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Pfahl J, Thompson JS, Matlock DD, Allen LA, Dionne-Odom JN, Bakitas MA, McIlvennan CK. ENABLE-LVAD: Development and Implementation of a Novel Training Program for Clinicians Supporting Family Caregivers of Patients With a Left Ventricular Assist Device. J Cardiovasc Nurs 2023:00005082-990000000-00152. [PMID: 37974325 DOI: 10.1097/jcn.0000000000001065] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2023]
Abstract
BACKGROUND Despite significant family caregiver (FCG) burnout, there are currently no tested interventions to support the FCG role after left ventricular assist device (LVAD) implantation or formalized training for clinicians to support FCGs. OBJECTIVE We adapted the existing ENABLE (Educate, Nurture, Advise Before Life Ends) intervention to LVAD clinicians and FCGs and assessed clinical implementation and dissemination. METHODS ENABLE-LVAD is an interactive, self-paced clinician training coupled with FCG-facing guidebooks and resources. Implementation and dissemination were evaluated by the RE-AIM (reach, effectiveness, adoption, implementation, and maintenance) framework. RESULTS As of May 2023, 187 clinicians registered for the training, and 41 completed all modules (22.0% completion rate). Of those who completed the training and responded to a 6-month survey, one-third (n = 10, 33.3%) used ENABLE-LVAD with FCGs, and 100% of those planned to continue using it. The primary barrier to completing the training was time. CONCLUSIONS The ENABLE-LVAD clinician training was successfully disseminated and implemented as a useful resource to support LVAD FCGs.
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Gazaway S, Wells RD, Azuero A, Pisu M, Guastaferro K, Rini C, Taylor R, Reed RD, Harrell ER, Bechthold AC, Bratches RW, McKie P, Lowers J, Williams GR, Rosenberg AR, Bakitas MA, Kavalieratos D, Dionne-Odom JN. Decision support training for advanced cancer family caregivers: Study protocol for the CASCADE factorial trial. Contemp Clin Trials 2023; 131:107259. [PMID: 37286131 PMCID: PMC10527385 DOI: 10.1016/j.cct.2023.107259] [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: 03/27/2023] [Revised: 05/31/2023] [Accepted: 05/31/2023] [Indexed: 06/09/2023]
Abstract
BACKGROUND Patients with advanced cancer face numerous decisions when diagnosed and often receive decision support from family caregivers. The CASCADE (CAre Supporters Coached to be Adept DEcision partners) factorial trial intervention aims to train caregivers in skills to provide effective decision support to patients and identify most effective intervention components. METHODS This is a 2-site, single-blind, 24 factorial trial to test components of the CASCADE decision support training intervention for family caregivers of patients with newly-diagnosed advanced cancer delivered by specially-trained, telehealth, palliative care lay coaches over 24 weeks. Family caregivers (target N = 352) are randomly assigned to one of 16 combinations of four components with two levels each: 1) psychoeducation on effective decision partnering principles (1 vs. 3 sessions); 2) decision support communication training (1 session vs. none); 3) Ottawa Decision Guide training (1 session vs. none) and 4) monthly follow-up (1 call vs. calls for 24 weeks). The primary outcome is patient-reported decisional conflict at 24 weeks. Secondary outcomes include patient distress, healthcare utilization, caregiver distress, and quality of life. Mediators and moderators (e.g., sociodemographics, decision self-efficacy, social support) will be explored between intervention components and outcomes. Results will be used to build two versions of CASCADE: one with only effective components (d ≥ 0.30) and another optimized for scalability and cost. DISCUSSION This protocol describes the first factorial trial, informed by the multiphase optimization strategy, of a palliative care decision-support intervention for advanced cancer family caregivers and will address the field's need to identify effective components that support serious illness decision-making. TRIAL REGISTRATION NCT04803604.
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Affiliation(s)
- Shena Gazaway
- School of Nursing, University of Alabama at Birmingham (UAB), Birmingham, AL, USA
| | - Rachel D Wells
- School of Nursing, University of Alabama at Birmingham (UAB), Birmingham, AL, USA
| | - Andres Azuero
- School of Nursing, University of Alabama at Birmingham (UAB), Birmingham, AL, USA
| | - Maria Pisu
- Division of Preventive Medicine, UAB Heersink School of Medicine, Birmingham, AL, USA
| | - Kate Guastaferro
- Department of Social and Behavioral Sciences, School of Global Public Health, New York University, New York, USA
| | - Christine Rini
- Cancer Survivorship Institute, Feinberg School of Medicine, Northwestern University, Evanston, IL, USA
| | - Richard Taylor
- School of Nursing, University of Alabama at Birmingham (UAB), Birmingham, AL, USA
| | - Rhiannon D Reed
- Division of Transplantation, Department of Medicine, UAB, Birmingham, AL, USA
| | - Erin R Harrell
- Department of Psychology, University of Alabama, Tuscaloosa, AL, USA
| | - Avery C Bechthold
- School of Nursing, University of Alabama at Birmingham (UAB), Birmingham, AL, USA
| | - Reed W Bratches
- School of Nursing, University of Alabama at Birmingham (UAB), Birmingham, AL, USA
| | - Peg McKie
- School of Nursing, University of Alabama at Birmingham (UAB), Birmingham, AL, USA
| | - Jane Lowers
- Division of Palliative Medicine, Department of Family and Preventive Medicine, School of Medicine, Emory University, Atlanta, GA, USA
| | | | - Abby R Rosenberg
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Department of Medicine, Boston Children's Hospital, Department of Pediatrics, Harvard Medical School, Boston, MA, USA
| | - Marie A Bakitas
- School of Nursing, University of Alabama at Birmingham (UAB), Birmingham, AL, USA
| | - Dio Kavalieratos
- Division of Palliative Medicine, Department of Family and Preventive Medicine, School of Medicine, Emory University, Atlanta, GA, USA
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Caston NE, Franks JA, Balas N, Eltoum N, Thigpen H, Patterson M, Azuero A, Ojesina AI, Dent DN, Hildreth K, Lalor FR, McGowen C, Huang CHS, Dionne-Odom JN, Weiner BJ, Jackson BE, Basch EM, Stover AM, Howell D, Pierce JY, Rocque GB. Evaluating Nurses' Time to Response by Severity and Cancer Stage in a Remote Symptom Monitoring Program for Patients With Breast Cancer. JCO Clin Cancer Inform 2023; 7:e2300015. [PMID: 37279409 PMCID: PMC10530733 DOI: 10.1200/cci.23.00015] [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: 01/26/2023] [Revised: 03/10/2023] [Accepted: 04/13/2023] [Indexed: 06/08/2023] Open
Abstract
PURPOSE Remote symptom monitoring (RSM) using electronic patient-reported outcomes enables patients with cancer to communicate symptoms between in-person visits. A better understanding of key RSM implementation outcomes is crucial to optimize efficiency and guide implementation efforts. This analysis evaluated the association between the severity of patient-reported symptom alerts and time to response by the health care team. METHODS This secondary analysis included women with stage I-IV breast cancer who received care at a large academic medical center in the Southeastern United States (October 2020-September 2022). Symptom surveys with at least one severe symptom alert were categorized as severe. Response time was categorized as optimal if the alert was closed by a health care team member within 48 hours. Odds ratios (ORs), predicted probabilities, and 95% CIs were estimated using a patient-nested logistic regression model. RESULTS Of 178 patients with breast cancer included in this analysis, 63% of patients identified as White and 85% of patients had a stage I-III or early-stage cancer. The median age at diagnosis was 55 years (IQR, 42-65). Of 1,087 surveys included, 36% reported at least one severe symptom alert and 77% had an optimal response time by the health care team. When compared with surveys that had no severe symptom alerts, surveys with at least one severe symptom alert had similar odds of having an optimal response time (OR, 0.97; 95% CI, 0.68 to 1.38). The results were similar when stratified by cancer stage. CONCLUSION Response times to symptom alerts were similar for alerts with at least one severe symptom compared with alerts with no severe symptoms. This suggests that alert management is being incorporated into routine workflows and not prioritized based on disease or symptom alert severity.
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Affiliation(s)
- Nicole E. Caston
- Department of Medicine, Division of Hematology and Oncology, University of Alabama at Birmingham, Birmingham, AL
| | - Jeffrey A. Franks
- Department of Medicine, Division of Hematology and Oncology, University of Alabama at Birmingham, Birmingham, AL
| | - Nora Balas
- Institute for Cancer Outcomes and Survivorship, University of Alabama at Birmingham, Birmingham, AL
| | - Noon Eltoum
- Department of Medicine, Division of Hematology and Oncology, University of Alabama at Birmingham, Birmingham, AL
| | - Haley Thigpen
- Department of Medicine, Division of Hematology and Oncology, University of Alabama at Birmingham, Birmingham, AL
| | - Megan Patterson
- Department of Medicine, Division of Hematology and Oncology, University of Alabama at Birmingham, Birmingham, AL
| | - Andres Azuero
- O'Neal Comprehensive Cancer Center, Birmingham, AL
- School of Nursing, University of Alabama at Birmingham, Birmingham, AL
| | - Akinyemi I. Ojesina
- Department of Obstetrics and Gynecology, Medical College of Wisconsin, Milwaukee, WI
| | - D'Ambra N. Dent
- Department of Medicine, Division of Hematology and Oncology, University of Alabama at Birmingham, Birmingham, AL
| | - Keyonsis Hildreth
- Department of Medicine, Division of Hematology and Oncology, University of Alabama at Birmingham, Birmingham, AL
| | - Fallon R. Lalor
- Department of Medicine, Division of Hematology and Oncology, University of Alabama at Birmingham, Birmingham, AL
| | - Chelsea McGowen
- University of South Alabama Mitchell Cancer Institute, Mobile, AL
| | - Chao-Hui S. Huang
- Department of Medicine, Division of Gerontology, Geriatrics, and Palliative Care, University of Alabama at Birmingham, Birmingham, AL
| | - J. Nicholas Dionne-Odom
- School of Nursing, University of Alabama at Birmingham, Birmingham, AL
- Department of Medicine, Division of Gerontology, Geriatrics, and Palliative Care, University of Alabama at Birmingham, Birmingham, AL
| | - Bryan J. Weiner
- Department of Health Systems and Population Health, University of Washington, Seattle, WA
| | - Bradford E. Jackson
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Ethan M. Basch
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Angela M. Stover
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC
- Department of Health Policy and Management, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Doris Howell
- Supportive Care, Princess Margaret Cancer Centre Research Institute, Toronto, ON, Canada
| | | | - Gabrielle B. Rocque
- Department of Medicine, Division of Hematology and Oncology, University of Alabama at Birmingham, Birmingham, AL
- O'Neal Comprehensive Cancer Center, Birmingham, AL
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Bechthold AC, Knoepke CE, Ejem DB, McIlvennan CK, Wells RD, Matlock DD, Bakitas MA, Dionne-Odom JN. How Values Are Discussed, Reflected Upon, and Acted On by Patients and Family Caregivers in the Context of Heart Failure: A Scoping Review. Med Decis Making 2023; 43:508-520. [PMID: 37057380 DOI: 10.1177/0272989x231165958] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/15/2023]
Abstract
PURPOSE Values are critical to how individuals make decisions and cope, yet the values of heart failure (HF) patients and their family caregivers (FCGs) remain understudied. We sought to report the state of the science on how values are discussed, reflected upon, and acted on by patients with HF, their FCGs, or both related to health-related decision making and coping. METHOD A scoping review was conducted of empirical studies using the following keywords: "heart failure," "values," "decision-making," and "coping." PubMed, PsycINFO, and Scopus were searched from inception to June 2022 in English. Included articles reported values as a key finding (outcome/theme) in their abstract. RESULTS Of 448 articles screened for eligibility, 16 met the inclusion criteria. Twelve articles reported findings addressing patient values, 3 addressed patient and FCG values, and 1 addressed FCG values. Values were reported to influence patient self-care behaviors and left ventricular assist device (LVAD) implantation decisions, although their prioritization varied across time and contexts. When prioritized values conflicted with recommended self-care activities, some patients modified their approach to achieving the value. Others modified or abandoned tasks in favor of the value and accompanying goals. Low motivation and alignment between unhealthy behaviors and values often led to nonadherent decisions. Five of 8 articles focusing on cardiac devices reported patient survival as the most prioritized value during implantation decisions. FCG values were rarely reported or evaluated separately from patient values. Patients leveraged several coping strategies, although the processes through which values affected coping was not described. CONCLUSIONS Prioritized values influenced HF-related decisions, including self-care and LVAD implantation. While several articles reported on coping and values, none described processes through which values affect coping, which highlights a research gap. HIGHLIGHTS Family caregiver values were rarely reported or evaluated separately from patient values, highlighting a gap in the literature.
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Affiliation(s)
- Avery C Bechthold
- School of Nursing, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Christopher E Knoepke
- Division of Cardiology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
- Adult and Child Consortium for Health Outcomes Research and Delivery Science, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Deborah B Ejem
- School of Nursing, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Colleen K McIlvennan
- Division of Cardiology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
- Adult and Child Consortium for Health Outcomes Research and Delivery Science, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Rachel D Wells
- School of Nursing, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Daniel D Matlock
- Adult and Child Consortium for Health Outcomes Research and Delivery Science, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
- Division of Geriatric Medicine, Department of Medicine, University of Colorado School of Medicine, Aurora, CO, USA
- VA Eastern Colorado Geriatric Research Education and Clinical Center, Denver, CO, USA
| | - Marie A Bakitas
- School of Nursing, University of Alabama at Birmingham, Birmingham, AL, USA
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Iyer AS, Wells RD, Dionne-Odom JN, Bechthold AC, Armstrong M, Byun JY, O'Hare L, Taylor R, Ford S, Coffee-Dunning J, Dransfield MT, Brown CJ, Bakitas MA. Project EPIC (Early Palliative Care In COPD): A Formative and Summative Evaluation of the EPIC Telehealth Intervention. J Pain Symptom Manage 2023; 65:335-347.e3. [PMID: 36496113 PMCID: PMC10023469 DOI: 10.1016/j.jpainsymman.2022.11.024] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Revised: 11/28/2022] [Accepted: 11/29/2022] [Indexed: 12/13/2022]
Abstract
CONTEXT Early, concurrent palliative care interventions in chronic obstructive pulmonary disease (COPD) are limited. Project EPIC (Early Palliative Care In COPD) is a multiphase mixed methods study working to fill this gap. OBJECTIVES To conduct a formative and summative evaluation of EPIC, a telephonic nurse coach-led early palliative care intervention for COPD adapted from the ENABLE© intervention in cancer. METHODS Phase I Formative Evaluation: Patients with moderate-to-very-severe COPD, family caregivers, and pulmonary and palliative care clinicians rated the acceptability and feasibility of EPIC (≥4 out of five on a Likert-scale survey). Phase II Summative Evaluation: Patients and family caregivers in Phase I participated in a pilot of the three month EPIC prototype to evaluate intervention and data collection feasibility (≥70% completion) and to seek qualitative feedback. RESULTS Phase I Formative Evaluation: Patients (n=10), family caregivers (n=10), pulmonary clinicians (n=6), and palliative care clinicians (n=6) found EPIC acceptable and feasible to support adaptation, while priority early palliative care needs in COPD from our prior research mapped well to the EPIC prototype. Phase II Summative Evaluation: Patients (n=5; ages 49-72, 40% moderate COPD, 40% Black) and their family caregivers (n=5; ages 51-73, 40% Black) completed 100% of EPIC prototype components, including weekly telephone sessions, a one month follow-up call, Advance Directive, palliative care clinic attendance, and 95% of monthly phone data collection sessions. Feedback from participants about EPIC was all positive. CONCLUSION EPIC was acceptable and feasible in patients with COPD and their family caregivers. Larger feasibility and effectiveness trials are warranted.
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Affiliation(s)
- Anand S Iyer
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine (A.S.I., L.O.H., M.T.D.), University of Alabama at Birmingham, Birmingham, Alabama; Center for Palliative and Supportive Care, Division of Gerontology, Geriatrics, and Palliative Care, Department of Medicine (A.S.I., R.D.W., J.N.D., J.C., M.A.B.), University of Alabama at Birmingham, Birmingham, Alabama; School of Nursing (A.S.I., R.D.W., J.N.D., J.C., M.A.B.), University of Alabama at Birmingham, Birmingham, Alabama.
| | - Rachel D Wells
- Center for Palliative and Supportive Care, Division of Gerontology, Geriatrics, and Palliative Care, Department of Medicine (A.S.I., R.D.W., J.N.D., J.C., M.A.B.), University of Alabama at Birmingham, Birmingham, Alabama; School of Nursing (A.S.I., R.D.W., J.N.D., J.C., M.A.B.), University of Alabama at Birmingham, Birmingham, Alabama
| | - J Nicholas Dionne-Odom
- Center for Palliative and Supportive Care, Division of Gerontology, Geriatrics, and Palliative Care, Department of Medicine (A.S.I., R.D.W., J.N.D., J.C., M.A.B.), University of Alabama at Birmingham, Birmingham, Alabama; School of Nursing (A.S.I., R.D.W., J.N.D., J.C., M.A.B.), University of Alabama at Birmingham, Birmingham, Alabama
| | - Avery C Bechthold
- School of Nursing (A.S.I., R.D.W., J.N.D., J.C., M.A.B.), University of Alabama at Birmingham, Birmingham, Alabama
| | - Margaret Armstrong
- School of Nursing (A.S.I., R.D.W., J.N.D., J.C., M.A.B.), University of Alabama at Birmingham, Birmingham, Alabama
| | - Jun Yeong Byun
- School of Nursing (A.S.I., R.D.W., J.N.D., J.C., M.A.B.), University of Alabama at Birmingham, Birmingham, Alabama
| | - Lanier O'Hare
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine (A.S.I., L.O.H., M.T.D.), University of Alabama at Birmingham, Birmingham, Alabama; School of Nursing (A.S.I., R.D.W., J.N.D., J.C., M.A.B.), University of Alabama at Birmingham, Birmingham, Alabama
| | - Richard Taylor
- School of Nursing (A.S.I., R.D.W., J.N.D., J.C., M.A.B.), University of Alabama at Birmingham, Birmingham, Alabama
| | - Stephanie Ford
- School of Nursing (A.S.I., R.D.W., J.N.D., J.C., M.A.B.), University of Alabama at Birmingham, Birmingham, Alabama
| | - Jazmine Coffee-Dunning
- Center for Palliative and Supportive Care, Division of Gerontology, Geriatrics, and Palliative Care, Department of Medicine (A.S.I., R.D.W., J.N.D., J.C., M.A.B.), University of Alabama at Birmingham, Birmingham, Alabama; School of Nursing (A.S.I., R.D.W., J.N.D., J.C., M.A.B.), University of Alabama at Birmingham, Birmingham, Alabama
| | - Mark T Dransfield
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine (A.S.I., L.O.H., M.T.D.), University of Alabama at Birmingham, Birmingham, Alabama; Birmingham Veterans Affairs Medical Center (M.T.D.), Birmingham, Alabama
| | - Cynthia J Brown
- Department of Internal Medicine(C.J.B.), Louisiana State University Health Sciences Center, New Orleans, Louisiana
| | - Marie A Bakitas
- Center for Palliative and Supportive Care, Division of Gerontology, Geriatrics, and Palliative Care, Department of Medicine (A.S.I., R.D.W., J.N.D., J.C., M.A.B.), University of Alabama at Birmingham, Birmingham, Alabama; School of Nursing (A.S.I., R.D.W., J.N.D., J.C., M.A.B.), University of Alabama at Birmingham, Birmingham, Alabama
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Ejem D, Stockdill M, Edwards R, Dionne-Odom JN, Taylor R, Baehr W, Nabors LB, Bakitas M, Warren P. “It's Not Just the Seizures”: Brain Tumor Caregivers’ Experiences and Educational Needs in Out-of-Hospital Seizure Management. J Palliat Care 2023:8258597231165898. [PMID: 36972511 DOI: 10.1177/08258597231165898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/29/2023]
Abstract
Objective: Family caregivers (FCGs) of persons with primary brain tumors (PBTs) report high levels of distress related to concerns about out-of-hospital seizures. This study aims to explore their experiences and needs with seizure management. Methods: Semi-structured interviews were held with 15 FCGs of persons with PBTs, both those who have and those who have not experienced a seizure, to elicit their concerns about out-of-hospital seizure management and related information needs. A qualitative descriptive study using thematic analysis was conducted based on interview data. Results: Three primary themes were identified relative to FCG experiences and needs related to care of PBTs patients, especially seizure management: (1) FCGs’ experiences with caring for persons with PBTs; (2) FCGs’ educational needs for seizure preparation and resources; and (3) FCGs’ desired type of educational resources and information about seizures. Often FCGs were reported being fearful of seizures and nearly all expressed difficulty knowing when to call emergency services. FCGs equally desired written and online resources, and most preferred graphics or videos detailing seizures. Most FCGs thought that seizure-related training should come after rather than at the time of PBTs diagnosis. FCGs of patients who have not experienced seizures were significantly less prepared to manage seizures than those with a prior seizure. Conclusions: Recognizing and managing out-of-hospital seizures can be a difficult and distressing task for FCGs of patients with PBTs and seizure-related resources are needed. Our results suggest that FCGs of care recipients with PBTs need early supportive interventions to provide self-care strategies and problem-solving skills to manage their roles as caregivers. Interventions should include educational components to assist them in understanding the best mechanisms to maintain a safe environment for their care recipients, and those that deepen knowledge about when to contact EMS.
