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Padula CB, Ball S, Wyman MF, Evans K, Grant H, Periyakoil VS, Zhu CW, Yaffe K, Huang GD. INviting Veterans InTo Enrollment in Alzheimer's Disease Research Centers (INVITE-ADRC): An NIA and VA-sponsored initiative to increase veteran participation in aging and dementia research. Alzheimers Dement 2024; 20:3088-3098. [PMID: 38348782 PMCID: PMC11032542 DOI: 10.1002/alz.13725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 01/04/2024] [Accepted: 01/06/2024] [Indexed: 04/22/2024]
Abstract
INTRODUCTION Older military veterans often present with unique and complex risk factors for Alzheimer's disease (AD) and related dementias. Increasing veteran participation in research studies offers one avenue to advance the field and improve health outcomes. METHODS To this end, the National Institute on Aging (NIA) and Department of Veterans Affairs (VA) partnered to build infrastructure, improve collaboration, and intensify targeted recruitment of veterans. This initiative, INviting Veterans InTo Enrollment in Alzheimer's Disease Research Centers (INVITE-ADRC), provided funding for five sites and cross-site organizing structure. Diverse and innovative recruitment strategies were used. RESULTS Across five sites, 172 veterans entered registries, and 99 were enrolled into ADRC studies. Of the enrolled, 39 were veterans from historically underrepresented racial and ethnic groups. CONCLUSIONS This initiative laid the groundwork to establish sustainable relationships between the VA and ADRCs. The partnership between both federal agencies demonstrates how mutual interests can accelerate progress. In turn, efforts can help our aging veterans.
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Affiliation(s)
- Claudia B. Padula
- VA Palo Alto Health Care System & Stanford University ADRCPalo AltoCaliforniaUSA
| | - Sherry Ball
- VA Northeast Ohio Healthcare System HSR&DClevelandOhioUSA
| | - Mary F. Wyman
- William S. Middleton Memorial Veterans Hospital & University of Wisconsin ADRCMadisonWisconsinUSA
| | - Kirsten Evans
- James J. Peters VAMC & Mount Sinai ADRCBronxNew YorkUSA
| | - Harli Grant
- University of California, San Francisco, ADRC & VA San FranciscoSan FranciscoCaliforniaUSA
| | | | | | - Kristine Yaffe
- University of California, San Francisco, ADRC & VA San FranciscoSan FranciscoCaliforniaUSA
| | - Grant D. Huang
- Office of Research and Development, US Department of Veterans AffairsWashingtonDistrict of ColumbiaUSA
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Balters S, Foland-Ross LC, Bruno J, Periyakoil VS, Valantine H, Reiss AL. Neural responses to gender-based microaggressions in academic medicine. J Neurosci Res 2023; 101:1803-1813. [PMID: 37654210 DOI: 10.1002/jnr.25240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Revised: 07/12/2023] [Accepted: 08/14/2023] [Indexed: 09/02/2023]
Abstract
Gender-based microaggressions have been associated with persistent disparities between women and men in academia. Little is known about the neural mechanisms underlying those often subtle and unintentional yet detrimental behaviors. Here, we assessed the neural responses to gender-based microaggressions in 28 early career faculty in medicine (N = 16 female, N = 12 male sex) using fMRI. Participants watched 33 videos of situations demonstrating gender-based microaggressions and control situations in academic medicine. Video topics had been previously identified through real-life anecdotes about microaggression from women faculty and were scripted and reenacted using professional actors. Primary voxel-wise analyses comparing group differences in activation elucidated a significant group by condition interaction in a right-lateralized cluster across the frontal (inferior and middle frontal gyri, frontal pole, precentral gyrus, postcentral gyrus) and parietal lobes (supramarginal gyrus, angular gyrus). Whereas women faculty exhibited reduced activation in these regions during the microaggression relative to the control condition, the opposite was true for men. Posthoc analyses showed that these patterns were significantly associated with the degree to which participants reported feeling judged for their gender in academic medicine. Lastly, secondary exploratory ROI analyses showed significant between-group differences in the right dorsolateral prefrontal cortex and inferior frontal gyrus. Women activated these two regions less in the microaggression condition compared to the control condition, whereas men did not. These findings indicate that the observation of gender-based microaggressions results in a specific pattern of neural reactivity in women early career faculty.
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Affiliation(s)
- Stephanie Balters
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California, USA
| | - Lara C Foland-Ross
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California, USA
| | - Jennifer Bruno
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California, USA
| | - Vyjeyanthi S Periyakoil
- Department of Primary Care and Population Health, Stanford University School of Medicine, Stanford, California, USA
| | - Hannah Valantine
- Department of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Allan L Reiss
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California, USA
- Department of Pediatrics, Stanford University School of Medicine, Stanford, California, USA
- Department of Radiology, Stanford University School of Medicine, Stanford, California, USA
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Rice EN, Lan RH, Nunes JC, Shah R, Clark K, Periyakoil VS, Chen JH, Lin B, Echols M, Awad C, Idris MY, Cruz ER, Poullos PD, Lewis EF, Brown‐Johnson C, Igwe J, Shen S, Palaniappan L, Stefanick ML, Ritter V, Pemu P, Rodriguez F, Deb B, Pundi K, Wang PJ. Who Are We Missing? Reporting of Transgender and Gender-Expansive Populations in Clinical Trials. J Am Heart Assoc 2023; 12:e030209. [PMID: 37947088 PMCID: PMC10727288 DOI: 10.1161/jaha.123.030209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Accepted: 07/31/2023] [Indexed: 11/12/2023]
Affiliation(s)
- Eli N. Rice
- Stanford University School of MedicineStanfordCAUSA
| | - Roy H. Lan
- Stanford University School of MedicineStanfordCAUSA
| | | | - Rushil Shah
- Stanford University School of MedicineStanfordCAUSA
| | - Kira Clark
- Stanford University School of MedicineStanfordCAUSA
| | | | | | - Bryant Lin
- Stanford University School of MedicineStanfordCAUSA
| | | | | | | | | | | | | | | | - Joseph Igwe
- Stanford University School of MedicineStanfordCAUSA
| | - Sa Shen
- Stanford University School of MedicineStanfordCAUSA
| | | | | | | | | | | | - Brototo Deb
- Georgetown University School of MedicineWashingtonDCUSA
| | | | - Paul J. Wang
- Stanford University School of MedicineStanfordCAUSA
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Lan RH, Rice EN, Nunes JC, Shah R, Igwe J, Clark K, Periyakoil VS, Chen JH, Lin B, Awad C, Idris M, Cruz ER, Lewis EF, Johnson CB, Wang PJ. Disabilities Reporting in Cardiac Clinical Trials: How Are We Doing? J Am Heart Assoc 2023; 12:e029726. [PMID: 37949834 PMCID: PMC10727282 DOI: 10.1161/jaha.123.029726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Accepted: 07/24/2023] [Indexed: 11/12/2023]
Affiliation(s)
- Roy H. Lan
- Stanford University School of MedicineStanfordCAUSA
| | - Eli N. Rice
- Stanford University School of MedicineStanfordCAUSA
| | | | - Rushil Shah
- Stanford University School of MedicineStanfordCAUSA
| | | | - Kira Clark
- Stanford University School of MedicineStanfordCAUSA
| | | | | | - Bryant Lin
- Stanford University School of MedicineStanfordCAUSA
| | | | | | | | | | | | - Paul J. Wang
- Stanford University School of MedicineStanfordCAUSA
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Raila H, Avanesyan T, Valentine KE, Koo B, Huang C, Tsutsumi Y, Andreeff E, Qiu T, Muñoz Rodríguez PA, Varias A, Filippou-Frye M, van Roessel P, Bullock K, Periyakoil VS, Rodríguez CI. Augmenting group hoarding disorder treatment with virtual reality discarding: A pilot study in older adults. J Psychiatr Res 2023; 166:25-31. [PMID: 37716272 PMCID: PMC10803069 DOI: 10.1016/j.jpsychires.2023.08.002] [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: 05/18/2023] [Revised: 07/26/2023] [Accepted: 08/08/2023] [Indexed: 09/18/2023]
Abstract
Hoarding disorder is common and debilitating, especially in older adults, and novel treatment approaches are needed. Many current treatments emphasize skills related to discarding and decision-making about possessions, which can be practiced in the patient's home. However in many cases, in-home visits are unfeasible, or real-life discarding is too difficult. Virtual reality (VR) offers the ability to create a virtual "home" including 3D scans of the patient's actual possessions that can be moved or discarded. VR discarding is an alternative to in-home visits and an approach that provides a stepping stone to real-life discarding. VR has been successfully utilized to treat many disorders but tested minimally in hoarding disorder. In nine older adults with hoarding disorder, we tested an 8-week VR intervention administered to augment a 16-week Buried in Treasures group treatment. Individualized VR rooms were uniquely modeled after each patient's home. During clinician-administered VR sessions, patients practiced sorting and discarding their virtual possessions. The intervention was feasible to administer. Open-ended participant responses, examined by two independent evaluators, indicated that VR sessions were well-tolerated and that participants found them useful, with nearly all participants noting that VR helped them increase real-life discarding. Self-reported hoarding symptoms decreased from baseline to close, with seven of the nine participants showing reliable improvement in this timeframe and none showing deterioration. Results from this exploratory pilot study suggest that VR is a feasible way to simulate an at-home sorting and discarding experience in a manner that may augment skills acquisition. It remains an open question whether VR discarding practice yields greater improvement than existing treatments. VR for this population merits further clinical investigation.
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Affiliation(s)
- Hannah Raila
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, USA; Department of Psychology, University of California Santa Cruz, Santa Cruz, CA, USA.
| | - Tatevik Avanesyan
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, USA
| | - Keara E Valentine
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, USA
| | - Brenden Koo
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, USA
| | - Chloe Huang
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, USA
| | - Yuri Tsutsumi
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, USA
| | - Elisabeth Andreeff
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, USA
| | - Tori Qiu
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, USA
| | - Paula Andrea Muñoz Rodríguez
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, USA; Department of Neurology and Neurological Sciences, Stanford University, Stanford, CA, USA
| | - Andrea Varias
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, USA
| | - Maria Filippou-Frye
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, USA
| | - Peter van Roessel
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, USA; Sierra Pacific Mental Illness Research, Education, and Clinical Center (MIRECC), VA Palo Alto Health Care System, Palo Alto, CA, USA
| | - Kim Bullock
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, USA
| | - Vyjeyanthi S Periyakoil
- Department of Medicine, Stanford University, Palo Alto, CA, USA; Extended Care and Palliative Medicine Service, Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA
| | - Carolyn I Rodríguez
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, USA; Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA.
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Mejía-Guevara I, Periyakoil VS. Childhood Bullying as a Risk Factor for Late-Life Psychological Distress and Cognitive Impairment. medRxiv 2023:2023.09.04.23295046. [PMID: 37732246 PMCID: PMC10508796 DOI: 10.1101/2023.09.04.23295046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/22/2023]
Abstract
In the United States, non-Hispanic Black (19%) older adults are more likely to develop dementia than White older adults (10%). As genetics alone cannot account for these differences, the impact of historical social factors is considered. This study examined whether childhood and late-life psychological distress associated with dementia risk could explain part of these disparities. Using longitudinal data from 379 White and 141 Black respondents from the Panel Study of Income Dynamics, we assessed the association between childhood bullying and late-life dementia risk, testing for mediation effects from late-life psychological distress. Mediation analysis was computed via negative binomial regression modeling, stratified by race (White/Black), type of bullying experience (target, bully, and bully-target), and the age range at which the experience occurred (6-12, 13-16). The results indicated that late-life psychological distress fully mediated the association between Black respondents who were bullies and dementia risk. However, no significant association was observed among White respondents. These results suggest that interventions aimed at preventing and treating psychological distress throughout the lifespan could be crucial in mitigating the development and progression of dementia risk.
