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Harrell ER, Roque NA, Boot WR. Comparing the effectiveness of two theory-based strategies to promote cognitive training adherence. J Exp Psychol Appl 2023; 29:782-792. [PMID: 37471032 DOI: 10.1037/xap0000485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/21/2023]
Abstract
This study compared the effectiveness of two theory-based strategies to promote cognitive training adherence among older adults (Mage = 70 years, SD = 4.42, range = 64-84). Strategies incorporated either (a) elements of implementation intention formation or (b) positive message framing, both of which have been found to promote adherence to health behaviors in other domains. Participants (N = 120) were asked to engage in technology-based cognitive training at home comprised of seven gamified neuropsychological tasks. In Phase 1 (structured), participants were provided a schedule that required engagement in 1 hr of cognitive training 5 days each week over 2 months. In Phase 2 (unstructured), participants were instructed to engage with the intervention as much as they desired for 1 month. Contrary to expectations, neither the implementation intention nor positive message framing produced greater adherence relative to control as measured by the total number of training sessions completed in each phase. However, exploratory analysis indicated a greater likelihood of intervention engagement for participants assigned to the implementation intention condition on many days of the intervention, though the trajectory of engagement decline was similar for all three groups. Measures of cognition, attitudes/personality, and technology proficiency also did not predict adherence over either phase. (PsycInfo Database Record (c) 2023 APA, all rights reserved).
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Steinberg N, Parisi JM, Feger DM, Clay OJ, Willis SL, Ball KK, Marsiske M, Harrell ER, Sisco SM, Rebok GW. Rural-Urban Differences in Cognition: Findings From the Advanced Cognitive Training for Independent and Vital Elderly Trial. J Aging Health 2023; 35:107S-118S. [PMID: 35604034 DOI: 10.1177/08982643221102718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
ObjectivesWe examined associations between three geographic areas (urban, suburban, rural) and cognition (memory, reasoning, processing speed) over a 10-year period. Methods: Data were obtained from 2539 participants in the Advanced Cognitive Training for Independent and Vital Elderly (ACTIVE) trial. Multilevel, mixed-effects linear regression was used to estimate cognitive trajectories by geographical areas over 10 years, after adjusting for social determinants of health. Results: Compared to urban and suburban participants, rural participants fared worse on all cognitive measures-memory (B = -1.17 (0.17)), reasoning (B = -1.55 (0.19)), and processing speed (B = 0.76 (0.19)) across the 10-year trajectory. Across geographic areas, greater economic stability, health care access and quality, and neighborhood resources were associated with better cognition over time. Discussion: Findings highlight the importance of geographical location when examining cognition later in life. More research examining place-based life experiences is needed to make the greatest impact on geographically diverse communities.
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Affiliation(s)
- Nessa Steinberg
- Marcus Institute for Aging, Hebrew SeniorLife, Boston, MA, USA
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Jeanine M Parisi
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Johns Hopkins Alzheimer's Disease Resource Center for Minority Aging Research, Baltimore, MD, USA
| | - Danielle M Feger
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Johns Hopkins Center on Aging and Health, Baltimore, MD, USA
| | - Olivio J Clay
- Department of Psychology, University of Alabama at Birmingham, Birmingham, AL, USA
- Deep South Resource Center for Minority Aging Research, Birmingham, AL, USA
- University of Alabama Alzheimer's Disease Research Center, Birmingham, AL, USA
| | - Sherry L Willis
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA
| | - Karlene K Ball
- Department of Psychology, University of Alabama at Birmingham, Birmingham, AL, USA
- Deep South Resource Center for Minority Aging Research, Birmingham, AL, USA
| | - Michael Marsiske
- Department of Clinical and Health Psychology, University of Florida, Gainesville, FL, USA
| | - Erin R Harrell
- Department of Psychology, University of Alabama, Tuscaloosa, AL, USA
| | | | - George W Rebok
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Johns Hopkins Alzheimer's Disease Resource Center for Minority Aging Research, Baltimore, MD, USA
- Johns Hopkins Center on Aging and Health, Baltimore, MD, USA
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Dionne‐Odom JN, Kent EE, Rocque GB, Azuero A, Harrell ER, Gazaway S, Reed RD, Bratches RW, Bechthold AC, Lee K, Puga F, Miller‐Sonet E, Ornstein KA. Family caregiver roles and challenges in assisting patients with cancer treatment decision-making: Analysis of data from a national survey. Health Expect 2023; 26:1965-1976. [PMID: 37394734 PMCID: PMC10485321 DOI: 10.1111/hex.13805] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 06/11/2023] [Accepted: 06/13/2023] [Indexed: 07/04/2023] Open
Abstract
BACKGROUND We aimed to describe the roles and challenges of family caregivers involved in patients' cancer treatment decision-making. METHODS Family caregiver-reported data were analyzed from a national survey conducted in the United States by CancerCare® (2/2021-7/2021). Four select-all-that-apply caregiver roles were explored: (1) observer (patient as primary decision-maker); (2) primary decision-maker; (3) shared decision-maker with patient and (4) decision delegated to healthcare team. Roles were compared across five treatment decisions: where to get treatment, the treatment plan, second opinions, beginning treatment and stopping treatment. Ten challenges faced by caregivers (e.g., information, cost, treatment understanding) were then examined. χ2 and regression analyses were used to assess associations between roles, decision areas, challenges and caregiver sociodemographics. RESULTS Of 2703 caregiver respondents, 87.6% reported involvement in patient decisions about cancer treatment, including 1661 who responded to a subsection further detailing their roles and challenges with specific treatment decisions. Amongst these 1661 caregivers, 22.2% reported an observing role, 21.3% a primary decision-making role, 53.9% a shared decision-making role and 18.1% a role delegating decisions to the healthcare team. Most caregivers (60.4%) faced ≥1 challenge, the most frequent being not knowing how treatments would affect the patient's physical condition (24.8%) and quality of life (23.2%). In multivariable models, being Hispanic/Latino/a was the strongest predictor of facing at least one challenge (b = -0.581, Wald = 10.69, p < .01). CONCLUSIONS Most caregivers were involved in patients' cancer treatment decisions. The major challenge was not understanding how treatments would impact patients' physical health and quality of life. Challenges may be more commonly faced by Hispanic/Latino/a caregivers. PATIENT OR PUBLIC CONTRIBUTION The CancerCare® survey was developed in partnership with caregiving services and research experts to describe the role of cancer family caregivers in patient decision-making and assess their needs for support. All survey items were reviewed by a CancerCare advisory board that included five professional patient advocates and piloted by a CancerCare social worker and other staff who provide counselling to cancer caregivers.
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Affiliation(s)
- James N. Dionne‐Odom
- Department of Acute, Chronic and Continuing Care, School of NursingUniversity of Alabama at BirminghamBirminghamAlabamaUSA
- Division of Gerontology, Geriatrics, and Palliative Care, School of MedicineUniversity of Alabama at BirminghamBirminghamAlabamaUSA
- Center for Palliative and Supportive CareUniversity of Alabama at BirminghamBirminghamAlabamaUSA
| | - Erin E. Kent
- Department of Health Policy and Management, Gillings School of Global Public HealthUniversity of North Carolina at Chapel HillChapel HillNorth CarolinaUSA
- Linebrger Comprehensive Cancer CenterUniversity of North Carolina at Chapel HillChapel HillNorth CarolinaUSA
| | - Gabrielle B. Rocque
- Division of Hematology‐Oncology, School of MedicineUniversity of Alabama at BirminghamBirminghamAlabamaUSA
| | - Andres Azuero
- Department of Acute, Chronic and Continuing Care, School of NursingUniversity of Alabama at BirminghamBirminghamAlabamaUSA
| | - Erin R. Harrell
- Department of PsychologyUniversity of AlabamaTuscaloosaAlabamaUSA
| | - Shena Gazaway
- Department of Acute, Chronic and Continuing Care, School of NursingUniversity of Alabama at BirminghamBirminghamAlabamaUSA
- Center for Palliative and Supportive CareUniversity of Alabama at BirminghamBirminghamAlabamaUSA
| | - Rhiannon D. Reed
- Comprehensive Transplant InstituteUniversity of Alabama at BirminghamBirminghamAlabamaUSA
| | - Reed W. Bratches
- Department of Acute, Chronic and Continuing Care, School of NursingUniversity of Alabama at BirminghamBirminghamAlabamaUSA
| | - Avery C. Bechthold
- Department of Acute, Chronic and Continuing Care, School of NursingUniversity of Alabama at BirminghamBirminghamAlabamaUSA
| | - Kyungmi Lee
- Department of Acute, Chronic and Continuing Care, School of NursingUniversity of Alabama at BirminghamBirminghamAlabamaUSA
| | - Frank Puga
- Department of Acute, Chronic and Continuing Care, School of NursingUniversity of Alabama at BirminghamBirminghamAlabamaUSA
| | | | - Katherine A. Ornstein
- Center for Equity in Aging, School of NursingJohns Hopkins UniversityBaltimoreMarylandUSA
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Gazaway S, Wells RD, Azuero A, Pisu M, Guastaferro K, Rini C, Taylor R, Reed RD, Harrell ER, Bechthold AC, Bratches RW, McKie P, Lowers J, Williams GR, Rosenberg AR, Bakitas MA, Kavalieratos D, Dionne-Odom JN. Decision support training for advanced cancer family caregivers: Study protocol for the CASCADE factorial trial. Contemp Clin Trials 2023; 131:107259. [PMID: 37286131 PMCID: PMC10527385 DOI: 10.1016/j.cct.2023.107259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 05/31/2023] [Accepted: 05/31/2023] [Indexed: 06/09/2023]
Abstract
BACKGROUND Patients with advanced cancer face numerous decisions when diagnosed and often receive decision support from family caregivers. The CASCADE (CAre Supporters Coached to be Adept DEcision partners) factorial trial intervention aims to train caregivers in skills to provide effective decision support to patients and identify most effective intervention components. METHODS This is a 2-site, single-blind, 24 factorial trial to test components of the CASCADE decision support training intervention for family caregivers of patients with newly-diagnosed advanced cancer delivered by specially-trained, telehealth, palliative care lay coaches over 24 weeks. Family caregivers (target N = 352) are randomly assigned to one of 16 combinations of four components with two levels each: 1) psychoeducation on effective decision partnering principles (1 vs. 3 sessions); 2) decision support communication training (1 session vs. none); 3) Ottawa Decision Guide training (1 session vs. none) and 4) monthly follow-up (1 call vs. calls for 24 weeks). The primary outcome is patient-reported decisional conflict at 24 weeks. Secondary outcomes include patient distress, healthcare utilization, caregiver distress, and quality of life. Mediators and moderators (e.g., sociodemographics, decision self-efficacy, social support) will be explored between intervention components and outcomes. Results will be used to build two versions of CASCADE: one with only effective components (d ≥ 0.30) and another optimized for scalability and cost. DISCUSSION This protocol describes the first factorial trial, informed by the multiphase optimization strategy, of a palliative care decision-support intervention for advanced cancer family caregivers and will address the field's need to identify effective components that support serious illness decision-making. TRIAL REGISTRATION NCT04803604.
