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Zhu X, Carpenter CJ, Smith RA, Myrick JG, Martin MA, Lennon RP, Small ML, Van Scoy LJ. Extending the Theory of Normative Social Behavior: Collective Norms, Opinion Leadership, and Masking During the COVID-19 Pandemic. Health Commun 2024; 39:49-61. [PMID: 36476292 DOI: 10.1080/10410236.2022.2152964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
Novel, public behaviors, such as masking, should be susceptible to normative influence. This paper advances the theory of normative social behavior by considering a new set of moderators of normative influence - superdiffuser traits - and by clarifying the antecedents and consequences of exposure to collective norms. We use data from a two-wave survey of a cohort living in one U.S. county during the pandemic (N = 913) to assess normative effects on masking. We also used a bipartite network (based on people shopping for food in the same stores) to examine exposure to collective norms. The results show different superdiffuser traits have distinct effects on the relationship between perceived injunctive norms and masking intentions. Exposure to collective norms influences masking, but this influence depends on how people interact with their social environments. Network analysis shows that behavioral homophily is a significant predictor of selective exposure to collective norms earlier (but not later) in the pandemic. Implications for understanding normative influence in a context where opinion leadership matters are discussed.
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Affiliation(s)
- Xun Zhu
- Department of Communication, University of North Dakota
| | | | - Rachel A Smith
- Department of Communication Arts and Sciences, Pennsylvania State University
| | - Jessica Gall Myrick
- Donald P. Bellisario College of Communications, Pennsylvania State University
| | - Molly A Martin
- Department of Sociology and Criminology, Pennsylvania State University
| | - Robert P Lennon
- Department of Family and Community Medicine, Pennsylvania State College of Medicine
| | - Meg L Small
- College of Health and Human Development, Pennsylvania State University
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2
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Van Scoy LJ, Scott AM, Higgins J, Wasserman E, Heyland D, Chinchilli V, Green MJ. Feasibility and Acceptability of a Novel Intensive Care Unit Communication Intervention ("Let's Talk") and Initial Assessment Using the Multiple Goals Theory of Communication. Am J Hosp Palliat Care 2024; 41:373-382. [PMID: 37173285 PMCID: PMC10885768 DOI: 10.1177/10499091231176296] [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: 05/15/2023] Open
Abstract
Background: Family members of intensive care unit (ICU) patients often report poor communication, feeling unprepared for ICU family meetings, and poor psychological outcomes after decision-making. The objective of this study was to create a tool to prepare families for ICU family meetings and assess feasibility of using Communication Quality Analysis (CQA) to measure communication quality of family meetings. Methods: This observational study was conducted at an academic tertiary care center in Hershey, PA from March 2019 to 2020. Phase 1a involved conceptual design. Phase 1b entailed acceptability testing of 2 versions of the tool (text-only, comic) with 9 family members of non-capacitated ICU patients; thematic analysis of semi-strucutred interviews was conducted. Phase 1c assessed feasibility of applying CQA to audio-recorded ICU family meetings (n = 17); 3 analysts used CQA to assess 6 domains of communication quality. Wilcoxon Signed Rank tests were used to interpret CQA scores. Results: Four themes emerged from Phase 1b interviews: participants 1) found the tool useful for meeting preparation and organizing thoughts, 2) appreciated emotional content, 3) preferred the comic form (67%), and 4) had indifferent or negative perceptions about specific elements. In Phase 1c, clinicians scored higher on the CQA content and engagement domains; family members scored higher on the emotion domain. CQA scores in the relationship and face domains had the lowest quality ratings. Conclusions: Let's Talk may help families become better prepared for ICU family meetings. CQA provides a feasible approach to assessing communication quality that identifies specific areas of strengths and weaknesses in communication.
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Affiliation(s)
- Lauren J Van Scoy
- Departments of Medicine, Humanities and Public Health Sciences, Penn State College of Medicine, Hershey, PA, USA
| | - Allison M Scott
- Department of Communication, University of Kentucky, Lexington, KY, USA
| | - Jacob Higgins
- Department of Nursing Professional Practice and Development, University of Kentucky College of Nursing and UK Healthcare, Lexington, KY, USA
| | - Emily Wasserman
- Departments of Public Health Sciences, Penn State College of Medicine, Hershey, PA, USA
| | - Daren Heyland
- Department of Critical Care Medicine, Queens University, Kingston, ON, Canada
| | - Vernon Chinchilli
- Departments of Public Health Sciences, Penn State College of Medicine, Hershey, PA, USA
| | - Michael J Green
- Departments of Medicine and Humanities, Penn State College of Medicine, Hershey, PA, USA
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3
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Scott AM, Coolidge AA, Donovan EE, Kerr AM, Longtin K, Thompson CM, Ring D, Van Scoy LJ. The Impact of Health Communication Research on Medical and Health Professional Education and Training. Health Commun 2024:1-8. [PMID: 38501301 DOI: 10.1080/10410236.2024.2326258] [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] [Subscribe] [Scholar Register] [Indexed: 03/20/2024]
Abstract
In this essay, we review how health communication scholarship has been translated into various communication skills trainings (CSTs), we present four case studies of how health communication research informed the development and implementation of specific CSTs, and we reflect on how we can productively define "impact" in looking back as well as looking forward within this line of research.
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Affiliation(s)
| | - Andrew A Coolidge
- Department of Communication Studies/UT Center for Health Communication, University of Texas at Austin
| | - Erin E Donovan
- Department of Communication Studies/UT Center for Health Communication, University of Texas at Austin
| | - Anna M Kerr
- Department of Primary Care, Ohio University Heritage College of Osteopathic Medicine
| | - Krista Longtin
- Department of Communication Studies, IUPUI
- Department of Obstetrics and Gynecology, Indiana University School of Medicine
| | - Charee M Thompson
- Department of Communication, College of Liberal Arts and Sciences, University of Illinois at Urbana-Champaign
| | - David Ring
- Department of Surgery and Perioperative Care, Dell Medical School, University of Texas at Austin
| | - Lauren J Van Scoy
- Department of Medicine, Humanities, and Public Health Sciences, The Pennsylvania State University
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Levi BH, Dimmock AEF, Van Scoy LJ, Smith T, Kunzler B, Foy AJ, Badzek L, Green MJ. What Counts as a Surrogate Decision? Am J Hosp Palliat Care 2024; 41:125-132. [PMID: 36997165 PMCID: PMC10751970 DOI: 10.1177/10499091231168976] [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: 04/01/2023] Open
Abstract
When patients lose decision-making capacity, others must make surrogate decisions on their behalf. What counts as a surrogate decision might seem self-evident. But as clinician-researchers in the field of advance care planning, we have found that it is not always so clear-cut. In this paper, we describe how and why this is a matter of concern, a novel approach for assessing whether a surrogate decision occurred, and findings from this assessment.
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Affiliation(s)
- Benjamin H Levi
- Department of Humanities, Pennsylvania State University College of Medicine, Hershey, PA, USA
| | - Anne EF Dimmock
- Department of Humanities, Pennsylvania State University College of Medicine, Hershey, PA, USA
| | - Lauren J Van Scoy
- Department of Humanities, Pennsylvania State University College of Medicine, Hershey, PA, USA
| | - Theresa Smith
- Department of Humanities, Pennsylvania State University College of Medicine, Hershey, PA, USA
| | - Bronson Kunzler
- Department of Humanities, Pennsylvania State University College of Medicine, Hershey, PA, USA
| | - Andrew J Foy
- Department of Humanities, Pennsylvania State University College of Medicine, Hershey, PA, USA
| | - Laurie Badzek
- Nursing Sciences Building University Park, Penn State College of Nursing, Hershey, PA, USA
| | - Michael J Green
- Department of Humanities, Pennsylvania State University College of Medicine, Hershey, PA, USA
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5
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Rao P, Kazak AE, Doerksen SE, Koehly LM, Verdery AM, Heitzenrater J, Harding BA, Byrnes CL, Costigan HJ, Rovniak LS, Sciamanna CN, Van Scoy LJ, Schmitz KH. AYA-UNITE: Lessons Learned on Intervention Development Promoting Social and Physical Health of Adolescent/Young Adult Cancer Survivors. J Adolesc Young Adult Oncol 2023; 12:929-934. [PMID: 37815633 PMCID: PMC10777817 DOI: 10.1089/jayao.2023.0093] [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: 10/11/2023] Open
Abstract
Adolescent/young adult cancer survivors (AYACS) struggle with poor psychosocial health related to social disruptions due to cancer diagnosis, impacting long-term goal achievement and overall health. In particular, social health promotion is overlooked in AYACS' care. AYA-UNITE, a sociobehavioral exercise intervention pilot for AYACS 15-21 years of age at cancer diagnosis, was designed to foster AYACS' social and physical health. AYA-UNITE was a 12-week group-based virtual exercise program incorporating strength training and aerobic activity. In this brief report, we account AYA-UNITE's conceptual design, lessons learned through AYA-UNITE intervention development, and opportunities for improvement in implementing effective AYACS psychosocial interventions (NCT03778658).
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Affiliation(s)
- Pooja Rao
- Division of Pediatric Hematology/Oncology, Penn State Health Children's Hospital, Hershey, Pennsylvania, USA
| | - Anne E. Kazak
- Center for Healthcare Delivery Science, A.I. du Pont Hospital for Children, Wilmington, Delaware, USA
| | - Shawna E. Doerksen
- Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Laura M. Koehly
- National Human Genome Research Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Ashton M. Verdery
- Department of Sociology and Criminology, The Pennsylvania State University, University Park, Pennsylvania, USA
| | - Jared Heitzenrater
- Department of Medicine, Penn State College of Medicine, Hershey, Pennsylvania, USA
| | - Brennen A. Harding
- Department of Medicine, Penn State College of Medicine, Hershey, Pennsylvania, USA
| | - Courtney L. Byrnes
- Department of Medicine, Penn State College of Medicine, Hershey, Pennsylvania, USA
| | - Heather J. Costigan
- Department of Medicine, Penn State College of Medicine, Hershey, Pennsylvania, USA
| | - Liza S. Rovniak
- Department of Medicine, Penn State College of Medicine, Hershey, Pennsylvania, USA
| | | | - Lauren J. Van Scoy
- Department of Medicine, Penn State College of Medicine, Hershey, Pennsylvania, USA
| | - Kathryn H. Schmitz
- Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
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Smith RA, Gall Myrick J, Martin MA, Lennon RP, Van Scoy LJ, Small ML. Adoption and Discontinuance of Innovation Packages: A Longitudinal Study of Transitions in COVID-19 Mitigation. Health Commun 2023:1-12. [PMID: 37936518 DOI: 10.1080/10410236.2023.2275911] [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] [Subscribe] [Scholar Register] [Indexed: 11/09/2023]
Abstract
The past decades have seen growing interest and application of interventions targeting the change of multiple behaviors at once. We advance this work by using the diffusion of innovations theory (DOI) to consider constellations of behaviors as innovation packages: multiple innovations that are logically related, interdependent in their use or effects, and often promoted as a set (Rogers, 2003). In addition, we embraced DOI's focus on behavioral decisions as a continual process that can include adoption and discontinuance over time, especially as new innovations (e.g., COVID-19 vaccine) appear. To that end, we conducted a latent transition analysis of COVID-19 mitigation behaviors (N = 697; 97% received a COVID-19 vaccine) across three time points in the pandemic: initial outbreak; a secondary, record-breaking rise in cases; and after the CDC recommended that fully vaccinated adults could discontinue wearing masks. This analysis allowed us to identify latent classes based on shared behavioral patterns and transitions between classes over time. The results showed evidence of three possible packages: (a) a package of traditional, symptom-management behaviors (covering coughs and sneezes, staying home if ill, and seeking medical care), (b) a package of just-novel COVID-19 behaviors (wearing masks, keeping six feet apart, and avoiding mass gatherings), and (c) a package of all COVID-19 mitigation behaviors. Movement between classes exemplified adoption and discontinuance of different packages, as well as widespread discontinuance with the replacement innovation: COVID-19 vaccines. Additional analyses showed that increases in hope were associated with sustained and delayed adoption; decreases in social approval were associated with discontinuance. Future directions in theorizing around innovation packages are discussed.