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Rodriguez DK, Periyakoil VS. Can virtual reality travel help nursing home patients fulfill their bucket list? J Am Geriatr Soc 2023; 71:2976-2978. [PMID: 37171553 PMCID: PMC10655748 DOI: 10.1111/jgs.18392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Accepted: 04/08/2023] [Indexed: 05/13/2023]
Affiliation(s)
- Dulce K. Rodriguez
- Stanford Aging and Ethnogeriatrics Transdisciplinary Collaborative Research Center, Stanford University School of Medicine, Palo Alto, California, USA
| | - Vyjeyanthi S. Periyakoil
- Stanford Aging and Ethnogeriatrics Transdisciplinary Collaborative Research Center, Stanford University School of Medicine, Palo Alto, California, USA
- VA Palo Alto Health Care Center, Palo Alto, California, USA
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8
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Banda JM, Shah NH, Periyakoil VS. Characterizing subgroup performance of probabilistic phenotype algorithms within older adults: a case study for dementia, mild cognitive impairment, and Alzheimer's and Parkinson's diseases. JAMIA Open 2023; 6:ooad043. [PMID: 37397506 PMCID: PMC10307941 DOI: 10.1093/jamiaopen/ooad043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 06/06/2023] [Accepted: 06/22/2023] [Indexed: 07/04/2023] Open
Abstract
Objective Biases within probabilistic electronic phenotyping algorithms are largely unexplored. In this work, we characterize differences in subgroup performance of phenotyping algorithms for Alzheimer's disease and related dementias (ADRD) in older adults. Materials and methods We created an experimental framework to characterize the performance of probabilistic phenotyping algorithms under different racial distributions allowing us to identify which algorithms may have differential performance, by how much, and under what conditions. We relied on rule-based phenotype definitions as reference to evaluate probabilistic phenotype algorithms created using the Automated PHenotype Routine for Observational Definition, Identification, Training and Evaluation framework. Results We demonstrate that some algorithms have performance variations anywhere from 3% to 30% for different populations, even when not using race as an input variable. We show that while performance differences in subgroups are not present for all phenotypes, they do affect some phenotypes and groups more disproportionately than others. Discussion Our analysis establishes the need for a robust evaluation framework for subgroup differences. The underlying patient populations for the algorithms showing subgroup performance differences have great variance between model features when compared with the phenotypes with little to no differences. Conclusion We have created a framework to identify systematic differences in the performance of probabilistic phenotyping algorithms specifically in the context of ADRD as a use case. Differences in subgroup performance of probabilistic phenotyping algorithms are not widespread nor do they occur consistently. This highlights the great need for careful ongoing monitoring to evaluate, measure, and try to mitigate such differences.
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Affiliation(s)
- Juan M Banda
- Corresponding Author: Juan M. Banda, PhD, Department of Computer Science, College of Arts and Sciences, Georgia State University, 25 Park Place, Suite 752, Atlanta, GA 30303, USA;
| | - Nigam H Shah
- Stanford Center for Biomedical Informatics Research, Stanford University School of Medicine, Stanford, California, USA
| | - Vyjeyanthi S Periyakoil
- Stanford Department of Medicine, Palo Alto, California, USA
- VA Palo Alto Health Care System, Palo Alto, California, USA
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9
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Rodriguez DK, Hewage SA, Periyakoil VS. Factors affecting the recruitment of Hispanic/Latinx American older adults in clinical trials in the United States: A scoping review. J Am Geriatr Soc 2023; 71:1974-1991. [PMID: 37013348 PMCID: PMC10258132 DOI: 10.1111/jgs.18264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2022] [Revised: 12/21/2022] [Accepted: 01/02/2023] [Indexed: 04/05/2023]
Abstract
OBJECTIVE Participation of Hispanic/Latinx American older adults (HLAOA) in clinical trials is fundamental to health equity in aging research. However, information on strategies for the successful recruitment of this population in clinical trials is limited. DESIGN This scoping review aims to identify hindering and facilitating factors that impact the recruitment of HLAOA in clinical trials in the United States. METHODS Two databases (PubMed, EMBASE) were searched for original research articles from inception until March 2022 reporting on factors that engaged HLAoa (≥65) in clinical trials. One thousand and thirteen studies were scrutinized to identify 31 eligible articles. RESULTS Most articles were from cancer clinical trials (14 studies). Hindering factors that impacted the recruitment of HLAoa in clinical trials were related to (i) study design and logistics challenges, (ii) challenges imposed by social determinants of health, (iii) communication barriers, and (iv) patients' mistrust, and (v) family issues. Facilitating factors include (i) effective modes of outreach, (ii) strategic clinical trial design, (iii) incorporating culturally-respectful approaches that are tailored to the participants' sociocultural background, and (iv) bridging language barriers. CONCLUSIONS Successful recruitment of HLAOA into clinical trials requires identifying the study question, co-designing the trial design, implementation, and evaluation in respectful collaboration with the Hispanic/Latinx community with careful attention to their needs and minimizing the study burden on this vulnerable population. Factors identified here may guide researchers to better understand the needs of HLAOA and successfully recruit them into clinical trials, leading to more equitable research that increases their representation in clinical research.
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Affiliation(s)
- Dulce K Rodriguez
- Stanford Aging and Ethnogeriatrics Transdisciplinary Collaborative Research Center, Stanford University, School of Medicine, Palo Alto, California, USA
| | - Sumali A Hewage
- Stanford Aging and Ethnogeriatrics Transdisciplinary Collaborative Research Center, Stanford University, School of Medicine, Palo Alto, California, USA
| | - Vyjeyanthi S Periyakoil
- Stanford Aging and Ethnogeriatrics Transdisciplinary Collaborative Research Center, Stanford University, School of Medicine, Palo Alto, California, USA
- Veterans Affairs Palo Alto Health Care Center, Palo Alto, California, USA
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Walling AM, Ast K, Harrison JM, Dy SM, Ersek M, Hanson LC, Kamal AH, Ritchie CS, Teno JM, Rotella JD, Periyakoil VS, Ahluwalia SC. Patient-Reported Quality Measures for Palliative Care: The Time is now. J Pain Symptom Manage 2023; 65:87-100. [PMID: 36395918 DOI: 10.1016/j.jpainsymman.2022.11.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [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: 10/11/2022] [Accepted: 11/02/2022] [Indexed: 11/16/2022]
Abstract
CONTEXT While progress has been made in the ability to measure the quality of hospice and specialty palliative care, there are notable gaps. A recent analysis conducted by Center for Medicare and Medicaid Services (CMS) revealed a paucity of patient-reported measures, particularly in palliative care domains such as symptom management and communication. OBJECTIVES The research team, consisting of quality measure and survey developers, psychometricians, and palliative care clinicians, used established state-of-the art methods for developing and testing patient-reported measures. METHODS We applied a patient-centered, patient-engaged approach throughout the development and testing process. This sequential process included 1) an information gathering phase; 2) a pre-testing phase; 3) a testing phase; and 4) an endorsement phase. RESULTS To fill quality measure gaps identified during the information gathering phase, we selected two draft measures ("Feeling Heard and Understood" and "Receiving Desired Help for Pain") for testing with patients receiving palliative care in clinic-based settings. In the pre-testing phase, we used an iterative process of cognitive interviews to refine draft items and corresponding response options for the proposed measures. The alpha pilot test supported establishment of protocols for the national beta field test. Measures met conventional criteria for reliability, had strong face and construct validity, and there was diversity in program level scores. The measures received National Quality Forum (NQF) endorsement. CONCLUSION These measures highlight the key role of patient voices in palliative care and fill a much-needed gap for patient-reported experience measures in our field.
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Affiliation(s)
- Anne M Walling
- Department of Medicine (A.W.), University of California, Los Angeles, California; VA Greater Los Angeles Health System (A.W.), Los Angeles, California; RAND Health Care (A.W., J.H., S.A.), Santa Monica, California.
| | - Katherine Ast
- American Academy of Hospice and Palliative Medicine (K.A.,J.R.), Chicago, Illinois
| | | | - Sydney M Dy
- Department of Health Policy and Management (S.D.), Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Mary Ersek
- Department of Veterans Affairs (M.E.), Philadelphia, Pennsylvania; University of Pennsylvania Schools of Nursing and Medicine (M.E.), Philadelphia, Pennsylvania
| | - Laura C Hanson
- Division of Geriatric Medicine and Palliative Care Program (L.H.), University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | - Arif H Kamal
- Duke University School of Medicine (A.K.), Durham, North Carolina
| | - Christine S Ritchie
- The Mongan Institute and the Division of Palliative Care and Geriatric Medicine ( C.R.), Massachusetts General Hospital, Boston, Massachusetts
| | - Joan M Teno
- Oregon Health and Science University School of Medicine (J.T.), Portland, Oregon
| | - Joseph D Rotella
- American Academy of Hospice and Palliative Medicine (K.A.,J.R.), Chicago, Illinois
| | - Vyjeyanthi S Periyakoil
- Stanford University School of Medicine (V.P.),Stanford, California; VA Palo Alto Health Care System (V.P.), Livemore, California, USA
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Periyakoil VS, Gunten CFV. Palliative Care Is Proven. J Palliat Med 2023; 26:2-4. [PMID: 36607788 DOI: 10.1089/jpm.2022.0568] [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: 01/07/2023] Open
Abstract
Palliative care was officially recognized by the World Health Organization in 1990 as a distinct specialty dedicated to relieving suffering and improving quality of life for patients with serious illnesses. Journal of Palliative Medicine (JPM) was founded in 1997 in response to the need for a scientifically rigorous peer-reviewed journal to advance the field. In our first quarter of the century, JPM has become a leading global peer-reviewed scientific journal. What is the way forward? We engaged with this question in two ways. First, we utilized artificial intelligence techniques to analyze the trends of the articles published in JPM for the past two decades to discern key topic themes. Second, we applied human intelligence by convening seven panels of experts to discuss current topics of interest to the field as a separate strategy for discerning the future. Taken together, the way forward is clear. The field of palliative care has become broader and more subspecialized than anyone ever imagined at the beginning. The expansion of new knowledge has accelerated in all directions from its origins in the end-of-life care of patients with cancer. Although implementation science is of paramount importance, the barriers to implementation of this growing body of specialized knowledge lie not just with the need for more science. Some of the barriers lie within our field. The way forward requires confidence in what we know and the establishment of new collaborations outside of our field, including with people outside of traditional health care.
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Affiliation(s)
- Vyjeyanthi S Periyakoil
- Department of Medicine, Stanford University, Palo Alto, California, USA.,Extended Care and Palliative Medicine Service, Veterans Affairs Palo Alto Health Care System, Palo Alto, California, USA
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Tamang S, Jin Z, Periyakoil VS. Revelations from a Machine Learning Analysis of the Most Downloaded Articles Published in Journal of Palliative Medicine 1999-2018. J Palliat Med 2023; 26:13-16. [PMID: 36607778 PMCID: PMC10024060 DOI: 10.1089/jpm.2022.0574] [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: 12/08/2022] [Indexed: 01/07/2023] Open
Abstract
The Journal of Palliative Medicine (JPM) is globally recognized as a leading interdisciplinary peer-reviewed palliative care journal providing balanced information that informs and improves the practice of palliative care. JPM shapes the values, integrity, and standards of the subspecialty of palliative medicine by what it chooses to publish. The global JPM readership chooses to download the articles that are of most relevance and utility to them. Utilizing machine learning methods, the top 100 most downloaded articles in JPM were analyzed to gain a better understanding of any latent trends and patterns in the topics between 1999 and 2018. The top five topic themes identified in the first decade were different from the ones identified in the second decade of publication. There is evidence of differentiation and maturation of the field in the context of comprehensive health care. Although noncancer serious illnesses have still not risen to the same prominence as cancer palliation, there is a directional quality to the emerging evidence as it pertains to cardiac, respiratory, neurological, renal, and other etiologies. Across both decades under study, there was persistent evidence of the importance of understanding and managing the mental health care needs of seriously ill patients and their families. A cause for concern is that the word "spirituality" was prominent in the first decade and was lacking in the second. Future palliative care clinical and research initiatives should focus on its development as an essential interprofessional and medical subspecialty germane to all types of serious illnesses and across all venues.
