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Huang L, Riggan KA, Torbenson VE, Osborne AK, Chesak SS, Finney RE, Allyse MA, Rivera-Chiauzzi EY. Second Victim Experiences of Health Care Learners and the Influence of the Training Environment on Postevent Adaptation. Mayo Clin Proc Innov Qual Outcomes 2024; 8:232-240. [PMID: 38708189 PMCID: PMC11068502 DOI: 10.1016/j.mayocpiqo.2024.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/07/2024] Open
Abstract
Objective To investigate the experience of medical and graduate learners with second victim experience (SVE) after medical errors or adverse patient outcomes, including impact on training and identification of factors that shape their postevent recovery. Patients and Methods The validated Second Victim Experience and Support Tool-Revised (SVEST-R), Physician Well-Being Index, and supplemental open-ended questions were administered to multidisciplinary health care learners between April 8, 2022, and May 30, 2022, across a large academic health institution. Open-ended responses were qualitatively analyzed for iterative themes related to impact of SVE on the training experience. Results Of the 206 survey respondents, 144 answered at least 1 open-ended question, with 62.1% (n=91) reporting at least 1 SVE. Participants discussed a wide range of SVEs and indicated that their postevent response was influenced by their training environment. Lack of support from supervisors and staff exacerbated high stress situations. Some trainees felt blamed and unsupported after a traumatic experience. Others emphasized that positive training experiences and supportive supervisors helped them grow and regain confidence. Learners described postevent processing strategies helpful to their recovery. Some, however, felt disincentivized from seeking support. Conclusion This multidisciplinary study of learners found that the training environment was influential in postevent recovery. Our findings support the need for the inclusion of education on SVEs and adaptive coping mechanisms as part of health care professional educational curriculums. Educators and health care staff may benefit from enhanced education on best practices to support trainees after stressful or traumatic patient events.
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Affiliation(s)
- Lily Huang
- Department of Quantitative Health Sciences, Mayo Clinic, Jacksonville, FL
| | | | | | - Alayna K. Osborne
- Division of Community and Employee Engagement, Mayo Clinic Health System–Southwest Minnesota region, Mankato, MN
| | | | - Robyn E. Finney
- Department of Anesthesiology and Perioperative Medicine and Healing the Emotional Lives of Peers Program, Mayo Clinic, Rochester, MN
| | - Megan A. Allyse
- Biomedical Ethics Research Program, Mayo, q1Clinic, Rochester, MN
- Department of Obstetrics & Gynecology, Mayo Clinic, Rochester, MN
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Riggan KA, Nguyen NV, Ennis JS, DeBruin DA, Sharp RR, Tilburt JC, Wolf SM, DeMartino ES. Behind the scenes: facilitators and barriers to developing state scarce resource allocation plans for the COVID-19 pandemic. Chest 2024:S0012-3692(24)00541-5. [PMID: 38710464 DOI: 10.1016/j.chest.2024.04.006] [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: 10/11/2023] [Revised: 03/22/2024] [Accepted: 04/03/2024] [Indexed: 05/08/2024] Open
Abstract
BACKGROUND In response to COVID-19, many states revised, developed, or attempted to develop plans to allocate scarce critical care resources in the event crisis standards of care were triggered. No prior analysis has assessed this plan development process, including whether plans were successfully adopted. RESEARCH QUESTION How did states develop or revise scarce resource allocation plans during the COVID-19 pandemic and what were the barriers and facilitators to their development and adoption at the state level? STUDY DESIGN AND METHODS Plan authors and state leaders completed a semi-structured interview February to September 2022. Interview transcripts were qualitatively analyzed for themes related to plan development and adoption according to the principles of grounded theory. RESULTS Thirty-six participants from 34 states completed an interview, from states distributed across all U.S. regions. Among participants' states with plans that existed prior to 2020 (n=24), 17 were revised and adopted in response to COVID-19. Six states wrote a plan de novo, with the remaining states failing to develop or adopt a plan. Thirteen states continued to revise their plans in response to disability or aging bias complaints or to respond to evolving needs. Many participants expressed that urgency in the early days of the pandemic prevented an ideal development process. Facilitators of successful plan development and adoption include: coordination or support from the state department of health and existing relationships with key community partners, including aging and disability rights groups and minoritized communities. Barriers include: lack of perceived political interest in a plan and development during a public health emergency. INTERPRETATION To avoid repeating mistakes from the early days of the COVID response, states should develop or revise plans with community engagement and consider maintaining a standing committee with diverse membership and content expertise to periodically review plans and advise state officials on pandemic preparedness.
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Affiliation(s)
| | | | - Jackson S Ennis
- Biomedical Ethics Research Program, Mayo Clinic, Rochester, MN
| | - Debra A DeBruin
- Center for Bioethics, University of Minnesota, Minneapolis, MN
| | - Richard R Sharp
- Biomedical Ethics Research Program, Mayo Clinic, Rochester, MN
| | - Jon C Tilburt
- Biomedical Ethics Research Program, Mayo Clinic, Rochester, MN; Division of General Internal Medicine, Mayo Clinic, Scottsdale, AZ
| | - Susan M Wolf
- University of Minnesota Medical School, Minneapolis, MN; University of Minnesota Law School, Minneapolis, MN
| | - Erin S DeMartino
- Biomedical Ethics Research Program, Mayo Clinic, Rochester, MN; Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN
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Riggan KA, Ormond KE, Allyse MA, Close S. Evidence-based recommendations for delivering the diagnosis of X & Y chromosome multisomies in children, adolescents, and young adults: an integrative review. BMC Pediatr 2024; 24:263. [PMID: 38649921 PMCID: PMC11034074 DOI: 10.1186/s12887-024-04723-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2023] [Accepted: 03/26/2024] [Indexed: 04/25/2024] Open
Abstract
BACKGROUND The diagnosis of supernumerary X & Y chromosome variations has increased following the implementation of genetic testing in pediatric practice. Empirical evidence suggests that the delivery of the diagnosis has a lasting impact on how affected individuals and their parents perceive and adapt to the diagnosis. The purpose of this review is to synthesize the literature to obtain useful recommendations for delivering a pediatric diagnosis of a sex chromosome multisomy (SCM) based upon a growing body of quantitative and qualitative literature on patient experiences. METHODS We conducted an integrative literature review using PubMed, Web of Science and CINAHL employing keywords "genetic diagnosis delivery," "genetic diagnosis disclosure," "sex chromosome aneuploidy," "Klinefelter syndrome" or ""47, XXY," "Jacob syndrome" or "47, XYY," "Trisomy X," "Triple X" or "47, XXX," and "48 XXYY from January 1, 2000, to October 31, 2023. RESULTS Literature supports that patients and parents value the provision of up-to-date information and connection with supportive resources. Discussion of next steps of care, including relevant referrals, prevents perceptions of provider abandonment and commitment to ongoing support. Proactively addressing special concerns such as disclosing the diagnosis to their child, family, and community is also beneficial. Tables are provided for useful information resources, medical specialties that may be required to support patients, and common misconceptions that interfere with accurate information about the diagnosis. CONCLUSION Patient experiences suggest there should be heightened attention to diagnosis delivery, in reference to the broader ethical and social impacts of a SCM diagnosis. We present recommendations for optimal disclosure of a SCM diagnosis in early and late childhood, adolescence, and young adulthood.
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Affiliation(s)
- Kirsten A Riggan
- Biomedical Ethics Research Program, Mayo Clinic, Rochester, MN, USA
| | - Kelly E Ormond
- Department of Health Sciences and Technology, Health Ethics and Policy Lab, ETH-Zurich, Zurich, Switzerland
- Department of Genetics, Stanford University School of Medicine, Stanford, CA, USA
| | - Megan A Allyse
- Biomedical Ethics Research Program, Mayo Clinic, Rochester, MN, USA
- Department of Obstetrics & Gynecology, Mayo Clinic, Rochester, MN, USA
| | - Sharron Close
- Nell Hodgson Woodruff School of Nursing, Emory University, 1520 Clifton Road NE, Atlanta, GA, 30342, USA.
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Artal JM, Randall L, Rubeck S, Allyse M, Michie M, Riggan KA, Meredith S, Skotko BG. Parents of children with Down syndrome reflect on their postnatal diagnoses, 2003-2022. Am J Med Genet A 2024:e63619. [PMID: 38619097 DOI: 10.1002/ajmg.a.63619] [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: 01/30/2024] [Revised: 03/20/2024] [Accepted: 03/22/2024] [Indexed: 04/16/2024]
Abstract
A 2003 survey revealed the scope of mothers' dissatisfaction with their postnatal support following a diagnosis of Down syndrome (DS). Substantial proportions of mothers reported that providers conveyed diagnoses with pity, emphasized negative aspects of DS, and neglected to provide adequate materials explaining DS. This study follows up on the 2003 survey by assessing whether parents' experiences have improved. Four DS nonprofit organizations, which participated in the original study, distributed a mixed-methods survey to families who have had children with DS between 2003 and 2022. Quantitative analysis assessed correlations among responses and differences between the 2003 and 2022 survey groups. Open-ended responses were qualitatively analyzed. Compared to the 2003 findings, parents' perceptions of their postnatal care have not improved (N = 89). Parents are increasingly likely to report that their providers pitied them, omitted positive aspects of DS, and provided insufficient materials describing DS. Substantial proportions of parents reported fear (77%) and anxiety (79%), only 24% described receiving adequate explanatory materials, and parents were 45% likelier to report that physicians discussed negative aspects of DS than positive aspects. Qualitatively, substantial numbers of parents recounted insensitive conduct by providers. These results suggest that despite interventions, parents' experiences of postnatal diagnoses of DS have not improved over time. Certain provider behaviors-such as describing positive aspects of DS and providing comprehensive explanatory materials-can reduce fear and anxiety, pointing to directions for reform.
