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Hudson MF. A "call to bear the burden of a long twilight struggle": a special issue on social determinants of health assessment and intervention. JNCI Cancer Spectr 2024; 8:pkae028. [PMID: 38657751 PMCID: PMC11042872 DOI: 10.1093/jncics/pkae028] [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: 03/01/2024] [Accepted: 03/05/2024] [Indexed: 04/26/2024] Open
Affiliation(s)
- Matthew F Hudson
- Department of Medicine, Prisma Health Cancer Institute, Greenville, SC, USA
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Woods SS, Oldenburg J, van Leeuwen D, Sarasohn-Kahn J, Hudson MF. An Extraordinary Voice Expressed Through Humor: A Tribute to Casey Quinlan. J Particip Med 2023; 15:e54527. [PMID: 38085561 PMCID: PMC10751629 DOI: 10.2196/54527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Revised: 11/20/2023] [Accepted: 11/20/2023] [Indexed: 12/29/2023] Open
Abstract
The Journal of Participatory Medicine introduces Extraordinary Lives, a new journal section celebrating the voices and work of steadfast advocates of participatory medicine that we have lost. This inaugural essay spotlights Casey Quinlan, a patient activist who effectively used her humor and incisive analysis of health care to encourage others to strive for meaningful change. A first-generation "professional patient," Casey served as a role model who inspired many to share their stories and achieve genuine partnerships in care delivery. A maker of "good trouble," her voice and stance were part of her power and influence in disrupting the status quo. We present her fight for personal access to health data, her aspiration for personally customized evidence, and her drive for all people to control their health and their health care.
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Affiliation(s)
- Susan S Woods
- Tufts University School of Medicine, Boston, MA, United States
| | - Jan Oldenburg
- Participatory Health Consulting, Richmond, VA, United States
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Allen CJ, Snyder RA, Horn DM, Hudson MF, Barber A, Smieliauskas F, Spears PA, Edge S, Greenup RA. Defining Priorities in Value-Based Cancer Care: Insights From the Alliance for Clinical Trials in Oncology National Cooperative Group Survey. JCO Oncol Pract 2023; 19:932-938. [PMID: 37651652 PMCID: PMC10615548 DOI: 10.1200/op.23.00159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Revised: 05/26/2023] [Accepted: 06/08/2023] [Indexed: 09/02/2023] Open
Abstract
PURPOSE We determine how stakeholders prioritize the importance of oncologic outcomes, patient-reported outcomes (PROs), and cancer-related health care costs. METHODS A survey was distributed to the National Clinical Trials Network Alliance for Clinical Trials in Oncology cooperative group membership from May 14 to June 30, 2022. Respondents were asked to rate (5-point Likert scale) and rank (1-9) evidence-based value domains: overall survival, treatment toxicities/complications, quality of life (QOL), financial toxicity, access to care, compliance with evidence-based care, health system performance, scientific discovery and innovation, and cost to the health care system. RESULTS A total of 514 members responded, including researchers (24.7%), nurses (19.5%), medical oncologists (17.9%), administrators (9.3%), surgical and radiation oncologists (9.1%), patient advocates (3.1%), and nonphysician providers (16.4%). Participants represented various practice settings including National Cancer Institute-designated cancer centers (29.8%), university-affiliated academic cancer centers (21%), hospital-owned oncology practices (21.8%), and others (27.4%). There was agreement in how respondents prioritized value domains (W = 0.39, P < .001). Respondents ranked patient QOL (mean rank: 2.6 ± 1.9) as most important above all other metrics including survival (mean rank: 3.5 ± 0.3) and access to care (mean rank: 3.5 ± 2.1; P < .001). Members engaged in direct patient care also ranked access to care of higher importance than nonclinicians (P = .026). Cost to the health care system (mean rank: 7.5 ± 2.1) and health system performance (mean rank: 7 ± 2) were ranked as least important (P < .001). Inclusion of PROs into therapeutic assessment (59.3%) was the most frequently selected priority of future cooperative group initiatives. CONCLUSION Oncology community stakeholders deemed patient-centered value domains as most important and considered patient QOL the highest priority. Inclusion of PROs into clinical trials was endorsed as an important component of therapeutic assessment. These findings can be taken into consideration when creating a value framework for inclusion in cancer clinical trials.
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Affiliation(s)
- Casey J Allen
- Division of Surgical Oncology, Institute of Surgery, Allegheny Health Network Cancer, Pittsburgh, PA
| | - Rebecca A Snyder
- Departments of Surgical Oncology and Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, TX
| | | | - Matthew F Hudson
- Prisma Health Cancer Institute and University of South Carolina School of Medicine Greenville, Greenville, SC
| | - Anne Barber
- Cancer Control Program of the Alliance for Clinical Trials in Oncology and Cancer Programs of the American College of Surgeons, Chicago, IL
| | - Fabrice Smieliauskas
- Department of Economics and Department of Pharmacy Practice, Wayne State University, Detroit, MI
| | - Patty A Spears
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Stephen Edge
- Roswell Park Comprehensive Cancer Center and Jacobs School of Medicine, University at Buffalo, Buffalo, NY
| | - Rachel A Greenup
- Department of Surgery and Smilow Cancer Hospital, Yale School of Medicine, New Haven, CT
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Mullins MA, Reber L, Washington A, Stasenko M, Rankin A, Friese CR, Cooley ME, Hudson MF, Wallner LP. Barriers, facilitators, and recommendations for sexual orientation and gender identity data collection in community oncology practices. Cancer Med 2023; 12:19203-19214. [PMID: 37732470 PMCID: PMC10557876 DOI: 10.1002/cam4.6517] [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: 05/23/2023] [Revised: 08/22/2023] [Accepted: 08/30/2023] [Indexed: 09/22/2023] Open
Abstract
BACKGROUND Sexual orientation and gender identity (SOGI) data collection in community oncology practices is critical to identify and address cancer inequities, but less than 20% of NCI Community Oncology Research Program (NCORP)-affiliated practices regularly collect SOGI data despite widespread recommendations. We evaluated multilevel barriers and facilitators for SOGI data collection at NCORP practices. METHODS We conducted 14 semi-structured interviews at seven purposefully sampled NCORP oncology practices. We interviewed one clinician (oncologist, advanced practice provider) and one clinic staff member per practice. Thematic analysis informed by the Consolidated Framework for Implementation Research (CFIR) was conducted to identify barriers and facilitators. RESULTS Thematic saturation occurred after interviews at six practices and was confirmed with interviews at an additional practice. Participants highlighted multilevel barriers including low levels of understanding, information technology infrastructure, and perceived low relative priority. Not understanding the role of SOGI data in oncology care contributed to cis-heteronormative culture. At the clinic level, this culture coincided with a lack of processes and policies for collecting SOGI from all patients. At the care team level, perceived irrelevance to oncology care was related to discomfort asking SOGI, fear of patient discomfort, and limited awareness of SOGI in electronic health records. Suggested solutions included: normalizing asking SOGI questions, giving patients privacy to complete SOGI, and clarifying clinical relevance. CONCLUSIONS SOGI data collection barriers stemmed from perceptions that SOGI disclosure does not influence care quality. Oncology teams may benefit from training on culturally sensitive SOGI collection, education on SOGI data relevance to oncology practices, and support for implementing SOGI data collection policies.
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Affiliation(s)
- Megan A. Mullins
- Peter O'Donnell Jr. School of Public HealthUT Southwestern Medical CenterDallasTexasUSA
- Harold C. Simmons Comprehensive Cancer CenterUT Southwestern Medical CenterDallasTexasUSA
| | - Lisa Reber
- Peter O'Donnell Jr. School of Public HealthUT Southwestern Medical CenterDallasTexasUSA
| | - Ariel Washington
- Karmanos Cancer Institute, Department of OncologyWayne State University School of MedicineDetroitMichiganUSA
| | - Marina Stasenko
- Division of Gynecologic Oncology, Department of Obstetrics and GynecologyNYU Langone HealthNew YorkNew YorkUSA
| | - Aaron Rankin
- Department of Internal MedicineUniversity of MichiganAnn ArborMichiganUSA
| | - Christopher R. Friese
- Center for Improving Patient and Population HealthUniversity of MichiganAnn ArborMichiganUSA
- Rogel Cancer CenterUniversity of MichiganAnn ArborMichiganUSA
| | - Mary E. Cooley
- Phyllis F. Cantor Center, Research in Nursing and Patient Care ServicesDana‐Farber Cancer InstituteBostonMassachusettsUSA
| | - Matthew F. Hudson
- Prisma Health Cancer Institute Greenville South CarolinaGreenvilleSouth CarolinaUSA
| | - Lauren P. Wallner
- Department of Internal MedicineUniversity of MichiganAnn ArborMichiganUSA
- Rogel Cancer CenterUniversity of MichiganAnn ArborMichiganUSA
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Hudson MF, Oostdyk AM, Simmons VM, Martin JC. Considering context in area-level socioeconomic status, cancer treatment initiation, and survival. JNCI Cancer Spectr 2023; 7:pkad078. [PMID: 37850333 PMCID: PMC10582689 DOI: 10.1093/jncics/pkad078] [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: 09/18/2023] [Accepted: 09/21/2023] [Indexed: 10/19/2023] Open
Affiliation(s)
- Matthew F Hudson
- Department of Medicine, Prisma Health Cancer Institute, Greenville, SC, USA
| | - Alicia M Oostdyk
- Department of Medicine, Prisma Health Cancer Institute, Greenville, SC, USA
| | - Virginia M Simmons
- Department of Medicine, Prisma Health Cancer Institute, Greenville, SC, USA
| | - Julie C Martin
- Department of Medicine, Prisma Health Cancer Institute, Greenville, SC, USA
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Corn BW, Feldman DB, Subbiah IM, Corn PD, Bakitas MA, Krouse RS, Hudson MF, Fowler LA, Fraser V, Siegal C, Agarwal R, Ge JL, Parajuli J, Myers JS, O’Rourke MA. Feasibility and acceptability of an online intervention to enhance hopefulness among oncology professionals. JNCI Cancer Spectr 2023; 7:pkad030. [PMID: 37104744 PMCID: PMC10208111 DOI: 10.1093/jncics/pkad030] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Revised: 02/28/2023] [Accepted: 03/28/2023] [Indexed: 04/29/2023] Open
Abstract
BACKGROUND Patients prefer medical communication including both hopefulness and realism, though health-care professional (HCPs) struggle to balance these. Providers could thus benefit from a detailed personal understanding of hope, allowing them to model and convey it to patients. Additionally, given that hope is associated with lower levels of burnout, HCPs may benefit from tools designed to enhance their own personal hopefulness. Several investigators have proposed offering HCPs interventions to augment hope. We developed an online workshop for this purpose. METHODS Feasibility and acceptability of the workshop were assessed in members of the SWOG Cancer Research Network. Three measures were used: the Was-It-Worth-It scale, a survey based on the Kirkpatrick Training Evaluation Model, and a single item prompting participants to rate the degree to which they believe concepts from the workshop should be integrated into SWOG studies. RESULTS Twenty-nine individuals signed up for the intervention, which consisted of a single 2-hour session, and 23 completed measures. Results from Was-It-Worth-It items indicate that nearly all participants found the intervention relevant, engaging, and helpful. Mean ratings for Kirkpatrick Training Evaluation Model items were high, ranging from 6.91 to 7.70 on 8-point scales. Finally, participants provided a mean rating of 4.44 on a 5-point scale to the item "To what degree do you believe it may be useful to integrate concepts from this workshop into SWOG trials/studies?" CONCLUSIONS An online workshop to enhance hopefulness is feasible and acceptable to oncology HCPs. The tool will be integrated into SWOG studies evaluating provider and patient well-being.
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Affiliation(s)
| | - David B Feldman
- Department of Counseling Psychology, Santa Clara University, Santa Clara, CA, USA
| | - Ishwaria M Subbiah
- Department of Palliative, Rehabilitation and Integrative Medicine, MD Anderson Cancer Center of the University of Texas, Houston, TX, USA
| | | | - Marie A Bakitas
- School of Nursing, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Robert S Krouse
- Department of Surgery, University of Pennsylvania School of Medicine, Philadelphia, PA, USA
| | - Matthew F Hudson
- Department of Medicine, Prisma Heath Cancer Institute, Greenville, SC, USA
| | - Lauren A Fowler
- Department of Physiology and Pharmacology, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Valerie Fraser
- Division of Patient Advocacy, SWOG Cancer Research Network, San Antonio, TX, USA
| | - Carole Siegal
- Division of Patient Advocacy, SWOG Cancer Research Network, San Antonio, TX, USA
| | - Rajiv Agarwal
- Division of Hematology/Oncology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Jacqueline L Ge
- Department of Counseling Psychology, Santa Clara University, Santa Clara, CA, USA
| | | | - Jamie S Myers
- School of Nursing, University of Kansas Medical Center, Kansas City, KS, USA
| | - Mark A O’Rourke
- Department of Medicine, Prisma Heath Cancer Institute, Greenville, SC, USA
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Hudson MF, Martin JC. Oncology Nurses Can Build Patient-Centered Outcomes Research Partnerships. Clin J Oncol Nurs 2023; 27:17-21. [PMID: 37677824 DOI: 10.1188/23.cjon.17-21] [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: 02/11/2023]
Abstract
Nurses can inform and lead patient-centered outcomes research (PCOR) projects that address care-related questions prioritized by patients. However, PCOR projects may fail to materialize because time constraints create barrier.
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Le-Rademacher J, Mohile S, Unger J, Hudson MF, Foster J, Lichtman S, Perlmutter J, Dotan E, Extermann M, Dodd K, Tew W, Klepin H, Wildes TM, Sedrak MS, Jatoi A, Little RF. Trial Design Considerations to Increase Older Adult Accrual to National Cancer Institute Clinical Trials. J Natl Cancer Inst Monogr 2022; 2022:135-141. [PMID: 36519818 PMCID: PMC9949574 DOI: 10.1093/jncimonographs/lgac023] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Revised: 08/19/2022] [Accepted: 09/26/2022] [Indexed: 12/23/2022] Open
Abstract
Although adults aged 65 years or older make up a strong majority of cancer patients, their underrepresentation in cancer clinical trials leads to the lack of representative data to guide evidence-based therapeutic decisions in this patient population. The Trial Design Working Group, convened as part of the workshop titled, Engaging Older Adults in the National Cancer Institute Clinical Trials Network: Challenges and Opportunities, recommended study designs and design elements that could improve accrual of older adults in National Cancer Institute-funded clinical trials. These include trials that are specifically designed to enroll older adults, trials that include a cohort of older patients (parallel cohort, stratified cohort, or embedded cohort), and trials with pragmatic design elements to facilitate enrollment of older adults. This manuscript provides brief descriptions of the recommended designs, examples of successful trials, and considerations for implementation of these designs. As with any clinical trial, the scientific questions and trial objectives should drive the study design, the selection of endpoints and intervention, and eligibility criteria. When designing trials that include older adults, the heterogeneity of fitness levels is an important consideration as fitness can influence accrual rates and outcomes. Appropriately incorporating geriatric assessments can help identify the optimal subset of older patients for inclusion and minimize selection bias. Incorporating pragmatic design elements to reduce the burden on trial participants as well as on accruing sites and retaining essential elements to ensure that the main goal of the trial can be accomplished can enhance enrollment without compromising the integrity of trials.
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Affiliation(s)
| | - Supriya Mohile
- Department of Medicine, University of Rochester Medical Center, Rochester, NY, USA
| | - Joseph Unger
- Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | | | - Jared Foster
- Division of Cancer Treatment and Diagnosis, National Cancer Institute, Rockville, MD, USA
| | | | | | - Efrat Dotan
- Department of Hematology/Oncology, Fox Chase Cancer Center, Philadelphia, PA, USA
| | | | - Kevin Dodd
- Division of Cancer Prevention, National Cancer Institute, Rockville, MD, USA
| | - William Tew
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Heidi Klepin
- Department of Medicine, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | | | - Mina S Sedrak
- Department of Medical Oncology and Therapeutics Research, City of Hope, Duarte, CA, USA
| | - Aminah Jatoi
- Department of Oncology, Mayo Clinic, Rochester, MN, USA
| | - Richard F Little
- Division of Cancer Treatment and Diagnosis, National Cancer Institute, Rockville, MD, USA
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Hopkins JO, Braun-Inglis C, Guidice S, Wells M, Moorthi K, Berenberg J, St. Germain D, Mohile S, Hudson MF. Enrolling Older Adults Onto National Cancer Institute-Funded Clinical Trials in Community Oncology Clinics: Barriers and Solutions. J Natl Cancer Inst Monogr 2022; 2022:117-124. [PMID: 36519815 PMCID: PMC9753219 DOI: 10.1093/jncimonographs/lgac019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Revised: 07/27/2022] [Accepted: 08/19/2022] [Indexed: 12/23/2022] Open
Abstract
In April 2021, the National Cancer Institute (NCI) Division of Cancer Prevention collaborated with the NCI Division of Cancer Treatment and Diagnosis to produce a virtual workshop that developed recommendations for enhancing NCI-sponsored clinical trial accrual of older adults. Prior to the workshop, a multidisciplinary group of stakeholders (eg, community oncologists, advanced practice practitioners, clinic and research staff, and patient advocates) gathered information related to accrual of older adults to clinical trials from the literature. Subsequently, a survey was conducted to detail NCI Community Oncology Research Program members' perspective on accrual barriers for this population; 305 individuals responded to the survey. Barriers to clinical trial accruals included comorbidity-attributed trial ineligibility, transportation and time issues, concern that the proposed regimen is too toxic for older adults, patient or family caregiver declined participation, and lack of trials relevant to older patients. Identified solutions included broadening clinical trial inclusion criteria, increasing the number of clinical trials specifically designed for older adults, simplifying consent forms, improving recruitment materials for older adults and their families, and facilitating transportation vouchers. At the workshop, participants, including stakeholders, used prior literature and survey results to develop recommendations, including interventions to address clinician bias, implement geriatric assessment, and promote clinician and staff engagement as mechanisms to improve accrual of older adults to clinical trials.
