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Walsh CA, Miller SJ, Smith CB, Prigerson HG, McFarland D, Yarborough S, Santos CDL, Thomas R, Czaja SJ, RoyChoudhury A, Chapman-Davis E, Lachs M, Shen MJ. Acceptability and usability of the Planning Advance Care Together (PACT) website for improving patients' engagement in advance care planning. PEC Innov 2024; 4:100245. [PMID: 38145252 PMCID: PMC10733677 DOI: 10.1016/j.pecinn.2023.100245] [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] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Revised: 12/06/2023] [Accepted: 12/07/2023] [Indexed: 12/26/2023]
Abstract
Objectives Most prior advance care planning (ACP) interventions lack integration of the social context of patients' ACP process, which patients indicate is critically important. The current study developed the Planning Advance Care Together (PACT) website to foster inclusion of loved ones in the ACP process. Methods To provide feedback about the PACT website, patients with advanced cancer (N = 11), their caregivers (N = 11), and experts (N = 10) participated in semi-structured interviews. Patients and caregivers also completed standardized ratings of acceptability and usability. Results Overall, patient (n = 11) and caregiver (n = 11) ratings of acceptability and usability of the website exceeded benchmark cut-offs (≥24 on the Acceptability E-Scale and ≥ 68 on the System Usability Scale). Patients, caregivers, and experts liked the topic of ACP but felt that it could be emotionally challenging. They recommended focusing more on planning and less on end of life. They appreciated being able to include loved ones and recommended adding resources for caregivers. Conclusions Study findings support the preliminary usability and acceptability of the PACT website. Findings will be used to inform a modified prototype of the PACT website that is interactive and ready for field testing with patients with advanced cancer and their loved ones. Innovation We utilized a novel application of the shared mind framework to support patients with advanced cancer in engaging their loved ones in the ACP process.
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Affiliation(s)
- Casey A. Walsh
- Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, WA, United States of America
| | - Sarah J. Miller
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, United States of America
| | - Cardinale B. Smith
- Division of Hematology and Medical Oncology, Division of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, United States of America
| | - Holly G. Prigerson
- Department of Medicine, Cornell Center for Research on End-of-Life Care, Weill Cornell Medical College, New York, NY, United States of America
| | - Daniel McFarland
- Department of Psychiatry, Wilmot Cancer Center, University of Rochester Medical Center, Rochester, NY, United States of America
| | - Sarah Yarborough
- Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, WA, United States of America
| | - Claudia De Los Santos
- Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, WA, United States of America
| | - Robert Thomas
- Division of General Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, United States of America
| | - Sara J. Czaja
- Division of Geriatrics and Palliative Medicine, Center on Aging and Behavioral Research, Weill Cornell Medicine, New York, NY, United States of America
| | - Arindam RoyChoudhury
- Department of Population Health Sciences, Weill Cornell Medical College, New York, NY, United States of America
| | - Eloise Chapman-Davis
- Division of Obstetrics and Gynecology, Weill Cornell Medical College, New York, NY, United States of America
| | - Mark Lachs
- Department of Medicine, Weill Cornell Medical College, New York, NY, United States of America
- Geriatrics and Palliative Medicine, New York Presbyterian Health Care System, United States of America
| | - Megan J. Shen
- Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, WA, United States of America
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Shen MJ, Wang MT, Jiang WX, Wu ZF, Chen QM. [Research progress in regional odontodysplasia]. Zhonghua Kou Qiang Yi Xue Za Zhi 2024; 59:512-516. [PMID: 38637007 DOI: 10.3760/cma.j.cn112144-20240129-00043] [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: 04/20/2024]
Abstract
Regional odontodysplasia (ROD) is a rare localized dental developmental anomaly. The typical clinical manifestations of ROD are abnormal tooth eruption, abnormal development of enamel and dentin. The radiographic characteristic is "ghost teeth". Its etiology still remains unknown. The care and treatment of a patient with ROD needs a multidisciplinary approach. And the treatment should be taken after the assessment of each individual case of ROD. This paper reviews the definition, etiology, epidemiological features, clinical manifestations, imaging features, dental microstructure and treatment strategies of ROD to provide reference for clinical diagnosis and treatment.
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Affiliation(s)
- M J Shen
- Department of Pediatric Stomatology, Stomatology Hospital, School of Stomatology, Zhejiang University School of Medicine & Clinical Research Center for Oral Diseases of Zhejiang Province & Key Laboratory of Oral Biomedical Research of Zhejiang Province & Cancer Center of Zhejiang University, Hangzhou 310006, China
| | - M T Wang
- Department of Pediatric Stomatology, Stomatology Hospital, School of Stomatology, Zhejiang University School of Medicine & Clinical Research Center for Oral Diseases of Zhejiang Province & Key Laboratory of Oral Biomedical Research of Zhejiang Province & Cancer Center of Zhejiang University, Hangzhou 310006, China
| | - W X Jiang
- Department of Pediatric Stomatology, Stomatology Hospital, School of Stomatology, Zhejiang University School of Medicine & Clinical Research Center for Oral Diseases of Zhejiang Province & Key Laboratory of Oral Biomedical Research of Zhejiang Province & Cancer Center of Zhejiang University, Hangzhou 310006, China
| | - Z F Wu
- Department of Pediatric Stomatology, Stomatology Hospital, School of Stomatology, Zhejiang University School of Medicine & Clinical Research Center for Oral Diseases of Zhejiang Province & Key Laboratory of Oral Biomedical Research of Zhejiang Province & Cancer Center of Zhejiang University, Hangzhou 310006, China
| | - Q M Chen
- Stomatology Hospital, School of Stomatology, Zhejiang University School of Medicine & Clinical Research Center for Oral Diseases of Zhejiang Province & Key Laboratory of Oral Biomedical Research of Zhejiang Province & Cancer Center of Zhejiang University, Hangzhou 310006, China
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3
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McConnell KM, Shen MJ. The need for multilevel supportive care infrastructure for cancer caregivers. Cancer 2024. [PMID: 38567689 DOI: 10.1002/cncr.35303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2024]
Abstract
Communication with cancer caregivers occurs in the broader multilevel context of oncology care. Improving communication with caregivers requires changes across multiple levels of this context.
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Affiliation(s)
- Kelly M McConnell
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Megan J Shen
- Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, Washington, USA
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4
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Torres-Blasco N, Peña-Vargas C, Costas-Muñiz R, Rosario-Ramos L, Shen MJ, Castro E. Psychosocial symptoms associated with spiritual well-being in Latino patients and caregivers coping with advanced cancer. Support Care Cancer 2024; 32:195. [PMID: 38411749 DOI: 10.1007/s00520-024-08360-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Accepted: 02/09/2024] [Indexed: 02/28/2024]
Abstract
PURPOSE The objective of this study was to investigate the relationship among hopelessness, anxiety, and depression, with spiritual well-being in patients and family caregivers. METHODS A cross-sectional survey was administered to patients (n = 57) and caregivers (n = 57) that incorporated assessments that measured spiritual well-being, depression, anxiety, hopelessness, quality of life, family relationship, burden, fatalism, religiosity, and distress. Logistic regression and cross-tabulation analyses were conducted to examine the relationship between hopelessness, anxiety, and depression, with spiritual well-being. Logistic regression was used to quantify the impact of spiritual well-being on anxiety, depression, and hopelessness. Additionally, cross-tabulations with chi-square tests were conducted to explore associations between severity of hopelessness and severity of anxiety and depression. RESULTS Logistic regression analyses showed negative associations between spiritual well-being and mental health outcomes, although not all findings were statistically significant. Among caregivers, a significant negative relationship was observed for depression (B = - 0.161, p = 0.022). Hopelessness also exhibited a negative association with spiritual well-being among caregivers (B = - 0.099, p = 0.054) and patients (B = - .152, p = 0.038). Cross-tabulations highlighted significant associations in the severity of hopelessness symptoms with anxiety and depression levels among caregivers (p < .001). CONCLUSION Results reveal a relationship among psychosocial symptoms among Latino patient-caregivers coping with cancer. By emphasizing spiritual well-being, hopelessness, and anxiety and involving family patients and caregivers in the treatment process as a unit of care. Also, it indicates the need to develop culturally tailored interventions that aim to provide valuable assistance to Latino patients and caregivers coping with cancer.
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Grants
- 5G12MD007579, 5R25MD007607, R21MD013674, and 5U54MS007579-35 National Institute of Minority Health and Health Disparities
- 5G12MD007579, 5R25MD007607, R21MD013674, and 5U54MS007579-35 National Institute of Minority Health and Health Disparities
- 5G12MD007579, 5R25MD007607, R21MD013674, and 5U54MS007579-35 National Institute of Minority Health and Health Disparities
- 5G12MD007579, 5R25MD007607, R21MD013674, and 5U54MS007579-35 National Institute of Minority Health and Health Disparities
- 5G12MD007579, 5R25MD007607, R21MD013674, and 5U54MS007579-35 National Institute of Minority Health and Health Disparities
- 5G12MD007579, 5R25MD007607, R21MD013674, and 5U54MS007579-35 National Institute of Minority Health and Health Disparities
- 2U54CA163071 and 2U54CA163068), R21CA180831-02 , , 5K08CA234397-01A1 National Cancer Institute National Cancer Institute
- 2U54CA163071 and 2U54CA163068), R21CA180831-02 , , 5K08CA234397-01A1 National Cancer Institute National Cancer Institute
- 2U54CA163071 and 2U54CA163068), R21CA180831-02 , , 5K08CA234397-01A1 National Cancer Institute National Cancer Institute
- 2U54CA163071 and 2U54CA163068), R21CA180831-02 , , 5K08CA234397-01A1 National Cancer Institute National Cancer Institute
- P30CA008748 Memorial Sloan Kettering Cancer Center
- P30CA008748 Memorial Sloan Kettering Cancer Center
- P30CA008748 Memorial Sloan Kettering Cancer Center
- P30CA008748 Memorial Sloan Kettering Cancer Center
- 133798-PF-19-120-01-CPPB American Cancer Society
- 133798-PF-19-120-01-CPPB American Cancer Society
- 133798-PF-19-120-01-CPPB American Cancer Society
- 133798-PF-19-120-01-CPPB American Cancer Society
- 133798-PF-19-120-01-CPPB American Cancer Society
- 5U54MS007579-35 by National Institute of Minority Health and Health Disparities
- 5U54MS007579-35 by National Institute of Minority Health and Health Disparities
- 5U54MS007579-35 by National Institute of Minority Health and Health Disparities
- 5U54MS007579-35 by National Institute of Minority Health and Health Disparities
- 5U54MS007579-35 by National Institute of Minority Health and Health Disparities
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Affiliation(s)
- Normarie Torres-Blasco
- School of Behavioral and Brain Sciences, Ponce Health Sciences University, Ponce, Puerto Rico.
- Ponce's Research Institute, Ponce Health Sciences University, Ponce, Puerto Rico.
| | - Cristina Peña-Vargas
- Ponce's Research Institute, Ponce Health Sciences University, Ponce, Puerto Rico
| | - Rosario Costas-Muñiz
- Department of Psychiatry & Behavioral Sciences, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - Lianel Rosario-Ramos
- School of Behavioral and Brain Sciences, Ponce Health Sciences University, Ponce, Puerto Rico
| | - Megan J Shen
- Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, WA, USA
| | - Eida Castro
- School of Behavioral and Brain Sciences, Ponce Health Sciences University, Ponce, Puerto Rico
- Ponce's Research Institute, Ponce Health Sciences University, Ponce, Puerto Rico
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5
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Shen MJ, Prigerson HG, Maciejewski PK, Daly B, Adelman R, McConnell Trevino KM. A communication intervention to improve prognostic understanding and engagement in advance care planning among diverse advanced cancer patient-caregiver dyads: A pilot study. Palliat Support Care 2024; 22:10-18. [PMID: 37526150 PMCID: PMC10901460 DOI: 10.1017/s1478951523000901] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/02/2023]
Abstract
OBJECTIVES Accurate prognostic understanding among patients with advanced cancer and their caregivers is associated with greater engagement in advance care planning (ACP) and receipt of goal-concordant care. Poor prognostic understanding is more prevalent among racial and ethnic minority patients. The purpose of this study was to examine the feasibility, acceptability, and impact of a patient-caregiver communication-based intervention to improve prognostic understanding, engagement in ACP, and completion of advance directives among a racially and ethnically diverse, urban sample of patients and their caregivers. METHODS Patients with advanced cancer and their caregivers (n = 22 dyads) completed assessments of prognostic understanding, engagement in ACP, and completion of advance directives at baseline and post-intervention, Talking About Cancer (TAC). TAC is a 7-session intervention delivered remotely by licensed social workers that includes distress management and communication skills, review of prognosis, and information on ACP. RESULTS TAC met a priori benchmarks for feasibility, acceptability, and fidelity. Prognostic understanding and engagement in ACP did not change over time. However, patients showed increases in completion of advance directives. SIGNIFICANCE OF RESULTS TAC was feasible, acceptable, and delivered with high fidelity. Involvement of caregivers in TAC may provide added layers of support to patients facing advanced cancer diagnoses, especially among racial and ethnic minorities. Trends indicated greater completion of advance directives but not in prognostic understanding or engagement in ACP. Future research is needed to optimize the intervention to improve acceptability, tailor to diverse patient populations, and examine the efficacy of TAC in a randomized controlled trial.
