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Gabarda A, Butterworth S, Liang Q, Beckjord E. Pilot Study of a Motivational Interviewing Training on Practitioners' Skill Set for Patient Centered Communication. Am J Health Promot 2023; 37:1070-1077. [PMID: 37494296 DOI: 10.1177/08901171231191130] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/28/2023]
Abstract
PURPOSE Increase practitioners' Motivational Interviewing (MI) skill set to develop intrinsic motivation and behavior change competencies. DESIGN Pilot comparing intervention group with waitlist-control group. SETTING Health Plan in northeast of U.S. INTERVENTION Training program including a 3 day 19 hour MI training intensive, 1.5 hour follow-up skill-building trainings, and quality assurance review using an MI assessment tool paired with strengths-based mentoring. Cohort 1 (experimental group) received the intervention for 6-months and cohort 2 for 3 months (control group). MEASURES Practitioners' MI skill set was assessed pre- and post-intervention using Motivational Interviewing Competency Assessment (MICA). Practitioners' MI knowledge and attitudes were assessed pre- and post-training using adapted Motivational Interviewing Knowledge and Attitudes Test (MIKAT). Active learning and confidence questionnaires were administered post-training. ANALYSIS A generalized linear mixed model with repeated measures to analyze difference in MICA growth rates; paired T-test for MIKAT pre/post training analysis. Descriptive statistics for active learning and confidence. RESULTS MICA scores significantly improved for both cohorts (P < .0001). Practitioners had significant increase in knowledge and attitudes for MI (P < .001) and confidence in using MI (P < .01). High levels of active learning were observed (93-100%). CONCLUSION With planning, adequate resources/support, and iterative processes for adjustment, practitioners can improve their MI skill set in a short period of time with modest investment of practitioner resources.
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Affiliation(s)
| | - Susan Butterworth
- Center for Health System Improvement, College of Medicine, The University of Tennessee Health Science Center, Memphis, TN, USA
| | - Qingfeng Liang
- UPMC Center for High Value Health Care, Pittsburgh, PA, USA
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Karslioglu French E, Kanter J, Winger ME, Williams K, Grumski T, Schuster J, Beckjord E. A Payer-Provider Partnership for Endocrine Targeted Automatic eConsults: Implementation and Early Impact on Diabetes and Cost Outcomes. Popul Health Manag 2023. [PMID: 37093168 DOI: 10.1089/pop.2023.0008] [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: 04/25/2023] Open
Abstract
In the United States, many individuals with diabetes mellitus (DM) do not achieve treatment goals despite the availability of effective interventions. Provider clinical inertia is one cause of these unfavorable outcomes. Targeted automatic eConsults (TACos) are an emerging technology-based intervention with potential to address clinical inertia in primary care (PC). TACos prospectively identify at-risk patients and use unsolicited specialist recommendations to prompt treatment intensification. Through a payer-provider collaboration, a TACos intervention was piloted for adults with uncontrolled DM (HbA1c >8%) to understand impact on DM clinical inertia and outcomes. Clinical inertia was assessed by measuring whether a PC provider implemented recommended therapeutic changes. Six-month changes in HbA1c and health care costs per member per month were evaluated using an observational matched design and intention-to-treat (ITT) analysis. The analysis included 196 individuals who received a TACos between February 2021 and August 2021 (ITT group) matched to 392 controls based on clinical and demographic criteria. TACos recommendations were implemented 65% of the time. Median percent change in HbA1c was significantly greater for the ITT group versus controls (-10.9% vs. -10.2%; P = 0.0359). Median total costs were 7.9% lower in the ITT group (P = 0.0900). A per protocol analysis was done to examine effects between ITT group individuals with an implemented TACos recommendation (n = 126) and controls. Median percent change in HbA1c was significantly greater (-19.5% vs. -10.2%; P < 0.0001), but there was no difference in total costs (-7.9%; P = 0.1753). TACos may feasibly address clinical inertia in PC and improve HbA1c for uncontrolled DM.
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Affiliation(s)
| | - Justin Kanter
- UPMC Center for High-Value Health Care, Pittsburgh, Pennsylvania, USA
| | - Mary E Winger
- UPMC Insurance Services Division, Department of Health Economics, Pittsburgh, Pennsylvania, USA
| | - Kelly Williams
- UPMC Center for High-Value Health Care, Pittsburgh, Pennsylvania, USA
| | - Tammi Grumski
- UPMC Insurance Services Division, Pittsburgh, Pennsylvania, USA
| | - James Schuster
- UPMC Insurance Services Division, Pittsburgh, Pennsylvania, USA
| | - Ellen Beckjord
- UPMC Insurance Services Division, Pittsburgh, Pennsylvania, USA
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3
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Alfano CM, Mayer DK, Beckjord E, Ahern DK, Galioto M, Sheldon LK, Klesges LM, Aronoff-Spencer E, Hesse BW. Mending Disconnects in Cancer Care: Setting an Agenda for Research, Practice, and Policy. JCO Clin Cancer Inform 2021; 4:539-546. [PMID: 32543897 DOI: 10.1200/cci.20.00046] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Cancer in the United States accounts for $600 billion in health care costs, lost work time and productivity, reduced quality of life, and premature mortality. The future of oncology delivery must mend disconnects to equitably improve patient outcomes while constraining costs and burden on patients, caregivers, and care teams. Embedding learning health systems into oncology can connect care, engaging patients and providers in fully interoperable data systems that remotely monitor patients; generate predictive and prescriptive analytics to facilitate appropriate, timely referrals; and extend the reach of clinicians beyond clinic walls. Incorporating functional learning systems into the future of oncology and follow-up care requires coordinated national attention to 4 synergistic strategies: (1) galvanize and shape public discourse to develop and adopt these systems, (2) demonstrate their value, (3) test and evaluate their use, and (4) reform policy to incentivize and regulate their use.
