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Moran HK, Spoozak L, Brooks JV. "A Mission and Purpose to Make Some Sense out of Everything That Was Happening to Me": A Qualitative Assessment of Mentorship in a Peer-to-Peer Gynecologic Cancer Program. J Cancer Educ 2024:10.1007/s13187-024-02443-8. [PMID: 38691304 DOI: 10.1007/s13187-024-02443-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 04/17/2024] [Indexed: 05/03/2024]
Abstract
This study aimed to elucidate the relationship between mentorship, survivorship, and identity construction in people who have had gynecologic cancer and participated as mentors in a peer mentorship program. A qualitative descriptive study was designed, and hour-long semi-structured interviews with peer mentors were conducted. Interviews investigated how serving as a peer mentor influenced understanding of mentors' own cancer experiences. Thematic analysis was then conducted. All authors open-coded a subset of interviews to develop a codebook, which was then used to code the remaining transcripts. This qualitative inductive analysis of over 7 h of data was managed with NVivo 12. Seven peer mentor participants (N = 7) were interviewed. Four main themes emerged: serving in the social role of mentor gave participants (i) a sense of daily direction in their lives, (ii) an opportunity to give back to others in the cancer community, (iii) an explanatory reason for their cancer journey, and (iv) the ability to reify their own status as survivor. Providing support through a peer mentorship program helped our participants make meaning in their own cancer experience.
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Affiliation(s)
- Hannah Kang Moran
- University of Kansas School of Medicine, 3901 Rainbow Blvd, Kansas City, KS, 66160, USA
| | - Lori Spoozak
- University of Kansas Cancer Center, 400 Cambridge St, Kansas City, KS, 66160, USA
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Kansas School of Medicine, Kansas City, USA
- Division of Palliative Medicine, Department of Internal Medicine, University of Kansas School of Medicine, Kansas City, USA
| | - Joanna Veazey Brooks
- University of Kansas Cancer Center, 400 Cambridge St, Kansas City, KS, 66160, USA.
- Division of Palliative Medicine, Department of Internal Medicine, University of Kansas School of Medicine, Kansas City, USA.
- Department of Population Health, University of Kansas School of Medicine, 3901 Rainbow Blvd, Kansas City, KS, 66160, USA.
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Brooks JV, Hughes D. Flipping the expert: faculty educator sensemaking during transition to an active learning-based curriculum. BMC Med Educ 2024; 24:85. [PMID: 38263065 PMCID: PMC10807172 DOI: 10.1186/s12909-024-05039-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/04/2023] [Accepted: 01/06/2024] [Indexed: 01/25/2024]
Abstract
PURPOSE Curricular change is becoming a standard feature of medical schools as they respond to learners' evolving needs. Implementing change is not always straightforward, however, especially when it directly shifts the expected roles of faculty educators. The authors investigated how faculty educators navigated a significant transition to the Active, Competency-Based, and Excellence-Driven (ACE) curriculum at one state medical school. METHOD The authors employed a qualitative descriptive design and conducted thematic analysis. From June 2018 to January 2019, the authors conducted individual, in-depth interviews with faculty educators and administrators involved in first-year medical student education. Data were analyzed inductively to identify the sensemaking process for faculty. RESULTS Twenty-one faculty educators participated in interviews averaging 58 min. Four phases were identified among educators as they moved through the change: (1) Making Sense of the Change; (2) Grieving the Lecturer Educator Role; (3) Risking an Active Learning Educator Role; and (4) Identifying the Rewards of Active Learning-based Teaching. CONCLUSION Faculty buy-in is an essential component of successful curricular change implementation. While most faculty in this study reported eventual enjoyment from the new interactional teaching that fostered critical thinking, navigating the change was not always smooth. This study suggests faculty development around curricular change should be tailored to address the varying faculty concerns relevant to the four phases that were identified. Effective and optimal faculty support during large-scale curricular change must take into account not just new skills but also the grief and risk faculty may experience as their roles shift.
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Affiliation(s)
- Joanna Veazey Brooks
- Departments of Population Health and Palliative Medicine, University of Kansas School of Medicine Kansas City, 3901 Rainbow Blvd, MS 3044, Kansas City, KS, 66160, USA.
| | - Dorothy Hughes
- Departments of Population Health and Surgery, University of Kansas School of Medicine, Salina, KS, USA
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Hughes D, Mammen J, Griebling TL, Brooks JV. Informing the surgical workforce pathway: how rural community characteristics matter. Rural Remote Health 2024; 24:8363. [PMID: 38570201 DOI: 10.22605/rrh8363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2024] Open
Abstract
INTRODUCTION Rural areas worldwide face a general surgeon shortage, limiting rural populations' access to surgical care. While individual and practice-related factors have been well-studied in the US, we need a better understanding of the role of community characteristics in surgeons' location choices. This study aimed to understand the deeper meanings surgeons associated with community characteristics in order to inform efforts spanning the rural surgeon workforce pathway, from early educational exposures, and undergraduate and graduate medical education, to recruitment and retention. METHODS We conducted a qualitative, descriptive interview study with general surgeons in the Midwestern US about the role and meaning of community characteristics, exploring their backgrounds, education, practice location choices, and future plans. We focused on rural surgeons and used an urban comparison group. We used convenience and snowball sampling, then conducted interviews in-person and via phone, and digitally recorded and professionally transcribed them. We coded inductively and continued collecting data until reaching code saturation. We used thematic network analysis to organize codes and draw conclusions. RESULTS A total of 37 general surgeons (22 rural and 15 urban) participated. Interviews totaled over 52 hours. Three global themes described how rural surgeons associated different, often deeper, meanings with certain community characteristics compared to their urban colleagues: physical environment symbolism, health resources' relationship to scope of practice, and implications of intense role overlap (professional and personal roles). All interviewees spoke to all three themes, but the meanings they found differed importantly between urban and rural surgeons. Physical landscapes and community infrastructure were representative of autonomy and freedom for rural surgeons. They also shared how facilities, equipment, staff, staff education, and surgical partners combined to create different scopes of practice than their urban counterparts experienced. Often, rural surgeons found these resources dictated when they needed to transfer patients to higher-acuity facilities. Rural surgeons experienced role overlap intensely, as they cared for patients who were also friends and neighbors. CONCLUSION Rural surgeons associated different meanings with certain community characteristics than their urban counterparts. As they work with prospective rural surgeons, educators and rural communities should highlight how health resources can translate into desired scopes of practice. They also should share with trainees the realities of role overlap, both how intense and stressful it can be but also how gratifying. Educators should include the rural social context in medical and surgical education, looking for even more opportunities to collaborate with rural communities to provide learners with firsthand experiences of rural environments, resources, and role overlap.
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Affiliation(s)
- Dorothy Hughes
- Department of Population Health, School of Medicine, University of Kansas, Salina, KS 67401, USA
- Department of Surgery, School of Medicine, University of Kansas, Salina, KS 67401, USA
| | - Joshua Mammen
- Division of Surgical Oncology, Department of Surgery, University of Nebraska Medical Center, Omaha, NE 68198, USA
| | - Tomas L Griebling
- The Landon Center on Aging, Department of Urology, School of Medicine, University of Kansas, Kansas City, KS 66160, USA
| | - Joanna Veazey Brooks
- Division of Palliative Medicine, Department of Population Health, School of Medicine, University of Kansas, Kansas City, KS 66160, USA
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Formagini T, Brooks JV, Roberts A, Bullard KM, Zhang Y, Saelee R, O'Brien MJ. Prediabetes prevalence and awareness by race, ethnicity, and educational attainment among U.S. adults. Front Public Health 2023; 11:1277657. [PMID: 38164446 PMCID: PMC10758124 DOI: 10.3389/fpubh.2023.1277657] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Accepted: 11/20/2023] [Indexed: 01/03/2024] Open
Abstract
Introduction Racial and ethnic minority groups and individuals with limited educational attainment experience a disproportionate burden of diabetes. Prediabetes represents a high-risk state for developing type 2 diabetes, but most adults with prediabetes are unaware of having the condition. Uncovering whether racial, ethnic, or educational disparities also occur in the prediabetes stage could help inform strategies to support health equity in preventing type 2 diabetes and its complications. We examined the prevalence of prediabetes and prediabetes awareness, with corresponding prevalence ratios according to race, ethnicity, and educational attainment. Methods This study was a pooled cross-sectional analysis of the National Health and Nutrition Examination Survey data from 2011 to March 2020. The final sample comprised 10,262 U.S. adults who self-reported being Asian, Black, Hispanic, or White. Prediabetes was defined using hemoglobin A1c and fasting plasma glucose values. Those with prediabetes were classified as "aware" or "unaware" based on survey responses. We calculated prevalence ratios (PR) to assess the relationship between race, ethnicity, and educational attainment with prediabetes and prediabetes awareness, controlling for sociodemographic, health and healthcare-related, and clinical characteristics. Results In fully adjusted logistic regression models, Asian, Black, and Hispanic adults had a statistically significant higher risk of prediabetes than White adults (PR:1.26 [1.18,1.35], PR:1.17 [1.08,1.25], and PR:1.10 [1.02,1.19], respectively). Adults completing less than high school and high school had a significantly higher risk of prediabetes compared to those with a college degree (PR:1.14 [1.02,1.26] and PR:1.12 [1.01,1.23], respectively). We also found that Black and Hispanic adults had higher rates of prediabetes awareness in the fully adjusted model than White adults (PR:1.27 [1.07,1.50] and PR:1.33 [1.02,1.72], respectively). The rates of prediabetes awareness were consistently lower among those with less than a high school education relative to individuals who completed college (fully-adjusted model PR:0.66 [0.47,0.92]). Discussion Disparities in prediabetes among racial and ethnic minority groups and adults with low educational attainment suggest challenges and opportunities for promoting health equity in high-risk groups and expanding awareness of prediabetes in the United States.
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Affiliation(s)
- Taynara Formagini
- Department of Family Medicine, University of California San Diego, San Diego, CA, United States
- Department of Population Health, University of Kansas School of Medicine, Kansas City, KS, United States
| | - Joanna Veazey Brooks
- Department of Population Health, University of Kansas School of Medicine, Kansas City, KS, United States
- University of Kansas Cancer Center, Kansas City, KS, United States
- Division of Palliative Medicine, University of Kansas School of Medicine, Kansas City, KS, United States
| | - Andrew Roberts
- Department of Population Health, University of Kansas School of Medicine, Kansas City, KS, United States
- Aetion Inc., New York, NY, United States
| | - Kai McKeever Bullard
- Division of Diabetes Translation, National Center for Chronic Disease Prevention and Health Promotion, CDC, Atlanta, GA, United States
| | - Yan Zhang
- Division of Diabetes Translation, National Center for Chronic Disease Prevention and Health Promotion, CDC, Atlanta, GA, United States
| | - Ryan Saelee
- Division of Diabetes Translation, National Center for Chronic Disease Prevention and Health Promotion, CDC, Atlanta, GA, United States
| | - Matthew James O'Brien
- Department of Medicine, Division of General Internal Medicine and Geriatrics, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
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Brooks JV, Dickinson BL, Quesnelle KM, Bonaminio GA, Chalk-Wilayto J, Dahlman KB, Fulton TB, Hyland KM, Kruidering M, Osheroff N, Tuan RL, Ho MJ. Professional Identity Formation of Basic Science Medical Educators: A Qualitative Study of Identity Supports and Threats. Acad Med 2023; 98:S14-S23. [PMID: 37556802 PMCID: PMC10657385 DOI: 10.1097/acm.0000000000005354] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/11/2023]
Abstract
PURPOSE Basic science medical educators (BSME) play a vital role in the training of medical students, yet little is known about the factors that shape their professional identities. This multi-institutional qualitative study investigated factors that support and threaten the professional identity formation (PIF) of these medical educators. METHOD A qualitative descriptive study was conducted with a purposive sample of 58 BSME from 7 allopathic medical schools in the U.S. In-depth semi-structured interviews of individual BSME were conducted between December 2020 and February 2021 to explore the facilitators and barriers shaping the PIF of BSME. Thematic analysis was conducted. RESULTS Factors shaping PIF were grouped into 3 broad domains: personal, social, and structural. Interrelated themes described a combination of factors that pushed BSME into teaching (early or positive teaching experiences) and kept them there (satisfaction and rewards of teaching, communities of like-minded people), as well as factors that challenged their PIF (misunderstanding from medical students, clinical, and research faculty, lack of formal training programs, and lack of tenure-track educator positions). The structural environment was reported to be crucial for PIF and determined whether BSME felt that they belonged and were valued. CONCLUSIONS This study shows that although most BSME derive a sense of fulfillment and meaning from their role as medical educators, they face considerable obstacles during their PIF. Structural change and support are needed to increase recognition, value, promotion, and belonging for BSME to improve the satisfaction and retention of this important group of faculty.
