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O'Regan A, Fish LJ, Makarushka C, Somers T, Fitzgerald Jones K, Merlin JS, Dinan M, Oeffinger K, Check D. Managing Chronic Pain in Cancer Survivorship: Communication Challenges and Opportunities as Described by Cancer Survivors. Am J Hosp Palliat Care 2024; 41:78-86. [PMID: 36927121 DOI: 10.1177/10499091231164634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/18/2023] Open
Abstract
OBJECTIVES Many cancer survivors experience chronic pain after completing curative-intent treatment. Based on available data, chronic pain may be undertreated in this context; however, little is known about cancer survivors' experiences with clinical management of chronic pain. The purpose of this study was to better understand cancer survivors' pain management experiences after curative-intent treatment. METHODS We conducted 13 semi-structured interviews with a convenience sample of cancer survivors who had completed treatment for stage I-III breast, head/neck, lung or colorectal cancer. We used a thematic approach to qualitative data analysis. RESULTS Participants described that chronic pain often goes unrecognized by their providers, potentially due to limitations in how pain is assessed clinically and the tendency of both cancer survivors and providers to minimize or invalidate the pain experience. To improve communication, participants suggested that providers ask more open-ended questions about their pain, help them to establish functional goals, and provide patients with options for pain management. SIGNIFICANCE OF RESULTS This study demonstrates the importance of provider-initiated communication around pain management for cancer survivors to make them feel more supported in their care. Communication and shared decision-making interventions may improve cancer survivor-provider communication around chronic pain management, addressing an important gap in survivorship care.
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Affiliation(s)
- Amy O'Regan
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA
| | - Laura J Fish
- Duke Cancer Institute, Duke University Health System, Durham, NC, USA
- Department of Family Medicine and Community Health, Duke School of Medicine Durham, NC, USA
| | - Christina Makarushka
- Duke Cancer Institute, Duke University Health System, Durham, NC, USA
- Duke Global Health Institute, Durham, NC, USA
| | - Tamara Somers
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA
| | - Katie Fitzgerald Jones
- Veterans Affairs Boston Healthcare System, Boston, MA, USA
- Harvard Medical School, Harvard University, Cambridge, MA, USA
| | - Jessica S Merlin
- Division of General Internal Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Michaela Dinan
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT, USA
- Yale Cancer Outcomes, Public Policy, and Effectiveness Research Center, New Haven, CT, USA
| | - Kevin Oeffinger
- Duke Cancer Institute, Duke University Health System, Durham, NC, USA
- Department of Medicine, Duke University School of Medicine, Durham, NC, USA
| | - Devon Check
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA
- Duke Cancer Institute, Duke University Health System, Durham, NC, USA
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Shammas RL, Hung A, Mullikin A, Sergesketter AR, Lee CN, Reed SD, Fish LJ, Greenup RA, Hollenbeck ST. Patient Preferences for Postmastectomy Breast Reconstruction. JAMA Surg 2023; 158:1285-1292. [PMID: 37755818 PMCID: PMC10535024 DOI: 10.1001/jamasurg.2023.4432] [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: 05/18/2023] [Accepted: 07/19/2023] [Indexed: 09/28/2023]
Abstract
Importance Up to 40% of women experience dissatisfaction after breast reconstruction due to unexpected outcomes that are poorly aligned with personal preferences. Identifying what attributes patients value when considering surgery could improve shared decision-making. Adaptive choice-based conjoint (ACBC) analysis can elicit individual-level treatment preferences. Objectives To identify which attributes of breast reconstruction are most important to women considering surgery and to describe how these attributes differ by those who prefer flap vs implant reconstruction. Design, Setting, and Participants This web-based, cross-sectional study was conducted from March 1, 2022, to January 31, 2023, at Duke University and between June 1 and December 31, 2022, through the Love Research Army with ACBC analysis. Participants were 105 women at Duke University with a new diagnosis of or genetic predisposition to breast cancer who were considering mastectomy with reconstruction and 301 women with a history of breast cancer or a genetic predisposition as identified through the Love Research Army registry. Main Outcomes and Measures Relative importance scores, part-worth utility values, and maximum acceptable risks were estimated. Results Overall, 406 women (105 from Duke University [mean (SD) age, 46.3 (10.5) years] and 301 from the Love Research Army registry [mean (SD) age, 59.2 (11.9) years]) participated. The attribute considered most important was the risk of abdominal morbidity (mean [SD] relative importance [RI], 28% [11%]), followed by chance of major complications (RI, 25% [10%]), number of additional operations (RI, 23% [12%]), appearance of the breasts (RI, 13% [12%]), and recovery time (RI, 11% [7%]). Most participants (344 [85%]) preferred implant-based reconstruction; these participants cared most about abdominal morbidity (mean [SD] RI, 30% [11%]), followed by the risk of complications (mean [SD], RI, 26% [11%]) and additional operations (mean [SD] RI, 21% [12%]). In contrast, participants who preferred flap reconstruction cared most about additional operations (mean [SD] RI, 31% [15%]), appearance of the breasts (mean [SD] RI, 27% [16%]), and risk of complications (mean [SD] RI, 18% [6%]). Factors independently associated with choosing flap reconstruction included being married (odds ratio [OR], 2.30 [95% CI, 1.04-5.08]; P = .04) and higher educational level (college education; OR, 2.43 [95% CI, 1.01-5.86]; P = .048), while having an income level of greater than $75 000 was associated with a decreased likelihood of choosing the flap profile (OR, 0.45 [95% CI, 0.21-0.97]; P = .01). Respondents who preferred flap appearance were willing to accept a mean (SD) increase of 14.9% (2.2%) chance of abdominal morbidity (n = 113) or 6.4% (4.8%) chance of complications (n = 115). Conclusions and Relevance This study provides information on how women value different aspects of their care when making decisions for breast reconstruction. Future studies should assess how decision aids that elicit individual-level preferences can help tailor patient-physician discussions to focus preoperative counseling on factors that matter most to each patient and ultimately improve patient-centered care.
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Affiliation(s)
- Ronnie L. Shammas
- Division of Plastic, Maxillofacial and Oral Surgery, Duke University, Durham, North Carolina
| | - Anna Hung
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Health Care System, Durham, North Carolina
- Department of Population Health Sciences, Duke University School of Medicine, Durham, North Carolina
| | - Alexandria Mullikin
- Division of Plastic, Maxillofacial and Oral Surgery, Duke University, Durham, North Carolina
| | - Amanda R. Sergesketter
- Division of Plastic, Maxillofacial and Oral Surgery, Duke University, Durham, North Carolina
| | - Clara N. Lee
- Department of Plastic and Reconstructive Surgery, College of Medicine, Division of Health Services Management and Policy, College of Public Health, The Ohio State University, Columbus
| | - Shelby D. Reed
- Department of Population Health Sciences, Duke University School of Medicine, Durham, North Carolina
| | - Laura J. Fish
- Cancer Control and Population Sciences, Duke Cancer Institute, Durham, North Carolina
| | - Rachel A. Greenup
- Department of Surgery, Yale Comprehensive Cancer Center, Yale University School of Medicine, New Haven, Connecticut
| | - Scott T. Hollenbeck
- Department of Plastic and Maxillofacial Surgery, University of Virginia School of Medicine, Charlottesville
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Devi GR, Fish LJ, Bennion A, Sawin GE, Weaver SM, Reddy K, Saincher R, Tran AN. Identification of barriers at the primary care provider level to improve inflammatory breast cancer diagnosis and management. Prev Med Rep 2023; 36:102519. [PMID: 38116289 PMCID: PMC10728446 DOI: 10.1016/j.pmedr.2023.102519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Revised: 11/19/2023] [Accepted: 11/20/2023] [Indexed: 12/21/2023] Open
Abstract
The purpose of this study, based in the United States, was to evaluate knowledge gaps and barriers related to diagnosis and care of inflammatory breast cancer (IBC), a rare but lethal breast cancer subtype, amongst Primary Care Providers (PCP) as they are often the first point of contact when patients notice initial symptoms. PCP participants in the Duke University Health System, federally qualified health center, corporate employee health and community practices, nearby academic medical center, Duke physician assistant and advanced practice nurse leadership program alumni were first selected in a convenience sample and for semi-structured interviews (n = 11). Based on these data, an online survey tool was developed and disseminated (n = 78) to assess salient measures of IBC diagnosis, health disparity factors, referral and care coordination practices, COVID-19 impact, and continuing medical education (CME). PCP reported access to care and knowledge gaps in symptom recognition (mean = 3.3, range 1-7) as major barriers. Only 31 % reported ever suspecting IBC in a patient. PCP (n = 49) responded being challenged with referral delays in diagnostic imaging. Additionally, since the COVID-19 pandemic started, 63 % reported breast cancer referral delays, and 33 % reported diagnosing less breast cancer. PCP stated interest in CME in their practice for improved diagnosis and patient care, which included online (53 %), lunch time or other in-service training (33 %), patient and provider-facing websites (32 %). Challenges communicating rare cancer information, gaps in confidence in diagnosing IBC, and timely follow-up with patients and specialists underscores the need for developing PCP educational modules to improve guideline-concordant care.
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Affiliation(s)
- Gayathri R. Devi
- Division of Surgical Sciences, Department of Surgery, Duke University School of Medicine, USA
- Duke Consortium for Inflammatory Breast Cancer, Duke Cancer Institute, 2606 DUMC, Durham, NC 27710, USA
| | - Laura J. Fish
- Department of Family Medicine and Community Health, Duke University School of Medicine, 2715 DUMC, Durham, NC 27710, USA
| | - Alexandra Bennion
- Division of Surgical Sciences, Department of Surgery, Duke University School of Medicine, USA
- Duke Consortium for Inflammatory Breast Cancer, Duke Cancer Institute, 2606 DUMC, Durham, NC 27710, USA
- Trinity School of Arts and Sciences, Duke University, 2606 DUMC, Durham, NC 27710, USA
| | - Gregory E. Sawin
- Department of Family Medicine and Community Health, Duke University School of Medicine, 2715 DUMC, Durham, NC 27710, USA
| | - Sarah M. Weaver
- Division of Surgical Sciences, Department of Surgery, Duke University School of Medicine, USA
- Duke Consortium for Inflammatory Breast Cancer, Duke Cancer Institute, 2606 DUMC, Durham, NC 27710, USA
| | - Katherine Reddy
- Duke Consortium for Inflammatory Breast Cancer, Duke Cancer Institute, 2606 DUMC, Durham, NC 27710, USA
- Trinity School of Arts and Sciences, Duke University, 2606 DUMC, Durham, NC 27710, USA
| | - Rashmi Saincher
- Duke Consortium for Inflammatory Breast Cancer, Duke Cancer Institute, 2606 DUMC, Durham, NC 27710, USA
- Department of Family Medicine and Community Health, Duke University School of Medicine, 2715 DUMC, Durham, NC 27710, USA
| | - Anh N. Tran
- Duke Consortium for Inflammatory Breast Cancer, Duke Cancer Institute, 2606 DUMC, Durham, NC 27710, USA
- Department of Family Medicine and Community Health, Duke University School of Medicine, 2715 DUMC, Durham, NC 27710, USA
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Hall RK, Rutledge J, Lucas A, Liu CK, Clair Russell JS, Peter WS, Fish LJ, Colón-Emeric C. Stakeholder Perspectives on Factors Related to Deprescribing Potentially Inappropriate Medications in Older Adults Receiving Dialysis. Clin J Am Soc Nephrol 2023; 18:1310-1320. [PMID: 37499693 PMCID: PMC10578639 DOI: 10.2215/cjn.0000000000000229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Accepted: 07/21/2023] [Indexed: 07/29/2023]
Abstract
BACKGROUND Potentially inappropriate medications, or medications that generally carry more risk of harm than benefit in older adults, are commonly prescribed to older adults receiving dialysis. Deprescribing, a systematic approach to reducing or stopping a medication, is a potential solution to limit potentially inappropriate medications use. Our objective was to identify clinicians and patient perspectives on factors related to deprescribing to inform design of a deprescribing program for dialysis clinics. METHODS We conducted rapid qualitative analysis of semistructured interviews and focus groups with clinicians (dialysis clinicians, primary care providers, and pharmacists) and patients (adults receiving hemodialysis aged 65 years or older and those aged 55-64 years who were prefrail or frail) from March 2019 to December 2020. RESULTS We interviewed 76 participants (53 clinicians [eight focus groups and 11 interviews] and 23 patients). Among clinicians, 24 worked in dialysis clinics, 18 worked in primary care, and 11 were pharmacists. Among patients, 13 (56%) were aged 65 years or older, 14 (61%) were Black race, and 16 (70%) reported taking at least one potentially inappropriate medication. We identified four themes (and corresponding subthemes) of contextual factors related to deprescribing potentially inappropriate medications: ( 1 ) system-level barriers to deprescribing (limited electronic medical record interoperability, time constraints and competing priorities), ( 2 ) undefined comanagement among clinicians (unclear role delineation, clinician caution about prescriber boundaries), ( 3 ) limited knowledge about potentially inappropriate medications (knowledge limitations among clinicians and patients), and ( 4 ) patients prioritize symptom control over potential harm (clinicians expect resistance to deprescribing, patient weigh risks and benefits). CONCLUSIONS Challenges to integration of deprescribing into dialysis clinics included siloed health systems, time constraints, comanagement behaviors, and clinician and patient knowledge and attitudes toward deprescribing.
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Affiliation(s)
- Rasheeda K. Hall
- Department of Medicine, Duke University School of Medicine, Durham, North Carolina
- Medicine Service, Durham Veterans Affairs Medical Center, Durham, North Carolina
| | - Jeanette Rutledge
- Department of Medicine, Duke University School of Medicine, Durham, North Carolina
| | - Anika Lucas
- Department of Medicine, Duke University School of Medicine, Durham, North Carolina
- Medicine Service, Durham Veterans Affairs Medical Center, Durham, North Carolina
| | - Christine K. Liu
- Section of Geriatric Medicine, Stanford University School of Medicine, Stanford, California
- Geriatric Research Education and Clinical Center, Palo Alto VA Health Care System, Palo Alto, California
| | - Jennifer St. Clair Russell
- Department of Medicine, Duke University School of Medicine, Durham, North Carolina
- Dimensions of Care, LLC, Rockville, Maryland
| | - Wendy St. Peter
- Department of Pharmaceutical Care and Health Systems, University of Minnesota College of Pharmacy, Minneapolis, Minnesota
| | - Laura J. Fish
- Department of Family Medicine and Community Health, Duke University School of Medicine, Durham, North Carolina
- Duke Cancer Institute, Duke University School of Medicine, Durham, North Carolina
| | - Cathleen Colón-Emeric
- Department of Medicine, Duke University School of Medicine, Durham, North Carolina
- Medicine Service, Durham Veterans Affairs Medical Center, Durham, North Carolina
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Zimmerman ME, Hart LJ, Medrano P, Piccone C, Ramirez DM, Huggins LK, Sotres-Alvarez D, Fish LJ, Østbye T, Holliday KM. COVID-19 in the Community: Changes to Women's Mental Health, Financial Security, and Physical Activity. AJPM Focus 2023; 2:100095. [PMID: 37234692 PMCID: PMC10039779 DOI: 10.1016/j.focus.2023.100095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/28/2023]
Abstract
Introduction This study describes changes in the mental health, financial security, and physical activity levels of women in North Carolina during the COVID-19 pandemic. Methods Data were collected from women aged 20-40 years receiving primary care at 2 health centers in North Carolina during 2020-2022. Surveys (N=127) evaluated changes in mental health, financial security, and physical activity during the COVID-19 pandemic. These outcomes were analyzed both descriptively and for association with sociodemographic factors using logistic regression. A subset of participants (n=46) participated in semistructured interviews. Interview transcripts were reviewed and evaluated for recurring themes by primary and secondary coders using a rapid-coding technique. Analysis was conducted in 2022. Results Women surveyed were 28.4% non-Hispanic White, 38.6% non-Hispanic Black, and 33.1% Hispanic/Latina. Compared with reports before the pandemic, participants reported increased frustration or boredom (69.1%), loneliness (51.6%), anxiety (64.3%), depression (52.4%), and changed sleep patterns (68.3%). Increased alcohol and other recreational substance use were associated with race and ethnicity (p<0.05) after adjustment for other sociodemographic factors. Participants reported difficulty in paying for basic expenses (44.0%). Financial difficulties during COVID-19 were associated with non-Hispanic Black race and ethnicity, less education, and lower prepandemic household income. Data showed pandemic-associated reductions in mild (32.8%), moderate (39.5%), and strenuous (43.3%) exercise, with a correlation between increased depression and reduced mild exercise. Interviews identified themes including reduced activity while working remotely, lack of gym access, and reduced motivation for exercise. Conclusions This mixed-methods study is one of the first to evaluate the mental health, financial security, and physical activity challenges women aged between 20 and 40 years in the southern U.S. faced during the COVID-19 pandemic.
