recruited 121 adult-child caregivers. Responses to one open-ended item were analyzed to capture strategies used to enhance communication with their parent and family. They reported utilizing digital communication modalities, prioritizing frequent communication, engaging in openness, establishing boundaries, kinkeeping, and enacting support. Within the quantitative data, we further explored two of these themes (openness and support) and their relationships to other variables using t-tests and regression analysis. Adult-child caregivers and diagnosed parents avoid talking about mortality and negative feelings. Openness in the family about cancer was linked to caregivers' perceptions of receiving social support. Findings demonstrate that cultivating openness between midlife adult children and diagnosed parents may enhance opportunities to receive support.
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Affiliation(s)
- Kevin B Wright
- Department of Communication, College of Humanities and Social Sciences, George Mason University, Fairfax, VA 22030, USA
| | - Carma L Bylund
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, Gainesville, FL 32611, USA
| | - Taylor S Vasquez
- Department of Advertising, College of Journalism and Communications, University of Florida, Gainesville, FL 32611, USA
| | - M Devyn Mullis
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, Gainesville, FL 32611, USA
| | - Maria Sae-Hau
- The Leukemia & Lymphoma Society, Rye Brook, NY 10573, USA
| | - Elisa S Weiss
- The Leukemia & Lymphoma Society, Rye Brook, NY 10573, USA
| | - Diliara Bagautdinova
- Department of Advertising, College of Journalism and Communications, University of Florida, Gainesville, FL 32611, USA
| | - Carla L Fisher
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, Gainesville, FL 32611, USA
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Bagautdinova D, Bylund CL, Kastrinos A, Hampton CN, Vasquez TS, Weiss ES, Sae-Hau M, Fisher CL. Adult sibling-related experiences while caring for a parent diagnosed with a blood cancer. Fam Syst Health 2023; 41:140-148. [PMID: 36222643 PMCID: PMC10321271 DOI: 10.1037/fsh0000748] [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] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
INTRODUCTION An older parent's blood cancer diagnosis impacts the entire family system, including adult siblings, an often overlooked subsystem of the family. Yet, adult siblings are typically involved in their parents' care needs. We explored sibling-related experiences adult child caregivers identify while caring for a parent diagnosed with a blood cancer to capture information useful for caregiving intervention development. METHOD Fifteen adult child caregivers with at least 1 sibling participated in an in-depth, semistructured interview. Participants were 87% white and 80% daughters. A majority of caregivers were in midlife (M age = 44), with parents diagnosed between age 56 and 90. A thematic analysis was conducted on transcripts using the constant comparative method. RESULTS Caregivers described 3 types of sibling-related experiences that centered on (a) caregiving responsibilities (e.g., sharing/not sharing tasks; challenging feelings about lack of involvement); (b) expectations about the caregiver role (e.g., gender, family status, and birth order expectations); and (c) coping together and apart (e.g., receiving information together, enhanced relationships, divergent maladaptive coping). DISCUSSION Findings illustrate how a parent's blood cancer diagnosis can enhance the sibling bond and family system as well as contribute to tension, particularly regarding the experiences of not sharing caregiving tasks or having divergent approaches to coping. Findings also provide insight into areas in which supportive interventions or resources are needed (e.g., helping siblings talk about caregiving involvement) to promote healthy family functioning after a blood cancer diagnosis. (PsycInfo Database Record (c) 2023 APA, all rights reserved).
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Affiliation(s)
| | - Carma L. Bylund
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida
| | - Amanda Kastrinos
- Memorial Sloan Kettering Cancer Center, New York, New York, United States
| | | | | | - Elisa S. Weiss
- The Leukemia & Lymphoma Society, Rye Brook, New York, United States
| | - Maria Sae-Hau
- The Leukemia & Lymphoma Society, Rye Brook, New York, United States
| | - Carla L. Fisher
- College of Journalism and Communications, University of Florida
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida
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12
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Kastrinos A, Bacharz K, Mroz EL, Fisher CL, Applebaum AJ. A Mixed-Method Examination of Emerging and Young Adult Cancer Caregivers' Experiences during the COVID-19 Pandemic. Int J Environ Res Public Health 2023; 20:5537. [PMID: 37107819 PMCID: PMC10138842 DOI: 10.3390/ijerph20085537] [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] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 03/27/2023] [Accepted: 04/11/2023] [Indexed: 05/11/2023]
Abstract
Advanced cancer caregivers in emerging and young adulthood (EYACs; ages 18-35) are an understudied yet vulnerable caregiving population. The COVID-19 pandemic created new challenges for advanced cancer caregivers but also created unique contexts from which caregivers sometimes benefited. To understand how the pandemic may have positively and negatively impacted their caregiving and bereavement experiences, we examined EYACs' experiences of caring for and losing a parent with advanced cancer during the pandemic in comparison to those of EYACs with a parent who died outside the context of the pandemic. Eligible EYACs completed an online survey and semi-structured interview. Quantitative analyses compared responses for pre-pandemic EYACS (n = 14) and pandemic EYACs (n = 26). A thematic analysis of the interview transcripts of pandemic EYACS (n = 14) was conducted. Pandemic EYACs experienced non-significant but higher communal coping, benefit finding, negative emotional experiences, and caregiver strain than pre-pandemic EYACs. Thematic analysis revealed that the pandemic negatively affected EYACs' caregiving efficacy, personal well-being, interpersonal dynamics, and bereavement; shifts to remote work and schooling were reported as benefits. The findings can inform the design of resources to support EYACs whose parents died during the pandemic and who are navigating the healthcare system today.
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Affiliation(s)
- Amanda Kastrinos
- Memorial Sloan Kettering Cancer Center, Department of Psychiatry and Behavioral Sciences, New York, NY 10065, USA
| | - Kelsey Bacharz
- Department of Clinical & Health Psychology, University of Florida, Gainesville, FL 32601, USA
| | - Emily L. Mroz
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT 06520, USA
| | - Carla L. Fisher
- University of Florida Health Cancer Center, Gainesville, FL 32601, USA
| | - Allison J. Applebaum
- Memorial Sloan Kettering Cancer Center, Department of Psychiatry and Behavioral Sciences, New York, NY 10065, USA
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Bylund CL, Mullis MD, Alpert J, Markham MJ, Onega T, Fisher CL, Johnson SB. Clinician Communication With Patients About Cancer Misinformation: A Qualitative Study. JCO Oncol Pract 2023; 19:e389-e396. [PMID: 36626708 DOI: 10.1200/op.22.00526] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
PURPOSE Clinicians regularly face conversations about information that patients have found online. Given the prevalence of misinformation, these conversations can include cancer-related misinformation, which is often harmful. Clinicians are in a key position as trusted sources of information to educate patients. However, there is no research on clinician-patient conversations about cancer-related misinformation. As a first step, the objective of this study was to describe how cancer clinicians report communicating with patients about online cancer misinformation. METHODS We used convenience and snowball sampling to contact 59 cancer clinicians by e-mail. Contacted clinicians predominately worked at academic centers across the United States. Clinicians who agreed participated in semistructured interviews about communication in health care. For this study, we focused specifically on clinicians' experiences discussing online cancer-related misinformation with patients. We conducted a thematic analysis using a constant comparative approach to identify how clinicians address misinformation during clinical visits. RESULTS Twenty-one cancer clinicians participated in the study. Nineteen were physicians, one was a physician assistant, and one was a nurse practitioner. The majority (62%) were female. We identified four themes that describe how cancer clinicians address misinformation: (1) work to understand the misinformation; (2) correct misinformation through education; (3) advise about future online searches, and (4) preserve the clinician-patient relationship. CONCLUSION Our study identified four strategies that clinicians use to address online cancer-related misinformation with their patients. These findings provide a foundation for future research, allowing us to test these strategies in larger samples to examine their effectiveness.
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Affiliation(s)
- Carma L Bylund
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, Gainesville, FL
| | - Michaela D Mullis
- College of Journalism and Communications, University of Florida, Gainesville, FL
| | - Jordan Alpert
- College of Journalism and Communications, University of Florida, Gainesville, FL
| | - Merry Jennifer Markham
- Division of Hematology and Oncology, Department of Medicine, University of Florida, Gainesville, FL
| | - Tracy Onega
- Department of Population Health Sciences, School of Medicine, University of Utah, Salt Lake City, UT
| | - Carla L Fisher
- College of Journalism and Communications, University of Florida, Gainesville, FL
| | - Skyler B Johnson
- Department of Radiation Oncology, School of Medicine, University of Utah, Salt Lake City, UT
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Canzona MR, Fisher CL, Garcia DS, Dong T, Ledford CJW. Partner presence in clinical conversations about sexual health: Breast cancer survivors', partners', and providers' perspectives of triadic interactions. J Psychosoc Oncol 2023; 41:166-181. [PMID: 35587166 DOI: 10.1080/07347332.2022.2068397] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
PURPOSE Breast cancer survivors' (BCSs') sexual health (SH) clinical conversations are rarely studied from a dyadic perspective let alone from a triadic perspective. Using a triadic approach, we evaluated BCSs' comfort discussing SH with partners present and identified factors that can contribute to their comfort level. DESIGN Qualitative approach using in-depth interviews. PARTICIPANTS 93 BCSs, partners, and providers involved in BCS care. METHODS In-depth interviews with BCSs, partners, and providers explored triadic perspectives to understand factors informing BCSs' comfort level. Thematic analysis was used to analyze data. FINDINGS Four themes characterize potential benefits of partner presence: 1) partner facilitates information exchange, 2) partner realizes BCS's SH concerns are "a real thing," 3) partner better understands SH challenges, and 4) partner presence encourages relational communication about SH. Five themes illustrate potential complications of partner presence: 1) partner feels/becomes embarrassed, 2) partner is/becomes defensive, 3) partner presence constrains BCS's agency in clinical conversations, 4) partner presence threatens partner's view of BCS as a sexual being, and 5) partner presence increases partner burden. IMPLICATIONS FOR PSYCHOSOCIAL ONCOLOGY Providers should (1) initiate conversations about BCS comfort with partner presence, (2) be aware of the interaction between BCS primary and secondary goals, (3) consider how BCS/partner goal conflicts obstruct BCS agency and sexual/relational health, and (4) offer opportunities to clarify goals and expectations, and coordinate therapeutic options.
