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Lemlem SB, Gary RA, Yeager KA, Sisay MM, Higgins MK. Psychometric properties of a modified health belief model for cervical cancer and visual inspection with acetic acid among healthcare professionals in Ethiopia. PLoS One 2024; 19:e0295905. [PMID: 38603678 PMCID: PMC11008815 DOI: 10.1371/journal.pone.0295905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Accepted: 11/24/2023] [Indexed: 04/13/2024] Open
Abstract
PURPOSE Evidence supports that the Health Belief Model (HBM) can explain and predicts certain health behaviors, including participation in cervical cancer (CC) screening. The purpose of this study was to evaluate the psychometric properties of a modified HBM for CC and visual inspection with acetic acid (VIA) in female healthcare professionals in Addis Ababa, Ethiopia, 2020. METHODS Psychometric properties related to CC and VIA were tested using 42-item modified HBM self-administered questionnaire and a cross-sectional study design with simple random sampling. Kaiser-Meyer-Olkin and Bartlett's sphericity test indicated that data sampling adequacy for exploratory factor analysis was 0.792 (χ2 = 3189.95, df = 351, p < .001). Items with cross-loading and factor loadings ≥ 0.5 were retained. Confirmatory factor analysis (CFA) was conducted to determine model fit. RESULTS The final analysis included 194 women, (mean age 30±4.34). Twelve items with ≤ 0.5 were removed and 30 retained items loaded into 6 factors; (benefits of VIA, perceived seriousness of CC, barrier (fear of negative outcome), self-efficacy, susceptibility to CC, and barriers (health system delivery)) explained 65% of the total variance. Cronbach's alpha for the total instrument was 0.8 and reliability for the 6 subscales was 0.76-0.92. Composite reliability and average variance extracted indicated good internal consistency and convergent validity. CFA identified 6 additional items to be removed with high residual covariance. The final 24 items of the modified HBM had an acceptable model fit (goodness-of-fit index (GFI) = 0.861, adjusted GFI = 0.823, comparative fit index = 0.937, root mean square error of approximation = 0.059). CONCLUSION The modified HBM for CC and VIA with 24 items had adequate psychometric properties and may be used by Ethiopian healthcare professionals for research or clinical purposes. To support external validity the updated 24 items tool is suggested for application in further study in different populations in Ethiopia.
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Affiliation(s)
- Semarya Berhe Lemlem
- Department of Midwifery, School of Nursing & Midwifery, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Rebecca A. Gary
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia, United States of America
| | - Katherine A. Yeager
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia, United States of America
| | - Mitike Molla Sisay
- School of Public Health, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Melinda K. Higgins
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia, United States of America
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Yeager KA, Zahnd WE, Eberth JM, Vanderpool RC, Rohweder C, Teal R, Vu M, Stradtman L, Frost EL, Trapl E, Gonzalez SK, Vu T, Ko LK, Cole A, Farris PE, Shannon J, Askelson N, Seegmiller L, White A, Edward J, Davis M, Petermann V, Wheeler SB. Correction to: Financial navigation: staff perspectives on patients' financial burden of cancer care. J Cancer Surviv 2024; 18:631-632. [PMID: 35194758 DOI: 10.1007/s11764-022-01191-2] [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: 10/19/2022]
Affiliation(s)
| | - Whitney E Zahnd
- University of Iowa, Iowa City, IA, USA
- University of South Carolina, Columbia, SC, USA
| | | | | | | | - Randall Teal
- University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Maihan Vu
- University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | | | | | - Erika Trapl
- Case Western Reserve University, Cleveland, OH, USA
| | | | - Thuy Vu
- University of Washington, Seattle, WA, USA
| | - Linda K Ko
- University of Washington, Seattle, WA, USA
| | | | | | | | | | | | - Arica White
- Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | - Melinda Davis
- Oregon Health & Science University, Portland, OR, USA
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Yeager KA, Rosa WE, Belcher SM, Lee SM, Lee H, Bruner DW, Meghani SH. A Qualitative Study of the Pain Experience of Black Individuals With Cancer Taking Long-Acting Opioids. Cancer Nurs 2024; 47:E73-E83. [PMID: 36737858 PMCID: PMC10400728 DOI: 10.1097/ncc.0000000000001197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND Little is known about the experience of Black individuals with cancer taking long-acting opioids for cancer pain. OBJECTIVE This study aimed to describe the day-to-day experience of living with pain and the experiences of taking opioids for pain management among Black individuals with cancer prescribed with long-acting opioids. METHODS This qualitative descriptive study was part of a larger investigation focused on opioid adherence. Participants (N = 14) were interviewed using a semistructured interview guide. Analysis followed conventional content analysis and constant comparison approaches. Sociodemographics, clinical information, and the Brief Pain Inventory form were collected. RESULTS The majority of the subsample was female (64.3%), not married (78.6%), and with a median age of 52.5 years. Participants were taking either MS Contin (85.7%) or OxyContin (14.3%). The Brief Pain Inventory median "average" pain severity scores and pain interference scores were 5.1/10 (interquartile range [IQR] = 6.1) and 3.5/10 (IQR = 6.7), respectively. Three themes are reported from the analyses: desire for control, barriers to pain relief, and isolation versus connectedness. CONCLUSION Our findings highlight the persistent nature of moderate to severe cancer pain and how pain and its treatment interfere with patients' lives. The findings describe ways that patients learn to manage and exert control over pain despite conflicting attitudes and dealing with opioid stigma. IMPLICATION FOR PRACTICE Clinicians should partner with patients with cancer, especially people of color, who may experience intersecting stigmas related to their cancer pain and opioid use, to best provide an individualized and culturally sensitive pain treatment plan.
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Affiliation(s)
- Katherine A Yeager
- Author Affiliations: Nell Hodgson Woodruff School of Nursing (Drs Bruner, Yeager, and H. Lee and Ms S. Lee); Winship Cancer Institute (Drs Bruner and Yeager); Office of the Senior Vice President for Research (Dr Bruner), Emory University, Atlanta, Georgia; Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center (Dr Rosa), New York, New York; School of Nursing (Dr Belcher); Palliative Research Center (Dr Belcher), University of Pittsburgh; Hillman Cancer Center, University of Pittsburgh Medical Center (Dr Belcher), Pennsylvania; and Department of Biobehavioral Health Sciences, School of Nursing, University of Pennsylvania (Dr Meghani), Philadelphia
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Worster B, Meghani SH, Leader AE, Nugent SM, Jones KF, Yeager KA, Liou K, Ashare RL. Toward reducing racialized pain care disparities: Approaching cannabis research and access through the lens of equity and inclusion. Cancer 2024; 130:497-504. [PMID: 37941524 DOI: 10.1002/cncr.35115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2023]
Abstract
There is growing interest in cannabis use for cancer pain. This commentary aims to discuss the evidence surrounding cannabis use for cancer pain in the context of the long-racialized landscape of cannabis policies and the disparity in pain control among cancer patients holding minoritized racial identities. Much evidence surrounding both the benefits and harms of cannabis use in cancer patients, and all patients in general, is lacking. Although drawing on the research in cancer that is available, it is also important to illustrate the broader context about how cannabis' deep roots in medical, political, and social history impact patient use and health care policies. There are lessons we can learn from the racialized disparities in opioid risk mitigation strategies, so they are not replicated in the settings of cannabis for cancer symptom management. Additionally, the authors intentionally use the term "cannabis" here rather than "marijuana.: In the early 1900s, the lay press and government popularized the use of the word "marijuana" instead of the more common "cannabis" to tie the drug to anti-Mexican prejudice.
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Affiliation(s)
- Brooke Worster
- Sidney Kimmel Cancer Center, Department of Medical Oncology, Jefferson Health, Philadelphia, Pennsylvania, USA
| | - Salimah H Meghani
- Department of Biobehavioral Health Science, School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Amy E Leader
- Sidney Kimmel Cancer Center, Department of Medical Oncology, Jefferson Health, Philadelphia, Pennsylvania, USA
| | - Shannon M Nugent
- Department of Psychiatry, Oregon Health and Science University, Portland, Oregon, USA
- Knight Cancer Institution, Oregon Health and Science University, Portland, Oregon, USA
| | - Katie Fitzgerald Jones
- Center for Aging and Serious Illness, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Katherine A Yeager
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia, USA
| | - Kevin Liou
- Integrative Medicine Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Rebecca L Ashare
- Department of Psychology, State University of New York at Buffalo, Buffalo, New York, USA
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Cross SH, Yabroff KR, Yeager KA, Curseen KA, Quest TE, Kamal A, Zarrabi AJ, Kavalieratos D. Social Deprivation and End-of-Life Care Use Among Adults With Cancer. JCO Oncol Pract 2024; 20:102-110. [PMID: 37983588 PMCID: PMC10827296 DOI: 10.1200/op.23.00420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2023] [Revised: 09/06/2023] [Accepted: 10/18/2023] [Indexed: 11/22/2023] Open
Abstract
PURPOSE Socioeconomic differences are partially responsible for racial inequities in cancer outcomes, yet the association of area-level socioeconomic disadvantage and race with end-of-life (EOL) cancer care quality is poorly understood. METHODS This retrospective study used electronic medical records from an academic health system to identify 33,635 adults with cancer who died between 2013 and 2019. Using multivariable logistic regression, we examined associations between decedent characteristics and EOL care, including emergency department (ED) visits, intensive care unit (ICU) stays, palliative care consultation (PCC), hospice order, and in-hospital deaths. Social deprivation index was used to measure socioeconomic disadvantages. RESULTS Racially minoritized decedents had higher odds of ICU stay than the least deprived White decedents (eg, other race Q3: aOR, 2.06 [99% CI, 1.26 to 0.3.39]). White and Black decedents from more deprived areas had lower odds of ED visit (White Q3: aOR, 0.382 [99% CI, 0.263 to 0.556]; Black Q3: aOR, 0.566 [99% CI, 0.373 to 0.858]) than least deprived White decedents. Compared with White decedents living in least deprived areas, racially minoritized decedents had higher odds of receiving PCC and hospice order, whereas White decedents in most deprived areas had lower odds of PCC (aOR, 0.727 [99% CI, 0.592 to 0.893]) and hospice order (aOR, 0.845 [99% CI, 0.724 to 0.986]). Greater deprivation was associated with greater odds of hospital death relative to least deprived White decedents, but only among minoritized decedents (eg, Black Q4: aOR, 2.16 [99% CI, 1.82 to 2.56]). CONCLUSION Area-level socioeconomic disadvantage is not uniformly associated with poorer EOL cancer care, with differences among decedents of different racial groups.
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Affiliation(s)
- Sarah H. Cross
- Division of Palliative Medicine, Department of Family and Preventive Medicine, Emory University, Atlanta, GA
| | | | | | - Kimberly A. Curseen
- Division of Palliative Medicine, Department of Family and Preventive Medicine, Emory University, Atlanta, GA
| | - Tammie E. Quest
- Division of Palliative Medicine, Department of Family and Preventive Medicine, Emory University, Atlanta, GA
| | | | - Ali John Zarrabi
- Division of Palliative Medicine, Department of Family and Preventive Medicine, Emory University, Atlanta, GA
| | - Dio Kavalieratos
- Division of Palliative Medicine, Department of Family and Preventive Medicine, Emory University, Atlanta, GA
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Brewster GS, Higgins M, McPhillips MV, Bonds Johnson K, Epps F, Yeager KA, Bliwise DL, Hepburn K. The Effect of Tele-Savvy on Sleep Quality and Insomnia in Caregivers of Persons Living with Dementia. Clin Interv Aging 2023; 18:2117-2127. [PMID: 38111602 PMCID: PMC10726954 DOI: 10.2147/cia.s425741] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Accepted: 12/01/2023] [Indexed: 12/20/2023] Open
Abstract
Introduction Sleep disturbance is prevalent in caregivers of persons living with dementia (PLwD). Tele-Savvy, a 7-week virtual psychoeducational intervention, enhances caregivers' competence and self-care, and reduces depression. While not explicitly designed to do so, Tele-Savvy can potentially improve caregivers' disturbed sleep. The present study aimed to examine the longitudinal effects of Tele-Savvy on caregivers' sleep quality and insomnia. Methods This was a secondary data analysis of a 3-arm randomized control trial [Tele-Savvy (active treatment), Healthy Living (attention control), and usual care (waitlist control)]. Multilevel mixed modeling with intent-to-treat principles tested for group, time, and group-by-time effects. Effect sizes were estimated for all changes from baseline to the initial 6-month post-intervention point. Following completion of the 6-month post-randomization delay, we examined combined outcomes for Tele-Savvy. Results Participants (n=137; mean age 64.7 years) were predominantly female (68.6%) and White (68.6%). We found no initial group-by-time effects for the Pittsburgh Sleep Quality Index (PSQI) and the Insomnia Severity Index (ISI). For the combined Tele-Savvy group, there was a statistically significant improvement in ISI scores across time (p=0.050). The combined Tele-Savvy effect size for PSQI was d=0.126 and ISI was d=0.310. Discussion Tele-Savvy resulted in a significant long-term reduction in insomnia symptoms in this sample of caregivers of PLwD and demonstrated a positive trend for improvement in their sleep quality. Since sleep disturbance is so prevalent among caregivers of PLwD, the inclusion of sleep health education into psychoeducation caregiver interventions may yield even better outcomes for caregivers.