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Affiliation(s)
- Jonathan M Artal
- Stanford Law School, Stanford University, Stanford, California, USA
- Down Syndrome Program, Division of Medical Genetics and Metabolism, Department of Pediatrics, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Lindsey Randall
- The Mayo Clinic Alix School of Medicine, Rochester, Minnesota, USA
- Mayo Clinic Graduate School of Biomedical Sciences, Rochester, Minnesota, USA
| | - Sabina Rubeck
- Department of Bioethics, School of Medicine, Case Western Reserve University, Cleveland, Ohio, USA
| | - Megan Allyse
- Biomedical Ethics Research Program, Mayo Clinic, Jacksonville, Florida, USA
- Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, MN
| | - Marsha Michie
- Department of Bioethics, School of Medicine, Case Western Reserve University, Cleveland, Ohio, USA
| | - Kirsten A Riggan
- Biomedical Ethics Research Program, Mayo Clinic, Jacksonville, Florida, USA
| | - Stephanie Meredith
- Human Development Institute, University of Kentucky, Lexington, Kentucky, USA
| | - Brian G Skotko
- Down Syndrome Program, Division of Medical Genetics and Metabolism, Department of Pediatrics, Massachusetts General Hospital, Boston, Massachusetts, USA
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA
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Riggan KA, Barwise A, Yap JQ, Condon N, Allyse MA. Patient experiences with prenatal cell-free DNA screening in a safety net setting. Prenat Diagn 2024; 44:409-417. [PMID: 38423995 PMCID: PMC11027152 DOI: 10.1002/pd.6541] [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: 09/30/2023] [Revised: 01/12/2024] [Accepted: 02/03/2024] [Indexed: 03/02/2024]
Abstract
OBJECTIVES Thirty-five states, including Florida, now cover cell-free DNA (cfDNA) screening of fetuses for all pregnant patients enrolled in state public insurance programs. We interviewed Black and Hispanic obstetric patients at a safety net clinic in Florida shortly after the state rolled out cfDNA as a first-tier screening method for publicly insured patients. METHODS Black and Hispanic patients receiving prenatal care from a prenatal or maternal fetal medicine clinic at a federally qualified health center in Jacksonville, FL were invited to participate in a qualitative interview in English or Spanish to explore experiences and perceptions of prenatal cfDNA screening. Participants were recruited following their first prenatal visit when cfDNA is typically introduced. Interview transcripts were qualitatively analyzed for iterative themes based on principles of grounded theory. RESULTS One hundred Black and Hispanic patients (n = 51 non-Hispanic Black, n = 43 Hispanic, n = 3 Hispanic Black, n = 3 Not Reported/Other) completed an interview. Participants described minimal opportunity for pre-screening counseling and limited health literacy about cfDNA or its uses. Some believed that cfDNA could positively impact pregnancy health. Many were unsure if they had received cfDNA even though they were aware of the information provided by it. Most participants expressed an interest in cfDNA as a means for early detection of fetal sex and as an additional indication of general fetal health. CONCLUSIONS Patient experiences indicate limited informed consent and decision-making for cfDNA, discordant with professional guidelines on pre-screen counseling. Our findings suggest that there should be additional investment in implementing cfDNA in safety net settings to ensure that patients and providers receive the support necessary for effective patient counseling and follow-on care for the ethical implementation of cfDNA.
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Affiliation(s)
| | - Amelia Barwise
- Biomedical Ethics Research Program, Mayo Clinic, Rochester, MN
| | - Jane Q. Yap
- Department of Quantitative Health Sciences, Mayo Clinic, Jacksonville, FL
| | - Niamh Condon
- Department of Maternal-Fetal Medicine, University of Florida Health, Jacksonville, FL
| | - Megan A. Allyse
- Biomedical Ethics Research Program, Mayo Clinic, Rochester, MN
- Department of Obstetrics & Gynecology, Mayo Clinic, Rochester, MN
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Ahlawat N, Elliott K, Ormond KE, Allyse MA, Riggan KA. Healthcare and support experiences of adolescents and young adults diagnosed with 47,XXY, 47,XXX, and 48,XXYY. J Community Genet 2024; 15:75-83. [PMID: 37864743 PMCID: PMC10857988 DOI: 10.1007/s12687-023-00682-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Accepted: 10/06/2023] [Indexed: 10/23/2023] Open
Abstract
Sex chromosome aneuploidies (SCAs) are among the most common chromosomal conditions. There is little scholarship on how adolescents and young adults (AYAs) affected by SCA engage with and adapt to their diagnosis. In order to understand how AYAs adapt to a SCA diagnosis, we conducted a secondary analysis of qualitative interviews with AYAs. Eight in-depth semi-structured interviews with individuals with a diagnosis of 47,XXY, 47,XXX, and 48,XXYY were analyzed for iterative themes related to adaptation to a SCA diagnosis in accordance with standard qualitative methodology. Our findings suggest that the process of adaptation is highly variable and complex and is mediated by external factors including diagnosis delivery and community support. Factors associated with adaptation include feeling understood and supported by healthcare providers; researching the condition; receiving hormone replacement therapy; and receiving support from a community of peers. As access to prenatal and pediatric genetic testing continues to expand, non-genetic pediatric providers are increasingly likely to interact with individuals with SCAs as part of their initial diagnostic odyssey or ongoing medical management. Understanding the diversity of lived experiences of AYAs with SCAs is helpful for healthcare providers to facilitate holistic care and provide meaningful support to patients.
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Affiliation(s)
- Nivedita Ahlawat
- Department of Genetics, Stanford University School of Medicine, Stanford, CA, USA
- Verily Life Sciences, San Francisco, CA, USA
| | - Kathryn Elliott
- Department of Genetics, Stanford University School of Medicine, Stanford, CA, USA
- Kaiser Permanente San Francisco, San Francisco, CA, USA
| | - Kelly E Ormond
- Department of Genetics, Stanford University School of Medicine, Stanford, CA, USA
- Stanford Center for Biomedical Ethics, Stanford University School of Medicine, Stanford, CA, USA
- Health Ethics and Policy Lab, Department of Health Sciences and Technology, ETH Zurich, Zurich, Switzerland
| | - Megan A Allyse
- Quantitative Health Sciences, Mayo Clinic, Jacksonville, FL, USA
- Obstetrics and Gynecology, Mayo Clinic, Rochester, MN, USA
- Biomedical Ethics Research Program, Mayo Clinic, 200 First Street S.W., Rochester, MN, 55905, USA
| | - Kirsten A Riggan
- Biomedical Ethics Research Program, Mayo Clinic, 200 First Street S.W., Rochester, MN, 55905, USA.
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James SE, Riggan KA, Halyard M, Kelly M, Cobran E, Allyse MA. The "Strong Black Woman" Paradox: Insights from a Cohort of Black Breast and Ovarian Cancer Patients and Family Members. J Racial Ethn Health Disparities 2024:10.1007/s40615-023-01905-x. [PMID: 38191790 DOI: 10.1007/s40615-023-01905-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Revised: 12/22/2023] [Accepted: 12/26/2023] [Indexed: 01/10/2024]
Abstract
BACKGROUND The strong Black woman (SBW) stereotype can be seen as a positive view of Black women and even a standard to uphold. SBW internalization is a coping mechanism for dealing with racism and sexism. However, multiple recent studies have indicated that Black women in the modern era experience the paradox of SBW internalization having negative generational health effects. We interviewed Black women with a personal or relation diagnosis of breast or ovarian cancer to understand their views and experiences, including how the perception of the SBW stereotype influenced their care. METHODS Qualitative semi-structured interviews were conducted via telephone or video conference and transcribed verbatim. Transcripts were qualitatively analyzed for iterative themes related to cancer care and psychosocial support. RESULTS Sixty-one Black women completed an interview. Responses in multiple transcripts expressed experiences and sentiments consistent with the SBW stereotype, including the importance of maintaining the appearance of strength during their cancer journey. This resulted in some patients declining assistance during their cancer journeys. Participants shared a hope that there would be more willingness to show vulnerability so that future generations of cancer patients receive adequate support. Key aspects of the SBW stereotype were also cited as potential contributors to ongoing racial disparities in breast and ovarian cancer outcomes. CONCLUSION(S) Participants described a paradox of the SBW stereotype that is ultimately detrimental to health and wellbeing. Healthcare professionals and cancer researchers should be aware of this phenomenon to address cancer care more appropriately in Black women.
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Affiliation(s)
- Sarah E James
- Department of Radiation Oncology, Mayo Clinic, Phoenix, AZ, USA.
- Coalition of Blacks Against Breast Cancer, Phoenix, AZ, USA.
| | - Kirsten A Riggan
- Biomedical Ethics Research Program, Mayo Clinic, Rochester, MN, USA
| | - Michele Halyard
- Department of Radiation Oncology, Mayo Clinic, Phoenix, AZ, USA
- Coalition of Blacks Against Breast Cancer, Phoenix, AZ, USA
| | - Marion Kelly
- Coalition of Blacks Against Breast Cancer, Phoenix, AZ, USA
- Department of Community Engagement, Mayo Clinic, Scottsdale, AZ, USA
| | - Ewan Cobran
- Department of Quantitative Health Science, Mayo Clinic, Scottsdale, AZ, USA
| | - Megan A Allyse
- Biomedical Ethics Research Program, Mayo Clinic, Rochester, MN, USA
- Department of Obstetrics & Gynecology, Mayo Clinic, Rochester, MN, USA
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Nguyen NV, Riggan KA, Ennis JS, Tilburt JC, Smith AK, Kramer DB, Sulmasy DP, DeMartino ES. Estimating population impact of state triage policies restricting healthcare access for older adults with chronic conditions. J Am Geriatr Soc 2024; 72:294-296. [PMID: 37694828 PMCID: PMC10872914 DOI: 10.1111/jgs.18589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Accepted: 08/19/2023] [Indexed: 09/12/2023]
Affiliation(s)
| | | | | | - Jon C. Tilburt
- Biomedical Ethics Research Program, Mayo Clinic, Rochester, MN
- Division of General Internal Medicine, Mayo Clinic, Scottsdale, AZ
| | - Alexander K. Smith
- Department of Medicine, Division of Geriatrics, University of California, San Francisco, San Francisco, CA
- San Francisco Veterans Affairs Medical Center, San Francisco, CA
| | - Daniel B. Kramer
- Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston MA
- Harvard Medical School Center for Bioethics, Boston MA
| | - Daniel P. Sulmasy
- Departments of Medicine and Philosophy, Georgetown University, Washington, DC
- Kennedy Institute of Ethics, Georgetown University, Washington, DC
| | - Erin S. DeMartino
- Biomedical Ethics Research Program, Mayo Clinic, Rochester, MN
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN
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Rivera-Chiauzzi EY, Huang L, Osborne AK, Musch AA, Berkland BE, Meyer AT, Vitek SM, Wieneke KC, Allyse MA, Riggan KA, Finney RE. Rapid Expansion of the Healing Emotional Lives of Peers Program During COVID-19: A Second Victim Peer Support Program for Healthcare Professionals. J Patient Saf 2024; 20:28-37. [PMID: 37966348 DOI: 10.1097/pts.0000000000001179] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2023]
Abstract
OBJECTIVES In 2018, the Healing Emotional Lives of Peers (HELP) Program was implemented at Mayo Clinic Rochester to guide healthcare professionals (HCPs) after a second victim experience, such as adverse patient events or medical errors. The HELP program was expanded to all HCPs in response to the anticipated stressors of the COVID-19 pandemic. This article aims to describe the rapid expansion of the peer support program and evaluate the effectiveness of peer support provided to affected colleagues (ACs). METHODS Quantitative data collected from workshop evaluations, activations, and associated metrics ( TPS Self-Assessment , Encounter Form , and AC Self-Assessment ) were summarized through standard descriptive statistics using SAS version 9.4 software. Open-ended responses were qualitatively analyzed for iterative themes about the HELP program and associated workshops. RESULTS Between April 2020 and December 2021, 22 virtual workshops to train peer supporters were conducted with 827 attendees. Of these, 464 employees completed the workshop evaluation. A total of 94.2% rated the workshop as excellent or very good. Participants perceived the workshop to be highly effective and felt more prepared to support ACs. Between May 2020 and December 2021, 247 activations were submitted through the HELP Program's intranet Web site and peer support was requested for 649 employees. Of the 268 TPS Self-Assessments , 226 (84.3%) felt that they provided helpful support to an AC. One hundred ACs evaluated support received, with 93% being "extremely" or "very satisfied." Affected colleagues appreciated having a TPS provide judgment-free support. CONCLUSIONS The HELP Program promotes a culture of safety by helping HCPs process traumatic events. To effectively meet the needs of patients, healthcare organizations need to prioritize the well-being of their employees through interpersonal support.
