1
|
Cook S, Pethick J, Kibbi N, Hollestein L, Lavelle K, de Vere Hunt I, Turnbull C, Rous B, Husain A, Burn J, Lüchtenborg M, Santaniello F, McRonald F, Hardy S, Linos E, Venables Z, Rajan N. Sebaceous carcinoma epidemiology, associated malignancies and Lynch/Muir-Torre syndrome screening in England from 2008 to 2018. J Am Acad Dermatol 2023; 89:1129-1135. [PMID: 37031776 DOI: 10.1016/j.jaad.2023.03.046] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Revised: 02/02/2023] [Accepted: 03/19/2023] [Indexed: 04/11/2023]
Abstract
BACKGROUND Sebaceous carcinomas (SC) may be associated with the cancer predisposition syndrome Muir-Torre/Lynch syndrome (MTS/LS), identifiable by SC mismatch repair (MMR) screening; however, there is limited data on MMR status of SC. OBJECTIVE To describe the epidemiology of SC, copresentation of other cancers, and population level frequency of MMR screening in SC. METHODS A population-based retrospective cohort study of SC patients in the National Cancer Registration and Analysis Service in England. RESULTS This study included 1077 SC cases (739 extraocular, 338 periocular). Age-standardized incidence rates (ASIR) were higher in men compared with women, 2.74 (95% CI, 2.52-9.69) per 1,000,000 person-years for men versus 1.47 person-years (95% CI, 1.4-1.62) for women. Of the patients, 19% (210/1077) developed at least one MTS/LS-associated malignancy. MMR immunohistochemical screening was performed in only 20% (220/1077) of SC tumors; of these, 32% (70/219) of tumors were MMR deficient. LIMITATIONS Retrospective design. CONCLUSIONS Incorporation of MMR screening into clinical practice guidelines for the management of SC will increase the opportunity for MTS/LS diagnoses, with implications for cancer surveillance, chemoprevention with aspirin, and immunotherapy treatment targeted to MTS/LS cancers.
Collapse
Affiliation(s)
- Sam Cook
- Department of Pathology, Royal Victoria Infirmary, Newcastle upon Tyne, United Kingdom
| | - Joanna Pethick
- National Disease Registration Service (NDRS), NHS Digital, London, United Kingdom
| | - Nour Kibbi
- Department of Dermatology, Stanford University School of Medicine, Stanford, California
| | - Loes Hollestein
- Department of Dermatology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands; Department of Research, Netherlands Comprehensive Cancer Center (IKNL), Utrecht, The Netherlands
| | - Katrina Lavelle
- National Disease Registration Service (NDRS), NHS Digital, London, United Kingdom
| | - Isabella de Vere Hunt
- Department of Dermatology, Stanford University School of Medicine, Stanford, California
| | - Clare Turnbull
- National Disease Registration Service (NDRS), NHS Digital, London, United Kingdom
| | - Brian Rous
- National Disease Registration Service (NDRS), NHS Digital, London, United Kingdom
| | - Akhtar Husain
- Department of Pathology, Royal Victoria Infirmary, Newcastle upon Tyne, United Kingdom
| | - John Burn
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Margreet Lüchtenborg
- National Disease Registration Service (NDRS), NHS Digital, London, United Kingdom; Centre for Cancer, Society & Public Health, Comprehensive Cancer Centre, King's College London, London, United Kingdom
| | - Francesco Santaniello
- National Disease Registration Service (NDRS), NHS Digital, London, United Kingdom; Health Data Insight, Cambridge, United Kingdom
| | - Fiona McRonald
- National Disease Registration Service (NDRS), NHS Digital, London, United Kingdom
| | - Steven Hardy
- National Disease Registration Service (NDRS), NHS Digital, London, United Kingdom
| | - Eleni Linos
- Department of Dermatology, Stanford University School of Medicine, Stanford, California
| | - Zoe Venables
- National Disease Registration Service (NDRS), NHS Digital, London, United Kingdom; Department of Dermatology, Norfolk and Norwich University Hospital, Norwich, United Kingdom; Norwich Medical School, University of East Anglia, Norwich, United Kingdom
| | - Neil Rajan
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, United Kingdom; Department of Dermatology, Royal Victoria Infirmary, Newcastle upon Tyne, United Kingdom.