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Affiliation(s)
- Shena Gazaway
- School of Nursing, University of Alabama at Birmingham (UAB), Birmingham, AL, USA
| | - Rachel D Wells
- School of Nursing, University of Alabama at Birmingham (UAB), Birmingham, AL, USA
| | - Andres Azuero
- School of Nursing, University of Alabama at Birmingham (UAB), Birmingham, AL, USA
| | - Maria Pisu
- Division of Preventive Medicine, UAB Heersink School of Medicine, Birmingham, AL, USA
| | - Kate Guastaferro
- Department of Social and Behavioral Sciences, School of Global Public Health, New York University, New York, USA
| | - Christine Rini
- Cancer Survivorship Institute, Feinberg School of Medicine, Northwestern University, Evanston, IL, USA
| | - Richard Taylor
- School of Nursing, University of Alabama at Birmingham (UAB), Birmingham, AL, USA
| | - Rhiannon D Reed
- Division of Transplantation, Department of Medicine, UAB, Birmingham, AL, USA
| | - Erin R Harrell
- Department of Psychology, University of Alabama, Tuscaloosa, AL, USA
| | - Avery C Bechthold
- School of Nursing, University of Alabama at Birmingham (UAB), Birmingham, AL, USA
| | - Reed W Bratches
- School of Nursing, University of Alabama at Birmingham (UAB), Birmingham, AL, USA
| | - Peg McKie
- School of Nursing, University of Alabama at Birmingham (UAB), Birmingham, AL, USA
| | - Jane Lowers
- Division of Palliative Medicine, Department of Family and Preventive Medicine, School of Medicine, Emory University, Atlanta, GA, USA
| | | | - Abby R Rosenberg
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Department of Medicine, Boston Children's Hospital, Department of Pediatrics, Harvard Medical School, Boston, MA, USA
| | - Marie A Bakitas
- School of Nursing, University of Alabama at Birmingham (UAB), Birmingham, AL, USA
| | - Dio Kavalieratos
- Division of Palliative Medicine, Department of Family and Preventive Medicine, School of Medicine, Emory University, Atlanta, GA, USA
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McDonough IM, Cody SL, Harrell ER, Garrett SL, Popp TE. Cognitive differences across ethnoracial category, socioeconomic status across the Alzheimer's disease spectrum: Can an ability discrepancy score level the playing field? Mem Cognit 2023; 51:543-560. [PMID: 35338450 DOI: 10.3758/s13421-022-01304-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/12/2022] [Indexed: 12/29/2022]
Abstract
An ability discrepancy (crystallized minus fluid abilities) might be a personally relevant cognitive marker of risk for Alzheimer's disease (AD) and might help reduce measurement bias often present in traditional measures of cognition. In a large national sample of adults aged 60-104 years (N = 14,257), we investigated whether the intersectionality of group characteristics previously shown to pose a risk for AD including ethnoracial category, socioeconomic status, and sex (a) differed in ability discrepancy compared to traditional neuropsychological tests and (b) moderated the relationship between an ability discrepancy and AD symptom severity. In cognitively normal older adults, results indicated that across each decade, fluid and memory composite scores generally exhibited large group differences with sex, education, and ethnoracial category. In contrast, the ability discrepancy score showed much smaller group differences, thus removing much of the biases inherent in the tests. Women with higher education differed in discrepancy performance from other groups, suggesting a subgroup in which this score might reduce bias to a lesser extent. Importantly, a greater ability discrepancy was associated with greater AD symptom severity across the AD continuum. Subgroup analyses suggest that this relationship holds for all groups except for some subgroups of Hispanic Americans. These findings suggest that an ability discrepancy measure might be a better indicator of baseline cognition than traditional measures that show more egregious measurement bias across diverse groups of people.
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Affiliation(s)
- Ian M McDonough
- Department of Psychology, The University of Alabama, Box 870348, Tuscaloosa, AL, 35487, USA.
| | - Shameka L Cody
- College of Nursing, The University of Alabama, Tuscaloosa, AL, USA
| | - Erin R Harrell
- Department of Psychology, The University of Alabama, Box 870348, Tuscaloosa, AL, 35487, USA
| | | | - Taylor E Popp
- Department of Psychology, The University of Alabama, Box 870348, Tuscaloosa, AL, 35487, USA
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Singh A, Chakraborty S, He Z, Tian S, Zhang S, Lustria MLA, Charness N, Roque NA, Harrell ER, Boot WR. Deep learning-based predictions of older adults' adherence to cognitive training to support training efficacy. Front Psychol 2022; 13:980778. [PMID: 36467206 PMCID: PMC9713845 DOI: 10.3389/fpsyg.2022.980778] [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: 06/28/2022] [Accepted: 10/25/2022] [Indexed: 11/18/2022] Open
Abstract
As the population ages, the number of older adults experiencing mild cognitive impairment (MCI), Alzheimer's disease, and other forms of dementia will increase dramatically over the next few decades. Unfortunately, cognitive changes associated with these conditions threaten independence and quality of life. To address this, researchers have developed promising cognitive training interventions to help prevent or reverse cognitive decline and cognitive impairment. However, the promise of these interventions will not be realized unless older adults regularly engage with them over the long term, and like many health behaviors, adherence to cognitive training interventions can often be poor. To maximize training benefits, it would be useful to be able to predict when adherence lapses for each individual, so that support systems can be personalized to bolster adherence and intervention engagement at optimal time points. The current research uses data from a technology-based cognitive intervention study to recognize patterns in participants' adherence levels and predict their future adherence to the training program. We leveraged the feature learning capabilities of deep neural networks to predict patterns of adherence for a given participant, based on their past behavior. A separate, personalized model was trained for each participant to capture individualistic features of adherence. We posed the adherence prediction as a binary classification problem and exploited multivariate time series analysis using an adaptive window size for model training. Further, data augmentation techniques were used to overcome the challenge of limited training data and enhance the size of the dataset. To the best of our knowledge, this is the first research effort to use advanced machine learning techniques to predict older adults' daily adherence to cognitive training programs. Experimental evaluations corroborated the promise and potential of deep learning models for adherence prediction, which furnished highest mean F-scores of 75.5, 75.5, and 74.6% for the Convolution Neural Network (CNN), Long Short-Term Memory (LSTM) network, and CNN-LSTM models respectively.
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Affiliation(s)
- Ankita Singh
- Department of Computer Science, Florida State University, Tallahassee, FL, United States
| | - Shayok Chakraborty
- Department of Computer Science, Florida State University, Tallahassee, FL, United States,*Correspondence: Shayok Chakraborty
| | - Zhe He
- School of Information, Florida State University, Tallahassee, FL, United States,College of Medicine, Florida State University, Tallahassee, FL, United States
| | - Shubo Tian
- Department of Statistics, Florida State University, Tallahassee, FL, United States
| | - Shenghao Zhang
- Department of Psychology, Florida State University, Tallahassee, FL, United States
| | - Mia Liza A. Lustria
- School of Information, Florida State University, Tallahassee, FL, United States
| | - Neil Charness
- Department of Psychology, Florida State University, Tallahassee, FL, United States
| | - Nelson A. Roque
- Department of Psychology, University of Central Florida, Orlando, FL, United States
| | - Erin R. Harrell
- Department of Psychology, The University of Alabama, Tuscaloosa, AL, United States
| | - Walter R. Boot
- Department of Psychology, Florida State University, Tallahassee, FL, United States
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He Z, Tian S, Singh A, Chakraborty S, Zhang S, Lustria MLA, Charness N, Roque NA, Harrell ER, Boot WR. A Machine-Learning Based Approach for Predicting Older Adults' Adherence to Technology-Based Cognitive Training. Inf Process Manag 2022; 59:103034. [PMID: 35909793 PMCID: PMC9337718 DOI: 10.1016/j.ipm.2022.103034] [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] [Indexed: 11/05/2022]
Abstract
Adequate adherence is a necessary condition for success with any intervention, including for computerized cognitive training designed to mitigate age-related cognitive decline. Tailored prompting systems offer promise for promoting adherence and facilitating intervention success. However, developing adherence support systems capable of just-in-time adaptive reminders requires understanding the factors that predict adherence, particularly an imminent adherence lapse. In this study we built machine learning models to predict participants' adherence at different levels (overall and weekly) using data collected from a previous cognitive training intervention. We then built machine learning models to predict adherence using a variety of baseline measures (demographic, attitudinal, and cognitive ability variables), as well as deep learning models to predict the next week's adherence using variables derived from training interactions in the previous week. Logistic regression models with selected baseline variables were able to predict overall adherence with moderate accuracy (AUROC: 0.71), while some recurrent neural network models were able to predict weekly adherence with high accuracy (AUROC: 0.84-0.86) based on daily interactions. Analysis of the post hoc explanation of machine learning models revealed that general self-efficacy, objective memory measures, and technology self-efficacy were most predictive of participants' overall adherence, while time of training, sessions played, and game outcomes were predictive of the next week's adherence. Machine-learning based approaches revealed that both individual difference characteristics and previous intervention interactions provide useful information for predicting adherence, and these insights can provide initial clues as to who to target with adherence support strategies and when to provide support. This information will inform the development of a technology-based, just-in-time adherence support systems.
