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McAndrew NS, Gray TF, Wallace L, Calkins K, Guttormson J, Harding ES, Applebaum AJ. Existential distress in family caregivers: scoping review of meaning-making interventions. BMJ Support Palliat Care 2024; 13:e676-e685. [PMID: 37604657 PMCID: PMC11040498 DOI: 10.1136/spcare-2023-004448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2023] [Accepted: 08/03/2023] [Indexed: 08/23/2023]
Abstract
OBJECTIVES Family and friend caregivers often feel overwhelmed by and ill-prepared for their responsibilities. Many feel helpless living with uncertainty about the outcome of the patient's illness, which leads to existential distress. Supportive care interventions that address existential distress by promoting meaning and purpose buffer the negative effects of caregiver burden and promote resilience and growth. The purpose of this scoping review is to describe the depth and breadth of available interventions targeting caregiver existential distress. METHODS We followed the Joanna Briggs Institute's scoping review methods and applied the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension checklist. SCOPUS, Ovid MEDLINE and PsycINFO databases were searched for interventions that targeted existential distress by promoting meaning-making, spiritual well-being, post-traumatic growth and/or benefit finding for caregivers of seriously ill adult patients. RESULTS We screened 1377 titles/abstracts and 42 full-text articles. Thirty-one articles (28 unique studies) met inclusion criteria. Most interventions were designed for caregivers supporting patients with cancer (n=14) or patients receiving palliative care (n=9). Promising interventions included Meaning-Centered Psychotherapy for Cancer Caregivers, Meaning-Based Intervention for Patients and their Partners, Legacy Intervention for Family Enactment, Family Participatory Dignity Therapy and Existential Behavioural Therapy. More than half of the studies (n=20, 64%) were in the feasibility/acceptability/pilot stage of intervention testing. CONCLUSION Large randomised controlled trials with more diverse samples of caregivers are needed. Future research should explore the impact of delivering meaning-making interventions to caregivers throughout the illness trajectory. Developing strategies for scaling up and conducting cost analyses will narrow the research and practice gap for meaning-making interventions.
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Affiliation(s)
- Natalie S McAndrew
- School of Nursing, College of Health Professions & Sciences, University of Wisconsin-Milwaukee, Milwaukee, Wisconsin, USA
- Department of Patient Care Research, Froedtert & the Medical College of Wisconsin, Froedtert Hospital, Milwaukee, Wisconsin, USA
| | - Tamryn F Gray
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Lyndsey Wallace
- Department of Psychiatry and Behavioral Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Kelly Calkins
- College of Nursing, Marquette University, Milwaukee, Wisconsin, USA
| | - Jill Guttormson
- College of Nursing, Marquette University, Milwaukee, Wisconsin, USA
| | - Eric S Harding
- Medical College of Wisconsin Libraries, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Allison J Applebaum
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, New York, USA
- Department of Psychiatry, Weill Cornell Medicine, New York, New York, USA
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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.
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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
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Applebaum AJ, Kent EE, Ellington L, Campbell G, Donovan H, Trivedi R, Van Houtven C, Gray TF, Gebert RR, Rosa WE, Odom JN. Top Ten Tips Palliative Care Clinicians Should Know About Caring for Family Caregivers. J Palliat Med 2023. [PMID: 38157333 DOI: 10.1089/jpm.2023.0640] [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] [Indexed: 01/03/2024] Open
Abstract
Family and friend caregivers play critical roles in ensuring that persons with serious illness receive high-quality care, and their responsibilities often increase as patients transition from receiving solely curative-focused care to primarily palliative-focused care. Integrating family caregivers into the health care team and supporting them in their role has significant benefits for family caregivers, patients, health care systems, communities, and society. Palliative care clinicians across all disciplines are uniquely suited to provide necessary training and support to family caregivers as they navigate the demands of their role. Here, we contend that providing comprehensive palliative care includes addressing the needs of family caregivers and provide ten tips and practical guidance to assist palliative care clinicians to support family caregivers. Engaging family caregivers as partners in care will ultimately allow palliative care clinicians to deliver the highest quality patient care and ensure the best possible outcomes for families facing serious illnesses.
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Affiliation(s)
- Allison J Applebaum
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Erin E Kent
- Department of Health Policy and Management, University of North Carolina Chapel Hill Gillings School of Global Public Health, Chapel Hill, North Carolina, USA
| | - Lee Ellington
- College of Nursing, University of Utah, Salt Lake City, Utah, USA
| | - Grace Campbell
- Duquesne University School of Nursing and University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Heidi Donovan
- University of Pittsburgh School of Nursing, Pittsburgh, Pennsylvania, USA
| | - Ranak Trivedi
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, California, USA
| | - Courtney Van Houtven
- Department of Population Health Science, Duke University School of Medicine, and Health Services Research and Development in Primary Care at the Durham Veteran's Administration, Durham, North Carolina, USA
| | - Tamryn F Gray
- Department of Psychosocial Oncology, Phyllis F. Cantor Center for Research in Nursing and Patient Care Services, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts, USA
| | - Rebecca R Gebert
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - William E Rosa
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - J Nicholas Odom
- School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama, USA
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Wiener L, Sannes TS, Randall J, Lahijana S, Applebaum AJ, Gray TF, McAndrew NS, Brewer BW, Amonoo HL. Psychosocial assessment practices for hematopoietic stem cell transplantation: a national survey study. Bone Marrow Transplant 2023; 58:1314-1321. [PMID: 37634015 PMCID: PMC10967240 DOI: 10.1038/s41409-023-02087-0] [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] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Revised: 08/02/2023] [Accepted: 08/10/2023] [Indexed: 08/28/2023]
Abstract
Psychosocial health predicts and contributes to medical outcomes for patients undergoing hematopoietic stem cell transplantation (HSCT). Yet, there are no standards for psychosocial assessments or support for both patients and caregivers across the care continuum. To examine the current state of psychosocial care, clinicians were sent a survey of their psychosocial assessment practices for patients and caregivers undergoing HSCT via the Listservs of professional organizations. Descriptive statistics and bivariate analyses were performed to summarize the findings. While 96% of participants reported routine pre-HSCT psychosocial assessment of patients, only 10.6% routinely used a validated transplant risk-assessment measure. Just 27% routinely performed follow-up psychosocial assessments. In contrast, only 47% of participants routinely assessed the psychosocial needs of family caregivers pre-HSCT, and 13% routinely performed follow-up assessments for caregivers. Most (90%) reported social workers were the primary providers of assessments. While patient-report measures were used for evaluation, the majority of assessments were clinical interviews. No significant differences were found between programs that treated adult and pediatric patients versus those only treating adult patients. Our findings highlight the lack of standard psychosocial practices for patients and family caregivers undergoing HSCT and we offer recommendations to fill this gap.