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Affiliation(s)
- Megan J Shen
- Division of Clinical Research, Fred Hutchinson Cancer Center, Seattle, WA, USA
| | - Holly G Prigerson
- Department of Medicine, Weill Cornell Medical College, New York, NY, USA
| | - Paul K Maciejewski
- Department of Radiology, Weill Cornell Medical College, New York, NY, USA
| | - Bobby Daly
- Thoracic Oncology Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Ronald Adelman
- Department of Medicine, Weill Cornell Medical College, New York, NY, USA
| | - Kelly M McConnell Trevino
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, USA
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6
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Walsh CA, Good J, Ismaiel A, Yarborough S, Shen MJ. Development and refinement of a novel end-of-life planning website for patients with advanced cancer: a mixed methods approach. Support Care Cancer 2023; 31:695. [PMID: 37962689 DOI: 10.1007/s00520-023-08153-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Accepted: 10/31/2023] [Indexed: 11/15/2023]
Abstract
PURPOSE Despite known benefits of planning for end-of-life, no digital tool exists to help patients with advanced cancer and their loved ones plan for death comprehensively. To address this unmet need, we developed a preliminary version of an innovative website to help patients with advanced cancer prepare for end-of-life tasks. METHODS Guided by the Obesity-Related Behavioral Intervention Trials (ORBIT) model for behavioral intervention development, patients with advanced cancer (n = 10) and their caregivers (n = 10) participated in a "Think Aloud" exercise and usability protocols to optimize the end-of-life planning website. The website was iteratively refined throughout the study in collaboration with the partnering company, Peacefully, Inc. Participants also completed the Acceptability E-Scale and System Usability Scale, with a priori benchmarks established for acceptability (scores of ≥ 24 on the Acceptability E-Scale) and usability (scores of ≥ 68 on the System Usability Scale). RESULTS Patients (N = 10) and caregivers (N = 10) completed usability testing. Patients were majority female (80%), White (100%), and had a mean age of 58 years. Caregivers (N = 10) were majority male (60%), spouse/partner (90%), White (90%), and had a mean age of 59 years. For patients, a priori hypotheses were met for both acceptability (mean score of 24.7, SD = 4.35) and usability (mean score of 73.8, SD = 6.15). For caregivers, acceptability was just below the cutoff (mean score of 22.9, SD = 4.07) and usability exceeded the cutoff (mean score of 70.0, SD = 8.42). Overall, patients and caregivers reported high levels of satisfaction and found the website helpful, with specific suggestions for changes (e.g., add more information about information security, improve text legibility). CONCLUSIONS The findings from this study will inform modifications to optimize an innovative website to support patients with advanced cancer to prepare holistically for end-of-life tasks.
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Affiliation(s)
- Casey A Walsh
- Clinical Research Division, Fred Hutchinson Cancer Center, 1100 Fairview Ave N., Seattle, WA, 98109, USA
| | | | - Anas Ismaiel
- Clinical Research Division, Fred Hutchinson Cancer Center, 1100 Fairview Ave N., Seattle, WA, 98109, USA
| | - Sarah Yarborough
- Clinical Research Division, Fred Hutchinson Cancer Center, 1100 Fairview Ave N., Seattle, WA, 98109, USA
| | - Megan J Shen
- Clinical Research Division, Fred Hutchinson Cancer Center, 1100 Fairview Ave N., Seattle, WA, 98109, USA.
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Hmaidan S, Goulder A, Bos L, Shen MJ, Wellman JD, Prescott L, Brown A. Too Close for Comfort? Attitudes of Gynecologic Oncologists Toward Caring for Dying Patients. Am J Hosp Palliat Care 2023; 40:1168-1173. [PMID: 36507696 DOI: 10.1177/10499091221145165] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/13/2023] Open
Abstract
PURPOSE To assess gynecologic oncologists' attitudes relating to palliative care referrals among advanced cancer patients. METHODS Gynecologic oncologists were surveyed using validated measures to assess stigmatizing attitudes toward palliative care, anticipated stigma of palliative care, acceptance of palliative care, and willingness to refer to palliative care. Descriptive statistics were calculated. Analysis was performed using linear regression. RESULTS 1200 physicians received the survey and 108 (9%) completed it. Most were female (69.4%) and white (82.4%). Most practiced in academics (64.8%) in urban environments (71.3%). Respondents did not have anticipated stigma surrounding palliative care referral (mean score 1.89, range 1-7, higher score indicating more stigma), were accepting of palliative care (mean score 1.45, range 1-7, higher score indicating less acceptance), and were willing to refer patients to palliative care (mean score 5.75, range 1-7, higher score indicating more willingness to refer). Linear regression demonstrated females had less anticipated stigma surrounding palliative care (B = -.213, P = .04) and higher acceptance of palliative care (B = -.244, P = .01). Most surveyed derived satisfaction from work with advanced cancer patients (83%). Nineteen percent were depressed by managing advanced cancer patients. One fourth felt emotionally burned out by dealing with too many deaths. CONCLUSIONS Most gynecologic oncologists did not exhibit stigma surrounding palliative care and derive satisfaction from their work. Some gynecologic oncologists experience depression and burnout related to their profession. This close connection with patients as they transition to the end of life may take a toll on providers.
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Affiliation(s)
- Sarah Hmaidan
- Department of OB/GYN, Vanderbilt University Medical Center, Nashville, TN
| | - Alison Goulder
- Department of Gynecologic Oncology, the Johns Hopkins Hospital, Baltimore, MD
| | - Lia Bos
- Department of OB/GYN, Vanderbilt University Medical Center, Nashville, TN
| | - Megan J Shen
- Department of Psychology, Fred Hutchinson Cancer Center, Seattle, WA
| | - J D Wellman
- Department of Psychology, University of Mississippi, University, MS
| | - Lauren Prescott
- Department of OB/GYN, Vanderbilt University Medical Center, Nashville, TN
| | - Alaina Brown
- Department of OB/GYN, Vanderbilt University Medical Center, Nashville, TN
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Banerjee SC, Malling CD, Shen MJ, Williamson TJ, Bylund CL, Studts JL, Mullett T, Carter-Bawa L, Hamann HA, Parker PA, Steliga M, Feldman J, Pantelas J, Borondy-Kitts A, Rigney M, King JC, Fathi JT, Rosenthal LS, Smith RA, Ostroff JS. Getting ready for prime time: Recommended adaptations of an Empathic Communication Skills training intervention to reduce lung cancer stigma for a national multi-center trial. Transl Behav Med 2023; 13:804-808. [PMID: 37579304 PMCID: PMC10538471 DOI: 10.1093/tbm/ibad048] [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] [Indexed: 08/16/2023] Open
Abstract
Building upon prior work developing and pilot testing a provider-focused Empathic Communication Skills (ECS) training intervention, this study sought feedback from key invested partners who work with individuals with lung cancer (i.e. stakeholders including scientific and clinical advisors and patient advocates) on the ECS training intervention. The findings will be used to launch a national virtually-delivered multi-center clinical trial that will examine the effectiveness and implementation of the evidence-based ECS training intervention to reduce patients' experience of lung cancer stigma. A 1-day, hybrid, key invested partners meeting was held in New York City in Fall 2021. We presented the ECS training intervention to all conference attendees (N = 25) to seek constructive feedback on modifications of the training content and platform for intervention delivery to maximize its impact. After participating in the immersive training, all participants engaged in a group discussion guided by semi-structured probes. A deductive thematic content analysis was conducted to code focus group responses into 12 distinct a priori content modification recommendations. Content refinement was suggested in 8 of the 12 content modification themes: tailoring/tweaking/refining, adding elements, removing elements, shortening/condensing content, lengthening/extending content, substituting elements, re-ordering elements, and repeating elements. Engagement and feedback from key invested multi-sector partner is a valuable resource for intervention content modifications. Using a structured format for refining evidence-based interventions can facilitate efforts to understand the nature of modifications required for scaling up interventions and the impact of these modifications on outcomes of interest. ClinicalTrials.gov Identifier: NCT05456841.
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Affiliation(s)
- Smita C Banerjee
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Charlotte D Malling
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Megan J Shen
- Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, WA, USA
| | - Timothy J Williamson
- Department of Psychological Science, Loyola Marymount University, Los Angeles, CA, USA
| | - Carma L Bylund
- Health Outcomes & Biomedical Informatics, University of Florida, Gainesville, FL, USA
| | - Jamie L Studts
- Department of Medicine, University of Colorado School of Medicine, Aurora, CO, USA
| | - Timothy Mullett
- Division of Cardiothoracic Surgery, UK Markey Cancer Center, Lexington, KY, USA
| | - Lisa Carter-Bawa
- Cancer Prevention Precision Control Institute, Center for Discovery & Innovation at Hackensack Meridian Health, Nutley, NJ, USA
| | - Heidi A Hamann
- Department of Psychology, University of Arizona, Tucson, AZ, USA
| | - Patricia A Parker
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Matthew Steliga
- Department of Surgery, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | | | | | | | | | | | | | | | - Robert A Smith
- American Cancer Society National Lung Cancer Roundtable, USA
| | - Jamie S Ostroff
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, USA
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Torres Blasco N, Rosario L, Shen MJ. Latino advanced cancer patients' prognostic awareness and familial cultural influences on advance care planning engagement: a qualitative study. Palliat Care Soc Pract 2023; 17:26323524231193038. [PMID: 37662440 PMCID: PMC10472825 DOI: 10.1177/26323524231193038] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Accepted: 07/21/2023] [Indexed: 09/05/2023] Open
Abstract
Background Advanced cancer patients need an accurate understanding of their prognoses in order to engage in informed end-of-life care treatment decision-making. Latino cancer patients experience disparities around prognostic understanding, in part due to a lack of culturally competent communication around prognosis and advance care planning (ACP). Objective The objective of the present study of Latino patients with advanced, terminally ill cancer is to examine their understanding of prognosis, and how cultural factors may influence this understanding and engagement in ACP. Methods A mixed methods study was conducted, which consisted of surveys and semi-structured interviews. Descriptive statistics were used for sociodemographic information and self-reported prognostic understanding. Interviews around prognostic understanding and cultural influences on this understanding and engagement in ACP were recorded, transcribed, and then coded and analyzed using thematic content analysis. Findings Latino patients with advanced cancer (n = 20) completed a self-reported survey and participated in a semi-structured interview. Results indicate that among terminally ill patients, 50% of the patients inaccurately believed they had early-stage cancer, 85% did not believe their cancer was terminal, and 70% believed their cancer was curable. Moreover, interviews yielded two main themes: varying levels of awareness of the incurability of their cancer and diverse end-of-life care decision-making and treatment preferences based on prognostic understanding. Within these themes, patients expressed denial or acceptance of their prognosis through communication with the oncologist, the importance of family, and incorporating their pre-existing beliefs. Conclusion Findings indicate the importance of communication, family involvement, and incorporation of beliefs for promoting an accurate prognostic understanding among Latino patients. It is imperative to address disparities in Latino advanced cancer patients' prognostic understanding so they can engage in informed treatment decision-making around end-of-life care.
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Affiliation(s)
- Normarie Torres Blasco
- School of Behavioral and Brain Science Ponce Health Science University, 388 Zona Industrial Reparada 2, Ponce, 00732-7004, USA
| | - Lianel Rosario
- Ponce Health Science University, School of Behavioral and Brain Science, Ponce, Puerto Rico
| | - Megan J. Shen
- Fred Hutchinson Cancer Center, Clinical Research Division, Seattle, WA, USA
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10
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Abstract
This essay describes the challenges of home care in the US and advocates for incorporating elements of advance care planning and building navigation systems for obtaining and managing care.
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Affiliation(s)
| | - David C Grabowski
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts
| | - Megan J Shen
- Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, Washington
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11
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Shen MJ, Cho S, De Los Santos C, Yarborough S, Maciejewski PK, Prigerson HG. Planning for Your Advance Care Needs (PLAN): A Communication Intervention to Improve Advance Care Planning among Latino Patients with Advanced Cancer. Cancers (Basel) 2023; 15:3623. [PMID: 37509284 PMCID: PMC10377387 DOI: 10.3390/cancers15143623] [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: 05/26/2023] [Revised: 07/02/2023] [Accepted: 07/11/2023] [Indexed: 07/30/2023] Open
Abstract
BACKGROUND The goal of this study was to develop and optimize an intervention designed to address barriers to engagement in advance care planning (ACP) among Latino patients with advanced cancer. The resulting intervention, titled Planning Your Advance Care Needs (PLAN), is grounded in theoretical models of communication competence and sociocultural theory. MATERIALS AND METHODS An initial version of the PLAN manual was developed based on a prior intervention, Ca-HELP, that was designed to improve communication around pain among cancer patients. PLAN uses this framework to coach patients on how to plan for and communicate their end-of-life care needs through ACP. In the present study, feedback was obtained from key stakeholders (n = 11 patients, n = 11 caregivers, n = 10 experts) on this preliminary version of the PLAN manual. Participants provided ratings of acceptability and feedback around the intervention content, format, design, modality, and delivery through quantitative survey questions and semi-structured qualitative interviews. RESULTS Results indicated that the PLAN manual was perceived to be helpful and easy to understand. All stakeholder groups liked the inclusion of explicit communication scripts and guidance for having conversations about ACP with loved ones and doctors. Specific feedback was given to modify PLAN to ensure it was optimized and tailored for Latino patients. Some patients noted reviewing the manual motivated engagement in ACP. CONCLUSIONS Feedback from stakeholders resulted in an optimized, user-centered version of PLAN tailored to Latino patients. Future research will examine the acceptability, feasibility, and potential efficacy of this intervention to improve engagement in ACP.