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Affiliation(s)
- Joanna Veazey Brooks
- J.V. Brooks is associate professor, Department of Population Health & Division of Palliative Medicine, University of Kansas Medical Center, Kansas City, Kansas
| | - Bonny L Dickinson
- B.L. Dickinson is senior associate dean for faculty affairs, director of medical education research, and professor, Department of Biomedical Sciences, Mercer University School of Medicine, Macon, Georgia
| | - Kelly M Quesnelle
- K.M. Quesnelle is clinical professor and chair, Department of Biomedical Sciences, University of South Carolina School of Medicine Greenville, Greenville, South Carolina
| | - Giulia A Bonaminio
- G.A. Bonaminio is professor, Department of Family Medicine and Community Health, University of Kansas School of Medicine, Kansas City, Kansas
| | - Janine Chalk-Wilayto
- J. Chalk-Wilayto is associate professor of anatomy, Department of Biomedical Sciences, Mercer University School of Medicine, Macon, Georgia
| | - Kimberly Brown Dahlman
- K.B. Dahlman is associate professor of medicine, Division of Hematology/Oncology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Tracy B Fulton
- T.B. Fulton is professor, Department of Biochemistry and Biophysics, University of California, San Francisco, San Francisco, California
| | - Katherine M Hyland
- K.M. Hyland is professor, Department of Biochemistry and Biophysics, Institute for Human Genetics, University of California, San Francisco, San Francisco, California
| | - Marieke Kruidering
- M. Kruidering is professor, Department of Cellular and Molecular Pharmacology, University of California San Francisco, San Francisco, California
| | - Neil Osheroff
- N. Osheroff is professor, Departments of Biochemistry and Medicine, Vanderbilt University School of Medicine, and has an appointment at VA Tennessee Valley Healthcare System, Nashville, Tennessee
| | - Rupa Lalchandani Tuan
- R.L. Tuan is associate professor, Department of Cellular and Molecular Pharmacology, University of California San Francisco, San Francisco, California
| | - Ming-Jung Ho
- M.-J. Ho is professor of family medicine and associate director, Center for Innovation and Leadership in Education, Georgetown University Medical Center, and director of education research, MedStar Health, Washington, DC
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Bassette E, Salyer C, McCammon S, Veazey Brooks J, Spoozak L. Value of Hospice and Palliative Medicine Fellowship After Surgical Training: Bridging the Gap for Improved Patient Care. Am J Hosp Palliat Care 2023; 40:711-719. [PMID: 36154697 DOI: 10.1177/10499091221128966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Objective: Surgeons comprise 2% of HPM-trained physicians. Little is known about the perceived value of HPM training to the surgeon or medical community. We aim to demonstrate the value of HPM fellowship training to surgeons and surgical practice from the point of view of HPM fellowship trained surgeons. Design: A qualitative analysis was performed using semi-structured zoom interviews that elicited the lived experiences of HPM trained surgeons. Data was analyzed using descriptive statistics and thematic analysis. Setting: Researchers were from the University of Kansas School of Medicine and the University of Alabama at Birmingham. Participants were trained and worked across the United States in a variety of settings. Participants: Eligibility included training in general surgery, obstetrics and gynecology, or affiliated subspecialties and completion of a 1-year HPM fellowship. Results: 17 interviews were performed. Several themes emerged regarding the transformative value of HPM training to their medical and surgical practice: (1) Learning to apply shared decision making and goal-concordant care to surgical decision making, and (2) Decreasing personal bias in medical decision making, and (3) Enabling wellness in surgeons. Two themes emerged regarding the perceived value to both the surgical community and the HPM community: (1) Value of the HPM Fellowship Trained Surgeon to the Surgical Community, and (2) Value of the HPM Fellowship Trained Surgeon to the HPM Community. All study participants valued their HPM training and felt highly valued by the healthcare team. Conclusion: HPM trained surgeons are highly valued on the healthcare team and improve patient-centered surgical care.
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Affiliation(s)
- Emma Bassette
- University of Kansas School of Medicine, Kansas City, KS, USA
| | - Chelsea Salyer
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, University of Kansas School of Medicine, Kansas City, KS, USA
| | - Susan McCammon
- Department of Otolaryngology, University of Alabama School of Medicine, Birmingham, AL, USA
- Department of Internal Medicine, Division of Gerontology, Geriatrics, and Palliative Care, University of Alabama School of Medicine, Birmingham, AL, USA
| | - Joanna Veazey Brooks
- Department of Population Health, University of Kansas School of Medicine, Kansas City, KS, USA
- Department of Internal Medicine, Palliative Medicine Division, University of Kansas School of Medicine, Kansas, USA
| | - Lori Spoozak
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, University of Kansas School of Medicine, Kansas City, KS, USA
- Department of Internal Medicine, Palliative Medicine Division, University of Kansas School of Medicine, Kansas, USA
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Ellis SD, Brooks JV, Birken SA, Morrow E, Hilbig ZS, Wulff-Burchfield E, Kinney AY, Ellerbeck EF. Determinants of targeted cancer therapy use in community oncology practice: a qualitative study using the Theoretical Domains Framework and Rummler-Brache process mapping. Implement Sci Commun 2023; 4:66. [PMID: 37308981 PMCID: PMC10259814 DOI: 10.1186/s43058-023-00441-3] [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: 03/11/2022] [Accepted: 05/25/2023] [Indexed: 06/14/2023] Open
Abstract
BACKGROUND Precision medicine holds enormous potential to improve outcomes for cancer patients, offering improved rates of cancer control and quality of life. Not all patients who could benefit from targeted cancer therapy receive it, and some who may not benefit do receive targeted therapy. We sought to comprehensively identify determinants of targeted therapy use among community oncology programs, where most cancer patients receive their care. METHODS Guided by the Theoretical Domains Framework, we conducted semi-structured interviews with 24 community cancer care providers and mapped targeted therapy delivery across 11 cancer care delivery teams using a Rummler-Brache diagram. Transcripts were coded to the framework using template analysis, and inductive coding was used to identify key behaviors. Coding was revised until a consensus was reached. RESULTS Intention to deliver precision medicine was high across all participants interviewed, who also reported untenable knowledge demands. We identified distinctly different teams, processes, and determinants for (1) genomic test ordering and (2) delivery of targeted therapies. A key determinant of molecular testing was role alignment. The dominant expectation for oncologists to order and interpret genomic tests is at odds with their role as treatment decision-makers' and pathologists' typical role to stage tumors. Programs in which pathologists considered genomic test ordering as part of their staging responsibilities reported high and timely testing rates. Determinants of treatment delivery were contingent on resources and ability to offset delivery costs, which low- volume programs could not do. Rural programs faced additional treatment delivery challenges. CONCLUSIONS We identified novel determinants of targeted therapy delivery that potentially could be addressed through role re-alignment. Standardized, pathology-initiated genomic testing may prove fruitful in ensuring patients eligible for targeted therapy are identified, even if the care they need cannot be delivered at small and rural sites which may have distinct challenges in treatment delivery. Incorporating behavior specification and Rummler-Brache process mapping with determinant analysis may extend its usefulness beyond the identification of the need for contextual adaptation.
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Affiliation(s)
- Shellie D. Ellis
- University of Kansas School of Medicine, 3901 Rainbow Blvd., Kansas City, KS 66610 USA
| | - Joanna Veazey Brooks
- University of Kansas School of Medicine, 3901 Rainbow Blvd., Kansas City, KS 66610 USA
| | - Sarah A. Birken
- Wake Forest University School of Medicine, 525 Vine Street, Winston-Salem, NC 27101 USA
| | - Emily Morrow
- Kansas City Kansas Community College, 7250 State Ave., Kansas City, KS 66112 USA
| | - Zachary S. Hilbig
- University of Kansas School of Medicine, 3901 Rainbow Blvd., Kansas City, KS 66610 USA
| | | | - Anita Y. Kinney
- Rutgers Cancer Institute of New Jersey, Rutgers University, 195 Little Albany St., New Brunswick, NJ 08901 USA
| | - Edward F. Ellerbeck
- University of Kansas School of Medicine, 3901 Rainbow Blvd., Kansas City, KS 66610 USA
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Formagini T, Saint Onge JM, O’Brien MJ, Ramírez M, Brooks JV. The Experience of Spanish-Speaking Latinos in Maintaining Dietary and Physical Activity Changes after the National Diabetes Prevention Program. American Journal of Health Education 2023. [DOI: 10.1080/19325037.2023.2187487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/08/2023]
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Brooks JV, Zegers C, Sinclair CT, Wulff-Burchfield E, Thimmesch AR, English D, Nelson-Brantley HV. Understanding the Cures Act Information Blocking Rule in cancer care: a mixed methods exploration of patient and clinician perspectives and recommendations for policy makers. BMC Health Serv Res 2023; 23:216. [PMID: 36879318 PMCID: PMC9990332 DOI: 10.1186/s12913-023-09230-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Accepted: 02/28/2023] [Indexed: 03/08/2023] Open
Abstract
BACKGROUND The 21st Century Cures Act Interoperability and Information Blocking Rule was created to increase patient access to health information. This federally mandated policy has been met with praise and concern. However, little is known about patient and clinician opinions of this policy within cancer care. METHODS We conducted a convergent parallel mixed methods study to understand patient and clinician reactions to the Information Blocking Rule in cancer care and what they would like policy makers to consider. Twenty-nine patients and 29 clinicians completed interviews and surveys. Inductive thematic analysis was used to analyze the interviews. Interview and survey data were analyzed separately, then linked to generate a full interpretation of the results. RESULTS Overall, patients felt more positive about the policy than clinicians. Patients wanted policy makers to understand that patients are unique, and they want to individualize their preferences for receiving health information with their clinicians. Clinicians highlighted the uniqueness of cancer care, due to the highly sensitive information that is shared. Both patients and clinicians were concerned about the impact on clinician workload and stress. Both expressed an urgent need for tailoring implementation of the policy to avoid unintended harm and distress for patients. CONCLUSIONS Our findings provide suggestions for optimizing the implementation of this policy in cancer care. Dissemination strategies to better inform the public about the policy and improve clinician understanding and support are recommended. Patients who have serious illness or diagnoses such as cancer and their clinicians should be included when developing and enacting policies that could have a significant impact on their well-being. Patients with cancer and their cancer care teams want the ability to tailor information release based on individual preferences and goals. Understanding how to tailor implementation of the Information Blocking Rule is essential for retaining its benefits and minimizing unintended harm for patients with cancer.