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Affiliation(s)
- Suzanne Tamang
- Stanford University School of Medicine, Palo Alto, California, USA
- VA Palo Alto Health Care System, Palo Alto, California, USA
| | - Zhijing Jin
- Stanford University School of Medicine, Palo Alto, California, USA
| | - Vyjeyanthi S. Periyakoil
- Stanford University School of Medicine, Palo Alto, California, USA
- VA Palo Alto Health Care System, Palo Alto, California, USA
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Periyakoil VS, von Gunten CF, Block S, Higginson I, Weissman D. 25 Years: Looking Back, Looking Forward. J Palliat Med 2022; 25:1761-1766. [PMID: 36472516 PMCID: PMC10771880 DOI: 10.1089/jpm.2022.0494] [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] [Accepted: 10/19/2022] [Indexed: 12/12/2022] Open
Abstract
Palliative medicine and the practice of palliative care has disseminated around the world for the past 25 years. In many countries, palliative medicine is a formally recognized specialty of medicine. Yet, there is a high variability, due in part to the variable resources devoted to its development. New research is needed to improve our ability to control symptoms and to know how best to implement the existing science so that the patients who need palliative care can get it easily and equitably. Achieving this level of access requires expertise in organizational structure and system change strategies. Building the evidence base for best practices requires us to forge research collaborations with collegues from all medical subspecialities, including experts from allied health disciplines, and partner closely with patients and families. It also compels us to look critically at ourselves to overcome the barriers we put in our own way to becoming a routine part of standard health care in all countries.
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Affiliation(s)
- Vyjeyanthi S. Periyakoil
- Department of Medicine, Stanford University, Palo Alto, California, USA
- Extended Care and Palliative Medicine Service, Veterans Affairs Palo Alto Health Care System, Palo Alto, California, USA
| | | | - Susan Block
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute and Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Irene Higginson
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, King's College London, London, United Kingdom
- King's College Hospital NHS Foundation Trust, Denmark Hill, United Kingdom
| | - David Weissman
- Founding Editor, Journal of Palliative Medicine, San Diego, California. USA
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14
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Abstract
The need for symptom control research has never been greater. Yet, this is an underdeveloped area in hospice and palliative care. Expert symptom control researchers point out a number of issues that show the way forward over the next 25 years. Chief among them is the need to do the research, rather than being content with the evidence we have. A barrier is to have the self-discipline to honestly evaluate the state of the palliative care science where the gold standard of randomized controlled trials has not been used to establish current practice. Commitment to organized symptom control research groups and clinical trials networks is important. Combining symptom control research with disease-directed research is a promising way forward. Investing in training junior clinicians and researchers is critical. All palliative care fellows and clinicians must receive training in the basics of research methods so that they can effectively support and advance research and evidence-based best practices.
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Affiliation(s)
- Vyjeyanthi S. Periyakoil
- Department of Medicine, Stanford University, Palo Alto, California, USA
- Extended Care and Palliative Medicine Service, Veterans Affairs Palo Alto Health Care System, Palo Alto, California, USA
| | | | - Eduardo Bruera
- Department of Palliative Care and Rehabilitation Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - David C. Currow
- Faculty of Science, Medicine, and Health, University of Wollongong, Wollongong, New South Wales, Australia
| | - Eric J. Roeland
- Division of Hematology/Oncology, Knight Cancer Institute, Oregon Health and Sciences University, Portland, Oregon, USA
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15
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Abstract
The past 25 years have proved that palliative care is effective in improving care of seriously ill patients. Research attention must pivot to focus on policy changes and systems and models of care that ensure easy access to quality palliative care to all patients who need it. Education, alone, has not worked. Leaving it to individual organizations to decide has not worked. The question of whether incentives should be used has arisen. Should we design treatment algorithms, such as for cardiopulmonary resuscitation, where palliative care is part of standard care and requires an "opt out"? Should payers pay more to health care organizations who demonstrate they provide universal access to palliative care and how can we control for unintended consequences? Should provision of specialist palliative care be required for a health care organization to be accredited? How can we advance the state of the science and best support the workforce?
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Affiliation(s)
- Vyjeyanthi S. Periyakoil
- Department of Medicine, Stanford University, Palo Alto, California, USA.,Extended Care and Palliative Medicine Service, Veterans Affairs Palo Alto Health Care System, Palo Alto, California, USA.,Address correspondence to: Vyjeyanthi S. Periyakoil, MD, Department of Medicine, Stanford University, 3801 Miranda Avenue, 100-4B, Palo Alto, CA 94304, USA
| | | | - Brynn Bowman
- Center to Advance Palliative Care, New York, New York, USA
| | - Ezekiel Emanuel
- Global Initiatives, Healthcare Transformation Institute, The Perelman School for Medicine and the Wharton School, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Thomas J. Smith
- Johns Hopkins Medical Institutions, Sidney Kimmel Comprehensive Cancer Center, Palliative Medicine, Baltimore Maryland, USA
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16
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Sossenheimer PH, Bharadwaj S, Johnston L, Periyakoil VS. Geriatrics assessment in older adults referred for hematopoietic cell transplantation. J Am Geriatr Soc 2022; 70:3038-3040. [PMID: 35708096 DOI: 10.1111/jgs.17929] [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] [Received: 03/03/2022] [Revised: 05/15/2022] [Accepted: 05/19/2022] [Indexed: 11/28/2022]
Affiliation(s)
| | - Sushma Bharadwaj
- Department of Medicine, Stanford University, Palo Alto, California, United States.,Division of Blood and Marrow Transplantation and Cellular Therapy, Stanford University, Palo Alto, California, United States
| | - Laura Johnston
- Department of Medicine, Stanford University, Palo Alto, California, United States.,Division of Blood and Marrow Transplantation and Cellular Therapy, Stanford University, Palo Alto, California, United States
| | - Vyjeyanthi S Periyakoil
- Department of Medicine, Stanford University, Palo Alto, California, United States.,VA Palo Alto Health Care System, Livermore, California, United States
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17
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Periyakoil VS, von Gunten CF, Bailey FA, Dingfield LE, Schlögl M. Mid-Career Training to Advance Palliative Care. J Palliat Med 2022; 25:705-711. [PMID: 35499371 PMCID: PMC9271329 DOI: 10.1089/jpm.2022.0144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
The demand for specialist palliative medicine physicians, advanced practice providers, and other team members outstrips supply. Traditional paths to specialty practice will not meet projected need. Therefore, innovation and research are required. One innovation is the training of midcareer professionals; those who have been in practice and want to change to palliative care. Barriers to leaving practice and returning to traditional training are high; not the least of which is the opportunity cost. In this roundtable, experts discuss what they have learned from current research, and point the way to additional needed research.
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Affiliation(s)
- Vyjeyanthi S Periyakoil
- Department of Medicine, Stanford University, Palo Alto, California, USA.,Extended Care and Palliative Medicine Service, Veterans Affairs Palo Alto Health Care System, Palo Alto, California, USA
| | | | - F Amos Bailey
- Department of General Internal Medicine, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Laura E Dingfield
- Perlman School of Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Mathias Schlögl
- University Clinic for Acute Geriatric Care, City Hospital Waid Zurich, Zürich, Switzerland
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18
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Prost SG, Golembeski C, Periyakoil VS, Arias J, Knittel AK, Ballin J, Oliver HD, Tran NT. Standardized outcome measures of mental health in research with older adults who are incarcerated. Int J Prison Health 2022; ahead-of-print:10.1108/IJPH-08-2021-0085. [PMID: 35362688 PMCID: PMC9328480 DOI: 10.1108/ijph-08-2021-0085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE The targeted use of standardized outcome measures (SOMs) of mental health in research with older adults who are incarcerated promotes a common language that enables interdisciplinary dialogue, contributes to the identification of disparities and supports data harmonization and subsequent synthesis. This paper aims to provide researchers with rationale for using "gold-standard" measures used in research with community-dwelling older adults, reporting associated study sample psychometric indexes, and detailing alterations in the approach or measure. DESIGN/METHODOLOGY/APPROACH The authors highlight the mental health of older adults who are incarcerated. They also discuss the benefits of SOMs in practice and research and then identify gold-standard measures of mental health used in research with community-dwelling older adults and measures used in research with older adults who are incarcerated. Finally, the authors provide several recommendations related to the use of SOMs of mental health in research with this population. FINDINGS Depression, anxiety and post-traumatic stress disorder are common among older adults who are incarcerated. Researchers have used a variety of measures to capture these mental health problems, some parallel to those used with community-dwelling samples. However, a more targeted use of SOMs of mental health in research with this population will contribute to important strides in this burgeoning field. ORIGINALITY/VALUE This review offers several practical recommendations related to SOMs of mental health in research with older adults who are incarcerated to contribute to a rigorous evidence base and thus inform practice and potentially improve the health and well-being of this population.
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Affiliation(s)
- Stephanie Grace Prost
- Raymond A. Kent School of Social Work, University of Louisville, Louisville, Kentucky, USA
| | - Cynthia Golembeski
- Milano School of Policy, Management, and Environment, The New School, New York, New York, USA
| | | | - Jalayne Arias
- University of California San Francisco, San Francisco, California, USA
| | - Andrea K Knittel
- Department of Obstetrics and Gynecology, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
| | - Jessica Ballin
- Department of Health Promotion and Sports Medicine, Oregon Health and Science University, Portland, Oregon, USA
| | - Heather D Oliver
- Raymond A. Kent School of Social Work, University of Louisville, Louisville, Kentucky, USA
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19
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Periyakoil VS, von Gunten CF, Check D, Kaufman B, Maxwell TL, Teno JM. Accountable and Transparent Palliative Quality Measures Will Improve Care. J Palliat Med 2022; 25:542-548. [PMID: 35363070 PMCID: PMC9206470 DOI: 10.1089/jpm.2022.0063] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
How do we build on the proven successes of hospice and palliative care and build clinical programs to serve those who need it in the context of real-world health care? Experiences with glide pathways have clearly shown that changes in financial incentives must always be implemented with counterbalancing measures that ensure that seriously ill patients are getting high-quality care consistent with their goals and values. There are quality measures for quality improvement and there are quality measures for accountability or transparency. We must balance any financial incentives with concrete quality measures that act as a check and balance to the care that is being provided. This area of investigation is rich in opportunity. Much research is needed to advance the craft of hospice and palliative care if the field is to move forward at scale in a timely manner. We need to democratize research and engage both "small r" and a "big R" researchers in the manner of other subspecialties such as oncology and cardiology. Future research should focus on building innovative systems and models of care to uncover needs of seriously ill patients and their caregivers and effectively cater to those needs.