| |
Collapse
|
2
|
de Vere Hunt I, Cai ZR, Nava V, Admassu NE, Bousheri S, Johnson T, Tomz A, Thompson J, Zhang L, Pagoto S, Wehner MR, Mathur MB, Linos E. A Social Media-Based Public Health Campaign to Reduce Indoor Tanning in High-Risk Populations. AJPM Focus 2023; 2:None. [PMID: 37662553 PMCID: PMC10465716 DOI: 10.1016/j.focus.2023.100123] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/05/2023]
Abstract
Introduction Indoor tanning beds cause more than 450,000 new skin cancers each year, yet their use remains common, with a global indoor tanning prevalence of 10.4%. Social media provides an opportunity for cost-effective, targeted public health messaging. We sought to direct Instagram users at high risk of indoor tanning to accurate health information about the risks of indoor tanning and to reduce indoor tanning bed use. Methods We disseminated a public health campaign on Instagram on April 6-27, 2022 with 34 video and still-image advertisements. We had 2 target audiences at high risk of indoor tanning: women aged 18-30 years in Kentucky, Nebraska, Ohio, or Tennessee interested in indoor tanning and men aged 18-45 years in California interested in indoor tanning. To evaluate the impact of the campaign, we tracked online metrics, including website visits, and conducted an interrupted time-series analysis of foot traffic data in our target states for all tanning salons documented on SafeGraph from January 1, 2018 to 3 months after the campaign. Results Our indoor tanning health information advertisements appeared on Instagram feeds 9.1 million times, reaching 1.06 million individuals. We received 7,004 views of our indoor tanning health information landing page (Average Time on Page of 56 seconds). We did not identify a significant impact on foot traffic data on tanning salons. Conclusions We show the successful use of social media advertising to direct high-risk groups to online health information about indoor tanning. Future research quantifying tanning visits before and after indoor tanning interventions is needed to guide future public health efforts.
Collapse
Affiliation(s)
- Isabella de Vere Hunt
- Program for Clinical Research and Technology, Stanford University, Stanford, California
- Nuffield Department of Primary Care Health Sciences, Medical Sciences Division, University of Oxford, Oxford, United Kingdom
| | - Zhuo Ran Cai
- Program for Clinical Research and Technology, Stanford University, Stanford, California
| | - Vanessa Nava
- Program for Clinical Research and Technology, Stanford University, Stanford, California
| | | | - Stephanie Bousheri
- Program for Clinical Research and Technology, Stanford University, Stanford, California
| | - Tiffani Johnson
- Program for Clinical Research and Technology, Stanford University, Stanford, California
| | - Anna Tomz
- Program for Clinical Research and Technology, Stanford University, Stanford, California
| | - Jessica Thompson
- Program for Clinical Research and Technology, Stanford University, Stanford, California
| | - Lucy Zhang
- Program for Clinical Research and Technology, Stanford University, Stanford, California
| | - Sherry Pagoto
- Department of Allied Health Sciences, University of Connecticut, Mansfield, Connecticut
| | - Mackenzie R. Wehner
- Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, Texas
- Department of Dermatology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Maya B. Mathur
- Quantitative Sciences Unit, Department of Pediatrics, Stanford University, Stanford, California
| | - Eleni Linos
- Program for Clinical Research and Technology, Stanford University, Stanford, California
- Department of Dermatology, Stanford University, Stanford, California
| |
Collapse
|
3
|
Barnes LA, Shukla N, Paul M, de Vere Hunt I, Halley MC, Linos E, Naik HB. Patient Perspectives of Health System Barriers to Accessing Care for Hidradenitis Suppurativa: A Qualitative Study. JAMA Dermatol 2023; 159:510-517. [PMID: 37017984 PMCID: PMC10077133 DOI: 10.1001/jamadermatol.2023.0486] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Accepted: 02/09/2023] [Indexed: 04/06/2023]
Abstract
Importance Patient-perceived barriers to hidradenitis suppurativa (HS) care are poorly understood. Understanding health care barriers is a critical first step toward improving care for this population. Objective To characterize the health care experiences of people living with HS, including perceived barriers and facilitators to health care access, and to elucidate potential associations among these barriers and facilitators, health care access, and disease activity. Design, Setting, and Participants In this qualitative study, an inductive thematic analysis was conducted on 45 in-depth, 60- to 90-minute semistructured interviews of 45 people with HS from diverse sociodemographic backgrounds that took place between March and April 2020. Individuals were eligible if they could speak English, were 18 years or older, and were diagnosed with HS. A diagnosis of HS was confirmed through physician diagnosis or through self-reported, affirmative response to the validated screening question, "Do you experience boils in your armpits or groin that recur at least every six months?" Main Outcomes and Measures Interviews were audio recorded and transcribed verbatim. A modified grounded theory approach was used to develop the codebook, which investigators used for inductive thematic analysis. Results Among the 45 participants included, the median (IQR) age was 37 (16) years, 33 (73%) were female, and 22 (49%) were White. There were 6 interrelated themes associated with participant-perceived barriers to accessing HS care: (1) bidirectional associations of disease activity and employment, (2) association of employment with health care coverage, (3) association of health care coverage with costs and perceived access to care, (4) association of costs with access to patient-centered care, (5) health care professional attitudes and knowledge influence patient-centered care and perceived access to care and disease activity, and (6) health system characteristics influence patient-centered care and associated costs, perceived access to care, and disease activity. Conclusions and Relevance This qualitative study highlights themes that generate a conceptual model for understanding barriers that may act synergistically to limit health care access and influence disease activity. The disease activity of HS may be reduced when cycle elements are optimized. This study also highlights areas for future investigations and potential systems-level changes to improve access to patient-centered HS care.
