1
|
Gazaway S, Odom JN, Herbey I, Armstrong M, Underwood F, Heard TV, Allen A, Ekelem C, Bakitas MA, Elk R. Cultural Values Influence on Rural Family Caregivers' Decision-Making for Ill Older Adult Loved Ones. J Pain Symptom Manage 2024:S0885-3924(24)00718-8. [PMID: 38641135 DOI: 10.1016/j.jpainsymman.2024.04.012] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Revised: 04/08/2024] [Accepted: 04/10/2024] [Indexed: 04/21/2024]
Abstract
CONTEXT Rural older adult Americans receive more intense treatment at end of life. Studies indicate that those who participate in goals of care conversations receive care more concordant with their values. Yet, rates of documented goals of care discussions are lower in rural and Black communities. Although multi-factorial, the role that rural family caregivers (FCGs) play in decision-making for ill loved ones is understudied. OBJECTIVE This study aimed to explore rural FCGs cultural values, beliefs, and attitudes about serious illness and treatment decision-making and to understand how these factors influence their decision-making around goals of care for their family members. METHODS This is an embedded qualitative study within a tele-palliative care consult randomized trial that the PEN-3 theoretical model guided. Semi-structured interviews were conducted with FCGs who had completed study participation. Thematic analysis was used to analyze the data. RESULTS Twelve rural FCGs center their decisions around core values, and the decision-making experience was supported by faith. A model of how the key themes and subthemes interact around the central space of supporting the seriously ill loved to demonstrate the complexity of caregiving when race and rurality intersect is presented. CONCLUSION This study is a foundational step in understanding how rural FCGs beliefs and values influence decision-making. We recommend incorporating those constructs into the development of culturally responsive decision-support interventions.
Collapse
Affiliation(s)
- Shena Gazaway
- School of Nursing (S.G., J.N.O., M.A., M.A.B.), University of Alabama at Birmingham, Birmingham, Alabama, USA; Center for Palliative and Supportive Care (S.G., J.N.O., F.U., C.E., M.A.B.), University of Alabama at Birmingham, Birmingham, Alabama, USA.
| | - James Nicholas Odom
- School of Nursing (S.G., J.N.O., M.A., M.A.B.), University of Alabama at Birmingham, Birmingham, Alabama, USA; Center for Palliative and Supportive Care (S.G., J.N.O., F.U., C.E., M.A.B.), University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Ivan Herbey
- School of Health Professions (I.H.), University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Margaret Armstrong
- School of Nursing (S.G., J.N.O., M.A., M.A.B.), University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Felicia Underwood
- Center for Palliative and Supportive Care (S.G., J.N.O., F.U., C.E., M.A.B.), University of Alabama at Birmingham, Birmingham, Alabama, USA; School of Medicine, Division of Geriatrics (F.U., C.E., R.E.), University of Alabama at Birmingham, Birmingham, Alabama, USA
| | | | - Ashley Allen
- Anderson Regional Medical Center (A.A.), Meridian, Mississippi, USA
| | - Christiana Ekelem
- Center for Palliative and Supportive Care (S.G., J.N.O., F.U., C.E., M.A.B.), University of Alabama at Birmingham, Birmingham, Alabama, USA; School of Medicine, Division of Geriatrics (F.U., C.E., R.E.), University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Marie A Bakitas
- School of Nursing (S.G., J.N.O., M.A., M.A.B.), University of Alabama at Birmingham, Birmingham, Alabama, USA; Center for Palliative and Supportive Care (S.G., J.N.O., F.U., C.E., M.A.B.), University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Ronit Elk
- Center for Palliative and Supportive Care (S.G., J.N.O., F.U., C.E., M.A.B.), University of Alabama at Birmingham, Birmingham, Alabama, USA; School of Medicine, Division of Geriatrics (F.U., C.E., R.E.), University of Alabama at Birmingham, Birmingham, Alabama, USA
| |
Collapse
|
2
|
Kimball J, Hawkins-Taylor C, Anderson A, Anderson DG, Fornehed MLC, Justis P, Lalani N, Mollman S, Pravecek B, Rice J, Shearer J, Stein D, Teshale SM, Bakitas MA. Top Ten Tips Palliative Clinicians Should Know About Rural Palliative Care in the United States. J Palliat Med 2024. [PMID: 38489603 DOI: 10.1089/jpm.2024.0032] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/17/2024] Open
Abstract
Palliative care improves outcomes, yet rural residents often lack adequate and equitable access. This study provides practical tips to address palliative care (PC)-related challenges in rural communities. Strategies include engaging trusted community partners, addressing cultural factors, improving pediatric care, utilizing telehealth, networking with rural teams including caregivers, and expanding roles for nurses and advanced practice providers. Despite complex barriers to access, providers can tailor PC to be patient-centered, respect local values, and bridge gaps. The "Top 10" format emphasizes the relevant issues to enable clinicians to provide optimal care for people from rural areas.
Collapse
Affiliation(s)
- Jack Kimball
- Department of Palliative Medicine, Duke University Health System, Durham, North Carolina, USA
| | | | - Anne Anderson
- Palliative Care Program, Seattle Children's Hospital, Seattle, Washington, USA
| | | | | | - Patricia Justis
- Rural Health/Office of Community Health Systems, Washington State Department of Health, Tumwater, Washington, USA
| | - Nasreen Lalani
- School of Nursing, Purdue University, West Lafayette, Indiana, USA
| | - Sarah Mollman
- College of Nursing, South Dakota State University, Rapid City, South Dakota, USA
| | - Brandi Pravecek
- College of Nursing, South Dakota State University, Sioux Falls, South Dakota, USA
| | | | | | - Dillon Stein
- Division of Palliative Care, Independence Health System, Butler, Pennsylvania, USA
| | - Salom M Teshale
- The National Academy for State Health Policy, Washington, District of Columbia, USA
| | - Marie A Bakitas
- School of Nursing/Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
| |
Collapse
|
3
|
Lyons KD, Wechsler SB, Ejem DB, Stevens CJ, Azuero A, Khalidi S, Hegel MT, dos Anjos SM, Codini ME, Chamberlin MD, Morency JL, Coffee-Dunning J, Thorp KE, Cloyd DZ, Goedeken S, Newman R, Muse C, Rocque G, Keene K, Pisu M, Echols J, Bakitas MA. Telephone-Based Rehabilitation Intervention to Optimize Activity Participation After Breast Cancer: A Randomized Clinical Trial. JAMA Netw Open 2024; 7:e242478. [PMID: 38517442 PMCID: PMC10960198 DOI: 10.1001/jamanetworkopen.2024.2478] [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: 11/20/2023] [Accepted: 01/22/2024] [Indexed: 03/23/2024] Open
Abstract
Importance Following treatment, breast cancer survivors face challenges participating in valued activities. Objective To determine whether a telephone-based coaching rehabilitation intervention enhances activity participation in the year following breast cancer treatment. Design, Setting, and Participants In this multisite, single-blind randomized clinical trial (Optimizing Functional Recovery of Breast Cancer Survivors), recruitment occurred between August 28, 2019, and April 30, 2022. Data collection was completed by April 1, 2023. Participants were recruited from 2 cancer centers (Dartmouth College and the University of Alabama at Birmingham) and via social media advertisements. Women aged 18 years or older who had completed primary treatment for stage I to III breast cancer within 1 year and reported participation restrictions were eligible to participate. Randomization was stratified by site, treatment, and time since treatment. Interventions The intervention, delivered via telephone over 9 sessions, used behavioral activation and problem-solving principles to promote activity participation. The education-based attention control condition was delivered via telephone at matched intervals. Main Outcomes and Measures The primary outcome was participation, assessed using 5 measures, including Patient-Reported Outcomes Measurement Information System (PROMIS) social participation-satisfaction measure. One individualized outcome allowed participants to specify activities for which they wanted to foster recovery. Outcomes were collected by telephone by blinded coordinators at baseline and at 8, 20, and 44 weeks. The individualized outcome was assessed at the first and last intervention and control session. Results Among 1996 patients identified, 303 were eligible and enrolled. Of these, 284 women (94%; mean [SD] age, 56.1 [10.2] years) completed baseline assessments and were randomized, and 81% or more of each group completed the final assessment with no adverse events. Of those who completed the final assessment, 118 of 114 (82%) were in the intervention group, and 113 of 140 (81%) were attention control participants. Between-group differences were not statistically significant for the main measures of PROMIS satisfaction (week 20: Cohen d, 0.1 [95% CI, -0.09 to 0.29] and week 44: Cohen d, -0.08 [95% CI, -0.27 to 0.11]) and ability (week 20: Cohen d, 0.15 [95% CI, -0.06 to 0.37] and week 44: Cohen d, -0.08 [95% CI, -0.27 to 0.11]). On the individualized outcome, intervention participants reported significantly greater improvements in activity satisfaction (Cohen d, 0.76 [95% CI, 0.48-1.02]) and performance (Cohen d, 0.60 [95% CI, 0.32-0.87]). Conclusions and Relevance In this randomized clinical trial, the intervention catalyzed greater improvements in self-selected activity participation and goal disengagement but did not otherwise accelerate recovery compared with the control condition. Future research should determine what intervention features may lead to the greatest reductions in participation restrictions and other measures that may detect functional recovery. Trial Registration ClinicalTrials.gov Identifier: NCT03915548.
Collapse
Affiliation(s)
- Kathleen Doyle Lyons
- Department of Occupational Therapy, Massachusetts General Hospital Institute of Health Professions, Boston
| | - Stephen B. Wechsler
- Department of Occupational Therapy, Massachusetts General Hospital Institute of Health Professions, Boston
| | - Deborah B. Ejem
- School of Nursing, University of Alabama at Birmingham, Birmingham
| | - Courtney J. Stevens
- Department of Psychiatry, Geisel School of Medicine at Dartmouth, Dartmouth College, Hanover, New Hampshire
| | - Andres Azuero
- School of Nursing, University of Alabama at Birmingham, Birmingham
| | - Sarah Khalidi
- School of Nursing, University of Alabama at Birmingham, Birmingham
| | - Mark T. Hegel
- Department of Psychiatry, Geisel School of Medicine at Dartmouth, Dartmouth College, Hanover, New Hampshire
| | - Sarah M. dos Anjos
- School of Health Professions, Department of Occupational Therapy, University of Alabama at Birmingham, Birmingham
| | - Megan E. Codini
- Department of Rehabilitation, Berkshire Medical Center, Pittsfield, Massachusetts
| | - Mary D. Chamberlin
- Dartmouth Cancer Center, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire
| | - Jamme L. Morency
- Rehabilitation Medicine, Dartmouth Health, Lebanon, New Hampshire
| | | | - Karen E. Thorp
- Rehabilitation Medicine, Dartmouth Health, Lebanon, New Hampshire
| | | | - Susan Goedeken
- Department of Neurology, Mass General Brigham, Boston, Massachusetts
| | - Robin Newman
- Department of Occupational Therapy, Sargent College of Health and Rehabilitation Sciences, Boston University, Boston, Massachusetts
| | - Colleen Muse
- Department of Occupational Therapy, Massachusetts General Hospital Institute of Health Professions, Boston
| | - Gabrielle Rocque
- Department of Medicine, Division of Hematology and Oncology, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham
- Department of Medicine, Division of Gerontology, Geriatrics, and Palliative Care, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham
- Center for Palliative and Supportive Care, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham
- O’Neal Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham
| | - Kimberly Keene
- O’Neal Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham
- Department of Radiation Oncology, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham
| | - Maria Pisu
- O’Neal Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham
- Division of Preventive Medicine, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham
| | - Jennifer Echols
- School of Nursing, University of Alabama at Birmingham, Birmingham
| | - Marie A. Bakitas
- School of Nursing, University of Alabama at Birmingham, Birmingham
- Center for Palliative and Supportive Care, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham
| |
Collapse
|
4
|
Odom JN, Young HM, Sterba K, Sannes TS, Reinhard S, Nightingale C, Meier D, Gray TF, Ferrell B, Fernandez ME, Donovan H, Curry K, Currie ER, Bryant T, Bakitas MA, Applebaum AJ. Developing a national implementation strategy to accelerate uptake of evidence-based family caregiver support in U.S. cancer centers. Psychooncology 2024; 33:e6221. [PMID: 37743780 PMCID: PMC10896495 DOI: 10.1002/pon.6221] [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: 07/23/2023] [Revised: 08/24/2023] [Accepted: 09/14/2023] [Indexed: 09/26/2023]
Abstract
OBJECTIVE Characterize key factors and training needs of U.S. cancer centers in implementing family caregiver support services. METHODS Sequential explanatory mixed methods design consisting of: (1) a national survey of clinicians and administrators from Commission-on-Cancer-accredited cancer centers (N = 238) on factors and training needed for establishing new caregiver programs and (2) qualitative interviews with a subsample of survey respondents (N = 30) to elicit feedback on survey findings and the outline of an implementation strategy to facilitate implementation of evidence-based family caregiver support (the Caregiver Support Accelerator). Survey data was tabulated using descriptive statistics and transcribed interviews were analyzed using thematic analysis. RESULTS Top factors for developing new caregiver programs were that the program be: consistent with the cancer center's mission and strategic plan (87%), supported by clinic leadership (86.5%) and providers and staff (85.7%), and low cost or cost effective (84.9%). Top training needs were how to: train staff to implement programs (72.3%), obtain program materials (63.0%), and evaluate program outcomes (62.6%). Only 3.8% reported that no training was needed. Qualitative interviews yielded four main themes: (1) gaining leadership, clinician, and staff buy-in and support is essential; (2) cost and clinician burden are major factors to program implementation; (3) training should help with adapting and marketing programs to local context and culture; and (4) the Accelerator strategy is comprehensive and would benefit from key organizational partnerships and policy standards. CONCLUSION Findings will be used to inform and refine the Accelerator implementation strategy to facilitate the adoption and growth of evidence-based cancer caregiver support in U.S. cancer centers.
Collapse
Affiliation(s)
- J. Nicholas Odom
- School of Nursing, University of Alabama at Birmingham (UAB), Birmingham, Alabama, USA
- Division of Geriatrics, Gerontology, and Palliative Care, UAB Department of Medicine, Birmingham, Alabama, USA
- UAB Center for Palliative and Supportive Care, Birmingham, Alabama, USA
| | - Heather M. Young
- Betty Irene Moore School of Nursing, University of California, Davis, Davis, CA, USA
| | - Katherine Sterba
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC, USA
| | | | | | - Chandelyn Nightingale
- Department of Social Sciences and Health Policy, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Diane Meier
- Mount Sinai Medical Center, New York, NY, USA
| | - Tamryn F. Gray
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | | | - Maria E. Fernandez
- Department of Health Promotion and Behavioral Sciences, University of Texas Health Science Center at Houston School of Public Health, Houston, TX, USA
| | - Heidi Donovan
- Schools of Nursing and Medicine, and the National Rehabilitation Research & Training Center on Family Support, University of Pittsburgh, Pittsburgh, PA, USA
| | - Kayleigh Curry
- School of Nursing, University of Alabama at Birmingham (UAB), Birmingham, Alabama, USA
| | - Erin R. Currie
- School of Nursing, University of Alabama at Birmingham (UAB), Birmingham, Alabama, USA
| | | | - Marie A. Bakitas
- School of Nursing, University of Alabama at Birmingham (UAB), Birmingham, Alabama, USA
- Division of Geriatrics, Gerontology, and Palliative Care, UAB Department of Medicine, Birmingham, Alabama, USA
- UAB Center for Palliative and Supportive Care, Birmingham, Alabama, USA
| | - Allison J. Applebaum
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| |
Collapse
|
5
|
Pfahl J, Thompson JS, Matlock DD, Allen LA, Dionne-Odom JN, Bakitas MA, McIlvennan CK. ENABLE-LVAD: Development and Implementation of a Novel Training Program for Clinicians Supporting Family Caregivers of Patients With a Left Ventricular Assist Device. J Cardiovasc Nurs 2023:00005082-990000000-00152. [PMID: 37974325 DOI: 10.1097/jcn.0000000000001065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2023]
Abstract
BACKGROUND Despite significant family caregiver (FCG) burnout, there are currently no tested interventions to support the FCG role after left ventricular assist device (LVAD) implantation or formalized training for clinicians to support FCGs. OBJECTIVE We adapted the existing ENABLE (Educate, Nurture, Advise Before Life Ends) intervention to LVAD clinicians and FCGs and assessed clinical implementation and dissemination. METHODS ENABLE-LVAD is an interactive, self-paced clinician training coupled with FCG-facing guidebooks and resources. Implementation and dissemination were evaluated by the RE-AIM (reach, effectiveness, adoption, implementation, and maintenance) framework. RESULTS As of May 2023, 187 clinicians registered for the training, and 41 completed all modules (22.0% completion rate). Of those who completed the training and responded to a 6-month survey, one-third (n = 10, 33.3%) used ENABLE-LVAD with FCGs, and 100% of those planned to continue using it. The primary barrier to completing the training was time. CONCLUSIONS The ENABLE-LVAD clinician training was successfully disseminated and implemented as a useful resource to support LVAD FCGs.
Collapse
|
6
|
Stevens CJ, Wechsler S, Ejem DB, Khalidi S, Coffee-Dunning J, Morency JL, Thorp KE, Codini ME, Newman RM, Echols J, Cloyd DZ, dos Anjos S, Muse C, Gallups S, Goedeken SC, Flannery K, Bakitas MA, Hegel MT, Lyons KD. A Process Evaluation of Intervention Delivery for a Cancer Survivorship Rehabilitation Clinical Trial Conducted during the COVID-19 Pandemic. Curr Oncol 2023; 30:9141-9155. [PMID: 37887560 PMCID: PMC10605104 DOI: 10.3390/curroncol30100660] [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: 08/30/2023] [Revised: 10/04/2023] [Accepted: 10/09/2023] [Indexed: 10/28/2023] Open
Abstract
The purpose of the present study was to conduct a process evaluation of intervention delivery for a randomized controlled trial (RCT) conducted during the COVID-19 pandemic (NCT03915548). The RCT tested the effects of a telephone-delivered behavioral intervention on changes in breast cancer survivors' satisfaction with social roles and activities, as compared to an attention control condition. This process evaluation examined (a) fidelity monitoring scores; (b) participants' perceived benefit ratings for gaining confidence, reducing distress, adjusting habits and routines, setting goals, and increasing exercise; and (c) field notes, email communications, and transcripts of coach supervision and debriefing sessions. The behavioral and attention control conditions were delivered with a high degree of fidelity (global quality rating score for the BA/PS condition was M = 4.6 (SD = 0.6) and M = 4.9 (SD = 0.3) for the attention control condition, where "5" is the highest rating). The behavioral intervention participants perceived greater benefits than the control participants pertaining to goal setting, t(248) = 5.73, p = <0.0001, adjusting habits and routines, t(248) = 2.94, p = 0.0036, and increasing exercise, t(248) = 4.66, p = <0.0001. Moreover, coaches' perceptions regarding the behavioral intervention's therapeutic aspects aligned with the study's a priori conceptual model including the use of a structured process to set small, observable goals and facilitate the independent use of problem-solving skills. However, coaches also noted that aspects of the attention control condition, including the perceived relevance of the educational content and opportunities for social support, may have made it more therapeutically potent than intended. The pandemic may have affected the activity goals behavioral intervention participants could set as well as augmented the relevancy of social support provided in both conditions.