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Affiliation(s)
- Rachel A Smith
- Department of Communication Arts and Sciences, Pennsylvania State University
| | - Jessica Gall Myrick
- Donald P. Bellisario College of Communications, Pennsylvania State University
| | - Molly A Martin
- Department of Sociology and Criminology, Pennsylvania State University
| | - Robert P Lennon
- Department of Family and Community Medicine, Pennsylvania State College of Medicine
| | | | - Meg L Small
- College of Health and Human Development, Pennsylvania State University
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7
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Marshall AP, Van Scoy LJ, Chaboyer W, Chew M, Davidson J, Day AG, Martinez A, Patel J, Roberts S, Skrobik Y, Taylor B, Tobiano G, Heyland DK. A randomised controlled trial of a nutrition and a decision support intervention to enable partnerships with families of critically ill patients. J Clin Nurs 2023; 32:6723-6742. [PMID: 37161555 DOI: 10.1111/jocn.16752] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Revised: 03/14/2023] [Accepted: 04/25/2023] [Indexed: 05/11/2023]
Abstract
AIMS AND OBJECTIVES The aim of the study was to investigate the effect of supporting family members to partner with health professionals on nutrition intakes and decision-making and to evaluate intervention and study feasibility. BACKGROUND Family partnerships can improve outcomes for critically ill patients and family members. Interventions that support families to engage with health professionals require evaluation. DESIGN A multi-centre, randomised, parallel group superiority Phase II randomised controlled trial. METHODS In nine intensive care units (ICUs) across three countries, critically ill patients ≥60 years, or those 55-59 years with advanced chronic diseases and expected ICU length of stay >72 h and their family member were enrolled between 9 May 2017 and 31 March 2020. Participants were randomised (1:1:1) to either a decision support or nutrition optimisation family-centred intervention, or usual care. Primary outcomes included protein and energy intake during ICU and hospital stay (nutrition intervention) and family satisfaction (decision support). Study feasibility was assessed as a composite of consent rate, intervention adherence, contamination and physician awareness of intervention assignment. RESULTS We randomised 135 patients/family members (consent rate 51.7%). The average rate of randomisation was 0.5 (0.13-1.53) per month. Unavailability (staff/family) was the major contributor to families not being approached for consent. Declined consent was attributed to families feeling overwhelmed (58/126, 46%). Pandemic visitor restrictions contributed to early study cessation. Intervention adherence for the decision support intervention was 76.9%-100.0% and for the nutrition intervention was 44.8%-100.0%. Nutritional adequacy, decisional conflict, satisfaction with decision-making and overall family satisfaction with ICU were similar for all groups. CONCLUSIONS Active partnerships between family members and health professionals are important but can be challenging to achieve in critical care contexts. We were unable to demonstrate the efficacy of either intervention. Feasibility outcomes suggest further refinement of interventions and study protocol may be warranted. RELEVANCE TO CLINICAL PRACTICE Interventions to promote family partnerships in critical illness are needed but require a greater understanding of the extent to which families want and are able to engage and the activities in which they have most impact. REPORTING METHOD This study has been reported following the Consolidated Standards of Reporting Trials (CONSORT) and the Template for Intervention Description and Replication (TIDieR) guidelines. PATIENT OR PUBLIC CONTRIBUTION Patients and caregivers were engaged in and contributed to the development and subsequent iterations of the two family-centred interventions use in this study. CLINICAL TRIAL REGISTRATION NUMBER Trial registration. CLINICALTRIALS gov, ID: NCT02920086. Registered on 30 September 2016. First patient enrolled on 9 May 2017 https://clinicaltrials.gov/ct2/results?cond=&term=NCT02920086&cntry=&state=&city=&dist=.
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Affiliation(s)
- Andrea P Marshall
- Menzies Health Institute Queensland, Griffith University, Southport, Queensland, Australia
- Intensive Care Unit, Gold Coast Health, Southport, Queensland, Australia
| | - Lauren J Van Scoy
- Department of Medicine, Humanities, and Public Health Sciences, Pennsylvania State University, Hershey, Pennsylvania, USA
| | - Wendy Chaboyer
- Menzies Health Institute Queensland, Griffith University, Southport, Queensland, Australia
| | - Mary Chew
- Phoenix VA Healthcare System, Phoenix, Arizona, USA
| | - Judy Davidson
- San Diego Health, University of California, San Diego, California, USA
| | - Andrew G Day
- Clinical Evaluation Research Unit, Kingston General Hospital, Kingston, Ontario, Canada
| | - Angelly Martinez
- Intensive Care Unit, Gold Coast Health, Southport, Queensland, Australia
| | - Jayshil Patel
- Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Shelley Roberts
- Menzies Health Institute Queensland, Griffith University, Southport, Queensland, Australia
- Gold Coast Health, Southport, Queensland, Australia
| | - Yoanna Skrobik
- Department of Medicine, McGill University, Montreal, Quebec, Canada
| | - Beth Taylor
- Barnes Jewish Hospital, Washington University School of Medicine in St Louis, St Louis, Missouri, USA
| | - Georgia Tobiano
- Menzies Health Institute Queensland, Griffith University, Southport, Queensland, Australia
- Gold Coast Health, Southport, Queensland, Australia
| | - Daren K Heyland
- Department of Critical Care Medicine, Queens's University, Kingston, Ontario, Canada
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8
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Nelson A, Stuckey H, Snyder B, Van Scoy LJ, Daymont C, Irvin C, Wasserman E, Beck M. Provider Perspectives of Transitions of Care at a Tertiary Care Children's Hospital With a Hospitalist-Run Discharge Clinic. Clin Pediatr (Phila) 2023; 62:926-934. [PMID: 36726290 PMCID: PMC10986183 DOI: 10.1177/00099228221149279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Children's hospitals are discharging patients to home with increasingly complex outpatient needs, making safe transitions of care (ToCs) of vital importance. Our study involved a survey of both outpatient providers and pediatric hospitalists associated with our medical center to better describe providers' views on the ToC process. The survey included questions assessing views on patient care responsibilities, resource availability, our hospitalist-run postdischarge clinic (PDC), and comfort with telemedicine. Our hospitalists generally believed that primary care providers (PCPs) did not have adequate access to important ToC elements, whereas PCPs felt their access was adequate. Both provider types felt it was the inpatient team's responsibility to manage patient events between discharge and PCP follow-up and that a hospitalist-run PDC may reduce interim emergency room visits. This study challenges perceptions about the ToC process in children and describes a generalizable approach to assessing provider perceptions surrounding the ToC within individual health systems.
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Affiliation(s)
- Abigail Nelson
- Penn State Children’s Hospital, Department of Pediatrics
| | - Heather Stuckey
- Penn State Hershey College of Medicine; Department of Medicine
| | - Bethany Snyder
- Penn State Hershey College of Medicine; Department of Medicine
| | | | - Carrie Daymont
- Penn State Children’s Hospital, Department of Pediatrics
- Penn State Hershey College of Medicine, Department of Public Health Sciences
| | | | - Emily Wasserman
- Penn State Hershey College of Medicine, Department of Public Health Sciences
| | - Michael Beck
- Penn State Children’s Hospital, Department of Pediatrics
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Lewis MM, Van Scoy LJ, De Jesus S, Hakun JG, Eslinger PJ, Fernandez-Mendoza J, Kong L, Yang Y, Snyder BL, Loktionova N, Duvvuri S, Gray DL, Huang X, Mailman RB. Dopamine D 1 Agonists: First Potential Treatment for Late-Stage Parkinson's Disease. Biomolecules 2023; 13:biom13050829. [PMID: 37238699 DOI: 10.3390/biom13050829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Revised: 03/17/2023] [Accepted: 05/08/2023] [Indexed: 05/28/2023] Open
Abstract
Current pharmacotherapy has limited efficacy and/or intolerable side effects in late-stage Parkinson's disease (LsPD) patients whose daily life depends primarily on caregivers and palliative care. Clinical metrics inadequately gauge efficacy in LsPD patients. We explored if a D1/5 dopamine agonist would have efficacy in LsPD using a double-blind placebo-controlled crossover phase Ia/b study comparing the D1/5 agonist PF-06412562 to levodopa/carbidopa in six LsPD patients. Caregiver assessment was the primary efficacy measure because caregivers were with patients throughout the study, and standard clinical metrics inadequately gauge efficacy in LsPD. Assessments included standard quantitative scales of motor function (MDS-UPDRS-III), alertness (Glasgow Coma and Stanford Sleepiness Scales), and cognition (Severe Impairment and Frontal Assessment Batteries) at baseline (Day 1) and thrice daily during drug testing (Days 2-3). Clinicians and caregivers completed the clinical impression of change questionnaires, and caregivers participated in a qualitative exit interview. Blinded triangulation of quantitative and qualitative data was used to integrate findings. Neither traditional scales nor clinician impression of change detected consistent differences between treatments in the five participants who completed the study. Conversely, the overall caregiver data strongly favored PF-06412562 over levodopa in four of five patients. The most meaningful improvements converged on motor, alertness, and functional engagement. These data suggest for the first time that there can be useful pharmacological intervention in LsPD patients using D1/5 agonists and also that caregiver perspectives with mixed method analyses may overcome limitations using methods common in early-stage patients. The results encourage future clinical studies and understanding of the most efficacious signaling properties of a D1 agonist for this population.
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Affiliation(s)
- Mechelle M Lewis
- Department of Neurology, Pennsylvania State University College of Medicine, Hershey, PA 17033, USA
- Department of Pharmacology, Pennsylvania State University College of Medicine, Hershey, PA 17033, USA
- Translational Brain Research Center, Penn State Milton S. Hershey Medical Center, Penn State College of Medicine, Hershey, PA 17033, USA
| | - Lauren J Van Scoy
- Translational Brain Research Center, Penn State Milton S. Hershey Medical Center, Penn State College of Medicine, Hershey, PA 17033, USA
- Department of Medicine, Pennsylvania State University College of Medicine, Hershey, PA 17033, USA
- Department of Humanities, Pennsylvania State University College of Medicine, Hershey, PA 17033, USA
| | - Sol De Jesus
- Department of Neurology, Pennsylvania State University College of Medicine, Hershey, PA 17033, USA
| | - Jonathan G Hakun
- Department of Neurology, Pennsylvania State University College of Medicine, Hershey, PA 17033, USA
| | - Paul J Eslinger
- Department of Neurology, Pennsylvania State University College of Medicine, Hershey, PA 17033, USA
- Department of Medicine, Pennsylvania State University College of Medicine, Hershey, PA 17033, USA
- Department of Radiology, Pennsylvania State University College of Medicine, Hershey, PA 17033, USA
- Department of Public Health Sciences, Pennsylvania State University College of Medicine, Hershey, PA 17033, USA
| | - Julio Fernandez-Mendoza
- Department of Neurology, Pennsylvania State University College of Medicine, Hershey, PA 17033, USA
- Department of Psychiatry, Pennsylvania State University College of Medicine, Hershey, PA 17033, USA
| | - Lan Kong
- Translational Brain Research Center, Penn State Milton S. Hershey Medical Center, Penn State College of Medicine, Hershey, PA 17033, USA
- Department of Public Health Sciences, Pennsylvania State University College of Medicine, Hershey, PA 17033, USA
| | - Yang Yang
- Department of Neurology, Pennsylvania State University College of Medicine, Hershey, PA 17033, USA
- Translational Brain Research Center, Penn State Milton S. Hershey Medical Center, Penn State College of Medicine, Hershey, PA 17033, USA
| | - Bethany L Snyder
- Department of Neurology, Pennsylvania State University College of Medicine, Hershey, PA 17033, USA
- Translational Brain Research Center, Penn State Milton S. Hershey Medical Center, Penn State College of Medicine, Hershey, PA 17033, USA
| | - Natalia Loktionova
- Department of Pharmacology, Pennsylvania State University College of Medicine, Hershey, PA 17033, USA
| | | | - David L Gray
- Cerevel Neurosciences LLC, Cambridge, MA 02141, USA
| | - Xuemei Huang
- Department of Neurology, Pennsylvania State University College of Medicine, Hershey, PA 17033, USA
- Department of Pharmacology, Pennsylvania State University College of Medicine, Hershey, PA 17033, USA
- Translational Brain Research Center, Penn State Milton S. Hershey Medical Center, Penn State College of Medicine, Hershey, PA 17033, USA
- Department of Radiology, Pennsylvania State University College of Medicine, Hershey, PA 17033, USA
- Department of Kinesiology, Pennsylvania State University, University Park, PA 16802, USA
- Department of Neurosurgery, Pennsylvania State University College of Medicine, Hershey, PA 17033, USA
| | - Richard B Mailman
- Department of Neurology, Pennsylvania State University College of Medicine, Hershey, PA 17033, USA
- Department of Pharmacology, Pennsylvania State University College of Medicine, Hershey, PA 17033, USA
- Translational Brain Research Center, Penn State Milton S. Hershey Medical Center, Penn State College of Medicine, Hershey, PA 17033, USA
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Callahan K, Van Scoy LJ, Kitko L, Acharya Y, Hardy MA, Hollenbeak CS. Cost-Savings of Do-not-Resuscitate Orders Among Elderly Patients With Heart Failure in the United States. Am J Med Qual 2023; 38:137-146. [PMID: 37021786 DOI: 10.1097/jmq.0000000000000121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/07/2023]
Abstract
Do-not-resuscitate (DNR) orders should preclude the use of cardiopulmonary resuscitation and may be associated with patient outcomes for patients hospitalized with heart failure (HF). This study examined the association between DNR and costs, mortality, and length of stay. The study cohort was a national sample of 700 922 hospital admissions of patients aged >65 with a primary diagnosis of HF. Elderly HF patients who died with a DNR had cost-savings of $5640 (P < 0.001). Patients with a DNR order were 8.9% points more likely to die before discharge than patients without (P < 0.001), and patients who died with a DNR had a significantly shorter hospital stay by 1.51 days (P < 0.001). DNR orders among elderly patients with HF are associated with cost-savings, as well as a higher mortality and shorter length of stay. In addition to primary benefits, advance care planning may aid in containing costs of care at end of life for HF.