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Affiliation(s)
| | - Lauren J. Hart
- Department of Family Medicine & Community Health, Duke University School of Medicine, Durham, North Carolina
| | - Perla Medrano
- Duke Global Health Institute, Duke University, Durham, North Carolina
| | - Caitlin Piccone
- Department of Family Medicine & Community Health, Duke University School of Medicine, Durham, North Carolina
| | - Diana M. Ramirez
- Sanford School of Public Policy, Duke University, Durham, North Carolina
| | - Lenique K.L. Huggins
- Duke Global Health Institute, Duke University, Durham, North Carolina
- Department of Biology, Trinity College of Arts and Sciences, Duke University, Durham, North Carolina
| | - Daniela Sotres-Alvarez
- Department of Biostatistics, Gillings School of Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Laura J. Fish
- Department of Family Medicine & Community Health, Duke University School of Medicine, Durham, North Carolina
| | - Truls Østbye
- Department of Family Medicine & Community Health, Duke University School of Medicine, Durham, North Carolina
- Duke Global Health Institute, Duke University, Durham, North Carolina
| | - Katelyn M. Holliday
- Department of Family Medicine & Community Health, Duke University School of Medicine, Durham, North Carolina
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Check DK, Jones KF, Fish LJ, Dinan MA, Dunbar TK, Farley S, Ma J, Merlin JS, O'Regan A, Oeffinger KC. Clinician Perspectives on Managing Chronic Pain After Curative-Intent Cancer Treatment. JCO Oncol Pract 2023; 19:e484-e491. [PMID: 36595729 PMCID: PMC10530392 DOI: 10.1200/op.22.00410] [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: 06/10/2022] [Revised: 08/19/2022] [Accepted: 11/04/2022] [Indexed: 01/04/2023] Open
Abstract
PURPOSE Among cancer survivors who have completed curative-intent treatment, the high prevalence and adverse consequences of chronic pain are well documented. Yet, research on clinicians' experiences with and perspectives on managing chronic pain among cancer survivors is critically lacking. METHODS We conducted semistructured interviews with 17 clinicians (six oncology, three palliative care, and eight primary care) affiliated with an academic medical center. Interview questions addressed clinicians' experiences with and perspectives on managing chronic pain (with or without opioid therapy) during the transition from active treatment to survivorship. A multidisciplinary team conducted content analysis of interview transcripts to identify and refine themes related to current practices and challenges in managing chronic pain in this context. RESULTS Overall, clinicians perceived chronic pain to be relatively uncommon among cancer survivors. Identified challenges included a lack of clarity about which clinician (or clinicians) are best positioned to manage chronic pain among cancer survivors, and (relatedly) complexities introduced by long-term opioid management, with many clinicians describing this practice as outside their skill set. Additionally, although most clinicians recognized chronic pain as a biopsychosocial phenomenon, they described challenges with effectively managing psychosocial stressors, including difficulty accessing mental or behavioral health services for cancer survivors. CONCLUSION Discovered challenges highlight unmet needs related to cancer survivor-clinician communication about chronic pain and the absence of a chronic pain management home for cancer survivors, including those requiring long-term opioid therapy. Research evaluating routine pain monitoring and accessible, tailored models of multimodal pain care in survivorship may help to address these challenges.
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Affiliation(s)
- Devon K. Check
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC
- Duke Cancer Institute, Durham, NC
| | - Katie F. Jones
- Boston College, William F. Connell School of Nursing, Chestnut Hill, MA
| | - Laura J. Fish
- Duke Cancer Institute, Durham, NC
- Department of Family Medicine and Community Health, Duke University School of Medicine, Durham, NC
| | - Michaela A. Dinan
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT
- Yale Cancer Outcomes, Public Policy, and Effectiveness Research Center, New Haven, CT
| | - T. Kayla Dunbar
- Doctor of Osteopathic Medicine Program, Philadelphia College of Osteopathic Medicine, Philadelphia, PA
| | | | - Jessica Ma
- Division of General Internal Medicine, Department of Medicine, Duke University School of Medicine, Durham, NC
| | - Jessica S. Merlin
- Division of General Internal Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Amy O'Regan
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC
| | - Kevin C. Oeffinger
- Duke Cancer Institute, Durham, NC
- Department of Medicine, Duke University School of Medicine, Durham, NC
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Fayanju OM, Oyekunle T, Thomas SM, Ingraham KL, Fish LJ, Greenup RA, Oeffinger KC, Zafar SY, Hyslop T, Hwang ES, Patierno SR, Barrett NJ. Modifiable patient-reported factors associated with cancer-screening knowledge and participation in a community-based health assessment. Am J Surg 2023; 225:617-629. [PMID: 36411107 PMCID: PMC10085670 DOI: 10.1016/j.amjsurg.2022.10.059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Revised: 10/25/2022] [Accepted: 10/28/2022] [Indexed: 11/19/2022]
Abstract
BACKGROUND We sought to identify modifiable factors associated with cancer screening in a community-based health assessment. METHODS 24 organizations at 47 community events in central North Carolina distributed a 91-item survey from April-December 2017. Responses about (1) interest in disease prevention, (2) lifestyle choices (e.g., diet, tobacco), and (3) perceptions of primary care access/quality were abstracted to examine their association with self-reported screening participation and knowledge about breast, prostate, and colorectal cancer. RESULTS 2135/2315 participants (92%; 38.5% White, 38% Black, 9.9% Asian) completed screening questions. >70% of screen-eligible respondents reported guideline-concordant screening. Healthy dietary habits were associated with greater knowledge about breast and colorectal cancer screening; reporting negative attitudes about and barriers to healthcare were associated with less breast, prostate, and colorectal cancer screening. Having a place to seek medical care (a proxy for primary care access) was independently associated with being ∼5 times as likely to undergo colorectal screening (OR 4.66, 95% CI 1.58-13.79, all p < 0.05). CONCLUSIONS In this diverse, community-based sample, modifiable factors were associated with screening engagement, highlighting opportunities for behavioral intervention.
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Affiliation(s)
- Oluwadamilola M Fayanju
- Department of Surgery, Duke University Medical Center, Box 3513, Durham, NC, 27710, USA; Duke Cancer Institute, Durham, NC, 27710, USA; Department of Population Health Sciences, Duke University School of Medicine, 215 Morris Street, Durham, NC, 27701, USA; Duke Forge, Duke University, Durham, NC, 27710, USA; Durham VA Medical Center, 508 Fulton St, Durham, NC, 27705, USA.
| | - Taofik Oyekunle
- Duke Cancer Institute, Durham, NC, 27710, USA; Durham VA Medical Center, 508 Fulton St, Durham, NC, 27705, USA
| | - Samantha M Thomas
- Duke Cancer Institute, Durham, NC, 27710, USA; Department of Biostatistics and Bioinformatics, Duke University Medical Center, Box 2717, Durham, NC, 27710, USA
| | | | - Laura J Fish
- Duke Cancer Institute, Durham, NC, 27710, USA; Department of Family Medicine and Community Health, Duke University Medical Center, Box 2914, Durham, NC, 27710, USA
| | - Rachel A Greenup
- Department of Surgery, Duke University Medical Center, Box 3513, Durham, NC, 27710, USA; Duke Cancer Institute, Durham, NC, 27710, USA; Department of Population Health Sciences, Duke University School of Medicine, 215 Morris Street, Durham, NC, 27701, USA; Duke Margolis Center for Health Policy, Duke University, Durham, NC, 27708, USA
| | - Kevin C Oeffinger
- Duke Cancer Institute, Durham, NC, 27710, USA; Department of Medicine, Duke University Medical Center, Box 3893, Durham, NC, 27710, USA
| | - S Yousuf Zafar
- Duke Cancer Institute, Durham, NC, 27710, USA; Department of Population Health Sciences, Duke University School of Medicine, 215 Morris Street, Durham, NC, 27701, USA; Duke Margolis Center for Health Policy, Duke University, Durham, NC, 27708, USA; Department of Medicine, Duke University Medical Center, Box 3893, Durham, NC, 27710, USA; Change Healthcare, 216 Centerview Dr #300, Nashville, TN, 37219, USA
| | - Terry Hyslop
- Duke Cancer Institute, Durham, NC, 27710, USA; Department of Biostatistics and Bioinformatics, Duke University Medical Center, Box 2717, Durham, NC, 27710, USA
| | - E Shelley Hwang
- Department of Surgery, Duke University Medical Center, Box 3513, Durham, NC, 27710, USA; Duke Cancer Institute, Durham, NC, 27710, USA
| | - Steven R Patierno
- Duke Cancer Institute, Durham, NC, 27710, USA; Department of Medicine, Duke University Medical Center, Box 3893, Durham, NC, 27710, USA
| | - Nadine J Barrett
- Duke Cancer Institute, Durham, NC, 27710, USA; Department of Family Medicine and Community Health, Duke University Medical Center, Box 2914, Durham, NC, 27710, USA; Duke Clinical and Translation Science Institute, Duke University School of Medicine, Durham, NC, 27710, USA
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Fayanju OM, Greenup RA, Zafar SY, Hyslop T, Hwang ES, Fish LJ. Modifiable Barriers and Facilitators for Breast Cancer Care: A Thematic Analysis of Patient and Provider Perspectives. J Surg Res 2023; 284:269-279. [PMID: 36610386 PMCID: PMC10020986 DOI: 10.1016/j.jss.2022.11.074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Revised: 11/14/2022] [Accepted: 11/16/2022] [Indexed: 01/06/2023]
Abstract
INTRODUCTION We sought to examine patient and provider perspectives regarding modifiable contributors to breast cancer treatment and to assess perceptual alignment between these two groups. MATERIALS Participants were women≥18 y with stage 0-IV breast cancer who received all oncologic care in a single health system and physicians and advanced practice providers who provided medical, radiation, or surgical oncology care for breast cancer. All completed ∼45-min semistructured interviews that were recorded and transcribed verbatim. A 5-stage approach to thematic analysis was conducted, with emergent themes and exemplar quotes placed into clinical, psychological, social/logistical, financial, and lifestyle categories using a multilevel conceptual framework. RESULTS Eighteen patients (9 Black, 9 White, and median age 60 y) and 10 providers (6 physicians and 4 advanced practice providers) were interviewed from May to November 2018. Both patients and providers perceived suboptimal communication, parking and transportation, and competing family-caregiving responsibilities as modifiable barriers to care. Treatment costs were cited by patients as barriers that were inadequately addressed even with referrals to financial counselors, but providers did not raise the issue of cost unless prompted by patients and did not feel prepared to discuss the topic when it arose. Providers cited obesity as a barrier to treatment, a view not shared by patients. CONCLUSIONS Several modifiable factors were recognized by both patients and providers as either promoting or detracting from treatment receipt, but there was also significant incongruence and asymmetry. Alignment of provider and patient perceptions regarding contributors to guideline-concordant care receipt could mitigate disparities in breast cancer treatment and outcomes.
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Affiliation(s)
- Oluwadamilola M Fayanju
- Department of Surgery, Duke University Medical Center, Durham, North Carolina; Duke Cancer Institute, Durham, North Carolina; Department of Population Health Sciences, Duke University School of Medicine, Durham, North Carolina; Duke Forge, Duke University, Durham, North Carolina; Durham VA Medical Center, Durham, North Carolina.
| | - Rachel A Greenup
- Department of Surgery, Duke University Medical Center, Durham, North Carolina; Duke Cancer Institute, Durham, North Carolina; Department of Population Health Sciences, Duke University School of Medicine, Durham, North Carolina; Duke Margolis Center for Health Policy, Duke University, Durham, North Carolina
| | - S Yousuf Zafar
- Duke Cancer Institute, Durham, North Carolina; Department of Population Health Sciences, Duke University School of Medicine, Durham, North Carolina; Duke Margolis Center for Health Policy, Duke University, Durham, North Carolina; Department of Medicine, Duke University Medical Center, Durham, North Carolina; Change Healthcare, Nashville, Tennessee
| | - Terry Hyslop
- Duke Cancer Institute, Durham, North Carolina; Department of Biostatistics and Bioinformatics, Duke University Medical Center, Durham, North Carolina
| | - E Shelley Hwang
- Department of Surgery, Duke University Medical Center, Durham, North Carolina; Duke Cancer Institute, Durham, North Carolina
| | - Laura J Fish
- Duke Cancer Institute, Durham, North Carolina; Department of Family Medicine and Community Health, Duke University Medical Center, Durham, North Carolina
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Miller HN, Lindo S, Fish LJ, Roberts J, Stover J, Schwark EH, Eberlein N, Mack D, Falkovic M, Makarushka C, Chatterjee R. Describing current use, barriers, and facilitators of patient portal messaging for research recruitment: Perspectives from study teams and patients at one institution. J Clin Transl Sci 2023; 7:e96. [PMID: 37125060 PMCID: PMC10130833 DOI: 10.1017/cts.2023.522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Revised: 03/28/2023] [Accepted: 03/30/2023] [Indexed: 05/02/2023] Open
Abstract
Introduction The electronic health record (EHR) and patient portal are used increasingly for clinical research, including patient portal recruitment messaging (PPRM). Use of PPRM has grown rapidly; however, best practices are still developing. In this study, we examined the use of PPRM at our institution and conducted qualitative interviews among study teams and patients to understand experiences and preferences for PPRM. Methods We identified study teams that sent PPRMs and patients that received PPRMs in a 60-day period. We characterized these studies and patients, in addition to the patients' interactions with the PPRMs (e.g., viewed, responded). From these groups, we recruited study team members and patients for semi-structured interviews. A pragmatic qualitative inquiry framework was used by interviewers. Interviews were audio-recorded and analyzed using a rapid qualitative analysis exploratory approach. Results Across ten studies, 35,037 PPRMs were sent, 33% were viewed, and 17% were responded to. Interaction rates varied across demographic groups. Six study team members completed interviews and described PPRM as an efficient and helpful recruitment method. Twenty-eight patients completed interviews. They were supportive of receiving PPRMs, particularly when the PPRM was relevant to their health. Patients indicated that providing more information in the PPRM would be helpful, in addition to options to set personalized preferences. Conclusions PPRM is an efficient recruitment method for study teams and is acceptable to patients. Engagement with PPRMs varies across demographic groups, which should be considered during recruitment planning. Additional research is needed to evaluate and implement recommended changes by study teams and patients.
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Affiliation(s)
| | - Sierra Lindo
- Duke Clinical and Translational Science Institute, Recruitment Innovation Center, Duke University, Durham, NC, USA
| | - Laura J. Fish
- Duke Cancer Institute, Behavioral Health and Survey Research Core, Duke University, Durham, NC, USA
- Department of Family Medicine and Community Health, Duke University, Durham, NC, USA
| | | | - John Stover
- Duke University School of Medicine, Durham, NC 27710, USA
| | | | - Nicholas Eberlein
- Duke Clinical and Translational Science Institute, Recruitment Innovation Center, Duke University, Durham, NC, USA
| | - Dalia Mack
- Duke University School of Medicine, Durham, NC 27710, USA
| | - Margaret Falkovic
- Duke Cancer Institute, Behavioral Health and Survey Research Core, Duke University, Durham, NC, USA
| | - Christina Makarushka
- Duke Cancer Institute, Behavioral Health and Survey Research Core, Duke University, Durham, NC, USA
| | - Ranee Chatterjee
- Duke Clinical and Translational Science Institute, Recruitment Innovation Center, Duke University, Durham, NC, USA
- Duke University School of Medicine, Durham, NC 27710, USA
- Address for correspondence: R. Chatterjee, MD, MPH, 710 W. Main Street, 1st floor, Durham, NC 27701, USA.
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Tyson CC, Svetkey LP, Lin PH, Granados I, Kennedy D, Dunbar KT, Redd C, Bennett G, Boulware LE, Fish LJ. Self-Perceived Barriers and Facilitators to Dietary Approaches to Stop Hypertension Diet Adherence Among Black Americans With Chronic Kidney Disease: A Qualitative Study. J Ren Nutr 2023; 33:59-68. [PMID: 35597318 PMCID: PMC10344422 DOI: 10.1053/j.jrn.2022.05.002] [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: 11/19/2021] [Revised: 03/25/2022] [Accepted: 05/01/2022] [Indexed: 01/25/2023] Open
Abstract
OBJECTIVE The Dietary Approaches to Stop Hypertension (DASH) eating plan improves hypertension in Black individuals and is associated with favorable chronic kidney disease (CKD) outcomes. Yet, adherence to DASH is low among US adults in general, particularly among Black Americans. We assessed perceptions about DASH, its cultural compatibility, and barriers and facilitators to DASH adherence in Black adults with CKD. DESIGN AND METHODS We conducted focus groups and semistructured individual interviews involving 22 Black men and women with CKD Stages 3-4 from outpatient clinics at a US academic medical center. Transcripts of audio-recorded interviews were analyzed using thematic analysis. RESULTS Among participants (2 focus groups [N = 8 and 5] and 9 individual interviews), 13 (59%) had CKD Stage 3, 13 (59%) were female, the median age was 61 years, and 19 (90%) had hypertension. After receiving information about DASH, participants perceived it as culturally compatible based on 3 emergent themes: (1) Black individuals already eat DASH-recommended foods ("Blacks eat pretty much like this"), (2) traditional recipes (e.g., southern or soul food) can be modified into healthy versions ("you can come up with decent substitutes to make it just as good"), and ( 3) diet is not uniform among Black individuals ("I can't say that I eat traditional"). Perceived barriers to DASH adherence included unfamiliarity with serving sizes, poor cooking skills, unsupportive household members, and high cost of healthy food. Eleven (52%) reported after paying monthly bills that they "rarely" or "never" had leftover money to purchase healthy food. Perceived facilitators included having local access to healthy food, living alone or with supportive household members, and having willpower and internal/external motivation for change. CONCLUSIONS Black adults with CKD viewed DASH as a healthy, culturally compatible diet. Recognizing that diet in Black adults is not uniform, interventions should emphasize person-centered, rather than stereotypically culture-centered, approaches to DASH adherence.