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Affiliation(s)
- Lori Wiener
- Pediatric Oncology Branch, National Cancer Institute, Center for Cancer Research, National Institutes of Health, Bethesda, MD, USA.
| | - Timothy S Sannes
- UMass Memorial Cancer Center, University of Massachusetts Chan Medical School, Worcester, MA, USA
| | - Jill Randall
- Center for Improving Patient and Population Health and Rogel Cancer Center, University of Michigan, Ann Arbor, MI, USA
| | - Sheila Lahijana
- Department of Psychiatry and Behavioral Sciences; Division of Medical Psychiatry, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Allison J Applebaum
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Tamryn F Gray
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Natalie S McAndrew
- School of Nursing, College of Health Professions & Sciences, University of Wisconsin-Milwaukee, Milwaukee, WI, USA
- Froedtert & the Medical College of Wisconsin, Froedtert Hospital, Patient Care Research, Milwaukee, WI, USA
| | - Benjamin W Brewer
- Department of Medicine, Division of Hematology, University of Colorado Anschutz Medical Campus, Denver, CO, USA
| | - Hermioni L Amonoo
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, MA, USA
- Department of Psychiatry, Brigham and Women's Hospital, Boston, MA, USA
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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.
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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
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Collons D, Florez N, Petrillo L, Dhawan N, Gray TF. Palliative Care for All? An Assessment of Racial and Ethnic Disparities Research With Solutions. J Pain Symptom Manage 2023; 66:e521-e523. [PMID: 37364736 DOI: 10.1016/j.jpainsymman.2023.06.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Revised: 06/02/2023] [Accepted: 06/09/2023] [Indexed: 06/28/2023]
Affiliation(s)
- Danielle Collons
- Dana-Farber Cancer Institute (D.C., N.F., T.F.G.), Boston, Massachusetts, USA; Brigham and Women's Hospital (D.C., N.F., T.F.G.), Boston, Massachusetts, USA; Massachusetts General Hospital (L.P.), Boston, Massachusetts, USA; Dartmouth-Hitchcock Medical Center (N.D.), Lebanon, New Hampshire, USA; Dartmouth Cancer Center (N.D.), Lebanon, New Hampshire, USA.
| | - Narjust Florez
- Dana-Farber Cancer Institute (D.C., N.F., T.F.G.), Boston, Massachusetts, USA; Brigham and Women's Hospital (D.C., N.F., T.F.G.), Boston, Massachusetts, USA; Massachusetts General Hospital (L.P.), Boston, Massachusetts, USA; Dartmouth-Hitchcock Medical Center (N.D.), Lebanon, New Hampshire, USA; Dartmouth Cancer Center (N.D.), Lebanon, New Hampshire, USA
| | - Laura Petrillo
- Dana-Farber Cancer Institute (D.C., N.F., T.F.G.), Boston, Massachusetts, USA; Brigham and Women's Hospital (D.C., N.F., T.F.G.), Boston, Massachusetts, USA; Massachusetts General Hospital (L.P.), Boston, Massachusetts, USA; Dartmouth-Hitchcock Medical Center (N.D.), Lebanon, New Hampshire, USA; Dartmouth Cancer Center (N.D.), Lebanon, New Hampshire, USA
| | - Natasha Dhawan
- Dana-Farber Cancer Institute (D.C., N.F., T.F.G.), Boston, Massachusetts, USA; Brigham and Women's Hospital (D.C., N.F., T.F.G.), Boston, Massachusetts, USA; Massachusetts General Hospital (L.P.), Boston, Massachusetts, USA; Dartmouth-Hitchcock Medical Center (N.D.), Lebanon, New Hampshire, USA; Dartmouth Cancer Center (N.D.), Lebanon, New Hampshire, USA
| | - Tamryn F Gray
- Dana-Farber Cancer Institute (D.C., N.F., T.F.G.), Boston, Massachusetts, USA; Brigham and Women's Hospital (D.C., N.F., T.F.G.), Boston, Massachusetts, USA; Massachusetts General Hospital (L.P.), Boston, Massachusetts, USA; Dartmouth-Hitchcock Medical Center (N.D.), Lebanon, New Hampshire, USA; Dartmouth Cancer Center (N.D.), Lebanon, New Hampshire, USA
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Gray TF, Do KM, Amonoo HL, Sullivan L, Kelkar AH, Pirl WF, Hammer MJ, Tulsky JA, El-Jawahri A, Cutler CS, Partridge AH. Family Caregiver Experiences in the Inpatient and Outpatient Reduced-Intensity Conditioning Allogeneic Hematopoietic Cell Transplantation Settings: A Qualitative Study. Transplant Cell Ther 2023:S2666-6367(23)01576-2. [PMID: 37783339 DOI: 10.1016/j.jtct.2023.09.023] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Revised: 09/21/2023] [Accepted: 09/24/2023] [Indexed: 10/04/2023]
Abstract
Caregivers (ie, family and friends) are essential in providing care and support for patients undergoing hematopoietic cell transplantation (HCT) and throughout their recovery. Traditionally delivered in the hospital, HCT is being increasingly provided in the outpatient setting, potentially heightening the burden on caregivers. Extensive work has examined the inpatient HCT caregiving experience, yet little is known about how caregiver experiences may differ based on whether the HCT was delivered on an inpatient or outpatient basis, particularly during the acute recovery period post-HCT. This study explored the similarities and differences in caregiver experiences in the inpatient and outpatient settings during the early recovery from reduced-intensity conditioning (RIC) allogeneic HCT. We conducted semistructured interviews (n = 15) with caregivers of adults undergoing RIC allogeneic HCT as either an inpatient (n = 7) or an outpatient (n = 8). We recruited caregivers using purposeful criterion sampling, based on the HCT setting, until thematic saturation occurred. Interview recordings were transcribed and coded through thematic analysis using Dedoose v.9.0. The study analysis was guided by the transactional model of stress and coping and the model of adaptation of family caregivers during the acute phase of BMT. Three themes emerged to describe similar experiences for HCT caregivers regardless of setting: (1) caregivers reported feeling like they were a necessary yet invisible part of the care team; (2) caregivers described learning to adapt to changing situations and varying patient