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Affiliation(s)
- Mollie Rose Canzona
- Department of Communication, Wake Forest University, Department Social Sciences & Health Policy, Wake Forest School of Medicine, Comprehensive Cancer Center of Wake Forest University, Winston-Salem, NC, USA
| | - Carla L Fisher
- College of Journalism and Communications, University of Florida, UF Health Cancer Center, Gainesville, Florida, USA
| | - David S Garcia
- Eglin Family Medicine Residency, Eglin Air Force Base, Okaloosa, Florida, USA
| | - Thrandia Dong
- Department of Communication, Wake Forest University, Winston-Salem, NC, USA
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Bagautdinova D, Bacharz KC, Bylund CL, Sae-Hau M, Weiss ES, Rajotte M, Lincoln G, Vasquez TS, Parker ND, Wright KB, Fisher CL. Understanding the Impact of COVID-19 on Chronic Lymphocytic Leukemia (CLL) Caregiving and Related Resource Needs. J Clin Med 2023; 12:jcm12041648. [PMID: 36836183 PMCID: PMC9965960 DOI: 10.3390/jcm12041648] [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: 01/29/2023] [Revised: 02/13/2023] [Accepted: 02/15/2023] [Indexed: 02/22/2023] Open
Abstract
Chronic lymphocytic leukemia (CLL) caregivers play a central role in disease management-a role that has been heightened during the COVID-19 pandemic given the healthcare system's reliance on frontline family caregivers and CLL patients' increased risk of infection and mortality. Using a mixed-method design, we investigated the impact of the pandemic on CLL caregivers (Aim 1) and their perceived resource needs (Aim 2): 575 CLL caregivers responded to an online survey; 12 spousal CLL caregivers were interviewed. Two open-ended survey items were thematically analyzed and compared with interview findings. Aim 1 results showed that two years into the pandemic, CLL caregivers continue to struggle with coping with distress, living in isolation, and losing in-person care opportunities. Caregivers described experiencing increasing caregiving burden, realizing the vaccine may not work or didn't work for their loved one with CLL, feeling cautiously hopeful about EVUSHELD, and dealing with unsupportive/skeptical individuals. Aim 2 results indicate that CLL caregivers needed reliable, ongoing information about COVID-19 risk, information about and access to vaccination, safety/precautionary measures, and monoclonal infusions. Findings illustrate ongoing challenges facing CLL caregivers and provide an agenda to better support the caregivers of this vulnerable population during the COVID-19 pandemic.
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Affiliation(s)
- Diliara Bagautdinova
- Department of Advertising, College of Journalism and Communications, University of Florida, Gainesville, FL 32611, USA
- Correspondence:
| | - Kelsey C. Bacharz
- Department of Clinical & Health Psychology, College of Public Health & Health Professions, University of Florida, Gainesville, FL 32610, USA
| | - Carma L. Bylund
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, Gainesville, FL 32610, USA
| | - Maria Sae-Hau
- The Leukemia & Lymphoma Society, Rye Brook, NY 10573, USA
| | - Elisa S. Weiss
- The Leukemia & Lymphoma Society, Rye Brook, NY 10573, USA
| | | | - Greg Lincoln
- P.K. Younge Developmental Research School, University of Florida, Gainesville, FL 32601, USA
| | - Taylor S. Vasquez
- Department of Advertising, College of Journalism and Communications, University of Florida, Gainesville, FL 32611, USA
| | - Naomi D. Parker
- Department of Advertising, College of Journalism and Communications, University of Florida, Gainesville, FL 32611, USA
| | - Kevin B. Wright
- Department of Communication, College of Humanities and Social Sciences, George Mason University, Fairfax, VA 22030, USA
| | - Carla L. Fisher
- Department of Advertising, College of Journalism and Communications, University of Florida, Gainesville, FL 32611, USA
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, Gainesville, FL 32610, USA
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16
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Staras SAS, Bylund CL, Mullis MD, Thompson LA, Hall JM, Hansen MD, Fisher CL. Messaging preferences among Florida caregivers participating in focus groups who had not yet accepted the HPV vaccine for their 11- to 12-year-old child. BMC Public Health 2022; 22:2413. [PMID: 36550434 PMCID: PMC9779937 DOI: 10.1186/s12889-022-14852-9] [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] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Accepted: 12/12/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND In the United States, human papillomavirus (HPV) vaccination rates remain low. The President's Cancer Panel suggests that effective messaging about the HPV vaccination focus on the vaccine's safety, efficacy, ability to prevent cancer, and recommendation at ages 11- to 12-years. We aimed to develop messages about HPV vaccine that include the President Cancer Panel's suggestions and were acceptable to caregivers of adolescents. METHODS From August to October 2020, we conducted one-hour, Zoom videoconference focus groups with caregivers who lived in Florida, had an 11- to 12-year-old child, and had not had any of their children receive the HPV vaccine. Focus group moderators asked caregivers to react to three videos of clinician (i.e., MD, DO, APRN, PA) recommendations and three text message reminders. Thematic analysis was conducted using the constant comparative method and led by one author with qualitative analysis expertise. Two additional authors validated findings. RESULTS Caregivers (n = 25 in six groups) were primarily non-Hispanic white (84%) and educated (64% had at least an Associate's degree). Approximately a third of caregivers had delayed (44%) or decided against a vaccine for their child (36%). Caregivers described six preferred message approaches: recognize caregivers' autonomy, balanced benefits and risks, trustworthy sources, increased feasibility of appointment scheduling, information prior to decision point, and preferred personalized information. Caregivers expressed a desire to have the follow-up doses mentioned in the introduction. CONCLUSIONS HPV vaccine messages, whether delivered by a clinician or via text message, will be more acceptable to caregivers if they approach HPV vaccination as the caregivers' decision, and include information from trusted sources to help caregivers make an informed choice.
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Affiliation(s)
- Stephanie A. S. Staras
- grid.15276.370000 0004 1936 8091Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, 2004 Mowry Road, Gainesville, FL 32610 USA ,grid.15276.370000 0004 1936 8091Institute for Child Health Policy, University of Florida, 2004 Mowry Road, Gainesville, FL 32610 USA
| | - Carma L. Bylund
- grid.15276.370000 0004 1936 8091Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, 2004 Mowry Road, Gainesville, FL 32610 USA
| | - Michaela D. Mullis
- grid.15276.370000 0004 1936 8091Department of Advertising, College of Journalism and Communications, University of Florida, 2096 Weimer Hall 1885 Stadium Rd, PO BOX 118400, Gainesville, FL 32611 USA
| | - Lindsay A. Thompson
- grid.15276.370000 0004 1936 8091Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, 2004 Mowry Road, Gainesville, FL 32610 USA ,grid.15276.370000 0004 1936 8091Institute for Child Health Policy, University of Florida, 2004 Mowry Road, Gainesville, FL 32610 USA ,grid.15276.370000 0004 1936 8091Department of Pediatrics, College of Medicine, University of Florida, 1600 SW Archer Rd, Gainesville, FL 32610 USA
| | - Jaclyn M. Hall
- grid.15276.370000 0004 1936 8091Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, 2004 Mowry Road, Gainesville, FL 32610 USA ,grid.15276.370000 0004 1936 8091Institute for Child Health Policy, University of Florida, 2004 Mowry Road, Gainesville, FL 32610 USA
| | - Marta D. Hansen
- grid.15276.370000 0004 1936 8091Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, 2004 Mowry Road, Gainesville, FL 32610 USA
| | - Carla L. Fisher
- grid.15276.370000 0004 1936 8091Department of Advertising, College of Journalism and Communications, University of Florida, 2096 Weimer Hall 1885 Stadium Rd, PO BOX 118400, Gainesville, FL 32611 USA
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Bagautdinova D, Lteif C, Eddy E, Terrell J, Fisher CL, Duarte JD. Patients' Perspectives of Factors That Influence Pharmacogenetic Testing Uptake: Enhancing Patient Counseling and Results Dissemination. J Pers Med 2022; 12:jpm12122046. [PMID: 36556266 PMCID: PMC9786315 DOI: 10.3390/jpm12122046] [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: 11/01/2022] [Revised: 11/29/2022] [Accepted: 12/01/2022] [Indexed: 12/14/2022] Open
Abstract
Patient preferences for pharmacogenetic (PGx) counseling, testing and results dissemination are not well-established, especially in medically underserved Black and Latino populations. The aim of this study was to capture the preferences of Black and Latino patients who received PGx testing to ascertain: (1) factors enhancing their willingness to do testing and (2) preferences for the dissemination of results. Using the constant comparative method, we thematically analyzed interviews with 13 patients from medically underserved populations who had undergone PGx testing. The findings describe participants wanting better medication options, receiving a clear explanation about the testing, valuing or having an interest in science or medicine and having misconceptions about testing results as factors affecting one's willingness to undergo PGx testing. Additionally, patients confirmed preferring receiving results of PGx testing in a sharable format and described the significance of discussing results in a clinical appointment. The findings provide insight into what Black and Latino patients may prefer in terms of clinical implementation of PGx testing. These results can be utilized for tailoring future implementation of PGx testing and informing best pre- and post-test patient counseling and education practices.
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Affiliation(s)
- Diliara Bagautdinova
- Department of Advertising, College of Journalism and Communications, University of Florida, Gainesville, FL 32611, USA
| | - Christelle Lteif
- Center for Pharmacogenomics and Precision Medicine, College of Pharmacy, University of Florida, Gainesville, FL 32610, USA
- Department of Pharmacotherapy and Translational Research, College of Pharmacy, University of Florida, Gainesville, FL 32610, USA
| | - Elizabeth Eddy
- Center for Pharmacogenomics and Precision Medicine, College of Pharmacy, University of Florida, Gainesville, FL 32610, USA
- Department of Pharmacotherapy and Translational Research, College of Pharmacy, University of Florida, Gainesville, FL 32610, USA
| | - Joshua Terrell
- Center for Pharmacogenomics and Precision Medicine, College of Pharmacy, University of Florida, Gainesville, FL 32610, USA
- Department of Pharmacotherapy and Translational Research, College of Pharmacy, University of Florida, Gainesville, FL 32610, USA
| | - Carla L. Fisher
- Department of Advertising, College of Journalism and Communications, University of Florida, Gainesville, FL 32611, USA
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, Gainesville, FL 32610, USA
- Correspondence: (C.L.F.); (J.D.D.)
| | - Julio D. Duarte
- Center for Pharmacogenomics and Precision Medicine, College of Pharmacy, University of Florida, Gainesville, FL 32610, USA
- Department of Pharmacotherapy and Translational Research, College of Pharmacy, University of Florida, Gainesville, FL 32610, USA
- Correspondence: (C.L.F.); (J.D.D.)
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Vasquez TS, Bylund CL, Fisher CL, Paige SR. Validation of the transactional eHealth literacy instrument with cancer caregivers. PEC Innov 2022; 1:100075. [PMID: 37213773 PMCID: PMC10194196 DOI: 10.1016/j.pecinn.2022.100075] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 07/27/2022] [Accepted: 08/17/2022] [Indexed: 05/23/2023]
Abstract
Objective Family members are important sources of support for patients with cancer. They access, evaluate, and engage with online information and discuss it with a cancer clinician. This study validates the 4-dimensions, 18-item Transactional eHealth Literacy Instrument (TeHLI) and proposed to include Clinical eHealth Literacy as a 5th dimension. Methods The Leukemia & Lymphoma Society (LLS) disseminated an online survey to 121 family member caregivers between March-June 2020. We conducted confirmatory factor analyses (1) to examine model fit for the 4-factor TeHLI in the cancer caregiver population, and (2) to examine the model fit when adding the 5th factor. Results The 4-dimension model yielded acceptable model fit (RMSEA = 0.09; 90% CI = 0.08-0.11; CFI = 0.98; TLI = 0.98; SRMR = 0.07). The 5-dimension model also yielded acceptable model fit (RMSEA = 0.08; 90% CI = 0.07-0.10; CFI = 0.97; TLI = 0.97; SRMR = 0.08), supporting the expansion of the TeHLI within this population. Conclusion The five-dimension TeHLI is a valid and reliable measure of eHealth literacy among blood cancer caregiver populations. Innovation The TeHLI can be used as an outcome measure for communication skills training for caregivers, patients, and clinicians.