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Affiliation(s)
- Crystal C Tyson
- Division of Nephrology, Department of Medicine, Duke University School of Medicine, Durham, North Carolina.
| | - Laura P Svetkey
- Division of Nephrology, Department of Medicine, Duke University School of Medicine, Durham, North Carolina; Duke Stedman Nutrition & Metabolism Center, Duke Molecular Physiology Institute, Durham, North Carolina
| | - Pao-Hwa Lin
- Division of Nephrology, Department of Medicine, Duke University School of Medicine, Durham, North Carolina; Duke Stedman Nutrition & Metabolism Center, Duke Molecular Physiology Institute, Durham, North Carolina
| | - Isa Granados
- Duke Cancer Institute, Duke University, Durham, North Carolina; Department of Population Health Sciences, Duke University School of Medicine, Durham, North Carolina
| | | | - Kayla T Dunbar
- Department of Population Health Sciences, Duke University School of Medicine, Durham, North Carolina
| | - Cynthia Redd
- Division of Nephrology, Department of Medicine, Duke University School of Medicine, Durham, North Carolina
| | - Gary Bennett
- Division of Nephrology, Department of Medicine, Duke University School of Medicine, Durham, North Carolina; Department of Psychology and Neuroscience, Duke Global Digital Health Science Center, Duke University, Durham, North Carolina
| | - L Ebony Boulware
- Division of General Internal Medicine, Department of Medicine, Duke University School of Medicine, Durham, North Carolina
| | - Laura J Fish
- Duke Cancer Institute, Duke University, Durham, North Carolina; Department of Family Medicine and Community Health, Duke University School of Medicine, Durham, North Carolina
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11
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Reid HW, Selvan B, Montes de Oca MK, Falkovic M, Malone S, Fish LJ, Wheeler S, Davidson BA. "You start feeling comfortable, you just start sharing:" A qualitative study of patient distress screening in Black and White patients with endometrial cancer. Gynecol Oncol 2023; 168:166-175. [PMID: 36502783 PMCID: PMC9884512 DOI: 10.1016/j.ygyno.2022.11.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Revised: 11/03/2022] [Accepted: 11/05/2022] [Indexed: 12/13/2022]
Abstract
OBJECTIVES Black patients with endometrial cancer are less likely to express distress and receive referrals for support services compared to White patients. We aim to characterize patient perceptions of the National Comprehensive Cancer Network Distress Thermometer and Problem List (NCCN DT & PL), a common distress screening tool, among Black and White patients with endometrial cancer and determine strategies to improve equity in referral to appropriate support services. METHODS We conducted semi-structured interviews with 15 Black and 15 White patients with endometrial cancer who reported varying levels of distress on the NCCN DT & PL. Interviews were audio-recorded, transcribed, evaluated through staged content analysis, and salient themes were compared by patient race. RESULTS The NCCN DT & PL was generally considered understandable, however the word "distress" could be alienating to participants who considered their stress to be less "drastic." Black participants mentioned fewer negative emotions such as worry and sadness in describing distress and spoke more often of a positive outlook. Additionally, Black participants emphasized the importance of relationship-building with clinicians for open communication on the NCCN DT & PL and clinical encounter. Finally, participants were divided on whether they would alter the way they completed the NCCN DT & PL given more information on cut off scores for referrals, but generally expressed a desire for more direct offers of support services. CONCLUSIONS Relationship-building, open communication around emotion, and longitudinal direct offers of support emerged as avenues to reduce inequities in referral to supportive services for patients with endometrial cancer.
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Affiliation(s)
- Hadley W Reid
- Duke University School of Medicine, DUMC 3710, Durham, NC 27710, USA.
| | - Bharathi Selvan
- Duke University School of Medicine, DUMC 3710, Durham, NC 27710, USA.
| | - Mary Katherine Montes de Oca
- Department of Obstetrics and Gynecology, Duke University School of Medicine, 2608 Erwin Rd, STE 210, Durham, NC 27710, USA.
| | - Margaret Falkovic
- Duke Cancer Institute, Behavioral Health and Survey Research Core, Duke University School of Medicine, Box 2715, Durham, NC 27710, USA.
| | - Shauna Malone
- Department of Population Health Sciences, Duke University School of Medicine, 215 Morris St, Durham, NC 27701, USA..
| | - Laura J Fish
- Duke Cancer Institute, Behavioral Health and Survey Research Core, Duke University School of Medicine, Box 2715, Durham, NC 27710, USA; Department of Family Medicine and Community Health, Duke University School of Medicine, DUMC 2914, Durham, NC 27710, USA.
| | - Sarahn Wheeler
- Division of Maternal Fetal Medicine, Duke University School of Medicine, DUMC 3967, Durham, NC 27710, USA.
| | - Brittany A Davidson
- Division of Gynecologic Oncology, Duke University School of Medicine, DUMC Box 3079, Durham, NC 27710, USA.
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12
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Fish LJ, Harrison SE, McDonald JA, Yelverton V, Williams C, Walter EB, Vasudevan L. Key stakeholder perspectives on challenges and opportunities for rural HPV vaccination in North and South Carolina. Hum Vaccin Immunother 2022; 18:2058264. [PMID: 35439108 PMCID: PMC9248957 DOI: 10.1080/21645515.2022.2058264] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 03/16/2022] [Indexed: 11/08/2022] Open
Abstract
The objective of this study was to identify factors at the individual, provider, and systems levels that serve as challenges or opportunities for increasing adolescent vaccination-including Human Papillomavirus (HPV) vaccination-in rural communities in the southern United States (US). As part of a broader study to increase HPV vaccine uptake in the southern US, we conducted in-depth interviews with vaccination stakeholders representing public health and education agencies in North Carolina (NC) and South Carolina (SC). Fourteen key stakeholders were recruited using purposive sampling to obtain insights into challenges and solutions to rural-urban disparities in HPV vaccination coverage. Stakeholders were also queried about their experiences and attitudes toward school-based vaccination promotion programs and campaigns. We used a rapid qualitative approach to analyze the data. Stakeholders identified factors at the individual, provider, and systems levels that serve as challenges to vaccination in rural communities. Similar to previous studies, stakeholders mentioned challenges with healthcare access and vaccine-related misconceptions that pose barriers to HPV vaccination for rural residents. Systems-level challenges identified included limited access to high-speed internet in rural areas that may impact providers' ability to interface with state-level digital systems such as the vaccination registry. Stakeholders identified a number of opportunities to increase HPV vaccination coverage, including through school-based health promotion programs. Stakeholders strongly supported school-based programs and approaches to strengthen confidence and demand for HPV vaccination and to help address persistent social determinants and system level factors that pose challenges to HPV vaccination coverage in many rural areas.
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Affiliation(s)
- Laura J. Fish
- Department of Family Medicine and Community Health, Duke University School of Medicine, Durham, NC, USA
- Duke Cancer Institute, Durham, NC, USA
| | - Sayward E Harrison
- Department of Psychology, Barnwell College, University of South Carolina, Columbia, SC, USA
- South Carolina Smart State Center for Healthcare Quality, University of South Carolina, Columbia, SC, USA
| | | | - Valerie Yelverton
- Department of Health Services Policy & Management, University of South Carolina, Columbia, SC, USA
| | - Charnetta Williams
- Immunization Services Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention (CDC), Atlanta, GA, USA
| | - Emmanuel B. Walter
- Duke Human Vaccine Institute, Durham, NC, USA
- Department of Pediatrics, Duke University School of Medicine, Durham, NC, USA
- Duke Global Health Institute, Durham, NC, USA
| | - Lavanya Vasudevan
- Department of Family Medicine and Community Health, Duke University School of Medicine, Durham, NC, USA
- Duke Human Vaccine Institute, Durham, NC, USA
- Duke Global Health Institute, Durham, NC, USA
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13
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Monuszko KA, Fish LJ, Sparacio D, Lizaso C, Burn K, Wickenheisser NE, Meyer LA, Reed SD, Davidson BA, Havrilesky LJ. Understanding the needs and perspectives of ovarian cancer patients when considering PARP inhibitor maintenance therapy: Findings from two online community events. Gynecol Oncol Rep 2022; 43:101050. [PMID: 35942110 PMCID: PMC9356188 DOI: 10.1016/j.gore.2022.101050] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 07/21/2022] [Accepted: 07/22/2022] [Indexed: 11/29/2022] Open
Abstract
Patients engaged in online patient communities have numerous educational needs regarding PARP inhibitors. 2 online events were held to sample ovarian cancer patient perceptions of, and information seeking about PARP inhibitors. Major themes included side effects, benefits, clinical trial results, genetic mutations, and cost. Patients would likely benefit from patient-centered educational tools regarding PARP inhibitors.
Objective The online environment is an ideal setting to understand how many women seek, receive, and understand information about cancer treatment. The purpose of this study was to understand women’s needs and information-seeking around Poly ADP ribose polymerase (PARP) inhibitors, an oral medication commonly prescribed as maintenance therapy at the conclusion of primary chemotherapy for ovarian cancer. Methods We held online discussion events with two social media communities, #gyncsm social media on Twitter and the Smart Patients ovarian cancer community, in November 2020, to sample ovarian cancer patient perceptions of, and information seeking about PARP inhibitors. Focused questions were presented to both communities, with participants able to answer and elaborate upon these questions, as well as to add their own comments or topics. Qualitative content analysis was performed on the transcripts from the two online events. Results A total of 254 unique tweets and 71 messages were generated from the Twitter and Smart Patients conversations, respectively. The majority of the content from these two events could be categorized into five major themes: (1) concerns about side effects, (2) expectations of benefit, (3) desire for more information regarding clinical trials, ) (4) desire to better understand the relationship between mutation status and PARP inhibitor effectiveness, and (5) financial toxicity. Misinformation was rarely identified. Conclusions Women with ovarian cancer who are engaged in online patient communities have numerous educational needs regarding PARP inhibitors. Given the complexity of clinical research on PARP inhibitors, patients would likely benefit from patient-centered educational tools.
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Affiliation(s)
| | - Laura J. Fish
- Department of Family Medicine and Community Health, Duke University School of Medicine, Durham, NC 27710, USA
- Duke Cancer Institute, Durham, NC 27710, USA
| | | | | | | | | | - Larissa A. Meyer
- Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Shelby D. Reed
- Duke Clinical Research Institute, Durham, NC 27710, USA
- Department of Population Health Sciences, Duke University, Durham, NC 27710, USA
| | | | - Laura J. Havrilesky
- Division of Gynecologic Oncology, Duke Cancer Institute, Durham, NC 27710, USA
- Corresponding author at: Box 3079 DUMC, Durham, NC 27710, USA.
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14
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Vasudevan L, Ostermann J, Wang Y, Harrison SE, Yelverton V, Fish LJ, Williams C, Walter EB. Association of caregiver attitudes with adolescent HPV vaccination in 13 southern US states. Vaccine X 2022; 11:100181. [PMID: 35789674 PMCID: PMC9250032 DOI: 10.1016/j.jvacx.2022.100181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Revised: 05/20/2022] [Accepted: 05/23/2022] [Indexed: 11/30/2022] Open
Affiliation(s)
- Lavanya Vasudevan
- Department of Family Medicine and Community Health, Duke University School of Medicine, 2200 W. Main Street, Suite 600, Durham, NC 27705, USA
- Duke Global Health Institute, 310 Trent Drive, Durham, NC 27710, USA
- Duke Human Vaccine Institute, 27 Alexandria Way, Durham, NC 27703, USA
- Corresponding author at: 2200 W. Main Street, Suite 600, Durham, NC 27710, USA.
| | - Jan Ostermann
- Duke Global Health Institute, 310 Trent Drive, Durham, NC 27710, USA
- Department of Health Services Policy & Management, University of South Carolina, 915 Greene Street, Columbia, SC 29208, USA
- South Carolina Smart State Center for Healthcare Quality, Arnold School of Public Health, University of South Carolina, 915 Greene Street, Columbia, SC 29208, USA
| | - Yunfei Wang
- Duke Human Vaccine Institute, 27 Alexandria Way, Durham, NC 27703, USA
| | - Sayward E. Harrison
- South Carolina Smart State Center for Healthcare Quality, Arnold School of Public Health, University of South Carolina, 915 Greene Street, Columbia, SC 29208, USA
- Department of Psychology, University of South Carolina, 1512 Pendleton Street, Barnwell College, Suite #220, Columbia, SC 29208, USA
| | - Valerie Yelverton
- Department of Health Services Policy & Management, University of South Carolina, 915 Greene Street, Columbia, SC 29208, USA
| | - Laura J. Fish
- Department of Family Medicine and Community Health, Duke University School of Medicine, 2200 W. Main Street, Suite 600, Durham, NC 27705, USA
- Duke Cancer Institute, 2424 Erwin Rd, Suite 602, Durham, NC 27710, USA
| | - Charnetta Williams
- Immunization Services Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention (CDC), 1600 Clifton Road, Atlanta, GA 30329, USA
| | - Emmanuel B. Walter
- Duke Global Health Institute, 310 Trent Drive, Durham, NC 27710, USA
- Duke Human Vaccine Institute, 27 Alexandria Way, Durham, NC 27703, USA
- Department of Pediatrics, Duke University School of Medicine, Box 3675, DUMC, Durham, NC 27710, USA
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15
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Gutnik LA, Fish LJ, Gallagher J, Greenup RA. 'At All Costs': Breast Cancer Patient Responses to Cost Transparency and Communication. Ann Surg Oncol 2022; 29:7259-7260. [PMID: 35810230 DOI: 10.1245/s10434-022-12160-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2022] [Accepted: 06/25/2022] [Indexed: 11/18/2022]
Affiliation(s)
- Lily A Gutnik
- Department of Surgery, UAB Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA.
| | - Laura J Fish
- Department of Family Medicine and Community Health, Duke University School of Medicine, Durham, NC, USA
| | - Jennifer Gallagher
- Department of Surgery, Duke University School of Medicine, Durham, NC, USA
| | - Rachel A Greenup
- Department of Surgery, Yale School of Medicine, New Haven, CT, USA
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16
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Grimm LJ, Fish LJ, Carrico CW, Martin JG, Nwankwo VC, Farley S, Meltzer CC, Maxfield CM. Radiology Stereotypes, Application Barriers, and Hospital Integration: A Mixed-methods Study of Medical Student Perceptions of Radiology. Acad Radiol 2022; 29:1108-1115. [PMID: 34563441 PMCID: PMC10150737 DOI: 10.1016/j.acra.2021.08.020] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [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: 05/18/2021] [Revised: 08/21/2021] [Accepted: 08/21/2021] [Indexed: 11/19/2022]
Abstract
RATIONALE AND OBJECTIVES Limited exposure to radiology by medical students can perpetuate negative stereotypes and hamper recruitment efforts. The purpose of this study is to understand medical students' perceptions of radiology and how they change based on medical education and exposure. MATERIALS AND METHODS A single-institution mixed-methods study included four groups of medical students with different levels of radiology exposure. All participants completed a 16-item survey regarding demographics, opinions of radiology, and perception of radiology stereotypes. Ten focus groups were administered to probe perceptions of radiology. Focus groups were coded to identify specific themes in conjunction with the survey results. RESULTS Forty-nine participants were included. Forty-two percent of participants had positive opinions of radiology. Multiple radiology stereotypes were identified, and false stereotypes were diminished with increased radiology exposure. Opinions of the impact of artificial intelligence on radiology closely aligned with positive or negative views of the field overall. Multiple barriers to applying for a radiology residency position were identified including board scores and lack of mentorship. COVID-19 did not affect perceptions of radiology. There was broad agreement that students do not enter medical school with many preconceived notions of radiology, but that subsequent exposure was generally positive. Exposure both solidified and eliminated various stereotypes. Finally, there was general agreement that radiology is integral to the health system with broad exposure on all services. CONCLUSION Medical student perceptions of radiology are notably influenced by exposure and radiology programs should take active steps to engage in medical student education.
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Affiliation(s)
- Lars J Grimm
- Department of Radiology, Duke University Medical Center, DUMC Box 3808, 40 Duke Medicine Circle, Durham, NC 27710; Duke Cancer Institute, DUMC Box 3917, Durham, NC 27710.
| | - Laura J Fish
- Duke Cancer Institute, DUMC Box 3917, Durham, NC 27710; Family Medicine and Community Health, Duke School of Medicine, Durham, North Carolina
| | - Caroline Wt Carrico
- Department of Radiology, Duke University Medical Center, DUMC Box 3808, 40 Duke Medicine Circle, Durham, NC 27710
| | - Jonathan G Martin
- Department of Radiology, Duke University Medical Center, DUMC Box 3808, 40 Duke Medicine Circle, Durham, NC 27710
| | - Vesta C Nwankwo
- Department of Radiology, Duke School of Medicine, Durham, North Carolina
| | | | - Carolyn C Meltzer
- Departments of Radiology and Imaging Sciences, Psychiatry and Behavioral Science, and Neurology, Emory University School of Medicine, Emory University Hospital, Atlanta, Georgia
| | - Charles M Maxfield
- Department of Radiology, Duke University Medical Center, DUMC Box 3808, 40 Duke Medicine Circle, Durham, NC 27710
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17
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Raman SR, O’Brien EC, Hammill BG, Nelson AJ, Fish LJ, Curtis LH, Marsolo K. Evaluating fitness-for-use of electronic health records in pragmatic clinical trials: reported practices and recommendations. J Am Med Inform Assoc 2022; 29:798-804. [PMID: 35171985 PMCID: PMC9006695 DOI: 10.1093/jamia/ocac004] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2021] [Revised: 12/10/2021] [Accepted: 02/12/2022] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE To empirically explore how pragmatic clinical trials (PCTs) that used real-world data (RWD) assessed study-specific fitness-for-use. METHODS We conducted interviews and surveys with PCT teams who used electronic health record (EHR) data to ascertain endpoints. The survey cataloged key concerns about RWD, activities used to assess data fitness-for-use, and related barriers encountered by study teams. Patterns and commonalities across trials were used to develop recommendations for study-specific fitness-for-use assessments. RESULTS Of 15 invited trial teams, 7 interviews were conducted. Of 31 invited trials, 15 responded to the survey. Most respondents had prior experience using RWD (93%). Major concerns about EHR data were data reliability, missingness or incompleteness of EHR elements, variation in data quality across study sites, and presence of implausible or incorrect values. Although many PCTs conducted fitness-for-use activities (eg, data quality assessments, 11/14, 79%), less than a quarter did so before choosing a data source. Fitness-for-use activities, findings, and resulting study design changes were not often publically documented. Overall costs and personnel costs were barriers to fitness-for-use assessments. DISCUSSION These results support three recommendations for PCTs that use EHR data for endpoint ascertainment. Trials should detail the rationale and plan for study-specific fitness-for-use activities, conduct study-specific fitness-for-use assessments early in the prestudy phase to inform study design changes before the trial begins, and share results of fitness-for-use assessments and description of relevant challenges and facilitators. CONCLUSION These recommendations can help researchers and end-users of real-world evidence improve characterization of RWD reliability and relevance in the PCT-specific context.