needs; and (3) caregivers recounted how the uncertainty following HCT felt like existing between life and death while also maintaining a sense of gratitude and hope for the future. Caregivers also reported distinct experiences based on the transplantation setting and 4 themes emerged: (1) disrupted routines: inpatient caregivers reported disrupted routines when caring for the HCT recipient while simultaneously trying to manage non-caregiving responsibilities at home and work, and outpatient caregivers reported having to establish new routines that included frequent clinic visits with the patient while altering or pausing home and work responsibilities; (2) timing of caregiver involvement: inpatient caregivers felt more involved in care after the patient was discharged from the HCT hospitalization, whereas outpatient caregivers were already providing the majority of care earlier in the post-transplantation period; (3) fear of missing vital information: inpatient caregivers worried about missing vital information about the patient's care and progress if not physically present in the hospital, whereas outpatient caregivers feared overlooking vital information that may warrant contacting the care team as they monitored the patient at home; and (4) perceived adequacy of resources to meet psychosocial and practical needs: inpatient caregivers reported having adequate access to resources (ie, hospital-based services), whereas outpatient caregivers felt they had more limited access and needed to be resourceful in seeking out assistance. Inpatient and outpatient HCT caregivers described both similar and distinct experiences during the acute recovery period post-HCT. Specific interventions should address caregiver psychosocial needs (ie, distress, illness uncertainty, communication, and coping) and practical needs (ie, community resource referral, preparedness for home-based caregiving, and transplantation education) of HCT caregivers based on setting.
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Affiliation(s)
- Tamryn F Gray
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts; Division of Population Sciences, Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts; Division of Stem Cell Transplantation and Cellular Therapies, Dana-Farber Cancer Institute, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts; Phyllis F. Cantor Center for Research in Nursing and Patient Care Services, Dana-Farber Cancer, Boston, Massachusetts; Division of Palliative Medicine, Brigham and Women's Hospital, Boston, Massachusetts; Cancer Outcomes Research and Education Program, Massachusetts General Hospital Cancer Center, Boston, Massachusetts.
| | - Khuyen M Do
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Hermioni L Amonoo
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts; Cancer Outcomes Research and Education Program, Massachusetts General Hospital Cancer Center, Boston, Massachusetts; Department of Psychiatry, Brigham and Women's Hospital, Boston, Massachusetts
| | - Lauren Sullivan
- Division of Stem Cell Transplantation and Cellular Therapies, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Amar H Kelkar
- Division of Stem Cell Transplantation and Cellular Therapies, Dana-Farber Cancer Institute, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts
| | - William F Pirl
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts; Department of Psychiatry, Brigham and Women's Hospital, Boston, Massachusetts
| | - Marilyn J Hammer
- Division of Population Sciences, Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts; Phyllis F. Cantor Center for Research in Nursing and Patient Care Services, Dana-Farber Cancer, Boston, Massachusetts
| | - James A Tulsky
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts; Division of Palliative Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| | - Areej El-Jawahri
- Harvard Medical School, Boston, Massachusetts; Cancer Outcomes Research and Education Program, Massachusetts General Hospital Cancer Center, Boston, Massachusetts; Divison of Hematology and Oncology, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts
| | - Corey S Cutler
- Division of Population Sciences, Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts; Division of Stem Cell Transplantation and Cellular Therapies, Dana-Farber Cancer Institute, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts; Division of Hematologic Malignancies, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Ann H Partridge
- Division of Population Sciences, Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts
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Anderson CM, Ardery N, Pesut D, Alvarez C, Gray TF, Rose KM, Travers JL, Taylor J, Wright KD. Nurse scholars of the Robert Wood Johnson Foundation Harold Amos Medical Faculty Development Program. Nurs Outlook 2023; 71:102027. [PMID: 37579575 DOI: 10.1016/j.outlook.2023.102027] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Revised: 07/17/2023] [Accepted: 07/17/2023] [Indexed: 08/16/2023]
Abstract
BACKGROUND The challenge to increase the diversity, inclusivity, and equity of nurse scientists is a critical issue to enhance nursing knowledge development, health care, health equity, and health outcomes in the United States. PURPOSE The purpose of this paper is to highlight the current nurse scholars in the Robert Wood Johnson Foundation (RWJF) Harold Amos Medical Faculty Development Program (AMFDP). DISCUSSION Profiles and the programs of research and scholarship of the current AMFDP nurse scholars are described and discussed. Scholars share lessons learned, and how the AMFDP program has influenced their thinking and commitments to future action in service of nursing science, diversity efforts, legacy leadership, issues of health equity. CONCLUSION RWJF has a history of supporting the development of nursing scholars. AMFDP is an example of legacy leadership program that contributes to a culture of health and the development of next-generation nursing science scholars.