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Affiliation(s)
| | | | - Ellen Beckjord
- Population Health and Clinical Affairs, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - David K Ahern
- Brigham and Women's Hospital, Boston, MA.,Connect2Health Task Force, Federal Communications Commission, Washington DC
| | - Michele Galioto
- ONS Center for Innovation at Oncology Nursing Society, Pittsburgh, PA
| | - Lisa K Sheldon
- ONS Center for Innovation at Oncology Nursing Society, Pittsburgh, PA
| | | | - Eliah Aronoff-Spencer
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St Louis, MO
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4
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Williams K, Markwardt S, Kearney SM, Karp JF, Kraemer KL, Park MJ, Freund P, Watson A, Schuster J, Beckjord E. Correction: Addressing Implementation Challenges to Digital Care Delivery for Adults With Multiple Chronic Conditions: Stakeholder Feedback in a Randomized Controlled Trial. JMIR Mhealth Uhealth 2021; 9:e27996. [PMID: 33635822 PMCID: PMC7954652 DOI: 10.2196/27996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Accepted: 02/16/2021] [Indexed: 11/13/2022] Open
Abstract
[This corrects the article DOI: 10.2196/23498.].
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Affiliation(s)
- Kelly Williams
- UPMC Center for High-Value Health Care, Insurance Services Division, UPMC, Pittsburgh, PA, United States
| | - Sarah Markwardt
- UPMC Center for High-Value Health Care, Insurance Services Division, UPMC, Pittsburgh, PA, United States
| | - Shannon M Kearney
- UPMC Center for High-Value Health Care, Insurance Services Division, UPMC, Pittsburgh, PA, United States
| | - Jordan F Karp
- Department of Psychiatry, College of Medicine-Tucson, University of Arizona, Tucson, AZ, United States
| | - Kevin L Kraemer
- Center for Research on Health Care, Division of General Internal Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States
| | - Margaret J Park
- Community Wellness Consultancy, Pittsburgh, PA, United States
| | - Paul Freund
- Consumer Action Response Team of Allegheny County, NAMI Keystone Pennsylvania, Pittsburgh, PA, United States
| | - Andrew Watson
- Department of Surgery, UPMC, Pittsburgh, PA, United States
| | - James Schuster
- UPMC Center for High-Value Health Care, Insurance Services Division, UPMC, Pittsburgh, PA, United States
| | - Ellen Beckjord
- UPMC Center for High-Value Health Care, Insurance Services Division, UPMC, Pittsburgh, PA, United States
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5
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Williams K, Markwardt S, Kearney SM, Karp JF, Kraemer KL, Park MJ, Freund P, Watson A, Schuster J, Beckjord E. Addressing Implementation Challenges to Digital Care Delivery for Adults With Multiple Chronic Conditions: Stakeholder Feedback in a Randomized Controlled Trial. JMIR Mhealth Uhealth 2021; 9:e23498. [PMID: 33522981 PMCID: PMC7884214 DOI: 10.2196/23498] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Revised: 11/06/2020] [Accepted: 11/17/2020] [Indexed: 01/23/2023] Open
Abstract
Background Digital tools accessed via smartphones can promote chronic condition management, reduce disparities in health care and hospital readmissions, and improve quality of life. However, whether digital care strategies can be implemented successfully on a large scale with traditionally underserved populations remains uncertain. Objective As part of a randomized trial comparing care delivery strategies for Medicaid and Medicare-Medicaid beneficiaries with multiple chronic conditions, our stakeholders identified implementation challenges, and we developed stakeholder-driven adaptions to improve a digitally delivered care management strategy (high-tech care). Methods We used 4 mechanisms (study support log, Patient Partners Work Group log, case interview log, and implementation meeting minutes) to capture stakeholder feedback about technology-related challenges and solutions from 9 patient partners, 129 participants, and 32 care managers and used these data to develop and implement solutions. To assess the impact, we analyzed high-tech care exit surveys and intervention engagement outcomes (video visits and condition-specific text message check-ins sent at varying intervals) before and after each solution was implemented. Results Challenges centered around 2 themes: difficulty using both smartphones and high-tech care components and difficulty using high-tech care components due to connectivity issues. To respond to the first theme’s challenges, we devised 3 solutions: tech visits (eg, in-person technology support visits), tech packet (eg, participant-facing technology user guide), and tailored condition-specific text message check-ins. During the first 20 months of implementation, 73 participants received at least one tech visit. We observed a 15% increase in video call completion for participants with data before and after the tech visit (n=25) and a 7% increase in check-in completion for participants with data before and after the tech visit (n=59). Of the 379 participants given a tech packet, 179 completed care during this timeframe and were eligible for an exit survey. Of the survey respondents, 76% (73/96) found the tech packet helpful and 64% (62/96) actively used it during care. To support condition-specific text message check-in completion, we allowed for adaption of day and/or time of the text message with 31 participants changing the time they received check-ins and change in standard biometric settings with 13 physicians requesting personalized settings for participants. To respond to the second theme’s challenges, tech visits or phone calls were made to demonstrate how to use a smartphone to connect or disconnect from the internet, to schedule video calls, or for condition-specific text message check-ins in a location with broadband/internet. Conclusions Having structured stakeholder feedback mechanisms is key to identify challenges and solutions to digital care engagement. Creating flexible and scalable solutions to technology-related challenges will increase equity in accessing digital care and support more effective engagement of chronically ill populations in the use of these digital care tools. Trial Registration ClinicalTrials.gov NCT03451630; https://clinicaltrials.gov/ct2/show/NCT03451630.