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Affiliation(s)
- Megan J. Shen
- Division of Clinical Research, Fred Hutchinson Cancer Center, 1100 Fairview Ave. N., Mail Stop D5-290, Seattle, WA 98109, USA; (C.D.L.S.); (S.Y.)
| | - Susie Cho
- School of Nursing, University of Washington, Seattle, WA 98195, USA;
| | - Claudia De Los Santos
- Division of Clinical Research, Fred Hutchinson Cancer Center, 1100 Fairview Ave. N., Mail Stop D5-290, Seattle, WA 98109, USA; (C.D.L.S.); (S.Y.)
| | - Sarah Yarborough
- Division of Clinical Research, Fred Hutchinson Cancer Center, 1100 Fairview Ave. N., Mail Stop D5-290, Seattle, WA 98109, USA; (C.D.L.S.); (S.Y.)
| | - Paul K. Maciejewski
- Department of Radiology, Weill Cornell Medical College, New York, NY 10065, USA;
| | - Holly G. Prigerson
- Department of Medicine, Weill Cornell Medical College, New York, NY 10065, USA;
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12
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Kern LM, Aucapina JE, Jacobson A, Kelly T, Ringel JB, Shen MJ, Ancker JS, Rodriguez NV. Building research capacity in primary care practices that serve predominantly racial and ethnic minority populations. Am J Manag Care 2023; 29:280-282. [PMID: 37341974 DOI: 10.37765/ajmc.2023.89368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 06/22/2023]
Abstract
Primary care research represents only 1% of all federally funded projects. However, innovation in primary care is central to advancing health care delivery. Indeed, leaders in health care innovation recently called for primary care payment reform proposals to be tested in accountable care organizations (ACOs) consisting of independent practices (ie, practices not owned by hospitals). Yet these same practices may have less experience with the kind of systematic innovation that leads to generalizable insights, because what little funding is available for primary care research is mostly awarded to large academic medical centers. In this commentary, we report on lessons learned over 2 years (2020-2022) from conducting primary care research through a novel alliance of an ACO consisting of independent practices, a health plan, and several academic researchers, with the support of a private foundation. This collaboration is also notable because it was specifically assembled to address racial and ethnic inequities in the midst of the COVID-19 pandemic.
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Affiliation(s)
- Lisa M Kern
- Weill Cornell Medicine, 420 E 70th St, Box 331, New York, NY 10021.
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13
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Goyal P, Zhu A, Clarkson SA, Brown TM, Durant R, Kingery JR, Shen MJ, Khodneva Y, Jackson EA, Safford MM, Levitan EB. Patient Awareness of Their Heart Failure Diagnosis and Its Implications for Epidemiologic Studies and Clinical Care. Am J Cardiol 2023; 195:27-27.c3. [PMID: 37003081 DOI: 10.1016/j.amjcard.2023.02.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Revised: 02/21/2023] [Accepted: 02/28/2023] [Indexed: 04/03/2023]
Affiliation(s)
- Parag Goyal
- Department of Medicine, Weill Cornell Medicine, New York, New York.
| | | | | | - Todd M Brown
- Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - Raegan Durant
- Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - Justin R Kingery
- Department of Medicine, Weill Cornell Medicine, New York, New York
| | - Megan J Shen
- Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, Washington
| | - Yulia Khodneva
- Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | | | - Monika M Safford
- Department of Medicine, Weill Cornell Medicine, New York, New York
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14
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Kern LM, Aucapina JE, Jacobson A, Shen MJ, Ancker JS, Ringel JB, Kelly T, Rodriguez NV. COVID-19 Vaccine Hesitancy in a Predominantly Minority Population and Trust in Primary Care Physicians as a Potential Solution. J Ambul Care Manage 2023; 46:63-68. [PMID: 36305803 PMCID: PMC10144426 DOI: 10.1097/jac.0000000000000443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
| | | | | | | | | | | | - Tim Kelly
- AdvantageCare Physicians, New York, NY
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15
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Ostroff JS, Banerjee SC, Lynch K, Shen MJ, Williamson TJ, Haque N, Riley K, Hamann HA, Rigney M, Park B. Reducing stigma triggered by assessing smoking status among patients diagnosed with lung cancer: De-stigmatizing do and don't lessons learned from qualitative interviews. PEC Innov 2022; 1:100025. [PMID: 36865902 PMCID: PMC9977138 DOI: 10.1016/j.pecinn.2022.100025] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Objective To characterize lung cancer patients' reactions to cancer care providers' (CCPs) assessment of smoking behavior and to develop recommendations to reduce stigma and improve patient-clinician communication about smoking in the context of lung cancer care. Methods Semi-structured interviews with 56 lung cancer patients (Study 1) and focus groups with 11 lung cancer patients (Study 2) were conducted and analyzed using thematic content analysis. Results Three broad themes were identified: cursory questions about smoking history and current behavior; stigma triggered by assessment of smoking behavior; and recommended dos and don'ts for CCPs treating patients with lung cancer. CCP communication that contributed to patients' comfort included responding in an empathic manner and using supportive verbal and non-verbal communication skills. Blaming statements, doubting patients' self-reported smoking status, insinuating subpar care, nihilistic statements, and avoidant behaviors contributed to patients' discomfort. Conclusions Patients often experienced stigma in response to smoking-related discussions with their CCPs and identified several communication strategies that CCPs can use to improve patients' comfort within these clinical encounters. Innovation These patient perspectives advance the field by providing specific communication recommendations that CCPs can adopt to mitigate stigma and enhance lung cancer patients' comfort, particularly when taking a routine smoking history.
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Affiliation(s)
- Jamie S. Ostroff
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, NY, NY, USA,Corresponding author at: Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, 641 Lexington Ave., 7th Floor, New York, NY 10022, USA. (J.S. Ostroff)
| | - Smita C. Banerjee
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, NY, NY, USA
| | - Kathleen Lynch
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, NY, NY, USA
| | - Megan J. Shen
- Department of Medicine, Weill Cornell Medical College, NY, NY, USA,Fred Hutchinson/University of Washington Cancer Center, Seattle, WA USA
| | - Timothy J. Williamson
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, NY, NY, USA
| | - Noshin Haque
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, NY, NY, USA
| | - Kristen Riley
- Rutgers Graduate School of Applied Psychology, Piscataway, NJ, USA
| | - Heidi A. Hamann
- Department of Psychology, University of Arizona, Tucson, AZ, USA
| | | | - Bernard Park
- Department of Surgery, Memorial Sloan Kettering Cancer Center, NY, NY, USA
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16
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Singer J, Daum C, Shen MJ, Zecha G, Kaplan L, Plakovic K, Blazey M, Arnold M, Silko B, Baker K, Loggers ET. Assessment of Oncology Advanced Practice Professional Willingness to Participate in Medical Aid in Dying. JAMA Netw Open 2022; 5:e2239068. [PMID: 36287559 PMCID: PMC9606841 DOI: 10.1001/jamanetworkopen.2022.39068] [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] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
IMPORTANCE In 2021, New Mexico passed legislation allowing nurse practitioners and physician assistants (referred to herein as advanced practice professionals [APPs]) to prescribe medications for medical aid in dying (MAID). Other US states with existing MAID laws (eg, Washington) are also considering expanding MAID prescribing authority to APPs. There is a lack of research exploring APP knowledge of, willingness to, and comfort with acting as a prescribing or consulting clinician for MAID. OBJECTIVE To assess perspectives of oncology APPs regarding MAID, including their willingness to prescribe and/or consult for MAID and factors associated with willingness. DESIGN, SETTING, AND PARTICIPANTS This cross-sectional, self-report survey study used data collected from APPs working at a comprehensive cancer center in Washington State in fall 2021. MAIN OUTCOMES AND MEASURES The primary survey question was whether APPs would be willing to participate in death with dignity, the term used for MAID in Washington. Survey questions evaluated how influential specific factors were on APP views on MAID as well as respondents' knowledge of and comfort with aspects of the MAID process. RESULTS Of 167 eligible APPs, 77 (46.1%) responded to the survey. Most respondents (68 [88.3%]) reported their race and ethnicity as White; 72 (93.5%) identified as a woman. Medical oncology (28 [36.4%]) was the most common field of practice, and 21 respondents (27.3%) reported having practiced as an APP for 6 to 10 years. Of all respondents, 61 (79.2%) reported having at least 1 patient who inquired about MAID; depending on the question, less than a third of respondents (5.0%-27.0%) endorsed feeling knowledgeable or very knowledgeable about any aspect of the MAID process. In this study, 39 APPs (50.6%) endorsed being willing to participate in MAID either as a consulting or prescribing clinician, whereas 31 (40.3%) were uncertain of whether they would participate. Willingness to participate was associated with having had more patients pursue MAID (33 of the 39 willing participants [84.6%] vs 15 of the 31 unsure participants [48.4%] reported having 1 or more patients pursue MAID). Higher knowledge and comfort scores were both significantly associated with increased odds of being willing to participate (odds ratio, 1.14 per 1-point score increase [95% CI, 1.03-1.27]; P = .01) vs unsure (1.18 [95% CI, 1.07-1.30; P = .001). CONCLUSIONS AND RELEVANCE The results of this survey study suggest that oncology APPs may require preparation for the addition of MAID to their scope of practice. This study also raises questions for future research regarding support for APPs who may be considering participation in MAID but question their role or want physician involvement.
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Affiliation(s)
- Jonathan Singer
- Department of Psychological Sciences, Texas Tech University, Lubbock
| | - Courtney Daum
- Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, Washington
| | - Megan J. Shen
- Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, Washington
| | | | - Louise Kaplan
- College of Nursing, Washington State University, Vancouver
| | | | | | - Molly Arnold
- Fred Hutchinson Cancer Center, Seattle, Washington
| | | | - Kelsey Baker
- Clinical Research Division, Department of Clinical Biostatistics, Fred Hutchinson Cancer Center, Seattle, Washington
| | - Elizabeth T. Loggers
- Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, Washington
- Division of Oncology, University of Washington, Seattle
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17
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Tergas AI, Prigerson HG, Shen MJ, Neugut AI, Maciejewski PK. Disparities in Therapeutic Alliance Among Latino Immigrants With Advanced Cancer. J Pain Symptom Manage 2022; 64:e173-e176. [PMID: 35700931 PMCID: PMC10026842 DOI: 10.1016/j.jpainsymman.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)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Revised: 06/07/2022] [Accepted: 06/07/2022] [Indexed: 11/18/2022]
Affiliation(s)
- Ana Isabel Tergas
- Division of Gynecologic Oncology, Department of Surgery, City of Hope Comprehensive Cancer Center, Duarte, California, USA; Division of Health Equity, Department of Population Science, Beckman Research Institute, City of Hope Comprehensive Cancer Center, Duarte, California, USA; Cornell Center for Research on End-of-Life Care, Weill Cornell, New York, New York, USA.
| | - Holly G Prigerson
- Cornell Center for Research on End-of-Life Care, Weill Cornell, New York, New York, USA; Department of Medicine, Weill Cornell Medicine, New York, New York, USA
| | - Megan J Shen
- Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, Washington, USA
| | - Alfred I Neugut
- Herbert Irving Comprehensive Cancer Center, Columbia University College of Physicians and Surgeons, New York, New York, USA; Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York, USA
| | - Paul K Maciejewski
- Cornell Center for Research on End-of-Life Care, Weill Cornell, New York, New York, USA; Department of Medicine, Weill Cornell Medicine, New York, New York, USA; Department of Radiology, Weill Cornell Medicine, New York, New York, USA
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18
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Torres-Blasco N, Costas-Muñiz R, Zamore C, Porter L, Claros M, Bernal G, Shen MJ, Breitbart W, Rosario L, Peña-Vargas C, Castro-Figueroa EM. Family as a Bridge to Improve Meaning in Latinx Individuals Coping with Cancer. Palliat Med Rep 2022; 3:186-193. [PMID: 36203712 PMCID: PMC9531875 DOI: 10.1089/pmr.2022.0035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/09/2022] [Indexed: 11/30/2022] Open
Abstract
Background: Family and meaning-making resources are culturally congruent and help support Latinx coping with cancer. Objectives: To explore Latinx advanced cancer patients' perspectives on the role of family and meaning/purpose in adjustment to advanced cancer. Methods: A qualitative study was conducted. In-depth interviews were performed and transcripts were analyzed using the method from applied thematic analysis. Setting/Subject: Participants were patients with any advanced cancer diagnosis, recruited from Memorial Sloan Kettering Cancer Center (MSKCC), New York; Lincoln Medical Center (LMC), New York; and Ponce Health Science University (PHSU), Puerto Rico. Measurements: Sociodemographic and semistructured interview. Results: N = 24 in-depth interviews were completed by Latinx advanced cancer patients (Stage III and IV). When evaluating patients' perspectives on the role of family and meaning/purpose in adjustment to advanced cancer, the team generated three categories: (1) family support, (2) family communication, and (3) include support for the family. Many patients reported the importance of family as a source of meaning and social support in the process of cancer diagnosis and treatment. They also reported communication as central to process information and planning. Also, participants describe their desire to incorporate family members into therapy and for encouraging them to seek counseling. Conclusions: Results highlight the need to include syntonic cultural values such as family and meaning for Latinx individuals coping with advanced cancer in psychological interventions.