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Affiliation(s)
- Vyjeyanthi S. Periyakoil
- Department of Medicine, Stanford University School of Medicine, Palo Alto, California, USA.,Veterans Affairs Palo Alto Health Care System, Palo Alto, California, USA.,Address correspondence to: Vyjeyanthi S. Periyakoil, MD, Stanford University School of Medicine, Veterans Affairs Palo Alto Health Care System, 3801 Miranda Avenue, 100-4B, Palo Alto, CA 94304, USA
| | | | - Devon Check
- Department of Population Health Sciences, Duke University School of Medicine, Durham, North Carolina, USA.,Duke Cancer Institute, Duke University Medical Center, Durham, North Carolina, USA
| | - Brystana Kaufman
- Department of Population Health Sciences, Duke University School of Medicine, Durham, North Carolina, USA.,Margolis Center for Health Policy, Duke University, Durham, North Carolina, USA.,Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham VA Medical Center, Durham, North Carolina, USA
| | - Terri L. Maxwell
- Turn-Key Health, A CareCentrix Company, Hartford, Connecticut, USA
| | - Joan M. Teno
- Division of General Internal Medicine and Geriatrics, School of Medicine, OHSU, Portland, Oregon, USA
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20
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Periyakoil VS, von Gunten CF, Arnold R, Hickman S, Morrison S, Sudore R. Caught in a Loop with Advance Care Planning and Advance Directives: How to Move Forward? J Palliat Med 2022; 25:355-360. [PMID: 35230896 PMCID: PMC9022450 DOI: 10.1089/jpm.2022.0016] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [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: 01/27/2023] Open
Abstract
Completion of an advance care planning (ACP) process and/or an advance directive should result in patients receiving the care they desire at the end of life. However, three decades of research have shown that is just not the case. ACP has been a front runner in developing the science within palliative care. Some positive outcomes such as lowering levels of surrogate grief may be associated with ACP. Yet, it does not appear that further ACP research will ensure that seriously ill patients will get goal-concordant care. An unfortunate consequence of palliative care research and advocacy so far is the misguided notion of many hospital systems trying to solve their palliative care problems by only implementing an ACP initiative. At best, ACP is but one tool in the collective palliative care toolbox. New tools are needed. Given that we have finite resources, future research should focus more on tools to improve symptom management, better models of care, and systems that will ensure goal-concordant care that meet the needs of the population that the health care system is designed to meet.
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Affiliation(s)
- Vyjeyanthi S. Periyakoil
- Department of Medicine, Stanford University, Palo Alto, California, USA.,Extended Care and Palliative Medicine Service, Veterans Affairs Palo Alto Health Care System, Palo Alto, California, USA.,Address correspondence to: Vyjeyanthi S. Periyakoil, MD, Department of Medicine, Stanford University, 3801 Miranda Avenue, 100-4B, Palo Alto, CA 94304, USA.
| | | | - Robert Arnold
- Section of Palliative Care and Medical Ethics, Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Susan Hickman
- Indiana University Center for Aging Research, Regenstrief Institute, Indianapolis, Indiana, USA
| | - Sean Morrison
- Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Rebecca Sudore
- Division of Geriatrics, University of California, San Francisco, San Francisco, California, USA.,San Francisco Veterans Affairs Medical Center, San Francisco, California, USA
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21
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Abstract
The issue of generalist versus specialist palliative care is on the minds of healthcare leaders everywhere. We are amid changing demographics of physicians. The industrialization of medicine is well underway in the US and around the developing world. Is it important to identify patients who benefit the most from specialist palliative care, given that it is currently a limited resource? Should we step out of standard practice and redesign palliative care using principles of population management? The COVID pandemic rapidly introduced virtual palliative care consults. Is it a better way to promote wide access to specialty palliative care? Looking forward, should we promote ways to advance primary palliative care and reserve specialty palliative care to patients who will benefit most from this level of care? These questions, and others, are considered in this transcribed discussion between leading physicians in the field.
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Affiliation(s)
- Vyjeyanthi S. Periyakoil
- Department of Medicine, Stanford University, Palo Alto, California, USA
- Extended Care and Palliative Medicine Service, Veterans Affairs Palo Alto Health Care System, Palo Alto, California, USA
| | - Charles F. von Gunten
- Journal of Palliative Medicine, Empire, Colorado, USA
- Address correspondence to: Charles F. von Gunten, MD, PhD, Journal of Palliative Medicine, 254 North Main Street, PO Box 282, Empire, CO 80438-0282, USA
| | - Stacy Fischer
- University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Steve Pantilat
- Division of Palliative Medicine, Department of Medicine, University of California, San Francisco, San Francisco, California, USA
| | - Timothy Quill
- Division of Palliative Care, University of Rochester Medical Center, Rochester, New York, USA
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22
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von Gunten CF, Periyakoil VS. 25 Year Anniversary: Looking Back, Looking Forward. J Palliat Med 2022; 25:2. [PMID: 34978904 PMCID: PMC9836662 DOI: 10.1089/jpm.2021.0543] [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: 01/22/2023] Open
Affiliation(s)
- Charles F. von Gunten
- Journal of Palliative Medicine, Empire, Colorado, USA.,Address correspondence to: Charles F. von Gunten, MD, PhD, Journal of Palliative Medicine, 254 North Main Street, PO Box 282, Empire, CO 80438-0282, USA
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23
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Singhal S, Krishnamurthy A, Wang B, Weng Y, Sharp C, Shah N, Ahuja N, Hosamani P, Periyakoil VS, Hom J. Effect of electronic clinical decision support on inappropriate prescriptions in older adults. J Am Geriatr Soc 2021; 70:905-908. [PMID: 34877652 DOI: 10.1111/jgs.17608] [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] [Received: 11/08/2021] [Accepted: 11/13/2021] [Indexed: 12/01/2022]
Affiliation(s)
- Surbhi Singhal
- Department of Medicine, Division of Medical Oncology, Stanford University, Stanford, California, USA
| | - Amrita Krishnamurthy
- Department of Medicine, Division of Cardiology, Weill Cornell Medicine, New York, New York, USA
| | - Bo Wang
- Department of Medicine, VA Palo Alto Health Care System, Palo Alto, California, USA
| | - Yingjie Weng
- Department of Medicine, Quantitative Sciences Unit, Stanford University School of Medicine, Stanford, California, USA
| | - Christopher Sharp
- Department of Medicine, Division of Primary Care and Population Health, Stanford University School of Medicine, Stanford, California, USA
| | - Neil Shah
- Department of Pathology, Stanford University School of Medicine, Stanford, California, USA
| | - Neera Ahuja
- Department of Medicine, Division of Hospital Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Poonam Hosamani
- Department of Medicine, Division of Hospital Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Vyjeyanthi S Periyakoil
- Department of Medicine, Division of Palliative Care, Stanford University School of Medicine, Stanford, California, USA
| | - Jason Hom
- Department of Medicine, Division of Hospital Medicine, Stanford University School of Medicine, Stanford, California, USA
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24
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Cano MT, Pennington DL, Reyes S, Pineda BS, Llamas JA, Periyakoil VS, Muñoz RF. Factors associated with smoking in low-income persons with and without chronic illness. Tob Induc Dis 2021; 19:59. [PMID: 34305505 PMCID: PMC8280622 DOI: 10.18332/tid/138241] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 05/26/2021] [Accepted: 05/26/2021] [Indexed: 01/25/2023] Open
Abstract
INTRODUCTION Tobacco disparities persist among low-income smokers who seek care from safety-net clinics. Many of these patients suffer from chronic illnesses (CILs) that are associated with and exacerbated by smoking. The objective of the current study was to examine the differences between safety-net patients with and without CILs in terms of nicotine dependence and related factors (such as depression, anxiety) and self-efficacy regarding ability to abstain from smoking. METHODS Sixty-four low-income smokers who thought about or intended to quit smoking were recruited from the San Francisco Health Network (SFHN) and assessed for CILs, nicotine dependence, depression, anxiety, and smoking abstinence self-efficacy. Four one-way analyses of variance were used to examine the difference between those with and without CIL on the latter four variables. RESULTS The CIL group had significantly higher anxiety (CIL: 8.0 ± 5.35; non-CIL: 4.44 ± 3.48; p=0.02) and tended to have higher nicotine dependence (CIL: 5.40 ± 2.58; non-CIL: 3.88 ± 2.28; p=0.04). In the CIL group, nicotine dependence was positively correlated with anxiety [r(62)=0.39; p<0.01] and negatively correlated with smoking abstinence self-efficacy [r(62)= -0.38; p<0.01]. Both depression (Spearman’s rho=0.39; p<0.01) and anxiety (Spearman’s rho=0.29; p<0.05) were associated with total number of CIL categories. CONCLUSIONS Safety-net patients who smoke and suffer from CILs may be suffering from higher levels of anxiety and have less confidence in their ability to quit smoking. Incorporating mood management and developing interventions that increase a sense of self-efficacy for refraining from smoking may be necessary to help low-income smokers quit smoking.
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Affiliation(s)
- Monique T Cano
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco, United States.,Research Service, San Francisco VA Health Care System, San Francisco, United States
| | - David L Pennington
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco, United States.,Research Service, San Francisco VA Health Care System, San Francisco, United States
| | - Sara Reyes
- Department of Psychology, University of Nebraska-Lincoln, Lincoln, United States
| | - Blanca S Pineda
- Institute for International Internet Interventions for Health, Palo Alto University, Palo Alto, United States
| | - Jazmin A Llamas
- Institute for International Internet Interventions for Health, Palo Alto University, Palo Alto, United States
| | | | - Ricardo F Muñoz
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco, United States.,Institute for International Internet Interventions for Health, Palo Alto University, Palo Alto, United States
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25
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Asprec L, Blinderman CD, Berlin A, Callahan ME, Widera E, Periyakoil VS, Smith AK, Nakagawa S. Virtual Interinstitutional Palliative Care Consultation during the COVID-19 Pandemic in New York City. J Palliat Med 2021; 24:1387-1390. [PMID: 34191591 DOI: 10.1089/jpm.2021.0208] [Citation(s) in RCA: 3] [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] [Indexed: 12/31/2022] Open
Abstract
Context: Amid the COVID-19 surge in New York City, the need for palliative care was highlighted. Virtual consultation was introduced to expand specialist-level care to meet demand. Objectives: To examine the outcomes of COVID-19 patients who received virtual palliative care consultation from outside institutions. Design: This is a retrospective case series. Setting/Subjects: Subjects were 34 patients who received virtual palliative care consultation between April 13, 2020, and June 14, 2020. Measurements: Follow-up frequency and duration, code status change, withdrawal of life-sustaining treatment (LST), and multidisciplinary involvement. Results: Twenty-eight patients (82.3%) were in the intensive care unit and 29 patients (85.3%) were on at least two LSTs. Fifteen patients (44.1%) died in the hospital, 9 patients (26.4%) were discharged alive, and 10 patients (29.4%) were signed off. The median frequency of visits was 4.5 (IQR 6) over 11 days follow-up (IQR 17). Code status change was more frequent in deceased patients. LSTs were withdrawn in eight patients (23.5%). Conclusions: Virtual palliative care consultation was feasible during the height of the COVID-19 pandemic.
