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Walsh CA, Currin-McCulloch J, Faris NR, Nguyen TST, Al Achkar M. "Living with Loss": A qualitative exploration of existential fears among people with advanced lung cancer in online lung cancer support groups. Palliat Support Care 2024:1-6. [PMID: 38420708 DOI: 10.1017/s147895152400004x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2024]
Abstract
OBJECTIVES With targeted therapies, people are surviving longer with advanced lung cancer and engaging in online lung cancer support communities. While these groups provide a sense of community, witnessing the death of peers can lead to emotional distress. This qualitative study aims to (1) explore the experience of witnessing death in online cancer support groups; (2) identify factors that contribute to the emotional struggles of witnessing the death of peers; and (3) identify strategies/options for dealing with losses in the cancer community. METHODS We conducted a cross-sectional analysis of qualitative interviews exploring existential concerns with participants (n = 25) from oncogene-specific online lung cancer support groups. The principal investigator conducted study interviews between August 2018 and March 2019 where participants were asked about their cancer experiences and existential concerns. We used thematic analysis and NVIVO 11 software to examine and store the de-identified interview data. RESULTS Participants indicated that they had often witnessed their peers die and felt the pain of the loss. Factors that played a part in their struggle with witnessing others' death included the closeness of the relationship with the person, the age of the person who died, seeing oneself in the experience of the other dying, disparities in care, and losing touch in the final stages. Participants used varied coping strategies such as celebrating the life of the individual who died, engaging in advocacy efforts, not focusing on the loss, participating in therapy, and bringing self-preserving thoughts. SIGNIFICANCE OF RESULTS Our study highlights the importance of addressing existential fears in online lung cancer support groups and incorporating conversations about death in spaces that deal with cancer.
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Affiliation(s)
- Casey A Walsh
- Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, WA, USA
| | | | - Nicholas R Faris
- Multidisciplinary Thoracic Oncology Program, Baptist Cancer Center, Memphis, TN, USA
| | - Thu Suong Thi Nguyen
- School of Education, Indiana University Purdue University Indianapolis, Indianapolis, IN, USA
| | - Morhaf Al Achkar
- Department of Family Medicine, University of Washington, Seattle, WA, USA
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Al Achkar M, Dahal A, Frogner BK, Skillman SM, Patterson DG. Integrating Immigrant Health Professionals into the U.S. Healthcare Workforce: Barriers and Solutions. J Immigr Minor Health 2023; 25:1270-1278. [PMID: 37084020 PMCID: PMC10119818 DOI: 10.1007/s10903-023-01472-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/16/2023] [Indexed: 04/22/2023]
Abstract
Internationally educated immigrant healthcare workers face skill underutilization working in lower-skilled healthcare jobs or outside healthcare. This study explored barriers to and solutions for integrating immigrant health professionals. Content analysis identifying key themes from semi-structured qualitative interviews with representatives from Welcome Back Centers (WBCs) and partner organizations. 18 participants completed interviews. Barriers facing immigrant health professionals included lack of access to resources, financial constraints, language difficulties, credentialing challenges, prejudice, and investment in current occupations. Barriers facing programs that assist immigrant health professionals included eligibility restrictions, funding challenges, program workforce instability, recruitment difficulties, difficulty maintaining connection, and pandemic challenges. Long-term program success depended on partner networks, advocacy, addressing prejudice, a client-centered approach, diverse resources and services, and conducting research. Initiatives to integrate immigrant health professionals require multi-level responses to diverse needs and collaborations among organizations that support immigrant health professionals, healthcare systems, labor, and other stakeholders.
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Affiliation(s)
- Morhaf Al Achkar
- Department of Family Medicine, University of Washington, Box 356390, Seattle, WA, 98195-6390, USA.
| | - Arati Dahal
- Department of Family Medicine, University of Washington, Box 356390, Seattle, WA, 98195-6390, USA
| | - Bianca K Frogner
- Department of Family Medicine, University of Washington, Box 356390, Seattle, WA, 98195-6390, USA
| | - Susan M Skillman
- Department of Family Medicine, University of Washington, Box 356390, Seattle, WA, 98195-6390, USA
| | - Davis G Patterson
- Department of Family Medicine, University of Washington, Box 356390, Seattle, WA, 98195-6390, USA
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Thuo N, Martins T, Manley E, Standifer M, Sultan DH, Faris NR, Hill A, Thompson M, Jeremiah R, Al Achkar M. Factors leading to disparity in lung cancer diagnosis among black/African American communities in the USA: a qualitative study. BMJ Open 2023; 13:e073886. [PMID: 37899158 PMCID: PMC10619042 DOI: 10.1136/bmjopen-2023-073886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Accepted: 09/29/2023] [Indexed: 10/31/2023] Open
Abstract
OBJECTIVE This study has two objectives: first, to explore the diagnostic experiences of black/African American (BAA) patients with lung cancer to pinpoint pitfalls, suboptimal experiences and instances of discrimination leading to disparities in outcomes compared with patients of other ethnic backgrounds, especially white patients. The second objective is to identify the underlying causes contributing to health disparities in the diagnosis of lung cancer among BAA patients. METHODS We employed a phenomenological research approach, guiding in-depth interviews with patients self-identifying as BAA diagnosed with lung cancer, as well as caregivers, healthcare professionals and community advocates knowledgeable about BAA experiences with lung cancer. We performed thematic analysis to identify experiences at patient, primary care and specialist levels. Contributing factors were identified using the National Institute of Minority Health and Health Disparities (NIMHD) health disparity model. RESULTS From March to November 2021, we conducted individual interviews with 19 participants, including 9 patients/caregivers and 10 providers/advocates. Participants reported recurring and increased pain before seeking treatment, treatment for non-cancer illnesses, delays in diagnostic tests and referrals, poor communication and bias when dealing with specialists and primary care providers. Factors contributing to suboptimal experiences included reluctance by insurers to cover costs, provider unwillingness to conduct comprehensive testing, provider bias in recommending treatment, high healthcare costs, and lack of healthcare facilities and qualified staff to provide necessary support. However, some participants reported positive experiences due to their insurance, availability of services and having an empowered support structure. CONCLUSIONS BAA patients and caregivers encountered suboptimal experiences during their care. The NIMHD model is a useful framework to organise factors contributing to these experiences that may be leading to health disparities. Additional research is needed to fully capture the extent of these experiences and identify ways to improve BAA patient experiences in the lung cancer diagnosis pathway.
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Affiliation(s)
- Nicholas Thuo
- Family Medicine, Univeristy of Washington, Seattle, WA, USA
| | - Tanimola Martins
- Health and Community Science, University of Exeter, Exeter, UK
- Health and Community Science, University of Exeter, Exeter, UK
| | | | - Maisha Standifer
- Health Policy, Morehouse School of Medicine, Atlanta, Georgia, USA
| | | | - Nicholas R Faris
- Multidisciplinary Thoracic Oncology Program, Baptist Cancer Center, Memphis, Tennessee, USA
| | - Angela Hill
- Pharmacotherapuetics and Clinical Research, University of South Florida, Tampa, Florida, USA
| | | | - Rohan Jeremiah
- Global Health, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Morhaf Al Achkar
- Oncology, Wayne State University/Karmanos Cancer Institute, Detroit, MI, USA
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Al Achkar M, Roy UB, Manley E, Standifer M, Baik C, Walsh CA. Correction to: A qualitative study of interactions with oncologists among patients with advanced lung cancer. Support Care Cancer 2023; 31:534. [PMID: 37615810 DOI: 10.1007/s00520-023-07995-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/25/2023]
Affiliation(s)
- Morhaf Al Achkar
- Department of Family Medicine, University of Washington, School of Medicine, Box 356390, Seattle, WA, 98195, USA.
| | | | | | - Maisha Standifer
- LUNGevity Foundation, Chicago, IL, USA
- Satcher Health Leadership Institute, Morehouse School of Medicine, Atlanta, GA, USA
| | - Christina Baik
- Department of Family Medicine, University of Washington, School of Medicine, Box 356390, Seattle, WA, 98195, USA
- Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, WA, USA
| | - Casey A Walsh
- Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, WA, USA
- Department of Orthopaedics & Sports Medicine, University of Washington School of Medicine, Seattle, WA, USA
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Meehan AA, Cox SN, Thuo NB, Rogers JH, Link AC, Martinez MA, Lo NK, Manns BJ, Rolfes MA, Chow EJ, Chu HY, Mosites E, Al Achkar M. Previous Health Care Experiences' Influence on Health Care Perceptions Among Residents of Six Homeless Shelters in Seattle, Washington, July-October 2021. J Patient Cent Res Rev 2023; 10:111-120. [PMID: 37483554 PMCID: PMC10358972 DOI: 10.17294/2330-0698.2012] [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: 07/25/2023] Open
Abstract
Purpose The study purpose was to learn and describe 1) where homeless shelter residents receive health care, 2) what contributes to positive or negative health care experiences among shelter residents, and 3) shelter resident perceptions toward health care. Methods Semi-structured interviews (SSIs) utilizing purposive sampling and focus group discussions (FGDs) utilizing convenience sampling were conducted at 6 homeless shelters in Seattle-King County, Washington, during July-October 2021. All residents (age ≥18) were eligible to participate. SSIs were conducted with 25 residents, and 8 FGDs were held. Thematic analysis was conducted using Dedoose. Results Participants received health care in settings ranging from no regular care to primary care providers. Four elements emerged as contributing positively and negatively to health care experiences: 1) ability to access health care financially, physically, and technologically; 2) clarity of communication from providers and staff about appointment logistics, diagnoses, and treatment options; 3) ease of securing timely follow-up services; and 4) respect versus stigma and discrimination from providers and staff. Participants who felt positively toward health care found low- or no-cost care to be widely available and encouraged others to seek care. However, some participants described health care in the United States as greedy, classist, discriminatory, and untrustworthy. Participants reported delaying care and self-medicating in anticipation of discrimination. Conclusions Findings demonstrate that while people experiencing homelessness can have positive experiences with health care, many have faced negative interactions with health systems. Improving the patient experience for those experiencing homelessness can increase engagement and improve health outcomes.