Collapse
Affiliation(s)
- Courtney J. Stevens
- Department of Psychiatry, Geisel School of Medicine, Dartmouth College, Hanover, NH 03755, USA
| | - Stephen Wechsler
- Department of Occupational Therapy, School of Rehabilitation Sciences, Massachusetts General Hospital Institute of Health Professions, Boston, MA 02129, USA (K.D.L.)
| | - Deborah B. Ejem
- School of Nursing, University of Alabama at Birmingham, Birmingham, AL 35294, USA
| | - Sarah Khalidi
- School of Nursing, University of Alabama at Birmingham, Birmingham, AL 35294, USA
| | | | - Jamme L. Morency
- Department of Rehabilitation Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, NH 03766, USA
| | - Karen E. Thorp
- Department of Rehabilitation Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, NH 03766, USA
| | - Megan E. Codini
- Department of Occupational Therapy, School of Rehabilitation Sciences, Massachusetts General Hospital Institute of Health Professions, Boston, MA 02129, USA (K.D.L.)
| | - Robin M. Newman
- Sargent College of Health and Rehabilitation Sciences, Boston University, Boston, MA 02215, USA
| | - Jennifer Echols
- School of Nursing, University of Alabama at Birmingham, Birmingham, AL 35294, USA
| | - Danielle Z. Cloyd
- School of Nursing, University of Alabama at Birmingham, Birmingham, AL 35294, USA
| | - Sarah dos Anjos
- Department of Occupational Therapy, School of Health Professions, University of Alabama at Birmingham, Birmingham, AL 35294, USA
| | - Colleen Muse
- Department of Occupational Therapy, School of Rehabilitation Sciences, Massachusetts General Hospital Institute of Health Professions, Boston, MA 02129, USA (K.D.L.)
| | - Sarah Gallups
- School of Nursing, University of Alabama at Birmingham, Birmingham, AL 35294, USA
| | - Susan C. Goedeken
- Department of Occupational Therapy, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Kaitlin Flannery
- Department of Occupational Therapy, School of Rehabilitation Sciences, Massachusetts General Hospital Institute of Health Professions, Boston, MA 02129, USA (K.D.L.)
| | - Marie A. Bakitas
- School of Nursing, University of Alabama at Birmingham, Birmingham, AL 35294, USA
| | - Mark T. Hegel
- Department of Psychiatry, Geisel School of Medicine, Dartmouth College, Hanover, NH 03755, USA
| | - Kathleen Doyle Lyons
- Department of Occupational Therapy, School of Rehabilitation Sciences, Massachusetts General Hospital Institute of Health Professions, Boston, MA 02129, USA (K.D.L.)
| |
Collapse
|
7
|
Odom JN, Applebaum A, Bakitas MA, Bryant T, Currie E, Curry K, Donovan H, Fernandez ME, Ferrell B, Azuero A, Gray TF, Hendricks BA, Meier D, Nightingale C, Reinhard S, Sannes TS, Sterba K, Young HM. Availability of Family Caregiver Programs in US Cancer Centers. JAMA Netw Open 2023; 6:e2337250. [PMID: 37819661 PMCID: PMC10568368 DOI: 10.1001/jamanetworkopen.2023.37250] [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: 06/23/2023] [Accepted: 08/29/2023] [Indexed: 10/13/2023] Open
Abstract
Importance Family caregivers provide the majority of health care to the 18 million patients with cancer in the US. Yet despite providing complex medical and nursing care, a large proportion of caregivers report no formal support or training. In recognition of this gap, many interventions to support cancer caregivers have been developed and tested over the past 2 decades. However, there are few system-level data on whether US cancer centers have adopted and implemented these interventions. Objective To describe and characterize the availability of family caregiver support programs in US cancer centers. Design, Setting, and Participants This cross-sectional national survey study was conducted between September 1, 2021, and April 30, 2023. Participants comprised clinical and administrative staff of Commission on Cancer-accredited US cancer centers. Data analysis was performed in May and June 2023. Main Outcomes and Measures Survey questions about the availability of 11 types of family caregiver programs (eg, peer mentoring, education classes, and psychosocial programs) were developed after literature review, assessment of similar program evaluation surveys, and discussions among a 13-member national expert advisory committee. Family caregiver programs were defined as structured, planned, and coordinated groups of activities and procedures aimed at specifically supporting family caregivers as part of usual care. Survey responses were tabulated using standard descriptive statistics, including means, proportions, and frequencies. Results Of the surveys sent to potential respondents at 971 adult cancer centers, 238 were completed (response rate, 24.5%). After nonresponse weight adjustment, most cancer centers (75.4%) had at least 1 family caregiver program; 24.6% had none. The most common program type was information and referral services (53.6%). Cancer centers with no programs were more likely to have smaller annual outpatient volumes (χ2 = 11.10; P = .011). Few centers had caregiver programs on training in medical and/or nursing tasks (21.7%), caregiver self-care (20.2%), caregiver-specific distress screening (19.3%), peer mentoring (18.9%), and children caregiving for parents (8.3%). Very few programs were developed from published evidence in a journal (8.1%). The top reason why cancer centers selected their programs was community members requesting the program (26.3%); only 12.3% of centers selected their programs based on scientific evidence. Most programs were funded by the cancer center or hospital (58.6%) or by philanthropy (42.4%). Conclusions and Relevance In this survey study, most cancer centers had family caregiver programs; however, a quarter had none. Furthermore, the scope of programming was limited and rarely evidence based, with few centers offering caregiving education and training. These findings suggest that implementation strategies are critically needed to foster uptake of evidence-based caregiver interventions.
Collapse
Affiliation(s)
- J. Nicholas Odom
- School of Nursing, The University of Alabama at Birmingham, Birmingham
- Division of Geriatrics, Gerontology, and Palliative Care, Department of Medicine, The University of Alabama at Birmingham, Birmingham
- Center for Palliative and Supportive Care, The University of Alabama at Birmingham, Birmingham
| | - Allison Applebaum
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Marie A. Bakitas
- School of Nursing, The University of Alabama at Birmingham, Birmingham
- Division of Geriatrics, Gerontology, and Palliative Care, Department of Medicine, The University of Alabama at Birmingham, Birmingham
- Center for Palliative and Supportive Care, The University of Alabama at Birmingham, Birmingham
| | | | - Erin Currie
- School of Nursing, The University of Alabama at Birmingham, Birmingham
| | - Kayleigh Curry
- School of Nursing, The University of Alabama at Birmingham, Birmingham
| | - Heidi Donovan
- School of Nursing, University of Pittsburgh, Pittsburgh, Pennsylvania
- School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
- National Rehabilitation Research and Training Center on Family Support, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Maria E. Fernandez
- Department of Health Promotion and Behavioral Sciences, University of Texas Health Science Center at Houston School of Public Health, Houston
| | | | - Andres Azuero
- School of Nursing, The University of Alabama at Birmingham, Birmingham
| | - Tamryn F. Gray
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts
| | | | - Diane Meier
- Mount Sinai Medical Center, New York, New York
| | - Chandylen Nightingale
- Department of Social Sciences and Health Policy, School of Medicine, Wake Forest University, Winston-Salem, North Carolina
| | | | | | - Katherine Sterba
- Department of Public Health Sciences, Medical University of South Carolina, Charleston
| | - Heather M. Young
- Betty Irene Moore School of Nursing, University of California, Davis
| |
Collapse
|
8
|
Gazaway S, Wells RD, Azuero A, Pisu M, Guastaferro K, Rini C, Taylor R, Reed RD, Harrell ER, Bechthold AC, Bratches RW, McKie P, Lowers J, Williams GR, Rosenberg AR, Bakitas MA, Kavalieratos D, Dionne-Odom JN. Decision support training for advanced cancer family caregivers: Study protocol for the CASCADE factorial trial. Contemp Clin Trials 2023; 131:107259. [PMID: 37286131 PMCID: PMC10527385 DOI: 10.1016/j.cct.2023.107259] [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: 03/27/2023] [Revised: 05/31/2023] [Accepted: 05/31/2023] [Indexed: 06/09/2023]
Abstract
BACKGROUND Patients with advanced cancer face numerous decisions when diagnosed and often receive decision support from family caregivers. The CASCADE (CAre Supporters Coached to be Adept DEcision partners) factorial trial intervention aims to train caregivers in skills to provide effective decision support to patients and identify most effective intervention components. METHODS This is a 2-site, single-blind, 24 factorial trial to test components of the CASCADE decision support training intervention for family caregivers of patients with newly-diagnosed advanced cancer delivered by specially-trained, telehealth, palliative care lay coaches over 24 weeks. Family caregivers (target N = 352) are randomly assigned to one of 16 combinations of four components with two levels each: 1) psychoeducation on effective decision partnering principles (1 vs. 3 sessions); 2) decision support communication training (1 session vs. none); 3) Ottawa Decision Guide training (1 session vs. none) and 4) monthly follow-up (1 call vs. calls for 24 weeks). The primary outcome is patient-reported decisional conflict at 24 weeks. Secondary outcomes include patient distress, healthcare utilization, caregiver distress, and quality of life. Mediators and moderators (e.g., sociodemographics, decision self-efficacy, social support) will be explored between intervention components and outcomes. Results will be used to build two versions of CASCADE: one with only effective components (d ≥ 0.30) and another optimized for scalability and cost. DISCUSSION This protocol describes the first factorial trial, informed by the multiphase optimization strategy, of a palliative care decision-support intervention for advanced cancer family caregivers and will address the field's need to identify effective components that support serious illness decision-making. TRIAL REGISTRATION NCT04803604.
Collapse
Affiliation(s)
- Shena Gazaway
- School of Nursing, University of Alabama at Birmingham (UAB), Birmingham, AL, USA
| | - Rachel D Wells
- School of Nursing, University of Alabama at Birmingham (UAB), Birmingham, AL, USA
| | - Andres Azuero
- School of Nursing, University of Alabama at Birmingham (UAB), Birmingham, AL, USA
| | - Maria Pisu
- Division of Preventive Medicine, UAB Heersink School of Medicine, Birmingham, AL, USA
| | - Kate Guastaferro
- Department of Social and Behavioral Sciences, School of Global Public Health, New York University, New York, USA
| | - Christine Rini
- Cancer Survivorship Institute, Feinberg School of Medicine, Northwestern University, Evanston, IL, USA
| | - Richard Taylor
- School of Nursing, University of Alabama at Birmingham (UAB), Birmingham, AL, USA
| | - Rhiannon D Reed
- Division of Transplantation, Department of Medicine, UAB, Birmingham, AL, USA
| | - Erin R Harrell
- Department of Psychology, University of Alabama, Tuscaloosa, AL, USA
| | - Avery C Bechthold
- School of Nursing, University of Alabama at Birmingham (UAB), Birmingham, AL, USA
| | - Reed W Bratches
- School of Nursing, University of Alabama at Birmingham (UAB), Birmingham, AL, USA
| | - Peg McKie
- School of Nursing, University of Alabama at Birmingham (UAB), Birmingham, AL, USA
| | - Jane Lowers
- Division of Palliative Medicine, Department of Family and Preventive Medicine, School of Medicine, Emory University, Atlanta, GA, USA
| | | | - Abby R Rosenberg
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Department of Medicine, Boston Children's Hospital, Department of Pediatrics, Harvard Medical School, Boston, MA, USA
| | - Marie A Bakitas
- School of Nursing, University of Alabama at Birmingham (UAB), Birmingham, AL, USA
| | - Dio Kavalieratos
- Division of Palliative Medicine, Department of Family and Preventive Medicine, School of Medicine, Emory University, Atlanta, GA, USA
| | | |
Collapse
|
9
|
Blum M, Beasley A, Ikejiani D, Goldstein NE, Bakitas MA, Kavalieratos D, Gelfman LP. Building a Cardiac Palliative Care Program: A Qualitative Study of the Experiences of Ten Program Leaders From Across the United States. J Pain Symptom Manage 2023; 66:62-69.e5. [PMID: 36972857 PMCID: PMC10330149 DOI: 10.1016/j.jpainsymman.2023.03.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [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: 02/10/2023] [Revised: 03/14/2023] [Accepted: 03/18/2023] [Indexed: 03/29/2023]
Abstract
CONTEXT Palliative care is guideline-recommended for patients with advanced heart failure (HF). However, studies on how cardiac palliative care is provided in the United States are lacking. OBJECTIVES To study how cardiac palliative care programs provide services, and to identify challenges and facilitators they encountered in program development. METHODS In this qualitative descriptive study, we used purposive and snowball sampling approaches to identify cardiac palliative care program leaders across the United States, administered a survey and conducted semi-structured interviews. Interview transcripts were coded and evaluated using thematic analysis. RESULTS While cardiac palliative care programs vary in their organizational setup, they all provide comprehensive interdisciplinary palliative care services, ideally across the care continuum. They predominantly serve HF patients who are evaluated for advanced therapies or have complex needs. The challenges which cardiac palliative care programs face include reaching those cardiac patients who need palliative care the most and collaborating with cardiologists who do not see value added from palliative care for their patients. Facilitators of cardiac palliative care program development include building personal relationships with cardiology providers, proactively assessing local institution needs, and tailoring palliative care services to meet patient and provider needs. CONCLUSION Cardiac palliative care programs vary in their organizational setup but provide similar services and face similar challenges. The challenges and facilitators we identified can inform the development of future cardiac palliative care programs.
Collapse
Affiliation(s)
- Moritz Blum
- Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai (M.B., N.E.G., L.P.G.), New York, New York, USA
| | - Amy Beasley
- School of Nursing and Department of Medicine, Division of Geriatrics, Gerontology, and Palliative Care (A.B., M.A.B.), University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Dara Ikejiani
- Section of Palliative Care and Medical Ethics, Division of General Internal Medicine (D.I., D.K.), University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Nathan E Goldstein
- Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai (M.B., N.E.G., L.P.G.), New York, New York, USA
| | - Marie A Bakitas
- School of Nursing and Department of Medicine, Division of Geriatrics, Gerontology, and Palliative Care (A.B., M.A.B.), University of Alabama at Birmingham, Birmingham, Alabama, USA; Division of Palliative Medicine, Department of Family and Preventive Medicine (D.K.), Emory University, Atlanta, Georgia, USA
| | - Dio Kavalieratos
- Section of Palliative Care and Medical Ethics, Division of General Internal Medicine (D.I., D.K.), University of Pittsburgh, Pittsburgh, Pennsylvania, USA; Division of Palliative Medicine, Department of Family and Preventive Medicine (D.K.), Emory University, Atlanta, Georgia, USA
| | - Laura P Gelfman
- Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai (M.B., N.E.G., L.P.G.), New York, New York, USA; James J. Peters Veterans Affairs Medical Center, Geriatric Research Education and Clinical Center (GRECC) (L.P.G.), Bronx, New York, USA.
| |
Collapse
|
10
|
Corn BW, Feldman DB, Subbiah IM, Corn PD, Bakitas MA, Krouse RS, Hudson MF, Fowler LA, Fraser V, Siegal C, Agarwal R, Ge JL, Parajuli J, Myers JS, O’Rourke MA. Feasibility and acceptability of an online intervention to enhance hopefulness among oncology professionals. JNCI Cancer Spectr 2023; 7:pkad030. [PMID: 37104744 PMCID: PMC10208111 DOI: 10.1093/jncics/pkad030] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Revised: 02/28/2023] [Accepted: 03/28/2023] [Indexed: 04/29/2023] Open
Abstract
BACKGROUND Patients prefer medical communication including both hopefulness and realism, though health-care professional (HCPs) struggle to balance these. Providers could thus benefit from a detailed personal understanding of hope, allowing them to model and convey it to patients. Additionally, given that hope is associated with lower levels of burnout, HCPs may benefit from tools designed to enhance their own personal hopefulness. Several investigators have proposed offering HCPs interventions to augment hope. We developed an online workshop for this purpose. METHODS Feasibility and acceptability of the workshop were assessed in members of the SWOG Cancer Research Network. Three measures were used: the Was-It-Worth-It scale, a survey based on the Kirkpatrick Training Evaluation Model, and a single item prompting participants to rate the degree to which they believe concepts from the workshop should be integrated into SWOG studies. RESULTS Twenty-nine individuals signed up for the intervention, which consisted of a single 2-hour session, and 23 completed measures. Results from Was-It-Worth-It items indicate that nearly all participants found the intervention relevant, engaging, and helpful. Mean ratings for Kirkpatrick Training Evaluation Model items were high, ranging from 6.91 to 7.70 on 8-point scales. Finally, participants provided a mean rating of 4.44 on a 5-point scale to the item "To what degree do you believe it may be useful to integrate concepts from this workshop into SWOG trials/studies?" CONCLUSIONS An online workshop to enhance hopefulness is feasible and acceptable to oncology HCPs. The tool will be integrated into SWOG studies evaluating provider and patient well-being.
Collapse
Affiliation(s)
| | - David B Feldman
- Department of Counseling Psychology, Santa Clara University, Santa Clara, CA, USA
| | - Ishwaria M Subbiah
- Department of Palliative, Rehabilitation and Integrative Medicine, MD Anderson Cancer Center of the University of Texas, Houston, TX, USA
| | | | - Marie A Bakitas
- School of Nursing, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Robert S Krouse
- Department of Surgery, University of Pennsylvania School of Medicine, Philadelphia, PA, USA
| | - Matthew F Hudson
- Department of Medicine, Prisma Heath Cancer Institute, Greenville, SC, USA
| | - Lauren A Fowler
- Department of Physiology and Pharmacology, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Valerie Fraser
- Division of Patient Advocacy, SWOG Cancer Research Network, San Antonio, TX, USA
| | - Carole Siegal
- Division of Patient Advocacy, SWOG Cancer Research Network, San Antonio, TX, USA
| | - Rajiv Agarwal
- Division of Hematology/Oncology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Jacqueline L Ge
- Department of Counseling Psychology, Santa Clara University, Santa Clara, CA, USA
| | | | - Jamie S Myers
- School of Nursing, University of Kansas Medical Center, Kansas City, KS, USA
| | - Mark A O’Rourke
- Department of Medicine, Prisma Heath Cancer Institute, Greenville, SC, USA
| |
Collapse
|
11
|
Bechthold AC, Knoepke CE, Ejem DB, McIlvennan CK, Wells RD, Matlock DD, Bakitas MA, Dionne-Odom JN. How Values Are Discussed, Reflected Upon, and Acted On by Patients and Family Caregivers in the Context of Heart Failure: A Scoping Review. Med Decis Making 2023; 43:508-520. [PMID: 37057380 DOI: 10.1177/0272989x231165958] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/15/2023]
Abstract
PURPOSE Values are critical to how individuals make decisions and cope, yet the values of heart failure (HF) patients and their family caregivers (FCGs) remain understudied. We sought to report the state of the science on how values are discussed, reflected upon, and acted on by patients with HF, their FCGs, or both related to health-related decision making and coping. METHOD A scoping review was conducted of empirical studies using the following keywords: "heart failure," "values," "decision-making," and "coping." PubMed, PsycINFO, and Scopus were searched from inception to June 2022 in English. Included articles reported values as a key finding (outcome/theme) in their abstract. RESULTS Of 448 articles screened for eligibility, 16 met the inclusion criteria. Twelve articles reported findings addressing patient values, 3 addressed patient and FCG values, and 1 addressed FCG values. Values were reported to influence patient self-care behaviors and left ventricular assist device (LVAD) implantation decisions, although their prioritization varied across time and contexts. When prioritized values conflicted with recommended self-care activities, some patients modified their approach to achieving the value. Others modified or abandoned tasks in favor of the value and accompanying goals. Low motivation and alignment between unhealthy behaviors and values often led to nonadherent decisions. Five of 8 articles focusing on cardiac devices reported patient survival as the most prioritized value during implantation decisions. FCG values were rarely reported or evaluated separately from patient values. Patients leveraged several coping strategies, although the processes through which values affected coping was not described. CONCLUSIONS Prioritized values influenced HF-related decisions, including self-care and LVAD implantation. While several articles reported on coping and values, none described processes through which values affect coping, which highlights a research gap. HIGHLIGHTS Family caregiver values were rarely reported or evaluated separately from patient values, highlighting a gap in the literature.
Collapse
Affiliation(s)
- Avery C Bechthold
- School of Nursing, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Christopher E Knoepke
- Division of Cardiology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
- Adult and Child Consortium for Health Outcomes Research and Delivery Science, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Deborah B Ejem
- School of Nursing, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Colleen K McIlvennan
- Division of Cardiology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
- Adult and Child Consortium for Health Outcomes Research and Delivery Science, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Rachel D Wells
- School of Nursing, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Daniel D Matlock
- Adult and Child Consortium for Health Outcomes Research and Delivery Science, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
- Division of Geriatric Medicine, Department of Medicine, University of Colorado School of Medicine, Aurora, CO, USA
- VA Eastern Colorado Geriatric Research Education and Clinical Center, Denver, CO, USA
| | - Marie A Bakitas
- School of Nursing, University of Alabama at Birmingham, Birmingham, AL, USA
| | | |
Collapse
|
12
|
Iyer AS, Wells RD, Dionne-Odom JN, Bechthold AC, Armstrong M, Byun JY, O'Hare L, Taylor R, Ford S, Coffee-Dunning J, Dransfield MT, Brown CJ, Bakitas MA. Project EPIC (Early Palliative Care In COPD): A Formative and Summative Evaluation of the EPIC Telehealth Intervention. J Pain Symptom Manage 2023; 65:335-347.e3. [PMID: 36496113 PMCID: PMC10023469 DOI: 10.1016/j.jpainsymman.2022.11.024] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [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: 09/19/2022] [Revised: 11/28/2022] [Accepted: 11/29/2022] [Indexed: 12/13/2022]
Abstract
CONTEXT Early, concurrent palliative care interventions in chronic obstructive pulmonary disease (COPD) are limited. Project EPIC (Early Palliative Care In COPD) is a multiphase mixed methods study working to fill this gap. OBJECTIVES To conduct a formative and summative evaluation of EPIC, a telephonic nurse coach-led early palliative care intervention for COPD adapted from the ENABLE© intervention in cancer. METHODS Phase I Formative Evaluation: Patients with moderate-to-very-severe COPD, family caregivers, and pulmonary and palliative care clinicians rated the acceptability and feasibility of EPIC (≥4 out of five on a Likert-scale survey). Phase II Summative Evaluation: Patients and family caregivers in Phase I participated in a pilot of the three month EPIC prototype to evaluate intervention and data collection feasibility (≥70% completion) and to seek qualitative feedback. RESULTS Phase I Formative Evaluation: Patients (n=10), family caregivers (n=10), pulmonary clinicians (n=6), and palliative care clinicians (n=6) found EPIC acceptable and feasible to support adaptation, while priority early palliative care needs in COPD from our prior research mapped well to the EPIC prototype. Phase II Summative Evaluation: Patients (n=5; ages 49-72, 40% moderate COPD, 40% Black) and their family caregivers (n=5; ages 51-73, 40% Black) completed 100% of EPIC prototype components, including weekly telephone sessions, a one month follow-up call, Advance Directive, palliative care clinic attendance, and 95% of monthly phone data collection sessions. Feedback from participants about EPIC was all positive. CONCLUSION EPIC was acceptable and feasible in patients with COPD and their family caregivers. Larger feasibility and effectiveness trials are warranted.
