A Provider-Facing Decision Support Tool for Prostate Cancer Screening in Primary Care: A Pilot Study

OBJECTIVES

 Our objective was to pilot test an electronic health record-embedded decision support tool to facilitate prostate-specific antigen (PSA) screening discussions in the primary care setting.

METHODS

 We pilot-tested a novel decision support tool that was used by 10 primary care physicians (PCPs) for 6 months, followed by a survey. The tool comprised (1) a risk-stratified algorithm, (2) a tool for facilitating shared decision-making (Simple Schema), (3) three best practice advisories (BPAs: <45, 45-75, and >75 years), and (4) a health maintenance module for scheduling automated reminders about PSA rescreening.

RESULTS

 All PCPs found the tool feasible, acceptable, and clear to use. Eight out of ten PCPs reported that the tool made PSA screening conversations somewhat or much easier. Before using the tool, 70% of PCPs felt confident in their ability to discuss PSA screening with their patient, and this improved to 100% after the tool was used by PCPs for 6 months. PCPs found the BPAs for eligible (45-75 years) and older men (>75 years) more useful than the BPA for younger men (<45 years). Among the 10 PCPs, 60% found the Simple Schema to be very useful, and 50% found the health maintenance module to be extremely or very useful. Most PCPs reported the components of the tool to be at least somewhat useful, with 10% finding them to be very burdensome.

CONCLUSION

 We demonstrated the feasibility and acceptability of the tool, which is notable given the marked low acceptance of existing tools. All PCPs reported that they would consider continuing to use the tool in their clinic and were likely or very likely to recommend the tool to a colleague.

Racism is a motivator and a barrier for people of color aspiring to become midwives in the United States

OBJECTIVE

To understand motivators and barriers of aspiring midwives of color.

DATA SOURCES AND STUDY SETTING

Primary data were collected via a national online survey among people of color in the United States interested in pursuing midwifery education and careers between February 22 and May 2, 2021.

STUDY DESIGN

Cross-sectional survey consisted of 76 questions (75 closed-ended and 1 open-ended questions) including personal, familial, community, and societal motivators and barriers to pursuing midwifery.

DATA COLLECTION/EXTRACTION METHODS

We recruited respondents 18 years and older who identified as persons of color by posting the survey link on midwifery, childbirth, and reproductive justice listservs, social media platforms, and through emails to relevant midwifery and doula networks. We conducted descriptive and bivariate analyses by demographic characteristics and used exemplar quotes from the open-ended question to illustrate findings from the descriptive data.

PRINCIPAL FINDINGS

The strongest motivating factors for the 799 respondents were providing racially concordant care for community members (87.7 percent), reducing racial disparities in health (67.2 percent), and personal experiences related to midwifery care (55.4 percent) and health care more broadly (54.6 percent). Main barriers to entering midwifery were direct (58.2 percent) and related (27.5 to 52.8 percent) costs of midwifery education, and lack of racial concordance in midwifery education and the midwifery profession (31.5 percent) that may contribute to racially motivated exclusion of people of color. Financial and educational barriers were strongest among those with lower levels of income or education.

CONCLUSIONS

Structural and interpersonal racisms are both motivators and barriers for aspiring midwives of color. Expanding and diversifying the perinatal workforce by addressing the financial and educational barriers of aspiring midwives of color, such as providing funding and culturally-competent midwifery education, creating a robust pipeline, and opening more midwifery schools, is a matter of urgency to address the maternal health crisis.

The Experience and Motivations of Midwives of Color in Minnesota: Nothing for Us Without Us

INTRODUCTION

Racial disparities in birth outcomes originate with a confluence of factors including social determinants of health, toxic stress, structural racism, and barriers to engaging, high-quality perinatal care. Historically and currently, midwives are disproportionately white, and attention to the racial and ethnic diversity of midwives is an increasing focus in birth equity efforts. This qualitative study helps fill the gap in literature by assessing the perspectives and motivations of midwives of color.

METHODS

Building on concepts from critical race theory, semistructured interviews (30-90 minutes long) were used to elicit an authentic voice from midwives of color, who primarily identified as African American. Participants (N = 7) were midwives who were affiliated with an African American-owned birth center in north Minneapolis, Minnesota. Participants represented an estimated 58% of all midwives of color in the state of Minnesota. Emergent themes were identified using a grounded theory, inductive approach. Three rounds of coding were conducted, and key themes were identified and analyzed.

RESULTS

Three primary themes emerged as motivations for midwives of color: 1) offering racially concordant care to the community, 2) racial justice as a primary motivation in their work, and 3) providing physically and emotionally safe care. Racially concordant care was identified both as a motivating factor and as a way of providing physically and emotionally safe care.

DISCUSSION

Findings suggest that midwives of color maintain a critical analysis of and commitment to eliminating racial perinatal inequities. Their motivation to provide racially concordant care elicits an urgency in current efforts to recruit and train more midwives of color, recognizing the current lack of racial and ethnic diversity in the field. Understanding how to support the work of equity-minded midwives of color may help to improve access to racially concordant health care providers and care that better meets the unique needs of African American individuals.

Non-traumatic musculoskeletal pain in Western Australian hospital emergency departments: A clinical audit of the prevalence, management practices and evidence-to-practice gaps

OBJECTIVES

Musculoskeletal pain (MSP) conditions are a leading cause of morbidity worldwide and a common reason for ED presentation. Little is currently known about non-traumatic MSP (NTMSP) presenting to EDs. The present study described the prevalence and management practices of NTMSP in EDs.

METHODS

The design was a retrospective clinical audit in two hospital EDs in Western Australia covering 3 months beginning 1 January 2016. We defined NTMSP as pain of musculoskeletal origin occurring in the absence of external force or excessive physical loading. The outcomes measured included: patient, condition and hospital-episode characteristics, as well as management practices. Management practices were compared to recommended care derived from guideline recommendations. These included: assessment for red flags and psychosocial risk factors, appropriate use of diagnostic imaging, provision of patient education, administration and prescription of analgesic medication, and assessment of risk factors for opioid-related harm.

RESULTS

Eight hundred and eighty-eight patients were included in the present study. NTMSP accounted for 3.0% of all ED presentations. According to clinician documentation, red flag and psychosocial assessments were recorded in 73.3 and 10.5% of patients. Forty-one percent of patients were referred for imaging, of which 39.7% were inconsistent with guideline recommendations. Education was recorded 52.0% of the time. At least one opioid medication was administered to 55.3% of patients and there was no documented assessment of risk factors for opioid-related harm.

CONCLUSIONS

NTMSP is a relatively common reason for ED presentation. Documented management practices are discordant with guideline recommendations. Strategies to improve the concordance between management and guideline recommendations are needed.