1
|
Newman AR, Moody KM, Becktell K, Connelly E, Holladay C, Parisio K, Powell JL, Steineck A, Hendricks-Ferguson VL. Ensuring Intervention Fidelity of an Attention Control Arm in a Multisite Randomized Controlled Trial. Nurs Res 2024; 73:166-171. [PMID: 38112626 PMCID: PMC10922234 DOI: 10.1097/nnr.0000000000000710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2023]
Abstract
BACKGROUND Intervention fidelity is a critical element of randomized controlled trials, yet reporting of intervention fidelity among attention control arms is limited. Lack of fidelity to attention control procedures can affect study outcomes by either overestimating or underestimating the efficacy of the intervention under examination. OBJECTIVES This brief report describes the approach researchers took to promote fidelity to the attention control arm of a pediatric palliative care randomized controlled trial funded by the National Institutes of Health. METHODS The Informational Meetings for Planning and Coordinating Treatment trial aims to determine the efficacy of a communication intervention that uses care team dyads (i.e., physicians partnered with nurses or advanced practice providers) to engage parents of children with cancer who have a poor prognosis in structured conversations about prognostic information, goals of care, and care planning. The intervention is compared with an attention control arm, which provides parents with structured conversations on common pediatric cancer education topics, such as talking to their child about their cancer, clinical trials, cancer treatment, side effects, and so forth. National Institutes of Health guidelines for assessing and implementing strategies to promote intervention fidelity were used to design (a) the attention control arm of a randomized controlled trial, (b) related attention control arm training, and (c) quality assurance monitoring. RESULTS Attention control study procedures were designed to mirror that of the intervention arm (i.e., same number, frequency, and time spent in study visits). Cluster randomization was used to allocate care team dyads to one arm of the randomized controlled trial. Care team dyads assigned to the attention control arm participated in online training sessions to learn attention control procedures, the different roles of research team members, and quality assurance methods. Fidelity to attention control procedures is assessed by both the interveners themselves and a quality assurance team. DISCUSSION Study design, training, and delivery are all critical to attention control fidelity. Baseline training often needs to be supplemented with booster training when time gaps occur between study start-up and implementation. Quality assurance procedures are essential to determine whether interveners consistently deliver attention control procedures correctly.
Collapse
|
2
|
Moody KM, Andersen C, Bradley J, Draper L, Garrington T, Gill J, Harrison D, Hayashi M, Heaton A, Holladay C, Lion A, Rajan A, Rozo B, Runco D, Salvador L, Ferguson V, Arnold R. In-person and virtual adaptation of an interprofessional palliative care communications skills training course for pediatric oncology clinicians. Res Sq 2023:rs.3.rs-3228580. [PMID: 37609163 PMCID: PMC10441465 DOI: 10.21203/rs.3.rs-3228580/v1] [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] [Subscribe] [Scholar Register] [Indexed: 08/24/2023]
Abstract
Purpose Effective, empathic communication is crucial for pediatric oncology clinicians when discussing palliative and end-of-life (PC/EOL) care with parents of children with cancer. Unfortunately, many parents report inadequate communication at these distressing times. This study evaluates the communication skills training (CST) clinicians received to deliver a PC/EOL communication intervention as part of a multi-site randomized-controlled trial (RCT). Methods Clinicians from eight sites formed dyads (one physician and one nurse [RN] or advanced practice provider [APP]) and were trained over 3 days (in-person or virtually). Training was adapted from VitalTalk™ and included didactic instruction, videos, visual aids, and dedicated time to practice with simulated patients. Study participants completed a confidential, post-training online evaluation survey. A self-reported quality assurance checklist was used to measure fidelity to the communication protocol when delivered to parents during the RCT. Results Thirty clinicians completed training; 26 completed post-training surveys including twelve (46.1%) physicians, 8 (30.8%) RNs and 6 (23.1%) APPs. Most were female (65.4%); white (80.8%), not Latinx (88.5%); 40-50 years old (53.9%); and in practice over 10 years (65.4%). Nine (34.6%) trained in-person; the rest trained virtually. Ninety-two percent reported the course was valuable or very valuable for developing their PC/EOL communication skills and 96% reported learning something new. Dyads trained virtually had similar fidelity to those trained in-person (95% and 90% respectively) when delivering the PC/EOL communication intervention to parents. Conclusion This PC/EOL CST was valuable for improving pediatric oncology clinicians' communication skills, successfully implemented in-person and virtually, and translated effectively into practice.