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Affiliation(s)
- Joanna Veazey Brooks
- University of Kansas School of Medicine, 3901 Rainbow Boulevard, Kansas City, KS, 66160, USA
| | - Carli Zegers
- University of Kansas School of Nursing, 3901 Rainbow Boulevard, Kansas City, KS, 66160, USA
| | - Christian T Sinclair
- University of Kansas School of Medicine, 3901 Rainbow Boulevard, Kansas City, KS, 66160, USA
| | | | - Amanda R Thimmesch
- University of Kansas School of Nursing, 3901 Rainbow Boulevard, Kansas City, KS, 66160, USA
| | - Daniel English
- University of Kansas School of Nursing, 3901 Rainbow Boulevard, Kansas City, KS, 66160, USA
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Salyer C, McCammon S, Bassette E, Landzaat LH, Spoozak L, Brooks JV. Facilitators and Barriers to Recruiting Surgeons into Hospice and Palliative Medicine Training. J Pain Symptom Manage 2023; 65:409-417. [PMID: 36682672 DOI: 10.1016/j.jpainsymman.2023.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2022] [Revised: 01/06/2023] [Accepted: 01/10/2023] [Indexed: 01/20/2023]
Abstract
CONTEXT Few individuals have fellowship training in both hospice and palliative medicine (HPM) and a surgical specialty including general surgery, general obstetrics and gynecology, or affiliated subspecialties. There is a paucity of data to explain why some surgeons choose to pursue HPM fellowship training. OBJECTIVE Identify facilitators and barriers to palliative medicine fellowship training among physicians from a surgical specialty. METHODS We conducted individual semistructured interviews with 17 surgeons who were also fellowship-trained in HPM. Interviews were recorded, transcribed, and thematic analysis was conducted to identify themes. RESULTS Participants reported pivotal experiences-either positive exposure to palliative care or suboptimal surgical care experiences-as a key motivator for pursuing specialty palliative care training. Additionally, participants chose HPM training because they felt that practicing from a HPM perspective aligned with their personal care philosophy, and in some cases, offered professional opportunities to help achieve career goals. Participants reported encountering bias from both HPM and surgical faculty, and also found that some HPM fellowship programs did not accept surgical trainees. Surgeons also reported logistical concerns related to coordinating a one-year fellowship as a barrier to formal HPM training. CONCLUSIONS Understanding the motivations of surgeons who pursue HPM training and identifying challenges to completing fellowship may inform solutions to expand surgeon representation in palliative care. Both HPM and surgical faculty should be educated on the benefits of specialty HPM training for surgical trainees and practicing surgeons. Further research should explore HPM fellowship best practices for welcoming and training surgeons and other underrepresented specialties.
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Affiliation(s)
- Chelsea Salyer
- Division of Gynecologic Oncology (C.S., L.S.), Department of OBGYN, University of Kansas, Kansas City, Kansas, USA; Department of Otolaryngology (S.M.), University of Alabama Birmingham, Alabama, USA; Division of Gerontology, Geriatrics, and Palliative Care (S.M.), University of Alabama Department of Medicine, Birmingham, Alabama, USA; Department of OBGYN (E.B.), Creighton University, Omaha, Nebraska, USA; Division of Palliative Medicine (L.H.L., L.S., J.V.B.), University of Kansas Department of Internal Medicine, Kansas City, Kansas, USA; Department of Population Health (J.V.B.), University of Kansas School of Medicine Kansas City, Kansas, USA.
| | - Susan McCammon
- Division of Gynecologic Oncology (C.S., L.S.), Department of OBGYN, University of Kansas, Kansas City, Kansas, USA; Department of Otolaryngology (S.M.), University of Alabama Birmingham, Alabama, USA; Division of Gerontology, Geriatrics, and Palliative Care (S.M.), University of Alabama Department of Medicine, Birmingham, Alabama, USA; Department of OBGYN (E.B.), Creighton University, Omaha, Nebraska, USA; Division of Palliative Medicine (L.H.L., L.S., J.V.B.), University of Kansas Department of Internal Medicine, Kansas City, Kansas, USA; Department of Population Health (J.V.B.), University of Kansas School of Medicine Kansas City, Kansas, USA
| | - Emma Bassette
- Division of Gynecologic Oncology (C.S., L.S.), Department of OBGYN, University of Kansas, Kansas City, Kansas, USA; Department of Otolaryngology (S.M.), University of Alabama Birmingham, Alabama, USA; Division of Gerontology, Geriatrics, and Palliative Care (S.M.), University of Alabama Department of Medicine, Birmingham, Alabama, USA; Department of OBGYN (E.B.), Creighton University, Omaha, Nebraska, USA; Division of Palliative Medicine (L.H.L., L.S., J.V.B.), University of Kansas Department of Internal Medicine, Kansas City, Kansas, USA; Department of Population Health (J.V.B.), University of Kansas School of Medicine Kansas City, Kansas, USA
| | - Lindy H Landzaat
- Division of Gynecologic Oncology (C.S., L.S.), Department of OBGYN, University of Kansas, Kansas City, Kansas, USA; Department of Otolaryngology (S.M.), University of Alabama Birmingham, Alabama, USA; Division of Gerontology, Geriatrics, and Palliative Care (S.M.), University of Alabama Department of Medicine, Birmingham, Alabama, USA; Department of OBGYN (E.B.), Creighton University, Omaha, Nebraska, USA; Division of Palliative Medicine (L.H.L., L.S., J.V.B.), University of Kansas Department of Internal Medicine, Kansas City, Kansas, USA; Department of Population Health (J.V.B.), University of Kansas School of Medicine Kansas City, Kansas, USA
| | - Lori Spoozak
- Division of Gynecologic Oncology (C.S., L.S.), Department of OBGYN, University of Kansas, Kansas City, Kansas, USA; Department of Otolaryngology (S.M.), University of Alabama Birmingham, Alabama, USA; Division of Gerontology, Geriatrics, and Palliative Care (S.M.), University of Alabama Department of Medicine, Birmingham, Alabama, USA; Department of OBGYN (E.B.), Creighton University, Omaha, Nebraska, USA; Division of Palliative Medicine (L.H.L., L.S., J.V.B.), University of Kansas Department of Internal Medicine, Kansas City, Kansas, USA; Department of Population Health (J.V.B.), University of Kansas School of Medicine Kansas City, Kansas, USA
| | - Joanna Veazey Brooks
- Division of Gynecologic Oncology (C.S., L.S.), Department of OBGYN, University of Kansas, Kansas City, Kansas, USA; Department of Otolaryngology (S.M.), University of Alabama Birmingham, Alabama, USA; Division of Gerontology, Geriatrics, and Palliative Care (S.M.), University of Alabama Department of Medicine, Birmingham, Alabama, USA; Department of OBGYN (E.B.), Creighton University, Omaha, Nebraska, USA; Division of Palliative Medicine (L.H.L., L.S., J.V.B.), University of Kansas Department of Internal Medicine, Kansas City, Kansas, USA; Department of Population Health (J.V.B.), University of Kansas School of Medicine Kansas City, Kansas, USA
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Bassette E, Salyer C, McCammon S, Brooks JV, Spoozak L. Corrigendum to "Hospice and Palliative Medicine Fellowship after Surgical Training: A Roadmap to the Future of Surgical Palliative Care". Journal of Surgical Education, Volume 79, Issue 5, September-October 2022, Pages 1177-1187. J Surg Educ 2023; 80:157. [PMID: 36220760 DOI: 10.1016/j.jsurg.2022.09.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Affiliation(s)
- Emma Bassette
- University of Kansas School of Medicine, Kansas City, Kansas
| | - Chelsea Salyer
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, University of Kansas School of Medicine, Kansas City, Kansas
| | - Susan McCammon
- Department of Otolaryngology, University of Alabama School of Medicine, Birmingham, Alabama; Department of Internal Medicine, Division of Gerontology, Geriatrics, and Palliative Care, University of Alabama School of Medicine, Birmingham, Alabama
| | - Joanna Veazey Brooks
- Department of Population Health, University of Kansas School of Medicine, Kansas City, Kansas; Department of Internal Medicine, Palliative Medicine Division, University of Kansas School of Medicine, Kansas City, Kansas
| | - Lori Spoozak
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, University of Kansas School of Medicine, Kansas City, Kansas; Department of Internal Medicine, Palliative Medicine Division, University of Kansas School of Medicine, Kansas City, Kansas.
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Ellis SD, Thompson JA, Boyd SS, Roberts AW, Charlton M, Brooks JV, Birken SA, Wulff-Burchfield E, Amponsah J, Petersen S, Kinney AY, Ellerbeck E. Geographic differences in community oncology provider and practice location characteristics in the central United States. J Rural Health 2022; 38:865-875. [PMID: 35384064 PMCID: PMC9589478 DOI: 10.1111/jrh.12663] [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: 01/03/2023]
Abstract
PURPOSE How care delivery influences urban-rural disparities in cancer outcomes is unclear. We sought to understand community oncologists' practice settings to inform cancer care delivery interventions. METHODS We conducted secondary analysis of a national dataset of providers billing Medicare from June 1, 2019 to May 31, 2020 in 13 states in the central United States. We used Kruskal-Wallis rank and Fisher's exact tests to compare physician characteristics and practice settings among rural and urban community oncologists. FINDINGS We identified 1,963 oncologists practicing in 1,492 community locations; 67.5% practiced in exclusively urban locations, 11.3% in exclusively rural locations, and 21.1% in both rural and urban locations. Rural-only, urban-only, and urban-rural spanning oncologists practice in an average of 1.6, 2.4, and 5.1 different locations, respectively. A higher proportion of rural community sites were solo practices (11.7% vs 4.0%, P<.001) or single specialty practices (16.4% vs 9.4%, P<.001); and had less diversity in training environments (86.5% vs 67.8% with <2 medical schools represented, P<.001) than urban community sites. Rural multispecialty group sites were less likely to include other cancer specialists. CONCLUSIONS We identified 2 potentially distinct styles of care delivery in rural communities, which may require distinct interventions: (1) innovation-isolated rural oncologists, who are more likely to be solo providers, provide care at few locations, and practice with doctors with similar training experiences; and (2) urban-rural spanning oncologists who provide care at a high number of locations and have potential to spread innovation, but may face high complexity and limited opportunity for care standardization.
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Affiliation(s)
- Shellie D Ellis
- Department of Population Health, University of Kansas Medical Center, Kansas City, Kansas, USA
- University of Kansas Cancer Center, Kansas City, Kansas, USA
| | - Jeffrey A Thompson
- University of Kansas Cancer Center, Kansas City, Kansas, USA
- Department of Biostatistics & Data Science, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Samuel S Boyd
- Department of Biostatistics & Data Science, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Andrew W Roberts
- Department of Population Health, University of Kansas Medical Center, Kansas City, Kansas, USA
- University of Kansas Cancer Center, Kansas City, Kansas, USA
- Department of Anesthesiology, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Mary Charlton
- Department of Epidemiology, University of Iowa College of Public Health, Iowa City, Iowa, USA
| | - Joanna Veazey Brooks
- Department of Population Health, University of Kansas Medical Center, Kansas City, Kansas, USA
- University of Kansas Cancer Center, Kansas City, Kansas, USA
| | - Sarah A Birken
- Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | - Elizabeth Wulff-Burchfield
- University of Kansas Cancer Center, Kansas City, Kansas, USA
- Division of Medical Oncology, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Jonah Amponsah
- Department of Biostatistics & Data Science, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Shariska Petersen
- Department of Obstetrics and Gynecology, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Anita Y Kinney
- Department of Biostatistics and Epidemiology, School of Public Health, Rutgers University, Haven, Kansas, USA
| | - Edward Ellerbeck
- Department of Population Health, University of Kansas Medical Center, Kansas City, Kansas, USA
- University of Kansas Cancer Center, Kansas City, Kansas, USA
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Bassette E, Salyer C, McCammon S, Brooks JV, Spoozak L. Hospice and Palliative Medicine Fellowship after Surgical Training: A Roadmap to the Future of Surgical Palliative Care. J Surg Educ 2022; 79:1177-1187. [PMID: 35662536 DOI: 10.1016/j.jsurg.2022.05.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Revised: 04/17/2022] [Accepted: 05/07/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVE Surgeons comprise only 2% of Hospice and Palliative Medicine (HPM) board-certified physicians. Little is known about the motivations of individuals who pursue this combined training or the perceived benefits of this pathway. This study aimed to capture the pathways and experiences of HPM fellowship trained surgeons and to establish recommendations for surgical trainees who may benefit from HPM fellowship training. DESIGN A qualitative study was designed using semi-structured zoom interviews that elicited experiences of HPM trained surgeons. Data was analyzed using descriptive statistics and thematic analysis. SETTING Researchers were from the University of Kansas School of Medicine and the University of Alabama at Birmingham. Participants were trained and worked across the United States in a variety of settings. PARTICIPANTS Eligibility included completion of a 1-year HPM fellowship and training in general surgery, general obstetrics and gynecology, or affiliated subspecialties. RESULTS Seventeen interviews were conducted. All participants expressed satisfaction with their HPM fellowship training. Four themes emerged as recommendations for surgeons to pursue HPM fellowship training: 1) a commitment to joining the HPM workforce, 2) becoming ambassadors for HPM and surgical culture change, 3) desire for advanced communication and symptom management skills at the specialist level, and 4) specialist level HPM skills may enhance surgical career. CONCLUSIONS HPM fellowship training is achievable through multiple pathways for surgeons from a variety of training backgrounds.