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Affiliation(s)
| | - Nina Ardery
- Harold Amos Medical Faculty Development Program, Indianapolis, IN
| | - Daniel Pesut
- Population Health, and Systems Cooperative Unit, University of Minnesota, Minneapolis, MN.
| | - Carmen Alvarez
- University of Pennsylvania School of Nursing, Philadelphia, PA
| | - Tamryn F Gray
- Harvard Medical School and Dana-Farber Cancer Institute, Boston, MA
| | - Karen M Rose
- The Ohio State University College of Nursing, Columbus, OH
| | | | | | - Kathy D Wright
- The Ohio State University College of Nursing, Columbus, OH
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Tabata-Kelly M, Ruan M, Dey T, Sheu C, Kerr E, Kaafarani H, Ornstein KA, Kelley A, Gray TF, Salim A, Joseph B, Cooper Z. Postdischarge Caregiver Burden Among Family Caregivers of Older Trauma Patients. JAMA Surg 2023; 158:945-952. [PMID: 37405733 PMCID: PMC10323760 DOI: 10.1001/jamasurg.2023.2500] [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] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Accepted: 03/30/2023] [Indexed: 07/06/2023]
Abstract
Importance Caregiver burden, characterized by psychological distress and physical morbidity, affects more than 50 million family caregivers of older adults in the United States. Risk factors for caregiver burden among caregivers of older trauma patients have not been well characterized. Objective To characterize postdischarge caregiver burden among caregivers of older trauma patients and identify targets that can inform interventions to improve their experience. Design, Setting, and Participants This study used a repeated cross-sectional design. Participants were family caregivers for adults 65 years or older with traumatic injury who were discharged from 1 of 2 level I trauma centers. Telephone interviews were conducted at 1 month and 3 months postdischarge with family caregivers (identified by the patient as family or friends who provided unpaid care). Admissions occurred between December 2019 and May 2021, and data were analyzed from June 2021 to May 2022. Exposure Hospital admission for geriatric trauma. Main Outcome and Measures High caregiver burden was defined by a score of 17 or higher on the 12-item Zarit Burden Interview. Caregiver self-efficacy and preparedness for caregiving were assessed via the Revised Scale for Caregiving Self-Efficacy and Preparedness for Caregiving Scale, respectively. Associations between caregiver self-efficacy, preparedness for caregiving, and caregiver burden were tested via mixed-effect logistic regression. Results There were 154 family caregivers enrolled in the study. Their mean (SD) age was 60.6 (13.0) years (range, 18-92 years), 108 of 154 were female (70.6%). The proportion of caregivers experiencing high burden (Zarit Burden Interview score ≥17) was unchanged over time (1 month, 38 caregivers [30.9%]; 3 months, 37 caregivers [31.4%]). Participants with lower caregiver self-efficacy and preparedness for caregiving were more likely to experience greater caregiver burden (odds ratio [OR], 7.79; 95% CI, 2.54-23.82; P < .001; and OR, 5.76; 95% CI, 1.86-17.88; P = .003, respectively). Conclusion and Relevance This study found that nearly a third of family caregivers of older trauma patients experience high caregiver burden up to 3 months after the patients' discharge. Targeted interventions to increase caregiver self-efficacy and preparedness may reduce caregiver burden in geriatric trauma.
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Affiliation(s)
- Masami Tabata-Kelly
- Center for Surgery and Public Health, Brigham and Woman’s Hospital, Boston, Massachusetts
- The Heller School for Social Policy and Management, Brandeis University, Waltham, Massachusetts
| | - Mengyuan Ruan
- Center for Surgery and Public Health, Brigham and Woman’s Hospital, Boston, Massachusetts
| | - Tanujit Dey
- Center for Surgery and Public Health, Brigham and Woman’s Hospital, Boston, Massachusetts
| | - Christina Sheu
- Center for Surgery and Public Health, Brigham and Woman’s Hospital, Boston, Massachusetts
| | - Emma Kerr
- Center for Surgery and Public Health, Brigham and Woman’s Hospital, Boston, Massachusetts
| | - Haytham Kaafarani
- Division of Trauma & Emergency Surgery, Department of Surgery, Massachusetts General Hospital, Boston
| | | | - Amy Kelley
- Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Tamryn F. Gray
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Institute, Boston, Massachusetts
| | - Ali Salim
- Department of Surgery, Brigham and Woman’s Hospital, Boston, Massachusetts
| | - Bellal Joseph
- Department of Surgery, University of Arizona, Tucson
| | - Zara Cooper
- Center for Surgery and Public Health, Brigham and Woman’s Hospital, Boston, Massachusetts
- Department of Surgery, Brigham and Woman’s Hospital, Boston, Massachusetts
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10
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Gray TF, Henderson MD, Barakat LP, Knafl KA, Deatrick JA. Advancing family science and health equity through the 2022-2026 National Institute of Nursing Research strategic plan. Nurs Outlook 2023; 71:102030. [PMID: 37696135 DOI: 10.1016/j.outlook.2023.102030] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Revised: 07/25/2023] [Accepted: 08/09/2023] [Indexed: 09/13/2023]
Abstract
BACKGROUND Consistent with the National Institute of Nursing Research's mission of leading nursing research to address current health challenges, the new Strategic Plan identifies five research lenses: health equity, social determinants of health, population and community health, prevention and health promotion, and systems and models of care. Family research, central to nursing research and practice, is the cornerstone of social ecology and represents a critical intersection of social and structural determinants of health. PURPOSE We argue why family health is essential to the 2022-2026 Strategic Plan and how the lenses can strengthen family research. METHODS Drawing from collective expertise and existing literature in family research, sociology, psychology, and nursing science, the authors present a new conceptual model that integrates structural racism and heteropatriarchy to examine the salience of family structure statuses for family outcomes and discuss approaches to research design, empirical measurement, and interpretation in order to bring this new model into practice. DISCUSSION The NINR Strategic Plan has the potential to dismantle structures that perpetuate racism and health inequity within and across family structures. An underaddressed research area under the new Strategic Plan relates to how social determinants of health influence and are influenced by families. CONCLUSION We challenge all investigators, not just family scientists, to expand the scope of their research to conceptualize the role of family on health inequities.
