1
|
Thompson AL, Kentor RA, Schaefer MR, McCarthy SR. Psychologists as Pivotal Members of the Pediatric Palliative Care Team. J Pain Symptom Manage 2024; 67:e907-e913. [PMID: 38355070 DOI: 10.1016/j.jpainsymman.2024.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Revised: 01/30/2024] [Accepted: 02/04/2024] [Indexed: 02/16/2024]
Abstract
CONTEXT Pediatric psychologists possess unique expertise to positively impact the care provided to children with serious illness and their families. Despite increasing recognition regarding the value of psychology in palliative care, psychologists are not yet routinely integrated into pediatric palliative care (PPC) teams. OBJECTIVES This special paper seeks to demonstrate distinctive contributions psychologists can offer to PPC teams, patients, and families, as well as highlight how psychologists enhance the work of their interdisciplinary PPC colleagues. METHODS Existing literature, consensus and policy statements, and recently developed competencies inform and provide evidence for the value of incorporating psychologists into PPC. RESULTS As children with serious illness are at risk for mental and physical health symptoms, psychologists' specialized training in evidence-based assessment and intervention allows them to assess areas of concern, create treatment plans, and implement nonpharmacological therapies targeting symptom management and promotion of quality of life. By improving patient and family outcomes, psychology involvement saves money. In addition to clinical care, psychologists are skilled researchers, which can help to advance PPC interdisciplinary research. Lastly, psychologists can play a valuable role in contributing to PPC team education, dynamics, and well-being. CONCLUSIONS With strong skills in research, clinical care, education, and advocacy, pediatric psychologists are exceptionally equipped to provide care to children with serious illness and their families. Given their unique contributions, it is critical future efforts are directed towards advocating for the inclusion of psychologists into PPC, with the ultimate goal of improving care for children with serious illness and their families.
Collapse
Affiliation(s)
- Amanda L Thompson
- Life with Cancer, Inova Schar Cancer Institute (A.L.T.), Fairfax, VA, USA.
| | - Rachel A Kentor
- Departments of Psychology and Palliative Care (R.A.K.), Texas Children's Hospital, Houston, TX, USA; Department of Pediatrics, Baylor College of Medicine (R.A.K.), Houston, TX, USA
| | - Megan R Schaefer
- Department of Pediatric Psychology, Nationwide Children's Hospital (M.R.S.), Columbus, OH, USA; Department of Clinical Pediatrics, The Ohio State University (M.R.S.), Columbus, OH, USA
| | - Sarah R McCarthy
- Department of Psychiatry and Psychology (S.R.M.), Mayo Clinic, Rochester, MN, USA
| |
Collapse
|
2
|
Polycarpou A, Chopko TC, Glasgow AE, McCarthy SR, Hilliker DR, Wilder RT, Klinkner DB. One-year Results of Minimally Invasive Sutured Fixation of the Slipped Ribs in the Pediatric Population. J Pediatr Surg 2024:S0022-3468(24)00109-X. [PMID: 38522977 DOI: 10.1016/j.jpedsurg.2024.02.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Revised: 02/07/2024] [Accepted: 02/21/2024] [Indexed: 03/26/2024]
Abstract
PURPOSE Costal cartilage resection with or without rib resection is the gold standard surgery for slipping rib syndrome. Minimally invasive restoration of normal anatomy via nonabsorbable sutures has been described in the adult population with encouraging results. We sought to assess the efficacy of minimally invasive sutured fixation of the hypermobile rib in the pediatric population. METHODS A retrospective review was performed at Mayo Clinic involving 31 pediatric patients diagnosed with slipped rib syndrome. Minimally invasive sutured open reduction internal fixation was performed between 2020 and 2022. The standardized Örebro Musculoskeletal Pain Screening Questionnaire was given at dedicated time points pre- and post-operatively to assess efficacy. Significance was determined via the Wilcoxon rank sum test. RESULTS SRS was diagnosed clinically in 31 patients (24 females, 7 males, 1220 years-old). Symptoms were present for an average of 18.9 months and patients had seen an average of 4.7 specialists. Traumatic causes were identified in three patients and eight patients had hypermobility. At one month follow up, there were no surgical complications and patients reported significantly less pain (p < 0.001). Preoperative analgesics reduced by 80%. Ultimately, seven patients underwent a second operation; three patients underwent a third operation; one patient underwent five total operations. Recurrent pain was reported in six patients. Only nine patients followed-up at 1-year post-operation. CONCLUSION Pediatric patients with SRS demonstrated an early positive response to suture fixation without costal cartilage excision. Reoperation and recurrent pain, however, remain significant in this population. LEVEL OF EVIDENCE Level IV. TYPE OF STUDY Case series with no comparison group.