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Affiliation(s)
- Kelly Williams
- UPMC Center for High-Value Health Care, Insurance Services Division, UPMC, Pittsburgh, PA, United States
| | - Sarah Markwardt
- UPMC Center for High-Value Health Care, Insurance Services Division, UPMC, Pittsburgh, PA, United States
| | - Shannon M Kearney
- UPMC Center for High-Value Health Care, Insurance Services Division, UPMC, Pittsburgh, PA, United States
| | - Jordan F Karp
- Department of Psychiatry, College of Medicine-Tucson, University of Arizona, Tuscon, AZ, United States
| | - Kevin L Kraemer
- Department of Psychiatry, College of Medicine-Tucson, University of Arizona, Tuscon, AZ, United States
| | - Margaret J Park
- Community Wellness Consultancy, Pittsburgh, PA, United States
| | - Paul Freund
- Consumer Action Response Team of Allegheny County, NAMI Keystone Pennsylvania, Pittsburgh, PA, United States
| | - Andrew Watson
- Department of Surgery, UPMC, Pittsburgh, PA, United States
| | - James Schuster
- UPMC Center for High-Value Health Care, Insurance Services Division, UPMC, Pittsburgh, PA, United States
| | - Ellen Beckjord
- UPMC Center for High-Value Health Care, Insurance Services Division, UPMC, Pittsburgh, PA, United States
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Arigo D, Jake-Schoffman DE, Wolin K, Beckjord E, Hekler EB, Pagoto SL. The history and future of digital health in the field of behavioral medicine. J Behav Med 2019; 42:67-83. [PMID: 30825090 PMCID: PMC6644720 DOI: 10.1007/s10865-018-9966-z] [Citation(s) in RCA: 85] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Accepted: 08/23/2018] [Indexed: 01/03/2023]
Abstract
Since its earliest days, the field of behavioral medicine has leveraged technology to increase the reach and effectiveness of its interventions. Here, we highlight key areas of opportunity and recommend next steps to further advance intervention development, evaluation, and commercialization with a focus on three technologies: mobile applications (apps), social media, and wearable devices. Ultimately, we argue that future of digital health behavioral science research lies in finding ways to advance more robust academic-industry partnerships. These include academics consciously working towards preparing and training the work force of the twenty first century for digital health, actively working towards advancing methods that can balance the needs for efficiency in industry with the desire for rigor and reproducibility in academia, and the need to advance common practices and procedures that support more ethical practices for promoting healthy behavior.
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Affiliation(s)
- Danielle Arigo
- Department of Psychology, Rowan University, Glassboro, USA.
| | | | | | - Ellen Beckjord
- Population Health and Clinical Affairs, University of Pittsburgh Medical Center Health Plan, Pittsburgh, USA
| | - Eric B Hekler
- Department of Family Medicine Public Health, Center for Wireless and Population Health Systems, University of California, San Diego, San Diego, USA
| | - Sherry L Pagoto
- Department of Allied Health Sciences, Institute for Collaboration in Health, Interventions, and Policy, Center for mHealth and Social Media, University of Connecticut, Storrs, USA
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Tarver WL, Menser T, Hesse BW, Johnson TJ, Beckjord E, Ford EW, Huerta TR. Growth Dynamics of Patient-Provider Internet Communication: Trend Analysis Using the Health Information National Trends Survey (2003 to 2013). J Med Internet Res 2018; 20:e109. [PMID: 29599107 PMCID: PMC5897625 DOI: 10.2196/jmir.7851] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2017] [Revised: 10/03/2017] [Accepted: 11/16/2017] [Indexed: 11/16/2022] Open
Abstract
Background Communication is key in chronic disease management, and the internet has altered the manner in which patients and providers can exchange information. Adoption of secure messaging differs among patients due to the digital divide that keeps some populations from having effective access to online resources. Objective This study aimed to examine the current state of online patient-provider communication, exploring trends over time in the use of online patient-provider communication tools. Methods A 3-part analytic process was used to study the following: (1) reanalysis, (2) close replication across years, and (3) trend analysis extension. During the reanalysis stage, the publicly available Health Information National Trends Survey (HINTS) 1 and 2 data were used with the goal of identifying the precise analytic methodology used in a prior study, published in 2007. The original analysis was extended to add 3 additional data years (ie, 2008, 2011, and 2013) using the original analytical approach with the purpose of identifying trends over time. Multivariate logistic regression was used to analyze pooled data across all years, with year as an added predictor, in addition to a model for each individual data year. Results The odds of internet users to communicate online with health care providers was significantly and increasingly higher year-over-year, starting in 2003 (2005: odds ratio [OR] 1.31, 95% CI 1.03-1.68; 2008: OR 2.14, 95% CI 1.76-2.59; 2011: OR 2.92, 95% CI 2.33-3.66; and 2013: OR 5.77; 95% CI 4.62-7.20). Statistically significant socio-economic factors found to be associated with internet users communicating online with providers included age, having health insurance, having a history of cancer, and living in an urban area of residence. Conclusions The proportion of internet users communicating online with their health care providers has significantly increased since 2003. Although these trends are encouraging, access challenges still exist for some groups, potentially giving rise to a new set of health disparities related to communication.