Collapse
Affiliation(s)
- Anand S Iyer
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine (A.S.I., L.O.H., M.T.D.), University of Alabama at Birmingham, Birmingham, Alabama; Center for Palliative and Supportive Care, Division of Gerontology, Geriatrics, and Palliative Care, Department of Medicine (A.S.I., R.D.W., J.N.D., J.C., M.A.B.), University of Alabama at Birmingham, Birmingham, Alabama; School of Nursing (A.S.I., R.D.W., J.N.D., J.C., M.A.B.), University of Alabama at Birmingham, Birmingham, Alabama.
| | - Rachel D Wells
- Center for Palliative and Supportive Care, Division of Gerontology, Geriatrics, and Palliative Care, Department of Medicine (A.S.I., R.D.W., J.N.D., J.C., M.A.B.), University of Alabama at Birmingham, Birmingham, Alabama; School of Nursing (A.S.I., R.D.W., J.N.D., J.C., M.A.B.), University of Alabama at Birmingham, Birmingham, Alabama
| | - J Nicholas Dionne-Odom
- Center for Palliative and Supportive Care, Division of Gerontology, Geriatrics, and Palliative Care, Department of Medicine (A.S.I., R.D.W., J.N.D., J.C., M.A.B.), University of Alabama at Birmingham, Birmingham, Alabama; School of Nursing (A.S.I., R.D.W., J.N.D., J.C., M.A.B.), University of Alabama at Birmingham, Birmingham, Alabama
| | - Avery C Bechthold
- School of Nursing (A.S.I., R.D.W., J.N.D., J.C., M.A.B.), University of Alabama at Birmingham, Birmingham, Alabama
| | - Margaret Armstrong
- School of Nursing (A.S.I., R.D.W., J.N.D., J.C., M.A.B.), University of Alabama at Birmingham, Birmingham, Alabama
| | - Jun Yeong Byun
- School of Nursing (A.S.I., R.D.W., J.N.D., J.C., M.A.B.), University of Alabama at Birmingham, Birmingham, Alabama
| | - Lanier O'Hare
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine (A.S.I., L.O.H., M.T.D.), University of Alabama at Birmingham, Birmingham, Alabama; School of Nursing (A.S.I., R.D.W., J.N.D., J.C., M.A.B.), University of Alabama at Birmingham, Birmingham, Alabama
| | - Richard Taylor
- School of Nursing (A.S.I., R.D.W., J.N.D., J.C., M.A.B.), University of Alabama at Birmingham, Birmingham, Alabama
| | - Stephanie Ford
- School of Nursing (A.S.I., R.D.W., J.N.D., J.C., M.A.B.), University of Alabama at Birmingham, Birmingham, Alabama
| | - Jazmine Coffee-Dunning
- Center for Palliative and Supportive Care, Division of Gerontology, Geriatrics, and Palliative Care, Department of Medicine (A.S.I., R.D.W., J.N.D., J.C., M.A.B.), University of Alabama at Birmingham, Birmingham, Alabama; School of Nursing (A.S.I., R.D.W., J.N.D., J.C., M.A.B.), University of Alabama at Birmingham, Birmingham, Alabama
| | - Mark T Dransfield
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine (A.S.I., L.O.H., M.T.D.), University of Alabama at Birmingham, Birmingham, Alabama; Birmingham Veterans Affairs Medical Center (M.T.D.), Birmingham, Alabama
| | - Cynthia J Brown
- Department of Internal Medicine(C.J.B.), Louisiana State University Health Sciences Center, New Orleans, Louisiana
| | - Marie A Bakitas
- Center for Palliative and Supportive Care, Division of Gerontology, Geriatrics, and Palliative Care, Department of Medicine (A.S.I., R.D.W., J.N.D., J.C., M.A.B.), University of Alabama at Birmingham, Birmingham, Alabama; School of Nursing (A.S.I., R.D.W., J.N.D., J.C., M.A.B.), University of Alabama at Birmingham, Birmingham, Alabama
| |
Collapse
|
13
|
Lee K, Cheongho Lee T, Yefimova M, Kumar S, Puga F, Azuero A, Kamal A, Bakitas MA, Wright AA, Demiris G, Ritchie CS, Pickering CE, Nicholas Dionne-Odom J. Using Digital phenotyping to understand health-related outcomes: A scoping review. Int J Med Inform 2023; 174:105061. [PMID: 37030145 DOI: 10.1016/j.ijmedinf.2023.105061] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Revised: 02/10/2023] [Accepted: 03/24/2023] [Indexed: 04/01/2023]
Abstract
BACKGROUND Digital phenotyping may detect changes in health outcomes and potentially lead to proactive measures to mitigate health declines and avoid major medical events. While health-related outcomes have traditionally been acquired through self-report measures, those approaches have numerous limitations, such as recall bias, and social desirability bias. Digital phenotyping may offer a potential solution to these limitations. OBJECTIVES The purpose of this scoping review was to identify and summarize how passive smartphone data are processed and evaluated analytically, including the relationship between these data and health-related outcomes. METHODS A search of PubMed, Scopus, Compendex, and HTA databases was conducted for all articles in April 2021 using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses for Scoping Review (PRISMA-ScR) guidelines. RESULTS A total of 40 articles were included and went through an analysis based on data collection approaches, feature extraction, data analytics, behavioral markers, and health-related outcomes. This review demonstrated a layer of features derived from raw sensor data that can then be integrated to estimate and predict behaviors, emotions, and health-related outcomes. Most studies collected data from a combination of sensors. GPS was the most used digital phenotyping data. Feature types included physical activity, location, mobility, social activity, sleep, and in-phone activity. Studies involved a broad range of the features used: data preprocessing, analysis approaches, analytic techniques, and algorithms tested. 55% of the studies (n = 22) focused on mental health-related outcomes. CONCLUSION This scoping review catalogued in detail the research to date regarding the approaches to using passive smartphone sensor data to derive behavioral markers to correlate with or predict health-related outcomes. Findings will serve as a central resource for researchers to survey the field of research designs and approaches performed to date and move this emerging domain of research forward towards ultimately providing clinical utility in patient care.
Collapse
|
14
|
Currie ER, Wolfe J, Boss R, Johnston EE, Paine C, Perna SJ, Buckingham S, McKillip KM, Li P, Dionne-Odom JN, Ejem D, Morvant A, Nichols C, Bakitas MA. Patterns of Pediatric Palliative and End-of-Life Care in Neonatal Intensive Care Patients in the Southern U.S. J Pain Symptom Manage 2023; 65:532-540. [PMID: 36801354 DOI: 10.1016/j.jpainsymman.2023.01.025] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 01/19/2023] [Accepted: 01/30/2023] [Indexed: 02/18/2023]
Abstract
CONTEXT Despite high rates of mortality among infants in the Southern U.S., little is known about the timing of pediatric palliative care (PPC), the intensity of end-of-life care, and whether there are differences among sociodemographic characteristics. OBJECTIVES To describe PPC patterns and treatment intensity during the last 48 hours of life among neonatal intensive care unit (NICU) patients in the Southern U.S. who received specialized PPC. METHODS Medical record abstraction of infant decedents who received PPC consultation in two NICUs (in Alabama and Mississippi) from 2009 to 2017 (n = 195) including clinical characteristics, palliative and end-of-life care characteristics, patterns of PPC, and intensive medical treatments in the last 48 hours of life. RESULTS The sample was racially (48.2% Black) and geographically (35.4% rural) diverse. Most infants died after withdrawal of life-sustaining interventions (58%) and had do not attempt resuscitation orders documented (75.9%); very few infants enrolled in hospice (6.2%). Initial PPC consult occurred a median of 13 days after admission and a median of 17 days before death. Infants with a primary diagnosis of genetic or congenital anomaly received earlier PPC consultation (P = 0.02) compared to other diagnoses. In the last 48 hours of life, NICU patients received intensive interventions including mechanical ventilation (81.5%), CPR (27.7%) and surgeries or invasive procedures (25.1%). Black infants were more likely to receive CPR compared to White infants (P = 0.04). CONCLUSION Overall, PPC consultation occurred late in NICU hospitalizations, infants received high-intensity medical interventions in the last 48 hours of life, and there are disparities in intensity of treatment interventions at end of life. Further research is needed to explore if these patterns of care reflect parent preferences and goal concordance.
Collapse
Affiliation(s)
- Erin R Currie
- School of Nursing (E.R.C.), University of Alabama at Birmingham, 1701 University Blvd., Birmingham, Alabama, USA.
| | - Joanne Wolfe
- Department of Pediatrics (J.W.), Boston, USA; Harvard Medical School
| | - Renee Boss
- Johns Hopkins University School of Medicine (R.B.)
| | - Emily E Johnston
- The University of Alabama at Birmingham Heersink School of Medicine (E.E.J.), Department of Pediatric Hematology-Oncology
| | | | - Samuel J Perna
- University of Alabama at Birmingham (S,J.P.), Department of Medicine, Gerontology, Geriatrics, and Palliative Care
| | - Susan Buckingham
- University of Alabama at Birmingham (S.B.), Palliative and Hospice Medicine
| | | | - Peng Li
- The University of Alabama at Birmingham School of Nursing (P.L., J.N.O., D.E., M.A.B.)
| | - James N Dionne-Odom
- The University of Alabama at Birmingham School of Nursing (P.L., J.N.O., D.E., M.A.B.)
| | - Deborah Ejem
- The University of Alabama at Birmingham School of Nursing (P.L., J.N.O., D.E., M.A.B.)
| | | | | | - Marie A Bakitas
- The University of Alabama at Birmingham School of Nursing (P.L., J.N.O., D.E., M.A.B.)
| |
Collapse
|
15
|
Bechthold AC, Azuero A, Pisu M, Pierce JY, Williams GR, Taylor RA, Wells R, Curry K, Reed RD, Harrell ER, Gazaway S, Mollman S, Engler S, Puga F, Bakitas MA, Dionne-Odom JN. The Project ENABLE Cornerstone randomized controlled trial: study protocol for a lay navigator-led, early palliative care coaching intervention for African American and rural-dwelling advanced cancer family caregivers. Trials 2022; 23:452. [PMID: 35655285 PMCID: PMC9161197 DOI: 10.1186/s13063-022-06305-w] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Accepted: 04/13/2022] [Indexed: 11/10/2022] Open
Abstract
Background Family caregivers play a vital, yet stressful role in managing the healthcare needs and optimizing the quality of life of patients with advanced cancer, from the time they are newly diagnosed until end of life. While early telehealth palliative care has been found to effectively support family caregivers, little work has focused on historically under-resourced populations, particularly African American and rural-dwelling individuals. To address this need, we developed and are currently testing Project ENABLE (Educate, Nurture, Advise, Before Life Ends) Cornerstone, a lay navigator-led, early palliative care coaching intervention for family caregivers of African American and rural-dwelling patients with newly diagnosed advanced cancer. Methods This is a 2-site, single-blind, hybrid type I implementation-effectiveness trial of the Cornerstone intervention versus usual care. Cornerstone is a multicomponent intervention based on Pearlin’s Stress-Health Process Model where African American and/or rural-dwelling family caregivers of patients with newly diagnosed advanced cancer (target sample size = 294 dyads) are paired with a lay navigator coach and receive a series of six, brief 20–60-min telehealth sessions focused on stress management and coping, caregiving skills, getting help, self-care, and preparing for the future/advance care planning. Subsequent to core sessions, caregivers receive monthly follow-up indefinitely until the patient’s death. Caregiver and patient outcomes are collected at baseline and every 12 weeks until the patient’s death (primary outcome: caregiver distress at 24 weeks; secondary outcomes: caregiver: quality of life and burden; patient: distress, quality of life, and healthcare utilization). Implementation costs and the intervention cost effectiveness are also being evaluated. Discussion Should this intervention demonstrate efficacy, it would yield an implementation-ready model of early palliative care support for under-resourced family caregivers. A key design principle that has centrally informed the Cornerstone intervention is that every caregiving situation is unique and each caregiver faces distinct challenges that cannot be addressed using a one-size-fits all approach. Hence, Cornerstone employs culturally savvy lay navigator coaches who are trained to establish a strong, therapeutic alliance with participants and tailor their coaching to a diverse range of individual circumstances. Trial registration ClinicalTrials.gov NCT04318886. Registered on 20 March, 2020. Supplementary Information The online version contains supplementary material available at 10.1186/s13063-022-06305-w.
Collapse
Affiliation(s)
- Avery C Bechthold
- School of Nursing, University of Alabama at Birmingham (UAB), Birmingham, AL, USA
| | - Andres Azuero
- School of Nursing, University of Alabama at Birmingham (UAB), Birmingham, AL, USA
| | - Maria Pisu
- Division of Preventive Medicine, UAB School of Medicine, Birmingham, AL, USA
| | | | - Grant R Williams
- Division of Hematology and Oncology, Department of Medicine, UAB, Birmingham, AL, USA
| | - Richard A Taylor
- School of Nursing, University of Alabama at Birmingham (UAB), Birmingham, AL, USA
| | - Rachel Wells
- School of Nursing, University of Alabama at Birmingham (UAB), Birmingham, AL, USA
| | - Kayleigh Curry
- School of Nursing, University of Alabama at Birmingham (UAB), Birmingham, AL, USA
| | - Rhiannon D Reed
- Division of Transplantation, Department of Surgery, UAB, Birmingham, AL, USA
| | - Erin R Harrell
- Department of Psychology, University of Alabama, Tuscaloosa, AL, USA
| | - Shena Gazaway
- School of Nursing, University of Alabama at Birmingham (UAB), Birmingham, AL, USA
| | - Sarah Mollman
- College of Nursing, South Dakota State University, Rapid City, SD, USA
| | - Sally Engler
- School of Nursing, University of Alabama at Birmingham (UAB), Birmingham, AL, USA
| | - Frank Puga
- School of Nursing, University of Alabama at Birmingham (UAB), Birmingham, AL, USA
| | - Marie A Bakitas
- School of Nursing, University of Alabama at Birmingham (UAB), Birmingham, AL, USA.,Division of Geriatrics, Gerontology, and Palliative Care, UAB Department of Medicine, Birmingham, AL, USA
| | - J Nicholas Dionne-Odom
- School of Nursing, University of Alabama at Birmingham (UAB), Birmingham, AL, USA. .,Division of Geriatrics, Gerontology, and Palliative Care, UAB Department of Medicine, Birmingham, AL, USA.
| |
Collapse
|
16
|
Gazaway S, Bakitas MA, Elk R, Eneanya ND, Dionne-Odom JN. Engaging African American family Caregivers in Developing a Culturally-responsive Interview Guide: A Multiphase Process and Approach. J Pain Symptom Manage 2022; 63:e705-e711. [PMID: 35247583 PMCID: PMC9133041 DOI: 10.1016/j.jpainsymman.2022.02.331] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Revised: 02/11/2022] [Accepted: 02/18/2022] [Indexed: 11/21/2022]
Abstract
Qualitatively eliciting historically marginalized populations' beliefs, values, and preferences is critical to capturing information that authentically characterizes their experiences and can be used to develop culturally-responsive interventions. Eliciting these rich perspectives requires researchers to have highly effective qualitative interviewing guides, which can be optimized through community engagement. However, researchers have had little methodological guidance on how community member engagement can aid development of interview guides. The purpose of this article is to provide a series of steps, each supported by a case example from our work with African American family caregivers, for developing an interview guide through community engagement. We conclude by highlighting how involving historically marginalized community members in these early stages of research study development can build trust, research partnerships, and acknowledge their contribution to the development of new knowledge.
Collapse
Affiliation(s)
- Shena Gazaway
- School of Nursing (S.G., M.A.B., J.N.D.-O.), University of Alabama at Birmingham, Birmingham, Alabama, USA; Center for Palliative and Supportive Care (S.G., M.A.B., R.E., J.N.D.-O.), University of Alabama at Birmingham, Birmingham, Alabama, USA.
| | - Marie A Bakitas
- School of Nursing (S.G., M.A.B., J.N.D.-O.), University of Alabama at Birmingham, Birmingham, Alabama, USA; Center for Palliative and Supportive Care (S.G., M.A.B., R.E., J.N.D.-O.), University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Ronit Elk
- Center for Palliative and Supportive Care (S.G., M.A.B., R.E., J.N.D.-O.), University of Alabama at Birmingham, Birmingham, Alabama, USA; School of Medicine (R.E.), Division of Geriatrics, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Nwamaka D Eneanya
- Perelman School of Medicine (N.D.E.), University of Pennsylvania, Philadelphia, Pennsylvania, USA; Palliative and Advanced Illness Research (PAIR) Center (N.D.E.), University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - J Nicholas Dionne-Odom
- School of Nursing (S.G., M.A.B., J.N.D.-O.), University of Alabama at Birmingham, Birmingham, Alabama, USA; Center for Palliative and Supportive Care (S.G., M.A.B., R.E., J.N.D.-O.), University of Alabama at Birmingham, Birmingham, Alabama, USA
| |
Collapse
|
17
|
Feldman DB, O'Rourke MA, Corn BW, Hudson MF, Patel N, Agarwal R, Fraser VL, Deininger H, Fowler LA, Bakitas MA, Krouse RA, Subbiah IM. Development of a measure of clinicians' self-efficacy for medical communication (SEMC). BMJ Support Palliat Care 2022:bmjspcare-2022-003593. [PMID: 35534186 DOI: 10.1136/bmjspcare-2022-003593] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2022] [Accepted: 04/21/2022] [Indexed: 11/04/2022]
Abstract
OBJECTIVES Studies of clinician-patient communication have used varied, ad hoc measures for communication efficacy. We developed and validated the Self-Efficacy for Medical Communication (SEMC) scale as a standard, quantitative measure of clinician-reported skills in communicating difficult news. METHODS Using evidence-based scale development guidelines, we created two 16-item forms of the SEMC, one assessing communication with patients and one assessing communication with families. Clinicians providing oncological care in four organisations were invited to participate and provided consent. Participant demographics, responses to the SEMC items and responses to convergent and discriminant measures (those expected to relate strongly and weakly to the SEMC) were collected online. We performed analyses to determine the convergent and discriminant validity of the SEMC as well as its reliability and factor structure. RESULTS Overall, 221 oncology clinicians (including physicians, residents, fellows, medical students, nurses, nurse practitioners and physician assistants) participated. The patient and family forms both demonstrated high internal consistency reliability (alpha=0.94 and 0.96, respectively) and were strongly correlated with one another (r=0.95, p<0.001). Exploratory factor analysis demonstrated that the SEMC measures a unitary construct (eigenvalue=9.0), and its higher mean correlation with convergent (r=0.46) than discriminant (r=0.22) measures further supported its validity. CONCLUSIONS Our findings support the SEMC's validity and reliability as a measure of clinician-rated communication skills regarding conducting difficult conversations with patients and families. It provides a useful standard tool for future research in oncology provider-patient serious illness communication.
