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Hotez E, Duan S, Ma J, Shankar S. An Urgent Need to Improve Accessibility of Preventive Services for People With Disabilities. Ann Intern Med 2025; 178:741-742. [PMID: 40063958 DOI: 10.7326/annals-25-00374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/21/2025] Open
Affiliation(s)
- Emily Hotez
- David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California
| | - Susan Duan
- David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California
| | - Janet Ma
- David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California
| | - Sahana Shankar
- David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California
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2
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Ho EY, Koenig CJ. Promoting interactional health equity through (Complementary and Integrative Health) talk during clinical encounters. PATIENT EDUCATION AND COUNSELING 2025; 134:108651. [PMID: 39862491 DOI: 10.1016/j.pec.2025.108651] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/20/2024] [Accepted: 01/08/2025] [Indexed: 01/27/2025]
Abstract
OBJECTIVES Complementary and Integrative Health (CIH) is recognized as a set of modalities to bolster health and well-being often outside of standard biomedical practice. How people discuss CIH with their biomedical providers is a microcosm for health communication more generally. In this Discussion, we propose a revision of the Street et al. (2009) conceptual framework to illustrate how CIH talk during a clinical encounter has the potential to contribute to (or detract from) interactional health equity. METHODS We use discourse analytic techniques to re-analyze two digitally recorded biomedical encounters. RESULTS Two case studies are re-analyzed to illustrate how clinician-client conversation about CIH during a clinical encounter might lead to interactional health equity. CONCLUSIONS Interactions with clinicians can be challenging due to differences in knowledge about biomedicine, administrative processes, and even navigating interpersonal relationships. How a clinician responds can either center a biomedical agenda in the Voice of Medicine or help ratify a patient's agenda in the Voice of the Lifeworld. How clinicians and patients negotiate CIH talk is conceptually linked with immediate interactional outcomes. PRACTICE IMPLICATIONS In populations in which patients/caregivers or their extended communities may already have low trust in biomedicine, a mistrustful therapeutic alliance, or history of discrimination, disattention of the Lifeworld and avoiding talk about CIH has the possibility of exacerbating inequities. Every turn at talk during a clinical encounter has the potential to foster increased social participation which, in turn, may contribute to health outcomes and influence patient and community well-being at individual, community, and institutional levels. CIH talk can open space for patients to actively participate in healthcare by incorporating the patients' Lifeworld into the clinical encounter and can contribute to interactional health equity within clinical encounters.
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Affiliation(s)
- Evelyn Y Ho
- Department of Communication Studies, University of San Francisco, San Francisco, USA; Asian American Research Center on Health, San Francisco, USA.
| | - Christopher J Koenig
- Department of Communication Studies, San Francisco State University, San Francisco, USA; Medical Cultures Lab, University of California, San Francisco, USA
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3
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Luercio M, Quiñones-Pérez B, Castellanos A, Ngo T, Elder B, Blaine K, Haskell H, Lopez K, Luff D, Mallick N, Mercer AN, Williams DN, Baird JD, Khan A. Communicating With Spanish-Speaking Families of Hospitalized Children With Medical Complexity. Hosp Pediatr 2024; 14:612-621. [PMID: 39069815 DOI: 10.1542/hpeds.2023-007700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Revised: 03/10/2024] [Accepted: 04/06/2024] [Indexed: 07/30/2024]
Abstract
BACKGROUND AND OBJECTIVES Hospitalized families who use languages other than English (LOE) for care encounter unique communication challenges, as do children with medical complexity (CMC). We sought to better understand communication challenges and opportunities to improve care of families who use LOE from the perspectives of hospital staff and Spanish-speaking parents of CMC. METHODS This qualitative project involved secondary analysis of transcripts from a study on family safety reporting at 2 quaternary care children's hospitals and additional primary data collection (interviews) of staff and parents. Bilingual researchers conducted audio-recorded, semistructured interviews with staff and Spanish-speaking parents of CMC during/after hospitalization. We professionally transcribed and translated interviews and developed, iteratively refined, and validated a codebook. Three independent researchers coded interviews using qualitative descriptive methodology and identified emerging themes through thematic analysis. RESULTS We coded 49 interviews (13 parents, 11 physicians, 13 nurses, 6 allied health professionals, 6 leaders). Five themes emerged: (1) assumptions and bias regarding specific groups who use LOE for care, (2) importance of trust and relationships, (3) importance of language-concordant care, (4) workarounds to address communication challenges, and (5) the "double-edged" sword of technology. Participant-suggested strategies to improve communication included increasing interpreter access for parents and staff, optimizing technology use, and minimizing bias and assumptions through training. CONCLUSIONS Parents of CMC and staff identified challenges and opportunities related to communicating with hospitalized families who use LOE for care. Solutions to improve communication and safety for these families should be attuned to needs of all parties involved.