Collapse
Affiliation(s)
- Leandra A. Barnes
- Department of Dermatology, Stanford University School of Medicine, Palo Alto, California
| | - Neha Shukla
- Department of Dermatology, School of Medicine, University of California, San Francisco
| | - Maia Paul
- Department of Dermatology, School of Medicine, University of California, San Francisco
| | - Isabella de Vere Hunt
- Program for Clinical Research and Technology, Stanford University, Stanford, California
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, England, United Kingdom
| | - Meghan C. Halley
- Center for Biomedical Ethics, Stanford University School of Medicine, Stanford, California
| | - Eleni Linos
- Department of Dermatology, Stanford University School of Medicine, Palo Alto, California
- Program for Clinical Research and Technology, Stanford University, Stanford, California
| | - Haley B. Naik
- Department of Dermatology, School of Medicine, University of California, San Francisco
| |
Collapse
|
4
|
de Vere Hunt I, Lester J, Linos E. Insufficient Evidence for Screening Reinforces Need for Primary Prevention of Skin Cancer. JAMA Intern Med 2023:2804038. [PMID: 37071418 DOI: 10.1001/jamainternmed.2023.0927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/19/2023]
Affiliation(s)
- Isabella de Vere Hunt
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, England, United Kingdom
| | - Jenna Lester
- Department of Dermatology, University of California, San Francisco
| | - Eleni Linos
- Program for Clinical Research and Technology, Stanford University, Stanford, California
| |
Collapse
|
5
|
van Egmond S, de Vere Hunt I, Cai ZR, Rizk N, Wakkee M, Chren MM, Goldfarb N, Simard JF, Linos E. The perspectives of 606 US dermatologists on active surveillance for low-risk basal cell carcinoma. Br J Dermatol 2023; 188:136-137. [PMID: 36689496 DOI: 10.1093/bjd/ljac002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Revised: 09/04/2022] [Accepted: 09/24/2022] [Indexed: 01/22/2023]
Abstract
In this survey study of over 600 US dermatologists, identical clinical scenarios (10mm primary asymptomatic BCC) were presented except for randomly varied patient characteristics including age, life expectancy, and tumor location. Most dermatologists (62%) recommended active surveillance for patients with advanced age (91 years) and a 1-year life expectancy. The odds ratio for choosing active surveillance was 20.31 (95% CI 14.10-35.30) comparing a patient with a 1-year life expectancy to a healthy patient.