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Affiliation(s)
| | - Lily Huang
- Department of Quantitative Health Sciences, Mayo Clinic, Jacksonville, Florida
| | - Alayna K Osborne
- Division of Community and Employee Engagement, Mayo Clinic Health System-Southwest Minnesota Region, Mankato
| | | | | | - Anne T Meyer
- Department of Human Resources-Employee Well-Being
| | | | | | | | | | - Robyn E Finney
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota
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Batbold S, Duke JD, Riggan KA, DeMartino ES. Decision-Making for Hospitalized Incarcerated Patients Lacking Decisional Capacity. JAMA Intern Med 2024; 184:28-35. [PMID: 38048093 PMCID: PMC10696514 DOI: 10.1001/jamainternmed.2023.5794] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Accepted: 09/07/2023] [Indexed: 12/05/2023]
Abstract
Importance Incarcerated patients admitted to the hospital face threats to their rights to privacy and self-determination in medical decision-making. Little is known about medical decision-making processes for hospitalized incarcerated persons who lack decisional capacity. Objective To characterize the prevalence of incapacity among hospitalized incarcerated patients and describe the decision-making processes, including who served as surrogate decision-makers, involvement of prison employees in medical decisions, and ethical concerns emerging from the patients' care. Design, Setting, and Participants Retrospective descriptive and qualitative study of medical records for all patients admitted from prison for at least 24 hours between January 1, 1999, and September 1, 2019, at a large Midwestern academic medical center. Data analysis was performed from March 15, 2021, to December 14, 2022. Main Outcomes and Measures Prevalence of prison-to-hospital admissions for patients with a loss of capacity and characteristics of medical decision-making. Results During the 20-year study period, 462 patients from the prison were admitted to the hospital, totaling 967 unique admissions. Of these, 131 admissions (14%) involved patients with a loss of capacity and 43 admissions (4%, representing 34 unique patients) required surrogate decision-making. Ten of these patients had advance directives. Surrogate decision-makers often faced decisions about end-of-life care (n = 17) or procedural consent (n = 23). A family member was identified as surrogate decision-maker in 23 admissions. In 6 cases with a kindred surrogate, additional consent was requested from a prison employee. In total, prison employees were documented as being present during or participating in major medical decisions for half of the admissions. Five themes emerged from thematic analysis: uncertainty and misinformation about patient rights and the role of prison employees in medical decision-making with respect to these two themes, privacy violations, deference to prison officials, and estrangement from family and friends outside of the prison. Conclusions and Relevance In this first in-depth description, to date, of decision-making practices for hospitalized incarcerated patients lacking decisional capacity, admissions of these patients generated uncertainty about their rights, sometimes infringing on patients' privacy and autonomy. Clinicians will encounter incarcerated patients in both hospital and clinic settings and should receive education on how to support ethically and legally sound decision-making practices for this medically vulnerable population.
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Affiliation(s)
- Sarah Batbold
- Mayo Clinic Alix School of Medicine, Rochester, Minnesota
| | - Jennifer D. Duke
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, Minnesota
| | - Kirsten A. Riggan
- Biomedical Ethics Research Program, Department of Quantitative Health Sciences, Mayo Clinic, Rochester, Minnesota
| | - Erin S. DeMartino
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, Minnesota
- Biomedical Ethics Research Program, Department of Quantitative Health Sciences, Mayo Clinic, Rochester, Minnesota
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Riggan KA, Weaver AL, Ashby G, Huang L, Long ME, Torbenson VE, Wick MJ, Allyse MA, Rivera-Chiauzzi EY. Influence of the COVID-19 pandemic on prenatal and postpartum patient experiences and well-being. Birth 2023; 50:1034-1044. [PMID: 37555375 PMCID: PMC10843728 DOI: 10.1111/birt.12760] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Revised: 12/08/2022] [Accepted: 07/25/2023] [Indexed: 08/10/2023]
Abstract
BACKGROUND It has yet to be fully elucidated how differing populations of obstetric patients adapted to the disruptions in perinatal care and postpartum support from the COVID-19 pandemic. We surveyed an enriched sample of socioeconomically advantaged patients to understand the influence of COVID-19 on their perinatal care experience, well-being, and coping. METHODS We surveyed pregnant and postpartum patients (n = 6140) at a large academic medical center in the Midwest of the United States using the Coronavirus and Perinatal Experiences instrument in Spring 2021. RESULTS The survey was sent to 6141 pregnant and postpartum patients; 1180 (17.8%) respondents completed the survey, including 256 who were pregnant and 834 postpartum. Most pregnant patients experienced no changes in their prenatal care with 16.5% indicating somewhat worsened care. In the postpartum cohort, 37.5% stated their care had somewhat worsened. In describing influences on stress and mental health, 58.1% of postpartum respondents stated it was moderately, and 17.4% significantly, worse. The pandemic had a somewhat or moderately negative influence for 72.7% of respondents, with 11.0% stating these effects were extremely negative. Both cohorts characterized a range of coping strategies, most commonly, talking with friends and family (76.3%). CONCLUSION(S) Even among this sample of socioeconomically advantaged patients, respondents indicated that the pandemic disrupted many facets of their medical care and daily life, especially social activities and postpartum support. Our findings suggest that counseling on coping and adaptation strategies for stressors and increased health systems support be part of perinatal care during public health emergencies for all demographic groups.
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Affiliation(s)
| | - Amy L. Weaver
- Division of Clinical Trials and Biostatistics, Mayo Clinic, Rochester, MN
| | | | - Lily Huang
- Department of Quantitative Health Sciences, Mayo Clinic, Jacksonville, FL
| | - Margaret E. Long
- Department of Obstetrics & Gynecology, Mayo Clinic, Rochester, MN
| | | | - Myra J. Wick
- Department of Obstetrics & Gynecology, Mayo Clinic, Rochester, MN
| | - Megan A. Allyse
- Biomedical Ethics Research Program, Mayo Clinic, Rochester, MN
- Department of Obstetrics & Gynecology, Mayo Clinic, Rochester, MN
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Rousseau A, Riggan KA, Halyard M, James SE, Kelly M, Phillips D, Allyse MA. Cancer Screening Experiences of Black Breast and Ovarian Cancer Patients and Family Members. J Community Health 2023; 48:882-888. [PMID: 37219788 PMCID: PMC10203662 DOI: 10.1007/s10900-023-01233-5] [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] [Accepted: 04/29/2023] [Indexed: 05/24/2023]
Abstract
Black women experience disproportionate rates of advanced breast cancer diagnoses and mortality. Mammography is a proven and effective tool in early breast cancer detection and impacts patient outcomes. We interviewed Black women with a personal or family history of breast and/or ovarian cancer to understand their screening experiences and views. N = 61 individuals completed an interview. Interview transcripts were qualitatively analyzed for themes regarding clinical experiences, guideline adherence, and family sharing specific to Black women and their families. Most participants were college educated with active health insurance. Women in this cohort were knowledgeable about the benefits of mammography and described few barriers to adhering to annual mammogram guidelines. Some with first-degree family history were frustrated at insurance barriers to mammography before the age of 40. Participants were generally comfortable encouraging family and friends to receive mammograms and expressed a desire for a similar screening tool for ovarian cancer. However, they expressed concern that factors such as screening awareness and education, lack of insurance coverage, and other systematic barriers might prevent other Black women from receiving regular screening. Black women in this cohort reported high adherence to mammography guidelines, but expressed concern about cultural and financial barriers that may impact cancer screening access in the population more generally and contribute to disparities. Participants noted the importance of frank and open discussions of breast cancer screening in their families and community as a means of improving awareness.
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Affiliation(s)
- Abigail Rousseau
- Biomedical Ethics Research Program, Mayo Clinic, Rochester, MN, USA
| | - Kirsten A Riggan
- Biomedical Ethics Research Program, Mayo Clinic, Rochester, MN, USA
| | - Michele Halyard
- Department of Radiation Oncology, Mayo Clinic, Phoenix, AZ, USA
- Coalition of Blacks Against Breast Cancer, Phoenix, AZ, USA
- ADVANCE Community Advisory Board, Phoenix, AZ, USA
| | - Sarah E James
- Department of Radiation Oncology, Mayo Clinic, Phoenix, AZ, USA
- Coalition of Blacks Against Breast Cancer, Phoenix, AZ, USA
| | - Marion Kelly
- Coalition of Blacks Against Breast Cancer, Phoenix, AZ, USA
- Department of Community Engagement, Mayo Clinic, Scottsdale, AZ, USA
- ADVANCE Community Advisory Board, Phoenix, AZ, USA
| | - Daphne Phillips
- Department of Speech Pathology, Mayo Clinic, Phoenix, AZ, USA
- ADVANCE Community Advisory Board, Phoenix, AZ, USA
| | - Megan A Allyse
- Biomedical Ethics Research Program, Mayo Clinic, Rochester, MN, USA.
- Department of Obstetrics & Gynecology, Mayo Clinic, Rochester, MN, USA.
- Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL, 32224, USA.
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13
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Riggan KA, Rousseau AC, DSouza KN, Woodward KT, Lue J, Phelan SM, Allyse MA, Shenoy CC. Patient perceptions of body mass index restrictions limiting fertility care for women with high body mass index. Reprod Biomed Online 2023; 47:103210. [PMID: 37246105 DOI: 10.1016/j.rbmo.2023.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Revised: 02/24/2023] [Accepted: 04/04/2023] [Indexed: 05/30/2023]
Abstract
RESEARCH QUESTION What is the patient experience of women with high body mass index (BMI) with BMI restrictions that limit fertility care? DESIGN Qualitative study using in-depth, semi-structured interview methodology. Interview transcripts were analysed for iterative themes in accordance with principles of grounded theory. RESULTS Forty women with a BMI of 35 kg/m2 or higher with scheduled or completed appointment at the Reproductive Endocrinology and Infertility (REI) clinic completed an interview. Most participants experienced BMI restrictions as unjust. Many perceived that BMI restrictions on fertility care may be medically justified and were in support of weight loss discussions to improve chances of pregnancy; however, several argued that they should have autonomy to commence treatment following an individualized risk assessment. Participants offered recommendations to improve discussion of BMI restrictions and weight loss, including framing the conversation as supportive of their reproductive goals and offering proactive referral to weight loss support to prevent the perception that BMI is a categorical exclusion to future fertility care. CONCLUSIONS Participant experiences highlight a need for enhanced strategies for communicating BMI restrictions and weight loss recommendations in ways that are perceived to be supportive of patients' fertility goals without further contributing to weight bias and stigma experienced in medical settings. Opportunities for training to mitigate experiences of weight stigma may be beneficial for clinical and non-clinical staff. Evaluation of BMI policies should be undertaken within the context of clinic policies that permit or prohibit fertility care for other high-risk groups.
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Affiliation(s)
- Kirsten A Riggan
- Biomedical Ethics Research Program, Mayo Clinic, Rochester, MN, USA
| | | | - Karen N DSouza
- Graduate School of Biomedical Sciences, Mayo Clinic, Jacksonville, FL, USA
| | - Kristen T Woodward
- Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, MN, USA
| | - Jaida Lue
- Graduate School of Biomedical Sciences, Mayo Clinic, Jacksonville, FL, USA
| | - Sean M Phelan
- Division of Health Care Delivery Research, Robert D. & Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA
| | - Megan A Allyse
- Biomedical Ethics Research Program, Mayo Clinic, Rochester, MN, USA; Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, MN, USA
| | - Chandra C Shenoy
- Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, MN, USA; Division of Reproductive Endocrinology and Infertility, Mayo Clinic, Rochester, MN, USA.