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Affiliation(s)
- Lawrence Asprec
- Adult Palliative Care Service, Department of Medicine, Department of Surgery, Columbia University Irving Medical Center, New York, New York, USA
| | - Craig D Blinderman
- Adult Palliative Care Service, Department of Medicine, Department of Surgery, Columbia University Irving Medical Center, New York, New York, USA
| | - Ana Berlin
- Adult Palliative Care Service, Department of Medicine, Department of Surgery, Columbia University Irving Medical Center, New York, New York, USA.,Division of General Surgery, Department of Surgery, Columbia University Irving Medical Center, New York, New York, USA
| | - Mary E Callahan
- Adult Palliative Care Service, Department of Medicine, Department of Surgery, Columbia University Irving Medical Center, New York, New York, USA
| | - Eric Widera
- Division of Geriatrics, Department of Medicine, University of California San Francisco, San Francisco, California, USA.,Geriatrics, Palliative, and Extended Care Service, San Francisco Veterans Affairs Medical Center, San Francisco, California, USA
| | - Vyjeyanthi S Periyakoil
- Department of Medicine, Stanford University, Palo Alto, California, USA.,Extended Care and Palliative Medicine Service, Veterans Affairs Palo Alto Health Care System, Palo Alto, California, USA
| | - Alexander K Smith
- Division of Geriatrics, Department of Medicine, University of California San Francisco, San Francisco, California, USA.,Geriatrics, Palliative, and Extended Care Service, San Francisco Veterans Affairs Medical Center, San Francisco, California, USA
| | - Shunichi Nakagawa
- Adult Palliative Care Service, Department of Medicine, Department of Surgery, Columbia University Irving Medical Center, New York, New York, USA
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26
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Ta Park V, Kim A, Cho IH, Nam B, Nguyen K, Vuong Q, Periyakoil VS, Hong YA. Motivation to Participate in Precision Health Research and Acceptability of Texting as a Recruitment and Intervention Strategy Among Vietnamese Americans: Qualitative Study. JMIR Mhealth Uhealth 2021; 9:e23058. [PMID: 33704080 PMCID: PMC7995081 DOI: 10.2196/23058] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Revised: 11/19/2020] [Accepted: 12/11/2020] [Indexed: 01/14/2023] Open
Abstract
Background The largest effort undertaken in precision health research is the Precision Medicine Initiative (PMI), also known as the All of Us Research Program, which aims to include 1 million or more participants to be a part of a diverse database that can help revolutionize precision health research studies. Research participation from Asian Americans and Pacific Islanders in precision health research is, however, limited; this includes Vietnamese Americans, especially those with limited English proficiency. PMI engagement efforts with underserved communities, including members of minority populations or individuals who have experienced health disparities such as Vietnamese Americans with limited English proficiency, may help to enrich the diversity of the PMI. Objective The aim of this study is to examine the attitudes towards and perceptions of precision health, motivations and barriers to participation in precision health research, and acceptability of SMS text messaging as a recruitment and intervention strategy among underserved Vietnamese Americans. Methods A community sample of 37 Vietnamese Americans completed a survey and participated in one of 3 focus groups classified by age (18-30, 31-59, and ≥60 years) on topics related to precision health, participation in precision health research, texting or social media use experience, and insights on how to use text messages for recruitment and intervention. Participants were recruited via community organizations that serve Vietnamese Americans, flyers, word of mouth, and Vietnamese language radio announcements. Results Most participants had little knowledge of precision health initially. After brief education, they had positive attitudes toward precision health, although the motivation to participate in precision health research varied by age and prior experience of research participation. The main motivators to participate included the desire for more knowledge and more representation of Vietnamese Americans in research. Participants were open to receiving text messages as part of their research participation and provided specific suggestions on the design and delivery of such messages (eg, simple, in both English and Vietnamese). Examples of barriers included misinterpretation of messages, cost (to send text messages), and preferences for different texting platforms across age groups. Conclusions This study represents one of the first formative research studies to recruit underserved Vietnamese Americans to precision health research. It is critical to understand target communities’ motivations and barriers to participation in research. Delivering culturally appropriate text messages via age-appropriate texting and social media platforms may be an effective recruitment and intervention strategy. The next step is to develop and examine the feasibility of a culturally tailored precision health texting strategy for Vietnamese Americans.
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Affiliation(s)
- Van Ta Park
- Department of Community Health Systems, School of Nursing, University of California, San Francisco, San Francisco, CA, United States
| | - Amber Kim
- School of Nursing, San Jose State University, San Jose, CA, United States
| | - In Hyang Cho
- School of Nursing, San Jose State University, San Jose, CA, United States
| | - Bora Nam
- Department of Community Health Systems, School of Nursing, University of California, San Francisco, San Francisco, CA, United States
| | - Khue Nguyen
- International Children Assistance Network, Milpitas, CA, United States
| | - Quyen Vuong
- International Children Assistance Network, Milpitas, CA, United States
| | - Vyjeyanthi S Periyakoil
- Department of Medicine - Primary Care and Population Health, School of Medicine, Stanford University, Stanford, CA, United States
| | - Y Alicia Hong
- College of Health and Human Services, George Mason University, Fairfax, VA, United States
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Affiliation(s)
| | | | | | - David Casarett
- Department of Medicine, Duke University School of Medicine, Durham, NC
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Morrison LJ, Periyakoil VS, Arnold RM, Tucker R, Chittenden E, Sanchez-Reilly S, Carey EC. Launching the Next Steps to Improve Hospice and Palliative Medicine Fellow Performance Assessment: A Look Back to the Initial Toolkit of Assessment Methods. J Pain Symptom Manage 2021; 61:613-627. [PMID: 33091584 PMCID: PMC7569474 DOI: 10.1016/j.jpainsymman.2020.10.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Revised: 10/15/2020] [Accepted: 10/16/2020] [Indexed: 11/24/2022]
Abstract
Education leaders in hospice and palliative medicine (HPM) have long acknowledged the challenge of fellow performance assessment and the need for HPM-specific fellow assessment tools. In 2010, and in alignment with the Accreditation Council for Graduate Medical Education's (ACGME's) directive toward competency-based medical education, the national HPM Competencies Workgroup curated a set of assessment tools, the HPM Toolkit of Assessment Methods. The Toolkit has been a resource for HPM fellowship directors in evolving practical, multifaceted fellow assessment strategies. Now, as American Academy of Hospice and Palliative Medicine plans for a national workgroup in 2020 to define current HPM fellow assessment methods and to propose strategies to strengthen and standardize future assessment, the Toolkit provides a strong base from which to launch. However, the field learned important lessons from the 2010 Workgroup about the consensus process, gaps in areas of assessment, opportunities to address gaps with new or adapted tools, and limitations in implementing the Toolkit over time in terms of tracking, accessibility, and dissemination. This article describes the development of the Toolkit, including recommended tools and methods for assessment within each ACGME competency domain, and links the lessons learned to recommendations for the 2020 workgroup to consider in creating the next HPM assessment strategy and toolkit. Effective implementation will be crucial in supporting fellows to reach independent practice, which will further strengthen the field and workforce to provide the highest quality patient and family-centered care in serious illness. This will require an inspired, committed effort from the HPM community, which we enthusiastically anticipate.
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Affiliation(s)
- Laura J Morrison
- Yale Palliative Care Program, Department of Medicine, Yale School of Medicine, New Haven, Connecticut, USA.
| | | | - Robert M Arnold
- Section of Palliative Care and Medical Ethics, University of Pittsburgh Medical School, Pittsburgh, Pennsylvania, USA
| | - Rodney Tucker
- University of Alabama at Birmingham Center for Palliative and Supportive Care, Birmingham, Alabama, USA
| | - Eva Chittenden
- Division of Palliative Care and Geriatric Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Sandra Sanchez-Reilly
- Department of Medicine, University of Texas Health Science Center at San Antonio and South Texas Veterans Health Care System, San Antonio, Texas, USA
| | - Elise C Carey
- Center for Palliative Medicine, Mayo Clinic, Rochester, Minnesota, USA
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Sable-Smith A, Hiroto K, Periyakoil VS. Assessment and Treatment of Post-Traumatic Stress Disorder at the End of Life #398. J Palliat Med 2020; 23:1270-1272. [PMID: 32877281 PMCID: PMC9836664 DOI: 10.1089/jpm.2020.0253] [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: 01/22/2023] Open
Affiliation(s)
- Alex Sable-Smith
- Address correspondence to: Alex Sable-Smith, MD, MPH, VA Palo Alto Health Care System, Palo Alto, CA 94304, USA
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Periyakoil VS, Blinderman CD, Schechter WS. Longitudinal Coaching and Decision Support Provided by a Patient‐Family Liaison Promotes Goal‐Concordant Care. J Am Geriatr Soc 2020; 68:1933-1935. [DOI: 10.1111/jgs.16684] [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] [Received: 06/06/2020] [Accepted: 06/08/2020] [Indexed: 12/13/2022]
Affiliation(s)
- Vyjeyanthi S. Periyakoil
- Department of Medicine, Stanford University School of Medicine and VA Palo Alto HealthCare System Palo Alto California USA
| | - Craig D. Blinderman
- Department of Medicine, Adult Palliative Care Service Columbia University Medical Center New York New York USA
| | - William S. Schechter
- Department of Anesthesiology and Pediatrics Columbia University Medical Center New York New York USA
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Nakagawa S, Berlin A, Widera E, Periyakoil VS, Smith AK, Blinderman CD. Pandemic Palliative Care Consultations Spanning State and Institutional Borders. J Am Geriatr Soc 2020; 68:1683-1685. [PMID: 32441788 PMCID: PMC7280694 DOI: 10.1111/jgs.16643] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Accepted: 05/18/2020] [Indexed: 01/02/2023]
Affiliation(s)
- Shunichi Nakagawa
- Department of Medicine, Columbia University Irving Medical Center, New York, New York, USA
| | - Ana Berlin
- Department of Medicine, Columbia University Irving Medical Center, New York, New York, USA
| | - Eric Widera
- Department of Medicine, University of California San Francisco, San Francisco, California, USA
| | | | - Alexander K Smith
- Department of Medicine, University of California San Francisco, San Francisco, California, USA
| | - Craig D Blinderman
- Department of Medicine, Columbia University Irving Medical Center, New York, New York, USA
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Spetz J, Periyakoil VS. Introduction to the Special Issue on the Workforce for Seriously Ill Older Adults in the Community. J Am Geriatr Soc 2020; 67:S390. [PMID: 31074848 DOI: 10.1111/jgs.15942] [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] [Received: 03/31/2019] [Accepted: 04/01/2019] [Indexed: 11/28/2022]
Affiliation(s)
- Joanne Spetz
- Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, San Francisco, California
| | - Vyjeyanthi S Periyakoil
- Department of Medicine/Primary Care and Population Health, Stanford University, Palo Alto, California
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Periyakoil VS. Building a Culturally Competent Workforce to Care for Diverse Older Adults: Scope of the Problem and Potential Solutions. J Am Geriatr Soc 2020; 67:S423-S432. [PMID: 31074850 DOI: 10.1111/jgs.15939] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2018] [Revised: 02/28/2019] [Accepted: 03/01/2019] [Indexed: 12/16/2022]
Abstract
The population of minority older adults is going to explode over the next four decades. Older adults from racial and ethnic minorities face persistent and pervasive health disparities. Health disparities exert a huge fiscal burden on the nation. The national financial cost of health disparities for the years 2002 to 2006 was an estimated 1.23 trillion dollars. As the aging population becomes more diverse, these disparity-related costs are expected to increase. Older adults from racial and ethnic minorities face multiple barriers to accessing health and support services that will help them to age and die in place in the community. Patient-related barriers include limited English proficiency, low health literacy, varying levels of acculturation, biases about Western healthcare and medications, mistrust of clinicians, inability to navigate the complex healthcare system, and cultural beliefs and taboos. Clinician-related barriers include ageism (ie, discrimination against older people due to negative and inaccurate stereotypes), conscious and unconscious bias, being deeply entrenched in the culture of biomedicine, and the lack of training in the principles and practice of providing culturally respectful care. Health system-related barriers include lack of culturally tailored services, including access to medical interpreters. We conclude by identifying three specific strategies to facilitate culturally humble and respectful care for diverse patients. J Am Geriatr Soc 67:S423-S432, 2019.