Collapse
Affiliation(s)
| | - Mark A O'Rourke
- Prisma Health Upstate Cancer Institute, Greenville, South Carolina, USA
| | | | - Matthew F Hudson
- Prisma Health Upstate Cancer Institute, Greenville, South Carolina, USA
| | - Naimik Patel
- Prisma Health Upstate Cancer Institute, Greenville, South Carolina, USA
| | - Rajiv Agarwal
- Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | | | - Heidi Deininger
- University of Michigan Rogel Cancer Center, Ann Arbor, Michigan, USA
| | - Lauren A Fowler
- University of South Carolina School of Medicine Greenville, Greenville, South Carolina, USA
| | - Marie A Bakitas
- University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Robert A Krouse
- University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | | |
Collapse
|
18
|
Dionne-Odom JN, Azuero A, Taylor RA, Dosse C, Bechthold AC, Currie E, Reed RD, Harrell ER, Engler S, Ejem DB, Ivankova NV, Martin MY, Rocque GB, Williams GR, Bakitas MA. A lay navigator-led, early palliative care intervention for African American and rural family caregivers of individuals with advanced cancer (Project Cornerstone): Results of a pilot randomized trial. Cancer 2022; 128:1321-1330. [PMID: 34874061 PMCID: PMC8882155 DOI: 10.1002/cncr.34044] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Revised: 10/25/2021] [Accepted: 11/13/2021] [Indexed: 12/18/2022]
Abstract
BACKGROUND The objective of this study was to assess the feasibility, acceptability, and potential efficacy of ENABLE (Educate, Nurture, Advise, Before Life Ends) Cornerstone-a lay navigator-led, early palliative care telehealth intervention for African American/Black and/or rural-dwelling family caregivers of individuals with advanced cancer (ClinicalTrials.gov identifier NCT03464188). METHODS This was a pilot randomized trial (November 2019 to March 2021). Family caregivers of patients with newly diagnosed, stage III/IV, solid-tumor cancers were randomized to receive either an intervention or usual care. Intervention caregivers were paired with a specially trained lay navigator who delivered 6 weekly, 20-minute to 60-minute telehealth coaching sessions plus monthly follow-up for 24 weeks, reviewing skills in stress management, self-care, getting help, staying organized, and future planning. Feasibility was assessed according to the completion of sessions and questionnaires (predefined as a completion rate ≥80%). Acceptability was determined through intervention participants' ratings of their likelihood of recommending the intervention. Measures of caregiver distress and quality of life were collected at 8 and 24 weeks. RESULTS Sixty-three family caregivers were randomized (usual care, n = 32; intervention, n = 31). Caregivers completed 65% of intervention sessions and 87% of questionnaires. Average ratings for recommending the program were 9.4, from 1 (not at all likely) to 10 (extremely likely). Over 24 weeks, the mean ± SE Hospital Anxiety and Depression Scale score improved by 0.30 ± 1.44 points in the intervention group and worsened by 1.99 ± 1.39 points in the usual care group (difference, -2.29; Cohen d, -0.32). The mean between-group difference scores in caregiver quality of life was -1.56 (usual care - intervention; d, -0.07). Similar outcome results were observed for patient participants. CONCLUSIONS The authors piloted ENABLE Cornerstone, an intervention for African American and rural-dwelling advanced cancer family caregivers. The acceptability of the intervention and data collection rates were high, and the preliminary efficacy for caregiver distress was promising. LAY SUMMARY To date, very few programs have been developed to support under-resourced cancer family caregivers. To address this need, the authors successfully pilot tested an early palliative care program, called Educate, Nurture, Advise, Before Life Ends (ENABLE) Cornerstone, for African American and rural family caregivers of individuals with advanced cancer. Cornerstone is led by specially trained lay people and involves a series of weekly phone sessions focused on coaching caregivers to manage stress and provide effective support to patients with cancer. The authors are now testing Cornerstone in a larger trial. If the program demonstrates benefit, it may yield a model of caregiver support that could be widely implemented.
Collapse
Affiliation(s)
- J Nicholas Dionne-Odom
- School of Nursing, University of Alabama at Birmingham (UAB), Birmingham, Alabama.,Division of Geriatrics, Gerontology, and Palliative Care, UAB Department of Medicine, Birmingham, Alabama.,UAB Center for Palliative and Supportive Care, Birmingham, Alabama
| | - Andres Azuero
- School of Nursing, University of Alabama at Birmingham (UAB), Birmingham, Alabama
| | - Richard A Taylor
- School of Nursing, University of Alabama at Birmingham (UAB), Birmingham, Alabama
| | - Chinara Dosse
- School of Nursing, University of Alabama at Birmingham (UAB), Birmingham, Alabama
| | - Avery C Bechthold
- School of Nursing, University of Alabama at Birmingham (UAB), Birmingham, Alabama
| | - Erin Currie
- School of Nursing, University of Alabama at Birmingham (UAB), Birmingham, Alabama
| | - Rhiannon D Reed
- Comprehensive Transplant Institute, UAB, Birmingham, Alabama
| | - Erin R Harrell
- Department of Psychology, University of Alabama, Tuscaloosa, Alabama
| | - Sally Engler
- School of Nursing, University of Alabama at Birmingham (UAB), Birmingham, Alabama
| | - Deborah B Ejem
- School of Nursing, University of Alabama at Birmingham (UAB), Birmingham, Alabama
| | | | - Michelle Y Martin
- Department of Preventive Medicine, Center for Innovation in Health Equity Research, University of Tennessee Health Science Center, Memphis, Tennessee
| | - Gabrielle B Rocque
- Division of Geriatrics, Gerontology, and Palliative Care, UAB Department of Medicine, Birmingham, Alabama.,UAB Center for Palliative and Supportive Care, Birmingham, Alabama.,Division of Hematology and Oncology, Department of Medicine, UAB, Birmingham, Alabama
| | - Grant R Williams
- Division of Hematology and Oncology, Department of Medicine, UAB, Birmingham, Alabama
| | - Marie A Bakitas
- School of Nursing, University of Alabama at Birmingham (UAB), Birmingham, Alabama.,Division of Geriatrics, Gerontology, and Palliative Care, UAB Department of Medicine, Birmingham, Alabama.,UAB Center for Palliative and Supportive Care, Birmingham, Alabama
| |
Collapse
|
19
|
Corn BW, Feldman DB, Hull JG, O'Rourke MA, Bakitas MA. Dispositional hope as a potential outcome parameter among patients with advanced malignancy: An analysis of the ENABLE database. Cancer 2022; 128:401-409. [PMID: 34613617 PMCID: PMC10008020 DOI: 10.1002/cncr.33907] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Revised: 07/25/2021] [Accepted: 08/16/2021] [Indexed: 12/25/2022]
Abstract
BACKGROUND Hopefulness, whether inherently present (dispositional hope) or augmented (by enhancement techniques), may affect outcomes. This study was performed to determine the association of dispositional hope with survival among patients diagnosed with advanced cancer. METHODS Data from ENABLE (Educate, Nurture, Advise, Before Life Ends), a palliative care intervention, were reanalyzed to determine the association of higher dispositional hope and patient survival. This was a secondary analysis of data combined from the ENABLE II and ENABLE III randomized controlled trials (RCTs) with respect to dispositional hope and survival. A dispositional hope index was created from 3 hope items from 2 validated baseline questionnaires. Dispositional hope and survival data were collected during the 2 RCTs. In ENABLE II, participants were randomly assigned to the ENABLE intervention or to usual care. In ENABLE III, participants were randomly assigned to receive the intervention immediately or 12 weeks after enrollment. RESULTS In all, 529 persons were included in Cox proportional hazards regression analyses to model the effects of dispositional hope on survival. An initial analysis without covariates yielded a significant effect of hope (Wald statistic, 8.649; hazard ratio, 0.941; confidence interval, 0.904-0.980; P = .003), such that higher dispositional hope was associated with longer survival. In a subsequent analysis that included all covariates, the effect of dispositional hope approached statistical significance (Wald statistic, 2.96; hazard ratio, 0.933; confidence interval, 0.863-1.010; P = .085). CONCLUSIONS Higher levels of dispositional hope were associated with longer survival in patients with advanced cancer. Prospective trials are needed to determine the effects of dispositional and augmented hope on the outcomes of patients with advanced cancer.
Collapse
Affiliation(s)
- Benjamin W Corn
- Department of Oncology, Shaare Zedek Cancer Center, Jerusalem, Israel
| | - David B Feldman
- Department of Counseling Psychology, Santa Clara University, Santa Clara, California
| | - Jay G Hull
- Department of Psychological and Brain Sciences, Dartmouth College, Hanover, New Hampshire
| | - Mark A O'Rourke
- Prisma Health Upstate Cancer Institute, Greenville, South Carolina
| | - Marie A Bakitas
- School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama.,Center for Palliative and Supportive Care, University of Alabama at Birmingham, Birmingham, Alabama
| |
Collapse
|
20
|
Kavalieratos D, Harinstein ME, Rose B, Lowers J, Hoydich ZP, Bekelman DB, Allen LA, Rollman BL, Ernecoff NC, Moreines LT, Bakitas MA, Arnold RM. Primary palliative care for heart failure provided within ambulatory cardiology: A randomized pilot trial. Heart Lung 2022; 56:125-132. [PMID: 35863099 PMCID: PMC9941979 DOI: 10.1016/j.hrtlng.2022.07.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Revised: 06/13/2022] [Accepted: 07/06/2022] [Indexed: 02/04/2023]
Abstract
BACKGROUND Heart failure is characterized by physical and emotional symptoms and decreased quality of life (QoL). Palliative care can reduce burdens of serious illness but often is limited to inpatient or academic settings. OBJECTIVES To develop and test the Primary Education for Nurses in Palliative care-HF (PENPal-HF) intervention, training outpatient cardiology nurses to address symptom burden, patient priorities for care and QoL, and advance care planning as part of quarterly HF visits. METHODS We conducted a pilot randomized clinical trial for adults with NYHA Stage III or IV HF and ≥ 2 hospitalizations in the past 12 months, recruited from a community-based cardiology clinic. Participants were randomized 2:1, PENPal-HF plus usual care versus usual care alone. Primary outcomes were feasibility and acceptability. RESULTS We randomized 30 adults with Stage III HF - 20 to PENPal-HF and 10 to usual care. Most in the intervention group (71%) and in the control group (62%) completed the study through the final outcome assessment in week 56; 5 participants died. Of 20 participants in the intervention, 14 (70%) remained in the study through the end of intervention visits; 11 (55%) completed all visits. Most intervention participants (93.75%) agreed or strongly agreed that they were satisfied with their care, and 87.5% agreed or strongly agreed that all people with HF should receive the intervention. Most intervention group participants (93.75%) reported a perceived improvement in physical symptoms, mood, and/or QoL. CONCLUSIONS This pilot study suggests that nurse-led primary palliative care in outpatient cardiology settings is promising. Research is warranted to determine efficacy and effectiveness.
Collapse
Affiliation(s)
| | | | - Beth Rose
- University of Pittsburgh Medical Center.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
21
|
Dionne-Odom JN, Wells RD, Guastaferro K, Azuero A, Hendricks BA, Currie ER, Bechthold A, Dosse C, Taylor R, Reed RD, Harrell ER, Gazaway S, Engler S, McKie P, Williams GR, Sudore R, Rini C, Rosenberg AR, Bakitas MA. An Early Palliative Care Telehealth Coaching Intervention to Enhance Advanced Cancer Family Caregivers' Decision Support Skills: The CASCADE Pilot Factorial Trial. J Pain Symptom Manage 2022; 63:11-22. [PMID: 34343621 PMCID: PMC8881798 DOI: 10.1016/j.jpainsymman.2021.07.023] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [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: 06/13/2021] [Revised: 07/16/2021] [Accepted: 07/26/2021] [Indexed: 01/03/2023]
Abstract
CONTEXT Patients with advanced cancer often involve family caregivers in health-related decision-making from diagnosis to end-of-life; however, few interventions have been developed to enhance caregiver decision support skills. OBJECTIVES Assess the feasibility, acceptability, and potential efficacy of individual intervention components of CASCADE (CAre Supporters Coached to be Adept DEcision Partners), an early telehealth, palliative care coach-led decision support training intervention for caregivers. METHODS Pilot factorial trial using the multiphase optimization strategy (October 2019-October 2020). Family caregivers and their care recipients with newly-diagnosed advanced cancer (n = 46 dyads) were randomized to1 of 8 experimental conditions that included a combination of one of the following three CASCADE components: 1) effective decision support psychoeducation; 2) decision support communication training; and 3) Ottawa Decision Guide training. Feasibility was assessed by completion of sessions and questionnaires (predefined as ≥80%). Acceptability was determined through postintervention interviews and participants' ratings of their likelihood to recommend. Measures of effective decision support and caregiver and patient distress were collected at Twelve and Twenty four weeks. RESULTS Caregiver participants completed 78% of intervention sessions and 81% of questionnaires; patients completed 80% of questionnaires. Across conditions, average caregiver ratings for recommending the program to others was 9.9 on a scale from 1-Not at all likely to 10-Extremely likely. Individual CASCADE components were observed to have potential benefit for effective decision support and caregiver distress. CONCLUSION We successfully piloted a factorial trial design to examine components of a novel intervention to enhance the decision support skills of advanced cancer family caregivers. A fully-powered factorial trial is warranted. KEY MESSAGE We pilot tested components of CASCADE, an early palliative care decision support training intervention for family caregivers of patients with advanced cancer. CASCADE components were acceptable and the trial design feasible, providing promising future directions for palliative care intervention development and testing. Pilot results will inform a fully-powered trial.
Collapse
Affiliation(s)
- J Nicholas Dionne-Odom
- School of Nursing, University of Alabama at Birmingham (J.N.D.O., R.D.W., A.A., B.A.H., E.R.C., A.B., C.D., R.T., S.G., S.E., P.M., M.A.B.), Birmingham, Alabama, USA; Division of Gerontology, Geriatrics, and Palliative Care, School of Medicine, University of Alabama at Birmingham (J.N.D.O., M.A.B.), Birmingham, Alabama, USA; Center for Palliative and Supportive Care, University of Alabama at Birmingham (J.N.D.O., M.A.B.), Birmingham, Alabama, USA.
| | - Rachel D Wells
- School of Nursing, University of Alabama at Birmingham (J.N.D.O., R.D.W., A.A., B.A.H., E.R.C., A.B., C.D., R.T., S.G., S.E., P.M., M.A.B.), Birmingham, Alabama, USA
| | - Kate Guastaferro
- Methodology Center, Pennsylvania State University (K.G.), University Park, Pennsylvania, USA
| | - Andres Azuero
- School of Nursing, University of Alabama at Birmingham (J.N.D.O., R.D.W., A.A., B.A.H., E.R.C., A.B., C.D., R.T., S.G., S.E., P.M., M.A.B.), Birmingham, Alabama, USA
| | - Bailey A Hendricks
- School of Nursing, University of Alabama at Birmingham (J.N.D.O., R.D.W., A.A., B.A.H., E.R.C., A.B., C.D., R.T., S.G., S.E., P.M., M.A.B.), Birmingham, Alabama, USA
| | - Erin R Currie
- School of Nursing, University of Alabama at Birmingham (J.N.D.O., R.D.W., A.A., B.A.H., E.R.C., A.B., C.D., R.T., S.G., S.E., P.M., M.A.B.), Birmingham, Alabama, USA
| | - Avery Bechthold
- School of Nursing, University of Alabama at Birmingham (J.N.D.O., R.D.W., A.A., B.A.H., E.R.C., A.B., C.D., R.T., S.G., S.E., P.M., M.A.B.), Birmingham, Alabama, USA
| | - Chinara Dosse
- School of Nursing, University of Alabama at Birmingham (J.N.D.O., R.D.W., A.A., B.A.H., E.R.C., A.B., C.D., R.T., S.G., S.E., P.M., M.A.B.), Birmingham, Alabama, USA
| | - Richard Taylor
- School of Nursing, University of Alabama at Birmingham (J.N.D.O., R.D.W., A.A., B.A.H., E.R.C., A.B., C.D., R.T., S.G., S.E., P.M., M.A.B.), Birmingham, Alabama, USA
| | - Rhiannon D Reed
- Comprehensive Transplant Institute, University of Alabama at Birmingham (R.D.R.), Birmingham, Alabama, USA
| | - Erin R Harrell
- Department of Psychology, University of Alabama (E.R.H.), Tuscaloosa, Alabama, USA
| | - Shena Gazaway
- School of Nursing, University of Alabama at Birmingham (J.N.D.O., R.D.W., A.A., B.A.H., E.R.C., A.B., C.D., R.T., S.G., S.E., P.M., M.A.B.), Birmingham, Alabama, USA
| | - Sally Engler
- School of Nursing, University of Alabama at Birmingham (J.N.D.O., R.D.W., A.A., B.A.H., E.R.C., A.B., C.D., R.T., S.G., S.E., P.M., M.A.B.), Birmingham, Alabama, USA
| | - Peg McKie
- School of Nursing, University of Alabama at Birmingham (J.N.D.O., R.D.W., A.A., B.A.H., E.R.C., A.B., C.D., R.T., S.G., S.E., P.M., M.A.B.), Birmingham, Alabama, USA
| | - Grant R Williams
- School of Medicine, Division of Hematology-Oncology, University of Alabama at Birmingham (G.R.W.), Birmingham, Alabama, USA
| | - Rebecca Sudore
- School of Medicine, Division of Geriatrics, University of California (R.S.), San Francisco, California, USA
| | - Christine Rini
- Feinberg School of Medicine, Robert H. Lurie Comprehensive Cancer Center, Northwestern University (C.R.), Chicago, Illinois, USA
| | - Abby R Rosenberg
- Division of Hematology-Oncology, Department of Pediatrics, School of Medicine, University of Washington (A.R.R.), Seattle, Washington, USA; Palliative Care and Resilience Lab, Seattle Children's Research Institute (A.R.R.), Seattle, Washington, USA; Cambia Palliative Care Center of Excellence, University of Washington (A.R.R.), Seattle, Washington, USA
| | - Marie A Bakitas
- School of Nursing, University of Alabama at Birmingham (J.N.D.O., R.D.W., A.A., B.A.H., E.R.C., A.B., C.D., R.T., S.G., S.E., P.M., M.A.B.), Birmingham, Alabama, USA; Division of Gerontology, Geriatrics, and Palliative Care, School of Medicine, University of Alabama at Birmingham (J.N.D.O., M.A.B.), Birmingham, Alabama, USA; Center for Palliative and Supportive Care, University of Alabama at Birmingham (J.N.D.O., M.A.B.), Birmingham, Alabama, USA
| |
Collapse
|
22
|
Schenker Y, Althouse AD, Rosenzweig M, White DB, Chu E, Smith KJ, Resick JM, Belin S, Park SY, Smith TJ, Bakitas MA, Arnold RM. Effect of an Oncology Nurse-Led Primary Palliative Care Intervention on Patients With Advanced Cancer: The CONNECT Cluster Randomized Clinical Trial. JAMA Intern Med 2021; 181:1451-1460. [PMID: 34515737 PMCID: PMC8438619 DOI: 10.1001/jamainternmed.2021.5185] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
IMPORTANCE Guidelines recommend early specialty palliative care for all patients with advanced cancer, but most patients lack access to such services. OBJECTIVE To assess the effect of CONNECT (Care Management by Oncology Nurses to Address Supportive Care Needs), a primary palliative care intervention delivered by oncology nurses, on patient outcomes. DESIGN, SETTING, AND PARTICIPANTS This cluster randomized clinical trial of the CONNECT intervention vs standard care was conducted from July 25, 2016, to October 6, 2020. Participants were adult patients with metastatic solid tumors who were undergoing oncological care and for whom an oncologist would agree with the statement "would not be surprised if the patient died in the next year." The trial was conducted at 17 community oncology practices in western Pennsylvania. Data analyses adhered to the intention-to-treat principle. INTERVENTIONS The CONNECT intervention included 3 monthly visits with an existing infusion room nurse who was trained to address symptoms, provide emotional support, engage in advance care planning, and coordinate care. MAIN OUTCOMES AND MEASURES The primary outcome was quality of life. At baseline and 3 months, participants completed assessments of quality of life (Functional Assessment of Chronic Illness Therapy-Palliative care: score range, 0-184, with higher scores indicating better quality of life), symptom burden (Edmonton Symptom Assessment Scale: score range, 0-90, with higher scores indicating greater symptom burden), and mood symptoms (Hospital Anxiety and Depression Scale [HADS]: score range, 0-21, with higher scores indicating substantial anxiety and depression). Linear mixed-effects models were used to estimate adjusted mean differences in 3-month outcomes. Preplanned, intensity-adjusted analyses were conducted. RESULTS A total of 672 patients were enrolled (mean [SD] age, 69.3 [10.2] years; 360 women [53.6%]). The mean (SD) number of CONNECT visits completed was 2.2 (1.0). At 3 months, no difference in mean (SD) quality-of-life score was found between the CONNECT and standard care groups (130.7 [28.2] vs 134.1 [28.1]; adjusted mean difference, 1.20; 95% CI, -2.75 to 5.15; P = .55). Similarly, there was no difference between groups in 3-month mean (SD) symptom burden (23.2 [16.6] vs 24.0 [16.1]; adjusted mean difference, -2.64; 95% CI, -5.85 to 0.58; P = .11) or mood symptoms (HADS depression subscale score: 5.1 [3.4] vs 4.8 [3.7], adjusted mean difference, -0.08 [95% CI, -0.71 to 0.57], P = .82; HADS anxiety subscale score: 5.7 [3.9] vs 5.4 [4.2], adjusted mean difference, -0.31 [95% CI, -0.96 to 0.33], P = .34). Intensity-adjusted analyses revealed a larger estimated treatment effect for patients who received a full dose (3 visits) of the CONNECT intervention. CONCLUSIONS AND RELEVANCE This cluster randomized clinical trial found that a primary palliative care intervention that was delivered by oncology nurses did not improve patient-reported outcomes at 3 months. Primary palliative care interventions with a higher dose intensity may be beneficial for most patients with advanced cancer who lack access to palliative care specialists. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT02712229.