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14
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Ennis JS, Riggan KA, Nguyen NV, Kramer DB, Smith AK, Sulmasy DP, Tilburt JC, Wolf SM, DeMartino ES. Triage Procedures for Critical Care Resource Allocation During Scarcity. JAMA Netw Open 2023; 6:e2329688. [PMID: 37642967 PMCID: PMC10466166 DOI: 10.1001/jamanetworkopen.2023.29688] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 07/10/2023] [Indexed: 08/31/2023] Open
Abstract
Importance During the COVID-19 pandemic, many US states issued or revised pandemic preparedness plans guiding allocation of critical care resources during crises. State plans vary in the factors used to triage patients and have faced criticism from advocacy groups due to the potential for discrimination. Objective To analyze the role of comorbidities and long-term prognosis in state triage procedures. Design, Setting, and Participants This cross-sectional study used data gathered from parallel internet searches for state-endorsed pandemic preparedness plans for the 50 US states, District of Columbia, and Puerto Rico (hereafter referred to as states), which were conducted between November 25, 2021, and June 16, 2023. Plans available on June 16, 2023, that provided step-by-step instructions for triaging critically ill patients were categorized for use of comorbidities and prognostication. Main Outcomes and Measures Prevalence and contents of lists of comorbidities and their stated function in triage and instructions to predict duration of postdischarge survival. Results Overall, 32 state-promulgated pandemic preparedness plans included triage procedures specific enough to guide triage in clinical practice. Twenty of these (63%) included lists of comorbidities that excluded (11 of 20 [55%]) or deprioritized (8 of 20 [40%]) patients during triage; one state's list was formulated to resolve ties between patients with equal triage scores. Most states with triage procedures (21 of 32 [66%]) considered predicted survival beyond hospital discharge. These states proposed different prognostic time horizons; 15 of 21 (71%) were numeric (ranging from 6 months to 5 years after hospital discharge), with the remaining 6 (29%) using descriptive terms, such as long-term. Conclusions and Relevance In this cross-sectional study of state-promulgated critical care triage policies, most plans restricted access to scarce critical care resources for patients with listed comorbidities and/or for patients with less-than-average expected postdischarge survival. This analysis raises concerns about access to care during a public health crisis for populations with high burdens of chronic illness, such as individuals with disabilities and minoritized racial and ethnic groups.
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Affiliation(s)
- Jackson S. Ennis
- Biomedical Ethics Research Program, Mayo Clinic, Rochester, Minnesota
| | - Kirsten A. Riggan
- Biomedical Ethics Research Program, Mayo Clinic, Rochester, Minnesota
| | | | - Daniel B. Kramer
- Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
- Harvard Medical School Center for Bioethics, Boston, Massachusetts
| | - Alexander K. Smith
- Department of Medicine, Division of Geriatrics, University of California, San Francisco
- San Francisco Veterans Affairs Medical Center, San Francisco, California
| | - Daniel P. Sulmasy
- Departments of Medicine and Philosophy, Georgetown University, Washington, DC
- Kennedy Institute of Ethics, Georgetown University, Washington, DC
| | - Jon C. Tilburt
- Biomedical Ethics Research Program, Mayo Clinic, Rochester, Minnesota
- Division of General Internal Medicine, Mayo Clinic, Scottsdale, Arizona
| | - Susan M. Wolf
- University of Minnesota Medical School, Minneapolis
- University of Minnesota Law School, Minneapolis
| | - Erin S. DeMartino
- Biomedical Ethics Research Program, Mayo Clinic, Rochester, Minnesota
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, Minnesota
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15
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Allyse MA, Meagher KM, Michie M, Isasi R, Ormond KE, Bonhomme N, Bombard Y, Howard H, Musunuru K, Riggan KA, Rubeck S. Translational Justice in Human Gene Editing: Bringing End User Engagement and Policy Together. Am J Bioeth 2023; 23:55-58. [PMID: 37339310 PMCID: PMC10441003 DOI: 10.1080/15265161.2023.2207513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/22/2023]
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16
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Barwise AK, Allyse MA, Hirsch JR, McGowan ML, Meaghar KM, Riggan KA. Wither Vulnerability? The Over/Under Protection Dilemma and Research Equity. Am J Bioeth 2023; 23:113-116. [PMID: 37220354 PMCID: PMC10753848 DOI: 10.1080/15265161.2023.2201201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
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17
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Batbold S, Cummings G, Riggan KA, Michie M, Allyse M. Views of parents of children with Down syndrome on Alzheimer's disease vaccination. J Intellect Disabil 2023:17446295231177787. [PMID: 37226465 DOI: 10.1177/17446295231177787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
Individuals with Down syndrome (DS) experience increased risk of Alzheimer's disease (AD). Recent studies suggest that a vaccine against AD may be forthcoming. Parental buy-in is critical to the success of any intervention in this population, as adults with DS often rely on familial support. This study aims to characterize parents' perceptions of a hypothetical vaccine to prevent AD in individuals with DS. A mixed-methods, anonymous survey was distributed via social media. Participants were asked about their experiences with DS and reactions to proposed interventions. Open-ended responses were thematically analyzed using NVivo 12. Of 1,093 surveys initiated, 532 were completed. Of the parents sampled (N = 532), a small majority (54.3%), supported the proposed AD vaccine. All expressed the need for extensive pre-enrollment education and minimal risk. For many, limited research and long-term sequelae were concerns.
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Affiliation(s)
- Sarah Batbold
- Mayo Clinic Alix School of Medicine, Mayo Clinic, Rochester, MN, USA
| | | | - Kirsten A Riggan
- Biomedical Ethics Research Program, Mayo Clinic, Rochester, MN, USA
| | - Marsha Michie
- Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Megan Allyse
- Biomedical Ethics Research Program, Mayo Clinic, Rochester, MN, USA
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18
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Craig KP, Riggan KA, Rubeck S, Meredith SH, Allyse MA, Michie M. Never "totally prepared": Support groups on helping families prepare for a child with a genetic condition. J Community Genet 2023:10.1007/s12687-023-00646-y. [PMID: 37046173 PMCID: PMC10092915 DOI: 10.1007/s12687-023-00646-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Accepted: 04/03/2023] [Indexed: 04/14/2023] Open
Abstract
A rapid increase in the reach and breadth of prenatal genetic screening and testing has led to an expanding need for prenatal support of families receiving this genetic information. As part of a larger study investigating prenatal preparation for a child with a genetic condition, we interviewed representatives of patient advocacy groups (PAGs) who support parents post-diagnosis. Groups supporting families with Down syndrome were often local or regional, while other groups were often national or international in scope. Groups varied in their willingness or ability to support families prior to making a pregnancy continuation decision, and participants reflected on ways they addressed these needs with individual counseling and referrals, if needed. Participants described supporting parents with information about conditions and a range of lived experiences for families, while referring families to healthcare professionals for technical questions and additional medical needs. PAGs also prioritized connecting parents experiencing a new diagnosis with other families for peer support and community-building, both in person and on social media. Participants discussed limitations, such as a lack of racially-concordant support, ability to offer resources in languages other than English, and a lack of funding to meet the expressed needs of families post-diagnosis. Overall, participants emphasized that the parenting experience of each child is unique, irrespective of a genetic diagnosis, an experience for which parents can never be "totally prepared."
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Affiliation(s)
- Kaitlynn P Craig
- Department of Bioethics, Case Western Reserve University School of Medicine, Cleveland, OH, USA.
| | - Kirsten A Riggan
- Biomedical Ethics Research Program, Mayo Clinic, Rochester, MN, USA
| | - Sabina Rubeck
- Department of Bioethics, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Stephanie H Meredith
- Lettercase National Center for Prenatal and Postnatal Resources, University of Kentucky's Human Development Institute, Lexington, KY, USA
| | - Megan A Allyse
- Biomedical Ethics Research Program & Department of Obstetrics & Gynecology, Mayo Clinic, Jacksonville, FL, USA
| | - Marsha Michie
- Department of Bioethics, Case Western Reserve University School of Medicine, Cleveland, OH, USA
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19
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Riggan KA, Rousseau A, Halyard M, James SE, Kelly M, Phillips D, Allyse MA. "There's not enough studies": Views of black breast and ovarian cancer patients on research participation. Cancer Med 2023; 12:8767-8776. [PMID: 36647342 PMCID: PMC10134334 DOI: 10.1002/cam4.5622] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Revised: 12/28/2022] [Accepted: 01/03/2023] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Black breast and ovarian cancer patients are underrepresented in clinical cancer trials disproportionate to the prevalence of these cancers in Black females. Historically, lower enrollment has been attributed to individualized factors, including medical mistrust, but more recently structural factors, including systemic racism, have received additional scrutiny. We interviewed Black women with a personal or family history of breast and ovarian cancer to understand their views and experiences related to research participation. METHODS Qualitative interviews were conducted via telephone or video conference and transcribed verbatim. Transcripts were qualitatively analyzed for iterative themes related to the offer and participation in cancer clinical trials and research studies, impact on cancer care, and recommendations to increase enrollment of Black patients. RESULTS Sixty-one Black women completed an interview. Participants expressed that Black women are underrepresented in cancer research, and that this negatively impacted their own care. Many cited past historical abuses, including the Tuskegee syphilis trial, as a potential factor for lower enrollment but suggested that lower enrollment was better understood in the context of the entirety of their healthcare experiences, including present-day examples of patient mistreatment or dismissal. Participants suggested that proactive community engagement, transparency, and increased representation of Black research team members were strategies likely to foster trust and bolster research participation. CONCLUSION(S) Medical mistrust is only a partial factor in the lower participation of Black patients in cancer research. Researchers should implement the strategies identified by our participants to promote diverse enrollment and ensure that Black patients are included in future therapeutic advances.
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Affiliation(s)
| | - Abigail Rousseau
- Biomedical Ethics Research ProgramMayo ClinicRochesterMinnesotaUSA
| | - Michele Halyard
- Department of Radiation OncologyMayo ClinicPhoenixArizonaUSA
- Coalition of Blacks Against Breast CancerPhoenixArizonaUSA
- ADVANCE Community Advisory BoardPhoenixArizonaUSA
| | - Sarah E. James
- Department of Radiation OncologyMayo ClinicPhoenixArizonaUSA
- Coalition of Blacks Against Breast CancerPhoenixArizonaUSA
| | - Marion Kelly
- Coalition of Blacks Against Breast CancerPhoenixArizonaUSA
- ADVANCE Community Advisory BoardPhoenixArizonaUSA
- Department of Community EngagementMayo ClinicScottsdaleArizonaUSA
| | - Daphne Phillips
- ADVANCE Community Advisory BoardPhoenixArizonaUSA
- Department of Speech PathologyMayo ClinicPhoenixArizonaUSA
| | - Megan A. Allyse
- Biomedical Ethics Research ProgramMayo ClinicRochesterMinnesotaUSA
- Department of Obstetrics & GynecologyMayo ClinicRochesterMinnesotaUSA
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20
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Riggan KA, Gross B, Close S, Steinberg A, Allyse MA. "Knowledge is Power": Parent Views on the Benefits of Early Diagnosis and Awareness of Sex Chromosome Multisomy Among Pediatric Professionals. J Dev Behav Pediatr 2023; 44:e119-e125. [PMID: 36454640 PMCID: PMC10117700 DOI: 10.1097/dbp.0000000000001153] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Accepted: 10/04/2022] [Indexed: 12/05/2022]
Abstract
OBJECTIVE Pediatric diagnoses of sex chromosome multisomies (SCMs) have increased as genetic testing has expanded. However, depending on SCM presentation, there may be significant delays between symptom recognition and diagnosis. We conducted a survey of parents of children diagnosed with SCMs to understand their experiences receiving an SCM diagnosis and their support needs. METHODS We conducted an inductive qualitative analysis of open-ended survey responses for iterative themes related to presenting symptoms, diagnostic odyssey, immediate and long-term support needs, and awareness of SCMs. RESULTS Of the 323 parents who completed the survey, 185 parents received a pediatric diagnosis (0-21 years) in a child. Many parents expressed feelings of relief when receiving the diagnosis, especially if it occurred after a lengthy diagnostic odyssey. Parents reported frustration that their child's nonmedical symptoms, including learning disabilities, speech delays, attention deficits, and behavioral issues, were not flagged as potential indications for SCMs and suggested that greater awareness of SCMs by pediatricians, educators, and other professionals involved in their child's care may lead to earlier diagnosis and intervention. CONCLUSION This is the largest qualitative study to date examining parent and caregiver experiences with a pediatric diagnosis of SCMs. Increased knowledge and awareness of nonmedical SCM symptoms are needed among medical, education, occupational, and psychology professionals for early testing referral and improved support of children with SCMs.