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Affiliation(s)
- Emma Bassette
- University of Kansas School of Medicine, Kansas City, Kansas
| | - Chelsea Salyer
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, University of Kansas School of Medicine, Kansas City, Kansas
| | - Susan McCammon
- Department of Otolaryngology, University of Alabama School of Medicine, Birmingham, Alabama; Department of Internal Medicine, Division of Gerontology, Geriatrics, and Palliative Care, University of Alabama School of Medicine, Birmingham, Alabama
| | - Joanna Veazey Brooks
- Department of Population Health, University of Kansas School of Medicine, Kansas City, Kansas; Department of Internal Medicine, Palliative Medicine Division, University of Kansas School of Medicine, Kansas City, Kansas
| | - Lori Spoozak
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, University of Kansas School of Medicine, Kansas City, Kansas; Department of Internal Medicine, Palliative Medicine Division, University of Kansas School of Medicine, Kansas City, Kansas.
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Tsai G, Veazey Brooks J. Professional Jurisdictions and Intraprofessional Identity Dynamics: Doctors of Osteopathic Medicine and the Doctors of General Medicine. J Hist Med Allied Sci 2022; 77:291-315. [PMID: 35641121 DOI: 10.1093/jhmas/jrac014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Professional jurisdictional boundaries change throughout time due to a myriad of factors such as scientific advances, social changes, or governmental requirements. Research on the negotiation of these jurisdictional changes has primarily focused on the relational dynamics between professions that affect these boundaries. We examine two physician groups that considered jurisdictional changes which were initially antithetical to their core professional identity. The DOs grappled with whether or not to incorporate drug therapy into their practice, and generalist MDs had to decide whether or not to become a specialty. We find that jurisdictional negotiations also occur within a profession, not just between them. We argue that for a profession to pursue a change in scope, members must settle on an interpretation of their professional identity congruent with the potential jurisdictional change.
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15
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Formagini T, Poague C, O'Neal A, Brooks JV. "When I Heard the Word Palliative": Obscuring and Clarifying Factors Affecting the Stigma Around Palliative Care Referral in Oncology. JCO Oncol Pract 2022; 18:e72-e79. [PMID: 34310185 PMCID: PMC8758121 DOI: 10.1200/op.21.00088] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
PURPOSE Palliative care (PC) can help patients with cancer manage symptoms and achieve a greater quality of life. However, there are many barriers to patients with cancer receiving referrals to PC, including the stigmatizing association of PC with end of life. This study explores factors that obscure or clarify the stigma around PC referrals and its associations with end of life in cancer care. METHODS A qualitative descriptive design using grounded theory components was designed to investigate barriers to PC referrals for patients receiving treatment at an outpatient cancer center. Interviews with patients, caregivers, and oncology professionals were audio-recorded, transcribed, and independently coded by three investigators to ensure rigor. Participants were asked about their perceptions of PC and PC referral experiences. RESULTS Interviews with 44 participants revealed both obscuring and clarifying factors surrounding the association of PC as end of life. Prognostic uncertainty, confusion about PC's role, and social network influence all perpetuated an inaccurate and stigmatizing association of PC with end of life. Contrarily, familiarity with PC, prognostic confidence, and clear referral communication helped delineate PC as distinct from end of life. CONCLUSION To reduce the stigmatizing association of PC with end of life, referring clinicians should clearly communicate prognosis, PC's role, and the reason for referral within the context of each patient and his or her unique cancer trajectory. The oncology team plays a vital role in framing the messaging surrounding referrals to PC.
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Affiliation(s)
- Taynara Formagini
- Department of Population Health, University of Kansas School of Medicine, Kansas City, KS
| | - Claire Poague
- Department of Population Health, University of Kansas School of Medicine, Kansas City, KS
| | - Alicia O'Neal
- Department of Population Health, University of Kansas School of Medicine, Kansas City, KS
| | - Joanna Veazey Brooks
- Department of Population Health, University of Kansas School of Medicine, Kansas City, KS,University of Kansas Cancer Center, Kansas City, KS,Joanna Veazey Brooks, MBE, PhD, 3901 Rainbow Blvd, Mail Stop 3044, Kansas City, KS 66106; e-mail:
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Williams JAR, Saint Onge JM, Gurley-Calvez T, Anderson R, Mosley J, Brooks JV. Aligning research and practice: The role of academic-community partnerships for improving measurement and process. Eval Program Plann 2021; 89:101990. [PMID: 34446311 DOI: 10.1016/j.evalprogplan.2021.101990] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 07/28/2021] [Accepted: 08/02/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVE Community programs addressing social determinants of health are growing in prominence and are increasingly expected to provide metrics of success. Our objective is to assess the role of an academic-community partnership for a community health worker program targeting social and medical needs, and determine factors impacting its effectiveness. METHODS We draw on a 4.5-year partnership that includes both quantitative and qualitative data collection and analysis. Quantitative data collection mechanisms evolved as a result of the partnership. Qualitative interviews were conducted with community health workers and leadership. RESULTS To align medical and social support services in a sustainable and measurable manner, our academic-community partnership found that creating and maintaining a mutually beneficial space through small wins enabled us to then address larger problems and needs. Ongoing self-study and process evaluation allowed quick adjustments. Unique partnership elements such as having consistent funding and flexible timelines and objectives were essential. CONCLUSIONS When integrating health and social services, academic-community partnerships create pathways for bidirectional learning than can quickly turn research into practice and support sustainability, especially when based on incrementally built trust and a history of small wins.
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Affiliation(s)
- Jessica A R Williams
- Department of Population Health, University of Kansas School of Medicine, 3901 Rainbow Blvd., Mail Stop 3044, Kansas City, KS 66160, United States.
| | - Jarron M Saint Onge
- Department of Population Health, University of Kansas School of Medicine, 3901 Rainbow Blvd., Mail Stop 3044, Kansas City, KS 66160, United States; Department of Sociology, University of Kansas, 1415 Jayhawk Blvd., 716 Fraser Hall, Lawrence, KS 66045-7540, United States
| | - Tami Gurley-Calvez
- Department of Population Health, University of Kansas School of Medicine, 3901 Rainbow Blvd., Mail Stop 3044, Kansas City, KS 66160, United States
| | | | - Jane Mosley
- Health Forward Foundation, 2300 Main, Suite 304, Kansas City, MO 64108, United States
| | - Joanna Veazey Brooks
- Department of Population Health, University of Kansas School of Medicine, 3901 Rainbow Blvd., Mail Stop 3044, Kansas City, KS 66160, United States
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Dwyer ML, Alt M, Brooks JV, Katz H, Poje AB. Burnout and Compassion Satisfaction: Survey Findings of Healthcare Employee Wellness During COVID-19 Pandemic using ProQOL. Kans J Med 2021; 14:121-127. [PMID: 34084270 PMCID: PMC8158419 DOI: 10.17161/kjm.vol1415171] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 02/25/2021] [Indexed: 11/26/2022] Open
Abstract
Introduction Healthcare systems are being bombarded during the COVID-19 pandemic. Understanding burnout, compassion fatigue, and potential protective factors, such as compassion satisfaction, will be important in supporting the vital healthcare workforce. The goal of the current study was to understand the key factors of burnout, compassion fatigue, and compassion satisfaction among healthcare employees during the pandemic within the U.S. in April 2020. Methods The authors conducted a single-center, cross-sectional online survey using the Professional Quality of Life (ProQOL) Questionnaire and three open-ended questions around stress and responses to stress during COVID-19 at a large Midwestern academic medical center with nearly 16,000 employees. Results Healthcare employees (613) representing over 25 professions or roles and 30 different departments within the health system were surveyed. Participants reported low levels of compassion fatigue and burnout, but moderate levels of compassion satisfaction. Compassion satisfaction was notably higher than prior literature. Key areas of stress outside of work included family, finances and housing, childcare and homeschooling, and personal health. Conclusions This was a cross-sectional survey, limiting causal analyses. Also, based on the qualitative responses, the ProQOL was somewhat insufficient in assessing the breadth of stressors, particularly outside of work, that healthcare employees faced due to the pandemic. Although compassion satisfaction was elevated during the initial phases of the pandemic, providing some possible protection against burnout, this may change as COVID-19 continues to surge. Healthcare systems are encouraged to assess and address the broad range of work and non-work-related stressors to best serve their vital workforce.
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Affiliation(s)
- Meagan L Dwyer
- Department of Psychiatry and Behavioral Sciences, University of Kansas School of Medicine, Kansas City, KS.,University of Kansas Cancer Center, Kansas City, KS
| | - Marcus Alt
- Department of Psychiatry and Behavioral Sciences, University of Kansas School of Medicine, Kansas City, KS.,University of Kansas Cancer Center, Kansas City, KS
| | - Joanna Veazey Brooks
- Department of Population Health, University of Kansas School of Medicine, Kansas City, KS.,University of Kansas Cancer Center, Kansas City, KS
| | - Hannah Katz
- Department of Psychiatry and Behavioral Sciences, University of Kansas School of Medicine, Kansas City, KS.,University of Kansas Cancer Center, Kansas City, KS
| | - Albert B Poje
- Department of Psychiatry and Behavioral Sciences, University of Kansas School of Medicine, Kansas City, KS
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Saint Onge JM, Brooks JV. The exchange and use of cultural and social capital among community health workers in the United States. Sociol Health Illn 2021; 43:299-315. [PMID: 33211336 DOI: 10.1111/1467-9566.13219] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Revised: 09/16/2020] [Accepted: 10/21/2020] [Indexed: 06/11/2023]
Abstract
Community health care workers (CHWs), lay community members with basic health care training, have been charged with providing appropriate care for vulnerable populations, addressing social determinants and improving population health. Frequently, CHWs lack the economic or cultural capital to accomplish these goals. Through analysis of 17 semi-structured interviews with CHWs and supervisors at a CHW programme in the United States, we draw on Bourdieu's theory of practice to examine how the exchange of cultural and social capital impact CHW effectiveness. We found that CHWs' reliance on bonding capital was perceived to effectively build social networks and mutual trust among marginalised communities. But, over-reliance on embodied cultural capital and bonding capital reduced integration into the health care field; limited access to bridging capital; and limited social standing. We highlight how the exchange of cultural to bonding and bridging capital presented structural limitations. Overall, the demonstrated tension demarcates and reinforces longstanding divisions between social issues and health care issues. Future efforts should focus on promoting the unique skills of CHWs within health care settings to avoid compromising CHWs' ability to advance population health.