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Affiliation(s)
- Glenna S Brewster
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA, USA
| | - Melinda Higgins
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA, USA
| | | | | | - Fayron Epps
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA, USA
| | - Katherine A Yeager
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA, USA
| | - Donald L Bliwise
- Division of Sleep Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Kenneth Hepburn
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA, USA
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Semprini JT, Biddell CB, Eberth JM, Charlton ME, Nash SH, Yeager KA, Evans D, Madhivanan P, Brandt HM, Askelson NM, Seaman AT, Zahnd WE. Measuring and addressing health equity: an assessment of cancer center designation requirements. Cancer Causes Control 2023; 34:23-33. [PMID: 36939948 PMCID: PMC10512189 DOI: 10.1007/s10552-023-01680-4] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Accepted: 02/27/2023] [Indexed: 03/21/2023]
Abstract
PURPOSE By requiring specific measures, cancer endorsements (e.g., accreditations, designations, certifications) promote high-quality cancer care. While 'quality' is the defining feature, less is known about how these endorsements consider equity. Given the inequities in access to high-quality cancer care, we assessed the extent to which equity structures, processes, and outcomes were required for cancer center endorsements. METHODS We performed a content analysis of medical oncology, radiation oncology, surgical oncology, and research hospital endorsements from the American Society of Clinical Oncology (ASCO), American Society of Radiation Oncology (ASTRO), American College of Surgeons Commission on Cancer (CoC), and the National Cancer Institute (NCI), respectively. We analyzed requirements for equity-focused content and compared how each endorsing body included equity as a requirement along three axes: structures, processes, and outcomes. RESULTS ASCO guidelines centered on processes assessing financial, health literacy, and psychosocial barriers to care. ASTRO guidelines related to language needs and processes to address financial barriers. CoC equity-related guidelines focused on processes addressing financial and psychosocial concerns of survivors, and hospital-identified barriers to care. NCI guidelines considered equity related to cancer disparities research, inclusion of diverse groups in outreach and clinical trials, and diversification of investigators. None of the guidelines explicitly required measures of equitable care delivery or outcomes beyond clinical trial enrollment. CONCLUSION Overall, equity requirements were limited. Leveraging the influence and infrastructure of cancer quality endorsements could enhance progress toward achieving cancer care equity. We recommend that endorsing organizations 1) require cancer centers to implement processes for measuring and tracking health equity outcomes and 2) engage diverse community stakeholders to develop strategies for addressing discrimination.
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Affiliation(s)
- Jason T Semprini
- Department of Health Management and Policy, College of Public Health, University of Iowa, 145 N. Riverside Dr. N277, Iowa City, IA, 52240, USA.
| | - Caitlin B Biddell
- Department of Health Policy and Management, Gillings School of Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Jan M Eberth
- Department of Health Management and Policy, Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA
| | - Mary E Charlton
- Department of Epidemiology, College of Public Health, University of Iowa, Iowa City, IA, USA
| | - Sarah H Nash
- Department of Epidemiology, College of Public Health, University of Iowa, Iowa City, IA, USA
- Department of Community and Behavioral Health, College of Public Health, University of Iowa, Iowa City, IA, USA
| | - Katherine A Yeager
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA, USA
| | - Donoria Evans
- National Partnerships and Innovations, American Cancer Society, Decatur, GA, USA
| | - Purnima Madhivanan
- Department of Health Promotion Sciences, Mel & Enid Zuckerman College of Public Health, University of Arizona. Tucson, Tuscon, AZ, USA
| | - Heather M Brandt
- St. Jude Children's Research Hospital and St. Jude Comprehensive Cancer Center, Memphis, TN, USA
| | - Natoshia M Askelson
- Department of Community and Behavioral Health, College of Public Health, University of Iowa, Iowa City, IA, USA
| | - Aaron T Seaman
- Department of Community and Behavioral Health, College of Public Health, University of Iowa, Iowa City, IA, USA
- Department of Internal Medicine, Carver College of Medicine, University of Iowa, Iowa City, IA, USA
| | - Whitney E Zahnd
- Department of Health Management and Policy, College of Public Health, University of Iowa, 145 N. Riverside Dr. N277, Iowa City, IA, 52240, USA
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Hirschey R, Rohweder C, Zahnd WE, Eberth JM, Adsul P, Guan Y, Yeager KA, Haines H, Farris PE, Bea JW, Dwyer A, Madhivanan P, Ranganathan R, Seaman AT, Vu T, Wickersham K, Vu M, Teal R, Giannone K, Hilton A, Cole A, Islam JY, Askelson N. Prioritizing rural populations in state comprehensive cancer control plans: a qualitative assessment. Cancer Causes Control 2023; 34:159-169. [PMID: 36840904 PMCID: PMC9959942 DOI: 10.1007/s10552-023-01673-3] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Accepted: 02/06/2023] [Indexed: 02/26/2023]
Abstract
PURPOSE The Centers for Disease Control and Prevention's National Comprehensive Cancer Control Program (NCCCP) requires that states develop comprehensive cancer control (CCC) plans and recommends that disparities related to rural residence are addressed in these plans. The objective of this study was to explore rural partner engagement and describe effective strategies for incorporating a rural focus in CCC plans. METHODS States were selected for inclusion using stratified sampling based on state rurality and region. State cancer control leaders were interviewed about facilitators and barriers to engaging rural partners and strategies for prioritizing rural populations. Content analysis was conducted to identify themes across states. RESULTS Interviews (n = 30) revealed themes in three domains related to rural inclusion in CCC plans. The first domain (barriers) included (1) designing CCC plans to be broad, (2) defining "rural populations," and (3) geographic distance. The second domain (successful strategies) included (1) collaborating with rural healthcare systems, (2) recruiting rural constituents, (3) leveraging rural community-academic partnerships, and (4) working jointly with Native nations. The third domain (strategies for future plan development) included (1) building relationships with rural communities, (2) engaging rural constituents in planning, (3) developing a better understanding of rural needs, and (4) considering resources for addressing rural disparities. CONCLUSION Significant relationship building with rural communities, resource provision, and successful strategies used by others may improve inclusion of rural needs in state comprehensive cancer control plans and ultimately help plan developers directly address rural cancer health disparities.
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Affiliation(s)
- Rachel Hirschey
- School of Nursing, UNC Chapel Hill, and Lineberger Comprehensive Cancer Center, Chapel Hill, NC, USA.
| | - Catherine Rohweder
- Center for Health Promotion & Disease Prevention, UNC Chapel Hill, Chapel Hill, NC, USA
| | - Whitney E Zahnd
- Department of Health Management and Policy, College of Public Health, University of Iowa, Iowa City, IA, USA
| | - Jan M Eberth
- Department of Health Management and Policy, Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA
| | - Prajakta Adsul
- Department of Internal Medicine, University of New Mexico & University of New Mexico Comprehensive Cancer Center, Albuquerque, NM, USA
| | - Yue Guan
- Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | | | - Heidi Haines
- Prevention Research Center for Rural Health, College of Public Health, University of Iowa, Iowa City, IA, USA
| | - Paige E Farris
- Knight Cancer Institute, Oregon Health and Science University, Portland, OR, USA
| | - Jennifer W Bea
- Department of Health Promotion Sciences, Mel & Enid Zuckerman, College of Public Health, University of Arizona, Tucson, AZ, USA
| | - Andrea Dwyer
- Community and Behavioral Health, The Colorado School of Public Health, University of Colorado, Aurora, CO, USA
| | - Purnima Madhivanan
- University of Arizona Mel & Enid Zuckerman College of Public Health, Tucson, AZ, USA
| | - Radhika Ranganathan
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Aaron T Seaman
- Department of Internal Medicine, Carver College of Medicine, University of Iowa, Iowa City, IA, USA
| | - Thuy Vu
- MPH Health Promotion Research Center, University of Washington, Seattle, WA, USA
| | - Karen Wickersham
- College of Nursing, University of South Carolina, Columbia, SC, USA
| | - Maihan Vu
- UNC CHAI Core, Connected Health Applications & Interventions (CHAI) Core, Lineberger Comprehensive Cancer Center, Chapel Hill, NC, USA
| | - Randall Teal
- UNC CHAI Core, Connected Health Applications & Interventions (CHAI) Core, Lineberger Comprehensive Cancer Center, Chapel Hill, NC, USA
| | - Kara Giannone
- UNC CHAI Core, Connected Health Applications & Interventions (CHAI) Core, Lineberger Comprehensive Cancer Center, Chapel Hill, NC, USA
| | - Alison Hilton
- UNC CHAI Core, Connected Health Applications & Interventions (CHAI) Core, Lineberger Comprehensive Cancer Center, Chapel Hill, NC, USA
| | | | - Jessica Y Islam
- Moffitt Cancer Center, University of South Florida, Tampa, FL, USA
| | - Natoshia Askelson
- Department of Community & Behavioral Health, College of Public Health, University of Iowa, Iowa City, IA, USA
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Yeager KA, Zahnd WE, Eberth JM, Vanderpool RC, Rohweder C, Teal R, Vu M, Stradtman L, Frost EL, Trapl E, Gonzalez SK, Vu T, Ko LK, Cole A, Farris PE, Shannon J, Askelson N, Seegmiller L, White A, Edward J, Davis M, Petermann V, Wheeler SB. Financial navigation: Staff perspectives on patients' financial burden of cancer care. J Cancer Surviv 2023; 17:1461-1470. [PMID: 35080699 PMCID: PMC9314461 DOI: 10.1007/s11764-022-01175-2] [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: 12/16/2021] [Accepted: 01/17/2022] [Indexed: 11/29/2022]
Abstract
PURPOSE To describe perceptions of financial navigation staff concerning patients' cancer-related financial burden. METHODS This qualitative descriptive study used a semi-structured interview guide to examine perceptions of financial navigation staff concerning patients' cancer-related financial burden. Staff who provided financial navigation support services to cancer patients were interviewed from different types of cancer programs across seven states representing rural, micropolitan, and urban settings. Interviews lasted approximately one hour, were audio recorded, and transcribed. Transcripts were double coded for thematic analysis. RESULTS Thirty-five staff from 29 cancer centers were interviewed. The first theme involved communication issues related to patient and financial navigation staff expectations, timing and the sensitive nature of financial discussions. The second theme involved the multi-faceted impact of financial burden on patients, including stress, difficulty adhering to treatments, and challenges meeting basic, non-medical needs. CONCLUSIONS AND IMPLICATIONS FOR CANCER SURVIVORS: Cancer-related financial burden has a profound impact on cancer survivors' health and non-health outcomes. Discussions regarding cancer-related costs between cancer survivors and healthcare team members could help to normalize conversations and mitigate the multi-faceted determinants and effects of cancer-related financial burden. As treatment may span months and years and unexpected costs arise, having this discussion regularly and systematically is needed.
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Affiliation(s)
| | - Whitney E Zahnd
- University of Iowa, Iowa City, IA, USA
- University of South Carolina, Columbia, SC, USA
| | | | | | | | - Randall Teal
- University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Maihan Vu
- University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | | | | | - Erika Trapl
- Case Western Reserve University, Cleveland, OH, USA
| | | | - Thuy Vu
- University of Washington, Seattle, WA, USA
| | - Linda K Ko
- University of Washington, Seattle, WA, USA
| | | | | | | | | | | | - Arica White
- Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | - Melinda Davis
- Oregon Health & Science University, Portland, OR, USA
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Brewster GS, Pierpaoli Parker C, Epps F, Bonds Johnson K, Yeager KA. Sleep Profiles of Caregivers for Persons Living with Dementia: A Qualitative Study. West J Nurs Res 2023; 45:688-695. [PMID: 37161397 DOI: 10.1177/01939459231175242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
Sleep disturbance is prevalent among caregivers of people living with dementia. However, gaps exist about caregivers' sleep patterns before and during their caregiving trajectory. This exploratory secondary analysis using a qualitative descriptive approach aimed to (1) identify and describe current caregivers' patterns of change in sleep before and during caregiving, and (2) understand caregivers' perceptions of their current sleep compared to their pre-caregiving sleep. We conducted semi-structured interviews with 19 caregivers taking part in a larger randomized controlled trial. Participants were female (n = 11), white (n = 13) and on average 63 years of age. Interview questions focused on caregivers' sleep patterns. The interviews were audio-recorded using a videoconferencing platform and ranged from 20 to 45 minutes. We conducted thematic analysis of the interview transcripts. Three distinct caregiver-sleep profiles emerged from the qualitative data: changed and dissatisfied, changed and satisfied, and unchanged and dissatisfied. Caregivers whose sleep was categorized as changed reported a difference when comparing their current sleep pattern to their pre-caregiving sleep pattern. This was usually a change from good to poor sleep. Caregivers whose sleep was unchanged had poor sleep pre-caregiving and continued to have poor sleep during caregiving. Caregivers also reported being satisfied or dissatisfied with their current sleep pattern, defined in terms of distress and impairment. These three subtypes highlight the heterogeneity of caregivers' sleep experiences and debut a useful clinical framework with which to identify, categorize, and target caregivers at risk for sleep disturbance, many who may be ready to engage in behaviors to improve their sleep. Knowing caregivers' sleep profiles will enable health care providers and researchers to determine caregivers' needs and readiness for interventions then work collaboratively with them to improve their sleep problems.
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Affiliation(s)
- Glenna S Brewster
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA, USA
| | - Christina Pierpaoli Parker
- Department of Psychiatry and Behavioral Neurobiology, Heersink School of Medicine, University of Alabama at Birmingham
| | - Fayron Epps
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA, USA
| | | | - Katherine A Yeager
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA, USA
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Liou KT, Ashare R, Worster B, Jones KF, Yeager KA, Acevedo AM, Ferrer R, Meghani SH. SIO-ASCO guideline on integrative medicine for cancer pain management: implications for racial and ethnic pain disparities. JNCI Cancer Spectr 2023; 7:pkad042. [PMID: 37307074 PMCID: PMC10336300 DOI: 10.1093/jncics/pkad042] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Accepted: 06/02/2023] [Indexed: 06/13/2023] Open
Abstract
Racial and ethnic disparities in pain management pose major challenges to equitable cancer care delivery. These disparities are driven by complex interactions between patient-, provider-, and system-related factors that resist reductionistic solutions and require innovative, holistic approaches. On September 19, 2022, the Society for Integrative Oncology and the American Society of Clinical Oncology published a joint guideline to provide evidence-based recommendations on integrative medicine for cancer pain management. Integrative medicine, which combines conventional treatments with complementary modalities from cultures and traditions around the world, are uniquely equipped to resonate with diverse cancer populations and fill existing gaps in pain management. Although some complementary modalities, such as music therapy and yoga, lack sufficient evidence to make a specific recommendation, other modalities, such as acupuncture, massage, and hypnosis, demonstrated an intermediate level of evidence, resulting in moderate strength recommendations for their use in cancer pain management. However, several factors may hinder real-world implementation of the Society for Integrative Oncology and the American Society of Clinical Oncology guideline and must be addressed to ensure equitable pain management for all communities. These barriers include, but are not limited to, the lack of insurance coverage for many complementary therapies, the limited diversity and availability of complementary therapy providers, the negative social norms surrounding complementary therapies, the underrepresentation of racial and ethnic subgroups in the clinical research of complementary therapies, and the paucity of culturally attuned interventions tailored to diverse individuals. This commentary examines both the challenges and the opportunities for addressing racial and ethnic disparities in cancer pain management through integrative medicine.