Collapse
Affiliation(s)
- Yael Schenker
- Division of General Internal Medicine, Section of Palliative Care and Medical Ethics, University of Pittsburgh, Pittsburgh, Pennsylvania.,Palliative Research Center, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Andrew D Althouse
- Division of General Internal Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Margaret Rosenzweig
- Palliative Research Center, University of Pittsburgh, Pittsburgh, Pennsylvania.,University of Pittsburgh School of Nursing, Pittsburgh, Pennsylvania
| | - Douglas B White
- Palliative Research Center, University of Pittsburgh, Pittsburgh, Pennsylvania.,Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Edward Chu
- Albert Einstein Cancer Center, Albert Einstein College of Medicine, New York, New York
| | - Kenneth J Smith
- Division of General Internal Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Judith M Resick
- Division of General Internal Medicine, Section of Palliative Care and Medical Ethics, University of Pittsburgh, Pittsburgh, Pennsylvania.,Palliative Research Center, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Shane Belin
- Division of General Internal Medicine, Section of Palliative Care and Medical Ethics, University of Pittsburgh, Pittsburgh, Pennsylvania.,Palliative Research Center, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Seo Young Park
- Department of Clinical Epidemiology and Biostatistics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Thomas J Smith
- Division of General Internal Medicine, Section of Palliative Medicine, Johns Hopkins University School of Medicine and Sidney Kimmel Comprehensive Cancer Center, Baltimore, Maryland
| | - Marie A Bakitas
- School of Nursing, UAB Center for Palliative and Supportive Care, University of Alabama at Birmingham, Birmingham
| | - Robert M Arnold
- Division of General Internal Medicine, Section of Palliative Care and Medical Ethics, University of Pittsburgh, Pittsburgh, Pennsylvania.,Palliative Research Center, University of Pittsburgh, Pittsburgh, Pennsylvania
| |
Collapse
|
23
|
Dionne-Odom JN, Azuero A, Taylor RA, Wells RD, Hendricks BA, Bechthold AC, Reed RD, Harrell ER, Dosse CK, Engler S, McKie P, Ejem D, Bakitas MA, Rosenberg AR. Resilience, preparedness, and distress among family caregivers of patients with advanced cancer. Support Care Cancer 2021; 29:6913-6920. [PMID: 34031751 PMCID: PMC9733586 DOI: 10.1007/s00520-021-06265-y] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Accepted: 04/30/2021] [Indexed: 12/13/2022]
Abstract
OBJECTIVE Resilience has been proposed as a primary factor in how many family caregivers of patients with advanced cancer are able to resist psychological strain and perform effectively in the role while bearing a high load of caregiving tasks. To evaluate this hypothesis, we examined whether self-perceived resilience is associated with distress (anxiety and depressive symptoms), caregiver preparedness, and readiness for surrogate decision-making among a racially diverse sample of family caregivers of patients with newly diagnosed advanced cancer. METHODS Secondary analysis of baseline data from two small-scale, pilot clinical trials that both recruited family caregivers of patients with newly diagnosed advanced cancer. Using multivariable linear regression, we analyzed relationships of resilience as a predictor of mood, caregiving preparedness, and readiness for surrogate decision-making, controlling for sociodemographics. RESULTS Caregiver participants (N = 112) were mean 56 years of age and mostly female (76%), the patient's spouse/partner (52%), and White (56%) or African-American/Black (43%). After controlling for demographics, standardized results indicated that higher resilience was relevantly associated with higher caregiver preparedness (beta = .46, p < .001), higher readiness for surrogate decision-making (beta = .20, p < .05) and lower anxiety (beta = - .19, p < .05), and depressive symptoms (beta = - .20, p < .05). CONCLUSIONS These results suggest that resilience may be critical to caregivers' abilities to manage stress, be effective sources of support to patients, and feel ready to make future medical decisions on behalf of patients. Future work should explore and clinicians should consider whether resilience can be enhanced in cancer caregivers to optimize their well-being and ability to perform in the caregiving and surrogate decision-making roles.
Collapse
Affiliation(s)
| | - Andres Azuero
- School of Nursing, University of Alabama At Birmingham, Birmingham, AL, USA
| | - Richard A. Taylor
- School of Nursing, University of Alabama At Birmingham, Birmingham, AL, USA
| | - Rachel D. Wells
- School of Nursing, University of Alabama At Birmingham, Birmingham, AL, USA
| | | | - Avery C. Bechthold
- School of Nursing, University of Alabama At Birmingham, Birmingham, AL, USA
| | - Rhiannon D. Reed
- Comprehensive Transplant Institute, University of Alabama At Birmingham, Birmingham, AL, USA
| | - Erin R. Harrell
- Department of Psychology, University of Alabama, Tuscaloosa, AL, USA
| | - Chinara K. Dosse
- School of Nursing, University of Alabama At Birmingham, Birmingham, AL, USA
| | - Sally Engler
- School of Nursing, University of Alabama At Birmingham, Birmingham, AL, USA
| | - Peggy McKie
- School of Nursing, University of Alabama At Birmingham, Birmingham, AL, USA
| | - Deborah Ejem
- School of Nursing, University of Alabama At Birmingham, Birmingham, AL, USA
| | - Marie A. Bakitas
- School of Nursing, University of Alabama At Birmingham, Birmingham, AL, USA
| | - Abby R. Rosenberg
- Division of Hematology-Oncology, Department of Pediatrics, School of Medicine, University of Washington, Seattle, WA, USA,Cambia Palliative Care Center of Excellence, University of Washington, Seattle, WA, USA,Palliative Care and Resilience Lab, Seattle Children’s Research Institute, Seattle, WA, USA
| |
Collapse
|
24
|
Wells RD, Guastaferro K, Azuero A, Rini C, Hendricks BA, Dosse C, Taylor R, Williams GR, Engler S, Smith C, Sudore R, Rosenberg AR, Bakitas MA, Dionne-Odom JN. Applying the Multiphase Optimization Strategy for the Development of Optimized Interventions in Palliative Care. J Pain Symptom Manage 2021; 62:174-182. [PMID: 33253787 PMCID: PMC8274323 DOI: 10.1016/j.jpainsymman.2020.11.017] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [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: 09/28/2020] [Revised: 11/09/2020] [Accepted: 11/17/2020] [Indexed: 12/21/2022]
Abstract
Recent systematic reviews and meta-analyses have reported positive benefit of multicomponent "bundled" palliative care interventions for patients and family caregivers while highlighting limitations in determining key elements and mechanisms of improvement. Traditional research approaches, such as the randomized controlled trial (RCT), typically treat interventions as "bundled" treatment packages, making it difficult to assess definitively which aspects of an intervention can be reduced or replaced or whether there are synergistic or antagonistic interactions between intervention components. Progressing toward palliative care interventions that are effective, efficient, and scalable will require new strategies and novel approaches. One such approach is the Multiphase Optimization Strategy (MOST), a framework informed by engineering principles, that uses a systematic process to empirically identify an intervention comprised of components that positively contribute to desired outcomes under real-life constraints. This article provides a brief overview and application of MOST and factorial trial design in palliative care research, including our insights from conducting a pilot factorial trial of an early palliative care intervention to enhance the decision support skills of advanced cancer family caregivers (Project CASCADE).
Collapse
Affiliation(s)
- Rachel D Wells
- School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama, USA.
| | - Kate Guastaferro
- Methodology Center, Pennsylvania State University, University Park, Pennsylvania, USA
| | - Andres Azuero
- School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Christine Rini
- Northwestern University Feinberg School of Medicine and Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, Illinois, USA
| | - Bailey A Hendricks
- School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Chinara Dosse
- School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Richard Taylor
- School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Grant R Williams
- School of Medicine, Division of Hematology-Oncology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Sally Engler
- School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Charis Smith
- School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Rebecca Sudore
- School of Medicine, Division of Geriatrics, University of California, San Francisco, San Francisco, California, USA
| | - Abby R Rosenberg
- Division of Hematology-Oncology, Department of Pediatrics, School of Medicine, University of Washington, Seattle, Washington, USA; Palliative Care and Resilience Lab, Seattle Children's Research Institute, Seattle, Washington, USA
| | - Marie A Bakitas
- School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama, USA; Center for Palliative and Supportive Care, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - J Nicholas Dionne-Odom
- School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama, USA; Center for Palliative and Supportive Care, University of Alabama at Birmingham, Birmingham, Alabama, USA
| |
Collapse
|
25
|
Feldman DB, O'Rourke MA, Bakitas MA, Krouse RS, Deininger HE, Hudson MF, Corn BW. Hope, Burnout, and Life Satisfaction: An Intriguing Trinity Among Investigators of the SWOG Cancer Research Network. JCO Oncol Pract 2021; 17:e908-e916. [PMID: 33900801 DOI: 10.1200/op.20.00990] [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: 11/20/2022] Open
Abstract
PURPOSE Although hope has been explored in patients, few studies have investigated hopefulness in health care professionals. We surveyed oncology professionals within the SWOG Cancer Research Network, exploring relationships among personal hopefulness, social support, work stress, burnout, and life satisfaction. We hypothesized that hope would mediate the relationships between these other variables and life satisfaction. METHODS SWOG members were randomly selected for an online survey containing measures of hope, social support, work stress, burnout, and satisfaction with life. Of 1,000 invitees, 226 responded. RESULTS We tested a multiple mediational model using Hayes' bootstrapping approach (ie, PROCESS v3.4). As hypothesized, hope partially mediated the relationships between burnout and life satisfaction as well as between social support and life satisfaction. In particular, hopefulness was associated with lower burnout (-0.23; P = .005), greater social support (0.23; P = .005), and greater life satisfaction (0.50; P < .001). Work stress was associated with greater burnout (0.57; P < .001) but was not associated with general life satisfaction. Finally, social support was associated with lower burnout (-0.16; P = .005) and greater life satisfaction (0.24; P < .001). CONCLUSION Our results suggest that hope may mitigate the effects of burnout. The combination of hope and social support may prove helpful for reducing burnout and improving life satisfaction. Single-session hope-enhancement interventions incorporating both hope and social support have previously been shown to increase hope and well-being in non-health care professionals. Such interventions for health care providers warrant further study.
Collapse
|
26
|
Dionne-Odom JN, Williams GR, Warren PP, Tims S, Huang CHS, Taylor RA, Ledbetter L, Lever T, Mitchell K, Thompson M, Dosse C, Engler S, Holmes A, Connelley B, Hicks J, Bakitas MA, Nabors B, Tucker R. Implementing a Clinic-Based Telehealth Support Service (FamilyStrong) for Family Caregivers of Individuals with Grade IV Brain Tumors. J Palliat Med 2021; 24:347-353. [PMID: 32721254 PMCID: PMC7894044 DOI: 10.1089/jpm.2020.0178] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [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] [Accepted: 06/15/2020] [Indexed: 01/21/2023] Open
Abstract
Background: Nearly 3 million U.S. family caregivers support someone with cancer. However, oncology clinic-based service lines that proactively screen, assess, and support cancer caregivers are nearly nonexistent. Objective: To examine first-year experiences of a nurse-led clinic-based telehealth support service (FamilyStrong) for family caregivers of patients with recently diagnosed grade IV brain tumors. Methods: This is a retrospective evaluation of operational outcomes from initial implementation of the FamilyStrong Service, developed in partnership with Caregiver and Bereavement Support Services at the University of Alabama at Birmingham (UAB) and the UAB Center for Palliative and Supportive Care. From August 2018 to December 2019, 53 family caregivers were proactively identified and enrolled by a palliative care nurse, working approximately one day/week, who performed monthly caregiver distress thermometer screenings by phone and provided emotional, educational, problem-solving, and referral support. Results: Enrolled family caregivers were a mean age of 53.5 years and mostly female (62.3%), full- or part-time employed (67.9%), and the patient's spouse/partner (79.3%). Caregivers provided support 6.7 days/week for 11.2 hours/day. The palliative care nurse performed 235 distress screenings and provided support that included 68 documented instances of emotional, problem-solving, and educational support, 41 nurse-facilitated communications with the neuro-oncology team about patient issues, and 24 referrals to UAB and community services (e.g., counseling). The most common problems caregivers wanted assistance with included: managing their relative's health condition and symptoms (51%), coordinating care/services (21%), and planning for the future/advance care planning (17%). Discussion: The FamilyStrong Program is among the first "real world" oncology clinic-based formal support services for advance cancer family caregivers.
Collapse
Affiliation(s)
- J. Nicholas Dionne-Odom
- School of Nursing, University of Alabama at Birmingham (UAB), Birmingham, Alabama, USA
- Center for Palliative and Supportive Care, School of Medicine, University of Alabama at Birmingham (UAB), Birmingham, Alabama, USA
| | - Grant R. Williams
- Division of Hematology and Oncology, Department of Medicine, School of Medicine, University of Alabama at Birmingham (UAB), Birmingham, Alabama, USA
| | - Paula P. Warren
- Division of Neuro-Oncology, Department of Neurology, School of Medicine, University of Alabama at Birmingham (UAB), Birmingham, Alabama, USA
| | - Sheri Tims
- Center for Palliative and Supportive Care, School of Medicine, University of Alabama at Birmingham (UAB), Birmingham, Alabama, USA
| | - Chao-Hui S. Huang
- Division of Geriatrics, Gerontology, and Palliative Care, Department of Medicine, School of Medicine, University of Alabama at Birmingham (UAB), Birmingham, Alabama, USA
| | - Richard A. Taylor
- School of Nursing, University of Alabama at Birmingham (UAB), Birmingham, Alabama, USA
- Center for Palliative and Supportive Care, School of Medicine, University of Alabama at Birmingham (UAB), Birmingham, Alabama, USA
| | | | - Trevor Lever
- Kirklin Clinic, UAB Hospital, Birmingham, Alabama, USA
| | - Kelsey Mitchell
- Clinicial Informatics, UAB Medicine, Birmingham, Alabama, USA
| | - Moneka Thompson
- Department of Pastoral Care, School of Medicine, University of Alabama at Birmingham (UAB), Birmingham, Alabama, USA
| | - Chinara Dosse
- School of Nursing, University of Alabama at Birmingham (UAB), Birmingham, Alabama, USA
| | - Sally Engler
- School of Nursing, University of Alabama at Birmingham (UAB), Birmingham, Alabama, USA
| | - Amy Holmes
- Social Work Services, UAB Medicine, Birmingham, Alabama, USA
| | | | - Jennifer Hicks
- Center for Palliative and Supportive Care, School of Medicine, University of Alabama at Birmingham (UAB), Birmingham, Alabama, USA
| | - Marie A. Bakitas
- School of Nursing, University of Alabama at Birmingham (UAB), Birmingham, Alabama, USA
- Center for Palliative and Supportive Care, School of Medicine, University of Alabama at Birmingham (UAB), Birmingham, Alabama, USA
- Division of Hematology and Oncology, Department of Medicine, School of Medicine, University of Alabama at Birmingham (UAB), Birmingham, Alabama, USA
| | - Burt Nabors
- Division of Neuro-Oncology, Department of Neurology, School of Medicine, University of Alabama at Birmingham (UAB), Birmingham, Alabama, USA
| | - Rodney Tucker
- Center for Palliative and Supportive Care, School of Medicine, University of Alabama at Birmingham (UAB), Birmingham, Alabama, USA
- Division of Geriatrics, Gerontology, and Palliative Care, Department of Medicine, School of Medicine, University of Alabama at Birmingham (UAB), Birmingham, Alabama, USA
| |
Collapse
|
27
|
Bakitas MA, Dionne-Odom JN, Ejem DB, Wells R, Azuero A, Stockdill ML, Keebler K, Sockwell E, Tims S, Engler S, Steinhauser K, Kvale E, Durant RW, Tucker RO, Burgio KL, Tallaj J, Swetz KM, Pamboukian SV. Effect of an Early Palliative Care Telehealth Intervention vs Usual Care on Patients With Heart Failure: The ENABLE CHF-PC Randomized Clinical Trial. JAMA Intern Med 2020; 180:1203-1213. [PMID: 32730613 PMCID: PMC7385678 DOI: 10.1001/jamainternmed.2020.2861] [Citation(s) in RCA: 60] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
IMPORTANCE National guidelines recommend early palliative care for patients with advanced heart failure, which disproportionately affects rural and minority populations. OBJECTIVE To determine the effect of an early palliative care telehealth intervention over 16 weeks on the quality of life, mood, global health, pain, and resource use of patients with advanced heart failure. DESIGN, SETTING, AND PARTICIPANTS A single-blind, intervention vs usual care randomized clinical trial was conducted from October 1, 2015, to May 31, 2019, among 415 patients 50 years or older with New York Heart Association class III or IV heart failure or American College of Cardiology stage C or D heart failure at a large Southeastern US academic tertiary medical center and a Veterans Affairs medical center serving high proportions of rural dwellers and African American individuals. INTERVENTIONS The ENABLE CHF-PC (Educate, Nurture, Advise, Before Life Ends Comprehensive Heartcare for Patients and Caregivers) intervention comprises an in-person palliative care consultation and 6 weekly nurse-coach telephonic sessions (20-40 minutes) and monthly follow-up for 48 weeks. MAIN OUTCOMES AND MEASURES Primary outcomes were quality of life (as measured by the Kansas City Cardiomyopathy Questionnaire [KCCQ]: score range, 0-100; higher scores indicate better perceived health status and clinical summary scores ≥50 are considered "fairly good" quality of life; and the Functional Assessment of Chronic Illness Therapy-Palliative-14 [FACIT-Pal-14]: score range, 0-56; higher scores indicate better quality of life) and mood (as measured by the Hospital Anxiety and Depression Scale [HADS]) over 16 weeks. Secondary outcomes were global health (Patient Reported Outcome Measurement System Global Health), pain (Patient Reported Outcome Measurement System Pain Intensity and Interference), and resource use (hospital days and emergency department visits). RESULTS Of 415 participants (221 men; baseline mean [SD] age, 63.8 [8.5] years) randomized to ENABLE CHF-PC (n = 208) or usual care (n = 207), 226 (54.5%) were African American, 108 (26.0%) lived in a rural area, and 190 (45.8%) had a high-school education or less, and a mean (SD) baseline KCCQ score of 52.6 (21.0). At week 16, the mean (SE) KCCQ score improved 3.9 (1.3) points in the intervention group vs 2.3 (1.2) in the usual care group (difference, 1.6; SE, 1.7; d = 0.07 [95% CI, -0.09 to 0.24]) and the mean (SE) FACIT-Pal-14 score improved 1.4 (0.6) points in the intervention group vs 0.2 (0.5) points in the usual care group (difference, 1.2; SE, 0.8; d = 0.12 [95% CI, -0.03 to 0.28]). There were no relevant between-group differences in mood (HADS-anxiety, d = -0.02 [95% CI, -0.20 to 0.16]; HADS-depression, d = -0.09 [95% CI, -0.24 to 0.06]). CONCLUSIONS AND RELEVANCE This randomized clinical trial with a majority African American sample and baseline good quality of life did not demonstrate improved quality of life or mood with a 16-week early palliative care telehealth intervention. However, pain intensity and interference (secondary outcomes) demonstrated a clinically important improvement. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT02505425.