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Affiliation(s)
- Vyjeyanthi S Periyakoil
- Stanford Aging and Ethnogeriatrics Center, Stanford University School of Medicine, VA Palo Alto Health Care System, Palo Alto, California
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Abstract
PURPOSE Microaggressions are subtle verbal or nonverbal everyday behaviors that arise from unconscious bias, covert prejudice, or hostility. They may contribute to the persistent disparities faced by women in medicine. In this study, the authors sought to identify common microaggressions experienced by women faculty in medicine and to determine if specific demographic characteristics affect the reported frequencies of these microaggressions. METHOD The authors used chain referral sampling to collect real-life anecdotes about microaggressions from women faculty across the nation. Thirty-four unique experiences from those reported were identified and scripted then reenacted using professional actors to create 34 videos of the real-life microaggressions and 34 corresponding fictional "control" versions of the same situations. The videos, presented in a random order, were evaluated by faculty from 4 academic medical centers from 2016 to 2018. RESULTS A total of 124 faculty (79 women, 45 men) participated. Women reported higher frequencies of microaggressions than men in 33 of the 34 videos depicting microaggressions (P value range: < .001 to .042, area under the curve range: 0.60-0.69). No such differences were seen with the control videos. Women identified 21 microaggressions as occurring frequently. No significant differences were found with respect to participants' age, race/ethnicity, academic rank, or years in medicine. Post hoc analyses showed that the microaggressions fell into 6 themes: encountering sexism, encountering pregnancy- and child care-related bias, having abilities underestimated, encountering sexually inappropriate comments, being relegated to mundane tasks, and feeling excluded/marginalized. CONCLUSIONS Privilege is often invisible to those who have it, whereas bias and discrimination are readily apparent to those who experience it. Knowledge of common microaggressions will allow for targeted individual, interpersonal, and institutional solutions to mitigate disparities in medicine.
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Affiliation(s)
- Vyjeyanthi S Periyakoil
- V.S. Periyakoil is associate professor of medicine, director, Stanford Aging and Ethnogeriatrics Center, and director, Palliative Care Education and Training, Department of Medicine, Stanford University School of Medicine, Stanford, California. L. Chaudron is professor of psychiatry, pediatrics, and OB/GYN, and associate vice president and senior associate dean for inclusion and culture development, University of Rochester Medical Center, Rochester, New York. E.V. Hill is director of research and evaluation, Converge, Office for Diversity Inclusion and Community Partnership, Harvard Medical School, Boston, Massachusetts. V. Pellegrini is professor of orthopedics and physical medicine, Medical University of South Carolina, Charleston, South Carolina. E. Neri is research data analyst, Center on Stress and Health, Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California. H.C. Kraemer is emerita professor of biostatistics in psychiatry, Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California
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Landis-Lewis Z, Kononowech J, Scott WJ, Hogikyan RV, Carpenter JG, Periyakoil VS, Miller SC, Levy C, Ersek M, Sales A. Designing clinical practice feedback reports: three steps illustrated in Veterans Health Affairs long-term care facilities and programs. Implement Sci 2020; 15:7. [PMID: 31964414 PMCID: PMC6975062 DOI: 10.1186/s13012-019-0950-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [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: 03/08/2019] [Accepted: 10/17/2019] [Indexed: 11/10/2022] Open
Abstract
Background User-centered design (UCD) methods are well-established techniques for creating useful artifacts, but few studies illustrate their application to clinical feedback reports. When used as an implementation strategy, the content of feedback reports depends on a foundational audit process involving performance measures and data, but these important relationships have not been adequately described. Better guidance on UCD methods for designing feedback reports is needed. Our objective is to describe the feedback report design method for refining the content of prototype reports. Methods We propose a three-step feedback report design method (refinement of measures, data, and display). The three steps follow dependencies such that refinement of measures can require changes to data, which in turn may require changes to the display. We believe this method can be used effectively with a broad range of UCD techniques. Results We illustrate the three-step method as used in implementation of goals of care conversations in long-term care settings in the U.S. Veterans Health Administration. Using iterative usability testing, feedback report content evolved over cycles of the three steps. Following the steps in the proposed method through 12 iterations with 13 participants, we improved the usability of the feedback reports. Conclusions UCD methods can improve feedback report content through an iterative process. When designing feedback reports, refining measures, data, and display may enable report designers to improve the user centeredness of feedback reports.
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Affiliation(s)
- Zach Landis-Lewis
- Department of Learning Health Sciences, University of Michigan Medical School, 1161 J NIB, 300 N. Ingalls Street, SPC 5403, Ann Arbor, Michigan, 48109-5403, USA.
| | | | | | - Robert V Hogikyan
- VA Ann Arbor Healthcare System, Ann Arbor, Michigan, USA.,Department of Internal Medicine, University of MichiganMedical School, Ann Arbor, Michigan, USA
| | - Joan G Carpenter
- Corporal Michael J. Crescenz VAMC, Philadelphia, Pennsylvania, USA.,School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - V S Periyakoil
- VA Palo Alto Health Care System, Palo Alto, California, USA.,School of Medicine, Stanford University, Palo Alto, California, USA
| | - Susan C Miller
- Brown University School of Public Health, Providence, Rhode Island, USA
| | - Cari Levy
- Eastern Colorado Health Care System, Aurora, Colorado, USA.,School of Medicine, University of Colorado Anschutz Campus, Aurora, Colorado, USA
| | - Mary Ersek
- Corporal Michael J. Crescenz VAMC, Philadelphia, Pennsylvania, USA.,School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Anne Sales
- Department of Learning Health Sciences, University of Michigan Medical School, 1161 J NIB, 300 N. Ingalls Street, SPC 5403, Ann Arbor, Michigan, 48109-5403, USA.,VA Ann Arbor Healthcare System, Ann Arbor, Michigan, USA
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Zeng H, Sekhon S, Periyakoil VS. Culture Eats Strategy for Breakfast: Reflections on Wang (DOI: 10.1089/jpm.2019.0251) Top Ten Tips Palliative Care Clinicians Should Know About Caring for Patients in the Emergency Department. J Palliat Med 2020; 23:12. [PMID: 31905087 PMCID: PMC9639232 DOI: 10.1089/jpm.2019.0472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Henry Zeng
- Hospice and Palliative Care Medicine, Stanford University, Stanford, California
| | - Simran Sekhon
- Hospice and Palliative Care Medicine, Stanford University, Stanford, California
| | - Vyjeyanthi S. Periyakoil
- Division of General Internal Medicine, Stanford University, Stanford, California
- VA Palo Alto Health Care System, Palo Alto, California
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Shinall MC, Hoskins A, Hawkins AT, Bailey C, Brown A, Agarwal R, Duggan MC, Beskow LM, Periyakoil VS, Penson DF, Jarrett RT, Chandrasekhar R, Ely EW. A randomized trial of a specialist palliative care intervention for patients undergoing surgery for cancer: rationale and design of the Surgery for Cancer with Option of Palliative Care Expert (SCOPE) Trial. Trials 2019; 20:713. [PMID: 31829237 PMCID: PMC6907134 DOI: 10.1186/s13063-019-3754-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [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: 05/31/2019] [Accepted: 09/25/2019] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND In medical oncology settings, early specialist palliative care interventions have demonstrated improvements in patient quality of life and survival compared with usual oncologic care. However, the effect of early specialist palliative care interventions in surgical oncology settings is not well studied. METHODS The Surgery for Cancer with Option for Palliative Care Expert (SCOPE) Trial is a single-center, prospective, single-blind, randomized controlled trial of a specialist palliative care intervention for cancer patients undergoing non-palliative surgery. It will enroll 236 patients scheduled for major abdominal operations for malignancy, who will be randomized 1:1 at enrollment to receive usual care (control arm) or specialist palliative care consultation (intervention arm). Intervention arm patients will receive consultations from a palliative care specialist (physician or nurse practitioner) preoperatively and postoperatively. The primary outcome is physical and functional wellbeing at 90 days postoperatively. Secondary outcomes are quality of life at 90 days postoperatively, posttraumatic stress disorder symptoms at 180 days postoperatively, days alive at home without an emergency room visit in the first 90 postoperative days, and overall survival at 1 year postoperatively. Participants will be followed for 3 years after surgery for exploratory analyses of their ongoing quality of life, healthcare utilization, and mortality. DISCUSSION SCOPE is an ongoing randomized controlled trial evaluating specialist palliative care interventions for cancer patients undergoing non-palliative oncologic surgery. Findings from the study will inform ways to identify and improve care of surgical patients who will likely benefit from specialist palliative care services. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT03436290 First Registered: 16 February 2018 Enrollment Began: 1 March 2018 Last Update: 20 December 2018.
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Affiliation(s)
- Myrick C Shinall
- Division of General Surgery, Department of Surgery, Vanderbilt University Medical Center, 1161 21st Avenue South, Room D5203 MCN, Nashville, TN, 37232, USA. .,Critical Illness, Brain Dysfunction, and Survivorship Center, Nashville, TN, USA. .,Section of Palliative Care, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA. .,Center for Biomedical Ethics and Society, Vanderbilt University Medical Center, Nashville, TN, USA.
| | - Aimee Hoskins
- Critical Illness, Brain Dysfunction, and Survivorship Center, Nashville, TN, USA
| | - Alexander T Hawkins
- Section of Colon & Rectal Surgery, Division of General Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Christina Bailey
- Division of Surgical Oncology, Department of Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Alaina Brown
- Division of GYN Oncology, Department of OB/GYN, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Rajiv Agarwal
- Critical Illness, Brain Dysfunction, and Survivorship Center, Nashville, TN, USA.,Vanderbilt-Ingram Cancer Center, Division of Hematology and Oncology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Maria C Duggan
- Geriatrics Research, Education, and Clinical Center, Veterans Affairs Tennessee Valley Health System, Nashville, TN, USA.,Division of Geriatric Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Laura M Beskow
- Center for Biomedical Ethics and Society, Vanderbilt University Medical Center, Nashville, TN, USA
| | | | - David F Penson
- Geriatrics Research, Education, and Clinical Center, Veterans Affairs Tennessee Valley Health System, Nashville, TN, USA.,Department of Urology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Ryan T Jarrett
- Department of Biostatistics, Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Rameela Chandrasekhar
- Department of Biostatistics, Vanderbilt University School of Medicine, Nashville, TN, USA
| | - E Wesley Ely
- Critical Illness, Brain Dysfunction, and Survivorship Center, Nashville, TN, USA.,Geriatrics Research, Education, and Clinical Center, Veterans Affairs Tennessee Valley Health System, Nashville, TN, USA.,Division of Allergy, Pulmonary, and Critical Care Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
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Carpenter J, Miller SC, Kolanowski AM, Karel MJ, Periyakoil VS, Lowery J, Levy C, Sales AE, Ersek M. Partnership to Enhance Resident Outcomes for Community Living Center Residents With Dementia: Description of the Protocol and Preliminary Findings. J Gerontol Nurs 2019; 45:21-30. [PMID: 30789986 DOI: 10.3928/00989134-20190211-03] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Accepted: 01/09/2019] [Indexed: 11/20/2022]
Abstract
The goal of this quality improvement project is to improve care planning around preferences for life-sustaining treatments (LST) and daily care to promote quality of life, autonomy, and safety for U.S. Department of Veterans Affairs (VA) Community Living Center (CLC) (i.e., nursing home) residents with dementia. The care planning process occurs through partnerships between staff and family surrogate decision makers. This process is separate from but supports implementation of the LST Decision Initiative-developed by the VA National Center for Ethics in Health Care-which seeks to increase the number, quality, and documentation of goals of care conversations (GOCC) with Veterans who have life-limiting illnesses. The current authors will engage four to six VA CLCs in the Mid-Atlantic states, provide teams with audit and feedback reports, and establish learning collaboratives to address implementation concerns and support action planning. The expected outcomes are an increase in CLC residents with dementia who have documented GOCC and LST plans. [Journal of Gerontological Nursing, 45(3), 21-30.].