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Affiliation(s)
- Will L Tarver
- Health Services Research and Development Service Center for Health Information and Communication, Richard L Roudebush VA Medical Center, Indianapolis, IN, United States
| | - Terri Menser
- Center for Outcomes Research, Houston Methodist Research Institute, Houston, TX, United States
| | - Bradford W Hesse
- Health Communication and Informatics Research Branch, National Cancer Institute, Bethesda, MD, United States
| | - Tyler J Johnson
- Department of Family Medicine, The Ohio State University, Columbus, OH, United States
| | - Ellen Beckjord
- Population Health Program Design and Engagement Optimization, UPMC Health Plan, Pittsburgh, PA, United States
| | - Eric W Ford
- Department of Health Care Organization and Policy, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Timothy R Huerta
- Department of Family Medicine, The Ohio State University, Columbus, OH, United States
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McGowan M, Keyser DJ, Kinsky S, Beckjord E, DeGrazia R, Shrank W. UPMC's Population Health Management Strategy: A Road Map to High-Value Health Care. Popul Health Manag 2017; 21:346-348. [PMID: 29232528 DOI: 10.1089/pop.2017.0171] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Affiliation(s)
- Marion McGowan
- 1 UPMC Insurance Services Division , Pittsburgh, Pennsylvania
| | - Donna J Keyser
- 2 UPMC Center for High-Value Health Care , Pittsburgh, Pennsylvania
| | - Suzanne Kinsky
- 2 UPMC Center for High-Value Health Care , Pittsburgh, Pennsylvania
| | - Ellen Beckjord
- 1 UPMC Insurance Services Division , Pittsburgh, Pennsylvania
| | | | - William Shrank
- 1 UPMC Insurance Services Division , Pittsburgh, Pennsylvania
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Dumortier A, Beckjord E, Shiffman S, Sejdić E. Classifying smoking urges via machine learning. Comput Methods Programs Biomed 2016; 137:203-213. [PMID: 28110725 PMCID: PMC5289882 DOI: 10.1016/j.cmpb.2016.09.016] [Citation(s) in RCA: 17] [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] [Received: 05/14/2016] [Revised: 08/12/2016] [Accepted: 09/20/2016] [Indexed: 05/30/2023]
Abstract
BACKGROUND AND OBJECTIVE Smoking is the largest preventable cause of death and diseases in the developed world, and advances in modern electronics and machine learning can help us deliver real-time intervention to smokers in novel ways. In this paper, we examine different machine learning approaches to use situational features associated with having or not having urges to smoke during a quit attempt in order to accurately classify high-urge states. METHODS To test our machine learning approaches, specifically, Bayes, discriminant analysis and decision tree learning methods, we used a dataset collected from over 300 participants who had initiated a quit attempt. The three classification approaches are evaluated observing sensitivity, specificity, accuracy and precision. RESULTS The outcome of the analysis showed that algorithms based on feature selection make it possible to obtain high classification rates with only a few features selected from the entire dataset. The classification tree method outperformed the naive Bayes and discriminant analysis methods, with an accuracy of the classifications up to 86%. These numbers suggest that machine learning may be a suitable approach to deal with smoking cessation matters, and to predict smoking urges, outlining a potential use for mobile health applications. CONCLUSIONS In conclusion, machine learning classifiers can help identify smoking situations, and the search for the best features and classifier parameters significantly improves the algorithms' performance. In addition, this study also supports the usefulness of new technologies in improving the effect of smoking cessation interventions, the management of time and patients by therapists, and thus the optimization of available health care resources. Future studies should focus on providing more adaptive and personalized support to people who really need it, in a minimum amount of time by developing novel expert systems capable of delivering real-time interventions.
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Affiliation(s)
- Antoine Dumortier
- Department of Electrical and Computer Engineering, University of Pittsburgh, Benedum Hall, Pittsburgh, PA 15260, USA
| | - Ellen Beckjord
- Department of Psychiatry, University of Pittsburgh, 5115 Centre Avenue, Suite 140, Pittsburgh, PA 15232, USA
| | - Saul Shiffman
- Department of Psychology, University of Pittsburgh, 510 BELPB, 130 N. Bellefield Avenue, Pittsburgh, PA 15260, USA
| | - Ervin Sejdić
- Department of Electrical and Computer Engineering, University of Pittsburgh, Benedum Hall, Pittsburgh, PA 15260, USA.
