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Nosheny RL, Yen D, Howell T, Camacho M, Moulder K, Gummadi S, Bui C, Kannan S, Ashford MT, Knight K, Mayo C, McMillan M, Petersen RC, Stricker NH, Roberson ED, Chambless C, Gersteneker A, Martin R, Kennedy R, Zhang Y, Kukull W, Flenniken D, Fockler J, Truran D, Mackin RS, Weiner MW, Morris JC, Li Y. Evaluation of the Electronic Clinical Dementia Rating for Dementia Screening. JAMA Netw Open 2023; 6:e2333786. [PMID: 37707812 PMCID: PMC10502518 DOI: 10.1001/jamanetworkopen.2023.33786] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Accepted: 08/01/2023] [Indexed: 09/15/2023] Open
Abstract
Importance The Clinical Dementia Rating (CDR) is a well-validated instrument widely used to detect and stage dementia due to Alzheimer disease. The digital Electronic Clinical Dementia Rating (eCDR) can be remotely self-administered and automatically scored, with potential to facilitate efficient dementia screening and staging. Objective To evaluate the association of the eCDR with the CDR and other in-clinic assessments for screening older adults for cognitive impairment. Design, Setting, and Participants This multisite, cross-sectional study used baseline data from a longitudinal, observational study from 2020 to 2023, including up to 3 years of follow-up. Participants were enrolled from 3 Alzheimer Disease Research Centers and the Brain Health Registry. Participants (aged ≥55 years, with a study partner, and no acute or unstable major medical conditions) were recruited during in-clinic visits or by automated emails. Exposures Participants completed the Uniform Data Set Version 3 (UDS; including the CDR) in supervised clinical research settings, and then completed the eCDR remotely, online and unsupervised, using their own device. Main Outcomes and Measures The primary outcomes were eCDR scores (item; categorical box and global; continuous box and global), CDR scores (item; categorical box and global), and UDS assessment scores. Associations were evaluated using linear and logistic regressions. Results A total of 3565 participants were contacted, and 288 were enrolled. Among 173 participants with item-level data (mean [SD] age, 70.84 [7.65] years; 76 women [43.9%]), eCDR to CDR concordance was 90% or higher for 33 items (63%) and 70% to 89% for 13 items (25%). Box (domain) level concordance ranged from 80% (memory) to 99% (personal care). The global score concordance rate was 81%. κ statistics were fair to moderate. Among 206 participants with box and global scores (mean [SD] age, 71.34 [7.68] years; 95 women [46.1%]), eCDR continuous global score was associated with CDR global (categorical) score with an area under the receiver operating characteristic curve of 0.79 (95% CI, 0.70-0.87). Correlations between eCDR and in-clinic UDS assessments were similar to those between CDR sum of box scores and the same in-clinic assessments. Conclusions and Relevance These findings suggest that the eCDR is valid and has potential use for screening and assessment of older adults for cognitive and functional decline related to Alzheimer disease. Instrument optimization and validation in diverse cohorts in remote settings are crucial for evaluating scalability and eCDR utility in clinical research, trials, and health care settings.
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Affiliation(s)
- Rachel L. Nosheny
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco
- Department of Radiology and Biomedical Imaging, University of California, San Francisco
- Northern California Institute for Research and Education, Department of Veterans Affairs Medical Center, San Francisco
| | - Daniel Yen
- Knight Alzheimer’s Disease Research Center, Department of Neurology, Washington University School of Medicine, St Louis, Missouri
| | - Taylor Howell
- Department of Radiology and Biomedical Imaging, University of California, San Francisco
| | - Monica Camacho
- Department of Radiology and Biomedical Imaging, University of California, San Francisco
| | - Krista Moulder
- Knight Alzheimer’s Disease Research Center, Department of Neurology, Washington University School of Medicine, St Louis, Missouri
| | - Shilpa Gummadi
- Department of Radiology and Biomedical Imaging, University of California, San Francisco
| | - Chau Bui
- Department of Radiology and Biomedical Imaging, University of California, San Francisco
| | - Sandhya Kannan
- Department of Radiology and Biomedical Imaging, University of California, San Francisco
| | - Miriam T. Ashford
- Northern California Institute for Research and Education, Department of Veterans Affairs Medical Center, San Francisco
| | - Kristen Knight
- Department of Radiology and Biomedical Imaging, University of California, San Francisco
| | - Connie Mayo
- Knight Alzheimer’s Disease Research Center, Department of Neurology, Washington University School of Medicine, St Louis, Missouri
| | - Maureen McMillan
- Knight Alzheimer’s Disease Research Center, Department of Neurology, Washington University School of Medicine, St Louis, Missouri
| | | | - Nikki H. Stricker
- Division of Neurocognitive Disorders, Department of Psychiatry and Psychology, Mayo Clinic, Rochester, Minnesota
| | - Erik D. Roberson
- Alzheimer’s Disease Center, Center for Neurodegeneration and Experimental Therapeutics, Department of Neurology, University of Alabama at Birmingham, Birmingham
