"Like pouring salt in a wound": A qualitative exploration of the consequences of unmet housing needs for cancer patients and survivors in New York City

OBJECTIVE

To identify consequences of unmet housing needs in the period following cancer diagnosis.

DESIGN

Qualitative descriptive design.

PARTICIPANTS

New York City-based cancer patients and survivors (n = 21) who reported experience of unmet housing needs while receiving cancer treatment. Key informants (n = 9) with relevant expertise (e.g. oncology social workers).

METHODS

One-time semi-structured telephone or in-person interviews were conducted with all participants. Inductive thematic coding was conducted using a pragmatic paradigm.

FINDINGS

Four categories of consequences emerged: 1) cancer management and health (rest and recovery, illness/injury risk, medical care); 2) psychological (stress and anxiety, lack of control and independence, self-esteem/pride, sadness/depression, cancer coping); 3) social (relationships, consequences for others, isolation); and 4) standard of functional living.

CONCLUSION

The simultaneous experience of cancer and unmet housing needs is broadly burdensome.

IMPLICATIONS FOR PSYCHOSOCIAL PROVIDERS

Screening and resources for addressing unmet housing needs must be prioritized to holistically care for patients.

Engaging African American Parents to Develop a Mobile Health Technology for Breastfeeding: KULEA-NET

BACKGROUND

African Americans breastfeed less than other groups, which has implications for health throughout the life course. Little is known about mobile health technologies to support breastfeeding.

RESEARCH AIMS

This study proceeded in two phases. The aim of Phase 1 was to identify ideal technological components and content of a mobile health intervention. The aim of Phase 2 was to determine the usability of a prototype, KULEA-NET, based on the Phase 1 findings.

METHODS

For this mixed-methods study, we used community-based participatory research methods and user-centered technology design methods. We used open coding in NVivo 11 to organize data from focus groups and in-depth interviews, then we analyzed the data. We then developed a prototype and tested the prototype's usability with the System Usability Scale. Fifty pregnant and postpartum African Americans from the District of Columbia participated.

RESULTS

Participants preferred an app with text messaging technology and identified areas for intervention: self-efficacy, parent-child attachment beliefs, social support, public breastfeeding and social desirability, and returning to work. Desired features included local resources, support person access, baby care logs, identification of public breastfeeding venues, and peer discussions. The System Usability Scale score was 73.8, which indicates above average usability.

CONCLUSIONS

A mobile health technology like KULEA-NET can be used to meet the breastfeeding needs of African Americans, build social desirability, and complement traditional health care. The appeal of an African American-specific intervention is unclear. Responding to mixed feeding practices is challenging. KULEA-NET is a mobile breastfeeding intervention guided by the preferences of African American parents and offers promising usability metrics.

"You Have to Keep a Roof Over Your Head": A Qualitative Study of Housing Needs Among Patients With Cancer in New York City

PURPOSE

Housing status can become compromised in the wake of financial hardship for some patients with cancer and become a source of disparity. This qualitative study describes the types of housing issues experienced by patients with cancer and survivors of cancer in New York City.

METHODS

Semistructured interviews were conducted with a volunteer sample of 21 patients with cancer or survivors of cancer treated in New York City who reported housing needs in the period after diagnosis through survivorship. Nine supplemental interviews were conducted with cancer and housing key informants. Conventional content analysis was conducted on transcripts to create a codebook describing types of housing needs.

RESULTS

Patients and survivors most commonly had breast (n = 9) and blood (n = 4) cancers and ranged from recently diagnosed to many years posttreatment. Twenty-nine distinct housing-related issues were identified, which were grouped into the following six major categories: housing costs (eg, rent, mortgage), home loss, doubled up or unstable housing, housing conditions, accessibility (eg, stairs, proximity to amenities), and safety. Issues were often interrelated. Housing needs sometimes predated cancer diagnosis. Other issues newly emerged in the wake of cancer-related physical limitations and disruption to finances. Needs ranged in severity and caused patients and survivors considerable burden during a difficult period of poor health and financial strain.