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Affiliation(s)
- Kevin T Liou
- Integrative Medicine Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Rebecca Ashare
- Department of Psychology, State University of New York at Buffalo, Buffalo, NY, USA
| | - Brooke Worster
- Department of Medical Oncology, Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA, USA
| | - Katie F Jones
- Center for Aging and Serious Illness, Massachusetts General Hospital, Boston, MA, USA
| | - Katherine A Yeager
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA, USA
| | - Amanda M Acevedo
- Behavioral Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD, USA
| | - Rebecca Ferrer
- Behavioral Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD, USA
| | - Salimah H Meghani
- Department of Biobehavioral Health Science, School of Nursing, University of Pennsylvania, Philadelphia, PA, USA
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Escoffery C, Petagna C, Agnone C, Perez S, Saber LB, Ryan G, Dhir M, Sekar S, Yeager KA, Biddell CB, Madhivanan P, Lee S, English AS, Savas L, Daly E, Vu T, Fernandez ME. A systematic review of interventions to promote HPV vaccination globally. BMC Public Health 2023; 23:1262. [PMID: 37386430 PMCID: PMC10308645 DOI: 10.1186/s12889-023-15876-5] [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: 09/22/2022] [Accepted: 05/11/2023] [Indexed: 07/01/2023] Open
Abstract
BACKGROUND Despite the human papillomavirus (HPV) vaccine being a safe, effective cancer prevention method, its uptake is suboptimal in the United States (U.S.). Previous research has found a variety of intervention strategies (environmental and behavioral) to increase its uptake. The purpose of the study is to systematically review the literature on interventions that promote HPV vaccination from 2015 to 2020. METHODS We updated a systematic review of interventions to promote HPV vaccine uptake globally. We ran keyword searches in six bibliographic databases. Target audience, design, level of intervention, components and outcomes were abstracted from the full-text articles in Excel databases. RESULTS Of the 79 articles, most were conducted in the U.S. (72.2%) and in clinical (40.5%) or school settings (32.9%), and were directed at a single level (76.3%) of the socio-ecological model. Related to the intervention type, most were informational (n = 25, 31.6%) or patient-targeted decision support (n = 23, 29.1%). About 24% were multi-level interventions, with 16 (88.9%) combining two levels. Twenty-seven (33.8%) reported using theory in intervention development. Of those reporting HPV vaccine outcomes, post-intervention vaccine initiation ranged from 5% to 99.2%, while series completion ranged from 6.8% to 93.0%. Facilitators to implementation were the use of patient navigators and user-friendly resources, while barriers included costs, time to implement and difficulties of integrating interventions into the organizational workflow. CONCLUSIONS There is a strong need to expand the implementation of HPV-vaccine promotion interventions beyond education alone and at a single level of intervention. Development and evaluation of effective strategies and multi-level interventions may increase the uptake of the HPV vaccine among adolescents and young adults.
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Affiliation(s)
- Cam Escoffery
- Rollins School of Public Health, Emory University, 1518 Clifton Road, NE, Atlanta, GA, 30322, 404-727-4701, USA.
| | - Courtney Petagna
- Rollins School of Public Health, Emory University, 1518 Clifton Road, NE, Atlanta, GA, 30322, 404-727-4701, USA
| | - Christine Agnone
- Rollins School of Public Health, Emory University, 1518 Clifton Road, NE, Atlanta, GA, 30322, 404-727-4701, USA
| | - Stephen Perez
- Rollins School of Public Health, Emory University, 1518 Clifton Road, NE, Atlanta, GA, 30322, 404-727-4701, USA
| | - Lindsay B Saber
- Rollins School of Public Health, Emory University, 1518 Clifton Road, NE, Atlanta, GA, 30322, 404-727-4701, USA
| | - Grace Ryan
- Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, MA, USA
| | - Meena Dhir
- Rollins School of Public Health, Emory University, 1518 Clifton Road, NE, Atlanta, GA, 30322, 404-727-4701, USA
| | - Swathi Sekar
- Rollins School of Public Health, Emory University, 1518 Clifton Road, NE, Atlanta, GA, 30322, 404-727-4701, USA
| | - Katherine A Yeager
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA, USA
| | - Caitlin B Biddell
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, Durham, NC, USA
| | - Purnima Madhivanan
- Mel & Enid Zuckerman College of Public Health, University of Arizona, Tucson, USA
| | - Stephanie Lee
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA, USA
| | - Amanda S English
- Institute for Health Disparities, University of North Texas Health Science Center, Fort Worth, TX, USA
| | - Lara Savas
- Center for Health Promotion and Prevention Research, School of Public Health, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Eliza Daly
- Prevention Research Center, College of Public Health, University of Iowa, Iowa City, IA, USA
| | - Thuy Vu
- Health Promotion Research Center, School of Public Health, University of Washington, Seattle, WA, USA
| | - Maria E Fernandez
- Center for Health Promotion and Prevention Research, School of Public Health, University of Texas Health Science Center at Houston, Houston, TX, USA
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Bai J, Pugh SL, Eldridge R, Yeager KA, Zhang Q, Lee WR, Shah AB, Dayes IS, D'Souza DP, Michalski JM, Efstathiou JA, Longo JM, Pisansky TM, Maier JM, Faria SL, Desai AB, Seaward SA, Sandler HM, Cooley ME, Bruner DW. Neighborhood Deprivation and Rurality Associated With Patient-Reported Outcomes and Survival in Men With Prostate Cancer in NRG Oncology RTOG 0415. Int J Radiat Oncol Biol Phys 2023; 116:39-49. [PMID: 36736921 PMCID: PMC10106367 DOI: 10.1016/j.ijrobp.2023.01.035] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Revised: 01/18/2023] [Accepted: 01/20/2023] [Indexed: 02/04/2023]
Abstract
PURPOSE Rurality and neighborhood deprivation can contribute to poor patient-reported outcomes, which have not been systematically evaluated in patients with specific cancers in national trials. Our objective was to examine the effect of rurality and neighborhood socioeconomic and environmental deprivation on patient-reported outcomes and survival in men with prostate cancer in NRG Oncology RTOG 0415. METHODS AND MATERIALS Data from men with prostate cancer in trial NRG Oncology RTOG 0415 were analyzed; 1,092 men were randomized to receive conventional radiation therapy or hypofractionated radiation therapy. Rurality was categorized as urban or rural. Neighborhood deprivation was assessed using the area deprivation index and air pollution indicators (nitrogen dioxide and particulate matter with a diameter less than 2.5 micrometers) via patient ZIP codes. Expanded Prostate Cancer Index Composite measured cancer-specific quality of life. The Hopkins symptom checklist measured anxiety and depression. EuroQoL-5 Dimension assessed general health. RESULTS We analyzed 751 patients in trial NRG Oncology RTOG 0415. At baseline, patients from the most deprived neighborhoods had worse bowel (P = .011), worse sexual (P = .042), and worse hormonal (P = .015) scores; patients from the most deprived areas had worse self-care (P = .04) and more pain (P = .047); and patients from rural areas had worse urinary (P = .03) and sexual (P = .003) scores versus patients from urban areas. Longitudinal analyses showed that the 25% most deprived areas (P = .004) and rural areas (P = .002) were associated with worse EuroQoL-5 Dimension visual analog scale score. Patients from urban areas (hazard ratio, 1.81; P = .033) and the 75% less-deprived neighborhoods (hazard ratio, 0.68; P = .053) showed relative decrease in risk of recurrence or death (disease-free survival). CONCLUSIONS Patients with prostate cancer from the most deprived neighborhoods and rural areas had low quality of life at baseline, poor general health longitudinally, and worse disease-free survival. Interventions should screen populations from deprived neighborhoods and rural areas to improve patient access to supportive care services.
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Affiliation(s)
- Jinbing Bai
- Emory University Nell Hodgson Woodruff School of Nursing, Atlanta, Georgia.
| | - Stephanie L Pugh
- NRG Oncology Statistics and Data Management Center, Philadelphia, Pennsylvania
| | - Ronald Eldridge
- Emory University Nell Hodgson Woodruff School of Nursing, Atlanta, Georgia
| | - Katherine A Yeager
- Emory University Nell Hodgson Woodruff School of Nursing, Atlanta, Georgia
| | - Qi Zhang
- Department of Geography, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - W Robert Lee
- Department of Radiation Oncology, Duke University Medical Center, Durham, North Carolina
| | - Amit B Shah
- WellSpan York Cancer Center, York, Pennsylvania
| | - Ian S Dayes
- McMaster University, Juravinski Cancer Center, Hamilton Health Science, Hamilton, Ontario, Canada
| | - David P D'Souza
- School of Medicine & Dentistry, University of Western Ontario Schulich, London, Ontario, Canada
| | | | | | - John M Longo
- Zablocki VAMC and the Medical College of Wisconsin, Milwaukee, Wisconsin
| | | | - Jordan M Maier
- Karmanos Cancer Institute, Wayne State University, Detroit, Michigan
| | - Sergio L Faria
- Department of Radiation Oncology, McGill University, Montreal, Quebec, Canada
| | | | | | | | - Mary E Cooley
- Dana-Farber/Harvard Cancer Center, Boston, Massachusetts
| | - Deborah W Bruner
- Emory University Nell Hodgson Woodruff School of Nursing, Atlanta, Georgia
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Lee H, Reilly M, Bruner DW, Bai J, Hu Y, Yeager KA. Obesity and patient‐reported sexual health outcomes in gynecologic cancer survivors: A systematic review. Res Nurs Health 2022; 45:664-679. [DOI: 10.1002/nur.22272] [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] [Received: 10/22/2021] [Revised: 09/08/2022] [Accepted: 09/27/2022] [Indexed: 11/06/2022]
Affiliation(s)
- Haerim Lee
- Nell Hodgson Woodruff School of Nursing Emory University Atlanta Georgia USA
| | - Megan Reilly
- Nell Hodgson Woodruff School of Nursing Emory University Atlanta Georgia USA
- Children's Healthcare of Atlanta Atlanta Georgia USA
| | - Deborah W. Bruner
- Nell Hodgson Woodruff School of Nursing Emory University Atlanta Georgia USA
- Winship Cancer Institute Emory University Atlanta Georgia USA
| | - Jinbing Bai
- Nell Hodgson Woodruff School of Nursing Emory University Atlanta Georgia USA
- Winship Cancer Institute Emory University Atlanta Georgia USA
| | - Yi‐Juan Hu
- Department of Biostatistics and Bioinformatics Emory University Rollins School of Public Health Atlanta Georgia USA
| | - Katherine A. Yeager
- Nell Hodgson Woodruff School of Nursing Emory University Atlanta Georgia USA
- Winship Cancer Institute Emory University Atlanta Georgia USA
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Lee H, Bruner DW, Hu YJ, Bai J, Eng TY, Shelton JW, Patel PR, Khanna N, Scott I, Yeager KA. Abstract 5940: Impact of obesity on sexual functioning in women with gynecologic cancer pre-and post-radiotherapy. Cancer Res 2022. [DOI: 10.1158/1538-7445.am2022-5940] [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: 11/16/2022]
Abstract
Abstract
Background: As the prevalence of obesity in women increases in the US, a better understanding of the effect of obesity on women with gynecologic cancer (GynCa) is imperative. However, whether obesity impacts sexual functioning (SF) in GynCa patients has been understudied. Limited studies have used body mass index (BMI) as the only obesity indicator, which may result in a misunderstanding of the effect of obesity on SF in GynCa patients with different body compositions. This study aimed to explore the role of obesity via two different measures in determining SF in GynCa patients pre-and post-radiotherapy (RT).
Methods: In this secondary analysis, obesity was measured pre-RT by both BMI and body fat percentage (BFP). BFP was calculated by using the Clinica Universidad de Navarra-Body Adiposity Estimator. SF, physical and emotional well-being were assessed pre-RT by the Female Sexual Function Index and the Functional Assessment of Cancer Therapy-General. At 6 months post-RT, SF was reassessed. Generalized linear models (GLM) and generalized linear mixed models (GLMM) with a log-link were implemented to identify the effect of obesity (using BMI and BFP) on SF pre-and post-RT. Regression-based mediation analysis was used to identify mediating effects of physical and emotional well-being between obesity and SF.
Results: Among 54 (24 cervical and 30 endometrial) patients, 48% were Black, 52% were married or in a domestic partnership, and 59% were treated with surgery and/or chemotherapy pre-RT (i.e. prior treatment). Less patients were classified as being obese when obesity was measured by BMI (48%) compared to BFP (61%). Patients with endometrial cancer and prior treatment history were more likely to be obese and reported better SF. Unadjusted GLM showed that patients with obesity had better SF than those without obesity pre-RT regardless of obesity measures (BMI p = .018; BFP p = .016). However, we found no association between obesity (both BMI-and BFP-based obesity) and SF pre-RT after adjusting for cancer type and prior treatment history. GLMM showed that BFP-based obesity had a negative effect on the improvement in SF from pre-RT to post-RT (p = .013) after adjusting for cancer type and prior treatment history. Patients without BFP-based obesity showed a significant improvement post-RT (p = .019), but those with obesity (per BFP) showed no changes in SF post-RT (p = .949) compared to pre-RT. BMI-based obesity did not affect the changes in SF post-RT. We found no mediation effects of physical and emotional well-being between obesity and SF.