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Affiliation(s)
- Sudha R Raman
- Department of Population Health Sciences, Duke University School of Medicine, Durham, North Carolina, USA
- Duke Clinical Research Institute, Durham, North Carolina, USA
| | - Emily C O’Brien
- Department of Population Health Sciences, Duke University School of Medicine, Durham, North Carolina, USA
- Duke Clinical Research Institute, Durham, North Carolina, USA
| | - Bradley G Hammill
- Department of Population Health Sciences, Duke University School of Medicine, Durham, North Carolina, USA
- Duke Clinical Research Institute, Durham, North Carolina, USA
| | - Adam J Nelson
- Duke Clinical Research Institute, Durham, North Carolina, USA
- Monash Heart, Monash University, Melbourne, Victoria, Australia
| | - Laura J Fish
- Department of Family Medicine and Community Health, Duke University School of Medicine, Durham, North Carolina, USA
| | - Lesley H Curtis
- Department of Population Health Sciences, Duke University School of Medicine, Durham, North Carolina, USA
- Duke Clinical Research Institute, Durham, North Carolina, USA
| | - Keith Marsolo
- Department of Population Health Sciences, Duke University School of Medicine, Durham, North Carolina, USA
- Duke Clinical Research Institute, Durham, North Carolina, USA
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18
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Moris D, Rushing C, McCracken E, Shah KN, Zani S, Perez A, Allen PJ, Niedzwiecki D, Fish LJ, Blazer DG. Quality of Life Associated with Open vs Minimally Invasive Pancreaticoduodenectomy: A Prospective Pilot Study. J Am Coll Surg 2022; 234:632-644. [PMID: 35290283 PMCID: PMC10166568 DOI: 10.1097/xcs.0000000000000102] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND This prospective study was designed to compare quality of life (QoL) among patients who underwent open (O-PD) vs minimally invasive pancreaticoduodenectomy (MI-PD), using a combination of validated qualitative and quantitative methodologies. STUDY DESIGN From 2017 to 2019, patients scheduled for pancreaticoduodenectomy (PD) were enrolled and presented with Functional Assessment of Cancer Therapy-Hepatobiliary surveys preoperatively, before discharge, at first postoperative visit and approximately 3 to 4 months after operation ("3 months"). Longitudinal plots of median QoL scores were used to illustrate change in each score over time. In a subset of patients, content analysis of semistructured interviews at postoperative time points (1.5 to 6 months after operation) was conducted. RESULTS Among 56 patients who underwent PD, 33 had an O-PD (58.9%). Physical and functional scores decreased in the postoperative period but returned to baseline by 3 months. No significant differences were found in any domains of QoL at baseline and in the postoperative period between patients who underwent O-PD and MI-PD. Qualitative findings were concordant with quantitative data (n = 14). Patients with O-PD and MI-PD reported similar experiences with complications, pain, and wound healing in the postoperative period. Approximately half the patients in both groups reported "returning to normal" in the 6-month postoperative period. A total of 4 patients reported significant long-term issues with physical and functional well-being. CONCLUSIONS Using a novel combination of qualitative and quantitative analyses in patients undergoing PD, we found no association between operative approach and QoL in patients who underwent O-PD vs MI-PD. Given the increasing use of minimally invasive techniques for PD and the steep learning curve associated with these techniques, continued assessment of patient benefit is critical.
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Affiliation(s)
- Dimitrios Moris
- Department of Surgery, Duke University Medical Center, Durham, NC, USA
| | - Christel Rushing
- Duke Cancer Institute-Biostatistics, Duke University Medical Center, Durham, NC, USA
| | - Emily McCracken
- Department of Surgery, Duke University Medical Center, Durham, NC, USA
| | - Kevin N. Shah
- Department of Surgery, Duke University Medical Center, Durham, NC, USA
| | - Sabino Zani
- Department of Surgery, Duke University Medical Center, Durham, NC, USA
| | - Alexander Perez
- Department of Surgery, Duke University Medical Center, Durham, NC, USA
| | - Peter J. Allen
- Department of Surgery, Duke University Medical Center, Durham, NC, USA
| | - Donna Niedzwiecki
- Duke Cancer Institute-Biostatistics, Duke University Medical Center, Durham, NC, USA
| | - Laura J. Fish
- Duke Family Medicine and Community Health, Duke University, Durham, NC, USA
- Duke Cancer Institute, Duke University Medical Center, Durham, NC, USA
| | - Dan G. Blazer
- Department of Surgery, Duke University Medical Center, Durham, NC, USA
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Noonan D, Lyna P, Kennedy DL, Gao X, Bejarano Hernandez S, Fish LJ, Pollak KI. Trajectories of Situational Temptations in Pregnant Smokers participating in a Scheduled Gradual Reduction Cessation Trial. Matern Child Health J 2022; 26:24-30. [PMID: 34860350 PMCID: PMC8770600 DOI: 10.1007/s10995-021-03321-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/24/2021] [Indexed: 01/03/2023]
Abstract
OBJECTIVE The purpose of this paper was to examine changes in situational temptations to smoke among women in early to late pregnancy enrolled in a texting trial to help them quit smoking. We compared changes between (1) intervention arms, (2) those who quit, (3) those who reduced by 50% or more, and (4) those who reduced by less than 50%. We also examined cravings overtime in the intervention arm and the relationship between real-time cravings assessed via text message and situational temptations. METHODS This was a secondary analysis of the Baby Steps trial, a randomized controlled trial testing the efficacy of a text-based scheduled gradual reduction (SGR) intervention on cessation. We used t-tests to examine changes across intervention arms and repeated measured proc mixed to explore changes in situational temptations and cravings. RESULTS Among all women, situational temptations decreased from early to late pregnancy for the positive, negative, and habitual subscales, (ps < 0.001). We found no difference in situational temptations across arms. We found a positive relationship between negative situational temptation and average craving during the Weeks 2 and Weeks 3 of the intervention. Negative ST increased by 0.11 for each unit increase of craving at Week 2. CONCLUSIONS As women progress through pregnancy their temptation to smoke reduces. A different relationship might exist, however with negative affect situations in which women reported higher craving but not in response to other temptations. Future work might have a particular focus on the intersection of negative affect with cravings and temptations to promote cessation during pregnancy. CLINICAL TRIAL NCT01995097.
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Affiliation(s)
- Devon Noonan
- School of Nursing, Duke University, 307 Trent Drive, Durham, NC, 27710, USA.
- Cancer Control and Population Sciences, Duke Cancer Institute, Durham, NC, 27705, USA.
| | - Pauline Lyna
- Cancer Control and Population Sciences, Duke Cancer Institute, Durham, NC, 27705, USA
| | - Danielle L Kennedy
- Cancer Control and Population Sciences, Duke Cancer Institute, Durham, NC, 27705, USA
| | - Xiaomei Gao
- Cancer Control and Population Sciences, Duke Cancer Institute, Durham, NC, 27705, USA
| | | | - Laura J Fish
- Cancer Control and Population Sciences, Duke Cancer Institute, Durham, NC, 27705, USA
- Department of Family Medicine and Community Health, Duke University School of Medicine, Durham, NC, 27710, USA
| | - Kathryn I Pollak
- Cancer Control and Population Sciences, Duke Cancer Institute, Durham, NC, 27705, USA
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, 27710, USA
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20
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Vasudevan L, Ostermann J, Wang Y, Harrison SE, Yelverton V, McDonald JA, Fish LJ, Williams C, Walter EB. Predictors of HPV vaccination in the southern US: A survey of caregivers from 13 states. Vaccine 2021; 39:7485-7493. [PMID: 34742592 PMCID: PMC8685535 DOI: 10.1016/j.vaccine.2021.10.036] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Revised: 10/01/2021] [Accepted: 10/17/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND OBJECTIVES Despite a high burden of human papillomavirus (HPV)-attributable cancers, the southern US lags other regions in HPV vaccination coverage. This study sought to characterize and contextualize predictors of HPV vaccination in the southern US. METHODS From December 2019 - January 2020, parents of adolescents (ages 9-17 years) living in thirteen southern US states were recruited from a nationally-representative online survey panel and completed a cross-sectional survey. The primary study outcome was initiation of HPV vaccination. RESULTS Of 1105 parents who responded to the survey, most were ≥35 years of age and of female gender. HPV vaccination initiation was reported only among 37.3% of adolescents and was highest at age 12. Cumulative HPV vaccination coverage was highest at age 15 (60%) but lower than coverage for tetanus-diphtheria-acellular pertussis (Tdap, 79.3%) and Meningococcal vaccines (MenACWY, 67.3%). Provider recommendation was strongly associated with higher odds of HPV vaccination (aOR: 49.9, 95 %CI: 23.1-107.5). In alternative predictive models, home/online (vs. public) schooling and parents' working status were associated with lower odds of vaccination; health care visits in the past 12 months and shorter travel times to adolescents' usual health care provider were associated with greater odds of vaccination. CONCLUSIONS Our findings suggest missed opportunities for HPV vaccination in the southern US and support strengthening provider recommendation for on-time initiation of HPV vaccination among adolescents. Other strategies to increase HPV vaccinations may include encouraging co-administration with other adolescent vaccines, increasing vaccine access, and promoting vaccinations for home/online-school students.
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Affiliation(s)
- Lavanya Vasudevan
- Department of Family Medicine and Community Health, Duke University School of Medicine, 2200 W. Main Street, Suite 600, Durham, NC 27705, USA; Duke Global Health Institute, 310 Trent Dr, Durham, NC 27710, USA.
| | - Jan Ostermann
- Duke Global Health Institute, 310 Trent Dr, Durham, NC 27710, USA; Department of Health Services Policy & Management, 915 Greene Street, University of South Carolina, Columbia, SC 29208, USA; South Carolina Smart State Center for Healthcare Quality, University of South Carolina, 915 Greene Street, Columbia, SC 29208, USA
| | - Yunfei Wang
- Duke Vaccine and Trials Unit, Duke Human Vaccine Institute, 2608 Erwin Road, Suite 210, Durham, NC 27705, USA
| | - Sayward E Harrison
- South Carolina Smart State Center for Healthcare Quality, University of South Carolina, 915 Greene Street, Columbia, SC 29208, USA; Department of Psychology, University of South Carolina, 1512 Pendleton Street, Barnwell College, Suite #220, Columbia, SC 29208, USA
| | - Valerie Yelverton
- Department of Health Services Policy & Management, 915 Greene Street, University of South Carolina, Columbia, SC 29208, USA
| | - Jodi-Ann McDonald
- Duke Vaccine and Trials Unit, Duke Human Vaccine Institute, 2608 Erwin Road, Suite 210, Durham, NC 27705, USA
| | - Laura J Fish
- Department of Family Medicine and Community Health, Duke University School of Medicine, 2200 W. Main Street, Suite 600, Durham, NC 27705, USA; Duke Cancer Institute, 2424 Erwin Rd, Suite 602, Durham, NC 27710, USA
| | - Charnetta Williams
- Immunization Services Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention (CDC), 1600 Clifton Road, Atlanta, GA 30329, USA
| | - Emmanuel B Walter
- Duke Global Health Institute, 310 Trent Dr, Durham, NC 27710, USA; Duke Vaccine and Trials Unit, Duke Human Vaccine Institute, 2608 Erwin Road, Suite 210, Durham, NC 27705, USA; Department of Pediatrics, Duke University School of Medicine, Box 3675, DUMC, Durham, NC 27710, USA
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21
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Harrison SE, Yelverton V, Wang Y, Ostermann J, Fish LJ, Williams CL, Vasudevan L, Walter EB. Examining Associations between Knowledge and Vaccine Uptake Using the Human Papillomavirus Knowledge Questionnaire (HPV-KQ). Am J Health Behav 2021; 45:810-827. [PMID: 34702429 PMCID: PMC8900988 DOI: 10.5993/ajhb.45.5.2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Objectives: Understanding the relationship between human papillomavirus (HPV) knowledge and vaccination behavior is important to inform public health interventions, yet few validated HPV knowledge scales exist. This study describes development of the Human Papillomavirus Knowledge Questionnaire (HPV-KQ) and its validation with parents residing in the southern United States (US). Methods: Drawing on previously published measures, we developed the 13-item HPV-KQ and administered the scale via Web-based survey to parents (N=1105) of adolescents ages 9 to 17 years. Dimensionality, internal consistency, model fit, and predictive validity were assessed. Results: The scale was bidimensional. One factor captured general HPV knowledge, and the second factor captured perceptions of gender differences in HPV infection and vaccine recommendations. The 13-item scale and 2-factor solution displayed strong internal consistency and good model fit. Parents of vaccinated adolescents scored higher on the 13-item HPV-KQ (Mean = 8.56) than parents of unvaccinated adolescents (Mean = 6.43) (p < .001). In regression models, controlling for key covariates, parents' performance on the HPV-KQ predicted adolescent HPV vaccination (p < .001). Conclusions: Evaluation indicates the HPV-KQ is a reliable and valid tool for measuring knowledge of HPV and the HPV vaccine among parents residing in the southern US. We recommend further efforts to validate the scale with other populations.
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Affiliation(s)
- Sayward E Harrison
- Sayward E Harrison, Department of Psychology, University of South Carolina, Columbia, SC, and South Carolina Smart State Center for Healthcare Quality, University of South Carolina, Columbia, SC, United States;,
| | - Valerie Yelverton
- Valerie Yelverton, Department of Health Services Policy & Management, University of South Carolina, Columbia, SC, United States
| | - Yunfei Wang
- Yunfei Wang, Duke Vaccine and Trials Unit, Duke Human Vaccine Institute, Durham, NC, United States
| | - Jan Ostermann
- Jan Ostermann, Department of Health Services Policy & Management, University of South Carolina, Columbia, SC, United States
| | - Laura J Fish
- Laura J Fish, Department of Family Medicine and Community Health, Duke University School of Medicine, Durham, NC, and Duke Cancer Institute, Durham, NC, United States
| | - Charnetta L Williams
- Charnetta L Williams, Immunization Services Division, National Center for Immunization and Respiratory Diseases, US Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Lavanya Vasudevan
- Lavanya Vasudevan, Department of Family Medicine and Community Health, Duke University School of Medicine, Durham, NC, and Duke Global Health Institute, Durham, NC, United States
| | - Emmanuel B Walter
- Emmanuel B Walter, Duke Vaccine and Trials Unit, Duke Human Vaccine Institute, Durham, NC, Duke Global Health Institute, Durham, NC, and Department of Pediatrics, Duke University School of Medicine, Durham, NC, United States
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22
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Shammas RL, Fish LJ, Sergesketter AR, Offodile AC, Phillips BT, Oshima S, Lee CN, Hollenbeck ST, Greenup RA. ASO Visual Abstract: Dissatisfaction After Post-Mastectomy Breast Reconstruction: A Mixed-Methods Study. Ann Surg Oncol 2021. [PMID: 34523001 DOI: 10.1245/s10434-021-10779-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Ronnie L Shammas
- Division of Plastic, Maxillofacial, and Oral Surgery, Duke University, Durham, NC, USA
| | - Laura J Fish
- Cancer Control and Population Sciences, Duke Cancer Institute, Durham, NC, USA
| | - Amanda R Sergesketter
- Division of Plastic, Maxillofacial, and Oral Surgery, Duke University, Durham, NC, USA
| | - Anaeze C Offodile
- Department of Plastic and Reconstructive Surgery, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Brett T Phillips
- Division of Plastic, Maxillofacial, and Oral Surgery, Duke University, Durham, NC, USA
| | - Sachi Oshima
- Division of Plastic, Maxillofacial, and Oral Surgery, Duke University, Durham, NC, USA
| | - Clara N Lee
- Department of Plastic and Reconstructive Surgery, College of Medicine, Division of Health Services Management and Policy, College of Public Health, OSU Comprehensive Cancer Center, The Ohio State University, Columbus, OH, USA
| | - Scott T Hollenbeck
- Division of Plastic, Maxillofacial, and Oral Surgery, Duke University, Durham, NC, USA
| | - Rachel A Greenup
- Department of Surgery, Section Chief of Breast Surgery, Yale School of Medicine, New Haven, CT, USA.
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23
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Shammas RL, Fish LJ, Sergesketter AR, Offodile AC, Phillips BT, Oshima S, Lee CN, Hollenbeck ST, Greenup RA. Correction to: Dissatisfaction After Post-Mastectomy Breast Reconstruction: A Mixed-Methods Study. Ann Surg Oncol 2021; 28:898. [PMID: 34514524 DOI: 10.1245/s10434-021-10796-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Ronnie L Shammas
- Division of Plastic, Maxillofacial, and Oral Surgery, Duke University, Durham, NC, USA
| | - Laura J Fish
- Cancer Control and Population Sciences, Duke Cancer Institute, Durham, NC, USA.,Department of Plastic and Reconstructive Surgery, College of Medicine, Division of Health Services Management and Policy, College of Public Health, OSU Comprehensive Cancer Center, The Ohio State University, Columbus, OH, USA
| | - Amanda R Sergesketter
- Division of Plastic, Maxillofacial, and Oral Surgery, Duke University, Durham, NC, USA
| | - Anaeze C Offodile
- Department of Plastic and Reconstructive Surgery, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Brett T Phillips
- Division of Plastic, Maxillofacial, and Oral Surgery, Duke University, Durham, NC, USA
| | - Sachi Oshima
- Division of Plastic, Maxillofacial, and Oral Surgery, Duke University, Durham, NC, USA
| | - Clara N Lee
- Department of Plastic and Reconstructive Surgery, College of Medicine, Division of Health Services Management and Policy, College of Public Health, OSU Comprehensive Cancer Center, The Ohio State University, Columbus, OH, USA
| | - Scott T Hollenbeck
- Division of Plastic, Maxillofacial, and Oral Surgery, Duke University, Durham, NC, USA
| | - Rachel A Greenup
- Department of Surgery, Section Chief of Breast Surgery, Yale School of Medicine, DUMC 3513, New Haven, CT, USA.