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Affiliation(s)
- Ashley A. Meehan
- COVID-19 Emergency Response, Centers for Disease Control and Prevention, Atlanta, GA
| | - Sarah N. Cox
- Department of Epidemiology, University of Washington, Seattle, WA
- Division of Allergy & Infectious Diseases, Department of Medicine, University of Washington, Seattle, WA
| | - Nicholas B. Thuo
- Division of Allergy & Infectious Diseases, Department of Medicine, University of Washington, Seattle, WA
| | - Julia H. Rogers
- Department of Epidemiology, University of Washington, Seattle, WA
- Division of Allergy & Infectious Diseases, Department of Medicine, University of Washington, Seattle, WA
| | - Amy C. Link
- Division of Allergy & Infectious Diseases, Department of Medicine, University of Washington, Seattle, WA
| | - Miguel A. Martinez
- Division of Allergy & Infectious Diseases, Department of Medicine, University of Washington, Seattle, WA
| | - Natalie K. Lo
- Division of Allergy & Infectious Diseases, Department of Medicine, University of Washington, Seattle, WA
| | - Brian J. Manns
- COVID-19 Emergency Response, Centers for Disease Control and Prevention, Atlanta, GA
| | - Melissa A. Rolfes
- COVID-19 Emergency Response, Centers for Disease Control and Prevention, Atlanta, GA
| | - Eric J. Chow
- Division of Allergy & Infectious Diseases, Department of Medicine, University of Washington, Seattle, WA
- Public Health – Seattle & King County, Seattle, WA
| | - Helen Y. Chu
- Division of Allergy & Infectious Diseases, Department of Medicine, University of Washington, Seattle, WA
| | - Emily Mosites
- COVID-19 Emergency Response, Centers for Disease Control and Prevention, Atlanta, GA
| | - Morhaf Al Achkar
- Department of Family Medicine, University of Washington, Seattle, WA
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Barton C, Al Achkar M, Blender JA, Farmen SH, Hall RB, Konidari AM, Martinez D, Pronsati N, Rosenzweig M, Vass C, Venanzi ES, Westlake W, Muskavitch MAT. Patient-led advocacy in ALK-positive lung cancer. Transl Lung Cancer Res 2023; 12:1303-1319. [PMID: 37425399 PMCID: PMC10326769 DOI: 10.21037/tlcr-22-713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Accepted: 05/31/2023] [Indexed: 07/11/2023]
Abstract
Patient-led advocacy organizations in the anaplastic lymphoma kinase (ALK)-positive lung cancer space are becoming increasingly influential. ALK Positive Inc. (hereafter "ALK Positive") is probably the most widely known among these organizations. Evolving from a private Facebook Support Group created in 2015 to provide a forum for ALK-positive lung cancer patients and caregivers to exchange information, empathy and support, ALK Positive transitioned in 2021 into a 501(c)(3) non-profit organization (NPO), with the mission to improve the life expectancy and quality of life for ALK-positive cancer patients worldwide. This review provides a historical perspective on the growth, activities and aspirations of ALK Positive to pursue patient advocacy and enable development of new therapies for individuals with ALK-positive cancers. This growth has been enabled by the collaborative efforts of ALK-positive cancer patients, their care-partners and oncologists, academic researchers, other NPO advocacy organizations, and members of the biotech and pharma communities who develop new therapies for ALK-positive cancers. ALK Positive has grown to provide a variety of patient services, to award competitive support for translational research and clinical trials intended to enable new therapies and improved quality and extent of life for ALK-positive cancer patients, and to collaborate with industry and academia to accelerate the development of improved therapies for ALK-positive cancer patients. ALK Positive continues grappling with a variety of challenges including further improving patient quality of life, enabling the development of new therapies, and extending its already substantial global reach and impact. This review summarizes many of the tangible impacts and aspirations engendered by ALK Positive for ALK-positive cancer patients in the past, present and future tenses-where we have been, where we stand and where we hope to go. The content is based on the historical recollections of the authors, and is accurate as of November 30, 2022, to the best of the authors' knowledge.
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Affiliation(s)
| | - Morhaf Al Achkar
- ALK Positive Inc., Atlanta, GA, USA
- Department of Family Medicine, University of Washington, School of Medicine, Seattle, WA, USA
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Prado MG, Kessler LG, Au MA, Burkhardt HA, Zigman Suchsland M, Kowalski L, Stephens KA, Yetisgen M, Walter FM, Neal RD, Lybarger K, Thompson CA, Al Achkar M, Sarma EA, Turner G, Farjah F, Thompson MJ. Symptoms and signs of lung cancer prior to diagnosis: case-control study using electronic health records from ambulatory care within a large US-based tertiary care centre. BMJ Open 2023; 13:e068832. [PMID: 37080616 PMCID: PMC10124310 DOI: 10.1136/bmjopen-2022-068832] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2022] [Accepted: 03/22/2023] [Indexed: 04/22/2023] Open
Abstract
OBJECTIVE Lung cancer is the most common cause of cancer-related death in the USA. While most patients are diagnosed following symptomatic presentation, no studies have compared symptoms and physical examination signs at or prior to diagnosis from electronic health records (EHRs) in the USA. We aimed to identify symptoms and signs in patients prior to diagnosis in EHR data. DESIGN Case-control study. SETTING Ambulatory care clinics at a large tertiary care academic health centre in the USA. PARTICIPANTS, OUTCOMES We studied 698 primary lung cancer cases in adults diagnosed between 1 January 2012 and 31 December 2019, and 6841 controls matched by age, sex, smoking status and type of clinic. Coded and free-text data from the EHR were extracted from 2 years prior to diagnosis date for cases and index date for controls. Univariate and multivariable conditional logistic regression were used to identify symptoms and signs associated with lung cancer at time of diagnosis, and 1, 3, 6 and 12 months before the diagnosis/index dates. RESULTS Eleven symptoms and signs recorded during the study period were associated with a significantly higher chance of being a lung cancer case in multivariable analyses. Of these, seven were significantly associated with lung cancer 6 months prior to diagnosis: haemoptysis (OR 3.2, 95% CI 1.9 to 5.3), cough (OR 3.1, 95% CI 2.4 to 4.0), chest crackles or wheeze (OR 3.1, 95% CI 2.3 to 4.1), bone pain (OR 2.7, 95% CI 2.1 to 3.6), back pain (OR 2.5, 95% CI 1.9 to 3.2), weight loss (OR 2.1, 95% CI 1.5 to 2.8) and fatigue (OR 1.6, 95% CI 1.3 to 2.1). CONCLUSIONS Patients diagnosed with lung cancer appear to have symptoms and signs recorded in the EHR that distinguish them from similar matched patients in ambulatory care, often 6 months or more before diagnosis. These findings suggest opportunities to improve the diagnostic process for lung cancer.
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Affiliation(s)
- Maria G Prado
- Department of Family Medicine, University of Washington, Seattle, Washington, USA
| | - Larry G Kessler
- Health Services, University of Washington, Seattle, Washington, USA
| | - Margaret A Au
- Department of Family Medicine, University of Washington, Seattle, Washington, USA
| | - Hannah A Burkhardt
- Department of Biomedical Informatics and Medical Education, University of Washington, Seattle, Washington, USA
| | | | - Lesleigh Kowalski
- Department of Family Medicine, University of Washington, Seattle, Washington, USA
| | - Kari A Stephens
- Department of Family Medicine, University of Washington, Seattle, Washington, USA
| | - Meliha Yetisgen
- Department of Biomedical Informatics and Medical Education, University of Washington, Seattle, Washington, USA
| | - Fiona M Walter
- Wolfson Institute of Population Health, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
- The Primary Care Unit Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | | | - Kevin Lybarger
- Department of Information Sciences and Technology, George Mason University, Fairfax, Virginia, USA
| | - Caroline A Thompson
- Department of Epidemiology, The University of North Carolina, Chapel Hill, North Carolina, USA
- Division of Epidemiology and Biostatistics, San Diego State University, San Diego, California, USA
| | - Morhaf Al Achkar
- Department of Family Medicine, University of Washington, Seattle, Washington, USA
| | | | - Grace Turner
- Department of Biomedical Informatics and Medical Education, University of Washington, Seattle, Washington, USA
| | - Farhood Farjah
- Department of Surgery, University of Washington, Seattle, Washington, USA
| | - Matthew J Thompson
- Department of Family Medicine, University of Washington, Seattle, Washington, USA
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Al Achkar M, Rogers TS, Weidner A, Seehusen DA, South-Paul JE. How to Sponsor, Coach, and Mentor: A Qualitative Study With Family Medicine Department Chairs. Fam Med 2023; 55:143-151. [PMID: 36888668 PMCID: PMC10622011 DOI: 10.22454/fammed.2023.830553] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
BACKGROUND AND OBJECTIVES The goal of this study was to explore how to use sponsoring, coaching, and mentoring (SCM) for faculty development by clarifying the functions embedded in SCM. The study aims to ensure that department chairs can be intentional in providing those functions and/or playing those roles for the benefit of all their faculty. METHODS We used qualitative, semistructured interviews in this study. We followed a purposeful sampling strategy to recruit a diverse sample of family medicine department chairs across the United States. Participants were asked about their experiences receiving and providing sponsoring, coaching, and mentoring. We iteratively coded audio recorded and transcribed interviews for content and themes. RESULTS We interviewed 20 participants between December 2020 and May 2021 to identify actions associated with sponsoring, coaching, and mentoring. Participants identified six main actions sponsors perform. These actions are identifying opportunities, recognizing an individual's strengths, encouraging opportunity-seeking, offering tangible support, optimizing candidacy, nominating as a candidate, and promising support. In contrast, they identified seven main actions a coach performs. These are clarifying, advising, giving resources, performing critical appraisals, giving feedback, reflecting, and scaffolding (ie, providing support while learning). Finally, participants identified six main actions the mentors perform. The list includes checking in, listening, sharing wisdom, directing, supporting, and collaborating. CONCLUSIONS We present SCM as an identifiable series of actions that need to be thought of and performed intentionally. Our clarification will help leaders purposefully select their actions and allows opportunity for evaluating their effectiveness. Future research will explore developing and evaluating programs that support learning how to provide SCM in order to enhance the process of faculty development and provide it equitably.