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Affiliation(s)
- Judith O Hopkins
- Novant Health Cancer Institute/SCOR National Cancer Institute Community Oncology Research Program (NCORP), Kernersville, NC, USA
| | - Christa Braun-Inglis
- University of Hawaii Cancer Center/Hawaii Minority/Underserved NCORP, Honolulu, HI, USA
| | - Sofia Guidice
- University of Rochester Cancer Center (URCC) NCORP Research Base, University of Rochester Medical Center, Rochester, NY, USA
| | - Meg Wells
- University of Rochester Cancer Center (URCC) NCORP Research Base, University of Rochester Medical Center, Rochester, NY, USA
| | - Kiran Moorthi
- University of Rochester Cancer Center (URCC) NCORP Research Base, University of Rochester Medical Center, Rochester, NY, USA
| | - Jeffrey Berenberg
- University of Hawaii Cancer Center/Hawaii Minority/Underserved NCORP, Honolulu, HI, USA
| | - Diane St. Germain
- Division of Cancer Prevention, National Cancer Institute, Rockville, MD, USA
| | - Supriya Mohile
- Correspondence to: Supriya G. Mohile, MD, Departments of Medicine and Surgery, University of Rochester Medical Center, 601 Elmwood Ave, Box 704, Rochester, NY 14642, USA (e-mail: )
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Fortuna KL, Kadakia A, Cosco TD, Rotondi A, Nicholson J, Mois G, Myers AL, Hamilton J, Brewer LC, Collins-Pisano C, Barr P, Hudson MF, Joseph K, Mullaly C, Booth M, Lebby S, Walker R. Guidelines to Establish an Equitable Mobile Health Ecosystem. Psychiatr Serv 2022; 74:393-400. [PMID: 36377370 DOI: 10.1176/appi.ps.202200011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Mobile health (mHealth)-that is, use of mobile devices, such as mobile phones, monitoring devices, personal digital assistants, and other wireless devices, in medical care-is a promising approach to the provision of support services. mHealth may aid in facilitating monitoring of mental health conditions, offering peer support, providing psychoeducation (i.e., information about mental health conditions), and delivering evidence-based practices. However, some groups may fail to benefit from mHealth despite a high need for mental health services, including people from racially and ethnically disadvantaged groups, rural residents, individuals who are socioeconomically disadvantaged, and people with disabilities. A well-designed mHealth ecosystem that considers multiple elements of design, development, and implementation can afford disadvantaged populations the opportunity to address inequities and facilitate access to and uptake of mHealth. This article proposes inclusion of the following principles and standards in the development of an mHealth ecosystem of equity: use a human-centered design, reduce bias in machine-learning analytical techniques, promote inclusivity via mHealth design features, facilitate informed decision making in technology selection, embrace adaptive technology, promote digital literacy through mHealth by teaching patients how to use the technology, and facilitate access to mHealth to improve health outcomes.
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Affiliation(s)
- Karen L Fortuna
- Department of Psychiatry (Fortuna) and Center for Technology and Behavioral Health (Barr), Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire; BRITE Center, University of Washington, Seattle (Kadakia); Gerontology Research Centre, Simon Fraser University, Vancouver, and Oxford Institute of Population Ageing, University of Oxford, Oxford (Cosco); Center for Health Equity Research and Promotion, Mental Illness Research, Education and Clinical Center, Department of Veterans Affairs Pittsburgh Health Care System, and Center for Behavioral Health, Media, and Technology, University of Pittsburgh, Pittsburgh (Rotondi); Heller School for Social Policy and Management, Brandeis University, Waltham, Massachusetts (Nicholson, Myers); School of Social Work, University of Illinois, Urbana (Mois); College of Applied Health Sciences Human Factors and Aging Laboratory, University of Illinois, Champaign (Mois); College of Social Work, University of Kentucky, Lexington (Hamilton); Department of Cardiovascular Medicine, Mayo Clinic College of Medicine, and Center for Health Equity and Community Engagement Research, Mayo Clinic, Rochester, Minnesota (Brewer); Psychology Department, University of Colorado, Colorado Springs (Collins-Pisano); Department of Medicine, University of South Carolina School of Medicine, and Prisma Health, Greenville (Hudson); Centre for Mental Health, University of Rwanda, Kigali (Joseph); Psychiatric Rehabilitation Division, Vinfen, Cambridge, Massachusetts (Mullaly); Clarity Health, Nashua, New Hampshire (Booth); College of Nursing and Health Sciences, University of Vermont, Burlington (Lebby); Office of Recovery and Empowerment, Massachusetts Department of Mental Health, Boston (Walker)
| | - Arya Kadakia
- Department of Psychiatry (Fortuna) and Center for Technology and Behavioral Health (Barr), Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire; BRITE Center, University of Washington, Seattle (Kadakia); Gerontology Research Centre, Simon Fraser University, Vancouver, and Oxford Institute of Population Ageing, University of Oxford, Oxford (Cosco); Center for Health Equity Research and Promotion, Mental Illness Research, Education and Clinical Center, Department of Veterans Affairs Pittsburgh Health Care System, and Center for Behavioral Health, Media, and Technology, University of Pittsburgh, Pittsburgh (Rotondi); Heller School for Social Policy and Management, Brandeis University, Waltham, Massachusetts (Nicholson, Myers); School of Social Work, University of Illinois, Urbana (Mois); College of Applied Health Sciences Human Factors and Aging Laboratory, University of Illinois, Champaign (Mois); College of Social Work, University of Kentucky, Lexington (Hamilton); Department of Cardiovascular Medicine, Mayo Clinic College of Medicine, and Center for Health Equity and Community Engagement Research, Mayo Clinic, Rochester, Minnesota (Brewer); Psychology Department, University of Colorado, Colorado Springs (Collins-Pisano); Department of Medicine, University of South Carolina School of Medicine, and Prisma Health, Greenville (Hudson); Centre for Mental Health, University of Rwanda, Kigali (Joseph); Psychiatric Rehabilitation Division, Vinfen, Cambridge, Massachusetts (Mullaly); Clarity Health, Nashua, New Hampshire (Booth); College of Nursing and Health Sciences, University of Vermont, Burlington (Lebby); Office of Recovery and Empowerment, Massachusetts Department of Mental Health, Boston (Walker)
| | - Theodore D Cosco
- Department of Psychiatry (Fortuna) and Center for Technology and Behavioral Health (Barr), Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire; BRITE Center, University of Washington, Seattle (Kadakia); Gerontology Research Centre, Simon Fraser University, Vancouver, and Oxford Institute of Population Ageing, University of Oxford, Oxford (Cosco); Center for Health Equity Research and Promotion, Mental Illness Research, Education and Clinical Center, Department of Veterans Affairs Pittsburgh Health Care System, and Center for Behavioral Health, Media, and Technology, University of Pittsburgh, Pittsburgh (Rotondi); Heller School for Social Policy and Management, Brandeis University, Waltham, Massachusetts (Nicholson, Myers); School of Social Work, University of Illinois, Urbana (Mois); College of Applied Health Sciences Human Factors and Aging Laboratory, University of Illinois, Champaign (Mois); College of Social Work, University of Kentucky, Lexington (Hamilton); Department of Cardiovascular Medicine, Mayo Clinic College of Medicine, and Center for Health Equity and Community Engagement Research, Mayo Clinic, Rochester, Minnesota (Brewer); Psychology Department, University of Colorado, Colorado Springs (Collins-Pisano); Department of Medicine, University of South Carolina School of Medicine, and Prisma Health, Greenville (Hudson); Centre for Mental Health, University of Rwanda, Kigali (Joseph); Psychiatric Rehabilitation Division, Vinfen, Cambridge, Massachusetts (Mullaly); Clarity Health, Nashua, New Hampshire (Booth); College of Nursing and Health Sciences, University of Vermont, Burlington (Lebby); Office of Recovery and Empowerment, Massachusetts Department of Mental Health, Boston (Walker)
| | - Armando Rotondi
- Department of Psychiatry (Fortuna) and Center for Technology and Behavioral Health (Barr), Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire; BRITE Center, University of Washington, Seattle (Kadakia); Gerontology Research Centre, Simon Fraser University, Vancouver, and Oxford Institute of Population Ageing, University of Oxford, Oxford (Cosco); Center for Health Equity Research and Promotion, Mental Illness Research, Education and Clinical Center, Department of Veterans Affairs Pittsburgh Health Care System, and Center for Behavioral Health, Media, and Technology, University of Pittsburgh, Pittsburgh (Rotondi); Heller School for Social Policy and Management, Brandeis University, Waltham, Massachusetts (Nicholson, Myers); School of Social Work, University of Illinois, Urbana (Mois); College of Applied Health Sciences Human Factors and Aging Laboratory, University of Illinois, Champaign (Mois); College of Social Work, University of Kentucky, Lexington (Hamilton); Department of Cardiovascular Medicine, Mayo Clinic College of Medicine, and Center for Health Equity and Community Engagement Research, Mayo Clinic, Rochester, Minnesota (Brewer); Psychology Department, University of Colorado, Colorado Springs (Collins-Pisano); Department of Medicine, University of South Carolina School of Medicine, and Prisma Health, Greenville (Hudson); Centre for Mental Health, University of Rwanda, Kigali (Joseph); Psychiatric Rehabilitation Division, Vinfen, Cambridge, Massachusetts (Mullaly); Clarity Health, Nashua, New Hampshire (Booth); College of Nursing and Health Sciences, University of Vermont, Burlington (Lebby); Office of Recovery and Empowerment, Massachusetts Department of Mental Health, Boston (Walker)
| | - Joanne Nicholson
- Department of Psychiatry (Fortuna) and Center for Technology and Behavioral Health (Barr), Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire; BRITE Center, University of Washington, Seattle (Kadakia); Gerontology Research Centre, Simon Fraser University, Vancouver, and Oxford Institute of Population Ageing, University of Oxford, Oxford (Cosco); Center for Health Equity Research and Promotion, Mental Illness Research, Education and Clinical Center, Department of Veterans Affairs Pittsburgh Health Care System, and Center for Behavioral Health, Media, and Technology, University of Pittsburgh, Pittsburgh (Rotondi); Heller School for Social Policy and Management, Brandeis University, Waltham, Massachusetts (Nicholson, Myers); School of Social Work, University of Illinois, Urbana (Mois); College of Applied Health Sciences Human Factors and Aging Laboratory, University of Illinois, Champaign (Mois); College of Social Work, University of Kentucky, Lexington (Hamilton); Department of Cardiovascular Medicine, Mayo Clinic College of Medicine, and Center for Health Equity and Community Engagement Research, Mayo Clinic, Rochester, Minnesota (Brewer); Psychology Department, University of Colorado, Colorado Springs (Collins-Pisano); Department of Medicine, University of South Carolina School of Medicine, and Prisma Health, Greenville (Hudson); Centre for Mental Health, University of Rwanda, Kigali (Joseph); Psychiatric Rehabilitation Division, Vinfen, Cambridge, Massachusetts (Mullaly); Clarity Health, Nashua, New Hampshire (Booth); College of Nursing and Health Sciences, University of Vermont, Burlington (Lebby); Office of Recovery and Empowerment, Massachusetts Department of Mental Health, Boston (Walker)
| | - George Mois
- Department of Psychiatry (Fortuna) and Center for Technology and Behavioral Health (Barr), Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire; BRITE Center, University of Washington, Seattle (Kadakia); Gerontology Research Centre, Simon Fraser University, Vancouver, and Oxford Institute of Population Ageing, University of Oxford, Oxford (Cosco); Center for Health Equity Research and Promotion, Mental Illness Research, Education and Clinical Center, Department of Veterans Affairs Pittsburgh Health Care System, and Center for Behavioral Health, Media, and Technology, University of Pittsburgh, Pittsburgh (Rotondi); Heller School for Social Policy and Management, Brandeis University, Waltham, Massachusetts (Nicholson, Myers); School of Social Work, University of Illinois, Urbana (Mois); College of Applied Health Sciences Human Factors and Aging Laboratory, University of Illinois, Champaign (Mois); College of Social Work, University of Kentucky, Lexington (Hamilton); Department of Cardiovascular Medicine, Mayo Clinic College of Medicine, and Center for Health Equity and Community Engagement Research, Mayo Clinic, Rochester, Minnesota (Brewer); Psychology Department, University of Colorado, Colorado Springs (Collins-Pisano); Department of Medicine, University of South Carolina School of Medicine, and Prisma Health, Greenville (Hudson); Centre for Mental Health, University of Rwanda, Kigali (Joseph); Psychiatric Rehabilitation Division, Vinfen, Cambridge, Massachusetts (Mullaly); Clarity Health, Nashua, New Hampshire (Booth); College of Nursing and Health Sciences, University of Vermont, Burlington (Lebby); Office of Recovery and Empowerment, Massachusetts Department of Mental Health, Boston (Walker)
| | - Amanda L Myers
- Department of Psychiatry (Fortuna) and Center for Technology and Behavioral Health (Barr), Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire; BRITE Center, University of Washington, Seattle (Kadakia); Gerontology Research Centre, Simon Fraser University, Vancouver, and Oxford Institute of Population Ageing, University of Oxford, Oxford (Cosco); Center for Health Equity Research and Promotion, Mental Illness Research, Education and Clinical Center, Department of Veterans Affairs Pittsburgh Health Care System, and Center for Behavioral Health, Media, and Technology, University of Pittsburgh, Pittsburgh (Rotondi); Heller School for Social Policy and Management, Brandeis University, Waltham, Massachusetts (Nicholson, Myers); School of Social Work, University of Illinois, Urbana (Mois); College of Applied Health Sciences Human Factors and Aging Laboratory, University of Illinois, Champaign (Mois); College of Social Work, University of Kentucky, Lexington (Hamilton); Department of Cardiovascular Medicine, Mayo Clinic College of Medicine, and Center for Health Equity and Community Engagement Research, Mayo Clinic, Rochester, Minnesota (Brewer); Psychology Department, University of Colorado, Colorado Springs (Collins-Pisano); Department of Medicine, University of South Carolina School of Medicine, and Prisma Health, Greenville (Hudson); Centre for Mental Health, University of Rwanda, Kigali (Joseph); Psychiatric Rehabilitation Division, Vinfen, Cambridge, Massachusetts (Mullaly); Clarity Health, Nashua, New Hampshire (Booth); College of Nursing and Health Sciences, University of Vermont, Burlington (Lebby); Office of Recovery and Empowerment, Massachusetts Department of Mental Health, Boston (Walker)
| | - Jennifer Hamilton
- Department of Psychiatry (Fortuna) and Center for Technology and Behavioral Health (Barr), Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire; BRITE Center, University of Washington, Seattle (Kadakia); Gerontology Research Centre, Simon Fraser University, Vancouver, and Oxford Institute of Population Ageing, University of Oxford, Oxford (Cosco); Center for Health Equity Research and Promotion, Mental Illness Research, Education and Clinical Center, Department of Veterans Affairs Pittsburgh Health Care System, and Center for Behavioral Health, Media, and Technology, University of Pittsburgh, Pittsburgh (Rotondi); Heller School for Social Policy and Management, Brandeis University, Waltham, Massachusetts (Nicholson, Myers); School of Social Work, University of Illinois, Urbana (Mois); College of Applied Health Sciences Human Factors and Aging Laboratory, University of Illinois, Champaign (Mois); College of Social Work, University of Kentucky, Lexington (Hamilton); Department of Cardiovascular Medicine, Mayo Clinic College of Medicine, and Center for Health Equity and Community Engagement Research, Mayo Clinic, Rochester, Minnesota (Brewer); Psychology Department, University of Colorado, Colorado Springs (Collins-Pisano); Department of Medicine, University of South Carolina School of Medicine, and Prisma Health, Greenville (Hudson); Centre for Mental Health, University of Rwanda, Kigali (Joseph); Psychiatric Rehabilitation Division, Vinfen, Cambridge, Massachusetts (Mullaly); Clarity Health, Nashua, New Hampshire (Booth); College of Nursing and Health Sciences, University of Vermont, Burlington (Lebby); Office of Recovery and Empowerment, Massachusetts Department of Mental Health, Boston (Walker)
| | - LaPrincess C Brewer
- Department of Psychiatry (Fortuna) and Center for Technology and Behavioral Health (Barr), Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire; BRITE Center, University of Washington, Seattle (Kadakia); Gerontology Research Centre, Simon Fraser University, Vancouver, and Oxford Institute of Population Ageing, University of Oxford, Oxford (Cosco); Center for Health Equity Research and Promotion, Mental Illness Research, Education and Clinical Center, Department of Veterans Affairs Pittsburgh Health Care System, and Center for Behavioral Health, Media, and Technology, University of Pittsburgh, Pittsburgh (Rotondi); Heller School for Social Policy and Management, Brandeis University, Waltham, Massachusetts (Nicholson, Myers); School of Social Work, University of Illinois, Urbana (Mois); College of Applied Health Sciences Human Factors and Aging Laboratory, University of Illinois, Champaign (Mois); College of Social Work, University of Kentucky, Lexington (Hamilton); Department of Cardiovascular Medicine, Mayo Clinic College of Medicine, and Center for Health Equity and Community Engagement Research, Mayo Clinic, Rochester, Minnesota (Brewer); Psychology Department, University of Colorado, Colorado Springs (Collins-Pisano); Department of Medicine, University of South Carolina School of Medicine, and Prisma Health, Greenville (Hudson); Centre for Mental Health, University of Rwanda, Kigali (Joseph); Psychiatric Rehabilitation Division, Vinfen, Cambridge, Massachusetts (Mullaly); Clarity Health, Nashua, New Hampshire (Booth); College of Nursing and Health Sciences, University of Vermont, Burlington (Lebby); Office of Recovery and Empowerment, Massachusetts Department of Mental Health, Boston (Walker)