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Affiliation(s)
- Taylor S. Vasquez
- University of Florida, College of Journalism and Communications, USA
- Corresponding author at: University of Florida, 1885 Stadium Road, Gainesville, FL 32607, USA
| | - Carma L. Bylund
- Department of Health Outcomes and Biomedical Informatics, University of Florida College of Medicine, USA
| | - Carla L. Fisher
- University of Florida, College of Journalism and Communications, USA
- Department of Health Outcomes and Biomedical Informatics, University of Florida College of Medicine, USA
| | - Samantha R. Paige
- Department of Health Outcomes and Biomedical Informatics, University of Florida College of Medicine, USA
- Johnson & Johnson, Inc., Health & Wellness Solutions, New Brunswick, New Jersey, USA
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Bylund CL, Wollney EN, Campbell-Salome G, Applebaum AJ, Paige SR, DeGruccio K, Weiss E, Sae-Hau M, Arnold J, Durante D, Amin TB, Hampton CN, Fisher CL. Improving Clinical and Family Communication for Adult Child Caregivers of a Parent With a Blood Cancer: Single-Arm Pre-Post Pilot Intervention. JMIR Cancer 2022; 8:e38722. [PMID: 35788019 PMCID: PMC9297135 DOI: 10.2196/38722] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [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: 04/27/2022] [Revised: 05/20/2022] [Accepted: 05/24/2022] [Indexed: 11/14/2022] Open
Abstract
Background Adult child caregivers of parents with cancer may face challenges when communicating with the patient and other family members, communicating during clinical interactions, and navigating web-based information seeking. Objective We developed and pilot-tested the Healthy Communication Practice program for adult child caregivers of parents with a blood cancer, which aims to help participants learn and implement communication skills central to caregiving. We assessed the feasibility and acceptability of the training. Methods Eligible participants completed a preprogram survey. We assessed the feasibility of participants completing the intervention in the allotted time. Participants had 2 weeks to complete the 2-part, 90-minute online program and completed a postprogram survey that included program evaluation items and the Acceptability of Intervention Measure (AIM) using a 1-5 rating scale (5=strongly agree). Results Of 50 caregivers who initially expressed interest, 34 consented, and 30 completed the program and both surveys (88% completion rate). Caregivers had a mean age of 45.07 (SD 11.96) years and provided care for parents who had a mean age of 73.31 (SD 9.38) years. Caregivers were primarily daughters (n=22, 73%). Overall, scores on the AIM scale were high (mean 4.48, SD 0.67). Specifically, caregivers felt the content met their communication needs (mean 4.58, SD 0.62) and their own needs as a caregiver of a parent with a blood cancer (mean 4.39, SD 0.72). Conclusions We demonstrated the feasibility and acceptability of the Healthy Communication Practice program, which aims to enhance family and clinical communication skills among caregivers of a parent with a blood cancer. Future studies will examine the efficacy of the program and its impact on both caregiver and patient communication and health outcomes.
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Affiliation(s)
- Carma L Bylund
- Department of Health Outcomes & Biomedical Informatics, University of Florida, Gainesville, FL, United States
| | - Easton N Wollney
- Department of Health Outcomes & Biomedical Informatics, University of Florida, Gainesville, FL, United States
| | | | | | - Samantha R Paige
- STEM Translational Communication Center, University of Florida, Gainesville, FL, United States
| | - Kennan DeGruccio
- School of Social Work, Columbia University, New York, NY, United States
| | - Elisa Weiss
- The Leukemia & Lymphoma Society, Rye Brook, NY, United States
| | - Maria Sae-Hau
- The Leukemia & Lymphoma Society, Rye Brook, NY, United States
| | - Jason Arnold
- E-Learning, Technology and Communications, University of Florida, Gainesville, FL, United States
| | - Domenic Durante
- E-Learning, Technology and Communications, University of Florida, Gainesville, FL, United States
| | - Tithi B Amin
- Department of Health Outcomes & Biomedical Informatics, University of Florida, Gainesville, FL, United States
| | - Chelsea N Hampton
- Department of Advertising, University of Florida, Gainesville, FL, United States
| | - Carla L Fisher
- Department of Advertising, University of Florida, Gainesville, FL, United States
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Fisher CL, Kastrinos A, Curley A, Canzona MR, Piemonte N, Wolf B, Pipe T. Helping Diagnosed Mothers and Their Adolescent-Young Adult Daughters Navigate Challenging Breast Cancer Conversations. Cancer Care Res Online 2022; 2:e025. [PMID: 38239410 PMCID: PMC10795856 DOI: 10.1097/cr9.0000000000000025] [Citation(s) in RCA: 2] [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] [Subscribe] [Scholar Register] [Indexed: 01/22/2024]
Abstract
Background Mothers diagnosed with breast cancer describe daughters as a critical source of support. Talking about breast cancer is especially distressing and challenging for mothers and their adolescent-young adult (AYA) daughters. Objective The over-arching study aim was to generate findings to integrate into an intervention to enhance diagnosed mothers' and AYA daughters' communication skills by identifying approaches they find helpful when talking about cancer. Methods We recruited 27 women (12 dyads). Diagnosed mothers and their AYA daughters (aged 18-29) participated in individual, in-depth, semi-structured interviews. Transcripts were thematically analyzed. Mothers'/daughters' perspectives were compared/ triangulated. Results Both mothers and daughters identified 3 approaches that helped them navigate cancer communication: (mothers) initiate conversations, keep communication positive, and limit cancer conversations. Only mothers reported it was helpful to downplay the seriousness of cancer. Only daughters identified it was important for them to reframe their perspective of mothers' disclosures. Conclusions Findings provide clinicians like nurses and families with a "psychosocial map" of communication approaches and associated strategies mothers and AYA daughters can use to talk about breast cancer in ways that promote daughters' comfort and/or alleviate distress. Implications for Practice Findings capture communication skills to focus on when tailoring developmentally focused interventions targeting diagnosed mothers and AYA daughters. Nurses can translate findings into practice to help patients talk to AYA daughters about cancer, thereby promoting a family-centered cancer care approach. What Is Foundational: AYA daughters are especially distressed talking about cancer with their diagnosed mothers. They can both use communication strategies to enhance their communal coping.
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Affiliation(s)
- Carla L. Fisher
- University of Florida, College of Journalism and Communications & College of Medicine, UF Health Cancer Center, Gainesville, Florida
| | | | - Alana Curley
- University of Florida, College of Journalism and Communications & College of Medicine, UF Health Cancer Center, Gainesville, Florida
| | - Mollie R. Canzona
- Wake Forest University, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Nicole Piemonte
- Creighton University, School of Medicine, Phoenix Regional Campus, Phoenix, Arizona
| | - Bianca Wolf
- University of Puget Sound, Tacoma, Washington
| | - Teri Pipe
- Arizona State University, Phoenix, Arizona
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21
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Campbell-Salome G, Walters NL, Ladd IG, Sheldon A, Ahmed CD, Brangan A, McMinn MN, Rahm AK, Schwartz MLB, Tricou E, Fisher CL, Sturm AC. Motivating cascade testing for familial hypercholesterolemia: applying the extended parallel process model for clinician communication. Transl Behav Med 2022; 12:800-809. [PMID: 35429393 PMCID: PMC9291357 DOI: 10.1093/tbm/ibac018] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Motivating at-risk relatives to undergo cascade testing for familial hypercholesterolemia (FH) is critical for diagnosis and lifesaving treatment. As credible sources of information, clinicians can assist in family communication about FH and motivate cascade testing uptake. However, there are no guidelines regarding how clinicians should effectively communicate with probands (the first person diagnosed in the family) and at-risk relatives. Individuals and families with FH can inform our understanding of the most effective communications to promote cascade testing. Guided by the extended parallel process model (EPPM), we analyzed the perspectives of individuals and families with FH for effective messaging clinicians can use to promote cascade testing uptake. We analyzed narrative data from interviews and surveys collected as part of a larger mixed-methods study. The EPPM was used to identify message features recommended by individuals and families with FH that focus on four key constructs (severity, susceptibility, response efficacy, self-efficacy) to promote cascade testing. Participants included 22 individuals from 11 dyadic interviews and 98 survey respondents. Participants described prioritizing multiple messages that address each EPPM construct to alert relatives about their risk. They illustrated strategies clinicians could use within each EPPM construct to communicate to at-risk relatives about the importance of pursuing diagnosis via cascade testing and subsequent treatment for high cholesterol due to FH. Findings provide guidance on effective messaging to motivate cascade testing uptake for FH and demonstrates how the EPPM may guide communication with at-risk relatives about genetic risk and motivate cascade testing broadly.