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Affiliation(s)
- Normarie Torres-Blasco
- Department of Psychiatry and Human Behavior, School of Behavioral and Brain Science, Ponce Research Institute, Ponce Health Sciences University, Ponce, Puerto Rico
| | - Rosario Costas-Muñiz
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan-Kettering Cancer Center, Immigrant Health & Cancer Disparities, New York, New York, USA
| | - Carolina Zamore
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan-Kettering Cancer Center, Immigrant Health & Cancer Disparities, New York, New York, USA
| | - Laura Porter
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, North Carolina, USA
| | - Maria Claros
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan-Kettering Cancer Center, Immigrant Health & Cancer Disparities, New York, New York, USA
| | - Guillermo Bernal
- Caribbean Alliance of National Psychological Associations, San Juan, Puerto Rico
| | - Megan J. Shen
- Division of Geriatrics and Palliative Medicine, Department of Medicine, New York, New York, USA
| | - William Breitbart
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan-Kettering Cancer Center, Immigrant Health & Cancer Disparities, New York, New York, USA
| | - Lianel Rosario
- Department of Psychiatry and Human Behavior, School of Behavioral and Brain Science, Ponce Research Institute, Ponce Health Sciences University, Ponce, Puerto Rico
| | - Cristina Peña-Vargas
- Department of Psychiatry and Human Behavior, School of Behavioral and Brain Science, Ponce Research Institute, Ponce Health Sciences University, Ponce, Puerto Rico
| | - Eida M. Castro-Figueroa
- Department of Psychiatry and Human Behavior, School of Behavioral and Brain Science, Ponce Research Institute, Ponce Health Sciences University, Ponce, Puerto Rico
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19
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Tergas AI, Prigerson HG, Shen MJ, Dinicu AI, Neugut AI, Wright JD, Hershman DL, Maciejewski PK. Association between immigrant status and advanced cancer patients' location and quality of death. Cancer 2022; 128:3352-3359. [PMID: 35801713 PMCID: PMC9542060 DOI: 10.1002/cncr.34385] [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: 12/01/2021] [Revised: 06/07/2022] [Accepted: 06/15/2022] [Indexed: 11/29/2022]
Abstract
Background Cancer patients often prefer to die at home, a location associated with better quality of death (QoD). Several studies demonstrate disparities in end‐of‐life care among immigrant populations in the United States. This study aimed to evaluate how immigrant status affects location and quality of death among patients with advanced cancer in the United States. Methods Data were derived from Coping with Cancer, a federally funded multi‐site prospective study of advanced cancer patients and caregivers. The sample of patients who died during the study period was weighted (Nw = 308) to reduce statistically significant differences between immigrant (Nw = 49) and nonimmigrant (Nw = 259) study participants. Primary outcomes were location of death, death at preferred location, and poor QoD. Results Analyses adjusted for covariates indicated that patients who were immigrants were more likely to die in a hospital than home (adjusted odds ratio [AOR], 3.33; 95% confidence interval [CI], 1.65–6.71) and less likely to die where they preferred (AOR, 0.42; 95% CI, 0.20–0.90). Furthermore, immigrants were more likely to have poor QoD (AOR, 5.47; 95% CI, 2.70–11.08). Conclusions Immigrants, as compared to nonimmigrants, are more likely to die in hospital settings, less likely to die at their preferred location, and more likely to have poor QoD. Lay summary Cancer patients typically prefer to die in their own homes, which is associated with improved quality of death. However, disparities in end‐of‐life care among immigrant populations in the United States remain significant. Our study found that immigrants are less likely to die in their preferred locations and more likely to die in hospital settings, resulting in poorer quality of death.
Disparities in end‐of‐life care and quality of death are prevalent among immigrants. The findings of this study illustrate that immigrants in the United States are more likely to die in hospital settings and less likely to die at their preferred location.
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Affiliation(s)
- Ana I Tergas
- Division of Gynecologic Oncology, Department of Surgery, City of Hope Comprehensive Cancer Center, Duarte, California, USA.,Division of Health Equity, Department of Population Science, Beckman Research Institute, City of Hope Comprehensive Cancer Center, Duarte, California, USA.,Cornell Center for Research on End-of-Life Care, Weill Cornell Medicine, New York, New York, USA
| | - Holly G Prigerson
- Cornell Center for Research on End-of-Life Care, Weill Cornell Medicine, New York, New York, USA.,Department of Medicine, Weill Cornell Medicine, New York, New York, USA
| | - Megan J Shen
- Cornell Center for Research on End-of-Life Care, Weill Cornell Medicine, New York, New York, USA.,Department of Medicine, Weill Cornell Medicine, New York, New York, USA
| | - Andreea I Dinicu
- Mailman School of Public Health, Columbia University, New York, New York, USA
| | - Alfred I Neugut
- Mailman School of Public Health, Columbia University, New York, New York, USA.,Columbia University College of Physicians and Surgeons, New York, New York, USA.,Herbert Irving Comprehensive Cancer Center, New York, New York, USA.,New York Presbyterian Hospital, New York, New York, USA
| | - Jason D Wright
- Columbia University College of Physicians and Surgeons, New York, New York, USA.,Herbert Irving Comprehensive Cancer Center, New York, New York, USA.,New York Presbyterian Hospital, New York, New York, USA
| | - Dawn L Hershman
- Mailman School of Public Health, Columbia University, New York, New York, USA.,Columbia University College of Physicians and Surgeons, New York, New York, USA.,Herbert Irving Comprehensive Cancer Center, New York, New York, USA.,New York Presbyterian Hospital, New York, New York, USA
| | - Paul K Maciejewski
- Cornell Center for Research on End-of-Life Care, Weill Cornell Medicine, New York, New York, USA.,Department of Medicine, Weill Cornell Medicine, New York, New York, USA.,Department of Radiology, Weill Cornell Medicine, New York, New York, USA
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20
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Banerjee SC, Haque N, Bylund CL, Shen MJ, Rigney M, Hamann HA, Parker PA, Ostroff JS. Responding empathically to patients: a communication skills training module to reduce lung cancer stigma. Transl Behav Med 2021; 11:613-618. [PMID: 32080736 PMCID: PMC7963287 DOI: 10.1093/tbm/ibaa011] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Most lung cancer patients report perceiving stigma surrounding their diagnosis, and routine clinical interactions with their health care providers (HCPs) are reported as a common source. The adverse effects of lung cancer stigma are associated with several adverse psychosocial and behavioral outcomes. One potential clinician-level intervention target is empathic communication because of its association with higher rates of patients' satisfaction, treatment adherence, and lower levels of psychological distress. This study describes the conceptual model and evaluation of clinician-targeted empathic communication skills training to reduce lung cancer patients' experience of stigma. The goal of the training module is to enhance clinician recognition and responsiveness to lung cancer patients' empathic opportunities by communicating understanding, reducing stigma and distress, and providing support. Thirty multidisciplinary HCPs working in thoracic oncology, thoracic surgery, or pulmonary medicine participated in 2.25 hr of didactic and experiential training on responding empathically to patients with lung cancer. Overall, participants reported highly favorable evaluations of the training, with at least 90% of participants agreeing or strongly agreeing to 11 of the 12 items assessing clinical relevance, novelty, clarity, and facilitator effectiveness. Participants' self-efficacy to communicate empathically with lung cancer patients increased significantly from pretraining to posttraining, t(29) = -4.58, p < .001. The empathic communication skills training module was feasible and well received by thoracic and pulmonary medicine HCPs and demonstrated improvements in self-efficacy in empathic communication from pretraining to posttraining. The examination of patient outcomes is warranted.
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Affiliation(s)
- Smita C Banerjee
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Noshin Haque
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Carma L Bylund
- Division of Hematology & Oncology, College of Medicine, University of Florida, Gainesville, FL, USA
| | - Megan J Shen
- Department of Medicine, Weill Cornell Medicine, New York, NY, USA
| | | | - Heidi A Hamann
- Department of Psychology, University of Arizona, Tucson, AZ, USA
| | - Patricia A Parker
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Jamie S Ostroff
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, USA
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21
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Yeary KHK, Alcaraz KI, Ashing KT, Chiu C, Christy SM, Felsted KF, Lu Q, Lumpkins CY, Masters KS, Newton RL, Park CL, Shen MJ, Silfee VJ, Yanez B, Yi J. Considering religion and spirituality in precision medicine. Transl Behav Med 2021; 10:195-203. [PMID: 31294809 DOI: 10.1093/tbm/ibz105] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Abstract
The emerging era of precision medicine (PM) holds great promise for patient care by considering individual, environmental, and lifestyle factors to optimize treatment. Context is centrally important to PM, yet, to date, little attention has been given to the unique context of religion and spirituality (R/S) and their applicability to PM. R/S can support and reinforce health beliefs and behaviors that affect health outcomes. The purpose of this article is to discuss how R/S can be considered in PM at multiple levels of context and recommend strategies for integrating R/S in PM. We conducted a descriptive, integrative literature review of R/S at the individual, institutional, and societal levels, with the aim of focusing on R/S factors with a high level of salience to PM. We discuss the utility of considering R/S in the suitability and uptake of PM prevention and treatment strategies by providing specific examples of how R/S influences health beliefs and practices at each level. We also propose future directions in research and practice to foster greater understanding and integration of R/S to enhance the acceptability and patient responsiveness of PM research approaches and clinical practices. Elucidating the context of R/S and its value to PM can advance efforts toward a more whole-person and patient-centered approach to improve individual and population health.
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Affiliation(s)
| | | | | | - Chungyi Chiu
- University of Illinois at Urbana-Champaign, Champaign, IL, USA
| | | | | | - Qian Lu
- University of Texas M.D. Anderson Cancer Center, Houston, TX, USA
| | - Crystal Y Lumpkins
- School of Medicine, University of Kansas Medical Center, Kansas City, KS, USA
| | | | | | | | - Megan J Shen
- Weill Cornell Medical College, New York City, NY, USA
| | | | - Betina Yanez
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Jean Yi
- Fred Hutchinson Cancer Research Center, Seattle, WA, USA
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Shen MJ, Maciejewski PK, Tergas AI, Prigerson HG. Inequities in End-of-Life Care Among Immigrant Patients Exaggerated by the COVID-19 Pandemic. J Pain Symptom Manage 2021; 62:e3-e4. [PMID: 33864844 PMCID: PMC8056820 DOI: 10.1016/j.jpainsymman.2021.04.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Revised: 03/22/2021] [Accepted: 04/04/2021] [Indexed: 11/26/2022]
Affiliation(s)
- Megan J Shen
- Weill Cornell Medical College, Department of Medicine, New York, NY, USA.
| | - Paul K Maciejewski
- Weill Cornell Medical College, Department of Radiology, New York, NY, USA
| | - Ana I Tergas
- Columbia University College of Physicians and Surgeons; New York Presbyterian Hospital-Columbia University Irving Medical Center, New York, NY, USA
| | - Holly G Prigerson
- Weill Cornell Medical College, Department of Medicine, New York, NY, USA
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Abstract
BACKGROUND Lung cancer patients commonly report stigma, often attributing it to the well-established association of smoking as the leading preventable cause. Theory and research suggest that patients' smoking history may differentiate patients' experience of lung cancer stigma. However, there is inconsistent evidence whether lung cancer stigma varies by patients' smoking history, owing to limitations in the literature. PURPOSE This study examined differences in lung cancer patients' reported experience of lung cancer stigma by smoking history. METHOD Participants (N = 266, 63.9% female) were men and women with lung cancer who completed a validated, multidimensional questionnaire measuring lung cancer stigma. Multivariable regression models characterized relationships between smoking history (currently, formerly, and never smoked) and lung cancer stigma, controlling for psychological and sociodemographic covariates. RESULTS Participants who currently smoked reported significantly higher total, internalized, and perceived lung cancer stigma compared to those who formerly or never smoked (all p < .05). Participants who formerly smoked reported significantly higher total and internalized stigma compared to those who never smoked (p < .001). Participants reported similar levels of constrained disclosure, regardless of smoking history (p = .630). CONCLUSIONS Total, internalized, and perceived stigma vary meaningfully by lung cancer patients' smoking history. Patients who smoke at diagnosis are at risk for experiencing high levels of stigma and could benefit from psychosocial support. Regardless of smoking history, patients reported similar levels of discomfort in sharing information about their lung cancer diagnosis with others. Future studies should test relationships between health-related stigma and associated health behaviors in other stigmatized groups.