Collapse
Affiliation(s)
- Marie A Bakitas
- School of Nursing, University of Alabama at Birmingham, Birmingham.,Division of Gerontology, Geriatrics and Palliative Care, UAB Center for Palliative and Supportive Care, Department of Medicine, University of Alabama at Birmingham, Birmingham
| | - J Nicholas Dionne-Odom
- School of Nursing, University of Alabama at Birmingham, Birmingham.,Division of Gerontology, Geriatrics and Palliative Care, UAB Center for Palliative and Supportive Care, Department of Medicine, University of Alabama at Birmingham, Birmingham
| | - Deborah B Ejem
- School of Nursing, University of Alabama at Birmingham, Birmingham.,Division of Preventive Medicine, Department of Medicine, University of Alabama at Birmingham, Birmingham
| | - Rachel Wells
- School of Nursing, University of Alabama at Birmingham, Birmingham
| | - Andres Azuero
- School of Nursing, University of Alabama at Birmingham, Birmingham
| | - Macy L Stockdill
- School of Nursing, University of Alabama at Birmingham, Birmingham
| | - Konda Keebler
- School of Nursing, University of Alabama at Birmingham, Birmingham
| | - Elizabeth Sockwell
- School of Nursing, University of Alabama at Birmingham, Birmingham.,Division of Gerontology, Geriatrics and Palliative Care, UAB Center for Palliative and Supportive Care, Department of Medicine, University of Alabama at Birmingham, Birmingham
| | - Sheri Tims
- School of Nursing, University of Alabama at Birmingham, Birmingham.,Division of Gerontology, Geriatrics and Palliative Care, UAB Center for Palliative and Supportive Care, Department of Medicine, University of Alabama at Birmingham, Birmingham
| | - Sally Engler
- School of Nursing, University of Alabama at Birmingham, Birmingham
| | - Karen Steinhauser
- Center for Innovation, Veterans Affairs Medical Center, Durham, North Carolina.,Department of Population Health Sciences, Division of General Internal Medicine, Duke University, Durham, North Carolina.,Department of Medicine, Division of General Internal Medicine, Duke University, Durham, North Carolina
| | - Elizabeth Kvale
- Department of Medicine, Dell Medical School, University of Texas at Austin, Austin
| | - Raegan W Durant
- Division of Preventive Medicine, Department of Medicine, University of Alabama at Birmingham, Birmingham
| | - Rodney O Tucker
- Division of Gerontology, Geriatrics and Palliative Care, UAB Center for Palliative and Supportive Care, Department of Medicine, University of Alabama at Birmingham, Birmingham
| | - Kathryn L Burgio
- Division of Gerontology, Geriatrics and Palliative Care, UAB Center for Palliative and Supportive Care, Department of Medicine, University of Alabama at Birmingham, Birmingham.,Geriatric Research, Education, and Clinical Center, Birmingham Veterans Affairs Medical Center, Birmingham, Alabama
| | - Jose Tallaj
- Division of Cardiovascular Diseases, Department of Medicine, University of Alabama at Birmingham, Birmingham
| | - Keith M Swetz
- Division of Gerontology, Geriatrics and Palliative Care, UAB Center for Palliative and Supportive Care, Department of Medicine, University of Alabama at Birmingham, Birmingham.,Division of Cardiovascular Diseases, Department of Medicine, University of Alabama at Birmingham, Birmingham
| | - Salpy V Pamboukian
- Division of Cardiovascular Diseases, Department of Medicine, University of Alabama at Birmingham, Birmingham
| |
Collapse
|
28
|
Dionne-Odom JN, Ejem DB, Wells R, Azuero A, Stockdill ML, Keebler K, Sockwell E, Tims S, Engler S, Kvale E, Durant RW, Tucker RO, Burgio KL, Tallaj J, Pamboukian SV, Swetz KM, Bakitas MA. Effects of a Telehealth Early Palliative Care Intervention for Family Caregivers of Persons With Advanced Heart Failure: The ENABLE CHF-PC Randomized Clinical Trial. JAMA Netw Open 2020; 3:e202583. [PMID: 32282044 PMCID: PMC7154802 DOI: 10.1001/jamanetworkopen.2020.2583] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
IMPORTANCE Family caregivers of persons with advanced heart failure perform numerous daily tasks to assist their relatives and are at high risk for distress and poor quality of life. OBJECTIVE To determine the effect of a nurse-led palliative care telehealth intervention (Educate, Nurture, Advise, Before Life Ends Comprehensive Heart Failure for Patients and Caregivers [ENABLE CHF-PC]) on quality of life and mood of family caregivers of persons with New York Heart Association Class III/IV heart failure over 16 weeks. DESIGN, SETTING, AND PARTICIPANTS This single-blind randomized clinical trial enrolled caregivers aged 18 years and older who self-identified as an unpaid close friend or family member who knew the patient well and who was involved with their day-to-day medical care. Participants were recruited from outpatient heart failure clinics at a large academic tertiary care medical center and a Veterans Affairs medical center from August 2016 to October 2018. INTERVENTION Four weekly psychosocial and problem-solving support telephonic sessions lasting between 20 and 60 minutes facilitated by a trained nurse coach plus monthly follow-up for 48 weeks. The usual care group received no additional intervention. MAIN OUTCOMES AND MEASURES The primary outcomes were quality of life (measured using the Bakas Caregiver Outcomes Scale), mood (anxiety and/or depressive symptoms measured using the Hospital Anxiety and Depression Scale), and burden (measured using the Montgomery-Borgatta Caregiver Burden scales) over 16 weeks. Secondary outcomes were global health (measured using the PROMIS Global Health instrument) and positive aspects of caregiving. RESULTS A total of 158 family caregivers were randomized, 82 to the intervention and 76 to usual care. The mean (SD) age was 57.9 (11.6) years, 135 (85.4%) were female, 82 (51.9%) were African American, and 103 (65.2%) were the patient's spouse or partner. At week 16, the mean (SE) Bakas Caregiver Outcomes Scale score was 66.9 (2.1) in the intervention group and 63.9 (1.7) in the usual care group; over 16 weeks, the mean (SE) Bakas Caregiver Outcomes Scale score improved 0.7 (1.7) points in the intervention group and 1.1 (1.6) points in the usual care group (difference, -0.4; 95% CI, -5.1 to 4.3; Cohen d = -0.03). At week 16, no relevant between-group differences were observed between the intervention and usual care groups for the Hospital Anxiety and Depression Scale anxiety measure (mean [SE] improvement from baseline, 0.3 [0.3] vs 0.4 [0.3]; difference, -0.1 [0.5]; d = -0.02) or depression measure (mean [SE] improvement from baseline, -0.2 [0.4] vs -0.3 [0.3]; difference, 0.1 [0.5]; d = 0.03). No between-group differences were observed in the Montgomery-Borgatta Caregiver Burden scales (d range, -0.18 to 0.0). Differences in secondary outcomes were also not significant (d range, -0.22 to 0.0). CONCLUSIONS AND RELEVANCE This 2-site randomized clinical trial of a telehealth intervention for family caregivers of patients with advanced heart failure, more than half of whom were African American and most of whom were not distressed at baseline, did not demonstrate clinically better quality of life, mood, or burden compared with usual care over 16 weeks. Future interventions should target distressed caregivers and assess caregiver effects on patient outcomes. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT02505425.
Collapse
Affiliation(s)
- J. Nicholas Dionne-Odom
- University of Alabama at Birmingham School of Nursing
- Center for Palliative and Supportive Care, Division of Gerontology, Geriatrics, and Palliative Care, Department of Medicine, University of Alabama at Birmingham
| | | | - Rachel Wells
- University of Alabama at Birmingham School of Nursing
| | - Andres Azuero
- University of Alabama at Birmingham School of Nursing
| | | | - Konda Keebler
- University of Alabama at Birmingham School of Nursing
| | | | - Sheri Tims
- University of Alabama at Birmingham School of Nursing
| | - Sally Engler
- University of Alabama at Birmingham School of Nursing
| | - Elizabeth Kvale
- Department of Medicine, Dell Medical School, The University of Texas at Austin
| | - Raegan W. Durant
- Division of Preventive Medicine, Department of Medicine, University of Alabama at Birmingham
| | - Rodney O. Tucker
- Center for Palliative and Supportive Care, Division of Gerontology, Geriatrics, and Palliative Care, Department of Medicine, University of Alabama at Birmingham
| | | | - Jose Tallaj
- Division of Cardiovascular Diseases, Department of Medicine, University of Alabama at Birmingham
| | - Salpy V. Pamboukian
- Division of Cardiovascular Diseases, Department of Medicine, University of Alabama at Birmingham
| | - Keith M. Swetz
- Center for Palliative and Supportive Care, Division of Gerontology, Geriatrics, and Palliative Care, Department of Medicine, University of Alabama at Birmingham
| | - Marie A. Bakitas
- University of Alabama at Birmingham School of Nursing
- Center for Palliative and Supportive Care, Division of Gerontology, Geriatrics, and Palliative Care, Department of Medicine, University of Alabama at Birmingham
| |
Collapse
|
29
|
Iyer AS, Dionne-Odom JN, Khateeb DM, O'Hare L, Tucker RO, Brown CJ, Dransfield MT, Bakitas MA. A Qualitative Study of Pulmonary and Palliative Care Clinician Perspectives on Early Palliative Care in Chronic Obstructive Pulmonary Disease. J Palliat Med 2020; 23:513-526. [PMID: 31657654 PMCID: PMC7104897 DOI: 10.1089/jpm.2019.0355] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [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] [Accepted: 10/02/2019] [Indexed: 12/25/2022] Open
Abstract
Background: Guidelines recommend that pulmonary clinicians involve palliative care in chronic obstructive pulmonary disease (COPD); however, integration before advanced stage, that is, early palliative care, is rare. Objective: To explore and compare pulmonary and palliative care clinician perspectives on barriers, facilitators, and potential referral criteria for early palliative care in COPD. Design: Qualitative descriptive formative evaluation study. Setting/Subjects: Pulmonary and palliative care clinicians at a tertiary academic medical center. Measurements: Transcribed interviews were thematically analyzed by specialty to identify within- and across-specialty perspectives on barriers, facilitators, and referral criteria. Results: Twelve clinicians (n = 6 pulmonary, n = 6 palliative care) participated. Clinicians from both specialties agreed that early palliative care could add value to disease-focused COPD care. Perspectives on many barriers and facilitators were shared between specialties along broad educational, clinical, and operational categories. Pulmonary and palliative care clinicians shared concerns about the misconception that palliative care was synonymous to end-of-life care. Pulmonologists were particularly concerned about the potential risks of opioids and benzodiazepines in COPD. Both specialties stressed the need for clearly defined roles, consensus referral criteria, and novel delivery models. Although no single referral criterion was discussed by all, frequent hospitalizations and emotional symptoms were raised by most across disciplines. Multimorbidity and poor prognosis were discussed only by palliative care clinicians, whereas medication adherence was discussed only by pulmonary clinicians. Conclusions: Pulmonary and palliative care clinicians supported early palliative care in COPD. Continued needs include addressing pulmonologists' misconceptions of palliative care, establishing consensus referral criteria, and implementing novel early palliative care models.
Collapse
Affiliation(s)
- Anand S. Iyer
- Department of Medicine, Division of Pulmonary, Allergy, and Critical Care Medicine, University of Alabama at Birmingham, Birmingham, Alabama
- Department of Medicine, Center for Outcomes and Effectiveness Research and Education, School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
- Department of Medicine, Lung Health Center, University of Alabama at Birmingham, Birmingham, Alabama
| | - James Nicholas Dionne-Odom
- Department of Medicine, Division of Gerontology, Geriatrics, and Palliative Care, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
- Department of Medicine, School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama
| | - Dina M. Khateeb
- Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Lanier O'Hare
- Department of Medicine, Division of Pulmonary, Allergy, and Critical Care Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - Rodney O. Tucker
- Department of Medicine, Division of Gerontology, Geriatrics, and Palliative Care, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - Cynthia J. Brown
- Department of Medicine, Division of Gerontology, Geriatrics, and Palliative Care, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
- Department of Medicine, Birmingham Veterans Affairs Medical Center, Birmingham, Alabama
| | - Mark T. Dransfield
- Department of Medicine, Division of Pulmonary, Allergy, and Critical Care Medicine, University of Alabama at Birmingham, Birmingham, Alabama
- Department of Medicine, Lung Health Center, University of Alabama at Birmingham, Birmingham, Alabama
- Department of Medicine, Birmingham Veterans Affairs Medical Center, Birmingham, Alabama
| | - Marie A. Bakitas
- Department of Medicine, Division of Gerontology, Geriatrics, and Palliative Care, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
- Department of Medicine, School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama
| |
Collapse
|
30
|
Williams BR, Bailey FA, Goode PS, Kvale EA, Slay LA, Bakitas MA, Burgio KL. "Online Training Is Great but Human Interaction Is Better": Training Preferences of VA Interdisciplinary Palliative Care Consult Teams. Am J Hosp Palliat Care 2020; 37:800-808. [PMID: 32122166 DOI: 10.1177/1049909120907599] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
A growing body of research has examined modalities for delivering palliative care education; however, we know little about education and training preferences of VA interdisciplinary Palliative Care Consult Teams (PCCT). In the BEACON II study, we explored training preferences of PCCTs from 46 Veterans Affairs Medical Centers (VAMCs) participating in either a multisite webinar or a small group, in-person workshop. We interviewed participants by telephone seven to eight month post-training. In all, 75.9% preferred in-person education and training, including 78.9% of workshop participants and 73.1% of webinar participants. Respondents described in-person training as fostering learning through the following processes: (1) active engagement and focus, (2) interaction and networking, (3) meaning-making and relevance, and (4) reciprocity and commitment. Although it is not possible for Web-based palliative care education programs to replicate all aspects of the in-person learning experience, building experiential, interactive, meaningful, and reciprocal components into Web-based education may help shift preferences and make interdisciplinary team-based palliative care education accessible to a larger audience.
Collapse
Affiliation(s)
- Beverly Rosa Williams
- Department of Veterans Affairs, Birmingham/Atlanta Geriatric Research, Education, and Clinical Center (GRECC), Birmingham, AL and Atlanta, GA, USA.,Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - F Amos Bailey
- Department of Veterans Affairs, Birmingham/Atlanta Geriatric Research, Education, and Clinical Center (GRECC), Birmingham, AL and Atlanta, GA, USA.,Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA.,Department of Medicine, Denver Health Medical Center, University of Colorado Denver, Denver, CO, USA
| | - Patricia S Goode
- Department of Veterans Affairs, Birmingham/Atlanta Geriatric Research, Education, and Clinical Center (GRECC), Birmingham, AL and Atlanta, GA, USA.,Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Elizabeth A Kvale
- Department of Veterans Affairs, Birmingham/Atlanta Geriatric Research, Education, and Clinical Center (GRECC), Birmingham, AL and Atlanta, GA, USA.,Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA.,Department of Medicine, University of Texas at Austin Dell Medical School, Austin, TX, USA
| | - Laurie A Slay
- Department of Veterans Affairs, Birmingham/Atlanta Geriatric Research, Education, and Clinical Center (GRECC), Birmingham, AL and Atlanta, GA, USA.,Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Marie A Bakitas
- Department of Veterans Affairs, Birmingham/Atlanta Geriatric Research, Education, and Clinical Center (GRECC), Birmingham, AL and Atlanta, GA, USA.,Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Kathryn L Burgio
- Department of Veterans Affairs, Birmingham/Atlanta Geriatric Research, Education, and Clinical Center (GRECC), Birmingham, AL and Atlanta, GA, USA.,Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| |
Collapse
|
31
|
Hadler RA, Curtis BR, Ikejiani DZ, Bekelman DB, Harinstein M, Bakitas MA, Hess R, Arnold RM, Kavalieratos D. "I'd Have to Basically Be on My Deathbed": Heart Failure Patients' Perceptions of and Preferences for Palliative Care. J Palliat Med 2020; 23:915-921. [PMID: 31916910 DOI: 10.1089/jpm.2019.0451] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Objectives: To identify patient perceptions of how and when palliative care (PC) could complement usual heart failure (HF) management. Background: Despite guidelines calling for the integration of PC into the management of HF, PC services remain underutilized by this population. Patient preferences regarding delivery of and triggers for PC are unknown. Setting/subjects: Individuals with New York Heart Association Class II-IV disease were recruited from inpatient and outpatient settings at an academic quaternary care hospital. Measurements: Participants completed semistructured interviews discussing perceptions, knowledge, and preferences regarding PC. They also addressed barriers and facilitators to PC delivery. Two investigators independently analyzed data using template analysis. Results: We interviewed 27 adults with HF (mean age 63, 85% white, 63% male, 30% Class II, 48% Class III, and 22% Class IV). Participants frequently conflated PC with hospice; once corrected, they expressed variable preferences for primary versus specialist services. Proponents of primary PC cited continuity in care, HF-specific expertise, convenience, and cost, whereas advocates for specialist care highlighted expertise in symptom management and caregiver support, reduced time constraints, and a comprehensive approach to care. Triggers for specialist PC focused on late-stage manifestations of disease such as loss of independence and absence of disease-directed therapies. Conclusions: Patients with HF demonstrated variable conceptions of PC and its relevance to their disease management. Although preferences for delivery model were based on a variety of logistical and relational factors, triggers for initiation remained focused on late-stage disease, suggesting that patients with HF may misconceive PC is an option of last resort.
Collapse
Affiliation(s)
- Rachel A Hadler
- Department of Anesthesiology and Critical Care, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Brett R Curtis
- University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Dara Z Ikejiani
- Division of Oncology, Department of Medicine, Johns Hopkins School of Medicine, Sibley Memorial Hospital, Washington, DC, USA
| | - David B Bekelman
- Division of General Internal Medicine, Department of Medicine, University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, Colorado; Department of Medicine, Department of Veterans Affairs, Eastern Colorado Health, Aurora, Colorado, USA
| | - Matthew Harinstein
- Heart and Vascular Institute, Division of Cardiology, Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Marie A Bakitas
- Center for Palliative and Supportive Care, School of Nursing and Department of Medicine, Division of Geriatrics, Gerontology, and Palliative Care, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Rachel Hess
- Division of Health System Innovation and Research, Department of Health Sciences, University of Utah Health Hospitals and Clinics, Salt Lake City, Utah, USA
| | - Robert M Arnold
- Section of Palliative Care and Medical Ethics, Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Dio Kavalieratos
- Section of Palliative Care and Medical Ethics, Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| |
Collapse
|
32
|
Hendricks BA, Lofton C, Azuero A, Kenny M, Taylor RA, Huang CHS, Rocque G, Williams GR, Dosse C, Louis K, Bakitas MA, Dionne-Odom JN. The project ENABLE Cornerstone randomized pilot trial: Protocol for lay navigator-led early palliative care for African-American and rural advanced cancer family caregivers. Contemp Clin Trials Commun 2019; 16:100485. [PMID: 31768470 PMCID: PMC6872851 DOI: 10.1016/j.conctc.2019.100485] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [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: 08/26/2019] [Revised: 11/04/2019] [Accepted: 11/09/2019] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Patients newly-diagnosed with advanced cancer often rely on family caregivers to provide daily support to manage healthcare needs and maintain quality of life. Early telehealth palliative care has been shown to effectively provide an extra layer of support to family caregivers, however there has been little work with underserved populations, especially African-Americans and rural-dwellers. This is concerning given the lack of palliative care access for these underserved groups. STUDY DESIGN Single-site, small-scale pilot randomized controlled trial (RCT) of Project ENABLE (Educate, Nurture, Advise, Before Life Ends) Cornerstone, a lay navigator-led, early palliative care coaching intervention for family caregivers of African-American and rural-dwelling patients with newly-diagnosed advanced cancer. Family caregivers are paired with a trained lay navigator overseen by specialist palliative care clinicians and receive a series of brief in-person and telehealth sessions focusing on stress management and coping, caregiving skills and organization, getting help, self-care, and preparing for the future/advance care planning. This pilot trial is assessing acceptability of the intervention, feasibility of recruitment and data collection procedures, and preliminary efficacy compared to usual care on caregiver and patient quality of life and mood over 24 weeks. CONCLUSION Once acceptability and feasibility are determined and issues addressed, the ENABLE Cornerstone intervention for underserved family caregivers of persons with advanced cancer will be primed for a fully powered efficacy RCT. Given its use of lay navigators and telehealth delivery, the intervention is potentially highly scalable and capable of overcoming many of the geographic, human resource, and cultural obstacles to accessing early palliative care support.