Collapse
Affiliation(s)
- Andreas Polycarpou
- Department of Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Trevor C Chopko
- Department of Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Amy E Glasgow
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Sarah R McCarthy
- Mayo Clinic College of Medicine & Science, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA; Department of Psychiatry and Psychology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Daniel R Hilliker
- Mayo Clinic College of Medicine & Science, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA; Department of Psychiatry and Psychology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Robert T Wilder
- Mayo Clinic College of Medicine & Science, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA; Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Denise B Klinkner
- Department of Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA; Mayo Clinic College of Medicine & Science, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.
| |
Collapse
|
3
|
Greenmyer JR, Ngo T, Smith M, Collura C, Schiltz B, McCarthy SR. Consultation patterns before and after embedding pediatric palliative care into a pediatric hematology/oncology clinic. Pediatr Blood Cancer 2023; 70:e30663. [PMID: 37710331 DOI: 10.1002/pbc.30663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Revised: 08/22/2023] [Accepted: 08/28/2023] [Indexed: 09/16/2023]
Abstract
INTRODUCTION Palliative care is a critical component of pediatric oncology care. Embedded pediatric palliative care (PPC) is relatively new in pediatric hematology/oncology (PHO) and may improve access, utilization, and quality of PPC. In June 2020, the Mayo Clinic PPC service transitioned from an afternoon, physically independent clinic to an all-day clinic embedded within PHO. METHODS Retrospective chart review was used to quantify consultation rates from PHO to PPC in 12-month study periods before and after establishment of an embedded clinic. Changes in descriptive statistics and consult patterns were calculated. Study periods were compared using either chi-square or Fisher's exact tests for categorical variables and Wilcox rank sum tests for continuous variables. RESULTS There was an 89% increase in consultations from PHO to PPC after initiation of an embedded clinic (n = 20 vs. n = 38 per 12 months). The absolute number of completed outpatient consults increased from three (15% of visits) pre-embedment to fourteen (37%) post-embedment (p = .082). The median number of days from first oncology visit to PPC assessment was unchanged after embedment (36 vs. 47 days, p = .98). Consults for solid tumors increased from 22% (n = 4) pre-embedment to 60% (n = 18) post-embedment (p < .05). Consults for symptom management increased from 60% (n = 12) to 87% (n = 33) (p < .05). CONCLUSIONS Embedment of PPC into a PHO workspace was associated with an increased number of total consults, outpatient consults, solid tumor consults, and consults for symptom management. Our "partial-PPO" model allowed for provision of PPC in the outpatient oncology setting in a clinic where there is not enough volume to support a full-time oncology-focused clinician team.