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Affiliation(s)
- Deborah Ejem
- School of Nursing, 9968University of Alabama at Birmingham, Birmingham, AL, USA
| | - Macy Stockdill
- School of Nursing, 9968University of Alabama at Birmingham, Birmingham, AL, USA
| | - Rebecca Edwards
- School of Nursing, 9968University of Alabama at Birmingham, Birmingham, AL, USA
| | | | - Richard Taylor
- School of Nursing, 9968University of Alabama at Birmingham, Birmingham, AL, USA
| | - Walter Baehr
- Division of Geriatrics, Gerontology, and Palliative Care, School of Medicine, The University of Alabama, Birmingham, AL, USA
| | - L Burt Nabors
- Department of Neurology, School of Medicine, The University of Alabama, Birmingham, AL, USA
| | - Marie Bakitas
- School of Nursing, 9968University of Alabama at Birmingham, Birmingham, AL, USA
| | - Paula Warren
- Department of Neurology, School of Medicine, The University of Alabama, Birmingham, AL, USA
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Mirshahi A, Ghiasvandian S, Khoshavi M, Riahi SM, Khanipour-Kencha A, Bakitas M, Dionne-Odom JN, Wells R, Zakerimoghadam M. The feasibility and acceptability of an early tele-palliative care intervention to improve quality of life in heart failure patients in Iran: A protocol for a randomized controlled trial. Contemp Clin Trials Commun 2023; 33:101114. [PMID: 36993787 PMCID: PMC10041464 DOI: 10.1016/j.conctc.2023.101114] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 02/27/2023] [Accepted: 03/10/2023] [Indexed: 03/28/2023] Open
Abstract
Background Heart failure (HF) has become a global health problem that has affected the quality of life of millions of people. One approach to improving patients’ quality of life (QoL) with chronic diseases such as HF is palliative care. In Iran, the bulk of palliative care research is directed to patients with cancer, with the primary focus on the physical aspect rather than the psychosocial and spiritual aspects of palliative care. To address this gap, this study aims to determine the feasibility and acceptability of this early tele-palliative care intervention to improve quality of life in heart failure patients in Iran. Methods The early tele-palliative care versus usual care study is designed as a single-centre, randomised, feasibility trial of 50 patients with heart failure aged 18 to 65 and clinician-determined New York Heart Association class II/III or American College of Cardiology stage B/C HF, recruited in Imam Khomeini Hospital Complex, Tehran, Iran. This intervention contains 6 weekly educational webinars and concurrent WhatsApp® group activities. Program feasibility and acceptability will be assessed by measuring the recruitment, attrition, and questionnaire completion rates; satisfaction and attitudes about the intervention will be measured via a telephone-based interviews. Secondary outcomes of Qol, mood status and number of emergency department visits will be measured with validated instruments. Participants in both groups will be followed up for 6 weeks, and the measures will be re-administered. Appropriate statistical tests will be used to analyse the data. Conclusion This is the first early tele-palliative care intervention designed for heart failure patients in Iran. The intervention has been developed by a multidisciplinary team of academic and clinical professionals with patient stakeholder input to create a rigorous and culturally responsive approach for palliative care delivery for heart failure patients in Iran. Trial registration IRCT registration number - IRCT20100725004443N29.
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Affiliation(s)
- Arvin Mirshahi
- Department of Medical-Surgical Nursing, School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran
- USERN Care (TUMS) Office, School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran
| | - Shahrzad Ghiasvandian
- Department of Medical-Surgical Nursing, School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran
| | - Meysam Khoshavi
- Department of Cardiology, School of Medicine, Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Seyed Mohammad Riahi
- School of Medicine, Cardiovascular Diseases Research Center, Birjand University of Medical Sciences, Tehran, Iran
| | - Ali Khanipour-Kencha
- Department of Medical-Surgical Nursing, School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran
- USERN Care (TUMS) Office, School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran
| | - Marie Bakitas
- School of Nursing, and Department of Medicine, Division of Gerontology, Geriatrics, and Palliative Care, University of Alabama at Birmingham, Birmingham, AL, USA
| | - J. Nicholas Dionne-Odom
- School of Nursing, University of Alabama at Birmingham (UAB) and UAB Center for Palliative and Supportive Care, USA
| | - Rachel Wells
- School of Nursing, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Masoumeh Zakerimoghadam
- Department of Medical-Surgical Nursing, School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran
- Corresponding author. Departments of Medical-Surgical Nursing, School of Nursing and Midwifery, Tehran University of Medical Sciences, Nosrat St., Tohid Sq., Post Code: 14197-33171, Tehran, Iran.
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Lee K, Cheongho Lee T, Yefimova M, Kumar S, Puga F, Azuero A, Kamal A, Bakitas MA, Wright AA, Demiris G, Ritchie CS, Pickering CE, Nicholas Dionne-Odom J. Using Digital phenotyping to understand health-related outcomes: A scoping review. Int J Med Inform 2023; 174:105061. [PMID: 37030145 DOI: 10.1016/j.ijmedinf.2023.105061] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Revised: 02/10/2023] [Accepted: 03/24/2023] [Indexed: 04/01/2023]
Abstract
BACKGROUND Digital phenotyping may detect changes in health outcomes and potentially lead to proactive measures to mitigate health declines and avoid major medical events. While health-related outcomes have traditionally been acquired through self-report measures, those approaches have numerous limitations, such as recall bias, and social desirability bias. Digital phenotyping may offer a potential solution to these limitations. OBJECTIVES The purpose of this scoping review was to identify and summarize how passive smartphone data are processed and evaluated analytically, including the relationship between these data and health-related outcomes. METHODS A search of PubMed, Scopus, Compendex, and HTA databases was conducted for all articles in April 2021 using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses for Scoping Review (PRISMA-ScR) guidelines. RESULTS A total of 40 articles were included and went through an analysis based on data collection approaches, feature extraction, data analytics, behavioral markers, and health-related outcomes. This review demonstrated a layer of features derived from raw sensor data that can then be integrated to estimate and predict behaviors, emotions, and health-related outcomes. Most studies collected data from a combination of sensors. GPS was the most used digital phenotyping data. Feature types included physical activity, location, mobility, social activity, sleep, and in-phone activity. Studies involved a broad range of the features used: data preprocessing, analysis approaches, analytic techniques, and algorithms tested. 55% of the studies (n = 22) focused on mental health-related outcomes. CONCLUSION This scoping review catalogued in detail the research to date regarding the approaches to using passive smartphone sensor data to derive behavioral markers to correlate with or predict health-related outcomes. Findings will serve as a central resource for researchers to survey the field of research designs and approaches performed to date and move this emerging domain of research forward towards ultimately providing clinical utility in patient care.
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Hudson PL, Gardiner C, Alvariza A, Nicholas Dionne-Odom J, Öhlén J, Carduff E, Harding R, Witkamp E, Payne S. Strategies and checklist for designing and conducting palliative care research with family carers: EAPC international expert elicitation study. Palliat Med 2023; 37:163-173. [PMID: 36380493 DOI: 10.1177/02692163221136162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND Palliative care services seek to improve the wellbeing of family carers of people living with serious and life-limiting illness. To help achieve this goal, systematic reviews have recommended priority areas for family carer research and the need to improve the quality of study design. Policy makers have also advocated for enhanced family carer support. However, there are specific methodological considerations and challenges in designing and conducting carer research conducted during the course of the serious illness trajectory and in bereavement. AIM To develop strategies to improve the design and conduct of research with family carers. DESIGN Expert elicitation study using an adapted version of the 'Identify, Discuss, Estimate and Aggregate' elicitation protocol, supplemented with strategies from peer-reviewed literature. SETTING/PARTICIPANTS Nine members of the management committee of the European Association for Palliative Care's Reference group on family carer research, comprising international senior research academics in family caregiving. RESULTS A compilation of recommended strategies and checklist was created to: (a) help researchers plan research involving family carers focussing on: preparation, conduct and dissemination and (b) assist ethics committees and funding bodies to evaluate proposals. CONCLUSIONS The strategies and checklist for conducting research with family carers may enhance methodologically rigorous research. Consequently, researchers, practitioners and policy makers will not only gain a more comprehensive understanding of the unmet needs of family carers but also promote the development of empirically sound interventions.
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Affiliation(s)
- P L Hudson
- Centre for Palliative Care, St Vincent's Hospital, Melbourne, Australia.,University of Melbourne, Melbourne, Australia.,Vrije Universiteit Brussel, Brussels, Belgium
| | - C Gardiner
- Health Sciences School, University of Sheffield, UK
| | - A Alvariza
- Department of Health Care Sciences, Palliative Research Centre, Marie Cederschiöld University, Stockholm, Sweden.,Capio Palliative Care, Dalen Hospital, Stockholm, Sweden
| | | | - J Öhlén
- Institute of Health and Care Sciences, and Centre for Person-Centred Care (GPCC), Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Palliative Centre, Sahlgrenska University Hospital, Västra Götaland Region, Gothenburg, Sweden
| | - E Carduff
- Marie Curie Hospice Glasgow, Glasgow, UK
| | - R Harding
- Florence Nightingale Faculty of Nursing Midwifery and Palliative Care, King's College London, Cicely Saunders Institute, London, UK
| | - E Witkamp
- Research Center Innovations in Care, Department of Public Health, Erasmus Medical Center, Rotterdam University of Applied Sciences, Rotterdam, the Netherlands
| | - S Payne
- International Observatory on End of Life Care, Faculty of Health and Medicine, Lancaster University, Lancaster, UK
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10
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Stockdill ML, Dionne-Odom JN, Wells R, Ejem D, Azuero A, Keebler K, Sockwell E, Tims S, Burgio KL, Engler S, Durant R, Pamboukian SV, Tallaj J, Swetz KM, Kvale E, Tucker R, Bakitas M. African American Recruitment in Early Heart Failure Palliative Care Trials: Outcomes and Comparison With the ENABLE CHF-PC Randomized Trial. J Palliat Care 2023; 38:52-61. [PMID: 33258422 PMCID: PMC8314978 DOI: 10.1177/0825859720975978] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND Palliative care trial recruitment of African Americans (AAs) is a formidable research challenge. OBJECTIVES Examine AA clinical trial recruitment and enrollment in a palliative care randomized controlled trial (RCT) for heart failure (HF) patients and compare patient baseline characteristics to other HF palliative care RCTs. METHODS This is a descriptive analysis the ENABLE CHF-PC (Educate, Nurture, Advise, Before Life Ends: Comprehensive Heartcare for Patients and Caregivers) RCT using bivariate statistics to compare racial and patient characteristics and differences through recruitment stages. We then compared the baseline sample characteristics among three palliative HF trials. RESULTS Of 785 patients screened, 566 eligible patients with NYHA classification III-IV were approached; 461 were enrolled and 415 randomized (AA = 226). African Americans were more likely to consent than Caucasians (55%; P FDR = .001), were younger (62.7 + 8; P FDR = .03), had a lower ejection fraction (39.1 + 15.4; PFDR = .03), were more likely to be single (P FDR = .001), and lack an advanced directive (16.4%; P FDR < .001). AAs reported higher goal setting (3.3 + 1.3; P FDR = .007), care coordination (2.8 + 1.3; P FDR = .001) and used more "denial" coping strategies (0.8 + 1; P FDR = .001). Compared to two recent HF RCTs, the ENABLE CHF-PC sample had a higher proportion of AAs and higher baseline KCCQ clinical summary scores. CONCLUSION ENABLE CHF-PC has the highest reported recruitment rate and proportion of AAs in a palliative clinical trial to date. Community-based recruitment partnerships, recruiter training, ongoing communication with recruiters and clinician co-investigators, and recruiter racial concordance likely contributed to successful recruitment of AAs. These important insights provide guidance for design of future HF palliative RCTs. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT02505425.
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Affiliation(s)
- Macy L. Stockdill
- School of Nursing, University of Alabama at Birmingham, Birmingham, AL, USA
| | | | - Rachel Wells
- School of Nursing, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Deborah Ejem
- School of Nursing, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Andres Azuero
- School of Nursing, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Konda Keebler
- School of Nursing, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Elizabeth Sockwell
- School of Nursing, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Sheri Tims
- School of Nursing, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Kathryn L. Burgio
- Division of Gerontology, Department of Medicine, Geriatrics, Palliative Care, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Sally Engler
- School of Nursing, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Raegan Durant
- Division of Preventative Medicine, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Salpy V. Pamboukian
- Division of Cardiovascular Diseases, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Jose Tallaj
- Division of Cardiovascular Diseases, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Keith M. Swetz
- Division of Gerontology, Department of Medicine, Geriatrics, Palliative Care, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Elizabeth Kvale
- Department of Medicine, Dell Medical School, University of Texas at Austin, Austin, TX, USA
| | - Rodney Tucker
- Department of Medicine, Dell Medical School, University of Texas at Austin, Austin, TX, USA
| | - Marie Bakitas
- Division of Gerontology, Geriatrics, and Palliative Care, Department of Medicine, School of Nursing, University of Alabama at Birmingham, Birmingham, AL, USA
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11
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Lee K, Kumar S, Puga F, Azuero A, Kamal A, Pickering C, Dionne-Odom JN. DIGITAL PHENOTYPING TO UNDERSTAND HEALTH-RELATED OUTCOMES: A SCOPING REVIEW. Innov Aging 2022. [DOI: 10.1093/geroni/igac059.2183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Abstract
Modeling passive data collected by smartphones, or digital phenotyping, may help detect the early signs of declines in daily health and lead to steps to prevent declines. Health-related outcomes have been typically acquired through self-report measures, however this broad approach has several limitations, such as recall and social desirability bias. A potential solution is digital phenotyping. Guided by the Arksey and O’Malley methodological framework, the aim of this scoping review was to identify studies that modeled passive smartphone-sensor data into behavioral markers that correlate or predict health-related outcomes. A literature search of peer-reviewed or conference studies in PubMed, Scopus, Compendex, and HTA yielded 3,170 articles. 40 studies met the inclusion criteria. Studies were organized and assessed for their: 1) data collection approaches (e.g., smartphone passive sensor data and questionnaire), 2) feature extraction (e.g., converting bedtime or wake time into sleep), 3) data analytics (e.g., identifying accelerometer data into sleep patterns using machine learning), 4) behavioral markers, which is observing the activity pattern for an extended period of time and then modeling the activities into appropriate behaviors, and 5) health-related outcomes. The findings of this study demonstrate how to transform passive smartphone-sensor data into behavioral markers that correlate or predict health-related outcomes, which could provide information for more grounded predictive use and successful implementation of digital phenotyping in future research.
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Affiliation(s)
- Kyungmi Lee
- The University of Alabama at Birmingham , Hoover, Alabama , United States
| | - Sidharth Kumar
- The University of Alabama at Birmingham , Birmingham, Alabama , United States
| | - Frank Puga
- The University of Alabama at Birmingham , Birmingham, Alabama , United States
| | - Andres Azuero
- The University of Alabama at Birmingham , Birmingham, Alabama , United States
| | - Arif Kamal
- Duke University , Durham, North Carolina , United States
| | - Carolyn Pickering
- The University of Alabama at Birmingham , Birmingham, Alabama , United States
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12
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Rocque GB, Dent DN, Ingram SA, Caston NE, Thigpen HB, Lalor FR, Jamy OH, Giri S, Azuero A, Young Pierce J, McGowen CL, Daniel CL, Andrews CJ, Huang CHS, Dionne-Odom JN, Weiner BJ, Howell D, Jackson BE, Basch EM, Stover AM. Adaptation of Remote Symptom Monitoring Using Electronic Patient-Reported Outcomes for Implementation in Real-World Settings. JCO Oncol Pract 2022; 18:e1943-e1952. [PMID: 36306496 PMCID: PMC9750550 DOI: 10.1200/op.22.00360] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [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: 05/23/2022] [Revised: 08/19/2022] [Accepted: 09/12/2022] [Indexed: 01/05/2023] Open
Abstract
PURPOSE Despite evidence of clinical benefits, widespread implementation of remote symptom monitoring has been limited. We describe a process of adapting a remote symptom monitoring intervention developed in a research setting to a real-world clinical setting at two cancer centers. METHODS This formative evaluation assessed core components and adaptations to improve acceptability and fit of remote symptom monitoring using Stirman's Framework for Modifications and Adaptations. Implementation outcomes were evaluated in pilot studies at the two cancer centers testing technology (phase I) and workflow (phase II and III) using electronic health data; qualitative evaluation with semistructured interviews of clinical team members; and capture of field notes from clinical teams and administrators regarding barriers and recommended adaptations for future implementation. RESULTS Core components of remote symptom monitoring included electronic delivery of surveys with actionable symptoms, patient education on the intervention, a system to monitor survey compliance in real time, the capacity to generate alerts, training nurses to manage alerts, and identification of personnel responsible for managing symptoms. In the pilot studies, while most patients completed > 50% of expected surveys, adaptations were identified to address barriers related to workflow challenges, patient and clinician access to technology, digital health literacy, survey fatigue, alert fatigue, and data visibility. CONCLUSION Using an implementation science approach, we facilitated adaptation of remote symptom monitoring interventions from the research setting to clinical practice and identified key areas to promote effective uptake and sustainability.