Conclusions: Obesity may play a negative role in SF improvement in GynCa patients post-RT. More rigorous research and clinical attention to obesity measurement are necessary to determine the association between obesity and SF in GynCa patients and thus lead to the discovery of new interventions for this long-neglected topic of SF in GynCa patients, particularly for those who are obese.
Citation Format: Haerim Lee, Deborah W. Bruner, Yi-Juan Hu, Jinbing Bai, Tony Y. Eng, Joseph W. Shelton, Pretesh R. Patel, Namita Khanna, Isabelle Scott, Katherine A. Yeager. Impact of obesity on sexual functioning in women with gynecologic cancer pre-and post-radiotherapy [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2022; 2022 Apr 8-13. Philadelphia (PA): AACR; Cancer Res 2022;82(12_Suppl):Abstract nr 5940.
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Affiliation(s)
- Haerim Lee
- 1Emory University Nell Hodgson Woodruff School of Nursing, Atlanta, GA
| | - Deborah W. Bruner
- 1Emory University Nell Hodgson Woodruff School of Nursing, Atlanta, GA
| | - Yi-Juan Hu
- 2Emory University Rollins School of Public Health, Atlanta, GA
| | - Jinbing Bai
- 1Emory University Nell Hodgson Woodruff School of Nursing, Atlanta, GA
| | - Tony Y. Eng
- 3Emory University School of Medicine, Atlanta, GA
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Janevic MR, Mathur VA, Booker SQ, Morais C, Meints SM, Yeager KA, Meghani SH. Making Pain Research More Inclusive: Why and How. J Pain 2022; 23:707-728. [PMID: 34678471 PMCID: PMC9018873 DOI: 10.1016/j.jpain.2021.10.004] [Citation(s) in RCA: 39] [Impact Index Per Article: 19.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Revised: 09/28/2021] [Accepted: 10/05/2021] [Indexed: 02/09/2023]
Abstract
Current knowledge about mechanisms and interventions for pain has largely been derived from samples that are healthier, wealthier, younger, and more likely to be White than the general population. Failure to conduct inclusive pain research not only restricts generalizability and application of findings, but also hampers the discovery of mechanisms and the development of measures and interventions that are valid across population subgroups. Most of all, inclusive practices are critical to ensure that underrepresented groups derive equitable benefit from pain research. Here, we provide guidance for the pain research community on how to adopt inclusive research practices. We define "inclusion" to encompass a range of identities and characteristics, including racialized group/ethnicity, disability status, gender identity, sexual orientation, and age. We first describe principles relevant to promoting inclusion in pain research, including attention to: 1) stakeholder engagement; 2) structural factors underlying inequities; 3) the limitations of "disparity" research; 4) intersectionality; and 5) universal design. Next, we provide checklists with practical strategies for making studies more inclusive at each stage of the research process. We conclude by calling for system-level changes to ensure that the future of pain research is socially just, scientifically productive, and responsive to the needs of all people. PERSPECTIVE: This paper offers guidance on promoting inclusion of underrepresented groups in pain research. We describe principles relevant to conducting more inclusive research; eg, attention to stakeholder engagement, structural factors, and universal design. We provide checklists with practical strategies for inclusion at each stage of the research process.
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Affiliation(s)
| | - Vani A. Mathur
- Department of Psychological & Brain Sciences, Texas A&M University
| | - Staja Q. Booker
- College of Nursing, Department of Biobehavioral Nursing Science University of Florida
| | - Calia Morais
- Department of Community Dentistry and Behavioral Science, University of Florida
| | - Samantha M. Meints
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women’s Hospital, Harvard Medical School
| | | | - Salimah H. Meghani
- Department of Biobehavioral Health Sciences; New Courtland Center for Transitions and Health; Leonard Davis Institute of Health Economics, University of Pennsylvania
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Bonds Johnson K, Bai J, Waldrop D, Paul S, Lee H, Lyons KS, Yeager KA. Barriers to Pain Management: Incongruence in Black Cancer Caregiving Dyads. J Pain Symptom Manage 2022; 63:711-720. [PMID: 34995683 PMCID: PMC9018523 DOI: 10.1016/j.jpainsymman.2021.12.033] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Revised: 12/28/2021] [Accepted: 12/30/2021] [Indexed: 11/25/2022]
Abstract
CONTEXT To effectively manage cancer pain, there is a need to understand how caregiving dyads appraise symptoms. Dyadic appraisal of symptoms influences whether the dyad perceives the patient's pain is managed well and whether they are on the same page with their appraisal. Beliefs can act as barriers to the dyadic appraisal. OBJECTIVES This secondary data analysis examined incongruence within Black cancer caregiving dyads regarding beliefs about pain management and potential medication side effects using the Barriers Questionnaire-13. Associated factors were also examined. METHODS Guided by the Theory of Dyadic Illness Management, dyadic multilevel modeling was conducted with data from 60 Black cancer caregiving dyads to determine the dyadic appraisal of beliefs about pain management and potential medication side effects, which includes the average perception of barriers within the dyad (i.e., dyadic average) and the dyadic incongruence (i.e., gap between patient and caregiver). RESULTS On average, Black cancer caregiving dyads reported moderate barriers regarding pain management (2.262 (SE=0.102, P<0.001) and medication side effects (2.223 (SE=0.144, P<0.001). There was significant variability across dyads regarding barriers to pain management and medication side effects. Lower patient education and higher patient-reported pain interference were significantly associated with more perceived barriers to pain management and potential medication side effects. Incongruence within dyads regarding barriers to pain management and medication side effects were significantly associated with the caregiver's report of patient's pain interference. CONCLUSION Findings suggest the importance of appraisal that includes both members of Black cancer caregiving dyads regarding pain management.
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Affiliation(s)
- Kalisha Bonds Johnson
- Nell Hodgson Woodruff School of Nursing (K.B.J., J.B., D.W., S.P., H.L., K.A.Y.), Emory University, Atlanta, Georgia, USA..
| | - Jinbing Bai
- Nell Hodgson Woodruff School of Nursing (K.B.J., J.B., D.W., S.P., H.L., K.A.Y.), Emory University, Atlanta, Georgia, USA.; Winship Cancer Institute (J.B., K.A.Y.),, Emory University, Atlanta, Georgia, USA
| | - Drenna Waldrop
- Nell Hodgson Woodruff School of Nursing (K.B.J., J.B., D.W., S.P., H.L., K.A.Y.), Emory University, Atlanta, Georgia, USA
| | - Sudeshna Paul
- Nell Hodgson Woodruff School of Nursing (K.B.J., J.B., D.W., S.P., H.L., K.A.Y.), Emory University, Atlanta, Georgia, USA
| | - Haerim Lee
- Nell Hodgson Woodruff School of Nursing (K.B.J., J.B., D.W., S.P., H.L., K.A.Y.), Emory University, Atlanta, Georgia, USA
| | - Karen S Lyons
- Connell School of Nursing (K.S.L.), Boston College, Chestnut Hill, Massachusetts, USA
| | - Katherine A Yeager
- Nell Hodgson Woodruff School of Nursing (K.B.J., J.B., D.W., S.P., H.L., K.A.Y.), Emory University, Atlanta, Georgia, USA.; Winship Cancer Institute (J.B., K.A.Y.),, Emory University, Atlanta, Georgia, USA
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Yeager KA, Bai J, Gogineni K, Meisel JL, Kweon J, Bruner DW, Waldrop-Valverde D. Pilot Feasibility Study of a Video Intervention to Educate Patients with Breast Cancer About Clinical Trials. J Cancer Educ 2022; 37:387-394. [PMID: 32654039 DOI: 10.1007/s13187-020-01826-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
The purpose of this project was to develop and test the feasibility and preliminary efficacy of a video about cancer clinical trials (CCTs) developed for breast cancer patients. We developed 2 brief 7-min videos that focused on breast cancer patients describing their experiences participating in CCTs, supplemented with doctors and research staff explaining key research concepts. One video was culturally tailored to Black patients and the other to White patients. To assess feasibility study, participants and their care providers completed a survey to evaluate their satisfaction with the video. Eligibility criteria for the study included ≥ 21 years of age, English-speaking, no prior experience participating in a CCT, and being potentially eligible for breast CCT enrollment. Preliminary efficacy was evaluated with a pretest-posttest design using a single item asking about intent to enroll in a clinical trial. The mean age of the patient sample (n = 50) was 53.0 years, and 50.0% were Black. Participants reported that the video was in the right length, useful, and easy to understand. Providers' evaluation (n = 5) revealed that viewing the video helped prepare patients for further CCT discussion. Preliminary efficacy showed no statistically significant difference in participant interest in CCT enrollment pre- and post-video. Changes in patients' intent in enrollment were associated with age and education. Culturally adapted video interventions can be helpful in supporting both patients and providers throughout the CCT education process but additional work is needed to improve enrollment into clinical trials.
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Affiliation(s)
- Katherine A Yeager
- Nell Hodgson Woodruff School of Nursing, Emory University, 1520 Clifton Road, Atlanta, GA, 30322, USA.
- Winship Cancer Institute, Emory University, 1365-C Clifton Road NE, Atlanta, GA, 30322-4207, USA.
| | - Jinbing Bai
- Nell Hodgson Woodruff School of Nursing, Emory University, 1520 Clifton Road, Atlanta, GA, 30322, USA
- Winship Cancer Institute, Emory University, 1365-C Clifton Road NE, Atlanta, GA, 30322-4207, USA
| | - Keerthi Gogineni
- Winship Cancer Institute, Emory University, 1365-C Clifton Road NE, Atlanta, GA, 30322-4207, USA
- School of Medicine, Emory University, 100 Woodruff Circle, Atlanta, GA, 30322, USA
| | - Jane Lowe Meisel
- Winship Cancer Institute, Emory University, 1365-C Clifton Road NE, Atlanta, GA, 30322-4207, USA
- School of Medicine, Emory University, 100 Woodruff Circle, Atlanta, GA, 30322, USA
| | - Jaime Kweon
- Nell Hodgson Woodruff School of Nursing, Emory University, 1520 Clifton Road, Atlanta, GA, 30322, USA
| | - Deborah W Bruner
- Nell Hodgson Woodruff School of Nursing, Emory University, 1520 Clifton Road, Atlanta, GA, 30322, USA
- Winship Cancer Institute, Emory University, 1365-C Clifton Road NE, Atlanta, GA, 30322-4207, USA
| | - Drenna Waldrop-Valverde
- Nell Hodgson Woodruff School of Nursing, Emory University, 1520 Clifton Road, Atlanta, GA, 30322, USA
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19
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Abstract
Public health concerns regarding opioids and marijuana have implications for their medical use. This study examined use motives and perceived barriers in relation to opioid and marijuana use and interest in use among US adult cancer survivors. Self-administered surveys were distributed using social media to assess use motives and perceived barriers among participants living with cancer. Overall, 40.9% of cancer survivors reported current (past 30-day) use of opioids, 42.5% used marijuana, and 39.7% used both. The most common use motives for either/both drugs were to cope with pain and stress/anxiety (>70%). Highest-rated barriers to using either/both drugs were missing symptoms of worsening illness and not wanting to talk about their symptoms. Controlling for sociodemographics, binary logistic regression indicated that current opioid use was associated with reporting greater barriers to use (OR = 1.17, p = .011; Nagelkerke R-square = .934) and that current marijuana use was associated with reporting greater barriers to use (OR = 1.37, p = .003; Nagelkerke R-square = .921). Cancer survivors report various use motives and barriers to use regarding opioids and marijuana. While use motives and barriers for both drugs were similar, these constructs were differentially associated with use and interest in use across drugs. Understanding patients' perceptions about opioids and marijuana is an essential component to effectively manage symptoms related to a cancer diagnosis and improve quality of life for cancer survivors.
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Affiliation(s)
- Jessica M Potts
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Betelihem Getachew
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Milkie Vu
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Eric Nehl
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Katherine A Yeager
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia
| | - Corinne R Leach
- Behavioral and Epidemiology Research Group, American Cancer Society, Atlanta, Georgia
| | - Carla J Berg
- Department of Prevention and Community Health, Milken Institute School of Public Health, George Washington University, 800 22nd Street NW, 7th Floor, Washington, DC, 20052, USA.
- George Washington University Cancer Center, George Washington University, Washington, DC, USA.
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20
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Yeager KA, Lee H, Bai J, Paul S, Johnson KB, Waldrop D. Congruence of pain perceptions between Black cancer patients and their family caregivers. Support Care Cancer 2021; 30:543-553. [PMID: 34338855 DOI: 10.1007/s00520-021-06448-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Accepted: 07/18/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE This cross-sectional study evaluated congruence in pain assessment among Black cancer patients taking opioids for pain and their family caregivers and the effects of patient-reported depressive symptoms and cognitive complaints on the congruence. METHODS Patient-reported pain scores (current, average, and worst pain severity and pain interference) and caregiver proxy scores were independently assessed (Brief Pain Inventory). Patient-reported depressive symptoms (Patient Health Questionnaire-8) and cognitive complaints (Cognitive Difficulties Scale) were also assessed. Paired t-test, intraclass correlation coefficient (ICC), and Bland-Altman (BA) plots were used to evaluate group and dyad level congruence in pain assessment. The influence of patient depressive symptoms and cognitive complaints on congruence was examined using bivariate analyses and BA plots. RESULTS Among 50 dyads, 62% of patients and 56% of caregivers were female. Patients were older than caregivers (57 vs. 50 years, p = .008). Neither statistically significant (t-test) nor clinically relevant mean differences in pain severity and interference were found at a group level. At the dyad level, congruence was poor in pain now (ICC = 0.343) and average pain severity (ICC = 0.435), but moderate in worst pain severity (ICC = 0.694) and pain interference (ICC = 0.603). Results indicated better congruence in pain severity between patients with depressive symptoms and their caregivers, compared to patients without depressive symptoms. Patient CDS scores had no significant correlations with score differences between patients and caregivers in any pain variables. CONCLUSION Congruence varied depending on how the analysis was done. More information is needed to understand pain assessment between patients and caregivers.