Collapse
Affiliation(s)
- Bailey A. Hendricks
- School of Nursing, University of Alabama at Birmingham (UAB), Birmingham, AL, Birmingham, AL, USA
| | - Corey Lofton
- School of Nursing, University of Alabama at Birmingham (UAB), Birmingham, AL, Birmingham, AL, USA
| | - Andres Azuero
- School of Nursing, University of Alabama at Birmingham (UAB), Birmingham, AL, Birmingham, AL, USA
| | - Matthew Kenny
- School of Nursing, University of Alabama at Birmingham (UAB), Birmingham, AL, Birmingham, AL, USA
| | - Richard A. Taylor
- School of Nursing, University of Alabama at Birmingham (UAB), Birmingham, AL, Birmingham, AL, USA
| | - Chao-Hui Sylvia Huang
- Division of Geriatrics, Gerontology, and Palliative Care, Department of Medicine, UAB Center for Palliative and Supportive Care, Birmingham, AL, USA
| | - Gabrielle Rocque
- Division of Hematology and Oncology, Department of Medicine, UAB, Birmingham, AL, USA
| | - Grant R. Williams
- Division of Hematology and Oncology, Department of Medicine, UAB, Birmingham, AL, USA
| | - Chinara Dosse
- Division of Preventive Medicine, UAB School of Medicine, Birmingham, AL, USA
| | - Kathryn Louis
- School of Nursing, University of Alabama at Birmingham (UAB), Birmingham, AL, Birmingham, AL, USA
| | - Marie A. Bakitas
- School of Nursing, University of Alabama at Birmingham (UAB), Birmingham, AL, Birmingham, AL, USA
- Division of Geriatrics, Gerontology, and Palliative Care, Department of Medicine, UAB Center for Palliative and Supportive Care, Birmingham, AL, USA
| | - J. Nicholas Dionne-Odom
- School of Nursing, University of Alabama at Birmingham (UAB), Birmingham, AL, Birmingham, AL, USA
- Division of Geriatrics, Gerontology, and Palliative Care, Department of Medicine, UAB Center for Palliative and Supportive Care, Birmingham, AL, USA
| |
Collapse
|
33
|
Lyons KD, Bruce ML, Hull JG, Kaufman PA, Li Z, Stearns DM, Lansigan F, Chamberlin M, Fuld A, Bartels SJ, Whipple J, Bakitas MA, Hegel MT. Health Through Activity: Initial Evaluation of an In-Home Intervention for Older Adults With Cancer. Am J Occup Ther 2019; 73:7305205070p1-7305205070p11. [PMID: 31484031 DOI: 10.5014/ajot.2019.035022] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
OBJECTIVE The objective of this study was to assess the feasibility of conducting a future full-scale trial to test the efficacy of an in-home occupational therapy intervention designed to reduce disability in older adult cancer survivors. METHOD Participants reporting activity limitations during or after cancer treatment were enrolled in a Phase 1 pilot randomized controlled trial comparing the 6-wk intervention (n = 30) to usual care (n = 29). Descriptive data on retention rates were collected to assess feasibility of intervention and study procedures. Potential efficacy was explored through participants' self-reported disability, quality of life, activity level, and behavioral activation at 0, 8, and 16 wk after enrollment. RESULTS Retention rates were high regarding completion of the intervention (90%) and outcome assessments (90% of usual-care participants and 80% of intervention participants). Outcomes consistently favored the intervention group, although group differences were small. CONCLUSION The procedures were feasible to implement and acceptable to participants.
Collapse
Affiliation(s)
- Kathleen Doyle Lyons
- Kathleen Doyle Lyons, ScD, OTR/L, is Scientist, Department of Psychiatry and Norris Cotton Cancer Center, Dartmouth-Hitchcock Medical Center, Lebanon, NH;
| | - Martha L Bruce
- Martha L. Bruce, PhD, MPH, is Professor, Department of Psychiatry, Dartmouth-Hitchcock Medical Center, Lebanon, NH, and The Dartmouth Institute of Health Policy and Clinical Practice, Geisel School of Medicine, Dartmouth College, Hanover, NH
| | - Jay G Hull
- Jay G. Hull, PhD, is Professor, Department of Psychological and Brain Sciences, Dartmouth College, Hanover, NH
| | - Peter A Kaufman
- Peter A. Kaufman, MD, is Professor, Department of Medicine, Breast Oncology, Division of Hematology/Oncology, University of Vermont Cancer Center, University of Vermont Medical Center, Burlington. At the time of the study, he was Associate Professor, Department of Medicine, Geisel School of Medicine, Dartmouth College, Hanover, NH, and Associate Professor, Norris Cotton Cancer Center, Dartmouth-Hitchcock Medical Center, Lebanon, NH
| | - Zhongze Li
- Zhongze Li, MS, is Data Analyst, Biomedical Data Science Department, Geisel School of Medicine, Dartmouth College, Hanover, NH
| | - Diane M Stearns
- Diane M. Stearns, APRN, MSN, is Lead Nurse Practitioner, Department of Medicine, Hematology/Oncology, Geisel School of Medicine, Dartmouth College, Hanover, NH, and Norris Cotton Cancer Center, Dartmouth-Hitchcock Medical Center, Lebanon, NH
| | - Frederick Lansigan
- Frederick Lansigan, MD, is Associate Professor, Department of Medicine, Hematology/Oncology, Geisel School of Medicine, Dartmouth College, Hanover, NH, and Norris Cotton Cancer Center, Dartmouth-Hitchcock Medical Center, Lebanon, NH
| | - Mary Chamberlin
- Mary Chamberlin, MD, is Associate Professor, Department of Medicine, Hematology/Oncology, Geisel School of Medicine, Dartmouth College, Hanover, NH, and Norris Cotton Cancer Center, Dartmouth-Hitchcock Medical Center, Lebanon, NH
| | - Alexander Fuld
- Alexander Fuld, MD, is Assistant Professor, Department of Medicine, Hematology/Oncology, Geisel School of Medicine, Dartmouth College, Hanover, NH, and Norris Cotton Cancer Center, Dartmouth-Hitchcock Medical Center, Lebanon, NH
| | - Stephen J Bartels
- Stephen J. Bartels, MD, MS, is Director, The Mongan Institute, Massachusetts General Hospital, Boston. At the time of the study, he was Professor of Psychiatry, Professor of Community and Family Medicine, and Professor of The Dartmouth Institute, Geisel School of Medicine, Dartmouth College, Hanover, NH
| | - Jessica Whipple
- Jessica Whipple, MS, OTR/L, is Occupational Therapist, Sunapee School District, Sunapee, NH. At the time of the study, she was Project Coordinator, Department of Psychiatry, Dartmouth College, Hanover, NH
| | - Marie A Bakitas
- Marie A. Bakitas, DNSc, is Professor, School of Nursing, University of Alabama at Birmingham
| | - Mark T Hegel
- Mark T. Hegel, PhD, is Professor Emeritus-Active, Department of Psychiatry and Norris Cotton Cancer Center, Dartmouth-Hitchcock Medical Center, Lebanon, NH
| |
Collapse
|
34
|
Akyar I, Dionne-Odom JN, Ozcan M, Bakitas MA. Needs Assessment for Turkish Family Caregivers of Older Persons with Cancer: First-Phase Results of Adapting an Early Palliative Care Model. J Palliat Med 2019; 22:1065-1074. [PMID: 30969144 PMCID: PMC7364320 DOI: 10.1089/jpm.2018.0643] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [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] [Accepted: 02/28/2019] [Indexed: 12/25/2022] Open
Abstract
Background: Although palliative care is expanding globally for patients with serious illness, Turkey has not had widespread integration of early concurrent oncology palliative care. Hence, adapting and testing models of concurrent oncology palliative care for Turkish patients is imperative. Furthermore, it is critical that these care models also address the needs of family caregivers. Objective: To assess needs and elicit suggestions that would inform the adaptation of the ENABLE (Educate, Nurture, Advise, Before Life Ends) evidence-based early palliative care model for Turkish family caregivers of older persons with cancer. Methods: Formative evaluation study. Semi-structured interviews were conducted with 25 primary family caregivers of older individuals with cancer. Thematic analyses yielded themes in four domains: meaning of caregiving, effect of caregiving, education and consulting needs, and preferences about the delivery of the ENABLE model of palliative care support. Results: Caregivers described the impact of the cancer on their daily lives and responsibilities in the areas of physical, psychological, work, social, and family life. Caregivers emphasized their needs for information about symptoms, physical care, cancer pathology, and prognosis. Regarding the ENABLE model of early concurrent palliative care, participants wanted encounters to be in-person with educational material support that was simple and focused on disease information (prognosis, medication, handling emergency situations), psychological support, caring, nutrition, and acquiring community services. Conclusion: Themes from this study will be used to modify the ENABLE intervention protocol for future pilot and efficacy testing in Turkish caregivers.
Collapse
Affiliation(s)
- Imatullah Akyar
- Faculty of Nursing, Hacettepe University, Ankara, Turkey
- School of Nursing, University of Alabama at Birmingham (UAB), Birmingham, Alabama
| | - J. Nicholas Dionne-Odom
- School of Nursing, University of Alabama at Birmingham (UAB), Birmingham, Alabama
- Division of Geriatrics, Gerontology, and Palliative Care, Department of Medicine, UAB Center for Palliative and Supportive Care, Birmingham, Alabama
| | - Munevver Ozcan
- Faculty of Nursing, Hacettepe University, Ankara, Turkey
| | - Marie A. Bakitas
- School of Nursing, University of Alabama at Birmingham (UAB), Birmingham, Alabama
- Division of Geriatrics, Gerontology, and Palliative Care, Department of Medicine, UAB Center for Palliative and Supportive Care, Birmingham, Alabama
| |
Collapse
|
35
|
Iyer AS, Dionne-Odom JN, Ford SM, Crump Tims SL, Sockwell ED, Ivankova NV, Brown CJ, Tucker RO, Dransfield MT, Bakitas MA. A Formative Evaluation of Patient and Family Caregiver Perspectives on Early Palliative Care in Chronic Obstructive Pulmonary Disease across Disease Severity. Ann Am Thorac Soc 2019; 16:1024-1033. [PMID: 31039003 PMCID: PMC6774751 DOI: 10.1513/annalsats.201902-112oc] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [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: 02/04/2019] [Accepted: 04/29/2019] [Indexed: 12/20/2022] Open
Abstract
Rationale: Little direction exists on how to integrate early palliative care in chronic obstructive pulmonary disease (COPD).Objectives: We sought to identify patient and family caregiver early palliative care needs across stages of COPD severity.Methods: As part of the Medical Research Council Framework developmental phase for intervention development, we conducted a formative evaluation of patients with moderate to very severe COPD (forced expiratory volume in 1 s [FEV1]/FVC < 70% and FEV1 < 80%-predicted) and their family caregivers. Validated surveys on quality of life, anxiety and depressive symptoms, and social isolation quantified symptom severity. Semi-structured interviews were analyzed for major themes on early palliative care and needs in patients and family caregivers and across COPD severity stages.Results: Patients (n = 10) were a mean (±SD) age of 60.4 (±7.5) years, 50% African American, and 70% male, with 30% having moderate COPD, 30% severe COPD, and 40% very severe COPD. Family caregivers (n = 10) were a mean age of 58.3 (±8.7) years, 40% African American, and 10% male. Overall, 30% (n = 6) of participants had poor quality of life, 45% (n = 9) had moderate-severe anxiety symptoms, 25% (n = 5) had moderate-severe depressive symptoms, and 40% (n = 8) reported social isolation. Only 30% had heard of palliative care, and most participants had misconceptions that palliative care was end-of-life care. All participants responded positively to a standardized description of early palliative care and were receptive to its integration as early as moderate stage. Five broad themes of early palliative care needs emerged: 1) coping with COPD; 2) emotional symptoms; 3) respiratory symptoms; 4) illness understanding; and 5) prognostic awareness. Coping with COPD and emotional symptoms were commonly shared early palliative care needs. Patients with very severe COPD and their family caregivers prioritized illness understanding and prognostic awareness compared with those with moderate-severe COPD.Conclusions: Patients with moderate to very severe COPD and their family caregivers found early palliative care acceptable and felt it should be integrated before end-stage. Of the five broad themes of early palliative care needs, coping with COPD and emotional symptoms were the highest priority, followed by respiratory symptoms, illness understanding, and prognostic awareness.
Collapse
Affiliation(s)
- Anand S. Iyer
- Division of Pulmonary, Allergy, and Critical Care Medicine
- Health Services, Outcomes, and Effectiveness Research Training Program
- Lung Health Center
| | - J. Nicholas Dionne-Odom
- Division of Gerontology, Geriatrics, and Palliative Care, Department of Medicine
- School of Nursing, and
| | - Stephanie M. Ford
- Lung Health Center
- Division of Gerontology, Geriatrics, and Palliative Care, Department of Medicine
| | - Sheri L. Crump Tims
- Division of Gerontology, Geriatrics, and Palliative Care, Department of Medicine
- School of Nursing, and
| | - Elizabeth D. Sockwell
- Division of Gerontology, Geriatrics, and Palliative Care, Department of Medicine
- School of Nursing, and
| | - Nataliya V. Ivankova
- School of Nursing, and
- School of Health Professions, University of Alabama at Birmingham, Birmingham, Alabama; and
| | - Cynthia J. Brown
- Division of Gerontology, Geriatrics, and Palliative Care, Department of Medicine
- Birmingham Veterans Affairs Medical Center, Birmingham, Alabama
| | - Rodney O. Tucker
- Division of Gerontology, Geriatrics, and Palliative Care, Department of Medicine
| | - Mark T. Dransfield
- Division of Pulmonary, Allergy, and Critical Care Medicine
- Lung Health Center
- Birmingham Veterans Affairs Medical Center, Birmingham, Alabama
| | - Marie A. Bakitas
- Division of Gerontology, Geriatrics, and Palliative Care, Department of Medicine
- School of Nursing, and
| |
Collapse
|
36
|
Calton BA, Rabow MW, Branagan L, Dionne-Odom JN, Parker Oliver D, Bakitas MA, Fratkin MD, Lustbader D, Jones CA, Ritchie CS. Top Ten Tips Palliative Care Clinicians Should Know About Telepalliative Care. J Palliat Med 2019; 22:981-985. [PMID: 31237467 DOI: 10.1089/jpm.2019.0278] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
The field of telehealth is rapidly growing and evolving across medical specialties and health care settings. While additional data are needed, telepalliative care (the application of telehealth technologies to palliative care) may help address important challenges inherent to our specialty, such as geography and clinician staffing; the burden of traveling to brick-and-mortar clinics for patients who are symptomatic and/or functionally limited; and the timely assessment and management of symptoms. Telepalliative care can take many forms, including, but not limited to, video visits between clinicians and patients, smartphone applications to promote caregiver well-being, and remote patient symptom-monitoring programs. This article, created by experts in telehealth and palliative care, provides a review of the current evidence for telepalliative care and potential applications and practical tips for using the technology.
Collapse
Affiliation(s)
- Brook Anne Calton
- 1Division of Palliative Medicine, Department of Medicine, University of California, San Francisco, San Francisco, California
| | - Michael W Rabow
- 1Division of Palliative Medicine, Department of Medicine, University of California, San Francisco, San Francisco, California
| | - Linda Branagan
- 2Telehealth Resource Center, University of California, San Francisco, San Francisco, California
| | | | - Debra Parker Oliver
- 4Department of Family and Community Medicine, School of Medicine, University of Missouri, Columbia, Missouri
| | - Marie A Bakitas
- 3University of Alabama at Birmingham, School of Nursing, Birmingham, Alabama.,5University of Alabama at Birmingham, Division of Gerontology, Geriatrics, and Palliative Care, Birmingham, Alabama
| | | | - Dana Lustbader
- 7Department of Palliative Care, ProHEALTH Care, Lake Success, New York
| | - Christopher A Jones
- 8Department of Medicine and Palliative and Advanced Illness Research Center, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Christine S Ritchie
- 9Division of Geriatrics, Department of Medicine, University of California, San Francisco, San Francisco, California
| |
Collapse
|
37
|
Abstract
The term nonhospice palliative care was developed to describe and differentiate palliative care that is delivered prior to the end of life. The purpose of this article is to better define and clarify this concept using Rodgers’s evolutionary concept analysis method. Attributes of nonhospice palliative care include (a) patient- and family-centered care, (b) holistic care, (c) interdisciplinary team, (d) early intervention, (e) quality of life-enhancing, (f) advanced care planning, (g) any age of the patient, (h) at any stage in illness, (i) care coordination, (j) concurrent curative treatment options, and (k) provided by primary and specialist providers. Nonhospice palliative care antecedents are serious illness, education, and access to services; consequences include benefits for the patient, family, provider, and health care system. Offering a clearly defined concept may allow for changes in health care to improve access to these services.
Collapse
|
38
|
Dionne-Odom JN, Ejem D, Wells R, Barnato AE, Taylor RA, Rocque GB, Turkman YE, Kenny M, Ivankova NV, Bakitas MA, Martin MY. How family caregivers of persons with advanced cancer assist with upstream healthcare decision-making: A qualitative study. PLoS One 2019; 14:e0212967. [PMID: 30865681 PMCID: PMC6415885 DOI: 10.1371/journal.pone.0212967] [Citation(s) in RCA: 51] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2018] [Accepted: 02/12/2019] [Indexed: 12/27/2022] Open
Abstract
Aims Numerous healthcare decisions are faced by persons with advanced cancer from diagnosis to end-of-life. The family caregiver role in these decisions has focused on being a surrogate decision-maker, however, little is known about the caregiver’s role in supporting upstream patient decision-making. We aimed to describe the roles of family caregivers in assisting community-dwelling advanced cancer patients with healthcare decision-making across settings and contexts. Methods Qualitative study using one-on-one, semi-structured interviews with community-dwelling persons with metastatic cancer (n = 18) and their family caregivers (n = 20) recruited from outpatient oncology clinics of a large tertiary care academic medical center, between October 2016 and October 2017. Transcribed interviews were analyzed using a thematic analysis approach. Findings Caregivers averaged 56 years and were mostly female (95%), white (85%), and the patient’s partner/spouse (70%). Patients averaged 58 years and were mostly male (67%) in self-reported “fair” or “poor” health (50%) with genitourinary (33%), lung (17%), and hematologic (17%) cancers. Themes describing family member roles in supporting patients’ upstream healthcare decision-making were: 1) seeking information about the cancer, its trajectory, and treatments options; 2) ensuring family and healthcare clinicians have a common understanding of the patient’s treatment plan and condition; 3) facilitating discussions with patients about their values and the framing of their illness; 5) posing “what if” scenarios about current and potential future health states and treatments; 6) addressing collateral decisions (e.g., work arrangements) resulting from medical treatment choices; 6) originating healthcare-related decision points, including decisions about seeking emergency care; and 7) making healthcare decisions for patients who preferred to delegate healthcare decisions to their family caregivers. Conclusions These findings highlight a previously unreported and understudied set of critical decision partnering roles that cancer family caregivers play in patient healthcare decision-making. Optimizing these roles may represent novel targets for early decision support interventions for family caregivers.
Collapse
Affiliation(s)
- J. Nicholas Dionne-Odom
- School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama, United States of America
- School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, United States of America
- * E-mail:
| | - Deborah Ejem
- School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama, United States of America
| | - Rachel Wells
- School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama, United States of America
| | - Amber E. Barnato
- Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire, United States of America
| | - Richard A. Taylor
- School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama, United States of America
| | - Gabrielle B. Rocque
- School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, United States of America
| | - Yasemin E. Turkman
- School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama, United States of America
| | - Matthew Kenny
- School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama, United States of America
| | - Nataliya V. Ivankova
- School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama, United States of America
- School of Health Professions, University of Alabama at Birmingham, Birmingham, Alabama, United States of America
| | - Marie A. Bakitas
- School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama, United States of America
- School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, United States of America
| | - Michelle Y. Martin
- Center for Innovation in Health Equity Research, University of Tennessee Health Science Center, Memphis, Tennessee, United States of America
| |
Collapse
|
39
|
Bejarano S, Freed ME, Zeron D, Medina R, Zuniga-Moya JC, Kennedy L, Bruce ML, Zubkoff L, Bakitas MA, Lyons KD. Feasibility of a Symptom Management Intervention for Honduran Adults Undergoing Chemotherapy. West J Nurs Res 2019; 41:1517-1539. [PMID: 30755109 DOI: 10.1177/0193945918825374] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Evidence-based interventions often need to be adapted to maximize their implementation potential in low-to middle-income countries. A single-arm feasibility study was conducted to determine the feasibility and acceptability of a telephone-delivered, nurse-led, symptom management intervention for adults undergoing chemotherapy in Honduras. Over the course of 6 months, nurses engaged 25 patients undergoing chemotherapy in the intervention. Each participant received an average of 16.2 attempts to contact them for telephone sessions (SD = 8.0, range = 2-28). Collectively, the participants discussed 24 different types of symptoms. The most commonly discussed symptoms were pain (12%), nausea (7%), and constipation (5%). Qualitative and quantitative data were used to identify treatment manual modifications (i.e., adding content about different symptoms and addressing scheduling of treatment) and workplace modifications (i.e., dedicated nurse time and space) that are needed to optimize implementation of the intervention.