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24
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Shammas RL, Fish LJ, Sergesketter AR, Offodile AC, Phillips BT, Oshima S, Lee CN, Hollenbeck ST, Greenup RA. Dissatisfaction After Post-Mastectomy Breast Reconstruction: A Mixed-Methods Study. Ann Surg Oncol 2021; 29:1109-1119. [PMID: 34460034 DOI: 10.1245/s10434-021-10720-9] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Accepted: 08/01/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUND Breast reconstruction is associated with improved patient well-being after mastectomy; however, factors that contribute to post-surgical dissatisfaction remain poorly characterized. METHODS Adult women who underwent post-mastectomy implant-based or autologous breast reconstruction between 2015 and 2019 were recruited to participate in semi-structured interviews regarding their lived experiences with reconstructive care. Participants completed the BREAST-Q, and tabulated scores were used to dichotomize patient-reported outcomes as satisfied or dissatisfied (high or low) for each BREAST-Q domain. A convergent mixed-methods analysis was used to evaluate interviews for content related to satisfaction or dissatisfaction with breast reconstruction. RESULTS Overall, we interviewed 21 women and identified 17 subcodes that corresponded with the five BREAST-Q domains. Sources of dissatisfaction were found to be related to the following domains: (a) low breast satisfaction due to asymmetry, cup size, and lack of sensation and physical feeling (n = 8, 38%); (b) poor sexual well-being due to shape, look and feel (n = 7, 78% [of 9 who discussed sexual well-being]); (c) reduced physical well-being of the chest due to persistent pain and weakness (n = 11, 52%); (d) reduced abdominal well-being due to changes in abdominal strength, numbness, and posture (n = 6, 38% [of 16 who underwent abdominally based reconstruction]); and (e) low psychosocial well-being impacted by an unexpected appearance that negatively influenced self-confidence and self-identity (n = 13, 62%). CONCLUSION Patients may be unprepared for the physical, sexual, and psychosocial outcomes of breast reconstruction. Targeted strategies to improve preoperative education and shared decision making are needed to mitigate unexpectedness associated with breast reconstruction and related outcomes.
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Affiliation(s)
- Ronnie L Shammas
- Division of Plastic, Maxillofacial, and Oral Surgery, Duke University, Durham, NC, USA
| | - Laura J Fish
- Cancer Control and Population Sciences, Duke Cancer Institute, Durham, NC, USA.,Department of Plastic and Reconstructive Surgery, College of Medicine, Division of Health Services Management and Policy, College of Public Health, OSU Comprehensive Cancer Center, The Ohio State University, Columbus, OH, USA
| | - Amanda R Sergesketter
- Division of Plastic, Maxillofacial, and Oral Surgery, Duke University, Durham, NC, USA
| | - Anaeze C Offodile
- Department of Plastic and Reconstructive Surgery, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Brett T Phillips
- Division of Plastic, Maxillofacial, and Oral Surgery, Duke University, Durham, NC, USA
| | - Sachi Oshima
- Division of Plastic, Maxillofacial, and Oral Surgery, Duke University, Durham, NC, USA
| | - Clara N Lee
- Department of Plastic and Reconstructive Surgery, College of Medicine, Division of Health Services Management and Policy, College of Public Health, OSU Comprehensive Cancer Center, The Ohio State University, Columbus, OH, USA
| | - Scott T Hollenbeck
- Division of Plastic, Maxillofacial, and Oral Surgery, Duke University, Durham, NC, USA
| | - Rachel A Greenup
- Department of Surgery, Section Chief of Breast Surgery, Yale School of Medicine, DUMC 3513, New Haven, CT, 06511, USA.
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25
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Pavon JM, Fish LJ, Colón-Emeric CS, Hall KS, Morey MC, Pastva AM, Hastings SN. Towards "mobility is medicine": Socioecological factors and hospital mobility in older adults. J Am Geriatr Soc 2021; 69:1846-1855. [PMID: 33755991 DOI: 10.1111/jgs.17109] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [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: 10/19/2020] [Revised: 02/11/2021] [Accepted: 02/19/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Understanding the factors that influence hospital mobility, especially in the context of a heightened focus on falls prevention, is needed to improve care. OBJECTIVE This qualitative study uses a socioecological framework to explore factors that influence hospital mobility in older adults. DESIGN Qualitative research PARTICIPANTS: Semi-structured interviews and focus groups were conducted with medically-ill hospitalized older adults (n = 19) and providers (hospitalists, nurses, and physical and occupational therapists (n = 48) at two hospitals associated with an academic health system. APPROACH Interview and focus group guides included questions on perceived need for mobility, communication about mobility, hospital mobility culture, and awareness of patients' walking activity. Data were analyzed thematically and mapped onto the constructs of the socioecological model. KEY RESULTS A consistent theme among patients and providers was that "mobility is medicine." Categories of factors reported to influence hospital walking activity included intrapersonal factors (patients' health status, fear of falls), interpersonal factors (patient-provider communication about mobility), organizational factors (clarity about provider roles and responsibilities, knowledge of safe patient handling, reliance on physical therapy for mobility), and environmental factors (falls as a never event, patient geographical locations on hospital units). Several of these factors were identified as potentially modifiable targets for intervention. Patients and providers offered recommendations for improving awareness of patient's ambulatory activity, assigning roles and responsibility for mobility, and enhancing education and communication between patients and providers across disciplines. CONCLUSION Patients and providers identified salient factors for future early mobility initiatives targeting hospitalized older adults. Consideration of these factors across all stages of intervention development and implementation will enhance impact and sustainability.
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Affiliation(s)
- Juliessa M Pavon
- Duke University, Durham, North Carolina, USA.,Geriatric Research Education Clinical Center, Durham Veteran Affairs Medical Center, Durham, North Carolina, USA.,Claude D. Pepper Older Americans Independence Center, Duke University, Durham, North Carolina, USA
| | | | - Cathleen S Colón-Emeric
- Duke University, Durham, North Carolina, USA.,Geriatric Research Education Clinical Center, Durham Veteran Affairs Medical Center, Durham, North Carolina, USA.,Claude D. Pepper Older Americans Independence Center, Duke University, Durham, North Carolina, USA
| | - Katherine S Hall
- Duke University, Durham, North Carolina, USA.,Geriatric Research Education Clinical Center, Durham Veteran Affairs Medical Center, Durham, North Carolina, USA.,Claude D. Pepper Older Americans Independence Center, Duke University, Durham, North Carolina, USA
| | - Miriam C Morey
- Duke University, Durham, North Carolina, USA.,Geriatric Research Education Clinical Center, Durham Veteran Affairs Medical Center, Durham, North Carolina, USA.,Claude D. Pepper Older Americans Independence Center, Duke University, Durham, North Carolina, USA
| | - Amy M Pastva
- Duke University, Durham, North Carolina, USA.,Claude D. Pepper Older Americans Independence Center, Duke University, Durham, North Carolina, USA
| | - Susan N Hastings
- Duke University, Durham, North Carolina, USA.,Geriatric Research Education Clinical Center, Durham Veteran Affairs Medical Center, Durham, North Carolina, USA.,Claude D. Pepper Older Americans Independence Center, Duke University, Durham, North Carolina, USA.,Health Services Research & Development, Durham Veterans Affairs Medical Center, Durham, North Carolina, USA
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26
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Pollak KI, Oliver JA, Pieper C, Davis JM, Gao X, Noonan D, Kennedy D, Granados I, Fish LJ. Cue-based treatment for light smokers: A proof of concept pilot. Addict Behav 2021; 114:106717. [PMID: 33109394 DOI: 10.1016/j.addbeh.2020.106717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 10/13/2020] [Accepted: 10/14/2020] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Light smoking (smoking ≤ 10 cigarettes per day or on some days) has become increasingly prevalent in the US and increases morbidity and mortality. Many light smokers do not experience significant nicotine withdrawal but instead smoke in response to cues. Minimal evidence exists supporting interventions to help light smokers quit smoking. METHODS We present results from a proof-of-concept pilot study designed to evaluate the feasibility and acceptability of a cue-based smoking cessation intervention targeted to light daily and intermittent smokers. Participants were randomized to one of two arms: Arm 1) standard smoking cessation treatment or Arm 2) standard smoking cessation treatment + enhanced cue-based treatment that included interactive texting to extend cue exposure treatment to real-world settings and cue management counseling.Outcomes included feasibility (number of participants who were recruited and who completed the intervention), acceptability (intervention ratings), and preliminary efficacy (7-day point prevalence abstinence). RESULTS We randomized 24 English and Spanish-speaking light smokers, 13 to the treatment arm and 11 to the control arm. Across both arms, 77% attended all counseling sessions, 90% rated these sessions as very useful and 100% said that they would recommend the intervention to a friend. 15% in the treatment arm had biochemically-validated smoking abstinence compared to 0% in the standard counseling arm. CONCLUSIONS Results from this proof-of-concept study demonstrated that a cue-based intervention is feasible and acceptable among light smokers and suggests the need for a fully powered study to assess this approach. TRIAL REGISTRATION This study is registered at www.clinicaltrials.gov NCT03416621.
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27
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Oshima SM, Tait SD, Rushing C, Lane W, Hyslop T, Offodile AC, Wheeler SB, Zafar SY, Greenup R, Fish LJ. Patient Perspectives on the Financial Costs and Burdens of Breast Cancer Surgery. JCO Oncol Pract 2021; 17:e872-e881. [PMID: 33566677 DOI: 10.1200/op.20.00780] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Although financial toxicity is a well-documented aspect of cancer care, little is known about how patients narratively characterize financial experiences related to breast cancer treatment. We sought to examine these patient experiences through mixed methods analysis. METHODS Women (≥ 18 years old) with a history of breast cancer were recruited from the Love Research Army and Sisters Network to complete an 88-item electronic survey including an open-ended response. Quantitative data were used to sort and stratify responses to the open-ended question, which comprised the qualitative data evaluated here. Descriptive statistics and qualitative content analysis were used to evaluate the financial costs and other burdens resulting from breast cancer surgery. RESULTS In total, 511 respondents completed the survey in its entirety and wrote an open-ended response. Participants reported significant financial burden in different categories including direct payments for medical care and indirect costs such as lost wages and travel expenses. Treatment-related costs burdened participants for years after diagnosis, forming a financial arc for many participants. Discrepancies existed between the degree of financial burden reported on multiple-choice questions and participants' corresponding open-ended descriptions of financial burden. Participants described a lack of communication surrounding costs with their providers and difficulty negotiating payments with insurance. CONCLUSION Breast cancer care can result in ongoing financial burden years after diagnosis among all patients, even those with adequate insurance patient populations.
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Affiliation(s)
| | | | - Christel Rushing
- Biostatistics Shared Resource, Duke Cancer Institute, Duke University, Durham, NC
| | - Whitney Lane
- Department of Surgery, Duke University School of Medicine, Durham, NC
| | - Terry Hyslop
- Biostatistics Shared Resource, Duke Cancer Institute, Duke University, Durham, NC
| | - Anaeze C Offodile
- Department of Plastic Surgery, MD Anderson Cancer Center, Houston, TX
| | - Stephanie B Wheeler
- Department of Health Policy and Management, UNC Gillings School of Global and Public Health, Chapel Hill, NC
| | - S Yousuf Zafar
- Duke University School of Medicine, Durham, NC.,Department of Population Health Sciences, Duke University, Durham, NC.,Department of Medicine, Duke University, Durham, NC.,Duke Cancer Institute, Durham, NC
| | - Rachel Greenup
- Department of Surgery, Duke University School of Medicine, Durham, NC.,Duke Cancer Institute, Durham, NC
| | - Laura J Fish
- Department of Family Medicine and Community Health, Duke University School of Medicine, Durham, NC.,Behavioral Health and Survey Research Core, Duke Cancer Institute, Duke University, Durham, NC
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28
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Racioppi A, Dalton T, Ramalingam S, Romero K, Ren Y, Bohannon L, Arellano C, Jonassaint J, Miller H, Barak I, Fish LJ, Choi T, Gasparetto C, Long GD, Lopez RD, Rizzieri DA, Sarantopoulos S, Horwitz ME, Chao NJ, Shah NR, Sung AD. Assessing the Feasibility of a Novel mHealth App in Hematopoietic Stem Cell Transplant Patients. Transplant Cell Ther 2021; 27:181.e1-181.e9. [PMID: 33830035 PMCID: PMC10522407 DOI: 10.1016/j.jtct.2020.10.017] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Revised: 10/23/2020] [Accepted: 10/25/2020] [Indexed: 12/22/2022]
Abstract
Hematopoietic stem cell transplantation (HCT) is a curative treatment option for patients with hematologic conditions but presents many complications that must be managed as a complex, chronic condition. Mobile health applications (mHealth apps) may permit tracking of symptoms in HCT. In seeking strategies to manage the complexities of HCT, our team collaborated with Sicklesoft, Inc., to develop an mHealth app specifically for HCT patients to allow for daily evaluation of patient health, Technology Recordings to better Understand Bone Marrow Transplantation (TRU-BMT). The primary value of this application is that of potentially enhancing the monitoring of symptoms and general health of patients undergoing HCT, with the ultimate goal of allowing earlier detection of adverse events, earlier intervention, and improving outcomes. To first evaluate patient interest in mHealth apps, we designed and administered an interest survey to patients at the 2017 BMT-InfoNet reunion. As a follow-up to the positive feedback received, we began testing the TRU-BMT app in a Phase 1 pilot study. Thirty patients were enrolled in this single-arm study and were given the TRU-BMT mHealth app on a smartphone device in addition to a wearable activity tracker. Patients were followed for up to 180 days, all the while receiving daily app monitoring. Adherence to TRU-BMT was approximately 30% daily and 44% weekly, and greater adherence was associated with increased meal completion, decreased heart rate, and shorter hospital stay. TRU-BMT assessments of symptom severity were significantly associated with duration of hospital stay and development of chronic graft-versus-host disease. Our findings suggest that using TRU-BMT throughout HCT is feasible for patients and established a proof-of-concept for a future randomized control trial of the TRU-BMT application in HCT. © 2021 American Society for Blood and Marrow Transplantation. Published by Elsevier Inc. All rights reserved.
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Affiliation(s)
- Alessandro Racioppi
- Duke University School of Medicine, Durham, North Carolina; Division of Hematologic Malignancies and Cellular Therapy, Department of Medicine, Duke University Medical Center, Durham, North Carolina.
| | - Tara Dalton
- Duke University School of Medicine, Durham, North Carolina
| | - Sendhilnathan Ramalingam
- Division of Hematologic Malignancies and Cellular Therapy, Department of Medicine, Duke University Medical Center, Durham, North Carolina
| | - Kristi Romero
- Duke Office of Clinical Research, Duke University School of Medicine, Durham, North Carolina
| | - Yi Ren
- Duke Cancer Institute Biostatistics Shared Resources, Duke Cancer Institute, Duke University Medical Center, Durham, North Carolina
| | - Lauren Bohannon
- Division of Hematologic Malignancies and Cellular Therapy, Department of Medicine, Duke University Medical Center, Durham, North Carolina
| | - Consuelo Arellano
- Department of Statistics, North Carolina State University, Raleigh, North Carolina
| | - Jude Jonassaint
- Division of Hematology, Department of Medicine, Duke University Medical Center, Durham, North Carolina
| | - Hilary Miller
- Division of Hematologic Malignancies and Cellular Therapy, Department of Medicine, Duke University Medical Center, Durham, North Carolina
| | - Ian Barak
- Duke Cancer Institute Biostatistics Shared Resources, Duke Cancer Institute, Duke University Medical Center, Durham, North Carolina
| | - Laura J Fish
- Family Medicine and Community Health, Duke University Medical Center, Durham, North, Carolina
| | - Taewoong Choi
- Division of Hematologic Malignancies and Cellular Therapy, Department of Medicine, Duke University Medical Center, Durham, North Carolina
| | - Cristina Gasparetto
- Division of Hematologic Malignancies and Cellular Therapy, Department of Medicine, Duke University Medical Center, Durham, North Carolina
| | - Gwynn D Long
- Division of Hematologic Malignancies and Cellular Therapy, Department of Medicine, Duke University Medical Center, Durham, North Carolina
| | - Richard D Lopez
- Division of Hematologic Malignancies and Cellular Therapy, Department of Medicine, Duke University Medical Center, Durham, North Carolina
| | - David A Rizzieri
- Division of Hematologic Malignancies and Cellular Therapy, Department of Medicine, Duke University Medical Center, Durham, North Carolina
| | - Stefanie Sarantopoulos
- Division of Hematologic Malignancies and Cellular Therapy, Department of Medicine, Duke University Medical Center, Durham, North Carolina
| | - Mitchell E Horwitz
- Division of Hematologic Malignancies and Cellular Therapy, Department of Medicine, Duke University Medical Center, Durham, North Carolina
| | - Nelson J Chao
- Division of Hematologic Malignancies and Cellular Therapy, Department of Medicine, Duke University Medical Center, Durham, North Carolina
| | - Nirmish R Shah
- Duke Cancer Institute Biostatistics Shared Resources, Duke Cancer Institute, Duke University Medical Center, Durham, North Carolina
| | - Anthony D Sung
- Division of Hematologic Malignancies and Cellular Therapy, Department of Medicine, Duke University Medical Center, Durham, North Carolina.
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Biederman DJ, Hartman AM, Felsman IC, Mountz H, Jacobs T, Rich N, Fish LJ, Noonan D. Improving the Health of Public Housing Residents Through a Housing Authority and Nursing School Partnership. Prog Community Health Partnersh 2021; 15:59-64. [PMID: 33775961 DOI: 10.1353/cpr.2021.0005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The connection between health and housing is well-established. People who are precariously housed have worse health than those who have stable housing arrangements.- Persons moving into public housing have a higher illness burden than the general population, and public housing residents engage in less healthy behaviors, which contribute to public housing residents having poorer health than persons living in other housing situations. Public housing authorities and residents can benefit from authentic and constructive relationships with academic partners; academicians and students can benefit from engaging in partnerships with housing authorities and residents to better understand the connection between housing and health. This article describes the well-established relationship between the Duke University School of Nursing (DUSON) and the Durham Housing Authority (DHA), the evolution of that relationship, our collaborative work in improving the health of DHA residents while advancing nursing education and science, and lessons learned.