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Affiliation(s)
| | - Brianna Gross
- Division of Neurology, Children’s Hospital of Philadelphia, Philadelphia, PA
| | - Sharron Close
- Nell Hodgson Woodruff School of Nursing, Emory University Atlanta, GA
| | | | - Megan A. Allyse
- Biomedical Ethics Research Program, Mayo Clinic, Rochester, MN
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21
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Orellana M, Riggan KA, DSouza K, Stewart EA, Venable S, Balls-Berry JE, Allyse MA. Perceptions of Ethnoracial Factors in the Management and Treatment of Uterine Fibroids. J Racial Ethn Health Disparities 2022; 9:1184-1191. [PMID: 34013445 PMCID: PMC10695323 DOI: 10.1007/s40615-021-01059-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Revised: 05/11/2021] [Accepted: 05/12/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Uterine fibroids are non-cancerous neoplasms of the uterus. Women of color, including non-Hispanic Black/African American women and Hispanic/Latinas, have a higher uterine fibroid prevalence, incidence, and disease burden compared to non-Hispanic White women. Therefore, understanding ethnoracial factors in the diagnosis and treatment of uterine fibroids in women of color is critical. This study provides insight on the ethnoracial factors and cultural barriers experienced by women of color in the management and treatment of uterine fibroids. METHODS Women were recruited via The Fibroid Foundation, a nonprofit that provides uterine fibroid support and education. Women who were interested completed an online screening survey. Eligible participants were interviewed via phone. Transcribed audio recordings were qualitatively analyzed using the principles of grounded theory. RESULTS Forty-seven women of reproductive age who were diagnosed with uterine fibroids and received U.S.-based care participated in a semi-structured interview exploring experiences with uterine fibroid diagnosis and management. Twenty-eight women self-identified as Black, Latina, or other ethnicity. Women of color reported fibroid symptoms that significantly disrupted their work and home life. Women of color also reported perceptions that their race/ethnicity impacted their uterine fibroid treatment, including negative interpersonal provider-patient interactions. These perceptions engendered feelings of skepticism towards the medical system based on historical injustices and/or their own negative experiences and led some to go without longitudinal care. CONCLUSION Cultural and familial factors have significant impact on uterine fibroid diagnosis and management. Greater attention to culturally sensitive care and potential bias reduction in the treatment of uterine fibroids should be a priority.
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Affiliation(s)
- Minerva Orellana
- Mayo Clinic Graduate School of Biomedical Sciences, Rochester, MN, USA
| | - Kirsten A Riggan
- Biomedical Ethics Research Program, Mayo Clinic, Rochester, MN, USA
| | - Karen DSouza
- Mayo Clinic Graduate School of Biomedical Sciences, Rochester, MN, USA
| | - Elizabeth A Stewart
- Division of Reproductive Endocrinology, Department of Obstetrics & Gynecology, Mayo Clinic, Rochester, MN, USA
| | | | - Joyce E Balls-Berry
- Department of Neurology, Washington University School of Medicine, St. Louis, MO, USA
| | - Megan A Allyse
- Biomedical Ethics Research Program, Mayo Clinic, Rochester, MN, USA.
- Department of Obstetrics & Gynecology, Mayo Clinic, Rochester, MN, USA.
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22
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Ashby GB, Riggan KA, Huang L, Torbenson VE, Long ME, Wick MJ, Allyse MA, Rivera-Chiauzzi EY. "I had so many life-changing decisions I had to make without support": a qualitative analysis of women's pregnant and postpartum experiences during the COVID-19 pandemic. BMC Pregnancy Childbirth 2022; 22:537. [PMID: 35787675 PMCID: PMC9251587 DOI: 10.1186/s12884-022-04816-7] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Accepted: 05/31/2022] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND The COVID-19 pandemic has posed profound challenges for pregnant patients and their families. Studies conducted early in the pandemic found that pregnant individuals reported increased mental health concerns in response to pandemic-related stress. Many obstetric practices changed their healthcare delivery models, further impacting the experiences of pregnant patients. We conducted a survey study to explore the ways in which COVID-19 impacted the lives of pregnant and newly postpartum people. METHODS A mixed-methods survey was distributed to all patients ≥18 years old who were pregnant between January 1st, 2020 - April 28, 2021 in a large Midwest health system. Open-ended survey responses were analyzed for common themes using standard qualitative methodology. RESULTS Among the 1182 survey respondents, 647 women provided an open-ended response. Of these, 77% were in the postpartum period. The majority of respondents identified as white, were partnered or married, and owned their own home. Respondents reported feeling greater uncertainty, social isolation, as though they had limited social and practical support, and negative mental health effects as a result of the pandemic. Many cited sudden or arbitrary changes to their medical care as a contributing factor. Though in the minority, some respondents also reported benefits from the changes to daily life, including perceived improvements to medical care, better work-life balance, and opportunities for new perspectives. CONCLUSIONS This large qualitative dataset provides insight into how healthcare policy and lifestyle changes impacted pregnant and postpartum people. Respondents expressed similar levels of uncertainty and mental health concerns compared to other cohorts but less overall positivity. Our findings suggest greater attention be given to the impact of pandemic-related stress on pregnant and postpartum women. As the pandemic continues, these data identify areas where investment in additional support may have the greatest impact.
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Affiliation(s)
| | - Kirsten A Riggan
- Biomedical Ethics Research Program, Mayo Clinic, Rochester, MN, USA
| | - Lily Huang
- Department of Quantitative Health Sciences, Mayo Clinic, Jacksonville, FL, USA
| | | | - Margaret E Long
- Department of Obstetrics & Gynecology, Mayo Clinic, Rochester, MN, USA
| | - Myra J Wick
- Department of Obstetrics & Gynecology, Mayo Clinic, Rochester, MN, USA
| | - Megan A Allyse
- Biomedical Ethics Research Program, Mayo Clinic, Rochester, MN, USA
- Department of Obstetrics & Gynecology, Mayo Clinic, Rochester, MN, USA
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23
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Rousseau AC, Riggan KA, Schenone MH, Whitford KJ, Pittock ST, Allyse MA. Ethical considerations of maternal-fetal surgery. J Perinat Med 2022; 50:519-527. [PMID: 35092654 DOI: 10.1515/jpm-2021-0476] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Accepted: 01/13/2022] [Indexed: 11/15/2022]
Abstract
The practice of maternal-fetal surgery (MFS) has expanded from lethal fetal conditions to conditions which are significantly disabling but not a lethal fetal abnormality. The inclusion of myelomeningocele within the scope of MFS in the 1990s sparked a renewed debate over the ethics of MFS. While demonstrating increasing efficacy and range of application, MFS continues to be ethically fraught due to the inherent tension between maternal and fetal interests. Ethical issues central to MFS include the patienthood of the fetus; the balance of risks and benefits between the woman and fetus; informed consent for experimental procedures; and determination of conditions that meet ethical qualifications for MFS intervention. These concerns are likely to persist and evolve as perinatal medicine continues to advance. Here we summarize the current state of MFS ethics, highlighting the major positions in the literature thus far as well as examine future directions. It is essential robust discussions of these important issues continue both to ensure ethical medical practice and to provide support to clinicians, pregnant women, and their families.
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Affiliation(s)
- Abigail C Rousseau
- Biomedical Ethics Research Program, Mayo Clinic Rochester, Rochester, MN, USA
| | - Kirsten A Riggan
- Biomedical Ethics Research Program, Mayo Clinic Rochester, Rochester, MN, USA
| | - Mauro H Schenone
- Department of Obstetrics & Gynecology, Division of Maternal and Fetal Medicine, Mayo Clinic, Rochester, MN, USA
| | - Kevin J Whitford
- Department of Internal Medicine, Division of Hospital Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - Siobhan T Pittock
- Department of Pediatric and Adolescent Medicine, Division of Pediatric Endocrinology and Metabolism, Mayo Clinic, Rochester, MN, USA
| | - Megan A Allyse
- Biomedical Ethics Research Program, Mayo Clinic Rochester, Rochester, MN, USA.,Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, MN, USA
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DSouza KN, Orellana M, Ainsworth AJ, Cummings G, Riggan KA, Shenoy CC, Allyse MA. Impact of the COVID-19 Pandemic on Patient Fertility Care. J Patient Exp 2022; 9:23743735221098255. [PMID: 35548663 PMCID: PMC9083039 DOI: 10.1177/23743735221098255] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
The effects of the COVID-19 pandemic on the healthcare system have been widespread, with many institutions in the United States pausing elective procedures to redirect resources to critical care. Fertility care and assisted reproductive procedures were classified as elective procedures and similarly paused. We conducted qualitative interviews with patients and/or their partners (n = 25 female patients; n = 3 male partners) receiving care at a fertility clinic in the Midwest to understand patient appraisal of COVID-19 risk on the resumption of care following a month-long closure of an infertility clinic, and patient agreement with the clinic closure. Interview transcripts were thematically analyzed from a grounded theory approach. Study participants reported an increased sense of urgency due to the delay in fertility procedures. This urgency often superseded concerns of potential COVID-19 infection, motivating patients to continue fertility treatment during a pandemic. In hindsight, some participants did not agree with the clinic's closure and treatment cessation, feeling that these steps negatively interrupted time-sensitive reproductive goals. Patient responses highlight the need for additional resources to support decision-making during times of crisis. Triaging patients based on time-sensitivity of treatment instead of a total shutdown respects patient autonomy for continuing treatment amidst uncertain COVID-19-impact.
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Affiliation(s)
- Karen N DSouza
- Mayo Clinic, Graduate School of Biomedical Sciences, Rochester, MN, USA
| | - Minerva Orellana
- Mayo Clinic, Graduate School of Biomedical Sciences, Rochester, MN, USA
| | | | | | - Kirsten A Riggan
- Biomedical Ethics Research Program, Mayo Clinic, Rochester, MN, USA
| | - Chandra C Shenoy
- Department of Obstetrics & Gynecology, Mayo Clinic, Rochester, MN, USA
| | - Megan A Allyse
- Department of Obstetrics & Gynecology, Mayo Clinic, Rochester, MN, USA
- Biomedical Ethics Research Program, Mayo Clinic, Rochester, MN, USA
- Megan A Allyse, Mayo Clinic, 4500 San Pablo Rd S, Jacksonville, FL, 32224, USA.