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Affiliation(s)
- Zhe He
- School of Information, Florida State University, Tallahassee, Florida USA
- College of Medicine, Florida State University, Tallahassee, Florida USA
| | - Shubo Tian
- Department of Statistics, Florida State University, Tallahassee, Florida USA
| | - Ankita Singh
- Department of Computer Science, Florida State University, Tallahassee, Florida USA
| | - Shayok Chakraborty
- Department of Computer Science, Florida State University, Tallahassee, Florida USA
| | - Shenghao Zhang
- Department of Psychology, Florida State University, Tallahassee, Florida USA
| | - Mia Liza A. Lustria
- School of Information, Florida State University, Tallahassee, Florida USA
- College of Medicine, Florida State University, Tallahassee, Florida USA
| | - Neil Charness
- Department of Psychology, Florida State University, Tallahassee, Florida USA
| | - Nelson A. Roque
- Department of Psychology, University of Central Florida, Orlando, Florida USA
| | - Erin R. Harrell
- Department of Psychology, The University of Alabama, Tuscaloosa, Alabama USA
| | - Walter R. Boot
- Department of Psychology, Florida State University, Tallahassee, Florida USA
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Dionne‐Odom JN, Ornstein KA, Azuero A, Harrell ER, Gazaway S, Watts KA, Ejem D, Bechthold AC, Lee K, Puga F, Miller‐Sonet E, Williams GR, Kent EE. Bias reported by family caregivers in support received when assisting patients with cancer-related decision-making. Cancer Med 2022; 12:3567-3576. [PMID: 36031864 PMCID: PMC9939189 DOI: 10.1002/cam4.5182] [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: 06/14/2022] [Revised: 08/12/2022] [Accepted: 08/16/2022] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND Family caregivers play an increasing role in cancer treatment decision-making. We examined bias reported by family caregivers in the support they and their patient received from their healthcare team when making these decisions, including associations with distress. METHODS Analysis of 2021 national survey data of family caregivers of patients with cancer (N = 2703). Bias experienced in decision support was assessed with the item: "Have you felt that the support you and the person with cancer have received for making cancer-related decisions by your doctor or healthcare team has been negatively affected by any of the following?" Check-all-that-apply response options included: age, race, language, education, political affiliation, body weight, insurance type or lack of insurance, income, religion, sexual orientation, and gender/sex. Chi-square and regression analyses assessed associations between bias and caregiver distress (GAD-2, PHQ-2). RESULTS Of 2703 caregiver respondents, 47.4% (n = 1281) reported experiencing ≥1 bias(es) when receiving decision support for making cancer-related decisions. Bias was more prevalent among younger caregivers, males, transwomen/men or gender non-conforming caregivers, racial/ethnic minorities, and those providing care over a longer time period. The odds of having high anxiety (GAD-2 scores ≥ 3) were 2.1 times higher for caregivers experiencing one type of bias (adjusted OR, 2.1; 95% CI, 1.6-2.8) and 4.2 times higher for caregivers experiencing ≥2 biases (adjusted OR, 4.2; 95% CI, 3.4-5.3) compared to none. Similar results were found for high depression scores (PHQ-2 scores ≥ 3). CONCLUSIONS Nearly half of caregivers involved in their care recipients' cancer-related decisions report bias in decision support received from the healthcare team. Experiencing bias was strongly associated with high psychological distress.
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Affiliation(s)
- J. Nicholas Dionne‐Odom
- School of NursingUniversity of Alabama at BirminghamBirminghamAlabamaUSA,Division of GerontologyGeriatrics, and Palliative CareSchool of MedicineUniversity of Alabama at BirminghamBirminghamAlabamaUSA,Center for Palliative and Supportive CareUniversity of Alabama at BirminghamBirminghamAlabamaUSA
| | - Katherine A. Ornstein
- Department of Geriatrics and Palliative MedicineIcahn School of Medicine at Mount SinaiNew YorkNew YorkUSA
| | - Andres Azuero
- School of NursingUniversity of Alabama at BirminghamBirminghamAlabamaUSA
| | - Erin R. Harrell
- Department of PsychologyUniversity of AlabamaTuscaloosaAlabamaUSA
| | - Shena Gazaway
- School of NursingUniversity of Alabama at BirminghamBirminghamAlabamaUSA,Center for Palliative and Supportive CareUniversity of Alabama at BirminghamBirminghamAlabamaUSA
| | - Kristen Allen Watts
- Division of Preventive MedicineSchool of MedicineUniversity of Alabama at BirminghamBirminghamAlabamaUSA
| | - Deborah Ejem
- School of NursingUniversity of Alabama at BirminghamBirminghamAlabamaUSA
| | - Avery C. Bechthold
- School of NursingUniversity of Alabama at BirminghamBirminghamAlabamaUSA
| | - Kyungmi Lee
- School of NursingUniversity of Alabama at BirminghamBirminghamAlabamaUSA
| | - Frank Puga
- School of NursingUniversity of Alabama at BirminghamBirminghamAlabamaUSA
| | | | - Grant R. Williams
- Division of Hematology‐OncologySchool of MedicineUniversity of Alabama at BirminghamBirminghamAlabamaUSA
| | - Erin E. Kent
- Gillings School of Global Public HealthUniversity of North CarolinaChapel HillChapel HillNorth CarolinaUSA
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9
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Bechthold AC, Azuero A, Pisu M, Pierce JY, Williams GR, Taylor RA, Wells R, Curry K, Reed RD, Harrell ER, Gazaway S, Mollman S, Engler S, Puga F, Bakitas MA, Dionne-Odom JN. The Project ENABLE Cornerstone randomized controlled trial: study protocol for a lay navigator-led, early palliative care coaching intervention for African American and rural-dwelling advanced cancer family caregivers. Trials 2022; 23:452. [PMID: 35655285 PMCID: PMC9161197 DOI: 10.1186/s13063-022-06305-w] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Accepted: 04/13/2022] [Indexed: 11/10/2022] Open
Abstract
Background Family caregivers play a vital, yet stressful role in managing the healthcare needs and optimizing the quality of life of patients with advanced cancer, from the time they are newly diagnosed until end of life. While early telehealth palliative care has been found to effectively support family caregivers, little work has focused on historically under-resourced populations, particularly African American and rural-dwelling individuals. To address this need, we developed and are currently testing Project ENABLE (Educate, Nurture, Advise, Before Life Ends) Cornerstone, a lay navigator-led, early palliative care coaching intervention for family caregivers of African American and rural-dwelling patients with newly diagnosed advanced cancer. Methods This is a 2-site, single-blind, hybrid type I implementation-effectiveness trial of the Cornerstone intervention versus usual care. Cornerstone is a multicomponent intervention based on Pearlin’s Stress-Health Process Model where African American and/or rural-dwelling family caregivers of patients with newly diagnosed advanced cancer (target sample size = 294 dyads) are paired with a lay navigator coach and receive a series of six, brief 20–60-min telehealth sessions focused on stress management and coping, caregiving skills, getting help, self-care, and preparing for the future/advance care planning. Subsequent to core sessions, caregivers receive monthly follow-up indefinitely until the patient’s death. Caregiver and patient outcomes are collected at baseline and every 12 weeks until the patient’s death (primary outcome: caregiver distress at 24 weeks; secondary outcomes: caregiver: quality of life and burden; patient: distress, quality of life, and healthcare utilization). Implementation costs and the intervention cost effectiveness are also being evaluated. Discussion Should this intervention demonstrate efficacy, it would yield an implementation-ready model of early palliative care support for under-resourced family caregivers. A key design principle that has centrally informed the Cornerstone intervention is that every caregiving situation is unique and each caregiver faces distinct challenges that cannot be addressed using a one-size-fits all approach. Hence, Cornerstone employs culturally savvy lay navigator coaches who are trained to establish a strong, therapeutic alliance with participants and tailor their coaching to a diverse range of individual circumstances. Trial registration ClinicalTrials.gov NCT04318886. Registered on 20 March, 2020. Supplementary Information The online version contains supplementary material available at 10.1186/s13063-022-06305-w.
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Affiliation(s)
- Avery C Bechthold
- School of Nursing, University of Alabama at Birmingham (UAB), Birmingham, AL, USA
| | - Andres Azuero
- School of Nursing, University of Alabama at Birmingham (UAB), Birmingham, AL, USA
| | - Maria Pisu
- Division of Preventive Medicine, UAB School of Medicine, Birmingham, AL, USA
| | | | - Grant R Williams
- Division of Hematology and Oncology, Department of Medicine, UAB, Birmingham, AL, USA
| | - Richard A Taylor
- School of Nursing, University of Alabama at Birmingham (UAB), Birmingham, AL, USA
| | - Rachel Wells
- School of Nursing, University of Alabama at Birmingham (UAB), Birmingham, AL, USA
| | - Kayleigh Curry
- School of Nursing, University of Alabama at Birmingham (UAB), Birmingham, AL, USA
| | - Rhiannon D Reed
- Division of Transplantation, Department of Surgery, UAB, Birmingham, AL, USA
| | - Erin R Harrell
- Department of Psychology, University of Alabama, Tuscaloosa, AL, USA
| | - Shena Gazaway
- School of Nursing, University of Alabama at Birmingham (UAB), Birmingham, AL, USA
| | - Sarah Mollman
- College of Nursing, South Dakota State University, Rapid City, SD, USA
| | - Sally Engler
- School of Nursing, University of Alabama at Birmingham (UAB), Birmingham, AL, USA
| | - Frank Puga
- School of Nursing, University of Alabama at Birmingham (UAB), Birmingham, AL, USA
| | - Marie A Bakitas
- School of Nursing, University of Alabama at Birmingham (UAB), Birmingham, AL, USA.,Division of Geriatrics, Gerontology, and Palliative Care, UAB Department of Medicine, Birmingham, AL, USA
| | - J Nicholas Dionne-Odom
- School of Nursing, University of Alabama at Birmingham (UAB), Birmingham, AL, USA. .,Division of Geriatrics, Gerontology, and Palliative Care, UAB Department of Medicine, Birmingham, AL, USA.