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Affiliation(s)
- Jarron M Saint Onge
- Department of Population Health, University of Kansas Medical Center, Kansas City, KS, USA
- Department of Sociology, University of Kansas, Lawrence, KS, USA
| | - Joanna Veazey Brooks
- Department of Population Health, University of Kansas Medical Center, Kansas City, KS, USA
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19
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Eiffert S, Nicol AL, Ellerbeck EF, Brooks JV, Roberts AW. Cancer survivorship and its association with perioperative opioid use for minor non-cancer surgery. Support Care Cancer 2020; 28:5763-5770. [PMID: 32215736 PMCID: PMC7529663 DOI: 10.1007/s00520-020-05420-1] [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: 11/26/2019] [Accepted: 03/17/2020] [Indexed: 10/24/2022]
Abstract
PURPOSE Reducing high-risk prescription opioid use after surgery has become a key strategy in mitigating the opioid crisis. Yet, despite their vulnerabilities, we know little about how cancer survivors use opioids for non-cancer perioperative pain compared to those with no history of cancer. The purpose was to examine the association of cancer survivorship with the likelihood of receiving perioperative opioid therapy for non-cancer minor surgery. METHODS Using 2007-2014 SEER-Medicare data for breast, colorectal, prostate, and non-cancer populations, we conducted retrospective cohort study of opioid-naïve Medicare beneficiaries who underwent one of six common minor non-cancer surgeries. Modified Poisson regression estimated the relative risk of receiving a perioperative opioid prescription associated with cancer survivorship compared to no history of cancer. Stabilized inverse probability of treatment weights were used to balance measurable covariates between cohorts. RESULTS We included 1486 opioid-naïve older adult cancer survivors and 3682 opioid-naïve non-cancer controls. Cancer survivorship was associated with a 5% lower risk of receiving a perioperative opioid prescription (95% confidence interval: 0.89, 1.00; p = 0.06) compared to no history of cancer. Cancer survivorship was not associated with the extent of perioperative opioid exposure. CONCLUSION Cancer survivors were slightly less likely to receive opioid therapy for non-cancer perioperative pain than those without a history of cancer. It is unclear if this reflects a reduced risk of opioid-related harms for cancer survivors or avoidance of appropriate perioperative pain therapy. Further examination of cancer survivors' experiences with and attitudes about opioids may inform improvements to non-cancer pain management for cancer survivors.
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Affiliation(s)
- Samantha Eiffert
- Division of Pharmaceutical Outcomes and Policy, UNC Eshelman School of Pharmacy, Chapel Hill, NC, USA
| | - Andrea L Nicol
- Department of Anesthesiology, University of Kansas Medical Center, Kansas City, KS, USA
| | - Edward F Ellerbeck
- Department of Population Health, University of Kansas Medical Center, Kansas City, KS, USA
- The University of Kansas Cancer Center, Kansas City, KS, USA
| | - Joanna Veazey Brooks
- Department of Population Health, University of Kansas Medical Center, Kansas City, KS, USA
| | - Andrew W Roberts
- Department of Anesthesiology, University of Kansas Medical Center, Kansas City, KS, USA.
- Department of Population Health, University of Kansas Medical Center, Kansas City, KS, USA.
- The University of Kansas Cancer Center, Kansas City, KS, USA.
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Brooks JV, Poague C, Formagini T, Roberts AW, Sinclair CT, Keirns CC. Palliative Care's Role Managing Cancer Pain During the Opioid Crisis: A Qualitative Study of Patients, Caregivers, and Clinicians. J Pain Symptom Manage 2020; 60:1127-1135.e2. [PMID: 32645454 PMCID: PMC7680449 DOI: 10.1016/j.jpainsymman.2020.06.039] [Citation(s) in RCA: 2] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 06/22/2020] [Accepted: 06/25/2020] [Indexed: 01/08/2023]
Abstract
CONTEXT Patients with cancer face symptoms because of disease and treatment, and pain is common and complex. The opioid crisis may complicate patients' and clinicians' experiences of managing pain in cancer care. OBJECTIVES In our study of perceptions and experiences with palliative care (PC) at an outpatient cancer center, we examined communication around symptom management throughout cancer care, and pain and its management emerged as particularly salient. The objective of this article is to describe, from the perspectives of patients, caregivers, and oncology health care professionals, the role of PC in navigating the complicated dynamics of pain management amidst the opioid crisis. METHODS A qualitative descriptive study with grounded theory components was designed to investigate experiences with and perceptions of specialist PC and symptom management, including pain. Interviews were audiorecorded and transcribed, and focused coding identified themes related to pain and pain management from all three perspectives. RESULTS About 44 patients, caregivers, and non-PC health care professionals completed interviews. Patients with cancer and their caregivers had many concerns about pain management and were specifically concerned about opioid use and stigma. For patients, PC improved pain management and helped to destigmatize appropriate pain management. Oncology clinicians reported that partnering with PC facilitated complex pain management and also provided moral support around difficult opioid recommendations for patients. CONCLUSION PC offers the potential to uniquely support both patients and other oncology professionals in optimally navigating the complexity around pain management for cancer care in the midst of the opioid crisis.
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Affiliation(s)
- Joanna Veazey Brooks
- Department of Population Health, University of Kansas School of Medicine, Kansas City, Kansas, USA; University of Kansas Cancer Center, Kansas City, Kansas, USA.
| | - Claire Poague
- Department of Population Health, University of Kansas School of Medicine, Kansas City, Kansas, USA
| | - Taynara Formagini
- Department of Population Health, University of Kansas School of Medicine, Kansas City, Kansas, USA
| | - Andrew W Roberts
- Department of Population Health, University of Kansas School of Medicine, Kansas City, Kansas, USA; University of Kansas Cancer Center, Kansas City, Kansas, USA; Department of Anesthesiology, University of Kansas School of Medicine, Kansas City, Kansas, USA
| | - Christian T Sinclair
- Department of Anesthesiology, University of Kansas School of Medicine, Kansas City, Kansas, USA; Division of Palliative Medicine, Department of Internal Medicine, University of Kansas School of Medicine, Kansas City, Kansas, USA
| | - Carla C Keirns
- Division of Palliative Medicine, Department of Internal Medicine, University of Kansas School of Medicine, Kansas City, Kansas, USA; Department of History and Philosophy of Medicine, University of Kansas School of Medicine, Kansas City, Kansas, USA
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K Moran H, Brooks JV, Spoozak L. Undergoing active treatment for gynecologic cancer during COVID-19: A qualitative study of the impact on healthcare and social support. Gynecol Oncol Rep 2020; 34:100659. [PMID: 33106774 PMCID: PMC7577250 DOI: 10.1016/j.gore.2020.100659] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Revised: 10/10/2020] [Accepted: 10/14/2020] [Indexed: 12/19/2022] Open
Abstract
COVID-19 challenges mechanisms of gynecologic cancer care delivery. COVID-19 complicates social support for cancer patients undergoing active treatment. Patient narratives of COVID-19 may offer targeted solutions to improve care delivery.
The COVID-19 pandemic poses unique challenges for oncology patients and clinicians. While guidelines for oncology care delivery during the pandemic have been established, there is a paucity of data examining patient experiences of cancer care during the COVID pandemic. This qualitative study captured the perspectives of women undergoing active treatment for gynecologic malignancy at an academic medical center. Hour-long semi-structured interviews were conducted via video-conference and transcribed verbatim. Focused coding was conducted to identify all data related to COVID-19. These data were then categorized into themes that emerged inductively. Seven women (N = 7) were interviewed. Several themes arose under two main categories: 1) Impact of COVID-19 on cancer care delivery and interactions and 2) Intersection of cancer and COVID-19 outside of the healthcare setting. Under category 1, themes included: going to treatment alone; variable access to care and information. Under category 2, themes included: unavailability of cancer-specific social support; mask wearing; COVID-19 & life outlook; adapting coping strategies. Participants’ perceptions of having cancer during the COVID-19 pandemic varied and were not always negative. Healthcare systems can draw on our findings to inform interventions to ensure optimal patient care. Additionally, given our finding that noncompliance with mask wearing and physical distancing can be uniquely distressing to cancer patients, healthcare systems should prioritize clear messaging around COVID-19 precautions and ensure compliance of staff and patrons. Due to the rapidly changing nature of the pandemic, outcomes for these patients should be monitored and care guidelines should incorporate first-hand patient narratives.
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Affiliation(s)
| | - Joanna Veazey Brooks
- Department of Population Health, University of Kansas, School of Medicine, United States.,University of Kansas, Cancer Center, United States
| | - Lori Spoozak
- University of Kansas, Cancer Center, United States.,Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Kansas, School of Medicine, United States.,Division of Palliative Medicine, Department of Internal Medicine, University of Kansas, School of Medicine, United States
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22
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Hughes D, Brooks JV. Using Qualitative Research to Study the Profession of Rural Surgery. Surg Clin North Am 2020; 100:949-970. [PMID: 32882176 DOI: 10.1016/j.suc.2020.05.011] [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: 10/23/2022]
Abstract
This is a systematic review of original research articles that use qualitative methods to investigate rural surgery over the last decade (2010-2019). This review found that interviews and focus groups were common, most often engaging with patients and health care professionals. Thematic analysis and grounded theory were data analysis methods most frequently used among these qualitative rural surgery studies. Studies in this review often pertained to obstetrics or the provision of other other surgical services. Areas for future qualitative research on rural surgery are surgical teamwork, scope of practice, workforce shortages, and issues related to the aging rural patient.
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Affiliation(s)
- Dorothy Hughes
- Department of Population Health, University of Kansas School of Medicine, 3901 Rainbow Boulevard, MS 3044, Kansas City, KS 66160, USA; Department of Surgery, University of Kansas School of Medicine, 3901 Rainbow Boulevard, MS 3044, Kansas City, KS 66160, USA.
| | - Joanna Veazey Brooks
- Department of Population Health, University of Kansas School of Medicine, 3901 Rainbow Boulevard, MS 3044, Kansas City, KS 66160, USA
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Ball J, Thompson J, Wulff-Burchfield E, Ellerbeck E, Kimminau K, Brooks JV, Petersen S, Rotich D, Kinney AY, Ellis SD. Precision community: a mixed methods study to identify determinants of adoption and implementation of targeted cancer therapy in community oncology. Implement Sci Commun 2020. [DOI: 10.1186/s43058-020-00064-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Abstract
Background
Precision medicine has enormous potential to improve cancer outcomes. Over one third of the 1.5 million Americans diagnosed with cancer each year have genetic mutations that could be targeted with an FDA-approved drug to treat their disease more effectively. However, the current uptake of targeted cancer therapy in clinical practice is suboptimal. Tumor testing is not widely used, and treatments based on molecular and genomic profiling are often not prescribed when indicated. Challenges with the uptake of precision medicine may disproportionately impact cancer patients in rural communities and other underserved populations. The objective of this study is to identify the determinants of adoption and implementation of precision cancer therapy to design an implementation strategy for community oncology practices, including those in rural areas.
Methods
This study is an explanatory sequential mixed methods study to identify factors associated with the use of targeted cancer therapy. Levels of targeted therapy use will be ascertained by secondary analysis of medical records to identify concordance with 18 national guideline recommendations for use of precision medicine in the treatment of breast, colorectal, lung, and melanoma skin cancer. Concurrently, facilitators and barriers associated with the use of precision cancer therapy will be elicited from interviews with up to a total of 40 oncologists, administrators, pathology, and pharmacy staff across the participating sites. Qualitative analysis will be a template analysis based on the Theoretical Domains Framework. Quantitative data aggregated at the practice level will be used to rank oncology practices’ adherence to targeted cancer therapy guidelines. Determinants will be compared among high and low users to isolate factors likely to facilitate targeted therapy use. The study will be conducted in eight community oncology practices, with an estimated 4121 targeted therapy treatment decision-making opportunities over a 3-year period.