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Affiliation(s)
- Gemme Campbell-Salome
- Genomic Medicine Institute, Geisinger, Danville, PA, USA
- College of Journalism and Communications, University of Florida, Gainesville, FL, USA
| | | | - Ilene G Ladd
- Genomic Medicine Institute, Geisinger, Danville, PA, USA
| | | | | | - Andrew Brangan
- Genomic Medicine Institute, Geisinger, Danville, PA, USA
| | - Megan N McMinn
- Genomic Medicine Institute, Geisinger, Danville, PA, USA
| | - Alanna K Rahm
- Genomic Medicine Institute, Geisinger, Danville, PA, USA
| | | | - Eric Tricou
- Genomic Medicine Institute, Geisinger, Danville, PA, USA
| | - Carla L Fisher
- College of Journalism and Communications, University of Florida, Gainesville, FL, USA
| | - Amy C Sturm
- Genomic Medicine Institute, Geisinger, Danville, PA, USA
- Heart Institute, Geisinger, Danville, PA, USA
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22
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Campbell-Salome G, Fisher CL, Wright KB, Lincoln G, Applebaum AJ, Sae-Hau M, Weiss ES, Bylund CL. Impact of the family communication environment on burden and clinical communication in blood cancer caregiving. Psychooncology 2022; 31:1212-1220. [PMID: 35218278 DOI: 10.1002/pon.5910] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [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: 10/04/2021] [Revised: 02/16/2022] [Accepted: 02/21/2022] [Indexed: 11/07/2022]
Abstract
OBJECTIVE We examined the effects of the family communication environment (conversation orientation) on adult child caregivers' burden and clinical interactions and if the effects are mediated by openness to communicate about cancer, avoidant cancer communication, and social support. METHOD Caregivers of a parent diagnosed with a blood cancer (N = 121) completed an online survey of validated measures of conversation orientation (i.e., the extent to which families openly communicate), social support, cancer openness, avoidance, caregiver burden, clinical communication skills, and quality of clinical interactions. RESULTS Conversation orientation had significant indirect effects on caregiver burden, mediated by social support (β = -0.11, p < .001), as well as cancer openness and avoidance (β = -0.07, p < .001). Conversation orientation also had significant indirect effects on caregivers' communication skills with a parent's clinician, mediated by avoidance (β = 0.08, p < .01) and social support (β = 0.06, p < .001). Finally, conversation orientation had significant indirect effects on caregivers' quality of clinical interactions mediated by avoidance (β = 0.71, p < .05). CONCLUSIONS Adult child caregivers whose families communicate more openly exhibit less caregiver burden and report better clinical interaction skills and perceived quality of the clinical interaction. Avoidance emerged as a key mediating factor. Caregivers from less open communication environments may benefit from interventions that help them navigate challenging but critical caregiving conversations. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Gemme Campbell-Salome
- College of Journalism and Communications, University of Florida, 118400, Gainesville, FL, United States, 32611.,Genomic Medicine Institute, Department of Population Health Sciences, Geisinger, Danville, US, United States, 17822
| | - Carla L Fisher
- College of Journalism and Communications, University of Florida, 118400, Gainesville, FL, United States, 32611
| | - Kevin B Wright
- Department of Communication, George Mason University, Fairfax, US, United States, 22030
| | - Greg Lincoln
- P.K. Younge Developmental Research School, University of Florida, Gainesville, US, United States, 32501
| | - Allison J Applebaum
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, United States, 10022
| | - Maria Sae-Hau
- The Leukemia & Lymphoma Society, Rye Brook, US, United States, 10573
| | - Elisa S Weiss
- The Leukemia & Lymphoma Society, Rye Brook, US, United States, 10573
| | - Carma L Bylund
- Health Outcomes & Biomedical Informatics, College of Medicine, University of Florida, 2004 Mowry Rd, Gainesville, US, United States, 32610
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23
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Taylor G, Bylund CL, Kastrinos A, Alpert JM, Puig A, Krajewski JMT, Sharma B, Fisher CL. Practicing Mindfulness through mHealth Applications: Emerging Adults' Health-Enhancing and Inhibiting Experiences. Int J Environ Res Public Health 2022; 19:ijerph19052619. [PMID: 35270309 PMCID: PMC8910211 DOI: 10.3390/ijerph19052619] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Revised: 02/01/2022] [Accepted: 02/22/2022] [Indexed: 12/17/2022]
Abstract
Mindfulness-based interventions (MBIs) and practices (MBPs) can promote better health outcomes. Although MBIs and MBPs were developed to be delivered in-person, mobile health (mHealth) tools such as apps have made these more accessible. Mindfulness apps (MAs) are popular among emerging adults (EAs) who have the highest ownership of smartphones and who are also at risk for distress. While adverse effects have been observed with MBIs/MBPs, this has not been examined when mindfulness is practiced using apps. We interviewed EAs (n = 22) to capture their motivations for using these apps and identified health-inhibiting and enhancing experiences. Data were thematically analyzed using the constant comparative method. Motivations for app use included accessibility, convenience, and stress/health management. EAs described health-enhancing outcomes (reduced distress, improved physical symptoms, increased focus) and health-inhibiting outcomes (worsened distress, performance uncertainty, dependency development, worsened physical health). They provided suggestions for improving apps (e.g., feedback option). These findings illustrate benefits and risks that EAs may encounter when practicing mindfulness using apps, which can inform the best practices for app design.
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Affiliation(s)
- Greenberry Taylor
- Department of Communication, Flagler College, St. Augustine, FL 32084, USA;
- Correspondence: ; Tel.: +1-2515910098
| | - Carma L. Bylund
- College of Medicine, University of Florida, Gainesville, FL 32603, USA;
| | - Amanda Kastrinos
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY 10022, USA;
| | - Jordan M. Alpert
- College of Journalism and Communications, University of Florida, Gainesville, FL 32611, USA; (J.M.A.); (B.S.); (C.L.F.)
| | - Ana Puig
- College of Education, University of Florida, Gainesville, FL 32611, USA;
| | | | - Bhakti Sharma
- College of Journalism and Communications, University of Florida, Gainesville, FL 32611, USA; (J.M.A.); (B.S.); (C.L.F.)
| | - Carla L. Fisher
- College of Journalism and Communications, University of Florida, Gainesville, FL 32611, USA; (J.M.A.); (B.S.); (C.L.F.)
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24
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Kastrinos AL, Bylund CL, Mullis MD, Wollney E, Sae-Hau M, Weiss E, Fisher CL. Parents Caring for Children Diagnosed with a Blood Cancer from Infancy to Emerging Adulthood: A Life span Perspective. J Adolesc Young Adult Oncol 2022; 11:61-67. [PMID: 34647791 PMCID: PMC9464088 DOI: 10.1089/jayao.2021.0070] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
Purpose: Pediatric blood cancer diagnosis is a stressful experience for families as it can involve urgent treatment that can be life-threatening and require extended hospital stays. Little is known about the experiences of parent caregivers of children with a blood cancer during the diagnosis period and how families' needs may differ in light of the patient's developmental phase in the life span. Methods: We conducted semistructured in-depth interviews with 20 parent caregivers (aged 30-65) of children diagnosed with a blood cancer, recruited through The Leukemia & Lymphoma Society's (LLS) constituency. Interview transcripts were thematically analyzed using the constant comparative method. To elucidate similarities and differences in caregiving experiences, findings were compared across parents with children diagnosed in three developmental periods: infancy-early childhood, age 0-6 (n = 9); pre-early adolescence, aged 9-14 (n = 5); and late adolescence-emerging adulthood, aged 16-27 (n = 6). Results: Across all developmental periods, parents described three similar caregiving experiences during the diagnosis period: being persistent to obtain a diagnosis, attending to the child's quality of life challenges, and attending to their other children's well-being. Among caregivers of younger children, persistence was motivated by parental intuition and challenges included coping with traumatic physical and psychological impacts of treatment procedures. For caregivers of late adolescents-early adults, persistence was motivated by the child's self-assessment and fertility-related concerns emerged. Conclusion: Results illustrate core issues for parent blood cancer caregivers and highlight ways to tailor supportive resources that facilitate good communication practices and shared decision-making to children's distinct developmental needs.
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Affiliation(s)
- Amanda L. Kastrinos
- Department of Psychiatry & Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, New York, USA.,Address correspondence to: Amanda L. Kastrinos, PhD, Department of Psychiatry & Behavioral Sciences, Memorial Sloan Kettering Cancer Center, 641 Lexington Avenue, New York, NY 10022, USA
| | - Carma L. Bylund
- College of Journalism and Communications, University of Florida, Gainesville, Florida, USA.,College of Medicine, University of Florida, Gainesville, Florida, USA.,University of Florida Health Cancer Center, Gainesville, Florida, USA
| | - Michaela D. Mullis
- College of Journalism and Communications, University of Florida, Gainesville, Florida, USA
| | - Easton Wollney
- College of Medicine, University of Florida, Gainesville, Florida, USA
| | - Maria Sae-Hau
- The Leukemia & Lymphoma Society, Rye Brook, New York, USA
| | - Elisa Weiss
- The Leukemia & Lymphoma Society, Rye Brook, New York, USA
| | - Carla L. Fisher
- College of Journalism and Communications, University of Florida, Gainesville, Florida, USA.,University of Florida Health Cancer Center, Gainesville, Florida, USA
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25
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Gutman CK, Lion KC, Fisher CL, Aronson PL, Patterson M, Fernandez R. Breaking through barriers: the need for effective research to promote language-concordant communication as a facilitator of equitable emergency care. J Am Coll Emerg Physicians Open 2022; 3:e12639. [PMID: 35072163 PMCID: PMC8759339 DOI: 10.1002/emp2.12639] [Citation(s) in RCA: 2] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Revised: 12/10/2021] [Accepted: 12/14/2021] [Indexed: 02/05/2023] Open
Abstract
Individuals with limited English proficiency (LEP) are at high risk for adverse outcomes in the US health care system. This is particularly true for patients with LEP seeking care in the emergency department (ED). Although professional language interpretation improves the quality of care for these patients, it remains underused. The dynamic, discontinuous nature of an ED visit poses distinct challenges and opportunities for providing equitable, high-quality care for patients with LEP. Evidence-based best practices for identifying patients with LEP and using professional interpretation are well described but inadequately implemented. There are few examples in the literature of rigorous interventions to improve quality of care and outcomes for patients with LEP. There is an urgent need for high-quality research to improve communication with patients with LEP along the continuum of emergency care in order to achieve equity in outcomes.
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Affiliation(s)
- Colleen K Gutman
- Department of Emergency Medicine University of Florida College of Medicine Gainesville Florida USA
| | - K Casey Lion
- Department of Pediatrics University of Washington School of Medicine Seattle, Washington USA
- Center for Child Health, Behavior, and Development Seattle Children's Research Institute Seattle, Washington USA
| | - Carla L Fisher
- STEM Translational Communication Center University of Florida College of Journalism and Communication Gainesville Florida USA
- UF Health Cancer Center, Center for Arts in Medicine University of Florida Gainesville Florida USA
| | - Paul L Aronson
- Department of Pediatrics Yale School of Medicine New Haven Connecticut USA
- Department of Emergency Medicine Yale School of Medicine New Haven Connecticut USA
| | - Mary Patterson
- Department of Emergency Medicine University of Florida College of Medicine Gainesville Florida USA
- Center for Experiential Learning and Simulation University of Florida College of Medicine Gainesville Florida USA
| | - Rosemarie Fernandez
- Department of Emergency Medicine University of Florida College of Medicine Gainesville Florida USA
- Center for Experiential Learning and Simulation University of Florida College of Medicine Gainesville Florida USA
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26
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Fisher CL, Kastrinos A, Piemonte N, Canzona MR, Wolf B, Pipe T. Coping with breast cancer together: Challenging topics for mothers and their adolescent-young adult (AYA) daughters. J Psychosoc Oncol 2021; 40:756-769. [PMID: 34898401 PMCID: PMC10360048 DOI: 10.1080/07347332.2021.2005734] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [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: 10/19/2022]
Abstract
Background. The mother-daughter relationship can be central to women who are coping with breast cancer and provide a key source of support. However, the adolescent and young adult (AYA) daughters of diagnosed mothers have been known to exhibit notable distress during this time, withdrawing and avoiding communication, further challenging their ability to cope together. Objective. We sought to identify challenging topics that contribute to this avoidant mother-daughter communication pattern, as a first step in helping mothers and AYA daughters facilitate health-promoting communication. Methods. We examined thematically analyzed transcripts of one-on-one, in-depth, semi-structured interviews with 27 women (12 mother-daughter dyads). Results. We to identified 3 broad topics that were challenging to discuss: daughters' future breast cancer risk; emotionally related concerns; and clinical and physical aspects of disease. Thematic properties illustrate the challenging nature of each topic that informed their ability to communally cope together. Implications. Findings provide an initial roadmap for developing communication skills interventions that help mothers and AYA daughters navigate challenging conversations and facilitate communal coping.