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10
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Dionne-Odom JN, Azuero A, Taylor RA, Dosse C, Bechthold AC, Currie E, Reed RD, Harrell ER, Engler S, Ejem DB, Ivankova NV, Martin MY, Rocque GB, Williams GR, Bakitas MA. A lay navigator-led, early palliative care intervention for African American and rural family caregivers of individuals with advanced cancer (Project Cornerstone): Results of a pilot randomized trial. Cancer 2022; 128:1321-1330. [PMID: 34874061 PMCID: PMC8882155 DOI: 10.1002/cncr.34044] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Revised: 10/25/2021] [Accepted: 11/13/2021] [Indexed: 12/18/2022]
Abstract
BACKGROUND The objective of this study was to assess the feasibility, acceptability, and potential efficacy of ENABLE (Educate, Nurture, Advise, Before Life Ends) Cornerstone-a lay navigator-led, early palliative care telehealth intervention for African American/Black and/or rural-dwelling family caregivers of individuals with advanced cancer (ClinicalTrials.gov identifier NCT03464188). METHODS This was a pilot randomized trial (November 2019 to March 2021). Family caregivers of patients with newly diagnosed, stage III/IV, solid-tumor cancers were randomized to receive either an intervention or usual care. Intervention caregivers were paired with a specially trained lay navigator who delivered 6 weekly, 20-minute to 60-minute telehealth coaching sessions plus monthly follow-up for 24 weeks, reviewing skills in stress management, self-care, getting help, staying organized, and future planning. Feasibility was assessed according to the completion of sessions and questionnaires (predefined as a completion rate ≥80%). Acceptability was determined through intervention participants' ratings of their likelihood of recommending the intervention. Measures of caregiver distress and quality of life were collected at 8 and 24 weeks. RESULTS Sixty-three family caregivers were randomized (usual care, n = 32; intervention, n = 31). Caregivers completed 65% of intervention sessions and 87% of questionnaires. Average ratings for recommending the program were 9.4, from 1 (not at all likely) to 10 (extremely likely). Over 24 weeks, the mean ± SE Hospital Anxiety and Depression Scale score improved by 0.30 ± 1.44 points in the intervention group and worsened by 1.99 ± 1.39 points in the usual care group (difference, -2.29; Cohen d, -0.32). The mean between-group difference scores in caregiver quality of life was -1.56 (usual care - intervention; d, -0.07). Similar outcome results were observed for patient participants. CONCLUSIONS The authors piloted ENABLE Cornerstone, an intervention for African American and rural-dwelling advanced cancer family caregivers. The acceptability of the intervention and data collection rates were high, and the preliminary efficacy for caregiver distress was promising. LAY SUMMARY To date, very few programs have been developed to support under-resourced cancer family caregivers. To address this need, the authors successfully pilot tested an early palliative care program, called Educate, Nurture, Advise, Before Life Ends (ENABLE) Cornerstone, for African American and rural family caregivers of individuals with advanced cancer. Cornerstone is led by specially trained lay people and involves a series of weekly phone sessions focused on coaching caregivers to manage stress and provide effective support to patients with cancer. The authors are now testing Cornerstone in a larger trial. If the program demonstrates benefit, it may yield a model of caregiver support that could be widely implemented.
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Affiliation(s)
- J Nicholas Dionne-Odom
- School of Nursing, University of Alabama at Birmingham (UAB), Birmingham, Alabama.,Division of Geriatrics, Gerontology, and Palliative Care, UAB Department of Medicine, Birmingham, Alabama.,UAB Center for Palliative and Supportive Care, Birmingham, Alabama
| | - Andres Azuero
- School of Nursing, University of Alabama at Birmingham (UAB), Birmingham, Alabama
| | - Richard A Taylor
- School of Nursing, University of Alabama at Birmingham (UAB), Birmingham, Alabama
| | - Chinara Dosse
- School of Nursing, University of Alabama at Birmingham (UAB), Birmingham, Alabama
| | - Avery C Bechthold
- School of Nursing, University of Alabama at Birmingham (UAB), Birmingham, Alabama
| | - Erin Currie
- School of Nursing, University of Alabama at Birmingham (UAB), Birmingham, Alabama
| | - Rhiannon D Reed
- Comprehensive Transplant Institute, UAB, Birmingham, Alabama
| | - Erin R Harrell
- Department of Psychology, University of Alabama, Tuscaloosa, Alabama
| | - Sally Engler
- School of Nursing, University of Alabama at Birmingham (UAB), Birmingham, Alabama
| | - Deborah B Ejem
- School of Nursing, University of Alabama at Birmingham (UAB), Birmingham, Alabama
| | | | - Michelle Y Martin
- Department of Preventive Medicine, Center for Innovation in Health Equity Research, University of Tennessee Health Science Center, Memphis, Tennessee
| | - Gabrielle B Rocque
- Division of Geriatrics, Gerontology, and Palliative Care, UAB Department of Medicine, Birmingham, Alabama.,UAB Center for Palliative and Supportive Care, Birmingham, Alabama.,Division of Hematology and Oncology, Department of Medicine, UAB, Birmingham, Alabama
| | - Grant R Williams
- Division of Hematology and Oncology, Department of Medicine, UAB, Birmingham, Alabama
| | - Marie A Bakitas
- School of Nursing, University of Alabama at Birmingham (UAB), Birmingham, Alabama.,Division of Geriatrics, Gerontology, and Palliative Care, UAB Department of Medicine, Birmingham, Alabama.,UAB Center for Palliative and Supportive Care, Birmingham, Alabama
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11
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Gray N, Yoon JS, Charness N, Boot WR, Roque NA, Andringa R, Harrell ER, Lewis KG, Vitale T. Relative effectiveness of general versus specific cognitive training for aging adults. Psychol Aging 2022; 37:210-221. [PMID: 34968102 PMCID: PMC10460574 DOI: 10.1037/pag0000663] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
In the present study, we examined three experimental cognitive interventions, two targeted at training general cognitive abilities and one targeted at training specific instrumental activities of daily living (IADL) abilities, along with one active control group to compare benefits of these interventions beyond expectation effects, in a group of older adults (N = 230). Those engaged in general training did so with either the web-based brain game suite BrainHQ or the strategy video game Rise of Nations, while those trained on IADL skills completed instructional programs on driving and fraud awareness. Active control participants completed sets of puzzles. Comparing baseline and postintervention data across conditions, none of the preregistered primary outcome measures demonstrated a significant interaction between session and intervention condition, indicating no differential benefits. Analysis of expectation effects showed differences between intervention groups consistent with the type of training. Those in the IADL training condition did demonstrate superior knowledge for specific trained information (driving and finances). Twelve months after training, significant interactions between session and intervention were present in the primary measure of fraud detection, as well as the secondary measures of the letter sets task and Rey's Auditory Verbal Learning Test. However, the specific source of these interactions was difficult to discern. At 1-year follow-up those in the IADL condition did not maintain superior knowledge of driving and finances gained through training, as was present immediately postintervention. Hence, the interventions, when compared to an active control condition, failed to show general or specific transfer in a meaningful or consistent way. (PsycInfo Database Record (c) 2022 APA, all rights reserved).
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12
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Choi SL, Harrell ER, Watkins K. The Impact of the COVID-19 Pandemic on Business Ownership Across Racial/Ethnic Groups and Gender. J Econ Race Policy 2022; 5:307-317. [PMID: 35647487 PMCID: PMC9130970 DOI: 10.1007/s41996-022-00102-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/05/2021] [Revised: 04/07/2022] [Accepted: 05/05/2022] [Indexed: 05/13/2023]
Abstract
This study examined the economic impact of the COVID-19 pandemic on US older entrepreneurs' businesses using the Health and Retirement Study. We estimated logistic regression models to document the odds of experiencing economic impact. The COVID-19 pandemic has affected nearly 76% of US older entrepreneurs but has disproportionately impacted the businesses of Black, Hispanic, Asian/other races, and women entrepreneurs. Older Black entrepreneurs had significantly higher odds of facing business closure (OR = 2.31, p < .01), implementing new procedures (OR = 2.44, p < .01), workers quitting (OR = 2.95, p < .001), and difficulty paying regular bills (OR = 2.88, p < .001) than their White counterparts. Older Hispanic entrepreneurs also had significantly higher odds of instituting new procedures (OR = 2.27, p < .05), workers quitting (OR = 2.26, p < .01), and difficulty paying regular bills (OR = 2.35, p < .01) than their White counterparts. Similarly, older Asian/other races entrepreneurs were significantly more likely to report difficulty paying regular bills since the start of the pandemic than their White counterparts (OR = 3.11, p < .01). Women entrepreneurs were significantly more likely to close their businesses than their male counterparts (OR = 2.11, p < .001). These significant associations persisted after controlling for confounders. Support for underserved racial/ethnic groups and older women entrepreneurs should focus on accessibility to financial services, capital, and support packages as well as legislative support for ensuring business continuity and success.