Collapse
Affiliation(s)
- Sven van Egmond
- Program for Clinical Research and Technology, Stanford University, Stanford, CA, USA
| | - Isabella de Vere Hunt
- Program for Clinical Research and Technology, Stanford University, Stanford, CA, USA
| | - Zhuo Ran Cai
- Program for Clinical Research and Technology, Stanford University, Stanford, CA, USA
| | - Nada Rizk
- Program for Clinical Research and Technology, Stanford University, Stanford, CA, USA
| | - Marlies Wakkee
- Department of Dermatology, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Mary-Margaret Chren
- Department of Dermatology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Noah Goldfarb
- Departments of Medicine and Dermatology, Minneapolis VA Health Care System, Minneapolis, MN, USA
- Departments of Medicine and Dermatology, University of Minnesota, Minneapolis, MN, USA
| | - Julia F Simard
- Department of Epidemiology and Population Health, Stanford University, Stanford, CA, USA
| | - Eleni Linos
- Program for Clinical Research and Technology, Stanford University, Stanford, CA, USA
| |
Collapse
|
6
|
de Vere Hunt I, Owen S, Amuzie A, Nava V, Tomz A, Barnes L, Robinson JK, Lester J, Swetter S, Linos E. Qualitative exploration of melanoma awareness in black people in the USA. BMJ Open 2023; 13:e066967. [PMID: 36631232 PMCID: PMC9835941 DOI: 10.1136/bmjopen-2022-066967] [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] [Indexed: 01/13/2023] Open
Abstract
OBJECTIVE Although black patients are more likely to have advanced melanomas at diagnosis, with a 5-year survival rate among black patients of 70% compared with 92% for white patients, black people are generally not the focus of melanoma public health campaigns. We sought to explore awareness and perspectives of melanoma among black people to inform the development of relevant and valued public health messages to promote early detection of melanoma. DESIGN Inductive thematic analysis of in-depth semistructured interviews. SETTING Interviews were conducted with participants via video software or telephone in the USA. PARTICIPANTS Participants were adults from the USA who self-identified as African American or black. Recruitment flyers were posted around the San Francisco Bay Area and shared on our team Facebook page, with further participants identified through snowball sampling. RESULTS We interviewed 26 participants from 10 different states. Overall, 12 were men and 14 were women, with a mean age of 43 years (range 18-85). We identified five key themes regarding melanoma awareness in black people: (1) lack of understanding of term 'melanoma' and features of skin cancer; (2) do not feel at risk of melanoma skin cancer; (3) surprise that melanoma can occur on palms, soles and nails; (4) skin cancer awareness messages do not apply to or include black people; and (5) Importance of relationship with healthcare and habits of utilisation. CONCLUSIONS Analysis of these in-depth semistructured interviews illuminate the pressing need for health information on melanoma designed specifically for black people. We highlight two key points for focused public health messaging: (1) melanoma skin cancer does occur in black people and (2) high-risk sites for melanoma in black people include the palms, soles and nail beds. Therefore, public health messages for black people and their healthcare providers may involve productively checking these body surface areas.
Collapse
Affiliation(s)
- Isabella de Vere Hunt
- Program for Clinical Research and Technology, Stanford University School of Medicine, Stanford, California, USA
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Sidney Owen
- Program for Clinical Research and Technology, Stanford University School of Medicine, Stanford, California, USA
| | | | - Vanessa Nava
- Program for Clinical Research and Technology, Stanford University School of Medicine, Stanford, California, USA
| | - Anna Tomz
- Program for Clinical Research and Technology, Stanford University School of Medicine, Stanford, California, USA
| | - Leandra Barnes
- Department of Dermatology, Stanford University Department of Medicine, Stanford, California, USA
| | | | - Jenna Lester
- Department of Dermatology, University of California, San Francisco, California, USA
| | - Susan Swetter
- Department of Dermatology, Stanford University Department of Medicine, Stanford, California, USA
| | - Eleni Linos
- Program for Clinical Research and Technology, Stanford University School of Medicine, Stanford, California, USA
- Department of Dermatology, Stanford University Department of Medicine, Stanford, California, USA
| |
Collapse
|
7
|
de Vere Hunt I, Linos E. Social Media for Public Health: Framework for Social Media-Based Public Health Campaigns. J Med Internet Res 2022; 24:e42179. [PMID: 36515995 PMCID: PMC9798262 DOI: 10.2196/42179] [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: 08/25/2022] [Revised: 11/29/2022] [Accepted: 11/30/2022] [Indexed: 12/05/2022] Open
Abstract
The pervasiveness of social media is irrefutable, with 72% of adults reporting using at least one social media platform and an average daily usage of 2 hours. Social media has been shown to influence health-related behaviors, and it offers a powerful tool through which we can rapidly reach large segments of the population with tailored health messaging. However, despite increasing interest in using social media for dissemination of public health messaging and research exploring the dangers of misinformation on social media, the specifics of how public health practitioners can effectively use social media for health promotion are not well described. In this viewpoint, we propose a novel framework with the following 5 key principles to guide the use of social media for public health campaigns: (1) tailoring messages and targeting them to specific populations-this may include targeting messages to specific populations based on age, sex, or language spoken; interests; or geotargeting messages at state, city, or zip code level; (2) including members of the target population in message development-messages should be designed with and approved by members of the community they are designed to reach, to ensure cultural sensitivity and trust-building; (3) identifying and addressing misinformation-public health practitioners can directly address misinformation through myth-busting messages, in which false claims are highlighted and explained and accurate information reiterated; (4) leveraging information sharing-when designing messages for social media, it is crucial to consider their "shareability," and consider partnering with social media influencers who are trusted messengers among their online followers; and (5) evaluating impact by measuring real-world outcomes, for example measuring foot traffic data. Leveraging social media to deliver public health campaigns enables us to capitalize on sophisticated for-profit advertising techniques to disseminate tailored messaging directly to communities that need it most, with a precision far beyond the reaches of conventional mass media. We call for the Centers for Disease Control and Prevention as well as state and local public health agencies to continue to optimize and rigorously evaluate the use of social media for health promotion.