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Turner K, Samuel CA, Donovan HA, Beckjord E, Cardy A, Dew MA, van Londen GJ. Provider perspectives on patient-provider communication for adjuvant endocrine therapy symptom management. Support Care Cancer 2016; 25:1055-1061. [PMID: 27864628 DOI: 10.1007/s00520-016-3491-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [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: 08/13/2016] [Accepted: 11/07/2016] [Indexed: 10/20/2022]
Abstract
PURPOSE Providers' communication skills play a key role in encouraging breast cancer survivors to report symptoms and adhere to long-term treatments such as adjuvant endocrine therapy (AET). The purpose of this study was to examine provider perspectives on patient-provider communication regarding AET symptom management and to explore whether provider perspectives vary across the multi-disciplinary team of providers involved in survivorship care. METHODS We conducted three one-hour focus groups with a multi-disciplinary group of health care providers including oncology specialists, primary care physicians, and non-physician providers experienced in caring for breast cancer survivors undergoing AET (n = 13). Themes were organized using Epstein and Street's (2007) Framework for Patient-Centered Communication in Cancer Care. RESULTS The findings of this study suggest providers' communication behaviors including managing survivors' uncertainty, responding to survivors' emotions, exchanging information, and enabling self-management influences the quality of patient-provider communication about AET symptoms. Additionally, lack of systematic symptom assessment tools for AET requires providers to use discretion in determining which symptoms to discuss with survivors resulting in approaches that vary based on providers' discipline. CONCLUSION There may be AET-specific provider communication skills and behaviors that promote effective patient-provider communication but additional research is needed to identify practices and policies that encourage these skills and behaviors among the many providers involved in survivorship care. Efforts are also needed to coordinate AET symptom assessment across providers, clarify providers' roles in symptom assessment, and determine best practices for AET symptom communication.
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Affiliation(s)
- Kea Turner
- Department of Health Policy and Management, University of North Carolina at Chapel Hill, Gillings School of Global Public Health, 1105F McGavran-Greenberg Hall, CB#7411, Chapel Hill, NC, USA.
| | - Cleo A Samuel
- Department of Health Policy and Management, University of North Carolina at Chapel Hill, Gillings School of Global Public Health, 1105F McGavran-Greenberg Hall, CB#7411, Chapel Hill, NC, USA.,Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, 450 West Drive, Chapel Hill, NC, USA
| | - Heidi As Donovan
- University of Pittsburgh Medical Center Cancer Center, School of Nursing, University of Pittsburgh, 415 Victoria Building, 3500 Victoria Street, Pittsburgh, PA, USA
| | - Ellen Beckjord
- University of Pittsburgh Medical Center Health Plan, University of Pittsburgh, 600 Grant Street, Pittsburgh, PA, USA
| | - Alexandra Cardy
- University of Pittsburgh Medical Center Health Plan, University of Pittsburgh, 600 Grant Street, Pittsburgh, PA, USA
| | - Mary Amanda Dew
- Departments of Psychiatry, Psychology, Epidemiology, Biostatistics, and Clinical and Translational Science, University of Pittsburgh, 3811 O'Hara Street, Pittsburgh, PA, USA
| | - G J van Londen
- Department of Medicine, University of Pittsburgh, A. 140 Cooper Pavilion, 5115 Centre Avenue, Pittsburgh, PA, USA
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Hesse BW, Beckjord E, Rutten LJF, Fagerlin A, Cameron LD. Cancer communication and informatics research across the cancer continuum. ACTA ACUST UNITED AC 2016; 70:198-210. [PMID: 25730725 DOI: 10.1037/a0036852] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Over the past decade, dramatic changes brought about by a rapid diffusion of Internet technologies, cellular telephones, mobile devices, personal digital assistants, electronic health records, and data visualization have helped to create a revolution in health communication. To understand the implications of this communication revolution for cancer care, the National Cancer Institute launched an ambitious set of research priorities under its "extraordinary opportunities" program. We present an overview of some of the relevant behavioral research being conducted within the perspective of this extraordinary opportunity in cancer communication research. We begin by tracing the implications of this research for behavioral scientists across the continuum of cancer care from primary prevention (e.g., tobacco control, diet, exercise, sun protection, and immunization against human papilloma virus), to secondary prevention (e.g., screening for polyps, lesions, and early stage neoplasms), to diagnosis and treatment, posttreatment survivorship, and end of life. Along each point of the continuum, we describe a natural evolution of knowledge from studies on the traditional role of media to research on the changing role of new media and informatics, and we carefully highlight the role that psychological research has played in improving communication- and health-related outcomes along the way. We conclude with an appeal to psychologists of many different backgrounds to join with biomedical researchers, engineers, clinical practitioners, and others to accelerate progress against cancer.