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Rosenberg LJ, Butler JM, Caprio AJ, Rhodes RL, Braun UK, Vitale CA, Telonidis J, Periyakoil VS, Farrell TW. Results From a Survey of American Geriatrics Society Members' Views on Physician‐Assisted Suicide. J Am Geriatr Soc 2019; 68:23-30. [DOI: 10.1111/jgs.16245] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Accepted: 10/06/2019] [Indexed: 11/28/2022]
Affiliation(s)
- Lisa J. Rosenberg
- Southwest Medical Hospice and Palliative Care Las Vegas Nevada
- Roseman University of Health Sciences Henderson Nevada
| | - Jorie M. Butler
- Division of Geriatrics, Department of Internal MedicineUniversity of Utah Salt Lake City Utah
- Geriatrics Research Education and Clinical Center, IDEAS HSR&D COINVeterans Affairs Medical Center Salt Lake City Utah
| | - Anthony J. Caprio
- Department of Family MedicineAtrium Health Charlotte North Carolina
- Department of Family MedicineUniversity of North Carolina at Chapel Hill Chapel Hill North Carolina
| | - Ramona L. Rhodes
- Division of Geriatric Medicine, Department of Internal MedicineUT Southwestern Medical Center Dallas Texas
| | - Ursula K. Braun
- Section of Geriatrics, Department of MedicineBaylor College of Medicine Houston Texas
- Center for Innovations in Quality, Effectiveness and SafetyMichael E. DeBakey VA Medical Center Houston Texas
| | - Caroline A. Vitale
- Division of Geriatric and Palliative Medicine, Department of Internal MedicineUniversity of Michigan Ann Arbor Michigan
- Geriatrics Research Education and Clinical CenterVA Ann Arbor Healthcare System Ann Arbor Michigan
| | - Jacqueline Telonidis
- Division of Geriatrics, Department of Internal MedicineUniversity of Utah Salt Lake City Utah
| | - Vyjeyanthi S. Periyakoil
- Stanford University School of Medicine Stanford California
- VA Palo Alto Health Care System Palo Alto California
| | - Timothy W. Farrell
- Division of Geriatrics, Department of Internal MedicineUniversity of Utah Salt Lake City Utah
- VA Salt Lake City Geriatric Research, Education, and Clinical Center Salt Lake City Utah
- University of Utah Health Interprofessional Education Program Salt Lake City Utah
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Patel MI, Sundaram V, Desai M, Periyakoil VS, Kahn JS, Bhattacharya J, Asch SM, Milstein A, Bundorf MK. Effect of a Lay Health Worker Intervention on Goals-of-Care Documentation and on Health Care Use, Costs, and Satisfaction Among Patients With Cancer: A Randomized Clinical Trial. JAMA Oncol 2019; 4:1359-1366. [PMID: 30054634 DOI: 10.1001/jamaoncol.2018.2446] [Citation(s) in RCA: 58] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Importance Although lay health workers (LHWs) improve cancer screening and treatment adherence, evidence on whether they can enhance other aspects of care is limited. Objective To determine whether an LHW program can increase documentation of patients' care preferences after cancer diagnosis. Design, Setting, and Participants Randomized clinical trial conducted from August 13, 2013, through February 2, 2015, among 213 patients with stage 3 or 4 or recurrent cancer at the Veterans Affairs Palo Alto Health Care System. Data analysis was by intention to treat and performed from January 15 to August 18, 2017. Interventions Six-month program with an LHW trained to assist patients with establishing end-of-life care preferences vs usual care. Main Outcomes and Measures The primary outcome was documentation of goals of care. Secondary outcomes were patient satisfaction on the Consumer Assessment of Health Care Providers and Systems "satisfaction with provider" item (on a scale of 0 [worst] to 10 [best possible]), health care use, and costs. Results Among the 213 participants randomized and included in the intention-to-treat analysis, the mean (SD) age was 69.3 (9.1) years, 211 (99.1%) were male, and 165 (77.5%) were of non-Hispanic white race/ethnicity. Within 6 months of enrollment, patients randomized to the intervention had greater documentation of goals of care than the control group (97 [92.4%] vs 19 [17.5%.]; P < .001) and larger increases in satisfaction with care on the Consumer Assessment of Health Care Providers and Systems "satisfaction with provider" item (difference-in-difference, 1.53; 95% CI, 0.67-2.41; P < .001). The number of patients who died within 15 months of enrollment did not differ between groups (intervention, 60 of 105 [57.1%] vs control, 60 of 108 [55.6%]; P = .68). In the 30 days before death, patients in the intervention group had greater hospice use (46 [76.7%] vs 29 [48.3%]; P = .002), fewer emergency department visits (mean [SD], 0.05 [0.22] vs 0.60 [0.76]; P < .001), fewer hospitalizations (mean [SD], 0.05 [0.22] vs 0.50 [0.62]; P < .001), and lower costs (median [interquartile range], $1048 [$331-$8522] vs $23 482 [$9708-$55 648]; P < .001) than patients in the control group. Conclusions and Relevance Incorporating an LHW into cancer care increases goals-of-care documentation and patient satisfaction and reduces health care use and costs at the end of life. Trial Registration ClinicalTrials.gov Identifier: NCT02966509.
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Affiliation(s)
- Manali I Patel
- Division of Oncology, Stanford University School of Medicine, Stanford, California.,Medical Services, Veterans Affairs Palo Alto Health Care System, Palo Alto, California.,Clinical Excellence Research Center, Stanford University School of Medicine, Stanford, California.,Center for Primary Care and Outcomes Research, Stanford University School of Medicine, Stanford, California
| | - Vandana Sundaram
- Quantitative Sciences Unit, Department of Medicine, Stanford University School of Medicine, Stanford, California
| | - Manisha Desai
- Quantitative Sciences Unit, Department of Medicine, Stanford University School of Medicine, Stanford, California
| | - Vyjeyanthi S Periyakoil
- Division of Primary Care and Population Health, Stanford University School of Medicine, Stanford, California.,Extended Care Services, Veterans Affairs Palo Alto Health Care System, Palo Alto, California
| | - James S Kahn
- Medical Services, Veterans Affairs Palo Alto Health Care System, Palo Alto, California.,Division of Primary Care and Population Health, Stanford University School of Medicine, Stanford, California
| | - Jay Bhattacharya
- Center for Primary Care and Outcomes Research, Stanford University School of Medicine, Stanford, California.,Department of Health Research and Policy, Stanford University School of Medicine, Stanford, California
| | - Steven M Asch
- Medical Services, Veterans Affairs Palo Alto Health Care System, Palo Alto, California.,Division of Primary Care and Population Health, Stanford University School of Medicine, Stanford, California.,Center for Innovation to Implementation, Veterans Affairs Palo Alto Health Care System, Palo Alto, California
| | - Arnold Milstein
- Clinical Excellence Research Center, Stanford University School of Medicine, Stanford, California.,Division of Primary Care and Population Health, Stanford University School of Medicine, Stanford, California
| | - M Kate Bundorf
- Center for Primary Care and Outcomes Research, Stanford University School of Medicine, Stanford, California.,Department of Health Research and Policy, Stanford University School of Medicine, Stanford, California
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Perissinotto C, Holt‐Lunstad J, Periyakoil VS, Covinsky K. Reply to: Older People's Loneliness in Clinical Work. J Am Geriatr Soc 2019; 67:2212-2213. [DOI: 10.1111/jgs.16115] [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] [Received: 07/02/2019] [Accepted: 07/10/2019] [Indexed: 11/27/2022]
Affiliation(s)
- Carla Perissinotto
- Department of Medicine University of California, San Francisco San Francisco California
| | | | - Vyjeyanthi S. Periyakoil
- Stanford Aging and Ethnogeriatrics Center Stanford California
- Stanford University, School of Medicine Stanford California
- VA Palo Alto Health Care System Palo Alto California
| | - Ken Covinsky
- Department of Medicine University of California, San Francisco San Francisco California
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42
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Tran QNH, Dieu-Hien HT, King IN, Sheehan K, Iglowitz ML, Periyakoil VS. Providing Culturally Respectful Care for Seriously Ill Vietnamese Americans. J Pain Symptom Manage 2019; 58:344-354. [PMID: 30922704 PMCID: PMC7310713 DOI: 10.1016/j.jpainsymman.2019.03.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2019] [Accepted: 03/18/2019] [Indexed: 10/27/2022]
Abstract
Vietnamese Americans are a heterogeneous population with a rich, shared experience and historical and cultural influences from Asia and Europe. Societal upheaval resulting from the Vietnam War and varied immigration patterns to the U.S. and levels of acculturation layer complexity to this resilient population. These experiences influence how the communities as a whole and how the family as a unit approach health care issues, their attitudes toward serious illness and care at the end of life. Challenges with caring for this population include lack of resources and training to provide culturally sensitive care, lack of appropriate advance care planning, and lack of interpreters or culture-specific care programs. All contribute to poor end-of-life care. An understanding of how these complexities interplay may help clinicians provide compassionate and patient-centric care to these patients, their families, and their supporting communities. This article provides an overview of culturally effective care for seriously ill Vietnamese American patients and makes recommendations for potential strategies for providing respectful end-of-life care.
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Affiliation(s)
- Quy N H Tran
- University of California Davis Health, Sacramento, California, USA; VA Northern California Health Care System, Mather, California, USA
| | | | - Isabelle N King
- University of California Davis Health, Sacramento, California, USA
| | - Kayla Sheehan
- California Northstate University College of Medicine, Elk Grove, California, USA
| | | | - Vyjeyanthi S Periyakoil
- Stanford University School of Medicine, Stanford, California, USA; VA Palo Alto Health Care System, Palo Alto, California, USA.
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43
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Weller R, Healy J, Hettler DL, Howe JL, Smith HM, Steckart MJ, Periyakoil VS. VA Interprofessional Fellowship in Palliative Care: 15 Years of Training Excellence. J Soc Work End Life Palliat Care 2019; 15:85-98. [PMID: 31385743 DOI: 10.1080/15524256.2019.1645797] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Since 2002, the Department of Veterans Affairs (VA) has provided a unique training opportunity in palliative care at six VA medical centers. The VA Interprofessional Fellowship in Palliative Care has trained chaplains, nurses, pharmacists, physicians, psychologists, and social workers to provide clinical palliative care and to develop as leaders in the profession. This article describes the program's origin, mission, outcomes, and lessons learned.