| | - Caroline Collins-Pisano
- Department of Psychiatry (Fortuna) and Center for Technology and Behavioral Health (Barr), Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire; BRITE Center, University of Washington, Seattle (Kadakia); Gerontology Research Centre, Simon Fraser University, Vancouver, and Oxford Institute of Population Ageing, University of Oxford, Oxford (Cosco); Center for Health Equity Research and Promotion, Mental Illness Research, Education and Clinical Center, Department of Veterans Affairs Pittsburgh Health Care System, and Center for Behavioral Health, Media, and Technology, University of Pittsburgh, Pittsburgh (Rotondi); Heller School for Social Policy and Management, Brandeis University, Waltham, Massachusetts (Nicholson, Myers); School of Social Work, University of Illinois, Urbana (Mois); College of Applied Health Sciences Human Factors and Aging Laboratory, University of Illinois, Champaign (Mois); College of Social Work, University of Kentucky, Lexington (Hamilton); Department of Cardiovascular Medicine, Mayo Clinic College of Medicine, and Center for Health Equity and Community Engagement Research, Mayo Clinic, Rochester, Minnesota (Brewer); Psychology Department, University of Colorado, Colorado Springs (Collins-Pisano); Department of Medicine, University of South Carolina School of Medicine, and Prisma Health, Greenville (Hudson); Centre for Mental Health, University of Rwanda, Kigali (Joseph); Psychiatric Rehabilitation Division, Vinfen, Cambridge, Massachusetts (Mullaly); Clarity Health, Nashua, New Hampshire (Booth); College of Nursing and Health Sciences, University of Vermont, Burlington (Lebby); Office of Recovery and Empowerment, Massachusetts Department of Mental Health, Boston (Walker)
| | - Paul Barr
- Department of Psychiatry (Fortuna) and Center for Technology and Behavioral Health (Barr), Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire; BRITE Center, University of Washington, Seattle (Kadakia); Gerontology Research Centre, Simon Fraser University, Vancouver, and Oxford Institute of Population Ageing, University of Oxford, Oxford (Cosco); Center for Health Equity Research and Promotion, Mental Illness Research, Education and Clinical Center, Department of Veterans Affairs Pittsburgh Health Care System, and Center for Behavioral Health, Media, and Technology, University of Pittsburgh, Pittsburgh (Rotondi); Heller School for Social Policy and Management, Brandeis University, Waltham, Massachusetts (Nicholson, Myers); School of Social Work, University of Illinois, Urbana (Mois); College of Applied Health Sciences Human Factors and Aging Laboratory, University of Illinois, Champaign (Mois); College of Social Work, University of Kentucky, Lexington (Hamilton); Department of Cardiovascular Medicine, Mayo Clinic College of Medicine, and Center for Health Equity and Community Engagement Research, Mayo Clinic, Rochester, Minnesota (Brewer); Psychology Department, University of Colorado, Colorado Springs (Collins-Pisano); Department of Medicine, University of South Carolina School of Medicine, and Prisma Health, Greenville (Hudson); Centre for Mental Health, University of Rwanda, Kigali (Joseph); Psychiatric Rehabilitation Division, Vinfen, Cambridge, Massachusetts (Mullaly); Clarity Health, Nashua, New Hampshire (Booth); College of Nursing and Health Sciences, University of Vermont, Burlington (Lebby); Office of Recovery and Empowerment, Massachusetts Department of Mental Health, Boston (Walker)
| | - Matthew F Hudson
- Department of Psychiatry (Fortuna) and Center for Technology and Behavioral Health (Barr), Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire; BRITE Center, University of Washington, Seattle (Kadakia); Gerontology Research Centre, Simon Fraser University, Vancouver, and Oxford Institute of Population Ageing, University of Oxford, Oxford (Cosco); Center for Health Equity Research and Promotion, Mental Illness Research, Education and Clinical Center, Department of Veterans Affairs Pittsburgh Health Care System, and Center for Behavioral Health, Media, and Technology, University of Pittsburgh, Pittsburgh (Rotondi); Heller School for Social Policy and Management, Brandeis University, Waltham, Massachusetts (Nicholson, Myers); School of Social Work, University of Illinois, Urbana (Mois); College of Applied Health Sciences Human Factors and Aging Laboratory, University of Illinois, Champaign (Mois); College of Social Work, University of Kentucky, Lexington (Hamilton); Department of Cardiovascular Medicine, Mayo Clinic College of Medicine, and Center for Health Equity and Community Engagement Research, Mayo Clinic, Rochester, Minnesota (Brewer); Psychology Department, University of Colorado, Colorado Springs (Collins-Pisano); Department of Medicine, University of South Carolina School of Medicine, and Prisma Health, Greenville (Hudson); Centre for Mental Health, University of Rwanda, Kigali (Joseph); Psychiatric Rehabilitation Division, Vinfen, Cambridge, Massachusetts (Mullaly); Clarity Health, Nashua, New Hampshire (Booth); College of Nursing and Health Sciences, University of Vermont, Burlington (Lebby); Office of Recovery and Empowerment, Massachusetts Department of Mental Health, Boston (Walker)
| | - Kalisa Joseph
- Department of Psychiatry (Fortuna) and Center for Technology and Behavioral Health (Barr), Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire; BRITE Center, University of Washington, Seattle (Kadakia); Gerontology Research Centre, Simon Fraser University, Vancouver, and Oxford Institute of Population Ageing, University of Oxford, Oxford (Cosco); Center for Health Equity Research and Promotion, Mental Illness Research, Education and Clinical Center, Department of Veterans Affairs Pittsburgh Health Care System, and Center for Behavioral Health, Media, and Technology, University of Pittsburgh, Pittsburgh (Rotondi); Heller School for Social Policy and Management, Brandeis University, Waltham, Massachusetts (Nicholson, Myers); School of Social Work, University of Illinois, Urbana (Mois); College of Applied Health Sciences Human Factors and Aging Laboratory, University of Illinois, Champaign (Mois); College of Social Work, University of Kentucky, Lexington (Hamilton); Department of Cardiovascular Medicine, Mayo Clinic College of Medicine, and Center for Health Equity and Community Engagement Research, Mayo Clinic, Rochester, Minnesota (Brewer); Psychology Department, University of Colorado, Colorado Springs (Collins-Pisano); Department of Medicine, University of South Carolina School of Medicine, and Prisma Health, Greenville (Hudson); Centre for Mental Health, University of Rwanda, Kigali (Joseph); Psychiatric Rehabilitation Division, Vinfen, Cambridge, Massachusetts (Mullaly); Clarity Health, Nashua, New Hampshire (Booth); College of Nursing and Health Sciences, University of Vermont, Burlington (Lebby); Office of Recovery and Empowerment, Massachusetts Department of Mental Health, Boston (Walker)
| | - Christa Mullaly
- Department of Psychiatry (Fortuna) and Center for Technology and Behavioral Health (Barr), Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire; BRITE Center, University of Washington, Seattle (Kadakia); Gerontology Research Centre, Simon Fraser University, Vancouver, and Oxford Institute of Population Ageing, University of Oxford, Oxford (Cosco); Center for Health Equity Research and Promotion, Mental Illness Research, Education and Clinical Center, Department of Veterans Affairs Pittsburgh Health Care System, and Center for Behavioral Health, Media, and Technology, University of Pittsburgh, Pittsburgh (Rotondi); Heller School for Social Policy and Management, Brandeis University, Waltham, Massachusetts (Nicholson, Myers); School of Social Work, University of Illinois, Urbana (Mois); College of Applied Health Sciences Human Factors and Aging Laboratory, University of Illinois, Champaign (Mois); College of Social Work, University of Kentucky, Lexington (Hamilton); Department of Cardiovascular Medicine, Mayo Clinic College of Medicine, and Center for Health Equity and Community Engagement Research, Mayo Clinic, Rochester, Minnesota (Brewer); Psychology Department, University of Colorado, Colorado Springs (Collins-Pisano); Department of Medicine, University of South Carolina School of Medicine, and Prisma Health, Greenville (Hudson); Centre for Mental Health, University of Rwanda, Kigali (Joseph); Psychiatric Rehabilitation Division, Vinfen, Cambridge, Massachusetts (Mullaly); Clarity Health, Nashua, New Hampshire (Booth); College of Nursing and Health Sciences, University of Vermont, Burlington (Lebby); Office of Recovery and Empowerment, Massachusetts Department of Mental Health, Boston (Walker)
| | - Mark Booth
- Department of Psychiatry (Fortuna) and Center for Technology and Behavioral Health (Barr), Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire; BRITE Center, University of Washington, Seattle (Kadakia); Gerontology Research Centre, Simon Fraser University, Vancouver, and Oxford Institute of Population Ageing, University of Oxford, Oxford (Cosco); Center for Health Equity Research and Promotion, Mental Illness Research, Education and Clinical Center, Department of Veterans Affairs Pittsburgh Health Care System, and Center for Behavioral Health, Media, and Technology, University of Pittsburgh, Pittsburgh (Rotondi); Heller School for Social Policy and Management, Brandeis University, Waltham, Massachusetts (Nicholson, Myers); School of Social Work, University of Illinois, Urbana (Mois); College of Applied Health Sciences Human Factors and Aging Laboratory, University of Illinois, Champaign (Mois); College of Social Work, University of Kentucky, Lexington (Hamilton); Department of Cardiovascular Medicine, Mayo Clinic College of Medicine, and Center for Health Equity and Community Engagement Research, Mayo Clinic, Rochester, Minnesota (Brewer); Psychology Department, University of Colorado, Colorado Springs (Collins-Pisano); Department of Medicine, University of South Carolina School of Medicine, and Prisma Health, Greenville (Hudson); Centre for Mental Health, University of Rwanda, Kigali (Joseph); Psychiatric Rehabilitation Division, Vinfen, Cambridge, Massachusetts (Mullaly); Clarity Health, Nashua, New Hampshire (Booth); College of Nursing and Health Sciences, University of Vermont, Burlington (Lebby); Office of Recovery and Empowerment, Massachusetts Department of Mental Health, Boston (Walker)
| | - Stephanie Lebby
- Department of Psychiatry (Fortuna) and Center for Technology and Behavioral Health (Barr), Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire; BRITE Center, University of Washington, Seattle (Kadakia); Gerontology Research Centre, Simon Fraser University, Vancouver, and Oxford Institute of Population Ageing, University of Oxford, Oxford (Cosco); Center for Health Equity Research and Promotion, Mental Illness Research, Education and Clinical Center, Department of Veterans Affairs Pittsburgh Health Care System, and Center for Behavioral Health, Media, and Technology, University of Pittsburgh, Pittsburgh (Rotondi); Heller School for Social Policy and Management, Brandeis University, Waltham, Massachusetts (Nicholson, Myers); School of Social Work, University of Illinois, Urbana (Mois); College of Applied Health Sciences Human Factors and Aging Laboratory, University of Illinois, Champaign (Mois); College of Social Work, University of Kentucky, Lexington (Hamilton); Department of Cardiovascular Medicine, Mayo Clinic College of Medicine, and Center for Health Equity and Community Engagement Research, Mayo Clinic, Rochester, Minnesota (Brewer); Psychology Department, University of Colorado, Colorado Springs (Collins-Pisano); Department of Medicine, University of South Carolina School of Medicine, and Prisma Health, Greenville (Hudson); Centre for Mental Health, University of Rwanda, Kigali (Joseph); Psychiatric Rehabilitation Division, Vinfen, Cambridge, Massachusetts (Mullaly); Clarity Health, Nashua, New Hampshire (Booth); College of Nursing and Health Sciences, University of Vermont, Burlington (Lebby); Office of Recovery and Empowerment, Massachusetts Department of Mental Health, Boston (Walker)
| | - Robert Walker
- Department of Psychiatry (Fortuna) and Center for Technology and Behavioral Health (Barr), Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire; BRITE Center, University of Washington, Seattle (Kadakia); Gerontology Research Centre, Simon Fraser University, Vancouver, and Oxford Institute of Population Ageing, University of Oxford, Oxford (Cosco); Center for Health Equity Research and Promotion, Mental Illness Research, Education and Clinical Center, Department of Veterans Affairs Pittsburgh Health Care System, and Center for Behavioral Health, Media, and Technology, University of Pittsburgh, Pittsburgh (Rotondi); Heller School for Social Policy and Management, Brandeis University, Waltham, Massachusetts (Nicholson, Myers); School of Social Work, University of Illinois, Urbana (Mois); College of Applied Health Sciences Human Factors and Aging Laboratory, University of Illinois, Champaign (Mois); College of Social Work, University of Kentucky, Lexington (Hamilton); Department of Cardiovascular Medicine, Mayo Clinic College of Medicine, and Center for Health Equity and Community Engagement Research, Mayo Clinic, Rochester, Minnesota (Brewer); Psychology Department, University of Colorado, Colorado Springs (Collins-Pisano); Department of Medicine, University of South Carolina School of Medicine, and Prisma Health, Greenville (Hudson); Centre for Mental Health, University of Rwanda, Kigali (Joseph); Psychiatric Rehabilitation Division, Vinfen, Cambridge, Massachusetts (Mullaly); Clarity Health, Nashua, New Hampshire (Booth); College of Nursing and Health Sciences, University of Vermont, Burlington (Lebby); Office of Recovery and Empowerment, Massachusetts Department of Mental Health, Boston (Walker)
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Mullins MA, Rankin A, Washington A, Stasenko M, Friese CR, Cooley ME, Hudson MF, Wallner LP. “It really does not matter to me, they can be two purple unicorns”: Barriers and facilitators to sexual orientation and gender identity (SOGI) measurement in the NCI Community Oncology Research Program (NCORP). J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.28_suppl.170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
170 Background: Despite recommendations from numerous clinical bodies (e.g., ASCO), less than 20% of NCORP-affiliated practices regularly collect SOGI data. This gap compromises the ability to identify and correct care inequities experienced by sexual and gender minority (SGM) individuals. Therefore, we evaluated provider- and clinic- level barriers and facilitators to SOGI collection at NCORP practices across the US. Methods: We conducted 14 interviews across seven NCORP oncology practices via Zoom. We purposefully sampled to ensure geographic, racial, and ethnic diversity of patient populations. We interviewed one clinician (oncologist, advanced practice provider) and one clinic staff member per practice. The Consolidated Framework for Implementation Research (CFIR) informed thematic analysis that identified barriers and facilitators to SOGI data collection. Interviews were recorded, transcribed, and coded by two coders who adjudicated any discordance. Analyses were conducted in NVivo. Results: Thematic saturation occurred after interviews at six practices, with interviews at the seventh practice confirming saturation. Participants represented five geographic regions and included three Minority Underserved practices and two rural practices. Several organizational context characteristics influenced SOGI data collection: access to knowledge, information technology infrastructure, staff processes, and perceived relative priority of SOGI for an oncology visit. All oncologists expressed a low relative priority of sexual orientation data for oncology care. Gender identity had higher priority because it influences how clinicians should address patients. At the clinic level, this low relative priority coincides with a lack of processes and policies for collecting SOGI from all patients. At the oncology care team level, perceived irrelevance to oncology care was related to discomfort in asking SOGI, fear of patient discomfort, and limited awareness of SOGI in electronic health records. Suggested solutions included: normalizing asking SOGI questions, giving patients privacy to complete SOGI, and clarifying relevance of SOGI for clinical purposes. Understanding how SOGI improves patient experiences was a facilitator for collection. Conclusions: Within this NCORP practice sample, SOGI data collection barriers included clinician-perceived low relative priority for collection, and perceptions that SOGI disclosure does not influence care quality, despite most interviewees expressing a strong desire to show respect to patients and provide high quality cancer care. Oncology teams may benefit from training on culturally sensitive SOGI collection, education on SOGI data relevance to oncology practices, and support for implementing SOGI data collection policies.