Collapse
Affiliation(s)
- Isabella de Vere Hunt
- Program for Clinical Research and Technology, Stanford University, Palo Alto, CA, United States
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Eleni Linos
- Program for Clinical Research and Technology, Stanford University, Palo Alto, CA, United States
| |
Collapse
|
8
|
Hunt IDV, Dunn T, Mahoney M, Chen M, Nava V, Linos E. A Social Media‒Based Public Health Campaign Encouraging COVID-19 Vaccination Across the United States. Am J Public Health 2022; 112:1253-1256. [PMID: 35797502 PMCID: PMC9382165 DOI: 10.2105/ajph.2022.306934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/04/2022] [Indexed: 11/04/2022]
Abstract
Tailored public health messaging encouraging COVID-19 vaccination may help increase vaccination rates and decrease the burden of COVID-19. We conducted a three-part COVID-19 vaccine uptake public health campaign disseminated on Facebook between April and June 2021. Our first campaign focused on reaching Black and Latinx communities; our second campaign focused on addressing vaccine access and scheduling in Latinx communities; and our third campaign focused on religious communities. Overall, we reached 25 million individuals with 171 million views across the United States. (Am J Public Health. 2022;112(9):1253-1256. https://doi.org/10.2105/AJPH.2022.306934).
Collapse
Affiliation(s)
- Isabella de Vere Hunt
- Isabella de Vere Hunt is with the Program for Clinical Research and Technology, Stanford University, Stanford, CA. Tamara Dunn and Megan Mahoney are with the Department of Medicine, Stanford University. Michael Chen, Vanessa Nava, and Eleni Linos are with the Program for Clinical Research and Technology, Stanford University
| | - Tamara Dunn
- Isabella de Vere Hunt is with the Program for Clinical Research and Technology, Stanford University, Stanford, CA. Tamara Dunn and Megan Mahoney are with the Department of Medicine, Stanford University. Michael Chen, Vanessa Nava, and Eleni Linos are with the Program for Clinical Research and Technology, Stanford University
| | - Megan Mahoney
- Isabella de Vere Hunt is with the Program for Clinical Research and Technology, Stanford University, Stanford, CA. Tamara Dunn and Megan Mahoney are with the Department of Medicine, Stanford University. Michael Chen, Vanessa Nava, and Eleni Linos are with the Program for Clinical Research and Technology, Stanford University
| | - Michael Chen
- Isabella de Vere Hunt is with the Program for Clinical Research and Technology, Stanford University, Stanford, CA. Tamara Dunn and Megan Mahoney are with the Department of Medicine, Stanford University. Michael Chen, Vanessa Nava, and Eleni Linos are with the Program for Clinical Research and Technology, Stanford University
| | - Vanessa Nava
- Isabella de Vere Hunt is with the Program for Clinical Research and Technology, Stanford University, Stanford, CA. Tamara Dunn and Megan Mahoney are with the Department of Medicine, Stanford University. Michael Chen, Vanessa Nava, and Eleni Linos are with the Program for Clinical Research and Technology, Stanford University
| | - Eleni Linos
- Isabella de Vere Hunt is with the Program for Clinical Research and Technology, Stanford University, Stanford, CA. Tamara Dunn and Megan Mahoney are with the Department of Medicine, Stanford University. Michael Chen, Vanessa Nava, and Eleni Linos are with the Program for Clinical Research and Technology, Stanford University
| |
Collapse
|
9
|
de Vere Hunt I, Halley M, Sum K, Yekrang K, Phung M, Good J, Linos E, Chiou AS. A qualitative exploration of the experiences of itch for adults living with epidermolysis bullosa. Br J Dermatol 2022; 187:261-263. [DOI: 10.1111/bjd.21031] [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: 11/16/2021] [Accepted: 01/21/2022] [Indexed: 11/30/2022]
Affiliation(s)
| | - Meghan Halley
- Center for Biomedical Ethics Stanford University Stanford USA
| | - Katie Sum
- Department of Dermatology Stanford University Stanford USA
| | - Kiana Yekrang
- Department of Dermatology Stanford University Stanford USA
| | - Michelle Phung