Discussion
Despite unprecedented investment in precision medicine, translation into practice is suboptimal. Our study will identify factors associated with the uptake of precision medicine in community settings. These findings will inform future interventions to increase equitable uptake of evidence-based targeted cancer treatment.
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Brooks JV, Istas K, Barth BE. Becoming a coach: experiences of faculty educators learning to coach medical students. BMC Med Educ 2020; 20:208. [PMID: 32611343 PMCID: PMC7329385 DOI: 10.1186/s12909-020-02119-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Accepted: 06/23/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND Despite the growth of coaching in medical education, many questions remain about the process of becoming a coach for medical students. We sought to understand the process through which faculty acclimated to this new role, and what benefits and challenges they experienced. METHODS A multi-phase qualitative focus group study was conducted with 20 faculty at one medical school in the United States during the initial year coaching was implemented. Focus group transcripts were analyzed using the constant comparative approach to inductively identify themes from the data. RESULTS Four main benefits were reported by faculty: student guidance, identifying student issues early, helping students develop work-life balance, and fostering clinician connectivity, which was seen as benefitting both students and faculty. The two main challenges were uncertainty regarding how adaptive the coaching sessions should be, and difficulty engaging in some of the roles simultaneously, like mentoring and supervision. CONCLUSIONS Schools that develop academic medical student coaching programs should design faculty support around coaching and recognize that the process of becoming a coach may not be or feel straightforward for faculty. Overall, faculty found coaching to be rewarding despite challenges they experienced.
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Affiliation(s)
- Joanna Veazey Brooks
- Department of Population Health, University of Kansas School of Medicine, 3901 Rainbow Blvd, Mail Stop 3044, Kansas City, KS 66160 USA
| | - Kathryn Istas
- Information and Evaluation Resource Specialist, Office of Medical Education, University of Kansas School of Medicine, Kansas City, USA
| | - Bradley E. Barth
- Department of Emergency Medicine, Assistant Dean of Student Affairs, University of Kansas School of Medicine, Kansas City, USA
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Solenberg AK, Hall JP, Veazey Brooks J. Barriers to colorectal cancer screening for people with spinal cord injuries and/or disorders: A qualitative study. Disabil Health J 2020; 14:100950. [PMID: 32624453 DOI: 10.1016/j.dhjo.2020.100950] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Revised: 05/21/2020] [Accepted: 05/31/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Limited research has shown people with spinal cord injuries and/or disorders (SCID) are less likely to be up to date with colorectal cancer (CRC) screening and therefore more likely to be diagnosed with advanced stage CRC compared to people without SCID. OBJECTIVE The aims of this study were to assess knowledge about CRC, CRC screening, and self-reported barriers to CRC screening for people with SCID. METHODS Interviews with 30 individuals with SCID were conducted using a semi-structured interview guide, audio recorded, and transcribed. Coding was performed using a hybrid approach of inductive and deductive analysis. Thematic analysis was used to identify, review, and modify themes and sub-themes. RESULTS Themes identified included barriers to CRC screening, such as socioeconomic, health system, transportation, psychological, and environmental or accessibility barriers. While most respondents were able to describe one CRC screening method (usually colonoscopy), knowledge of other screening modalities was limited. Low CRC literacy and misinformation about CRC screening appeared to increase respondent association between CRC screening and colonoscopy. While most respondents associated CRC screening with colonoscopy, almost half reported the colonoscopy preparation was the most substantial barrier to screening. CONCLUSIONS In addition to addressing identified barriers such as accessibility and transportation, communication, and prevention interventions should be specifically targeted to ensure all people with SCID are informed about appropriate and various modalities and the benefits of screening. Specific, evidence-based guidelines on the use of stool specimens first with follow up direct visualization, if needed, should be developed for this population.
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Affiliation(s)
- Allen K Solenberg
- University of Kansas Medical Center, 3901 Rainbow Blvd, Kansas City, KS, 66160, USA.
| | - Jean P Hall
- University of Kansas, Institute for Health and Disability Policy Studies and Department of Applied Behavioral Science, 1000 Sunnyside Ave, Lawrence, KS, 66045, USA
| | - Joanna Veazey Brooks
- Department of Population Health, University of Kansas Cancer Center, University of Kansas Medical Center, 3901 Rainbow Blvd, Kansas City, KS, 66160, USA
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Hughes D, Williams JAR, Brooks JV. Movers and Stayers: What Birthplaces Can Teach Us About Rural Practice Choice Among Midwestern General Surgeons. J Rural Health 2020; 37:55-60. [PMID: 32406098 DOI: 10.1111/jrh.12428] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
PURPOSE This study compares practicing rural Midwestern general surgeons born in urban areas to those born in rural areas to describe the association between birthplace and current practice location. METHODS The 2017 AMA MasterFile was used to study general surgeons in the Midwest Census Division. Surgeons were assigned to categories based on birthplace and current practice locations: urban-urban stayers, urban-rural movers, rural-rural stayers, and rural-urban movers. Urban and rural classifications corresponded to the metropolitan and nonmetropolitan definitions with Rural-Urban Continuum Codes (urban, RUCCs 1-3; rural, RUCCs 4-9). Bivariate tests and logistic regression were used to determine factors associated with rural practice choice. FINDINGS There were 3,070 general surgeons in the study population: 70.6% urban-urban stayers, 13.1% urban-rural movers, 10.7% rural-urban movers, and 5.7% rural-rural stayers. Rural areas netted 74 surgeons (327 rural-urban movers versus 401 urban-rural movers). Logistic regression results found different factors predicted rural practice among urban-born versus rural-born surgeons. Older urban-born surgeons were more likely to practice rurally, as were male surgeons, DOs, and those trained in less-urban residency programs. Among rural-born surgeons, more rural birthplaces and having trained at a less-urban residency were associated with practicing rurally. CONCLUSIONS Recruiting urban-born surgeons to rural areas has proven successful in the Midwest; our findings show urban-born surgeons outnumber rural-born surgeons in rural communities. Given the ongoing need for surgeons in rural areas, urban-born surgeons should not be overlooked. Findings suggest educators and community leaders should expand less-urban training opportunities given their potential influence on all general surgeons.
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Affiliation(s)
- Dorothy Hughes
- Department of Population Health, University of Kansas School of Medicine, Kansas City, Kansas
| | - Jessica A R Williams
- Department of Population Health, University of Kansas School of Medicine, Kansas City, Kansas
| | - Joanna Veazey Brooks
- Department of Population Health, University of Kansas School of Medicine, Kansas City, Kansas
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Affiliation(s)
- Lori Spoozak
- Obstetrics and Gynecology, University of Kansas Cancer Center, Kansas City, KS
| | - Elizabeth Wulff-Burchfield
- Medical Oncology Division and Palliative Medicine Division, Department of Internal Medicine, University of Kansas School of Medicine, University of Kansas Cancer Center, The University of Kansas Health System, Kansas City, KS
| | - Joanna Veazey Brooks
- Department of Population Health, University of Kansas School of Medicine, Kansas City, KS
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French‐Bravo M, Nelson‐Brantley HV, Williams K, Ford DJ, Manos L, Veazey Brooks J. Exploring nurses’ perceptions of nurse managers’ communicative relationships that encourage nurses’ decisions to buy‐in to initiatives that enhance patients’ experiences with care. J Nurs Manag 2020; 28:567-576. [DOI: 10.1111/jonm.12958] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2019] [Revised: 12/12/2019] [Accepted: 01/15/2020] [Indexed: 11/27/2022]
Affiliation(s)
| | | | | | - Debra J. Ford
- University of Kansas Medical Center Kansas City Kansas
| | - Laverne Manos
- University of Kansas Medical Center Kansas City Kansas
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Brooks JV, Poague C, Formagini T, Sinclair CT, Nelson-Brantley HV. The Role of a Symptom Assessment Tool in Shaping Patient-Physician Communication in Palliative Care. J Pain Symptom Manage 2020; 59:30-38. [PMID: 31494177 DOI: 10.1016/j.jpainsymman.2019.08.024] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Revised: 08/23/2019] [Accepted: 08/27/2019] [Indexed: 12/25/2022]
Abstract
CONTEXT Patients with cancer experience many symptoms that disrupt quality of life, and symptom communication and management can be challenging. The Edmonton Symptom Assessment System (ESAS) was developed to standardize assessment and documentation of symptoms, yet research is needed to understand patients' and caregivers' experiences using the tool and its ability to impact patient-provider aligned care. OBJECTIVES The objective of this study was to understand how the ESAS shapes communication between patients and providers by exploring patients' and caregivers' experiences using the ESAS and assessing the level of agreement in symptom assessment between patients and palliative care physicians. METHODS This study used a mixed-methods design. Thirty-one semistructured interviews were conducted and audio-recorded with patients (n = 18) and caregivers (n = 13). Data were analyzed following a social constructionist grounded theory approach. Patient and provider ESAS scores were obtained by medical chart review. Intraclass correlation coefficients were used to assess the level of agreement between patient-completed ESAS scores and provider-completed ESAS scores. RESULTS Participants reported that the ESAS was a beneficial tool in establishing priorities for symptom control and guiding the appointment with the palliative care physician, despite challenges in completing the ESAS. Filling out the ESAS can also help patients more clearly identify their priorities before meeting with their physician. There was a good to excellent level of agreement between patients and physicians in all symptoms analyzed. CONCLUSION The ESAS is beneficial in enhancing symptom communication when used as a guide to identify and understand patients' main concerns.
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Affiliation(s)
- Joanna Veazey Brooks
- Department of Population Health, University of Kansas School of Medicine, Kansas City, Kansas, USA.
| | - Claire Poague
- Department of Population Health, University of Kansas School of Medicine, Kansas City, Kansas, USA
| | - Taynara Formagini
- Department of Population Health, University of Kansas School of Medicine, Kansas City, Kansas, USA
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30
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Brooks JV, Chien AT, Singer SJ, Peters AS. Intentional or Not: Teamwork Learning at Primary Care Clinics. Med Sci Educ 2019; 29:969-975. [PMID: 34457573 PMCID: PMC8368961 DOI: 10.1007/s40670-019-00784-4] [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] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
BACKGROUND AND OBJECTIVES Primary care teamwork has been shown to increase satisfaction and decrease stress for physicians but the impact of outpatient teamwork for primary care residents' learning has not been described. This study aimed to understand the role of teamwork in residents' learning during and after the establishment of teams. METHODS Interviews with 37 primary care residents addressed their experiences at outpatient clinic, including their perceptions about whether team-based care affected their educational experience. Using qualitative thematic analysis, transcripts were coded to identify themes about teamwork and learning, both positive and negative. RESULTS Residents described learning both about and through teamwork at continuity clinic, despite variation in the speed and extent of initial integration into teams. As residents learned how to work on a team, they realized the importance of face-to-face time together and trusting one another. Team members also taught residents about the clinical system and social aspects of patient care, as well as some procedural skills, which led them to understand how teamwork can improve patient care and efficiency. Finally, residents learned, through both optimal and suboptimal first-hand team experiences, to see team-based care as a model for future primary care practice. CONCLUSIONS While integrating residents into primary care teams, educators should consider the potential value of teamwork as an intentional learning method. Team members, beyond the preceptor, can offer valuable instruction, and team-based workplace learning prepares residents to use teamwork to optimize care for patients.