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Affiliation(s)
- Shinae L. Choi
- Department of Consumer Sciences, The University of Alabama, 304 Adams Hall, Box 870158, Tuscaloosa, AL 35487 USA
| | - Erin R. Harrell
- Department of Psychology, The University of Alabama, 172A Gordon Palmer Hall, Box 870348, Tuscaloosa, AL 35487 USA
| | - Kimberly Watkins
- Department of Financial Planning, Housing, and Consumer Economics, University of Georgia, 205 Dawson Hall, Athens, GA 30602 USA
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13
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Dionne-Odom JN, Wells RD, Guastaferro K, Azuero A, Hendricks BA, Currie ER, Bechthold A, Dosse C, Taylor R, Reed RD, Harrell ER, Gazaway S, Engler S, McKie P, Williams GR, Sudore R, Rini C, Rosenberg AR, Bakitas MA. An Early Palliative Care Telehealth Coaching Intervention to Enhance Advanced Cancer Family Caregivers' Decision Support Skills: The CASCADE Pilot Factorial Trial. J Pain Symptom Manage 2022; 63:11-22. [PMID: 34343621 PMCID: PMC8881798 DOI: 10.1016/j.jpainsymman.2021.07.023] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2021] [Revised: 07/16/2021] [Accepted: 07/26/2021] [Indexed: 01/03/2023]
Abstract
CONTEXT Patients with advanced cancer often involve family caregivers in health-related decision-making from diagnosis to end-of-life; however, few interventions have been developed to enhance caregiver decision support skills. OBJECTIVES Assess the feasibility, acceptability, and potential efficacy of individual intervention components of CASCADE (CAre Supporters Coached to be Adept DEcision Partners), an early telehealth, palliative care coach-led decision support training intervention for caregivers. METHODS Pilot factorial trial using the multiphase optimization strategy (October 2019-October 2020). Family caregivers and their care recipients with newly-diagnosed advanced cancer (n = 46 dyads) were randomized to1 of 8 experimental conditions that included a combination of one of the following three CASCADE components: 1) effective decision support psychoeducation; 2) decision support communication training; and 3) Ottawa Decision Guide training. Feasibility was assessed by completion of sessions and questionnaires (predefined as ≥80%). Acceptability was determined through postintervention interviews and participants' ratings of their likelihood to recommend. Measures of effective decision support and caregiver and patient distress were collected at Twelve and Twenty four weeks. RESULTS Caregiver participants completed 78% of intervention sessions and 81% of questionnaires; patients completed 80% of questionnaires. Across conditions, average caregiver ratings for recommending the program to others was 9.9 on a scale from 1-Not at all likely to 10-Extremely likely. Individual CASCADE components were observed to have potential benefit for effective decision support and caregiver distress. CONCLUSION We successfully piloted a factorial trial design to examine components of a novel intervention to enhance the decision support skills of advanced cancer family caregivers. A fully-powered factorial trial is warranted. KEY MESSAGE We pilot tested components of CASCADE, an early palliative care decision support training intervention for family caregivers of patients with advanced cancer. CASCADE components were acceptable and the trial design feasible, providing promising future directions for palliative care intervention development and testing. Pilot results will inform a fully-powered trial.
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Affiliation(s)
- J Nicholas Dionne-Odom
- School of Nursing, University of Alabama at Birmingham (J.N.D.O., R.D.W., A.A., B.A.H., E.R.C., A.B., C.D., R.T., S.G., S.E., P.M., M.A.B.), Birmingham, Alabama, USA; Division of Gerontology, Geriatrics, and Palliative Care, School of Medicine, University of Alabama at Birmingham (J.N.D.O., M.A.B.), Birmingham, Alabama, USA; Center for Palliative and Supportive Care, University of Alabama at Birmingham (J.N.D.O., M.A.B.), Birmingham, Alabama, USA.
| | - Rachel D Wells
- School of Nursing, University of Alabama at Birmingham (J.N.D.O., R.D.W., A.A., B.A.H., E.R.C., A.B., C.D., R.T., S.G., S.E., P.M., M.A.B.), Birmingham, Alabama, USA
| | - Kate Guastaferro
- Methodology Center, Pennsylvania State University (K.G.), University Park, Pennsylvania, USA
| | - Andres Azuero
- School of Nursing, University of Alabama at Birmingham (J.N.D.O., R.D.W., A.A., B.A.H., E.R.C., A.B., C.D., R.T., S.G., S.E., P.M., M.A.B.), Birmingham, Alabama, USA
| | - Bailey A Hendricks
- School of Nursing, University of Alabama at Birmingham (J.N.D.O., R.D.W., A.A., B.A.H., E.R.C., A.B., C.D., R.T., S.G., S.E., P.M., M.A.B.), Birmingham, Alabama, USA
| | - Erin R Currie
- School of Nursing, University of Alabama at Birmingham (J.N.D.O., R.D.W., A.A., B.A.H., E.R.C., A.B., C.D., R.T., S.G., S.E., P.M., M.A.B.), Birmingham, Alabama, USA
| | - Avery Bechthold
- School of Nursing, University of Alabama at Birmingham (J.N.D.O., R.D.W., A.A., B.A.H., E.R.C., A.B., C.D., R.T., S.G., S.E., P.M., M.A.B.), Birmingham, Alabama, USA
| | - Chinara Dosse
- School of Nursing, University of Alabama at Birmingham (J.N.D.O., R.D.W., A.A., B.A.H., E.R.C., A.B., C.D., R.T., S.G., S.E., P.M., M.A.B.), Birmingham, Alabama, USA
| | - Richard Taylor
- School of Nursing, University of Alabama at Birmingham (J.N.D.O., R.D.W., A.A., B.A.H., E.R.C., A.B., C.D., R.T., S.G., S.E., P.M., M.A.B.), Birmingham, Alabama, USA
| | - Rhiannon D Reed
- Comprehensive Transplant Institute, University of Alabama at Birmingham (R.D.R.), Birmingham, Alabama, USA
| | - Erin R Harrell
- Department of Psychology, University of Alabama (E.R.H.), Tuscaloosa, Alabama, USA
| | - Shena Gazaway
- School of Nursing, University of Alabama at Birmingham (J.N.D.O., R.D.W., A.A., B.A.H., E.R.C., A.B., C.D., R.T., S.G., S.E., P.M., M.A.B.), Birmingham, Alabama, USA
| | - Sally Engler
- School of Nursing, University of Alabama at Birmingham (J.N.D.O., R.D.W., A.A., B.A.H., E.R.C., A.B., C.D., R.T., S.G., S.E., P.M., M.A.B.), Birmingham, Alabama, USA
| | - Peg McKie
- School of Nursing, University of Alabama at Birmingham (J.N.D.O., R.D.W., A.A., B.A.H., E.R.C., A.B., C.D., R.T., S.G., S.E., P.M., M.A.B.), Birmingham, Alabama, USA
| | - Grant R Williams
- School of Medicine, Division of Hematology-Oncology, University of Alabama at Birmingham (G.R.W.), Birmingham, Alabama, USA
| | - Rebecca Sudore
- School of Medicine, Division of Geriatrics, University of California (R.S.), San Francisco, California, USA
| | - Christine Rini
- Feinberg School of Medicine, Robert H. Lurie Comprehensive Cancer Center, Northwestern University (C.R.), Chicago, Illinois, USA
| | - Abby R Rosenberg
- Division of Hematology-Oncology, Department of Pediatrics, School of Medicine, University of Washington (A.R.R.), Seattle, Washington, USA; Palliative Care and Resilience Lab, Seattle Children's Research Institute (A.R.R.), Seattle, Washington, USA; Cambia Palliative Care Center of Excellence, University of Washington (A.R.R.), Seattle, Washington, USA
| | - Marie A Bakitas
- School of Nursing, University of Alabama at Birmingham (J.N.D.O., R.D.W., A.A., B.A.H., E.R.C., A.B., C.D., R.T., S.G., S.E., P.M., M.A.B.), Birmingham, Alabama, USA; Division of Gerontology, Geriatrics, and Palliative Care, School of Medicine, University of Alabama at Birmingham (J.N.D.O., M.A.B.), Birmingham, Alabama, USA; Center for Palliative and Supportive Care, University of Alabama at Birmingham (J.N.D.O., M.A.B.), Birmingham, Alabama, USA
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14
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Abstract
Purpose of Review The purpose of this review is to examine racism in healthcare as it relates to older African American adults. We focus on health disparities in old age and medical mismanagement throughout their lifespan. Recent Findings In the United States there have been extensive medical advances over the past several decades. Individuals are living longer, and illnesses that were deemed terminal in the past are now considered chronic illnesses. While most individuals living with chronic illness have experienced better quality of life, this is not the case for many African American older adults. Summary Older African American adults are less likely to have their chronic illness sufficiently managed and are more likely to die from chronic illnesses that are well controlled in Whites. African American older adults also continue to suffer from poorer healthcare outcomes throughout the lifespan to end-of-life.