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Affiliation(s)
- Katherine Callahan
- Department of Health Policy and Administration, College of Health and Human Development, The Pennsylvania State University, University Park, PA
| | - Lauren J Van Scoy
- College of Nursing, The Pennsylvania State University, University Park, PA
| | - Lisa Kitko
- Department of Pulmonary Medicine, College of Medicine, The Pennsylvania State University, Hershey, PA
| | - Yubraj Acharya
- Department of Health Policy and Administration, College of Health and Human Development, The Pennsylvania State University, University Park, PA
| | - Melissa A Hardy
- Department of Sociology and Criminology, College of the Liberal Arts, The Pennsylvania State University, University Park, PA
| | - Christopher S Hollenbeak
- Department of Health Policy and Administration, College of Health and Human Development, The Pennsylvania State University, University Park, PA
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11
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Kunzler BR, Smith TJ, Levi BH, Green MJ, Badzek L, Katsaros MG, Van Scoy LJ. The Value of Advance Care Planning for Spokespersons of Patients With Advanced Illness. J Pain Symptom Manage 2023; 65:471-478.e4. [PMID: 36690164 DOI: 10.1016/j.jpainsymman.2022.12.143] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Revised: 12/22/2022] [Accepted: 12/27/2022] [Indexed: 01/21/2023]
Abstract
CONTEXT Advance Care Planning (ACP) has fallen under scrutiny primarily because research has not consistently demonstrated patient-focused benefits. OBJECTIVES To better understand how spokespersons regard, engage with, and find value in ACP during decision-making for their loved ones. METHODS This qualitative analysis was part of a randomized controlled trial involving spokespersons of patients with advanced illness who had completed ACP. After making a medical decision on behalf of their loved one (or that loved one's death), semi-structured interviews explored spokespersons' experience of decision-making and if (and how) ACP played a role. Thematic analysis was conducted on interview transcripts. RESULTS From 120 interviews, five themes emerged: 1) Written advance directives (ADs) helped increase spokespersons' confidence that decisions were aligned with patient wishes (serving as a physical reminder of previous discussions and increasing clarity during decision-making and family conflict); 2) Iterative discussions involving ACP facilitated "In the moment" decision-making; 3) ADs and ACP conversations helped spokespersons feel more prepared for future decisions; 4) Spokespersons sometimes felt there was "no choice" regarding their loved one's medical care; and 5) Regrets and second-guessing were the most common negative emotions experienced by spokespersons. CONCLUSION Considering the recent debate about the utility of ACP and ADs, this analysis highlights the value of ACP for spokespersons involved in surrogate decision-making. Reframing the goals of ACP in terms of their benefit for spokespersons (and identifying appropriate outcome measures) may provide additional perspective on the utility of ACP.
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Affiliation(s)
| | - Theresa J Smith
- Department of Humanities, Penn State College of Medicine (T.J.S., B.H.L, M.J.G., M.G.K., L.J.V.S), Hershey, PA, USA
| | - Benjamin H Levi
- Department of Humanities, Penn State College of Medicine (T.J.S., B.H.L, M.J.G., M.G.K., L.J.V.S), Hershey, PA, USA; Department of Pediatrics, Penn State College of Medicine (B.H.L.), Hershey, PA, USA
| | - Michael J Green
- Department of Humanities, Penn State College of Medicine (T.J.S., B.H.L, M.J.G., M.G.K., L.J.V.S), Hershey, PA, USA; Department of Medicine, Penn State College of Medicine (M.J.G, L.J.V.S.), Hershey, PA, USA
| | - Laurie Badzek
- Penn State Ross and Carol Nese College of Nursing (L.B.), University Park, PA, USA
| | - Maria G Katsaros
- Department of Humanities, Penn State College of Medicine (T.J.S., B.H.L, M.J.G., M.G.K., L.J.V.S), Hershey, PA, USA
| | - Lauren J Van Scoy
- Department of Humanities, Penn State College of Medicine (T.J.S., B.H.L, M.J.G., M.G.K., L.J.V.S), Hershey, PA, USA; Department of Medicine, Penn State College of Medicine (M.J.G, L.J.V.S.), Hershey, PA, USA; Department of Public Health Sciences, Penn State College of Medicine (L.J.V.S.), Hershey, PA, USA.
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12
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Van Scoy LJ, Duda SH, Scott AM, Baker A, Costigan H, Loeffler M, Sherman MS, Brown MD. A mixed methods study exploring requests for unproven COVID therapies such as ivermectin and healthcare distrust in the rural South. Prev Med Rep 2022; 31:102104. [PMID: 36619802 PMCID: PMC9804965 DOI: 10.1016/j.pmedr.2022.102104] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2022] [Revised: 12/28/2022] [Accepted: 12/30/2022] [Indexed: 01/01/2023] Open
Abstract
The COVID-19 pandemic has led to contentious discourse regarding unproven COVID-19 therapies (UCTs),(e.g. ivermectin). Despite recommendations against it, ivermectin remains, in some areas, highly demanded. The goal of this study is to understand patient and provider perspectives about UCTs (e.g., ivermectin) and how responses to requests for UCTs impact healthcare distrust. This mixed methods observational study was conducted in a rural healthcare system in the Southern United States. Adults (n = 26) with a history of COVID-19 or clinicians (n = 8) from the same system were interviewed using questionnaires assessing healthcare distrust and qualitatively interviewed exploring perceptions about UCTs. Patient themes were: 1) Importance of anecdotal stories for decision-making; 2) Use of haphazard approaches to 'research'; 3) Strong distrust of government and healthcare organizations; 4) Inherent trust in local healthcare; 5) Decision-making as weighing pros/cons; and 6) Feeling a right to try medications. High survey medians indicated high distrust with differences of 8.5 points for those who requested/used ivermectin versus those who did not (p = 0.027). Clinician themes were: 1) Frustration when patients trust social media over clinicians; 2) Acceptance of community beliefs about UCTs; 3) Distrust originating outside of the healthcare system; 4) Feeling torn about prescribing UCTs to build trust; and 5) Variable educational strategies. When clinicians are perceived as aligned with government, this may void patients' trust of clinicians. Clinicians should leverage trust in local healthcare and distance themselves from distrusted information sources. Ethical questions arise regarding appropriateness of acquiescing to patient requests for ivermectin for building trust.
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Affiliation(s)
- Lauren J. Van Scoy
- Penn State University College of Medicine, Hershey, PA, United States,Corresponding author at: Humanities and Public Health Sciences, Department of Medicine, Division of Pulmonary, Allergy, and Critical Care, Penn State College of Medicine, 500 University Dr., H-041, Hershey, PA 17033-0850, United States.
| | - Sarah H. Duda
- Penn State University College of Medicine, Hershey, PA, United States
| | | | - Arian Baker
- Colquitt Regional Medical Center, Moultrie, GA, United States
| | - Heather Costigan
- Penn State University College of Medicine, Hershey, PA, United States
| | - Morgan Loeffler
- Penn State University College of Medicine, Hershey, PA, United States
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13
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Van Scoy LJ, Green MJ, Smith T, VanDyke E, Foy AJ, Badzek L, Levi BH. Conceptualization of Surrogate Decision-making Among Spokespersons for Chronically Ill Patients. JAMA Netw Open 2022; 5:e2245608. [PMID: 36480203 PMCID: PMC9856522 DOI: 10.1001/jamanetworkopen.2022.45608] [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] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
IMPORTANCE The value of advance care planning (ACP) has been the subject of recent debate because of mixed findings. This may be, in part, because trials presume that researchers and patient spokespersons share the same understanding of the role of a surrogate decision-maker. We explored how patient surrogates conceptualized and defined surrogate decision-making vs patient advocacy. Understanding how surrogates perceive their role in decision-making is important to avoid misinterpreting the effectiveness of ACP interventions. OBJECTIVE To understand how patient spokespersons distinguish surrogate decision-making from patient advocacy. DESIGN, SETTING, AND PARTICIPANTS This qualitative thematic analysis of a subsample of participants from a randomized clinical trial at a tertiary medical center was conducted from September 27, 2012, to June 30, 2021. Participants (n = 36) were the designated spokespersons of adult patients with severe illness who had made a surrogate decision on behalf of the patient since the last follow-up. Analysis was performed from March 21, 2021, to February 7, 2022. MAIN OUTCOMES AND MEASURES Semistructured interviews examined how patient spokespersons conceptualize differences between surrogate decision-making and advocacy. RESULTS The study included 36 patient spokespersons (32 women [88.9%]; mean [SD] age, 62.1 [11.8] years) and found substantial variability in how the spokespersons conceptualized what it means to make a surrogate decision for another. A total of 10 spokespersons (27.8%) did not distinguish surrogate decision-making from advocacy. There were 5 definitions for both surrogate decision-making and advocacy. The 3 most common definitions of surrogate decision-making were (1) acting as the final decision-maker (18 [50.0%]), (2) doing what is best for the patient (8 [22.2%]), and (3) making decisions on behalf of patients so that their wishes are respected (6 [16.7%]). The 3 most common definitions of advocacy were (1) doing what is best for the patient (8 [22.2%]), (2) respecting patients' wishes (6 [16.7%]), and (3) providing support to the patient (6 [16.7%]). The most common pairing of definitions by an individual spokesperson involved defining surrogate decision-making as being the final decision-maker, and defining advocacy as acting in the best interest of the patient (6 [16.7%]). CONCLUSIONS AND RELEVANCE This qualitative study found that many spokespersons perceive their roles as surrogate decision-makers differently than clinicians and researchers likely do, often conflating surrogacy with advocacy. These findings may help explain why researchers have found that ACP does not consistently improve traditional outcomes. If spokespersons do not distinguish surrogate decision-making from advocacy, then what is being reported by spokespersons and measured by clinicians and researchers may not accurately reflect the true association of ACP with outcomes.
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Affiliation(s)
- Lauren J. Van Scoy
- Department of Medicine, Penn State College of Medicine, Hershey, Pennsylvania
- Department of Humanities, Penn State College of Medicine, Hershey, Pennsylvania
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, Pennsylvania
| | - Michael J. Green
- Department of Medicine, Penn State College of Medicine, Hershey, Pennsylvania
- Department of Humanities, Penn State College of Medicine, Hershey, Pennsylvania
| | - Theresa Smith
- Department of Humanities, Penn State College of Medicine, Hershey, Pennsylvania
| | - Erika VanDyke
- Department of Medicine, Penn State College of Medicine, Hershey, Pennsylvania
| | - Andrew J. Foy
- Department of Medicine, Penn State College of Medicine, Hershey, Pennsylvania
| | - Laurie Badzek
- Ross and Carol Nese College of Nursing, Pennsylvania State University, University Park
| | - Benjamin H. Levi
- Department of Humanities, Penn State College of Medicine, Hershey, Pennsylvania
- Department of Pediatrics, Penn State College of Medicine, Hershey, Pennsylvania
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14
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Weng X, Shen C, Vasekar M, Boltz M, Joshi M, Van Scoy LJ, Wang L. Alzheimer's disease and related dementias is a risk factor for lower utilization of breast cancer screening and unstaged cancer diagnosis: Observational study from SEER-Medicare 2004–2016 data. J Geriatr Oncol 2022; 14:101407. [PMID: 36446722 DOI: 10.1016/j.jgo.2022.11.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Revised: 10/31/2022] [Accepted: 11/23/2022] [Indexed: 11/27/2022]
Affiliation(s)
- Xingran Weng
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA, USA
| | - Chan Shen
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA, USA; Division of Outcomes, Research and Quality, Department of Surgery, Penn State College of Medicine, Hershey, PA, USA
| | - Monali Vasekar
- Division of Hematology and Oncology, Department of Medicine, Penn State College of Medicine, PA, USA
| | - Marie Boltz
- Penn State College of Nursing, University Park, PA, USA
| | - Monika Joshi
- Division of Hematology and Oncology, Department of Medicine, Penn State College of Medicine, PA, USA
| | - Lauren J Van Scoy
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA, USA; Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, Penn State College of Medicine, Hershey, PA, USA; Department of Humanities, Penn State College of Medicine, Hershey, PA, USA
| | - Li Wang
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA, USA.
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15
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Weng X, Shen C, Van Scoy LJ, Boltz M, Joshi M, Wang L. End-of-Life Costs of Cancer Patients With Alzheimer's Disease and Related Dementias in the U.S. J Pain Symptom Manage 2022; 64:449-460. [PMID: 35931403 DOI: 10.1016/j.jpainsymman.2022.07.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Revised: 07/23/2022] [Accepted: 07/25/2022] [Indexed: 12/24/2022]
Abstract
CONTEXT End-of-Life (EOL) care consumes a substantial amount of healthcare resources, especially among older persons with cancer. Having Alzheimer's Disease and Related Dementias (ADRD) brings additional complexities to these patients' EOL care. OBJECTIVES To examine the Medicare expenditures at the EOL (last 12 months of life) among beneficiaries having cancer and ADRD vs. those without ADRD. METHODS A retrospective cohort study used 2004-2016 Surveillance, Epidemiology, and End Results-Medicare data. Patient populations were deceased Medicare beneficiaries with cancer (breast, lung, colorectal, and prostate) and continuously enrolled for 12 months before death. Beneficiaries with ADRD were propensity score matched with non-ADRD counterparts. Generalized Estimating Equation Model was deployed to estimate monthly Medicare expenditures. Generalized Linear Models were constructed to assess total EOL expenditures. RESULTS Eighty six thousand three hundred ninety-six beneficiaries were included (43,198 beneficiaries with ADRD and 43,198 beneficiaries without ADRD). Beneficiaries with ADRD utilized $64,901 at the EOL, which was roughly $407 more than those without ADRD ($64,901 vs. $64,494, P = 0.31). Compared to beneficiaries without ADRD, those with ADRD had 11% higher monthly expenditure and 7% higher in total expenditures. Greater expenditure was incurred on inpatient (5%), skilled nursing facility (SNF) (119%), home health (42%), and hospice (44%) care. CONCLUSION Medicare spending at the EOL per beneficiary was not statistically different between cohorts. However, specific types of service (i.e., inpatient, SNF, home health, and hospice) were significantly higher in the ADRD group compared to their non-ADRD counterparts. This study underscored the potential financial burden and informed Medicare about allocation of resources at the EOL.