| | - Carol Chambless
- Alzheimer’s Disease Center, Center for Neurodegeneration and Experimental Therapeutics, Department of Neurology, University of Alabama at Birmingham, Birmingham
| | - Adam Gersteneker
- Division of Neuropsychology, Department of Neurology, The University of Alabama at Birmingham, Birmingham
| | - Roy Martin
- Division of Neuropsychology, Department of Neurology, The University of Alabama at Birmingham, Birmingham
| | - Richard Kennedy
- Division of Gerontology, Geriatrics, and Palliative Care, Department of Medicine, University of Alabama at Birmingham, Birmingham
| | - Yue Zhang
- Alzheimer’s Disease Center, Center for Neurodegeneration and Experimental Therapeutics, Department of Neurology, University of Alabama at Birmingham, Birmingham
| | - Walter Kukull
- Department of Epidemiology, University of Washington, Seattle
- National Alzheimer’s Coordinating Center, Seattle, Washington
| | - Derek Flenniken
- Northern California Institute for Research and Education, Department of Veterans Affairs Medical Center, San Francisco
| | - Juliet Fockler
- Department of Radiology and Biomedical Imaging, University of California, San Francisco
| | - Diana Truran
- Northern California Institute for Research and Education, Department of Veterans Affairs Medical Center, San Francisco
| | - R. Scott Mackin
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco
- Northern California Institute for Research and Education, Department of Veterans Affairs Medical Center, San Francisco
| | - Michael W. Weiner
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco
- Department of Radiology and Biomedical Imaging, University of California, San Francisco
- Northern California Institute for Research and Education, Department of Veterans Affairs Medical Center, San Francisco
| | - John C. Morris
- Knight Alzheimer’s Disease Research Center, Department of Neurology, Washington University School of Medicine, St Louis, Missouri
| | - Yan Li
- Knight Alzheimer’s Disease Research Center, Department of Neurology, Washington University School of Medicine, St Louis, Missouri
- Department of Biostatistics, Washington University School of Medicine, St Louis, Missouri
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Howell T, Gummadi S, Bui C, Santhakumar J, Knight K, Roberson ED, Marson D, Chambless C, Gersteneker A, Martin R, Kennedy R, Zhang Y, Morris JC, Moulder KL, Mayo C, Carroll M, Li Y, Petersen RC, Stricker NH, Nosheny RL, Mackin S, Weiner MW. Development and implementation of an electronic Clinical Dementia Rating and Financial Capacity Instrument-Short Form. Alzheimers Dement (Amst) 2022; 14:e12331. [PMID: 35898521 PMCID: PMC9309008 DOI: 10.1002/dad2.12331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Accepted: 05/10/2022] [Indexed: 06/15/2023]
Abstract
INTRODUCTION To address the need for remote assessments of cognitive decline and dementia, we developed and administered electronic versions of the Clinical Dementia Rating (CDR®) and the Financial Capacity Instrument-Short Form (FCI-SF) (F-CAP®), called the eCDR and eFCI, respectively. METHODS The CDR and FCI-SF were adapted for remote, unsupervised, online use based on item response analysis of the standard instruments. Participants completed the eCDR and eFCI first in clinic, and then at home within 2 weeks. RESULTS Of the 243 enrolled participants, 179 (73%) cognitively unimpaired (CU), 50 (21%) with mild cognitive impairment (MCI) or dementia, and 14 (6%) with an unknown diagnosis, 84% and 85% of them successfully completed the eCDR and eFCI, respectively, at home. DISCUSSION These results show initial feasibility in developing and administering online instruments to remotely assess and monitor cognitive decline along the CU to MCI/very mild dementia continuum. Validation is an important next step.
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Affiliation(s)
- Taylor Howell
- San Francisco Department of Radiology and Biomedical ImagingUniversity of CaliforniaSan FranciscoCaliforniaUSA
- VA Advanced Imaging Research CenterSan Francisco Veteran's Administration Medical CenterSan FranciscoCaliforniaUSA
| | - Shilpa Gummadi
- San Francisco Department of Radiology and Biomedical ImagingUniversity of CaliforniaSan FranciscoCaliforniaUSA
- VA Advanced Imaging Research CenterSan Francisco Veteran's Administration Medical CenterSan FranciscoCaliforniaUSA
| | - Chau Bui
- San Francisco Department of Radiology and Biomedical ImagingUniversity of CaliforniaSan FranciscoCaliforniaUSA
- VA Advanced Imaging Research CenterSan Francisco Veteran's Administration Medical CenterSan FranciscoCaliforniaUSA
| | - Jessica Santhakumar
- San Francisco Department of Radiology and Biomedical ImagingUniversity of CaliforniaSan FranciscoCaliforniaUSA
- VA Advanced Imaging Research CenterSan Francisco Veteran's Administration Medical CenterSan FranciscoCaliforniaUSA
| | - Kristen Knight
- San Francisco Department of Radiology and Biomedical ImagingUniversity of CaliforniaSan FranciscoCaliforniaUSA
- VA Advanced Imaging Research CenterSan Francisco Veteran's Administration Medical CenterSan FranciscoCaliforniaUSA
| | - Erik D. Roberson
- Alzheimer's Disease CenterUniversity of Alabama at BirminghamBirminghamAlabamaUSA
- Department of NeurologyUniversity of Alabama at BirminghamBirminghamAlabamaUSA
| | - Daniel Marson
- Alzheimer's Disease CenterUniversity of Alabama at BirminghamBirminghamAlabamaUSA