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Affiliation(s)
- Carla L Fisher
- UF Health Cancer Center, University of Florida, Gainesville, Florida, USA
| | | | - Nicole Piemonte
- School of Medicine, Creighton University, Phoenix, Arizona, USA
| | - Mollie R Canzona
- School of Medicine, Wake Forest University, Winston-Salem, North Carolina, USA
| | - Bianca Wolf
- University of Puget Sound, Puget Sound, Tacoma, Washington, USA
| | - Teri Pipe
- Arizona State University, Phoenix, Arizona, USA
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27
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Fisher CL, Wright KB, Hampton CN, Vasquez TS, Kastrinos A, Applebaum AJ, Sae-Hau M, Weiss ES, Lincoln G, Bylund CL. Blood cancer caregiving during COVID-19: understanding caregivers' needs. Transl Behav Med 2021; 11:1187-1197. [PMID: 34042962 PMCID: PMC8194588 DOI: 10.1093/tbm/ibab021] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
The COVID-19 pandemic likely exacerbated caregiving challenges for caregivers of parents diagnosed with a blood cancer. Providing care during a public health crisis presents a complex web of uncertainties regarding cancer care, personal health, and COVID-19 risk. Identifying caregivers’ uncertainty experiences during the COVID-19 pandemic can be a first step in learning where to direct resources or alter policies to ensure that they can not only perform their caregiver role but also cope in health-promoting ways. Using uncertainty management theory, this study explored how the pandemic has impacted adult child caregivers’ experiences caring for a parent diagnosed with a blood cancer, as well as their experiences of uncertainty and uncertainty management. As part of a larger study on blood cancer caregivers’ needs, a survey was administered from March 30 to June 1, 2020, to recruit caregivers through the Leukemia and Lymphoma Society. A qualitative and quantitative content analysis was conducted on open-ended responses from 84 caregivers. Caregivers described changes illustrating the complexity of providing care during a pandemic: (a) increased fears and uncertainty-related distress, b) reduced in-person care opportunities, (c) increased isolation, and (d) enhanced family communication. Caregivers with parents diagnosed with acute blood cancers used significantly more uncertainty management strategies and had more sources of uncertainty than caregivers with parents living with chronic blood cancer types. Findings highlight the need for supportive services to help caregivers manage uncertainty and improve their capacity to provide care in an unpredictable global health crisis. Such support may reduce poor psychosocial outcomes.
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Affiliation(s)
- Carla L Fisher
- College of Journalism and Communications, University of Florida, Gainesville, FL, USA.,Cancer Control and Population Sciences Program (CCPS), University of Florida Health Cancer Center, Gainesville, FL, USA
| | - Kevin B Wright
- Department of Communication, George Mason University, Fairfax, VA, USA
| | - Chelsea N Hampton
- College of Journalism and Communications, University of Florida, Gainesville, FL, USA
| | - Taylor S Vasquez
- College of Journalism and Communications, University of Florida, Gainesville, FL, USA
| | - Amanda Kastrinos
- College of Journalism and Communications, University of Florida, Gainesville, FL, USA
| | - Allison J Applebaum
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | | | | | - Greg Lincoln
- P. K. Younge Developmental Research School, University of Florida, Gainesville, FL, USA
| | - Carma L Bylund
- College of Journalism and Communications, University of Florida, Gainesville, FL, USA.,College of Medicine, University of Florida, Gainesville, FL, USA
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28
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Taylor GB, Radhakrishnan N, Fisher CL, Price C, Tighe P, Le T, Bylund CL. A qualitative analysis of clinicians' communication strategies with family members of patients experiencing hospital-acquired delirium. Geriatr Nurs 2021; 42:694-699. [PMID: 33831716 DOI: 10.1016/j.gerinurse.2021.02.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Revised: 02/12/2021] [Accepted: 02/16/2021] [Indexed: 12/22/2022]
Abstract
OBJECTIVE Identify doctors' and nurses' perceptions of effective communication strategies when talking with family members of patients with hospital-acquired delirium. METHODS We conducted focus groups and interviews of hospitalists, anesthesiologists, and nurses using a semi-structured approach. We rigorously analyzed transcribed data using a constant comparative method. RESULTS We conducted six focus groups and 14 interviews. Participants included 20 hospitalists, 9 anesthesiologists, and 21 nurses. Clinicians identified three communication approaches as effective when communicating with family of delirium patients: Provide reassurance, educate families, and engage in family-centered communication. CONCLUSION In communicating with families of patients with post-operative delirium, clinicians work to reassure and educate families using family-centered communication. Different approaches are used by different types of clinicians to accomplish this goal. Clinicians recognized the importance of involving family members in the patients' recovery. PRACTICE IMPLICATIONS Though clinically common and familiar to clinicians, delirium may be a new diagnosis for family members and thus compassion and education are vital. Due to the different clinical roles, education may be different for each discipline.
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Affiliation(s)
- Greenberry B Taylor
- Department of Journalism, College of Journalism and Communications, University of Florida, 1885 Stadium Road, Gainesville, FL 32611, United States
| | - Nila Radhakrishnan
- Department of Medicine, College of Medicine, PO Box 100215, University of Florida, Gainesville, FL 32610, United States
| | - Carla L Fisher
- Department of Advertising, College of Journalism and Communications, University of Florida, 1885 Stadium Road, Gainesville, FL 32611, United States
| | - Catherine Price
- Department of Clinical and Health Psychology, College of Public Health and Health Professions, University of Florida, 1225 Center Drive, Gainesville, FL 32610, United States
| | - Patrick Tighe
- Department of Anesthesiology, College of Medicine, PO Box 100215, University of Florida, Gainesville, FL 32610, United States
| | - Tien Le
- Department of Journalism, College of Journalism and Communications, University of Florida, 1885 Stadium Road, Gainesville, FL 32611, United States
| | - Carma L Bylund
- Department of Public Relations, University of Florida, College of Journalism and Communications, University of Florida, 1885 Stadium Road, Gainesville, FL 32611, United States.
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29
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Fisher CL, Wright KB, Rising CJ, Mullis MD, Afanaseva D, Burke-Garcia A, Cai X. Culturally Appropriate Breast Cancer and Environmental Risk Messages: Targeting Racially and Ethnically Diverse Mothers. J Cancer Educ 2021; 36:284-293. [PMID: 31820415 DOI: 10.1007/s13187-019-01626-y] [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] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
The National Institute of Environmental Health Sciences (NIEHS)-funded Breast Cancer and Environment Research Program (BCERP) provides evidence-informed educational materials targeting mothers with daughters to help them engage in lifestyle changes to reduce their environmental risk of breast cancer. Building on a partnership we developed to disseminate these materials via social media, we teamed with mommy bloggers and readers to evaluate the cultural appropriateness of the information using evidence-based practices for message design. We sought to (1) identify cross-culture factors that speak to a broad group of mothers and culture-specific factors to integrate when targeting specific cultures and (2) capture cultural challenges mothers encounter when they share the information with family to understand the social context in which they receive, interpret, and act on risk-reducing messages. We conducted 50 interviews with racially and ethnically diverse bloggers/readers and thematically analyzed transcripts, comparing findings across cultures. Across cultures, mothers identified five key factors for ensuring cultural appropriateness, but with notable cultural differences: (1) incorporate diverse images, (2) provide more information specific to environmental and cultural risk, (3) heighten the message of "it's a family affair", (4) make behavioral changes feasible, and (5) use less text, more visuals. Across cultures, women experienced intergenerational communication challenges with family, which were tied to (1) lack of openness, (2) relational norms, and (3) generational resistance. Findings provide message design considerations for targeting mothers broadly or based on race/ethnicity and support the notion that the larger family system should be considered when disseminating cancer risk education.
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Affiliation(s)
- Carla L Fisher
- College of Journalism and Communications, University of Florida, UF Health Cancer Center, PO Box 118400, Gainesville, FL, 32611-8400, USA.
| | - Kevin B Wright
- Department of Communication, George Mason University, 4400 University Dr, MSN3D6, Fairfax, VA, 22030, USA
| | - Camella J Rising
- Department of Communication, George Mason University, 4400 University Dr, MSN3D6, Fairfax, VA, 22030, USA
| | - Michaela Devyn Mullis
- College of Journalism and Communications, University of Florida, PO Box 118400, Gainesville, FL, 32611-8400, USA
| | | | - Amelia Burke-Garcia
- NORC at the University of Chicago, 4350 East-West Highway, 8th floor, Bethesda, MD, 20814, USA
| | - Xiaomei Cai
- Department of Communication, George Mason University, 4400 University Dr, MSN3D6, Fairfax, VA, 22030, USA
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30
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Abstract
INTRODUCTION How families function and provide support plays a central role in patients' self-management of Type 2 diabetes (T2DM) and prediabetes (preDM). Families would benefit from communication training, which is rarely incorporated into diabetes self-management education (DSME). Mothers are especially in need of this support. Women are at a higher risk of T2DM, and when mothers are patients, they can prioritize their family role and family's well-being over their personal needs as a patient. METHOD To identify family communication that affects mothers' ability to self-manage T2DM/preDM, we interviewed 17 mothers aged 36-64 (M = 56). Transcripts were thematically analyzed. RESULTS Women described four family communication experiences affecting self-care: (a) family-of-origin communication (e.g., weight/diet messages during childhood), (b) communal coping communication (e.g., adopting healthy behaviors as a family), (c) communication inhibiting communal coping (e.g., negative response to mothers' lifestyle changes), and (d) mothers taking the lead (e.g., leading conversations or communicating control over family's lifestyle decisions). DISCUSSION Findings highlight the need for a family systems approach to DSME. Communication from multiple bonds (e.g., spouse, children) and past family-of-origin experiences impact self-care. Communal coping (appraising diabetes as "our" problem) was critical to self-management as mothers struggled to balance their needs with family members' preferences/attitudes. When not supported, mothers who took the lead communicatively could facilitate communal coping or prioritize self-care needs. Findings can inform a family-centered approach to DSME that highlights the importance of communal coping, provides all members communication skills training, and addresses the need for mothers to prioritize personal well-being. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
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31
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Fisher CL, Wright KB, Rising CJ, Cai X, Mullis MD, Burke-Garcia A, Afanaseva D. Helping Mothers and Daughters Talk about Environmental Breast Cancer Risk and Risk-Reducing Lifestyle Behaviors. Int J Environ Res Public Health 2020; 17:ijerph17134757. [PMID: 32630657 PMCID: PMC7370108 DOI: 10.3390/ijerph17134757] [Citation(s) in RCA: 4] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 06/22/2020] [Accepted: 06/28/2020] [Indexed: 01/30/2023]
Abstract
Background: Mothers and daughters struggle to talk about breast cancer risk. Even less attention is paid to environmental determinants of cancer. Third-party online approaches can be helpful navigating these conversations. The aim of this study was to obtain feedback from mothers exposed to a social media intervention (“mommy bloggers”) and identify their preferences for message-design approaches that could help them talk to their daughter(s) about environmental breast cancer risk. Methods: We conducted semi-structured interviews with 50 mothers. A thematic analysis was conducted using the constant comparative method. Results: Mothers identified four approaches to message design that could help facilitate mother–daughter communication about environmental breast cancer risk. These included two action-oriented approaches that centered on getting the conversation started and keeping the conversation going and two approaches based on lifespan factors to promote daughters’ engagement by using age-appropriate language and visuals and focusing on developmentally specific lifestyle behaviors. Mothers also provided recommended strategies within each approach. Conclusions: Mothers identified various approaches interventionists can utilize to overcome barriers to talking to daughters about environmental breast cancer risk. To promote mother–daughter communication, the messages should be action-oriented to facilitate interaction, but also developed with lifespan and developmental considerations in mind to engage daughters.