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Affiliation(s)
- Timothy J Williamson
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, 641 Lexington Ave., 7th Floor, New York, NY, USA
| | - Diana M Kwon
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, 641 Lexington Ave., 7th Floor, New York, NY, USA
| | - Kristen E Riley
- Graduate School of Applied and Professional Psychology, Rutgers University, Piscataway, NJ, USA
| | - Megan J Shen
- Department of Medicine, Weill Cornell Medical College, New York, NY, USA
| | - Heidi A Hamann
- Department of Psychology, University of Arizona, Tucson, AZ, USA.,Department of Family and Community Medicine, University of Arizona, Tucson, AZ, USA
| | - Jamie S Ostroff
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, 641 Lexington Ave., 7th Floor, New York, NY, USA
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Banerjee SC, Haque N, Schofield EA, Williamson TJ, Martin CM, Bylund CL, Shen MJ, Rigney M, Hamann HA, Parker PA, McFarland DC, Park BJ, Molena D, Moreno A, Ostroff JS. Oncology Care Provider Training in Empathic Communication Skills to Reduce Lung Cancer Stigma. Chest 2021; 159:2040-2049. [PMID: 33338443 PMCID: PMC8129726 DOI: 10.1016/j.chest.2020.11.024] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 10/14/2020] [Accepted: 11/11/2020] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Despite the clinical importance of assessing smoking history and advising patients who smoke to quit, patients with lung cancer often experience feelings of blame and stigma during clinical encounters with their oncology care providers (OCPs). Promoting empathic communication during these encounters may help reduce patients' experience of stigma and improve related clinical outcomes. This paper presents the evaluation of OCP- and patient-reported data on the usefulness of an OCP-targeted empathic communication skills (ECS) training to reduce the stigma of lung cancer and improve communication. RESEARCH QUESTION What is the impact of the ECS intervention on OCPs' communication skills uptake and patient-reported outcomes (lung cancer stigma, satisfaction with communication, and perceived OCP empathy)? METHODS Study subjects included 30 multidisciplinary OCPs treating patients with lung cancer who participated in a 2.25 h ECS training. Standardized Patient Assessments were conducted prior to and following training to assess ECS uptake among OCPs. In addition, of a planned 180 patients who currently or formerly smoked (six unique patients per OCP [three pretraining, three posttraining]), 175 patients (89 pretraining, 86 posttraining) completed post-OCP visit surveys eliciting feedback on the quality of their interaction with their OCP. RESULTS OCPs exhibited an overall increase in use of empathic communication skills [t(28) = -2.37; P < .05], stigma-mitigating skills [t(28) = -3.88; P < .001], and breadth of communication skill use [t(28) = -2.91; P < .01]. Patients reported significantly higher overall satisfaction with communication post-ECS training, compared with pretraining [t(121) = 2.15; P = .034; Cohen d = 0.35]. There were no significant differences from pretraining to posttraining for patient-reported stigma or perceived OCP empathy. INTERPRETATION Empathy-based, stigma-reducing communication may lead to improved assessments of tobacco use and smoking cessation for patients with smoking-related cancers. These findings support the dissemination and further testing of a new ECS model for training OCPs in best practices for assessment of smoking history and engagement of patients who currently smoke in tobacco treatment delivery.
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Affiliation(s)
- Smita C Banerjee
- From the Department of Psychiatry and Behavioral Sciences (S. C. Banerjee, N. Haque, E. A. Schofield, T. J. Williamson, C. M. Martin, P. A. Parker, D. C. McFarland, A. Moreno, J. S. Ostroff), Memorial Sloan Kettering Cancer Center, New York, NY; Department of Public Relations (C. L. Bylund), Division of Hematology & Oncology, College of Medicine, University of Florida, Gainesville, FL; Department of Medicine (M. J. Shen), Weill Cornell Medical College, New York, NY; Support Initiatives, GO2 Foundation for Lung Cancer (M. Rigney), Washington, DC; Department of Psychology and the Department of Family and Community Medicine (H. A. Hamann), University of Arizona, Tucson, AZ; and Department of Surgery (B. J. Park, D. Molena), Memorial Sloan Kettering Cancer Center, New York, NY..
| | - Noshin Haque
- From the Department of Psychiatry and Behavioral Sciences (S. C. Banerjee, N. Haque, E. A. Schofield, T. J. Williamson, C. M. Martin, P. A. Parker, D. C. McFarland, A. Moreno, J. S. Ostroff), Memorial Sloan Kettering Cancer Center, New York, NY; Department of Public Relations (C. L. Bylund), Division of Hematology & Oncology, College of Medicine, University of Florida, Gainesville, FL; Department of Medicine (M. J. Shen), Weill Cornell Medical College, New York, NY; Support Initiatives, GO2 Foundation for Lung Cancer (M. Rigney), Washington, DC; Department of Psychology and the Department of Family and Community Medicine (H. A. Hamann), University of Arizona, Tucson, AZ; and Department of Surgery (B. J. Park, D. Molena), Memorial Sloan Kettering Cancer Center, New York, NY
| | - Elizabeth A Schofield
- From the Department of Psychiatry and Behavioral Sciences (S. C. Banerjee, N. Haque, E. A. Schofield, T. J. Williamson, C. M. Martin, P. A. Parker, D. C. McFarland, A. Moreno, J. S. Ostroff), Memorial Sloan Kettering Cancer Center, New York, NY; Department of Public Relations (C. L. Bylund), Division of Hematology & Oncology, College of Medicine, University of Florida, Gainesville, FL; Department of Medicine (M. J. Shen), Weill Cornell Medical College, New York, NY; Support Initiatives, GO2 Foundation for Lung Cancer (M. Rigney), Washington, DC; Department of Psychology and the Department of Family and Community Medicine (H. A. Hamann), University of Arizona, Tucson, AZ; and Department of Surgery (B. J. Park, D. Molena), Memorial Sloan Kettering Cancer Center, New York, NY
| | - Timothy J Williamson
- From the Department of Psychiatry and Behavioral Sciences (S. C. Banerjee, N. Haque, E. A. Schofield, T. J. Williamson, C. M. Martin, P. A. Parker, D. C. McFarland, A. Moreno, J. S. Ostroff), Memorial Sloan Kettering Cancer Center, New York, NY; Department of Public Relations (C. L. Bylund), Division of Hematology & Oncology, College of Medicine, University of Florida, Gainesville, FL; Department of Medicine (M. J. Shen), Weill Cornell Medical College, New York, NY; Support Initiatives, GO2 Foundation for Lung Cancer (M. Rigney), Washington, DC; Department of Psychology and the Department of Family and Community Medicine (H. A. Hamann), University of Arizona, Tucson, AZ; and Department of Surgery (B. J. Park, D. Molena), Memorial Sloan Kettering Cancer Center, New York, NY
| | - Chloe M Martin
- From the Department of Psychiatry and Behavioral Sciences (S. C. Banerjee, N. Haque, E. A. Schofield, T. J. Williamson, C. M. Martin, P. A. Parker, D. C. McFarland, A. Moreno, J. S. Ostroff), Memorial Sloan Kettering Cancer Center, New York, NY; Department of Public Relations (C. L. Bylund), Division of Hematology & Oncology, College of Medicine, University of Florida, Gainesville, FL; Department of Medicine (M. J. Shen), Weill Cornell Medical College, New York, NY; Support Initiatives, GO2 Foundation for Lung Cancer (M. Rigney), Washington, DC; Department of Psychology and the Department of Family and Community Medicine (H. A. Hamann), University of Arizona, Tucson, AZ; and Department of Surgery (B. J. Park, D. Molena), Memorial Sloan Kettering Cancer Center, New York, NY
| | - Carma L Bylund
- From the Department of Psychiatry and Behavioral Sciences (S. C. Banerjee, N. Haque, E. A. Schofield, T. J. Williamson, C. M. Martin, P. A. Parker, D. C. McFarland, A. Moreno, J. S. Ostroff), Memorial Sloan Kettering Cancer Center, New York, NY; Department of Public Relations (C. L. Bylund), Division of Hematology & Oncology, College of Medicine, University of Florida, Gainesville, FL; Department of Medicine (M. J. Shen), Weill Cornell Medical College, New York, NY; Support Initiatives, GO2 Foundation for Lung Cancer (M. Rigney), Washington, DC; Department of Psychology and the Department of Family and Community Medicine (H. A. Hamann), University of Arizona, Tucson, AZ; and Department of Surgery (B. J. Park, D. Molena), Memorial Sloan Kettering Cancer Center, New York, NY
| | - Megan J Shen
- From the Department of Psychiatry and Behavioral Sciences (S. C. Banerjee, N. Haque, E. A. Schofield, T. J. Williamson, C. M. Martin, P. A. Parker, D. C. McFarland, A. Moreno, J. S. Ostroff), Memorial Sloan Kettering Cancer Center, New York, NY; Department of Public Relations (C. L. Bylund), Division of Hematology & Oncology, College of Medicine, University of Florida, Gainesville, FL; Department of Medicine (M. J. Shen), Weill Cornell Medical College, New York, NY; Support Initiatives, GO2 Foundation for Lung Cancer (M. Rigney), Washington, DC; Department of Psychology and the Department of Family and Community Medicine (H. A. Hamann), University of Arizona, Tucson, AZ; and Department of Surgery (B. J. Park, D. Molena), Memorial Sloan Kettering Cancer Center, New York, NY
| | - Maureen Rigney
- From the Department of Psychiatry and Behavioral Sciences (S. C. Banerjee, N. Haque, E. A. Schofield, T. J. Williamson, C. M. Martin, P. A. Parker, D. C. McFarland, A. Moreno, J. S. Ostroff), Memorial Sloan Kettering Cancer Center, New York, NY; Department of Public Relations (C. L. Bylund), Division of Hematology & Oncology, College of Medicine, University of Florida, Gainesville, FL; Department of Medicine (M. J. Shen), Weill Cornell Medical College, New York, NY; Support Initiatives, GO2 Foundation for Lung Cancer (M. Rigney), Washington, DC; Department of Psychology and the Department of Family and Community Medicine (H. A. Hamann), University of Arizona, Tucson, AZ; and Department of Surgery (B. J. Park, D. Molena), Memorial Sloan Kettering Cancer Center, New York, NY
| | - Heidi A Hamann
- From the Department of Psychiatry and Behavioral Sciences (S. C. Banerjee, N. Haque, E. A. Schofield, T. J. Williamson, C. M. Martin, P. A. Parker, D. C. McFarland, A. Moreno, J. S. Ostroff), Memorial Sloan Kettering Cancer Center, New York, NY; Department of Public Relations (C. L. Bylund), Division of Hematology & Oncology, College of Medicine, University of Florida, Gainesville, FL; Department of Medicine (M. J. Shen), Weill Cornell Medical College, New York, NY; Support Initiatives, GO2 Foundation for Lung Cancer (M. Rigney), Washington, DC; Department of Psychology and the Department of Family and Community Medicine (H. A. Hamann), University of Arizona, Tucson, AZ; and Department of Surgery (B. J. Park, D. Molena), Memorial Sloan Kettering Cancer Center, New York, NY
| | - Patricia A Parker
- From the Department of Psychiatry and Behavioral Sciences (S. C. Banerjee, N. Haque, E. A. Schofield, T. J. Williamson, C. M. Martin, P. A. Parker, D. C. McFarland, A. Moreno, J. S. Ostroff), Memorial Sloan Kettering Cancer Center, New York, NY; Department of Public Relations (C. L. Bylund), Division of Hematology & Oncology, College of Medicine, University of Florida, Gainesville, FL; Department of Medicine (M. J. Shen), Weill Cornell Medical College, New York, NY; Support Initiatives, GO2 Foundation for Lung Cancer (M. Rigney), Washington, DC; Department of Psychology and the Department of Family and Community Medicine (H. A. Hamann), University of Arizona, Tucson, AZ; and Department of Surgery (B. J. Park, D. Molena), Memorial Sloan Kettering Cancer Center, New York, NY
| | - Daniel C McFarland
- From the Department of Psychiatry and Behavioral Sciences (S. C. Banerjee, N. Haque, E. A. Schofield, T. J. Williamson, C. M. Martin, P. A. Parker, D. C. McFarland, A. Moreno, J. S. Ostroff), Memorial Sloan Kettering Cancer Center, New York, NY; Department of Public Relations (C. L. Bylund), Division of Hematology & Oncology, College of Medicine, University of Florida, Gainesville, FL; Department of Medicine (M. J. Shen), Weill Cornell Medical College, New York, NY; Support Initiatives, GO2 Foundation for Lung Cancer (M. Rigney), Washington, DC; Department of Psychology and the Department of Family and Community Medicine (H. A. Hamann), University of Arizona, Tucson, AZ; and Department of Surgery (B. J. Park, D. Molena), Memorial Sloan Kettering Cancer Center, New York, NY
| | - Bernard J Park
- From the Department of Psychiatry and Behavioral Sciences (S. C. Banerjee, N. Haque, E. A. Schofield, T. J. Williamson, C. M. Martin, P. A. Parker, D. C. McFarland, A. Moreno, J. S. Ostroff), Memorial Sloan Kettering Cancer Center, New York, NY; Department of Public Relations (C. L. Bylund), Division of Hematology & Oncology, College of Medicine, University of Florida, Gainesville, FL; Department of Medicine (M. J. Shen), Weill Cornell Medical College, New York, NY; Support Initiatives, GO2 Foundation for Lung Cancer (M. Rigney), Washington, DC; Department of Psychology and the Department of Family and Community Medicine (H. A. Hamann), University of Arizona, Tucson, AZ; and Department of Surgery (B. J. Park, D. Molena), Memorial Sloan Kettering Cancer Center, New York, NY
| | - Daniela Molena
- From the Department of Psychiatry and Behavioral Sciences (S. C. Banerjee, N. Haque, E. A. Schofield, T. J. Williamson, C. M. Martin, P. A. Parker, D. C. McFarland, A. Moreno, J. S. Ostroff), Memorial Sloan Kettering Cancer Center, New York, NY; Department of Public Relations (C. L. Bylund), Division of Hematology & Oncology, College of Medicine, University of Florida, Gainesville, FL; Department of Medicine (M. J. Shen), Weill Cornell Medical College, New York, NY; Support Initiatives, GO2 Foundation for Lung Cancer (M. Rigney), Washington, DC; Department of Psychology and the Department of Family and Community Medicine (H. A. Hamann), University of Arizona, Tucson, AZ; and Department of Surgery (B. J. Park, D. Molena), Memorial Sloan Kettering Cancer Center, New York, NY
| | - Aimee Moreno
- From the Department of Psychiatry and Behavioral Sciences (S. C. Banerjee, N. Haque, E. A. Schofield, T. J. Williamson, C. M. Martin, P. A. Parker, D. C. McFarland, A. Moreno, J. S. Ostroff), Memorial Sloan Kettering Cancer Center, New York, NY; Department of Public Relations (C. L. Bylund), Division of Hematology & Oncology, College of Medicine, University of Florida, Gainesville, FL; Department of Medicine (M. J. Shen), Weill Cornell Medical College, New York, NY; Support Initiatives, GO2 Foundation for Lung Cancer (M. Rigney), Washington, DC; Department of Psychology and the Department of Family and Community Medicine (H. A. Hamann), University of Arizona, Tucson, AZ; and Department of Surgery (B. J. Park, D. Molena), Memorial Sloan Kettering Cancer Center, New York, NY
| | - Jamie S Ostroff
- From the Department of Psychiatry and Behavioral Sciences (S. C. Banerjee, N. Haque, E. A. Schofield, T. J. Williamson, C. M. Martin, P. A. Parker, D. C. McFarland, A. Moreno, J. S. Ostroff), Memorial Sloan Kettering Cancer Center, New York, NY; Department of Public Relations (C. L. Bylund), Division of Hematology & Oncology, College of Medicine, University of Florida, Gainesville, FL; Department of Medicine (M. J. Shen), Weill Cornell Medical College, New York, NY; Support Initiatives, GO2 Foundation for Lung Cancer (M. Rigney), Washington, DC; Department of Psychology and the Department of Family and Community Medicine (H. A. Hamann), University of Arizona, Tucson, AZ; and Department of Surgery (B. J. Park, D. Molena), Memorial Sloan Kettering Cancer Center, New York, NY
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Affiliation(s)
- Megan J Shen
- Megan J. Shen is an assistant professor at Weill Cornell Medicine. Send your career story to
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J. Shen M. Zoom meetings present particular challenges for mothers. Here’s how colleagues can help. Science 2021. [DOI: 10.1126/science.caredit.abi4553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
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Williamson TJ, Ostroff JS, Haque N, Martin CM, Hamann HA, Banerjee SC, Shen MJ. Dispositional shame and guilt as predictors of depressive symptoms and anxiety among adults with lung cancer: The mediational role of internalized stigma. Stigma Health 2020; 5:425-433. [PMID: 34027060 PMCID: PMC8132596 DOI: 10.1037/sah0000214] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [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] [Indexed: 01/19/2023]
Abstract
PURPOSE The current study investigated whether dispositional tendencies to experience shame and guilt (i.e., shame- and guilt- proneness) were associated with higher levels of internalized stigma and, in turn, higher depressive symptoms and anxiety in adults with lung cancer. METHOD Participants (N = 50, 56.0% female) were men and women who received a clinical consultation for lung cancer and completed validated questionnaires. Mediation modeling using bootstrapping was used to characterize relationships between shame- and guilt-proneness, lung cancer stigma, depressive symptoms, and anxiety. RESULTS Higher guilt-proneness was associated significantly with higher anxiety (b = 0.69, SE=0.28, 95% CI [0.13, 1.26]) and higher shame-proneness was associated significantly with higher depressive symptoms (b = 0.56, SE = 0.19, 95% CI [0.18, 0.93]), beyond sociodemographic, medical, and smoking-related characteristics. Higher lung cancer stigma also significantly mediated the relationship between guilt-proneness and anxiety (indirect effect = 0.43, SE = .20, 95% CI [0.08, 0.89]) but not between shame-proneness and depressive symptoms. CONCLUSIONS Shame- and guilt-proneness are associated significantly with depressive symptoms and anxiety, respectively, and the relationship between guilt-proneness and anxiety is explained in part by internalized stigma in a sample of newly diagnosed lung cancer patients. Findings carry implications for the early identification of lung cancer patients in need of additional supportive care services and highlight internalized stigma as a target for psychosocial intervention.