Collapse
Affiliation(s)
- Jacob R Greenmyer
- Pediatric and Adolescent Medicine, Mayo Clinic Minnesota, Rochester, Minnesota, USA
| | - Tiffany Ngo
- Pediatric and Adolescent Medicine, Mayo Clinic Minnesota, Rochester, Minnesota, USA
| | - Melissa Smith
- Hospice and Palliative Medicine, Mayo Clinic Minnesota, Rochester, Minnesota, USA
| | - Christopher Collura
- Neonatal and Perinatal Medicine, Hospice and Palliative Medicine, Mayo Clinic Minnesota, Rochester, Minnesota, USA
| | - Brenda Schiltz
- Hospice and Palliative Medicine, Pediatric Critical Care, Mayo Clinic Minnesota, Rochester, Minnesota, USA
| | - Sarah R McCarthy
- Pediatric and Adolescent Medicine, Mayo Clinic Minnesota, Rochester, Minnesota, USA
- Psychiatry and Psychology, Mayo Clinic Minnesota, Rochester, Minnesota, USA
| |
Collapse
|
4
|
Thompson AL, Schaefer MR, McCarthy SR, Hildenbrand AK, Cousino MK, Marsac ML, Majeski J, Wohlheiter K, Kentor RA. Competencies for Psychology Practice in Pediatric Palliative Care. J Pediatr Psychol 2023:7152461. [PMID: 37141582 DOI: 10.1093/jpepsy/jsad007] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 01/10/2023] [Accepted: 01/29/2023] [Indexed: 05/06/2023] Open
Abstract
OBJECTIVE Pediatric psychologists have unique expertise to contribute to the care of youth with serious illnesses yet are not routinely integrated into pediatric palliative care (PPC) teams. To better define the role and unique skillset of psychologists practicing in PPC, support their systematic inclusion as part of PPC teams, and advance trainee knowledge of PPC principles and skills, the PPC Psychology Working Group sought to develop core competencies for psychologists in this subspecialty. METHODS A Working Group of pediatric psychologists with expertise in PPC met monthly to review literature and existing competencies in pediatrics, pediatric and subspecialty psychology, adult palliative care, and PPC subspecialties. Using the modified competency cube framework, the Working Group drafted core competencies for PPC psychologists. Interdisciplinary review was conducted by a diverse group of PPC professionals and parent advocates, and competencies were revised accordingly. RESULTS The six competency clusters include Science, Application, Education, Interpersonal, Professionalism, and Systems. Each cluster includes essential competencies (i.e., knowledge, skills, attitudes, roles) and behavioral anchors (i.e., examples of concrete application). Reviewer feedback highlighted clarity and thoroughness of competencies and suggested additional consideration of siblings and caregivers, spirituality, and psychologists' own positionality. CONCLUSIONS Newly developed competencies for PPC psychologists highlight unique contributions to PPC patient care and research and provide a framework for highlighting psychology's value in this emerging subspecialty. Competencies help to advocate for inclusion of psychologists as routine members of PPC teams, standardize best practices among the PPC workforce, and provide optimal care for youth with serious illness and their families.
Collapse
Affiliation(s)
| | - Megan R Schaefer
- Department of Pediatric Psychology, Nationwide Children's Hospital, Columbus, OH, USA
- Department of Clinical Pediatrics, The Ohio State University, Columbus, OH, USA
| | - Sarah R McCarthy
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, USA
| | - Aimee K Hildenbrand
- Center for Healthcare Delivery Science, Nemours Children's Health, Wilmington, DE, USA
- Division of Behavioral Health, Nemours Children's Hospital, Wilmington, DE, USA
- Department of Pediatrics, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA
| | - Melissa K Cousino
- Department of Pediatrics, University of Michigan, Ann Arbor, MI, USA
| | - Meghan L Marsac
- Department of Pediatrics, University of Kentucky Healthcare, Lexington, KY, USA
| | - Jill Majeski
- Department of Pediatrics, University of Pittsburgh Medical Center, Children's Hospital of Pittsburgh, Pittsburgh, PA, USA
| | - Karen Wohlheiter
- Division of Behavioral Health, Nemours Children's Hospital, Wilmington, DE, USA
| | - Rachel A Kentor
- Department of Pediatric Psychology, Texas Children's Hospital, Houston, TX, USA
- Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA
| |
Collapse
|
5
|
McCarthy SR, Golembiewski EH, Gravholt DL, Clark JE, Clark J, Fischer C, Mulholland H, Babcock K, Montori VM, Jones A. Documentation of Psychosocial Distress and Its Antecedents in Children with Rare or Life-Limiting Chronic Conditions. Children 2022; 9:children9050664. [PMID: 35626841 PMCID: PMC9139272 DOI: 10.3390/children9050664] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Revised: 04/21/2022] [Accepted: 04/29/2022] [Indexed: 11/16/2022]
Abstract
Children with rare or life-limiting chronic conditions and their families are at high risk of psychosocial distress. However, despite its impact on patient and family health and functioning, psychosocial distress and its antecedents may not routinely be captured in medical records. The purpose of this study was to characterize current medical record documentation practices around psychosocial distress among children with rare or life-limiting chronic conditions and their families. Medical records for patients with rare or life-limiting chronic conditions (n = 60) followed by a pediatric complex care program were reviewed. Study team members extracted both structured data elements (e.g., diagnoses, demographic information) and note narratives from the most recent visit with a clinician in the program. Psychosocial topics were analyzed using a mixed quantitative (i.e., frequency counts of topics) and qualitative approach. Topics related to psychosocial distress that were documented in notes included child and parent emotional problems, parent social support, sibling emotional or physical problems, family structure (e.g., whether parents were together), and financial concerns. However, 35% of notes lacked any mention of psychosocial concerns. Although examples of psychosocial concerns were included in some notes, none were present in over one-third of this sample. For both patients with rare or life-limiting chronic conditions and their caregivers, more active elicitation and standard documentation of psychosocial concerns may improve the ability of healthcare providers to identify and intervene on psychosocial concerns and their risk factors.