CONCLUSION

This study contributes depth to current understandings of housing needs among patients with cancer and survivors by providing detailed disaggregated descriptions. We recommend increasing availability of services responsive to these needs and exploring promising options such as patient navigation and legal services. Findings also highlight the importance of creative solutions addressing ecologic-level factors such as housing affordability.

A pilot randomized trial of school-based administration of inhaled corticosteroids for at-risk children with asthma

OBJECTIVE

To investigate whether high adherence to inhaled corticosteroids (ICS) among disadvantaged urban public school children on public insurance with persistent asthma is achievable by having school nurses administer morning doses on each day that school is in session.

DESIGN/METHODS

This was a pilot prospective randomized clinical trial of home versus school nurse-administered ICS among children on Medicaid enrolled in grades K-8. The primary outcome was the proportion of expected morning doses of ICS given to the intervention group in school over the 60-day treatment period. Secondary outcomes included the relative proportions of expected doses (morning, evening, and total), asthma-related morbidity, quality of life, and health-care utilization.

RESULTS

A total of 46 patients were enrolled (mean age 8.21 ± 2.45; 56.5% male; 91.3% non-Hispanic, African-Americans), and follow-up data were available for 44/46 (95.7%) patients. The groups did not differ in age, gender, race/ethnicity, or asthma severity. The intervention group received 91.7% of expected morning doses of ICS at school over the 60-day treatment period (95% CI [87.7, 95.5]). Intervention patients reported significantly less functional limitation (42.9% vs. 73.9%, p = 0.04), adjustment to family life (23.8% vs. 56.5%, p = 0.03), and sleep loss (1.7 vs. 4.1 nights in last 2 weeks, p = 0.035) than control patients at the end of the 60-days study period. There were no differences in unscheduled health-care utilization by group.

CONCLUSIONS

These pilot data suggest that school-based administration of ICS has the potential to achieve high adherence to morning doses of ICS on school days among urban, disadvantaged, and largely minority children with asthma.

A literature synthesis of health promotion research in salons and barbershops

CONTEXT

Barbershops and beauty salons are located in all communities and frequented by diverse groups of people, making them key settings for addressing health disparities. No studies have reviewed the growing body of literature describing studies promoting health in these settings. This review summarized the literature related to promoting health within barbershops and beauty salons to inform future approaches that target diverse populations in similar settings.

EVIDENCE ACQUISITION

We identified and reviewed published research articles describing formative research, recruitment, and health-related interventions set in beauty salons and barbershops. PubMed and other secondary search engines were searched in 2010 and again in 2013 for English-language papers indexed from 1990 through August 2013. The search yielded 113 articles, 71 of which were formerly reviewed, and 54 were eligible for inclusion.

EVIDENCE SYNTHESIS

Included articles were categorized as formative research (n=27); recruitment (n=7); or intervention (n=20). Formative research studies showed that owners, barbers/stylists, and their customers were willing participants, clarifying the feasibility of promoting health in these settings. Recruitment studies demonstrated that salon/shop owners will join research studies and can enroll customers. Among intervention studies, level of stylist/barber involvement was categorized. More than 73.3% of intervention studies demonstrated statistically significant results, targeted mostly racial/ethnic minority groups and focused on a variety of health topics.

CONCLUSIONS

Barbershops and beauty salons are promising settings for reaching populations most at risk for health disparities. Although these results are encouraging, more rigorous research and evaluation of future salon- and barbershop-based interventions are needed.

Organizational- and employee-level recruitment into a worksite-based weight loss study

BACKGROUND

Based on national estimates, the majority of working adults are overweight or obese. Overweight and obesity are associated with diminished health, productivity, and increased medical costs for employers. Worksite-based weight loss interventions are desirable from both employee and employer perspectives.

PURPOSE

To investigate organizational- and employee-level participation in a group-randomized controlled worksite-based weight loss trial.

METHODS

Using a set of inclusion criteria and pre-established procedures, we recruited worksites (and overweight/obese employees from enrolled worksites) from the North Carolina Community College System to participate in a weight loss study. Recruitment results at the worksite (organization) and employee levels are described, along with an assessment of representativeness.