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Affiliation(s)
- Timothy J. Williamson
- Department of Psychiatry & Biobehavioral Sciences, Memorial Sloan-Kettering Cancer Center, New York, NY
| | - Jamie S. Ostroff
- Department of Psychiatry & Biobehavioral Sciences, Memorial Sloan-Kettering Cancer Center, New York, NY
| | - Noshin Haque
- Department of Psychiatry & Biobehavioral Sciences, Memorial Sloan-Kettering Cancer Center, New York, NY
| | - Chloe M. Martin
- Department of Psychiatry & Biobehavioral Sciences, Memorial Sloan-Kettering Cancer Center, New York, NY
| | | | - Smita C. Banerjee
- Department of Psychiatry & Biobehavioral Sciences, Memorial Sloan-Kettering Cancer Center, New York, NY
| | - Megan J. Shen
- Department of Medicine, Weill Cornell Medical College, New York, NY
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Goyal P, Requijo T, Siceloff B, Shen MJ, Masterson Creber R, Hilmer SN, Kronish IM, Lachs MS, Safford MM. Patient-Reported Barriers and Facilitators to Deprescribing Cardiovascular Medications. Drugs Aging 2020; 37:125-135. [PMID: 31858449 PMCID: PMC7339041 DOI: 10.1007/s40266-019-00729-x] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Medications endorsed by clinical practice guidelines, such as cardiovascular medications, could still have risks that outweigh potential benefits, and could thus warrant deprescribing. OBJECTIVES The objective of this study was to develop a framework of facilitators and barriers specific to deprescribing cardiovascular medications in the setting of uncertain benefit. Given the frequent use of β-blockers in heart failure with preserved ejection fraction, and its uncertain benefits with potential for harm, we used this scenario as an example case for a cardiovascular medication that may be reasonable to deprescribe. METHODS We conducted one-on-one, semi-structured interviews of older adults until we reached thematic saturation. Two coders independently reviewed each interview, and developed codes using deductive thematic analysis based on a prior conceptual framework for deprescribing. Subthemes and themes were finalized with a third coder. RESULTS Ten participants were interviewed. We identified three key previously described patient-reported facilitators to deprescribing: (1) appropriateness of cessation; (2) process of cessation; and (3) dislike of medications; and identified three key previously described patient-reported barriers: (1) appropriateness of cessation; (2) process of cessation; and (3) fear. We found that these facilitators and barriers often co-occurred within the same individual. This observation, coupled with subthemes from our patient interviews, yielded two barriers to deprescribing specific to cardiovascular medications-uncertainty and conflicting attitudes. CONCLUSION We adapted a new framework of patient-reported barriers and facilitators specific to deprescribing cardiovascular medications. In addition to addressing barriers previously described, future deprescribing interventions targeting cardiovascular medications must also address uncertainty and conflicting attitudes.
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Affiliation(s)
- Parag Goyal
- Division of Cardiology/Department of Medicine, Weill Cornell Medicine, 420 East 70th Street, New York, NY, 10063, USA. .,Division of General Internal Medicine/Department of Medicine, Weill Cornell Medicine, 420 East 70th Street, New York, NY, 10063, USA.
| | - Tatiana Requijo
- School of Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Birgit Siceloff
- Division of Cardiology/Department of Medicine, Weill Cornell Medicine, 420 East 70th Street, New York, NY, 10063, USA.,Division of General Internal Medicine/Department of Medicine, Weill Cornell Medicine, 420 East 70th Street, New York, NY, 10063, USA
| | - Megan J Shen
- Division of Geriatrics/Department of Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Ruth Masterson Creber
- Department of Healthcare Policy and Research, Weill Cornell Medicine, New York, NY, USA
| | - Sarah N Hilmer
- Department of Clinical Pharmacology, Royal North Shore Hospital, Sydney, NSW, Australia.,Sydney Medical School and Kolling Institute of Medical Research, University of Sydney, Sydney, NSW, Australia
| | - Ian M Kronish
- Center for Behavioral Cardiovascular Health, Columbia University Medical Center, New York, NY, USA
| | - Mark S Lachs
- Division of Geriatrics/Department of Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Monika M Safford
- Division of General Internal Medicine/Department of Medicine, Weill Cornell Medicine, 420 East 70th Street, New York, NY, 10063, USA
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George LS, Prigerson HG, Epstein AS, Richards KL, Shen MJ, Derry HM, Reyna VF, Shah MA, Maciejewski PK. Palliative Chemotherapy or Radiation and Prognostic Understanding among Advanced Cancer Patients: The Role of Perceived Treatment Intent. J Palliat Med 2019; 23:33-39. [PMID: 31580753 PMCID: PMC6931912 DOI: 10.1089/jpm.2018.0651] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background: As patients' accurate understanding of their prognosis is essential for informed end-of-life planning, identifying associated factors is important. Objective: We examine if receiving palliative chemotherapy or radiation, and the perception of those treatments as curative or noncurative, is associated with prognostic understanding. Design: Cross-sectional analyses from a multisite, observational study. Setting/Subjects: Patients with advanced cancers refractory to at least one chemotherapy regimen (N = 334). Measurements: In structured interviews, patients reported whether they were receiving chemotherapy or radiation, and whether its intent was curative or not. Their responses were categorized into three groups: patients not receiving chemotherapy/radiation (no cancer treatment group); patients receiving chemotherapy/radiation and misperceiving it as curative (treatment misperception group); and patients receiving chemotherapy/radiation and accurately perceiving it as noncurative (accurate treatment perception group). Patients also reported on various aspects of their prognostic understanding (e.g., life expectancy). Results: Eighty-six percent of the sample was receiving chemotherapy or radiation; of those, 16.7% reported the purpose of treatment to be curative. The no-treatment group had higher prognostic understanding scores compared with the treatment misperception group (adjusted odds ratio [AOR] = 5.00, p < 0.001). However, the accurate treatment perception group had the highest prognostic understanding scores in comparison to the no-treatment group (AOR = 2.04, p < 0.05) and the treatment misperception group (AOR = 10.19, p < 0.001). Conclusions: Depending on patient perceptions of curative intent, receipt of palliative chemotherapy or radiation is associated with better or worse prognostic understanding. Research should examine if enhancing patients' understanding of treatment intent can improve accurate prognostic expectations.
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Affiliation(s)
- Login S George
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Holly G Prigerson
- Center for Research on End-of-Life Care, Department of Medicine, Weill Cornell Medicine, New York, New York
| | | | - Kristy L Richards
- Center for Research on End-of-Life Care, Department of Medicine, Weill Cornell Medicine, New York, New York
| | - Megan J Shen
- Center for Research on End-of-Life Care, Department of Medicine, Weill Cornell Medicine, New York, New York
| | - Heather M Derry
- Center for Research on End-of-Life Care, Department of Medicine, Weill Cornell Medicine, New York, New York
| | - Valerie F Reyna
- Center for Behavioral Economics and Decision Research, College of Human Ecology, Cornell University, Ithaca, New York
| | - Manish A Shah
- Meyer Cancer Center of Weill Cornell Medical College, Medical Oncology/Solid Tumor Program, New York, New York
| | - Paul K Maciejewski
- Center for Research on End-of-Life Care, Department of Medicine, Weill Cornell Medicine, New York, New York.,Department of Radiology, Weill Cornell Medicine, New York, New York
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Tergas AI, Prigerson HG, Shen MJ, Bates LM, Neugut AI, Wright JD, Maciejewski PK. Latino Ethnicity, Immigrant Status, and Preference for End-of-Life Cancer Care. J Palliat Med 2019; 22:833-837. [PMID: 30973302 PMCID: PMC6648166 DOI: 10.1089/jpm.2018.0537] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/04/2019] [Indexed: 11/13/2022] Open
Abstract
Background: Little is known about how immigration status influences preference for life-extending care (LEC) at the end of life (EoL). Objective: The purpose was to determine how preference for LEC at the EoL for advanced cancer patients varied by Latino ethnicity and immigrant status, and over time between two large cohorts. Methods: Data were derived from two sequential multi-institutional, longitudinal cohort studies of advanced cancer patients, recruited from 2002 to 2008 (coping with cancer I [CwC-1]) and 2010 to 2015 (coping with cancer II [CwC-2]). Self-reported U.S.-born whites (whites) (N = 253), U.S.-born Latinos (US-L) (N = 34), and Latino immigrants (LI) (N = 65) with a poor-prognosis cancer were included. The primary independent variables were immigrant status, Latino ethnicity, and CwC cohort. The primary dependent variable was preference for LEC. Results: Within CwC-2, LI were 9.4 times more likely to prefer LEC over comfort care versus US-L (adjusted odds ratio [AOR] = 9.4; 95% confidence interval [CI]: 1.2-72.4), and US-L were 0.3 times less likely to prefer LEC versus whites (AOR = 0.3; 95% CI: 0.1-1.0). LI from CwC-2 were 11.4 times more likely to prefer LEC versus LI from CwC-1 (AOR = 11.4; 95% CI: 2.7-48.4). Within CwC-1, there was no difference in LEC preference between LI and US-L, nor between US-L and whites. Conclusions: Immigrant status had a strong effect on preference for LEC at the EoL among the more recent cohort of Latino cancer patients. Preference for LEC appears to have increased significantly over time for LI but remained unchanged for US-L. LI may increasingly want LEC near death.