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Affiliation(s)
- Morhaf Al Achkar
- Department of Family Medicine, University of WashingtonSeattle, WA
| | - Tyler S. Rogers
- Department of Family Medicine, Uniformed Services University of Health SciencesBethesda, MD
- Family Medicine Residency Program, Martin Army Community HospitalGA
| | - Amanda Weidner
- Family Medicine Residency Network, Department of Family Medicine, University of WashingtonWA, Seattle
- Association of Departments of Family MedicineLeawood, KS
| | - Dean A. Seehusen
- Department of Family Medicine, Medical College of Georgia at Augusta UniversityAugusta, GA
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Cox SN, Thuo N, Rogers JH, Meehan AA, Link AC, Lo NK, Manns B, Ogokeh CE, Chow EJ, Rolfes MA, Mosites E, Achkar MA, Chu HY. 1929. A Qualitative Analysis of COVID-19 Vaccination Intent and Recommendations to Increase Uptake Among Residents and Staff in Six Seattle Homeless Shelters. Open Forum Infect Dis 2022. [PMCID: PMC9752652 DOI: 10.1093/ofid/ofac492.1556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Background COVID-19 vaccines are important to mitigate severe disease in congregate settings, yet uptake remains lower among people experiencing homelessness (PEH) than in the general population. This study aimed to explain changes in COVID-19 vaccination intent over time and identify modifiable factors to improve vaccine acceptance among PEH. Methods We utilized the Health Belief Model and 3Cs Model of Vaccine Hesitancy to develop a conceptual framework to explore factors that may influence COVID-19 vaccination intent among PEH. Between July 27 - October 15, 2021, we conducted semi-structured interviews (SSIs) and focus group discussions (FGDs) across six homeless shelters in Seattle-King County, Washington. Residents and staff aged 18 years and older were recruited through purposive sampling for SSIs and convenience sampling for FGDs. We captured retrospective information about perceptions of and intent to receive COVID-19 vaccines between March 2020 - August 2021. Thematic analysis was conducted using Dedoose. Results We conducted 31 SSIs (25 residents and six staff) and eight FGDs with 43 residents. Participants reported that too much contradictory and changing information about COVID-19 vaccines led to confusion. Information deemed trustworthy (i.e., objective, honest, professional, and recommended by others) contributed to individual’s knowledge and in some cases changed their vaccination intent. Despite intention to vaccinate, participants reported barriers to COVID-19 vaccine access including availability, eligibility, appointments, and timeliness. While many intended to get vaccinated on their own, others were motivated by incentives and requirements. Participants presented recommendations to improve COVID-19 information content and dissemination, access, and incentives in shelter settings (Table 1).
Recommendations for Interventions to Increase COVID-19 Vaccine Uptake in Shelter Settings ![]() Conclusion COVID-19 vaccination strategies that are rooted in the voices and experiences of PEH are presented and can inform improved vaccine implementation among key stakeholders. Future research should test recommended strategies to determine feasibility and effectiveness in shelter settings. Disclosures Helen Y. Chu, MD, MPH, Cepheid: Reagents|Ellume: Advisor/Consultant|Gates Ventures: Grant/Research Support|Merck: Advisor/Consultant|Pfizer: Advisor/Consultant.
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Affiliation(s)
- Sarah N Cox
- University of Washington, Seattle, Washington
| | | | | | - Ashley A Meehan
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Amy C Link
- University of Washington, Seattle, Washington
| | | | - Brian Manns
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | - Eric J Chow
- Public Health - Seattle & King County, Seattle, Washington
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Zigman Suchsland M, Kowalski L, Burkhardt HA, Prado MG, Kessler LG, Yetisgen M, Au MA, Stephens KA, Farjah F, Schleyer AM, Walter FM, Neal RD, Lybarger K, Thompson CA, Achkar MA, Sarma EA, Turner G, Thompson M. How Timely Is Diagnosis of Lung Cancer? Cohort Study of Individuals with Lung Cancer Presenting in Ambulatory Care in the United States. Cancers (Basel) 2022; 14:cancers14235756. [PMID: 36497238 PMCID: PMC9740627 DOI: 10.3390/cancers14235756] [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] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2022] [Revised: 10/22/2022] [Accepted: 11/16/2022] [Indexed: 11/25/2022] Open
Abstract
The diagnosis of lung cancer in ambulatory settings is often challenging due to non-specific clinical presentation, but there are currently no clinical quality measures (CQMs) in the United States used to identify areas for practice improvement in diagnosis. We describe the pre-diagnostic time intervals among a retrospective cohort of 711 patients identified with primary lung cancer from 2012-2019 from ambulatory care clinics in Seattle, Washington USA. Electronic health record data were extracted for two years prior to diagnosis, and Natural Language Processing (NLP) applied to identify symptoms/signs from free text clinical fields. Time points were defined for initial symptomatic presentation, chest imaging, specialist consultation, diagnostic confirmation, and treatment initiation. Median and interquartile ranges (IQR) were calculated for intervals spanning these time points. The mean age of the cohort was 67.3 years, 54.1% had Stage III or IV disease and the majority were diagnosed after clinical presentation (94.5%) rather than screening (5.5%). Median intervals from first recorded symptoms/signs to diagnosis was 570 days (IQR 273-691), from chest CT or chest X-ray imaging to diagnosis 43 days (IQR 11-240), specialist consultation to diagnosis 72 days (IQR 13-456), and from diagnosis to treatment initiation 7 days (IQR 0-36). Symptoms/signs associated with lung cancer can be identified over a year prior to diagnosis using NLP, highlighting the need for CQMs to improve timeliness of diagnosis.
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Affiliation(s)
| | - Lesleigh Kowalski
- Department of Family Medicine, University of Washington, Seattle, WA 98195, USA
| | - Hannah A. Burkhardt
- Department of Biomedical Informatics and Medical Education, University of Washington, Seattle, WA 98195, USA
| | - Maria G. Prado
- Department of Family Medicine, University of Washington, Seattle, WA 98195, USA
| | - Larry G. Kessler
- Department of Health Systems and Population Health, School of Public Health, University of Washington, Seattle, WA 98195, USA
| | - Meliha Yetisgen
- Department of Biomedical Informatics and Medical Education, University of Washington, Seattle, WA 98195, USA
| | - Maggie A. Au
- Department of Family Medicine, University of Washington, Seattle, WA 98195, USA
| | - Kari A. Stephens
- Department of Family Medicine, University of Washington, Seattle, WA 98195, USA
| | - Farhood Farjah
- Department of Surgery, University of Washington, Seattle, WA 98195, USA
| | | | - Fiona M. Walter
- Wolfson Institute of Population Health, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London E1 4NS, UK
- The Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge CB1 8RN, UK
| | - Richard D. Neal
- University of Exeter Medical School, University of Exeter, Exeter EX1 2LU, UK
| | - Kevin Lybarger
- Department of Information Sciences and Technology, George Mason University, Fairfax, VA 22039, USA
| | - Caroline A. Thompson
- Department of Epidemiology, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
- Division of Epidemiology and Biostatistics, School of Public Health, San Diego State University, San Diego, CA 92182, USA
| | - Morhaf Al Achkar
- Department of Family Medicine, University of Washington, Seattle, WA 98195, USA
| | - Elizabeth A. Sarma
- Healthcare Delivery Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD 20892, USA
| | - Grace Turner
- Department of Biomedical Informatics and Medical Education, University of Washington, Seattle, WA 98195, USA
| | - Matthew Thompson
- Department of Family Medicine, University of Washington, Seattle, WA 98195, USA
- Correspondence:
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Al Achkar M, Basu Roy U, Manley E, Standifer M, Baik C, Walsh CA. A qualitative study of interactions with oncologists among patients with advanced lung cancer. Support Care Cancer 2022; 30:9049-9055. [PMID: 35948849 PMCID: PMC9365681 DOI: 10.1007/s00520-022-07309-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Accepted: 07/27/2022] [Indexed: 11/04/2022]
Abstract
INTRODUCTION To support the care of lung cancer patients, oncologists have needed to stay current on treatment advancements and build relationships with a new group of survivors in an era where lung cancer survivorship has been re-defined. The objectives of the study were to (1) understand the perspectives of advanced lung cancer patients whose tumors have oncogenic alterations about their care experiences with their oncologist(s) and (2) describe the perceptions of advanced lung cancer patients about seeking second opinions and navigating care decisions. METHODS In this qualitative study, patients with advanced lung cancer (n = 25) on targeted therapies were interviewed to discuss their ongoing experience with their oncologists. We used deductive and inductive qualitative approaches in the coding of the data. We organized the data using the self-determination framework. RESULTS Patients described both positive and negative aspects of their care as related to autonomy, provider competency, and connectedness. Patients sought second opinions for three primary reasons: expertise, authoritative advice, and access to clinical trial opportunities. When there is disagreement in the treatment plan between the primary oncologist and the specialist, there can be confusion and tension, and patients have to make difficult choices about their path forward. CONCLUSIONS Patients value interactions that support their autonomy, demonstrate the competency of their providers, and foster connectedness. To ensure that patients receive quality and goal-concordant care, developing decision aids and education materials that help patients negotiate recommendations from two providers is an area that deserves further attention.
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Affiliation(s)
- Morhaf Al Achkar
- Department of Family Medicine, University of Washington, School of Medicine, Box 356390, Seattle, WA, 98195, USA.
| | | | | | - Maisha Standifer
- LUNGevity Foundation, Chicago, IL, USA
- Satcher Health Leadership Institute, Morehouse School of Medicine, Atlanta, GA, USA
| | - Christina Baik
- Department of Family Medicine, University of Washington, School of Medicine, Box 356390, Seattle, WA, 98195, USA
- Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, WA, USA
| | - Casey A Walsh
- Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, WA, USA
- Department of Orthopaedics & Sports Medicine, University of Washington School of Medicine, Seattle, WA, USA
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12
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Cox SN, Rogers JH, Thuo NB, Meehan A, Link AC, Lo NK, Manns BJ, Chow EJ, Al Achkar M, Hughes JP, Rolfes MA, Mosites E, Chu HY. Trends and factors associated with change in COVID-19 vaccination intent among residents and staff in six Seattle homeless shelters, March 2020 to August 2021. Vaccine X 2022; 12:100232. [PMID: 36276877 PMCID: PMC9578969 DOI: 10.1016/j.jvacx.2022.100232] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 09/30/2022] [Accepted: 10/17/2022] [Indexed: 11/17/2022] Open
Abstract
Introduction Achieving high COVID-19 vaccination coverage in homeless shelters is critical in preventing morbidity, mortality, and outbreaks, however, vaccination coverage remains lower among people experiencing homelessness (PEH) than the general population. Methods We conducted a cross-sectional study to retrospectively describe attitudes and identify factors associated with change in COVID-19 vaccination intent among shelter residents and staff during March 2020 - August 2021. To identify factors associated with change in COVID-19 vaccine intent becoming more positive overall compared to other attitudes, we utilized a Poisson model to calculate Risk Ratios with robust standard errors, adjusting for confounding by shelter site and demographic variables determined a priori. Results From July 12 - August 2, 2021, 97 residents and 20 staff participated in surveys across six shelters in Seattle King County, Washington. Intent to be vaccinated against COVID-19 increased from 45.3 % (n = 53) when recalling attitudes in March 2020 to 74.4 % (n = 87) as of August 2021, and was similar among residents and staff. Many participants (43.6 %, n = 51) indicated feeling increasingly accepting about receiving a COVID-19 vaccine since March 2020, while 13.7 % (n = 16) changed back and forth, 10.3 % (n = 12) became more hesitant, and 32.5 % (n = 38) had no change in intent. In the model examining the relationship between becoming more positive about receiving a COVID-19 vaccine compared to all other attitudes (n = 116), we found a 57.2 % increase in vaccine acceptability (RR 1.57; 95 % CI: 1.01, 2.45) among those who reported worsening mental health since the start of the pandemic. Conclusions Findings highlight opportunities to improve communication with residents and staff about COVID-19 vaccination and support a need for continued dialogue and a person-centered approach to understanding the sociocultural complexities and dynamism of vaccine attitudes at shelters.Clinical Trial Registry Number: NCT04141917.