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Affiliation(s)
- Carla L. Fisher
- UF Health Cancer Center, College of Journalism and Communications, University of Florida, P.O. Box 118400, Gainesville, FL 32611-8400, USA;
- Correspondence: ; Tel.: +1-352-294-1019
| | - Kevin B. Wright
- Department of Communication, George Mason University, 4400 University, Dr, MSN3D6, Fairfax, VA 22030, USA; (K.B.W.); (C.J.R.); (X.C.)
| | - Camella J. Rising
- Department of Communication, George Mason University, 4400 University, Dr, MSN3D6, Fairfax, VA 22030, USA; (K.B.W.); (C.J.R.); (X.C.)
| | - Xiaomei Cai
- Department of Communication, George Mason University, 4400 University, Dr, MSN3D6, Fairfax, VA 22030, USA; (K.B.W.); (C.J.R.); (X.C.)
| | - Michaela D. Mullis
- UF Health Cancer Center, College of Journalism and Communications, University of Florida, P.O. Box 118400, Gainesville, FL 32611-8400, USA;
| | - Amelia Burke-Garcia
- NORC at the University of Chicago, 4350 East West Highway, Bethesda, MD 20814, USA;
| | - Dasha Afanaseva
- Fors Marsh Group, 901 N. Glebe Road, Arlington, VA 22201, USA;
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Ledford CJW, Fisher CL, Cafferty LA, Jackson JT, Crawford PF, Seehusen DA. How patients make sense of a diabetes diagnosis: An application of Weick's model of organizing. Diabetes Res Clin Pract 2020; 162:108117. [PMID: 32179127 DOI: 10.1016/j.diabres.2020.108117] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Revised: 02/27/2020] [Accepted: 03/06/2020] [Indexed: 11/22/2022]
Abstract
AIMS To identify communication cycles patients use to make sense of a diabetes diagnosis and barriers patients encounter in their sensemaking process. METHODS Researchers conducted interviews with 33 participants with type 2 diabetes mellitus or prediabetes at medical centers in Georgia and Nevada. A thematic analysis using the constant comparative method identified communication cycles. RESULTS Patients reported engaging three communication cycles to make sense of the diagnosis: (1) interacting with healthcare clinicians; (2) seeking information online; and (3) taking a nutrition/diabetes management class. Patients reported system-level barriers that impact sensemaking: (1) lack of consistent or routine care; and (2) lack of access to resources. CONCLUSION Results here reinforce the theoretical proposition that receiving a diagnosis is an equivocal process that requires patients to make sense of new information through communication cycles. Patients in this sample repeatedly described communication cycles to interpret this new information rather than relying on assembly rules. Clinicians can promote patient understanding of diabetes and self-management by taking time to explain the diagnosis, maintaining consistent care, providing guidance to online sources, and ensuring patients have access to diabetes education.
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Affiliation(s)
- Christy J W Ledford
- Military Primary Care Research Network, Uniformed Services University of the Health Sciences, Department of Family Medicine, 4301 Jones Bridge Road, Bethesda, MD, USA
| | - Carla L Fisher
- University of Florida, College of Journalism and Communications, P.O. Box 118400, Gainesville, FL, USA
| | - Lauren A Cafferty
- Henry M. Jackson Foundation, 6720A Rockledge Dr. Bethesda, MD, USA; Henry M. Jackson Foundation, 6720A Rockledge Dr. Bethesda, MD, USA
| | - Jeremy T Jackson
- Henry M. Jackson Foundation, 6720A Rockledge Dr. Bethesda, MD, USA; Henry M. Jackson Foundation, 6720A Rockledge Dr. Bethesda, MD, USA.
| | - Paul F Crawford
- Henry M. Jackson Foundation, 6720A Rockledge Dr. Bethesda, MD, USA; Nellis Family Medicine Residency, 4700 Las Vegas Boulevard North, Las Vegas, NV, USA
| | - Dean A Seehusen
- Augusta University, Department of Family Medicine, 1120 15th Street, Augusta, GA, USA
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Hong YR, Cardel M, Suk R, Vaughn IA, Deshmukh AA, Fisher CL, Pavela G, Sonawane K. Teach-Back Experience and Hospitalization Risk Among Patients with Ambulatory Care Sensitive Conditions: a Matched Cohort Study. J Gen Intern Med 2019; 34:2176-2184. [PMID: 31385206 PMCID: PMC6816654 DOI: 10.1007/s11606-019-05135-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [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] [Received: 02/28/2019] [Revised: 03/29/2019] [Accepted: 05/20/2019] [Indexed: 12/25/2022]
Abstract
BACKGROUND The teach-back method, also known as the "show-me" method, has been endorsed by many medical and health care societies. However, limited investigation has been conducted regarding its association with patient outcomes. OBJECTIVES To examine the association between patient teach-back experience and the risk of hospitalizations and length of hospital stay among patients with ambulatory care sensitive conditions (ACSCs). DESIGN A matched cohort study. SETTING Data from the 2011-2015 Longitudinal Medical Expenditure Panel Survey (panels 16-19). PARTICIPANTS Three thousand nine hundred ninety-four US adults aged ≥ 18 years with any of 5 ACSCs (hypertension, type 2 diabetes, heart disease, asthma, and chronic obstructive pulmonary disease [COPD]). MEASUREMENTS Hospital admissions (all-cause or ACSC-related) and the length of stay of the first admission were examined by teach-back during interaction with a health provider. RESULTS Patients with teach-back experience were less likely to experience hospitalization for an ACSC-related condition (relative risk, 0.85; 95% CI, 0.71 to 0.99) and had a lower risk for a condition-related readmission (hazard ratio, 0.77; 95% CI, 0.60 to 0.99), compared with those without teach-back experience. The median length of hospital stay did not differ between patients with teach-back experience and those without teach-back experience (median 3 days [IQR 1 to 8 days] and median 3 days [IQR 0 to 8 days], respectively; P = 0.84). Subgroup analysis showed that the association of reported teach-back experience on the outcomes was relatively stable among those with hypertension, diabetes, and heart disease, but was not among those with asthma or COPD. LIMITATION Teach-back exposure relied on patient self-reported information. CONCLUSIONS Our findings suggest that patient teach-back method is associated with reduced risk of hospitalization for those with ACSCs, especially among patients with cardiovascular diseases and type 2 diabetes. Encouraging providers to utilize the teach-back method at every visit has the potential to further reduce hospitalizations for individuals with ACSCs.
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Affiliation(s)
- Young-Rock Hong
- Department of Health Services Research, Management and Policy in the College of Public Health and Health Professions, University of Florida, Gainesville, FL, USA.
| | - Michelle Cardel
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, Gainesville, FL, USA
| | - Ryan Suk
- Department of Management, Policy and Community Health, The University of Texas Health Science Center, Houston, TX, USA
| | - Ivana A Vaughn
- Center for Evaluation and Applied Research, The New York Academy of Medicine, New York, NY, USA
| | - Ashish A Deshmukh
- Department of Management, Policy and Community Health, The University of Texas Health Science Center, Houston, TX, USA
| | - Carla L Fisher
- Department of Advertising, College of Journalism and Communications, University of Florida, Gainesville, FL, USA.,UF Health Cancer Center, Center for Arts in Medicine, STEM Translational Communication Center, University of Florida, Gainesville, FL, USA
| | - Gregory Pavela
- Department of Health Behavior, School of Public Health University of Alabama, Birmingham, AL, USA
| | - Kalyani Sonawane
- Department of Management, Policy and Community Health, The University of Texas Health Science Center, Houston, TX, USA
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Abstract
BACKGROUND AND OBJECTIVES As evidence establishes the efficacy of medical acupuncture, more family physicians and family medicine residents may receive medical acupuncture training and need to know how to effectively communicate about the treatment option with patients. By identifying how physicians talk about acupuncture treatment with their patients, we aimed to develop a model for physician training that could enhance their ability to integrate and practice medical acupuncture in conventional clinical settings. METHODS To capture the communication process that family physicians engage in when integrating acupuncture treatment into a clinical environment, we sought both physicians' and patients' perspectives. We conducted interviews with 17 family physicians and 15 patients in a US family medicine clinic that has integrated medical acupuncture into its practice. Audio recordings were transcribed and analyzed by two members of the study team in ATLAS.ti, using the constant comparative method. RESULTS Integrating acupuncture into family medicine entailed a three-phase communication process: (1) introduce acupuncture, (2) explain the medical process, and (3) evaluate treatment outcomes. CONCLUSIONS The emerging three-phase process of communicating acupuncture described here provides an initial model for teaching communication in the context of medical acupuncture. Given the exploratory nature of this initial study and the rarity of acupuncture treatment integrated into family medical settings, this is a first step in building knowledge in this realm of practice. Future research is needed to better understand the experience of patients who do not report notable results of acupuncture and to extend this study into other family medicine settings.