- Department of NeurologyUniversity of Alabama at BirminghamBirminghamAlabamaUSA
| | - Carol Chambless
- Alzheimer's Disease CenterUniversity of Alabama at BirminghamBirminghamAlabamaUSA
- Department of NeurologyUniversity of Alabama at BirminghamBirminghamAlabamaUSA
| | - Adam Gersteneker
- Department of NeurologyUniversity of Alabama at BirminghamBirminghamAlabamaUSA
| | - Roy Martin
- Department of NeurologyUniversity of Alabama at BirminghamBirminghamAlabamaUSA
| | - Richard Kennedy
- Alzheimer's Disease CenterUniversity of Alabama at BirminghamBirminghamAlabamaUSA
- Division of Gerontology, Geriatrics, and Palliative CareDepartment of MedicineUniversity of Alabama at BirminghamBirminghamAlabamaUSA
| | - Yue Zhang
- Division of Gerontology, Geriatrics, and Palliative CareDepartment of MedicineUniversity of Alabama at BirminghamBirminghamAlabamaUSA
| | - John C. Morris
- Department of NeurologyWashington University in St. LouisSt. LouisMissouriUSA
| | - Krista L. Moulder
- Department of NeurologyWashington University in St. LouisSt. LouisMissouriUSA
| | - Connie Mayo
- Department of NeurologyWashington University in St. LouisSt. LouisMissouriUSA
| | - Maria Carroll
- Department of NeurologyWashington University in St. LouisSt. LouisMissouriUSA
| | - Yan Li
- Department of NeurologyWashington University in St. LouisSt. LouisMissouriUSA
| | | | - Nikki H. Stricker
- Mayo ClinicDepartment of Psychiatry and PsychologyRochesterMinnesotaUSA
| | - Rachel L. Nosheny
- VA Advanced Imaging Research CenterSan Francisco Veteran's Administration Medical CenterSan FranciscoCaliforniaUSA
- San Francisco Department of Psychiatry and Behavioral SciencesUniversity of CaliforniaSan FranciscoCaliforniaUSA
| | - Scott Mackin
- VA Advanced Imaging Research CenterSan Francisco Veteran's Administration Medical CenterSan FranciscoCaliforniaUSA
- San Francisco Department of Psychiatry and Behavioral SciencesUniversity of CaliforniaSan FranciscoCaliforniaUSA
| | - Michael W. Weiner
- San Francisco Department of Radiology and Biomedical ImagingUniversity of CaliforniaSan FranciscoCaliforniaUSA
- VA Advanced Imaging Research CenterSan Francisco Veteran's Administration Medical CenterSan FranciscoCaliforniaUSA
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Lemon SC, Allison JJ, Danila MI, Goins KV, Chiriboga G, Fischer M, Puliafico M, Mudano AS, Rahn EJ, Merchant J, Lawrrence CE, Dunkel L, Israel T, Barton B, Jenoure F, Alexander T, Cruz D, Douglas M, Sims J, Richmond A, Roberson E, Chambless C, Harris PA, Saag KG. Abstract IA-52: Improving access to research among individuals from under-represented racial and ethnic minority communities: The Strengthening Research In Diverse Enrollment (STRIDE) Study. Cancer Epidemiol Biomarkers Prev 2022. [DOI: 10.1158/1538-7755.disp21-ia-52] [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: 11/16/2022] Open
Abstract
Abstract
INTRODUCTION Under-representation in health-related research is one of a multitude of factors that contribute to cancer disparities experienced by African American and Latinx communities. Barriers to research participation stem from historical social injustices, are multi-faceted and include factors specific to the research process, research team members and community experiences and expectations about research participation. Informed consent is a longitudinal process and represents an opportunity to address these barriers and potentially improve access to research by individuals from underrepresented groups. The purpose of the Strengthening Translational Research in Diverse Enrollment (STRIDE) study was to develop and test an integrated, literacy- and culturally-sensitive, multi-component intervention that addresses barriers to research participation during the informed consent process. METHODS A multi-pronged community engaged approach was used to inform the development the three components of the STRIDE intervention. At each of the three study sites, Community Investigators, local community members of diverse racial/ethnic backgrounds, contribute to intervention development, pilot testing and dissemination activities. Community engagement studios provided a semi-structured opportunity to solicit feedback from community experts in a facilitated group regarding the relevance, usability and understandability of the STRIDE intervention components. Additionally, component-specific approaches to obtaining community input were utilized. RESULTS The three components were developed and refined with community input. The STRIDE intervention includes: (1) an electronic consent (eConsent) framework within the REDCap software platform that incorporates tools designed to facilitate material comprehension and relevance, (2) a storytelling intervention in which prior research participants from diverse backgrounds share their experiences, and (3) a simulation-based training program for research assistants that emphasizes cultural competency and communication skills for assisting in the informed consent process. CONCLUSIONS The STRIDE project had produced an integrated set of interventions that are available to support researchers across the CTSA hubs and beyond in efforts to enhance diversity in clinical research. Early dissemination of STRIDE intervention components include utilization in national COVID-19 trials and research networks.