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Rivera-Chiauzzi E, Finney RE, Riggan KA, Weaver AL, Long ME, Torbenson VE, Allyse MA. Understanding the Second Victim Experience Among Multidisciplinary Providers in Obstetrics and Gynecology. J Patient Saf 2022; 18:e463-e469. [PMID: 33871416 PMCID: PMC8521555 DOI: 10.1097/pts.0000000000000850] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [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] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The aim of the study was to determine the prevalence of second victim experience (SVE) among obstetrics and gynecology (OBGYN) clinical and nonclinical healthcare workers and compare healthcare workers who did and did not identify as a second victim (SV) in the last year. METHODS The validated Second Victim Experience and Support Tool and additional questions designed to explore SVE topics specific to OBGYN healthcare workers were administered to a multidisciplinary group. RESULTS Of 571 individuals sent a survey link, 205 completed the survey: 117 worked in obstetrics (OB), 73 in gynecology (GYN), and 15 in both areas. Overall, 44.8% of respondents identified as an SV sometime during their career, 18.8% within the last 12 months. Among nonclinical staff respondents, 26.7% identified as an SV during their career and 13.3% in the last 12 months. Respondents who identified as an SV in the last 12 months reported experiencing significantly more psychological and physical distress, a greater degree to which colleague and institutional support were perceived as inadequate, decreased professional self-efficacy, and increased turnover intentions. The most common events identified as likely triggers for SVE were fetal or neonatal loss (72.7%) and maternal death (68.2%) in OB and patient accusations or complaints (69.3%) in GYN. CONCLUSIONS Among survey respondents, there was a high prevalence of SVs in OBGYN staff, distributed equally between OB and GYN. Nonclinical healthcare workers also identified as SVs. The OBGYN departments should consider using the Second Victim Experience and Support Tool to screen for potential SV among their healthcare workers to provide additional support after events.
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Affiliation(s)
| | | | | | - Amy L Weaver
- Division of Biomedical Statistics and Informatics, Mayo Clinic Rochester, Rochester, Minnesota
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Riggan KA, Rousseau A, Pittock S, Schenone M, Segura L, Warner L, Allyse MA. Multidisciplinary Ethics Review for Liminal Cases in Maternal-Fetal Surgery: A Model. Am J Bioeth 2022; 22:65-68. [PMID: 35258427 DOI: 10.1080/15265161.2022.2027568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
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27
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Riggan KA, Reckhow J, Allyse MA, Long M, Torbenson V, Rivera-Chiauzzi EY. Impact of the COVID-19 Pandemic on Obstetricians/Gynecologists. Mayo Clin Proc Innov Qual Outcomes 2021; 5:1128-1137. [PMID: 34849457 PMCID: PMC8613070 DOI: 10.1016/j.mayocpiqo.2021.11.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Objective To assess the impact of the coronavirus disease 2019 (COVID-19) pandemic on obstetricians/gynecologists (OB/GYNs). Participants and Methods A 49-item survey was distributed to OB/GYNs through the websites and electronic mailing lists of professional OB/GYN organizations. The survey was open from June 22, 2020, through November 22, 2020. Of the 122 initiated surveys, 89 were completed (73.0% completion rate); 72 respondents answered at least one open-ended question and were included for qualitative analysis. Results Respondents reported policy changes, limited personal protective equipment availability, patient compliance with safety protocols and personal protective equipment use, staff shortages, and concerns about COVID-19 exposure as primary stressors related to the pandemic. Respondents felt that the pandemic had a negative professional impact on their relationships with patients and colleagues. Workplace and pandemic stressors resulted in feelings of anxiety and frustration; physical effects were also reported. Some respondents indicated that they were considering early retirement or leaving the profession as a result of the pandemic, which suggests that OB/GYNs may be at increased risk for burnout. Conclusion The COVID-19 pandemic will have important long-term effects on OB/GYN well-being and workforce retention. Proactive support for OB/GYNs is needed to combat burnout and counteract workforce attrition. Implementing peer support programs that promote healthy emotional processing following adverse events may mitigate these feelings and reduce OB/GYN burnout.
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Affiliation(s)
| | - Jensen Reckhow
- Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, MN
| | - Megan A Allyse
- Biomedical Ethics Research Program, Mayo Clinic, Rochester, MN.,Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, MN
| | - Margaret Long
- Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, MN
| | | | - Enid Y Rivera-Chiauzzi
- Biomedical Ethics Research Program, Mayo Clinic, Rochester, MN.,Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, MN
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28
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Finney RE, Czinski S, Fjerstad K, Arteaga GM, Weaver AL, Riggan KA, Allyse MA, Long ME, Torbenson VE, Rivera-Chiauzzi EY. Evaluation of a Second Victim Peer Support Program on Perceptions of Second Victim Experiences and Supportive Resources in Pediatric Clinical Specialties Using the Second Victim Experience and Support Tool (SVEST). J Pediatr Nurs 2021; 61:312-317. [PMID: 34500175 DOI: 10.1016/j.pedn.2021.08.023] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Revised: 08/17/2021] [Accepted: 08/23/2021] [Indexed: 11/26/2022]
Abstract
PURPOSE Pediatric healthcare professionals (HCPs) may experience events that lead to psychological distress or second victim experiences (SVEs). This project evaluates the impact of a newly implemented peer support program on SVEs and perceptions of supportive resources among pediatric HCPs. DESIGN AND METHODS A second victim (SV) peer support program was implemented in the pediatric inpatient and intensive care units in September 2019. Multidisciplinary HCPs in these units were invited to participate in an anonymous survey that included the Second Victim Experience and Support Tool before and one-year after implementation. The survey assessed HCPs' SVEs, desired support, and perceptions of the peer support program. RESULTS 52.0% (194/373) completed the pre-implementation survey, and 43.9% (177/403) completed the post-implementation survey. At both timepoints, participants reported SV-related psychosocial distress, physical distress, or low professional self-efficacy; the most desired support was 'a respected peer to discuss the details of what happened'. Following implementation of the peer support program, HCPs were significantly more likely to have heard of the term 'second victim' (51.8 vs. 74.0%; p < 0.001) and to have felt like there were adequate resources to support SVs (35.8% vs. 89.1%; p < 0.001). In the post-implementation survey, most respondents indicated a likelihood to use the program for themselves (65.7%) or colleagues (84.6%) after involvement in future traumatic clinical events. CONCLUSIONS Implementation of a peer support program significantly influenced awareness and perceptions of support available for SV-related distress. PRACTICE IMPLICATIONS Peer support programs should be implemented to help HCPs navigate SVEs and decrease SV-related turnover intentions.
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Affiliation(s)
- Robyn E Finney
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic Rochester, MN, United States of America.
| | - Scott Czinski
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic Rochester, MN, United States of America
| | - Kelly Fjerstad
- Department of Nursing, Mayo Clinic Rochester, MN, United States of America
| | - Grace M Arteaga
- Pediatric Critical Care Medicine, Mayo Clinic Rochester, MN, United States of America
| | - Amy L Weaver
- Division of Clinical Trials and Biostatistics, Mayo Clinic Rochester, MN, United States of America
| | - Kirsten A Riggan
- Biomedical Ethics Research Program, Mayo Clinic Rochester, MN, United States of America
| | - Megan A Allyse
- Biomedical Ethics Research Program, Mayo Clinic Rochester, MN, United States of America
| | - Margaret E Long
- Department of Obstetrics and Gynecology, Mayo Clinic Rochester, MN, United States of America
| | - Vanessa E Torbenson
- Department of Obstetrics and Gynecology, Mayo Clinic Rochester, MN, United States of America
| | - Enid Y Rivera-Chiauzzi
- Department of Obstetrics and Gynecology, Mayo Clinic Rochester, MN, United States of America
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29
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Riggan KA, Stewart EA, Balls-Berry JE, Venable S, Allyse MA. Patient Recommendations for Shared Decision-Making in Uterine Fibroid Treatment Decisions. J Patient Exp 2021; 8:23743735211049655. [PMID: 34692992 PMCID: PMC8532210 DOI: 10.1177/23743735211049655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Uterine fibroids are noncancerous tumors associated with significant morbidity among symptomatic patients. While medical and surgical treatments have expanded, hysterectomy remains common. We interviewed women diagnosed with uterine fibroids (n = 47) to explore their experiences and recommendations for shared decision-making. A majority were non-Hispanic Black, highly educated (51.1%), and had graduate degrees (40.4%). Participants with both positive and negative provider experiences expressed a desire for a more proactive therapeutic approach, including a presentation by their provider of the spectrum of medical and surgical treatment options, and greater provider recognition of the impact of symptoms on quality of life. Women advocated for expanded shared decision-making that acknowledged their contribution to their own treatment plan and felt early screening and improved patient/provider education of uterine fibroid symptoms would facilitate greater congruence between treatment approaches and patient goals. Perceptions of insufficient input into their treatment plans frequently served as a barrier to care-seeking and treatment acceptance among women with uterine fibroid symptoms. Improved discussion of treatment options in the context of the unique symptom burden and values of the patient may facilitate greater provider trust and acceptance of uterine fibroid treatment.
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Affiliation(s)
- Kirsten A Riggan
- Biomedical Ethics Research Program, Mayo Clinic, Rochester, MN, USA
| | - Elizabeth A Stewart
- Department of Obstetrics & Gynecology, Mayo Clinic, Rochester, MN, USA.,Mayo Clinic College of Medicine and Science, Rochester, MN, USA
| | - Joyce E Balls-Berry
- Mayo Clinic College of Medicine and Science, Rochester, MN, USA.,Department of Health Science Research, Division of Epidemiology, Mayo Clinic, Rochester, MN, USA
| | | | - Megan A Allyse
- Biomedical Ethics Research Program, Mayo Clinic, Rochester, MN, USA.,Department of Obstetrics & Gynecology, Mayo Clinic, Rochester, MN, USA.,Mayo Clinic Graduate School of Biomedical Sciences, Mayo Clinic, Rochester, MN, USA
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30
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Torbenson VE, Riggan KA, Weaver AL, Long ME, Finney RE, Allyse MA, Rivera-Chiauzzi E. Second Victim Experience among OBGYN Trainees: What Is Their Desired Form of Support? South Med J 2021; 114:218-222. [PMID: 33787935 DOI: 10.14423/smj.0000000000001237] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVES Physician trainees in obstetrics and gynecology (OBGYN) experience unexpected outcomes similar to those of supervising physicians. A relative lack of experience and perspective may make them more vulnerable to second victim experience (SVE), however. The objectives of our study were to contrast the prevalence of SVE between supervising physicians and trainees and to identify their preferred methods of support. METHODS In 2019, the Second Victim Experience and Support Tool, a validated survey with supplemental questions, was administered to healthcare workers caring for OBGYN patients at a large academic center in the midwestern United States. RESULTS The survey was sent to 571 healthcare workers working in OBGYN. A total of 205 healthcare workers completed the survey, including 18 (43.9% of 41) supervising physicians and 12 (48.0% of 25) resident/fellow physicians. The mean scores for the Second Victim Experience and Support Tool dimensions and outcomes were similar between the two groups. Seven (58.3%) trainees reported feeling like a second victim after an adverse patient safety event at some point in their work experience compared with 10 (55.6%) of the supervising physicians. Five (41.7%) trainees identified as a second victim in the previous 12 months compared with 3 (16.7%) supervising physicians (P = 0.21). The most common form of desired support for both groups was conversations with their peers. CONCLUSIONS Trainees and supervising physicians are both at risk of SVE after an unexpected medical event and prefer conversations with peers as a desired form of support. Because trainees commonly encounter SVEs early in their careers, program directors should consider implementing a program for peer support after an unexpected event.