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Affiliation(s)
- Bradford W Hesse
- Health Communication and Informatics Research Branch, National Cancer Institute
| | - Ellen Beckjord
- Biobehavioral Medicine in Oncology Program, University of Pittsburgh
| | - Lila J Finney Rutten
- Population Health Science Program, Department of Health Sciences Research, Mayo Clinic
| | - Angela Fagerlin
- Center for Bioethics and Social Sciences in Medicine, University of Michigan
| | - Linda D Cameron
- Health Communications and Interventions Lab and Department of Psychology, University of California, Merced
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Finney Rutten LJ, Agunwamba AA, Beckjord E, Hesse BW, Moser RP, Arora NK. The Relation Between Having a Usual Source of Care and Ratings of Care Quality: Does Patient-Centered Communication Play a Role? J Health Commun 2015; 20:759-765. [PMID: 26010552 DOI: 10.1080/10810730.2015.1018592] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Having a usual source of health care has been consistently associated with greater use of preventive services, decreased use of emergency services, and with patients' ratings of quality and satisfaction with care. Ongoing patient-provider relationships may be, in part, fostered by patient-centered communication. Growing evidence demonstrates that positive patient-centered communication improves adherence to treatment recommendations, management of chronic disease, quality of life, and disease-related outcomes. We aimed to determine how patient-centered communication between patients and physicians might mediate the relation between having a source of usual care and ratings of health care quality. We analyzed data from Cycle 1 of the fourth iteration of the Health Information National Trends Survey. Data were collected through mailed questionnaire in October 2011 through February 2012 (N = 3,959). Overall, individuals with a usual source of care reported more patient-centered communication experiences and had higher ratings of quality of care. Parameter estimates for each pathway in the mediation model were estimated through regression analysis. Results confirm the importance of patient-centered communication in shaping patients' perceptions of the quality of their care, accounting for a significant portion of the observed relation between having a usual source of care and ratings of quality.
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Affiliation(s)
- Lila J Finney Rutten
- a Robert D. and Patricia E. Kern Center for the Science of Healthcare Delivery , Mayo Clinic , Rochester , Minnesota , USA
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Posluszny DM, Dew MA, Beckjord E, Bovbjerg DH, Schmidt JE, Low CA, Lowery A, Nutt SA, Arvey SR, Rechis R. Existential challenges experienced by lymphoma survivors: Results from the 2010 LIVESTRONG Survey. J Health Psychol 2015; 21:2357-66. [PMID: 25845834 DOI: 10.1177/1359105315576352] [Citation(s) in RCA: 9] [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: 11/17/2022] Open
Abstract
We sought to examine the existential challenges that cancer survivors may experience as they strive to make meaning, regain their self-identity, cope with fear of recurrence, and experience feelings of grief and guilt. Lymphoma survivors (n = 429) completed the 2010 LIVE STRONG: survey and provided responses about meaning, cancer worry, security, identity, grief, guilt, and perceived functional impairment due to these concerns. Most survivors (73%-86%) endorsed existential concerns, with 30-39 percent reporting related perceived functional impairment. Concerns were associated with being female, younger, unmarried, and having undergone stem cell transplantation. Lymphoma survivors experience existential challenges that impact their life even years after diagnosis.
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Patel V, Beckjord E, Moser RP, Hughes P, Hesse BW. The role of health care experience and consumer information efficacy in shaping privacy and security perceptions of medical records: national consumer survey results. JMIR Med Inform 2015; 3:e14. [PMID: 25843686 PMCID: PMC4400314 DOI: 10.2196/medinform.3238] [Citation(s) in RCA: 18] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2014] [Revised: 11/25/2014] [Accepted: 12/12/2014] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Providers' adoption of electronic health records (EHRs) is increasing and consumers have expressed concerns about the potential effects of EHRs on privacy and security. Yet, we lack a comprehensive understanding regarding factors that affect individuals' perceptions regarding the privacy and security of their medical information. OBJECTIVE The aim of this study was to describe national perceptions regarding the privacy and security of medical records and identify a comprehensive set of factors associated with these perceptions. METHODS Using a nationally representative 2011-2012 survey, we reported on adults' perceptions regarding privacy and security of medical records and sharing of health information between providers, and whether adults withheld information from a health care provider due to privacy or security concerns. We used multivariable models to examine the association between these outcomes and sociodemographic characteristics, health and health care experience, information efficacy, and technology-related variables. RESULTS Approximately one-quarter of American adults (weighted n=235,217,323; unweighted n=3959) indicated they were very confident (n=989) and approximately half indicated they were somewhat confident (n=1597) in the privacy of their medical records; we found similar results regarding adults' confidence in the security of medical records (very confident: n=828; somewhat confident: n=1742). In all, 12.33% (520/3904) withheld information from a health care provider and 59.06% (2100/3459) expressed concerns about the security of both faxed and electronic health information. Adjusting for other characteristics, adults who reported higher quality of care had significantly greater confidence in the privacy and security of their medical records and were less likely to withhold information from their health care provider due to privacy or security concerns. Adults with higher information efficacy had significantly greater confidence in the privacy and security of medical records and less concern about sharing of health information by both fax and electronic means. Individuals' perceptions of whether their providers use an EHR was not associated with any privacy or security outcomes. CONCLUSIONS Although most adults are confident in the privacy and security of their medical records, many express concerns regarding sharing of information between providers; a minority report withholding information from their providers due to privacy and security concerns. Whether individuals thought their provider was using an EHR was not associated with negative privacy/security perceptions or withholding, suggesting the transition to EHRs is not associated with negative perceptions regarding the privacy and security of medical information. However, monitoring to see how this evolves will be important. Given that positive health care experiences and higher information efficacy were associated with more favorable perceptions of privacy and security, efforts should continue to encourage providers to secure medical records, provide patients with a "meaningful choice" in how their data are shared, and enable individuals to access information they need to manage their care.