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Affiliation(s)
- Christy J W Ledford
- Department of Family Medicine, F. Edward Hébert School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD
| | - Carla L Fisher
- STEM Translational Communication Center, University of Florida Cancer Center, Gainesville, FL
| | - Paul Crawford
- Nellis Family Medicine Residency Program, Mike O'Calaghan Military Medical Center, Nellis Air Force Base, NV
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Peterson EB, Fisher CL, Zhao X. Pediatric primary healthcare providers’ preferences, experiences and perceived barriers to discussing electronic cigarettes with adolescent patients. ACTA ACUST UNITED AC 2018. [DOI: 10.1080/17538068.2018.1460960] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
- Emily B. Peterson
- Department of Communication, George Mason University, Fairfax, VA, USA
| | - Carla L. Fisher
- Department of Communication, George Mason University, Fairfax, VA, USA
- Department of Advertising, STEM Translational Communication Center, University of Florida, UF Health Cancer Center, UF Center for Arts in Medicine, Gainesville, FL, USA
| | - Xiaoquan Zhao
- Department of Communication, George Mason University, Fairfax, VA, USA
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Abstract
Integrating complementary therapies (acupuncture) into conventional medicine has garnered recent support. Given the health benefits, low cost, and minimal risks, the military has advocated for acupuncture and begun training family medicine physicians. Little is known about the role of physician communication in patients' acupuncture engagement (uptake and adherence) in conventional medicine settings. We interviewed physicians (N = 15) and patients (N = 17) to capture physician communication they perceived affected treatment engagement. Data for each group were thematically analyzed. Physicians and patients prioritized different communication approaches and associated strategies. Physicians identified four approaches that enhance treatment engagement: (1) using shared decision-making (e.g., treatment options); (2) not being pushy (e.g., in tone); (3) carefully choosing language (e.g., Eastern versus Western terms); and (4) explaining treatment outcomes (e.g., efficacy). Patients also prioritized explaining treatment outcomes but differently (e.g., timing clarity), with two additional approaches: (5) talking with the same physician (e.g., continuity) and (6) being responsive to patient (e.g., flexibility). Findings highlight how physicians and patients prioritize patient-centered communication differently and how it is embedded within a unique, complex therapy. Data showcase authentic narratives that could be translated into physician communication skills training to promote treatment engagement in integrative care.
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Affiliation(s)
- Carla L Fisher
- a College of Journalism & Communications, STEM Translational Communication Center, UF Health Cancer Center; UF Health Center for Arts in Medicine , University of Florida , Gainesville , FL , USA
| | - Christy J W Ledford
- b Department of Family Medicine, F. Edward Hebert School of Medicine, Military Primary Care Research Network , Uniformed Services University of the Health Sciences , Bethesda , MD , USA
| | - David A Moss
- c Nellis Family Medicine Residency Program , Mike O'Callaghan Military Medical Center , Nellis Air Force Base , NV , USA
| | - Paul Crawford
- b Department of Family Medicine, F. Edward Hebert School of Medicine, Military Primary Care Research Network , Uniformed Services University of the Health Sciences , Bethesda , MD , USA
- c Nellis Family Medicine Residency Program , Mike O'Callaghan Military Medical Center , Nellis Air Force Base , NV , USA
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Canzona MR, Ledford CJW, Fisher CL, Garcia D, Raleigh M, Kalish VB. Clinician barriers to initiating sexual health conversations with breast cancer survivors: The influence of assumptions and situational constraints. Fam Syst Health 2018; 36:20-28. [PMID: 29608082 DOI: 10.1037/fsh0000307] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
INTRODUCTION Sexual health (SH) is an important dimension of physical, emotional, and social functioning after breast cancer (BC). Research suggests that survivors' SH concerns are not being adequately addressed in oncology or primary care settings. It is important to understand why these conversations are not taking place and what can be done to enhance care for women in this context. This research aims to identify when clinicians initiate SH conversations with survivors and to uncover factors that influence these decisions. METHOD Thirty-six clinicians from family medicine, internal medicine, oncology, and gynecology participated in semistructured interviews. Analysis uncovered themes that influence clinicians' decisions about initiating SH conversations with survivors. Attention was given to capturing the personal, professional, and system-level issues that inform clinicians' communication choices. RESULTS Clinicians reported their decisions are based on (a) beliefs about patients, (b) inability to address survivors' concerns, (c) time constraints that affect the delivery of care, and (d) views of professional function in survivor health care. DISCUSSION Clinician decisions are based on sometimes-erroneous assumptions and situational constraints. This suggests the need for medical education and support regarding SH care. Several practice points are outlined to facilitate clinicians' efforts to improve SH care for female BC survivors. (PsycINFO Database Record
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Affiliation(s)
| | - Christy J W Ledford
- Department of Family Medicine, Uniformed Services University of the Health Sciences
| | | | | | - Meghan Raleigh
- Department of Family Medicine, Uniformed Services University of the Health Sciences
| | - Virginia B Kalish
- Department of Family Medicine, National Capital Consortium Family Medicine Residency
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Canzona MR, Garcia D, Fisher CL, Raleigh M, Kalish V, Ledford CJW. Communication about sexual health with breast cancer survivors: Variation among patient and provider perspectives. Patient Educ Couns 2016; 99:1814-1820. [PMID: 27387120 DOI: 10.1016/j.pec.2016.06.019] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/13/2016] [Revised: 06/07/2016] [Accepted: 06/16/2016] [Indexed: 06/06/2023]
Abstract
OBJECTIVE Breast cancer survivors experience a range of sexual health (SH) issues. Communication problems between patient and provider can prevent survivors from pursuing SH goals and can negatively influence biopsychosocial outcomes. The primary aims of this study were to identify provider communication behaviors that facilitate or impede clinical interactions regarding SH (according to survivors and providers) and to highlight discrepancies that affect care. METHODS Forty breast cancer survivors and forty health care providers from a variety of specialties participated in semi-structured interviews informed by the Critical Incident Technique. Transcripts were thematically analyzed using the constant comparative method. RESULTS Survivors and providers discussed the importance of honoring individual patient needs and conveying compassionate messages. However, accounts varied significantly regarding the appropriate timing and method of initiating SH discussions and the helpfulness of certain support behaviors and linguistic devices. CONCLUSION Provider and survivor accounts of what constitutes helpful and unhelpful provider communication behaviors when discussing SH concerns are misaligned in nuanced and meaningful ways. These discrepancies reveal potential areas for educational intervention. PRACTICE IMPLICATIONS SH discussions require providers to examine assumptions about patients' communication preferences and information needs. Patients may benefit from frank yet sensitive discussions earlier in the cancer continuum.
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Affiliation(s)
- Mollie Rose Canzona
- Department of Communication, Department of Social Sciences & Health Policy, Wake Forest University/Wake Forest University School of Medicine, Mailing Address: P.O. Box 7347, Winston-Salem NC 27109, (336) 414-8989, United States.
| | - David Garcia
- Edwards Family Health Clinic, 30 Nightingale Rd., Edwards AFB, CA 93524, United States
| | - Carla L Fisher
- University of Florida Health Cancer Center, UF STEM Translational Communication Center, 2086 Weimer Hall, 1885 Stadium Road, Gainesville, FL 32611, United States
| | - Meghan Raleigh
- Department of Family Medicine, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Rd., Bethesda, MD 20814, United States
| | - Virginia Kalish
- Department of Family Medicine, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Rd., Bethesda, MD 20814, United States
| | - Christy J W Ledford
- Department of Family Medicine, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Rd., Bethesda, MD 20814, Department of Family Medicine, National Capital Consortium Family Medicine Residency, 9300 DeWitt Loop, Fort Belvoir, VA 22060, United States
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Fisher CL, Wolf BM, Fowler C, Canzona MR. Experiences of “openness” between mothers and daughters during breast cancer: implications for coping and healthy outcomes. Psychooncology 2016; 26:1872-1880. [DOI: 10.1002/pon.4253] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2016] [Revised: 08/01/2016] [Accepted: 08/14/2016] [Indexed: 11/06/2022]
Affiliation(s)
- Carla L. Fisher
- Department of Advertising, UF Health Cancer Center, STEM Translational Communication Center; University of Florida; Gainesville FL USA
| | - Bianca M. Wolf
- Department of Communication Studies; University of Puget Sound; Tacoma WA USA
| | - Craig Fowler
- School of Communication, Journalism and Marketing; Massey University; Aukland New Zealand
| | - Mollie Rose Canzona
- Department of Communication, Social Sciences and Health Policy; Wake Forest University School of Medicine; Winston-Salem NC USA
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Fisher CL, Roccotagliata T, Rising CJ, Kissane DW, Glogowski EA, Bylund CL. “I Don’t Want to Be an Ostrich”: Managing Mothers’ Uncertainty during BRCA1/2 Genetic Counseling. J Genet Couns 2016; 26:455-468. [DOI: 10.1007/s10897-016-9998-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2016] [Accepted: 07/12/2016] [Indexed: 10/21/2022]
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Fisher CL, Nussbaum JF. Maximizing Wellness in Successful Aging and Cancer Coping: The Importance of Family Communication from a Socioemotional Selectivity Theoretical Perspective. J Fam Commun 2015; 15:3-19. [PMID: 26997920 PMCID: PMC4797998 DOI: 10.1080/15267431.2014.946512] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
Interpersonal communication is a fundamental part of being and key to health. Interactions within family are especially critical to wellness across time. Family communication is a central means of adaptation to stress, coping, and successful aging. Still, no theoretical argument in the discipline exists that prioritizes kin communication in health. Theoretical advances can enhance interventions and policies that improve family life. This article explores socioemotional selectivity theory (SST), which highlights communication in our survival. Communication partner choice is based on one's time perspective, which affects our prioritization of goals to survive-goals sought socially. This is a first test of SST in a family communication study on women's health and aging. More than 300 women of varying ages and health status participated. Two time factors, later adulthood and late-stage breast cancer, lead women to prioritize family communication. Findings provide a theoretical basis for prioritizing family communication issues in health reform.
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Affiliation(s)
- Carla L Fisher
- Department of Communication, Center for Health & Risk Communication, George Mason University, 4400 University Dr. 3D6, Fairfax, VA 22030, ; 703/993-1090
| | - Jon F Nussbaum
- Department of Communication Arts & Sciences, Affiliate Faculty, Department of Human Development & Family Studies, The Pennsylvania State University, 234 Sparks Building, University Park, PA 16802, ; 814/863-3619
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Fisher CL, Maloney E, Glogowski E, Hurley K, Edgerson S, Lichtenthal WG, Kissane D, Bylund C. Talking about familial breast cancer risk: topics and strategies to enhance mother-daughter interactions. Qual Health Res 2014; 24:517-535. [PMID: 24633365 DOI: 10.1177/1049732314524638] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
A hereditary cancer predisposition can rattle families, creating dysfunctional interactions. Families need assistance navigating conversations about risk. Because mothers and daughters uniquely share breast cancer experiences and risk, there is a particular need for practitioners to assist them with communication. Three focus groups were conducted with 11 mothers with an elevated cancer risk (with adolescent daughters) receiving genetic counseling. We explored three inquiries to capture mother-daughter communication: emergent challenging topics (e.g., health-promotion behavior, daughter's risk, mother's risk of death), factors complicating discussions (e.g., balancing what to share and when, guilt and blaming, confusion about risk and prevention), and strategies enhancing conversations initiated by mothers (e.g., paying attention to daughter's cues) or practitioners (e.g., inviting daughters to appointments). Findings suggested that mothers struggle to balance eliciting daughters' concerns, providing them with support, and imparting knowledge without overwhelming them. We offer mothers and practitioners guidance to help facilitate these conversations.