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Affiliation(s)
- Marcella Luercio
- Division of General Pediatrics, Department of Pediatrics
- Departments of Pediatrics
| | | | - Angela Castellanos
- Division of General Pediatrics, Department of Pediatrics
- Departments of Pediatrics
| | - Tiffany Ngo
- Division of General Pediatrics, Department of Pediatrics
| | - Brynn Elder
- Division of General Pediatrics, Department of Pediatrics
| | - Kevin Blaine
- Institute for Nursing and Interprofessional Research, Children's Hospital Los Angeles, Los Angeles, California
| | - Helen Haskell
- Mothers Against Medical Errors, Columbia, South Carolina
| | - Kelleen Lopez
- Institute for Nursing and Interprofessional Research, Children's Hospital Los Angeles, Los Angeles, California
| | | | - Nandini Mallick
- Division of General Pediatrics, Department of Pediatrics
- Departments of Pediatrics
| | | | - David N Williams
- Institutional Centers for Clinical and Translational Research, Boston Children's Hospital, Boston, Massachusetts
- Orthopedic Surgery, Harvard Medical School, Boston, Massachusetts
| | - Jennifer D Baird
- Institute for Nursing and Interprofessional Research, Children's Hospital Los Angeles, Los Angeles, California
| | - Alisa Khan
- Division of General Pediatrics, Department of Pediatrics
- Departments of Pediatrics
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4
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Ng IK. Physicians, know thy patient. J R Coll Physicians Edinb 2024; 54:84-88. [PMID: 38523064 DOI: 10.1177/14782715241240510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/26/2024] Open
Abstract
Person-centered care is presently the standard healthcare model, which emphases shared clinical decision-making, patient autonomy and empowerment. However, many aspects of the modern-day clinical practice such as the increased reliance on medical technologies, artificial intelligence, and teleconsultation have significantly altered the quality of patient-physician communications. Moreover, many countries are facing an aging population with longer life expectancies but increasingly complex medical comorbidities, which, coupled with medical subspecialization and competing health systems, often lead to fragmentation of clinical care. In this article, I discuss what it truly means for a clinician to know a patient, which is, in fact, a highly intricate skill that is necessary to meet the high bar of person-centered care. I suggest that this can be achieved through the implementation of a holistic biopsychosocial model of clinical consultation at the physician level and fostering coordinated and continuity of care at the health systems level.
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Affiliation(s)
- Isaac Ks Ng
- Department of Medicine, National University Hospital, Singapore, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
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5
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Hogans-Mathews S, Flowers K, Terrance TC, Mouratidis R. Tossing and turning: Time to wake up and address racial inequities in insomnia treatment and health care. Sleep Health 2024; 10:7-8. [PMID: 37951774 DOI: 10.1016/j.sleh.2023.09.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Revised: 09/19/2023] [Accepted: 09/24/2023] [Indexed: 11/14/2023]
Affiliation(s)
| | - Kerwyn Flowers
- Florida State University College of Medicine, Tallahassee, Florida, USA
| | - Traci C Terrance
- University of Rochester Medical Center, Rochester, New York, USA
| | - Roxann Mouratidis
- Florida State University College of Medicine, Tallahassee, Florida, USA
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6
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Santoro CM, Farmer MC, Lobato G, James M, Herring SJ. Antiracism Training for Nutrition Professionals in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC): a Promising Strategy to Improve Attitudes, Awareness, and Actions. J Racial Ethn Health Disparities 2023; 10:2882-2889. [PMID: 36472807 PMCID: PMC9734826 DOI: 10.1007/s40615-022-01465-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Revised: 03/12/2022] [Accepted: 11/21/2022] [Indexed: 12/12/2022]
Abstract
INTRODUCTION Women, Infants and Children (WIC) nutrition professionals serve as frontline providers for Black families who disproportionately experience poor perinatal outcomes. With racism driving inequities, we developed an antiracism training tailored to WIC. This report describes the training framework, design, components, and evaluation. METHODS In 2019, with feedback from WIC providers, we created a 3-h antiracism training for Philadelphia WIC nutrition professionals that included an identity reflection, key concept definitions, workplace scenario and debrief, a model for repair and disruption, and an action tool. We implemented this training in August 2019 and surveyed WIC staff trainees' awareness of racism and skills to address bias before, immediately after, and 6 months post-training, comparing responses at each time point. RESULTS Among 42 WIC staff trainees, mean age was 30 years, 56% were white, 91% female, and 74% had no prior antiracism training. Before the training, 48% felt quite a bit or extremely aware of the role of racism in the healthcare system; this increased to 91% immediately after and was 75% 6 months later. Similar increases in confidence identifying and addressing interactions that perpetuate racism were achieved immediately after training, although the magnitude decreased by 6 months. One-third felt quite a bit or extremely confident the training improved participant interactions at the 6-month timepoint. Qualitative feedback reinforced findings. DISCUSSION Results suggest antiracism training may improve WIC nutrition professionals' attitudes, awareness, and actions and could be valuable in efforts to advance health equity. More work is needed to examine how changes translate into improvements for WIC participants.
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Affiliation(s)
- Christine M Santoro
- Program for Maternal Health Equity, Center for Urban Bioethics, Department of Urban Health and Population Science, Lewis Katz School of Medicine at Temple University, 3223 N. Broad Street, Suite 175, Philadelphia, PA, USA.