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Affiliation(s)
- Xingran Weng
- Department of Public Health Sciences, Penn State College of Medicine (X.W., C.S., L.J.V.S., L.W.), Hershey, Pennsylvania, USA.
| | - Chan Shen
- Department of Public Health Sciences, Penn State College of Medicine (X.W., C.S., L.J.V.S., L.W.), Hershey, Pennsylvania, USA; Division of Outcomes, Research and Quality, Department of Surgery, Penn State College of Medicine (C.S.), Hershey, Pennsylvania, USA
| | - Lauren J Van Scoy
- Department of Public Health Sciences, Penn State College of Medicine (X.W., C.S., L.J.V.S., L.W.), Hershey, Pennsylvania, USA; Department of Medicine, Penn State College of Medicine (L.J.V.S.), Hershey, Pennsylvania, USA; Department of Humanities, Penn State College of Medicine (L.J.V.S.), Hershey, Pennsylvania, USA
| | - Marie Boltz
- Ross and Carole Nese Penn State College of Nursing (M.B.), University Park, Pennsylvania, USA
| | - Monika Joshi
- Division of Hematology-Oncology, Department of Medicine, Penn State Cancer Institute (M.J.), Hershey, Pennsylvania, USA
| | - Li Wang
- Department of Public Health Sciences, Penn State College of Medicine (X.W., C.S., L.J.V.S., L.W.), Hershey, Pennsylvania, USA
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16
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Van Scoy LJ, Bliton CF, Smith T, Badzek L, Green MJ, Levi BH, Foy AJ. Intrinsic Traits Such as Personality and Decision-Making Style are Predictive of Stress in Surrogate Decision-Makers. Am J Hosp Palliat Care 2022:10499091221135594. [PMID: 36266775 DOI: 10.1177/10499091221135594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Introduction: Despite its prominence in psychology, little is known about how personality traits play a role in the stress experiences of surrogate decision-makers. We tested the hypothesis that intrinsic traits (personality and decision-making styles) would be related to surrogates' stress in order to learn whether screening or tailoring interventions based on personality traits could help support surrogate decision-makers. Methods: This pre-specified secondary analysis evaluated data from an interventional study with dyads of patients with advanced chronic illness and their spokespersons. Measures included stress after decision-making or patient death (Impact of Events-Revised), personality (Big Five Index; BFI) and decision-making style (maximization and regret scales). Multivariate linear regressions explored the impact of personality on the stress experience; linear regressions independently modeled the impact of maximization and regret on the stress experience. Results: Of 38 spokespersons, 89.5% were women, 97.4% non-Hispanic, and 29.0% had a college degree or higher. In univariate analyses, total stress was correlated with neuroticism (r = .56, P < .01), higher scores on the regret (r = .55, P < .01) and maximization (r = .48, P < .05). In adjusted models, BFI was significantly associated with total stress (R2 = 27.08, P = .02). However, only neuroticism was independently associated with total stress. Conclusions: Personality traits, particularly neuroticism, and decision-making styles predicted heightened stress in spokespersons of patients with advanced chronic illness. If ACP interventions are intended to reduce spokesperson stress, personality and decision-making style scales may help identify spokespersons most likely to benefit from ACP interventions.
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Affiliation(s)
- Lauren J Van Scoy
- Departments of Medicine, 12310Penn State College of Medicine, Hershey, PA, USA.,Department of Humanities, 12310Penn State College of Medicine, Hershey, PA, USA.,Department of Public Health Sciences, 12310Penn State College of Medicine, Hershey, PA, USA
| | - Chloe F Bliton
- Department of Psychology, Pennsylvania State University, State College, PA, USA
| | - Theresa Smith
- Department of Humanities, 12310Penn State College of Medicine, Hershey, PA, USA
| | - Laurie Badzek
- 15965Penn State Ross and Carol Nese College of Nursing, University Park, PA, USA
| | - Michael J Green
- Departments of Medicine, 12310Penn State College of Medicine, Hershey, PA, USA.,Department of Humanities, 12310Penn State College of Medicine, Hershey, PA, USA
| | - Benjamin H Levi
- Department of Humanities, 12310Penn State College of Medicine, Hershey, PA, USA.,Department of Pediatrics, 12310Penn State College of Medicine, Hershey, PA, USA
| | - Andrew J Foy
- Departments of Medicine, 12310Penn State College of Medicine, Hershey, PA, USA
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17
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Martin MA, Lennon RP, Smith RA, Myrick JG, Small ML, Van Scoy LJ. Essential and non-essential US workers' health behaviors during the COVID-19 pandemic. Prev Med Rep 2022; 29:101889. [PMID: 35847125 PMCID: PMC9270843 DOI: 10.1016/j.pmedr.2022.101889] [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: 01/17/2022] [Revised: 05/09/2022] [Accepted: 07/01/2022] [Indexed: 11/26/2022] Open
Abstract
We seek to quantify the relationship between health behaviors and work-related experiences during the COVID-19 pandemic by predicting health behaviors as a function of essential worker status, job loss, change in work hours, and COVID-19 experiences. We use multivariate models and survey data from 913 employed adults in a semi-rural mid-Atlantic US county, and test whether essential worker results vary by gender, parenthood, and/or university employment. Multivariate models indicate that essential workers used tobacco on more days (4.5; p <.01) and were less likely to sleep 8 h (odds ratio [OR] 0.6; p <.01) than non-essential workers. The risk of sleeping less than 8 h is concentrated among essential workers in the service industry (OR 0.5; p <.05) and non-parents (OR 0.5; p <.05). Feminine essential workers exercised on fewer days (-0.8; p <.05) than feminine non-essential workers. Workers with reduced work hours consumed more alcoholic drinks (0.3; p <.05), while workers with increased work hours consumed alcohol (0.3; p <.05) and exercised (0.6; p <.05) on more days. Essential worker status and changes in work hours are correlated with unhealthy behaviors during the COVID-19 pandemic.
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Affiliation(s)
- Molly A Martin
- Department of Sociology and Criminology, Pennsylvania State University, University Park, PA, USA
| | - Robert P Lennon
- Department of Family and Community Medicine, Pennsylvania State College of Medicine, Hershey, PA, USA
| | - Rachel A Smith
- Department of Communication Arts and Sciences, Pennsylvania State University, University Park, PA, USA
| | - Jessica G Myrick
- Donald P. Bellisario College of Communications, Pennsylvania State University, University Park, PA, USA
| | - Meg L Small
- College of Health and Human Development, Pennsylvania State University, University Park, PA, USA
| | - Lauren J Van Scoy
- Department of Public Health Sciences, Pennsylvania State College of Medicine, Hershey, PA, USA
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18
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Van Scoy LJ, Levi BH, Bramble C, Calo W, Chinchilli VM, Currin L, Grant D, Hollenbeak C, Katsaros M, Marlin S, Scott AM, Tucci A, VanDyke E, Wasserman E, Witt P, Green MJ. Comparing two advance care planning conversation activities to motivate advance directive completion in underserved communities across the USA: The Project Talk Trial study protocol for a cluster, randomized controlled trial. Trials 2022; 23:829. [PMID: 36180899 PMCID: PMC9523194 DOI: 10.1186/s13063-022-06746-3] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2022] [Accepted: 09/13/2022] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Advance care planning (ACP) is a process involving conversations between patients, loved ones, and healthcare providers that consider patient preferences for the types of medical therapies received at the end of life. Underserved populations, including Black, Hispanic, rural, and low-income communities are less likely to engage in ACP than other communities, a health inequity that results in lower-quality care and reduced hospice utilization. The purpose of this trial is to compare efficacy of two interventions intended to motivate ACP (particularly advance directive completion) for those living in underserved communities. METHODS This 3-armed cluster, randomized controlled mixed methods design is being conducted in 75 community venues in underserved communities across the USA. The goal of the trial is to compare the efficacy of two interventions at motivating ACP. Arm 1 uses an end-of-life conversation game (Hello); Arm 2 uses a nationally utilized workshop format for ACP conversations (The Conversation Project); and Arm 3 uses an attention control game (TableTopics). Events are held in partnership with 75 local community-based host organizations and will involve 1500 participants (n=20 per event). The primary outcome is completion of a visually verified advance directive at 6 months post-event. Primary analyses compare efficacy of each intervention to each other and the control arm. Secondary mixed methods outcomes include (a) other ACP behaviors and engagement; (b) communication quality; (c) impact of sociocultural environment on ACP (via qualitative interviews); and (d) implementation and sustainability. Subgroup analyses examine outcomes for Black, Hispanic, and rural groups in particular. DISCUSSION This trial will add to the evidence base behind various conversational ACP interventions, examine potential mechanisms of action for such interventions, and provide qualitative data to better understand the sociocultural environment of how community-based ACP interventions are experienced by underserved populations. Results will also provide important data for future researchers to learn whether visual verification of advance directives is necessary or whether reliance on self-reported outcomes is of comparable value. Data from this study will inform ways to effectively motivate underserved communities to participate in advance care planning. TRIAL REGISTRATION ClinicalTrials.gov NCT04612738. Registered on October 12, 2020. All information from the WHO Trial Registration Data Set can be found within the protocol.
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Affiliation(s)
- Lauren J. Van Scoy
- Department of Medicine, Penn State College of Medicine, 500 University Dr., H-041, Hershey, PA 17033-0850 USA
- Department of Humanities, Penn State College of Medicine, 500 University Drive, Hershey, PA 17036 USA
- Department of Public Health Sciences, Penn State College of Medicine, 90 Hope Drive, Academic Support Building, Suite 2200, Mail Code A210, Hershey, PA 17033 USA
| | - Benjamin H. Levi
- Department of Humanities, Penn State College of Medicine, 500 University Drive, Hershey, PA 17036 USA
- Department of Pediatrics, Penn State College of Medicine, Suite 4400, Mail Code A444, Hershey, PA 17033 USA
| | - Cindy Bramble
- Hospice Foundation of America, 1707 L St. NW, Suite 220, Washington, DC, 20036 USA
| | - William Calo
- Department of Public Health Sciences, Penn State College of Medicine, 90 Hope Drive, Academic Support Building, Suite 2200, Mail Code A210, Hershey, PA 17033 USA
| | - Vernon M. Chinchilli
- Department of Public Health Sciences, Penn State College of Medicine, 90 Hope Drive, Academic Support Building, Suite 2200, Mail Code A210, Hershey, PA 17033 USA
| | - Lindsey Currin
- Hospice Foundation of America, 1707 L St. NW, Suite 220, Washington, DC, 20036 USA
| | - Denise Grant
- Hospice Foundation of America, 1707 L St. NW, Suite 220, Washington, DC, 20036 USA
| | - Christopher Hollenbeak
- Department of Health Policy and Administration, The Pennsylvania State University, 604E Donald H. Ford Bldg., University Park, PA 16802 USA
| | - Maria Katsaros
- Department of Medicine, Penn State College of Medicine, 500 University Dr., H-041, Hershey, PA 17033-0850 USA
| | - Sara Marlin
- Department of Public Health Sciences, Penn State College of Medicine, 90 Hope Drive, Academic Support Building, Suite 2200, Mail Code A210, Hershey, PA 17033 USA
| | - Allison M. Scott
- Department of Communication, University of Kentucky, 275 Blazer Dining Hall, University of Kentucky, Lexington, KY 40506 USA
| | - Amy Tucci
- Hospice Foundation of America, 1707 L St. NW, Suite 220, Washington, DC, 20036 USA
| | - Erika VanDyke
- Department of Medicine, Penn State College of Medicine, 500 University Dr., H-041, Hershey, PA 17033-0850 USA
| | - Emily Wasserman
- Department of Public Health Sciences, Penn State College of Medicine, 90 Hope Drive, Academic Support Building, Suite 2200, Mail Code A210, Hershey, PA 17033 USA
| | - Pamela Witt
- Department of Medicine, Penn State College of Medicine, 500 University Dr., H-041, Hershey, PA 17033-0850 USA
| | - Michael J. Green
- Department of Medicine, Penn State College of Medicine, 500 University Dr., H-041, Hershey, PA 17033-0850 USA
- Department of Humanities, Penn State College of Medicine, 500 University Drive, Hershey, PA 17036 USA
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19
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Van Scoy LJ, Costigan H, Smith RA, Snyder B, Martin MA, Myrick JG, Small ML, Lennon RP. Mixed-methods Analysis of Adults Likely versus Unlikely to Get a COVID-19 Vaccination. Am J Health Behav 2022; 46:467-476. [PMID: 36109856 DOI: 10.5993/ajhb.46.4.7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Objectives: This mixed-methods study compared perspectives of those 'very likely' versus 'very unlikely' to receive a hypothetical COVID-19 vaccine. Methods: We used an explanatory, sequential, mixed- methods design to analyze quantitative data from a rural Pennsylvania sample. Of the 976 participants, 67 selected 'very unlikely' to get the COVID-19 vaccine. Responses to open-ended questions: "What worries you the most about the COVID 19 pandemic?" and "What are your thoughts about a potential COVID 19 vaccine?" were qualitatively compared to answers from the 67 participants who selected 'very likely' to get the COVID-19 vaccine. We used descriptive content analysis to compare themes across the 2 groups. Results: Both groups had thematic commonalities related to their concerns. Themes that were more common among those 'very unlikely' to get vaccinated included concern for politics overriding vaccine safety and rushed vaccine development timeline, whereas themes related to hope and optimism about vaccination were exclusive to the 'very likely' group. Conclusions: Shared beliefs existed across groups with different intents to vaccinate; yet, identification with vaccine spokespersons differed. Messaging campaigns can use these commonalities to address vaccine hesitancy.