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Affiliation(s)
- Joanna Veazey Brooks
- Department of Population Health, University of Kansas School of Medicine, 3901 Rainbow Blvd, Mail Stop 3044, Kansas City, KS 66160 USA
| | - Alyna T. Chien
- Division of General Pediatrics, Department of Medicine, Boston Children’s Hospital and Harvard Medical School, Boston, USA
| | - Sara J. Singer
- Department of Medicine, Stanford University School of Medicine, Stanford, USA
| | - Antoinette S. Peters
- Department of Population Medicine, Harvard Pilgrim Health Care Institute and Harvard Medical School, Boston, USA
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Brooks JV, Williams JAR, Gorbenko K. The work of sterile processing departments: An exploratory study using qualitative interviews and a quantitative process database. Am J Infect Control 2019; 47:816-821. [PMID: 30685129 DOI: 10.1016/j.ajic.2018.12.010] [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: 08/21/2018] [Revised: 11/29/2018] [Accepted: 12/08/2018] [Indexed: 02/02/2023]
Abstract
BACKGROUND The sterile processing of surgical instruments and equipment is an essential part of surgical operations. Although clean instruments prevent infections, little is known about the departments that conduct this work. We sought to describe sterile processing departments (SPDs) and to identify factors impacting them. METHODS We analyzed data from 22 qualitative interviews of staff and managers and a quantitative benchmarking database. RESULTS Qualitative results indicated 4 primary factors impacting sterile processing work: (1) role and visibility, (2) relationships and communication with other departments and vendors, (3) staffing and management, and (4) technical problems and solutions. Quantitative analysis revealed significant differences in SPD responsibilities and scope. DISCUSSION Relationships with operating room staff were of paramount importance in the ability of the SPD to accomplish its job and in staff motivations and feelings. Differences in management practices, communication strategies, and problem-solving resources were also emphasized. Both quantitative and qualitative data showed concern for the role of the SPD in patient safety, particularly concerning practices such as the use of immediate-use steam sterilization. CONCLUSIONS To more completely address adverse patient events and surgical patient safety, we must move toward examining the entire surgical process, including the vital role of SPDs.
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Affiliation(s)
- Joanna Veazey Brooks
- Department of Health Policy and Management, University of Kansas School of Medicine, Kansas City, KS
| | - Jessica A R Williams
- Department of Health Policy and Management, University of Kansas School of Medicine, Kansas City, KS.
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Mackay CB, Hepler K, Daley CM, Brooks JV. Use of a theoretical framework to examine declines in clinical trial enrollment. J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.15_suppl.e18037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e18037 Background: Clinical trial enrollment at a group of community oncology sites dropped significantly surrounding acquisition by an academic medical center. While previous research used empirical data to identify enrollment barriers, this study used a theoretical framework to investigate research site personnel behavior associated with enrollment, and to further explore clinical trial enrollment barriers. Methods: Data from focus groups and interviews were analyzed using the integrated TDF and COM-B theoretical framework [1] . [1] Theoretical Domains Framework with Capability, Opportunity, Motivation Behavior Wheel. Results: Fifty-six community personnel [2] participated in focus groups and interviews about enrollment experiences before and after the acquisition. Participants described how changes in the workplace and resources affected their Opportunity to enroll: "It's kind of hard to put somebody on a study when you don't have one available." -cs "You can't grow a research department by cutting staff. What message does it send to the organization as far as the importance of research? …it makes you wonder whether the organization truly backs the research effort." -m Physician participants specifically shared that the lack of time and staff devoted to research hampered enrollment efforts, consequently affecting their Motivation: “Current road block is that doc doesn't have time to go through the patient records, so if [the study coordinator] could determine eligibility before the patient visit, that would be helpful.” -p Participants expressed frustration in not knowing the processes for opening trials, therefore their Capability was affected. “I think [in the past], we knew more about what was out there, where I don't see as much of that here now. I don't know if it's because we don't have a research nurse or we are not getting a list [of trials] anymore or what is going on." -cs [2] Quotes from personnel cs = clinic staff, m = manager, p = provider. Conclusions: Participants perceived many barriers to clinical trial enrollment after the acquisition. To optimally continue providing services as expected, support systems need to be maintained. This study provided evidence of using the TDF for exploring enrollment barriers.
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Affiliation(s)
- Christine B. Mackay
- University of Kansas Cancer Center 1 and University of Kansas Medical Center 2, Fairway, KS
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Brooks JV, Singer SJ, Rosenthal M, Chien AT, Peters AS. Feeling inadequate: Residents' stress and learning at primary care clinics in the United States. Med Teach 2018; 40:920-927. [PMID: 29228837 DOI: 10.1080/0142159x.2017.1413236] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
BACKGROUND Educators hope that residents' experiences in primary care continuity clinics will influence more trainees to enter primary care careers. Unfortunately, evidence shows that outpatient primary care training in the United States is stressful and fails to promote primary care careers. We conducted qualitative interviews with residents to understand the source of stress and to explain this failure. METHODS In-person individual interviews were conducted with 37 primary care residents training at outpatient clinics in the US. Analysis used the constant comparative method and included open and focused coding, allowing themes to emerge inductively from the data. RESULTS 73% of residents interviewed reported negative emotions about clinic. Beyond stress, residents reported feeling inadequate as primary care physicians at clinic. Four factors contributed: mental distractions, unfamiliarity with primary care medicine, management of outpatients, and relationships with patients. Residents' comparisons of hospital-based and outpatient experiences favored the former in relation to the four factors. CONCLUSIONS Residents feel unprepared for primary care and inadequate as primary care physicians, and these feelings discourage them from practicing primary care. This phenomenon must be studied within the entire context of residency, as residents' attitudes about their outpatient experiences were shaped in relation to their inpatient experiences.
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Affiliation(s)
- Joanna Veazey Brooks
- a Department of Health Policy & Management , University of Kansas School of Medicine , Kansas City , KS , USA
| | - Sara J Singer
- b Department of Health Policy & Management , Harvard Chan School of Public Health , Boston , MA , USA
| | - Meredith Rosenthal
- b Department of Health Policy & Management , Harvard Chan School of Public Health , Boston , MA , USA
| | - Alyna T Chien
- c Department of Medicine, Division of General Pediatrics , Boston Children's Hospital and Harvard Medical School , Boston , MA , USA
| | - Antoinette S Peters
- d Department of Population Medicine , Harvard Pilgrim Health Care Institute and Harvard Medical School , Boston , MA , USA
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Brooks JV, Ellis SD, Morrow E, Kimminau KS, Thrasher JB. Patient Factors That Influence How Physicians Discuss Active Surveillance With Low-Risk Prostate Cancer Patients: A Qualitative Study. Am J Mens Health 2018; 12:1719-1727. [PMID: 29973123 PMCID: PMC6142114 DOI: 10.1177/1557988318785741] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
For men diagnosed with prostate cancer, making treatment decisions can be overwhelming. Navigating treatment options, along with potential treatment side effects, can be difficult, and patients often rely heavily on the advice of their physicians. This study was aimed at understanding more about the way urologists talk with their patients about one treatment option: active surveillance (AS), a recognized management strategy for men with low-risk prostate cancer that includes close observation and monitoring of the cancer. This study reports, through 22 interviews with urologists, that urologists believe patients are hesitant about AS for a number of reasons, including misperceptions about cancer severity, anxiety, aversion to repeated biopsies that accompany AS, or family member preferences. Because urologists play an influential role in educating patients about treatment options, the discussion around AS can be impacted by barriers that physicians believe matter for their patients. Improving awareness among urologists about what factors impact their patient education about low-risk prostate cancer is important. Identifying tools to improve shared decision making in this area could result in treatment decisions that are increasingly concordant with patients' values, concerns, and goals.
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Affiliation(s)
- Joanna Veazey Brooks
- 1 Department of Health Policy and Management, University of Kansas Medical Center, Kansas City, KS, USA
| | - Shellie D Ellis
- 1 Department of Health Policy and Management, University of Kansas Medical Center, Kansas City, KS, USA
| | - Emily Morrow
- 2 Department of Sociology, University of Kansas, Lawrence, KS, USA
| | - Kim S Kimminau
- 1 Department of Health Policy and Management, University of Kansas Medical Center, Kansas City, KS, USA.,3 Department of Family Medicine, University of Kansas Medical Center, Kansas City, KS, USA
| | - J Brantley Thrasher
- 4 Department of Urology, University of Kansas Medical Center, Kansas City, KS, USA
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Abstract
BACKGROUND Implementing quality improvement in hospitals requires a multifaceted commitment from leaders, including financial, material, and personnel resources. However, little is known about the interactional resources needed for project implementation. The aim of this analysis was to identify the types of interactional support hospital teams sought in a surgical quality improvement project. METHODS Hospital site visits were conducted using a combination of observations, interviews, and focus groups to explore the implementation of a surgical quality improvement project. Twenty-six site visits were conducted between October 2012 and August 2014 at a total of 16 hospitals that agreed to participate. All interviews were recorded, transcribed, and coded for themes using inductive analysis. RESULTS We interviewed 321 respondents and conducted an additional 28 focus groups. Respondents reported needing the following types of interactional support during implementation of quality improvement interventions: (1) a critical outside perspective on their implementation progress; (2) opportunities to learn from peers, especially around clinical innovations; and (3) external validation to help establish visibility for and commitment to the project. CONCLUSIONS Quality improvement in hospitals is both a clinical endeavor and a social endeavor. Our findings show that teams often desire interactional resources as they implement quality improvement initiatives. In-person site visits can provide these resources while also activating emotional energy for teams, which builds momentum and sustainability for quality improvement work. IMPLICATIONS Policymakers and quality improvement leaders will benefit from developing strategies to maximize interactional learning and feedback for quality improvement teams. Further research should investigate the most effective methods for meeting these needs.
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Affiliation(s)
- Joanna Veazey Brooks
- Assistant Professor, Department of Health Policy and Management,
University of Kansas School of Medicine
| | - Ksenia Gorbenko
- Instructor, Department of Population Health Science and Policy,
Institute of Healthcare Delivery Science, Icahn School of Medicine at Mount
Sinai
| | - Charles Bosk
- Professor, Department of Sociology, Department of Anesthesia and
Critical Care, Senior Fellow, Leonard Davis Institute of Health Economics,
University of Pennsylvania
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Abstract
PURPOSE The environment during medical school has been shown to dissuade students from choosing primary care careers. The purpose of this study was (1) to explore how long-standing this hostility toward primary care is historically and (2) to understand the mechanisms through which the environment conveys disparagement of primary care to students. METHODS The study is based on a qualitative analysis of 52 primary care physician oral histories. The data are from the Primary Care Oral History Collection, created by Fitzhugh Mullan and deposited in the National Library of Medicine. Transcripts were analyzed using qualitative data analysis and the constant comparative method. RESULTS Respondents (63.5%) reported experiencing discouragement or disparagement about primary care, and this proportion remained fairly high through 5 decades. Findings indicate that hostility toward primary care operates through the culture and the structure of medical training, creating barriers to the portrayal of primary care as appealing and important. Support for primary care choice was uncommon but was reported by some respondents. CONCLUSION The primary care shortage and primary care's unfavorable representation during medical training is a multifaceted problem. The evidence reported here shows that cultural and structural factors are critical components of the problem, and have existed for decades. For policy responses to be most effective in meeting the primary care workforce problem, they must address the presence and power of persistent hostility against primary care during training.