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Affiliation(s)
- Sarah N. Cox
- Department of Medicine, Division of Allergy & Infectious Diseases, University of Washington, Seattle, WA, USA,Department of Epidemiology, University of Washington, Seattle, WA, USA,Corresponding author at: UW Medicine Box 358061, Chu Lab Room E630, 750 Republican Street, Seattle, WA, 98109, USA.
| | - Julia H. Rogers
- Department of Medicine, Division of Allergy & Infectious Diseases, University of Washington, Seattle, WA, USA,Department of Epidemiology, University of Washington, Seattle, WA, USA
| | - Nicholas B. Thuo
- Department of Medicine, Division of Allergy & Infectious Diseases, University of Washington, Seattle, WA, USA
| | - Ashley Meehan
- Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Amy C. Link
- Department of Medicine, Division of Allergy & Infectious Diseases, University of Washington, Seattle, WA, USA
| | - Natalie K. Lo
- Department of Medicine, Division of Allergy & Infectious Diseases, University of Washington, Seattle, WA, USA
| | - Brian J. Manns
- Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Eric J. Chow
- Department of Medicine, Division of Allergy & Infectious Diseases, University of Washington, Seattle, WA, USA
| | - Morhaf Al Achkar
- Department of Family Medicine, University of Washington, Seattle, WA, USA
| | - James P. Hughes
- Department of Biostatistics, University of Washington, Seattle, WA, USA
| | | | - Emily Mosites
- Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Helen Y. Chu
- Department of Medicine, Division of Allergy & Infectious Diseases, University of Washington, Seattle, WA, USA
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13
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Markwardt HS, Taghavi SE, Williams AP, Olivares MN, McDuffee PR, Al Achkar M, Hall BC. The AYA Care Plan: Initial Evaluation of a Web-Based Psychosocial Intervention. JCO Clin Cancer Inform 2022; 6:e2200086. [DOI: 10.1200/cci.22.00086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
PURPOSE Adolescents and young adults (AYA) with cancer do not fit neatly into pediatric or older adult oncology care settings. Recent efforts have led to the development of psychosocial interventions for AYAs, but studies show AYAs demonstrate low levels of engagement in psychosocial services. The AYA Care Plan is one of the only web-based tools providing a personalized, psychosocial resource that addresses unmet needs for AYAs in active treatment and post-treatment survivorship. The current study aims to assess the usability and utility of the AYA Care Plan and identify opportunities for improvement. METHODS Clinic staff administered an online distress and needs assessment to AYA patients with cancer at outpatient oncology clinics. Personalized care plans were sent to participants on the basis of their responses. A total of 11 AYAs between the ages 18 and 39 years, with a mean age of 31.64 years, then completed qualitative interviews about their experiences. Thematic analysis was used to identify themes on the AYA Care Plan. RESULTS A majority of participants reported positive usability features. Half of the participants reported using their care plan to make health care decisions. One person indicated not finding the resources helpful, and the other half of participants reported not engaging with the care plan. Participants also offered suggestions for improvement. CONCLUSION The AYA Care Plan appears to be a useful psychosocial intervention for some AYAs with cancer. Future research should continue to examine the AYA Care Plan's usability and utility, and specify when, how, and for whom the AYA Care Plan is useful.
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Affiliation(s)
- Haley S. Markwardt
- Department of Psychiatry, UT Southwestern Medical Center, Dallas, TX
- UT Southwestern Moncrief Cancer Institute, Fort Worth, TX
| | - Sarah E. Taghavi
- Department of Psychiatry, UT Southwestern Medical Center, Dallas, TX
- UT Southwestern Moncrief Cancer Institute, Fort Worth, TX
| | | | | | | | | | - Brittany C. Hall
- Department of Psychiatry, UT Southwestern Medical Center, Dallas, TX
- UT Southwestern Moncrief Cancer Institute, Fort Worth, TX
- Fort Worth Adolescent Young Adult Oncology Coalition, Fort Worth, TX
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14
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Godfrey EM, Thayer EK, Mentch L, Kazmerski TM, Brown G, Pam M, Al Achkar M. Development and evaluation of a virtual patient-centered outcomes research training program for the cystic fibrosis community. Res Involv Engagem 2021; 7:86. [PMID: 34863273 PMCID: PMC8645106 DOI: 10.1186/s40900-021-00328-4] [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] [Figures] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Accepted: 11/15/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND Patient-centered outcomes research (PCOR) emphasizes patient-generated research priorities and outcomes, and engages patients throughout every stage of the research process. In the cystic fibrosis (CF) community, patients frequently provide input into research studies, but rarely are integrated onto research teams. Therefore, we developed and evaluated a virtual pilot PCOR training program to build PCOR capacity in the CF community (patients, caregivers, researchers, nonprofit stakeholders and providers). We aimed to show changes among participants' perceived PCOR knowledge (a.k.a PCOR knowledge), confidence in engaging stakeholders, and post-training session satisfaction. METHODS Guided by a prior CF community educational needs assessment, our researcher and patient-partner team co-developed a four-part virtual online training program. We structured the program towards two learner groups: patients/caregivers and researchers/providers. We evaluated participants' PCOR knowledge, confidence in engaging stakeholders, and session satisfaction by administering 5-point Likert participant surveys. We tested for significant differences between median ratings pre- and post-training. RESULTS A total of 28 patients/caregivers, and 31 researchers/providers participated. For both learner groups, we found the training resulted in significantly higher PCOR knowledge scores regarding "levels of engagement" (p = .008). For the patient/caregiver group, training significantly increased their PCOR knowledge about the barriers/enablers to doing PCOR (p = .017), effective PCOR team elements (p = .039), active participation (p = .012), and identifying solutions for successful PCOR teams (p = .021). For the researcher/healthcare provider group, training significantly increased participants' ability to describe PCOR core principles (p = .016), identify patient-partners (p = .039), formulate research from patient-driven priorities (p = .039), and describe engagement in research grants (p = .006). No learner group had significant changes in their confidence score. Most participants were either "satisfied" or "very satisfied" with the training program. CONCLUSIONS Overall, our virtual pilot PCOR training program was well received by patients, caregivers, researchers and providers in the CF community. Participants significantly improved their perceived knowledge with core PCOR learning items. Trial registration Retrospectively registered at clinicaltrials.gov (NCT04999865).
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Affiliation(s)
- Emily M Godfrey
- Department of Family Medicine, School of Medicine, University of Washington, 4311 11th Ave NE, Box 354982, Seattle, WA, 98105, USA.
| | - Erin K Thayer
- Department of Family Medicine, School of Medicine, University of Washington, 4311 11th Ave NE, Box 354982, Seattle, WA, 98105, USA
| | - Laura Mentch
- Cystic Fibrosis Reproductive and Sexual Health Collaborative, Seattle, USA
| | - Traci M Kazmerski
- Department of Pediatrics, School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Georgia Brown
- Cystic Fibrosis Reproductive and Sexual Health Collaborative, Seattle, USA
| | - Molly Pam
- Cystic Fibrosis Reproductive and Sexual Health Collaborative, Seattle, USA
| | - Morhaf Al Achkar
- Department of Family Medicine, School of Medicine, University of Washington, 4311 11th Ave NE, Box 354982, Seattle, WA, 98105, USA
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15
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Abstract
BACKGROUND AND OBJECTIVES Coaching, mentoring, and sponsoring are tools academic leaders can utilize to develop junior faculty. Each tool has a unique goal, time frame and method. It has been suggested that sponsoring may be a particularly useful tool for furthering the careers of women in medicine. Our primary aim was to understand to what extent one group of academic leaders-family medicine department chairs-have benefited from each tool in their own career development and how often they use each to develop others. A secondary aim was to compare women's experiences with sponsorship to their male colleagues. METHODS We surveyed all US family medicine department chairs electronically about their experiences with coaching, mentoring, and sponsoring. We collected data from August 2019 to October 2019. RESULTS One hundred five of 193 family medicine department chairs responded to our survey (54.4% response rate). Most indicated that mentoring played a significant role in their career development, with fewer reporting coaching and sponsorship played significant roles. More reported frequent use of mentoring to develop faculty compared to coaching or sponsoring. Training in mentoring and sponsoring was associated with increased use, but coaching was not. No gender difference was found in this study population. CONCLUSIONS Chairs have less experience with coaching and sponsoring than mentoring. Personal experience being coached, mentored, or sponsored was associated with increased use of these tools. Formal training may increase use of mentoring and sponsoring. Contrary to our hypothesis, female chairs' experience with sponsoring was similar to their male peers.