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Affiliation(s)
- Lauren J Van Scoy
- Lauren J. Van Scoy, Department of Medicine, Department of Humanities, and Department of Public Health Sciences, The Pennsylvania State University College of Medicine, Hershey, PA, United States;,
| | - Heather Costigan
- Heather Costigan, Department of Medicine, The Pennsylvania State University College of Medicine, Hershey, PA, United States
| | - Rachel A Smith
- Rachel A. Smith, Department of Communication Arts and Sciences, The Pennsylvania State University, University Park, PA, United States
| | - Bethany Snyder
- Bethany Snyder, Department of Medicine, The Pennsylvania State University College of Medicine, Hershey, PA, United States
| | - Molly A Martin
- Molly A. Martin, Department of Sociology and Criminology, The Pennsylvania State University, University Park, PA, United States
| | - Jessica G Myrick
- Jessica G. Myrick, Donald P. Bellisario College of Communications, The Pennsylvania State University, University Park, PA, United States. Meg L. Small, College of Health and Human Development, The Pennsylvania State University, University Park, PA, United States
| | - Meg L Small
- Meg L. Small, College of Health and Human Development, The Pennsylvania State University, University Park, PA, United States
| | - Robert P Lennon
- Robert P. Lennon, Department of Family and Community Medicine, The Pennsylvania State University College of Medicine, Hershey, PA, and Penn State Law, The Pennsylvania State University, University Park, PA, United States
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20
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Nordell RH, Van Scoy LJ, Witt PD, Flamm A. Flight Teams' Learning Needs Assessment on Ultrasound: A Mixed Methods Approach. Air Med J 2022; 41:237-242. [PMID: 35307150 DOI: 10.1016/j.amj.2021.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2021] [Accepted: 11/07/2021] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The goal of this study was to understand flight clinicians' learning needs and attitudes with regard to a prehospital ultrasound curriculum. METHODS In this convergent mixed methods study, 21 prehospital clinicians completed a questionnaire, and 20 attended a 1-hour focus group to explore attitudes regarding learning ultrasound. These participants were from a single emergency medical service agency. RESULTS Five themes emerged from the focus group transcripts and were supported by the quantitative data: 1) theme 1, hands-on training in ultrasound is a highly preferred modality; 2) theme 2, emergency medical service providers desire learning integrated into shifts and real-life practice; 3) theme 3, prehospital providers express concerns about training and maintenance of competency; 4) theme 4, participants recognize the need for quality control during the training phase and after; and 5) theme 5, participants were enthusiastic about how ultrasound could help guide clinical decision making and potentially improve patient outcomes. CONCLUSION Those who participated in an evidence-based assessment of prehospital ultrasound needs and barriers were experienced flight clinicians who would use prehospital ultrasound if made available. These adult learners indicated their preferred learning method would be using standardized patients, simulators, and hands-on in the field with physicians. They preferred follow-up courses and simulators to maintain competency.
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Affiliation(s)
- Robert H Nordell
- The Pennsylvania State University College of Medicine, Hershey, PA
| | - Lauren J Van Scoy
- Department of Medicine, Penn State College of Medicine, Hershey, PA; Department of Humanities, Penn State College of Medicine, Hershey, PA; Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA
| | - Pamela D Witt
- Department of Medicine, Penn State College of Medicine, Hershey, PA
| | - Avram Flamm
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA; Department of Emergency Medicine, Penn State Health Milton S. Hershey Medical Center, Hershey, PA.
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21
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Smith RA, Zhu X, Martin MA, Myrick JG, Lennon RP, Small ML, Van Scoy LJ. Longitudinal study of an emerging COVID-19 stigma: Media exposure, danger appraisal, and stress. Stigma and Health 2022. [DOI: 10.1037/sah0000359] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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22
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Lennon RP, Fraleigh R, Van Scoy LJ, Keshaviah A, Hu XC, Snyder BL, Miller EL, Calo WA, Zgierska AE, Griffin C. Developing and testing an automated qualitative assistant (AQUA) to support qualitative analysis. Fam Med Community Health 2021; 9:fmch-2021-001287. [PMID: 34824135 PMCID: PMC8627418 DOI: 10.1136/fmch-2021-001287] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Qualitative research remains underused, in part due to the time and cost of annotating qualitative data (coding). Artificial intelligence (AI) has been suggested as a means to reduce those burdens, and has been used in exploratory studies to reduce the burden of coding. However, methods to date use AI analytical techniques that lack transparency, potentially limiting acceptance of results. We developed an automated qualitative assistant (AQUA) using a semiclassical approach, replacing Latent Semantic Indexing/Latent Dirichlet Allocation with a more transparent graph-theoretic topic extraction and clustering method. Applied to a large dataset of free-text survey responses, AQUA generated unsupervised topic categories and circle hierarchical representations of free-text responses, enabling rapid interpretation of data. When tasked with coding a subset of free-text data into user-defined qualitative categories, AQUA demonstrated intercoder reliability in several multicategory combinations with a Cohen’s kappa comparable to human coders (0.62–0.72), enabling researchers to automate coding on those categories for the entire dataset. The aim of this manuscript is to describe pertinent components of best practices of AI/machine learning (ML)-assisted qualitative methods, illustrating how primary care researchers may use AQUA to rapidly and accurately code large text datasets. The contribution of this article is providing guidance that should increase AI/ML transparency and reproducibility.
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Affiliation(s)
- Robert P Lennon
- Family and Community Medicine, Penn State Health Milton S. Hershey Medical Center, Hershey, Pennsylvania, USA
| | - Robbie Fraleigh
- Applied Research Laboratory, Pennsylvania State University, University Park, Pennsylvania, USA
| | - Lauren J Van Scoy
- Internal Medicine, Penn State Health Milton S. Hershey Medical Center, Hershey, Pennsylvania, USA
| | | | - Xindi C Hu
- Mathematica Policy Research Inc, Princeton, New Jersey, USA
| | - Bethany L Snyder
- Center for Community Health Integration, Case Western Reserve University, Cleveland, Ohio, USA
| | - Erin L Miller
- Family and Community Medicine, Penn State Health Milton S. Hershey Medical Center, Hershey, Pennsylvania, USA
| | - William A Calo
- Public Health Services, Penn State Health Milton S. Hershey Medical Center, Hershey, Pennsylvania, USA
| | - Aleksandra E Zgierska
- Family and Community Medicine, Penn State Health Milton S. Hershey Medical Center, Hershey, Pennsylvania, USA
| | - Christopher Griffin
- Applied Research Laboratory, Pennsylvania State University, University Park, Pennsylvania, USA
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23
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Kunzler BR, Foy AJ, Levi BH, Van Scoy LJ, Lehman EB, Smith TJ, Green MJ. Does Caregiver Participation in Advance Care Planning Using a Decision Support Tool Together With Patients Reduce Caregiver Strain, Burden and Anxiety Over Time? A Post-Hoc Analysis of a Randomized Controlled Trial. Am J Hosp Palliat Care 2021; 39:757-761. [PMID: 34414808 DOI: 10.1177/10499091211040233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
CONTEXT Surrogate decision makers experience significant amounts of anxiety, burden, and strain in their role as caregivers and decision makers for loved ones. OBJECTIVES To investigate longitudinally whether surrogate decision makers engaging in ACP together with their loved one reduces perceived anxiety, burden, and strain felt by surrogate decision makers. METHODS Post-hoc analysis of a randomized controlled trial evaluating caregivers' perceived self-efficacy to serve as surrogate decision makers. The trial employed a 2×2 study design of patient/caregiver dyads who engaged in advance care planning (ACP) using a standard living will form vs "Making Your Wishes Known" (MYWK), and having the patient engage in ACP alone vs together with the family caregiver. Surrogates completed validated survey instruments surveys longitudinally to compare levels of anxiety, burden, and strain. RESULTS 246 of 285 dyads completed the measures. No significant reductions in anxiety, burden, or strain were found longitudinally in surrogate decision makers using MYWK together with loved one's vs other control groups. Increases in strain and anxiety were seen across all study groups and increases in burden across 2/4 study groups. Strain and burden increased most in the MYWK Together arm (▴ = +2.22 and ▴ = +1.91 respectively). CONCLUSION Family caregivers who engaged in ACP together with patients using the decision support tool MYWK did not experience less strain, burden, or anxiety longitudinally compared to other study arms. These results may help inform the design of future studies and interventions that promote caregivers' involvement in ACP interventions.
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Affiliation(s)
| | - Andrew J Foy
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA, USA.,Heart and Vascular Institute, Penn State College of Medicine, Hershey, PA, USA
| | - Benjamin H Levi
- Department of Humanities, Penn State College of Medicine, Hershey, PA, USA.,Department of Pediatrics, Penn State College of Medicine, Hershey, PA, USA
| | - Lauren J Van Scoy
- Department of Humanities, Penn State College of Medicine, Hershey, PA, USA.,Department of Medicine, Penn State College of Medicine, Hershey, PA, USA
| | - Erik B Lehman
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA, USA
| | - Theresa J Smith
- Department of Humanities, Penn State College of Medicine, Hershey, PA, USA
| | - Michael J Green
- Department of Humanities, Penn State College of Medicine, Hershey, PA, USA.,Department of Medicine, Penn State College of Medicine, Hershey, PA, USA
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24
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Lennon RP, Small ML, Smith RA, Van Scoy LJ, Myrick JG, Martin MA, Group DAR. Unique Predictors of Intended Uptake of a COVID-19 Vaccine in Adults Living in a Rural College Town in the United States. Am J Health Promot 2021; 36:180-184. [PMID: 34269077 DOI: 10.1177/08901171211026132] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE To explore public confidence in a COVID-19 vaccine. DESIGN Cross-sectional survey. SETTING A rural college town in central Pennsylvania. SUBJECTS Adult residents without minor children. MEASURES The primary outcome was COVID-19 vaccination intention. Secondary measures included vaccination attitudes, norms, efficacy, past behavior, trust in the vaccination process, and sociodemographic variables of education, financial standing, political viewpoint, and religiosity. ANALYSIS Descriptive statistics were used to describe quantitative data. Multivariate ordinal regression was used to model predictors of vaccine intention. RESULTS Of 950 respondents, 55% were "very likely" and 20% "somewhat likely" to take a coronavirus vaccine, even though 70% had taken the flu vaccine since September 2019. The strongest predictors of vaccine acceptance were trust in the system evaluating vaccines and perceptions of local COVID-19 vaccination norms. The strongest predictors of negative vaccine intentions were worries about unknown side-effects and positive attitudes toward natural infection. Sociodemographic factors, political views, and religiosity did not predict vaccine intentions. CONCLUSION Fewer adults intend to take a coronavirus vaccine than currently take the flu vaccine. Traditional sociodemographic factors may not be effective predictors of COVID-19 vaccine uptake. Although based on a small sample, the study adds to our limited understanding of COVID-19-specific vaccine confidence among some rural Americans and suggests that traditional public health vaccination campaigns based on sociodemographic characteristics may not be effective.
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Affiliation(s)
- Robert P Lennon
- Department of Family and Community Medicine, Penn State Milton S. Hershey Medical Center, Hershey, PA, USA
| | - Meg L Small
- College of Health and Human Development, Pennsylvania State University, University Park, PA, USA
| | - Rachel A Smith
- Department of Communication Arts and Sciences, Pennsylvania State University, University Park, PA, USA
| | - Lauren J Van Scoy
- Department of Medicine, Penn State Milton S. Hershey Medical Center, Hershey, PA, USA
| | - Jessica G Myrick
- College of Communications, Pennsylvania State University, State College, PA, USA
| | - Molly A Martin
- Department of Sociology and Criminology, Pennsylvania State University, State College, PA, USA
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25
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George DR, Snyder B, Van Scoy LJ, Brignone E, Sinoway L, Sauder C, Murray A, Gladden R, Ramedani S, Ernharth A, Gupta N, Saran S, Kraschnewski J. Perceptions of Diseases of Despair by Members of Rural and Urban High-Prevalence Communities: A Qualitative Study. JAMA Netw Open 2021; 4:e2118134. [PMID: 34297071 PMCID: PMC8303097 DOI: 10.1001/jamanetworkopen.2021.18134] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
IMPORTANCE Diseases of despair (ie, mortality or morbidity from suicidality, drug abuse, and alcoholism) were first characterized as increasing in rural White working-class populations in midlife with low educational attainment and associated with long-term economic decline. Excess mortality now appears to be associated with working-class citizens across demographic and geographic boundaries, but no known qualitative studies have engaged residents of rural and urban locales with high prevalence of diseases of despair to learn their perspectives. OBJECTIVE To explore perceptions about despair-related illness and potential intervention strategies among diverse community members residing in discrete rural and urban hotspots. DESIGN, SETTING, AND PARTICIPANTS In this qualitative study, high-prevalence hotspots for diseases of despair were identified from health insurance claims data in Central Pennsylvania. Four focus groups were conducted with 60 community members in organizations and coalitions from 3 census block group hotspot clusters in the health system between September 2019 and January 2020. Focus groups explored awareness and beliefs about causation and potential intervention strategies. MAIN OUTCOMES AND MEASURES A descriptive phenomenological approach was applied to thematic analysis, and a preliminary conceptual model was constructed to describe how various factors may be associated with perpetuating despair and with public health. RESULTS In total, 60 adult community members participated in 4 focus groups (44 women, 16 men; 40 White non-Hispanic, 17 Black, and 3 Hispanic/Latino members). Three focus groups with 43 members were held in rural areas with high prevalence of diseases of despair, and 1 focus group with 17 members in a high-prevalence urban area. Four themes emerged with respect to awareness and believed causation of despair-related illness, and participants identified common associated factors, including financial distress, lack of critical infrastructure and social services, deteriorating sense of community, and family fragmentation. Intervention strategies focused around 2 themes: (1) building resilience to despair through better community and organizational coordination and peer support at the local level and (2) encouraging broader state investments in social services and infrastructure to mitigate despair-related illness. CONCLUSIONS AND RELEVANCE In this qualitative study, rural and urban community members identified common factors associated with diseases of despair, highlighting the association between long-term political and economic decline and public health and a need for both community- and state-level solutions to address despair. Health care systems participating in addressing community health needs may improve processes to screen for despair (eg, social history taking) and codesign primary, secondary, and tertiary interventions aimed at addressing factors associated with distress. Such actions have taken on greater urgency with the COVID-19 pandemic.