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Affiliation(s)
- Vaishali Patel
- U.S. Department of Health and Human Services, Office of the National Coordinator for Health Information Technology, Washington, DC, United States.
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Parry C, Beckjord E, Moser RP, Vieux SN, Padgett LS, Hesse BW. It takes a (virtual) village: crowdsourcing measurement consensus to advance survivorship care planning. Transl Behav Med 2015; 5:53-9. [PMID: 25729453 DOI: 10.1007/s13142-014-0289-5] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
We report results from the use of an innovative tool (the Grid-Enabled Measures (GEM) database) to drive consensus on the use of measures evaluating the efficacy and implementation of survivorship care plans. The goal of this initiative was to increase the use of publicly available shared measures to enable comparability across studies. Between February and August 2012, research and practice communities populated the GEM platform with constructs and measures relevant to survivorship care planning, rated the measures, and provided qualitative feedback on the quality of the measures. Fifty-one constructs and 124 measures were entered into the GEM-Care Planning workspace by participants. The greatest number of measures appeared in the domains of Health and Psychosocial Outcomes, Health Behaviors, and Coordination of Care/Transitional Care. Using technology-mediated social participation, GEM presents a novel approach to how we measure and improve the quality of survivorship care.
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Affiliation(s)
- Carla Parry
- National Cancer Institute, Rockville, MD USA ; Southern California Permanente Medical Group, Department of Research and Evaluation, Kaiser Permanente, 100 South Los Robles, 2d Floor, Pasadena, CA 91101 USA
| | - Ellen Beckjord
- University of Pittsburgh Cancer Center, Pittsburgh, PA USA
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Low CA, Beckjord E, Bovbjerg DH, Dew MA, Posluszny DM, Schmidt JE, Lowery AE, Nutt SA, Arvey SR, Rechis R. Correlates of positive health behaviors in cancer survivors: results from the 2010 LIVESTRONG survey. J Psychosoc Oncol 2015; 32:678-95. [PMID: 25176347 DOI: 10.1080/07347332.2014.955243] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [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: 10/24/2022]
Abstract
Positive health-promoting behaviors, including lifestyle factors (e.g., physical activity) and appropriate health service utilization (e.g., screening for secondary cancers), can minimize the health risks and challenges facing cancer survivors. The goal of this article is to examine factors associated with positive health behaviors in 2,615 posttreatment cancer survivors who completed the 2010 LIVESTRONG survey. Multivariate logistic regression was used to model odds of reporting each of six positive health behaviors "as a result of your experience with cancer": three "healthy lifestyle" behaviors and three "health care utilization" behaviors. In fully adjusted models, factors associated with greater likelihood of engaging in positive lifestyle behaviors (e.g., physical activity, changing diet) included sociodemographic factors, greater knowledge about how to reduce cancer risk; and reporting more psychological benefits due to cancer (ps <.01). Factors associated with greater likelihood of attending medical appointments and obtaining recommended cancer screenings included older age, better patient-provider communication, greater knowledge about how to reduce cancer risk, and more psychological benefits of cancer (ps <.01). Results suggest that knowledge about how to prevent cancer and benefit finding after cancer are related to positive health behaviors broadly, whereas better patient-provider communication is associated with positive cancer screening and health care utilization but not healthy lifestyle behaviors. Clinical interventions targeting these modifiable factors could maximize positive health behavior changes among cancer survivors, affecting risk for cancer recurrence as well as overall health and well-being.
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Affiliation(s)
- Carissa A Low
- a Department of Medicine , University of Pittsburgh , Pittsburgh , PA , USA
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17
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Hesse BW, Gaysynsky A, Ottenbacher A, Moser RP, Blake KD, Chou WYS, Vieux S, Beckjord E. Meeting the healthy people 2020 goals: using the Health Information National Trends Survey to monitor progress on health communication objectives. J Health Commun 2014; 19:1497-509. [PMID: 25491584 PMCID: PMC4266162 DOI: 10.1080/10810730.2014.954084] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
The Healthy People initiative outlines a comprehensive set of goals aimed at improving the nation's health and reducing health disparities. Health communication has been included as an explicit goal since the launch of Healthy People 2010. The Health Information National Trends Survey (HINTS) was established as a means of exploring how the changing information environment was affecting the public's health, and is therefore an ideal tool for monitoring key health communication objectives included in the Healthy People agenda. In this article, the authors apply an integrative data analysis strategy to more than 10 years of HINTS data to demonstrate how public health surveillance can be used to evaluate broad national health goals, like those set forth under the Healthy People initiative. The authors analyzed just one item from the HINTS survey regarding Internet access in order to illustrate what public health surveillance tools, like HINTS, can reveal about important indicators that are of interest to all those who work to improve the health of the public. Results show that reported Internet penetration has exceeded the Healthy People 2020 target of 75.4%. HINTS data also allowed modeling of the effects of various sociodemographic factors, which revealed persistent differences on the basis of age and education, with the oldest age groups and those with less than a college education falling short of the Healthy People 2020 target as of 2013. Furthermore, although differences by race/ethnicity were observed, the analyses suggest that race in itself accounts for very little of the variance in Internet access.