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Affiliation(s)
- Ana I. Tergas
- Department of Obstetrics and Gynecology, Columbia University College of Physicians and Surgeons, New York, New York
- Herbert Irving Comprehensive Cancer Center, Columbia University College of Physicians and Surgeons, New York, New York
- New York Presbyterian Hospital, Columbia University Irving Medical Center, New York, New York
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York
- Cornell Center for Research on End-of-Life Care, Weill Cornell Medicine, New York, New York
| | - Holly G. Prigerson
- Cornell Center for Research on End-of-Life Care, Weill Cornell Medicine, New York, New York
- Department of Medicine, Weill Cornell Medicine, New York, New York
| | - Megan J. Shen
- Cornell Center for Research on End-of-Life Care, Weill Cornell Medicine, New York, New York
- Department of Medicine, Weill Cornell Medicine, New York, New York
| | - Lisa M. Bates
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York
| | - Alfred I. Neugut
- Herbert Irving Comprehensive Cancer Center, Columbia University College of Physicians and Surgeons, New York, New York
- New York Presbyterian Hospital, Columbia University Irving Medical Center, New York, New York
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York
- Department of Medicine, Columbia University College of Physicians and Surgeons, New York, New York
| | - Jason D. Wright
- Department of Obstetrics and Gynecology, Columbia University College of Physicians and Surgeons, New York, New York
- Herbert Irving Comprehensive Cancer Center, Columbia University College of Physicians and Surgeons, New York, New York
- New York Presbyterian Hospital, Columbia University Irving Medical Center, New York, New York
| | - Paul K. Maciejewski
- Cornell Center for Research on End-of-Life Care, Weill Cornell Medicine, New York, New York
- Department of Medicine, Weill Cornell Medicine, New York, New York
- Department of Radiology, Weill Cornell Medicine, New York, New York
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Ostroff JS, Riley KE, Shen MJ, Atkinson TM, Williamson TJ, Hamann HA. Lung cancer stigma and depression: Validation of the Lung Cancer Stigma Inventory. Psychooncology 2019; 28:1011-1017. [PMID: 30779396 DOI: 10.1002/pon.5033] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [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: 03/28/2018] [Revised: 02/14/2019] [Accepted: 02/16/2019] [Indexed: 12/19/2022]
Abstract
OBJECTIVE In an effort to provide further evidence for the validity of the Lung Cancer Stigma Inventory (LCSI), this paper examined group differences in lung cancer stigma for patients who report clinically significant depressive symptoms and established a suggested scoring benchmark to identify patients with clinically meaningful levels of lung cancer stigma. METHODS Patients (N = 231) who were diagnosed with lung cancer and treated within the past 12 months at one of two National Cancer Institute (NCI)-designated Cancer Centers located in the northeast and southern parts of the United States completed a single battery of questionnaires examining lung cancer stigma and depressed mood. Group differences, bivariate correlations, and receiver operating characteristic (ROC) analyses were conducted. RESULTS Slightly more than a third of patients (35.9%) reported an elevated level of depression. There was a significant correlation (r = 0.44) between lung cancer stigma and depressive mood. The ROC curve analysis indicated an area under curve (AUC) of 0.71. A LCSI cutoff score of 37.5 yielded the optimal ratio of sensitivity (0.93) to specificity (0.70) for identifying patients with clinically meaningful lung cancer stigma. CONCLUSIONS Consistent with prior work, lung cancer stigma, as measured by the LCSI, was found to be moderately associated with depressed mood. Clinical investigators may use an LCSI total score above 37.5 (ie, greater than or equal to 38 on the LCSI scale of integer scores) as a clinical threshold for identifying patients who may be experiencing clinically meaningful stigma and may benefit from stigma-reducing interventions.
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Affiliation(s)
- Jamie S Ostroff
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Kristen E Riley
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Megan J Shen
- Medicine Department, Weill Cornell Medical College, New York, New York
| | - Thomas M Atkinson
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Timothy J Williamson
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Heidi A Hamann
- Department of Psychology and Department of Family & Community Medicine, University of Arizona, Tucson, Arizona
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Hamann HA, Shen MJ, Thomas AJ, Craddock Lee SJ, Ostroff JS. Development and Preliminary Psychometric Evaluation of a Patient-Reported Outcome Measure for Lung Cancer Stigma: The Lung Cancer Stigma Inventory (LCSI). Stigma Health 2018; 3:195-203. [PMID: 30393760 PMCID: PMC6208151 DOI: 10.1037/sah0000089] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [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] [Indexed: 01/12/2023]
Abstract
INTRODUCTION Among patients with lung cancer, stigma is associated with negative psychosocial and behavioral outcomes. There is a need to develop psychometrically robust patient-reported outcome (PRO) measures for stigma that incorporate perspectives of patients diagnosed with lung cancer. As part of our multi-phase process of measure development and validation, we report on scale formation and preliminary psychometric evaluation of the Lung Cancer Stigma Inventory (LCSI). METHOD Building on previously reported concept elicitation (Phase I) work, Phase II of LCSI development involved item generation and refinement, informed by literature review, provider input, and patient (N=20) feedback. Phase III focused on initial psychometric scale evaluation in a unique sample of 231 lung cancer patients. RESULTS Based on provider input and patient cognitive interviews, 49 items were included in a preliminary measure. In an exploratory factor analysis (EFA) of the 37 retained items, three factors emerged: Perceived Stigma, Internalized Stigma, and Constrained Disclosure. Internal consistency of the final, 25-item LCSI scale was high (Cronbach's alpha= 0.89) and the three subscales demonstrated good internal consistency. The test-retest correlation was high (r = 0.91), suggesting strong stability of measurement over time. There was good convergent validity between the LCSI and an existing measure of lung cancer stigma, the Cataldo Lung Cancer Stigma Scale (CLCSS; r= 0.58, p< 0.001). DISCUSSION In a multi-phase process, we have developed a reliable, multi-dimensional measure of lung cancer stigma, the Lung Cancer Stigma Inventory (LCSI). Subsequent work will be conducted to establish further evidence of validity and clinically meaningful change.
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Affiliation(s)
- Heidi A Hamann
- Department of Psychology, Department of Family and Community Medicine, University of Arizona, Tucson, AZ
- Department of Psychiatry, UT Southwestern Medical Center, Dallas, TX
- Department of Clinical Sciences, UT Southwestern Medical Center, Dallas, TX
- Harold C. Simmons Cancer Center, UT Southwestern Medical Center, Dallas, TX
| | - Megan J Shen
- Department of Medicine, Weill Cornell Medicine, New York, NY
| | - Anna J Thomas
- Department of Psychiatry, UT Southwestern Medical Center, Dallas, TX
| | - Simon J Craddock Lee
- Department of Clinical Sciences, UT Southwestern Medical Center, Dallas, TX
- Harold C. Simmons Cancer Center, UT Southwestern Medical Center, Dallas, TX
| | - Jamie S Ostroff
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY
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Cohen SM, Maciejewski RC, Shah MA, Trevino KM, Shen MJ, Maciejewski PK, Prigerson HG. Being present: oncologists' role in promoting advanced cancer patients' illness understanding. Cancer Med 2018; 7:1511-1518. [PMID: 29479843 PMCID: PMC5911627 DOI: 10.1002/cam4.1389] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2017] [Revised: 01/18/2018] [Accepted: 01/19/2018] [Indexed: 01/02/2023] Open
Abstract
Realistic illness understanding is essential to an advanced cancer patient's ability to make informed medical decisions at the end of life. This study sought to determine whether advanced cancer patients better understood the late stage of their cancer if an oncologist, compared to other members of the care team, was present to discuss their scan results. Data were derived from a multi-institutional, longitudinal cohort study of patients recruited between 2010 and 2015. Patients (n = 209) with late-stage cancers (metastatic cancers that progressed after at least one chemotherapy regimen) were interviewed before and after clinic visits in which scan results were discussed. Patients reported pre- and postvisit if their cancer was at a late stage. Postvisit, patients reported if they discussed scan results with an oncologist or another oncology provider (i.e., oncology fellow, oncology resident, nurse practitioner, nurse, physician's assistant, or other). Logistic regression analysis was used to determine if the presence of an oncologist during scan results discussions differentially predicted the patients' likelihood of postvisit late-stage illness understanding (LSIU). Propensity weighting was used to correct for sociodemographic imbalances between groups, and previsit LSIU and the presence of multiple providers were controlled for in the logistic regression analyses. After propensity-weighted adjustment and controlling for previsit LSIU and the presence of multiple providers, patients were 2.6 times more likely (AOR = 2.6; 95% CI = 1.2, 6.0; P = 0.021) to report that their disease was late stage if an oncologist was present for the scan results discussion compared to if an oncologist was absent. The presence of an oncologist during scan results discussions was associated with a higher likelihood of patients acknowledging being in a late stage of their disease. These results suggest that oncologist involvement in scan results discussions is associated with advanced cancer patients having better prognostic understanding.
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Affiliation(s)
- Simon M. Cohen
- Department of MedicineCenter for Research on End‐of‐Life CareWeill Cornell MedicineNew York CityNew York
- Division of Geriatric and Palliative MedicineDepartment of MedicineWeill Cornell MedicineNew York CityNew York
| | - Renee C. Maciejewski
- Department of MedicineCenter for Research on End‐of‐Life CareWeill Cornell MedicineNew York CityNew York
- Division of Geriatric and Palliative MedicineDepartment of MedicineWeill Cornell MedicineNew York CityNew York
| | - Manish A. Shah
- Division of Hematology and Medical OncologyDepartment of MedicineWeill Cornell MedicineNew York CityNew York
| | - Kelly M. Trevino
- Department of MedicineCenter for Research on End‐of‐Life CareWeill Cornell MedicineNew York CityNew York
- Division of Geriatric and Palliative MedicineDepartment of MedicineWeill Cornell MedicineNew York CityNew York
| | - Megan J. Shen
- Department of MedicineCenter for Research on End‐of‐Life CareWeill Cornell MedicineNew York CityNew York
- Division of Geriatric and Palliative MedicineDepartment of MedicineWeill Cornell MedicineNew York CityNew York
| | - Paul K. Maciejewski
- Department of MedicineCenter for Research on End‐of‐Life CareWeill Cornell MedicineNew York CityNew York
- Division of Geriatric and Palliative MedicineDepartment of MedicineWeill Cornell MedicineNew York CityNew York
- Department of RadiologyWeill Cornell MedicineNew York CityNew York
| | - Holly G. Prigerson
- Department of MedicineCenter for Research on End‐of‐Life CareWeill Cornell MedicineNew York CityNew York
- Division of Geriatric and Palliative MedicineDepartment of MedicineWeill Cornell MedicineNew York CityNew York
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Abelson JS, Chait A, Shen MJ, Charlson M, Dickerman A, Yeo HL. Sources of distress among patients undergoing surgery for colorectal cancer: a qualitative study. J Surg Res 2018; 226:140-149. [PMID: 29661279 DOI: 10.1016/j.jss.2018.01.017] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2017] [Revised: 01/02/2018] [Accepted: 01/08/2018] [Indexed: 11/17/2022]
Abstract
BACKGROUND Distress is common among cancer and surgical patients and can lead to worse outcomes if untreated. The objective of this study was to explore sources of distress among colorectal cancer patients undergoing surgery. MATERIALS AND METHODS This was a qualitative study using in-depth, semistructured, one-on-one interviews in an academic setting. Patients were recruited if they had a pathologically confirmed diagnosis of colon or rectal cancer. Purposive sampling was used to recruit patients who were about to undergo (preoperative), or had recently undergone (postoperative), curative resection for colorectal cancer. RESULTS All participants (n = 24) reported experiencing distress during treatment. Participants identified sources of distress preoperatively (negative emotional reaction to diagnosis, distress from preconception of cancer diagnosis, and distress interacting with healthcare system). Sources of distress during in-hospital recovery included negative emotional reaction to having a surgery and negative emotions experienced in the hospital. Postoperative sources of distress included mismatch of expectations and experience of recovery, dealing with distressing physical symptoms and complications after surgery, and distress worrying about recurrence. Participants identified other sources of distress that were not time-specific (distress related to social support network, from disruption of life, and worrying about death). CONCLUSIONS Our results highlight a potential role for a comprehensive screening program to identify which patients require assistance with addressing sources of distress during the surgical experience. Understanding how sources of distress may vary by time will help us tailor interventions at different time points of the surgical experience.