Citation Format: Stephenie C. Lemon, Jeroan J. Allison, Maria I. Danila, Karin Valentine Goins, German Chiriboga, Melissa Fischer, Melissa Puliafico, Amy S. Mudano, Elizabeth J. Rahn, Jeanne Merchant, Colleen E. Lawrrence, Leah Dunkel, Tiffany Israel, Bruce Barton, Fred Jenoure, Tiffany Alexander, Danny Cruz, Marva Douglas, Jacqueline Sims, Al Richmond, Erik Roberson, Carol Chambless, Paul A. Harris, Kenneth G. Saag. Improving access to research among individuals from under-represented racial and ethnic minority communities: The Strengthening Research In Diverse Enrollment (STRIDE) Study [abstract]. In: Proceedings of the AACR Virtual Conference: 14th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2021 Oct 6-8. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr IA-52.
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Affiliation(s)
| | | | - Maria I. Danila
- 2University of Alabama at Birmingham School of Medicine, Birmingham, AL,
| | | | | | | | | | - Amy S. Mudano
- 2University of Alabama at Birmingham School of Medicine, Birmingham, AL,
| | - Elizabeth J. Rahn
- 2University of Alabama at Birmingham School of Medicine, Birmingham, AL,
| | - Jeanne Merchant
- 2University of Alabama at Birmingham School of Medicine, Birmingham, AL,
| | | | - Leah Dunkel
- 3Vanderbilt University Medical Center, Nashville, TN,
| | | | - Bruce Barton
- 1University of Massachusetts Medical School, Worcester, MA,
| | - Fred Jenoure
- 1University of Massachusetts Medical School, Worcester, MA,
| | - Tiffany Alexander
- 2University of Alabama at Birmingham School of Medicine, Birmingham, AL,
| | - Danny Cruz
- 3Vanderbilt University Medical Center, Nashville, TN,
| | - Marva Douglas
- 2University of Alabama at Birmingham School of Medicine, Birmingham, AL,
| | - Jacqueline Sims
- 2University of Alabama at Birmingham School of Medicine, Birmingham, AL,
| | - Al Richmond
- 4Community Campus Partnerships for Health, Raleigh, NC,
| | - Erik Roberson
- 5University of Alabama at Birmingham, Birmingham, AL
| | | | | | - Kenneth G. Saag
- 2University of Alabama at Birmingham School of Medicine, Birmingham, AL,
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Danila MI, Allison JJ, Goins KV, Chiriboga G, Fischer M, Puliafico M, Mudano AS, Rahn EJ, Merchant J, Lawrence CE, Dunkel L, Israel T, Barton B, Jenoure F, Alexander T, Cruz D, Douglas M, Sims J, Richmond A, Roberson ED, Chambless C, Harris PA, Saag KG, Lemon SC. Development of a multi-component intervention to promote participation of Black and Latinx individuals in biomedical research. J Clin Transl Sci 2021; 5:e134. [PMID: 34367678 PMCID: PMC8327553 DOI: 10.1017/cts.2021.797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Revised: 05/28/2021] [Accepted: 06/01/2021] [Indexed: 11/15/2022] Open
Abstract
INTRODUCTION Barriers to research participation by racial and ethnic minority group members are multi-factorial, stem from historical social injustices and occur at participant, research team, and research process levels. The informed consent procedure is a key component of the research process and represents an opportunity to address these barriers. This manuscript describes the development of the Strengthening Translational Research in Diverse Enrollment (STRIDE) intervention, which aims to improve research participation by individuals from underrepresented groups. METHODS We used a community-engaged approach to develop an integrated, culturally, and literacy-sensitive, multi-component intervention that addresses barriers to research participation during the informed consent process. This approach involved having Community Investigators participate in intervention development activities and using community engagement studios and other methods to get feedback from community members on intervention components. RESULTS The STRIDE intervention has three components: a simulation-based training program directed toward clinical study research assistants that emphasizes cultural competency and communication skills for assisting in the informed consent process, an electronic consent (eConsent) framework designed to improve health-related research material comprehension and relevance, and a "storytelling" intervention in which prior research participants from diverse backgrounds share their experiences delivered via video vignettes during the consent process. CONCLUSIONS The community engaged development approach resulted in a multi-component intervention that addresses known barriers to research participation and can be integrated into the consent process of research studies. Results of an ongoing study will determine its effectiveness at increasing diversity among research participants.