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Affiliation(s)
- Tamryn F Gray
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, MA; Department of Medicine, Harvard Medical School, Boston, MA; Division of Palliative Medicine, Brigham and Women's Hospital, Boston, MA; Cancer Outcomes Research and Education Program, Massachusetts General Hospital Cancer Center, Boston, MA.
| | - Marcus D Henderson
- Johns Hopkins School of Nursing, Baltimore, MD; Department of Family and Community Health, University of Pennsylvania School of Nursing, Philadelphia, PA
| | - Lamia P Barakat
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA; Department of Child and Adolescent Psychiatry and Behavioral Science, Children's Hospital of Philadelphia, Philadelphia, PA
| | - Kathleen A Knafl
- School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Janet A Deatrick
- Department of Family and Community Health, University of Pennsylvania School of Nursing, Philadelphia, PA
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11
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Starkweather A, Cohen B, Gray TF, Linder L, Zanville N. Cancer-Specific health equity metrics in the United States of America: A scoping review. Cancer Med 2023. [PMID: 37017500 DOI: 10.1002/cam4.5881] [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] [Received: 01/24/2023] [Revised: 03/03/2023] [Accepted: 03/19/2023] [Indexed: 04/06/2023] Open
Abstract
Health disparities in cancer care persist, and in some cases are growing, despite decades of research aimed at achieving equal outcomes for all Americans. There is growing consensus that reducing disparities will require a shift from aiming to provide care that is equal, to aiming to provide care that is equitable. The current landscape of metrics and interventions that move beyond equality (i.e., care provided equally to all patients) and towards equity (i.e., care provided variably and justly such that patients achieve equal outcomes) have not been characterized. Thus, the aim of this scoping literature review was to identify cancer-specific health equity metrics and interventions, and to explore current gaps in the field. Following PRISMA guidelines, PubMed, CINAHL, PsycInfo, and Scopus were searched for studies published in English between 2012 and 2022 that implemented a metric to identify or an intervention to address cancer care inequities in the United States. The search returned 36,724 unique articles, of which 40 articles (1%) included an intervention to advance health equity. Metrics included timeliness of screening and treatment, receipt of goal-concordant care, and survival. The vast majority of articles were cross-sectional or cohort studies that described health disparities using one or more outcome metrics. Gaps identified included research on receipt of guideline-concordant care, interventions addressing multiple levels of structural and social determinants of health, inclusion of children and families, and patient-reported outcomes or other sources of data that could help inform interventions to advance equity.
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Affiliation(s)
| | - Bevin Cohen
- Mount Sinai Health System, New York, New York, USA
| | - Tamryn F Gray
- Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts, USA
| | - Lauri Linder
- University of Utah College of Nursing, Primary Children's Hospital, Huntsman Cancer Institute, Salt Lake City, Utah, USA
| | - Noah Zanville
- Clinical Services Group, HCA Healthcare, Nashville, Tennessee, USA
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12
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Hu FY, Wang Y, Abbas M, Bollens-Lund E, Reich AJ, Lipsitz SR, Gray TF, Kim D, Ritchie C, Kelley AS, Cooper Z. Prevalence of unpaid caregiving, pain, and depression in older seriously ill patients undergoing elective surgery. J Am Geriatr Soc 2023. [PMID: 36914427 PMCID: PMC10363213 DOI: 10.1111/jgs.18316] [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] [Received: 09/25/2022] [Revised: 01/22/2023] [Accepted: 02/07/2023] [Indexed: 03/14/2023]
Abstract
INTRODUCTION Serious illness is a life-limiting condition negatively impacting daily function, quality of life, or excessively straining caregivers. Over 1 million older seriously ill adults undergo major surgery annually, and national guidelines recommend that palliative care be available to all seriously ill patients. However, the palliative care needs of elective surgical patients are incompletely described. Understanding baseline caregiving needs and symptom burden among seriously ill older surgical patients could inform interventions to improve outcomes. METHODS Using Health and Retirement Study data (2008-2018) linked to Medicare claims, we identified patients ≥66 years who met an established serious illness definition from administrative data and underwent major elective surgery using Agency for Healthcare Research and Quality (AHRQ) criteria. Descriptive analyses were performed for preoperative patient characteristics, including: unpaid caregiving (no or yes); pain (none/mild or moderate/severe); and depression (no, CES-D < 3, or yes, CES-D ≥ 3). Multivariable regression was performed to examine the association between unpaid caregiving, pain, depression, and in-hospital outcomes, including hospital days (days admitted between discharge date and one-year post-discharge), in-hospital complications (no or yes), and discharge destination (home or non-home). RESULTS Of the 1343 patients, 55.0% were female and 81.6% were non-Hispanic White. Mean age was 78.0 (SD 6.8); 86.9% had ≥2 comorbidities. Before admission, 27.3% of patients received unpaid caregiving. Pre-admission pain and depression were 42.6% and 32.8%, respectively. Baseline depression was significantly associated with non-home discharge (OR 1.6, 95% CI 1.2-2.1, p = 0.003), while baseline pain and unpaid caregiving needs were not associated with in-hospital or post-acute outcomes in multivariable analysis. CONCLUSIONS Prior to elective surgery, older adults with serious illnesses have high unpaid caregiving needs and a prevalence of pain and depression. Baseline depression alone was associated with discharge destinations. These findings highlight opportunities for targeted palliative care interventions throughout the surgical encounter.