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Affiliation(s)
- Gabrielle B. Rocque
- University of Alabama at Birmingham, Department of Medicine, Division of Hematology and Oncology, Birmingham, AL
- University of Alabama at Birmingham, Department of Medicine, Division of Gerontology, Geriatrics, and Palliative Care, Birmingham, AL
- O'Neal Comprehensive Cancer Center, Birmingham, AL
| | - D’Ambra N. Dent
- University of Alabama at Birmingham, Department of Medicine, Division of Hematology and Oncology, Birmingham, AL
| | - Stacey A. Ingram
- University of Alabama at Birmingham, Department of Medicine, Division of Hematology and Oncology, Birmingham, AL
| | - Nicole E. Caston
- University of Alabama at Birmingham, Department of Medicine, Division of Hematology and Oncology, Birmingham, AL
| | - Haley B. Thigpen
- University of Alabama at Birmingham, Department of Medicine, Division of Hematology and Oncology, Birmingham, AL
| | - Fallon R. Lalor
- University of Alabama at Birmingham, Department of Medicine, Division of Hematology and Oncology, Birmingham, AL
| | - Omer H. Jamy
- University of Alabama at Birmingham, Department of Medicine, Division of Hematology and Oncology, Birmingham, AL
- O'Neal Comprehensive Cancer Center, Birmingham, AL
| | - Smith Giri
- University of Alabama at Birmingham, Department of Medicine, Division of Hematology and Oncology, Birmingham, AL
- O'Neal Comprehensive Cancer Center, Birmingham, AL
| | - Andres Azuero
- University of Alabama at Birmingham School of Nursing, Birmingham, AL
| | | | | | - Casey L. Daniel
- University of South Alabama Mitchell Cancer Institute, Mobile, AL
| | - Courtney J. Andrews
- Institute for Human Rights, University of Alabama at Birmingham, Birmingham, AL
| | - Chao-Hui Sylvia Huang
- University of Alabama at Birmingham, Department of Medicine, Division of Gerontology, Geriatrics, and Palliative Care, Birmingham, AL
| | - J. Nicholas Dionne-Odom
- University of Alabama at Birmingham, Department of Medicine, Division of Gerontology, Geriatrics, and Palliative Care, Birmingham, AL
- University of Alabama at Birmingham School of Nursing, Birmingham, AL
| | - Bryan J. Weiner
- Department of Health Systems and Population Health, University of Washington, Seattle, WA
| | - Doris Howell
- Supportive Care, Princess Margaret Cancer Centre Research Institute, Toronto, Ontario, Canada
| | - Bradford E. Jackson
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Ethan M. Basch
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Angela M. Stover
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC
- University of North Carolina at Chapel Hill Department of Health Policy and Management, Chapel Hill, NC
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13
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Bechthold AC, Montgomery AP, Fazeli PL, Dionne-Odom JN. Values elicitation among adults making health-related decisions: A concept analysis. Nurs Forum 2022; 57:885-892. [PMID: 35430733 DOI: 10.1111/nuf.12730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Revised: 02/21/2022] [Accepted: 04/03/2022] [Indexed: 06/14/2023]
Abstract
AIM To conduct a concept analysis of values elicitation in the context of health care and treatment decision-making and formulate a conceptual definition. BACKGROUND Values elicitation is a commonly cited term for an activity to help patients identify values and evaluate their application in health care decision-making, yet it remains ambiguous and difficult to differentiate from similar concepts. DESIGN Concept analysis. DATA SOURCE Three databases, including PubMed, CINAHL Plus, and Scopus, were searched from inception to February 2021. REVIEW METHODS Walker and Avant's eight-stage method was used to identify attributes, cases, antecedents, consequences, and empirical referents and formulate a conceptual definition. RESULTS The concept analysis identified 3 attributes, 10 consequences, 7 antecedents, and 3 empirical referents. Our analysis defines values elicitation as an intentional process whereby individuals explore their core beliefs, alone or with others, to (1) determine their preference, or a lack thereof, between health or treatment options, and (2) frame decisions. CONCLUSIONS The findings have the potential to influence the identification, discussion, and measurement of values elicitation by nurses and researchers across disciplines. Further exploration of this concept is warranted as the literature continues to emerge.
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Affiliation(s)
- Avery C Bechthold
- School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Aoyjai P Montgomery
- School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Pariya L Fazeli
- School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama, USA
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14
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Bechthold AC, Azuero A, Pisu M, Pierce JY, Williams GR, Taylor RA, Wells R, Curry K, Reed RD, Harrell ER, Gazaway S, Mollman S, Engler S, Puga F, Bakitas MA, Dionne-Odom JN. The Project ENABLE Cornerstone randomized controlled trial: study protocol for a lay navigator-led, early palliative care coaching intervention for African American and rural-dwelling advanced cancer family caregivers. Trials 2022; 23:452. [PMID: 35655285 PMCID: PMC9161197 DOI: 10.1186/s13063-022-06305-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Accepted: 04/13/2022] [Indexed: 11/10/2022] Open
Abstract
Background Family caregivers play a vital, yet stressful role in managing the healthcare needs and optimizing the quality of life of patients with advanced cancer, from the time they are newly diagnosed until end of life. While early telehealth palliative care has been found to effectively support family caregivers, little work has focused on historically under-resourced populations, particularly African American and rural-dwelling individuals. To address this need, we developed and are currently testing Project ENABLE (Educate, Nurture, Advise, Before Life Ends) Cornerstone, a lay navigator-led, early palliative care coaching intervention for family caregivers of African American and rural-dwelling patients with newly diagnosed advanced cancer. Methods This is a 2-site, single-blind, hybrid type I implementation-effectiveness trial of the Cornerstone intervention versus usual care. Cornerstone is a multicomponent intervention based on Pearlin’s Stress-Health Process Model where African American and/or rural-dwelling family caregivers of patients with newly diagnosed advanced cancer (target sample size = 294 dyads) are paired with a lay navigator coach and receive a series of six, brief 20–60-min telehealth sessions focused on stress management and coping, caregiving skills, getting help, self-care, and preparing for the future/advance care planning. Subsequent to core sessions, caregivers receive monthly follow-up indefinitely until the patient’s death. Caregiver and patient outcomes are collected at baseline and every 12 weeks until the patient’s death (primary outcome: caregiver distress at 24 weeks; secondary outcomes: caregiver: quality of life and burden; patient: distress, quality of life, and healthcare utilization). Implementation costs and the intervention cost effectiveness are also being evaluated. Discussion Should this intervention demonstrate efficacy, it would yield an implementation-ready model of early palliative care support for under-resourced family caregivers. A key design principle that has centrally informed the Cornerstone intervention is that every caregiving situation is unique and each caregiver faces distinct challenges that cannot be addressed using a one-size-fits all approach. Hence, Cornerstone employs culturally savvy lay navigator coaches who are trained to establish a strong, therapeutic alliance with participants and tailor their coaching to a diverse range of individual circumstances. Trial registration ClinicalTrials.gov NCT04318886. Registered on 20 March, 2020. Supplementary Information The online version contains supplementary material available at 10.1186/s13063-022-06305-w.
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Affiliation(s)
- Avery C Bechthold
- School of Nursing, University of Alabama at Birmingham (UAB), Birmingham, AL, USA
| | - Andres Azuero
- School of Nursing, University of Alabama at Birmingham (UAB), Birmingham, AL, USA
| | - Maria Pisu
- Division of Preventive Medicine, UAB School of Medicine, Birmingham, AL, USA
| | | | - Grant R Williams
- Division of Hematology and Oncology, Department of Medicine, UAB, Birmingham, AL, USA
| | - Richard A Taylor
- School of Nursing, University of Alabama at Birmingham (UAB), Birmingham, AL, USA
| | - Rachel Wells
- School of Nursing, University of Alabama at Birmingham (UAB), Birmingham, AL, USA
| | - Kayleigh Curry
- School of Nursing, University of Alabama at Birmingham (UAB), Birmingham, AL, USA
| | - Rhiannon D Reed
- Division of Transplantation, Department of Surgery, UAB, Birmingham, AL, USA
| | - Erin R Harrell
- Department of Psychology, University of Alabama, Tuscaloosa, AL, USA
| | - Shena Gazaway
- School of Nursing, University of Alabama at Birmingham (UAB), Birmingham, AL, USA
| | - Sarah Mollman
- College of Nursing, South Dakota State University, Rapid City, SD, USA
| | - Sally Engler
- School of Nursing, University of Alabama at Birmingham (UAB), Birmingham, AL, USA
| | - Frank Puga
- School of Nursing, University of Alabama at Birmingham (UAB), Birmingham, AL, USA
| | - Marie A Bakitas
- School of Nursing, University of Alabama at Birmingham (UAB), Birmingham, AL, USA.,Division of Geriatrics, Gerontology, and Palliative Care, UAB Department of Medicine, Birmingham, AL, USA
| | - J Nicholas Dionne-Odom
- School of Nursing, University of Alabama at Birmingham (UAB), Birmingham, AL, USA. .,Division of Geriatrics, Gerontology, and Palliative Care, UAB Department of Medicine, Birmingham, AL, USA.
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15
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Gazaway S, Bakitas MA, Elk R, Eneanya ND, Dionne-Odom JN. Engaging African American family Caregivers in Developing a Culturally-responsive Interview Guide: A Multiphase Process and Approach. J Pain Symptom Manage 2022; 63:e705-e711. [PMID: 35247583 PMCID: PMC9133041 DOI: 10.1016/j.jpainsymman.2022.02.331] [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: 11/05/2021] [Revised: 02/11/2022] [Accepted: 02/18/2022] [Indexed: 11/21/2022]
Abstract
Qualitatively eliciting historically marginalized populations' beliefs, values, and preferences is critical to capturing information that authentically characterizes their experiences and can be used to develop culturally-responsive interventions. Eliciting these rich perspectives requires researchers to have highly effective qualitative interviewing guides, which can be optimized through community engagement. However, researchers have had little methodological guidance on how community member engagement can aid development of interview guides. The purpose of this article is to provide a series of steps, each supported by a case example from our work with African American family caregivers, for developing an interview guide through community engagement. We conclude by highlighting how involving historically marginalized community members in these early stages of research study development can build trust, research partnerships, and acknowledge their contribution to the development of new knowledge.
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Affiliation(s)
- Shena Gazaway
- School of Nursing (S.G., M.A.B., J.N.D.-O.), University of Alabama at Birmingham, Birmingham, Alabama, USA; Center for Palliative and Supportive Care (S.G., M.A.B., R.E., J.N.D.-O.), University of Alabama at Birmingham, Birmingham, Alabama, USA.
| | - Marie A Bakitas
- School of Nursing (S.G., M.A.B., J.N.D.-O.), University of Alabama at Birmingham, Birmingham, Alabama, USA; Center for Palliative and Supportive Care (S.G., M.A.B., R.E., J.N.D.-O.), University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Ronit Elk
- Center for Palliative and Supportive Care (S.G., M.A.B., R.E., J.N.D.-O.), University of Alabama at Birmingham, Birmingham, Alabama, USA; School of Medicine (R.E.), Division of Geriatrics, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Nwamaka D Eneanya
- Perelman School of Medicine (N.D.E.), University of Pennsylvania, Philadelphia, Pennsylvania, USA; Palliative and Advanced Illness Research (PAIR) Center (N.D.E.), University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - J Nicholas Dionne-Odom
- School of Nursing (S.G., M.A.B., J.N.D.-O.), University of Alabama at Birmingham, Birmingham, Alabama, USA; Center for Palliative and Supportive Care (S.G., M.A.B., R.E., J.N.D.-O.), University of Alabama at Birmingham, Birmingham, Alabama, USA
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16
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Liu B, Kent EE, Dionne-Odom JN, Alpert N, Ornstein KA. A national profile of health-focused caregiving activities prior to a new cancer diagnosis. J Geriatr Oncol 2022; 13:454-461. [PMID: 34801426 PMCID: PMC9058151 DOI: 10.1016/j.jgo.2021.11.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Revised: 10/22/2021] [Accepted: 11/09/2021] [Indexed: 01/22/2023]
Abstract
BACKGROUND Little is known about how unpaid family caregivers may already be engaged in caregiving activities prior to their care recipient's cancer diagnosis. We examined pre-cancer diagnosis caregiving patterns and their association with caregiving strain. METHODS We conducted a population-based analysis of 2011-2017 National Health and Aging Trends Study (NHATS) linked with the National Study of Caregiving (NSOC) and Medicare claims data. Latent class analysis was used to examine patterns of 16 health-focused caregiving tasks (e.g., tracking medications, making appointments) of family caregivers assisting adults ≥65 years prior to an incident cancer diagnosis. High caregiving strain was defined as a total score ≥ 85th percentile of 6 caregiving strain items (e.g., financial difficulty, no time for self). Association between caregiving patterns and strain were examined using multivariable logistic regression, adjusting for care recipient and caregiver characteristics. RESULTS An estimated 4.2 million caregivers cared for older adults prior to care recipients' new cancer diagnoses during 2011-2017. They engaged in a median of four health-focused caregiving activities. Nearly 1-in-5 (18.7%) pre-cancer caregivers had high caregiving strain. Caregivers were classified into 3 health-focused caregiving activity classes: Low-level (41.2%), Moderate-coordination (29.3%), and High-intensity (29.4%). Higher caregiving activity was associated with higher caregiving strain (adjusted odds ratio (aOR) = 3.85, 95% CI: 2.34-6.33). Caregivers in the High-intensity class had the highest caregiving strain (39.9%), and included more spouses (28.1% vs <18%). CONCLUSION One-third of U.S. caregivers who help older adults prior to their cancer diagnoses are already highly strained and engaged in high-level health-focused caregiving tasks. Oncology clinicians should assess the capacity and strain of family caregivers who may already be supporting patients with new cancer diagnoses and refer caregivers to additional supportive care services.
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Affiliation(s)
- Bian Liu
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, United States of America; Institute for Translational Epidemiology, Icahn School of Medicine at Mount Sinai, New York, NY, United States of America; Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, United States of America.
| | - Erin E Kent
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, United States of America; Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, NC, United States of America
| | - J Nicholas Dionne-Odom
- School of Nursing, University of Alabama at Birmingham, Birmingham, AL, United States of America; Center for Palliative and Supportive Care, University of Alabama at Birmingham, Birmingham, AL, United States of America
| | - Naomi Alpert
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, United States of America; Institute for Translational Epidemiology, Icahn School of Medicine at Mount Sinai, New York, NY, United States of America
| | - Katherine A Ornstein
- Institute for Translational Epidemiology, Icahn School of Medicine at Mount Sinai, New York, NY, United States of America; Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, United States of America
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17
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Rocque GB, Dionne-Odom JN, Stover AM, Daniel CL, Azuero A, Huang CHS, Ingram SA, Franks JA, Caston NE, Dent DAN, Basch EM, Jackson BE, Howell D, Weiner BJ, Pierce JY. Evaluating the implementation and impact of navigator-supported remote symptom monitoring and management: a protocol for a hybrid type 2 clinical trial. BMC Health Serv Res 2022; 22:538. [PMID: 35459238 PMCID: PMC9027833 DOI: 10.1186/s12913-022-07914-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [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: 03/09/2022] [Accepted: 04/06/2022] [Indexed: 12/31/2022] Open
Abstract
Background Symptoms in patients with advanced cancer are often inadequately captured during encounters with the healthcare team. Emerging evidence demonstrates that weekly electronic home-based patient-reported symptom monitoring with automated alerts to clinicians reduces healthcare utilization, improves health-related quality of life, and lengthens survival. However, oncology practices have lagged in adopting remote symptom monitoring into routine practice, where specific patient populations may have unique barriers. One approach to overcoming barriers is utilizing resources from value-based payment models, such as patient navigators who are ideally positioned to assume a leadership role in remote symptom monitoring implementation. This implementation approach has not been tested in standard of care, and thus optimal implementation strategies are needed for large-scale roll-out. Methods This hybrid type 2 study design evaluates the implementation and effectiveness of remote symptom monitoring for all patients and for diverse populations in two Southern academic medical centers from 2021 to 2026. This study will utilize a pragmatic approach, evaluating real-world data collected during routine care for quantitative implementation and patient outcomes. The Consolidated Framework for Implementation Research (CFIR) will be used to conduct a qualitative evaluation at key time points to assess barriers and facilitators, implementation strategies, fidelity to implementation strategies, and perceived utility of these strategies. We will use a mixed-methods approach for data interpretation to finalize a formal implementation blueprint. Discussion This pragmatic evaluation of real-world implementation of remote symptom monitoring will generate a blueprint for future efforts to scale interventions across health systems with diverse patient populations within value-based healthcare models. Trial registration NCT04809740; date of registration 3/22/2021. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-022-07914-6.
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Affiliation(s)
- Gabrielle B Rocque
- Department of Medicine, Division of Hematology and Oncology, University of Alabama at Birmingham, 1824 6th Avenue South, 35924-3300 - WTI 240E, Birmingham, AL, USA. .,Department of Medicine, Division of Gerontology, Geriatrics, and Palliative Care, University of Alabama at Birmingham, Birmingham, AL, USA. .,O'Neal Comprehensive Cancer Center, Birmingham, AL, USA.
| | - J Nicholas Dionne-Odom
- Department of Medicine, Division of Gerontology, Geriatrics, and Palliative Care, University of Alabama at Birmingham, Birmingham, AL, USA.,University of Alabama at Birmingham School of Nursing, Birmingham, AL, USA
| | - Angela M Stover
- University of South Alabama Mitchell Cancer Institute, Mobile, AL, USA
| | - Casey L Daniel
- Supportive Care, Princess Margaret Cancer Centre Research Institute, Toronto, Ontario, Canada
| | - Andres Azuero
- University of Alabama at Birmingham School of Nursing, Birmingham, AL, USA
| | - Chao-Hui Sylvia Huang
- Department of Medicine, Division of Gerontology, Geriatrics, and Palliative Care, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Stacey A Ingram
- Department of Medicine, Division of Hematology and Oncology, University of Alabama at Birmingham, 1824 6th Avenue South, 35924-3300 - WTI 240E, Birmingham, AL, USA
| | - Jeffrey A Franks
- Department of Medicine, Division of Hematology and Oncology, University of Alabama at Birmingham, 1824 6th Avenue South, 35924-3300 - WTI 240E, Birmingham, AL, USA
| | - Nicole E Caston
- Department of Medicine, Division of Hematology and Oncology, University of Alabama at Birmingham, 1824 6th Avenue South, 35924-3300 - WTI 240E, Birmingham, AL, USA
| | - D' Ambra N Dent
- Department of Medicine, Division of Hematology and Oncology, University of Alabama at Birmingham, 1824 6th Avenue South, 35924-3300 - WTI 240E, Birmingham, AL, USA
| | - Ethan M Basch
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, NC, Chapel Hill, USA
| | - Bradford E Jackson
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, NC, Chapel Hill, USA
| | - Doris Howell
- Supportive Care, Princess Margaret Cancer Centre Research Institute, Toronto, Ontario, Canada
| | - Bryan J Weiner
- Department of Health Systems and Population Health, University of Washington, Seattle, Washington, USA
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18
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Bratches RWR, Freundlich NZ, Dionne-Odom JN, O'Malley AJ, Barr PJ. Perceptions of the impact of COVID-19 on healthcare communication in a nationally representative cross-sectional survey of family caregivers. BMJ Open 2022; 12:e051154. [PMID: 35418422 PMCID: PMC9016173 DOI: 10.1136/bmjopen-2021-051154] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE To understand the perceptions of the impact of the COVID-19 pandemic on healthcare communication with family caregivers. DESIGN Nationally representative survey. SETTING USA (national). PARTICIPANTS 340 family caregivers, demographically representative of the US population by race/ethnicity. PRIMARY OUTCOME MEASURES Communication outcomes (feeling involved by the provider, feeling involved by the care recipient, feeling more encouraged to be involved in care, feeling contributory to discussions, feeling questions are being answered), behavioural/wellness outcomes (feeling anxious, feeling isolated, feeling it is easier to attend the clinic visit), and desire to continue using telemedicine. RESULTS Having less than a college degree was associated with decreased odds of feeling involved by the provider (OR 0.46; 95% CI 0.26 to 0.83; p=0.01), feeling involved by the care recipient (OR 0.44; 95% CI 0.24 to 0.79; p=0.01), feeling more encouraged to be involved in care (OR 0.49; 95% CI 0.27 to 0.86; p=0.01), feeling like they contribute to discussions (OR 0.45; 95% CI 0.25 to 0.82; p=0.01) and feeling like their questions are being answered (OR 0.33; 95% CI 0.18 to 0.60; p<0.001). CONCLUSION In our sample, the shift to telemedicine during COVID-19 was well received but caregivers of low educational attainment reported poorer health communication, and a greater proportion of black/African American and Hispanic caregivers reported a desire to return to in-person visits. There is an opportunity to improve health systems and increase equity as telemedicine becomes more widespread.