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Ellis SD, Vaidya R, Unger JM, Stratton K, Gills J, Van Veldhuizen P, Mederos E, Dressler EV, Hudson MF, Kamen C, Neuman HB, Kazak AE, Carlos RC, Weaver KE. Access to urologists for participation in research: An analysis of NCI's Community Oncology Research Program landscape survey. Contemp Clin Trials Commun 2022; 29:100981. [PMID: 36033360 PMCID: PMC9403500 DOI: 10.1016/j.conctc.2022.100981] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Revised: 07/29/2022] [Accepted: 08/09/2022] [Indexed: 11/08/2022] Open
Abstract
Purpose Urological cancer clinical trials face accrual challenges, which may stem from structural barriers within cancer programs. We sought to describe the extent to which urology cancer care providers are available within community cancer research programs and explore the role of oncology practice group ownership in their access to urology practices to participate in research. Materials and methods We conducted secondary analysis of organizational survey data collected in 2017 among National Cancer Institute Community Oncology Research Program practice groups. We used logistic regression to assess the association of self-reported access to urologists to participate in research and oncology practice group ownership type: independent, payor-provider, health-system, or public ownership. Results Of the 209 community oncology practice groups in the analysis sample, 133 (63.6%) had access to urologists for research participation. Ownership was not statistically significantly associated with access to urology practices after controlling for other covariates (p = 0.4). Instead, having a hospital outpatient clinic (p = 0.008) and identifying as a safety-net hospital (p = 0.035) were both positively significantly associated with access to urologists to participate in research. Conclusions Two-thirds of community cancer research groups have access to urology. Oncology ownership status was not associated with access to urologists for research. Research groups may need support to increase their capacity to engage non-oncology cancer care providers in research.
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Affiliation(s)
- Shellie D. Ellis
- University of Kansas Cancer Center, University of Kansas Medical Center, USA
| | - Riha Vaidya
- SWOG Statistics and Data Management Center, Fred Hutchinson Cancer Research Center, Seattle, USA
| | - Joseph M. Unger
- SWOG Statistics and Data Management Center, Fred Hutchinson Cancer Research Center, Seattle, USA
| | - Kelly Stratton
- Stephenson Cancer Center, University of Oklahoma Health Sciences Center, USA
| | - Jessie Gills
- Gulf South NCORP, Louisiana State University Health Sciences Center, USA
| | | | - Eileen Mederos
- Gulf South NCORP, Louisiana State University Health Sciences Center, USA
| | - Emily V. Dressler
- Wake Forest School of Medicine, Department of Biostatistics and Data Science, Winston-Salem, NC, USA
| | | | | | - Heather B. Neuman
- University of Wisconsin School of Medicine and Public Health, Madison, USA
| | | | - Ruth C. Carlos
- University of Michigan School of Medicine, Ann Arbor, USA
| | - Kathryn E. Weaver
- Wake Forest Baptist Comprehensive Cancer Center, Wake Forest School of Medicine, Winston-Salem, NC, USA
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13
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Bischof JJ, Elsaid MI, Bridges JFP, Rosko AE, Presley CJ, Abar B, Adler D, Bastani A, Baugh CW, Bernstein SL, Coyne CJ, Durham DD, Grudzen CR, Henning DJ, Hudson MF, Klotz A, Lyman GH, Madsen TE, Reyes-Gibby CC, Rico JF, Ryan RJ, Shapiro NI, Swor R, Thomas CR, Venkat A, Wilson J, Yeung SCJ, Yilmaz S, Caterino JM. Characterization of older adults with cancer seeking acute emergency department care: A prospective observational study. J Geriatr Oncol 2022; 13:943-951. [PMID: 35718667 DOI: 10.1016/j.jgo.2022.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2021] [Revised: 04/05/2022] [Accepted: 06/10/2022] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Disparities in care of older adults in cancer treatment trials and emergency department (ED) use exist. This report provides a baseline description of older adults ≥65 years old who present to the ED with active cancer. MATERIALS AND METHODS Planned secondary analysis of the Comprehensive Oncologic Emergencies Research Network observational ED cohort study sponsored by the National Cancer Institute. Of 1564 eligible adults with active cancer, 1075 patients were prospectively enrolled, of which 505 were ≥ 65 years old. We recruited this convenience sample from eighteen participating sites across the United States between February 1, 2016 and January 30, 2017. RESULTS Compared to cancer patients younger than 65 years of age, older adults were more likely to be transported to the ED by emergency medical services, have a higher Charlson Comorbidity Index score, and be admitted despite no significant difference in acuity as measured by the Emergency Severity Index. Despite the higher admission rate, no significant difference was noted in hospitalization length of stay, 30-day mortality, ED revisit or hospital admission within 30 days after the index visit. Three of the top five ED diagnoses for older adults were symptom-related (fever of other and unknown origin, abdominal and pelvic pain, and pain in throat and chest). Despite this, older adults were less likely to report symptoms and less likely to receive symptomatic treatment for pain and nausea than the younger comparison group. Both younger and older adults reported a higher symptom burden on the patient reported Condensed Memorial Symptom Assessment Scale than to ED providers. When treating suspected infection, no differences were noted in regard to administration of antibiotics in the ED, admissions, or length of stay ≤2 days for those receiving ED antibiotics. DISCUSSION We identified several differences between older (≥65 years old) and younger adults with active cancer seeking emergency care. Older adults frequently presented for symptom-related diagnoses but received fewer symptomatic interventions in the ED suggesting that important opportunities to improve the care of older adults with cancer in the ED exist.
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Affiliation(s)
- Jason J Bischof
- Departments of Emergency Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, USA.
| | - Mohamed I Elsaid
- Department of Biomedical Informatics, College of Medicine, The Ohio State University, Columbus, OH, USA.
| | - John F P Bridges
- Department of Biomedical Informatics, College of Medicine, The Ohio State University, Columbus, OH, USA.
| | - Ashley E Rosko
- Department of Internal Medicine, Division of Hematology, Ohio State University Comprehensive Cancer Center, The Ohio State University, Columbus, OH, USA.
| | - Carolyn J Presley
- Department of Internal Medicine, Division of Medical Oncology, Ohio State University Comprehensive Cancer Center, The Ohio State University, Columbus, OH, USA.
| | - Beau Abar
- Department of Emergency Medicine, University of Rochester, Rochester, NY, USA.
| | - David Adler
- Department of Emergency Medicine, University of Rochester, Rochester, NY, USA.
| | - Aveh Bastani
- Department of Emergency Medicine, William Beaumont Hospital - Troy Campus, Troy, MI, USA.
| | - Christopher W Baugh
- Department of Emergency Medicine, Brigham and Women's Hospital, Boston, MA, USA.
| | - Steven L Bernstein
- Department of Emergency Medicine, Yale School of Medicine, New Haven, CT, USA.
| | - Christopher J Coyne
- Department of Emergency Medicine, University of California San Diego, San Diego, CA, USA.
| | - Danielle D Durham
- Department of Radiology, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, USA.
| | - Corita R Grudzen
- Ronald O. Perelman Department of Emergency Medicine and Population Health, New York University Grossman School of Medicine, New York, NY, USA.
| | - Daniel J Henning
- Department of Emergency Medicine, University of Washington, Seattle, WA, USA.
| | | | - Adam Klotz
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
| | - Gary H Lyman
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center and the Department of Medicine, University of Washington School of Medicine, Seattle, WA, USA.
| | - Troy E Madsen
- Division of Emergency Medicine, University of Utah, Salt Lake City, UT, USA.
| | - Cielito C Reyes-Gibby
- Department of Emergency Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
| | - Juan Felipe Rico
- Department of Pediatrics, University of South Florida Morsani College of Medicine, Tampa, FL, USA.
| | - Richard J Ryan
- Department of Emergency Medicine, University of Cincinnati, Cincinnati, OH, USA.
| | - Nathan I Shapiro
- Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA.
| | - Robert Swor
- Department of Emergency Medicine, William Beaumont Hospital, Royal Oak, MI, USA.
| | - Charles R Thomas
- Department of Radiation Oncology, Geisel School of Medicine @ Dartmouth, Lebanon, NH, USA.
| | - Arvind Venkat
- Department of Emergency Medicine, Allegheny Health Network, Pittsburgh, PA, USA.
| | - Jason Wilson
- Department of Emergency Medicine, University of South Florida Morsani College of Medicine, Tampa, FL, USA
| | - Sai-Ching Jim Yeung
- Department of Emergency Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
| | - Sule Yilmaz
- Department of Surgery, Division of Supportive Care in Cancer, University of Rochester Medical Center, Rochester, NY, USA.
| | - Jeffrey M Caterino
- Departments of Emergency Medicine and Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, USA.
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14
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Hudson MF. Short‐ and
long‐term
strategies for navigating
research‐ambivalent
organizational cultures besetting embedded researchers. Learn Health Syst 2022; 7:e10329. [PMID: 37066096 PMCID: PMC10091197 DOI: 10.1002/lrh2.10329] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Revised: 06/19/2022] [Accepted: 07/04/2022] [Indexed: 12/23/2022] Open
Abstract
Many health systems may host embedded researchers (ERs) and provide fiscal resources to encourage health service research. However, ERs may remain challenged to initiate research in these settings. This discussion examines how health system culture may impede research initiation, thereby exposing a paradox for embedded researchers immersed in research-ambivalent health systems. The discussion ultimately describes potential short-term and long-term strategies embedded researchers may employ to initiate scholarly inquiry in research-ambivalent health systems.
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Affiliation(s)
- Matthew F. Hudson
- Department of Medicine Prisma Health Cancer Institute Greenville South Carolina USA
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15
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Yilmaz S, Grudzen CR, Durham DD, McNaughton C, Marcelin I, Abar B, Adler D, Bastani A, Baugh CW, Bernstein SL, Bischof JJ, Coyne CJ, Henning DJ, Hudson MF, Klotz A, Lyman GH, Madsen TE, Pallin DJ, Reyes-Gibby C, Rico JF, Ryan RJ, Shapiro NI, Swor R, Thomas CR, Venkat A, Wilson J, Yeung SCJ, Caterino JM. Palliative Care Needs and Clinical Outcomes of Patients with Advanced Cancer in the Emergency Department. J Palliat Med 2022; 25:1115-1121. [PMID: 35559758 PMCID: PMC9467631 DOI: 10.1089/jpm.2021.0567] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background: Older adults with cancer use the emergency department (ED) for acute concerns. Objectives: Characterize the palliative care needs and clinical outcomes of advanced cancer patients in the ED. Design: A planned secondary data analysis of the Comprehensive Oncologic Emergencies Research Network (CONCERN) data. Settings/Subjects: Cancer patients who presented to the 18 CONCERN affiliated EDs in the United States. Measurements: Survey included demographics, cancer type, functional status, symptom burden, palliative and hospice care enrollment, and advance directive code status. Results: Of the total (674/1075, 62.3%) patients had advanced cancer and most were White (78.6%) and female (50.3%); median age was 64 (interquartile range 54-71) years. A small proportion of them were receiving palliative (6.5% [95% confidence interval; CI 3.0-7.6]; p = 0.005) and hospice (1.3% [95% CI 1.0-3.2]; p = 0.52) care and had a higher 30-day mortality rate (8.3%, [95% CI 6.2-10.4]). Conclusions: Patients with advanced cancer continue to present to the ED despite recommendations for early delivery of palliative care.
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Affiliation(s)
- Sule Yilmaz
- Division of Supportive Care in Cancer, Department of Surgery, University of Rochester Medical Center, Rochester, New York, USA
- Address correspondence to: Sule Yilmaz, PhD, Division of Supportive Care in Cancer, Department of Surgery, University of Rochester Medical Center, 265 Crittenden Boulevard, Rochester, NY 14642, USA
| | - Corita R. Grudzen
- Ronald O. Perelman Department of Emergency Medicine and Population Health, New York University School of Medicine, New York, New York, USA
| | - Danielle D. Durham
- Department of Radiology, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina, USA
| | | | - Isabelle Marcelin
- Ronald O. Perelman Department of Emergency Medicine and Population Health, New York University School of Medicine, New York, New York, USA
| | - Beau Abar
- Department of Emergency Medicine, University of Rochester, Rochester, New York, USA
| | - David Adler
- Department of Emergency Medicine, University of Rochester, Rochester, New York, USA
| | - Aveh Bastani
- Department of Emergency Medicine, William Beaumont Hospital—Troy Campus, Troy, Michigan, USA
| | - Christopher W. Baugh
- Department of Emergency Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Steven L. Bernstein
- Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Jason J. Bischof
- Department of Emergency Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Christopher J. Coyne
- Department of Emergency Medicine, University of California San Diego, San Diego, California, USA
| | - Daniel J. Henning
- Department of Emergency Medicine, University of Washington, Seattle, Washington, USA
| | | | - Adam Klotz
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Gary H. Lyman
- Hutchinson Institute for Cancer Outcomes Research, Fred Hutchinson Cancer Research Center and the Department of Medicine, University of Washington School of Medicine, Seattle, Washington, USA
| | - Troy E. Madsen
- Division of Emergency Medicine, University of Utah, Salt Lake City, Utah, USA
| | - Daniel J. Pallin
- Department of Emergency Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Cielito Reyes-Gibby
- Department of Emergency Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Juan Felipe Rico
- Department of Pediatrics, University of South Florida Morsani College of Medicine, Tampa, Florida, USA
| | - Richard J. Ryan
- Department of Emergency Medicine, University of Cincinnati, Cincinnati, Ohio, USA
| | - Nathan I. Shapiro
- Department of Emergency Medicine, Beth Israel Deaconness Medical Center, Boston, Massachusetts, USA
| | - Robert Swor
- Department of Emergency Medicine, William Beaumont Hospital, Royal Oak, Michigan, USA
| | - Charles R. Thomas
- Department of Radiation Medicine, Knight Cancer Institute, Oregon Health and Sciences University, Portland, Oregon, USA
| | - Arvind Venkat
- Department of Emergency Medicine, Allegheny Health Network, Pittsburgh, Pennsylvania, USA
| | - Jason Wilson
- Department of Emergency Medicine, University of South Florida Morsani College of Medicine, Tampa, Florida, USA
| | - Sai-Ching Jim Yeung
- Department of Emergency Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Jeffrey M. Caterino
- Department of Emergency Medicine and Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
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16
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Feldman DB, O'Rourke MA, Corn BW, Hudson MF, Patel N, Agarwal R, Fraser VL, Deininger H, Fowler LA, Bakitas MA, Krouse RA, Subbiah IM. Development of a measure of clinicians' self-efficacy for medical communication (SEMC). BMJ Support Palliat Care 2022:bmjspcare-2022-003593. [PMID: 35534186 DOI: 10.1136/bmjspcare-2022-003593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2022] [Accepted: 04/21/2022] [Indexed: 11/04/2022]
Abstract
OBJECTIVES Studies of clinician-patient communication have used varied, ad hoc measures for communication efficacy. We developed and validated the Self-Efficacy for Medical Communication (SEMC) scale as a standard, quantitative measure of clinician-reported skills in communicating difficult news. METHODS Using evidence-based scale development guidelines, we created two 16-item forms of the SEMC, one assessing communication with patients and one assessing communication with families. Clinicians providing oncological care in four organisations were invited to participate and provided consent. Participant demographics, responses to the SEMC items and responses to convergent and discriminant measures (those expected to relate strongly and weakly to the SEMC) were collected online. We performed analyses to determine the convergent and discriminant validity of the SEMC as well as its reliability and factor structure. RESULTS Overall, 221 oncology clinicians (including physicians, residents, fellows, medical students, nurses, nurse practitioners and physician assistants) participated. The patient and family forms both demonstrated high internal consistency reliability (alpha=0.94 and 0.96, respectively) and were strongly correlated with one another (r=0.95, p<0.001). Exploratory factor analysis demonstrated that the SEMC measures a unitary construct (eigenvalue=9.0), and its higher mean correlation with convergent (r=0.46) than discriminant (r=0.22) measures further supported its validity. CONCLUSIONS Our findings support the SEMC's validity and reliability as a measure of clinician-rated communication skills regarding conducting difficult conversations with patients and families. It provides a useful standard tool for future research in oncology provider-patient serious illness communication.