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Affiliation(s)
- Dean A Seehusen
- Department of Family Medicine, Augusta University, Augusta, GA
| | | | - Morhaf Al Achkar
- Department of Family Medicine, University of Washington, Seattle, WA
| | - Tammy Chang
- University of Michigan Department of Family Medicine and Institute for Healthcare Policy and Innovation, Ann Arbor, MI
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16
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Markwardt HS, Taghavi SE, Sligar KB, Al Achkar M, Hall BC. Web-Based Psychosocial Care Plan for Adolescent and Young Adult Patients With Cancer: A Proposed Model and Plan for Analysis. JCO Clin Cancer Inform 2021; 5:490-493. [PMID: 33950709 DOI: 10.1200/cci.21.00029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Haley S Markwardt
- Department of Psychiatry, UT Southwestern Medical Center, Dallas, TX.,UT Southwestern Moncrief Cancer Institute, Fort Worth, TX
| | - Sarah E Taghavi
- UT Southwestern Moncrief Cancer Institute, Fort Worth, TX.,Department of Psychology, Texas Christian University, Fort Worth, TX
| | - Kylie B Sligar
- Department of Psychiatry, UT Southwestern Medical Center, Dallas, TX.,UT Southwestern Moncrief Cancer Institute, Fort Worth, TX
| | | | - Brittany C Hall
- Department of Psychiatry, UT Southwestern Medical Center, Dallas, TX.,UT Southwestern Moncrief Cancer Institute, Fort Worth, TX.,Fort Worth Adolescent Young Adult Oncology Coalition, Fort Worth, TX
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17
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Al Achkar M, Zigman Suchsland M, Walter FM, Neal RD, Goulart BHL, Thompson MJ. Experiences along the diagnostic pathway for patients with advanced lung cancer in the USA: a qualitative study. BMJ Open 2021; 11:e045056. [PMID: 33888529 PMCID: PMC8070881 DOI: 10.1136/bmjopen-2020-045056] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Most patients with lung cancer are diagnosed at advanced stages. However, the advent of oral targeted therapies has improved the prognosis of many patients with lung cancer. PURPOSE We aimed to understand the diagnostic experiences of patients with advanced lung cancer with oncogenic mutations. METHODS Qualitative interviews were conducted with patients with advanced or metastatic non-small cell lung cancer with oncogenic alterations. Patients were recruited from online support groups within the USA. Interviews were conducted remotely or in person. Analysis used an iterative inductive and deductive process. Themes were mapped to the Model for Pathways to Treatment. RESULTS 40 patients (12 male and 28 female) with a median age of 48 were included. We identified nine distinct themes. During the 'patient interval', individuals became concerned about symptoms, but often attributed them to other causes. Prolonged or more severe symptoms prompted care-seeking. During the 'primary care interval', doctors initially treated for illnesses other than cancer. Discovery of an imaging abnormality was a turning point in diagnostic pathways. Occasionally, severity of symptoms prompted patients to seek emergency care. During the 'secondary care interval', obtaining tissue samples was pivotal in confirming diagnosis. Delays in accessing oncology care sometimes led to patient distress. Obtaining genetic testing was crucial in directing patients to receive targeted treatments. CONCLUSIONS Patients experienced multiple different routes to their diagnosis. Some patients perceived delays, inefficiencies and lack of coordination, which could be distressing. Shifting the stage of diagnosis of lung cancer to optimise the impact of targeted therapies will require concerted efforts in early detection.
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Affiliation(s)
- Morhaf Al Achkar
- Department of Family Medicine, University of Washington, Seattle, Washington, USA
| | | | - Fiona M Walter
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | | | | | - Matthew J Thompson
- Department of Family Medicine, University of Washington, Seattle, Washington, USA
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18
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Collins K, Spice C, Ingraham BC, Al Achkar M. Family Medicine Resident Knowledge of Adverse Childhood Experiences. PRiMER 2021; 5:13. [PMID: 33860168 DOI: 10.22454/primer.2021.971170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Introduction Exposure to adverse childhood experiences (ACEs) has been associated with poor health in adulthood. Primary care providers can provide more appropriate medical care and intervene if they ask patients about ACEs. The purpose of this study is to determine existing knowledge and attitudes about ACEs among family medicine residents within the Washington, Wyoming, Alaska, Montana, and Idaho (WWAMI) region. Methods Researchers developed a nine-question survey to assess family medicine residents' knowledge and attitudes about ACEs, and their comfort level in addressing ACEs. The survey was distributed to 540 residents in 22 family medicine residency programs in the WWAMI region. Results Most residents reported they had some (32%) or moderate (35%) knowledge of the ACEs study. However, 30% reported no knowledge of the ACEs study, and very few (3%) reported significant knowledge. Of 117 respondents reporting at least some prior knowledge of ACEs, 42% had first heard about ACEs during residency. The ACEs topics that respondents felt least comfortable addressing during a patient encounter were a patient's personal history of sexual abuse (75%) and witnessing physical abuse (47%). Most residents (84%) indicated that they would like to see ACEs integrated into their residency curriculum. Discussion This study demonstrates a gap in residency training on the topic of ACEs in family medicine residencies within the WWAMI region. Residents are uncomfortable addressing ACEs with patients but are receptive to learning about this topic. More teaching about ACEs can increase residents' comfort level with addressing these topics in the primary care setting.
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19
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Thayer EK, Pam M, Al Achkar M, Mentch L, Brown G, Kazmerski TM, Godfrey E. Best Practices for Virtual Engagement of Patient-Centered Outcomes Research Teams During and After the COVID-19 Pandemic: Qualitative Study. J Particip Med 2021; 13:e24966. [PMID: 33646964 PMCID: PMC7954110 DOI: 10.2196/24966] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Revised: 12/10/2020] [Accepted: 12/14/2020] [Indexed: 11/20/2022] Open
Abstract
Background Patient-centered outcomes research (PCOR) engages patients as partners in research and focuses on questions and outcomes that are important to patients. The COVID-19 pandemic has forced PCOR teams to engage through web-based platforms rather than in person. Similarly, virtual engagement is the only safe alternative for members of the cystic fibrosis (CF) community, who spend their lives following strict infection control guidelines and are already restricted from in-person interactions. In the absence of universal best practices, the CF community has developed its own guidelines to help PCOR teams engage through web-based platforms. Objective This study aimed to identify the important attributes, facilitators, and barriers to teams when selecting web-based platforms. Methods We conducted semistructured interviews with CF community members, nonprofit stakeholders, and researchers to obtain information regarding their experience with using web-based platforms, including the effectiveness and efficiency of these platforms and their satisfaction with and confidence while using each platform. Interviews conducted via Zoom were audio recorded and transcribed. We identified key themes through content analysis with an iterative, inductive, and deductive coding process. Results In total, 15 participants reported using web-based platforms for meetings, project management, document sharing, scheduling, and communication. When selecting web-based platforms, participants valued their accessibility, ease of use, and integration with other platforms. Participants speculated that successful web-based collaboration involved platforms that emulate in-person interactions, recognized the digital literacy levels of the team members, intentionally aligned platforms with collaboration goals, and achieved team member buy-in to adopt new platforms. Conclusions Successful web-based engagement in PCOR requires the use of multiple platforms in order to fully meet the asynchronous or synchronous goals of the project. This study identified the key attributes for the successful practice of PCOR on web-based platforms and the common challenges and solutions associated with their use. Our findings provide the best practices for selecting platforms and the lessons learned through web-based PCOR collaborations.
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Affiliation(s)
- Erin K Thayer
- Department of Family Medicine, University of Washington, Seattle, WA, United States
| | - Molly Pam
- Cystic Fibrosis Reproductive and Sexual Health Collaborative, Seattle, WA, United States
| | - Morhaf Al Achkar
- Department of Family Medicine, University of Washington, Seattle, WA, United States
| | - Laura Mentch
- Cystic Fibrosis Reproductive and Sexual Health Collaborative, Seattle, WA, United States
| | - Georgia Brown
- Cystic Fibrosis Reproductive and Sexual Health Collaborative, Seattle, WA, United States
| | - Traci M Kazmerski
- Department of Pediatrics, University of Pittsburgh, Pittsburgh, PA, United States
| | - Emily Godfrey
- Department of Family Medicine, University of Washington, Seattle, WA, United States
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20
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Godfrey EM, Kazmerski TM, Brown G, Thayer EK, Mentch L, Pam M, Al Achkar M. Educational Needs and Preferences for Patient-Centered Outcomes Research in the Cystic Fibrosis Community: Mixed Methods Study. JMIR Form Res 2021; 5:e24302. [PMID: 33661127 PMCID: PMC7974760 DOI: 10.2196/24302] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 11/04/2020] [Accepted: 01/17/2021] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND Cystic fibrosis (CF) is a rare, life-shortening, multiorgan disease, the treatment of which has seen significant increases in the life expectancy of those with CF. Many advances in CF care are thanks to the dedicated and active participation of people with CF as research participants. Unfortunately, most CF research teams still do not fully partner with people with CF or their caregivers. OBJECTIVE The aim of this study was to determine the interest, knowledge gaps, and desired format for patient-centered outcomes research (PCOR) training in the CF community. METHODS We surveyed patients, caregivers, researchers, research staff, and diverse health care providers via list servers and social media outreach about their knowledge of, experience with, and preferences for PCOR training components. We followed the survey with 3 small-group discussion sessions with 22 participants who completed the survey to establish consensus and prioritize key learning components of a PCOR training program. We summarized results using descriptive statistics. RESULTS A total of 170 participants completed the survey (patients/caregivers: 96/170, 56.5%; researchers/health care providers: 74/170, 43.5%). Among providers, 26% (19/74) were physicians/advanced practice providers, 20% (15/74) were nurses, and 54% (40/74) were from other disciplines. Among all participants, 86.5% (147/170) expressed interest in learning about PCOR, although training topics and training format differed between the patient/caregiver and researcher/health care provider groups. Before participating in PCOR, patients/caregivers wanted to understand more about expectations of them as partners on PCOR research teams (82/96, 85%). Meanwhile, researchers/health care providers desired information on how to include outcomes important to patients/caregivers (55/74, 74%) and the quality and impact of PCOR research (52/74, 70% and 51/74, 69%, respectively). Patients/caregivers were most interested in learning about the time commitment as a PCOR team member (75/96, 78%). Researchers/health care providers wanted to receive training about how to establish trust (47/74, 64%) and maintain confidentiality (47/74, 64%) when including patient or caregiver partners on the PCOR team. During follow-up discussions, participants emphasized the importance of addressing the traditional patient/caregiver and researchers/health care provider hierarchy by teaching about transparency, appreciation, creating a common language between the groups, and providing specific training on "how" to do PCOR. CONCLUSIONS Our findings suggest CF community members are interested in PCOR. A high-quality training program would fill a current deficit in methodological research. This assessment identified the topics and formats desired and can be used to develop targeted training to enhance meaningful PCOR in CF.