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Affiliation(s)
- Reed W R Bratches
- The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire, USA
- Center for Technology and Behavioral Health, Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire, USA
| | | | | | - A James O'Malley
- The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire, USA
- Center for Technology and Behavioral Health, Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire, USA
- Department of Biomedical Data Science, Geisel School of Medicine, Dartmouth College, Hanover, NH, USA
| | - Paul J Barr
- The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire, USA
- Center for Technology and Behavioral Health, Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire, USA
- Department of Biomedical Data Science, Geisel School of Medicine, Dartmouth College, Hanover, NH, USA
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19
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Dionne-Odom JN, Azuero A, Taylor RA, Dosse C, Bechthold AC, Currie E, Reed RD, Harrell ER, Engler S, Ejem DB, Ivankova NV, Martin MY, Rocque GB, Williams GR, Bakitas MA. A lay navigator-led, early palliative care intervention for African American and rural family caregivers of individuals with advanced cancer (Project Cornerstone): Results of a pilot randomized trial. Cancer 2022; 128:1321-1330. [PMID: 34874061 PMCID: PMC8882155 DOI: 10.1002/cncr.34044] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Revised: 10/25/2021] [Accepted: 11/13/2021] [Indexed: 12/18/2022]
Abstract
BACKGROUND The objective of this study was to assess the feasibility, acceptability, and potential efficacy of ENABLE (Educate, Nurture, Advise, Before Life Ends) Cornerstone-a lay navigator-led, early palliative care telehealth intervention for African American/Black and/or rural-dwelling family caregivers of individuals with advanced cancer (ClinicalTrials.gov identifier NCT03464188). METHODS This was a pilot randomized trial (November 2019 to March 2021). Family caregivers of patients with newly diagnosed, stage III/IV, solid-tumor cancers were randomized to receive either an intervention or usual care. Intervention caregivers were paired with a specially trained lay navigator who delivered 6 weekly, 20-minute to 60-minute telehealth coaching sessions plus monthly follow-up for 24 weeks, reviewing skills in stress management, self-care, getting help, staying organized, and future planning. Feasibility was assessed according to the completion of sessions and questionnaires (predefined as a completion rate ≥80%). Acceptability was determined through intervention participants' ratings of their likelihood of recommending the intervention. Measures of caregiver distress and quality of life were collected at 8 and 24 weeks. RESULTS Sixty-three family caregivers were randomized (usual care, n = 32; intervention, n = 31). Caregivers completed 65% of intervention sessions and 87% of questionnaires. Average ratings for recommending the program were 9.4, from 1 (not at all likely) to 10 (extremely likely). Over 24 weeks, the mean ± SE Hospital Anxiety and Depression Scale score improved by 0.30 ± 1.44 points in the intervention group and worsened by 1.99 ± 1.39 points in the usual care group (difference, -2.29; Cohen d, -0.32). The mean between-group difference scores in caregiver quality of life was -1.56 (usual care - intervention; d, -0.07). Similar outcome results were observed for patient participants. CONCLUSIONS The authors piloted ENABLE Cornerstone, an intervention for African American and rural-dwelling advanced cancer family caregivers. The acceptability of the intervention and data collection rates were high, and the preliminary efficacy for caregiver distress was promising. LAY SUMMARY To date, very few programs have been developed to support under-resourced cancer family caregivers. To address this need, the authors successfully pilot tested an early palliative care program, called Educate, Nurture, Advise, Before Life Ends (ENABLE) Cornerstone, for African American and rural family caregivers of individuals with advanced cancer. Cornerstone is led by specially trained lay people and involves a series of weekly phone sessions focused on coaching caregivers to manage stress and provide effective support to patients with cancer. The authors are now testing Cornerstone in a larger trial. If the program demonstrates benefit, it may yield a model of caregiver support that could be widely implemented.
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Affiliation(s)
- J Nicholas Dionne-Odom
- School of Nursing, University of Alabama at Birmingham (UAB), Birmingham, Alabama.,Division of Geriatrics, Gerontology, and Palliative Care, UAB Department of Medicine, Birmingham, Alabama.,UAB Center for Palliative and Supportive Care, Birmingham, Alabama
| | - Andres Azuero
- School of Nursing, University of Alabama at Birmingham (UAB), Birmingham, Alabama
| | - Richard A Taylor
- School of Nursing, University of Alabama at Birmingham (UAB), Birmingham, Alabama
| | - Chinara Dosse
- School of Nursing, University of Alabama at Birmingham (UAB), Birmingham, Alabama
| | - Avery C Bechthold
- School of Nursing, University of Alabama at Birmingham (UAB), Birmingham, Alabama
| | - Erin Currie
- School of Nursing, University of Alabama at Birmingham (UAB), Birmingham, Alabama
| | - Rhiannon D Reed
- Comprehensive Transplant Institute, UAB, Birmingham, Alabama
| | - Erin R Harrell
- Department of Psychology, University of Alabama, Tuscaloosa, Alabama
| | - Sally Engler
- School of Nursing, University of Alabama at Birmingham (UAB), Birmingham, Alabama
| | - Deborah B Ejem
- School of Nursing, University of Alabama at Birmingham (UAB), Birmingham, Alabama
| | | | - Michelle Y Martin
- Department of Preventive Medicine, Center for Innovation in Health Equity Research, University of Tennessee Health Science Center, Memphis, Tennessee
| | - Gabrielle B Rocque
- Division of Geriatrics, Gerontology, and Palliative Care, UAB Department of Medicine, Birmingham, Alabama.,UAB Center for Palliative and Supportive Care, Birmingham, Alabama.,Division of Hematology and Oncology, Department of Medicine, UAB, Birmingham, Alabama
| | - Grant R Williams
- Division of Hematology and Oncology, Department of Medicine, UAB, Birmingham, Alabama
| | - Marie A Bakitas
- School of Nursing, University of Alabama at Birmingham (UAB), Birmingham, Alabama.,Division of Geriatrics, Gerontology, and Palliative Care, UAB Department of Medicine, Birmingham, Alabama.,UAB Center for Palliative and Supportive Care, Birmingham, Alabama
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20
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Flannery MA, Mohile S, Culakova E, Norton S, Kamen C, Dionne-Odom JN, DiGiovanni G, Griggs L, Bradley T, Hopkins JO, Liu JJ, Loh KP. Completion of Patient-Reported Outcome Questionnaires Among Older Adults with Advanced Cancer. J Pain Symptom Manage 2022; 63:301-310. [PMID: 34371137 PMCID: PMC8816807 DOI: 10.1016/j.jpainsymman.2021.07.032] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [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: 07/08/2020] [Revised: 07/22/2021] [Accepted: 07/28/2021] [Indexed: 02/03/2023]
Abstract
CONTEXT Systematic collection of patient-reported outcomes (PROs) reduces symptom burden and improves quality of life. The ability of older adults to complete PROs, however, has not been thoroughly studied. OBJECTIVES To determine whether older adults with advanced cancer received assistance completing PROs, the nature of the assistance, the factors associated with receiving assistance, and how the prevalence of assistance changed over time. METHODS Data were obtained from a multisite cluster randomized controlled study of geriatric assessment (Clinicaltrials.gov: NCT02107443). Adults ≥70 years with advanced cancer completed multiple PROs at 4 time points (enrollment, 6 weeks, 3 months, 6 months). Factors associated with receipt of assistance were assessed with bivariate and multivariate analyses. RESULTS The study included 541 adults (range 70-96 years, 49% female, mixed incurable cancer diagnoses). Twenty-eight percent (153/541) received assistance completing PROs. Of these, 42% received assistance from caregivers, 37% from research staff, and 15% from both. Factors associated with receiving assistance included older age [Adjusted Odds Ratio (AOR) 3.71, 95% Confidence Interval (CI) 1.03-13.38], lower education level (3.92, 2.11-7.29), impaired cognition (1.90, 1.23-2.93), impaired functional status (2.16, 1.33-3.52), and impaired hearing (1.38, 1.05-1.80). Eighty percent of individuals who received assistance were identified at study initiation. Receiving assistance decreased over time from 28% to 18%, partially due to drop-outs. CONCLUSION Over a quarter of older adults with advanced cancer in this study received assistance completing PROs. Completing PROs is a key aspect of many clinical programs and cancer trials; assistance in completing PROs should be offered and provided.
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Affiliation(s)
- Marie A Flannery
- School of Nursing (M.A.F., S.N.), University of Rochester School of Medicine and Dentistry, Rochester, New York, USA.
| | - Supriya Mohile
- University of Rochester School of Medicine and Dentistry (S.M., E.C., C.K., G.D., K.P.L.), Rochester, New York, USA
| | - Eva Culakova
- University of Rochester School of Medicine and Dentistry (S.M., E.C., C.K., G.D., K.P.L.), Rochester, New York, USA
| | - Sally Norton
- School of Nursing (M.A.F., S.N.), University of Rochester School of Medicine and Dentistry, Rochester, New York, USA
| | - Charles Kamen
- University of Rochester School of Medicine and Dentistry (S.M., E.C., C.K., G.D., K.P.L.), Rochester, New York, USA
| | - J Nicholas Dionne-Odom
- University of Alabama (J.N.D.-O.), Birmingham, School of Nursing, Birmingham, Alabama, USA
| | - Grace DiGiovanni
- University of Rochester School of Medicine and Dentistry (S.M., E.C., C.K., G.D., K.P.L.), Rochester, New York, USA
| | - Lorraine Griggs
- University of Rochester Medical Center (L.G.), SCOREBOARD, Patient Advisory Board, Rochester, New York, USA
| | | | - Judith O Hopkins
- Southeast Clinical Oncology Research Consortium NCORP (J.O.H.), Winston Salem, North Carolina, USA
| | - Jane Jijun Liu
- Illinois Cancer Care and Heartland NCORP (J.J.L.), Illnois, USA
| | - Kah Poh Loh
- University of Rochester School of Medicine and Dentistry (S.M., E.C., C.K., G.D., K.P.L.), Rochester, New York, USA
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21
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Dionne-Odom JN, Wells RD, Guastaferro K, Azuero A, Hendricks BA, Currie ER, Bechthold A, Dosse C, Taylor R, Reed RD, Harrell ER, Gazaway S, Engler S, McKie P, Williams GR, Sudore R, Rini C, Rosenberg AR, Bakitas MA. An Early Palliative Care Telehealth Coaching Intervention to Enhance Advanced Cancer Family Caregivers' Decision Support Skills: The CASCADE Pilot Factorial Trial. J Pain Symptom Manage 2022; 63:11-22. [PMID: 34343621 PMCID: PMC8881798 DOI: 10.1016/j.jpainsymman.2021.07.023] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [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: 06/13/2021] [Revised: 07/16/2021] [Accepted: 07/26/2021] [Indexed: 01/03/2023]
Abstract
CONTEXT Patients with advanced cancer often involve family caregivers in health-related decision-making from diagnosis to end-of-life; however, few interventions have been developed to enhance caregiver decision support skills. OBJECTIVES Assess the feasibility, acceptability, and potential efficacy of individual intervention components of CASCADE (CAre Supporters Coached to be Adept DEcision Partners), an early telehealth, palliative care coach-led decision support training intervention for caregivers. METHODS Pilot factorial trial using the multiphase optimization strategy (October 2019-October 2020). Family caregivers and their care recipients with newly-diagnosed advanced cancer (n = 46 dyads) were randomized to1 of 8 experimental conditions that included a combination of one of the following three CASCADE components: 1) effective decision support psychoeducation; 2) decision support communication training; and 3) Ottawa Decision Guide training. Feasibility was assessed by completion of sessions and questionnaires (predefined as ≥80%). Acceptability was determined through postintervention interviews and participants' ratings of their likelihood to recommend. Measures of effective decision support and caregiver and patient distress were collected at Twelve and Twenty four weeks. RESULTS Caregiver participants completed 78% of intervention sessions and 81% of questionnaires; patients completed 80% of questionnaires. Across conditions, average caregiver ratings for recommending the program to others was 9.9 on a scale from 1-Not at all likely to 10-Extremely likely. Individual CASCADE components were observed to have potential benefit for effective decision support and caregiver distress. CONCLUSION We successfully piloted a factorial trial design to examine components of a novel intervention to enhance the decision support skills of advanced cancer family caregivers. A fully-powered factorial trial is warranted. KEY MESSAGE We pilot tested components of CASCADE, an early palliative care decision support training intervention for family caregivers of patients with advanced cancer. CASCADE components were acceptable and the trial design feasible, providing promising future directions for palliative care intervention development and testing. Pilot results will inform a fully-powered trial.
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Affiliation(s)
- J Nicholas Dionne-Odom
- School of Nursing, University of Alabama at Birmingham (J.N.D.O., R.D.W., A.A., B.A.H., E.R.C., A.B., C.D., R.T., S.G., S.E., P.M., M.A.B.), Birmingham, Alabama, USA; Division of Gerontology, Geriatrics, and Palliative Care, School of Medicine, University of Alabama at Birmingham (J.N.D.O., M.A.B.), Birmingham, Alabama, USA; Center for Palliative and Supportive Care, University of Alabama at Birmingham (J.N.D.O., M.A.B.), Birmingham, Alabama, USA.
| | - Rachel D Wells
- School of Nursing, University of Alabama at Birmingham (J.N.D.O., R.D.W., A.A., B.A.H., E.R.C., A.B., C.D., R.T., S.G., S.E., P.M., M.A.B.), Birmingham, Alabama, USA
| | - Kate Guastaferro
- Methodology Center, Pennsylvania State University (K.G.), University Park, Pennsylvania, USA
| | - Andres Azuero
- School of Nursing, University of Alabama at Birmingham (J.N.D.O., R.D.W., A.A., B.A.H., E.R.C., A.B., C.D., R.T., S.G., S.E., P.M., M.A.B.), Birmingham, Alabama, USA
| | - Bailey A Hendricks
- School of Nursing, University of Alabama at Birmingham (J.N.D.O., R.D.W., A.A., B.A.H., E.R.C., A.B., C.D., R.T., S.G., S.E., P.M., M.A.B.), Birmingham, Alabama, USA
| | - Erin R Currie
- School of Nursing, University of Alabama at Birmingham (J.N.D.O., R.D.W., A.A., B.A.H., E.R.C., A.B., C.D., R.T., S.G., S.E., P.M., M.A.B.), Birmingham, Alabama, USA
| | - Avery Bechthold
- School of Nursing, University of Alabama at Birmingham (J.N.D.O., R.D.W., A.A., B.A.H., E.R.C., A.B., C.D., R.T., S.G., S.E., P.M., M.A.B.), Birmingham, Alabama, USA
| | - Chinara Dosse
- School of Nursing, University of Alabama at Birmingham (J.N.D.O., R.D.W., A.A., B.A.H., E.R.C., A.B., C.D., R.T., S.G., S.E., P.M., M.A.B.), Birmingham, Alabama, USA
| | - Richard Taylor
- School of Nursing, University of Alabama at Birmingham (J.N.D.O., R.D.W., A.A., B.A.H., E.R.C., A.B., C.D., R.T., S.G., S.E., P.M., M.A.B.), Birmingham, Alabama, USA
| | - Rhiannon D Reed
- Comprehensive Transplant Institute, University of Alabama at Birmingham (R.D.R.), Birmingham, Alabama, USA
| | - Erin R Harrell
- Department of Psychology, University of Alabama (E.R.H.), Tuscaloosa, Alabama, USA
| | - Shena Gazaway
- School of Nursing, University of Alabama at Birmingham (J.N.D.O., R.D.W., A.A., B.A.H., E.R.C., A.B., C.D., R.T., S.G., S.E., P.M., M.A.B.), Birmingham, Alabama, USA
| | - Sally Engler
- School of Nursing, University of Alabama at Birmingham (J.N.D.O., R.D.W., A.A., B.A.H., E.R.C., A.B., C.D., R.T., S.G., S.E., P.M., M.A.B.), Birmingham, Alabama, USA
| | - Peg McKie
- School of Nursing, University of Alabama at Birmingham (J.N.D.O., R.D.W., A.A., B.A.H., E.R.C., A.B., C.D., R.T., S.G., S.E., P.M., M.A.B.), Birmingham, Alabama, USA
| | - Grant R Williams
- School of Medicine, Division of Hematology-Oncology, University of Alabama at Birmingham (G.R.W.), Birmingham, Alabama, USA
| | - Rebecca Sudore
- School of Medicine, Division of Geriatrics, University of California (R.S.), San Francisco, California, USA
| | - Christine Rini
- Feinberg School of Medicine, Robert H. Lurie Comprehensive Cancer Center, Northwestern University (C.R.), Chicago, Illinois, USA
| | - Abby R Rosenberg
- Division of Hematology-Oncology, Department of Pediatrics, School of Medicine, University of Washington (A.R.R.), Seattle, Washington, USA; Palliative Care and Resilience Lab, Seattle Children's Research Institute (A.R.R.), Seattle, Washington, USA; Cambia Palliative Care Center of Excellence, University of Washington (A.R.R.), Seattle, Washington, USA
| | - Marie A Bakitas
- School of Nursing, University of Alabama at Birmingham (J.N.D.O., R.D.W., A.A., B.A.H., E.R.C., A.B., C.D., R.T., S.G., S.E., P.M., M.A.B.), Birmingham, Alabama, USA; Division of Gerontology, Geriatrics, and Palliative Care, School of Medicine, University of Alabama at Birmingham (J.N.D.O., M.A.B.), Birmingham, Alabama, USA; Center for Palliative and Supportive Care, University of Alabama at Birmingham (J.N.D.O., M.A.B.), Birmingham, Alabama, USA
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22
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McDarby M, Mroz E, Carpenter BD, Dionne-Odom JN, Kamal A. A Research Agenda for the Question Prompt List in Outpatient Palliative Care. J Palliat Med 2021; 24:1596-1597. [PMID: 34726517 DOI: 10.1089/jpm.2021.0437] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Meghan McDarby
- Department of Psychological and Brain Sciences, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Emily Mroz
- Department of Psychology, University of Florida, Gainesville, Florida, USA.,Section of Geriatrics, Department of Internal Medicine, Yale University, New Haven, Connecticut, USA
| | - Brian D Carpenter
- Department of Psychological and Brain Sciences, Washington University in St. Louis, St. Louis, Missouri, USA
| | - J Nicholas Dionne-Odom
- School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama, USA.,Center for Palliative and Supportive Care, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Arif Kamal
- Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA
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23
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Dionne-Odom JN, Azuero A, Taylor RA, Wells RD, Hendricks BA, Bechthold AC, Reed RD, Harrell ER, Dosse CK, Engler S, McKie P, Ejem D, Bakitas MA, Rosenberg AR. Resilience, preparedness, and distress among family caregivers of patients with advanced cancer. Support Care Cancer 2021; 29:6913-6920. [PMID: 34031751 PMCID: PMC9733586 DOI: 10.1007/s00520-021-06265-y] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Accepted: 04/30/2021] [Indexed: 12/13/2022]
Abstract
OBJECTIVE Resilience has been proposed as a primary factor in how many family caregivers of patients with advanced cancer are able to resist psychological strain and perform effectively in the role while bearing a high load of caregiving tasks. To evaluate this hypothesis, we examined whether self-perceived resilience is associated with distress (anxiety and depressive symptoms), caregiver preparedness, and readiness for surrogate decision-making among a racially diverse sample of family caregivers of patients with newly diagnosed advanced cancer. METHODS Secondary analysis of baseline data from two small-scale, pilot clinical trials that both recruited family caregivers of patients with newly diagnosed advanced cancer. Using multivariable linear regression, we analyzed relationships of resilience as a predictor of mood, caregiving preparedness, and readiness for surrogate decision-making, controlling for sociodemographics. RESULTS Caregiver participants (N = 112) were mean 56 years of age and mostly female (76%), the patient's spouse/partner (52%), and White (56%) or African-American/Black (43%). After controlling for demographics, standardized results indicated that higher resilience was relevantly associated with higher caregiver preparedness (beta = .46, p < .001), higher readiness for surrogate decision-making (beta = .20, p < .05) and lower anxiety (beta = - .19, p < .05), and depressive symptoms (beta = - .20, p < .05). CONCLUSIONS These results suggest that resilience may be critical to caregivers' abilities to manage stress, be effective sources of support to patients, and feel ready to make future medical decisions on behalf of patients. Future work should explore and clinicians should consider whether resilience can be enhanced in cancer caregivers to optimize their well-being and ability to perform in the caregiving and surrogate decision-making roles.