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Watson CH, Fish LJ, Falkovic M, Monuszko K, Lorenzo A, Havrilesky LJ, Secord AA, Davidson BA. Adherence to Oral Anticancer Therapeutics in the Gynecologic Oncology Population. Obstet Gynecol 2020; 136:1145-1153. [DOI: 10.1097/aog.0000000000004170] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Abstract
Rationale & Objective Attention to geriatric impairments is not routinely provided to older adults receiving dialysis. Our objective was to identify patient and personnel perspectives on experiences with geriatric problems, unmet needs that may affect a patient’s ability to maintain his or her functional status, and preferences for design of a geriatric model of care tailored to address the unmet needs. Study Design Qualitative study using semi-structured interviews and focus groups. Setting & Participants 14 hemodialysis patients 55 years and older and 24 dialysis unit personnel (eg, nephrologists, nurses, patient care technicians, and social workers) representing 5 dialysis units. Analytical Approach Content analysis to identify themes reflecting unmet needs and design considerations for a geriatric model of care for older adults receiving dialysis. Results 4 themes (or unmet needs) identified from both patient and personnel transcripts were: (1) mobility, which referred to the insufficient mobility assessment and transportation services; (2) medications, which referred to insufficient attention to appropriate prescribing and medication self-management; (3) social support, which referred to insufficient support for activities of daily living and emotional problems; and (4) communication, which referred to insufficient patient-provider and interprofessional communication, including data transfer across separate health systems. Although participants generally acknowledged that an integrated model of care could result in benefits across all 4 areas of unmet need, they noted that the program design would need to minimize disruption of current workflow and practices in dialysis units. Limitations The findings may not be broadly representative of all older adults receiving dialysis and dialysis unit personnel. Conclusions There is insufficient attention to mobility, medication management, social support, and communication needs for older adults receiving in-center hemodialysis. Addressing these unmet needs in a geriatric model of care and measuring its effectiveness are areas of future research.
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Affiliation(s)
- Rasheeda Hall
- Renal Section, Durham Veterans Affairs Healthcare System, Durham, NC.,Geriatric Research Education and Clinical Center, Durham Veterans Affairs Healthcare System, Durham, NC.,Division of Nephrology, Department of Medicine, Duke University, Durham, NC.,Center for the Study of Aging and Human Development, Duke University, Durham, NC
| | - Jeanette Rutledge
- Division of Nephrology, Department of Medicine, Duke University, Durham, NC
| | - Cathleen Colón-Emeric
- Geriatric Research Education and Clinical Center, Durham Veterans Affairs Healthcare System, Durham, NC.,Center for the Study of Aging and Human Development, Duke University, Durham, NC.,Division of Geriatric Medicine, Department of Medicine, Duke University, Durham, NC
| | - Laura J Fish
- Department of Family Medicine and Community Health, Duke University School of Medicine, Durham, NC.,Duke Cancer Institute, Behavioral Health and Survey Research Core, Duke University School of Medicine, Durham, NC
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Hofacker SA, Fish LJ, Blewer AL, Pun PH. Barriers and Facilitators to Performing Cardiopulmonary Resuscitation During Treatment in Outpatient Hemodialysis Clinics: A Qualitative Study. Nephrol Nurs J 2020; 47:401-411. [PMID: 33107712] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Cardiac arrest is the leading cause of death among patients receiving hemodialysis, and major deficiencies exist in hemodialysis staff-provided cardiopulmonary resuscitation (CPR). Our study aimed to identify factors influencing CPR delivery in the outpatient hemodialysis clinic. Through content analysis of in-depth interviews with 10 staff members of a hemodialysis clinic, we identified three broad themes regarding barriers and facilitators to performing CPR in the hemodialysis clinic: 1) physical and environmental challenges regarding the layout of the clinic; 2) uncertainty about optimal in-clinic CPR procedures, particularly concerning patient positioning and dealing with the hemodialysis machine; and 3) benefit of continuous improvement programs, including hemodialysis-specific protocols, hands-on training, and pre-defined team roles. Our findings call for further investigation of optimal in-clinic resuscitation procedures to inform hemodialysis clinic CPR protocols and hemodialysis staff training.
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Affiliation(s)
- Samuel A Hofacker
- House Staff Physician, Massachusetts General Hospital, Department of Medicine, Harvard University School of Medicine, Boston, MA
| | - Laura J Fish
- Assistant Professor of Medicine, the Department of Family Medicine and Community Health, Duke University School of Medicine, Durham, NC
- Member, Cancer Control and Population Sciences, Duke Cancer Institute, Durham, NC
| | - Audrey L Blewer
- Assistant Professor of Family Medicine, the Department of Family Medicine and Community Health, Duke University School of Medicine, Durham, NC
- Assistant Professor of Population Health Sciences, the Department of Population Health Sciences, Duke University School of Medicine, Durham, NC
| | - Patrick H Pun
- Associate Professor of Medicine, the Division of Nephrology, Department of Medicine, Duke University School of Medicine, Durham, NC
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Noonan D, Silva S, Fish LJ, Peter K, Conley C, Simmons LA, Severson H, Pollak KI. Feasibility of a text-based reduction intervention in helping rural and underserved smokeless tobacco users quit. Addict Behav 2020; 108:106434. [PMID: 32361367 PMCID: PMC7337980 DOI: 10.1016/j.addbeh.2020.106434] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2019] [Revised: 03/29/2020] [Accepted: 04/06/2020] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Smokeless tobacco (ST) use significantly affects morbidity and mortality and remains disproportionally prevalent in rural and medically underserved communities. Few programs exist for rural smokeless tobacco users. Text-based interventions may increase the reach of cessation interventions; yet, none has tested them in ST users. We evaluated the feasibility, acceptability, and preliminary efficacy of a text-based Scheduled Gradual Reduction (SGR) intervention in rural and underserved ST users. METHODS ST users were randomized in 2:1 fashion to the SGR group (N = 65), a text-based reduction program plus text-based support counseling messages or text-based support messages only group (N = 33). We surveyed participants at 30-days post intervention initiation to assess feasibility and acceptability and examined self-report 7-day point prevalence cessation at 30-days and 6-months post intervention initiation in the two arms. RESULTS We achieved benchmarks for feasibility and acceptability. Among the SGR participants 51% (n = 48) reported that intervention was useful in helping them quit, 83% (n = 48) indicated that they would recommend the intervention to a friend. Over 95% (n = 39) of SGR participants said that they read all alert texts. The SGR participants had a higher quit rate at 30-days compared to support messages alone (SGR = 21.5%, Control = 9.1%, p = 0.1627, Cohen's d equivalent = 0.56, medium effect). However, the quit rate at 6-months was 21% (p = 0.9703) for both groups. CONCLUSIONS A text-based intervention was feasible and acceptable among underserved ST users. SGR helped promote short-term cessation. The text-based interventions both had long-term efficacy. Given that text-based interventions have the potential to increase reach in underserved ST users, further testing is warranted.
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Affiliation(s)
- Devon Noonan
- Duke University School of Nursing, 307 Trent Drive, Durham, NC 27710, United States; Cancer Control and Population Sciences, Duke Cancer Insitute, 20 Duke Medicine Cir, Durham, NC 27710, United States.
| | - Susan Silva
- Duke University School of Nursing, 307 Trent Drive, Durham, NC 27710, United States
| | - Laura J Fish
- Cancer Control and Population Sciences, Duke Cancer Insitute, 20 Duke Medicine Cir, Durham, NC 27710, United States; Duke University School of Medicine, Department of Community and Family Medicine, 2424 Erwin Rd, Suite 602, Durham, NC 27710, United States
| | - Kellen Peter
- Duke University School of Nursing, 307 Trent Drive, Durham, NC 27710, United States
| | - Cherie Conley
- Duke University School of Nursing, 307 Trent Drive, Durham, NC 27710, United States
| | - Leigh Ann Simmons
- Duke University School of Nursing, 307 Trent Drive, Durham, NC 27710, United States; University of California, Davis, Department of Human Ecology, 301 Shields Avenue, Davis, CA 95616, United States
| | - Herbert Severson
- Oregon Research Institute, 1776 Millrace Dr, Eugene, OR 97403, United States
| | - Kathryn I Pollak
- Cancer Control and Population Sciences, Duke Cancer Insitute, 20 Duke Medicine Cir, Durham, NC 27710, United States; Duke University School of Medicine, Department of Pupulation Health Sciences, 2424 Erwin Road Suite 602, Durham, NC 27710, United States
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Pollak KI, Lyna P, Gao X, Noonan D, Bejarano Hernandez S, Subudhi S, Swamy GK, Fish LJ. Efficacy of a Texting Program to Promote Cessation Among Pregnant Smokers: A Randomized Control Trial. Nicotine Tob Res 2020; 22:1187-1194. [PMID: 31647564 PMCID: PMC7291805 DOI: 10.1093/ntr/ntz174] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Accepted: 09/10/2019] [Indexed: 12/29/2022]
Abstract
INTRODUCTION Smoking during pregnancy poses serious risks to baby and mother. Few disseminable programs exist to help pregnant women quit or reduce their smoking. We hypothesized that an SMS text-delivered scheduled gradual reduction (SGR) program plus support texts would outperform SMS support messages alone. METHODS We recruited 314 pregnant women from 14 prenatal clinics. Half of the women received theory-based support messages throughout their pregnancy to promote cessation and prevent relapse. The other half received the support messages plus alert texts that gradually reduced their smoking more than 3-5 weeks. We conducted surveys at baseline, end of pregnancy, and 3 months postpartum. Our primary outcome was biochemically validated 7-day point prevalence abstinence at late pregnancy. Our secondary outcome was reduction in cigarettes per day. RESULTS Adherence to the SGR was adequate with 70% responding to alert texts to smoke within 60 minutes. Women in both arms quit smoking at the same rate (9%-12%). Women also significantly reduced their smoking from baseline to the end of pregnancy from nine cigarettes to four; we found no arm differences in reduction. CONCLUSIONS Support text messages alone produced significant quit rates above naturally occurring quitting. SGR did not add significantly to helping women quit or reduce. Sending support messages can reach many women and is low-cost. More obstetric providers might consider having patients who smoke sign up for free texting programs to help them quit. IMPLICATIONS A disseminable texting program helped some pregnant women quit smoking.Clinical Trial Registration number: NCT01995097.
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Affiliation(s)
- Kathryn I Pollak
- Cancer Control and Population Sciences, Duke Cancer Institute, Durham, NC.,Department of Population Health Sciences, Duke University School of Medicine, Durham, NC
| | - Pauline Lyna
- Cancer Control and Population Sciences, Duke Cancer Institute, Durham, NC
| | - Xiaomei Gao
- Cancer Control and Population Sciences, Duke Cancer Institute, Durham, NC
| | - Devon Noonan
- Cancer Control and Population Sciences, Duke Cancer Institute, Durham, NC.,School of Nursing, Duke University, Durham, NC
| | | | - Sonia Subudhi
- Doctor of Medicine Program, Eastern Virginia Medical School, Norfolk, VA
| | - Geeta K Swamy
- Department of Obstetrics and Gynecology, DUMC 3083, Duke University School of Medicine, Durham, NC
| | - Laura J Fish
- Cancer Control and Population Sciences, Duke Cancer Institute, Durham, NC.,Department of Family Medicine and Community Health, Duke University School of Medicine, Durham, NC
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Barrett NJ, Ingraham KL, Bethea K, Hwa-Lin P, Chirinos M, Fish LJ, Randolph S, Zhang P, Le P, Harvey D, Godbee RL, Patierno SR. Project PLACE: Enhancing community and academic partnerships to describe and address health disparities. Adv Cancer Res 2020; 146:167-188. [PMID: 32241388 DOI: 10.1016/bs.acr.2020.01.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Achieving cancer health equity is a national imperative. Cancer is the second leading cause of death in the United States and in North Carolina (NC), where the disease disproportionately impacts traditionally underrepresented race and ethnic groups, those who live in rural communities, the impoverished, and medically disenfranchised and/or health-disparate populations at high-risk for cancer. These populations have worse cancer outcomes and are less likely to be participants in clinical research and trials. It is critical for cancer centers and other academic health centers to understand the factors that contribute to poor cancer outcomes, the extent to which they impact the cancer burden, and develop effective interventions to address them. Key to this process is engaging diverse stakeholders in the development and execution of community and population health assessments, and the subsequent programs and interventions designed to address the need across the catchment area. This chapter describes the processes and lessons learned of the Duke Cancer Institute's (DCI) long standing community partnerships that led to Project PLACE (Population Level Approaches to Cancer Elimination), a National Cancer Institute (NCI)-funded community health assessment reaching 2315 respondents in 7 months, resulting in a community partnered research agenda to advance cancer equity within the DCI catchment area. We illustrate the application of a community partnered health assessment and offer examples of strategic opportunities, successes, lessons learned, and implications for practice.
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Affiliation(s)
- Nadine J Barrett
- Duke Cancer Institute, Duke University Medical Center, Durham, NC, United States; Department of Family Medicine and Community Health, Duke School of Medicine, Durham, NC, United States; Duke Clinical and Translational Science Institute, Duke University School of Medicine, Durham, NC, United States.
| | - Kearston L Ingraham
- Duke Cancer Institute, Duke University Medical Center, Durham, NC, United States
| | - Kenisha Bethea
- Duke Clinical and Translational Science Institute, Duke University School of Medicine, Durham, NC, United States
| | - Pao Hwa-Lin
- Chinese Christian Church, Raleigh, NC, United States; Department of Medicine, Duke University School of Medicine, Durham, NC, United States
| | | | - Laura J Fish
- Duke Cancer Institute, Duke University Medical Center, Durham, NC, United States
| | | | - Ping Zhang
- Chinese American Friendly Association, Raleigh, NC, United States
| | - Peter Le
- St. Joseph's Primary Care, Raleigh, NC, United States
| | - Demetrius Harvey
- Black Men's Health Initiative, Wilson, NC, United States; Alumni Chapter of Kappa Alpha Psi Fraternity, Inc., Smithfield, NC, United States
| | | | - Steven R Patierno
- Department of Medicine, Division of Medical Oncology, Duke University Medical Center, Durham, NC, United States
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Pollak KI, Lyna P, Gao X, Noonan D, Hernandez SB, Subudhi S, Kennedy D, Farrell D, Swamy GK, Fish LJ. Pilot Test of Connecting Pregnant Women who Smoke to Short Message Service (SMS) Support Texts for Cessation. Matern Child Health J 2020; 24:419-422. [PMID: 32026323 DOI: 10.1007/s10995-020-02893-8] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Most pregnant women know that smoking poses serious risks to baby and mother, yet many still smoke. We conducted a large randomized controlled trial and found that an SMS text-delivered program helped about 10% of these women quit smoking. In this paper, we describe the feasibility of disseminating a text-based intervention to pregnant women who smoke. METHODS We tested dissemination in two ways from prenatal clinics and compared recruitment rates to those found in our large randomized controlled trial. The first method involved "direct texting" where study staff identified women who smoked and sent them a text asking them to text back if they wanted to receive texts to help them quit. The second involved "nurse screening" where clinic staff from county health departments screened women for smoking and asked them to send a text to the system if they wanted to learn more about the program. Our primary outcome was feasibility assessed by the number of women who texted back their baby's due date, which served as "enrolling" in the texting program, which we compared to the recruitment rate we found in our large trial. RESULTS Over 4 months, we texted 91 women from the academic health system. Of those, 17 texted back and were counted as "enrolled." In the health departments, across the 4 months, 12 women texted the system initially. Of those, 10 were enrolled. This rate was similar to the rate enrolled in the randomized controlled trial. DISCUSSION Two different methods connected pregnant women who smoke to a texting program. One of these methods can be automated further and have the potential of helping many women quit smoking with minimal effort. Clinical Trial # NCT01995097.
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Affiliation(s)
- Kathryn I Pollak
- Cancer Control and Population Sciences, Duke Cancer Institute, Durham, NC, 27710, USA.
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, 27710, USA.