RESULTS

Eighty-one percent (48/59) of community colleges indicated initial interest in participating in the weight loss study, and of those, 17 colleges were enrolled. Few characteristics distinguished enrolled community colleges from unenrolled colleges in the overall system. Eligible employees (n = 1004) at participating colleges were enrolled in the weight loss study. On average, participants were aged 46.9 years (SD = 12.1 years), had a body mass index (BMI) of 33.6 kg/m(2) (SD = 7.9 kg/m(2)), 83.2% were White, 13.3% African American, 82.2% female, and 41.8% reported holding an advanced degree (master's or doctoral degree). Compared with the larger North Carolina Community College employee population, participants most often were women, but few other differences were observed.

LIMITATIONS

Employees with reduced computer access may have been less likely to participate, and limited data on unenrolled individuals or colleges were available.

CONCLUSIONS

Community colleges are willing partners for weight loss intervention studies, and overweight/obese employees were receptive to joining a weight loss study offered in the workplace. The results from this study are useful for planning future worksite-based weight loss interventions and research studies that achieve high participation rates at the employee and organizational levels.

It's not over when it's over: long-term symptoms in cancer survivors--a systematic review

BACKGROUND

The number of cancer survivors is steadily increasing. Following completion of primary cancer treatment and many years thereafter, specific symptoms continue to negatively affect cancer survivors. The purpose of this article is to review the evidence of symptom burden following primary treatment for cancer in survivors of the most common types of cancer (breast, gynecological, prostate, and colorectal).

METHODS

A systematic review of literature published between the years 2000-2008 that reported late-effects and/or long-term psychosocial symptoms associated with cancer survivorship post-completion of primary cancer treatment was conducted. The symptoms include physical limitations, cognitive limitations, depression/anxiety, sleep problems, fatigue, pain, and sexual dysfunctions.

RESULTS

Symptom burden associated with cancer survivorship was consistent among the four most common types of cancer (breast, gynecological, prostate, and rectal/colon), despite various types of treatment exposure. Generally, across the cancer groups, depressive symptoms, pain, and fatigue were commonly found in cancer survivors.

CONCLUSIONS

Based on longitudinal and cross-sectional evidence, cancer survivors can experience symptoms for more than 10 years following treatment. These symptoms were present in survivors of all four cancer types who underwent a wide variety of treatment. The results indicate that these symptoms should be evaluated and managed to optimize long-term outcomes.

Workstyle as a predictor of pain and restricted work associated with upper extremity disorders: a prospective study

PURPOSE

A patient's reaction to a perceived increase in work demand may be related to his or her upper limb symptoms. The purpose of this study was to determine whether a brief measure of a patient's perception of how they respond to perceived increases in demands at work predicts pain levels and work status 6 months after an initial consultation with a hand surgeon.

METHODS

Working patients with diverse upper extremity diagnoses completed a measure of response to job stress at their first clinic visit and were followed for 6 months during their prescribed treatment course. Controlling for age, gender, job type, diagnosis, patient perceptions of work-relatedness, baseline pain, grip strength, and treatment (surgery vs no surgery) analyses were conducted to determine whether self-reported response to perceived job stress was associated with pain and work status 6 months after the initial consultation.

RESULTS

Higher scores on the patient-reported job stress measure predicted higher levels of pain at 6 months. The measure was also a modest but significant predictor of work status at 6 months.

CONCLUSIONS

Evaluation of a working patient's self-reported cognitive and behavioral response to perceived increases in work demands, or what has been referred to as workstyle, predicts subsequent levels of upper extremity pain and work status. Generalization to other practice settings requires further study. This measure provides a brief evaluation of reaction to job stress that can be an important factor in certain patients with upper extremity symptoms. Future controlled studies addressing this aspect of the clinical picture are indicated.

TYPE OF STUDY/LEVEL OF EVIDENCE

Prognostic IV.

Pattern of workplace disputes in cancer survivors: a population study of ADA claims

BACKGROUND

The Americans with Disability Act (ADA) claim patterns can provide information on sources of potential work discrimination faced by employees with various health problems. This study investigated the pattern of ADA disputes among cancer survivors and non-cancer related impairments.