| | - Mari-Carmen Farmer
- Department of Obstetrics and Gynecology, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Gloria Lobato
- Program for Maternal Health Equity, Center for Urban Bioethics, Department of Urban Health and Population Science, Lewis Katz School of Medicine at Temple University, 3223 N. Broad Street, Suite 175, Philadelphia, PA, USA
- NORTH, Inc., Managers of the Philadelphia WIC Program, Philadelphia, PA, USA
| | - Monica James
- NORTH, Inc., Managers of the Philadelphia WIC Program, Philadelphia, PA, USA
| | - Sharon J Herring
- Program for Maternal Health Equity, Center for Urban Bioethics, Department of Urban Health and Population Science, Lewis Katz School of Medicine at Temple University, 3223 N. Broad Street, Suite 175, Philadelphia, PA, USA
- Department of Medicine, Lewis Katz School of Medicine at Temple University, Philadelphia, PA, USA
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7
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Masciale M, DiValerio Gibbs K, Asaithambi R, Murillo MC, Espinoza-Candelaria G, Jaramillo M, Domínguez J, Haq H, Fredricks K, Lopez MA, Bocchini C. Qualitative Study of Barriers and Facilitators to Care Among Children in Immigrant Families. Hosp Pediatr 2023; 13:1087-1096. [PMID: 37986609 DOI: 10.1542/hpeds.2023-007276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2023]
Abstract
OBJECTIVES Children in immigrant families comprise ∼25% of US children and live in families with high levels of poverty and food insecurity. Studies suggest a decline in public benefit enrollment among children in immigrant families. We aimed to explore perspectives on barriers and facilitators in accessing care among immigrant caregivers of hospitalized children. METHODS With a general qualitative descriptive design, we developed a semistructured interview guide using an iterative process informed by literature and content expertise. Using purposive sampling, we recruited immigrant caregivers of hospitalized children in March 2020 and conducted interviews in English or Spanish. Interviews were recorded, transcribed, and translated to English. Three authors coded transcripts using Dedoose and identified themes via thematic analysis. RESULTS Analysis of 12 caregiver interviews revealed barriers and facilitators in accessing healthcare and public benefit use. Barriers included healthcare system barriers, immigration-related fear, and racism and discrimination. Within healthcare system barriers, subthemes included language barriers, cost, complexity of resource application, and lack of guidance on available benefits. Within immigration-related fear, subthemes included fear of familial separation, fear of deportation, fear that benefit use affects immigration status, and provider distrust. Healthcare system facilitators of resource use included recruiting diverse workforces, utilizing language interpretation, guidance on benefit enrollment, legal services, and mental health services. Participants also recommended hospital partnership with trusted information sources, including media stations and low-cost clinics. CONCLUSIONS Immigrant caregivers of hospitalized children identified barriers and facilitators in access to care. Further research is needed to assess the efficacy of caregiver-suggested interventions.
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Affiliation(s)
- Marina Masciale
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas
| | | | - Rathi Asaithambi
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas
| | | | | | | | - José Domínguez
- Department of Psychiatry, Cambridge Health Alliance, Cambridge, Massachusetts
| | - Heather Haq
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas
| | - Karla Fredricks
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas
| | - Michelle A Lopez
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas
- Center for Child Health Policy and Advocacy, Texas Children's Hospital, Houston, Texas
| | - Claire Bocchini
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas
- Center for Child Health Policy and Advocacy, Texas Children's Hospital, Houston, Texas
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Loue S, Nicholas T. The CARE (Curiosity, Attentiveness, Respect and Responsiveness, and Embodiment) Model: Operationalizing Cultural Humility in the Conduct of Clinical Research. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:2021. [PMID: 38004070 PMCID: PMC10673287 DOI: 10.3390/medicina59112021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Revised: 10/23/2023] [Accepted: 10/25/2023] [Indexed: 11/26/2023]
Abstract
Cultural competence training has been criticized for reinforcing existing stereotypes, ignoring intersectionality and inadvertently marginalizing some individuals and groups. In contrast, cultural humility offers the possibility of transformational learning, requiring individuals to pursue a lifelong course of self-examination. This approach makes authentic engagement with others possible. We review the premises underlying cultural competence and cultural humility, as well as proposed models for the integration of cultural humility into the clinical context. We propose a new model for the integration of cultural humility into clinical research: CARE, signifying Curiosity, Attentiveness, Respect and Responsiveness, and Embodiment. We conclude that the concept of cultural humility can be integrated into the conduct of clinical research.
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Affiliation(s)
- Sana Loue
- School of Medicine, Case Western Reserve University, Cleveland, OH 44106, USA;
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9
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Ferro HP, Williams K, Holbrook DS, O'Conor KJ. Disproportionate impact of abortion restriction: Implications for emergency department clinicians. Am J Emerg Med 2023; 69:160-166. [PMID: 37121065 DOI: 10.1016/j.ajem.2023.04.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 04/11/2023] [Accepted: 04/18/2023] [Indexed: 05/02/2023] Open
Abstract
Individuals experiencing intimate partner violence (IPV) and/or human trafficking (HT) are at increased risk of severe health consequences as a result of legislation criminalizing and/or restricting abortion, which is expected to increase as a result of the Supreme Court decision Dobbs v. Jackson. These risks are further stratified by race, socioeconomics, and other marginalizing demographic attributes. IPV and HT introduce barriers to maintaining physical and mental health, due to control of access to transportation and funds by the abuser, fear of retribution for seeking healthcare, and other barriers. Individuals experiencing IPV or HT often lack reproductive autonomy, as a result of facing reproductive coercion at the hands of their abusers. Following the Dobbs decision, these vulnerable patient populations will face further limitations on their reproductive autonomy and increased obstacles to obtaining an abortion if they medically need or desire one. This will likely result in more patients presenting to the emergency department due to complications from unsafe or unsupervised self-managed abortions, as well as patients being reluctant to report having obtained an unlawful abortion due to fear of legal consequences. This is particularly relevant to individuals experiencing IPV and HT, as they may be more likely to use these methods for obtaining an abortion due to numerous barriers. Emergency medicine clinicians are vital in providing care to these patients, as they frequently present to emergency departments. A multi-pronged approach to better support these patients is essential, involving an increased index of suspicion for IPV, HT or the complications of unsupervised abortion, improved organizational structures, specialized training for staff, improved screening methods, reflection on implicit bias, and recommendations for mindful documentation and legal considerations.
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Affiliation(s)
- Haleigh P Ferro
- Johns Hopkins University School of Medicine, 733 N Broadway, Baltimore, MD 21287, United States.
| | - Kelly Williams
- Johns Hopkins Medicine, 1800 Orleans St, Baltimore, MD 21287, United States.
| | - Debra S Holbrook
- Mercy Medical Center, 345 St. Paul Pl, Baltimore, MD 21202, United States.
| | - Katie J O'Conor
- Johns Hopkins University School of Medicine, 733 N Broadway, Baltimore, MD 21287, United States.