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Affiliation(s)
- Maria I. Danila
- Department of Medicine, Division of Clinical Immunology/Rheumatology, University of Alabama at Birmingham School of Medicine, Birmingham, AL, USA
- University of Alabama at Birmingham Center for Clinical and Translational Science, University of Alabama at Birmingham School of Medicine, Birmingham, AL, USA
| | - Jeroan J. Allison
- UMass Center for Clinical and Translational Science, University of Massachusetts Medical School, Worcester, MA, USA
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, USA
| | - Karin Valentine Goins
- UMass Center for Clinical and Translational Science, University of Massachusetts Medical School, Worcester, MA, USA
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, USA
| | - Germán Chiriboga
- UMass Center for Clinical and Translational Science, University of Massachusetts Medical School, Worcester, MA, USA
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, USA
| | - Melissa Fischer
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, USA
- Department of Medicine, University of Massachusetts Medical School, Worcester, MA, USA
| | - Melissa Puliafico
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, USA
- Department of Medicine, University of Massachusetts Medical School, Worcester, MA, USA
| | - Amy S. Mudano
- Department of Medicine, Division of Clinical Immunology/Rheumatology, University of Alabama at Birmingham School of Medicine, Birmingham, AL, USA
- University of Alabama at Birmingham Center for Clinical and Translational Science, University of Alabama at Birmingham School of Medicine, Birmingham, AL, USA
| | - Elizabeth J. Rahn
- Department of Medicine, Division of Clinical Immunology/Rheumatology, University of Alabama at Birmingham School of Medicine, Birmingham, AL, USA
| | - Jeanne Merchant
- Department of Medicine, Division of Clinical Immunology/Rheumatology, University of Alabama at Birmingham School of Medicine, Birmingham, AL, USA
- University of Alabama at Birmingham Center for Clinical and Translational Science, University of Alabama at Birmingham School of Medicine, Birmingham, AL, USA
| | - Colleen E. Lawrence
- Vanderbilt Institute for Clinical and Translational Research (VICTR), Vanderbilt University Medical Center, Nashville, TN, USA
| | - Leah Dunkel
- Vanderbilt Institute for Clinical and Translational Research (VICTR), Vanderbilt University Medical Center, Nashville, TN, USA
| | - Tiffany Israel
- Vanderbilt Institute for Clinical and Translational Research (VICTR), Vanderbilt University Medical Center, Nashville, TN, USA
| | - Bruce Barton
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, USA
| | - Fred Jenoure
- UMass Center for Clinical and Translational Science, University of Massachusetts Medical School, Worcester, MA, USA
| | - Tiffany Alexander
- University of Alabama at Birmingham Center for Clinical and Translational Science, University of Alabama at Birmingham School of Medicine, Birmingham, AL, USA
| | - Danny Cruz
- Vanderbilt Institute for Clinical and Translational Research (VICTR), Vanderbilt University Medical Center, Nashville, TN, USA
| | - Marva Douglas
- University of Alabama at Birmingham Center for Clinical and Translational Science, University of Alabama at Birmingham School of Medicine, Birmingham, AL, USA
| | - Jacqueline Sims
- Vanderbilt Institute for Clinical and Translational Research (VICTR), Vanderbilt University Medical Center, Nashville, TN, USA
| | - Al Richmond
- Community Campus Partnerships for Health, Raleigh, NC, USA
| | - Erik D. Roberson
- Department of Neurology, University of Alabama at Birmingham School of Medicine, Birmingham, AL, USA
| | - Carol Chambless
- Department of Neurology, University of Alabama at Birmingham School of Medicine, Birmingham, AL, USA
| | - Paul A. Harris
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Kenneth G. Saag
- Department of Medicine, Division of Clinical Immunology/Rheumatology, University of Alabama at Birmingham School of Medicine, Birmingham, AL, USA
- University of Alabama at Birmingham Center for Clinical and Translational Science, University of Alabama at Birmingham School of Medicine, Birmingham, AL, USA
| | - Stephenie C. Lemon
- UMass Center for Clinical and Translational Science, University of Massachusetts Medical School, Worcester, MA, USA
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, USA
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Dionne-Odom JN, Taylor R, Rocque G, Chambless C, Ramsey T, Azuero A, Ivankova N, Martin MY, Bakitas MA. Adapting an Early Palliative Care Intervention to Family Caregivers of Persons With Advanced Cancer in the Rural Deep South: A Qualitative Formative Evaluation. J Pain Symptom Manage 2018; 55:1519-1530. [PMID: 29474939 PMCID: PMC5951755 DOI: 10.1016/j.jpainsymman.2018.02.009] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [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: 12/21/2017] [Revised: 02/12/2018] [Accepted: 02/13/2018] [Indexed: 11/19/2022]
Abstract
CONTEXT There is a scarcity of early palliative care interventions to support family caregivers of persons with advanced cancer living in the rural Southern U.S. OBJECTIVE The objective of this study was to adapt the content, format, and delivery of a six session, palliative care, telehealth intervention with monthly follow-up for rural family caregivers to enhance their own self-care and caregiving skills. METHODS Qualitative formative evaluation consisting of one-on-one, semistructured interviews with rural-dwelling persons with metastatic cancer (n = 18), their primary family caregiver (n = 20), and lay patient navigators (n = 26) were conducted to elicit feedback on a family caregiver intervention outline based on published evidence-based interventions. Transcribed interviews were analyzed using a thematic analysis approach. Coinvestigators reviewed and refined preliminary themes. RESULTS Participants recommended that intervention topical content be flexible and has an adaptable format based on continuous needs assessment. Sessions should be 20 minutes long at minimum, and additional sessions should be offered if requested. Faith and spirituality is essential to address but should not be an overarching intervention theme. Content needs to be communicated in simple language. Intervention delivery via telephone is acceptable, but face-to-face contact is desired to establish relationships. Other Internet-based technologies (e.g., video-conferencing) could be helpful, but many rural dwellers may not be technology savvy or have Internet access. Most lay navigators believed they could lead the intervention with additional training, protocols for professional referral, and supervision by specialty-trained palliative care clinicians. CONCLUSIONS A potentially scalable palliative care intervention is being adapted for family caregivers of rural-dwelling persons with advanced cancer and will undergo piloting in a small-scale randomized controlled trial.