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Affiliation(s)
- Frances Y Hu
- Center for Surgery and Public Health, Brigham and Woman's Hospital, Boston, Massachusetts, USA.,Department of Surgery, Brigham and Woman's Hospital, Boston, Massachusetts, USA
| | - Yihan Wang
- Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Muhammad Abbas
- Center for Surgery and Public Health, Brigham and Woman's Hospital, Boston, Massachusetts, USA
| | - Evan Bollens-Lund
- Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Amanda J Reich
- Center for Surgery and Public Health, Brigham and Woman's Hospital, Boston, Massachusetts, USA
| | - Stuart R Lipsitz
- Center for Surgery and Public Health, Brigham and Woman's Hospital, Boston, Massachusetts, USA
| | - Tamryn F Gray
- Department of Psychosocial Oncology and Palliative Care, Dana Farber Cancer Institute, Boston, Massachusetts, USA.,Department of Medicine, Brigham and Woman's Hospital, Boston, Massachusetts, USA
| | - Dae Kim
- Department of Medicine, Brigham and Woman's Hospital, Boston, Massachusetts, USA.,Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Christine Ritchie
- Division of Palliative Care and Geriatric Medicine, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Amy S Kelley
- Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Zara Cooper
- Center for Surgery and Public Health, Brigham and Woman's Hospital, Boston, Massachusetts, USA.,Department of Surgery, Brigham and Woman's Hospital, Boston, Massachusetts, USA
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13
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Applebaum AJ, Sannes T, Mitchell HR, McAndrew NS, Wiener L, Knight JM, Nelson AJ, Gray TF, Fank PM, Lahijani SC, Pozo-Kaderman C, Rueda-Lara M, Miran DM, Landau H, Amonoo HL. Fit for Duty: Lessons Learned from Outpatient and Homebound Hematopoietic Cell Transplantation to Prepare Family Caregivers for Home-Based Care. Transplant Cell Ther 2023; 29:143-150. [PMID: 36572386 PMCID: PMC9780643 DOI: 10.1016/j.jtct.2022.12.014] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 12/15/2022] [Accepted: 12/16/2022] [Indexed: 12/24/2022]
Abstract
In the past decade, the demand for home-based care has been amplified by the Coronavirus disease 2019 pandemic. Home-based care has significant benefits for patients, their families, and healthcare systems, but it relies on the often-invisible workforce of family and friend caregivers who shoulder essential health care responsibilities, frequently with inadequate training and support. Hematopoietic cell transplantation (HCT), a potentially curative but intensive treatment for many patients with blood disorders, is being increasingly offered in home-based care settings and necessitates the involvement of family caregivers for significant patient care responsibilities. However, guidelines for supporting and preparing HCT caregivers to effectively care for their loved ones at home have not yet been established. Here, informed by the literature and our collective experience as clinicians and researchers who care for diverse patients with hematologic malignancies undergoing HCT, we provide considerations and recommendations to better support and prepare family caregivers in home-based HCT and, by extension, family caregivers supporting patients with other serious illnesses at home. We suggest tangible ways to screen family caregivers for distress and care delivery challenges, educate and train them to prepare for their caregiving role, and create an infrastructure of support for family caregivers within this emerging care delivery model.
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Affiliation(s)
- A J Applebaum
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, New York.
| | - T Sannes
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts
| | - H R Mitchell
- Ferkauf Graduate School of Psychology, Yeshiva University, Bronx, New York
| | - N S McAndrew
- College of Nursing, University of Wisconsin-Milwaukee, Milwaukee, WI, USA; Froedtert & the Medical College of Wisconsin, Froedtert Hospital, Patient Care Research, Milwaukee, Wisconsin
| | - L Wiener
- Pediatric Oncology Branch, National Cancer Institute, Center for Cancer Research, National Institutes of Health, Bethesda, MD
| | - J M Knight
- Departments of Psychiatry, Medicine, and Microbiology & Immunology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - A J Nelson
- Department of Psychiatry, Harvard Medical School/Massachusetts General Hospital, Boston, Massachusetts
| | - T F Gray
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts
| | - P M Fank
- Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, Chicago, Illinois
| | - S C Lahijani
- Department of Psychiatry & Behavioral Sciences, Division of Medical Psychiatry, Stanford University School of Medicine, Palo Alto, California
| | - C Pozo-Kaderman
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts
| | - M Rueda-Lara
- University of Miami/Leonard Miller School of Medicine, Department of Psychiatry and Behavioral Sciences, Sylvester Comprehensive Cancer Center, Miami, Florida
| | - D M Miran
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - H Landau
- Adult Bone Marrow Transplant Service, Memorial Sloan Kettering Cancer Center, New York, New York
| | - H L Amonoo
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
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14
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Gray TF, Plotke R, Heuer L, Topping CE, Nipp RD, Wang AC, Gasca Banda J, Greer JA, Temel JS, El-Jawahri A. Perceptions of prognosis and end-of-life care outcomes in patients with advanced lung and gastrointestinal cancer. Palliat Med 2023; 37:740-748. [PMID: 36802979 DOI: 10.1177/02692163231155511] [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] [Indexed: 02/20/2023]
Abstract
BACKGROUND Many patients with advanced cancer have misperceptions of their prognosis, which may impact end-of-life decision-making. Data regarding associations between prognostic perceptions over time and end-of-life care outcomes are lacking. AIM To describe patients' perceptions of their prognosis with advanced cancer and examine associations between these perceptions and end-of-life care outcomes. DESIGN Secondary analysis of longitudinal data from a randomized controlled trial of a palliative care intervention for patients with newly diagnosed incurable cancer. SETTING/PARTICIPANTS Conducted at an outpatient cancer center in the northeastern United States and patients were within 8 weeks of a diagnosis with incurable lung or non-colorectal gastrointestinal cancer. RESULTS We enrolled 350 patients in the parent trial, of which 80.5% (281/350) died during the study period. Overall, 59.4% (164/276) of patients reported they were terminally ill, and 66.1% (154/233) reported that their cancer was likely curable at the assessment closest to death. Patient acknowledgment of terminal illness was only associated with lower risk of hospitalizations in the last 30 days of life (OR = 0.52, p = 0.025). Patients who reported their cancer as likely curable were less likely to utilize hospice (OR = 0.25, p = 0.002) or die at home (OR = 0.56, p = 0.043), and they were more likely to be hospitalized in the last 30 days of life (OR = 2.28, p = 0.011). CONCLUSIONS Patients' perceptions of their prognosis are associated with important end-of-life care outcomes. Interventions are needed to enhance patients' perceptions of their prognosis and optimize their end-of-life care.