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Affiliation(s)
- Katherine A Yeager
- Nell Hodgson Woodruff School of Nursing, Emory University, Room 228, 1520 Clifton Road, Atlanta, GA, 30322, USA. .,Winship Cancer Institute, Emory University, 1365-C Clifton Road NE, Atlanta, GA, 30322-4207, USA.
| | - Haerim Lee
- Nell Hodgson Woodruff School of Nursing, Emory University, Room 228, 1520 Clifton Road, Atlanta, GA, 30322, USA
| | - Jinbing Bai
- Nell Hodgson Woodruff School of Nursing, Emory University, Room 228, 1520 Clifton Road, Atlanta, GA, 30322, USA.,Winship Cancer Institute, Emory University, 1365-C Clifton Road NE, Atlanta, GA, 30322-4207, USA
| | - Sudeshna Paul
- Nell Hodgson Woodruff School of Nursing, Emory University, Room 228, 1520 Clifton Road, Atlanta, GA, 30322, USA
| | - Kalisha Bonds Johnson
- Nell Hodgson Woodruff School of Nursing, Emory University, Room 228, 1520 Clifton Road, Atlanta, GA, 30322, USA
| | - Drenna Waldrop
- Nell Hodgson Woodruff School of Nursing, Emory University, Room 228, 1520 Clifton Road, Atlanta, GA, 30322, USA
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21
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Zanville N, Cohen B, Gray TF, Phillips J, Linder L, Starkweather A, Yeager KA, Cooley ME. The Oncology Nursing Society Rapid Review and Research Priorities for Cancer Care in the Context of COVID-19. Oncol Nurs Forum 2021; 48:131-145. [PMID: 33600397 DOI: 10.1188/21.onf.131-145] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVES To identify research priorities addressing COVID-19 that build on the 2019-2022 Oncology Nursing Society (ONS) Research Agenda, in alignment with ONS's mission to promote excellence in oncology nursing and quality cancer care. METHODS & VARIABLES Priority areas were identified using a multistep approach combining rapid review of the literature; consultation with experts/stakeholders; and review of priorities from other funding agencies, public health, and cancer-focused organizations. RESULTS The rapid research response team identified five priority areas for research related to COVID-19. IMPLICATIONS FOR NURSING Oncology nurses are well positioned to address the research priorities and cross-cutting themes identified through this review. The use of innovative methodologic approaches and attention to disparities are necessary to advance cancer care related to COVID-19.
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22
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Abstract
Objectives: In this study, we examined use of and interest in using opioids and marijuana, particularly in relation to use motives and perceived barriers to use, among people living with HIV (PLWH). Methods: We analyzed online survey data from 304 PLWH in the United States recruited via social media in Summer 2018. Results: In this sample (Mage = 30.86, 40.5% male, 64.5% white), 16.1% reported current (past 30-day) use of opioids, 18.1% marijuana, and 15.8% both. Participants reported more use motives and fewer barriers to using marijuana versus opioids (p's < .001). The most frequently endorsed motive for using either/both drugs were to cope with pain and stress/anxiety. Highest-rated barriers to using either/both drugs were missing symptoms of worsening illness and addiction concerns. Regression analyses indicated that current opioid use correlated with reporting greater opioid use motives; among past-month opioid nonusers, greater interest in using opioids correlated with greater opioid use motives. Current marijuana use correlated with reporting greater marijuana use motives and greater barriers; among past-month marijuana nonusers, greater interest in using marijuana correlated with greater marijuana use motives and fewer barriers. Conclusions: Use motives and barriers differentially correlated with use and interest in use across drugs, thereby indicating different intervention approaches to address appropriate use.
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Affiliation(s)
- Jessica M Potts
- Jessica M. Potts, Student, Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, GA, United States
| | - Betelihem Getachew
- Betelihem Getachew, Project Coordinator, Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, GA, United States
| | - Milkie Vu
- Milkie Vu, Doctoral Student, Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, GA, United States
| | - Eric Nehl
- Eric Nehl, Associate Research Professor, Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, GA, United States
| | - Katherine A Yeager
- Katherine A. Yeager, Associate Professor, Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA, United States
| | - Carla J Berg
- Carla J. Berg, Professor, Department of Preventive and Community Health, Milken School of Public Health, George Washington Cancer Center, George Washington University, Washington, DC, United States;,
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23
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Cohen B, Cooley ME, Gray TF, Linder L, Phillips J, Starkweather A, Yeager KA, Zanville N. Nursing's seat at the research roundtable. Lancet 2020; 396:1397-1398. [PMID: 33065036 PMCID: PMC7553737 DOI: 10.1016/s0140-6736(20)32143-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Accepted: 09/30/2020] [Indexed: 11/22/2022]
Affiliation(s)
- Bevin Cohen
- Center for Nursing Research and Innovation, The Mount Sinai Hospital, New York, NY 10029, USA.
| | | | | | - Lauri Linder
- University of Utah College of Nursing, Salt Lake City, UT, USA
| | | | | | - Katherine A Yeager
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA, USA
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24
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Belcher SM, Watkins Bruner D, Hofmeister CC, Kweon J, Meghani SH, Yeager KA. Characterizing Pain Experiences: African American Patients With Multiple Myeloma Taking Around-the-Clock Opioids. Clin J Oncol Nurs 2020; 24:538-546. [PMID: 32945786 PMCID: PMC10432153 DOI: 10.1188/20.cjon.538-546] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Despite known disparities by race, studies to date have not focused on pain characterization among African American patients with multiple myeloma. OBJECTIVES This study aimed to characterize the pain experience, beliefs about pain and pain control, and additional symptoms among African American patients with multiple myeloma taking around-the-clock opioids. METHODS This study employed secondary analysis of baseline data from a completed longitudinal study of opioid adherence. Descriptive statistics were used to characterize the sample, pain experience, beliefs regarding pain and pain control, and related symptoms. FINDINGS Participants (N = 34) experienced everyday pain and additional symptoms, and half experienced depression. Pain management barriers included dislike of pills, fear of addiction, and bothersome side effects from pain and medication. Additional larger studies can incorporate multilevel factors contributing to high symptom burden.
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25
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Yeager KA, Waldrop-Valverde D, Paul S, Bruner DW, Klisovic R, Burns E, Mason TA, Patel N, Jennings BM. Adherence trajectories in oral therapy for chronic myeloid leukemia: Overview of a research protocol. Res Nurs Health 2020; 43:443-452. [PMID: 32866350 DOI: 10.1002/nur.22069] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Accepted: 08/16/2020] [Indexed: 12/15/2022]
Abstract
Over a quarter of chemotherapy regimens now include oral agents. Individuals living with cancer are now responsible for administering this lifesaving therapy at home by taking every dose as prescribed. One type of oral chemotherapy, tyrosine kinase inhibitors (TKIs), is the current recommended treatment for chronic myeloid leukemia. This targeted therapy has markedly improved survival but comes with significant side effects and financial costs. In the study described in this protocol, the investigators seek to understand the dynamic nature of TKI adherence experienced by individuals diagnosed with CML. Using a mixed-method approach in this prospective observational study, funded by the National Cancer Institute, we seek to describe subjects' adherence trajectories over 1 year. We aim to characterize adherence trajectories in individuals taking TKIs using model-based cluster analysis. Next, we will determine how side effects and financial toxicity influence adherence trajectories. Then we will examine the influence of TKI adherence trajectories on disease outcomes. Additionally, we will explore the experience of patients taking TKIs by interviewing a subset of participants in different adherence trajectories. The projected sample includes 120 individuals taking TKIs who we will assess monthly for 12 months, measuring adherence with an objective measure (Medication Event Monitoring System). Identifying differential trajectories of adherence for TKIs is important for detecting subgroups at the highest risk of nonadherence and will support designing targeted interventions. Results from this study can potentially translate to other oral agents to improve care across different types of cancer.
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Affiliation(s)
- Katherine A Yeager
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia
| | | | - Sudeshna Paul
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia
| | - Deborah Watkins Bruner
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia.,Department of Radiation Oncology, Emory School of Medicine, Atlanta, Georgia
| | - Rebecca Klisovic
- Department of Hematology and Medical Oncology, Emory School of Medicine, Atlanta, Georgia
| | - Emily Burns
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia
| | - Tamara A Mason
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia
| | - Nisha Patel
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia
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26
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Pugh SL, Rodgers JP, Yeager KA, Chen RC, Movsas B, Bonanni R, Dignam J, Bruner DW. Characteristics of Participation in Patient-Reported Outcomes and Electronic Data Capture Components of NRG Oncology Clinical Trials. Int J Radiat Oncol Biol Phys 2020; 108:950-959. [PMID: 32590048 DOI: 10.1016/j.ijrobp.2020.06.030] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Revised: 06/04/2020] [Accepted: 06/17/2020] [Indexed: 12/22/2022]
Abstract
PURPOSE To assess the reasons why patients do not consent to patient-reported outcome (PRO) and electronic PRO data capture components of clinical trials and potential selection bias by having a separate consent. METHODS AND MATERIALS Selected NRG Oncology trials were included based on disease site and inclusion of PROs and electronic PRO data capture via VisionTree Optimal Care as separate consent questions. Reasons for not participating were assessed. Pretreatment characteristics between patients who did and did not consent were tested using χ2 and t tests for univariate comparisons and logistic regression for multivariable analyses. RESULTS Ten trials were selected in head and neck, prostate, gynecologic, breast, lung, and gastrointestinal cancers, with 4 of these trials having electronic PRO data capture. Most patients consented to the PRO component (75.3%) but not electronic PRO data capture (37.8%). More white patients consented to PROs than nonwhite patients across all trials (odds ratio [OR], 0.53; 95% confidence interval [CI], 0.45-0.63; P < .001), and more patients with education after high school consented compared with those with less education (OR, 1.71; 95% CI, 1.46-2.02; P < .001). Patients who are younger (OR, 0.63; 95% CI, 0.47-0.85; P = .002), white (OR, 0.60; 95% CI, 0.44-0.82; P = .001), and a never or former smoker (OR, 0.57; 95% CI, 0.41-0.78; P = .001) are more likely to participate in electronic PRO data capture. CONCLUSIONS These results suggest that a patient's race, age, and education can affect whether a patient chooses to consent or is offered to participate in PRO or electronic PRO data capture components. More investigation is needed, but this analysis provides support for making PROs integrated in the trial.
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Affiliation(s)
- Stephanie L Pugh
- NRG Oncology, Statistics and Data Management Center, American College of Radiology, Philadelphia, Pennsylvania.
| | - Joseph P Rodgers
- NRG Oncology, Statistics and Data Management Center, American College of Radiology, Philadelphia, Pennsylvania
| | | | - Ronald C Chen
- UNC Hospitals Radiation Oncology Clinic, NC Cancer Hospital, Chapel Hill, North Carolina
| | - Benjamin Movsas
- Henry Ford Cancer Institute, Henry Ford Health System, Detroit, Michigan
| | - Roseann Bonanni
- NRG Oncology, Statistics and Data Management Center, American College of Radiology, Philadelphia, Pennsylvania
| | - James Dignam
- NRG Oncology, Statistics and Data Management Center, University of Chicago, Chicago, Illinois
| | - Deborah W Bruner
- Emory University Hospital, Winship Cancer Institute, Atlanta, Georgia
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27
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Kang Y, Meghani SH, Bruner DW, Yeager KA. Factors Associated with Depression in African American Patients Being Treated for Cancer Pain. Pain Manag Nurs 2020; 21:410-415. [PMID: 32513560 DOI: 10.1016/j.pmn.2020.03.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Revised: 02/17/2020] [Accepted: 03/17/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND Among cancer patients in the United States, African American cancer patients have the highest mortality rate and shortest survival rate. Although depression is known as a predictor of mortality in cancer and a potential barrier to health care utilization, research on depression in African American patients is limited. Cancer pain can interfere with an individual's ability to cope with depression. AIMS To identify factors that are associated with a positive screening of depressive symptoms assessed by the PHQ-8 in African American patients treated for cancer pain. DESIGN Secondary data analysis of a cross-sectional study of opioid adherence. SETTING Medical oncology, palliative care, and radiation oncology clinics in Atlanta, Georgia. PARTICIPANTS/SUBJECTS African American patients with cancer pain in the parent study. METHODS Independent samples t-test was used to assess variable correlations with and without depressive symptoms. Adjusted logistic regression was conducted to identify factors that were associated with presence of depressive symptoms. RESULTS Mean patient age was 55.6 years, and nearly 38% had a PHQ-8 score of >10 indicating presence of moderate to severe depressive symptoms. Participants with depressive symptoms had significantly higher means for anxiety and pain interference with mood than those without depressive symptoms. Factors that were significantly associated with depressive symptoms were anxiety, pain interfering with mood, and lack of involvement with a religious congregation. CONCLUSIONS The findings of this study help to identify African American cancer patients at risk for depression and demonstrates the need for increased screening for depression in this underserved population.
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Affiliation(s)
- Youjeong Kang
- University of Utah College of Nursing, Salt Lake City, Utah.
| | - Salimah H Meghani
- Department of Biobehavioral Health Sciences, University of Pennsylvania, School of Nursing, Philadelphia, Pennsylvania
| | - Deborah W Bruner
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia
| | - Katherine A Yeager
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia
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28
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Abstract
Communicating is essential. The communication chain within units and facilities must be kept strong. Good communication will help staff take responsibility for one another; knowing your work family is looking out for you can offer strength. Respecting each other encourages speaking up to create a platform for shared decision-making and problem-solving. Such shared responsibility will yield the best solutions because the whole is stronger together than individuals alone. Speaking up also is a way to offer immediate feedback if mistakes are observed so that errors are corrected. And when, not if, mistakes are made, staff need to be able to communicate these without fear of retribution.