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Affiliation(s)
| | - Mark A O'Rourke
- Prisma Health Upstate Cancer Institute, Greenville, South Carolina, USA
| | | | - Matthew F Hudson
- Prisma Health Upstate Cancer Institute, Greenville, South Carolina, USA
| | - Naimik Patel
- Prisma Health Upstate Cancer Institute, Greenville, South Carolina, USA
| | - Rajiv Agarwal
- Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | | | - Heidi Deininger
- University of Michigan Rogel Cancer Center, Ann Arbor, Michigan, USA
| | - Lauren A Fowler
- University of South Carolina School of Medicine Greenville, Greenville, South Carolina, USA
| | - Marie A Bakitas
- University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Robert A Krouse
- University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
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17
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Hudson MF, Strassels SA, Durham DD, Siddique S, Adler D, Yeung SJ, Bernstein SL, Baugh CW, Coyne CJ, Grudzen CR, Henning DJ, Klotz A, Madsen TE, Pallin DJ, Rico JF, Ryan RJ, Shapiro NI, Swor R, Venkat A, Wilson J, Thomas CR, Bischof JJ, Lyman GH, Caterino JM. Examining pain among non-Hispanic Black and non-Hispanic White patients with cancer visiting emergency departments: CONCERN (Comprehensive Oncologic Emergencies Research Network). Acad Emerg Med 2022; 29:364-368. [PMID: 34606137 DOI: 10.1111/acem.14395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Revised: 09/28/2021] [Accepted: 09/30/2021] [Indexed: 11/28/2022]
Affiliation(s)
| | - Scott A. Strassels
- Division of Pharmacy Atrium Health Charlotte North Carolina USA
- Department of Surgery The Ohio State University Columbus Ohio USA
| | - Danielle D. Durham
- Department of Radiology School of Medicine University of North Carolina Chapel Hill North Carolina USA
| | - Sunny Siddique
- Healthcare Delivery Research Program Division of Cancer Control and Population Sciences National Cancer Institute Rockville Maryland USA
| | - David Adler
- Department of Emergency Medicine University of Rochester Rochester New York USA
| | - Sai‐Ching J. Yeung
- Department of Emergency Medicine The University of Texas MD Anderson Cancer Center Houston Texas USA
| | - Steven L. Bernstein
- Department of Emergency Medicine Dartmouth Hitchcock Medical Center Hanover New Hampshire USA
| | - Christopher W. Baugh
- Department of Emergency Medicine Brigham and Women’s Hospital Boston Massachusetts USA
| | - Christopher J. Coyne
- Department of Emergency Medicine University of California San Diego San Diego California USA
| | - Corita R. Grudzen
- Ronald O. Perelman Department of Emergency Medicine and Population Health New York University School of Medicine New York New York USA
| | - Daniel J. Henning
- Department of Emergency Medicine University of Washington Seattle Washington USA
| | - Adam Klotz
- Department of Medicine Memorial Sloan Kettering Cancer Center New York New York USA
| | - Troy E. Madsen
- Division of Emergency Medicine University of Utah Salt Lake City, Utah USA
| | - Daniel J. Pallin
- Department of Emergency Medicine Brigham and Women’s Hospital Boston Massachusetts USA
| | - Juan F. Rico
- Department of Pediatrics University of South Florida Morsani College of Medicine Tampa Florida USA
| | - Richard J. Ryan
- Department of Emergency Medicine University of Cincinnati Cincinnati Ohio USA
| | - Nathan I. Shapiro
- Department of Emergency Medicine Beth Israel Deaconess Medical Center Boston Massachusetts USA
| | - Robert Swor
- Department of Emergency Medicine William Beaumont Hospital Royal Oak Michigan USA
| | - Arvind Venkat
- Department of Emergency Medicine Allegheny Health Network Pittsburgh Pennsylvania USA
| | - Jason Wilson
- Department of Emergency Medicine University of South Florida Morsani College of Medicine Tampa Florida USA
| | - Charles R. Thomas
- Department of Radiation Medicine Knight Cancer Institute Oregon Health & Sciences University Portland Oregon USA
| | - Jason J. Bischof
- Department of Emergency Medicine The Ohio State University, Wexner Medical Center Columbus Ohio USA
| | - Gary H. Lyman
- Hutchinson Institute for Cancer Outcomes Research, Fred Hutchinson Cancer Research Center and the Department of Medicine University of Washington School of Medicine Seattle Washington USA
| | - Jeffrey M. Caterino
- Department of Emergency Medicine The Ohio State University, Wexner Medical Center Columbus Ohio USA
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18
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Fortuna KL, Hudson MF, Myers A, Kadakia A, Rivera J, Nutz T. How can we achieve health equity? Revisit the premise informing the scientific method. Health Expect 2022; 25:1-3. [PMID: 35171530 PMCID: PMC8849369 DOI: 10.1111/hex.13369] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2021] [Revised: 09/21/2021] [Accepted: 09/25/2021] [Indexed: 01/01/2023] Open
Affiliation(s)
- Karen L. Fortuna
- Department of PsychiatryGeisel School of Medicine at DartmouthHanoverNew HampshireUSA
| | | | | | | | | | - Tony Nutz
- National Alliance on Mental IllnessWichitaKansasUSA
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19
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Klotz AD, Caterino JM, Durham D, Felipe Rico J, Pallin DJ, Grudzen CR, McNaughton C, Marcelin I, Abar B, Adler D, Bastani A, Bernstein SL, Bischof JJ, Coyne CJ, Henning DJ, Hudson MF, Lyman GH, Madsen TE, Reyes‐Gibby CC, Ryan RJ, Shapiro NI, Swor R, Thomas CR, Venkat A, Wilson J, Jim Yeung S, Yilmaz S, Stutman R, Baugh CW. Observation unit use among patients with cancer following emergency department visits: Results of a multicenter prospective cohort from CONCERN. Acad Emerg Med 2021; 29:174-183. [PMID: 34811858 PMCID: PMC10359998 DOI: 10.1111/acem.14392] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Revised: 09/08/2021] [Accepted: 09/19/2021] [Indexed: 11/26/2022]
Abstract
PURPOSE Emergency department (ED) visits by patients with cancer frequently end in hospitalization. As concerns about ED and hospital crowding increase, observation unit care may be an important strategy to deliver safe and efficient treatment for eligible patients. In this investigation, we compared the prevalence and clinical characteristics of cancer patients who received observation unit care with those who were admitted to the hospital from the ED. METHODS We performed a multicenter prospective cohort study of patients with cancer presenting to an ED affiliated with one of 18 hospitals of the Comprehensive Oncologic Emergency Research Network (CONCERN) between March 1, 2016 and January 30, 2017. We compared patient characteristics with the prevalence of observation unit care usage, hospital admission, and length of stay. RESULTS Of 1051 enrolled patients, 596 (56.7%) were admitted as inpatients, and 72 (6.9%) were placed in an observation unit. For patients admitted as inpatients, 23.7% had a length of stay ≤2 days. The conversion rate from observation to inpatient was 17.1% (95% CI 14.6-19.4) among those receiving care in an observation unit. The average observation unit length of stay was 14.7 h. Patient factors associated ED disposition to observation unit care were female gender and low Charlson Comorbidity Index. CONCLUSION In this multicenter prospective cohort study, the discrepancy between observation unit care use and short inpatient hospitalization may represent underutilization of this resource and a target for process change.
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Affiliation(s)
- Adam D. Klotz
- Department of Medicine Memorial Sloan Kettering Cancer Center New York New York USA
| | - Jeffrey M. Caterino
- Departments of Emergency Medicine and Internal Medicine Wexner Medical Center The Ohio State University Columbus Ohio USA
| | - Danielle Durham
- Department of Radiology School of Medicine University of North Carolina at Chapel Hill Chapel Hill North Carolina USA
| | - Juan Felipe Rico
- Department of Pediatrics Morsani College of Medicine University of South Florida Tampa Florida USA
| | - Daniel J. Pallin
- Department of Emergency Medicine Brigham and Women’s Hospital Boston Massachusetts USA
| | - Corita R. Grudzen
- Ronald O. Perelman Department of Emergency Medicine and Population Health School of Medicine New York University New York New York USA
| | | | - Isabelle Marcelin
- Ronald O. Perelman Department of Emergency Medicine and Population Health School of Medicine New York University New York New York USA
| | - Beau Abar
- Department of Emergency Medicine University of Rochester Rochester New York USA
| | - David Adler
- Department of Emergency Medicine University of Rochester Rochester New York USA
| | - Aveh Bastani
- Department of Emergency Medicine William Beaumont Hospital Troy Michigan USA
| | - Steven L. Bernstein
- Department of Emergency Medicine Yale School of Medicine New Haven Connecticut USA
| | - Jason J. Bischof
- Department of Emergency Medicine Wexner Medical Center The Ohio State University Columbus Ohio USA
| | - Christopher J. Coyne
- Department of Emergency Medicine University of California San Diego San Diego California USA
| | - Daniel J. Henning
- Department of Emergency Medicine University of Washington Seattle Washington USA
| | | | - Gary H Lyman
- Fred Hutchinson Cancer Research Center and the Department of Medicine Hutchinson Institute for Cancer Outcomes Research University of Washington School of Medicine Seattle Washington USA
| | - Troy E. Madsen
- Division of Emergency Medicine University of Utah Salt Lake City Utah USA
| | - Cielito C. Reyes‐Gibby
- Department of Emergency Medicine and Biostatistics The University of Texas MD Anderson Cancer Center Houston Texas USA
| | - Richard J. Ryan
- Department of Emergency Medicine University of Cincinnati Cincinnati Ohio USA
| | - Nathan I. Shapiro
- Department of Emergency Medicine Beth Israel Deaconess Medical Center Boston Massachusetts USA
| | - Robert Swor
- Department of Emergency Medicine William Beaumont Hospital Royal Oak Michigan USA
| | - Charles R. Thomas
- Department of Radiation Medicine Knight Cancer Institute Oregon Health & Sciences University Portland Oregon USA
| | - Arvind Venkat
- Department of Emergency Medicine Allegheny Health Network Pittsburgh Pennsylvania USA
| | - Jason Wilson
- Department of Emergency Medicine Morsani College of Medicine University of South Florida Tampa Florida USA
| | - Sai‐Ching Jim Yeung
- Department of Emergency Medicine The University of Texas MD Anderson Cancer Center Houston Texas USA
| | - Sule Yilmaz
- Department of Geriatric Oncology University of Rochester Medical center Rochester New York USA
| | - Robin Stutman
- Department of Medicine Memorial Sloan Kettering Cancer Center New York New York USA
| | - Christopher W. Baugh
- Department of Emergency Medicine Brigham and Women’s Hospital Boston Massachusetts USA
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20
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Feldman DB, O'Rourke MA, Corn D, Subbiah IM, Manasseh M, Hudson MF, Agarwal R, Bakitas M, Fraser VL, Fowler LA, Corn BW. Hope-enhancement workshops in the SWOG Cancer Research Network: Feasibility of an online intervention. J Clin Oncol 2021. [DOI: 10.1200/jco.2020.39.28_suppl.210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
210 Background: Research shows that healthcare professionals’ personal hopefulness is associated with burnout and life satisfaction, highlighting the value of hope-enhancement interventions. Feldman and Dreher developed a single-session hope intervention, but this has been used rarely with oncology professionals, and only in in-person format (Shah, Ferguson, Corn et al.). Given SWOG Cancer Research Network’s commitment to assessing hope-enhancement approaches and the need for online interventions given COVID-19, we report a feasibility study of a virtual hope workshop in SWOG members. Methods: The workshop was a single 2-hour session delivered live via Zoom to 6-8 participants at a time. The workshop comprises 3 components: A brief lecture on hope and two exercises—a “hope mapping” exercise (aided by a smartphone app created for the workshop) and a hope visualization exercise—both designed to build hope for a life goal of each participant’s choosing. 29 SWOG members participated. A link to post-workshop measures was sent to participants, which they were given a week to complete. Measures included Thanarajasingamet al’s 5-item Was-it-Worth-it (WIWI) measure; Kirkpatrick’s 4-item Training Evaluation Model (TEM; reaction, learning, behavior, results); and an item assessing the degree to which participants believe concepts from the workshop should be integrated into SWOG studies. Results: In all, 25 participants (86%) completed measures. Participants were physicians (n = 8), nurses (n = 4), patient advocates (n = 3), research staff (n = 3), and others (n = 7); mostly female (n = 17), mostly white (n = 18), with a mean age of 55.5 (SD = 13.95). Results for the WIWI items are as follows: “Was it worthwhile to participate in the Hope Workshop?” (23 Yes, 2 No/Undecided/Missing Answer); “If you had to do over, would you participate in the Hope Workshop again?” (22 Yes, 3 No/Undecided/Missing Answer); “Would you recommend participating in the Hope Workshop to others?” (22 Yes, 3 No/Undecided/Missing Answer). Two additional items on the WIWI asked participants to rate on a 3-point scale the degree to which they believe their quality of life had increased due to the workshop (M = 2.52, SD =.51) and their overall experience in the workshop (M = 2.70, SD =.64). Ratings for Kirkpatrick’s TEM items likewise were high, ranging from 6.91 (SD = 1.31) to 7.70 (SD =.70) on an 8-point scale. Finally, participants gave a mean rating of 4.44 (SD =.59) on a 5-point scale to the item “To what degree do you believe it may be useful to integrate concepts from this workshop into SWOG trials/studies?” Conclusions: It is feasible to implement hope-enhancement workshops in an online platform that includes a smartphone app. Data obtained from two validated tools (WIWI instrument and Kirkpatrick’s TEM) attest to an array of positive outcomes. Participants also overwhelmingly advocated integrating hope concepts into SWOG’s research.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Lauren A. Fowler
- University of South Carolina School of Medicine, Greenville, Greenville, SC
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21
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Hudson MF. General orders for the embedded researcher: Moorings for a developing profession. Learn Health Syst 2021; 5:e10254. [PMID: 34667876 PMCID: PMC8512733 DOI: 10.1002/lrh2.10254] [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: 10/12/2020] [Revised: 11/23/2020] [Accepted: 11/28/2020] [Indexed: 11/18/2022] Open
Abstract
Learning health systems increasingly welcome embedded researchers as stakeholders poised to inform evidence-based practice. While care systems are potentially familiar with the embedded researcher tools and techniques, care systems may less frequently consider embedded research as a vocation. This insensitivity potentially reduces embedded researchers merely to instruments, as opposed to professional partners in transdisciplinary research. This discussion outlines "general orders" for embedded researchers. The general orders outline embedded researchers' fundamental identity and guide conduct as a means to encourage a shared identity among embedded researchers and clarify embedded researchers' roles in learning health system teams. Students and embedded researchers newly engaging learning health systems may particularly benefit from this rudimentary order list.
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22
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Feldman DB, O'Rourke MA, Corn BW, Hudson MF, Agarwal R, Fraser VL, Deininger H, Fowler LA, Subbiah IM. Development and validation of the self-efficacy for medical communication scale. J Clin Oncol 2021. [DOI: 10.1200/jco.2021.39.15_suppl.12124] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
12124 Background: Most studies of clinician-patient communication use scales created ad hoc with unknown validity. To provide a standard measure for future studies, we developed and validated a new scale of clinician-reported skills in communicating difficult news: the Self-Efficacy for Medical Communication (SEMC) scale. Methods: Using evidence-based scale development guidelines, we created 16 items sampling a range of communication skills, including “Disclose difficult news in manageable chunks, so the patient is not overwhelmed,” and “Determine how to present information based on the patient’s emotional state.” Items are rated on Likert scales from 1 ( cannot do at all) to 10 ( highly certain can do). We constructed two forms—one assessing communication with patients and one with family—using identical items but replacing “patient” with “family/caregiver.” We examined the convergent and discriminant validity of the SEMC (correlations with similar and dissimilar measures) as well as its reliability and factor structure. A total of 221 clinicians working in oncology settings (physicians, nurses, medical students) completed measures online. Convergent measures included medical communication items from past studies; the Self-Perceived Communication Competence Scale to measure communication ability outside the medical realm; and the General Self-Efficacy and Occupational Self-Efficacy scales to measure overall self-efficacy/confidence. Discriminant measures included the Ten Item Personality Inventory to measure personality factors; the Maslach Burnout Inventory to measure job burnout; and the Satisfaction with Life Scale to measure well-being. Finally, the Marlowe-Crowne Social Desirability (MCSD) scale measured motivation to “look good” in responding to survey questions. Results: Mean scores were similar for the patient (126.36) and family (127.09) forms (max score 160), both with excellent reliability ( alphas =.94,.96, respectively). Because these forms were almost perfectly correlated ( r =.95, p <.001), we used only the patient form in subsequent analyses. Factor analysis demonstrated that the SEMC measures a unitary construct ( eigenvalue = 9.0). Its mean correlation was higher with convergent ( r =.46) than discriminant measures ( r =.22), supporting its validity. Moreover, its correlation with the MCSD was small ( r =.28) and no larger than between the MCSD and other measures, indicating minimal social-desirability effects. Finally, no differences emerged for gender or profession; higher scores did correlate with age ( r =.29, p <.001) and years working in oncology ( r =.18, p =.01). Conclusions: Our findings support the SEMC’s validity and reliability. Scores on the patient and family forms were similar, indicating that either may be used. The SEMC provides a useful tool for measuring clinician-rated communication skills in future research, ultimately allowing standardization across studies.