Collapse
Affiliation(s)
- Sarah R. McCarthy
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN 55905, USA
- Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, MN 55905, USA; (E.H.G.); (D.L.G.); (V.M.M.)
- Correspondence: ; Tel.: +1-507-284-2933
| | - Elizabeth H. Golembiewski
- Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, MN 55905, USA; (E.H.G.); (D.L.G.); (V.M.M.)
| | - Derek L. Gravholt
- Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, MN 55905, USA; (E.H.G.); (D.L.G.); (V.M.M.)
| | - Jennifer E. Clark
- Department of Endocrinology, Diabetes, and Metabolism, Mayo Clinic College of Medicine and Science, Mayo Clinic, Rochester, MN 55905, USA;
| | - Jeannie Clark
- Mayo Clinic Children’s Center, Mayo Clinic, Rochester, MN 55905, USA; (J.C.); (C.F.)
| | - Caree Fischer
- Mayo Clinic Children’s Center, Mayo Clinic, Rochester, MN 55905, USA; (J.C.); (C.F.)
| | - Hannah Mulholland
- Section of Social Work, Mayo Clinic, Rochester, MN 55905, USA; (H.M.); (K.B.)
| | - Kristina Babcock
- Section of Social Work, Mayo Clinic, Rochester, MN 55905, USA; (H.M.); (K.B.)
| | - Victor M. Montori
- Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, MN 55905, USA; (E.H.G.); (D.L.G.); (V.M.M.)
- Department of Endocrinology, Diabetes, and Metabolism, Mayo Clinic College of Medicine and Science, Mayo Clinic, Rochester, MN 55905, USA;
| | - Amie Jones
- Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN 55905, USA;
| |
Collapse
|
6
|
Chung MK, Fagerlin A, Wang PJ, Ajayi TB, Allen LA, Baykaner T, Benjamin EJ, Branda M, Cavanaugh KL, Chen LY, Crossley GH, Delaney RK, Eckhardt LL, Grady KL, Hargraves IG, Hills MT, Kalscheur MM, Kramer DB, Kunneman M, Lampert R, Langford AT, Lewis KB, Lu Y, Mandrola JM, Martinez K, Matlock DD, McCarthy SR, Montori VM, Noseworthy PA, Orland KM, Ozanne E, Passman R, Pundi K, Roden DM, Saarel EV, Schmidt MM, Sears SF, Stacey D, Stafford RS, Steinberg BA, Wass SY, Wright JM. Shared Decision Making in Cardiac Electrophysiology Procedures and Arrhythmia Management. Circ Arrhythm Electrophysiol 2021; 14:e007958. [PMID: 34865518 PMCID: PMC8692382 DOI: 10.1161/circep.121.007958] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Shared decision making (SDM) has been advocated to improve patient care, patient decision acceptance, patient-provider communication, patient motivation, adherence, and patient reported outcomes. Documentation of SDM is endorsed in several society guidelines and is a condition of reimbursement for selected cardiovascular and cardiac arrhythmia procedures. However, many clinicians argue that SDM already occurs with clinical encounter discussions or the process of obtaining informed consent and note the additional imposed workload of using and documenting decision aids without validated tools or evidence that they improve clinical outcomes. In reality, SDM is a process and can be done without decision tools, although the process may be variable. Also, SDM advocates counter that the low-risk process of SDM need not be held to the high bar of demonstrating clinical benefit and that increasing the quality of decision making should be sufficient. Our review leverages a multidisciplinary group of experts in cardiology, cardiac electrophysiology, epidemiology, and SDM, as well as a patient advocate. Our goal is to examine and assess SDM methodology, tools, and available evidence on outcomes in patients with heart rhythm disorders to help determine the value of SDM, assess its possible impact on electrophysiological procedures and cardiac arrhythmia management, better inform regulatory requirements, and identify gaps in knowledge and future needs.