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10
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Syed G, Sims J, House SH, Bruno B, Boulware A, Tang K, Curenton SM. Innovations and Opportunities in Care for Black Mothers and Birthing People. FAMILY & COMMUNITY HEALTH 2023; 46:87-94. [PMID: 36799941 DOI: 10.1097/fch.0000000000000361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
In recent years, there has been increased attention given to how racism fuels health inequities, including the inadequacy of prenatal care (PNC) that Black women and Black birthing people receive. This increase of attention has brought notable advancements in research, practice, and policy that intend to better understand and address these systemic inequities within the health care system. This review aims to provide an overview of promising developments in the study of Black mothers' and birthing people's experiences in PNC and delivery, to detail current research surrounding interventions to improve quality and mitigate bias in obstetric care, and to offer ways in which legislation can support such strategies targeting the root causes of inequities in care.
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Affiliation(s)
- Gullnar Syed
- SRI International, Arlington, Virginia (Ms Syed); Wheelock College of Education & Human Development, Boston University, Boston, Massachusetts (Mss Syed, Bruno, and Tang and Drs Sims and Curenton); Center for Youth, Family, and Community Partnerships, Durham County Cooperative Extension, North Carolina State University (Dr House); and Comparative Human Development, University of Chicago, Chicago, Illinois (Dr Boulware)
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11
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Benton TD. A Culturally Informed Approach to Supporting Suicidal Minoritized Patients. FOCUS (AMERICAN PSYCHIATRIC PUBLISHING) 2023; 21:166-167. [PMID: 37201136 PMCID: PMC10172557 DOI: 10.1176/appi.focus.20220077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/20/2023]
Affiliation(s)
- Tami D Benton
- Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
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12
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Abstract
ABSTRACT Recent studies indicate that practicing cultural humility versus cultural competency increases the quality of care for patients. This article discusses the differences between cultural competence and humility and explores the best practices for adopting and demonstrating cultural humility in nursing care.
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Affiliation(s)
- Aishia Wall
- Aishia Wall is a family nurse practitioner student at SUNY Brockport
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13
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Richman I, Tessier-Sherman B, Galusha D, Oladele CR, Wang K. Breast cancer screening during the COVID-19 pandemic: moving from disparities to health equity. J Natl Cancer Inst 2023; 115:139-145. [PMID: 36069622 PMCID: PMC9494402 DOI: 10.1093/jnci/djac172] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Revised: 08/02/2022] [Accepted: 08/29/2022] [Indexed: 11/19/2022] Open
Abstract
The COVID-19 pandemic created unprecedented disruptions to routine health care in the United States. Screening mammography, a cornerstone of breast cancer control and prevention, was completely halted in the spring of 2020, and screening programs have continued to face challenges with subsequent COVID-19 waves. Although screening mammography rates decreased for all women during the pandemic, a number of studies have now clearly documented that reductions in screening have been greater for some populations than others. Specifically, minoritized women have been screened at lower rates than White women across studies, although the specific patterns of disparity vary depending on the populations and communities studied. We posit that these disparities are likely due to a variety of structural and contextual factors, including the differential impact of COVID-19 on communities. We also outline key considerations for closing gaps in screening mammography. First, practices, health systems, and communities must measure screening mammography use to identify whether gaps exist and which populations are most affected. Second, we propose that strategies to close disparities in breast cancer screening must be multifaceted, targeting the health system or practice, but also structural factors at the policy level. Health disparities arise from a complex set of conditions, and multimodal solutions that address the complex, multifactorial conditions that lead to disparities may be more likely to succeed and are necessary for promoting health equity.
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Affiliation(s)
- Ilana Richman
- Department of Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Baylah Tessier-Sherman
- Department of Medicine, Equity Research and Innovation Center, Yale School of Medicine, New Haven, CT, USA
| | - Deron Galusha
- Department of Medicine, Equity Research and Innovation Center, Yale School of Medicine, New Haven, CT, USA
| | - Carol R Oladele
- Department of Medicine, Yale School of Medicine, New Haven, CT, USA
- Department of Medicine, Equity Research and Innovation Center, Yale School of Medicine, New Haven, CT, USA
| | - Karen Wang
- Department of Medicine, Yale School of Medicine, New Haven, CT, USA
- Department of Medicine, Equity Research and Innovation Center, Yale School of Medicine, New Haven, CT, USA
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14
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Janus SE, Makhlouf M, Chahine N, Motairek I, Al-Kindi SG. Examining Disparities and Excess Cardiovascular Mortality Before and During the COVID-19 Pandemic. Mayo Clin Proc 2022; 97:2206-2214. [PMID: 36336516 PMCID: PMC9300586 DOI: 10.1016/j.mayocp.2022.07.008] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Revised: 06/25/2022] [Accepted: 07/15/2022] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To investigate the patterns and demographic features of cardiovascular disease (CVD) death and subtypes myocardial infarction (MI), stroke, and heart failure in the pre-COVID-19 era (2018-2019) vs during the COVID-19 pandemic (2020-2021) in the United States. METHODS In this cross-sectional study, we used the US Multiple Cause of Death files for 2018 to 2021 to examine the trend of excess cause-specific deaths using International Classification of Diseases, Tenth Revision codes for CVD (I00 to I99), MI (I21 and I22), stroke (I60 to I69), and heart failure (I42 and I50). Our primary outcome was excess mortality from CVD and its 3 subtypes (MI, stroke, and heart failure) between prepandemic (2018-2019) and pandemic (2020-2021) years. We performed a subgroup analysis on race and month-to-month and year-to-year variation using χ2 analysis to test statistical significance. RESULTS Overall, 3,598,352 CVD deaths were analyzed during the study period. There was a 6.7% excess CVD mortality, 2.5% MI mortality, and 8.5% stroke mortality during the COVID-19 pandemic (2020-2021) compared with the prepandemic era (2018-2019). Black individuals had higher excess CVD mortality (13.8%) than White individuals (5.1%; P<.001). This remained consistent across subtypes of CVD, including MI (9.6% vs 1.0%; P<.001), stroke (14.5% vs 6.9%; P<.001), and heart failure (5.1% vs -1.2%; P<.001). CONCLUSION There has been a significant rise in CVD and subtype-specific mortality during the COVID-19 pandemic that has been persistent despite 2 years since the onset of the pandemic. Excess CVD mortality has disproportionately affected Black compared with White individuals. Further studies targeting and eliminating health care disparities are necessary.