Collapse
|
3
|
Robb SL, Stegenga K, Perkins SM, Stump TE, Moody KM, Henley AK, MacLean J, Jacob SA, Delgado D, Haut PR. Mediators and Moderators of Active Music Engagement to Reduce Traumatic Stress Symptoms and Improve Well-being in Parents of Young Children With Cancer. Integr Cancer Ther 2023; 22:15347354231218266. [PMID: 38145309 PMCID: PMC10750508 DOI: 10.1177/15347354231218266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Revised: 10/03/2023] [Accepted: 11/17/2023] [Indexed: 12/26/2023] Open
Abstract
OBJECTIVE This trial examined the effects of proximal/distal mediators and moderators of an Active Music Engagement (AME) intervention on young child/parent distress, quality of life, and family function outcomes. METHODS Child/parent dyads (n = 125) were randomized to AME or Audio-storybooks attention control condition. Each group received 3 sessions with a credentialed music therapist for 3 consecutive days with data collection at baseline, post-intervention (T2), and 30-days later (T3). Potential proximal mediators included within session child and parent engagement. Potential distal mediators included changes in perceived family normalcy, parent self-efficacy, and independent use of play materials. Potential moderators included parent/child distress with prior hospitalizations, parent traumatic stress screener (PCL-6), and child age. Outcomes included child emotional distress and quality of life; parent emotion, traumatic stress symptoms (IES-R), well-being; and family function. Mediation effects were estimated using ANCOVA, with indirect effects estimated using the percentile bootstrap approach. Moderation effects were tested by including appropriate interaction terms in models. RESULTS No significant mediation effects were observed. Child distress with prior hospitalizations moderated AME effects for IES-R intrusion subscale scores at T2 (P = .01) and avoidance subscale scores at T3 (P = .007). Traumatic stress screener scores (PCL-6) moderated intervention effects for IES-R hyperarousal subscale scores at T2 (P = .01). There were no moderation effects for child age. CONCLUSIONS AME is a promising intervention for mitigating traumatic stress symptoms and supporting well-being in parents of children with cancer, particularly for parents who screen high for traumatic stress and whose children are more highly distressed with hospitalization.
Collapse
Affiliation(s)
| | | | | | | | | | - Amanda K. Henley
- Purdue School of Engineering and Technology, IUPUI, Indianapolis, IN, USA
| | | | | | - David Delgado
- Astellas Pharma Global Development, Inc, Northbrook, IL, USA
| | | |
Collapse
|
4
|
Moody KM, Hendricks-Ferguson VL, Baker R, Perkins S, Haase JE. A Pilot Study of the Effects of COMPLETE: A Communication Plan Early Through End of Life, on End-of-Life Outcomes in Children With Cancer. J Pain Symptom Manage 2020; 60:417-421. [PMID: 32315752 DOI: 10.1016/j.jpainsymman.2020.03.033] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Revised: 03/26/2020] [Accepted: 03/27/2020] [Indexed: 11/28/2022]
Abstract
CONTEXT Most children with cancer die in hospital settings, without hospice, and many suffer from high-intensity medical interventions and pain at end of life (EOL). OBJECTIVES To examine the effects of COMPLETE: a communication plan early through EOL to increase hospice enrollment in children with cancer at EOL. METHODS This is a two-phase, single-arm, two-center, and prospective pilot study of hospice enrollment in children with cancer whose parents received COMPLETE. COMPLETE is a series of medical doctor (MD)/registered nurse (RN)-guided discussions of goals of care using visual aids that begin at diagnosis. COMPLETE training for MD/RNs in Phase II was revised to increase their use of empathy. Preintervention/postintervention measurements for child include: time of hospice enrollment, pain, high-intensity medical interventions at EOL, and location of death; and for parent the following: uncertainty and hope. RESULTS Twenty-one parents of 18 children enrolled in the study, and 13 children were followed through EOL. At EOL, 11 (84.6%) died on home hospice or inpatient hospice, and only two (15%) received high-intensity medical interventions. Similar to published findings in the initial 13 parents enrolled in Phase I, parents in Phase II (n = 7) had improvement in hope and uncertainty, and child pain was decreased. Revised training resulted in significant improvement in MD/RN (N = 6) use of empathy (11% in Phase I vs. 100% in Phase II; P = 0.001). CONCLUSION COMPLETE resulted in increased hospice enrollment in children with cancer at EOL compared with historical controls. In preanalysis/postanalysis, COMPLETE decreased child pain while supporting hope and reducing uncertainty in their parents.