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Affiliation(s)
- Siobhan P Aaron
- College of Nursing, University of Utah, 10 2000 E, Salt Lake City, UT 84112 U.S.A
| | - Shena B Gazaway
- School of Nursing, University of Alabama Birmingham, Birmingham, AL U.S.A
| | - Erin R Harrell
- Department of Psychology, University of Alabama, Tuscaloosa, AL U.S.A
| | - Ronit Elk
- Department of Medicine, University of Alabama Birmingham, Birmingham, AL U.S.A
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15
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Abstract
A cognitive intervention study was conducted with the purpose of exploring methods to improve adherence to a technology-based cognitive intervention and uncover individual differences that predict adherence (N = 120). The study was divided into two phases: Phase 1, in which participants were asked to follow a prescribed schedule of training that involved gamified neuropsychological tests administered via tablet, and Phase 2, in which participants were asked to play as frequently as they wished. Positive- and negative-framed messages about brain health were delivered via the software program, and measures of cognition, technology proficiency, self-efficacy, technology attitudes, and belief in the benefits of cognitive training were collected. Generalized linear mixed-effects models revealed that positive-framed messages encouraged greater adherence over negative-framed messages, but this effect was restricted to Phase 2 of the study in the absence of social pressure. Measures of memory and self-efficacy demonstrated some, but limited, ability to predict individual differences in adherence. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
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16
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Dionne-Odom JN, Azuero A, Taylor RA, Wells RD, Hendricks BA, Bechthold AC, Reed RD, Harrell ER, Dosse CK, Engler S, McKie P, Ejem D, Bakitas MA, Rosenberg AR. Resilience, preparedness, and distress among family caregivers of patients with advanced cancer. Support Care Cancer 2021; 29:6913-6920. [PMID: 34031751 PMCID: PMC9733586 DOI: 10.1007/s00520-021-06265-y] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Accepted: 04/30/2021] [Indexed: 12/13/2022]
Abstract
OBJECTIVE Resilience has been proposed as a primary factor in how many family caregivers of patients with advanced cancer are able to resist psychological strain and perform effectively in the role while bearing a high load of caregiving tasks. To evaluate this hypothesis, we examined whether self-perceived resilience is associated with distress (anxiety and depressive symptoms), caregiver preparedness, and readiness for surrogate decision-making among a racially diverse sample of family caregivers of patients with newly diagnosed advanced cancer. METHODS Secondary analysis of baseline data from two small-scale, pilot clinical trials that both recruited family caregivers of patients with newly diagnosed advanced cancer. Using multivariable linear regression, we analyzed relationships of resilience as a predictor of mood, caregiving preparedness, and readiness for surrogate decision-making, controlling for sociodemographics. RESULTS Caregiver participants (N = 112) were mean 56 years of age and mostly female (76%), the patient's spouse/partner (52%), and White (56%) or African-American/Black (43%). After controlling for demographics, standardized results indicated that higher resilience was relevantly associated with higher caregiver preparedness (beta = .46, p < .001), higher readiness for surrogate decision-making (beta = .20, p < .05) and lower anxiety (beta = - .19, p < .05), and depressive symptoms (beta = - .20, p < .05). CONCLUSIONS These results suggest that resilience may be critical to caregivers' abilities to manage stress, be effective sources of support to patients, and feel ready to make future medical decisions on behalf of patients. Future work should explore and clinicians should consider whether resilience can be enhanced in cancer caregivers to optimize their well-being and ability to perform in the caregiving and surrogate decision-making roles.
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Affiliation(s)
| | - Andres Azuero
- School of Nursing, University of Alabama At Birmingham, Birmingham, AL, USA
| | - Richard A. Taylor
- School of Nursing, University of Alabama At Birmingham, Birmingham, AL, USA
| | - Rachel D. Wells
- School of Nursing, University of Alabama At Birmingham, Birmingham, AL, USA
| | | | - Avery C. Bechthold
- School of Nursing, University of Alabama At Birmingham, Birmingham, AL, USA
| | - Rhiannon D. Reed
- Comprehensive Transplant Institute, University of Alabama At Birmingham, Birmingham, AL, USA
| | - Erin R. Harrell
- Department of Psychology, University of Alabama, Tuscaloosa, AL, USA
| | - Chinara K. Dosse
- School of Nursing, University of Alabama At Birmingham, Birmingham, AL, USA
| | - Sally Engler
- School of Nursing, University of Alabama At Birmingham, Birmingham, AL, USA
| | - Peggy McKie
- School of Nursing, University of Alabama At Birmingham, Birmingham, AL, USA
| | - Deborah Ejem
- School of Nursing, University of Alabama At Birmingham, Birmingham, AL, USA
| | - Marie A. Bakitas
- School of Nursing, University of Alabama At Birmingham, Birmingham, AL, USA
| | - Abby R. Rosenberg
- Division of Hematology-Oncology, Department of Pediatrics, School of Medicine, University of Washington, Seattle, WA, USA,Cambia Palliative Care Center of Excellence, University of Washington, Seattle, WA, USA,Palliative Care and Resilience Lab, Seattle Children’s Research Institute, Seattle, WA, USA
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17
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Gazaway SB, Barnett MD, Bowman EH, Ejem D, Harrell ER, Brown CJ, Bakitas M. Health Professionals Palliative Care Education for Older Adults: Overcoming Ageism, Racism, and Gender Bias. Curr Geriatr Rep 2021; 10:148-156. [PMID: 34745842 PMCID: PMC8556773 DOI: 10.1007/s13670-021-00365-7] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/23/2021] [Indexed: 12/03/2022]
Abstract
Purpose of review Most aging Americans lack access to specialist palliative care aimed at those experiencing serious illness and/or high symptom burden at end of life. The curricula used by training programs for all healthcare professions should focus on helping learners develop the primary palliative care skills and competencies necessary to provide compassionate bias-free care for adults with serious illness. We believe there is much opportunity to improve this landscape via the incorporation of palliative care competencies throughout generalist healthcare professional programs. Recent findings Several recent publications highlight multiple issues with recruitment and retention of diverse students and faculty into healthcare professional training programs. There are also concerns that the curricula are reinforcing age, race, and gender biases. Due to these biases, healthcare professionals graduate from their training programs with socialized stereotypes unquestioned when caring for older adult minority patients and caregivers. Summary Important lessons must be incorporated to assure that bias against age, race, and gender are discovered and openly addressed in healthcare professional’s education programs. This review highlights these three types of bias and their interrelationships with the aim of revealing hidden truths in the education of healthcare professionals. Ultimately, we offer targeted recommendations of focus for programs to address implicit bias within their curricula.
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Affiliation(s)
- Shena B. Gazaway
- School of Nursing Center for Palliative and Supportive Care, University of Alabama, 1720 2nd Avenue South, AL 35294-1210 Birmingham, USA
| | - Michael D. Barnett
- Associate Professor of Medicine & Pediatrics, Center for Palliative and Supportive Care, University of Alabama at Birmingham, Birmingham, USA
| | - Ella H. Bowman
- Professor of Medicine, Section Chief of Geriatric Medicine, University of Alabama at Birmingham, Alabama VA Health Care System, Birmingham, USA
| | - Deborah Ejem
- Assistant Professor School of Nursing, University of Alabama Birmingham, Birmingham, USA
| | - Erin R. Harrell
- Assistant Professor Department of Psychology, University of Alabama, Tuscaloosa, USA
| | - Cynthia J. Brown
- Professor and Chair Department of Internal Medicine, Louisiana State University Health Sciences Center, New Orleans , USA
| | - Marie Bakitas
- Professor and Associate Dean for Research and Scholarship School of Nursing Center for Palliative and Supportive, University of Alabama, Birmingham, USA
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18
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Fletcher PA, Worthen DL, McSweeney-Feld MH, Gibson A, Seblova D, Pagán L, Troya MI, Fang ML, Owusu B, Lane C, Wada M, Harrell ER, Viana A. Rural Older Adults in Disasters: A Study of Recovery From Hurricane Michael. Disaster Med Public Health Prep 2021; 16:1-5. [PMID: 34672250 DOI: 10.1017/dmp.2021.276] [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: 11/07/2022]
Abstract
OBJECTIVE This study aims for a greater understanding of how older adults (age 65 and older) in Jackson County, Florida, are prepared for and cope with the effects of a natural disaster. METHODS A multidisciplinary, international research team developed a survey examining: (1) resources available to individuals aged 65+ in rural communities for preparing for a disaster; (2) challenges they face when experiencing a disaster; and (3) their physical, social, emotional, and financial needs when it strikes. The survey was administered with older adults (65+) in Jackson County, Florida, following Hurricane Michael in 2018. The descriptive, multivariate logistic, and linear regression analyses were performed to examine the relationship between respondents' demographic information and needs, concerns, and consequences of disaster. RESULTS Results indicated (n = 139) rural community-dwelling older adults rely on social support, community organizations, and trusted disaster relief agencies to prepare for and recover from disaster-related events. CONCLUSIONS Such findings can be used to inform the development of new interventions, programs, policies, practices, and tools for emergency management and social service agencies to improve disaster preparedness and resiliency among older populations in rural communities.
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Affiliation(s)
- Patricia A Fletcher
- Federal Emergency Management Agency, Interagency Coordination Division, Recovery Directorate, Washington, DC, USA
| | - Dreamal L Worthen
- Florida Agricultural and Mechanical University, Cooperative Extension, Tallahassee, FL, USA
| | | | | | - Dominika Seblova
- Columbia University College of Physicians and Surgeons, Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Department of Neurology, New York, NY, USA
| | - Lisandra Pagán
- Federal Emergency Management Agency, Interagency Coordination Division, Recovery Directorate, Washington, DC, USA
| | - M Isabela Troya
- University College Cork, School of Public Health National Suicide Research Foundation WHO Collaborating Centre for Surveillance and Research in Suicide Prevention, Cork, Ireland
| | - Mei Lan Fang
- University of Dundee, School of Nursing & Health Sciences Dundee, Dundee, United Kingdom
| | - Brenda Owusu
- University of Miami, School of Nursing and Health Studies, Coral Gables, FL, USA
| | - Charlene Lane
- Messiah College, Social Work, Mechanicsburg, PA, USA
| | - Mineko Wada
- Adler University - Vancouver, Public Policy and Administration, Vancouver, BC, Canada
| | - Erin R Harrell
- The University of Alabama System, Psychology, Tuscaloosa, AL, USA
| | - Aline Viana
- Fundação Oswaldo Cruz, National School of Public Health - RJ/BR, Rio de Janeiro, Brazil
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Harrell ER, Bui C, Newman SD. A Mixed-Effects Model of Associations between Interleukin-6 and Hippocampal Volume. J Gerontol A Biol Sci Med Sci 2021; 77:683-688. [PMID: 34637514 DOI: 10.1093/gerona/glab313] [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] [Received: 04/22/2021] [Indexed: 11/12/2022] Open
Abstract
Previous studies report hippocampal volume loss can help predict conversion from normative aging to mild cognitive impairment (MCI) to dementia. Additionally, a growing literature indicates that stress-related allostatic load may increase disease vulnerability. The current study examined the relationship between stress related cytokines (i.e., interleukin-6 - IL-6), cognition as measured by Mini Mental Status scores (MMSE), and hippocampal volume. Mixed-models were employed to examine both within (across time) and between subjects effects of IL-6 and hippocampal volume on MMSE score among 566 participants from the Alzheimer's Disease Neuroimaging Initiative (ADNI). The within subjects analysis found left hippocampal volume significantly (p= .009) predicted MMSE score. Between subjects analysis found the effect of IL-6 on MMSE was moderated by right hippocampal volume (p = .001). These results replicate previous findings and also extend prior work demonstrating stress-related cytokines may play a role in Alzheimer's disease (AD) progression.