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Affiliation(s)
- Daniel R. George
- Department of Humanities, Penn State College of Medicine, Hershey, Pennsylvania
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, Pennsylvania
| | - Bethany Snyder
- Qualitative and Mixed Methods Core, Penn State College of Medicine, Hershey, Pennsylvania
| | - Lauren J. Van Scoy
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, Pennsylvania
- Department of Medicine, Penn State College of Medicine, Hershey, Pennsylvania
| | | | - Lawrence Sinoway
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, Pennsylvania
- Clinical and Translational Science Institute, Penn State College of Medicine, Hershey, Pennsylvania
| | - Charity Sauder
- Clinical and Translational Science Institute, Penn State College of Medicine, Hershey, Pennsylvania
| | - Andrea Murray
- Clinical and Translational Science Institute, Penn State College of Medicine, Hershey, Pennsylvania
| | | | | | | | - Neha Gupta
- Penn State College of Medicine, Hershey, Pennsylvania
| | - Savreen Saran
- Penn State College of Medicine, Hershey, Pennsylvania
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26
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Smith RA, Myrick JG, Lennon RP, Martin MA, Small ML, Van Scoy LJ, Research Group TDA. Exploring Behavioral Typologies to Inform COVID-19 Health Campaigns: A Person-Centered Approach. J Health Commun 2021; 26:402-412. [PMID: 34292858 DOI: 10.1080/10810730.2021.1946218] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
As the United States continues to be ravaged by COVID-19, it becomes increasingly important to implement effective public health campaigns to improve personal behaviors that help control the spread of the virus. To design effective campaigns, research is needed to understand the current mitigation intentions of the general public, diversity in those intentions, and theoretical predictors of them. COVID-19 campaigns will be particularly challenging because mitigation involves myriad, diverse behaviors. This study takes a person-centered approach to investigate data from a survey (N = 976) of Pennsylvania adults. Latent class analysis revealed five classes of mitigation: one marked by complete adherence with health recommendations (34% of the sample), one by complete refusal (9% of the sample), and three by a mixture of adherence and refusal. Statistically significant covariates of class membership included relatively positive injunctive norms, risk due to essential workers in the household, personal knowledge of someone who became infected with COVID-19, and belief that COVID-19 was a leaked biological weapon. Additionally, trait reactance was associated with non-adherence while health mavenism was associated with adherence. These findings may be used to good effect by local healthcare providers and institutions, and also inform broader policy-making decisions regarding public health campaigns to mitigate COVID-19.
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Affiliation(s)
- Rachel A Smith
- Department of Communication Arts and Sciences, Pennsylvania State University, University Park, Pennsylvania , USA
| | - Jessica G Myrick
- Donald P. Bellisario College of Communications, Pennsylvania State University, University Park, Pennsylvania , USA
| | - Robert P Lennon
- Department of Family and Community Medicine, Pennsylvania State College of Medicine, Hershey, Pennsylvania , USA
| | - Molly A Martin
- Department of Sociology and Criminology, Pennsylvania State University, University Park, Pennsylvania , USA
| | - Meg L Small
- College of Health and Human Development, Pennsylvania State University, University Park, Pennsylvania , USA
| | - Lauren J Van Scoy
- Department of Medicine, Pennsylvania State College of Medicine, Hershey, Pennsylvania
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27
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Lipnick D, Green M, Thiede E, Smith TJ, Lehman EB, Johnson R, La IS, Wiegand D, Levi BH, Van Scoy LJ. Surrogate Decision Maker Stress in Advance Care Planning Conversations: A Mixed-Methods Analysis From a Randomized Controlled Trial. J Pain Symptom Manage 2020; 60:1117-1126. [PMID: 32645452 PMCID: PMC8109394 DOI: 10.1016/j.jpainsymman.2020.07.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 06/22/2020] [Accepted: 07/01/2020] [Indexed: 10/23/2022]
Abstract
CONTEXT Spokespersons serving as surrogate decision makers for their loved ones report high levels of stress. Despite known benefits, advance care planning (ACP) conversations often do not occur. More information is needed to understand spokesperson stress during ACP. OBJECTIVES To explore if and how spokespersons perceive stress related to ACP conversations; compare factors related to stress; and assess whether ACP intervention impacted stress. METHODS Secondary and mixed-methods analysis with data transformation of semistructured interviews occurring during a 2 × 2 factorial (four armed) randomized controlled trial that compared standard online ACP to a comprehensive online ACP decision aid. Tools were completed by patients with advanced illness (n = 285) alone or with their spokesperson (n = 285). About 200 spokesperson interviews were purposively sampled from each of the four arms (50 per arm). RESULTS ACP conversations were reported as stressful by 54.41% (74 of 136) and nonstressful by 45.59% (62 of 136). Five themes impacting spokesperson stress were the nature of the relationship with their loved one; self-described personality and belief systems; knowledge and experience with illness and ACP conversations; attitude toward ACP conversations; and social support in caregiving and decision making. No significant differences in stress were associated with arm assignment. CONCLUSION Identifying what factors impact spokesperson stress in ACP conversations can be used to help design ACP interventions to more appropriately address the needs and concerns of spokespersons.
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Affiliation(s)
- Daniella Lipnick
- Penn State College of Medicine, Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania, USA.
| | - Michael Green
- Department of Humanities, Penn State College of Medicine, Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania, USA; Department of Medicine, Penn State College of Medicine, Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania, USA
| | - Elizabeth Thiede
- Penn State College of Nursing, University Park, Pennsylvania, USA
| | - Theresa J Smith
- Department of Humanities, Penn State College of Medicine, Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania, USA
| | - Erik B Lehman
- Department of Humanities, Penn State College of Medicine, Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania, USA; Public Health Sciences at Penn State College of Medicine, Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania, USA
| | - Rhonda Johnson
- Department of Humanities, Penn State College of Medicine, Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania, USA
| | - In Seo La
- University of Maryland School of Nursing, Baltimore, Maryland, USA
| | - Debra Wiegand
- University of Maryland School of Nursing, Baltimore, Maryland, USA
| | - Benjamin H Levi
- Department of Humanities, Penn State College of Medicine, Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania, USA; Department of Pediatrics, Penn State College of Medicine, Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania, USA
| | - Lauren J Van Scoy
- Department of Humanities, Penn State College of Medicine, Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania, USA; Department of Medicine, Penn State College of Medicine, Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania, USA; Public Health Sciences at Penn State College of Medicine, Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania, USA
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28
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Callahan K, Kitko L, Van Scoy LJ, Hollenbeak CS. Do-not-resuscitate orders and readmission among elderly patients with heart failure in Pennsylvania: An observational study, 2011 - 2014. Heart Lung 2020; 49:812-816. [PMID: 33010520 DOI: 10.1016/j.hrtlng.2020.09.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Revised: 09/03/2020] [Accepted: 09/09/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Readmissions for patients with heart failure (HF) continues to be a target of value-based purchasing initiatives. Do-not-resuscitate (DNR) orders-one part of advance care planning (ACP)-have been shown to be related to other patient outcomes but has not been explored as a risk factor for HF readmission. OBJECTIVES Examine the association between DNR and 30-day readmissions among elderly patients with HF admitted to hospitals in Pennsylvania. METHODS Data included hospital discharges from 2011 to 2014 of patients 65+ years with a primary diagnosis of HF. Logistic regression was used to model the relationship between DNR and 30-day readmission. RESULTS Among 107,806 patients, 20.9% were readmitted within 30 days. After controlling for covariates, patients with HF who had a DNR were less likely to be readmitted to the hospital (OR=0.85, 95% CI: 0.80-0.91, p<0.001). CONCLUSIONS Documentation of a DNR may inform efforts to reduce readmissions among elderly patients with HF.
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Affiliation(s)
- Katherine Callahan
- Department of Health Policy and Administration, College of Health and Human Development, The Pennsylvania State University, 604E Donald H. Ford Building, University Park, PA 16802 United States.
| | - Lisa Kitko
- School of Nursing, The Pennsylvania State University, University Park, PA, United States
| | - Lauren J Van Scoy
- Department of Pulmonary Medicine, College of Medicine, The Pennsylvania State University, Hershey, PA, United States
| | - Christopher S Hollenbeak
- Department of Health Policy and Administration, College of Health and Human Development, The Pennsylvania State University, 604E Donald H. Ford Building, University Park, PA 16802 United States
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29
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Green MJ, Van Scoy LJ, Foy AJ, Dimmock AEF, Lehman E, Levi BH. Patients With Advanced Cancer Choose Less Aggressive Medical Treatment on Vignettes After Using a Computer-Based Decision Aid. Am J Hosp Palliat Care 2019; 37:537-541. [PMID: 31830798 DOI: 10.1177/1049909119892596] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Although patients often prefer less rather than more treatment at the end of life, in the absence of contrary instructions, the medical profession's de facto position is to treat aggressively. It is unknown whether a computer-based decision aid can affect treatment choices. METHODS Secondary analysis of a single-center, single-blind randomized controlled trial of an advance care planning (ACP) intervention among 200 patients with stage IV cancer. Participants were randomized to intervention (Making Your Wishes Known, a values-neutral, educational, computer-based decision aid) or control (standard living will + brochure). After reading a hypothetical clinical vignette, participants were asked whether they would want 11 medical/surgical treatments in that situation (dialysis, cardiopulmonary resuscitation [CPR], ventilator, feeding tube, etc). The median number of treatments wanted by participants was compared between groups, and logistic regression was used to compare between-group likelihood of not wanting each specific treatment. RESULTS The median number of treatments wanted was 1 in the intervention group versus 5 in the control (P < .001). For 6 of 11 treatments, the intervention group was significantly less likely than control to want aggressive treatment. Most notably, compared to control, intervention participants were less likely to want CPR (odds ratio [OR] = 0.31), short-term mechanical ventilation (OR = 0.34), short-term dialysis (OR = 0.38), surgery (OR = 0.37), and transfusion (OR = 0.21). CONCLUSIONS Individuals using an educational ACP decision aid were less likely to want aggressive medical treatment than those completing standard living wills. These findings have implications not only for how to respect patient's wishes but also potentially for reducing costs at the end of life.
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Affiliation(s)
- Michael J Green
- Department of Medicine, Penn State College of Medicine, Hershey, PA, USA.,Department of Humanities, Penn State College of Medicine, Hershey, PA, USA
| | - Lauren J Van Scoy
- Department of Medicine, Penn State College of Medicine, Hershey, PA, USA.,Department of Humanities, Penn State College of Medicine, Hershey, PA, USA
| | - Andrew J Foy
- Department of Medicine, Penn State College of Medicine, Hershey, PA, USA.,Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA, USA
| | - Anne E F Dimmock
- Department of Medicine, Penn State College of Medicine, Hershey, PA, USA
| | - Erik Lehman
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA, USA
| | - Benjamin H Levi
- Department of Humanities, Penn State College of Medicine, Hershey, PA, USA.,Department of Pediatrics, Penn State College of Medicine, Hershey, PA, USA
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30
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Van Scoy LJ, Day AG, Howard M, Sudore R, Heyland DK. Adaptation and Preliminary Validation of the Advance Care Planning Engagement Survey for Surrogate Decision Makers. J Pain Symptom Manage 2019; 57:980-988.e9. [PMID: 30684633 PMCID: PMC6857702 DOI: 10.1016/j.jpainsymman.2019.01.008] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Revised: 01/09/2019] [Accepted: 01/13/2019] [Indexed: 11/29/2022]
Abstract
CONTEXT Although measures that assess patient engagement in the advance care planning (ACP) process exist, there are no validated tools to assess surrogate decision makers' (SDMs') role in ACP. OBJECTIVES The objective of this study was to adapt and begin to validate a patient-oriented questionnaire for use with SDMs of patients with chronic illness. METHODS Questions from the 55-item patient-oriented ACP engagement survey were adapted for SDMs and assessed for face validity. The resultant 47-item questionnaire was administered to 65 SDMs of patients with chronic illness. Responses were assessed and items were flagged for removal based on item redundancy, nonresponses, and ceiling effects. A preliminary exploratory factor analysis was performed, internal consistency was assessed, and domains were constructed based on findings. RESULTS The 47-item questionnaire was administered to 65 participants (mean age 51.8; 81% female; 96% Caucasian). Seventeen items were removed owing to redundancy (r > 0.80), and 13 items lacking face validity were removed. In a preliminary exploratory factor analysis of the resultant 17-item questionnaire, a three-factor solution was deemed most statistically and conceptually sound. Items were organized into domains: 1) serving as an SDM (seven items); 2) contemplation (four items); 3) readiness (six items). Internal consistency for each domain was high (Cronbach alpha 0.90-0.91). CONCLUSION The 17-item ACP engagement survey for SDMs (ACP-17-SDM) is a conceptually sound and reliable questionnaire adaptation of the original ACP engagement survey. This questionnaire may be used by researchers in parallel with the patient-oriented ACP engagement survey to more fully understand the impact of ACP interventions on SDMs. Larger studies are needed to more closely examine construct validity.