Collapse
Affiliation(s)
| | - Angela Fagerlin
- University of Utah, Salt Lake City, UT
- Salt Lake City Veterans Affairs Informatics Decision-Enhancement and Analytic Sciences Center for Innovation, Salt Lake City, UT
| | | | | | | | | | | | - Megan Branda
- University of Colorado, Aurora, CO
- Mayo Clinic, Rochester, MN
| | | | | | | | | | | | | | | | | | | | | | - Marleen Kunneman
- Mayo Clinic, Rochester, MN
- Leiden University Medical Center, Leiden, the Netherlands
| | | | | | | | - Ying Lu
- Stanford University, Stanford, CA
| | | | | | | | | | | | | | | | | | | | | | - Dan M. Roden
- Vanderbilt University Medical Center, Nashville, TN
| | | | | | | | | | | | | | - Sojin Youn Wass
- Cleveland Clinic, Cleveland, OH
- University Hospitals Cleveland Medical Center, Cleveland, OH
| | | |
Collapse
|
7
|
Gao CC, Espinoza Suarez NR, Toloza FJK, Malaga Zuniga AS, McCarthy SR, Boehmer KR, Yao L, Fu S, Brito JP. Patients' Perspective About the Cost of Diabetes Management: An Analysis of Online Health Communities. Mayo Clin Proc Innov Qual Outcomes 2021; 5:898-906. [PMID: 34585085 PMCID: PMC8455864 DOI: 10.1016/j.mayocpiqo.2021.07.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Objective To understand the perspectives of persons' living with diabetes about the increasing cost of diabetes management through an analysis of online health communities (OHCs) and the impact of persons' participation in OHCs on their capacity and treatment burden. Patients and Methods A qualitative study of 556 blog posts submitted between January 1, 2007 and December 31, 2017 to 4 diabetes social networking sites was conducted between March 2018 and July 2019. All posts were coded inductively using thematic analysis procedures. Eton's Burden of Treatment Framework and Boehmer's Theory of Patient Capacity directed triangulation of themes with existing theory. Results Three themes were identified: (1) cost barriers to care: participants describe individual and systemic cost barriers that inhibit prescribed therapy goals; (2) impact of financial cost on health: participants describe the financial effects of care on their physical and emotional health; and (3) saving strategies to overcome cost impact: participants discuss practical strategies that help them achieve therapy goals. Finally, we also identify that the use of OHCs serves to increase persons' capacity with the potential to decrease treatment burden, ultimately improving mental and physical health. Conclusion High cost for diabetes care generated barriers that negatively affected physical health and emotional states. Participant-shared experiences in OHCs increased participants' capacity to manage the burden. Potential solutions include cost-based shared decision-making tools and advocacy for policy change.