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Affiliation(s)
- Scott E Janus
- Department of Medicine, University Hospitals, Cleveland, OH; Harrington Heart and Vascular Institute, University Hospitals and School of Medicine, Case Western Reserve University, Cleveland, OH
| | - Mohamed Makhlouf
- Department of Medicine, University Hospitals, Cleveland, OH; Harrington Heart and Vascular Institute, University Hospitals and School of Medicine, Case Western Reserve University, Cleveland, OH
| | | | - Issam Motairek
- Department of Medicine, University Hospitals, Cleveland, OH; Harrington Heart and Vascular Institute, University Hospitals and School of Medicine, Case Western Reserve University, Cleveland, OH
| | - Sadeer G Al-Kindi
- Department of Medicine, University Hospitals, Cleveland, OH; Harrington Heart and Vascular Institute, University Hospitals and School of Medicine, Case Western Reserve University, Cleveland, OH.
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15
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Attanasio LB, Ranchoff BL, Paterno MT, Kjerulff KH. Person-Centered Maternity Care and Health Outcomes at 1 and 6 Months Postpartum. J Womens Health (Larchmt) 2022; 31:1411-1421. [PMID: 36067084 PMCID: PMC9618378 DOI: 10.1089/jwh.2021.0643] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Objectives: Person-centered care has been increasingly recognized as an important aspect of health care quality, including in maternity care. Little is known about correlates and outcomes of person-centered care in maternity care in the United States. Materials and Methods: Data were from a prospective cohort of more than 3000 individuals who gave birth to a first baby in a Pennsylvania hospital. Person-centered maternity care was measured via a 13-item rating scale administered 1-month postpartum. Content validity was established through exploratory factor analysis. The resulting scale had scores ranging from 13 to 54, with Cronbach's alpha of 0.86. Using linear and logistic regression models to control for covariates, we examined associations between participants' characteristics and person-centered maternity care and between person-centered maternity care and postpartum outcomes. Results: Participants had a mean total score of 47.80 on the person-centered maternity care scale. Patient factors independently associated with more person-centered maternity care included older age, more positive attitude toward vaginal birth during pregnancy, and spontaneous vaginal birth. In adjusted models, higher person-centered maternity scale scores were strongly associated with many positive physical and mental health outcomes at 1 and 6 months postpartum. Conclusions: Our findings underscore the importance of person-centered maternity not just due to its intrinsic value but also because it may be associated with both mental and physical health outcomes through the postpartum period. Results suggest that policy efforts are necessary to ensure person-centered maternity care, especially for delivery hospitalization experience.
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Affiliation(s)
- Laura B. Attanasio
- Department of Health Promotion and Policy, School of Public Health and Health Sciences, University of Massachusetts Amherst, Amherst, Massachusetts, USA
| | - Brittany L. Ranchoff
- Department of Health Promotion and Policy, School of Public Health and Health Sciences, University of Massachusetts Amherst, Amherst, Massachusetts, USA
| | - Mary T. Paterno
- Cooley Dickinson ObGyn and Midwifery, Cooley Dickinson Medical Group, Northampton, Massachusetts, USA
| | - Kristen H. Kjerulff
- Department of Public Health Sciences and Penn State College of Medicine, Hershey, Pennsylvania, USA
- Department of Obstetrics and Gynecology, Penn State College of Medicine, Hershey, Pennsylvania, USA
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Rivera D, Jukkala A, Rohini T. Introduction to Rivera's Gender Affirming Nursing Care Model: A Middle-Range Theory. J Holist Nurs 2022; 40:255-264. [PMID: 34665078 DOI: 10.1177/08980101211046747] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Purpose: Currently, standards for transgender care guide surgical, hormonal, cosmetic and psychological care, yet do not include the domain of nursing care and nursing sensitive care outcomes. In response, the purpose of this project was to create a middle-range nursing theory to guide transgender nursing care. Methods: Rivera's Gender Affirming Nursing Care (GANC) Model was developed using a community informed iterative process, combining and modifying two existing theories. Each theory was evaluated, construct templates were created, modified, and expanded to create the proposed gender transcendent model. Face validity was established through expert and community review. Findings: Concepts identified include: Relationship (Join With), Knowledge (Learn With) and Engagement (Partner With). Action within the model is propelled by drivers, including ongoing learning, ongoing research, ongoing self-assessment, and leadership. The model operates within the recognized domains of nursing, to support gender affirming nursing care. Conclusions: The middle-range theory was tested and found to stimulate gender neutral thinking; however, the model would benefit from additional testing to determine impact on nursing and patient outcomes. The model allows the nurse, through self-reflection and other internal growth mechanisms, to identify personal implicit and explicit bias. It is through these actions and shifting paradigms that nurses develop a personal gender affirming nursing practice.