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Abstract
We explored how older adults evaluated the strategies used by an adult child to initiate discussion of future care needs, and subsequently, whether these judgments affected older adults' willingness to engage in discussions about eldercare if approached in a similar fashion by one of their own children. One hundred and thirty older adults were randomly assigned to read one of four scripts depicting efforts by a middle-aged daughter to raise the topic of future care needs with her mother by implementing a variety of facework behaviors. Scripts manipulated the degree to which the daughter conveyed respect for her mother's desires for autonomy (negative face) and connection (positive face). The daughter's facework significantly predicted older parents' evaluation of her as supportive, which in turn predicted their willingness to discuss future care needs with one of their own children if they were to approach the conversation in a similar way.
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Affiliation(s)
- Craig Fowler
- a School of Communication, Journalism, and Marketing , Massey University
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Bylund CL, Fisher CL, Brashers D, Edgerson S, Glogowski EA, Boyar SR, Kemel Y, Spencer S, Kissane D. Sources of Uncertainty About Daughters’ Breast Cancer Risk that Emerge During Genetic Counseling Consultations. J Genet Couns 2011; 21:292-304. [DOI: 10.1007/s10897-011-9400-y] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2011] [Accepted: 07/28/2011] [Indexed: 11/29/2022]
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Abstract
Adult children are the primary source of informal eldercare in the United States. Unfortunately, however, families rarely prepare for an aging parent's future care needs. This is problematic, as advance preparation may reduce depression and anxiety in older adults and be helpful for adult children. Given the importance of preparation prior to parental dependency, we examined factors associated with preparation for caregiving. Using survey methodology, we studied 2 groups of people: Functionally independent parents at least 60 years of age, and adult children at least 40 years of age. Several variables appeared to be associated with awareness of care needs, gathering information, and discussion of possible care arrangements. Most notably, attitudes regarding shared autonomy and aging anxiety were positively associated with each of these stages of preparation. Other findings suggest that being concerned about possible negative effects of caregiving and perceiving the future as limited may also be associated with preparation for caregiving. The results provide gerontologists, interventionists, and families with insight into attitudes that may inhibit or facilitate preparation for future caregiving needs.
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Affiliation(s)
- Craig Fowler
- Department of Communication, California Sate University, Fresno, CA 93740, USA.
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Stewart JE, Fisher CL, Aagaard PJ, Wilson MR, Isenberg AR, Polanskey D, Pokorak E, DiZinno JA, Budowle B. Length variation in HV2 of the human mitochondrial DNA control region. J Forensic Sci 2001; 46:862-70. [PMID: 11451068] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/20/2023]
Abstract
Hair samples were typed from three individuals who exhibited length heteroplasmy in the homopolymeric cytosine stretches (C-stretch) in hypervariable region 2 (HV2). The study demonstrated that for different hairs within an individual, the HV2 C-stretch region can vary with respect to the number of cytosines and/or proportion of C-stretch length variants. Length heteroplasmy may occur regardless of the prominent length variant present in this region. Differences in the number of cytosines at the C-stretch region, or a variation in the relative amounts of heteroplasmic length variants, cannot be used to support an interpretation of exclusion.
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Affiliation(s)
- J E Stewart
- DNA Analysis Unit II, FBI Laboratory, Washington, DC 20535, USA
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Anzueto A, Fisher CL, Busman T, Olson CA. Comparison of the efficacy of extended-release clarithromycin tablets and amoxicillin/clavulanate tablets in the treatment of acute exacerbation of chronic bronchitis. Clin Ther 2001; 23:72-86. [PMID: 11219481 DOI: 10.1016/s0149-2918(01)80031-x] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND Clarithromycin has established efficacy and safety in the treatment of respiratory infections. OBJECTIVE This study examined the efficacy and safety of a new extended-release formulation of clarithromycin compared with amoxicillin/clavulanate in the treatment of acute exacerbation of chronic bronchitis (AECB). METHODS This phase IIIB, multicenter, randomized, parallel-group, investigator-blinded study in patients with AECB and productive cough with purulent sputum compared treatment with extended-release clarithromycin (two 500-mg tablets once daily for 7 days) and amoxicillin/clavulanate (one 875-mg tablet twice daily for 10 days). Assessments were performed before treatment, between study days 10 and 12 (or within 48 hours after premature discontinuation), and between study days 17 and 21 (test of cure). RESULTS Of 287 patients randomized and treated, 270 were clinically evaluable (137 clarithromycin, 133 amoxicillin/clavulanate). Treatment groups were well matched in terms of demographic characteristics, medical condition, and history. Among clinically evaluable patients at test of cure, 85% and 87% of clarithromycin- and amoxicillin/clavulanate-treated patients, respectively, demonstrated clinical cure (as defined in 1998 draft US Food and Drug Administration guidelines); among clinically and bacteriologically evaluable patients, 92% versus 89%, respectively, demonstrated bacteriologic cure. Overall pathogen eradication rates were similar in the 2 groups (88% clarithromycin, 89% amoxicillin/clavulanate). Rates of premature discontinuation of study drug for any reason differed between treatments: 3% (4/142) of clarithromycin-treated patients versus 12% (17/145) of amoxicillin/clavulanate-treated patients (P = 0.005). One percent (2/142) and 6% (8/145) of the respective treatment groups discontinued study drug because of adverse events. Adverse events generally occurred with a similar frequency in the 2 groups; however, taste alteration was more common with clarithromycin (9/142 [6%]) than with amoxicillin/clavulanate (1/145 [1%]; P = 0.01). Mean severity scores for gastrointestinal adverse events showed a significant difference between groups (1.16 for clarithromycin-treated patients and 1.58 for amoxicillin/clavulanate-treated patients: P = 0.016). CONCLUSIONS The results of this study demonstrate the clinical and bacteriologic equivalence and improved gastrointestinal tolerability of a 7-day course of once-daily extended-release clarithromycin relative to a 10-day course of twice-daily amoxicillin/clavulanate in the treatment of AECB.
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Affiliation(s)
- A Anzueto
- Division of Pulmonary Diseases/Critical Care Medicine, University of Texas Health Science Center at San Antonio, 78284-7885, USA.
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Abstract
We have isolated a human cDNA encoding a novel ATP-binding cassette (ABC) protein whose gene was previously localized to chromosome 1q42 [Allikmets et al. (1995) Mamm. Genome 6, 111-117]. The gene transcript is expressed in all human tissues examined, with the highest levels in bone marrow. A non-expressed pseudogene also exists at chromosome 15q13-14. The new protein, which is most similar to the mitochondrial (M)-ABC1 protein, was also localized to mitochondria and therefore designated 'M-ABC2'. The N-terminus of M-ABC2 was shown to contain a mitochondrial-targeting signal sequence.
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Affiliation(s)
- F Zhang
- BC Cancer Research Centre, British Columbia Cancer Agency, University of British Columbia, 601 West 10th Avenue, V5Z 1L3, Vancouver, BC, Canada
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Zhang F, Zhang W, Liu L, Fisher CL, Hui D, Childs S, Dorovini-Zis K, Ling V. Characterization of ABCB9, an ATP binding cassette protein associated with lysosomes. J Biol Chem 2000; 275:23287-94. [PMID: 10748049 DOI: 10.1074/jbc.m001819200] [Citation(s) in RCA: 79] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
We have cloned full-length human and mouse cDNAs of ABCB9, which encodes a predicted multiple-spanning transmembrane domain and a nucleotide-binding domain with Walker motifs. It is therefore designated as a "half" ATP binding cassette (ABC) transporter. Northern analysis shows that the ABCB9 mRNA is expressed at a high level in testes and moderate levels in brain and spinal cord. A splice variant mRNA deleted in the last pair of predicted transmembrane segments was shown to be expressed in human tissues. Phylogenetic analysis indicates that ABCB9 is closely related to TAP1 and TAP2, two "half" ABC proteins found in endoplasmic reticulum. ABCB9 protein colocalized with the lysosomal markers, LAMP1 and LAMP2, in transfected cells. ABCB9 protein appears to be most highly expressed in the Sertoli cells of the seminiferous tubules in mouse and rat testes. These cells have high levels of phagocytosis and secretory activities. These findings pave the way for further investigation into the potential novel function of ABCB9 in lysosomes.
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Affiliation(s)
- F Zhang
- British Columbia Cancer Research Centre, British Columbia Cancer Agency, University of British Columbia, Vancouver, V5Z 1L3 Canada
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Shi Y, Ullrich SJ, Zhang J, Connolly K, Grzegorzewski KJ, Barber MC, Wang W, Wathen K, Hodge V, Fisher CL, Olsen H, Ruben SM, Knyazev I, Cho YH, Kao V, Wilkinson KA, Carrell JA, Ebner R. A novel cytokine receptor-ligand pair. Identification, molecular characterization, and in vivo immunomodulatory activity. J Biol Chem 2000; 275:19167-76. [PMID: 10749887 DOI: 10.1074/jbc.m910228199] [Citation(s) in RCA: 168] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
As part of a large scale effort to discover novel secreted proteins, a cDNA encoding a novel cytokine was identified. Alignments of the sequence of the new protein, designated IL-17B, suggest it to be a homolog of the recently described T cell-derived cytokine, IL-17. By Northern analysis, EST distribution and real-time quantitative polymerase chain reaction analysis, mRNA was detected in many cell types. A novel type I transmembrane protein, identified in an EST data base by homology to IL-17R, was found to bind specifically IL-17B, as determined by surface plasmon resonance analysis, flow cytometry, and co-immunoprecipitation experiments. Readily detectable transcription of IL-17BR was restricted to human kidney, pancreas, liver, brain, and intestines and only a few of the many cell lines tested. By using a rodent ortholog of IL-17BR as a probe, IL-17BR message was found to be drastically up-regulated during intestinal inflammation elicited by indomethacin treatment in rats. In addition, intraperitoneal injection of IL-17B purified from Chinese hamster ovary cells caused marked neutrophil migration in normal mice, in a specific and dose-dependent manner. Together these results suggest that IL-17B may be a novel proinflammatory cytokine acting on a restricted set of target cell types. They also demonstrate the strength of genomic approaches in the unraveling of novel biological pathways.
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MESH Headings
- Adjuvants, Immunologic/chemistry
- Adjuvants, Immunologic/genetics
- Adjuvants, Immunologic/metabolism
- Adjuvants, Immunologic/pharmacology
- Amino Acid Sequence
- Animals
- Base Sequence
- Cell Line
- Cell Movement
- Cricetinae
- DNA, Complementary
- Expressed Sequence Tags
- Humans
- Interleukin-17/metabolism
- Ligands
- Mice
- Molecular Sequence Data
- Neutrophils/cytology
- RNA, Messenger/genetics
- Rats
- Receptors, Interleukin/chemistry
- Receptors, Interleukin/genetics
- Receptors, Interleukin/metabolism
- Receptors, Interleukin-17
- Recombinant Proteins/chemistry
- Recombinant Proteins/genetics
- Recombinant Proteins/metabolism
- Sequence Homology, Amino Acid
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Affiliation(s)
- Y Shi
- Departments of Molecular Biology, Protein Development, Strategic Drug Development, and Cell Biology, Human Genome Sciences, Inc., Rockville, Maryland 20850, USA
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