MATERIALS AND METHODS

Using multivariable logistic regression adjusting for demographics, employees with cancer related claims were compared to employees with other impairment related claims for alleged violations from 2000 to 2005. The impairments were grouped into orthopedic, behavioral, medical, neurological, sensory, cancer, cancer comorbid (cancer and non-cancer impairments), and comorbid "other" (non-cancer comorbid disorders). The dispute categories included: termination, reasonable accommodation, relations, terms, hiring, and a nonspecific "other" category.

RESULTS

This study analyzed 59,981 cases over a 6 year period. All comparisons were made in relation to the cancer group. There was a protective effect for any impairment other than cancer (OR = 0.29-0.63, 95% CI = 0.25-0.72) related to discharge from work. Also, orthopedic (OR = 0.81, 95% CI = 0.71-0.93), general medical (OR = 0.82, 95% CI = 0.72-0.94), and neurological (OR = 0.83, 95% CI = 0.71-0.96) impairments were found to be protective for claims related to terms of employment relative to cancer. Cancer survivors who reported a second impairment in addition to cancer were more likely to file disputes that involved relations with others at work (OR = 1.47, 95% CI = 1.16-1.87) in comparison to those with cancer only. Orthopedic (OR = 2.42, 95% CI = 2.13-2.76), neurological (OR = 1.50, 95% CI = 1.30-1.72), and sensory (OR = 1.50, 95% CI = 1.29-1.73) groups were more likely to file accommodation related disputes than the cancer group. Sensory (OR = 4.41, 95% CI = 3.45-5.63), other-comorbid (OR = 2.33, 95% CI = 1.85-2.94), medical (OR = 1.92, 95% CI = 1.51-2.44), and neurological (OR = 1.59, 95% CI = 1.23-2.05) impairment groups filed more disputes related to hiring than the cancer or the cancer-comorbid group.

CONCLUSION

Cancer survivors are more likely to file job loss claims and differential treatment related to workplace policies. Those with cancer and another impairment file more claims related to relationship problems at work than cancer only. The factors accounting for these claims need to be explored in future research in order to develop more specific evidence based policy and practice.

IMPLICATIONS FOR CANCER SURVIVORS

While the percentage of cancer survivors who file claims are relatively small, job termination and terms of employment are more likely to be concerns for cancer survivors than employees with other types of impairments. If a cancer survivor has another health problem as well relationship disputes are likely to emerge.

Secondary prevention of work-related upper extremity disorders: recommendations from the Annapolis conference

INTRODUCTION

Efforts to improve the secondary prevention of work-related upper extremity (WRUE) symptoms continue to present a challenge. As with many occupational musculoskeletal pain disorders no single, direct cause-effect relationship exists among specific exposures, pathologic processes, and symptoms. The field has yet to create truly effective and efficient interventions for these problems that are based on current epidemiological and clinical knowledge.

METHODS

A working conference was held in Annapolis, Maryland on September 23rd and 24th, 2005 with leaders in research and application related to upper extremity disorders to address this challenge. The intent of the meeting was to review "state of the art" evidence in epidemiology and intervention research in order to develop suggestions regarding next steps in intervention research and application. On day 2 a number of stakeholders were present to discuss what they perceived as the missing pieces in both epidemiological research and applied intervention research in order to generate more effective workplace interventions.

RESULTS

The papers in this series of the Journal of Occupational Rehabilitation indicate that scientifically sound progress has been made over the past decade in identifying ergonomic, workplace psychosocial, and individual factors in both the etiology and exacerbation of these symptoms/disorders. However, there is a gap between this knowledge and the development and practical implementation of comprehensive interventions for these problems. The conference also highlighted the paucity of economic analyses of the impact of these disorders as well as the economic study of the impact of intervention. Approaches for such evaluations were presented and are included in this special section of the journal.

CONCLUSIONS

This series of papers and the summary of the invited group's discussions provided in this paper clearly emphasize the need for innovative ways to think about these problems and specific research topics that can help translate this knowledge into effective secondary prevention efforts.