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17
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Tackling the lack of diversity in health research. Br J Gen Pract 2022. [DOI: 10.3399/bjgp22x720665] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
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18
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19
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Respectful Maternity Care Framework and Evidence-Based Clinical Practice Guideline. J Obstet Gynecol Neonatal Nurs 2022; 51:e3-e54. [PMID: 35101344 DOI: 10.1016/j.jogn.2022.01.001] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
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20
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Abstract
Medical educators' stressors continue to increase, and they increasingly find themselves removed from their learners. This distance is thought to contribute to the disenchantment many educators feel. The challenge for educators is to reengage with their learners and restore their satisfaction in teaching. Mindful teaching can help educators meet this challenge. Mindful teaching is not an instructional technique; rather, it is a way of being that the teacher embodies. Mindful teachers practice awareness, acceptance and curiosity. They recognize the needs of their learners, engaging with learners who are 'at the ready'; encouraging those who might not be engaged; and advocating for those who need support. These educators are less susceptible to burnout and help learners develop their own mindfulness. The Tips noted in this article can help educators make deeper connections with their learners, garner greater sense of personal accomplishment and become invigorated by their learners' achievements.
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Affiliation(s)
- Elisa Sottile
- University of Florida College of Medicine Jacksonville, Jacksonville, FL, USA
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21
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Ruggiero KJ, Anton MT, Davidson TM, deRoon-Cassini TA, Hink AB. It is time to prioritize complete trauma care. J Trauma Acute Care Surg 2022; 92:e18-e21. [PMID: 34591038 DOI: 10.1097/ta.0000000000003423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Kenneth J Ruggiero
- From the Departments of Nursing and Psychiatry and Behavioral Sciences, College of Nursing (K.J.R., T.M.D.), College of Nursing (M.T.A.), Medical University of South Carolina, Charleston, South Carolina; Departments of Surgery, Psychiatry, and Institute for Health and Equity (T.A.dR.-C.), Medical College of Wisconsin, Milwaukee, Wisconsin; and Department of Surgery (A.B.H.), College of Medicine, Medical University of South Carolina, Charleston, South Carolina
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22
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Purtell R, Tam RP, Avondet E, Gradick K. We are part of the problem: the role of children's hospitals in addressing health inequity. Hosp Pract (1995) 2021; 49:445-455. [PMID: 35061953 DOI: 10.1080/21548331.2022.2032072] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Accepted: 01/17/2022] [Indexed: 06/14/2023]
Abstract
Racism is an ongoing public health crisis that undermines health equity for all children in hospitals across our nation. The presence and impact of institutionalized racism contributes to health inequity and is under described in the medical literature. In this review, we focus on key interdependent areas to foster inclusion, diversity, and equity in Children's Hospitals, including 1) promotion of workforce diversity 2) provision of anti-racist, equitable hospital patient care, and 3) prioritization of academic scholarship focused on health equity research, quality improvement, medical education, and advocacy. We discuss the implications for clinical and academic practice.Plain Language Summary: Racism in Children's Hospitals harms children. We as health-care providers and hospital systems are part of the problem. We reviewed the literature for the best ways to foster inclusion, diversity, and equity in hospitals. Hospitals can be leaders in improving child health equity by supporting a more diverse workforce, providing anti-racist patient care, and prioritizing health equity scholarship.
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Affiliation(s)
- Rebecca Purtell
- Assistant Professor of Pediatrics, Division of Pediatric Hospital Medicine, Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Reena P Tam
- Assistant Professor of Pediatrics, Division of Pediatric Hospital Medicine, Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Erin Avondet
- Assistant Professor of Pediatrics, Division of Pediatric Hospital Medicine, Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Katie Gradick
- Assistant Professor of Pediatrics, Division of Pediatric Palliative Care, Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, Utah, USA
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23
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Pedrotty M, Wong TS, Wilde EA, Bigler ED, Laatsch LK. Application of neuropsychology and imaging to brain injury and use of the integrative cognitive rehabilitation psychotherapy model. NeuroRehabilitation 2021; 49:307-327. [PMID: 34420990 DOI: 10.3233/nre-218028] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND An early approach to cognitive rehabilitation therapy (CRT) was developed based on A. R. Luria's theory of brain function. Expanding upon this approach, the Integrative Cognitive Rehabilitation Psychotherapy model (ICRP) was advanced. OBJECTIVE To describe the ICRP approach to treatment of clients post brain injury and provide a comprehensive list of evaluation tools to determine the client's abilities and needs. Finally, to provide a link between CRT and functional imaging studies designed to improve rehabilitation efforts. METHODS History of cognitive rehabilitation and neuropsychological testing is reviewed and description of cognitive, academic, psychiatric, and substance abuse tools are provided. Cognitive and emotional treatment techniques are fully described. Additionally, a method of determining the client's stage of recovery and pertinent functional imaging studies is detailed. RESULTS Authors have been able to provide a set of tools and techniques to use in comprehensive treatment of clients with brain injury. CONCLUSIONS Inclusive treatment which is outlined in the ICRP model is optimal for the client's recovery and return to a full and satisfying life post brain injury. The model provides a framework for neuropsychologists to integrate issues that tend to co-occur in clients living with brain injury into a unified treatment plan.