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Affiliation(s)
- J Nicholas Dionne-Odom
- School of Nursing, University of Alabama at Birmingham (UAB), Birmingham, Alabama, USA; Division of Geriatrics, Gerontology, and Palliative Care, Department of Medicine, UAB Center for Palliative and Supportive Care, Birmingham, Alabama, USA.
| | - Richard Taylor
- School of Nursing, University of Alabama at Birmingham (UAB), Birmingham, Alabama, USA
| | - Gabrielle Rocque
- Division of Hematology and Oncology, Department of Medicine, UAB, Birmingham, Alabama
| | | | - Thomas Ramsey
- School of Nursing, University of Alabama at Birmingham (UAB), Birmingham, Alabama, USA
| | - Andres Azuero
- School of Nursing, University of Alabama at Birmingham (UAB), Birmingham, Alabama, USA
| | - Nataliya Ivankova
- School of Nursing, University of Alabama at Birmingham (UAB), Birmingham, Alabama, USA; Department of Health Services Administration, UAB, Birmingham, Alabama, USA
| | - Michelle Y Martin
- Department of Preventive Medicine, Center for Innovation in Health Equity Research, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Marie A Bakitas
- School of Nursing, University of Alabama at Birmingham (UAB), Birmingham, Alabama, USA; Division of Geriatrics, Gerontology, and Palliative Care, Department of Medicine, UAB Center for Palliative and Supportive Care, Birmingham, Alabama, USA
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Rocque GB, Taylor RA, Acemgil A, Li X, Pisu M, Kenzik K, Jackson BE, Halilova KI, Demark-Wahnefried W, Meneses K, Li Y, Martin MY, Chambless C, Lisovicz N, Fouad M, Partridge EE, Kvale EA. Guiding Lay Navigation in Geriatric Patients With Cancer Using a Distress Assessment Tool. J Natl Compr Canc Netw 2016; 14:407-14. [PMID: 27059189 DOI: 10.6004/jnccn.2016.0047] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2015] [Accepted: 01/27/2016] [Indexed: 12/30/2022]
Abstract
BACKGROUND There is growing interest in psychosocial care and evaluating distress in patients with cancer. As of 2015, the Commission on Cancer requires cancer centers to screen patients for distress, but the optimal approach to implementation remains unclear. METHODS We assessed the feasibility and impact of using distress assessments to frame lay navigator interactions with geriatric patients with cancer who were enrolled in navigation between January 1, 2014, and December 31, 2014. RESULTS Of the 5,121 patients enrolled in our lay patient navigation program, 4,520 (88%) completed at least one assessment using a standardized distress tool (DT). Navigators used the tool to structure both formal and informal distress assessments. Of all patients, 24% reported distress scores of 4 or greater and 5.5% reported distress scores of 8 or greater. The most common sources of distress at initial assessment were pain, balance/mobility difficulties, and fatigue. Minority patients reported similar sources of distress as the overall program population, with increased relative distress related to logistical issues, such as transportation and financial/insurance questions. Patients were more likely to ask for help with questions about insurance/financial needs (79%), transportation (76%), and knowledge deficits about diet/nutrition (76%) and diagnosis (66%) when these items contributed to distress. CONCLUSIONS Lay navigators were able to routinely screen for patient distress at a high degree of penetration using a structured distress assessment.