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Affiliation(s)
| | - Andres Azuero
- School of Nursing, University of Alabama At Birmingham, Birmingham, AL, USA
| | - Richard A. Taylor
- School of Nursing, University of Alabama At Birmingham, Birmingham, AL, USA
| | - Rachel D. Wells
- School of Nursing, University of Alabama At Birmingham, Birmingham, AL, USA
| | | | - Avery C. Bechthold
- School of Nursing, University of Alabama At Birmingham, Birmingham, AL, USA
| | - Rhiannon D. Reed
- Comprehensive Transplant Institute, University of Alabama At Birmingham, Birmingham, AL, USA
| | - Erin R. Harrell
- Department of Psychology, University of Alabama, Tuscaloosa, AL, USA
| | - Chinara K. Dosse
- School of Nursing, University of Alabama At Birmingham, Birmingham, AL, USA
| | - Sally Engler
- School of Nursing, University of Alabama At Birmingham, Birmingham, AL, USA
| | - Peggy McKie
- School of Nursing, University of Alabama At Birmingham, Birmingham, AL, USA
| | - Deborah Ejem
- School of Nursing, University of Alabama At Birmingham, Birmingham, AL, USA
| | - Marie A. Bakitas
- School of Nursing, University of Alabama At Birmingham, Birmingham, AL, USA
| | - Abby R. Rosenberg
- Division of Hematology-Oncology, Department of Pediatrics, School of Medicine, University of Washington, Seattle, WA, USA,Cambia Palliative Care Center of Excellence, University of Washington, Seattle, WA, USA,Palliative Care and Resilience Lab, Seattle Children’s Research Institute, Seattle, WA, USA
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Wells RD, Guastaferro K, Azuero A, Rini C, Hendricks BA, Dosse C, Taylor R, Williams GR, Engler S, Smith C, Sudore R, Rosenberg AR, Bakitas MA, Dionne-Odom JN. Applying the Multiphase Optimization Strategy for the Development of Optimized Interventions in Palliative Care. J Pain Symptom Manage 2021; 62:174-182. [PMID: 33253787 PMCID: PMC8274323 DOI: 10.1016/j.jpainsymman.2020.11.017] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [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: 09/28/2020] [Revised: 11/09/2020] [Accepted: 11/17/2020] [Indexed: 12/21/2022]
Abstract
Recent systematic reviews and meta-analyses have reported positive benefit of multicomponent "bundled" palliative care interventions for patients and family caregivers while highlighting limitations in determining key elements and mechanisms of improvement. Traditional research approaches, such as the randomized controlled trial (RCT), typically treat interventions as "bundled" treatment packages, making it difficult to assess definitively which aspects of an intervention can be reduced or replaced or whether there are synergistic or antagonistic interactions between intervention components. Progressing toward palliative care interventions that are effective, efficient, and scalable will require new strategies and novel approaches. One such approach is the Multiphase Optimization Strategy (MOST), a framework informed by engineering principles, that uses a systematic process to empirically identify an intervention comprised of components that positively contribute to desired outcomes under real-life constraints. This article provides a brief overview and application of MOST and factorial trial design in palliative care research, including our insights from conducting a pilot factorial trial of an early palliative care intervention to enhance the decision support skills of advanced cancer family caregivers (Project CASCADE).
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Affiliation(s)
- Rachel D Wells
- School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama, USA.
| | - Kate Guastaferro
- Methodology Center, Pennsylvania State University, University Park, Pennsylvania, USA
| | - Andres Azuero
- School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Christine Rini
- Northwestern University Feinberg School of Medicine and Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, Illinois, USA
| | - Bailey A Hendricks
- School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Chinara Dosse
- School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Richard Taylor
- School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Grant R Williams
- School of Medicine, Division of Hematology-Oncology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Sally Engler
- School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Charis Smith
- School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Rebecca Sudore
- School of Medicine, Division of Geriatrics, University of California, San Francisco, San Francisco, California, USA
| | - Abby R Rosenberg
- Division of Hematology-Oncology, Department of Pediatrics, School of Medicine, University of Washington, Seattle, Washington, USA; Palliative Care and Resilience Lab, Seattle Children's Research Institute, Seattle, Washington, USA
| | - Marie A Bakitas
- School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama, USA; Center for Palliative and Supportive Care, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - J Nicholas Dionne-Odom
- School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama, USA; Center for Palliative and Supportive Care, University of Alabama at Birmingham, Birmingham, Alabama, USA
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Ejem D, Steinhauser K, Dionne-Odom JN, Wells R, Durant RW, Clay OJ, Bakitas M. Exploring Culturally Responsive Religious and Spirituality Health Care Communications among African Americans with Advanced Heart Failure, Their Family Caregivers, and Clinicians. J Palliat Med 2021; 24:1798-1806. [PMID: 34182804 DOI: 10.1089/jpm.2021.0044] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: Religion and spirituality (R/S) impact how African Americans (AAs) cope with serious illness, yet are infrequently addressed in patient-clinician communication. Objectives: To explore AAs with advanced heart failure and their family caregivers' (FCGs) preferences about R/S in patient-clinician communication. Methods: An embedded qualitative interview within a parent randomized trial about the role of R/S in the illness experience and in clinician interactions with patients and FCGs in a Southern U.S. state. Transcribed interviews were analyzed using constant comparative analysis to identify emergent themes. Results: AA participants (n = 15) were a mean age of 62 years, were female (40%), and had >high school diploma/GED (87%). AA FCGs (n = 14) were a mean age of 58; were female (93%); had >high school diploma/General Education Development (GED) (93%); and were unemployed (86%). Most (63%) were patients' spouses/partners. All patients and FCGs were Protestant. Participants reported the critical role of R/S in living with illness; however, patients' and FCGs' perspectives related to inclusion of R/S in health care communications differed. Patients' perspectives were as follows: (1) R/S is not discussed in clinical encounters and (2) R/S should be discussed only if patient initiated. FCGs' perspectives about ideal inclusion of R/S represented three main diverging themes: (1) clinicians' R/S communication is not a priority, (2) clinicians should openly acknowledge patients' R/S beliefs, and (3) clinicians should engage in R/S conversations with patients. Conclusion: Key thematic differences about the role of R/S in illness and preferences for incorporating R/S in health care communications reveal important considerations about the need to assess and individualize this aspect of palliative care research and practice.
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Affiliation(s)
- Deborah Ejem
- School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Karen Steinhauser
- Departments of Population Health Sciences, and Medicine, Center for the Study of Aging and Human Development, Duke University; Durham VA Adapt Center of Innovation, Durham, North Carolina, USA
| | | | - Rachel Wells
- School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Raegan W Durant
- School of Medicine-Division of Preventive Medicine, and University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Olivio J Clay
- Department of Psychology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Marie Bakitas
- School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama, USA
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Yang GM, Dionne-Odom JN, Foo YH, Chung AHM, Kamal NHA, Tan L, Yu CC, Khanh LM, Koh ARX, Teo I, Yoon S, Bakitas M. Adapting ENABLE for patients with advanced cancer and their family caregivers in Singapore: a qualitative formative evaluation. BMC Palliat Care 2021; 20:86. [PMID: 34158022 PMCID: PMC8218975 DOI: 10.1186/s12904-021-00799-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2021] [Accepted: 06/09/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND ENABLE (Educate, Nurture, Advise, Before Life Ends) is a nurse coach-led, early palliative care model for patients with advanced cancer and their family caregivers. Content covered includes problem-solving, advance care planning, symptom management and self-care. The aim was to evaluate the cultural acceptability of ENABLE among patients with advanced cancer and their caregivers in Singapore and identify modifications for an adapted ENABLE-SG model. METHODS Qualitative formative evaluation with a thematic analysis approach in two hospitals in Singapore, involving patients (n = 10), family caregivers (n = 11) and healthcare professionals (n = 10) who care for patients with advanced cancer. Semi-structured interviews were conducted to explore (i) the main needs and challenges facing individuals with advanced cancer and their family caregivers; (ii) patient involvement in healthcare decision making; and (iii) content and delivery of ENABLE. RESULTS While physical needs were largely well met, participants expressed that psychosocial care was delivered too late in the illness trajectory. Healthcare decision making approaches varied from a patient-centred shared decision-making model to a family-centred model where patients may not know their cancer diagnosis and prognosis. The content was considered to be relevant, comprehensive and practical; financial assistance, adjustment to body image, and evaluation of complementary therapy were also recommended. Face-to-face rather than telephone sessions were preferred to facilitate rapport building. CONCLUSIONS ENABLE was broadly acceptable with some modifications, including adjusting the content to ensure it can be delivered even if the patient is not fully aware of cancer diagnosis and delivering the first session face-to-face with flexibility for subsequent sessions.
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Affiliation(s)
- Grace Meijuan Yang
- National Cancer Centre Singapore, 11 Hospital Crescent, Singapore, 169610, Singapore.
| | | | - Yi Han Foo
- National University of Singapore, Singapore, Singapore
| | | | | | | | - Chou Chuen Yu
- Geriatric Education and Research Institute, Singapore, Singapore
| | - Le Mai Khanh
- Geriatric Education and Research Institute, Singapore, Singapore
| | - Audrey Rui Xuan Koh
- National Cancer Centre Singapore, 11 Hospital Crescent, Singapore, 169610, Singapore
| | - Irene Teo
- Duke-NUS Medical School, Lien Centre for Palliative Care, Singapore, Singapore
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Affiliation(s)
| | - Douglas B White
- Program on Ethics and Decision Making in Critical Illness, Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
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Bakitas M, Cheville AL, Mulvey TM, Peppercorn J, Watts K, Dionne-Odom JN. Telehealth Strategies to Support Patients and Families Across the Cancer Trajectory. Am Soc Clin Oncol Educ Book 2021; 41:413-422. [PMID: 34010046 DOI: 10.1200/edbk_320979] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Effective delivery of cancer care via telehealth requires a planned care system that accounts for myriad patient, provider, and practice/cancer center resources before, during, and after the care episode. Telehealth is broadly defined as a method to have virtual, bidirectional communication between patients and providers. Telehealth can include methods such as audio-only, video-consultation, and tele-monitoring, which can occur in a synchronous, asynchronous, or blended format. The purpose of this review is to present common foundational principles for providing clinical cancer care via telehealth, followed by an overview of three distinct examples of comprehensive telehealth programs that have been developed to meet the needs of patients and families across the cancer trajectory, including survivorship, rehabilitation, and palliative care phases. The programs described are exemplars that were developed and implemented prior to the coronavirus pandemic, so they reflect many years of planning and evidence. Lessons learned include the need for ongoing patient support, clinician training, and cancer health system/practice programmatic considerations such as billing, scheduling, reimbursement, software, and hardware/platform security. Although the COVID-19 pandemic produced an explosive shift in regulations and implementation, sustainability of these changes may not be long-term. Nevertheless, a permanent shift in cancer care to include telehealth is likely here to stay.
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Affiliation(s)
- Marie Bakitas
- School of Nursing, Center for Palliative and Supportive Care, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL
| | | | | | | | | | - J Nicholas Dionne-Odom
- School of Nursing, Center for Palliative and Supportive Care, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL
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29
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Rosenberg AR, Zhou C, Bradford MC, Barton K, Junkins CC, Taylor M, Kross EK, Curtis JR, Dionne-Odom JN, Yi-Frazier JP. Parent Perspectives after the PRISM-P Randomized Trial: A Mixed-Methods Analysis. J Palliat Med 2021; 24:1505-1515. [PMID: 33720787 DOI: 10.1089/jpm.2020.0720] [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] [Indexed: 12/23/2022] Open
Abstract
Background: Parents experience high distress following their child's diagnosis of cancer. We previously tested two delivery models (group and one-on-one) of the "Promoting Resilience in Stress Management for Parents" (PRISM-P) intervention in a randomized trial: one-on-one delivery improved resilience and benefit finding at three months when compared to usual care (UC). Objective: The objective of this analysis was to evaluate quantitative and qualitative outcomes at six months. Design: In this single-center, phase 2, parallel, 1:1:1 randomized trial conducted December 2016 to December 2018, English-speaking parents with a 2-24 year-old child diagnosed with new cancer were randomly assigned to UC, one-on-one, or group PRISM-P, a brief, skill-based curriculum targeting stress management, goal setting, cognitive reframing, and meaning making. We collected parent-reported outcomes (resilience, benefit finding, and psychological distress) at baseline and three and six months. We applied linear mixed-effects regression models to examine six-month outcomes among all participants and conducted directed content analyses of exit interviews with the first 12 parents to complete each study arm. Results: The 94 participating parents were median aged 35-38 years and predominantly white, college-educated mothers. At six months, there was no statistically significant difference in parent-reported outcomes. Exit interviews (n = 36) suggested that PRISM-P was highly valued: 100% of interviewed recipients recommended it for other parents. Most suggested more coaching would help them retain skills, and almost all endorsed a combined one-on-one and group program. Conclusions: Although the PRISM-P benefits observed at three months were not sustained for six months, all interviewed parents found it valuable. Additional opportunities to strengthen and sustain resilience resources include longer follow-up, flexible format, and skill reinforcement. Trial Registration: NCT02998086.
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Affiliation(s)
- Abby R Rosenberg
- Palliative Care and Resilience Research Laboratory, Center for Clinical and Translational Research, Epidemiology, and Analytics in Research Program, Seattle Children's Research Institute, Seattle, Washington, USA.,Division of Hematology/Oncology and Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington, USA.,Cambia Palliative Care Center of Excellence, University of Washington, Seattle, Washington, USA
| | - Chuan Zhou
- Division of General Pediatrics, Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington, USA.,Biostatistics, Epidemiology, and Analytics in Research Program, Seattle Children's Research Institute, Seattle, Washington, USA
| | - Miranda C Bradford
- Biostatistics, Epidemiology, and Analytics in Research Program, Seattle Children's Research Institute, Seattle, Washington, USA
| | - Krysta Barton
- Palliative Care and Resilience Research Laboratory, Center for Clinical and Translational Research, Epidemiology, and Analytics in Research Program, Seattle Children's Research Institute, Seattle, Washington, USA.,Biostatistics, Epidemiology, and Analytics in Research Program, Seattle Children's Research Institute, Seattle, Washington, USA
| | - Courtney C Junkins
- Palliative Care and Resilience Research Laboratory, Center for Clinical and Translational Research, Epidemiology, and Analytics in Research Program, Seattle Children's Research Institute, Seattle, Washington, USA
| | - Mallory Taylor
- Palliative Care and Resilience Research Laboratory, Center for Clinical and Translational Research, Epidemiology, and Analytics in Research Program, Seattle Children's Research Institute, Seattle, Washington, USA.,Division of Hematology/Oncology and Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington, USA.,Cambia Palliative Care Center of Excellence, University of Washington, Seattle, Washington, USA
| | - Erin K Kross
- Cambia Palliative Care Center of Excellence, University of Washington, Seattle, Washington, USA.,Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, University of Washington, Seattle, Washington, USA
| | - J Randall Curtis
- Cambia Palliative Care Center of Excellence, University of Washington, Seattle, Washington, USA.,Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, University of Washington, Seattle, Washington, USA
| | - J Nicholas Dionne-Odom
- Department of Acute, Chronic, and Continuing Care, University of Alabama at Birmingham School of Nursing, Birmingham, Alabama, USA
| | - Joyce P Yi-Frazier
- Palliative Care and Resilience Research Laboratory, Center for Clinical and Translational Research, Epidemiology, and Analytics in Research Program, Seattle Children's Research Institute, Seattle, Washington, USA
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Zubkoff L, Lyons KD, Dionne-Odom JN, Hagley G, Pisu M, Azuero A, Flannery M, Taylor R, Carpenter-Song E, Mohile S, Bakitas MA. A cluster randomized controlled trial comparing Virtual Learning Collaborative and Technical Assistance strategies to implement an early palliative care program for patients with advanced cancer and their caregivers: a study protocol. Implement Sci 2021; 16:25. [PMID: 33706770 PMCID: PMC7951124 DOI: 10.1186/s13012-021-01086-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Accepted: 01/26/2021] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Virtual Learning Collaboratives (VLC), learning communities focused on a common purpose, are used frequently in healthcare settings to implement best practices. Yet, there is limited research testing the effectiveness of this approach compared to other implementation strategies. This study evaluates the effectiveness of a VLC compared to Technical Assistance (TA) among community oncology practices implementing ENABLE (Educate, Nurture, Advise, Before Life Ends), an evidence-based, early palliative care telehealth, psycho-educational intervention for patients with newly diagnosed advanced cancer and their caregivers. METHODS Using Reach, Effectiveness, Adoption, Implementation, Maintenance (RE-AIM) and Proctor's Implementation Outcomes Frameworks, this two-arm hybrid type-III cluster-randomized controlled trial (RCT) will compare two implementation strategies, VLC versus TA, among the 48 National Cancer Institute Community Oncology Research Program (NCORP) practice clusters that have not historically provided palliative care to all patients with advanced cancer. Three cohorts of practice clusters will be randomized to the study arms. Each practice cluster will recruit 15-27 patients and a family caregiver to participate in ENABLE. The primary study outcome is ENABLE uptake (patient level), i.e., the proportion of eligible patients who complete the ENABLE program (receive a palliative care assessment and complete the six ENABLE sessions over 12 weeks). The secondary outcome is overall program implementation (practice cluster level), as measured by the General Organizational Index at baseline, 6, and 12 months. Exploratory aims assess patient and caregiver mood and quality of life outcomes at baseline, 12, and 24 weeks. Practice cluster randomization will seek to keep the proportion of rural practices, practice sizes, and minority patients seen within each practice balanced across the two study arms. DISCUSSION This study will advance the field of implementation science by evaluating VLC effectiveness, a commonly used but understudied, implementation strategy. The study will advance the field of palliative care by building the capacity and infrastructure to implement an early palliative care program in community oncology practices. TRIAL REGISTRATION Clinicaltrials.gov . NCT04062552; Pre-results. Registered: August 20, 2019. https://clinicaltrials.gov/ct2/show/NCT04062552?term=NCT04062552&draw=2&rank=1.