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Affiliation(s)
- Emily M Godfrey
- Department of Family Medicine, University of Washington School of Medicine, Seattle, WA, United States
| | - Traci M Kazmerski
- Department of Pediatrics, School of Medicine, University of Pittsburgh, Pittsburgh, PA, United States
| | - Georgia Brown
- Cystic Fibrosis Reproductive and Sexual Health Collaborative, Seattle, WA, United States
| | - Erin K Thayer
- Department of Family Medicine, University of Washington School of Medicine, Seattle, WA, United States
| | - Laura Mentch
- Cystic Fibrosis Reproductive and Sexual Health Collaborative, Seattle, WA, United States
| | - Molly Pam
- Cystic Fibrosis Reproductive and Sexual Health Collaborative, Seattle, WA, United States
| | - Morhaf Al Achkar
- Department of Family Medicine, University of Washington School of Medicine, Seattle, WA, United States
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21
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Walsh CA, Al Achkar M. A qualitative study of online support communities for lung cancer survivors on targeted therapies. Support Care Cancer 2021; 29:4493-4500. [PMID: 33458808 PMCID: PMC7811894 DOI: 10.1007/s00520-021-05989-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Accepted: 01/06/2021] [Indexed: 12/18/2022]
Abstract
Background Due to recent treatment advances, people who have non–small cell lung cancer with oncogenic alterations are an important new group of cancer survivors. Little is known about lung cancer online support communities. This research was guided by two primary questions: (1) How do these lung cancer survivors engage in online support communities? and (2) What are the psychological, social, and physical impacts of such engagement? Methods Qualitative in-depth interviews were conducted with patients with advanced lung cancer (N = 40) to learn about their experiences with the illness. We used qualitative thematic analysis, inductive and deductive, as outlined by Carspecken. We adapted the framework for studying online communities developed by Zhang and colleagues to examine engagement with and impacts of involvement in online lung cancer support communities. Results Participants described engaging in the online community through (1) initializing communication through asking questions or sharing resources, (2) responding to others comments or inquiries, or (3) simply observing/reading others posts. Participation had physical, psychological, or social impacts, with benefits (e.g., empowerment) and risks (e.g., feelings of jealousy or misinformation) in each domain. Participants used various strategies to mitigate negative impacts, such as distancing oneself as needed. Conclusions Online lung cancer support communities provide support, camaraderie, and specialized health information. However, there are also risks of online engagement, such as social comparison or accessing misinformation. Understanding the utility of online support communities for lung cancer survivors on targeted therapies and further addressing their risks are urgent tasks, especially in the post-COVID era.
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Affiliation(s)
- Casey A Walsh
- Department of Health Services, University of Washington, Seattle, WA, USA.
- Clinical Research Division, Fred Hutchinson Cancer Research Center, 1100 Fairview Ave N., Mail Stop D5-220, Seattle, WA, 98109, USA.
| | - Morhaf Al Achkar
- Department of Family Medicine, University of Washington School of Medicine, Seattle, WA, USA
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22
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Lyon AR, Pullmann MD, Jacobson J, Osterhage K, Al Achkar M, Renn BN, Munson SA, Areán PA. Assessing the Usability of Complex Psychosocial Interventions: The Intervention Usability Scale. Implement Res Pract 2021; 2:2633489520987828. [PMID: 35601889 PMCID: PMC9122125 DOI: 10.1177/2633489520987828] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [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: 09/07/2023] Open
Abstract
BACKGROUND Usability - the extent to which an intervention can be used by specified users to achieve specified goals with effectiveness, efficiency, and satisfaction - may be a key determinant of implementation success. However, few instruments have been developed to measure the design quality of complex health interventions (i.e., those with several interacting components). This study evaluated the structural validity of the Intervention Usability Scale (IUS), an adapted version of the well-established System Usability Scale (SUS) for digital technologies, to measure the usability of a leading complex psychosocial intervention, Motivational Interviewing (MI), for behavioral health service delivery in primary care. Prior SUS studies have found both one- and two-factor solutions, both of which were examined in the current study of the IUS. METHOD A survey administered to 136 medical professionals from 11 primary care sites collected demographic information and IUS ratings for MI, the evidence-based psychosocial intervention that primary care providers reported using most often for behavioral health service delivery. Factor analyses replicated procedures used in prior research on the SUS. RESULTS Analyses indicated that a two-factor solution (with "usable" and "learnable" subscales) best fit the data, accounting for 54.1% of the variance. Inter-item reliabilities for the total score, usable subscale, and learnable subscale were α = .83, α = .84, and α = .67, respectively. CONCLUSIONS This study provides evidence for a two-factor IUS structure consistent with some prior research, as well as acceptable reliability. Implications for implementation research evaluating the usability of complex health interventions are discussed, including the potential for future comparisons across multiple interventions and provider types, as well as the use of the IUS to evaluate the relationship between usability and implementation outcomes such as feasibility.
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Al Achkar M, Bennett IM, Chwastiak L, Hoeft T, Normoyle T, Vredevoogd M, Patterson DG. Telepsychiatric Consultation as a Training and Workforce Development Strategy for Rural Primary Care. Ann Fam Med 2020; 18:438-445. [PMID: 32928760 PMCID: PMC7489960 DOI: 10.1370/afm.2561] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Revised: 02/25/2020] [Accepted: 03/09/2020] [Indexed: 11/09/2022] Open
Abstract
PURPOSE There is a shortage of rural primary care personnel with expertise in team care for patients with common mental disorders. Building the workforce for this population is a national priority. We investigated the feasibility of regular systematic case reviews through telepsychiatric consultation, within collaborative care for depression, as a continuous training and workforce development strategy in rural clinics. METHODS We developed and pilot-tested a qualitative interview guide based on a conceptual model of training and learning. We conducted individual semistructured interviews in 2018 with diverse clinical and nonclinical staff at 3 rural primary care sites in Washington state that used ongoing collaborative care and telepsychiatric consultation. Two qualitative researchers independently analyzed transcripts with iterative input from other research team members. RESULTS A total of 17 clinical, support, and administrative staff completed interviews. Participants' feedback supported the view that telepsychiatric case review-based consultation enhanced skills of diverse clinical team members over time, even those who had not directly participated in case reviews. All interviewees identified specific ways in which the consultations improved their capacity to identify and treat psychiatric disorders. Perceived benefits in implementation and sustainability included fidelity of the care process, team resilience despite member turnover, and enhanced capacity to use quality improvement methods. CONCLUSIONS Weekly systematic case reviews using telepsychiatric consultation served both as a model for patient care and as a training and workforce development strategy in rural primary care sites delivering collaborative care. These are important benefits to consider in implementing the collaborative care model of behavioral health integration.
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Affiliation(s)
- Morhaf Al Achkar
- Department of Family Medicine, University of Washington, Seattle, Washington
| | - Ian M Bennett
- Department of Family Medicine, University of Washington, Seattle, Washington.,Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, Washington
| | - Lydia Chwastiak
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, Washington
| | - Theresa Hoeft
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, Washington
| | | | - Melinda Vredevoogd
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, Washington
| | - Davis G Patterson
- Department of Family Medicine, University of Washington, Seattle, Washington
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Al Achkar M. Explicating practice norms and tensions between values in resident training in family medicine. BMC Fam Pract 2020; 21:174. [PMID: 32842992 PMCID: PMC7447569 DOI: 10.1186/s12875-020-01242-6] [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] [Subscribe] [Scholar Register] [Received: 07/05/2019] [Accepted: 08/11/2020] [Indexed: 11/10/2022]
Abstract
Background Residency programs have the intricate and complex role of training health care providers. But little is known about what residents and attendings consider norms of practice or the tensions among different values residents are expected to uphold. Thus, dialogical and reflective frameworks are being explored for resident learning. Methods This study examined the use of facilitated conversations with groups of residents and attending physicians while reviewing video-recorded resident–patient interactions. The conversations were recorded, transcribed, and qualitatively analyzed. Results A total of 24 residents and 10 attendings participated in conversations while separately and in parallel groups reviewing 15 resident sessions. Residents explicated the norms of practice and evaluated their performance, which often agreed with those of attending physicians in calling out important learning opportunities. When disagreement occurred, residents’ explications of their reasoning were often relevant and, via reflection and dialogue, helped clarify intentions that were not apparent in the videos. Residents and attendings often judged actions on more than one domain of value. For instance, if a resident addressed problems, built relationships in a timely manner, and acted autonomously without jeopardizing the quality of care, she satisfactorily performed her duty. Conclusions Practice norms and value struggles were addressed by participants during reviews, which provided a promising framework for learning and assessment. Also, the non-hierarchical structure opened space to acknowledge a diversity of positions and for tensions among values to be explicated.
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Affiliation(s)
- Morhaf Al Achkar
- Department of Family Medicine, University of Washington, Seattle, WA, USA.
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Al Achkar M, Marchand L, Thompson M, Chow LQM, Revere D, Baldwin LM. Unmet needs and opportunities for improving care for patients with advanced lung cancer on targeted therapies: a qualitative study. BMJ Open 2020; 10:e032639. [PMID: 32205370 PMCID: PMC7103815 DOI: 10.1136/bmjopen-2019-032639] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
OBJECTIVE Lung cancer is increasingly recognised as a heterogeneous disease. Recent advances with targeted therapies for lung cancer with oncogenic mutations have greatly improved the prognosis for this subset of patients, yet little is known about their experiences. This study aimed to identify the needs and explore the healthcare experiences of these advanced patients with oncogenic mutation driven lung cancer. DESIGN Qualitative interviews with patients with advanced or metastatic non-small cell lung cancer with oncogenic alterations in anaplastic lymphoma kinase, epidermal growth factor receptor or c-ros oncogene 1. SETTINGS Patients were recruited from online lung cancer support groups within the USA. Interviews were conducted remotely or in person, transcribed verbatim and analysed using an iterative inductive and deductive process. PARTICIPANTS We included 39 patients (11 males and 28 females) with a median age of 48. RESULTS Two primary theme categories emerged: patients' unmet needs and improving healthcare experiences. Unmet needs are related to patients' desire to view their disease as a chronic illness, aspire to live a meaningful existence without financial devastation, desire for understanding along with emotional support and needing help with practical matters. Improving healthcare experiences involved patients' desire to trust the expertise of clinical providers, receive reliable care and be treated holistically and as informed partners. CONCLUSIONS Patients with lung cancer with oncogenic mutations live uncharted experiences. Targeted therapy brings hope, but uncertainty is daunting. Patients grapple with the meaning and purpose of their lives while day-to-day obligations remain challenging. Healthcare teams are instrumental in their care experiences, and patients desire providers who are up-to-date on advances in the field and treat them as whole persons.