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Affiliation(s)
- Gabrielle B Rocque
- University of Alabama at Birmingham Comprehensive Cancer Center,Hematology and Oncology, University of Alabama at Birmingham School of Medicine
| | - Richard A Taylor
- University of Alabama at Birmingham Comprehensive Cancer Center,Preventive Medicine, University of Alabama at Birmingham School of Medicine
| | - Aras Acemgil
- University of Alabama at Birmingham Comprehensive Cancer Center,University of Alabama at Birmingham School of Nursing
| | - Xuelin Li
- University of Alabama at Birmingham School of Nursing
| | - Maria Pisu
- University of Alabama at Birmingham Comprehensive Cancer Center,University of Alabama at Birmingham School of Nursing
| | - Kelly Kenzik
- University of Alabama at Birmingham School of Nursing
| | - Bradford E Jackson
- Preventive Medicine, University of Alabama at Birmingham School of Medicine
| | | | | | - Karen Meneses
- University of Alabama at Birmingham Comprehensive Cancer Center,Preventive Medicine, University of Alabama at Birmingham School of Medicine
| | - Yufeng Li
- University of Alabama at Birmingham Comprehensive Cancer Center,University of Alabama at Birmingham School of Nursing
| | | | - Carol Chambless
- University of Alabama at Birmingham Comprehensive Cancer Center
| | - Nedra Lisovicz
- University of Alabama at Birmingham Comprehensive Cancer Center,University of Alabama at Birmingham School of Nursing
| | - Mona Fouad
- University of Alabama at Birmingham Comprehensive Cancer Center,University of Alabama at Birmingham School of Nursing
| | | | - Elizabeth A Kvale
- University of Alabama at Birmingham Comprehensive Cancer Center,Birmingham VA Medical Center, Birmingham, Alabama
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Rocque GB, Partridge EE, Pisu M, Martin MY, Demark-Wahnefried W, Acemgil A, Kenzik K, Kvale EA, Meneses K, Li X, Li Y, Halilova KI, Jackson BE, Chambless C, Lisovicz N, Fouad M, Taylor RA. The Patient Care Connect Program: Transforming Health Care Through Lay Navigation. J Oncol Pract 2016; 12:e633-42. [PMID: 27165489 DOI: 10.1200/jop.2015.008896] [Citation(s) in RCA: 70] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
The Patient Care Connect Program (PCCP) is a lay patient navigation program, implemented by the University of Alabama at Birmingham Health System Cancer Community Network. The PCCP's goal is to provide better health and health care, as well as to lower overall expenditures. The program focuses on enhancing the health of patients, with emphasis on patient empowerment and promoting proactive participation in health care. Navigator training emphasizes palliative care principles and includes development of skills to facilitate advance care planning conversations. Lay navigators are integrated into the health care team, with the support of a nurse supervisor, physician medical director, and administrative champion. The intervention focuses on patients with high needs to reach those with the greatest potential for benefit from supportive services. Navigator activities are guided by frequent distress assessments, which help to identify patient concerns across multiple domains, triage patients to appropriate resources, and ultimately overcome barriers to health care. In this article, we describe the PCCP's development, infrastructure, selection and training of lay navigators, and program operations.
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Affiliation(s)
- Gabrielle B Rocque
- University of Alabama at Birmingham; and Birmingham Veterans Affairs Medical Center, Birmingham, AL
| | - Edward E Partridge
- University of Alabama at Birmingham; and Birmingham Veterans Affairs Medical Center, Birmingham, AL
| | - Maria Pisu
- University of Alabama at Birmingham; and Birmingham Veterans Affairs Medical Center, Birmingham, AL
| | - Michelle Y Martin
- University of Alabama at Birmingham; and Birmingham Veterans Affairs Medical Center, Birmingham, AL
| | - Wendy Demark-Wahnefried
- University of Alabama at Birmingham; and Birmingham Veterans Affairs Medical Center, Birmingham, AL
| | - Aras Acemgil
- University of Alabama at Birmingham; and Birmingham Veterans Affairs Medical Center, Birmingham, AL
| | - Kelly Kenzik
- University of Alabama at Birmingham; and Birmingham Veterans Affairs Medical Center, Birmingham, AL
| | - Elizabeth A Kvale
- University of Alabama at Birmingham; and Birmingham Veterans Affairs Medical Center, Birmingham, AL
| | - Karen Meneses
- University of Alabama at Birmingham; and Birmingham Veterans Affairs Medical Center, Birmingham, AL
| | - Xuelin Li
- University of Alabama at Birmingham; and Birmingham Veterans Affairs Medical Center, Birmingham, AL
| | - Yufeng Li
- University of Alabama at Birmingham; and Birmingham Veterans Affairs Medical Center, Birmingham, AL
| | - Karina I Halilova
- University of Alabama at Birmingham; and Birmingham Veterans Affairs Medical Center, Birmingham, AL
| | - Bradford E Jackson
- University of Alabama at Birmingham; and Birmingham Veterans Affairs Medical Center, Birmingham, AL
| | - Carol Chambless
- University of Alabama at Birmingham; and Birmingham Veterans Affairs Medical Center, Birmingham, AL
| | - Nedra Lisovicz
- University of Alabama at Birmingham; and Birmingham Veterans Affairs Medical Center, Birmingham, AL
| | - Mona Fouad
- University of Alabama at Birmingham; and Birmingham Veterans Affairs Medical Center, Birmingham, AL
| | - Richard A Taylor
- University of Alabama at Birmingham; and Birmingham Veterans Affairs Medical Center, Birmingham, AL
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Rocque GB, Kvale EA, Jackson BE, Kenzik K, Lisovicz N, Demark-Wahnefried W, Meneses KM, Taylor RA, Acemgil A, Chambless C, Li Y, Martin M, Fouad M, Pisu M, Partridge EE. Abstract P6-11-02: Hospitalizations and costs during Implementation of a lay navigation program for older patients with breast cancer in the deep south. Cancer Res 2016. [DOI: 10.1158/1538-7445.sabcs15-p6-11-02] [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: 11/16/2022]
Abstract
Abstract
Background: Patient-centered strategies are needed to enhance the value of cancer care particularly at the end of life. Lay navigators (LN) can be trained to provide an extra layer of support for cancer patients from diagnosis through survivorship or end of life. We hypothesized that integrating LNs into the care team would reduce healthcare utilization and cost for patients with cancer, including those with breast cancer.