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Affiliation(s)
- Vanessa E Torbenson
- From the Departments of Obstetrics and Gynecology, Biomedical Ethics Research, and Anesthesiology and Perioperative Medicine, and the Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota
| | - Kirsten A Riggan
- From the Departments of Obstetrics and Gynecology, Biomedical Ethics Research, and Anesthesiology and Perioperative Medicine, and the Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota
| | - Amy L Weaver
- From the Departments of Obstetrics and Gynecology, Biomedical Ethics Research, and Anesthesiology and Perioperative Medicine, and the Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota
| | - Margaret E Long
- From the Departments of Obstetrics and Gynecology, Biomedical Ethics Research, and Anesthesiology and Perioperative Medicine, and the Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota
| | - Robyn E Finney
- From the Departments of Obstetrics and Gynecology, Biomedical Ethics Research, and Anesthesiology and Perioperative Medicine, and the Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota
| | - Megan A Allyse
- From the Departments of Obstetrics and Gynecology, Biomedical Ethics Research, and Anesthesiology and Perioperative Medicine, and the Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota
| | - Enid Rivera-Chiauzzi
- From the Departments of Obstetrics and Gynecology, Biomedical Ethics Research, and Anesthesiology and Perioperative Medicine, and the Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota
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31
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Riggan KA, Gross B, Close S, Weinberg A, Allyse MA. Prenatal Genetic Diagnosis of a Sex Chromosome Aneuploidy: Parent Experiences. J Genet Couns 2021; 30:1407-1417. [PMID: 33723878 DOI: 10.1002/jgc4.1407] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Revised: 02/12/2021] [Accepted: 02/14/2021] [Indexed: 02/06/2023]
Abstract
Sex chromosome aneuploidies (SCAs) occur in 1 in every 400 births. SCAs are highly variable and have uncertain prognoses, complicating the delivery of prenatal cell-free DNA (cfDNA) results or diagnosis following amniocentesis or chorionic villus sampling. Using a mixed-methods approach, we explored the experiences of parents receiving a prenatal diagnosis of a fetus with SCA. Responses to open-ended questions were qualitatively analyzed. Of the 323 parents who completed the survey, 122 received a prenatal diagnosis and answered at least one open-ended question. Most parents did not recall being informed that cfDNA screening or amniocentesis could reveal the presence of a SCA prior to testing and described feeling unprepared for a positive result. Variation was found between parents who were delivered a diagnosis by a genetic professional versus other clinical specialties. Many parents expressed that the diagnosis was delivered in a way that emphasized the negative attributes of the SCA and that they were provided limited support materials. Parents who received a prenatal diagnosis of a SCA expressed a desire for more supportive delivery of prenatal diagnosis that focuses on parental education and nuanced discussion of potential phenotypes. Genetic counselors should be aware of the range of parental experiences when receiving a SCA diagnosis from non-genetic providers. Prenatal SCA diagnoses are predicted to increase as prenatal cfDNA screening becomes more widely used. Collaborations for greater provider education and comprehensive materials on SCAs are essential to facilitate the delivery of SCA diagnoses and improve parent understanding and support.
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Affiliation(s)
- Kirsten A Riggan
- Biomedical Ethics Research Program, Mayo Clinic, Rochester, MN, USA
| | - Brianna Gross
- Division of Neurology, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Sharron Close
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA, USA
| | | | - Megan A Allyse
- Biomedical Ethics Research Program, Mayo Clinic, Rochester, MN, USA
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Finney RE, Torbenson VE, Riggan KA, Weaver AL, Long ME, Allyse MA, Rivera-Chiauzzi EY. Second victim experiences of nurses in obstetrics and gynaecology: A Second Victim Experience and Support Tool Survey. J Nurs Manag 2020; 29:642-652. [PMID: 33113207 DOI: 10.1111/jonm.13198] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Revised: 10/02/2020] [Accepted: 10/15/2020] [Indexed: 11/30/2022]
Abstract
AIM (S) To investigate second victim experiences and supportive resources for nurses in obstetrics and gynaecology. BACKGROUND Nurses are at risk of developing second victim experiences after exposure to work related events. METHODS Nurses at a single institution were invited to participate in an anonymous survey that included the validated Second Victim Experience and Support Tool to assess symptoms related to second victim experiences and current and desired supportive resources. RESULTS Of 310 nurses, 115 (37.1%) completed the survey; 74.8% had not heard of the term 'second victim'. Overall, 47.8% reported feeling like a second victim during their career and 19.1% over the previous 12 months. As a result of a second victim experience, 18.4% experienced psychological distress, 14.3% turnover intentions, 13.0% decreased professional self-efficacy, and 12.2% felt that institutional support was poor. Both clinical and non-clinical events were reported as possible triggers for second victim experiences. Peer support was the most desired form of support as reported by 95.5%. CONCLUSION(S) Nurses in obstetrics and gynaecology face clinical and non-clinical situations that lead to potential second victim experiences. IMPLICATIONS FOR NURSING MANAGEMENT The second victim experiences of nurses should be acknowledged, and resources should be implemented to navigate it. Educational opportunities and peer supportive interventions specific to second victim experiences should be encouraged.
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Affiliation(s)
- Robyn E Finney
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic Rochester, Rochester, MN, USA
| | - Vanessa E Torbenson
- Department of Obstetrics and Gynecology, Mayo Clinic Rochester, Rochester, MN, USA
| | - Kirsten A Riggan
- Biomedical Ethics Research Program, Mayo Clinic Rochester, Rochester, MN, USA
| | - Amy L Weaver
- Division of Biomedical Statistics and Informatics, Mayo Clinic Rochester, Rochester, MN, USA
| | - Margaret E Long
- Department of Obstetrics and Gynecology, Mayo Clinic Rochester, Rochester, MN, USA
| | - Megan A Allyse
- Department of Obstetrics and Gynecology, Mayo Clinic Rochester, Rochester, MN, USA.,Biomedical Ethics Research Program, Mayo Clinic Rochester, Rochester, MN, USA
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Snure Beckman E, Deuitch N, Michie M, Allyse MA, Riggan KA, Ormond KE. Attitudes Toward Hypothetical Uses of Gene-Editing Technologies in Parents of People with Autosomal Aneuploidies. CRISPR J 2020; 2:324-330. [PMID: 31599684 DOI: 10.1089/crispr.2019.0021] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Researchers are exploring the use of gene-editing technologies to prevent and/or treat genetic conditions in humans. Stakeholder views, including those of patient and family populations, are important in the ongoing bioethical discussion. We conducted 27 semi-structured interviews with parents of people with trisomy 21 (T21; N = 10), trisomy 18 (T18; N = 8), and trisomy 13 (T13; N = 9)-conditions not previously studied in regard to attitudes toward hypothetical gene editing. While many discussions focus on the morality of gene editing, parents in our study focused on quality of life and concerns about changing their children's identity. All participants prioritized ameliorating life-threatening health issues when those were present; many also emphasized increasing their children's communication and cognitive ability. These results suggest that patient populations with the lived experience of genetic conditions have unique concerns that may differ from broader discourse.
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Affiliation(s)
- Erika Snure Beckman
- Department of Genetics, Stanford University School of Medicine, Stanford, California
| | - Natalie Deuitch
- Department of Genetics, Stanford University School of Medicine, Stanford, California
| | - Marsha Michie
- Department of Bioethics, Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Megan A Allyse
- Biomedical Ethics Program, Mayo Clinic, Rochester, Minnesota
| | | | - Kelly E Ormond
- Department of Genetics, Stanford University School of Medicine, Stanford, California.,Stanford Center for Biomedical Ethics, Stanford University School of Medicine, Stanford, California
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Riggan KA, Gilbert A, Allyse MA. Acknowledging and Addressing Allostatic Load in Pregnancy Care. J Racial Ethn Health Disparities 2020; 8:69-79. [PMID: 32383045 DOI: 10.1007/s40615-020-00757-z] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [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: 01/10/2020] [Revised: 03/18/2020] [Accepted: 04/06/2020] [Indexed: 12/11/2022]
Abstract
The USA is one of the few countries in the world in which maternal and infant morbidity and mortality continue to increase, with the greatest disparities observed among non-Hispanic Black women and their infants. Traditional explanations for disparate outcomes, such as personal health behaviors, socioeconomic status, health literacy, and access to healthcare, do not sufficiently explain why non-Hispanic Black women continue to die at three to four times the rate of White women during pregnancy, childbirth, or postpartum. One theory gaining prominence to explain the magnitude of this disparity is allostatic load or the cumulative physiological effects of stress over the life course. People of color disproportionally experience social, structural, and environmental stressors that are frequently the product of historic and present-day racism. In this essay, we present the growing body of evidence implicating the role of elevated allostatic load in adverse pregnancy outcomes among women of color. We argue that there is a moral imperative to assign additional resources to reduce the effects of elevated allostatic load before, during, and after pregnancy to improve the health of women and their children.
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Affiliation(s)
- Kirsten A Riggan
- Biomedical Ethics Research Program, Mayo Clinic, 200 First St. SW, Rochester, MN, 55905, USA
| | - Anna Gilbert
- Biomedical Ethics Research Program, Mayo Clinic, 200 First St. SW, Rochester, MN, 55905, USA
| | - Megan A Allyse
- Biomedical Ethics Research Program, Mayo Clinic, 200 First St. SW, Rochester, MN, 55905, USA. .,Department of Obstetrics & Gynecology, Mayo Clinic, Rochester, MN, USA.
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Gammon BL, Jaramillo C, Riggan KA, Allyse M. Decisional regret in women receiving high risk or inconclusive prenatal cell-free DNA screening results. J Matern Fetal Neonatal Med 2020; 33:1412-1418. [PMID: 30269633 PMCID: PMC10694839 DOI: 10.1080/14767058.2018.1519541] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Objectives: This study examined the experiences of women receiving high-risk cell-free DNA (cfDNA) screening results, with particular focus on decisional satisfaction after receiving high-risk, false, or inconclusive results. It is already known that cell-free DNA screening is rapidly expanding in the clinical practice. A growing number of women are offered cfDNA screening for an increasingly broad range of chromosomal and microdeletion syndromes. However, research shows that the very low false positive rate attributed to cfDNA screening for trisomy 21 does not apply to other conditions.Methods: As a part of the larger study on patient experiences, 40 semistructured telephone interviews were conducted with women who were, or had recently been, pregnant and received high-risk (n = 15), false positive/negative (n = 20), or inconclusive (n = 5) results from cfDNA screening.Results: One third of participants would not elect to have cfDNA screening in a future pregnancy, and another third would only have the screen under particular circumstances or if the scope of the panel was limited. Many women reported feeling misled by the information they received prior to accepting cfDNA screening or receiving their results.Conclusions: Study participants described issues with the clinical dialog when cfDNA screening is offered; when results are returned; and problems with the availability of information about the existence of false positives. These reports suggest that inadequate pretest discussion contributes to women's experience of decisional regret after receiving high-risk, false positive, or inconclusive results. Given the confusion about cfDNA screening accuracy, the prevalence of follow-up invasive tests, and the number of women who reported that they regretted choosing cfDNA screening, the mode of offering cfDNA should be reassessed.