- Department of Community and Family Medicine, Duke University School of Medicine, 2424 Erwin Road, Suite 602, Durham, NC, 27710, 27705, USA.
| | - Pauline Lyna
- Cancer Control and Population Sciences, Duke Cancer Institute, Durham, NC, 27710, USA
- Department of Community and Family Medicine, Duke University School of Medicine, 2424 Erwin Road, Suite 602, Durham, NC, 27710, 27705, USA
| | - Xiaomei Gao
- Cancer Control and Population Sciences, Duke Cancer Institute, Durham, NC, 27710, USA
- Department of Community and Family Medicine, Duke University School of Medicine, 2424 Erwin Road, Suite 602, Durham, NC, 27710, 27705, USA
| | - Devon Noonan
- Cancer Control and Population Sciences, Duke Cancer Institute, Durham, NC, 27710, USA
- School of Nursing, Duke University, Durham, USA
- Department of Community and Family Medicine, Duke University School of Medicine, 2424 Erwin Road, Suite 602, Durham, NC, 27710, 27705, USA
| | - Santiago Bejarano Hernandez
- Cancer Control and Population Sciences, Duke Cancer Institute, Durham, NC, 27710, USA
- Department of Community and Family Medicine, Duke University School of Medicine, 2424 Erwin Road, Suite 602, Durham, NC, 27710, 27705, USA
| | - Sonia Subudhi
- Doctor of Medicine Program, Eastern Virginia Medical School, Norfolk, VA, 23507, USA
- Department of Community and Family Medicine, Duke University School of Medicine, 2424 Erwin Road, Suite 602, Durham, NC, 27710, 27705, USA
| | - Danielle Kennedy
- Cancer Control and Population Sciences, Duke Cancer Institute, Durham, NC, 27710, USA
- Department of Community and Family Medicine, Duke University School of Medicine, 2424 Erwin Road, Suite 602, Durham, NC, 27710, 27705, USA
| | - David Farrell
- People Designs, Inc, Durham, NC, USA
- Department of Community and Family Medicine, Duke University School of Medicine, 2424 Erwin Road, Suite 602, Durham, NC, 27710, 27705, USA
| | - Geeta K Swamy
- Department of Obstetrics and Gynecology, Duke University School of Medicine, DUMC 3083, Durham, NC, 27710, USA
- Department of Community and Family Medicine, Duke University School of Medicine, 2424 Erwin Road, Suite 602, Durham, NC, 27710, 27705, USA
| | - Laura J Fish
- Cancer Control and Population Sciences, Duke Cancer Institute, Durham, NC, 27710, USA
- Department of Community and Family Medicine, Duke University School of Medicine, 2424 Erwin Road, Suite 602, Durham, NC, 27710, 27705, USA
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Barrett NJ, Rodriguez EM, Iachan R, Hyslop T, Ingraham KL, Le GM, Martin K, Haring RC, Rivadeneira NA, Erwin DO, Fish LJ, Middleton D, Hiatt RA, Patierno SR, Sarkar U, Gage-Bouchard EA. Factors associated with biomedical research participation within community-based samples across 3 National Cancer Institute-designated cancer centers. Cancer 2020; 126:1077-1089. [PMID: 31909824 DOI: 10.1002/cncr.32487] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2018] [Revised: 05/21/2019] [Accepted: 05/27/2019] [Indexed: 12/17/2022]
Abstract
BACKGROUND Engaging diverse populations in biomedical research, including biospecimen donation, remains a national challenge. This study examined factors associated with an invitation to participate in biomedical research, intent to participate in biomedical research in the future, and participation in biomedical research and biospecimen donation among a diverse, multilingual, community-based sample across 3 distinct geographic areas. METHODS Three National Cancer Institute-designated cancer centers engaged in community partnerships to develop and implement population health assessments, reaching a convenience sample of 4343 participants spanning their respective catchment areas. Data harmonization, multiple imputation, and multivariable logistic modeling were used. RESULTS African Americans, Hispanic/Latinos, and other racial minority groups were more likely to be offered opportunities to participate in biomedical research compared to whites. Access to care, history of cancer, educational level, survey language, nativity, and rural residence also influenced opportunity, intent, and actual participation in biomedical research. CONCLUSIONS Traditionally underserved racial and ethnic groups reported heightened opportunity and interest in participating in biomedical research. Well-established community partnerships and long-standing community engagement around biomedical research led to a diverse sample being reached at each site and may in part explain the current study findings. However, this study illustrates an ongoing need to establish trust and diversify biomedical research participation through innovative and tailored approaches. National Cancer Institute-designated cancer centers have the potential to increase opportunities for diverse participation in biomedical research through community partnerships and engagement. Additional work remains to identify and address system-level and individual-level barriers to participation in both clinical trials and biospecimen donation for research.
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Affiliation(s)
- Nadine J Barrett
- Duke Cancer Institute, Duke University Medical Center, Durham, North Carolina.,Department of Community and Family Medicine, Duke School of Medicine, Durham, North Carolina.,Duke Clinical and Translational Science Institute, Duke University School of Medicine, Durham, North Carolina
| | - Elisa M Rodriguez
- Department of Cancer Prevention and Control, Roswell Park Comprehensive Cancer Center, Buffalo, New York
| | | | - Terry Hyslop
- Duke Cancer Institute, Duke University Medical Center, Durham, North Carolina.,Department of Biostatistics and Bioinformatics, Duke University, Durham, North Carolina
| | - Kearston L Ingraham
- Duke Cancer Institute, Duke University Medical Center, Durham, North Carolina
| | - Gem M Le
- Center for Vulnerable Populations, Division of General Internal Medicine, Department of Medicine, University of California at San Francisco, San Francisco, California
| | | | - Rodney C Haring
- Department of Cancer Prevention and Control, Roswell Park Comprehensive Cancer Center, Buffalo, New York
| | - Natalie A Rivadeneira
- Center for Vulnerable Populations, Division of General Internal Medicine, Department of Medicine, University of California at San Francisco, San Francisco, California.,Division of General Internal Medicine, Department of Medicine, University of California at San Francisco, San Francisco, California
| | - Deborah O Erwin
- Department of Cancer Prevention and Control, Roswell Park Comprehensive Cancer Center, Buffalo, New York
| | - Laura J Fish
- Duke Cancer Institute, Duke University Medical Center, Durham, North Carolina
| | | | - Robert A Hiatt
- Helen Diller Family Comprehensive Cancer Center, University of California at San Francisco, San Francisco, California.,Department of Epidemiology and Biostatistics, School of Medicine, University of California at San Francisco, San Francisco, California
| | - Steven R Patierno
- Duke Cancer Institute, Duke University Medical Center, Durham, North Carolina.,Division of Medical Oncology, Department of Medicine, Duke University Medical Center, Durham, North Carolina
| | - Urmimala Sarkar
- Helen Diller Family Comprehensive Cancer Center, University of California at San Francisco, San Francisco, California
| | - Elizabeth A Gage-Bouchard
- Department of Cancer Prevention and Control, Roswell Park Comprehensive Cancer Center, Buffalo, New York
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Hofacker SA, Fish LJ, Blewer AL, Pun PH. Barriers and Facilitators to Performing Cardiopulmonary Resuscitation During Treatment in Outpatient Hemodialysis Clinics: A Qualitative Study. Nephrol Nurs J 2020. [DOI: 10.37526/1526-744x.2020.47.5.401] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Greenup RA, Rushing CN, Fish LJ, Lane WO, Peppercorn JM, Bellavance E, Tolnitch L, Hyslop T, Myers ER, Zafar SY, Hwang ES. Perspectives on the Costs of Cancer Care: A Survey of the American Society of Breast Surgeons. Ann Surg Oncol 2019; 26:3141-3151. [PMID: 31342390 DOI: 10.1245/s10434-019-07594-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Indexed: 12/17/2022]
Abstract
BACKGROUND Cancer treatment costs are not routinely addressed in shared decisions for breast cancer surgery. Thus, we sought to characterize cost awareness and communication among surgeons treating breast cancer. METHODS We conducted a self-administered, confidential electronic survey among members of the American Society of Breast Surgeons from 1 July to 15 September 2018. Questions were based on previously published or validated survey items, and assessed surgeon demographics, cost sensitivity, and communication. Descriptive summaries and cross-tabulations with Chi-square statistics were used, with exact tests where warranted, to assess findings. RESULTS Of those surveyed (N = 2293), 598 (25%) responded. Surgeons reported that 'risk of recurrence' (70%), 'appearance of the breast' (50%), and 'risks of surgery' (47%) were the most influential on patients' decisions for breast cancer surgery; 6% cited out-of-pocket costs as significant. Over half (53%) of the surgeons agreed that doctors should consider patient costs when choosing cancer treatment, yet the majority of surgeons (58%) reported 'infrequently' (43%) or 'never' (15%) considering patient costs in medical recommendations. The overwhelming majority (87%) of surgeons believed that patients should have access to the costs of their treatment before making medical decisions. Surgeons treating a higher percentage of Medicaid or uninsured patients were more likely to consistently consider costs (p < 0.001). Participants reported that insufficient knowledge or resources (61%), a perceived inability to help with costs (24%), and inadequate time (22%) impeded cost discussions. Notably, 20% of participants believed that discussing costs might impact the quality of care patients receive. CONCLUSIONS Cost transparency remains rare, however in shared decisions for breast cancer surgery, improved cost awareness by surgeons has the potential to reduce financial hardship.
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Affiliation(s)
- Rachel A Greenup
- Department of Surgery, Duke University, Durham, NC, USA. .,Department of Population Health Sciences, Duke University, Durham, NC, USA. .,Duke Cancer Institute, Duke University, Durham, NC, USA. .,Duke Cancer Control and Population Sciences, Duke University, Durham, NC, USA.
| | - Christel N Rushing
- Duke Cancer Institute, Duke University, Durham, NC, USA.,Department of Biostatistics and Bioinformatics, Duke University, Durham, NC, USA
| | - Laura J Fish
- Duke Cancer Institute, Duke University, Durham, NC, USA.,Duke Cancer Control and Population Sciences, Duke University, Durham, NC, USA.,Duke School of Medicine, Duke University, Durham, NC, USA
| | | | | | | | - Lisa Tolnitch
- Department of Surgery, Duke University, Durham, NC, USA
| | - Terry Hyslop
- Duke Cancer Institute, Duke University, Durham, NC, USA.,Department of Biostatistics and Bioinformatics, Duke University, Durham, NC, USA
| | - Evan R Myers
- Department of Medicine, Duke University, Durham, NC, USA.,Department of Obstetrics and Gynecology, Duke University, Durham, NC, USA
| | - S Yousuf Zafar
- Department of Population Health Sciences, Duke University, Durham, NC, USA.,Duke Cancer Institute, Duke University, Durham, NC, USA.,Duke Cancer Control and Population Sciences, Duke University, Durham, NC, USA.,Department of Medicine, Duke University, Durham, NC, USA
| | - E Shelley Hwang
- Department of Surgery, Duke University, Durham, NC, USA.,Duke Cancer Institute, Duke University, Durham, NC, USA
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Pollak KI, Fish LJ, Sutton LM, Gao X, Lyna P, Owen L, Patel ML, Somers TJ. A smoking cessation and pain management program for cancer survivors. J Cancer Surviv 2018; 12:821-827. [PMID: 30328056 DOI: 10.1007/s11764-018-0719-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2018] [Accepted: 09/24/2018] [Indexed: 11/29/2022]
Abstract
PURPOSE Many cancer survivors continue to smoke. Further, most survivors also report high levels of persistent pain and smoke in response to pain. The investigators tested the feasibility, acceptability, and preliminary efficacy of a smoking cessation program paired with a pain management program for cancer survivors. METHODS The investigators conducted a two-arm, wait-list randomized controlled pilot study in which they delivered a combined smoking cessation and pain management intervention. RESULTS The investigators randomized 30 survivors (14 intervention and 16 wait-list control). Seventy-one percent of the survivors who received the intervention rated it as extremely useful (5 out of 5) in helping them quit smoking. Further, 86% would recommend the program to other survivors. Although we could not conduct inferential statistics, 14% of those in the intervention arm, compared to 6% in the control condition had biochemically validated cessation at 2-months post-randomization. Survivors in the intervention also reported less pain, had improvements in depressive symptoms, and better physical function than those in the control arm. CONCLUSIONS Our pilot data suggest the feasibility, acceptability, and preliminary efficacy of this approach. The next step is to conduct a large randomized controlled trial to fully test the efficacy of the intervention. IMPLICATIONS FOR CANCER SURVIVORS A combined smoking cessation and pain program might help improve both issues simultaneously.
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Affiliation(s)
- Kathryn I Pollak
- Cancer Control and Population Sciences, Duke Cancer Institute, Durham, NC, USA. .,Department of Population Health Sciences, Duke School of Medicine, 2424 Erwin Road, Suite 602, Durham, NC, 27705, USA.
| | - Laura J Fish
- Cancer Control and Population Sciences, Duke Cancer Institute, Durham, NC, USA.,Department of Medicine, Duke School of Medicine, Durham, NC, USA
| | - Linda M Sutton
- Duke Cancer Network, Duke Cancer Institute, Durham, NC, USA.,Department of Psychology and Neuroscience, Duke School of Medicine, Durham, NC, USA
| | - Xiaomei Gao
- Cancer Control and Population Sciences, Duke Cancer Institute, Durham, NC, USA
| | - Pauline Lyna
- Cancer Control and Population Sciences, Duke Cancer Institute, Durham, NC, USA
| | - Lynda Owen
- Duke Cancer Network, Duke Cancer Institute, Durham, NC, USA
| | - Michele L Patel
- Department of Psychiatry and Behavioral Sciences, Duke School of Medicine, Durham, NC, USA
| | - Tamara J Somers
- Cancer Control and Population Sciences, Duke Cancer Institute, Durham, NC, USA.,Faculty Practice in Psychiatry Erwin Square, Duke School of Medicine, 2200 W. Main Street Suite 340, Durham, NC, 27705, USA
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Noonan D, Silva S, Njuru J, Bishop T, Fish LJ, Simmons LA, Choi SH, Pollak KI. Feasibility of a text-based smoking cessation intervention in rural older adults. Health Educ Res 2018; 33:81-88. [PMID: 29309599 PMCID: PMC6279146 DOI: 10.1093/her/cyx080] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/21/2016] [Accepted: 11/30/2017] [Indexed: 05/10/2023]
Abstract
Text-based interventions are effective for smoking cessation, but have not been tested in rural older adults. The purpose of this study was to compare the feasibility, acceptability and preliminary efficacy of a text-based Scheduled Gradual Reduction (SGR) program to a non-SGR text messaging support condition among rural older adults. Adults over 60 years were randomized to either: (i) the SGR program (n = 20), a text-based program to reduce smoking over 4-weeks plus text-based support messages; or (ii) control (n = 20), receipt of text-based support messages only. Participants completed surveys at baseline and end of program to assess feasibility and acceptability of the intervention, and biochemically validated 7-day point prevalence cessation was assessed at end of treatment. Most participants (81%) reported reading all the messages they received. Participants found both interventions useful in quitting smoking (SGR = 57%, Control = 63%) and would recommend it to a friend (SGR = 72%, Control = 79%). Although not statically significant, the SGR group had a higher rate of biochemically validated cessation (SGR = 15%, Control = 5%, Cohen d = 0.67). Among those still smoking, the median percent reduction in cigarettes was 33.3% for both groups. Text-based cessation interventions are feasible, acceptable and can be easily disseminated to rural older adult tobacco users.
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Affiliation(s)
- D Noonan
- Duke University School of Nursing, 307 Trent Drive, Durham, NC 27710, USA
- Cancer Control and Population Sciences, Duke Cancer Institute, 20 Duke Medicine Cir, Durham, NC 27710, USA
- Correspondence to: D. Noonan. E-mail:
| | - S Silva
- Duke University School of Nursing, 307 Trent Drive, Durham, NC 27710, USA
| | - J Njuru
- Duke Office of Clinical Research, Duke University School of Medicine, 2200 West Main Street 10th Floor, Suite 1000. Durham, NC 27705, USA
| | - T Bishop
- Duke Office of Clinical Research, Duke University School of Medicine, 2200 West Main Street 10th Floor, Suite 1000. Durham, NC 27705, USA
| | - L J Fish
- Cancer Control and Population Sciences, Duke Cancer Institute, 20 Duke Medicine Cir, Durham, NC 27710, USA
- Department of Community and Family Medicine, Duke University School of Medicine, 2100 Erwin Rd, Durham, NC 27705, USA
| | - L A Simmons
- Duke University School of Nursing, 307 Trent Drive, Durham, NC 27710, USA
| | - S H Choi
- Michigan State University College of Nursing, 1355 Bogue St, East Lansing, MI 48824, USA
| | - K I Pollak
- Duke Office of Clinical Research, Duke University School of Medicine, 2200 West Main Street 10th Floor, Suite 1000. Durham, NC 27705, USA
- Department of Population Health Sciences, Duke University School of Medicine, 2200 West Main Street, Suite 720A, Durham, NC 27707, USA
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Freel SA, Fish LJ, Mirman B, Sudan R, Devi GR. Advancement of multidisciplinary education and research in translational sciences: MERITS program development at Duke University. J Clin Transl Sci 2018; 2:57-62. [PMID: 31660219 PMCID: PMC6799111 DOI: 10.1017/cts.2018.17] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2017] [Revised: 03/01/2018] [Accepted: 03/12/2018] [Indexed: 11/06/2022] Open
Abstract
INTRODUCTION The Duke Multidisciplinary Education and Research in Translational Sciences Program provides educational resources for faculty and trainees in translational research. METHODS To aid in program development, we assessed perceptions of translational science through focus groups targeting different career stages. RESULTS In total, 3 essential themes emerged: collaboration, movement toward application, and public health impact. Facilitators and barriers varied among groups. CONCLUSION Training programs must provide specific strategies for collaboration and selectively accelerating discoveries to therapies.
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Affiliation(s)
- Stephanie A. Freel
- Duke Academy for Health Professions Education and Academic Development, Duke University School of Medicine, Durham, NC, USA
- Duke Office of Clinical Research, Duke University School of Medicine, Durham, NC, USA
| | - Laura J. Fish
- Duke Cancer Institute, Duke University School of Medicine, Durham, NC, USA
- Department of Community and Family Medicine, Duke University School of Medicine, Durham, NC, USA
| | - Benjamin Mirman
- Trinity College of Arts and Sciences, Duke University, Durham, NC, USA
| | - Ranjan Sudan
- Duke Academy for Health Professions Education and Academic Development, Duke University School of Medicine, Durham, NC, USA
- Department of Surgery, Duke University School of Medicine, Durham, NC, USA
| | - Gayathri R. Devi
- Duke Academy for Health Professions Education and Academic Development, Duke University School of Medicine, Durham, NC, USA
- Duke Cancer Institute, Duke University School of Medicine, Durham, NC, USA
- Department of Surgery, Duke University School of Medicine, Durham, NC, USA
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LeBlanc TW, Fish LJ, Bloom CT, El-Jawahri A, Davis DM, Locke SC, Steinhauser KE, Pollak KI. Patient experiences of acute myeloid leukemia: A qualitative study about diagnosis, illness understanding, and treatment decision-making. Psychooncology 2016; 26:2063-2068. [DOI: 10.1002/pon.4309] [Citation(s) in RCA: 58] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2016] [Revised: 10/24/2016] [Accepted: 11/11/2016] [Indexed: 11/11/2022]
Affiliation(s)
- Thomas W. LeBlanc
- Duke Cancer Institute; Durham NC USA
- Division of Hematologic Malignancies and Cellular Therapy, Department of Medicine; Duke University School of Medicine; Durham NC USA
| | | | | | | | | | | | - Karen E. Steinhauser
- Division of General Internal Medicine, Department of Medicine; Duke University School of Medicine; Durham NC USA
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Noonan D, Lyna P, Fish LJ, Bilheimer AK, Gordon KC, Roberson P, Gonzalez A, Pollak KI. Unintended Effects of a Smoking Cessation Intervention on Latino Fathers' Binge Drinking In Early Postpartum. Ann Behav Med 2016; 50:622-7. [PMID: 26868270 PMCID: PMC6087664 DOI: 10.1007/s12160-016-9781-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Background Research suggests that when smokers reduce their smoking, they also reduce their alcohol consumption. Purpose To examine the effects of a smoking cessation intervention and actual quitting smoking on binge drinking behavior among Latino expectant and new fathers. Methods Logistic regression models were used to examine the effect of intervention arm and quitting smoking on past 30-day binge drinking measured at 3-months and 12-months postpartum while controlling for known covariates. Results Fathers in the intervention arm were significantly more likely to decrease their binge drinking at the 12-month follow-up (OR=0.57, 95% CI=0.35–0.93). Quitting smoking, measured by both 7-day and 30-day point prevalence, was positively associated with reduced binge drinking at 3-months (OR=0.25, 95% CI=0.14–0.45; OR=0.44, 95% CI= 0.26–0.75) and 12-months (OR=0.22, 95% CI=0.11–0.42; OR=0.43, 95% CI= 0.24–0.77). Conclusions The results of this study support the positive effects of a smoking cessation intervention on decreasing binge drinking behavior among Latino fathers in the postpartum period.