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Affiliation(s)
- Lauren J Van Scoy
- Medicine, Humanities and Public Health Sciences, Pennsylvania State University College of Medicine, Hershey, Pennsylvania, USA.
| | - Andrew G Day
- Kingston General Health Research Institute and Clinical Evaluation Unit, Kingston, Ontario, Canada
| | - Michelle Howard
- Department of Family Medicine, McMaster University, Hamilton, Canada
| | - Rebecca Sudore
- Division of Geriatrics, University of California San Francisco, San Francisco, California, USA
| | - Daren K Heyland
- Department of Critical Care Medicine, Clinical Evaluation Research Unit, Kingston General Health Research Institute, Queen's University, Kingston, Ontario, Canada
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Foy AJ, Levi BH, Van Scoy LJ, Bucher A, Dimmock A, Green MJ. Patient Preference to Accept Medical Treatment Is Associated with Spokesperson Agreement. Ann Am Thorac Soc 2019; 16:518-521. [PMID: 30714833 PMCID: PMC6441700 DOI: 10.1513/annalsats.201806-428rl] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | | | | | | | - Anne Dimmock
- Penn State College of MedicineHershey, Pennsylvania
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Stewart RR, Dimmock AEF, Green MJ, Van Scoy LJ, Schubart JR, Yang C, Farace E, Bascom R, Levi BH. An Analysis of Recruitment Efficiency for an End-of-Life Advance Care Planning Randomized Controlled Trial. Am J Hosp Palliat Care 2018; 36:50-54. [PMID: 29976075 DOI: 10.1177/1049909118785158] [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] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND: Optimizing recruitment efficiency is an important strategy to address the resource limitations that typically constrain clinical research. Surprisingly, little empiric data exist to guide research teams attempting to recruit a difficult population into similar studies. Our objective was to investigate factors associated with enrollment into an advance care planning interventional trial. METHODS: This study used secondary data of patients with advanced cancer receiving treatment at an academic medical center in central Pennsylvania who were referred to a randomized controlled trial of an advance care planning intervention. Enrolled participants were compared to nonparticipants with regard to age, gender, race, season of recruitment, elapsed time between recruitment stage, distance to study site, and number of recruitment calls. RESULTS: Of the 1988 patients referred, 200 participants were enrolled yielding a recruitment efficiency of 10%. Two-thirds of all enrolled participants were recruited with 1 or less phone calls, whereas only 5% were enrolled after 3 calls. There were no statistically significant differences in enrollment based on gender ( P = .88) or elapsed time between recruitment contacts ( P = .22). However, nonparticipants were slightly older ( P = .02). CONCLUSIONS: Our finding that individuals were more likely to enroll within the first 3 phone calls suggests that recruitment efforts should be focused on making initial contacts with potential participants, rather than continuing attempts to those who are unable to be contacted easily. Researchers could optimize their recruitment strategy by periodically performing similar analyses, comparing differences between participants and nonparticipants.
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Affiliation(s)
- Renee R Stewart
- 1 Department of Humanities, Penn State College of Medicine, Hershey, PA, USA
| | - Anne E F Dimmock
- 2 Division of Pulmonary, Department of Medicine, Allergy and Critical Care Medicine, Penn State College of Medicine, Hershey, PA, USA
| | - Michael J Green
- 1 Department of Humanities, Penn State College of Medicine, Hershey, PA, USA.,3 Department of Medicine, Penn State College of Medicine, Hershey, PA, USA
| | - Lauren J Van Scoy
- 1 Department of Humanities, Penn State College of Medicine, Hershey, PA, USA.,2 Division of Pulmonary, Department of Medicine, Allergy and Critical Care Medicine, Penn State College of Medicine, Hershey, PA, USA
| | - Jane R Schubart
- 4 Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA, USA.,5 Department of Surgery, Penn State College of Medicine, Hershey, PA, USA
| | - Chengwu Yang
- 6 Department of Epidemiology and Health Promotion, College of Dentistry, New York University, New York, NY, USA
| | - Elana Farace
- 4 Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA, USA.,7 Department of Neurosurgery, Penn State College of Medicine, Hershey, PA, USA
| | - Rebecca Bascom
- 2 Division of Pulmonary, Department of Medicine, Allergy and Critical Care Medicine, Penn State College of Medicine, Hershey, PA, USA
| | - Benjamin H Levi
- 1 Department of Humanities, Penn State College of Medicine, Hershey, PA, USA.,8 Department of Pediatrics, Penn State College of Medicine, Hershey, PA, USA
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Heyland DK, Davidson J, Skrobik Y, des Ordons AR, Van Scoy LJ, Day AG, Vandall-Walker V, Marshall AP. Improving partnerships with family members of ICU patients: study protocol for a randomized controlled trial. Trials 2018; 19:3. [PMID: 29301555 PMCID: PMC5753514 DOI: 10.1186/s13063-017-2379-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2017] [Accepted: 11/24/2017] [Indexed: 11/24/2022] Open
Abstract
Background Over the last decade, health care delivery has shifted to partnering with patients and their families to improve health and quality of care, and to lower costs. Partnering with family members (FMs) of critically ill patients who lack capacity is particularly important for improving experiences and outcomes for both patients and FMs. How best to apply such partnering strategies, however, is yet unknown. The IMPACT trial will evaluate two interventions that enable partnerships with families of critically ill patients, each in a distinct content area, but similar in that they empower and support FMs. Methods This multi-center, open-label, randomized, phase II clinical trial aims to randomize 150 older, long-stay ICU patients and their families into one of three groups (50 in each group): (1) The OPTimal nutrition by Informing and Capacitating FMs of best practices (OPTICs) group, a multi-faceted intervention to engage and empower FMs to advocate for, and audit, best nutritional practices for their critically ill FMs, (2) A web-based decision-support intervention called the ICU Workbook (The Canadian Researchers at the End of Life Network (CARENET) ICU Workbook; https://www.myicuguide.ca/. Accessed 3 Feb 2017.) to support families in shared decision-making process regarding goals of medical treatments, and (3) Usual care. The main outcomes for this trial include nutritional adequacy in hospital and hand-grip strength prior to hospital discharge; satisfaction with decision-making; decision conflict; and degree of shared decision-making. Discussion With the goal of improving the functional recovery of nutritionally high-risk older patients and the quality of care at the end of life for these patients and their FMs in the ICU, we have proposed two novel family capacitation strategies. We hope that the nutrition and decision-support interventions implemented and evaluated in our study will contribute to the evidentiary basis for best family partnered care pathways focused on optimizing the quality of ICU care for patients with life-threatening illness and their families. Trial registration Clinical trials.gov, ID: NCT02920086. Registered on 30 September 2016. Protocol version dated 11 October 2016. Electronic supplementary material The online version of this article (doi:10.1186/s13063-017-2379-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Daren K Heyland
- Department of Critical Care Medicine, Queen's University, Kingston, ON, Canada. .,Clinical Evaluation Research Unit, Kingston General Hospital, Kingston, ON, Canada. .,Kingston General Hospital, Angada 4, Kingston, ON, K7L 2 V7, Canada.
| | - Judy Davidson
- EBP/Research Nurse Liaison, University of California, San Diego Health, San Diego, CA, USA
| | - Yoanna Skrobik
- Department of Medicine, McGill University, Montreal, QC, Canada
| | - Amanda Roze des Ordons
- Department of Critical Care Medicine and Division of Palliative Medicine, University of Calgary, Calgary, AB, Canada
| | - Lauren J Van Scoy
- Department of Medicine and Humanities, Division of Pulmonary, Allergy and Critical Care, Pennsylvania State University, Hershey, PA, USA
| | - Andrew G Day
- Clinical Evaluation Research Unit, Kingston General Hospital, Kingston, ON, Canada
| | - Virginia Vandall-Walker
- Faculty of Health Disciplines, Athabasca University, Athabasca, AB, Canada.,Faculty of Nursing, University of Alberta, Edmonton, AB, Canada
| | - Andrea P Marshall
- Menzies Health Institute Queensland, Griffith University and Gold Coast Health, Southport, QLD, Australia
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Green MJ, Van Scoy LJ, Foy AJ, Stewart RR, Sampath R, Schubart JR, Lehman EB, Dimmock AEF, Bucher AM, Lehmann LS, Harlow AF, Yang C, Levi BH. A Randomized Controlled Trial of Strategies to Improve Family Members' Preparedness for Surrogate Decision-Making. Am J Hosp Palliat Care 2017; 35:866-874. [PMID: 29186982 DOI: 10.1177/1049909117744554] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE To evaluate 2 strategies for preparing family members for surrogate decision-making. DESIGN A 2 × 2 factorial, randomized controlled trial testing whether: (1) comprehensive online advance care planning (ACP) is superior to basic ACP, and (2) having patients engage in ACP together with family members is superior to ACP done by patients alone. SETTING Tertiary care centers in Hershey, Pennsylvania, and Boston, Massachusetts. PARTICIPANTS Dyads of patients with advanced, severe illness (mean age 64; 46% female; 72% white) and family members who would be their surrogate decision-makers (mean age 56; 75% female; 75% white). INTERVENTIONS Basic ACP: state-approved online advance directive plus brochure. Making Your Wishes Known (MYWK): Comprehensive ACP decision aid including education and values clarification. MEASUREMENTS Pre-post changes in family member self-efficacy (100-point scale) and postintervention concordance between patients and family members using clinical vignettes. RESULTS A total 285 dyads enrolled; 267 patients and 267 family members completed measures. Baseline self-efficacy in both MYWK and basic ACP groups was high (90.2 and 90.1, respectively), and increased postintervention to 92.1 for MYWK ( P = .13) and 93.3 for basic ACP ( P = .004), with no between-group difference. Baseline self-efficacy in alone and together groups was also high (90.2 and 90.1, respectively), and increased to 92.6 for alone ( P = .03) and 92.8 for together ( P = .03), with no between-group difference. Overall adjusted concordance was higher in MYWK compared to basic ACP (85.2% vs 79.7%; P = .032), with no between-group difference. CONCLUSION The disconnect between confidence and performance raises questions about how to prepare family members to be surrogate decision-makers.
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Affiliation(s)
- Michael J Green
- 1 Department of Humanities, Penn State College of Medicine, Hershey, PA, USA.,2 Department of Medicine, Penn State College of Medicine, Hershey, PA, USA
| | - Lauren J Van Scoy
- 1 Department of Humanities, Penn State College of Medicine, Hershey, PA, USA.,2 Department of Medicine, Penn State College of Medicine, Hershey, PA, USA
| | - Andrew J Foy
- 3 Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA, USA.,4 Heart and Vascular Institute, Penn State College of Medicine, Hershey, PA, USA
| | - Renee R Stewart
- 1 Department of Humanities, Penn State College of Medicine, Hershey, PA, USA
| | - Ramya Sampath
- 5 Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital, Boston, MA, USA
| | - Jane R Schubart
- 3 Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA, USA.,6 Department of Surgery, Penn State College of Medicine, Hershey, PA, USA
| | - Erik B Lehman
- 3 Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA, USA
| | - Anne E F Dimmock
- 2 Department of Medicine, Penn State College of Medicine, Hershey, PA, USA
| | - Ashley M Bucher
- 4 Heart and Vascular Institute, Penn State College of Medicine, Hershey, PA, USA
| | - Lisa S Lehmann
- 5 Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital, Boston, MA, USA.,7 National Center for Ethics in Health Care, Veterans Administration, Washington, DC, USA
| | - Alyssa F Harlow
- 5 Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital, Boston, MA, USA
| | - Chengwu Yang
- 8 Department of Epidemiology and Health Promotion, College of Dentistry, New York University, New York, NY, USA
| | - Benjamin H Levi
- 1 Department of Humanities, Penn State College of Medicine, Hershey, PA, USA.,9 Department of Pediatrics, Penn State College of Medicine, Hershey, PA, USA
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Van Scoy LJ, Reading JM, Hopkins M, Smith B, Dillon J, Green MJ, Levi BH. Community Game Day: Using an End-of-Life Conversation Game to Encourage Advance Care Planning. J Pain Symptom Manage 2017; 54:680-691. [PMID: 28743662 DOI: 10.1016/j.jpainsymman.2017.07.034] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2017] [Revised: 07/17/2017] [Accepted: 07/18/2017] [Indexed: 10/19/2022]
Abstract
CONTEXT Advance care planning (ACP) is an important process that involves discussing and documenting one's values and preferences for medical care, particularly end-of-life treatments. OBJECTIVES This convergent, mixed-methods study assessed whether an end-of-life conversation card game is an acceptable and effective means for performing ACP for patients with chronic illness and/or their caregivers when deployed in a community setting. METHODS Twenty-two games (n = 93 participants) were held in community settings surrounding Hershey, PA in 2016. Participants were recruited using random sampling from patient databases and also convenience sampling (i.e., flyers). Quantitative questionnaires and qualitative focus group interviews were administered to assess the game experience and subsequent performance of ACP behaviors. RESULTS Both quantitative and qualitative data found that Community Game Day was a well-received, positive experience for participants and 75% of participants performed ACP within three months post-intervention. CONCLUSIONS These findings suggest that using a conversation game during community outreach is a useful approach for engaging patients and caregivers in ACP. The convergence of quantitative and qualitative data strongly supports the continued investigation of the game in randomized controlled trials.