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Affiliation(s)
- Ryan Weller
- VA Portland Health Care System , Portland , Oregon , USA
| | - Jennifer Healy
- South Texas Veterans Health Care System , San Antonio , Texas , USA
| | - Debbie L Hettler
- Department of Veterans Affairs, Office of Academic Affiliations , Washington , DC , USA
| | - Judith L Howe
- Icahn School of Medicine at Mount Sinai and James J. Peters VA Medical Center , Bronx , New York , USA
| | - Heather M Smith
- Clement J. Zablocki VA Medical Center and Medical College of Wisconsin , Milwaukee , Wisconsin , USA
| | - M Jillisa Steckart
- VA Greater Los Angeles Health Care System , Los Angeles , California , USA
| | - Vyjeyanthi S Periyakoil
- Stanford University School of Medicine and Palo Alto VA Health Care System , Palo Alto , California , USA
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44
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Perissinotto C, Holt-Lunstad J, Periyakoil VS, Covinsky K. A Practical Approach to Assessing and Mitigating Loneliness and Isolation in Older Adults. J Am Geriatr Soc 2019; 67:657-662. [PMID: 30762228 DOI: 10.1111/jgs.15746] [Citation(s) in RCA: 106] [Impact Index Per Article: 21.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2017] [Revised: 11/07/2018] [Accepted: 11/26/2018] [Indexed: 01/17/2023]
Abstract
Loneliness and social isolation are strongly associated with several adverse health outcomes in older persons including death and functional impairments. The strength of these associations has been compared with smoking. Accordingly, loneliness and isolation have significant public health implications. Despite the adverse impacts of loneliness and social isolation on quality of life, and their strong association with health outcomes, the evaluation of loneliness and isolation have not been integrated into medical care. The risks for loneliness may be of particular concern to persons with serious illness as patients and caregivers cope with the experience of loss, loss of independence, and increasing care needs. To date, there has been no uniform way of evaluating and documenting loneliness and social isolation as a part of a review of a patient's social determinants of health. This article provides a framework for healthcare systems, providers, and community members working with older adults to (1) understand loneliness, isolation, and its counterpart social connection; (2) describe the different ways loneliness affects health; and (3) create a framework for asking about and documenting these experiences. Finally, because the lack of studies assessing whether targeting loneliness can improve health outcomes is a major gap, we provide guidance on the future of interventions. J Am Geriatr Soc 67:657-662, 2019.
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Affiliation(s)
- Carla Perissinotto
- Department of Medicine, University of California, San Francisco, San Francisco, California
| | | | - Vyjeyanthi S Periyakoil
- Stanford Aging and Ethnogeriatrics Center.,Stanford University, School of Medicine, Palo Alto, California.,VA Palo Alto Health Care System, Palo Alto, California
| | - Ken Covinsky
- Department of Medicine, University of California, San Francisco, San Francisco, California
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45
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Alagappan M, Richardson MT, Schoen MK, Muffly L, Tierney K, Jenkins P, Neri E, Kraemer HC, Periyakoil VS. A Three-Step Letter Advance Directive Procedure to Facilitate Patient-Proxy Alignment in Advance Care Planning. J Palliat Med 2018; 21:1749-1754. [PMID: 30247088 DOI: 10.1089/jpm.2018.0150] [Citation(s) in RCA: 4] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background: Little is known about the extent of alignment between hematopoietic stem cell transplant (HSCT) patients and their healthcare proxies with respect to advance care planning (ACP). Aim: To determine if a structured three-step process using the letter advance directive (LAD) could (1) allow for the differences in opinion between patient-proxy dyads to surface and (2) help bridge preexisting discordance about specific treatment choices. Design: Blinded to each other, the HSCT patient (LAD-1) and proxy (LAD-2) each completed the LAD (step 1). They unmasked, compared LAD-1 and LAD-2, and discussed their choices (step 2). They completed a final letter directive (LAD-3) by consensus (step 3). Settings/Participants: Convenience sample of eighty dyads (patient and proxy) at a regional HSCT referral center. Results: The mean patient-proxy concordance was 72.9% for the 12 questions in the LAD. Wanting to be pain free at the end of life was the statement with the most amount of agreement (88.75% in LAD-1, 91.25% in LAD-2, and 90% in LAD-3). Patient-proxy dyads had notable discordance related to specific treatments. The highest discordance was related to ventilator support (46.3% of patients refused it, while 58.8% of proxies refused on behalf of the patient). Overall, proxies were more likely than patients to opt in for dialyses and hospice care but more likely to opt out for cardiac resuscitation and sedation to palliate refractory symptoms. On open discussion, patient-proxy discordance mostly resolved in favor of the patient. Conclusions: The ACP process should allow for patient-proxy differences to surface, facilitate a discussion about the granular details with the goal of reaching consensus. Our three-step approach using the LAD is an effective way to identify areas of patient-proxy concordance and discordance about specific treatment preferences. A structured patient-proxy discussion using the LAD helped reconcile discordance and most often in favor of a patient's original wishes.
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Affiliation(s)
- Muthuraman Alagappan
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | | | | | - Lori Muffly
- Stanford University School of Medicine, Stanford, California
| | | | | | - Eric Neri
- Stanford University School of Medicine, Stanford, California
| | | | - Vyjeyanthi S Periyakoil
- Stanford University School of Medicine, Stanford, California.,VA Palo Alto Health Care System, Palo Alto, California
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46
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deLima Thomas J, Sanchez-Reilly S, Bernacki R, O'Neill L, Morrison LJ, Kapo J, Periyakoil VS, Carey EC. Advance Care Planning in Cognitively Impaired Older Adults. J Am Geriatr Soc 2018; 66:1469-1474. [PMID: 30277566 DOI: 10.1111/jgs.15471] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2017] [Revised: 04/30/2018] [Accepted: 05/07/2018] [Indexed: 02/02/2023]
Abstract
Older adults with cognitive impairment face many healthcare challenges, chief among them participating in medical decision-making about their own health care. Advance care planning (ACP) is the process whereby individuals communicate their wishes for future care with their clinicians and surrogate decision-makers while they are still able to do so. ACP has been shown to improve important outcomes for individuals with cognitive impairment, but rates of ACP for these individuals are low because of individual-, clinician-, and system-related factors. Addressing ACP early in the illness trajectory can maximize the chances that people can participate meaningfully. This article recommends best practices for approaching ACP for older adults with cognitive impairment. The importance of providing anticipatory guidance and eliciting values to guide future care to create a shared framework between clinicians, individuals, and surrogate decision-makers is emphasized. It is recommended that ACP be approached as an iterative process to continue to honor and support people's wishes as cognitive impairment progresses and increasingly threatens independence and function. The article describes effective strategies for assessing decision-making capacity, identifying surrogate decision-makers, and using structured communication tools for ACP. It also provides guidelines for documentation and billing. Finally, special considerations for individuals with advanced dementia are described, including the use of artificial hydration and nutrition, decisions about site of care, and the role of hospice care.
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Affiliation(s)
- Jane deLima Thomas
- Dana-Farber Cancer Institute and Harvard Medical School, Boston, Massachusetts
| | - Sandra Sanchez-Reilly
- Geriatrics and Extended Care/Geriatric Research, Education, and Clinical Center, South Texas Veterans Health Care System and University of Texas Health Science Center at San Antonio, San Antonio, Texas
| | - Rachelle Bernacki
- Dana-Farber Cancer Institute and Harvard Medical School, Boston, Massachusetts.,Ariadne Labs, Boston, Massachusetts
| | - Lynn O'Neill
- Atlanta Veterans Affairs Medical Center and Emory University School of Medicine, Atlanta, Georgia
| | - Laura J Morrison
- Palliative Care Program, School of Medicine, Yale University, New Haven, Connecticut
| | - Jennifer Kapo
- Palliative Care Program, School of Medicine, Yale University, New Haven, Connecticut
| | - Vyjeyanthi S Periyakoil
- VA Palo Alto Health Care System and, Stanford University School of Medicine, Stanford, California
| | - Elise C Carey
- Center for Palliative Medicine, Mayo Clinic, Rochester, Minnesota
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47
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Affiliation(s)
- Vyjeyanthi S Periyakoil
- Stanford University School of Medicine, Stanford, California; VA Palo Alto Health Care System, Palo Alto, California.
| | | | - Ronit Elk
- College of Nursing, University of South Carolina, Columbia, South Carolina
| | - Timothy Quill
- University of Rochester Medical Center, Rochester, New York
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Abstract
The Universal Declaration of Human Rights recognizes the inherent dignity, the equal and unalienable rights to be universally protected for all humans irrespective of race, color, gender, language, religion, political or other opinion, national or social origin, property, birth or other status. Though this includes the right to dignity-conserving care for terminally ill unauthorized immigrants, access to quality end-of-life care eludes them. Most of the estimated 11.3 million unauthorized immigrants either entered the country without the knowledge of the U.S. Immigration and Customs Enforcement, or were admitted on a temporary visa and stayed past its expiration date. Unsafe living conditions, occupational hazards, lack of access to routine healthcare, scarceness of a social and financial support system, fear of deportation, discrimination and incarceration limit healthcare access of unauthorized immigrants. Lack of access to preventative primary care encounters often results in this population's dependence on acute emergency services for treatment. Lack of opportunity for advance care planning discussions and lack of eligibility to hospice services commonly contributes to poor end of life care. As unauthorized immigrants approach the last days of life, they may often die alone, away from their loved ones, with little-to-no psychosocial support in their final moments. This article provides an overview on end-of-life care for unauthorized immigrants and makes recommendations for potential strategies to providing humane care and support to this vulnerable population.
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Affiliation(s)
| | | | - Vyjeyanthi S Periyakoil
- Stanford University School of Medicine, Stanford, California; VA Palo Alto Health Care System, Palo Alto, California.
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49
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Affiliation(s)
- Alexander K Smith
- Division of Geriatrics, Department of Medicine, University of California, San Francisco, San Francisco, CA.,San Francisco Veterans Affairs Medical Center, San Francisco, CA
| | - Vyjeyanthi S Periyakoil
- Division of Primary Care and Population Health, Department of Medicine, School of Medicine, Stanford University, Palo Alto, CA.,Veterans Affairs Palo Alto Health Care System, Palo Alto, CA
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50
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Sales AE, Ersek M, Intrator OK, Levy C, Carpenter JG, Hogikyan R, Kales HC, Landis-Lewis Z, Olsan T, Miller SC, Montagnini M, Periyakoil VS, Reder S. Correction to: Implementing goals of care conversations with veterans in VA long-term care setting: a mixed methods protocol. Implement Sci 2018; 13:29. [PMID: 29426346 PMCID: PMC5809112 DOI: 10.1186/s13012-018-0724-y] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Accepted: 02/01/2018] [Indexed: 11/10/2022] Open
Affiliation(s)
- Anne E Sales
- Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI, USA. .,University of Michigan Medical School, 300 N. Ingalls Street, Room 1161-I, Ann Arbor, MI, 48109-5423, USA.
| | - Mary Ersek
- Corporal Michael J. Crescenz VAMC, Philadelphia, PA, USA.,School of Nursing, University of Pennsylvania, Philadelphia, PA, USA
| | - Orna K Intrator
- Canandaigua VAMC, Canandaigua, NY, USA.,University of Rochester Medical Center, Rochester, NY, USA
| | - Cari Levy
- Eastern Colorado Health Care System, Denver, CO, USA.,School of Medicine, University of Colorado Anschutz Campus, Denver, CO, USA
| | | | - Robert Hogikyan
- Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI, USA.,University of Michigan Medical School, 300 N. Ingalls Street, Room 1161-I, Ann Arbor, MI, 48109-5423, USA
| | - Helen C Kales
- Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI, USA.,University of Michigan Medical School, 300 N. Ingalls Street, Room 1161-I, Ann Arbor, MI, 48109-5423, USA
| | - Zach Landis-Lewis
- Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI, USA
| | - Tobie Olsan
- Canandaigua VAMC, Canandaigua, NY, USA.,University of Rochester Medical Center, Rochester, NY, USA
| | - Susan C Miller
- Brown University School of Public Health, Providence, RI, USA
| | - Marcos Montagnini
- Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI, USA.,University of Michigan Medical School, 300 N. Ingalls Street, Room 1161-I, Ann Arbor, MI, 48109-5423, USA
| | - Vyjeyanthi S Periyakoil
- VA Palo Alto Health Care System, Palo Alto, CA, USA.,Stanford University School of Medicine, Stanford University, Palo Alto, CA, USA
| | - Sheri Reder
- Puget Sound Health Care System, Seattle, WA, USA
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