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Affiliation(s)
| | | | | | | | | | | | | | - Lauren A. Fowler
- University of South Carolina School of Medicine, Greenville, Greenville, SC
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23
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Feldman DB, O'Rourke MA, Bakitas MA, Krouse RS, Deininger HE, Hudson MF, Corn BW. Hope, Burnout, and Life Satisfaction: An Intriguing Trinity Among Investigators of the SWOG Cancer Research Network. JCO Oncol Pract 2021; 17:e908-e916. [PMID: 33900801 DOI: 10.1200/op.20.00990] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Although hope has been explored in patients, few studies have investigated hopefulness in health care professionals. We surveyed oncology professionals within the SWOG Cancer Research Network, exploring relationships among personal hopefulness, social support, work stress, burnout, and life satisfaction. We hypothesized that hope would mediate the relationships between these other variables and life satisfaction. METHODS SWOG members were randomly selected for an online survey containing measures of hope, social support, work stress, burnout, and satisfaction with life. Of 1,000 invitees, 226 responded. RESULTS We tested a multiple mediational model using Hayes' bootstrapping approach (ie, PROCESS v3.4). As hypothesized, hope partially mediated the relationships between burnout and life satisfaction as well as between social support and life satisfaction. In particular, hopefulness was associated with lower burnout (-0.23; P = .005), greater social support (0.23; P = .005), and greater life satisfaction (0.50; P < .001). Work stress was associated with greater burnout (0.57; P < .001) but was not associated with general life satisfaction. Finally, social support was associated with lower burnout (-0.16; P = .005) and greater life satisfaction (0.24; P < .001). CONCLUSION Our results suggest that hope may mitigate the effects of burnout. The combination of hope and social support may prove helpful for reducing burnout and improving life satisfaction. Single-session hope-enhancement interventions incorporating both hope and social support have previously been shown to increase hope and well-being in non-health care professionals. Such interventions for health care providers warrant further study.
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Coyne CJ, Reyes-Gibby CC, Durham DD, Abar B, Adler D, Bastani A, Bernstein SL, Baugh CW, Bischof JJ, Grudzen CR, Henning DJ, Hudson MF, Klotz A, Lyman GH, Madsen TE, Pallin DJ, Rico JF, Ryan RJ, Shapiro NI, Swor R, Thomas CR, Venkat A, Wilson J, Yeung SCJ, Caterino JM. Cancer pain management in the emergency department: a multicenter prospective observational trial of the Comprehensive Oncologic Emergencies Research Network (CONCERN). Support Care Cancer 2021; 29:4543-4553. [PMID: 33483789 DOI: 10.1007/s00520-021-05987-3] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Accepted: 01/04/2021] [Indexed: 11/25/2022]
Abstract
PURPOSE Many patients with cancer seek care for pain in the emergency department (ED). Prospective research on cancer pain in this setting has historically been insufficient. We conducted this study to describe the reported pain among cancer patients presenting to the ED, how pain is managed, and how pain may be associated with clinical outcomes. METHODS We conducted a multicenter cohort study on adult patients with active cancer presenting to 18 EDs in the USA. We reported pain scores, response to medication, and analgesic utilization. We estimated the associations between pain severity, medication utilization, and the following outcomes: 30-day mortality, 30-day hospital readmission, and ED disposition. RESULTS The study population included 1075 participants. Those who received an opioid in the ED were more likely to be admitted to the hospital and were more likely to be readmitted within 30 days (OR 1.4 (95% CI: 1.11, 1.88) and OR 1.56 (95% CI: 1.17, 2.07)), respectively. Severe pain at ED presentation was associated with increased 30-day mortality (OR 2.30, 95% CI: 1.05, 5.02), though this risk was attenuated when adjusting for clinical factors (most notably functional status). CONCLUSIONS Patients with severe pain had a higher risk of mortality, which was attenuated when correcting for clinical characteristics. Those patients who required opioid analgesics in the ED were more likely to require admission and were more at risk of 30-day hospital readmission. Future efforts should focus on these at-risk groups, who may benefit from additional services including palliative care, hospice, or home-health services.
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Affiliation(s)
- Christopher J Coyne
- Department of Emergency Medicine, University of California San Diego, 200 W. Arbor Dr. #8676, San Diego, CA, 92103, USA.
| | - Cielito C Reyes-Gibby
- Department of Emergency Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Danielle D Durham
- The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Beau Abar
- Department of Emergency Medicine, University of Rochester, Rochester, NY, USA
| | - David Adler
- Department of Emergency Medicine, University of Rochester, Rochester, NY, USA
| | - Aveh Bastani
- Department of Emergency Medicine, William Beaumont Hospital - Troy Campus, Troy, MI, USA
| | - Steven L Bernstein
- Department of Emergency Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Christopher W Baugh
- Department of Emergency Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Jason J Bischof
- Department of Emergency Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Corita R Grudzen
- Ronald O. Perelman Department of Emergency Medicine and Population Health, New York University School of Medicine, New York, NY, USA
| | - Daniel J Henning
- Department of Emergency Medicine, University of Washington, Seattle, WA, USA
| | | | - Adam Klotz
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Gary H Lyman
- Hutchinson Institute for Cancer Outcomes Research, Fred Hutchinson Cancer Research Center and the Department of Medicine, University of Washington School of Medicine, Seattle, WA, USA
| | - Troy E Madsen
- Division of Emergency Medicine, University of Utah, Salt Lake City, UT, USA
| | - Daniel J Pallin
- Department of Emergency Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Juan Felipe Rico
- Department of Pediatrics, University of South Florida Morsani College of Medicine, Tampa, FL, USA
| | - Richard J Ryan
- Department of Emergency Medicine, University of Cincinnati, Cincinnati, OH, USA
| | - Nathan I Shapiro
- Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Robert Swor
- Department of Emergency Medicine, William Beaumont Hospital, Royal Oak, MI, USA
| | - Charles R Thomas
- Department of Radiation Medicine, Knight Cancer Institute, Oregon Health & Sciences University, Portland, OR, USA
| | - Arvind Venkat
- Department of Emergency Medicine, Allegheny Health Network, Pittsburgh, PA, USA
| | - Jason Wilson
- Department of Emergency Medicine, University of South Florida Morsani College of Medicine, Tampa, FL, USA
| | - Sai-Ching Jim Yeung
- Department of Emergency Medicine and Department of Endocrine Neoplasia & Hormonal Disorders, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Jeffrey M Caterino
- Departments of Emergency Medicine and Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, USA
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McLouth LE, Nightingale CL, Dressler EV, Snavely AC, Hudson MF, Unger JM, Kazak AE, Lee SJC, Edward J, Carlos R, Kamen CS, Neuman HB, Weaver KE. Current Practices for Screening and Addressing Financial Hardship within the NCI Community Oncology Research Program. Cancer Epidemiol Biomarkers Prev 2020; 30:669-675. [PMID: 33355237 DOI: 10.1158/1055-9965.epi-20-1157] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Revised: 11/12/2020] [Accepted: 12/15/2020] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Cancer-related financial hardship is associated with poor care outcomes and reduced quality of life for patients and families. Scalable intervention development to address financial hardship requires knowledge of current screening practices and services within community cancer care. METHODS The NCI Community Oncology Research Program (NCORP) 2017 Landscape Assessment survey assessed financial screening and financial navigation practices within U.S. community oncology practices. Logistic models evaluated associations between financial hardship screening and availability of a cancer-specific financial navigator and practice group characteristics (e.g., safety-net designation, critical access hospital, proportion of racial and ethnic minority patients served). RESULTS Of 221 participating NCORP practice groups, 72% reported a financial screening process and 50% had a cancer-specific financial navigator. Practice groups with more than 10% of new patients with cancer enrolled in Medicaid (adjOR = 2.81, P = 0.02) and with less than 30% racial/ethnic minority cancer patient composition (adjOR = 3.91, P < 0.01) were more likely to screen for financial concerns. Practice groups with less than 30% racial/ethnic minority cancer patient composition (adjOR = 2.37, P < 0.01) were more likely to have a dedicated financial navigator or counselor for patients with cancer. CONCLUSIONS Most NCORP practice groups screen for financial concerns and half have a cancer-specific financial navigator. Practices serving more racial or ethnic minority patients are less likely to screen and have a designated financial navigator. IMPACT The effectiveness of financial screening and navigation for mitigating financial hardship could be tested within NCORP, along with specific interventions to address cancer care inequities.See related commentary by Yabroff et al., p. 593.
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Affiliation(s)
- Laurie E McLouth
- Department of Behavioral Science, University of Kentucky, Markey Cancer Center, Center for Health Equity Transformation, Lexington, Kentucky.
| | - Chandylen L Nightingale
- Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Emily V Dressler
- Department of Biostatistics and Data Sciences, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Anna C Snavely
- Department of Biostatistics and Data Sciences, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Matthew F Hudson
- NCORP of the Carolinas, Prisma Health, Greenville, South Carolina
| | - Joseph M Unger
- Department of Public Health Sciences, Fred Hutchinson Cancer Research Center, SWOG Statistics and Data Management Center, Seattle, Washington
| | - Anne E Kazak
- Centers for Healthcare Delivery Service, Nemours Children's Health System, Wilmington, Delaware
| | - Simon J Craddock Lee
- Department of Population and Data Sciences, University of Texas-Southwestern Medical Center, Dallas, Texas
| | - Jean Edward
- College of Nursing, University of Kentucky, Markey Cancer Center, UK Healthcare, Lexington, Kentucky
| | - Ruth Carlos
- Department of Radiology, University of Michigan Health System, Ann Arbor, Michigan
| | | | - Heather B Neuman
- Department of Surgery, University of Wisconsin, Madison, Wisconsin
| | - Kathryn E Weaver
- Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Winston-Salem, North Carolina
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Nightingale CL, Sterba KR, McLouth LE, Kent EE, Dressler EV, Dest A, Snavely AC, Adonizio CS, Wojtowicz M, Neuman HB, Kazak AE, Carlos RC, Hudson MF, Unger JM, Kamen CS, Weaver KE. Caregiver engagement practices in National Cancer Institute Clinical Oncology Research Program settings: Implications for research to advance the field. Cancer 2020; 127:639-647. [PMID: 33136296 DOI: 10.1002/cncr.33296] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 08/20/2020] [Accepted: 10/06/2020] [Indexed: 12/18/2022]
Abstract
BACKGROUND Supportive care interventions have demonstrated benefits for both informal and/or family cancer caregivers and their patients, but uptake generally is poor. To the authors' knowledge, little is known regarding the availability of supportive care services in community oncology practices, as well as engagement practices to connect caregivers with these services. METHODS Questions from the National Cancer Institute Community Oncology Research Program (NCORP)'s 2017 Landscape Survey examined caregiver engagement practices (ie, caregiver identification, needs assessment, and supportive care service availability). Logistic regression was used to assess the relationship between the caregiver engagement outcomes and practice group characteristics. RESULTS A total of 204 practice groups responded to each of the primary outcome questions. Only 40.2% of practice groups endorsed having a process with which to systematically identify and document caregivers, although approximately 76% were routinely using assessment tools to identify caregiver needs and approximately 63.7% had supportive care services available to caregivers. Caregiver identification was more common in sites affiliated with a critical access hospital (odds ratio [OR], 2.44; P = .013), and assessments were less common in safety-net practices (OR, 0.41; P = .013). Supportive care services were more commonly available in the Western region of the United States, in practices with inpatient services (OR, 2.96; P = .012), and in practices affiliated with a critical access hospital (OR, 3.31; P = .010). CONCLUSIONS Although many practice groups provide supportive care services, fewer than one-half systematically identify and document informal cancer caregivers. Expanding fundamental engagement practices such as caregiver identification, assessment, and service provision will be critical to support recent calls to improve caregivers' well-being and skills to perform caregiving tasks.
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Affiliation(s)
- Chandylen L Nightingale
- Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Katherine R Sterba
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, South Carolina
| | - Laurie E McLouth
- Department of Behavioral Science, Markey Cancer Center, Center for Health Equity Transformation, University of Kentucky College of Medicine, Lexington, Kentucky
| | - Erin E Kent
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Emily V Dressler
- Department of Biostatistics and Data Science, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Alexandra Dest
- Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Anna C Snavely
- Department of Biostatistics and Data Science, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Christian S Adonizio
- Center for Oncology Research and Innovation, Geisinger Cancer Institute, Danville, Pennsylvania
| | - Mark Wojtowicz
- Center for Oncology Research and Innovation, Geisinger Cancer Institute, Danville, Pennsylvania
| | - Heather B Neuman
- Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Anne E Kazak
- Center for Healthcare Delivery Science, Nemours Children's Health System, Wilmington, Delaware
| | - Ruth C Carlos
- Department of Radiology, University of Michigan, Ann Arbor, Michigan
| | - Matthew F Hudson
- NCORP of the Carolinas, Prisma Health Cancer Institute, Greenville, South Carolina
| | - Joseph M Unger
- SWOG Cancer Research Network Statistics and Data Management Center, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Charles S Kamen
- Department of Surgery, University of Rochester, Rochester, New York
| | - Kathryn E Weaver
- Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Winston-Salem, North Carolina
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Chen B, Cheng X, Streetman-Loy B, Hudson MF, Jindal D, Hair N. Effect of care coordination on patients with Alzheimer disease and their caregivers. Am J Manag Care 2020; 26:e369-e375. [PMID: 33196288 DOI: 10.37765/ajmc.2020.88532] [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: 11/15/2022]
Abstract
OBJECTIVES To assess whether a care coordination and caregiver support intervention reduced use of acute medical services for both patients with Alzheimer disease (AD) and their caregivers. STUDY DESIGN Data were collected from patients with AD (n = 101) and their caregivers (n = 63) at Greenville Health System (now Prisma Health) in late 2012. Their data were linked to secondary all-payer claims data in South Carolina between 2011 and 2014. METHODS We conducted both a difference-in-differences regression and segmented regression analysis on the patients' health care utilization patterns pre- and post intervention. Propensity score matching identified a control group composed of nonintervention patients with AD in South Carolina (n = 928). We examined caregiver differences via t tests of differences in means. RESULTS Overall, the Memory Program did not reduce acute medical services. However, program participants experienced increases in total charges ($5243; 95% CI, $977-$9510) and in inpatient admissions with AD as a diagnosis (0.15; 95% CI, 0.029-0.272) but no increase in total all-cause charges. Intervention patients also had fewer emergency department (ED) visits (-0.0538; 95% CI, -0.102 to -0.0052) in some analyses. Finally, results suggest that post intervention, caregivers had half as many acute visits with depression as a diagnosis (from 0.22 to 0.11, difference of 0.11; 95% CI, -0.242 to 0.0198). CONCLUSIONS Although care coordination did not decrease overall acute health services use, coordination improved clinical documentation of patients' memory impairment. ED visits may have begun to decrease among patients. Finally, stress levels may have fallen among caregivers.
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Affiliation(s)
- Brian Chen
- Department of Health Services Policy and Management, Arnold School of Public Health, University of South Carolina, 915 Greene St, Ste 354, Columbia, SC 29208.
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Feldman DB, O'Rourke MA, Krouse RS, Bakitas M, Deininger H, Hudson MF, Corn BW. A hopefulness survey of SWOG members: Relationships among hope, job stress, and burnout. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.29_suppl.185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
185 Background: Hope is a cognitive, goal-directed phenomenon that is measurable. It is “a cognitive set that is based on a reciprocally-derived sense of successful agency (goal-directed determination) and pathways (planning to meet goals).” Although hope has been explored in patients, few studies have investigated hope in physicians and other healthcare providers. Low hope has been shown to predict work burnout in other professions. This survey in the SWOG Cancer Research Network tests the relationships among hope, work stress, burnout, and general satisfaction with life. Methods: SWOG members randomly selected and invited to participate by email linked to a 10-minute online survey consisting of the following: The Adult Hope Scale, Satisfaction with Life Scale, demographic questionnaire, and items assessing burnout, work stress, and general social support. Of 1000 invitees, 226 responded to the survey, including physicians ( n = 77) and RNs ( n = 46). Results: On average, respondents reported relatively high work stress ( M = 3.59 out of 5). Levels of work stress were positively associated with burnout ( r = .58, p < .001), but not with general satisfaction with life ( r = .11, p = .08). Hope levels were negatively associated with burnout ( r = -.21, p = .003) and positively associated with satisfaction with life ( r = .58, p < .001). Consistent with past research showing that people with greater availability of general social support suffer from lower rates of burnout and experience higher levels of psychological well-being, we found that social support was negatively associated with burnout ( r = -.18, p = .007) and positively associated with life satisfaction ( r = .38, p < .001). In addition, we tested a meditational model using Hayes’ bootstrapping approach via the PROCESS macro in SPSS. In this model, hope partially mediated the relationships between social support and both burnout and life satisfaction. In the model, job stress also predicted burnout, but, as in the previous correlational analysis, had no relationship with general life satisfaction. Conclusions: Our cross-sectional results suggest that hope may mitigate the effects of burnout. Our data indicate that the particular combination of social support and hope may prove helpful for reducing job burnout and increasing general satisfaction with life. Single-session hope-enhancement workshops that incorporate both of these elements have been shown to increase hope and psychological well-being in non-medical populations. Such interventions for healthcare professionals warrant further study.