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Affiliation(s)
- Mark Pedrotty
- Tingley Hospital Outpatient -UNM, Albuquerque, NM, USA
| | - Tiffanie S Wong
- Polytrauma Rehabilitation Center, Comprehensive Rehabilitation Center, Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA.,Stem Cognitive and Psychological Rehabilitation, Inc., Palo Alto, CA, USA
| | - Elisabeth A Wilde
- Traumatic Brain Injury and Concussion Center, Department of Neurology, University of Utah, Salt Lake City, UT, USA.,George E. Wahlen Veterans' Affairs Medical Center, Salt Lake City, UT, USA
| | - Erin D Bigler
- Traumatic Brain Injury and Concussion Center, Department of Neurology, University of Utah, Salt Lake City, UT, USA.,Psychology Department and Neuroscience Center, Brigham Young University, Provo, UT, USA
| | - Linda K Laatsch
- Department of Neurology, University of Illinois, Chicago, IL, USA
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24
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Akerele O, McCall M, Aragam G. Healing Ethno-Racial Trauma in Black Communities: Cultural Humility as a Driver of Innovation. JAMA Psychiatry 2021; 78:703-704. [PMID: 33881471 DOI: 10.1001/jamapsychiatry.2021.0537] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Opemipo Akerele
- David Geffen School of Medicine at the University of California, Los Angeles, Charles R. Drew University of Medicine and Science, Los Angeles.,Brainstorm, Stanford Lab for Mental Health Innovation, Stanford School of Medicine, Palo Alto, California
| | - Madison McCall
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill.,Brainstorm, Stanford Lab for Mental Health Innovation, Stanford School of Medicine, Palo Alto, California
| | - Gowri Aragam
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston.,Brainstorm, Stanford Lab for Mental Health Innovation, Stanford School of Medicine, Palo Alto, California
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25
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Bennett CL, Yiadom MYAB, Baker O, Marsh RH. Examining Parity among Black and Hispanic Resident Physicians. J Gen Intern Med 2021; 36:1722-1725. [PMID: 33629264 PMCID: PMC8175607 DOI: 10.1007/s11606-021-06650-7] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Accepted: 01/31/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND The US physician workforce does not represent the racial or ethnic diversity of the population it serves. OBJECTIVES To assess whether the proportion of US physician trainees of Black race and Hispanic ethnicity has changed over time and then provide a conceptual projection of future trends. DESIGN Cross-sectional, retrospective, analysis based on 11 years of publicly available data paired with recent US census population estimates. PARTICIPANTS A total of 86,303 (2007-2008) to 103,539 (2017-2018) resident physicians in the 20 largest US Accreditation Council for Graduate Medical Education resident specialties. MAIN MEASURES Changes in proportion of physician trainees of Black race and Hispanic ethnicity per academic year. Projected number of years it will then take, for specialties with positive changes, to reach proportions of Black race and Hispanic ethnicity comparable to that of the US population. KEY RESULTS Among the 20 largest specialty training programs, Radiology was the only specialty with a statistically significant increase in the proportion of Black trainees, but it could take Radiology 77 years to reach levels of Black representation comparable to that of the US population. Obstetrics/Gynecology, Emergency Medicine, Internal Medicine/Pediatrics, and Orthopedic Surgery demonstrated a statistically significant increase in the proportion of Hispanic trainees, but it could take these specialties 35, 54, 61, and 93 years respectively to achieve Hispanic representation comparable to that of the US population. CONCLUSIONS Among US residents in the 20 largest specialties, no specialty represented either the Black or Hispanic populations in proportions comparable to the overall US population. Only a small number of specialties demonstrated statistically significant increases. This conceptual projection suggests that current efforts to promote diversity are insufficient.
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Affiliation(s)
- Christopher L Bennett
- Department of Emergency Medicine, Stanford University School of Medicine, Stanford, USA.
| | - Maame Yaa A B Yiadom
- Department of Emergency Medicine, Stanford University School of Medicine, Stanford, USA
| | - Olesya Baker
- Center for Clinical Investigation, Brigham and Women's Hospital and Harvard Medical School, Boston, USA
| | - Regan H Marsh
- Department of Emergency Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, USA
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26
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Saluja B, Bryant Z. How Implicit Bias Contributes to Racial Disparities in Maternal Morbidity and Mortality in the United States. J Womens Health (Larchmt) 2020; 30:270-273. [PMID: 33237843 DOI: 10.1089/jwh.2020.8874] [Citation(s) in RCA: 99] [Impact Index Per Article: 19.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Over the past two decades, maternal mortality rates have declined around the world. In the United States, however, 700 women die each year as a result of pregnancy or delivery complications. This represents a 50% increase in the U.S. maternal mortality rate over the same time period. According to the Centers for Disease Control and Prevention (CDC), the pregnancy-related mortality ratios vary significantly by race, with White women experiencing 13.0 deaths per 100,000 births, compared with 42.8 deaths per 100,000 births for Black women, from 2011 to 2015. Multiple studies suggest that implicit bias-defined as the attitudes or stereotypes that affect our understanding, actions, and decisions in an unconscious manner-is most likely a contributing factor to this alarming racial health disparity. The failure to recognize the pain of African American patients, regardless of whether it is conscious or unconscious, has the potential to affect the way obstetrician/gynecologists counsel patients about treatment options when it comes to chronic conditions, contraception, vaginal birth after cesarean delivery, and the management of fibroids. In this article, we will review implicit bias and the impact it can have on health care and health disparities.