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Affiliation(s)
- Lisa Zubkoff
- Division of Preventive Medicine, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA.
- Birmingham/Atlanta VA Geriatric Research Education and Clinical Center (GRECC), Department of Veterans Affairs, Birmingham, AL, USA.
| | - Kathleen Doyle Lyons
- Dartmouth Hitchcock Medical Center, Lebanon, NH, USA
- Department of Psychiatry, Geisel School of Medicine, Hanover, NH, USA
| | - J Nicholas Dionne-Odom
- School of Nursing, University of Alabama at Birmingham, Birmingham, AL, USA
- Division of Gerontology, Geriatrics and Palliative Care, UAB Center for Palliative and Supportive Care, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
- O'Neal Comprehensive Cancer Center, Birmingham, AL, USA
| | | | - Maria Pisu
- Division of Preventive Medicine, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
- O'Neal Comprehensive Cancer Center, Birmingham, AL, USA
| | - Andres Azuero
- Division of Preventive Medicine, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
- School of Nursing, University of Alabama at Birmingham, Birmingham, AL, USA
- Division of Gerontology, Geriatrics and Palliative Care, UAB Center for Palliative and Supportive Care, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Marie Flannery
- University of Rochester Medical Center, Rochester, NY, USA
| | - Richard Taylor
- School of Nursing, University of Alabama at Birmingham, Birmingham, AL, USA
- Division of Gerontology, Geriatrics and Palliative Care, UAB Center for Palliative and Supportive Care, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | | | - Supriya Mohile
- University of Rochester Medical Center, Rochester, NY, USA
| | - Marie Anne Bakitas
- School of Nursing, University of Alabama at Birmingham, Birmingham, AL, USA
- Division of Gerontology, Geriatrics and Palliative Care, UAB Center for Palliative and Supportive Care, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
- O'Neal Comprehensive Cancer Center, Birmingham, AL, USA
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Dionne-Odom JN, Williams GR, Warren PP, Tims S, Huang CHS, Taylor RA, Ledbetter L, Lever T, Mitchell K, Thompson M, Dosse C, Engler S, Holmes A, Connelley B, Hicks J, Bakitas MA, Nabors B, Tucker R. Implementing a Clinic-Based Telehealth Support Service (FamilyStrong) for Family Caregivers of Individuals with Grade IV Brain Tumors. J Palliat Med 2021; 24:347-353. [PMID: 32721254 PMCID: PMC7894044 DOI: 10.1089/jpm.2020.0178] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [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: 06/15/2020] [Indexed: 01/21/2023] Open
Abstract
Background: Nearly 3 million U.S. family caregivers support someone with cancer. However, oncology clinic-based service lines that proactively screen, assess, and support cancer caregivers are nearly nonexistent. Objective: To examine first-year experiences of a nurse-led clinic-based telehealth support service (FamilyStrong) for family caregivers of patients with recently diagnosed grade IV brain tumors. Methods: This is a retrospective evaluation of operational outcomes from initial implementation of the FamilyStrong Service, developed in partnership with Caregiver and Bereavement Support Services at the University of Alabama at Birmingham (UAB) and the UAB Center for Palliative and Supportive Care. From August 2018 to December 2019, 53 family caregivers were proactively identified and enrolled by a palliative care nurse, working approximately one day/week, who performed monthly caregiver distress thermometer screenings by phone and provided emotional, educational, problem-solving, and referral support. Results: Enrolled family caregivers were a mean age of 53.5 years and mostly female (62.3%), full- or part-time employed (67.9%), and the patient's spouse/partner (79.3%). Caregivers provided support 6.7 days/week for 11.2 hours/day. The palliative care nurse performed 235 distress screenings and provided support that included 68 documented instances of emotional, problem-solving, and educational support, 41 nurse-facilitated communications with the neuro-oncology team about patient issues, and 24 referrals to UAB and community services (e.g., counseling). The most common problems caregivers wanted assistance with included: managing their relative's health condition and symptoms (51%), coordinating care/services (21%), and planning for the future/advance care planning (17%). Discussion: The FamilyStrong Program is among the first "real world" oncology clinic-based formal support services for advance cancer family caregivers.
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Affiliation(s)
- J. Nicholas Dionne-Odom
- School of Nursing, University of Alabama at Birmingham (UAB), Birmingham, Alabama, USA
- Center for Palliative and Supportive Care, School of Medicine, University of Alabama at Birmingham (UAB), Birmingham, Alabama, USA
| | - Grant R. Williams
- Division of Hematology and Oncology, Department of Medicine, School of Medicine, University of Alabama at Birmingham (UAB), Birmingham, Alabama, USA
| | - Paula P. Warren
- Division of Neuro-Oncology, Department of Neurology, School of Medicine, University of Alabama at Birmingham (UAB), Birmingham, Alabama, USA
| | - Sheri Tims
- Center for Palliative and Supportive Care, School of Medicine, University of Alabama at Birmingham (UAB), Birmingham, Alabama, USA
| | - Chao-Hui S. Huang
- Division of Geriatrics, Gerontology, and Palliative Care, Department of Medicine, School of Medicine, University of Alabama at Birmingham (UAB), Birmingham, Alabama, USA
| | - Richard A. Taylor
- School of Nursing, University of Alabama at Birmingham (UAB), Birmingham, Alabama, USA
- Center for Palliative and Supportive Care, School of Medicine, University of Alabama at Birmingham (UAB), Birmingham, Alabama, USA
| | | | - Trevor Lever
- Kirklin Clinic, UAB Hospital, Birmingham, Alabama, USA
| | - Kelsey Mitchell
- Clinicial Informatics, UAB Medicine, Birmingham, Alabama, USA
| | - Moneka Thompson
- Department of Pastoral Care, School of Medicine, University of Alabama at Birmingham (UAB), Birmingham, Alabama, USA
| | - Chinara Dosse
- School of Nursing, University of Alabama at Birmingham (UAB), Birmingham, Alabama, USA
| | - Sally Engler
- School of Nursing, University of Alabama at Birmingham (UAB), Birmingham, Alabama, USA
| | - Amy Holmes
- Social Work Services, UAB Medicine, Birmingham, Alabama, USA
| | | | - Jennifer Hicks
- Center for Palliative and Supportive Care, School of Medicine, University of Alabama at Birmingham (UAB), Birmingham, Alabama, USA
| | - Marie A. Bakitas
- School of Nursing, University of Alabama at Birmingham (UAB), Birmingham, Alabama, USA
- Center for Palliative and Supportive Care, School of Medicine, University of Alabama at Birmingham (UAB), Birmingham, Alabama, USA
- Division of Hematology and Oncology, Department of Medicine, School of Medicine, University of Alabama at Birmingham (UAB), Birmingham, Alabama, USA
| | - Burt Nabors
- Division of Neuro-Oncology, Department of Neurology, School of Medicine, University of Alabama at Birmingham (UAB), Birmingham, Alabama, USA
| | - Rodney Tucker
- Center for Palliative and Supportive Care, School of Medicine, University of Alabama at Birmingham (UAB), Birmingham, Alabama, USA
- Division of Geriatrics, Gerontology, and Palliative Care, Department of Medicine, School of Medicine, University of Alabama at Birmingham (UAB), Birmingham, Alabama, USA
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Stockdill ML, Barnett MD, Taylor R, Dionne-Odom JN, Bakitas M. Telehealth in Palliative Care: Communication Strategies From the COVID-19 Pandemic. Clin J Oncol Nurs 2021; 25:17-22. [PMID: 33480883 DOI: 10.1188/21.cjon.17-22] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Palliative care was once believed to be too high-touch to be delivered via telehealth. However, numerous studies have demonstrated the positive effects of palliative care delivered through telehealth. Because the COVID-19 pandemic has quickly shifted how health care is delivered to patients with cancer, particularly because of their immunocompromised status and the risks associated with unnecessary exposures in the clinic, previous lessons from palliative care research studies can be used to inform practice. This article presents a case study that illustrates evidence and best practices for continuing to deliver palliative care via telehealth after COVID-19 restrictions are lifted.
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Schulman-Green D, Feder SL, Dionne-Odom JN, Batten J, En Long VJ, Harris Y, Wilpers A, Wong T, Whittemore R. Family Caregiver Support of Patient Self-Management During Chronic, Life-Limiting Illness: A Qualitative Metasynthesis. J Fam Nurs 2021; 27:55-72. [PMID: 33334232 PMCID: PMC8114560 DOI: 10.1177/1074840720977180] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [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: 05/25/2023]
Abstract
Family caregivers play an integral role in supporting patient self-management, yet how they perform this role is unclear. We conducted a qualitative metasynthesis of family caregivers' processes to support patient self-management of chronic, life-limiting illness and factors affecting their support. Methods included a systematic literature search, quality appraisal of articles, data abstraction, and data synthesis to produce novel themes. Thirty articles met inclusion criteria, representing 935 international family caregivers aged 18 to 89 years caring for patients with various health conditions. Three themes characterized family caregivers' processes to support patient self-management: "Focusing on the Patient's Illness Needs," "Activating Resources to Support Oneself as the Family Caregiver," and "Supporting a Patient Living with a Chronic, Life-Limiting Illness." Factors affecting family caregivers' support included Personal Characteristics, Health Status, Resources, Environmental Characteristics, and the Health Care System. The family caregiver role in supporting patient self-management is multidimensional, encompassing three processes of care and influenced by multiple factors.
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Affiliation(s)
| | | | | | | | | | | | | | - Tiffany Wong
- Geisel School of Medicine at Dartmouth, Lebanon, NH, USA
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Applebaum AJ, Kent E, Litzelman K, Ferrell B, Nicholas Dionne-Odom J, Northouse L. Cancer Caregivers. Psychooncology 2021. [DOI: 10.1093/med/9780190097653.003.0092] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
This chapter describes prevalence estimates of cancer caregivers in the United States and provides a comprehensive review of the effect of cancer on caregivers’ psychological, physical, and financial well-being. The unique burden faced by spouse caregivers versus adult child caregivers is clearly delineated. Four evidence-based interventions to assist cancer caregivers or patient-caregiver dyads are described: psychoeducational interventions (e.g., ENABLE), dyadic interventions (e.g., FOCUS), cognitive behavioral therapy (CBT), and Meaning-Centered Psychotherapy for Cancer Caregivers (MCP-C). The chapter also explores the ethical and legal issues faced by caregivers and concludes with important future directions including the need for (1) more comprehensive caregiver assessment, (2) more research on optimal intervention dose and delivery, and (3) more implementation of evidence-based interventions for caregivers in formal health care systems.
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Allen Watts K, Malone E, Dionne-Odom JN, McCammon S, Currie E, Hicks J, Tucker RO, Wallace E, Elk R, Bakitas M. Can you hear me now?: Improving palliative care access through telehealth. Res Nurs Health 2021; 44:226-237. [PMID: 33393704 PMCID: PMC7958991 DOI: 10.1002/nur.22105] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [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: 07/09/2020] [Revised: 12/10/2020] [Accepted: 12/20/2020] [Indexed: 12/24/2022]
Abstract
Telehealth has been increasingly used to expand healthcare access over the last two decades. However, this had not been the case for palliative care (PC), because telehealth was considered nontraditional and impractical due to the sensitive nature of conversations and a "high touch" philosophy. Motivated by limited PC access to rural and underserved populations and positive PC telehealth studies, clinical PC telehealth models have been developing. However, nearly overnight, the COVID-19 pandemic accelerated the use and uptake of telehealth across health care and especially in PC. As a result, clinicians, administrators, and others agree that telehealth is "here to stay," and will likely maintain widespread use and refinement beyond rural areas. The purpose of this review is to describe exemplar PC telehealth programs in research and clinical practice, including pros and cons, lessons learned, and future directions for the ongoing development and expansion of PC via telehealth across diseases and the lifespan.
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Affiliation(s)
- Kristen Allen Watts
- Department of Medicine, Division of Gerontology, Geriatrics, and Palliative Care, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Emily Malone
- Department of Medicine, Division of Gerontology, Geriatrics, and Palliative Care, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | | | - Susan McCammon
- Department of Medicine, Division of Gerontology, Geriatrics, and Palliative Care, University of Alabama at Birmingham, Birmingham, Alabama, USA
- Department of Otolaryngology, School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Erin Currie
- School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Jennifer Hicks
- School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Rodney O Tucker
- Department of Medicine, Division of Gerontology, Geriatrics, and Palliative Care, University of Alabama at Birmingham, Birmingham, Alabama, USA
- Center for Palliative and Supportive Care, Schools of Medicine and Nursing, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Eric Wallace
- Department of Medicine, Division of Nephrology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Ronit Elk
- Department of Medicine, Division of Gerontology, Geriatrics, and Palliative Care, University of Alabama at Birmingham, Birmingham, Alabama, USA
- Center for Palliative and Supportive Care, Schools of Medicine and Nursing, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Marie Bakitas
- Department of Medicine, Division of Gerontology, Geriatrics, and Palliative Care, University of Alabama at Birmingham, Birmingham, Alabama, USA
- School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama, USA
- Center for Palliative and Supportive Care, Schools of Medicine and Nursing, University of Alabama at Birmingham, Birmingham, Alabama, USA
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36
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Reed RD, Killian AC, Mustian MN, Hendricks DH, Baldwin KN, Kumar V, Dionne-Odom JN, Saag K, Hites L, Ivankova NV, Locke JE. The Living Donor Navigator Program Provides Support Tools for Caregivers. Prog Transplant 2020; 31:55-61. [PMID: 33353498 DOI: 10.1177/1526924820978598] [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: 11/17/2022]
Abstract
INTRODUCTION The Living Donor Navigator (LDN) program is one of several initiatives designed to help transplant candidates identify living donors with the help of a friend or family member advocate to speak on their behalf. More than half of advocates in the LDN program were the spouse or parent of the candidate and served in a caregiving role. Caregivers for patients awaiting transplantation have reported poorer quality of life than the general population, suggesting more support is needed for this vulnerable group. The purpose of this study was to understand whether the LDN program met the needs of advocates who were also caregivers for the transplant candidate. METHODS We performed a supplementary secondary qualitative analysis of a parent study conducted December 2017-January 2018 with 9 advocates who participated in the LDN program. Transcripts were reanalyzed from focus group discussions, concentrating on comments about caregiving or made by caregivers. Using manual coding and reflexive thematic analysis, we identified broad codes and major themes. FINDINGS Our re-analysis revealed one theme overlapping with our previous analysis (Support) and 2 new themes specific to caregiver advocates: Quality of Life and Fear. Caregivers agreed that the LDN program equipped them with tools to address these areas and best serve their simultaneous caregiver/advocate roles. DISCUSSION These analyses demonstrated that those who served as advocate and caregiver derived a benefit from the LDN program but had distinct needs from other advocates. These findings can inform continued refinement of the program and expansion to support needs of caregiver.
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Affiliation(s)
- Rhiannon D Reed
- 9968University of Alabama at Birmingham Comprehensive Transplant Institute, Birmingham, AL, USA
| | - A Cozette Killian
- 9968University of Alabama at Birmingham Comprehensive Transplant Institute, Birmingham, AL, USA
| | - Margaux N Mustian
- 9968University of Alabama at Birmingham Comprehensive Transplant Institute, Birmingham, AL, USA
| | - Daagye H Hendricks
- 9968University of Alabama at Birmingham Comprehensive Transplant Institute, Birmingham, AL, USA
| | - Kimberly N Baldwin
- 9968University of Alabama at Birmingham Comprehensive Transplant Institute, Birmingham, AL, USA
| | - Vineeta Kumar
- 9968University of Alabama at Birmingham Comprehensive Transplant Institute, Birmingham, AL, USA
| | | | - Kenneth Saag
- 9968University of Alabama at Birmingham School of Medicine, Birmingham, AL, USA
| | - Lisle Hites
- 37364University of Alabama College of Community Health Sciences, Tuscaloosa, AL, USA
| | - Natalia V Ivankova
- 9968University of Alabama at Birmingham School of Nursing, Birmingham, AL, USA.,9968University of Alabama at Birmingham School of Health Professions, Birmingham, AL, USA
| | - Jayme E Locke
- 9968University of Alabama at Birmingham Comprehensive Transplant Institute, Birmingham, AL, USA
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Bakitas MA, Dionne-Odom JN, Ejem DB, Wells R, Azuero A, Stockdill ML, Keebler K, Sockwell E, Tims S, Engler S, Steinhauser K, Kvale E, Durant RW, Tucker RO, Burgio KL, Tallaj J, Swetz KM, Pamboukian SV. Effect of an Early Palliative Care Telehealth Intervention vs Usual Care on Patients With Heart Failure: The ENABLE CHF-PC Randomized Clinical Trial. JAMA Intern Med 2020; 180:1203-1213. [PMID: 32730613 PMCID: PMC7385678 DOI: 10.1001/jamainternmed.2020.2861] [Citation(s) in RCA: 60] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
IMPORTANCE National guidelines recommend early palliative care for patients with advanced heart failure, which disproportionately affects rural and minority populations. OBJECTIVE To determine the effect of an early palliative care telehealth intervention over 16 weeks on the quality of life, mood, global health, pain, and resource use of patients with advanced heart failure. DESIGN, SETTING, AND PARTICIPANTS A single-blind, intervention vs usual care randomized clinical trial was conducted from October 1, 2015, to May 31, 2019, among 415 patients 50 years or older with New York Heart Association class III or IV heart failure or American College of Cardiology stage C or D heart failure at a large Southeastern US academic tertiary medical center and a Veterans Affairs medical center serving high proportions of rural dwellers and African American individuals. INTERVENTIONS The ENABLE CHF-PC (Educate, Nurture, Advise, Before Life Ends Comprehensive Heartcare for Patients and Caregivers) intervention comprises an in-person palliative care consultation and 6 weekly nurse-coach telephonic sessions (20-40 minutes) and monthly follow-up for 48 weeks. MAIN OUTCOMES AND MEASURES Primary outcomes were quality of life (as measured by the Kansas City Cardiomyopathy Questionnaire [KCCQ]: score range, 0-100; higher scores indicate better perceived health status and clinical summary scores ≥50 are considered "fairly good" quality of life; and the Functional Assessment of Chronic Illness Therapy-Palliative-14 [FACIT-Pal-14]: score range, 0-56; higher scores indicate better quality of life) and mood (as measured by the Hospital Anxiety and Depression Scale [HADS]) over 16 weeks. Secondary outcomes were global health (Patient Reported Outcome Measurement System Global Health), pain (Patient Reported Outcome Measurement System Pain Intensity and Interference), and resource use (hospital days and emergency department visits). RESULTS Of 415 participants (221 men; baseline mean [SD] age, 63.8 [8.5] years) randomized to ENABLE CHF-PC (n = 208) or usual care (n = 207), 226 (54.5%) were African American, 108 (26.0%) lived in a rural area, and 190 (45.8%) had a high-school education or less, and a mean (SD) baseline KCCQ score of 52.6 (21.0). At week 16, the mean (SE) KCCQ score improved 3.9 (1.3) points in the intervention group vs 2.3 (1.2) in the usual care group (difference, 1.6; SE, 1.7; d = 0.07 [95% CI, -0.09 to 0.24]) and the mean (SE) FACIT-Pal-14 score improved 1.4 (0.6) points in the intervention group vs 0.2 (0.5) points in the usual care group (difference, 1.2; SE, 0.8; d = 0.12 [95% CI, -0.03 to 0.28]). There were no relevant between-group differences in mood (HADS-anxiety, d = -0.02 [95% CI, -0.20 to 0.16]; HADS-depression, d = -0.09 [95% CI, -0.24 to 0.06]). CONCLUSIONS AND RELEVANCE This randomized clinical trial with a majority African American sample and baseline good quality of life did not demonstrate improved quality of life or mood with a 16-week early palliative care telehealth intervention. However, pain intensity and interference (secondary outcomes) demonstrated a clinically important improvement. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT02505425.