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Affiliation(s)
| | | | - Robert S. Krouse
- Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA
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Hudson MF, O'Rourke MA, Blackhurst DW, Caldwell JD, Feldman DB, Corn BW, Horner RD. Relationship between clinical work intensity, hopefulness and well-being among medical oncologists. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.29_suppl.46] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
46 Background: Oncology providers’ well-being particularly concerns administrators, as projections suggest a shortfall in number of providers available to care for an increasing cancer survivor population. This pilot study solicited medical oncologists’ ratings on Clinical Work Intensity (CWI), well-being, and hope constructs: agency (goal-directed determination) and pathways (planning ways to meet goals), to understand relationships between clinical work intensity, hopefulness and well-being. Methods: Eleven providers (8 = MD and 3 = NP) practicing in three distinct community-based oncology sites completed the CWI measure, NASA-TLX, immediately following an office visit, for 20 separate visits. Each provider also completed one well-being index and one Adult Hope Scale that included agency and pathways subscales after the 20 visits. Lower well-being scores indicated higher well-being; higher hope scores indicated greater hopefulness. Results: Clinical work intensity positively correlates with well-being (Spearman rho = 0.16; p = 0.02). Clinical work intensity was inversely related to the total hopefulness score (Spearman rho = -0.25; p < 0.001) and Hope construct subcomponents of perceived pathway to goal achievement (Spearman rho = -0.24; p < 0.001), and determination to meet goals (agency) (Spearman rho = -0.15; p < 0.001). Favorable provider well-being was also related to agency (Spearman rho = -0.71; p < 0.0001). Conclusions: Higher provider-rated work intensity in sampled clinical encounters correlates, albeit weakly, with less favorable well-being scores. Higher CWI also correlates with lower hope scale scores. Thus, providers’ perceptions of their mental workload in clinical care are potentially related to their sense of well-being and hopefulness. Results also suggest provider determination to meet goals (agency) is also reflected in sense of well-being. These findings support further investigation using larger, more diverse samples to affirm observed relationships. Future research may also elucidate intervention targets through which to abate provider distress portending burnout. Insights gleaned from future work may inform improvements to the work life of oncology care providers.
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Affiliation(s)
| | | | | | | | | | | | - Ronnie D. Horner
- University of South Carolina Arnold School of Public Health, Columbia, SC
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30
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Adler D, Abar B, Durham DD, Bastani A, Bernstein SL, Baugh CW, Bischof JJ, Coyne CJ, Grudzen CR, Henning DJ, Hudson MF, Klotz A, Lyman GH, Madsen TE, Pallin DJ, Reyes-Gibby CC, Rico JF, Ryan RJ, Shapiro NI, Swor R, Thomas CR, Venkat A, Wilson J, Yeung SCJ, Caterino JM. Validation of the Emergency Severity Index (Version 4) for the Triage of Adult Emergency Department Patients With Active Cancer. J Emerg Med 2019; 57:354-361. [PMID: 31353265 DOI: 10.1016/j.jemermed.2019.05.023] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Revised: 04/25/2019] [Accepted: 05/06/2019] [Indexed: 11/19/2022]
Abstract
BACKGROUND Patients with active cancer account for a growing percentage of all emergency department (ED) visits and have a unique set of risks related to their disease and its treatments. Effective triage for this population is fundamental to facilitating their emergency care. OBJECTIVES We evaluated the validity of the Emergency Severity Index (ESI; version 4) triage tool to predict ED-relevant outcomes among adult patients with active cancer. METHODS We conducted a prespecified analysis of the observational cohort established by the National Cancer Institute-supported Comprehensive Oncologic Emergencies Research Network's multicenter (18 sites) study of ED visits by patients with active cancer (N = 1075). We used a series of χ2 tests for independence to relate ESI scores with 1) disposition, 2) ED resource use, 3) hospital length of stay, and 4) 30-day mortality. RESULTS Among the 1008 subjects included in this analysis, the ESI distribution skewed heavily toward high acuity (>95% of subjects had an ESI level of 1, 2, or 3). ESI was significantly associated with patient disposition and ED resource use (p values < 0.05). No significant associations were observed between ESI and the non-ED based outcomes of hospital length of stay or 30-day mortality. CONCLUSION ESI scores among ED patients with active cancer indicate higher acuity than the general ED population and are predictive of disposition and ED resource use. These findings show that the ESI is a valid triage tool for use in this population for outcomes directly relevant to ED care.
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Affiliation(s)
- David Adler
- Department of Emergency Medicine, University of Rochester, Rochester, New York
| | - Beau Abar
- Department of Emergency Medicine, University of Rochester, Rochester, New York
| | - Danielle D Durham
- Healthcare Delivery Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, Maryland
| | - Aveh Bastani
- Department of Emergency Medicine, William Beaumont Hospital, Troy Campus, Troy, Michigan
| | - Steven L Bernstein
- Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Christopher W Baugh
- Department of Emergency Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| | - Jason J Bischof
- Department of Emergency Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Christopher J Coyne
- Department of Emergency Medicine, University of California San Diego, San Diego, California
| | - Corita R Grudzen
- Ronald O. Perelman Department of Emergency Medicine and Population Health, New York University School of Medicine, New York, New York
| | - Daniel J Henning
- Department of Emergency Medicine, University of Washington, Seattle, Washington
| | - Matthew F Hudson
- Prisma Health-Upstate Cancer Institute, Greenville, South Carolina
| | - Adam Klotz
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Gary H Lyman
- Hutchinson Institute for Cancer Outcomes Research, Fred Hutchinson Cancer Research Center and the Department of Medicine, University of Washington School of Medicine, Seattle, Washington
| | - Troy E Madsen
- Division of Emergency Medicine, University of Utah, Salt Lake City, Utah
| | - Daniel J Pallin
- Department of Emergency Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| | - Cielito C Reyes-Gibby
- Department of Emergency Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Juan Felipe Rico
- Department of Pediatrics, University of South Florida Morsani College of Medicine, Tampa, Florida
| | - Richard J Ryan
- Department of Emergency Medicine, University of Cincinnati, Cincinnati, Ohio
| | - Nathan I Shapiro
- Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Robert Swor
- Department of Emergency Medicine, William Beaumont Hospital, Royal Oak, Michigan
| | - Charles R Thomas
- Department of Radiation Medicine, Knight Cancer Institute, Oregon Health and Sciences University, Portland, Oregon
| | - Arvind Venkat
- Department of Emergency Medicine, Allegheny Health Network, Pittsburgh, Pennsylvania
| | - Jason Wilson
- Department of Emergency Medicine, University of South Florida Morsani College of Medicine, Tampa, Florida
| | - Sai-Ching Jim Yeung
- Department of Emergency Medicine, Department of Endocrine Neoplasia and Hormonal Disorders, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Jeffrey M Caterino
- Department of Emergency Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio
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Hudson MF, O'Rourke MA, Blackhurst DW, Caldwell J, Horner RD. Clinical Work Intensity Among Medical Oncologists Practicing in National Community Oncology Research Program Community Sites. J Oncol Pract 2019; 15:e870-e877. [PMID: 31335248 DOI: 10.1200/jop.19.00132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE This study (1) assesses the level of clinical work intensity medical oncologists and oncologic nurse practitioners experience providing care and (2) identifies patient, provider, and practice factors mediating intensity. PATIENTS AND METHODS Seventeen medical oncologists (12 physicians and five nurse practitioners) from five national sites national reported on the level of work intensity associated with 339 patient visits. Data collection at each site occurred over a 2- to 6 week period; for each provider, five visits were randomly selected from each of 4 randomly selected clinic days, yielding 20 visits per provider. Intensity was measured by the NASA-Task Load Index. Patient and visit characteristics were abstracted from the medical record; provider characteristics were self-reported by questionnaire. RESULTS Clinical work intensity increased monotonically with level of service and was greatest when the visit involved discussion of either chemotherapy or terminal prognosis. Provider characteristics (including age, sex, and years of experience) were unrelated to intensity. Dimensions of work intensity that correlated directly with level of service included mental, physical, and temporal demand; effort; frustration; and stress. Perceptions of performance and of satisfaction with the visit were unrelated to level of service. Visits related to chemotherapy had greater mental, physical, and temporal demand, and effort, but worse perception of performance. When the visit involved a discussion of a terminal prognosis, greater intensity was reflected in all dimensions; stress was also greater, whereas visit satisfaction was significantly lower. CONCLUSION Clinical work intensity increases with level of service provided and is greater for visits involving discussion of either terminal prognosis or chemotherapy.
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Affiliation(s)
| | | | | | | | - Ronnie D Horner
- Arnold School of Public Health, University of South Carolina, Columbia, SC
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Wirth MD, Franco R, Wagner Robb S, Daniels K, Susko K, Hudson MF, O’Rourke MA. Randomized Controlled Trial of a 4-Week Mindfulness Intervention among Cancer Survivors Compared to a Breathing Control. Cancer Invest 2019; 37:227-232. [DOI: 10.1080/07357907.2019.1610968] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Michael D. Wirth
- College of Nursing, University of South Carolina, Columbia, SC, USA
- Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
- Cancer Prevention and Control Program, University of South Carolina, Columbia, SC, USA
| | - Regina Franco
- Center for Integrative Oncology and Survivorship, Cancer Institute Prisma Health, Greenville, SC, USA
| | - Sara Wagner Robb
- College of Behavioral, Social, and Health Sciences, Clemson University, Clemson, SC, USA
| | - Katie Daniels
- Center for Integrative Oncology and Survivorship, Cancer Institute Prisma Health, Greenville, SC, USA
| | - Kerri Susko
- Center for Integrative Oncology and Survivorship, Cancer Institute Prisma Health, Greenville, SC, USA
| | - Matthew F. Hudson
- Center for Integrative Oncology and Survivorship, Cancer Institute Prisma Health, Greenville, SC, USA
| | - Mark A. O’Rourke
- Center for Integrative Oncology and Survivorship, Cancer Institute Prisma Health, Greenville, SC, USA
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Caterino JM, Adler D, Durham DD, Yeung SCJ, Hudson MF, Bastani A, Bernstein SL, Baugh CW, Coyne CJ, Grudzen CR, Henning DJ, Klotz A, Madsen TE, Pallin DJ, Reyes-Gibby CC, Rico JF, Ryan RJ, Shapiro NI, Swor R, Venkat A, Wilson J, Thomas CR, Bischof JJ, Lyman GH. Analysis of Diagnoses, Symptoms, Medications, and Admissions Among Patients With Cancer Presenting to Emergency Departments. JAMA Netw Open 2019; 2:e190979. [PMID: 30901049 PMCID: PMC6583275 DOI: 10.1001/jamanetworkopen.2019.0979] [Citation(s) in RCA: 75] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
IMPORTANCE Better understanding of the emergency care needs of patients with cancer will inform outpatient and emergency department (ED) management. OBJECTIVE To provide a benchmark description of patients who present to the ED with active cancer. DESIGN, SETTING, AND PARTICIPANTS This multicenter prospective cohort study included 18 EDs affiliated with the Comprehensive Oncologic Emergencies Research Network (CONCERN). Of 1564 eligible patients, 1075 adults with active cancer were included from February 1, 2016, through January 30, 2017. Data were analyzed from February 1 through August 1, 2018. MAIN OUTCOMES AND MEASURES The proportion of patients reporting symptoms (eg, pain, nausea) before and during the ED visit, ED and outpatient medications, most common diagnoses, and suspected infection as indicated by ED antibiotic administration. The proportions observed, admitted, and with a hospital length of stay (LOS) of no more than 2 days were identified. RESULTS Of 1075 participants, mean (SD) age was 62 (14) years, and 51.8% were female. Seven hundred ninety-four participants (73.9%; 95% CI, 71.1%-76.5%) had undergone cancer treatment in the preceding 30 days; 674 (62.7%; 95% CI, 59.7%-65.6%) had advanced or metastatic cancer; and 505 (47.0%; 95% CI, 43.9%-50.0%) were 65 years or older. The 5 most common ED diagnoses were symptom related. Of all participants, 82 (7.6%; 95% CI, 6.1%-9.4%) were placed in observation and 615 (57.2%; 95% CI, 54.2%-60.2%) were admitted; 154 of 615 admissions (25.0%; 95% CI, 21.7%-28.7%) had an LOS of 2 days or less (median, 3 days; interquartile range, 2-6 days). Pain during the ED visit was present in 668 patients (62.1%; 95% CI, 59.2%-65.0%; mean [SD] pain score, 6.4 [2.6] of 10.0) and in 776 (72.2%) during the prior week. Opioids were administered in the ED to 228 of 386 patients (59.1%; 95% CI, 18.8%-23.8%) with moderate to severe ED pain. Outpatient opioids were prescribed to 368 patients (47.4%; 95% CI, 3.14%-37.2%) of those with pre-ED pain, including 244 of 428 (57.0%; 95% CI, 52.2%-61.8%) who reported quite a bit or very much pain. Nausea in the ED was present in 336 (31.3%; 95% CI, 28.5%-34.1%); of these, 160 (47.6%; 95% CI, 12.8%-17.1%) received antiemetics in the ED. Antibiotics were administered in the ED to 285 patients (26.5%; 95% CI, 23.9%-29.2%). Of these, 209 patients (73.3%; 95% CI, 17.1%-21.9%) were admitted compared with 427 of 790 (54.1%; 95% CI, 50.5%-57.6%) not receiving antibiotics. CONCLUSIONS AND RELEVANCE This initial prospective, multicenter study profiling patients with cancer who were treated in the ED identifies common characteristics in this patient population and suggests opportunities to optimize care before, during, and after the ED visit. Improvement requires collaboration between specialists and emergency physicians optimizing ED use, improving symptom control, avoiding unnecessary hospitalizations, and appropriately stratifying risk to ensure safe ED treatment and disposition of patients with cancer.
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Affiliation(s)
- Jeffrey M. Caterino
- Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus
- Department of Emergency Medicine, The Ohio State University Wexner Medical Center, Columbus
| | - David Adler
- Department of Emergency Medicine, University of Rochester, Rochester, New York
| | - Danielle D. Durham
- Healthcare Delivery Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, Maryland
| | - Sai-Ching Jim Yeung
- Department of Endocrine Neoplasia and Hormonal Disorders, The University of Texas MD Anderson Cancer Center, Houston
- Department of Emergency Medicine, The University of Texas MD Anderson Cancer Center, Houston
| | - Matthew F. Hudson
- Greenville Health System Cancer Institute, Greenville, South Carolina
| | - Aveh Bastani
- Department of Emergency Medicine, William Beaumont Hospital–Troy Campus, Troy, Michigan
| | - Steven L. Bernstein
- Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Christopher W. Baugh
- Department of Emergency Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
| | | | - Corita R. Grudzen
- Ronald O. Perelman Department of Emergency Medicine and Population Health, New York University School of Medicine, New York
| | | | - Adam Klotz
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Troy E. Madsen
- Division of Emergency Medicine, University of Utah, Salt Lake City
| | - Daniel J. Pallin
- Department of Emergency Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Cielito C. Reyes-Gibby
- Department of Emergency Medicine, The University of Texas MD Anderson Cancer Center, Houston
| | - Juan Felipe Rico
- Department of Pediatrics, University of South Florida Morsani College of Medicine, Tampa
| | - Richard J. Ryan
- Department of Emergency Medicine, University of Cincinnati, Cincinnati, Ohio
| | - Nathan I. Shapiro
- Department of Emergency Medicine, Beth Israel Deaconness Medical Center, Boston, Massachusetts
| | - Robert Swor
- Department of Emergency Medicine, William Beaumont Hospital, Royal Oak, Michigan
| | - Arvind Venkat
- Department of Emergency Medicine, Allegheny Health Network, Pittsburgh, Pennsylvania
| | - Jason Wilson
- Department of Emergency Medicine, University of South Florida Morsani College of Medicine, Tampa
| | - Charles R. Thomas
- Department of Radiation Medicine, Knight Cancer Institute, Oregon Health & Sciences University, Portland
| | - Jason J. Bischof
- Department of Emergency Medicine, The Ohio State University Wexner Medical Center, Columbus
| | - Gary H. Lyman
- Hutchinson Institute for Cancer Outcomes Research, Fred Hutchinson Cancer Research Center, Department of Medicine, University of Washington School of Medicine, Seattle
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Hudson MF, O'Rourke MA, Blackhurst DW, Caldwell J, Franco RA, Russ-Sellers R, Horner R. Clinical work intensity among medical oncologists. J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.30_suppl.118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
118 Background: Oncology faces workforce shortages and increasing stress. Oncology provider well-being and resilience are mediated by organizational factors through clinical work intensity. Clinical work intensity (CWI) is the level of requisite technical skill, physical and mental effort and clinical judgement necessary, plus care provision-associated stress. Suboptimal clinical work intensity may result from unfavorable practice organizational factors preceding burnout. This pilot study assess CWI experienced by medical oncologists and oncologic advanced practice registered nurses (APRNs)/nurse practitioners as a prelude to a study of provider resilience. Methods: Investigators solicited seventeen medical oncologists-12 physicians and 5 nurse practitioners-from five oncology clinics in the Northwest, Midwest, and Southern regions of the United States Providers reported on level of work intensity associated with 339 patient visits occurring over an 8 week period where for each provider 5 visits were randomly selected from each of 4 randomly selected clinic days. Intensity was measured by the NASA-Task Load Index that assesses 6 dimensions (subscales) with additional questions measuring stress and visit satisfaction. Results: Compared to medical oncologists, APRNs reported a higher work intensity score on average (38.6 vs. 32.9; p < 0.0064), and higher scores on the frustration subscale (36.5 vs. 21.5; p < 0.0001). APRNs also scored higher on stress (27.8 vs. 22.2; p < 0.048), and scored lower on provider-perceived satisfaction with the visit (73.0 vs. 81.1; p < 0.0001). There was no difference between oncologists and nurse practitioners on the other dimensions, including mental, time, and physical demand, and effort. Conclusions: Oncologic APRNs may experience greater work intensity than medical oncologists. Future research will consider whether APRN work intensity scores reflect different or disproportionate challenges owing to scope of practice, workload, or administrative responsibilities, and determine those dimensions of higher work intensity that portend provider burnout. The goal is to identify strategies optimizing work intensity among oncology providers, mitigating provider burnout and enhancing the practice environment.