Collapse
Key Words
- BS, blood sugar
- BoTF, Burden of Treatment Framework
- DME, Durable Medical Equipment
- HMO, health maintenance organization
- IDDM, insulin-dependent diabetes mellitus
- IRB, institutional review board
- OHC, online health community
- PLWD, person living with diabetes
- PPA, Partnership for Prescription Assistance
- RX, prescription
- T1D, type 1 diabetes
- TPC, Theory of Patient Capacity
Collapse
Affiliation(s)
- Catherine C Gao
- Mayo Clinic Alix School of Medicine.,Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, MN
| | | | - Freddy J K Toloza
- Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, MN.,Division of Endocrinology and Metabolism, University of Arkansas for Medical Sciences, Little Rock
| | - Ariana S Malaga Zuniga
- Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, MN.,Ruprecht-Karls University of Heidelberg, Heidelberg, Germany
| | - Sarah R McCarthy
- Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, MN.,Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN
| | - Kasey R Boehmer
- Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, MN
| | - Lixia Yao
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN
| | - Sunyang Fu
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN
| | - Juan P Brito
- Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, MN.,Department of Internal Medicine, Mayo Clinic, Rochester, MN
| |
Collapse
|
8
|
Feraco AM, McCarthy SR, Revette AC, Stevens SE, Das PJ, Al-Sayegh H, Ma C, Tulsky JA, Wolfe J. Feasibility and acceptability of the "Day 100 Talk": An interdisciplinary communication intervention during the first six months of childhood cancer treatment. Cancer 2020; 127:1134-1145. [PMID: 33320337 DOI: 10.1002/cncr.33362] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Revised: 08/28/2020] [Accepted: 09/21/2020] [Indexed: 11/10/2022]
Abstract
BACKGROUND Communication gaps arise early in the childhood cancer trajectory and may persist. The authors conducted a pilot study of the feasibility and acceptability of a communication intervention, the Day 100 Talk (D100). D100 involves an interprofessional family conference during initial months of treatment between oncologists, psychosocial clinicians, and parents, facilitated by a 3-part conversation tool. METHODS The authors enrolled English-speaking parents of children with nonrelapsed, nonprogressive cancer who were receiving continuity care from enrolled pediatric oncologists and psychosocial clinicians at a single site. The a priori feasibility threshold was 60% parent completion of the D100 intervention. Surveys from parents and professionals and debrief interviews with professionals assessed D100 acceptability. RESULTS Thirty-seven parents (77%) and 38 oncology professionals (67%) enrolled. Twenty of 33 evaluable parents (61%) participated in a D100 family conference. Most commonly, parents did not complete the D100 intervention because of scheduling difficulties related to clinical team constraints. All 17 parents who completed a post-D100 survey agreed or strongly agreed that D100 participation was helpful. In debrief interviews, professionals identified D100 benefits, namely, stepping back to the big picture and getting on the same page, and barriers related to logistical challenges and professionals' anticipatory dread. CONCLUSIONS The D100 intervention pilot demonstrates high acceptability among parents of children with cancer. Despite meeting the prespecified feasibility threshold, findings highlight important barriers to D100 dissemination, namely, perceived burdens on professionals. Potential strategies to reduce burden may include using virtual visit platforms, incorporating D100 elements across multiple visits, or prioritizing intervention delivery to parents with the greatest need for enhanced communication.
Collapse
Affiliation(s)
- Angela M Feraco
- Department of Pediatric Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts.,Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts.,Department of Pediatrics, Boston Children's Hospital, Boston, Massachusetts.,Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
| | - Sarah R McCarthy
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts.,Department of Psychiatry and Psychology, Mayo Clinic, Rochester, Minnesota
| | - Anna C Revette
- Survey and Data Management Core, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Sarah E Stevens
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - P Jeet Das
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Hasan Al-Sayegh
- Biostatistics Program, Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, Massachusetts
| | - Clement Ma
- Department of Pediatric Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts.,Department of Pediatrics, Boston Children's Hospital, Boston, Massachusetts.,Department of Pediatrics, Harvard Medical School, Boston, Massachusetts.,Biostatistics Program, Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, Massachusetts
| | - James A Tulsky
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts.,Division of Palliative Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| | - Joanne Wolfe
- Department of Pediatric Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts.,Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts.,Department of Pediatrics, Boston Children's Hospital, Boston, Massachusetts.,Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
| |
Collapse
|
9
|
Mbiribindi B, Pena JK, Arvedson MP, Moreno Romero C, McCarthy SR, Hatton OL, Esquivel CO, Martinez OM, Krams SM. Epstein-Barr virus peptides derived from latent cycle proteins alter NKG2A + NK cell effector function. Sci Rep 2020; 10:19973. [PMID: 33203899 PMCID: PMC7673117 DOI: 10.1038/s41598-020-76344-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Accepted: 10/21/2020] [Indexed: 12/11/2022] Open
Abstract
Natural killer (NK) cells control viral infection through the interaction between inhibitory receptors and human leukocyte antigen (HLA) ligands and bound peptide. NK cells expressing the inhibitory receptor NKG2A/CD94 recognize and respond to autologous B cells latently infected with Epstein-Barr virus (EBV). The mechanism is not yet understood, thus we investigated peptides derived from seven latent proteins of EBV in the interaction of NKG2A and its ligand HLA-E. Functional analysis demonstrated that EBV peptides can bind to HLA-E and block inhibition of NK cell effector function. Moreover, analysis of DNA from 79 subjects showed sequence variations in the latent protein, LMP1, which alters NK responses to EBV. We provide evidence that peptides derived from EBV latent cycle proteins can impair the recognition of NKG2A despite being presented by HLA-E, resulting in NK cell activation.