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29
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Meghani SH, Wool J, Davis J, Yeager KA, Mao JJ, Barg FK. When Patients Take Charge of Opioids: Self-Management Concerns and Practices Among Cancer Outpatients in the Context of Opioid Crisis. J Pain Symptom Manage 2020; 59:618-625. [PMID: 31711967 DOI: 10.1016/j.jpainsymman.2019.10.029] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Revised: 10/19/2019] [Accepted: 10/23/2019] [Indexed: 12/13/2022]
Abstract
CONTEXT With concerns about opioid prescribing practices prominent in the professional and lay literature, there is less focus on patients' self-management of opioids for cancer pain and potential safety risks. OBJECTIVES To investigate reports of opioid self-management practices and concerns among patients undergoing active cancer treatments-a group excluded from the scope of most policy initiatives on prescription opioids. METHODS This sequential multimethod study used freelisting (n = 65) and open-ended semistructured interviews with a racially diverse subgroup (n = 32). Adult ambulatory patients with solid malignancies or multiple myeloma and pain (≥4 on a scale of 0-10) were recruited from an urban National Cancer Institute-designated cancer center in Philadelphia. Freelists were analyzed using consensus analysis and semistructured interview data were analyzed using thematic analysis. RESULTS In freelisting, "pain relief" emerged as the primary term in relation to taking pain medications preceding "addiction" concerns. In interviews, patients described several heuristics and some potentially unsafe practices to minimize opioid use to a self-defined "normal." These included reducing opioid dose by cutting pills; self-tapering off opioids; using extended-release/long-acting opioids on an as-needed basis; mixing over-the-counter, nonopioid analgesics; and using illicit drugs to avoid "harder medicines" (opioids). Many patients preferred nonopioid treatments for pain but invariably faced access barriers. Some described assuming stewardship of their prescribed opioids and felt that oncology clinicians are quick to prescribe opioids without providing workable alternatives. CONCLUSIONS Risks related to self-management of opioids among cancer outpatients, including potential overdose risks, need urgent attention. Interventions are needed for improving clinician-patient communication, patient education, safety, and access to effective nonopioid alternatives.
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Affiliation(s)
- Salimah H Meghani
- Department of Biobehavioral Health Sciences, NewCourtland Center for Transitions and Health, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
| | - Jesse Wool
- Department of Biobehavioral Health Sciences, NewCourtland Center for Transitions and Health, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Jessica Davis
- School of Arts and Sciences, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Katherine A Yeager
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia, USA
| | - Jun J Mao
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Frances K Barg
- School of Arts and Sciences, University of Pennsylvania, Philadelphia, Pennsylvania, USA; Department of Family and Community Health, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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30
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Zackon AY, Ayers AA, Yeager KA, Somma ML, Friedberg JW, Flowers CR, Nastoupil LJ. Maximizing the effectiveness of oral therapies in lymphoid cancers: research gaps and unmet needs. Leuk Lymphoma 2019; 60:2356-2364. [PMID: 31164024 PMCID: PMC6791753 DOI: 10.1080/10428194.2019.1594217] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [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: 12/27/2018] [Revised: 02/27/2019] [Accepted: 03/05/2019] [Indexed: 12/27/2022]
Abstract
Oral therapies have become a common treatment choice for several lymphoid cancers. While therapeutic efficacy and patient preference for this therapy type have been reported, there is a lack of knowledge about its effectiveness for lymphoma in clinical practice, particularly in regard to the effects of medication nonadherence. While studies of oral medications in other diseases have shown that adherence is a major factor in outcomes and costs, there is scant research investigating adherence specifically in lymphoma patients, who face unique challenges in their diseases and treatments. To address the limited data available, we constructed a conceptual model and highlighted key opportunities for future research to better elucidate oral therapy adherence in lymphoma. This research will hopefully improve understanding and efficacy of oral treatment for lymphoma patients, while also informing other cancers utilizing oral therapies currently and in the future.
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Affiliation(s)
| | - Amy A. Ayers
- Winship Cancer Institute, Emory University, Atlanta, GA, U.S.A
| | | | - Mary L. Somma
- Scientific and Research Programs, Lymphoma Research Foundation, New York, NY, U.S.A
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31
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Jefferson K, Quest T, Yeager KA. Factors Associated with Black Cancer Patients' Ability to Obtain Their Opioid Prescriptions at the Pharmacy. J Palliat Med 2019; 22:1143-1148. [PMID: 30883244 PMCID: PMC6735324 DOI: 10.1089/jpm.2018.0536] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/18/2019] [Indexed: 12/11/2022] Open
Abstract
Background: Black cancer patients experience pain. Barriers to opioid medications for pain may include geographic factors. This study examines neighborhood factors associated with difficulties receiving prescription opioids from pharmacies for black cancer patients. Design: A secondary data analysis of a study on opioid adherence was used to examine neighborhood-level and individual factors related to difficulties filling prescriptions for opioids. Setting/Subjects: Patients being treated for cancer pain with opioids (n = 104) were recruited. All self-identified as black, were 21 years or older, had cancer diagnoses, and had been prescribed extended release opioids. Measurements: A seven-item survey to identify problems filling opioids was completed by 98 participants along with a nine-item scale to assess perceived neighborhood characteristics. Scales of neighborhood amenities and neglect were created from the perceived neighborhood characteristics scale using principal components analysis. The 2009-2013 American Community Survey data were used to estimate the census tract percentage of non-Hispanic black residents, residents ≥25 years of age without a high school degree or equivalent, and households earning below the federal poverty level within the past 12 months. Results: Nearly 51% reported problems getting their opioids filled: 28% had to wait days and 24% had to return to the pharmacy multiple times. The main theme identified in analysis of an open-ended question was pharmacies not stocking medication. Neighborhood locations that rated higher on the amenities scale were protective for pharmacies sufficiently stocking opioids. Conclusions: Additional research on pharmacies sufficiently stocking opioid pain and neighborhood perceptions is warranted.
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Affiliation(s)
- Kevin Jefferson
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Tammie Quest
- Department of Emergency Medicine, School of Medicine, Emory University, Atlanta, Georgia
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32
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Yeager KA, Williams B, Bai J, Cooper HLF, Quest T, Meghani SH, Bruner DW. Factors Related to Adherence to Opioids in Black Patients With Cancer Pain. J Pain Symptom Manage 2019; 57:28-36. [PMID: 30316809 PMCID: PMC6310640 DOI: 10.1016/j.jpainsymman.2018.10.491] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [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: 08/23/2018] [Revised: 10/03/2018] [Accepted: 10/05/2018] [Indexed: 11/15/2022]
Abstract
CONTEXT Cancer pain relief is often inadequate because of poor adherence to pain medication, especially for black patients. OBJECTIVES The purpose of this study is to describe factors related to adherence to around-the-clock opioids among 110 black patients being treated for cancer pain. METHODS Sociodemographic, clinical, symptoms, and social support data were collected at baseline; pain and adherence data were collected at 30 days. Associations between these variables and opioid adherence measured by Medication Event Monitoring System were estimated using multiple regression. RESULTS Mean age was 56 (±10.1), the majority were women (63%) and college educated (56%). Mean pain severity at baseline equaled 4.6 (±2.3). Mean dose adherence was 60% (±28.5), while mean schedule adherence was 33.0% (±31.0). In adjusted analysis, 26% of the variance in dose adherence was explained by recent chemotherapy, changes in pain, concerns about nausea, and doctors' focus on cure versus pain control (P<0.001); 27% of the variance in schedule adherence was explained by recent chemotherapy, changes in pain, symptom burden, and concerns about doctors focus on cure versus pain control (P<0.001). CONCLUSION Findings confirm pain medication adherence is poor and pain was not well relieved. Multiple factors influence adherence to around-the-clock opioids. Clinicians need to partner with patients by providing a personalized pain treatment plan including an in-depth assessment of treatment choices and adherence.
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Affiliation(s)
- Katherine A Yeager
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia, USA; Winship Cancer Institute, Emory University, Atlanta, Georgia, USA.
| | - Bryan Williams
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia, USA
| | - Jinbing Bai
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia, USA
| | - Hannah L F Cooper
- Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Tammie Quest
- School of Medicine, Emory University, Atlanta, Georgia, USA
| | - Salimah H Meghani
- School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Deborah W Bruner
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia, USA; Winship Cancer Institute, Emory University, Atlanta, Georgia, USA
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Lal A, Bai J, Basri D, Yeager KA. Pharmacists' Perspectives on Practice, Availability, and Barriers Related to Opioids in Georgia. Am J Hosp Palliat Care 2018; 36:472-477. [PMID: 30522338 DOI: 10.1177/1049909118815440] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
OBJECTIVES To explore pharmacists' perspectives on practice, availability, and barriers related to opioids. METHODS This cross-sectional study evaluated pharmacists' perspectives on practice, availability, and barriers related to opioids. Electronic surveys were distributed to pharmacists practicing in Georgia via Survey Monkey. The χ2 or Fisher Exact test was used to test differences in practice, availability, and barriers with respect to type of pharmacy and location of pharmacy. RESULTS Most participating pharmacists practiced in an independent (47%) or community chain pharmacies (37%). The majority checked the Prescription Drug-Monitoring Program (PDMP) on a regular basis (73%), and about a third reported contacting the prescriber prior to dispensing. The most common barrier included concerns about diversion (82%) and illicit use (90%). About two-thirds reported experiencing a shortage of opioids. Significant differences ( P < .05) were found between types of pharmacy in dispensing practices, availability, and barriers. No significant differences were found with respect to pharmacy location. CONCLUSION Findings suggest that pharmacists are facing challenges in availability of opioids and are employing stewardship approaches to optimize dispensing practices. This research provides insight regarding broken links in the "pain relief chain" and identifies opportunities to improve the accessibility of opioids when medically indicated. Pharmacists can play an important role in addressing the opioid crisis as well as providing quality care to patients with cancer seeking pain relief.
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Affiliation(s)
- Ashima Lal
- 1 Department of General Medicine and Geriatrics, Emory University School of Medicine, Atlanta, GA, USA.,2 Grady Memorial Hospital, Atlanta, GA, USA
| | - Jinbing Bai
- 3 Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA, USA
| | - Danny Basri
- 4 WellStar Kennestone Hospital, Marietta, GA, USA
| | - Katherine A Yeager
- 3 Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA, USA
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Jennings BM, Yeager KA, Feistritzer NR, Gullatte MM, Martyn KK. Enacting high reliability principles while caring for people with Ebola Virus Disease. Am J Infect Control 2018; 46:1167-1173. [PMID: 29784444 DOI: 10.1016/j.ajic.2018.04.208] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Revised: 04/09/2018] [Accepted: 04/10/2018] [Indexed: 11/30/2022]
Abstract
BACKGROUND Fear surrounds Ebola Virus Disease (EVD) because it is highly infectious. Yet members of the Serious Communicable Diseases Unit (SCDU) at Emory University Hospital (EUH) had to overcome that fear when caring for patients with EVD. PURPOSE The analysis reported here illustrates how the members of EUH's SCDU tacitly enacted high reliability (HR) principles while caring for patients with EVD. METHODS A qualitative study was conducted to describe the experience of members of the EUH SCDU who worked with EVD patients in 2014. We completed 17 semi-structured interviews involving registered nurses, physicians, and support personnel (eg, laboratory technicians). Interview recordings were transcribed and analyzed using conventional content analysis. Exploring HR principles was not among the questions guiding this exploration, but the participants repeatedly described concepts related to HR. RESULTS The goal of the SCDU team was to save patients' lives while protecting their own lives. Rigorous training and meeting high standards were required to make the team. The fear surrounding EVD set in motion the enactment of HR principles. HR principles served to alleviate failures or breakdowns in infection prevention and control, thus keeping patients and staff safe. CONCLUSIONS These findings illustrate that it is possible to move HR principles from theory to practice in high-risk situations. HR principles were essential to safety and to infection prevention and control.
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Affiliation(s)
| | | | | | - Mary M Gullatte
- Nursing Innovation and Research, Emory Healthcare, Inc., Atlanta, GA
| | - Kristy K Martyn
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA
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Bai J, Brubaker A, Meghani SH, Bruner DW, Yeager KA. Spirituality and Quality of Life in Black Patients With Cancer Pain. J Pain Symptom Manage 2018; 56:390-398. [PMID: 29857179 DOI: 10.1016/j.jpainsymman.2018.05.020] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [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: 03/23/2018] [Revised: 05/21/2018] [Accepted: 05/22/2018] [Indexed: 10/16/2022]
Abstract
PURPOSE The objective of this study was to examine the associations between spirituality and overall quality of life (QOL) and individual QOL domains in black patients with cancer pain. METHODS A secondary data analysis of a parent study exploring pain medication adherence in black patients receiving around-the-clock opioids with cancer pain was performed. All the participating patients completed Functional Assessment of Chronic Illness Therapy-Spiritual Well-Being Scale (spirituality), Brief Pain Inventory (pain severity and interference), Edmonton Symptom Assessment Scale (symptoms), and Functional Assessment of Cancer Therapy-General (QOL). Pearson correlation and multiple linear regression analyses were conducted to examine the associations between spirituality and overall QOL and QOL domains and to identify the predictors of overall QOL and QOL domains. RESULTS Black patients treated for cancer pain (n = 102) completed the study. Pearson correlation showed significant positive associations between spirituality and overall QOL (P < 0.001) and individual QOL domains (physical, social, emotional, and functional). Higher spirituality was associated with lower pain severity (P = 0.01), pain interference (P = 0.001), and total symptoms score (P < 0.001). In multiple regression analysis, the best model for the overall QOL explained 67% of the variance (P < 0.001) and included total symptoms score, pain interference, spirituality, and age. Spirituality significantly predicted QOL domains of social (P < 0.0001), emotional (P = 0.002), and functional well-being (P = 0.001) rather than physical well-being. CONCLUSIONS Spirituality is associated with decreased pain and lower symptom burden and may serve as a protective factor against diminished overall QOL, specifically social, emotional, and functional domains in black patients with cancer pain. There is a need to develop spirituality-based interventions along with symptom management interventions to improve QOL for this population.