Methods: A prospective, observational study of Medicare claims data was conducted of beneficiaries ≥ 65 years old diagnosed with cancer after 2008 who received care within the UAB Health System Cancer Community Network (12 cancer centers of varying size located in AL, MS, TN, GA, and FL). The first breast cancer (BC) patient was enrolled in navigation in April 2013, and ∼18% of BC patients were navigated by the end of 2014. For this analysis, we report on the subset of patients with BC. The outcomes of interest were calculated per quarter from 2012-2014: (1) the proportion of patients with at least 1 hospitalization, (2) the proportion of the 492 deceased BC patients with a hospitalization in the last 30 and 14 days of life and (3) the Total costs for Medicare, excluding prescription drug costs. We used general linear models to evaluate changes in both health care utilization and cost over time, adjusting for age, sex, cancer stage, phase of care, and navigation group. Differential effects for navigated and non-navigated groups were tested with a group*time interaction. Healthcare utilization estimates are presented as Incidence Rate Ratios (IRR), and costs for Medicare as parameter estimates (β) in terms of dollar amounts.
Results: 4835 BC patients received care from 2012-2014: 622 received navigation services. 14.2 % of navigated BC patients were stage III/IV, compared to 9.33% of non-navigated patients. The proportion of hospitalizations trended downward from 7.9% in quarter 1 (Q1) 2012 to 5.7% in Q4 of 2014 (IRR 0.965, p =0.14), with similar decreases for navigated and non-navigated patients (IRR= 1.00, p > 0.05). Hospitalization in the last 30 days and last 14 days of life were 49.7% and 29.3%, respectively, with no between groups difference. Costs per beneficiary per quarter decreased overall from $4,161 in Q1 2012 to $3,010 in Q4 2014 (p <0.0001). In adjusted analysis, the navigated patients had an average $577 greater decline per quarter than the non-navigated patients (βNavigated=-$636; βnon-Navigated=-$59; p<0.0001).
Conclusions: Medicare costs declined during implementation of a lay navigation program, with greater reductions for navigated patients than non-navigated BC patients. Overall hospitalizations also declined, yet rates remain high for breast cancer patients at the end of life. Integration of LNs should be considered by health systems aiming to transition to value-based healthcare delivery.
The project described was supported by Grant Number 1C1CMS331023 from the Department of Health and Human Services, Centers for Medicare & Medicaid Services. The contents of this abstract are solely the responsibility of the authors and do not necessarily represent the official views of the U.S. Department of Health and Human Services or any of its agencies.
Citation Format: Rocque GB, Kvale EA, Jackson BE, Kenzik K, Lisovicz N, Demark-Wahnefried W, Meneses KM, Taylor RA, Acemgil A, Chambless C, Li Y, Martin M, Fouad M, Pisu M, Partridge EE. Hospitalizations and costs during Implementation of a lay navigation program for older patients with breast cancer in the deep south. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr P6-11-02.
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Affiliation(s)
- GB Rocque
- University of Alabama at Birmingham, Birmingham, AL
| | - EA Kvale
- University of Alabama at Birmingham, Birmingham, AL
| | - BE Jackson
- University of Alabama at Birmingham, Birmingham, AL
| | - K Kenzik
- University of Alabama at Birmingham, Birmingham, AL
| | - N Lisovicz
- University of Alabama at Birmingham, Birmingham, AL
| | | | - KM Meneses
- University of Alabama at Birmingham, Birmingham, AL
| | - RA Taylor
- University of Alabama at Birmingham, Birmingham, AL
| | - A Acemgil
- University of Alabama at Birmingham, Birmingham, AL
| | - C Chambless
- University of Alabama at Birmingham, Birmingham, AL
| | - Y Li
- University of Alabama at Birmingham, Birmingham, AL
| | - M Martin
- University of Alabama at Birmingham, Birmingham, AL
| | - M Fouad
- University of Alabama at Birmingham, Birmingham, AL
| | - M Pisu
- University of Alabama at Birmingham, Birmingham, AL
| | - EE Partridge
- University of Alabama at Birmingham, Birmingham, AL
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McDonnell J, Nofs D, Hardman M, Chambless C. An analysis of the procedural components of supported employment programs associated with employment outcomes. J Appl Behav Anal 1989; 22:417-28. [PMID: 2613600 PMCID: PMC1286198 DOI: 10.1901/jaba.1989.22-417] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
This study examined the relation between the procedural components of supported employment programs and employment outcomes for 120 individuals with disabilities. These individuals were involved in supported employment programs established through the Utah Supported Employment Project. The results suggest that successful implementation of supported employment services led to ongoing employment of study participants in community work sites, increased wages, and ongoing opportunities for workers to interact with nondisabled peers. In addition, several procedural components were found to be strongly associated with successful employment outcomes for workers. Results of the study are discussed in terms of the training needs of supported employment program staff and future research for the dissemination of a cohesive technology of supported employment.
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Affiliation(s)
- J McDonnell
- Department of Special Education, University of Utah, Salt Lake City 84112
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