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Affiliation(s)
- Morhaf Al Achkar
- Family Medicine, University of Washington, Seattle, Washington, USA
| | - Lucille Marchand
- Family Medicine, University of Washington, Seattle, Washington, USA
| | - Matthew Thompson
- Family Medicine, University of Washington, Seattle, Washington, USA
| | - Laura Q M Chow
- Department of Oncology, University of Texas at Austin, Dell Medical School, Austin, Texas, USA
| | - Debra Revere
- School of Public Health, University of Washington, Seattle, Washington, USA
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Al Achkar M, Kengeri-Srikantiah S, Yamane BM, Villasmil J, Busha ME, Gebke KB. Billing by residents and attending physicians in family medicine: the effects of the provider, patient, and visit factors. BMC Med Educ 2018; 18:136. [PMID: 29895287 PMCID: PMC5998502 DOI: 10.1186/s12909-018-1246-7] [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] [Figures] [Subscribe] [Scholar Register] [Received: 08/15/2017] [Accepted: 05/31/2018] [Indexed: 06/08/2023]
Abstract
BACKGROUND Medical billing and coding are critical components of residency programs since they determine the revenues and vitality of residencies. It has been suggested that residents are less likely to bill higher evaluation and management (E/M) codes compared with attending physicians. The purpose of this study is to assess the variation in billing patterns between residents and attending physicians, considering provider, patient, and visit characteristics. METHOD A retrospective cohort study of all established outpatient visits at a family medicine residency clinic over a 5-year period was performed. We employed the logistic regression methodology to identify residents' and attending physicians' variations in coding E/M service levels. We also employed Poisson regression to test the sensitivity of our result. RESULTS Between January 5, 2009 and September 25, 2015, 98,601 visits to 116 residents and 18 attending physicians were reviewed. After adjusting for provider, patient, and visit characteristics, residents billed higher E/M codes less often compared with attending physicians for comparable visits. In comparison with attending physicians, the odds ratios for billing higher E/M codes were 0.58 (p = 0.01), 0.56 (p = 0.01), and 0.63 (p = 0.01) for the third, second, and first years of postgraduate training, respectively. In addition to the main factors of patient age, medical conditions, and number of addressed problems, the gender of the provider was also implicated in the billing variations. CONCLUSION Residents are less likely to bill higher E/M codes than attending physicians are for similar visits. While these variations are known to contribute to lost revenues, further studies are required to explore their effect on patient care in relation to attendings' direct involvement in higher E/M-coded versus their indirect involvement in lower E/M-coded visits.
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Affiliation(s)
- Morhaf Al Achkar
- Department of Family Medicine, University of Washington, 314 NE Thornton Place, Seattle, WA 98125 USA
| | - Seema Kengeri-Srikantiah
- Department of Family Medicine, Indiana University, 1110 W Michigan St #200, Indianapolis, IN 46202 USA
| | - Biniyam M. Yamane
- Department of Economics, Indiana University, 100 S Woodlawn Ave, Bloomington, IN 47405 USA
| | - Jomil Villasmil
- Department of Family Medicine, Indiana University, 1110 W Michigan St #200, Indianapolis, IN 46202 USA
| | - Michael E. Busha
- Western Michigan University Homer Stryker MD School of Medicine, 300 Portage Street, Kalamazoo, MI 49007 USA
| | - Kevin B. Gebke
- Department of Family Medicine, Indiana University, 1110 W Michigan St #200, Indianapolis, IN 46202 USA
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Abstract
BACKGROUND Evidence-based medicine (EBM) plays a critical part in ensuring that practitioners use the soundest available medical procedures while avoiding ineffective ones. As such, it plays a key role in medical residency education. However, little research has shown what factors influence residents' adoption of habits in, self-efficacy in, and skills of EBM. MATERIALS AND METHODS This study gathered responses from a cross section of family medicine residents and new interns from 40 different residencies across the USA. The survey was based on Taylor et al's survey of EBM attitudes and behaviors and the Fresno test's assessment of EBM knowledge and skills. The study used negative binomial regression, ordinary least squares regression, and nonparametric tests of difference to assess the impact of residents' background (year in residency, type of residency, previous EBM training, and previous research experience) on these EBM outcomes. RESULTS Residents with previous research experience are associated with stronger EBM habits, more self-efficacy in applying EBM, and greater ability in using EBM skills. Previous research experience had a bigger impact on these outcomes than any other predictor. EBM habits, self-efficacy, and skills did not appear to show even increases by year in residency. Previous EBM training was associated with more hours spent reading the literature and higher EBM skill test scores. CONCLUSION Our findings suggest the practice of EBM may benefit from medical education increasing research experiences and EBM training. Research experiences provide the practical training, while EBM training provides focused instruction necessary for EBM self-efficacy, habits, and skills. These EBM outcomes are not inherently gained through time in family medicine residency. Future research, particularly longitudinal designs, should continue to pursue this line of inquiry.
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Affiliation(s)
- Justin Paulsen
- School of Education, Indiana University, Bloomington, IN, USA
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Al Achkar M, Grannis S, Revere D, MacKie P, Howard M, Gupta S. The effects of state rules on opioid prescribing in Indiana. BMC Health Serv Res 2018; 18:29. [PMID: 29347984 PMCID: PMC5774127 DOI: 10.1186/s12913-018-2830-6] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2016] [Accepted: 01/04/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Prescription opioids have been linked to over half of the 28,000 opioid overdose deaths in 2014. High rates of prescription opioid non-medical use have continued despite nearly all states implementing large-scale prescription drug monitoring programs (PDMP), which points to the need to examine the impact of state PDMP's on curbing inappropriate opioid prescribing. In the short-term, PDMPs have been associated with short-term prescribing declines. Yet little is known about how such policies differentially impact patient subgroups or are interpreted by prescribing providers. Our objective was to compare volumes of prescribed opioids before and after Indiana implemented opioid prescribing emergency rules and stratify the changes in opioid prescribing by patient and provider subgroups. METHODS An interrupted time series analysis was conducted using data obtained from the Indiana PDMP. Prescription level data was merged with census data to characterize patient socioeconomic status. Analyses were stratified by patients' gender, age, opioid dosage, and payer. The primary outcome indicator was the total morphine equivalent dose (MED) of dispensed opioids per day in the state of Indiana. Also considered were number of unique patients, unique providers, and prescriptions; MED per transaction and per day; and number of days supplied. RESULTS After controlling for time trends, we found that total MED for opioids decreased after implementing the new emergency rules, differing by patient gender, age, and payer. The effect was larger for males than females and almost 10 times larger for 0-20 year olds as compared to the 60+ age range. Medicare and Medicaid patients experienced more decline in prescribing than patients with private insurance. Patients with prescriptions paid for by workers' comp experienced the most significant decline. The emergency rules were associated with decline in both the number of prescribers and the number of day supply. CONCLUSIONS Although the Indiana opioid prescribing emergency rules impacted statewide prescribing behavior across all individual patient and provider characteristics, the emergency rules' effect was not consistent across patient characteristics. Further studies are needed to assess how individual patient characteristics influence the interpretation and application of state policies on opioid prescribing.
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Affiliation(s)
| | - Shaun Grannis
- Indiana University School of Medicine, Indianapolis, IN, USA.,Regenstrief Institute, Indianapolis, IN, USA
| | - Debra Revere
- University of Washington School of Public Health, Seattle, WA, USA
| | - Palmer MacKie
- Indiana University School of Medicine, Indianapolis, IN, USA
| | - Meredith Howard
- University of North Texas System College of Pharmacy, Fort Worth, TX, USA
| | - Sumedha Gupta
- Indiana University-Purdue University School of Liberal Art, Indianapolis, IN, USA
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Al Achkar M, Hanauer M, Colavecchia C, Seehusen DA. Interprofessional education in graduate medical education: survey study of residency program directors. BMC Med Educ 2018; 18:11. [PMID: 29321024 PMCID: PMC5763580 DOI: 10.1186/s12909-017-1104-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/08/2017] [Accepted: 12/12/2017] [Indexed: 05/08/2023]
Abstract
BACKGROUND The overarching purpose of this study is to examine the current trends in interprofessional education (IPE) within graduate medical education in the Unites States. METHODS A survey was sent to program directors across with different specialties between March and April 2016. The survey was completed by 233 out of 1757 program directors, which represents a response rate of 13.3%. RESULTS IPE is currently being used by over 60% of the GME program directors that completed the survey. The median number of IPE hours is 60. Classroom learning (70.8%) and team-based approaches (70.1%) to patient care are the two most common forms of IPE. The two most prevalent reasons for implementing IPE are improving collaboration (92.2%) and communication (87%). More than half of the program directors agreed or strongly agreed that lack of time both for teachers (54.4) and for residents (51.5%) are barriers to IPE. About one third of the respondents whose programs do not include IPE are interested in implementing some IPE in the future. CONCLUSION IPE in its varying formats has been implemented as a training model by many residency programs. Further studies are needed to explore the comparative effectiveness of the different modalities of IPE.
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Affiliation(s)
- Morhaf Al Achkar
- University of Washington Family Medicine Residency, 331 NE Thornton Place, Seattle, WA 98125 USA
| | - Mathew Hanauer
- Department of Family Medicine-Indiana University, Indianapolis, Indiana USA
| | | | - Dean A. Seehusen
- Dwight D. Eisenhower Army Medical Center, Fort Gordon, Georgia USA
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Al Achkar M, Revere D, Dennis B, MacKie P, Gupta S, Grannis S. Exploring perceptions and experiences of patients who have chronic pain as state prescription opioid policies change: a qualitative study in Indiana. BMJ Open 2017; 7:e015083. [PMID: 29133312 PMCID: PMC5695446 DOI: 10.1136/bmjopen-2016-015083] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES The misuse and abuse of prescription opioids (POs) is an epidemic in the USA today. Many states have implemented legislation to curb the use of POs resulting from inappropriate prescribing. Indiana legislated opioid prescribing rules that went into effect in December 2013. The rules changed how chronic pain is managed by healthcare providers. This qualitative study aims to evaluate the impact of Indiana's opioid prescription legislation on the patient experiences around pain management. SETTING This is a qualitative study using interviews of patient and primary care providers to obtain triangulated data sources. The patients were recruited from an integrated pain clinic to which chronic pain patients were referred from federally qualified health clinics (FQHCs). The primacy care providers were recruited from the same FQHCs. The study used inductive, emergent thematic analysis. PARTICIPANTS Nine patient participants and five primary care providers were included in the study. RESULTS Living with chronic pain is disruptive to patients' lives on multiple dimensions. The established pain management practices were disrupted by the change in prescription rules. Patient-provider relationships, which involve power dynamics and decision making, shifted significantly in parallel to the rule change. CONCLUSIONS As a result of the changes in pain management practice, some patients experienced significant challenges. Further studies into the magnitude of this change are necessary. In addition, exploring methods for regulating prescribing while assuring adequate access to pain management is crucial.