Collapse
Affiliation(s)
- Karen M Moody
- Division of Pediatrics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.
| | | | - Rebecca Baker
- Indiana University School of Nursing, Indianapolis, Indiana, USA
| | - Susan Perkins
- Department of Biostatistics, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Joan E Haase
- Indiana University School of Nursing, Indianapolis, Indiana, USA
| |
Collapse
|
5
|
Moody KM, Baker RA, Santizo RO, Olmez I, Spies JM, Buthmann A, Granowetter L, Dulman RY, Ayyanar K, Gill JB, Carroll AE. A randomized trial of the effectiveness of the neutropenic diet versus food safety guidelines on infection rate in pediatric oncology patients. Pediatr Blood Cancer 2018; 65. [PMID: 28696047 DOI: 10.1002/pbc.26711] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2017] [Revised: 05/19/2017] [Accepted: 06/08/2017] [Indexed: 02/06/2023]
Abstract
BACKGROUND The neutropenic diet (ND) is prescribed to avoid introduction of bacteria into a host's gastrointestinal tract and reduce infection. Due to a lack of evidence to support the ND, there continues to be debate among pediatric oncologists regarding its usefulness. This prospective randomized controlled trial evaluated the difference in neutropenic infection rates in pediatric oncology patients randomized to Food and Drug Administration approved food safety guidelines (FSGs) versus the ND plus FSGs during one cycle of chemotherapy. PROCEDURE Pediatric patients receiving cancer treatment with myelosuppressive chemotherapy were eligible. Neutropenic infection was the primary outcome and defined as (i) fever with neutropenia or (ii) hospital admission and treatment for clinical infection and neutropenia. The rate of neutropenic infection was compared with Student's t-test for independent samples. Documented infections were identified by comprehensive chart review and compared between groups using a χ2 test. RESULTS One hundred fifty patients were randomly assigned to FSGs (n = 73) or ND + FSGs (n = 77). The most common diagnoses were acute lymphoblastic leukemia (32%) and sarcoma (32%). There was no significant difference between the groups in the percentage of patients who developed neutropenic infection: FSGs 33% versus ND + FSGs 35% (P = 0.78). Patients randomized to ND + FSGs reported that following the diet required more effort than those on FSGs alone. CONCLUSION The ND offers no benefit over FSGs in the prevention of infection in pediatric oncology patients undergoing myelosuppressive chemotherapy and adherence requires more effort for patients and families. Institutions caring for children with cancer should consider replacing ND guidelines with FSGs.
Collapse
Affiliation(s)
- Karen M Moody
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana
| | - Rebecca A Baker
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana
| | - Ruth O Santizo
- Department of Pediatrics, Albert Einstein College of Medicine, Bronx, New York
| | - Inan Olmez
- Department of Neurology, University of Virginia, Charlottesville, Virginia
| | - Jeanie M Spies
- Rady Children's Hospital, Peckham Center for Cancer and Blood Disorders, San Diego, California
| | - Amanda Buthmann
- The Stephen D. Hassenfeld Children's Center for Cancer and Blood Disorders, New York
| | - Linda Granowetter
- Department of Pediatrics, New York University School of Medicine, New York
| | - Robin Y Dulman
- Pediatric Specialists of Virginia and Inova Fairfax Hospital, Virginia
| | | | - Jonathan B Gill
- Department of Pediatrics, Albert Einstein College of Medicine, Bronx, New York
| | - Aaron E Carroll
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana
| |
Collapse
|
6
|
Moody KM, Schonberger LB, Maddox RA, Zou WQ, Cracco L, Cali I. Sporadic fatal insomnia in a young woman: a diagnostic challenge: case report. BMC Neurol 2011; 11:136. [PMID: 22040318 PMCID: PMC3214133 DOI: 10.1186/1471-2377-11-136] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2011] [Accepted: 10/31/2011] [Indexed: 11/17/2022] Open
Abstract
Background Sporadic fatal insomnia (sFI) and fatal familial insomnia (FFI) are rare human prion diseases. Case Presentation We report a case of a 33-year-old female who died of a prion disease for whom the diagnosis of sFI or FFI was not considered clinically. Following death of this patient, an interview with a close family member indicated the patient's illness included a major change in her sleep pattern, corroborating the reported autopsy diagnosis of sFI. Genetic tests identified no prion protein (PrP) gene mutation, but neuropathological examination and molecular study showed protease-resistant PrP (PrPres) in several brain regions and severe atrophy of the anterior-ventral and medial-dorsal thalamic nuclei similar to that described in FFI. Conclusions In patients with suspected prion disease, a characteristic change in sleep pattern can be an important clinical clue for identifying sFI or FFI; polysomnography (PSG), genetic analysis, and nuclear imaging may aid in diagnosis.