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Affiliation(s)
- Bani Saluja
- Department of Behavioral and Community Health, University of Maryland School of Public Health, College Park, Maryland, USA
| | - Zenobia Bryant
- Scientific Consulting Group, Inc., Gaithersburg, Maryland, USA
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27
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Robinson D, Masters C, Ansari A. The 5Rs of Cultural Humility: A Conceptual Model for Healthcare Leaders. Am J Med 2020; 134:S0002-9343(20)30914-1. [PMID: 34756854 DOI: 10.1016/j.amjmed.2020.09.029] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Revised: 09/12/2020] [Accepted: 09/14/2020] [Indexed: 12/01/2022]
Affiliation(s)
- Dea Robinson
- Metropolitan State University, Department of Health Professions, Denver, CO
| | - Christie Masters
- University of California - Los Angeles, Department of Medicine, Westwood, California
| | - Aziz Ansari
- Loyola University Medical Center, Division of Hospital Medicine, Maywood, IL.
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28
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Ko E, Fuentes D, Singh-Carlson S, Nedjat-Haiem F. Challenges and facilitators of hospice decision-making: a retrospective review of family caregivers of home hospice patients in a rural US-Mexico border region-a qualitative study. BMJ Open 2020; 10:e035634. [PMID: 32611740 PMCID: PMC7332198 DOI: 10.1136/bmjopen-2019-035634] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVES Hospice care (HC) is seen as a comprehensive approach, that enhances quality of end-of-life (EOL) care, for terminally ill patients. Despite its positive aspects, HC enrolment is disproportionate for rural patients, who are less likely to use HC in comparison to their urban counterparts. The purpose of this study was to explore decision-making experiences, related to utilisation of HC programmes from a retrospective perspective, with family caregivers (FCGs) in a rural US-Mexico border region. DESIGN This qualitative study was conducted from May 2017 to January 2018 using semistructured face to face interviews with FCGs. Data were analysed using thematic analysis. SETTING The HC programme was situated at a local home health agency, located in rural Southern California, USA. PARTICIPANTS Twenty-eight informal FCGs of patients who were actively enrolled in the HC programme agreed to participate in the study. RESULTS Conversation about HC as an option was initiated by home healthcare staff (39.3%), followed by physicians (32.1%). Emerging themes related to challenges in utilisation of HC and decision-making included: (1) communication barriers; (2) lack of knowledge/misperception about HC; (3) emotional difficulties, including fear of losing their patient, doubt and uncertainty about the decision, denial and (4) patients are not ready for HC. Facilitators included: (1) patient's known EOL wishes; (2) FCG-physician EOL communication; (3) the patient's deteriorating health and (4) home as the place for death. CONCLUSIONS HC patients' FCGs in this rural region reported a lack of knowledge or misunderstanding of HC. It is recommended that healthcare providers need to actively engage family members in patient's EOL care planning. Optimal transition to an HC programme can be facilitated when FCGs are informed and have a clear understanding about patients' medical status along with information about HC.
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Affiliation(s)
- Eunjeong Ko
- Social Work, San Diego State University, San Diego, California, USA
| | - Dahlia Fuentes
- Social Work, San Diego State University, San Diego, California, USA
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29
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Burke RE, Leonard C, Lee M, Ayele R, Cumbler E, Allyn R, Greysen SR. Cognitive Biases Influence Decision-Making Regarding Postacute Care in a Skilled Nursing Facility. J Hosp Med 2020; 15:22-27. [PMID: 31433771 PMCID: PMC6932595 DOI: 10.12788/jhm.3273] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Revised: 05/28/2019] [Accepted: 06/23/2019] [Indexed: 11/20/2022]
Abstract
BACKGROUND Decisions about postacute care are increasingly important as the United States population ages, its use becomes increasingly common, and payment reforms target postacute care. However, little is known about how to improve these decisions. OBJECTIVE To understand whether cognitive biases play an important role in patient and clinician decision-making regarding postacute care in skilled nursing facilities (SNFs) and identify the most impactful biases. DESIGN Secondary analysis of 105 semistructured interviews with patients, caregivers, and clinicians. SETTING Three hospitals and three SNFs in a single metropolitan area. PATIENTS Adults over age 65 discharged to SNFs after hospitalization as well as patients, caregivers, and multidisciplinary frontline clinicians in both hospital and SNF settings. MEASUREMENTS We identified potential cognitive biases from prior systematic and narrative reviews and conducted a team-based framework analysis of interview transcripts to identify potential biases. RESULTS Authority bias/halo effect and framing bias were the most prevalent and seemed the most impactful, while default/status quo bias and anchoring bias were also present in decision-making about SNFs. CONCLUSIONS Cognitive biases play an important role in decision-making about postacute care in SNFs. The combination of authority bias/halo effect and framing bias may synergistically increase the likelihood of patients accepting SNFs for postacute care. As postacute care undergoes a transformation spurred by payment reforms, it is increasingly important to ensure that patients understand their choices at hospital discharge and can make high-quality decisions consistent with their goals.
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Affiliation(s)
- Robert E Burke
- Center for Health Equity Research and Promotion (CHERP); Corporal Crescenz VA Medical Center, Philadelphia, Pennsylvania
- Hospital Medicine Section, Division of General Internal Medicine, Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Chelsea Leonard
- Center of Innovation for Veteran-Centered and Value-Driven Care; Denver VA Medical Center, Aurora, Colorado
| | - Marcie Lee
- Center of Innovation for Veteran-Centered and Value-Driven Care; Denver VA Medical Center, Aurora, Colorado
| | - Roman Ayele
- Center of Innovation for Veteran-Centered and Value-Driven Care; Denver VA Medical Center, Aurora, Colorado
| | - Ethan Cumbler
- Division of Hospital Medicine, Department of Medicine, University of Colorado School of Medicine, Aurora, Colorado
| | - Rebecca Allyn
- Department of Medicine, Denver Health and Hospital Authority, Denver, Colorado
| | - S Ryan Greysen
- Hospital Medicine Section, Division of General Internal Medicine, Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
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