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Affiliation(s)
- Devon Noonan
- Duke University School of Nursing, 307 Trent Drive, Durham, NC, USA.
| | - Pauline Lyna
- Cancer Control and Population Science, Duke Cancer Institute, Durham, NC, USA
| | - Laura J Fish
- Department of Community and Family Medicine, Duke University School of Medicine, Durham, NC, USA
| | - Alicia K Bilheimer
- Cancer Control and Population Science, Duke Cancer Institute, Durham, NC, USA
| | - Kristina C Gordon
- Department of Psychology, University of Tennessee at Knoxville, Knoxville, TN, USA
| | - Patricia Roberson
- Department of Psychology, University of Tennessee at Knoxville, Knoxville, TN, USA
| | - Alicia Gonzalez
- Duke AHEC Program, Duke University School of Medicine, Durham, NC, USA
| | - Kathryn I Pollak
- Department of Community and Family Medicine, Duke University School of Medicine, Durham, NC, USA
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Pollak KI, Fish LJ, Lyna P, Peterson BL, Myers ER, Gao X, Swamy GK, Brown-Johnson A, Whitecar P, Bilheimer AK, Pletsch PK. Efficacy of a Nurse-Delivered Intervention to Prevent and Delay Postpartum Return to Smoking: The Quit for Two Trial. Nicotine Tob Res 2016; 18:1960-6. [PMID: 27091830 DOI: 10.1093/ntr/ntw108] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2016] [Accepted: 04/08/2016] [Indexed: 11/12/2022]
Abstract
INTRODUCTION Most pregnant women who quit smoking return to smoking postpartum. Trials to prevent this return have been unsuccessful. We tested the efficacy of a nurse-delivered intervention in maintaining smoking abstinence after delivery among pregnant women who quit smoking that was tailored on their high risk of relapse (eg, had strong intentions to return). METHODS We recruited 382 English-speaking spontaneous pregnant quitters from 14 prenatal clinics and randomized them to receive either a smoking abstinence booklet plus newsletters about parenting and stress (control) or a nurse-delivered smoking abstinence intervention that differed in intensity for the high and low risk groups. Our primary outcome was smoking abstinence at 12 months postpartum. RESULTS Using intent-to-treat analyses, there was a high rate of biochemically validated smoking abstinence at 12 months postpartum but no arm differences ( CONTROL 36% [95% confidence interval [CI]: 29-43] vs. INTERVENTION 35% [95% CI: 28-43], P = .81). Among women at low risk of returning to smoking, the crude abstinence rate was significantly higher in the control arm (46%) than in the intervention arm (33%); among women at high risk of returning to smoking, the crude abstinence rate was slightly lower but not different in the control arm (31%) than in the intervention arm (37%). CONCLUSIONS Low-risk women fared better with a minimal intervention that focused on parenting skills and stress than when they received an intensive smoking abstinence intervention. The opposite was true for women who were at high risk of returning to smoking. Clinicians might need to tailor their approach based on whether women are at high or low risk of returning to smoking. IMPLICATIONS Results suggest that high-risk and low-risk women might benefit from different types of smoking relapse interventions. Those who are lower risk of returning to smoking might benefit from stress reduction that is devoid of smoking content, whereas those who are higher risk might benefit from smoking relapse prevention.
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Affiliation(s)
- Kathryn I Pollak
- Cancer Control and Population Sciences, Duke Cancer Institute, Durham, NC; Department of Community and Family Medicine, Duke University School of Medicine, Durham, NC;
| | - Laura J Fish
- Department of Community and Family Medicine, Duke University School of Medicine, Durham, NC
| | - Pauline Lyna
- Cancer Control and Population Sciences, Duke Cancer Institute, Durham, NC
| | | | - Evan R Myers
- Department of Obstetrics and Gynecology, Duke University School of Medicine, Durham, NC
| | - Xiaomei Gao
- Cancer Control and Population Sciences, Duke Cancer Institute, Durham, NC
| | - Geeta K Swamy
- Department of Obstetrics and Gynecology, Duke University School of Medicine, Durham, NC
| | - Angela Brown-Johnson
- Department of Obstetrics and Gynecology, Womack Army Medical Center, Ft Bragg, NC
| | - Paul Whitecar
- Department of Obstetrics and Gynecology, Womack Army Medical Center, Ft Bragg, NC
| | - Alicia K Bilheimer
- Cancer Control and Population Sciences, Duke Cancer Institute, Durham, NC
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Bastian LA, Fish LJ, Gierisch JM, Stechuchak KM, Grambow SC, Keefe FJ. Impact of Smoking Cessation on Subsequent Pain Intensity Among Chronically Ill Veterans Enrolled in a Smoking Cessation Trial. J Pain Symptom Manage 2015. [PMID: 26210348 DOI: 10.1016/j.jpainsymman.2015.06.012] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [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: 11/22/2022]
Abstract
CONTEXT Prior cross-sectional studies have reported greater pain intensity among persistent smokers compared with nonsmokers or former smokers; yet, few prospective studies have examined how smoking abstinence affects pain intensity. OBJECTIVES To determine the impact of smoking cessation on subsequent pain intensity in smokers with chronic illness enrolled in a smoking cessation trial. METHODS We recruited veteran smokers with chronic illness (heart disease, cancer, chronic obstructive pulmonary disease, diabetes, or hypertension) for a randomized controlled smoking cessation trial and prospectively examined pain intensity and smoking status. Participants (n = 380) were asked to rate their pain in the past week from 0 to 10 at baseline and the five-month follow-up. The primary outcome measure was self-reported pain intensity at the five-month follow-up survey. Self-reported smoking status was categorized as an abstainer if patients reported no cigarettes in the seven days before the follow-up survey. RESULTS In unadjusted analyses, abstainers reported significantly lower pain levels at the five-month follow-up compared with patients who continued to smoke (parameter estimate = -1.07; 95% CI = -1.77, -0.36). In multivariable modeling, abstaining from cigarettes was not associated with subsequent pain intensity at five-month follow-up (parameter estimate = -0.27; 95% CI = -0.79, 0.25). CONCLUSION Participants who were classified as abstainers did not report significantly different levels of pain intensity than patients who continued to smoke. Future studies should expand on our findings and monitor pain intensity in smoking cessation trials. TRIAL REGISTRATION ClinicalTrials.govNCT00448344.
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Affiliation(s)
- Lori A Bastian
- Veterans Affairs Connecticut Healthcare System, West Haven, Connecticut, USA; Department of Medicine, University of Connecticut Health Center, Farmington, Connecticut, USA.
| | - Laura J Fish
- Cancer Control and Population Sciences, Duke Cancer Institute, Duke University Medical Center, Durham, North Carolina, USA; Department of Community and Family Medicine, Duke University Medical Center, Durham, North Carolina, USA
| | - Jennifer M Gierisch
- Center for Health Services Research in Primary Care, Durham Veterans Affairs Medical Center, Durham, North Carolina, USA; Department of Medicine, Duke University Medical Center, Durham, North Carolina, USA
| | - Karen M Stechuchak
- Center for Health Services Research in Primary Care, Durham Veterans Affairs Medical Center, Durham, North Carolina, USA
| | - Steven C Grambow
- Center for Health Services Research in Primary Care, Durham Veterans Affairs Medical Center, Durham, North Carolina, USA; Department of Biostatistics and Bioinformatics, Duke University Medical Center, Durham, North Carolina, USA
| | - Francis J Keefe
- Cancer Control and Population Sciences, Duke Cancer Institute, Duke University Medical Center, Durham, North Carolina, USA; Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, North Carolina, USA
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Khaddouma A, Gordon KC, Fish LJ, Bilheimer A, Gonzalez A, Pollak KI. Relationships among spousal communication, self-efficacy, and motivation among expectant Latino fathers who smoke. Health Psychol 2015; 34:1038-42. [PMID: 25844907 PMCID: PMC4579045 DOI: 10.1037/hea0000224] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Cigarette smoking is a prevalent problem among Latinos, yet little is known about what factors motivate them to quit smoking or make them feel more confident that they can. Given cultural emphases on familial bonds among Latinos (e.g., familismo), it is possible that communication processes among Latino spouses play an important role. The present study tested a mechanistic model in which perceived spousal constructive communication patterns predicted changes in level of motivation for smoking cessation through changes in self-efficacy among Latino expectant fathers. METHODS Latino males (n = 173) and their pregnant partners participated in a couple-based intervention targeting males' smoking. Couples completed self-report measures of constructive communication, self-efficacy (male partners only), and motivation to quit (male partners only) at 4 time points throughout the intervention. RESULTS Higher levels of perceived constructive communication among Latino male partners predicted subsequent increases in male partners' self-efficacy and, to a lesser degree, motivation to quit smoking; however, self-efficacy did not mediate associations between constructive communication and motivation to quit smoking. Furthermore, positive relationships with communication were only significant at measurements taken after completion of the intervention. Female partners' level of perceived constructive communication did not predict male partners' outcomes. CONCLUSION These results provide preliminary evidence to support the utility of couple-based interventions for Latino men who smoke. Findings also suggest that perceptions of communication processes among Latino partners (particularly male partners) may be an important target for interventions aimed at increasing desire and perceived ability to quit smoking among Latino men. (PsycINFO Database Record
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Pollak KI, Fish LJ, Lyna P, Peterson BL, Swamy GK, Levine MD. Predictors of pregnant quitters' intention to return to smoking postpartum. Nicotine Tob Res 2014; 17:742-5. [PMID: 25542912 DOI: 10.1093/ntr/ntu270] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2014] [Accepted: 11/27/2014] [Indexed: 11/12/2022]
Abstract
INTRODUCTION Although many pregnant women quit smoking, most return to smoking postpartum. Returning to smoking is strongly related to women's stated intention about smoking during pregnancy. We examined factors related to women's intention to return to smoking to improve intervention trials. METHODS We report cross-sectional baseline data from a randomized controlled trial to prevent postpartum return to smoking. Women (n = 382; 98% consent rate) were English-speaking women who smoked at least 100 cigarettes in their lifetimes and at least 5 cigarettes a day prior to becoming pregnant. We fit logistic regression models to test whether women's intention to return to smoking was associated with demographic and smoking factors such as race, parity, and smoker self-identity. RESULTS Forty-three percent of women had a strong intention of returning to smoking. Factors independently associated with intending to return to smoking were: stating they did not want to be currently pregnant (OR = 2.1, CI = 1.1-3.9), reporting being abstinent for fewer days (OR = 0.8, CI = 0.7-0.9), being less concerned about the harmful effects of smoking to themselves (OR = 1.6, CI = 0.9-2.8), viewing quit as temporary (OR = 2.1, CI = 1.2-3.6), and self-identifying selves as smokers (OR = 8.7, CI = 5.0-15.2). CONCLUSIONS Although some factors related to intention to return to smoking were unchangeable, it might be possible to attempt to change women's attribution of why they quit to be more permanent and to have them change their self-identity to be a "nonsmoker" from a "smoker who is not currently smoking." Helping women have stronger intentions to stay quit could promote less return to smoking postpartum.
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Affiliation(s)
- Kathryn I Pollak
- Cancer Control and Population Sciences, Duke Cancer Institute, Durham, NC; Department of Community and Family Medicine, Duke University School of Medicine, Durham, NC;
| | - Laura J Fish
- Cancer Control and Population Sciences, Duke Cancer Institute, Durham, NC; Department of Community and Family Medicine, Duke University School of Medicine, Durham, NC
| | - Pauline Lyna
- Cancer Control and Population Sciences, Duke Cancer Institute, Durham, NC
| | - Bercedis L Peterson
- Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, NC
| | - Geeta K Swamy
- Department of Obstetrics and Gynecology, Duke University School of Medicine, Durham, NC
| | - Michele D Levine
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA
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Pollak KI, Lyna P, Bilheimer AK, Gordon KC, Peterson BL, Gao X, Swamy GK, Denman S, Gonzalez A, Rocha P, Fish LJ. Efficacy of a couple-based randomized controlled trial to help Latino fathers quit smoking during pregnancy and postpartum: the Parejas trial. Cancer Epidemiol Biomarkers Prev 2014; 24:379-85. [PMID: 25406226 DOI: 10.1158/1055-9965.epi-14-0841] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Although many Latinos in the United States smoke, they receive assistance to quit less often than non-Latinos. To address this disparity, we recruited Latino couples into a randomized controlled trial and provided a smoking cessation program during a teachable moment, when men's partners were pregnant. METHODS We compared two interventions: (i) written materials plus nicotine replacement therapy (NRT) to (ii) materials, NRT, and couple-based counseling that addressed smoking cessation and couples communication. We recruited 348 expectant fathers who smoked via their pregnant partners from county health departments. Our primary outcome was 7-day point prevalence smoking abstinence and was collected from November 2010 through April 2013 and analyzed in February 2014. RESULTS We found high rates of cessation but no arm differences in smoking rates at the end of pregnancy (0.31 vs. 0.30, materials only vs. counseling, respectively) and 12 months after randomization (postpartum: 0.39 vs. 0.38). We found high quit rates among nondaily smokers but no arm differences (0.43 vs. 0.46 in pregnancy and 0.52 vs. 0.48 postpartum). Among daily smokers, we found lower quit rates with no arm differences but effects favoring the intervention arm (0.13 vs. 0.16 in pregnancy and 0.17 vs. 0.24 postpartum). CONCLUSIONS A less intensive intervention promoted cessation equal to more intensive counseling. Postpartum might be a more powerful time to promote cessation among Latino men. IMPACT Less intensive interventions when delivered during teachable moments for Latino men could result in a high smoking cessation rate and could reduce disparities.
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Affiliation(s)
- Kathryn I Pollak
- Cancer Control and Population Science, Duke Cancer Institute, Durham, North Carolina. Department of Community and Family Medicine, Duke University School of Medicine, Durham, North Carolina.
| | - Pauline Lyna
- Cancer Control and Population Science, Duke Cancer Institute, Durham, North Carolina
| | - Alicia K Bilheimer
- Cancer Control and Population Science, Duke Cancer Institute, Durham, North Carolina
| | - Kristina C Gordon
- Department of Psychology, University of Tennessee at Knoxville, Knoxville, Tennessee
| | - Bercedis L Peterson
- Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, North Carolina
| | - Xiaomei Gao
- Cancer Control and Population Science, Duke Cancer Institute, Durham, North Carolina
| | - Geeta K Swamy
- Department of Obstetrics and Gynecology, Duke University School of Medicine, Durham, North Carolina
| | - Susan Denman
- School of Nursing, Duke University, Durham, North Carolina. University of North Carolina, Greensboro, North Carolina
| | - Alicia Gonzalez
- Duke AHEC Program, Duke University School of Medicine, Durham, North Carolina
| | | | - Laura J Fish
- Department of Community and Family Medicine, Duke University School of Medicine, Durham, North Carolina
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Fish LJ, Pollak KI, Scheuermann TS, Cox LS, Mathur C, Ahluwalia JS. Comparison of native light daily smokers and light daily smokers who were former heavy smokers. Nicotine Tob Res 2014; 17:546-51. [PMID: 25180075 DOI: 10.1093/ntr/ntu169] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2014] [Accepted: 08/17/2014] [Indexed: 11/13/2022]
Abstract
INTRODUCTION An increasing proportion of daily smokers are light smokers (≤10 cigarettes per day). Some light smokers have never smoked more than 10 cigarettes per day (native light smokers) and others smoked at higher levels but have cut down (converted light smokers). It is important that we expand our understanding of these distinct subgroups of light smokers in order to develop effective interventions. METHODS Data for this report come from a larger sample of smokers who completed a cross-sectional survey administered through an online panel survey service. The sample of 522 light smokers included 256 native light smokers and 266 as converted light smokers. The goal of the analysis was to examine demographic, smoking, and psychosocial factors that differentiate between native and converted light smokers. RESULTS Multivariable logistic regression results showed 4 variables that differentiated between native and converted light smokers. Native light smokers were more likely to be Black than White, smoke fewer cigarettes per day, smoked fewer total years, and had higher perceived risk of heart disease than converted light smokers. CONCLUSIONS Native and converted light smokers are similar in many ways and also differ on some important characteristics. Further exploration of group difference is needed and could help to inform for cessation strategies for daily light smokers.
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Affiliation(s)
- Laura J Fish
- Cancer Control and Population Sciences and Community and Family Medicine, Duke University, Cancer Control and Population Sciences, Duke Cancer Institute, Durham, NC;
| | - Kathryn I Pollak
- Cancer Control and Population Sciences and Community and Family Medicine, Duke University, Cancer Control and Population Sciences, Duke Cancer Institute, Durham, NC
| | - Taneisha S Scheuermann
- Department of Preventive Medicine and Public Health, School of Medicine, University of Kansas, Kansas City, KS
| | - Lisa Sanderson Cox
- Department of Preventive Medicine and Public Health, School of Medicine, University of Kansas, Kansas City, KS
| | - Charu Mathur
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN
| | - Jasjit S Ahluwalia
- Center for Health Equity and Department of Medicine, University of Minnesota, Minneapolis, MN
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