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Affiliation(s)
- Betsy L. Gammon
- Mayo Clinic, Biomedical Ethics Program, Rochester, MN, USA
- University of Virginia School of Medicine, Charlottesville, VA, USA
| | | | | | - Megan Allyse
- Mayo Clinic, Biomedical Ethics Program, Rochester, MN, USA
- Obstetrics and Gynecology, Mayo Clinic, Rochester, MN, USA
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Riggan KA, Close S, Allyse MA. Family experiences and attitudes about receiving the diagnosis of sex chromosome aneuploidy in a child. Am J Med Genet C Semin Med Genet 2020; 184:404-413. [PMID: 32181570 DOI: 10.1002/ajmg.c.31781] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Revised: 02/24/2020] [Accepted: 02/26/2020] [Indexed: 01/03/2023]
Abstract
The most common sex chromosome aneuploidies (SCA) (47, XXY; 47, XYY; 47, XXX) frequently result in a milder phenotype than autosomal aneuploidies. Nevertheless, these conditions are highly variable and more symptomatic phenotypes may require significant clinical involvement, including specialty care. While historically most individuals with mild phenotypes remained undiagnosed during their lifetime, the increasing use of genetic testing in clinical care has increased the prenatal and postnatal diagnosis of SCAs. These genetic tests are frequently ordered by nongenetic providers who are also responsible for delivering the diagnosis. We surveyed parents of children (n = 308) to evaluate their experience of receiving a diagnosis and their support needs. The majority (73.3%) received the diagnosis from a nongenetic medical provider. Following a prenatal diagnosis parents reported experiencing depression, anxiety, and less optimism than those receiving a postnatal diagnosis. Few parents reported receiving materials explaining their child's condition that they found to be up-to-date, accurate, and unbiased. The frequently negative reported experiences of parents at time of diagnosis suggests more educational opportunities should be provided for nongenetic providers in order to become more informed about these conditions and communicate the diagnosis in a way parents experience as supportive.
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Affiliation(s)
- Kirsten A Riggan
- Biomedical Ethics Research Program, Mayo Clinic, Rochester, Minnesota, USA
| | - Sharron Close
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia, USA
| | - Megan A Allyse
- Biomedical Ethics Research Program, Mayo Clinic, Rochester, Minnesota, USA
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Riggan KA, Nyquist C, Michie M, Allyse M. Evaluating the Risks and Benefits of Genetic and Pharmacologic Interventions for Down Syndrome: Views of Parents. Am J Intellect Dev Disabil 2020; 125:1-13. [PMID: 31877259 PMCID: PMC7754248 DOI: 10.1352/1944-7558-125.1.1] [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] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Researchers are investigating new technologies to mitigate or prevent symptoms of Down syndrome (DS), including chromosome silencing and pharmacotherapy. We surveyed parents of individuals with DS to assess their opinions on two hypothetical scenarios describing prenatal chromosome silencing and pediatric pharmacological intervention to improve neurocognition in children with DS. Although a slim majority of participants supported the availability of both therapies, respondent support was contingent on the risks presented, including the risk of miscarriage in the prenatal intervention and the impact of pharmaceuticals on their children's personality. Many parents expressed ambivalence, articulating a desire to improve their children's quality of life but requiring more safety and efficacy research before agreeing to a genetic or pharmacological intervention.
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Affiliation(s)
| | | | - Marsha Michie
- Department of Bioethics, Case Western Reserve University, Cleveland, OH
| | - Megan Allyse
- Biomedical Ethics Research Program, Mayo Clinic, Rochester, MN
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Abstract
The application of gene editing technologies to prevent or mitigate genetic disease in humans is considered one of its most promising applications. However, as the technology advances, it is imperative to understand the views of the broader public on how it should be used. We conducted focus groups to understand public views on the ethical permissibility and governance of gene editing technologies in humans. A total of 50 urban and semirural residents in the upper Midwest took part in six focus groups. Participants expressed multiple concerns about nonmedical uses of gene editing and its potential for unknown harms to human health, and were divided as to whether the individual patient or "medical experts" should be charged with overseeing the scope of its application. As potential stakeholders, the perspectives from the general public are critical to assess as genome editing technologies advance toward the clinic.
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Ormond KE, Bombard Y, Bonham VL, Hoffman-Andrews L, Howard H, Isasi R, Musunuru K, Riggan KA, Michie M, Allyse M. The clinical application of gene editing: ethical and social issues. Per Med 2019; 16:337-350. [DOI: 10.2217/pme-2018-0155] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Gene-editing techniques have progressed rapidly in the past 5 years. There are already ongoing human somatic gene-editing clinical trials for multiple diseases. And there has been one purported scenario of human germline gene editing in late 2018. In this paper, we will review the current state of the technology, discuss the ethical and social issues that surround the various forms of gene editing, as well as review emerging stakeholder data from professionals, the ‘general public’ and individuals and families dealing with genetic diseases potentially treatable by gene editing.
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Affiliation(s)
- Kelly E Ormond
- Department of Genetics & Stanford Center for Biomedical Ethics, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Yvonne Bombard
- Institute of Health Policy, Management & Evaluation, University of Toronto; Li Ka Shing Knowledge Institute of St Michael’s Hospital, Toronto, ON, Canada
- Li Ka Shing Knowledge Institute of St Michael’s Hospital, Toronto, ON, Canada
| | - Vence L Bonham
- Social & Behavioral Research Branch, National Human Genome Research Institute, NIH, Bethesda, MD 20892, USA
| | - Lily Hoffman-Andrews
- Penn Center for Inherited Cardiac Disease, Penn Medicine, Philadelphia, PA 19104, USA
| | - Heidi Howard
- Centre for Research Ethics & Bioethics, Uppsala University, Uppsala, Sweden
- Society & Ethics Research, Connecting Science, Wellcome Genome Campus, Cambridge, UK
| | - Rosario Isasi
- Dr J T Macdonald Foundation Department of Human Genetics, Institute of Bioethics & Health Policy, University of Miami Miller School of Medicine, Miami, FL 33136, USA
| | - Kiran Musunuru
- Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, PA 19104, USA
| | - Kirsten A Riggan
- Biomedical Ethics Research Program, Mayo Clinic, Rochester, MN 55905, USA
| | - Marsha Michie
- Department of Bioethics, Case Western Reserve University School of Medicine, Cleveland, OH 44106, USA
| | - Megan Allyse
- Biomedical Ethics Research Program & Center for Individualized Medicine, Mayo Clinic, Rochester, MN 55905, USA
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Riggan KA, Collura CA, Pittock ST, Ruano R, Whitford KJ, Allyse M. Ethical considerations of maternal-fetal intervention in a twin pregnancy discordant for anomalies. J Matern Fetal Neonatal Med 2019; 34:1312-1317. [PMID: 31189438 DOI: 10.1080/14767058.2019.1631793] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
BACKGROUND Recent evidence suggests prenatal fetoscopic tracheal occlusion (FETO) may improve the survival and long-term morbidity of neonates with congenital diaphragmatic hernia, yet little guidance exists in the medical literature as to the ethical permissibility of performing a maternal-fetal surgical intervention in a twin pregnancy discordant for a structural abnormality. CASE Here, we present a case of a twin pregnancy with an unaffected twin (Twin A) and a twin diagnosed with severe congenital diaphragmatic hernia (Twin B). A proposed fetoscopic tracheal occlusion (FETO) procedure may improve the likelihood of survival and postnatal outcome of Twin B; however, balloon placement may also initiate very preterm birth at 28 weeks of gestation. The Fetal Ethics Advisory Board was asked to provide guidance on the permissibility of FETO in this pregnancy. DISCUSSION A literature review identified one brief mention of FETO in a 34-week dichorionic twin pregnancy in the medical literature, which resulted in the rupture of fetal membranes in the sac of the nonsurgical twin. Only one paper specifically addressed the question of whether it would be ethically permissible to subject a healthy twin to the risks of maternal-fetal surgery for the benefit of a compromised twin, finding that any risk to the unaffected twin would be an ethical contraindication. We offer our own analysis of moral weight and risk/benefit considerations of this proposed intervention, and present our findings on the circumstances in which it may be ethically permissible to perform a maternal-fetal intervention in a twin pregnancy. CONCLUSION While FETO was not ethically advisable in this pregnancy, we find that in limited circumstances, certain maternal-fetal surgical interventions may be ethically permissible in a twin pregnancy discordant for a structural abnormality if the risks to the unaffected twin are minimal and the procedure would improve the likelihood of survival and postnatal outcome of a critically compromised co-twin.
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Affiliation(s)
- Kirsten A Riggan
- Biomedical Ethics Research Program, Mayo Clinic Rochester, Rochester, MN, USA
| | - Christopher A Collura
- Division of Neonatal Medicine, Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN, USA
| | - Siobhan T Pittock
- Division of Pediatric Endocrinology and Metabolism, Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN, USA
| | - Rodrigo Ruano
- Division of Maternal and Fetal Medicine, Department of Obstetrics & Gynecology, Mayo Clinic, Rochester, MN, USA
| | - Kevin J Whitford
- Department of Internal Medicine, Division of Hospital Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - Megan Allyse
- Biomedical Ethics Research Program, Mayo Clinic Rochester, Rochester, MN, USA.,Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, MN, USA
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Riggan KA, Allyse M. ‘Compassionate transfer’: an alternative option for surplus embryo disposition. Hum Reprod 2019; 34:791-794. [DOI: 10.1093/humrep/dez038] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2018] [Revised: 02/18/2019] [Accepted: 02/26/2019] [Indexed: 01/19/2023] Open
Affiliation(s)
- Kirsten A Riggan
- Biomedical Ethics Research Program, Mayo Clinic, Rochester MN, USA
| | - Megan Allyse
- Biomedical Ethics Research Program, Mayo Clinic, Rochester MN, USA
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Jaramillo C, Nyquist C, Riggan KA, Egginton J, Phelan S, Allyse M. Delivering the Diagnosis of Sex Chromosome Aneuploidy: Experiences and Preferences of Parents and Individuals. Clin Pediatr (Phila) 2019; 58:336-342. [PMID: 30516062 DOI: 10.1177/0009922818817310] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [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] [Indexed: 02/06/2023]
Abstract
Increased prenatal diagnoses of sex chromosome aneuploidies (SCAs) amid limited knowledge of their prognoses heighten the need to understand how families contend with the implications of an SCA. To explore the experiences of parents and individuals who received a genetic diagnosis of an SCA (excluding Turner syndrome), we conducted semistructured qualitative telephone interviews with 43 participants affected by these conditions. Parents (n = 35) and individuals (n = 8) expressed almost unanimous interest in more optimistic portrayals of their condition from their providers, even when the prognosis is uncertain. While some participants reported success in receiving accurate information from their provider and identifying supportive resources, numerous families received outdated or misleading information about their condition and lacked direction in accessing follow-up care and support. Parents desire greater coordination of their child's medical care and access to care that approaches an SCA holistically. Opportunities remain to improve the diagnosis and care of individuals with SCAs.
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