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Affiliation(s)
- Marie A Bakitas
- School of Nursing, University of Alabama at Birmingham, Birmingham.,Division of Gerontology, Geriatrics and Palliative Care, UAB Center for Palliative and Supportive Care, Department of Medicine, University of Alabama at Birmingham, Birmingham
| | - J Nicholas Dionne-Odom
- School of Nursing, University of Alabama at Birmingham, Birmingham.,Division of Gerontology, Geriatrics and Palliative Care, UAB Center for Palliative and Supportive Care, Department of Medicine, University of Alabama at Birmingham, Birmingham
| | - Deborah B Ejem
- School of Nursing, University of Alabama at Birmingham, Birmingham.,Division of Preventive Medicine, Department of Medicine, University of Alabama at Birmingham, Birmingham
| | - Rachel Wells
- School of Nursing, University of Alabama at Birmingham, Birmingham
| | - Andres Azuero
- School of Nursing, University of Alabama at Birmingham, Birmingham
| | - Macy L Stockdill
- School of Nursing, University of Alabama at Birmingham, Birmingham
| | - Konda Keebler
- School of Nursing, University of Alabama at Birmingham, Birmingham
| | - Elizabeth Sockwell
- School of Nursing, University of Alabama at Birmingham, Birmingham.,Division of Gerontology, Geriatrics and Palliative Care, UAB Center for Palliative and Supportive Care, Department of Medicine, University of Alabama at Birmingham, Birmingham
| | - Sheri Tims
- School of Nursing, University of Alabama at Birmingham, Birmingham.,Division of Gerontology, Geriatrics and Palliative Care, UAB Center for Palliative and Supportive Care, Department of Medicine, University of Alabama at Birmingham, Birmingham
| | - Sally Engler
- School of Nursing, University of Alabama at Birmingham, Birmingham
| | - Karen Steinhauser
- Center for Innovation, Veterans Affairs Medical Center, Durham, North Carolina.,Department of Population Health Sciences, Division of General Internal Medicine, Duke University, Durham, North Carolina.,Department of Medicine, Division of General Internal Medicine, Duke University, Durham, North Carolina
| | - Elizabeth Kvale
- Department of Medicine, Dell Medical School, University of Texas at Austin, Austin
| | - Raegan W Durant
- Division of Preventive Medicine, Department of Medicine, University of Alabama at Birmingham, Birmingham
| | - Rodney O Tucker
- Division of Gerontology, Geriatrics and Palliative Care, UAB Center for Palliative and Supportive Care, Department of Medicine, University of Alabama at Birmingham, Birmingham
| | - Kathryn L Burgio
- Division of Gerontology, Geriatrics and Palliative Care, UAB Center for Palliative and Supportive Care, Department of Medicine, University of Alabama at Birmingham, Birmingham.,Geriatric Research, Education, and Clinical Center, Birmingham Veterans Affairs Medical Center, Birmingham, Alabama
| | - Jose Tallaj
- Division of Cardiovascular Diseases, Department of Medicine, University of Alabama at Birmingham, Birmingham
| | - Keith M Swetz
- Division of Gerontology, Geriatrics and Palliative Care, UAB Center for Palliative and Supportive Care, Department of Medicine, University of Alabama at Birmingham, Birmingham.,Division of Cardiovascular Diseases, Department of Medicine, University of Alabama at Birmingham, Birmingham
| | - Salpy V Pamboukian
- Division of Cardiovascular Diseases, Department of Medicine, University of Alabama at Birmingham, Birmingham
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Rosa WE, Gray TF, Chow K, Davidson PM, Dionne-Odom JN, Karanja V, Khanyola J, Kpoeh JDN, Lusaka J, Matula ST, Mazanec P, Moreland PJ, Pandey S, de Campos AP, Meghani SH. Recommendations to Leverage the Palliative Nursing Role During COVID-19 and Future Public Health Crises. J Hosp Palliat Nurs 2020; 22:260-269. [PMID: 32511171 PMCID: PMC8018720 DOI: 10.1097/njh.0000000000000665] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [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: 01/03/2023]
Abstract
With the daily number of confirmed COVID-19 cases and associated deaths rising exponentially, social fabrics on a global scale are being worn by panic, uncertainty, fear, and other consequences of the health care crisis. Comprising more than half of the global health care workforce and the highest proportion of direct patient care time than any other health professional, nurses are at the forefront of this crisis. Throughout the evolving COVID-19 pandemic, palliative nurses will increasingly exercise their expertise in symptom management, ethics, communication, and end-of-life care, among other crucial skills. The literature addressing the palliative care response to COVID-19 has surged, and yet, there is a critical gap regarding the unique contributions of palliative nurses and their essential role in mitigating the sequelae of this crisis. Thus, the primary aim herein is to provide recommendations for palliative nurses and other health care stakeholders to ensure their optimal value is realized and to promote their well-being and resilience during COVID-19 and, by extension, in anticipation of future public health crises.
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Affiliation(s)
- William E Rosa
- William E. Rosa, PhD, MBE, ACHPN, FAANP, FAAN, is Robert Wood Johnson Foundation Future of Nursing Scholar, University of Pennsylvania School of Nursing, Philadelphia. Tamryn F. Gray, PhD, RN, is research fellow, Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts. Kimberly Chow, RN, ANP-BC, ACHPN, is nurse practitioner, Supportive Care Service, Memorial Sloan Kettering Cancer Center, New York. Patricia M. Davidson, PhD, RN, FAAN, is dean and professor, Johns Hopkins University School of Nursing, Baltimore, Maryland. J. Nicholas Dionne-Odom, PhD, MSN, MA, ACHPN, FPCN, is assistant professor, University of Alabama at Birmingham School of Nursing; and codirector, Caregiver and Bereavement Support Services, UAB Center for Palliative and Supportive Care. Viola Karanja, BSN, RN, is deputy executive director, Partners in Health Liberia, Harper. Judy Khanyola, MSc, RCHN, is Chair, Nursing and Midwifery, University of Global Health Equity, Butaro, Rwanda. Julius D. N. Kpoeh, ASN, RN, is senior clinical mentor, Partners in Health Liberia, Harper. Joseph Lusaka, BSc HM, DCM, PA, is clinical manager, Pleebo Health Centre, Liberia. Samuel T. Matula, PhD, RN, PCNS-BC, is lecturer, University of Botswana, Gaborone. Polly Mazanec, PhD, AOCN, ACHPN, FPCN, FAAN, is research associate professor, Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, Ohio. Patricia J. Moreland, PhD, CPNP, FAAN, is assistant clinical professor, Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia. Shila Pandey, MSN, AGPCNP-BC, ACHPN, is nurse practitioner, Supportive Care Service, Memorial Sloan Kettering Cancer Center, New York. Amisha Parekh de Campos, PhD, MPH, CHPN, Robert Wood Johnson Foundation Future of Nursing Scholar, University of Connecticut, Storrs; quality and education coordinator, Hospice Program, Middlesex Health, Connecticut. Salimah H. Meghani, PhD, MBE, RN, FAAN, is professor and term chair of Palliative Care, University of Pennsylvania School of Nursing, Philadelphia
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Abstract
The coronavirus disease 2019 (COVID-19) pandemic presents unique challenges to those who work with the seriously ill population, including both health care providers and the family caregivers providing unpaid care. We rely on this lay workforce as health care routinely transitions care to the home, and now more than ever, we are depending on them in the current pandemic. As palliative care and other health care providers become overwhelmed with patients critically ill with COVID-19, and routine care becomes delayed, we have a charge to recognize and work with family caregivers. Our commentary provides rationale for the need to focus on family caregivers and key considerations for how to include them in pandemic clinical decision making.
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Affiliation(s)
- Erin E Kent
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.
| | - Katherine A Ornstein
- Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - J Nicholas Dionne-Odom
- Caregiver and Bereavement Support Services, UAB Center for Palliative and Supportive Care, School of Nursing, The University of Alabama at Birmingham, Birmingham, Alabama, USA
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40
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Kitko L, McIlvennan CK, Bidwell JT, Dionne-Odom JN, Dunlay SM, Lewis LM, Meadows G, Sattler EL, Schulz R, Strömberg A. Family Caregiving for Individuals With Heart Failure: A Scientific Statement From the American Heart Association. Circulation 2020; 141:e864-e878. [DOI: 10.1161/cir.0000000000000768] [Citation(s) in RCA: 53] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Many individuals living with heart failure (HF) rely on unpaid support from their partners, family members, friends, or neighbors as caregivers to help manage their chronic disease. Given the advancements in treatments and devices for patients with HF, caregiving responsibilities have expanded in recent decades to include more intensive care for increasingly precarious patients with HF—tasks that would previously have been undertaken by healthcare professionals in clinical settings. The specific tasks of caregivers of patients with HF vary widely based on the patient’s symptoms and comorbidities, the relationship between patient and caregiver, and the complexity of the treatment regimen. Effects of caregiving on the caregiver and patient range from physical and psychological to financial. Therefore, it is critically important to understand the needs of caregivers to support the increasingly complex medical care they provide to patients living with HF. This scientific statement synthesizes the evidence pertaining to caregiving of adult individuals with HF in order to (1) characterize the HF caregiving role and how it changes with illness trajectory; (2) describe the financial, health, and well-being implications of caregiving in HF; (3) evaluate HF caregiving interventions to support caregiver and patient outcomes; (4) summarize existing policies and resources that support HF caregivers; and (5) identify knowledge gaps and future directions for providers, investigators, health systems, and policymakers.
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41
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Johnston EE, Molina J, Martinez I, Dionne-Odom JN, Currie ER, Crowl T, Butterworth L, Chamberlain LJ, Bhatia S, Rosenberg AR. Bereaved parents' views on end-of-life care for children with cancer: Quality marker implications. Cancer 2020; 126:3352-3359. [PMID: 32383817 DOI: 10.1002/cncr.32935] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Revised: 03/12/2020] [Accepted: 04/12/2020] [Indexed: 11/09/2022]
Abstract
BACKGROUND End-of-life (EOL) quality markers in adult oncology include home death and intensive care unit avoidance. Corresponding markers are lacking in pediatric oncology. This study was aimed at describing bereaved parents' perspectives of high-quality EOL care in pediatric oncology. METHODS This study enrolled a convenience sample of 28 bereaved parents (English- or Spanish-speaking) whose children (0-21 years old) had died of cancer ≥6 months before. Semistructured interviews were conducted to elicit parental perceptions of medically intense/quality EOL care. Interviews were recorded and transcribed verbatim (30 hours), and study team consensus and content analyses identified themes related to EOL quality markers. Related quotes were scored on a 5-point Likert scale ranging from 1 (supported comfort care) to 5 (supported medically aggressive care). RESULTS The children died in 1998-2017 at a mean age of 10 years (SD, 5.2 years); 50% had a solid tumor, and 46% were Spanish-speaking. Themes included 1) home death preference (unless home support was inadequate; median score, 1.6), nonaggressive care (median score, 2.4), and continued anticancer therapy (median score, 3.2); 2) programs/policies that could alleviate barriers limiting a family's time with a dying child (visiting restrictions and financial strains); 3) the need to prepare the family for death (eg, what would happen to the child's body), and 4) perceived abandonment. CONCLUSIONS This is the first qualitative study to identify quality makers for children dying of cancer from bereaved parents' perspectives. Natural death is generally preferred, and quality measures that address barriers to parents' spending time with their children, a lack of preparation for the events surrounding death, and feelings of abandonment are critical. Future studies need to validate these findings and develop targeted interventions.
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Affiliation(s)
- Emily E Johnston
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, Stanford University, Stanford, California, USA.,Division of Pediatric Hematology/Oncology, Department of Pediatrics, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Jannelle Molina
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, Stanford University, Stanford, California, USA
| | - Isaac Martinez
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | | | - Erin R Currie
- School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Terra Crowl
- Jacob's Heart Children's Cancer Support Services, Watsonville, California, USA
| | - Lori Butterworth
- Jacob's Heart Children's Cancer Support Services, Watsonville, California, USA
| | - Lisa J Chamberlain
- Division of General Pediatrics, Department of Pediatrics, Stanford University School of Medicine, Stanford, California, USA
| | - Smita Bhatia
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Abby R Rosenberg
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington, USA.,Cancer and Blood Disorders Center, Seattle Children's Hospital, Seattle, Washington, USA.,Treuman Katz Center for Pediatric Bioethics, Department of Pediatrics, Seattle Children's Research Institute, Seattle, Washington, USA
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Dionne-Odom JN, Ejem DB, Wells R, Azuero A, Stockdill ML, Keebler K, Sockwell E, Tims S, Engler S, Kvale E, Durant RW, Tucker RO, Burgio KL, Tallaj J, Pamboukian SV, Swetz KM, Bakitas MA. Effects of a Telehealth Early Palliative Care Intervention for Family Caregivers of Persons With Advanced Heart Failure: The ENABLE CHF-PC Randomized Clinical Trial. JAMA Netw Open 2020; 3:e202583. [PMID: 32282044 PMCID: PMC7154802 DOI: 10.1001/jamanetworkopen.2020.2583] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
IMPORTANCE Family caregivers of persons with advanced heart failure perform numerous daily tasks to assist their relatives and are at high risk for distress and poor quality of life. OBJECTIVE To determine the effect of a nurse-led palliative care telehealth intervention (Educate, Nurture, Advise, Before Life Ends Comprehensive Heart Failure for Patients and Caregivers [ENABLE CHF-PC]) on quality of life and mood of family caregivers of persons with New York Heart Association Class III/IV heart failure over 16 weeks. DESIGN, SETTING, AND PARTICIPANTS This single-blind randomized clinical trial enrolled caregivers aged 18 years and older who self-identified as an unpaid close friend or family member who knew the patient well and who was involved with their day-to-day medical care. Participants were recruited from outpatient heart failure clinics at a large academic tertiary care medical center and a Veterans Affairs medical center from August 2016 to October 2018. INTERVENTION Four weekly psychosocial and problem-solving support telephonic sessions lasting between 20 and 60 minutes facilitated by a trained nurse coach plus monthly follow-up for 48 weeks. The usual care group received no additional intervention. MAIN OUTCOMES AND MEASURES The primary outcomes were quality of life (measured using the Bakas Caregiver Outcomes Scale), mood (anxiety and/or depressive symptoms measured using the Hospital Anxiety and Depression Scale), and burden (measured using the Montgomery-Borgatta Caregiver Burden scales) over 16 weeks. Secondary outcomes were global health (measured using the PROMIS Global Health instrument) and positive aspects of caregiving. RESULTS A total of 158 family caregivers were randomized, 82 to the intervention and 76 to usual care. The mean (SD) age was 57.9 (11.6) years, 135 (85.4%) were female, 82 (51.9%) were African American, and 103 (65.2%) were the patient's spouse or partner. At week 16, the mean (SE) Bakas Caregiver Outcomes Scale score was 66.9 (2.1) in the intervention group and 63.9 (1.7) in the usual care group; over 16 weeks, the mean (SE) Bakas Caregiver Outcomes Scale score improved 0.7 (1.7) points in the intervention group and 1.1 (1.6) points in the usual care group (difference, -0.4; 95% CI, -5.1 to 4.3; Cohen d = -0.03). At week 16, no relevant between-group differences were observed between the intervention and usual care groups for the Hospital Anxiety and Depression Scale anxiety measure (mean [SE] improvement from baseline, 0.3 [0.3] vs 0.4 [0.3]; difference, -0.1 [0.5]; d = -0.02) or depression measure (mean [SE] improvement from baseline, -0.2 [0.4] vs -0.3 [0.3]; difference, 0.1 [0.5]; d = 0.03). No between-group differences were observed in the Montgomery-Borgatta Caregiver Burden scales (d range, -0.18 to 0.0). Differences in secondary outcomes were also not significant (d range, -0.22 to 0.0). CONCLUSIONS AND RELEVANCE This 2-site randomized clinical trial of a telehealth intervention for family caregivers of patients with advanced heart failure, more than half of whom were African American and most of whom were not distressed at baseline, did not demonstrate clinically better quality of life, mood, or burden compared with usual care over 16 weeks. Future interventions should target distressed caregivers and assess caregiver effects on patient outcomes. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT02505425.