Collapse
Affiliation(s)
- Karen M Moody
- Texas Department of State Health Services, Austin, TX 78756-3199, USA.
| | | | | | | | | | | |
Collapse
|
7
|
Affiliation(s)
- Adam S. Levy
- The Children's Hospital at Montefiore, Albert Einstein College of Medicine, Bronx, New York
| | - Michael E. Roth
- The Children's Hospital at Montefiore, Albert Einstein College of Medicine, Bronx, New York
| | - Kerry A. Morrone
- The Children's Hospital at Montefiore, Albert Einstein College of Medicine, Bronx, New York
| | - Karen M. Moody
- The Children's Hospital at Montefiore, Albert Einstein College of Medicine, Bronx, New York
| |
Collapse
|
8
|
Abstract
The effect of ovariectomy, hysterectomy, and cerviectomy on systemic oxytocin-PGE2 induced facilitation of lordosis behavior was examined in estrogen and progesterone treated rats. Females were injected with 0.25 micrograms estradiol benzoate for 3 days, followed by 500 micrograms progesterone on day 4, 4 hr prior to behavioral testing. Ten minutes before behavioral testing with a male, females were injected systemically with either oxytocin (2.1, 4.2, or 8.4 micrograms); PGE2 (0.05, 0.10, or 0.20 micrograms); concomitant administration of both oxytocin and PGE2; or physiological saline. Oxytocin (2.1 micrograms) or PGE2 (0.05 micrograms) significantly increased lordosis behavior in ovariectomized females; however, neither had any facilitatory effect in hysterectomized animals. Facilitated lordosis behavior was only reinstated in hysterectomized females that received concomitant administration of 2.1 micrograms oxytocin plus 0.05 micrograms PGE2. This latter dose also resulted in a further potentiation of lordosis behavior in ovariectomized animals, compared to 2.1 micrograms oxytocin or 0.05 micrograms PGE2 alone. Concomitant administration of oxytocin and PGE2 at all doses had no facilitatory effect on lordosis behavior in cerviectomized animals. These results suggest that the uterus and the cervix may be important components of a peripheral mechanism by which systemic oxytocin and/or PGE2 induce facilitated lordosis behavior in female rats.
Collapse
Affiliation(s)
- K M Moody
- Institute of Neurological Sciences, University of Pennsylvania, Philadelphia, PA 19104, USA
| | | |
Collapse
|
9
|
Abstract
The effect of bilateral pelvic, hypogastric, or pudendal neurectomy on oxytocin-induced facilitation of lordosis behavior was examined in ovariectomized, estrogen, and progesterone primed female rats. Oxytocin-induced facilitation of lordosis behavior was significantly decreased following bilateral pelvic, or combined bilateral pelvic and hypogastric neurectomy. Hypogastric only or pudendal only neurectomy had no effect on the facilitation of lordosis behavior after systemic administration of oxytocin. These results suggest that the integrity of the pelvic nerve is necessary and sufficient to mediate the stimulatory effects of systemically administered oxytocin on receptivity.
Collapse
Affiliation(s)
- K M Moody
- Institute of Neurological Sciences, University of Pennsylvania, Philadelphia
| | | | | | | |
Collapse
|
10
|
Affiliation(s)
- K M Moody
- Institute of Neuroscience, University of Pennsylvania, Philadelphia 19104
| | | | | | | |
Collapse
|