Collapse
Affiliation(s)
- Berenice Mbiribindi
- Division of Abdominal Transplantation, Department of Surgery, Stanford University School of Medicine, Stanford, CA, USA
| | - Josselyn K Pena
- Division of Abdominal Transplantation, Department of Surgery, Stanford University School of Medicine, Stanford, CA, USA
| | - Matthew P Arvedson
- Division of Abdominal Transplantation, Department of Surgery, Stanford University School of Medicine, Stanford, CA, USA
| | - Claudia Moreno Romero
- Division of Abdominal Transplantation, Department of Surgery, Stanford University School of Medicine, Stanford, CA, USA
| | - Sarah R McCarthy
- Division of Abdominal Transplantation, Department of Surgery, Stanford University School of Medicine, Stanford, CA, USA
| | - Olivia L Hatton
- Department of Molecular Biology, Colorado College, Colorado Springs, CO, USA
| | - Carlos O Esquivel
- Division of Abdominal Transplantation, Department of Surgery, Stanford University School of Medicine, Stanford, CA, USA
| | - Olivia M Martinez
- Division of Abdominal Transplantation, Department of Surgery, Stanford University School of Medicine, Stanford, CA, USA
| | - Sheri M Krams
- Division of Abdominal Transplantation, Department of Surgery, Stanford University School of Medicine, Stanford, CA, USA.
| |
Collapse
|
10
|
Feraco AM, McCarthy SR, Das PJ, Revette A, Tulsky JA, Wolfe J. Pediatric cancer care professionals’ experiences with an interprofessional communication intervention. J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.34_suppl.53] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
53 Background: The National Academy of Medicine recommends interprofessional collaboration to promote optimal patient- and family-centered care. We sought to understand whether medical and psychosocial professionals who participated in an interprofessional communication intervention perceived it as distinct from usual clinical care. Methods: Our intervention targeted “medical” (physicians, nurse practitioners) and “psychosocial” (social workers, psychologists) professionals. It consisted of an interprofessional family conference, using a structured conversation guide, conducted during the first 6 months of a child’s cancer care. Conferences aimed to enable families to share hopes and worries and ask questions about their child’s care. Clinicians received a 60-minute training focused on communication skills, such as eliciting families’ hopes and worries, and suggested approaches to collaborating during conferences. Clinicians participated in debriefing interviews after each conference (range 1-3). Three of us conducted thematic analysis of interview data. Results: Twenty-two professionals (6 attending MDs, 4 fellow MDs, 8 NPs, and 8 psychosocial clinicians) gave 34 interviews. Medical and psychosocial professionals described interprofessional family conferences as distinct from usual practice patterns, largely due to their interprofessional colleagues’ presence. This co-presence contributed to “being on the same page.” Conferences sometimes bred a new understanding of a family’s needs and consequent care changes. However, both medical and psychosocial professionals noted that psychosocial professionals often were not vocal contributors to the conference. Some psychosocial clinicians reported being unsure of “the rules.” Conclusions: An interprofessional communication intervention promoted shared understanding between interprofessional colleagues. However, medical professionals were described as more vocal, perhaps due to insufficient role clarity or medical dominance.
Collapse
Affiliation(s)
- Angela Marie Feraco
- Dana-Farber and Boston Children's Cancer and Blood Disorders Center, Boston, MA
| | | | | | | | | | | |
Collapse
|
11
|
Abstract
Evoked visual responses that were triggered by spontaneous blinking were recorded from the human subject. Although their waveform resembled that of conventionally recorded responses, two differences were noted: there was an early potential that was seen only with blink responses, and the late negative potential was smaller than that seen with conventional recording. Off- and on-components were seen in the blink responses, and these were compared with those produced by switching the stimulus off and on. The amplitudes of all of the components increased with stimulus intensity. The results suggest that blinking may play a role in vision, per se, as well as acting to protect the cornea.
Collapse
|