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Affiliation(s)
- Jinbing Bai
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia, USA.
| | - Andrea Brubaker
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia, USA
| | - Salimah H Meghani
- School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Deborah W Bruner
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia, USA; Winship Cancer Institute, Emory University, Atlanta, Georgia, USA
| | - Katherine A Yeager
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia, USA; Winship Cancer Institute, Emory University, Atlanta, Georgia, USA
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Cook ED, Yeager KA, Cecchini RS, Boparai J, Brown CL, Duncan M, Cronin WM, Paskett ED. Recruitment practices for U.S. minority and underserved populations in NRG oncology: Results of an online survey. Contemp Clin Trials Commun 2018; 10:100-104. [PMID: 30023443 PMCID: PMC6046466 DOI: 10.1016/j.conctc.2018.03.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2017] [Revised: 03/04/2018] [Accepted: 03/08/2018] [Indexed: 11/30/2022] Open
Abstract
Introduction Cancer clinical trials (CCT) provide much of the evidence for clinical guidelines and standards of care. But low levels of CCT participation are well documented, especially for minorities. Methods and materials We conducted an online survey of 556 recruitment practices across the NRG Oncology network. Survey aims were 1) to learn how sites recruit minority/underserved populations; 2) to better understand the catchment areas of the NRG institutions; and 3) to aid in planning education programs for accrual of minority/underserved populations. Results The survey response rate was 34.9%. The most effective methods reported for recruiting minority/underserved participants were patient navigators (44.4%) and translators (38.9%). All institutions reported using a mechanism for eligibility screening and 71% of institutions reported using a screening/enrollment tracking system. CCT training was required at 78.1% and cultural competency training was required at 47.5% of responding institutions. Only 19.9% of sites used community partners to assist with minority recruitment and just 37.1% of respondents reported a defined catchment area. Sites reported very little race and ethnicity data. Conclusion This NRG Oncology online survey provides useful data for improvements in trial enrollment and training to recruit minority/underserved populations to CCT. Areas for further investigation include web-based methods for recruitment and tracking, cultural competency training, definition of catchment areas, use of patient navigators, and community partnerships. The survey results will guide recruitment training programs.
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Affiliation(s)
- Elise D Cook
- Department of Clinical Cancer Prevention, Unit 1360, UT M. D. Anderson Cancer Center, P. O. Box 301439, Houston, TX 77230-1439, USA
| | - Katherine A Yeager
- Nell Hodgson Woodruff School of Nursing, Emory University, Winship Cancer Institute, USA
| | - Reena S Cecchini
- NRG Oncology Statistics and Data Management Center, USA.,Department of Biostatistics, Graduate School of Public Health, University of Pittsburgh, USA
| | | | - Carol L Brown
- Office of Diversity Programs, Memorial Sloan Kettering Cancer Center, USA
| | - Martha Duncan
- Clinical Coordinating Department (CCD), NRG Oncology, Pittsburgh Office, USA
| | - Walter M Cronin
- NRG Oncology, Statistics and Data Management Center, University of Pittsburgh, USA
| | - Electra D Paskett
- Division of Cancer Prevention and Control, Department of Internal Medicine, College of Medicine, Ohio State University, USA.,Population Sciences, Comprehensive Cancer Center, Ohio State University, USA
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Wells JS, Pugh S, Boparai K, Rearden J, Yeager KA, Bruner DW. Cultural Competency Training to Increase Minority Enrollment into Radiation Therapy Clinical Trials-an NRG Oncology RTOG Study. J Cancer Educ 2017; 32:721-727. [PMID: 27209044 PMCID: PMC5118189 DOI: 10.1007/s13187-016-1051-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [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] [Indexed: 05/12/2023]
Abstract
Despite initiatives to increase the enrollment of racial and ethnic minorities into cancer clinical trials in the National Cancer Institute National Cancer Clinical Trials Network (NCCTN), participation by Latino and African American populations remain low. The primary aims of this pilot study are (1) to develop a Cultural Competency and Recruitment Training Program (CCRTP) for physician investigators and clinical research associates (CRAs), (2) to determine if the CCRTP increases cultural competency scores among physician investigators and CRAs, and (3) to determine the impact of the CCRTP on minority patient recruitment into NRG Oncology Radiation Therapy Oncology Group (RTOG) clinical trials. Sixty-seven CRAs and physicians participated in an in-person or online 4-h CRRTP training. Five knowledge and attitude items showed significant improvements from pre- to post-training. A comparison between enrolling sites that did and did not participate in the CCRTP demonstrated a pre to 1-year post-incremental increase in minority accrual to clinical trials of 1.2 % among participating sites. While not statistically significant, this increase translated into an additional 300 minority patients accrued to NCCTN clinical trials in the year following the training from those sites who participated in the training.
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Affiliation(s)
- Jessica S Wells
- Nell Hodgson Woodruff School of Nursing, Emory University, 1520 Clifton Road, Room 230, Atlanta, GA, 30322-4201, USA.
| | - Stephanie Pugh
- NRG Oncology Statistics and Data Management Center, Philadelphia, PA, USA
| | | | | | - Katherine A Yeager
- Nell Hodgson Woodruff School of Nursing, Emory University, 1520 Clifton Road, Room 230, Atlanta, GA, 30322-4201, USA
| | - Deborah W Bruner
- Nell Hodgson Woodruff School of Nursing, Emory University, 1520 Clifton Road, Room 230, Atlanta, GA, 30322-4201, USA
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Ferranti EP, Wands L, Yeager KA, Baker B, Higgins MK, Wold JL, Dunbar SB. Implementation of an educational program for nursing students amidst the Ebola virus disease epidemic. Nurs Outlook 2016; 64:597-603. [PMID: 27364913 PMCID: PMC7111699 DOI: 10.1016/j.outlook.2016.04.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2015] [Revised: 03/26/2016] [Accepted: 04/08/2016] [Indexed: 11/28/2022]
Abstract
Background The global Ebola virus disease (EVD) epidemic of 2014/2015 prompted faculty at Emory University to develop an educational program for nursing students to increase EVD knowledge and confidence and decrease concerns about exposure risk. Purpose The purpose of this article is to describe the development, implementation, and evaluation of the EVD Just-in-Time Teaching (JiTT) educational program. Methods Informational sessions, online course links, and a targeted, self-directed slide presentation were developed and implemented for the EVD educational program. Three student surveys administered at different time points were used to evaluate the program and change in students' EVD knowledge, confidence in knowledge, and risk concern. Discussion Implementation of a JiTT educational program effectively achieved our goals to increase EVD knowledge, decrease fear, and enhance student confidence in the ability to discuss EVD risk. These achievements were sustained over time. Conclusion JiTT methodology is an effective strategy for schools of nursing to respond quickly and comprehensively during an unanticipated infectious disease outbreak.
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Affiliation(s)
- Erin P Ferranti
- Office of Academic Advancement, Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA.
| | - LisaMarie Wands
- Office of Academic Advancement, Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA
| | - Katherine A Yeager
- Office of Academic Advancement, Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA
| | - Brenda Baker
- Office of Academic Advancement, Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA
| | - Melinda K Higgins
- Office of Academic Advancement, Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA
| | - Judith Lupo Wold
- Office of Academic Advancement, Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA
| | - Sandra B Dunbar
- Office of Academic Advancement, Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA
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Bruner DW, Pugh SL, Yeager KA, Bruner J, Curran W. Cartographic Mapping and Travel Burden to Assess and Develop Strategies to Improve Minority Access to National Cancer Clinical Trials. Int J Radiat Oncol Biol Phys 2015; 93:702-9. [PMID: 26281827 DOI: 10.1016/j.ijrobp.2015.06.041] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2015] [Revised: 06/22/2015] [Accepted: 06/28/2015] [Indexed: 11/26/2022]
Abstract
PURPOSE To assess how accrual to clinical trials is related to US minority population density relative to clinical trial site location and distance traveled to Radiation Therapy Oncology Group (RTOG) clinical trial sites. METHODS AND MATERIALS Data included member site address and ZIP codes, patient accrual, and patient race or ethnicity and ZIP code. Geographic Information System maps were developed for overall, Latino, and African American accrual to trials by population density. The Kruskal-Wallis test was used to assess differences in distance traveled by site, type of trial, and race or ethnicity. RESULTS From 2006 to 2009, 6168 patients enrolled on RTOG trials. The RTOG US site distribution is generally concordant with overall population density. Sites with highest accrual are located throughout the United States and parts of Canada and do not cluster, nor does highest minority accrual cluster in areas of highest US minority population density. Of the 4913 US patients with complete data, patients traveled a median of 11.6 miles to participate in clinical trials. Whites traveled statistically longer distances (12.9 miles; P<.0001) to participate, followed by Latinos (8.22 miles) and African Americans (5.85 miles). Patients were willing to drive longer distances to academic sites than community sites, and there was a trend toward significantly longer median travel for therapeutic versus cancer control or metastatic trials. CONCLUSIONS Location matters, but only to a degree, for minority compared with nonminority participation in clinical trials. Geographic Information System tools help identify gaps in geographic access and travel burden for clinical trials participation. Strategies that emerged using these tools are discussed.
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Affiliation(s)
| | - Stephanie L Pugh
- NRG Oncology Statistics and Data Management Center, Philadelphia, Pennsylvania
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Yeager KA, Bruner J, Pugh SL, Bruner DW. Abstract A71: Clinical trial participation: Differences in distance traveled across different ethnic groups. Cancer Epidemiol Biomarkers Prev 2014. [DOI: 10.1158/1538-7755.disp13-a71] [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: 11/16/2022] Open
Abstract
Abstract
Background: Latinos and African Americans make up a significant portion of the U.S. population, and face either high prevalence and/or high morbidity related to cancer compared to Whites but cancer clinical trial participation rates continue to be low. Multiple barriers have been identified including travel distance but little work has assessed differences between ethnic groups. The purpose of this analysis was to examine the distance between participants' home zip codes and the Radiation Therapy Oncology Group (RTOG) site where they participated in a clinical trial and look for differences between types of sites and racial/ethnic identification.
Methods: Data was obtained from RTOG, including zip codes of RTOG full and affiliate members and their satellite sites along with Community Clinical Oncology Program (CCOP) members. In addition, patient accrual to all RTOG clinical trials per site over the period of 2006-2009 was collected. Patient data collected included zip code, race, and ethnicity only. Only patients with complete data were included. Racial/ethnic categories included Latino, African American, and other. The other category included 96% Whites and was subsequently labeled Whites. No additional identifiers were collected. Next the distance (direct distance in miles) was calculated between the centroid of the U.S. postal zip codes of all individual patients and the RTOG site address where the patient was accrued. Descriptive statistics were calculated for distance traveled for the different types of sites and the three ethnic categories (African American, Latino and White).
Results: Of the total sample size of 6168 patients, 80% had complete information and were included in the analysis. 4072 were treated at full/affiliate site and 841 at a CCOP site. Of those patients who participated in a full or affiliate site, 11% were African American and 4.1% were Latino with the remainder being White. Similarly of those who participated at a CCOP site, 11.4% were African American and were 4.5% Latino. Concerning distance traveled to different types of sites, travel to full/affiliate membership sites was greatest for Whites (median 13.4 miles) and least for African Americans (median 5.75 miles). Whites and Latinos traveled a significant greater distance to a Full/Affiliate sites compared to a community sites (p<0.0001 and p=.01 respectively) whereas African American's travel distance to Full/Affiliate or community sites was not significantly different (p=0.60). Per post hoc analysis, White patients traveled significant longer than African American or Latinos patients to community sites (p<0.0001, p=0.001, respectively). For full/affiliate sites (non-community), African Americans traveled a significantly shorter distance when compared to Latinos or Whites (p<0.0001 for both).
Conclusion: Distance traveled to participate in clinical trials is an area which requires consideration especially in radiation treatment trials. Different racial/ethnic groups experience different travel burden sometimes based on where they live. For urban dwellers, factors such as public and private transportation options including access to private car, bus and rail routes, bus and rail stops, transfers, walk times and wait times are important to consider in addition to distance. For rural residents, distance traveled and economic factors, such as gas prices are important. With a greater understanding of travel burden for clinical trial participants, we can alter outreach efforts to include more minorities in cancer clinical trials to help improve treatment outcomes.
(This study was supported by the Pennsylvania Commonwealth Universal Research Enhancement (C.U.R.E.) Program ME-02-149, RTOG U10 CA21661 and CCOP U10 CA37422 grants from the NCI.)
Citation Format: Katherine A. Yeager, Jesse Bruner, Stephanie L. Pugh, Deborah Watkins Bruner. Clinical trial participation: Differences in distance traveled across different ethnic groups. [abstract]. In: Proceedings of the Sixth AACR Conference: The Science of Cancer Health Disparities; Dec 6–9, 2013; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2014;23(11 Suppl):Abstract nr A71. doi:10.1158/1538-7755.DISP13-A71
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Yeager KA, Bauer-Wu S. Cultural humility: essential foundation for clinical researchers. Appl Nurs Res 2013; 26:251-6. [PMID: 23938129 DOI: 10.1016/j.apnr.2013.06.008] [Citation(s) in RCA: 135] [Impact Index Per Article: 12.3] [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: 03/07/2013] [Revised: 06/28/2013] [Accepted: 06/30/2013] [Indexed: 11/30/2022]
Abstract
Cultural humility is a process of self-reflection and discovery in order to build honest and trustworthy relationships. It offers promise for researchers to understand and eliminate health disparities, a continual and disturbing problem necessitating attention and action on many levels. This paper presents a discussion of the process of cultural humility and its important role in research to better understand the perspectives and context of the researcher and the research participant. We discern cultural humility from similar concepts, specifically cultural competence and reflexivity. We will also explore ways to cultivate cultural humility in the context of human subjects research. Mindfulness is one approach that can be helpful in enhancing awareness of self and others in this process. With a foundation in cultural humility, nurse researchers and other investigators can implement meaningful and ethical projects to better address health disparities.