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Affiliation(s)
- Lauren J Van Scoy
- Department of Medicine and Humanities, Pennsylvania State University College of Medicine, Hershey, Pennsylvania, USA.
| | - Jean M Reading
- Department of Medicine, Pennsylvania State University College of Medicine, Hershey, Pennsylvania, USA
| | - Margaret Hopkins
- Department of Humanities, Pennsylvania State University College of Medicine, Hershey, Pennsylvania, USA
| | - Brandi Smith
- Department of Medicine, Pennsylvania State University College of Medicine, Hershey, Pennsylvania, USA
| | - Judy Dillon
- Department of Nursing, Pennsylvania State University College of Medicine, Hershey, Pennsylvania, USA
| | - Michael J Green
- Department of Medicine and Humanities, Pennsylvania State University College of Medicine, Hershey, Pennsylvania, USA
| | - Benjamin H Levi
- Department of Pediatrics and Humanities, Pennsylvania State University College of Medicine, Hershey, Pennsylvania, USA
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Van Scoy LJ, Green MJ, Dimmock AE, Bascom R, Boehmer JP, Hensel JK, Hozella JB, Lehman EB, Schubart JR, Farace E, Stewart RR, Levi BH. High satisfaction and low decisional conflict with advance care planning among chronically ill patients with advanced chronic obstructive pulmonary disease or heart failure using an online decision aid: A pilot study. Chronic Illn 2016; 12:227-35. [PMID: 27055468 DOI: 10.1177/1742395316633511] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2015] [Accepted: 12/08/2015] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Many patients with chronic illnesses report a desire for increased involvement in medical decision-making. This pilot study aimed to explore how patients with exacerbation-prone disease trajectories such as advanced heart failure or chronic obstructive pulmonary disease experience advance care planning using an online decision aid and to compare whether patients with different types of exacerbation-prone illnesses had varied experiences using the tool. METHODS Pre-intervention questionnaires measured advance care planning knowledge. Post-intervention questionnaires measured: (1) advance care planning knowledge; (2) satisfaction with tool; (3) decisional conflict; and (4) accuracy of the resultant advance directive. Comparisons were made between patients with heart failure and chronic obstructive pulmonary disease. RESULTS Over 90% of the patients with heart failure (n = 24) or chronic obstructive pulmonary disease (n = 25) reported being "satisfied" or "highly satisfied" with the tool across all satisfaction domains; over 90% of participants rated the resultant advance directive as "very accurate." Participants reported low decisional conflict. Advance care planning knowledge scores rose by 18% (p < 0.001) post-intervention. There were no significant differences between participants with heart failure and chronic obstructive pulmonary disease. DISCUSSION Patients with advanced heart failure and chronic obstructive pulmonary disease were highly satisfied after using an online advance care planning decision aid and had increased knowledge of advance care planning. This tool can be a useful resource for time-constrained clinicians whose patients wish to engage in advance care planning.
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Affiliation(s)
- Lauren J Van Scoy
- Department of Medicine, Division of Pulmonary, Allergy and Critical Care Medicine, Penn State College of Medicine, Hershey, Pennsylvania, USA Department of Humanities, Penn State College of Medicine, Hershey, Pennsylvania, USA
| | - Michael J Green
- Department of Humanities, Penn State College of Medicine, Hershey, Pennsylvania, USA Department of Medicine, Penn State College of Medicine, Hershey, Pennsylvania, USA
| | - Anne Ef Dimmock
- Department of Medicine, Division of Pulmonary, Allergy and Critical Care Medicine, Penn State College of Medicine, Hershey, Pennsylvania, USA
| | - Rebecca Bascom
- Department of Medicine, Division of Pulmonary, Allergy and Critical Care Medicine, Penn State College of Medicine, Hershey, Pennsylvania, USA
| | - John P Boehmer
- Division of Cardiology, Penn State College of Medicine, Hershey, Pennsylvania, USA
| | - Jessica K Hensel
- Pennsylvania State University, College of Medicine, Hershey, Pennsylvania, USA
| | - Joshua B Hozella
- Pennsylvania State University, College of Medicine, Hershey, Pennsylvania, USA
| | - Erik B Lehman
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, Pennsylvania, USA
| | - Jane R Schubart
- Department of Surgery, Penn State College of Medicine, Hershey, Pennsylvania, USA
| | - Elana Farace
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, Pennsylvania, USA Department of Neurosurgery, Penn State College of Medicine, Hershey, Pennsylvania, USA
| | - Renee R Stewart
- Department of Humanities, Penn State College of Medicine, Hershey, Pennsylvania, USA
| | - Benjamin H Levi
- Department of Humanities, Penn State College of Medicine, Hershey, Pennsylvania, USA Department of Pediatrics, Penn State College of Medicine, Hershey, Pennsylvania, USA
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Van Scoy LJ, Green MJ, Reading JM, Scott AM, Chuang CH, Levi BH. Can Playing an End-of-Life Conversation Game Motivate People to Engage in Advance Care Planning? Am J Hosp Palliat Care 2016; 34:754-761. [PMID: 27406696 DOI: 10.1177/1049909116656353] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Advance care planning (ACP) involves several behaviors that individuals undertake to prepare for future medical care should they lose decision-making capacity. The goal of this study was to assess whether playing a conversation game could motivate participants to engage in ACP. METHODS Sixty-eight English-speaking, adult volunteers (n = 17 games) from communities around Hershey, Pennsylvania, and Lexington, Kentucky, played a conversation card game about end-of-life issues. Readiness to engage in 4 ACP behaviors was measured by a validated questionnaire (based on the transtheoretical model) immediately before and 3 months postgame and a semistructured phone interview. These behaviors were (1) completing a living will; (2) completing a health-care proxy; (3) discussing end-of-life wishes with loved ones; and (4) discussing quality versus quantity of life with loved ones. RESULTS Participants' (n = 68) mean age was 51.3 years (standard deviation = 0.7, range: 22-88); 94% of the participants were caucasian and 67% were female. Seventy-eight percent of the participants engaged in ACP behaviors within 3 months of playing the game (eg, updating documents, discussing end-of-life issues). Furthermore, 73% of the participants progressed in stage of change (ie, readiness) to perform at least 1 of the 4 behaviors. Scores on measures of decisional balance and processes of change increased significantly by 3 months postintervention. CONCLUSION This pilot study found that individuals who played a conversation game had high rates of performing ACP behaviors within 3 months. These findings suggest that using a game format may be a useful way to motivate people to perform important ACP behaviors.
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Affiliation(s)
- Lauren J Van Scoy
- 1 Department of Medicine and Humanities, Pennsylvania State University College of Medicine, Hershey, PA, USA
| | - Michael J Green
- 1 Department of Medicine and Humanities, Pennsylvania State University College of Medicine, Hershey, PA, USA
| | - Jean M Reading
- 2 Department of Medicine, Pennsylvania State University College of Medicine, Hershey, PA, USA
| | - Allison M Scott
- 3 Department of Communication, University of Kentucky, Lexington, KY, USA
| | - Cynthia H Chuang
- 4 Department of Medicine and Public Health Sciences, Pennsylvania State University College of Medicine, Hershey, PA, USA
| | - Benjamin H Levi
- 5 Department of Pediatrics and Humanities, Pennsylvania State University College of Medicine, Hershey, PA, USA
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Schubart JR, Green MJ, Van Scoy LJ, Lehman E, Farace E, Gusani NJ, Levi BH. Advanced Cancer and End-of-Life Preferences: Curative Intent Surgery Versus Noncurative Intent Treatment. J Palliat Med 2015; 18:1015-8. [PMID: 26262942 DOI: 10.1089/jpm.2015.0021] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND People with cancer face complex medical decisions, including whether to receive life-sustaining treatments at the end of life. It is not unusual for clinicians to make assumptions about patients' wishes based on whether they had previously chosen to pursue curative treatment. OBJECTIVE We hypothesized that cancer patients who initially underwent curative intent surgery (CIS) would prefer more aggressive end-of-life treatments compared to patients whose treatment was noncurative intent (non-CIT). METHODS This study was a retrospective review of data from a large, randomized controlled trial examining the use of an online decision aid for advance care planning, "Making Your Wishes Known" (MYWK), with patients who had advanced cancer. We reviewed patients' medical records to determine which patients underwent CIS versus non-CIT. In the parent trial, conducted at an academic medical center (2007-2012), 200 patients were enrolled with stage IV malignancy or other poor prognosis cancer. Patients' preferences for aggressive treatment were measured in two ways: using patient-selected General Wishes statements generated by the decision aid and patient-selected wishes for specific treatments under various hypothetical clinical scenarios (Specific Wishes). RESULTS We evaluated 79 patients. Of these, 48 had undergone initial CIS and 31 had non-CIT. Cancer patients who initially underwent CIS did not prefer more aggressive end-of-life treatments compared to patients whose treatment was non-CIT. CONCLUSIONS Clinicians should avoid assumptions about patients' preferences for life-sustaining treatment based on their prior choices for aggressive treatment.
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Affiliation(s)
- Jane R Schubart
- 1 Departments of Surgery and Public Health Sciences, The Pennsylvania State University , College of Medicine, Hershey, Pennsylvania
| | - Michael J Green
- 2 Department of Humanities, The Pennsylvania State University , College of Medicine, Hershey, Pennsylvania
| | - Lauren J Van Scoy
- 3 Department of Medicine, The Pennsylvania State University , College of Medicine, Hershey, Pennsylvania
| | - Erik Lehman
- 4 Department of Public Health Sciences, The Pennsylvania State University , College of Medicine, Hershey, Pennsylvania
| | - Elana Farace
- 4 Department of Public Health Sciences, The Pennsylvania State University , College of Medicine, Hershey, Pennsylvania
| | - Niraj J Gusani
- 5 Department of Surgery, The Pennsylvania State University , College of Medicine, Hershey, Pennsylvania
| | - Benjamin H Levi
- 6 Department of Pediatrics and Humanities, The Pennsylvania State University , College of Medicine, Hershey, Pennsylvania
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Van Scoy LJ, Howrylak J, Nguyen A, Chen M, Sherman M. Family structure, experiences with end-of-life decision making, and who asked about advance directives impacts advance directive completion rates. J Palliat Med 2014; 17:1099-106. [PMID: 25000276 DOI: 10.1089/jpm.2014.0033] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Advance directives are an important but underutilized resource. Reasons for this underutilization need to be determined. OBJECTIVE We investigated factors associated with completion of advance directives among inpatients. DESIGN We conducted prospective, structured interviews on family structure, health care, disease, and end-of-life experiences. We compared those with completed advance directives and those without. SETTING/SUBJECTS We interviewed 130 inpatients in an urban university hospital. MEASUREMENTS We used bivariate analysis and logistic regression to identify characteristics of patients with living wills and health care proxies versus patients without them. RESULTS Twenty-one percent of patients had a living will and 35% had a health care proxy. Patients with completed living wills were older (p≤0.0046), had more comorbidities (p=0.018), were widowed (p=0.02), and were more often admitted with chronic disease (p=0.009) compared to those without living wills. Patients with health care proxies were older (p<0.001), had religious affiliations (p=0.04), more children (p=0.03), and more often widowed (p≤0.001) than those without health care proxies. Patients were 10.8 times (95% confidence interval [CI] 4.59-25.3), 46.5 times (95% CI 15.1-139.4), and 68.6 times (95% CI 13.0-361.3) more likely to complete a living will when asked by medical staff, legal staff, or family and friends, respectively, than those not asked. Patients with health care proxies were 1.68 times (95% CI 0.81-3.47), 4.34 times (95% CI 1.50-12.6), and 18.0 times (95% CI 2.03-158.8) more likely to have been asked by the same groups. Patients with experience in end-of-life decision-making were 2.54 times more likely to possess a living will (95%CI 1.01-6.42) and 3.53 times more likely to possess a health care proxy (95% CI 1.51-8.25) than those without experiences. CONCLUSIONS Having been asked about advance directives by medical staff, legal staff, or family and friends increases the likelihood that patients will possess an advance directive. Those with prior experience with end-of-life decision-making are more likely to possess an advance directive. Family structure and health care utilization also impacts possession of advance directives.
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Affiliation(s)
- Lauren J Van Scoy
- 1 Department of General Internal Medicine, Drexel University College of Medicine , Philadelphia, Pennsylvania
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