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Affiliation(s)
- Erin R Harrell
- Department of Psychology, University of Alabama, Tuscaloosa, United States of America
| | - Chuong Bui
- Alabama Life Research Institute, University of Alabama, Tuscaloosa, United States of America
| | - Sharlene D Newman
- Department of Psychology, University of Alabama, Tuscaloosa, United States of America.,Alabama Life Research Institute, University of Alabama, Tuscaloosa, United States of America
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20
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Onafraychuk D, Sanders EC, Harrell ER, Boot WR. Exploring Individuals' Willingness to Engage in Interventions to Improve Cognitive Health and Prolong Late-Life Independence: An Extension of Harrell, Kmetz, and Boot (2019). J Cogn Enhanc 2021; 5:259-265. [PMID: 34485809 PMCID: PMC8415010 DOI: 10.1007/s41465-020-00197-x] [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: 06/28/2020] [Accepted: 10/20/2020] [Indexed: 10/23/2022]
Abstract
Interventions designed to preserve cognition have become increasingly popular as our population ages. In exploring intervention effectiveness, however, researchers have often overlooked a potentially important factor: willingness to engage. Recent findings from Harrell, Kmetz, Boot (2019) showed that perceived cognitive deficits and perceived training efficacy were significant predictors of willingness to engage in a brain training intervention designed to preserve cognition. However, they did not explore another potentially important factor: anticipated intervention enjoyment. In the current study, younger, middle-aged, and older adults (N = 169) completed surveys that assessed their willingness to engage in different types of training (aerobic exercise, brain, meditation) to improve cognition and the extent that factors such as health, perceived cognitive deficits, belief in training efficacy, and personality contributed to willingness to engage. Participants reported being least willing to engage in meditation training and meditation training was rated by participants as the least likely to improve cognition. Anticipated training enjoyment was the overriding factor that predicted willingness. These findings provide additional insights into why, and for how long, individuals may be willing to engage in training to prolong independence and have implications for understanding intervention adoption and adherence.
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Affiliation(s)
| | - Edie C Sanders
- Department of Psychology, Florida State University, Tallahassee, FL, USA
| | - Erin R Harrell
- Department of Psychology, Florida State University, Tallahassee, FL, USA
| | - Walter R Boot
- Department of Psychology, Florida State University, Tallahassee, FL, USA
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21
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McDonough IM, Harrell ER, Black SR, Allen RS, Parmelee PA. Sources of nonreplicability in aging ethnoracial health disparities research. Psychol Aging 2021; 37:60-71. [PMID: 33914578 DOI: 10.1037/pag0000606] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The older adult population in the U.S. is becoming increasingly diverse across a constellation of factors including ethnoracial group, socioeconomic status, and immigration status. However, our understanding of the consequences of this diversity for cognitive and mental health is masked by the lack of inclusion of diverse sample characteristics, the use of assessments that might hold a different meaning for different groups of people, and analytical choices that do not probe the impact of diverse characteristics or assume an unwarranted degree of homogeneity within groups. Each of these factors not only hinders our ability to understand various psychological mechanisms that differ as a function of age but also threatens the likelihood of replicability across aging research studies. This article provides our perspective on three key sources of nonreplicability in ethnoracial health disparities research among older adults: (a) what is lost in creating monolithic groups rather than identifying subgroups of minorities, (b) understanding aging from the perspective of intersecting identities, and (c) biases of research materials. We also provide recommendations to increase replicability in aging research with respect to the challenges outlined. Approaching questions on aging from a health disparities lens can both increase the generalizability of research outcomes and improve initiatives of social justice that are long overdue. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
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22
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Harrell ER, Kmetz B, Boot WR. Is Cognitive Training Worth It? Exploring Individuals' Willingness to Engage in Cognitive Training. J Cogn Enhanc 2019; 3:405-415. [PMID: 31773088 PMCID: PMC6879105 DOI: 10.1007/s41465-019-00129-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [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: 10/29/2018] [Accepted: 02/16/2019] [Indexed: 10/27/2022]
Abstract
We assessed how much time individuals would be willing to spend engaging in game-based cognitive training to gain prolonged functional independence. In Study 1 (N = 294), participants completed a survey with questions assessing how much time they would be willing to invest in daily cognitive training to extend their functional independence by certain amounts of time using a slider response that ranged from 0 to 100 minutes. Participants also completed surveys that measured self-perceived health and cognitive functioning, personality, and other demographic variables. Even for relatively small gains, participants reported being willing to dedicate an average of 11 minutes every day to cognitive training, with some participants willing to engage for significantly longer. The best predictor of willingness to invest time in training was belief in cognitive training efficacy, followed by openness to experience, and participants' self-perceived cognitive deficit. Study 2 examined the same question in a sample of 120 older adults, this time allowing for open-ended responses. Participants reported being willing to invest significantly more time, ranging from more than 40 minutes every day to gain just one week of independence, to over 2.5 hours every day to gain an additional 3 years of independence. Again, perception of cognitive training efficacy was the strongest predictor of willingness to invest time. Results confirm that older adults are willing to invest significant amounts of time to gain independence later in life, and have implications for predicting the adoption of, and adherence to, potentially effective treatments for cognitive decline.
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23
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Yoon JS, Roque NA, Andringa R, Harrell ER, Lewis KG, Vitale T, Charness N, Boot WR. Intervention Comparative Effectiveness for Adult Cognitive Training (ICE-ACT) Trial: Rationale, design, and baseline characteristics. Contemp Clin Trials 2019; 78:76-87. [PMID: 30711665 PMCID: PMC6485952 DOI: 10.1016/j.cct.2019.01.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [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: 11/01/2018] [Revised: 01/20/2019] [Accepted: 01/30/2019] [Indexed: 11/17/2022]
Abstract
Age-related perceptual and cognitive declines are associated with difficulties performing everyday tasks required to remain independent. Encouraging improvements in cognitive abilities have been shown for various short-term interventions but there is little evidence for direct impact on independence. This project compares the effect of broad and directed (narrow) technology-based training on basic perceptual and cognitive abilities in older adults and on the performance of simulated tasks of daily living including driving and fraud avoidance. Participants (N = 230, Mean age = 72) were randomly assigned to one of four training conditions: broad training using either (1) a web-based brain game suite, Brain HQ, or (2) a strategy video game, Rise of Nations, or to directed training for (3) Instrumental Activities of Daily Living (IADL) training using web-based programs for both driving and fraud avoidance training, or (4) to an active control condition of puzzle solving. Training took approximately 15-20 h for each intervention condition across four weeks. Before training began, participants received baseline ability tests of perception, attention, memory, cognition, and IADL, including a driving simulator test for hazard perception, and a financial fraud recognition test. They were tested again on these measures following training completion (post-test). A one-year follow-up from training completion is also scheduled. The baseline results support that randomization was successful across the intervention conditions. We discuss challenges and potential solutions for using technology-based interventions with older adults. We also discuss how the current trial addressed methodological limitations of previous intervention studies. TRIAL REGISTRATION NUMBER: NCT03141281.
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Affiliation(s)
- Jong-Sung Yoon
- Florida State University, Department of Psychology, Tallahassee, FL, United States.
| | - Nelson A Roque
- Penn State University, Center for Healthy Aging, University Park, PA, United States
| | - Ronald Andringa
- Florida State University, Department of Psychology, Tallahassee, FL, United States
| | - Erin R Harrell
- Florida State University, Department of Psychology, Tallahassee, FL, United States
| | - Katharine G Lewis
- Florida State University, Department of Psychology, Tallahassee, FL, United States
| | - Thomas Vitale
- Florida State University, Department of Psychology, Tallahassee, FL, United States
| | - Neil Charness
- Florida State University, Department of Psychology, Tallahassee, FL, United States
| | - Walter R Boot
- Florida State University, Department of Psychology, Tallahassee, FL, United States
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24
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O'Donnell M, Nelson LD, Ackermann E, Aczel B, Akhtar A, Aldrovandi S, Alshaif N, Andringa R, Aveyard M, Babincak P, Balatekin N, Baldwin SA, Banik G, Baskin E, Bell R, Białobrzeska O, Birt AR, Boot WR, Braithwaite SR, Briggs JC, Buchner A, Budd D, Budzik K, Bullens L, Bulley RL, Cannon PR, Cantarero K, Cesario J, Chambers S, Chartier CR, Chekroun P, Chong C, Cleeremans A, Coary SP, Coulthard J, Cramwinckel FM, Denson TF, Díaz-Lago M, DiDonato TE, Drummond A, Eberlen J, Ebersbach T, Edlund JE, Finnigan KM, Fisher J, Frankowska N, García-Sánchez E, Golom FD, Graves AJ, Greenberg K, Hanioti M, Hansen HA, Harder JA, Harrell ER, Hartanto A, Inzlicht M, Johnson DJ, Karpinski A, Keller VN, Klein O, Koppel L, Krahmer E, Lantian A, Larson MJ, Légal JB, Lucas RE, Lynott D, Magaldino CM, Massar K, McBee MT, McLatchie N, Melia N, Mensink MC, Mieth L, Moore-Berg S, Neeser G, Newell BR, Noordewier MK, Ali Özdoğru A, Pantazi M, Parzuchowski M, Peters K, Philipp MC, Pollmann MMH, Rentzelas P, Rodríguez-Bailón R, Philipp Röer J, Ropovik I, Roque NA, Rueda C, Rutjens BT, Sackett K, Salamon J, Sánchez-Rodríguez Á, Saunders B, Schaafsma J, Schulte-Mecklenbeck M, Shanks DR, Sherman MF, Steele KM, Steffens NK, Sun J, Susa KJ, Szaszi B, Szollosi A, Tamayo RM, Tinghög G, Tong YY, Tweten C, Vadillo MA, Valcarcel D, Van der Linden N, van Elk M, van Harreveld F, Västfjäll D, Vazire S, Verduyn P, Williams MN, Willis GB, Wood SE, Yang C, Zerhouni O, Zheng R, Zrubka M. Registered Replication Report: Dijksterhuis and van Knippenberg (1998). Perspect Psychol Sci 2018; 13:268-294. [PMID: 29463182 DOI: 10.1177/1745691618755704] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Dijksterhuis and van Knippenberg (1998) reported that participants primed with a category associated with intelligence ("professor") subsequently performed 13% better on a trivia test than participants primed with a category associated with a lack of intelligence ("soccer hooligans"). In two unpublished replications of this study designed to verify the appropriate testing procedures, Dijksterhuis, van Knippenberg, and Holland observed a smaller difference between conditions (2%-3%) as well as a gender difference: Men showed the effect (9.3% and 7.6%), but women did not (0.3% and -0.3%). The procedure used in those replications served as the basis for this multilab Registered Replication Report. A total of 40 laboratories collected data for this project, and 23 of these laboratories met all inclusion criteria. Here we report the meta-analytic results for those 23 direct replications (total N = 4,493), which tested whether performance on a 30-item general-knowledge trivia task differed between these two priming conditions (results of supplementary analyses of the data from all 40 labs, N = 6,454, are also reported). We observed no overall difference in trivia performance between participants primed with the "professor" category and those primed with the "hooligan" category (0.14%) and no moderation by gender.