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Affiliation(s)
- J. Nicholas Dionne-Odom
- University of Alabama at Birmingham School of Nursing
- Center for Palliative and Supportive Care, Division of Gerontology, Geriatrics, and Palliative Care, Department of Medicine, University of Alabama at Birmingham
| | | | - Rachel Wells
- University of Alabama at Birmingham School of Nursing
| | - Andres Azuero
- University of Alabama at Birmingham School of Nursing
| | | | - Konda Keebler
- University of Alabama at Birmingham School of Nursing
| | | | - Sheri Tims
- University of Alabama at Birmingham School of Nursing
| | - Sally Engler
- University of Alabama at Birmingham School of Nursing
| | - Elizabeth Kvale
- Department of Medicine, Dell Medical School, The University of Texas at Austin
| | - Raegan W. Durant
- Division of Preventive Medicine, Department of Medicine, University of Alabama at Birmingham
| | - Rodney O. Tucker
- Center for Palliative and Supportive Care, Division of Gerontology, Geriatrics, and Palliative Care, Department of Medicine, University of Alabama at Birmingham
| | | | - Jose Tallaj
- Division of Cardiovascular Diseases, Department of Medicine, University of Alabama at Birmingham
| | - Salpy V. Pamboukian
- Division of Cardiovascular Diseases, Department of Medicine, University of Alabama at Birmingham
| | - Keith M. Swetz
- Center for Palliative and Supportive Care, Division of Gerontology, Geriatrics, and Palliative Care, Department of Medicine, University of Alabama at Birmingham
| | - Marie A. Bakitas
- University of Alabama at Birmingham School of Nursing
- Center for Palliative and Supportive Care, Division of Gerontology, Geriatrics, and Palliative Care, Department of Medicine, University of Alabama at Birmingham
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Bakitas M, Allen Watts K, Malone E, Dionne-Odom JN, McCammon S, Taylor R, Tucker R, Elk R. Forging a New Frontier: Providing Palliative Care to People With Cancer in Rural and Remote Areas. J Clin Oncol 2020; 38:963-973. [PMID: 32023156 DOI: 10.1200/jco.18.02432] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Mounting evidence supports oncology organizations' recommendations of early palliative care as a cancer care best practice for patients with advanced cancer and/or high symptom burden. However, few trials on which these best practices are based have included rural and remote community-based oncology care. Therefore, little is known about whether early palliative care models are applicable in these low-resource areas. This literature synthesis identifies some of the challenges of integrating palliative care in rural and remote cancer care. Prominent themes include being mindful of rural culture; adapting traditional geographically based specialty care delivery models to under-resourced rural practices; and using novel palliative care education delivery methods to increase community-based health professional, layperson, and family palliative expertise to account for limited local specialty palliative care resources. Although there are many limitations, many rural and remote communities also have strengths in their capacity to provide high-quality care by capitalizing on close-knit, committed community practitioners, especially if there are receptive local palliative and hospice care champions. Hence, adapting palliative care models, using culturally appropriate novel delivery methods, and providing remote education and support to existing community providers are promising advances to aid rural people to manage serious illness and to die in place. Reformulating health policy and nurturing academic-community partnerships that support best practices are critical components of providing early palliative care for everyone everywhere.
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Affiliation(s)
| | | | - Emily Malone
- University of Alabama at Birmingham, Birmingham, AL
| | | | | | | | | | - Ronit Elk
- University of Alabama at Birmingham, Birmingham, AL
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Abstract
The purpose of this update is to summarize and critique research articles in Hospice and Palliative Care from 2018 that are pertinent and impactful in informing clinical practice. The articles were presented at the 2019 Annual Assembly of Hospice and Palliative Medicine (AAHPM) and the Hospice and Palliative Nurses Association (HPNA). Eight original research articles published between January 1, 2018, and December 31, 2018, were identified through a systematic PubMed search using the terms "hospice" and "palliative care," a hand search of 22 leading healthcare journals, and discussion with experts in the field. The final articles were chosen based on each study's methodological quality, its ability to be applied across different care settings, and its ability to impact clinical practice. We summarize the eight articles that were chosen and identify ways the articles can be used to inform clinical practice.
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Affiliation(s)
- Karen Hyden
- College of Nursing, University of Colorado Denver, Anschutz Medical Campus, Aurora, Colorado
| | - Laura Gelfman
- Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, New York.,Geriatric Research Education and Clinical Center, James J. Peters VA Medical Center, Bronx, New York
| | | | - Cardinale B Smith
- Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, New York.,Division of Hematology/Medical Oncology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Heather Coats
- College of Nursing, University of Colorado Denver, Anschutz Medical Campus, Aurora, Colorado
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Dionne-Odom JN, Currie ER, Johnston EE, Rosenberg AR. Supporting Family Caregivers of Adult and Pediatric Persons with Leukemia. Semin Oncol Nurs 2019; 35:150954. [DOI: 10.1016/j.soncn.2019.150954] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Abstract
OBJECTIVE Despite their key role in caring for individuals with serious, chronic illness, there have been no national studies examining family caregiver awareness and perceptions of palliative care. Hence, our objectives were to ascertain level of knowledge of palliative care among U.S. family caregivers and describe demographic variation in awareness and perceptions of palliative care. METHOD Using the 2018 National Cancer Institute Health Information National Trends Survey, we identified unpaid family caregivers caring or making healthcare decisions for someone with a medical, behavioral, disability, or other condition. Respondents were asked about their awareness of the term "palliative care" and, if aware, how much they agreed with statements representing common (mis)perceptions about palliative care (e.g., "Palliative care is the same as hospice"). RESULT More than one-half of caregivers (55%) had "never heard" of palliative care; 19.2% knew what palliative care was and "could explain it to someone else." In adjusted models, racial minorities (vs. whites) and those without a college degree were less likely to have heard of palliative care. Among those aware of palliative care, ~40% "strongly" or "somewhat" agreed that "Palliative care is the same as hospice"; another 10.5% "didn't know." Similarly, 40% reported that "When I think of palliative care, I automatically think of death." SIGNIFICANCE OF RESULTS One-half of family caregivers of adults with serious chronic illness have never heard of palliative care. Even among those who had heard of palliative care, the majority do not distinguish it from hospice care and death. Given the role family caregivers may play in decisions to access palliative care, public messaging efforts are needed to clarify palliative care services in a way that is patient- and family-centered.
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Affiliation(s)
- J. Nicholas Dionne-Odom
- School of Nursing, University of Alabama at Birmingham (UAB), Birmingham, AL
- Center for Palliative and Supportive Care, UAB Health System, Birmingham, AL
| | - Katherine A. Ornstein
- Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Erin E. Kent
- Outcomes Research Branch, Healthcare Delivery Research Program, Division of Cancer Control & Population Science, National Cancer Institute, Bethesda, MD
- ICF International, Fairfax, VA
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Hendricks BA, Lofton C, Azuero A, Kenny M, Taylor RA, Huang CHS, Rocque G, Williams GR, Dosse C, Louis K, Bakitas MA, Dionne-Odom JN. The project ENABLE Cornerstone randomized pilot trial: Protocol for lay navigator-led early palliative care for African-American and rural advanced cancer family caregivers. Contemp Clin Trials Commun 2019; 16:100485. [PMID: 31768470 PMCID: PMC6872851 DOI: 10.1016/j.conctc.2019.100485] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [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: 08/26/2019] [Revised: 11/04/2019] [Accepted: 11/09/2019] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Patients newly-diagnosed with advanced cancer often rely on family caregivers to provide daily support to manage healthcare needs and maintain quality of life. Early telehealth palliative care has been shown to effectively provide an extra layer of support to family caregivers, however there has been little work with underserved populations, especially African-Americans and rural-dwellers. This is concerning given the lack of palliative care access for these underserved groups. STUDY DESIGN Single-site, small-scale pilot randomized controlled trial (RCT) of Project ENABLE (Educate, Nurture, Advise, Before Life Ends) Cornerstone, a lay navigator-led, early palliative care coaching intervention for family caregivers of African-American and rural-dwelling patients with newly-diagnosed advanced cancer. Family caregivers are paired with a trained lay navigator overseen by specialist palliative care clinicians and receive a series of brief in-person and telehealth sessions focusing on stress management and coping, caregiving skills and organization, getting help, self-care, and preparing for the future/advance care planning. This pilot trial is assessing acceptability of the intervention, feasibility of recruitment and data collection procedures, and preliminary efficacy compared to usual care on caregiver and patient quality of life and mood over 24 weeks. CONCLUSION Once acceptability and feasibility are determined and issues addressed, the ENABLE Cornerstone intervention for underserved family caregivers of persons with advanced cancer will be primed for a fully powered efficacy RCT. Given its use of lay navigators and telehealth delivery, the intervention is potentially highly scalable and capable of overcoming many of the geographic, human resource, and cultural obstacles to accessing early palliative care support.
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Affiliation(s)
- Bailey A. Hendricks
- School of Nursing, University of Alabama at Birmingham (UAB), Birmingham, AL, Birmingham, AL, USA
| | - Corey Lofton
- School of Nursing, University of Alabama at Birmingham (UAB), Birmingham, AL, Birmingham, AL, USA
| | - Andres Azuero
- School of Nursing, University of Alabama at Birmingham (UAB), Birmingham, AL, Birmingham, AL, USA
| | - Matthew Kenny
- School of Nursing, University of Alabama at Birmingham (UAB), Birmingham, AL, Birmingham, AL, USA
| | - Richard A. Taylor
- School of Nursing, University of Alabama at Birmingham (UAB), Birmingham, AL, Birmingham, AL, USA
| | - Chao-Hui Sylvia Huang
- Division of Geriatrics, Gerontology, and Palliative Care, Department of Medicine, UAB Center for Palliative and Supportive Care, Birmingham, AL, USA
| | - Gabrielle Rocque
- Division of Hematology and Oncology, Department of Medicine, UAB, Birmingham, AL, USA
| | - Grant R. Williams
- Division of Hematology and Oncology, Department of Medicine, UAB, Birmingham, AL, USA
| | - Chinara Dosse
- Division of Preventive Medicine, UAB School of Medicine, Birmingham, AL, USA
| | - Kathryn Louis
- School of Nursing, University of Alabama at Birmingham (UAB), Birmingham, AL, Birmingham, AL, USA
| | - Marie A. Bakitas
- School of Nursing, University of Alabama at Birmingham (UAB), Birmingham, AL, Birmingham, AL, USA
- Division of Geriatrics, Gerontology, and Palliative Care, Department of Medicine, UAB Center for Palliative and Supportive Care, Birmingham, AL, USA
| | - J. Nicholas Dionne-Odom
- School of Nursing, University of Alabama at Birmingham (UAB), Birmingham, AL, Birmingham, AL, USA
- Division of Geriatrics, Gerontology, and Palliative Care, Department of Medicine, UAB Center for Palliative and Supportive Care, Birmingham, AL, USA
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Akyar I, Dionne-Odom JN, Ozcan M, Bakitas MA. Needs Assessment for Turkish Family Caregivers of Older Persons with Cancer: First-Phase Results of Adapting an Early Palliative Care Model. J Palliat Med 2019; 22:1065-1074. [PMID: 30969144 PMCID: PMC7364320 DOI: 10.1089/jpm.2018.0643] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [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: 02/28/2019] [Indexed: 12/25/2022] Open
Abstract
Background: Although palliative care is expanding globally for patients with serious illness, Turkey has not had widespread integration of early concurrent oncology palliative care. Hence, adapting and testing models of concurrent oncology palliative care for Turkish patients is imperative. Furthermore, it is critical that these care models also address the needs of family caregivers. Objective: To assess needs and elicit suggestions that would inform the adaptation of the ENABLE (Educate, Nurture, Advise, Before Life Ends) evidence-based early palliative care model for Turkish family caregivers of older persons with cancer. Methods: Formative evaluation study. Semi-structured interviews were conducted with 25 primary family caregivers of older individuals with cancer. Thematic analyses yielded themes in four domains: meaning of caregiving, effect of caregiving, education and consulting needs, and preferences about the delivery of the ENABLE model of palliative care support. Results: Caregivers described the impact of the cancer on their daily lives and responsibilities in the areas of physical, psychological, work, social, and family life. Caregivers emphasized their needs for information about symptoms, physical care, cancer pathology, and prognosis. Regarding the ENABLE model of early concurrent palliative care, participants wanted encounters to be in-person with educational material support that was simple and focused on disease information (prognosis, medication, handling emergency situations), psychological support, caring, nutrition, and acquiring community services. Conclusion: Themes from this study will be used to modify the ENABLE intervention protocol for future pilot and efficacy testing in Turkish caregivers.
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Affiliation(s)
- Imatullah Akyar
- Faculty of Nursing, Hacettepe University, Ankara, Turkey
- School of Nursing, University of Alabama at Birmingham (UAB), Birmingham, Alabama
| | - J. Nicholas Dionne-Odom
- School of Nursing, University of Alabama at Birmingham (UAB), Birmingham, Alabama
- Division of Geriatrics, Gerontology, and Palliative Care, Department of Medicine, UAB Center for Palliative and Supportive Care, Birmingham, Alabama
| | - Munevver Ozcan
- Faculty of Nursing, Hacettepe University, Ankara, Turkey
| | - Marie A. Bakitas
- School of Nursing, University of Alabama at Birmingham (UAB), Birmingham, Alabama
- Division of Geriatrics, Gerontology, and Palliative Care, Department of Medicine, UAB Center for Palliative and Supportive Care, Birmingham, Alabama
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Iyer AS, Dionne-Odom JN, Ford SM, Crump Tims SL, Sockwell ED, Ivankova NV, Brown CJ, Tucker RO, Dransfield MT, Bakitas MA. A Formative Evaluation of Patient and Family Caregiver Perspectives on Early Palliative Care in Chronic Obstructive Pulmonary Disease across Disease Severity. Ann Am Thorac Soc 2019; 16:1024-1033. [PMID: 31039003 PMCID: PMC6774751 DOI: 10.1513/annalsats.201902-112oc] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Accepted: 04/29/2019] [Indexed: 12/20/2022] Open
Abstract
Rationale: Little direction exists on how to integrate early palliative care in chronic obstructive pulmonary disease (COPD).Objectives: We sought to identify patient and family caregiver early palliative care needs across stages of COPD severity.Methods: As part of the Medical Research Council Framework developmental phase for intervention development, we conducted a formative evaluation of patients with moderate to very severe COPD (forced expiratory volume in 1 s [FEV1]/FVC < 70% and FEV1 < 80%-predicted) and their family caregivers. Validated surveys on quality of life, anxiety and depressive symptoms, and social isolation quantified symptom severity. Semi-structured interviews were analyzed for major themes on early palliative care and needs in patients and family caregivers and across COPD severity stages.Results: Patients (n = 10) were a mean (±SD) age of 60.4 (±7.5) years, 50% African American, and 70% male, with 30% having moderate COPD, 30% severe COPD, and 40% very severe COPD. Family caregivers (n = 10) were a mean age of 58.3 (±8.7) years, 40% African American, and 10% male. Overall, 30% (n = 6) of participants had poor quality of life, 45% (n = 9) had moderate-severe anxiety symptoms, 25% (n = 5) had moderate-severe depressive symptoms, and 40% (n = 8) reported social isolation. Only 30% had heard of palliative care, and most participants had misconceptions that palliative care was end-of-life care. All participants responded positively to a standardized description of early palliative care and were receptive to its integration as early as moderate stage. Five broad themes of early palliative care needs emerged: 1) coping with COPD; 2) emotional symptoms; 3) respiratory symptoms; 4) illness understanding; and 5) prognostic awareness. Coping with COPD and emotional symptoms were commonly shared early palliative care needs. Patients with very severe COPD and their family caregivers prioritized illness understanding and prognostic awareness compared with those with moderate-severe COPD.Conclusions: Patients with moderate to very severe COPD and their family caregivers found early palliative care acceptable and felt it should be integrated before end-stage. Of the five broad themes of early palliative care needs, coping with COPD and emotional symptoms were the highest priority, followed by respiratory symptoms, illness understanding, and prognostic awareness.
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Affiliation(s)
- Anand S. Iyer
- Division of Pulmonary, Allergy, and Critical Care Medicine
- Health Services, Outcomes, and Effectiveness Research Training Program
- Lung Health Center
| | - J. Nicholas Dionne-Odom
- Division of Gerontology, Geriatrics, and Palliative Care, Department of Medicine
- School of Nursing, and
| | - Stephanie M. Ford
- Lung Health Center
- Division of Gerontology, Geriatrics, and Palliative Care, Department of Medicine
| | - Sheri L. Crump Tims
- Division of Gerontology, Geriatrics, and Palliative Care, Department of Medicine
- School of Nursing, and
| | - Elizabeth D. Sockwell
- Division of Gerontology, Geriatrics, and Palliative Care, Department of Medicine
- School of Nursing, and
| | - Nataliya V. Ivankova
- School of Nursing, and
- School of Health Professions, University of Alabama at Birmingham, Birmingham, Alabama; and
| | - Cynthia J. Brown
- Division of Gerontology, Geriatrics, and Palliative Care, Department of Medicine
- Birmingham Veterans Affairs Medical Center, Birmingham, Alabama
| | - Rodney O. Tucker
- Division of Gerontology, Geriatrics, and Palliative Care, Department of Medicine
| | - Mark T. Dransfield
- Division of Pulmonary, Allergy, and Critical Care Medicine
- Lung Health Center
- Birmingham Veterans Affairs Medical Center, Birmingham, Alabama
| | - Marie A. Bakitas
- Division of Gerontology, Geriatrics, and Palliative Care, Department of Medicine
- School of Nursing, and
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Romo RD, Carpenter JG, Buck H, Lindley LC, Xu J, Owen JA, Sullivan SS, Bakitas M, Dionne-Odom JN, Zubkoff L, Matzo M. HPNA 2019-2022 Research Agenda: Development and Rationale. J Hosp Palliat Nurs 2019; 21:E17-E23. [PMID: 31166302 PMCID: PMC6776462 DOI: 10.1097/njh.0000000000000580] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Building on the strong work of previous research agendas (2009-2012, 2012-2015, 2015-2018), the Hospice and Palliative Nurses Association Research Advisory Council developed the 2019-2022 Research Agenda in consultation with Hospice and Palliative Nurses Association (HPNA) membership and assessment of major trends in palliative nursing. The HPNA Research Advisory Council identified 5 priority areas and asked subject experts in each area to summarize the state of the science, identify critical gaps, and provide recommendations for future research. This document expands the executive summary published on the HPNA website (www.advancingexpertcare.org/hpna/) and provides supporting evidence for the 2019-2022 recommendations. The 5 priority areas are as follows: (1) pediatric hospice and palliative nursing research; (2) family caregiving; (3) interprofessional education and collaborative practice; (4) big data science, precision health, and nursing informatics; and (5) implementation science.
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Affiliation(s)
- Rafael D Romo
- Rafael D. Romo, PhD, RN, PHN, is assistant professor of Nursing, University of Virginia School of Nursing, Charlottesville. Joan G. Carpenter, PhD, CRNP, ACHPN, FPCN, is research associate, University of Pennsylvania School of Nursing, and health science specialist, Corporal Michael J. Crescenz Veterans Affairs Medical Center Philadelphia, Pennsylvania. Harleah Buck, PhD, RN, FPCN, FAHA, FAAN, is associate professor and coordinator of Chronic Illness Initiatives, University of Southern Florida, Tampa. Lisa C. Lindley, PhD, RN, FPCN, is associate professor, College of Nursing, University of Tennessee, Knoxville. Jiayun Xu, PhD, RN, is assistant professor, College of Health and Human Sciences, Purdue University School of Nursing, West Lafayette, Indiana. John A. Owen, EdD, MSc, is associate director, Center for Academic Strategic Partnerships for Interprofessional Research and Education (ASPIRE), University of Virginia School of Nursing, Charlottesville. Suzanne S. Sullivan, PhD, MBA, RN, CHPN, is assistant professor, University at Buffalo State University of New York School of Nursing. Marie Bakitas, DNSc, CRNP, NP-C, AOCN, ACHPN, FAAN, is professor and Marie L. O'Koren Endowed Chair in Nursing, University of Alabama at Birmingham School of Nursing. J. Nicholas Dionne-Odom, PhD, MSN, MA, RN, FPCN, is assistant professor of nursing, University of Alabama at Birmingham School of Nursing. Lisa Zubkoff, PhD, is assistant professor of psychiatry, Dartmouth University Geisel School of Medicine and the Dartmouth Institute, Hanover, New Hampshire. Marianne Matzo, PhD, RN, APRN-CNP, AOCNP, AHPCN, FPCN, FAAN, is director of research, Hospice and Palliative Nurses Association, Pittsburgh, PA
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