Collapse
Affiliation(s)
| | - Meghan E Freed
- Geisel School of Medicine at Dartmouth, Hanover, NH, USA
| | | | | | | | - Linda Kennedy
- Geisel School of Medicine at Dartmouth, Hanover, NH, USA.,Asociacion Cientifica de Estudiantes de Medicina, Universidad Catolica de Honduras, SPSP, Honduras
| | - Martha L Bruce
- Geisel School of Medicine at Dartmouth, Hanover, NH, USA.,Norris Cotton Cancer Center, Lebanon, NH, USA
| | - Lisa Zubkoff
- Geisel School of Medicine at Dartmouth, Hanover, NH, USA.,Norris Cotton Cancer Center, Lebanon, NH, USA.,Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
| | - Marie A Bakitas
- White River Junction VA Medical Center, White River Junction, VT, USA
| | - Kathleen Doyle Lyons
- Asociacion Cientifica de Estudiantes de Medicina, Universidad Catolica de Honduras, SPSP, Honduras.,Norris Cotton Cancer Center, Lebanon, NH, USA
| |
Collapse
|
40
|
Beasley A, Bakitas MA, Edwards R, Kavalieratos D. Models of non-hospice palliative care: a review. Ann Palliat Med 2019; 8:S15-S21. [DOI: 10.21037/apm.2018.03.11] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/04/2018] [Accepted: 03/20/2018] [Indexed: 11/06/2022]
|
41
|
Abstract
A qualitative secondary analysis was undertaken to identify aspects of health care service quality in an intensive care unit from the perspective of surrogate decision makers (N = 19) who were making decisions for relatives at end of life. Directed content analysis was guided by the Donabedian model of health care quality. Nineteen participants averaged 59 years old and were over half female (53%) and patients' spouses (53%) and adult children (32%). Salient aspects of quality service included surrogate perceptions that clinicians conveyed honesty about the patient's condition and in an easily understandable way; staff were sensitive and responsive to emotions and practical needs; clinicians demonstrated a clear, confident understanding of the patient's condition; and support by clinicians was given for surrogates' choices. Surrogates also commented on the hospital and intensive care unit environment, including cleanliness, comfort, privacy, and noise level. Further research is needed to explore how decision-support strategies might include service quality concepts.
Collapse
Affiliation(s)
- Senay Gul
- Hacettepe University, Ankara, Turkey
| | | | | | | |
Collapse
|
42
|
Iyer AS, Benzo RP, Bakitas MA. Easing the Tension Between Palliative Care and Intensive Care in Chronic Obstructive Pulmonary Disease. J Palliat Care 2018; 33:123-124. [PMID: 29902961 DOI: 10.1177/0825859718782505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Anand S Iyer
- 1 Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA.,2 Health Services, Outcomes, and Effectiveness Research Training Program, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Roberto P Benzo
- 3 Division of Pulmonary and Critical Care Medicine, Mindful Breathing Laboratory, Mayo Clinic, Rochester, MN, USA
| | - Marie A Bakitas
- 4 Center for Palliative and Supportive Care, Division of Gerontology, Geriatrics, and Palliative Care, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA.,5 School of Nursing, University of Alabama at Birmingham, Birmingham, AL, USA
| |
Collapse
|
43
|
Iyer AS, Wells JM, Bhatt SP, Kirkpatrick DP, Sawyer P, Brown CJ, Allman RM, Bakitas MA, Dransfield MT. Life-Space mobility and clinical outcomes in COPD. Int J Chron Obstruct Pulmon Dis 2018; 13:2731-2738. [PMID: 30233163 PMCID: PMC6130264 DOI: 10.2147/copd.s170887] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Background Social isolation is a common experience in patients with COPD but is not captured by existing patient-reported outcomes, and its association with clinical outcomes is unknown. Methods We prospectively enrolled adults with stable COPD who completed the University of Alabama at Birmingham Life Space Assessment (LSA) (range: 0–120, restricted Life-Space mobility: ≤60 and a marker of social isolation in older adults); six-minute walk test (6MWT), and the University of California at San Diego Shortness of Breath Questionnaire, COPD Assessment Test, and Hospital Anxiety and Depression Scale. The occurrence of severe exacerbations (emergency room visit or hospitalization) was recorded by review of the electronic record up to 1 year after enrollment. We determined associations between Life-Space mobility and clinical outcomes using regression analyses. Results Fifty subjects had a mean ± SD %-predicted FEV1 of 42.9±15.5, and 23 (46%) had restricted Life-Space mobility. After adjusting for age, gender, %-predicted FEV1, comorbidity count, inhaled corticosteroid/long-acting beta2-agonist use, and prior cardiopulmonary rehabilitation, subjects with restricted Life-Space had an increased risk for severe exacerbations (adjusted incidence rate ratio 4.65, 95% CI 1.19–18.23, P=0.03). LSA scores were associated with 6MWD (R=0.50, P<0.001), dyspnea (R=−0.58, P<0.001), quality of life (R=−0.34, P=0.02), and depressive symptoms (R=−0.39, P=0.005). Conclusion Restricted Life-Space mobility predicts severe exacerbations and is associated with reduced exercise tolerance, more severe dyspnea, reduced quality of life, and greater depressive symptoms.
Collapse
Affiliation(s)
- Anand S Iyer
- Department of Medicine, Division of Pulmonary, Allergy, and Critical Care Medicine, University of Alabama at Birmingham, Birmingham, AL, USA, .,Health Services, Outcomes, and Effectiveness Research Training Program, University of Alabama at Birmingham, Birmingham, AL, USA, .,Department of Medicine, Lung Health Center, University of Alabama at Birmingham, Birmingham, AL, USA,
| | - James M Wells
- Department of Medicine, Division of Pulmonary, Allergy, and Critical Care Medicine, University of Alabama at Birmingham, Birmingham, AL, USA, .,Department of Medicine, Lung Health Center, University of Alabama at Birmingham, Birmingham, AL, USA, .,Veterans Affairs Medical Center, Birmingham, AL, USA
| | - Surya P Bhatt
- Department of Medicine, Division of Pulmonary, Allergy, and Critical Care Medicine, University of Alabama at Birmingham, Birmingham, AL, USA, .,Department of Medicine, Lung Health Center, University of Alabama at Birmingham, Birmingham, AL, USA,
| | - deNay P Kirkpatrick
- Department of Medicine, Division of Pulmonary, Allergy, and Critical Care Medicine, University of Alabama at Birmingham, Birmingham, AL, USA, .,Department of Medicine, Lung Health Center, University of Alabama at Birmingham, Birmingham, AL, USA,
| | - Patricia Sawyer
- Department of Medicine, Division of Gerontology, Geriatrics, and Palliative Care, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Cynthia J Brown
- Veterans Affairs Medical Center, Birmingham, AL, USA.,Department of Medicine, Division of Gerontology, Geriatrics, and Palliative Care, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Richard M Allman
- Department of Medicine, George Washington University School of Medicine, Washington, DC, USA
| | - Marie A Bakitas
- Department of Medicine, Division of Gerontology, Geriatrics, and Palliative Care, University of Alabama at Birmingham, Birmingham, AL, USA.,Department of Medicine, Center for Palliative and Supportive Care, Division of Geriatrics, Gerontology, and Palliative Care Medicine, University of Alabama at Birmingham, Birmingham, AL, USA.,School of Nursing, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Mark T Dransfield
- Department of Medicine, Division of Pulmonary, Allergy, and Critical Care Medicine, University of Alabama at Birmingham, Birmingham, AL, USA, .,Department of Medicine, Lung Health Center, University of Alabama at Birmingham, Birmingham, AL, USA, .,Veterans Affairs Medical Center, Birmingham, AL, USA
| |
Collapse
|
44
|
Dionne-Odom JN, Ejem D, Azuero A, Taylor RA, Rocque GB, Turkman Y, Thompson MA, Knight SJ, Martin MY, Bakitas MA. Factors Associated with Family Caregivers' Confidence in Future Surrogate Decision Making for Persons with Cancer. J Palliat Med 2018; 21:1705-1712. [PMID: 30129873 DOI: 10.1089/jpm.2018.0148] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background: Improving family caregiver preparation for surrogate decision making is a critical priority. Objective: Determine a parsimonious set of intrapersonal factors associated with family caregivers' confidence in making future medical decisions for their relatives with cancer. Methods: Cross-sectional mail survey. Family caregivers of Medicare beneficiaries with pancreatic, lung, brain, ovarian, head and neck, hematologic, and stage IV cancers from communities of eight U.S. cancer centers. Participants completed validated measures of their social and mental health, self-care behaviors, coping styles, and surrogate decision-making confidence. Using linear modeling, the Bayesian information criterion was used to identify factors associated with decision-making confidence. A bootstrap approach was used to conduct penalized inference on the selected model coefficients. Model fit validation was assessed with a random forest ensemble. Results: Caregivers (n = 294) were on average 65.5 years old, mostly female (72.8%), and care recipients' spouse/partner (60.2%). The parsimonious set of factors associated with low caregiver decision-making confidence included less engagement in spiritual growth self-care, more use of avoidant coping, low emotional social support, and younger care recipient age (in-sample R2 = 0.22). These factors were also identified by a random forest approach. After overfitting adjustment (shrunken R2 = 0.09), the strongest associations with low surrogate decision-making confidence were low spiritual growth self-care (adjusted standardized B = 0.17, p = 0.005) and high use of avoidant coping (adjusted standardized B = -0.12, p = 0.049). Discussion: Identifying strategies to enhance spiritual growth and reduce avoidant coping may be promising targets for interventions to improve family caregivers' confidence in future surrogate decision making.
Collapse
Affiliation(s)
- J Nicholas Dionne-Odom
- School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama.,Division of Geriatrics, Gerontology, and Palliative Care, Department of Medicine, Center for Palliative and Supportive Care, University of Alabama at Birmingham, Birmingham, Alabama
| | - Deborah Ejem
- School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama
| | - Andres Azuero
- School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama
| | - Richard A Taylor
- School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama
| | - Gabrielle B Rocque
- Division of Hematology and Oncology, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - Yasemin Turkman
- School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama
| | - Moneka A Thompson
- Department of Pastoral Care, School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - Sara J Knight
- Department of Preventive Medicine, School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - Michelle Y Martin
- Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis, Tennessee
| | - Marie A Bakitas
- School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama.,Division of Geriatrics, Gerontology, and Palliative Care, Department of Medicine, Center for Palliative and Supportive Care, University of Alabama at Birmingham, Birmingham, Alabama
| |
Collapse
|
45
|
Bakitas MA, Dionne-Odom JN. Introduction. Semin Oncol Nurs 2018; 34:189-191. [PMID: 30100371 DOI: 10.1016/j.soncn.2018.06.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- Marie A Bakitas
- School of Nursing, University of Alabama at Birmingham (UAB), Birmingham, AL; UAB Center for Palliative and Supportive Care, Birmingham, AL Guest Editors
| | - J Nicholas Dionne-Odom
- School of Nursing, University of Alabama at Birmingham (UAB), Birmingham, AL; UAB Center for Palliative and Supportive Care, Birmingham, AL Guest Editors
| |
Collapse
|
46
|
|
47
|
Mudumbi SK, Bourgeois CE, Hoppman NA, Smith CH, Verma M, Bakitas MA, Brown CJ, Markland AD. Palliative Care and Hospice Interventions in Decompensated Cirrhosis and Hepatocellular Carcinoma: A Rapid Review of Literature. J Palliat Med 2018; 21:1177-1184. [PMID: 29698124 PMCID: PMC6104656 DOI: 10.1089/jpm.2017.0656] [Citation(s) in RCA: 11] [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] [Subscribe] [Scholar Register] [Accepted: 03/22/2018] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Patients with decompensated cirrhosis (DC) and/or hepatocellular carcinoma (HCC) have a high symptom burden and mortality and may benefit from palliative care (PC) and hospice interventions. OBJECTIVE Our aim was to search published literature to determine the impact of PC and hospice interventions for patients with DC/HCC. METHODS We searched electronic databases for adults with DC/HCC who received PC, using a rapid review methodology. Data were extracted for study design, participant and intervention characteristics, and three main groups of outcomes: healthcare resource utilization (HRU), end-of-life care (EOLC), and patient-reported outcomes. RESULTS Of 2466 results, eight were included in final results. There were six retrospective cohort studies, one prospective cohort, and one quality improvement study. Five of eight studies had a high risk of bias and seven studied patients with HCC. A majority found a reduction in HRU (total cost of hospitalization, number of emergency department visits, hospital, and critical care admissions). Some studies found an impact on EOLC, including location of death (less likely to die in the hospital) and resuscitation (less likely to have resuscitation). One study evaluated survival and found hospice had no impact and another showed improvement of symptom burden. CONCLUSION Studies included suggest that PC and hospice interventions in patients with DC/HCC reduce HRU, impact EOLC, and improve symptoms. Given the few number of studies, heterogeneity of interventions and outcomes, and high risk of bias, further high-quality research is needed on PC and hospice interventions with a greater focus on DC.
Collapse
Affiliation(s)
- Sandhya K. Mudumbi
- Center for Palliative and Supportive Care, University of Alabama at Birmingham, Birmingham, Alabama
- Division of Gerontology, Geriatrics, and Palliative Care, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
- Health Services and Outcomes Research Post-Doctoral Training Program, University of Alabama at Birmingham, Birmingham, Alabama
| | | | - Nicholas A. Hoppman
- Division of Gastroenterology and Hepatology, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - Catherine H. Smith
- Lister Hill Library of the Health Sciences, University of Alabama at Birmingham, Birmingham, Alabama
| | - Manisha Verma
- Division of Hepatology, Department of Transplantation, Einstein Healthcare Network, Philadelphia, Pennsylvania
| | - Marie A. Bakitas
- Center for Palliative and Supportive Care, University of Alabama at Birmingham, Birmingham, Alabama
- University of Alabama at Birmingham School of Nursing, Birmingham, Alabama
| | - Cynthia J. Brown
- Division of Gerontology, Geriatrics, and Palliative Care, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
- Department of Veterans Affairs Birmingham/Atlanta Geriatric Research, Education and Clinical Center, Birmingham, Alabama
- Comprehensive Center for Healthy Aging, University of Alabama at Birmingham, Birmingham, Alabama
| | - Alayne D. Markland
- Division of Gerontology, Geriatrics, and Palliative Care, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
- Department of Veterans Affairs Birmingham/Atlanta Geriatric Research, Education and Clinical Center, Birmingham, Alabama
- Comprehensive Center for Healthy Aging, University of Alabama at Birmingham, Birmingham, Alabama
| |
Collapse
|
48
|
Akyar I, Dionne-Odom JN, Bakitas MA. Using Patients and Their Caregivers Feedback to Develop ENABLE CHF-PC: An Early Palliative Care Intervention for Advanced Heart Failure. J Palliat Care 2018; 34:103-110. [PMID: 29952216 DOI: 10.1177/0825859718785231] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
OBJECTIVE: Models of early, community-based palliative care for individuals with New York Heart Association (NYHA) class III/IV heart failure and their families are lacking. We used the Medical Research Council process of developing complex interventions to conduct a formative evaluation study to translate an early palliative care intervention from cancer to heart failure. METHOD: One component of the parent formative evaluation pilot study was qualitative satisfaction interviews with 8 patient-caregiver dyad participants who completed Educate, Nurture, Advise, Before Life Ends Comprehensive Heartcare For Patient and Caregivers (ENABLE CHF-PC) intervention. The ENABLE CHF-PC consists of an in-person palliative care assessment, weekly telehealth coaching sessions, and monthly follow-up. Subsequent to completing the coaching sessions, patient and caregiver participants were interviewed to elicit their experiences with ENABLE CHF-PC. Digitally recorded interviews were transcribed and analyzed using a thematic approach. RESULTS: Patients (n = 8) mean age was 67.3, 62.5% were female, 75% were married/living with a partner; caregivers (n = 8) mean age was 56.8, and 87.5% were female. Four themes related to experiences with ENABLE CHF-PC included "allowed me to vent," "gained perspective," "helped me plan," and "gained illness management and decision-making skills." Recommendations for intervention modification included (1) start program at diagnosis, (2) maintain phone-based approach, and (3) expand topics and modify format. CONCLUSION: Patients and caregivers unanimously found the intervention to be helpful and acceptable. After incorporating modifications, ENABLE CHF-PC is currently undergoing efficacy testing in a large randomized controlled trial.
Collapse
Affiliation(s)
- Imatullah Akyar
- 1 Faculty of Nursing, Hacettepe University, Ankara, Turkey.,2 School of Nursing, University of Alabama at Birmingham, Birmingham, AL, USA
| | - J Nicholas Dionne-Odom
- 2 School of Nursing, University of Alabama at Birmingham, Birmingham, AL, USA.,3 Division of Geriatrics, Gerontology, and Palliative Care, Department of Medicine, University of Alabama at Birmingham Center for Palliative and Supportive Care, Birmingham, AL, USA
| | - Marie A Bakitas
- 2 School of Nursing, University of Alabama at Birmingham, Birmingham, AL, USA.,3 Division of Geriatrics, Gerontology, and Palliative Care, Department of Medicine, University of Alabama at Birmingham Center for Palliative and Supportive Care, Birmingham, AL, USA
| |
Collapse
|
49
|
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.
Collapse
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
| |
Collapse
|
50
|
Dionne-Odom JN, Applebaum AJ, Ornstein KA, Azuero A, Warren PP, Taylor RA, Rocque GB, Kvale EA, Demark-Wahnefried W, Pisu M, Partridge EE, Martin MY, Bakitas MA. Participation and interest in support services among family caregivers of older adults with cancer. Psychooncology 2017; 27:969-976. [PMID: 29226997 DOI: 10.1002/pon.4603] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2017] [Revised: 10/31/2017] [Accepted: 11/30/2017] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The purpose of this study was to describe distressed and underprepared family caregiver's use of and interest in formal support services (eg, professional counseling, education, organizational assistance). METHOD Cross-sectional mail survey conducted in communities of 8 cancer centers in Tennessee, Alabama, and Florida (response rate: 42%). Family caregivers of Medicare beneficiaries with pancreatic, lung, brain, ovarian, head and neck, hematologic, and stage IV cancers reported support service use and completed validated measures of depression, anxiety, burden, preparedness, and health. RESULTS Caregivers (n = 294) were on average age 65 years and mostly female (73%), White (91%), and care recipients' spouse/partner (60%); patients averaged 75 years were majority male (54%) with lung cancer (39%). Thirty-two percent of caregivers reported accessing services while 28% were "mostly" or "extremely" interested. Thirty-five percent of caregivers with high depressive symptoms (n = 122), 33% with high anxiety symptoms (n = 100), and 25% of those in the lowest quartile of preparedness (n = 77) accessed services. Thirty-eight percent of those with high depressive symptoms, 47% with high anxiety symptoms, and 36% in the lowest quartile of preparedness were "mostly" or "extremely" interested in receiving services. Being interested in support services was significantly associated with being a minority, shorter durations of caregiving, and with higher stress burden. CONCLUSIONS A large proportion of family caregivers, including those experiencing depression and anxiety symptoms and who were underprepared, are not using formal support services but have a strong interest in services. Strategies to increase service use may include targeting distressed caregivers early in their caregiving experience.
Collapse
Affiliation(s)
| | | | | | - Andres Azuero
- School of Nursing, University of Alabama at Birmingham (UAB), Birmingham, AL, USA
| | | | - Richard A Taylor
- School of Nursing, University of Alabama at Birmingham (UAB), Birmingham, AL, USA
| | - Gabrielle B Rocque
- UAB Comprehensive Cancer Center, Birmingham, AL, USA.,Department of Medicine, Division of Hematology and Oncology, Birmingham, AL, USA
| | - Elizabeth A Kvale
- Department of Medicine, Division of Geriatrics, Gerontology, and Palliative Care, UAB Center for Palliative and Supportive Care, Birmingham, AL, USA.,Birmingham Veterans Administration Medical Center, Birmingham, AL, USA
| | | | - Maria Pisu
- Department of Preventive Medicine, UAB, Birmingham, AL, USA
| | | | - Michelle Y Martin
- Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Marie A Bakitas
- School of Nursing, University of Alabama at Birmingham (UAB), Birmingham, AL, USA.,Department of Medicine, Division of Geriatrics, Gerontology, and Palliative Care, UAB Center for Palliative and Supportive Care, Birmingham, AL, USA
| |
Collapse
|