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Affiliation(s)
- Jonathan S Abelson
- Department of Surgery, Weill Cornell Medicine, New York-Presbyterian Hospital, New York, New York.
| | - Alanna Chait
- Department of Psychiatry, Weill Cornell Medicine, New York-Presbyterian Hospital, New York, New York
| | - Megan J Shen
- Department of Psychology, Weill Cornell Medicine, New York-Presbyterian Hospital, New York, New York
| | - Mary Charlson
- Department of Integrative Medicine, Weill Cornell Medicine, New York-Presbyterian Hospital, New York, New York
| | - Anna Dickerman
- Department of Psychiatry, Weill Cornell Medicine, New York-Presbyterian Hospital, New York, New York
| | - Heather L Yeo
- Department of Surgery, Weill Cornell Medicine, New York-Presbyterian Hospital, New York, New York; Department of Public Health, Weill Medical College of Cornell University, New York-Presbyterian Hospital, New York, New York
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Buckley de Meritens A, Margolis B, Blinderman C, Prigerson HG, Maciejewski PK, Shen MJ, Hou JY, Burke WM, Wright JD, Tergas AI. Practice Patterns, Attitudes, and Barriers to Palliative Care Consultation by Gynecologic Oncologists. J Oncol Pract 2017; 13:e703-e711. [PMID: 28783424 DOI: 10.1200/jop.2017.021048] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
PURPOSE We sought to describe practice patterns, attitudes, and barriers to the integration of palliative care services by gynecologic oncologists. METHODS Members of the Society of Gynecologic Oncology were electronically surveyed regarding their practice of incorporating palliative care services and to identify barriers for consultation. Descriptive statistics were used, and two-sample z-tests of proportions were performed to compare responses to related questions. RESULTS Of the 145 respondents, 71% were attending physicians and 58% worked at an academic medical center. The vast majority (92%) had palliative care services available for consultation at their hospital; 48% thought that palliative care services were appropriately used, 51% thought they were underused, and 1% thought they were overused. Thirty percent of respondents thought that palliative care services should be incorporated at first recurrence, whereas 42% thought palliative care should be incorporated when prognosis for life expectancy is ≤ 6 months. Most participants (75%) responded that palliative care consultation is reasonable for symptom control at any stage of disease. Respondents were most likely to consult palliative care services for pain control (53%) and other symptoms (63%). Eighty-three percent of respondents thought that communicating prognosis is the primary team's responsibility, whereas the responsibilities for pain and symptom control, resuscitation status, and goals of care discussions were split between the primary team only and both teams. The main barrier for consulting palliative care services was the concern that patients and families would feel abandoned by the primary oncologist (73%). Ninety-seven percent of respondents answered that palliative care services are useful to improve patient care. CONCLUSION The majority of gynecologic oncologists perceived palliative care as a useful collaboration that is underused. Fear of perceived abandonment by the patient and family members was identified as a significant barrier to palliative care consult.
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Affiliation(s)
- Alexandre Buckley de Meritens
- Rutgers Cancer Institute of New Jersey, New Brunswick, NJ; Columbia University College of Physicians and Surgeons; New York Presbyterian Hospital-Columbia University Irving Medical Center; Weill Cornell Medicine; and Mailman School of Public Health, Columbia University, New York, NY
| | - Benjamin Margolis
- Rutgers Cancer Institute of New Jersey, New Brunswick, NJ; Columbia University College of Physicians and Surgeons; New York Presbyterian Hospital-Columbia University Irving Medical Center; Weill Cornell Medicine; and Mailman School of Public Health, Columbia University, New York, NY
| | - Craig Blinderman
- Rutgers Cancer Institute of New Jersey, New Brunswick, NJ; Columbia University College of Physicians and Surgeons; New York Presbyterian Hospital-Columbia University Irving Medical Center; Weill Cornell Medicine; and Mailman School of Public Health, Columbia University, New York, NY
| | - Holly G Prigerson
- Rutgers Cancer Institute of New Jersey, New Brunswick, NJ; Columbia University College of Physicians and Surgeons; New York Presbyterian Hospital-Columbia University Irving Medical Center; Weill Cornell Medicine; and Mailman School of Public Health, Columbia University, New York, NY
| | - Paul K Maciejewski
- Rutgers Cancer Institute of New Jersey, New Brunswick, NJ; Columbia University College of Physicians and Surgeons; New York Presbyterian Hospital-Columbia University Irving Medical Center; Weill Cornell Medicine; and Mailman School of Public Health, Columbia University, New York, NY
| | - Megan J Shen
- Rutgers Cancer Institute of New Jersey, New Brunswick, NJ; Columbia University College of Physicians and Surgeons; New York Presbyterian Hospital-Columbia University Irving Medical Center; Weill Cornell Medicine; and Mailman School of Public Health, Columbia University, New York, NY
| | - June Y Hou
- Rutgers Cancer Institute of New Jersey, New Brunswick, NJ; Columbia University College of Physicians and Surgeons; New York Presbyterian Hospital-Columbia University Irving Medical Center; Weill Cornell Medicine; and Mailman School of Public Health, Columbia University, New York, NY
| | - William M Burke
- Rutgers Cancer Institute of New Jersey, New Brunswick, NJ; Columbia University College of Physicians and Surgeons; New York Presbyterian Hospital-Columbia University Irving Medical Center; Weill Cornell Medicine; and Mailman School of Public Health, Columbia University, New York, NY
| | - Jason D Wright
- Rutgers Cancer Institute of New Jersey, New Brunswick, NJ; Columbia University College of Physicians and Surgeons; New York Presbyterian Hospital-Columbia University Irving Medical Center; Weill Cornell Medicine; and Mailman School of Public Health, Columbia University, New York, NY
| | - Ana I Tergas
- Rutgers Cancer Institute of New Jersey, New Brunswick, NJ; Columbia University College of Physicians and Surgeons; New York Presbyterian Hospital-Columbia University Irving Medical Center; Weill Cornell Medicine; and Mailman School of Public Health, Columbia University, New York, NY
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Shen MJ, Wang GG, Zhu XH, Ding X. [Influence of trabecular microstructure modeling on finite element analysis of dental implant]. Zhonghua Kou Qiang Yi Xue Za Zhi 2016; 51:542-545. [PMID: 27596344 DOI: 10.3760/cma.j.issn.1002-0098.2016.09.007] [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: 06/06/2023]
Abstract
OBJECTIVE To analyze the influence of trabecular microstructure modeling on the biomechanical distribution of implant-bone interface with a three-dimensional finite element mandible model of trabecular structure. METHODS Dental implants were embeded in the mandibles of a beagle dog. After three months of the implant installation, the mandibles with dental implants were harvested and scaned by micro-CT and cone-beam CT. Two three-dimensional finite element mandible models, trabecular microstructure(precise model) and macrostructure(simplified model), were built. The values of stress and strain of implant-bone interface were calculated using the software of Ansys 14.0. RESULTS Compared with the simplified model, the precise models' average values of the implant bone interface stress increased obviously and its maximum values did not change greatly. The maximum values of quivalent stress of the precise models were 80% and 110% of the simplified model and the average values were 170% and 290% of simplified model. The maximum and average values of equivalent strain of precise models were obviously decreased, and the maximum values of the equivalent effect strain were 17% and 26% of simplified model and the average ones were 21% and 16% of simplified model respectively. Stress and strain concentrations at implant-bone interface were obvious in the simplified model. However, the distributions of stress and strain were uniform in the precise model. CONCLUSIONS The precise model has significant effect on the distribution of stress and strain at implant-bone interface.
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Affiliation(s)
- M J Shen
- Department of Stomatology, The First Hospital Affiliated of Wenzhou Medical University, Wenzhou Zhejiang 325000, China
| | - G G Wang
- Department of Stomatology, The First Hospital Affiliated of Wenzhou Medical University, Wenzhou Zhejiang 325000, China
| | - X H Zhu
- Department of Stomatology, The First Hospital Affiliated of Wenzhou Medical University, Wenzhou Zhejiang 325000, China
| | - X Ding
- Department of Stomatology, The First Hospital Affiliated of Wenzhou Medical University, Wenzhou Zhejiang 325000, China
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Trevino KM, Zhang B, Shen MJ, Prigerson HG. Accuracy of advanced cancer patients' life expectancy estimates: The role of race and source of life expectancy information. Cancer 2016; 122:1905-12. [PMID: 27028270 DOI: 10.1002/cncr.30001] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2016] [Revised: 02/18/2016] [Accepted: 03/08/2016] [Indexed: 11/11/2022]
Abstract
BACKGROUND The objective of this study was to examine the source of advanced cancer patients' information about their prognosis and determine whether this source of information could explain racial disparities in the accuracy of patients' life expectancy estimates (LEEs). METHODS Coping With Cancer was a prospective, longitudinal, multisite study of terminally ill cancer patients followed until death. In structured interviews, patients reported their LEEs and the sources of these estimates (ie, medical providers, personal beliefs, religious beliefs, and other). The accuracy of LEEs was calculated through a comparison of patients' self-reported LEEs with their actual survival. RESULTS The sample for this analysis included 229 patients: 31 black patients and 198 white patients. Only 39.30% of the patients estimated their life expectancy within 12 months of their actual survival. Black patients were more likely to have an inaccurate LEE than white patients. A minority of the sample (18.3%) reported that a medical provider was the source of their LEEs; none of the black patients (0%) based their LEEs on a medical provider. Black race remained a significant predictor of an inaccurate LEE, even after the analysis had been controlled for sociodemographic characteristics and the source of LEEs. CONCLUSIONS The majority of advanced cancer patients have an inaccurate understanding of their life expectancy. Black patients with advanced cancer are more likely to have an inaccurate LEE than white patients. Medical providers are not the source of information for LEEs for most advanced cancer patients and especially for black patients. The source of LEEs does not explain racial differences in LEE accuracy. Additional research into the mechanisms underlying racial differences in prognostic understanding is needed. Cancer 2016;122:1905-12. © 2016 The Authors. Cancer published by Wiley Periodicals, Inc. on behalf of American Cancer Society. This is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made.
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Affiliation(s)
- Kelly M Trevino
- Cornell Center for Research on End-of-Life Care, New York, New York.,Department of Medicine, Weill Cornell Medicine, New York, New York
| | - Baohui Zhang
- Johnson & Johnson Medical Device, New Brunswick, New Jersey
| | - Megan J Shen
- Cornell Center for Research on End-of-Life Care, New York, New York.,Department of Medicine, Weill Cornell Medicine, New York, New York
| | - Holly G Prigerson
- Cornell Center for Research on End-of-Life Care, New York, New York.,Department of Medicine, Weill Cornell Medicine, New York, New York
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Xiao SD, Shen MJ, Shi Y, Li YY, Wang JW, Jiang SJ. Evaluation of HemoQuant test and enteroclysis in estimating the sites of obscure gastrointestinal bleeding. Gastroenterol Jpn 1991; 26 Suppl 3:111-5. [PMID: 1884942 DOI: 10.1007/bf02779277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
The HemoQuant test includes the measurement of total fecal hemoglobin (Hb) or porphyrin derived from heme, and of intestinal converted fraction (ICF) which is the performed porphyrin probably by bacteria during enterocolic transit. The mean +/- SD of HemoQuant in 31 healthy subjects was 0.57 +/- 0.49 mg Hb/g stool, values above 2 mg Hb/g stool are considered to be positive. In patients with upper GI bleeding (n = 44), small bowel bleeding (n = 11) and large bowel bleeding (n = 16), the ICF ranged 0.03-23%, 0.09-20.20% and 0.35-11.0%, respectively. There was major overlap in individual ICF due to some influencing factors such as the quantity of fecal blood and the enterocolic transit. We conclude that HemoQuant is a sensitive assay for detection of fecal occult blood, but ICF is not helpful in estimating the anatomic site of bleeding. Seventy-one patients with GI bleeding of obscure origin underwent enteroclysis. The results showed 77.5% had definite lesions in the small bowel, but 22.5% still were undefined. It is suggested that enteroclysis should be performed without delay if upper and lower GI endoscopic studies are negative.
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Affiliation(s)
- S D Xiao
- Shanghai Second Medical University, Shanghai Institute of Digestive Disease, Shanghai Ren-ji Hospital, People's Republic of China
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Huang Z, Sun QY, Shen MJ. Rewarming with microwave irradiation in severe cold injury syndrome. Chin Med J (Engl) 1980; 93:119-20. [PMID: 6768511] [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: 01/21/2023] Open
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Shen MJ. [Isolation and identification of the virus from acute hemorrhagic conjunctivitis in Shanghai (author's transl)]. Zhonghua Yan Ke Za Zhi 1979; 15:90-3. [PMID: 233651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Bailin G, Shen MJ, Katz AM. Cooperative interactions between the contractile proteins of cardiac and skeletal muscle. Biochim Biophys Acta 1977; 480:469-78. [PMID: 138446 DOI: 10.1016/0005-2744(77)90039-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
The calcium activation of the ATPase (ATP phosphohydrolase, EC 3.6.1.3) activity of cardiac actomyosin reconstituted from bovine cardiac myosin and a complex of actin-tropomyosin-troponin extracted from bovine cardiac muscle at 37 degrees C was studied and compared with similar proteins from rabbit fast skeletal muscle. The proteins of the actin complex were identified by polyacrylamide gel electrophoresis in sodium dodecyl sulfate. Half-maximal activation of the cardiac actomyosin was seen at a calcium concentration of 1.2 +/- 0.002 (S.E. of mean) muM. A hybridized reconstituted actomyosin made with cardiac myosin and the actin-tropomyosin-troponin complex extracted from rabbit skeletal muscle was also activated by calcium but the half-maximal value was shifted to 0.65 +/- 0.02 (S.E. of mean) muM Ca2+. Homologous rabbit skeletal actomyosin showed half-maximal activation at 0.90 +/- 0.01 (S.E. of mean) muM Ca2+ and the value for a hybridized actomyosin made with rabbit skeletal myosin and the actin-complex from cardiac muscle was found at 1.4 +/- 0.03 (S.E. of mean) muM Ca2+ concentration. Kinetic analysis of the Ca2+ activated ATPase activity of reconstituted bovine cardiac actomyosin indicated some degree of cooperativity with respect to calcium. Double reciprocal plots of reconstituted actomyosins made with bovine cardiac actin complex were curvilinear and significantly different than those of reconstituted actomyosins made with the rabbit fast skeletal actin complex. The Ca2+-dependent cooperativity was of a mixed type as determined from Hill plots for homologous reconstituted bovine cardiac and rabbit fast skeletal actomyosin. The results show that cooperative interactions in reconstituted actomyosins were greater when the actin-tropomyosin-troponin complex was derived from cardiac than skeletal muscle.
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