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Affiliation(s)
- Tamryn F Gray
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Rachel Plotke
- Massachusetts General Hospital Cancer Center, Boston, MA, USA
| | - Lauren Heuer
- Massachusetts General Hospital Cancer Center, Boston, MA, USA
| | | | - Ryan D Nipp
- Harvard Medical School, Boston, MA, USA.,Massachusetts General Hospital Cancer Center, Boston, MA, USA
| | - Annie C Wang
- Massachusetts General Hospital Cancer Center, Boston, MA, USA
| | | | - Joseph A Greer
- Harvard Medical School, Boston, MA, USA.,Massachusetts General Hospital Cancer Center, Boston, MA, USA
| | - Jennifer S Temel
- Harvard Medical School, Boston, MA, USA.,Massachusetts General Hospital Cancer Center, Boston, MA, USA
| | - Areej El-Jawahri
- Harvard Medical School, Boston, MA, USA.,Massachusetts General Hospital Cancer Center, Boston, MA, USA
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15
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Gray TF, Kwok A, Do KM, Zeng S, Moseley ET, Dbeis YM, Umeton R, Tulsky JA, El-Jawahri A, Lindvall C. Associations Between Family Member Involvement and Outcomes of Patients Admitted to the Intensive Care Unit: Retrospective Cohort Study. JMIR Med Inform 2022; 10:e33921. [PMID: 35704362 PMCID: PMC9244649 DOI: 10.2196/33921] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Revised: 04/01/2022] [Accepted: 04/21/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Little is known about family member involvement, by relationship status, for patients treated in the intensive care unit (ICU). OBJECTIVE Using documentation of family interactions in clinical notes, we examined associations between child and spousal involvement and ICU patient outcomes, including goals of care conversations (GOCCs), limitations in life-sustaining therapy (LLST), and 3-month mortality. METHODS Using a retrospective cohort design, the study included a total of 858 adult patients treated between 2008 and 2012 in the medical ICU at a tertiary care center in northeastern United States. Clinical notes generated within the first 48 hours of admission to the ICU were used with standard machine learning methods to predict patient outcomes. We used natural language processing methods to identify family-related documentation and abstracted sociodemographic and clinical characteristics of the patients from the medical record. RESULTS Most of the 858 patients were White (n=650, 75.8%); 437 (50.9%) were male, 479 (55.8%) were married, and the median age was 68.4 (IQR 56.5-79.4) years. Most patients had documented GOCC (n=651, 75.9%). In adjusted regression analyses, child involvement (odds ratio [OR] 0.81; 95% CI 0.49-1.34; P=.41) and child plus spouse involvement (OR 1.28; 95% CI 0.8-2.03; P=.3) were not associated with GOCCs compared to spouse involvement. Child involvement was not associated with LLST when compared to spouse involvement (OR 1.49; 95% CI 0.89-2.52; P=.13). However, child plus spouse involvement was associated with LLST (OR 1.6; 95% CI 1.02-2.52; P=.04). Compared to spouse involvement, there were no significant differences in the 3-month mortality by family member type, including child plus spouse involvement (OR 1.38; 95% CI 0.91-2.09; P=.13) and child involvement (OR 1.47; 95% CI 0.9-2.41; P=.12). CONCLUSIONS Our findings demonstrate that statistical models derived from text analysis in the first 48 hours of ICU admission can predict patient outcomes. Early child plus spouse involvement was associated with LLST, suggesting that decisions about LLST were more likely to occur when the child and spouse were both involved compared to the involvement of only the spouse. More research is needed to further understand the involvement of different family members in ICU care and its association with patient outcomes.
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Affiliation(s)
- Tamryn F Gray
- Department of Medicine, Harvard Medical School, Boston, MA, United States.,Division of Palliative Medicine, Brigham and Women's Hospital, Boston, MA, United States.,Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, MA, United States
| | - Anne Kwok
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, MA, United States
| | - Khuyen M Do
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, MA, United States
| | - Sandra Zeng
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, MA, United States
| | - Edward T Moseley
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, MA, United States
| | - Yasser M Dbeis
- Department of Informatics & Analytics, Dana-Farber Cancer Institute, Boston, MA, United States
| | - Renato Umeton
- Department of Informatics & Analytics, Dana-Farber Cancer Institute, Boston, MA, United States.,Department of Biological Engineering and Department of Mechanical Engineering, Massachusetts Institute of Technology, Cambridge, MA, United States.,Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA, United States.,Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, NY, United States
| | - James A Tulsky
- Department of Medicine, Harvard Medical School, Boston, MA, United States.,Division of Palliative Medicine, Brigham and Women's Hospital, Boston, MA, United States.,Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, MA, United States
| | - Areej El-Jawahri
- Department of Medicine, Harvard Medical School, Boston, MA, United States.,Department of Medicine, Massachusetts General Hospital Cancer Center, Boston, MA, United States
| | - Charlotta Lindvall
- Department of Medicine, Harvard Medical School, Boston, MA, United States.,Division of Palliative Medicine, Brigham and Women's Hospital, Boston, MA, United States.,Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, MA, United States
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16
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Bullock K, Gray TF, Tucker R, Quest TE. Race Roundtable Series: Structural Racism in Palliative Care. J Pain Symptom Manage 2022; 63:e455-e459. [PMID: 35157982 DOI: 10.1016/j.jpainsymman.2022.01.015] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Revised: 01/08/2022] [Accepted: 01/13/2022] [Indexed: 11/30/2022]
Abstract
This series will focus on addressing the intersection of race and racism in palliative care through a series of roundtable discussions with interdisciplinary clinicians, researchers, educators, and leaders in palliative care. These short discussions are intended to stimulate readers to examine issues of race and racism within the field of hospice and palliative care - in the various forms that it appears - as well as serve as a continual call to action to facilitate and promote equity.