- Department of Dermatology Stanford University Stanford USA
| | - Julie Good
- Department of Anaesthesiology, Perioperative and Pain Medicine Stanford University Stanford USA
| | - Eleni Linos
- Program for Clinical Research and Technology Stanford University Stanford USA
- Department of Dermatology Stanford University Stanford USA
| | | |
Collapse
|
10
|
de Vere Hunt I, Kilgour JM, Danby R, Peniket A, Matin RN. "Is this the GVHD?" A qualitative exploration of quality of life issues in individuals with graft-versus-host disease following allogeneic stem cell transplant and their experiences of a specialist multidisciplinary bone marrow transplant service. Health Qual Life Outcomes 2021; 19:11. [PMID: 33413414 PMCID: PMC7791741 DOI: 10.1186/s12955-020-01651-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2020] [Accepted: 12/14/2020] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Graft-versus-host disease (GVHD) is a significant cause of morbidity and mortality following allogeneic stem cell transplantation. These patients face unique challenges due to the complexity of GVHD which can affect multiple organ systems, and the toxicity of treatments. Despite the known impact on quality of life (QOL), qualitative data within the bone marrow transplantation (BMT) literature is rare, and there has been no qualitative work exploring patient experience of specialist healthcare provision for GVHD in the United Kingdom. METHODS We conducted a primary explorative qualitative study of the experience of QOL issues and multidisciplinary care in patients with chronic GVHD following allogeneic stem cell transplantation. Eight patients were identified using convenience sampling from specialist BMT outpatient clinics. Following consent, patients were interviewed individually via telephone. Transcripts of interviews were analyzed using an inductive thematic approach. RESULTS Mean participant age was 61-years-old (range 45-68), with a mean time post-transplant of 3 years at time of interview (range 3 months-15 years). Five key QOL themes were identified: (1) 'Restricted as to what I can do'; (2) Troubling symptoms-'you can sort of get GVHD anywhere'; (3) Confusion/uncertainty over GVHD symptoms-'Is this the GVHD?'; (4) Unpredictable course and uncertainty about the future; and (5) Adapting to the sick role. In addition, four themes related to experience of service provision were identified: (1) personal care and close relationship with BMT nurses; (2) efficiency versus long waits-'On the case straight away'; (3) information provision-'went into it with a bit of a rosy view'; and (4) the role of support groups. CONCLUSIONS These qualitative data reflect the heterogeneity of experiences of the GVHD patient population, reflecting the need for a flexible and nuanced approach to patient care with emphasis on comprehensive information provision. We have identified the key role that BMT specialist nurses within the multidisciplinary team play in supporting patients. We advocate future research should focus on ways to meet the complex needs of this patient group and ensure that the personal care and close relationships are not lost in service redesigns embracing remote consultations.
Collapse
Affiliation(s)
- Isabella de Vere Hunt
- Department of Dermatology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - James M Kilgour
- Department of Dermatology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK.
- Department of Dermatology, Stanford University, Discovery Hall - D143, 455 Broadway, Redwood City, CA, 94063, USA.
| | - Robert Danby
- Department of Haematology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Andy Peniket
- Department of Haematology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Rubeta N Matin
- Department of Dermatology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| |
Collapse
|
11
|
de Vere Hunt I, Tavare A. Webcast: We hope not the future of medical school teaching. Med Teach 2016; 38:751-752. [PMID: 27092585 DOI: 10.3109/0142159x.2016.1170793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
|