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Affiliation(s)
- Katherine A Yeager
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA 30322, USA.
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McGuire DB, Reifsnyder J, Soeken K, Kaiser KS, Yeager KA. Assessing pain in nonresponsive hospice patients: development and preliminary testing of the multidimensional objective pain assessment tool (MOPAT). J Palliat Med 2011; 14:287-92. [PMID: 21265631 DOI: 10.1089/jpm.2010.0302] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Accurate assessment in hospice patients who cannot communicate their pain is almost impossible, increasing their risk for unrecognized and inadequately managed pain. OBJECTIVE The purpose of this article is to describe a series of small-scale projects aimed at developing and refining an instrument to assess acute pain in noncommunicative hospice patients. METHODS Project 1 was a clinical project in which focus groups with hospice nurses yielded an adaptation of an existing pain assessment measure that was named the Multidimensional Objective Pain Assessment Tool (MOPAT) and had behavioral and physiological subscales. Projects 2 and 3 tested the MOPAT in 30 cognitively impaired/nonresponsive hospice inpatients and 28 alert and oriented hospice inpatients, with study nurses and hospice nurses rating pain with the MOPAT before and after a pain-relieving intervention and rating its clinical usefulness. Projects 3 and 4 analyzed the reliability, validity, and clinical utility of the MOPAT. RESULTS Overall internal consistency reliability of the MOPAT was demonstrated with Cronbach's α coefficients of 0.79 before and 0.84 after the pain-relieving intervention. The behavioral and physiological subscale scores changed significantly (p < .035) after pain medication, demonstrating sensitivity to changes in pain. Principal components factor analysis revealed two factors matching the subscales and accounting for 66% of the variance. Nearly all the hospice nurses found the MOPAT helpful, easy to use and understand, and conducive to use in daily practice. CONCLUSION The MOPAT has preliminary evidence of reliability, validity, and clinical utility. Full-scale psychometric testing in hospice and acute care hospital patients is currently underway.
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Affiliation(s)
- Deborah B McGuire
- University of Maryland School of Nursing , Baltimore, MD 21201, USA.
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DiIorio C, Escoffery C, McCarty F, Yeager KA, Henry TR, Koganti A, Reisinger EL, Wexler B. Evaluation of WebEase: an epilepsy self-management Web site. Health Educ Res 2009; 24:185-197. [PMID: 18682382 DOI: 10.1093/her/cyn012] [Citation(s) in RCA: 66] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
People with epilepsy have various education needs and must adopt many self-management behaviors in order to control their condition. This study evaluates WebEase, an Internet-based, theory-driven, self-management program for adults with epilepsy. Thirty-five participants took part in a 6-week pilot implementation of WebEase. The main components of WebEase are My Log, a behavioral journal, and the Medication, Stress and Sleep Modules, which provide tailored information and feedback designed to prompt participants to assess their status with self-management behaviors, think about their behaviors and make a goal. In this article, we discuss the results of the feasibility, acceptability and usability assessments and the behavioral outcomes. The process results indicate that theoretical components that served as the program framework were successfully integrated into the program and that participants viewed WebEase as relevant, acceptable and easy to use. Additionally, participants showed some improvement in epilepsy self-management, adherence, sleep quality, self-efficacy and social support following the program. The initial results are encouraging and continued development of WebEase has the potential to facilitate education and self-management strategies among people with epilepsy.
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Affiliation(s)
- Colleen DiIorio
- Department of Behavioral Sciences.ealth Education, Rollins School of Public Health, Emory University, Atlanta, GA 30322, USA.
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DiIorio C, Escoffery C, Yeager KA, Koganti A, Reisinger E, Koganti A, McCarty F, Henry TR, Robinson E, Kobau R, Price P. WebEase: development of a Web-based epilepsy self-management intervention. Prev Chronic Dis 2008; 6:A28. [PMID: 19080034 PMCID: PMC2644585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
People with epilepsy must adopt many self-management behaviors, especially regarding medication adherence, stress management, and sleep quality. In response to the need for theory-based self-management programs that people with epilepsy can easily access, the WebEase Web site was created and tested for feasibility, acceptability, and usability. This article discusses the theoretical background and developmental phases of WebEase and lessons learned throughout the development process. The WebEase research team developed content for the Web site on the basis of social cognitive theory, the transtheoretical model of behavior change, and motivational interviewing. Formative research and development of the WebEase program included a literature search, computer use survey, a focus group, and review by content experts and consumers. The program has 2 main components: 1) the modules, which provide a tailored opportunity for learning, reflection, and goal setting, and 2) MyLog, a place to enter daily information.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Rosemarie Kobau
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Patricia Price
- Centers for Disease Control and Prevention, Atlanta, Georgia
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Escoffery C, Diiorio C, Yeager KA, McCarty F, Robinson E, Reisinger E, Henry T, Koganti A. Use of computers and the Internet for health information by patients with epilepsy. Epilepsy Behav 2008; 12:109-14. [PMID: 17959420 DOI: 10.1016/j.yebeh.2007.07.013] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2007] [Revised: 07/10/2007] [Accepted: 07/14/2007] [Indexed: 10/22/2022]
Abstract
The purpose of this study was to describe computer and Internet use among an online group and a clinic-based group of people with epilepsy. Greater than 95% of the online group and 60% of the clinic group have access to computers and the Internet. More than 99% of the online group and 57% of the clinic group used the Internet to find health information. A majority of people reported being likely to employ an Internet-based self-management program to control their epilepsy. About 43% reported searching for general information on epilepsy, 30% for medication, 23% for specific types of epilepsy, and 20% for treatment. This study found that people with epilepsy have access to computers and the Internet, desire epilepsy-specific information, and are receptive to online health information on how to manage their epilepsy.
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Affiliation(s)
- Cam Escoffery
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, GA 30322, USA.
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Pluhar E, McDonnell Holstad M, Yeager KA, Denzmore-Nwagbara P, Corkran C, Fielder B, McCarty F, Diiorio C. Implementation of audio computer-assisted interviewing software in HIV/AIDS research. J Assoc Nurses AIDS Care 2007; 18:51-63. [PMID: 17662924 PMCID: PMC2075082 DOI: 10.1016/j.jana.2007.05.002] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.5] [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: 01/23/2006] [Indexed: 10/23/2022]
Abstract
Computer-assisted interviewing (CAI) has begun to play a more prominent role in HIV/AIDS prevention research. Despite the increased popularity of CAI, particularly audio computer-assisted self-interviewing (ACASI), some research teams are still reluctant to implement ACASI technology because of lack of familiarity with the practical issues related to using these software packages. The purpose of this report is to describe the implementation of one particular ACASI software package, the Questionnaire Development System (QDS; Nova Research Company, Bethesda, MD), in several nursing and HIV/AIDS prevention research settings. The authors present acceptability and satisfaction data from two large-scale public health studies in which they have used QDS with diverse populations. They also address issues related to developing and programming a questionnaire; discuss practical strategies related to planning for and implementing ACASI in the field, including selecting equipment, training staff, and collecting and transferring data; and summarize advantages and disadvantages of computer-assisted research methods.
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Affiliation(s)
- Erika Pluhar
- Rollins School of Public Health at Emory University, Atlanta, GA, USA
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Yeager KA, Diiorio C, Shafer PO, McCarty F, Letz R, Henry T, Schomer DL. The complexity of treatments for persons with epilepsy. Epilepsy Behav 2005; 7:679-86. [PMID: 16150652 DOI: 10.1016/j.yebeh.2005.07.008] [Citation(s) in RCA: 14] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2005] [Revised: 06/30/2005] [Accepted: 07/06/2005] [Indexed: 11/24/2022]
Abstract
The purpose of this study was to describe the types of antiepileptic medication regimens and the types of actions required to take medications for a group of patients with epilepsy. The Epilepsy Medication and Treatment Complexity Index (EMTCI) was used to gather information about medications and treatments. The sample of 314 reported on 585 epilepsy medications. The majority (56%) were on more than one treatment. On average, an individual took 1.86 medications per day (range, 1-6) and 7.98 pills per day (range, 1-36 pills). Most medications (54%) were taken twice a day. The most common special instruction was taking different doses on the same day. Taking more than one tablet per dose was the most common administrative action. Data presented here raise interesting areas for further research as well as important clinical implications.
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Affiliation(s)
- Katherine A Yeager
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, 1520 Clifton Road, Atlanta, GA 30322, USA.
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DiIorio C, Yeager KA, Donahue BH, Wasserman J, Postier A, Broderick L. An Evaluation of Neuroscience Nursing Research Published During the Decade of the Brain. J Neurosci Nurs 2004; 36:58-66, 71. [PMID: 15115359 DOI: 10.1097/01376517-200404000-00002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [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: 11/25/2022]
Abstract
The purpose of this study was to extend a previous evaluation of neuroscience nursing research to an assessment of the research published during the 1990s--the Decade of the Brain. The evaluation was conducted to assess the focus of neuroscience nursing research and to identify research strategies and scientific methods. The Journal of Neuroscience Nursing, Nursing Research, Research in Nursing & Health, and Western Journal of Nursing Research were canvassed. An assessment form developed by the authors was used to evaluate selected articles published between January 1989 and December 2000. The number of neuroscience research studies published in nursing journals increased substantially during the 1990s. The studies focused more on individuals with neurological disorders and less on neurological trauma. The findings demonstrated major changes in subspecialty area, care orientation, and nature of study variables from that observed in the previous evaluation in which acute care and physiological variables were most representative of the pre-1989 studies. As noted in the previous evaluation, the trend toward theory-then-research studies continued and the scientific methods grew more complex.
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Affiliation(s)
- Colleen DiIorio
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, GA, USA.
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Letz R, DiIorio CK, Shafer PO, Yeager KA, Henry TR, Schomer DL. A computer-based reading test for use as an index of premorbid general intellectual level in North American English-speaking adults. Neurotoxicology 2003; 24:503-12. [PMID: 12900063 DOI: 10.1016/s0161-813x(03)00076-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [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: 11/21/2022]
Abstract
Brief tests of vocabulary or reading ability are often used as an index of general intellectual level to hypothesize deficits in patients, to establish comparability of comparison groups, and as a covariate of performance on other neuropsychological tests. We evaluated a new variant of a reading test for potential use in estimating premorbid general intellectual ability and implementation as a computerized-adaptive test. A total of 319 outpatients who participated in an epilepsy self-management study were tested on three occasions, completing the Wide-Range Achievement Test-3 (WRAT-3) Reading test at baseline and the NES3 Adult Reading Test (ART) at the 3-month follow-up. At the 6-month follow-up, some participants completed the ART and some the NES2 Vocabulary test. ART and WRAT-3 Reading scores obtained 3 months apart were highly correlated (r=0.87, n=179), while ART and NES2 Vocabulary scores were somewhat less correlated (r=0.80, n=61). The ART test-retest correlation was high (r=0.95, n=79). The ART distribution was spread out more evenly at the high end than that of the WRAT-3 Reading. ART score was significantly related to education, race, income, and examiner category, but was unrelated to age category and depression status. Non-significant gender differences were observed. An item-response theory (Rasch model) analysis showed good fit of the model to the observed data and yielded an improved ranking of the ART items in order of difficulty. The NES3 ART exhibited high reliability and strong association with WRAT-3 Reading. These results suggest that the NES3-ART may be useful as an index of general intellectual ability for comparison of groups and for use as a covariate in data analyses among English-speaking, North American adults. The Rasch model analysis provides a basis for implementing the ART as a computerized-adaptive test, which should improve its time efficiency and reduce participant burden in taking the test.
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Affiliation(s)
- Richard Letz
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, GA 30306, USA.
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Abstract
NES3 is a computer-based neurobehavioral testing system designed for use in investigating potential cognitive impairment. Data from NES3 tests employed in a study of epilepsy self-management were analyzed to estimate test-retest reliability for NES3 tests on a large sample and to estimate the effect of some common covariates of test performance. A total of 319 participants in an epilepsy self-management study were examined on three occasions (baseline, 3-month follow-up, and 6-month follow-up) with a set of psychological questionnaires and seven neuropsychological tests from NES3. Test-retest correlations were calculated between measures obtained at baseline and at 3 months. Principal components analysis was performed on the baseline data. The potential effects of covariates (age, education, reading test scores, depression status, and examiner) were investigated in regression models. Three-month test-retest correlations were excellent for Adult Reading Test (ART) (r=0.95), strong for Digit-Symbol (r=0.82), Sequence B (r=0.79), and Sequence A (r=0.76); and modest (r's between 0.56 and 0.67) for Digit Span Forward and Backward, Visual Span Forward and Backward, and Pattern Memory. Alternate-forms correlations were strong for HVLT (r's between 0.71 and 0.82). Principal components analysis yielded four interpretable components. Age and reading score were significant covariates of virtually all of the test summary measures, while education, gender, race, and depression were not generally significant covariates. Changes to the method of calculation of some summary measures, changes to the initial instructions to the subjects, and addition of correctional feedback to subjects during the tests appeared to improve the reliability of some NES3 tests. Implementation of the HVLT and ART in computer-assisted format added breadth of coverage to the battery. NES3 tests may provide reliable, efficient data for use in epidemiologic studies of potential cognitive effects of occupational and environmental exposures.
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Affiliation(s)
- Richard Letz
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, GA, USA.
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