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Affiliation(s)
- Morhaf Al Achkar
- Department of Family Medicine, University of Washington, Seattle, Washington, USA
| | - Debra Revere
- School of Public Health, University of Washington, Seattle, Washington, USA
| | - Barbara Dennis
- School of Education, Indiana University, Bloomington, Indiana, USA
| | - Palmer MacKie
- Department of Clinical Medicine, Indiana University, Indianapolis, Indiana, USA
| | - Sumedha Gupta
- School of Liberal Arts, Indiana University-Purdue University, Indianapolis, Indiana, USA
| | - Shaun Grannis
- Department of Family Medicine, Indiana University, Indianapolis, Indiana, USA
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Abstract
Journal club (JC), as a pedagogical strategy, has long been used in graduate medical education (GME). As evidence-based medicine (EBM) becomes a mainstay in GME, traditional models of JC present a number of insufficiencies and call for novel models of instruction. A flipped classroom model appears to be an ideal strategy to meet the demands to connect evidence to practice while creating engaged, culturally competent, and technologically literate physicians. In this article, we describe a novel model of flipped classroom in JC. We present the flow of learning activities during the online and face-to-face instruction, and then we highlight specific considerations for implementing a flipped classroom model. We show that implementing a flipped classroom model to teach EBM in a residency program not only is possible but also may constitute improved learning opportunity for residents. Follow-up work is needed to evaluate the effectiveness of this model on both learning and clinical practice.
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Affiliation(s)
| | | | - Morhaf Al Achkar
- Department of Family Medicine, School of Medicine, University of Washington, Seattle, WA, USA
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Al Achkar M, Hanauer M, Morrison EH, Davies MK, Oh RC. Changing trends in residents-as-teachers across graduate medical education. Adv Med Educ Pract 2017; 8:299-306. [PMID: 28496376 PMCID: PMC5417659 DOI: 10.2147/amep.s127007] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
BACKGROUND Teaching residents how to teach is a critical part of residents' training in graduate medical education (GME). The purpose of this study was to assess the change in resident-as-teacher (RaT) instruction in GME over the past 15 years in the US. METHODS We used a quantitative and qualitative survey of all program directors (PDs) across specialties. We compared our findings with a previous work from 2000-2001 that studied the same matter. Finally, we qualitatively analyzed PDs' responses regarding the reasons for implementing and not implementing RaT instruction. RESULTS Two hundred and twenty-one PDs completed the survey, which yields a response rate of 12.6%. Over 80% of PDs implement RaT, an increase of 26.34% compared to 2000-2001. RaT instruction uses multiple methods with didactic lectures reported as the most common, followed by role playing in simulated environments, then observing and giving feedback. Residents giving feedback, clinical supervision, and bedside teaching were the top three targeted skills. Through our qualitative analysis we identified five main reasons for implementing RaT: teaching is part of the residents' role; learners desire formal RaT training; regulatory bodies require RaT training; RaT improves residents' education; and RaT prepares residents for their current and future roles. CONCLUSION The use of RaT instruction has increased significantly in GME. More and more PDs are realizing its importance in the residents' formative training experience. Future studies should examine the effectiveness of each method for RaT instruction.
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Affiliation(s)
- Morhaf Al Achkar
- Department of Family Medicine-Indiana University, Indianapolis, IN, USA
| | - Mathew Hanauer
- Department of Family Medicine-Indiana University, Indianapolis, IN, USA
| | - Elizabeth H Morrison
- Health Sciences, University of California, Riverside School of Medicine, Riverside, CA, USA
| | - M Kelly Davies
- Department of Family Medicine-Indiana University, Indianapolis, IN, USA
| | - Robert C Oh
- Family Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
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Abstract
BACKGROUND Evidence-based medicine (EBM) skills are invaluable tools for residents and practicing physicians. The purpose of this study is to evaluate the effectiveness of small-group learning models in teaching fundamental EBM skills. METHODS The intervention consisted of an EBM bootcamp divided into four 2-hour sessions across 4-week rotations. Residents worked in small groups of three to four to explore fundamentals of EBM through interactive dialogue and mock clinical scenario practice. The intervention's effectiveness was evaluated using pre- and post-assessments. RESULTS A total of 40 (93.0%) residents out of a potential 43 participated in the EBM bootcamps across the 3 years. There was significant improvement of 3.28 points on self-assessed EBM skills from an average of 9.66-12.945 out of a maximum score of 15 (P=0.000). There was significant improvement of 1.68 points on the EBM skills test from an average of 6.02-7.71 out of a maximum score of 9 (P=0.00). All residents (100%) agreed or strongly agreed that EBM is important for a physician's clinical practice. This view did not change after the training. CONCLUSION A brief small-group interactive workshop in EBM basic skills at the start of residency was effective in developing fundamental EBM skills.
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Affiliation(s)
- Morhaf Al Achkar
- Department of Family Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
| | - M Kelly Davies
- Department of Family Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
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Hernandez R, Sevilla Martir JF, Van Durme DJ, Faller MJ, Yong-Yow S, Davies MK, Achkar MA. Global Health in Family Medicine Residency Programs: A Nationwide Survey of US Residency Directors: A CERA Study. Fam Med 2016; 48:532-537. [PMID: 27472790] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
BACKGROUND AND OBJECTIVES Interest in global health (GH) has increased significantly among medical trainees in the past 3 decades. Despite the potential for family medicine to be a major contributor to GH, there are no recent, large-scale studies of GH education and experiences in family medicine training. This study was designed to assess current opportunities, educational activities, resident interest, perceived program benefits, and barriers to international and domestic GH training in US family medicine residencies. METHODS Data for this study were elicited as part of a 2015 survey conducted by the Council of Academic Family Medicine (CAFM) Educational Research Alliance (CERA). The nationwide, web-based survey was sent to 452 family medicine residency program directors. RESULTS A total of 257 program directors completed the GH portion of the survey. A total of 74.3% of programs offered international or domestic GH experiences. Program directors identified preparing physicians to practice underserved medicine and teaching community medicine or public health as primary goals for GH training. Program directors also reported that GH opportunities were important for attracting future residents. Programs offered a variety of preparatory activities to their residents. Funding and time constraints were identified as the primary barriers to GH training in residency. CONCLUSIONS Global health continues to be a focus of interest in the training of family medicine residents while attracting the passion of student applicants and residents.
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Abstract
The gap between production and implementation of knowledge is the main reason for the suboptimal quality of health care. To eliminate this gap and improve the quality of patient care, journal club (JC) in graduate medical education provides an opportunity for learning the skills of evidence-based medicine. JC, however, continues to face many challenges mainly due to poorly defined goals, inadequate preparation, and lack of interest. This article presents an innovative model to prepare and present JC based on three pillars: dialogical learning through group discussion, mentored residents as peer teachers, and including JC as part of a structured curriculum to learn evidence-based medicine. This engaging model has the potential to transform JC from a moribund session that is daunting for residents into a lively discussion to redefine clinical practice using the most current evidence.
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Affiliation(s)
- Morhaf Al Achkar
- Department of Family Medicine, Indiana University, Indianapolis, IN, USA
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36
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Al Achkar M, Davies MK, Busha ME, Oh RC. Resident-as-teacher in family medicine: a CERA survey. Fam Med 2015; 47:452-458. [PMID: 26039762] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
BACKGROUND AND OBJECTIVES Teaching has been increasingly recognized as a primary responsibility of residents. Residents enjoy teaching, and their majority report interest in the continuation of teaching activities after graduation. Resident-as-teacher programs have emerged nationally as a means of enhancing teaching skills. This study examined the current use of residents-as-teachers programs in family medicine residencies through a national survey of family medicine residency program directors. METHODS This survey project was part of the Council of Academic Family Medicine Education Research Alliance (CERA) 2014 survey to family medicine program directors that was conducted between February 2014 and May 2014. RESULTS The response rate of the survey was 49.6% (224/451). The majority (85.8%) of residency programs offer residents formal instruction in teaching skills. The vast majority (95.6%) of programs mandated the training. The average total hours of teaching instruction residents receive while in residency training was 7.72. The residents are asked to formally evaluate the teaching instruction in 68.1% of the programs. Less than a quarter (22.6%) of residency programs offer the teaching instruction in collaboration with other programs. "Retreat, workshop, and seminars" were identified as the main form of instruction by 33.7% of programs. In 83.3% of programs not offering instruction, lack of resources was identified as the primary barrier. CONCLUSIONS The majority of family medicine residency programs provide resident-as-teacher instructions, which reflects increasing recognition of importance of the teaching role of residents. Further research is needed to assess the effectiveness of such instruction on residents' teaching skills and their attitudes toward teaching.
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Achkar MA, Rogers JS, Muszynski MJ. Pantoea species sepsis associated with sickle cell crisis in a pregnant woman with a history of pica. Am J Case Rep 2012; 13:26-8. [PMID: 23569479 PMCID: PMC3616125 DOI: 10.12659/ajcr.882588] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2011] [Accepted: 02/07/2012] [Indexed: 11/09/2022]
Abstract
Background: Bacteria in the Pantoea genus are plant and soil associated Gram-negative rods described as nosocomial pathogens and as rare causes of community-acquired infections. The latter have been classically associated with gardening and plant thorn injuries and immunocompromised states are additional risk factors. We report a patient with pica and geophagia, Pantoea sepsis, and sickle cell crisis, associations not previously described. Case Report: A 23-year-old pregnant female presented to the emergency department with sickle cell pain crisis. On the third day of hospitalization the patient developed fever subsequently determined to be caused by Pantoea bacteremia and sepsis. She was successfully treated with a two-week course of ceftriaxone. The patient admitted to a habit of frequently eating large amounts of soil and this geophagia had increased since she became pregnant. She had marked clinical improvement with treatment and she was counseled to stop eating soil. Conclusions: This is the first reported case of Pantoea infection possibly associated with geophagia and the first reported case of Pantoea bacteremia and sepsis related to an episode of sickle cell crisis.
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Affiliation(s)
- Morhaf Al Achkar
- Family Medicine Residency Program-Florida Hospital, Winter Park, FL, U.S.A
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