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Voorhees JJ, Duell EA, Creehan P, Stawiski M, Harrell ER. Cyclic AMP and cyclic GMP in epidermal physiology and pathophysiology. Curr Probl Dermatol 2015; 6:107-53. [PMID: 8278 DOI: 10.1159/000399008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
The second messengers cyclic AMP and cyclic GMP in several organs appear to coordinate those molecular events which are responsible for specialized organ function. As a result of balanced cell proliferation and specialization, epidermis functions by terminal specialization which provides a barrier between man and environment. Since the epidermal component of psoriasis is a classic example of deranged epidermal homeostasis, which has a low level of cyclic AMP and a high level of cyclic GMP, it seems reasonable that rebalancing these cyclic nucleotides might ultimately be a safe and effective therapy for psoriasis and other proliferative skin diseases.
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Abstract
PVC plastisol exhibits pseudo-plastic flow in steady shear; that is, viscosity decreases with the increasing shear rate. At higher shear rates viscosity reaches a minimum and then increases, i.e., dilatant behavior. Previously, pseudo-plastic behavior was explained by a mechanism in which the suspended particles partition into an immobilized layer and a mobile phase. The development of the immobilized layer with the increase in shear rate was shown to quantitatively account for pseudo-plastic behavior. In higher shear rates dilatation of the immobilized layer was shown to be the cause of dilatacy. At even higher shear rates the immobilized layer fractures. In this paper the viscosity minimum was interpreted as the yielding of the immobilized layer. Subsequently, data in the literature were analyzed to find criteria for the yielding and fracture of the immobilized layer. Yielding was found to obey Coulomb's criterion, from which the coefficient of friction and the cohesive strength of the immobilized layer were evaluated. These properties were controlled by the nature of particle assembly in the immobilized layer and the plasticizer type had only a minor effect. The value of the coefficient of friction was on the lower side and within the range of values found in the literature for other materials. There were two modes of fracture of the immobilized layer, one with low strength, low strain to break, and the other with high strength, high strain to break. The former is analogous to the brittle fracture of solids and the latter ductile failure. The strength of brittle fracture was somewhat higher than cohesive strength, which was evaluated from yielding data. This is akin to Griffith's criterion for brittle fracture of a solid. Ductile failure occurred when the shear stress exceeded normal stress.
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Affiliation(s)
- N Nakajima
- Institute of Polymer Engineering, The University of Akron, Akron, Ohio, 44325-0301, USA.
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27
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Abstract
Our previous work with PVC plastisols showed that pseudo-plastic behavior under increasing frequency of dynamic measurement was a result of the development of an immobilized layer. Subsequently, the dynamic viscosity and the storage modulus of the mobile phase were evaluated. The samples consisted of fine and coarse particles, of which the fine/coarse ratio was varied. The present work relates the storage modulus at different frequencies to the fine/coarse ratio through a model network consisting of particle-particle contacts. The contacts are of three kinds, fine-fine (f-f), fine-coarse (f-c), and coarse-coarse (c-c). The average number of contact points per particle has been evaluated for the above kinds of contacts at different frequencies. Also, a number of particles participating in the network have been evaluated as a relative measure. At lower frequency relatively larger numbers of f-f contact points exist per particle but fewer numbers of particles participate in the network. Therefore, the network is rather loose. The f-c contact shows a similar trend but fewer contact points per particle at all frequency levels. The c-c contact is limited to a pair formation, i.e., only 0.5 contact point per particle on average. However, c-c contact contributes significantly to the magnitude of the modulus, because of the size of the particle. At the higher frequency there are fewer f-f contacts, but a larger number of particles are participating in the network. The trend with the f-c contact is very similar. The c-c contact increases significantly at the higher frequencies.
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Affiliation(s)
- N Nakajima
- Institute of Polymer Engineering, The University of Akron, Akron, Ohio, 44325-0301, USA.
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Nakajima N, Isner JD, Harrell ER, Daniels CA. Dependence of Gelation and Fusion Behavior of Poly(vinyl chloride) Plastisols upon Particle Size and Size Distribution. Polym J 1981. [DOI: 10.1295/polymj.13.955] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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29
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Rusin LJ, Harrell ER. Arteriovenous fistula. Cutaneous manifestations. Arch Dermatol 1976; 112:1135-8. [PMID: 952533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
The association between congenital large-vessel arteriovenous (AV) fistulae of the extremities with Kaposiform acroangiomatosis is well established. Based on pathogenetic considerations, it is likely that many benign, cutaneous angiomatoses represent minute or microscopic AV fistulae. Combined large vessel and small vessel congenital AV fistulae of the extremity would result in the previously mentioned syndrome.
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Basler RS, Harrell ER. Uticaria pigmentosa associated with scleroderma. Arch Dermatol 1974; 109:393-4. [PMID: 4814940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
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32
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Voorhees JJ, Duell EA, Bass LJ, Harrell ER. Role of cyclic AMP in the control of epidermal cell growth and differentiation. Natl Cancer Inst Monogr 1973; 38:47-59. [PMID: 4356798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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33
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Harrell ER, Lazar P, March CH, Rees RB, Kanof NM. Cosmetics, the physician and the consumer. J Am Med Womens Assoc (1972) 1972; 27:540-1. [PMID: 4342348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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Voorhees JJ, Wilkins JW, Hayes E, Harrell ER. Nodulocystic acne as a phenotypic feature of the XYY genotype. Arch Dermatol 1972; 105:913-9. [PMID: 4260543] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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36
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Voorhees JJ, Duell EA, Bass LJ, Powell JA, Harrell ER. Decreased cyclic AMP in the epidermis of lesions of psoriasis. Arch Dermatol 1972; 105:695-701. [PMID: 4337376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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38
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Dubin HV, Courter MH, Harrell ER. Toxoplasmosis. A complication of corticosteroid-and cyclophosphamide-treated lupus erythematosus. Arch Dermatol 1971; 104:547-50. [PMID: 5120183 DOI: 10.1001/archderm.104.5.547] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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39
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Voorhees JJ, Wilkins J, Hayes E, Harrell ER. The XYY syndrome in prisoners and outpatients with cystic acne. Birth Defects Orig Artic Ser 1971; 7:186-92. [PMID: 4281325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
The XYY complement appears to be more common in individuals with nodulocystic acne than in those without acne. Consequently, nodulocystic acne may prove to be a useful adjunct to height as an easily recognizable, phenotypic feature of the XYY syndrome.
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40
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Dubin HV, Harrell ER. Azaribine in the treatment of psoriasis. Ann Intern Med 1971; 74:797-8. [PMID: 5559450 DOI: 10.7326/0003-4819-74-5-797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
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41
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Lynch PJ, Voorhees JJ, Harrell ER. Sporotrichosis and sarcoidosis. Arch Dermatol 1971; 103:298-303. [PMID: 5548276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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42
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Lynch PJ, Harrell ER. Factors in the choice of an academic career. Results of a questionnaire. Arch Dermatol 1971; 103:328. [PMID: 5548281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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43
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Dubin HV, Harrell ER. Liver disease associated with methotrexate treatment of psoriatic patients. Arch Dermatol 1970; 102:498-503. [PMID: 5474111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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Millikan LE, Harrell ER. Drug reactions to the sulfones. Arch Dermatol 1970; 102:220-4. [PMID: 4914268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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46
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47
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Voorhees JJ, Chakrabarti SG, Botero F, Miedler L, Harrell ER. Zinc therapy and distribution in psoriasis. Arch Dermatol 1969; 100:669-73. [PMID: 4903875] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
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48
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Voorhees JJ, Janzen MK, Harrell ER, Chakrabarti SG. Cytogenetic evaluation of methotrexate-treated psoriatic patients. Arch Dermatol 1969; 100:269-74. [PMID: 5822367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
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50
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Lowney ED, Baublis JV, Kreye GM, Harrell ER, McKenzie AR. The scalded skin syndrome in small children. Arch Dermatol 1967; 95:359-69. [PMID: 6023040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
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