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Affiliation(s)
| | | | | | | | - Regina A. Franco
- Center for Integrative Oncology and Survivorship, Greenville Health System Cancer Institute, Greenville, SC
| | | | - Ronnie Horner
- University of South Carolina Arnold School of Public Health, Columbia, SC
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Affiliation(s)
- Mark A O'Rourke
- Greenville Health System, Greenville, SC; and Washington DC Veterans Affairs Medical Center, Washington, DC
| | - M Colleen O'Rourke
- Greenville Health System, Greenville, SC; and Washington DC Veterans Affairs Medical Center, Washington, DC
| | - Matthew F Hudson
- Greenville Health System, Greenville, SC; and Washington DC Veterans Affairs Medical Center, Washington, DC
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Abstract
Introduction: This study assessed health providers’ perceptions of factors related to professional interpretation services and the association between these factors and the potential use of ad hoc interpreters. Method: Data were collected from a convenience sample of 150 health services providers at a large, regional health system in South Carolina. Results: Providers rated “ability to communicate effectively during a clinical encounter” as paramount regarding the use of interpretation services. The most important factors related to the likely use of ad hoc interpreters (cutting corners) included locating a qualified interpreter, having to wait for a qualified interpreter, and technical difficulties regarding phone and video technology. Conclusion: Health care organizations may benefit from increasing staff awareness about patient safety and legal and regulatory risks involved with the use of ad hoc interpreters.
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Hudson MF. A primer of research strategies undertaken in health centers. J Multidiscip Healthc 2013; 6:93-8. [PMID: 23526168 PMCID: PMC3603335 DOI: 10.2147/jmdh.s42322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
This discussion defines various research approaches undertaken in health care or health promotion settings, notably basic science research, translational research, comparative effectiveness research (CER), implementation sciences, and quality improvement. This discussion particularly clarifies the relationship between translational research implementation sciences, comparative effectiveness research (CER), and quality improvement; this discussion further notes how these particular efforts are included in the Health Service Research. The discussion may: (1) introduce novice researchers, practitioners and administrators to various research approaches, (2) establish shared language that enhances comprehension of research strategies sharing similar attributes, and (3) clarify future research direction and resource allocation for health researchers, administrators, and practitioners.
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Hughes MD, Wu J, Williams TC, Loberger JM, Hudson MF, Burdine JR, Wagner PJ. The experience of headaches in health care workers: opportunity for care improvement. Headache 2013; 53:962-9. [PMID: 23463958 DOI: 10.1111/head.12069] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/05/2013] [Indexed: 11/28/2022]
Abstract
OBJECTIVE/BACKGROUND This study assessed the relationship between health care workers' self-reported experience of headaches/migraines, their overall quality of life, and treatment outcomes. METHODS The study sample consisted of adults employed by a self-insured hospital system located in the Southeast United States. Study participants responded to a web-based survey disseminated via work email accounts. The survey measured headache medication use, health care service utilization, and impacts on quality of life and treatment optimization using standardized instruments. RESULTS We received responses from 2453 employees (response rate 33.8%), of which 84.4% reported headaches, suggesting that those with headaches were more likely to complete the survey. Forty percent of respondents reported mild to severe disability due to headaches, and approximately 65% used prescription or over-the-counter medications to treat headaches. Approximately 45% of participants taking headache medications reported unsatisfactory treatment. Among all respondents, those with mild, moderate, or severe migraine disability were 2.35, 1.7, or 2.08 times more likely to take headache medications than those with little or no migraine disability. Among those taking headache medications for treatment, respondents with nonclinical job titles, presenting better physical health status, or reporting little or no migraine disability were more likely to achieve treatment optimization. CONCLUSIONS Recognizing the potential over response by employees who have headaches, our study remains suggestive of a care improvement opportunity in the health care workforce.
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Affiliation(s)
- Mary D Hughes
- Division of Neurology, Department of Medicine, Greenville Hospital System, University Medical Group, Greenville, SC, USA
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O’Rourke MA, Hudson MF, Craig JB, Ropp JC, Reeves K. Physician order for scope of treatment (POST) in South Carolina (SC). J Clin Oncol 2012. [DOI: 10.1200/jco.2012.30.34_suppl.21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
21 Background: Physician Order for Life-Sustaining Treatment (POLST, www.POLST.org ) is a process and tool that translates patients’ goals of care into medical orders in a highly visible, portable way. Trained providers meet with seriously ill patients (or the surrogates) and discuss the available treatment options in light of their current condition, and help clarify the patient’s preferences. The physician then documents those preferences on a standardized medical order form, which travels with the patient if he or she changes settings of care. The POLST form is 1. a physician order, 2. signed by the patient, 3. after consultation with the physician, 4. facilitated by a person trained in advance care planning, 5. directed toward people with serious, chronic illness such that death in the next year would not be a surprise, 6. addressing the decision at a moment of medical crisis to a. hospitalize with full therapeutic intervention, or b. hospitalize with limited therapeutic intervention (such as no CPR), or c. provide supportive, palliative care in the present setting (home or nursing facility), 1. addressing further decisions such as feeding tube, parenteral (IV) hydration, or antibiotics, 2. documented in a widely publicized, recognized and understood form with a distinct pink color, and 3. accepted by EMS responders, hospices, nursing facilities, and hospitals across the state. Methods: The SC Coalition for the Care of the Seriously Ill is comprised of clinical and administrative leaders representing key statewide organizational partners, healthcare entities, and individuals. The Coalition proposes a template order for statewide integration to be called POST. The target population is persons with serious illness for whom death in the next year would “not be a surprise.” Results: Presently, the Coalition is working with state government to undertake a three-county pilot study of POST. Challenges include creating a legal framework, IRB approval, and education of providers and the public. Conclusions: POST may facilitate patient-centered advanced cancer care. Implementation of the POST in SC will require collaboration by stakeholders. Collaboration will require responsiveness to constituents’ concerns in order to facilitate patient-centered care.
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Affiliation(s)
| | - Matthew F. Hudson
- Greenville Hospital System University Medical Center, Greenville, SC
| | | | - John C. Ropp
- South Carolina Medical Association, Columbia, SC
| | - Karen Reeves
- South Carolina Hospital Association, Columbia, SC
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O’Rourke MA, Franco RA, Blackhurst DW, Trilk JC, Hudson MF, Gluck WL. Supervised exercise for cancer survivors during and after active therapy. J Clin Oncol 2012. [DOI: 10.1200/jco.2012.30.34_suppl.121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
121 Background: Supervised exercise for cancer survivors can reduce symptoms and improve physical conditioning. This program evaluation reports the benefits of a nurse-supervised exercise program for cancer survivor participants both during and after active cancer therapy. Methods: The treating oncologist referred participants to the oncology rehabilitation program, called Moving On, either during or at the completion of active therapy. Participants enrolled in a 12-week program of supervised exercise for one hour, three days per week. Baseline and follow up evaluation included a patient reported fatigue score, on a scale from 1 to 10 (with higher scores indicating more fatigue), and the 6-minute walk test (6MWT), in feet. Results: In calendar 2011, 152 participants enrolled in the program and 91 completed all 12 weeks (completers). Participants were 71% female, 86% Caucasian, 14% African American, 68% enrolled on completion of active therapy, and 32% enrolled during active therapy. More than half were older than 60 years. More than half had cancer diagnoses other than breast cancer. A consistent decrease in fatigue and increase in exercise capacity was seen in subgroup analysis by gender, race, age, status on cancer therapy or after completion of therapy, and diagnosis. Conclusions: In this diverse group of cancer survivors, a program of 12 weeks of nurse-supervised exercise was feasible, substantially reduced fatigue, and increased exercise capacity. It is noteworthy that participants, both on active therapy and after, older and younger, and across diagnosis groups, experienced the benefits of the program. [Table: see text]
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Affiliation(s)
| | - Regina A Franco
- Greenville Hospital System University Medical Center, Greenville, SC
| | | | - Jennifer C. Trilk
- University of South Carolina School of Medicine-Greenville, Greenville, SC
| | - Matthew F. Hudson
- Greenville Hospital System University Medical Center, Greenville, SC
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Wagner PJ, Dias J, Howard S, Kintziger KW, Hudson MF, Seol YH, Sodomka P. Personal health records and hypertension control: a randomized trial. J Am Med Inform Assoc 2012; 19:626-34. [PMID: 22234404 DOI: 10.1136/amiajnl-2011-000349] [Citation(s) in RCA: 83] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
PURPOSE To examine the impact of a personal health record (PHR) in patients with hypertension measured by changes in biological outcomes, patient empowerment, patient perception of quality of care, and use of medical services. METHODS A cluster-randomized effectiveness trial with PHR and no PHR groups was conducted in two ambulatory clinics. 453 of 1686 (26.4%) patients approached were included in the analyses. A PHR tethered to the patient's electronic medical record (EMR) was the primary intervention and included security measures, patient control of access, limited transmission of EMR data, blood pressure (BP) tracking, and appointment assistance. BP was the main outcome measure. Patient empowerment was assessed using the Patient Activation Measure and Patient Empowerment Scale. Quality of care was assessed using the Clinician and Group Assessment Score (CAHPS) and the Patient Assessment of Chronic Illness Care. Frequency of use of medical services was self-reported. RESULTS No impact of the PHR was observed on BP, patient activation, patient perceived quality, or medical utilization in the intention-to-treat analysis. Sub-analysis of intervention patients self-identified as active PHR users (25.7% of those with available information) showed a 5.25-point reduction in diastolic BP. Younger age, self-reported computer skills, and more positive provider communication ratings were associated with frequency of PHR use. CONCLUSIONS Few patients provided with a PHR actually used the PHR with any frequency. Thus simply providing a PHR may have limited impact on patient BP, empowerment, satisfaction with care, or use of health services without additional education or clinical intervention designed to increase PHR use. CLINICAL TRIAL REGISTRATION NUMBER http://ClinicalTrials.gov Identifier: NCT01317537.
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Affiliation(s)
- Peggy J Wagner
- School of Medicine, Department of Family Medicine, Georgia Health Sciences University, Augusta, Georgia, USA.
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Wu J, Hughes MD, Hudson MF, Wagner PJ. Antimigraine medication use and associated health care costs in employed patients. J Headache Pain 2011; 13:121-7. [PMID: 22127427 PMCID: PMC3274581 DOI: 10.1007/s10194-011-0405-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2011] [Accepted: 11/16/2011] [Indexed: 01/13/2023] Open
Abstract
Migraine is under diagnosed and suboptimally treated in the majority of patients, and also associated with decreased productivity in employees. The objective of this retrospective study is to assess the antimigraine medication use and associated resource utilization in employed patients. Patients with primary diagnosis of migraine or receiving antimigraine prescription drugs were identified from an employer-sponsored health insurance plan in 2010. Medical utilization and health care costs were determined for the year of 2010. Generalized linear regression was applied to evaluate the association between health care costs and the use of antimigraine medications by controlling covariates. Of 465 patients meeting the study criteria, nearly 30% that had migraine diagnosis were prescribed antimigraine medications, and 20% that had migraine diagnosis were not prescribed antimigraine medications. The remaining 50% were prescribed antimigraine medications but did not have migraine diagnosis. Patients with antimigraine medication prescriptions showed lower frequency of emergency department visits than those without antimigraine medication prescriptions. Regression models indicated an increase in migraine-related health care costs by 86% but decreases in all-cause medical costs and total health care costs by 42 and 26%, respectively, in the antimigraine medication use group after adjusting for covariates. Employed patients experienced inadequate pharmacotherapy for migraine treatment. After controlling for covariates, antimigraine prescription drug use was associated with lower total medical utilization and health care costs. Further studies should investigate patient self-reported care and needs to manage headache and develop effective intervention to improve patient quality of life and productivity.
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Affiliation(s)
- Jun Wu
- South Carolina College of Pharmacy, University of South Carolina, Health Sciences Administration Bldg (MIPH), 701 Grove Road, Greenville, SC 29607, USA.
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Silverman J, Hudson MF. Elder mistreatment. A guide for medical professionals. N C Med J 2000; 61:291-6. [PMID: 11008461] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
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Abstract
In order to gain a greater understanding of what "elder abuse" means to the American public, a random sample of adults from seven culturally diverse counties in North Carolina was interviewed. Two of the six Native American groups residing in North Carolina were represented in the sample. The two Native American groups' responses were compared with each other and with the views of a panel of elder mistreatment experts. There were areas of agreement and disagreement. The relevance of the findings is discussed in relation to research, practice, education, and policy.
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Affiliation(s)
- M F Hudson
- Department of Adult and Geriatric Health, School of Nursing, University of North Carolina at Chapel Hill 27599-7460, USA.
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Hudson MF. Elder mistreatment: its relevance to older women. J Am Med Womens Assoc (1972) 1997; 52:142-6, 158. [PMID: 9240004] [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] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Elder mistreatment, both abuse and neglect, is an important health care problem for women since they are involved as victims and as perpetrators. The incidence of both forms of such mistreatment is increasing, and both often occur within the context of long-term care. Elder abuse occurs in both unidirectional and dual directional forms, and includes parent abuse and spouse abuse. Elder neglect occurs in two forms; neglect by others and self-neglect. While elderly men and women are both neglected and/or abused, women may suffer greater physical and psychological consequences. To date, researchers have inadequately addressed the relevance of gender to both forms of elder mistreatment. This literature review addresses what is currently known about elder abuse and neglect that is of particular relevance to older women.
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Affiliation(s)
- M F Hudson
- University of North Carolina at Chapel Hill, USA
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Hudson MF. How often can antihypertensive treatment be discontinued? J Hum Hypertens 1988; 2:65-9. [PMID: 3072421] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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Hackett GI, Hudson MF, Wylie JB, Jackson AD, Small KM, Harrison P, O'Brien J, Harrison P. Evaluation of the efficacy and acceptability to patients of a physiotherapist working in a health centre. Br Med J (Clin Res Ed) 1987; 294:24-6. [PMID: 3101786 PMCID: PMC1245044 DOI: 10.1136/bmj.294.6563.24] [Citation(s) in RCA: 27] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
The records of the first 805 patients who had been referred by general practitioners at this health centre to the attached physiotherapist were examined in November 1985, three years after the physiotherapy department was opened. Seventy per cent (549) of the patients had been treated within one week, treatment having started on the same day for 8.5% (67) of the patients. This compares with a mean of six weeks for direct access to a district general hospital that is eight miles away and between six and 13 months for the three nearest orthopaedic consultants who are 13 miles away. The most common conditions treated were knee injuries (16.5%), followed by cervical (15.5%) and shoulder (13.8%) injuries. Surprisingly, only 9% were back injuries. The non-attendance rate was 2.2% and only 7% of patients failed to complete treatment. Nearly all the patients were able to attend the clinic, only 4% requiring home treatment. By March 1986, 90 treatments a week were being carried out at a cost of 6.11 pounds per patient. Compared with official hospital figures, this represents a savings of 21,500 pounds a year for a practice of 12,000 patients.
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Hudson MF. Drugs and the older adult, take special care. Nursing 1984; 14:47-51. [PMID: 6565205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2023]
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