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Gorbenko KO, Brooks JV, van de Ruit C, Ju MH, Hobson DB, Holzmueller CG, Pronovost PJ, Ko CY, Bosk CL, Wick EC. Sustaining quality improvement during data lag: A qualitative study in a perioperative setting. ACTA ACUST UNITED AC 2015. [DOI: 10.1016/j.pcorm.2015.10.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Szymczak JE, Brooks JV, Volpp KG, Bosk CL. To leave or to lie? Are concerns about a shift-work mentality and eroding professionalism as a result of duty-hour rules justified? Milbank Q 2010; 88:350-81. [PMID: 20860575 DOI: 10.1111/j.1468-0009.2010.00603.x] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
CONTEXT Medical educators worry that the 2003 Accreditation Council for Graduate Medical Education (ACGME) duty-hour rules (DHR) have encouraged a "shift work" mentality among residents and eroded their professionalism by forcing them either to abandon patients when they have worked for eighty hours or lie about the number of hours worked. In this qualitative study, we explore how medical and surgical residents perceive and respond to DHR by examining the "local" organizational culture in which their work is embedded. METHODS In 2008, we conducted three months of ethnographic observation of internal medicine and general surgery residents as they went about their everyday work in two hospitals affiliated with the same training program, as well as in-depth interviews with seventeen residents. Field notes and interview transcripts were analyzed for perceptions and behaviors in regard to beginning and leaving work, reporting duty hours, and expressing opinions about DHR. FINDINGS The respondents did not exhibit a "shift work" mentality in relation to their work. We found that residents: (1) occasionally stay in the hospital in order to complete patient care tasks even when, according to the clock, they are required to leave, because the organizational culture stresses performing work thoroughly, (2) do not blindly embrace noncompliance with DHR but are thoughtful about the tradeoffs inherent in the regulations, and (3) express nuanced and complex reasons for erroneously reporting duty hours, suggesting that reporting hours worked is not a simple issue of lying or truth telling. CONCLUSIONS Concerns about DHR and the erosion of resident professionalism resulting from the development of a "shift work" mentality likely have been overstated. Instead, the influence of DHR on professionalism is more complex than the conventional wisdom suggests and requires additional assessment.
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Turner J, Gonzalez-Juarrero M, Saunders BM, Brooks JV, Marietta P, Ellis DL, Frank AA, Cooper AM, Orme IM. Immunological basis for reactivation of tuberculosis in mice. Infect Immun 2001; 69:3264-70. [PMID: 11292749 PMCID: PMC98285 DOI: 10.1128/iai.69.5.3264-3270.2001] [Citation(s) in RCA: 55] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2000] [Accepted: 02/09/2001] [Indexed: 11/20/2022] Open
Abstract
In this study different inbred strains of mice appeared to control and contain a low dose aerosol infection with Mycobacterium tuberculosis in a similar manner, giving rise to a chronic state of disease. Thereafter, however, certain strains gradually began to show evidence of regrowth of the infection, whereas others consistently did not. Using C57BL/6 mice as an example of a resistant strain and CBA/J mice as an example of a strain susceptible to bacterial growth, we found that these animals revealed distinct differences in the cellular makeup of lung granulomas. The CBA/J mice exhibited a generally poor lymphocyte response within the lungs and vastly increased degenerative pathology at a time associated with regrowth of the infection. As a possible explanation for these events, it was then observed that the CBA/J mouse strain was also less able to upregulate adhesion molecules, including CD11a and CD54, on circulating lymphocytes. These results therefore suggest that a failure to control a chronic infection with M. tuberculosis may reflect an inability to localize antigen-specific lymphocytes within the lung.
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Affiliation(s)
- J Turner
- Departments of Microbiology, Colorado State University, Fort Collins, Colorado 80523, USA.
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Abstract
An effective new vaccine for the control of tuberculosis is badly needed. While current research attempts to improve vaccination are concentrating on new prophylactic or immunotherapeutic vaccines, virtually no emphasis has been placed on boosting individuals already inoculated with Mycobacterium bovis BCG. It is shown here that mice vaccinated with BCG gradually lose their capacity to resist an aerosol challenge infection as they age. However, if these mice are inoculated with the 30-kDa mycolyl transferase A protein in midlife, after challenge when aged they express levels of protection in the lungs comparable to those of young mice, associated with minimal pathological damage.
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Affiliation(s)
- J V Brooks
- Mycobacteria Research Laboratories, Colorado State University, Fort Collins, Colorado 80523, USA
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Turner J, Frank AA, Brooks JV, Gonzalez-Juarrero M, Orme IM. The progression of chronic tuberculosis in the mouse does not require the participation of B lymphocytes or interleukin-4. Exp Gerontol 2001; 36:537-45. [PMID: 11250124 DOI: 10.1016/s0531-5565(00)00257-6] [Citation(s) in RCA: 56] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The aging process is associated with alterations in the immune system. Some of the changes reported are an increase in the proportion of B lymphocytes, and a shift to a TH2-like cytokine environment. It has been hypothesized that the development of immunopathology within the lung during tuberculosis is linked to increased interleukin-4 (IL-4) production. In addition, a role for B cells in maintaining granuloma integrity has been recently proposed. This study investigated the role of B cells and IL-4 during the long-term course of chronic tuberculosis in mice and showed that the course of Mycobacterium tuberculosis infection in the lungs was not influenced by the absence of B lymphocytes or the TH2 cytokine IL-4.
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Affiliation(s)
- J Turner
- Department of Microbiology, Colorado State University, Fort Collins, CO 80523, USA.
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Gonzalez-Juarrero M, Turner OC, Turner J, Marietta P, Brooks JV, Orme IM. Temporal and spatial arrangement of lymphocytes within lung granulomas induced by aerosol infection with Mycobacterium tuberculosis. Infect Immun 2001; 69:1722-8. [PMID: 11179349 PMCID: PMC98078 DOI: 10.1128/iai.69.3.1722-1728.2001] [Citation(s) in RCA: 143] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2000] [Accepted: 11/20/2000] [Indexed: 11/20/2022] Open
Abstract
The progression of the immune response in the lungs after aerosol infection with Mycobacterium tuberculosis is a complex cellular event dominated by macrophages and lymphocytes. Although the phenotype of lymphocytes participating in this response is becoming increasingly well characterized, the dynamic influx of these cells during the infection and their spatial arrangements within the lung tissue are still poorly understood. This study shows that in the first month after aerosol infection with M. tuberculosis there was a steady increase in the percentages of total CD3+, CD3+ CD4+ and CD3+ CD8+ cells, with consistently larger numbers of CD3+ CD4+ cells than of CD3+ CD8+ cells. As granuloma formation continued, the granuloma was found to consist of macrophages, CD4, and CD8 T cells, as well as a smaller number of B cells. Whereas CD4 T cells formed organized aggregates, CD8 T cells were fewer and more scattered and tended to be more prominent toward the periphery of the granulomas. The possible ramifications of the juxtapositions of these two major T-cell subsets are discussed.
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Affiliation(s)
- M Gonzalez-Juarrero
- Mycobacteria Research Laboratories, Department of Microbiology, Colorado State University, Fort Collins, Colorado 80523, USA.
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Turner J, Frank AA, Brooks JV, Marietta PM, Orme IM. Pentoxifylline treatment of mice with chronic pulmonary tuberculosis accelerates the development of destructive pathology. Immunology 2001; 102:248-53. [PMID: 11260331 PMCID: PMC1783172 DOI: 10.1046/j.1365-2567.2001.01161.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
It is well established in animal models that production of the cytokine tumour necrosis factor-alpha (TNF-alpha) is essential to the proper expression of acquired specific resistance following infection with Mycobacterium tuberculosis. This gives rise to an apparent state of chronic disease which over the next 100-200 days is characterized by slowly worsening pathological changes in the lung. To determine whether continued TNF-alpha production was harmful during this phase mice were treated with a TNF-alpha inhibitor, pentoxifylline. It was observed that although this therapy did not alter the numbers of bacteria recovered from the lungs of the infected mice, tissue damage within the lung was accelerated. These data thus demonstrate that production of TNF-alpha, already known to be important during the early expression of resistance to tuberculosis, remains important and beneficial during the chronic stage of the disease.
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Affiliation(s)
- J Turner
- Departments of Microbiology and Pathology, Colorado State University, Fort Collins, CO, USA
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Abstract
In young mice exposed to aerosol infection with Mycobacterium tuberculosis removal of the gammadelta T cell population by targeted gene disruption does not affect the expression of host resistance, but does influence the integrity of the early granulomatous response. The current study demonstrates that in aged gammadelta T cell gene disrupted mice similar immunopathologic changes ensued in both gene knockout and wild type control mice. Changes in cell surface marker expression, evident in other gene knockout models, was not observed in the aged gammadelta T cell knockout mice. These data imply that gammadelta T cell functions previously observed in young mice become much less important as the animal ages.
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Affiliation(s)
- J Turner
- Department of Microbiology, Mycobacteria Research Laboratories, Colorado State University, Fort Collins, CO 80523, USA.
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Cooper AM, Pearl JE, Brooks JV, Ehlers S, Orme IM. Expression of the nitric oxide synthase 2 gene is not essential for early control of Mycobacterium tuberculosis in the murine lung. Infect Immun 2000; 68:6879-82. [PMID: 11083808 PMCID: PMC97793 DOI: 10.1128/iai.68.12.6879-6882.2000] [Citation(s) in RCA: 113] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
The interleukin-12 and gamma interferon (IFN-gamma) pathway of macrophage activation plays a pivotal role in controlling tuberculosis. In the murine model, the generation of supplementary nitric oxide by the induction of the nitric oxide synthase 2 (NOS2) gene product is considered the principal antimicrobial mechanism of IFN-gamma-activated macrophages. Using a low-dose aerosol-mediated infection model in the mouse, we have investigated the role of nitric oxide in controlling Mycobacterium tuberculosis in the lung. In contrast to the consequences of a systemic infection, a low dose of bacteria introduced directly into the lungs of mice lacking the NOS2 gene is controlled almost as well as in intact animals. This is in contrast to the rapid progression of disease in mice lacking IFN-gamma or a key member of the IFN signaling pathway, interferon regulatory factor 1. Thus while IFN-gamma is pivotal in early control of bacterial growth in the lung, this control does not completely depend upon the expression of the NOS2 gene. The absence of inducible nitric oxide in the lung does, however, result in increased polymorphonuclear cell involvement and eventual necrosis in the pulmonary granulomas of the infected mice lacking the NOS2 gene.
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Affiliation(s)
- A M Cooper
- Mycobacterial Research Laboratories, Department of Microbiology, Colorado State University, Fort Collins, Colorado 80523, USA.
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Brooks JV, Furney SK, Orme IM. Metronidazole therapy in mice infected with tuberculosis. Antimicrob Agents Chemother 1999; 43:1285-8. [PMID: 10223954 PMCID: PMC89261 DOI: 10.1128/aac.43.5.1285] [Citation(s) in RCA: 73] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/1998] [Accepted: 02/27/1999] [Indexed: 11/20/2022] Open
Abstract
The capacity of metronidazole to inhibit the growth of Mycobacterium tuberculosis was tested in in vitro and in vivo mouse models. In vitro addition of metronidazole to cultures of infected bone marrow-derived macrophages had no effect, nor did it increase the reduction in bacterial load due to isoniazid. In vivo, metronidazole did not reduce bacterial numbers in the lungs of aerosol-infected mice during the active stage of the disease, during a phase of containment, or after prolonged isoniazid therapy (Cornell model). A small but significant reduction was seen if metronidazole therapy was given during an established chronic disease state 100 days after aerosol administration. These data indicate that under most conditions M. tuberculosis organisms are not in a metabolic state in which they are susceptible to the action of metronidazole and, hence, that this drug would be of limited clinical value.
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Affiliation(s)
- J V Brooks
- Mycobacteria Research Laboratories, Department of Microbiology, Colorado State University, Fort Collins, Colorado 80523, USA
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Brooks JV, Orme IM. Evaluation of once-weekly therapy for tuberculosis using isoniazid plus rifamycins in the mouse aerosol infection model. Antimicrob Agents Chemother 1998; 42:3047-8. [PMID: 9797254 PMCID: PMC105994 DOI: 10.1128/aac.42.11.3047] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Once-weekly therapy with combinations of isoniazid plus a rifamycin was tested in the mouse low-dose aerosol infection model against two strains of Mycobacterium tuberculosis. Combinations of isoniazid and rifalizil and isoniazid and rifapentine were both highly effective. These animal model data thus support the evaluation of these regimens under clinical conditions.
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Affiliation(s)
- J V Brooks
- Mycobacteria Research Laboratories, Department of Microbiology, Colorado State University, Fort Collins, Colorado 80523, USA
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