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18
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Jain P, Klein D, Beckjord E. FitNinja Mobile System for Providers and Patients: Demonstrating Potential to Improve Regimen Compliance. J Acad Nutr Diet 2014. [DOI: 10.1016/j.jand.2014.06.282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Affiliation(s)
- Ellen Beckjord
- Corresponding author: Ellen Beckjord, PhD, MPH, University of Pittsburgh, Biobehavioral Medicine in Oncology Program, University of Pittsburgh Cancer Institute, 5115 Centre Avenue, Suite 140, Pittsburgh, PA; e-mail:
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Abstract
Sexual quality of life (QOL) is a significant concern for breast cancer survivors. This study investigated sexual quality of life in a sample of 191 newly diagnosed breast cancer patients. Sixty percent of the sample indicated disruption in their sexual quality of life. Sexual QOL during treatment was significantly more disrupted among women who received chemotherapy, were younger, had higher stage of disease, reported more depressive symptoms near time of diagnosis, and underwent a total mastectomy. Hierarchical linear regression was used to model sexual QOL and feelings of sexual attractiveness. Worse physical quality of life, chemotherapy, and depressive symptoms near time of diagnosis were associated with worse sexual QOL during treatment. An interaction between chemotherapy status and type of surgery, for feelings of sexual attractiveness, suggested that chemotherapy affected sexual attractiveness only among women who underwent a lumpectomy. These results add to growing evidence that sexual QOL is a multidimensional construct with aspects differentially affected by variables related to cancer survivorship.
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Affiliation(s)
- Ellen Beckjord
- Cancer Prevention Fellowship Program, National Cancer Institute, National Institutes of Health, DHHS, 6130 Executive Boulvard, DCCPS, 4051A, MSC 7365, Bethesda, MD 20892-7361, USA.
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21
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Glinder JG, Beckjord E, Kaiser CR, Compas BE. Psychological adjustment to breast cancer: Automatic and controlled responses to stress. Psychol Health 2007. [DOI: 10.1080/14768320600843168] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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22
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Abstract
This study examined relations between behavioral and characterological self-blame attributions for breast cancer and psychological distress in the year following a diagnosis. One hundred fifteen women with newly diagnosed breast cancer participated. First, we predicted that both forms of self-blame would be associated with distress shortly after diagnosis (i.e., at 4 months). Second, we predicted that only characterological self-blame would be related to distress at 7 and 12 months post-diagnosis because behavioral self-blame would enhance perceptions of control, thereby protecting against distress. Results supported the first hypothesis; both forms of self-blame were related to symptoms of anxiety and depression at 4 months post-diagnosis. Findings did not support the second hypothesis because both forms of self-blame continued to be related to distress at 7 and 12 months post-diagnosis. Furthermore, perceptions of control did not mediate the self-blame/distress relation. Implications for social cognitive processes in adaptation to breast cancer are discussed.
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Affiliation(s)
- Kymberley K Bennett
- Department of Psychology, Indiana State University, Terre Haute, IN 47809, USA.
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Compas BE, Beckjord E, Agocha B, Sherman ML, Langrock A, Grossman CI, Dausch B, Glinder J, Kaiser C, Anderson-Hanley C, Luecken L. Measurement of coping and stress responses in women with breast cancer. Psychooncology 2006; 15:1038-54. [PMID: 17009343 DOI: 10.1002/pon.999] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
The development of the Responses to Stress Questionnaire-cancer version (RSQ-CV) to assess coping with and responses to the stress of breast cancer is described. The RSQ-CV was completed by 232 women with breast cancer near the time of their diagnosis. Confirmatory factor analyses verified a model that includes three voluntary coping factors (primary control engagement coping, secondary control engagement coping, disengagement coping) and two involuntary stress response factors (involuntary engagement, involuntary disengagement). Internal consistency reliability, and stability over 12 weeks for the five factors were adequate to excellent. Convergent and discriminant validity was examined through correlations with measures of intrusive thoughts, avoidance, and dimensions of perceived control. Significant correlations with symptoms of anxiety and depression are also reported. Applications of the RSQ-CV for research with breast cancer patients are discussed.
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Affiliation(s)
- Bruce E Compas
- Department of Psychology & Human Development, Vanderbilt University, Peabody 512, 230 Appleton Place, Nashville, TN 37203, USA.
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Waller NG, Compas BE, Hollon SD, Beckjord E. Measurement of Depressive Symptoms in Women With Breast Cancer and Women With Clinical Depression: A Differential Item Functioning Analysis. J Clin Psychol Med Settings 2005. [DOI: 10.1007/s10880-005-3273-x] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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Dausch BM, Compas BE, Beckjord E, Luecken L, Anderson-Hanley C, Sherman M, Grossman C. Rates and Correlates of DSM-IV Diagnoses in Women Newly Diagnosed with Breast Cancer. J Clin Psychol Med Settings 2004. [DOI: 10.1023/b:jocs.0000037610.60644.d6] [Citation(s) in RCA: 29] [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] [Indexed: 11/12/2022]
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