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Affiliation(s)
- Karen Bullock
- School of Social Work, North Carolina State University (K.B.), Raleigh, North Carolina, USA
| | - Tamryn F Gray
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, MA; and Department of Medicine, Harvard Medical School (T.F.G.), Boston, MA
| | - Rodney Tucker
- Center for Palliative and Supportive Care, University of Alabama (R.T.), Birmingham
| | - Tammie E Quest
- Emory University School of Medicine, Emory Palliative Care Center (T.E.Q.), Atlanta, GA.
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17
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Gray TF, Allgood SJ, Nolan MT, Gallo JJ, Han HR, Clayman ML, Budhathoki C, Lansey DG, Wenzel J. "It All Depends": Patient and Decision Partner Experiences in Cancer Clinical Trial Decision-Making. Qual Health Res 2022; 32:887-901. [PMID: 35343318 DOI: 10.1177/10497323221083355] [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] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
While the supporting role of families and friends has been widely recognized in cancer care, little data exist on how they influence patients' decisions regarding clinical trial participation, accounting for patients' decisional preferences. The goal of our study was to examine the process of clinical trial decision-making from the perspective of adults with cancer and their decision partners. Semi-structured interviews were conducted with 12 patients and 12 decision partners-family and friends engaged in the medical decision-making. Themes included: (1) having the ability and confidence to make decisions; (2) gaining insight about clinical trials; (3) trusting someone in the process; and (4) realizing readiness and context. Our findings will enhance understanding of how patients make clinical trial decisions based on decisional preferences from the perspectives of patients and decision partners. The findings may also help to increase clinician awareness and inclusion of decision partners in conversations regarding clinical trials.
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Affiliation(s)
- Tamryn F Gray
- 1855Dana-Farber Cancer Institute, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | | | - Marie T Nolan
- 15851Johns Hopkins School of Nursing, Baltimore, MD, USA
| | - Joseph J Gallo
- 15851Johns Hopkins School of Nursing, Baltimore, MD, USA
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Hae-Ra Han
- 15851Johns Hopkins School of Nursing, Baltimore, MD, USA
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Marla L Clayman
- 560937Center for Healthcare Organization and Implementation Research (CHOIR), VA Health Services Research and Development Service, Bedford, MA, USA
| | | | - Dina G Lansey
- Department of Oncology, 1500Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Jennifer Wenzel
- 15851Johns Hopkins School of Nursing, Baltimore, MD, USA
- Department of Oncology, 1500Johns Hopkins School of Medicine, Baltimore, MD, USA
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18
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Durieux BN, Berrier A, Catzen HZ, Gray TF, Lakin JR, Cunningham R, Morris SE, Tulsky JA, Sanders JJ. " I think that she would have wanted. . .": Qualitative interviews with bereaved caregivers reveal complexity in measuring goal-concordant care at the end of life. Palliat Med 2022; 36:742-750. [PMID: 35164612 DOI: 10.1177/02692163221078472] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Experts consider goal-concordant care an important healthcare outcome for individuals with serious illness. Despite their relationship to the patient and knowledge about the patient's wishes and values, little is known about bereaved family caregivers' perceptions of how end-of-life care aligns with patient goals and preferences. AIM To understand caregivers' perceptions about patients' care experiences, the extent to which care was perceived as goal-concordant, and the factors that contextualized the end-of-life care experience. DESIGN Qualitative interview study employing a semi-structured interview guide based on the National Health and Aging Trends Survey end-of-life planning module. Template analysis was used to identify themes. SETTING/PARTICIPANTS Nineteen recently bereaved family caregivers of people with serious illness in two academic medical centers in the Northeastern United States. RESULTS Most caregivers reported goal-concordant care, though many also recalled experiences of goal discordance. Three themes characterized care perceptions and related to perceived quality: communication, relationships and humanistic care, and care transitions. Within communication, caregivers described the importance of clear communication, inadequate prognostic communication, and information gaps that undermined caregiver confidence in decision making. Patient-clinician relationships enriched care and were considered higher-quality when felt to be humanistic. Finally, care transitions impacted goal discordance when marked by logistical barriers, a need to establish relationships with new providers, inadequate information transfer, and poor care coordination. CONCLUSIONS Bereaved caregivers commonly rated care as goal-concordant while also identifying areas of disappointing and low-quality care. Communication, relationships and humanistic care, and care transitions are modifiable quality improvement targets for patients with advanced cancer.
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Affiliation(s)
| | - Anna Berrier
- Dana-Farber Cancer Institute, Boston, MA, USA.,Gillings School of Global Public Health at The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | | | - Tamryn F Gray
- Dana-Farber Cancer Institute, Boston, MA, USA.,Brigham and Women's Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Joshua R Lakin
- Dana-Farber Cancer Institute, Boston, MA, USA.,Brigham and Women's Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Rebecca Cunningham
- Brigham and Women's Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Sue E Morris
- Dana-Farber Cancer Institute, Boston, MA, USA.,Brigham and Women's Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - James A Tulsky
- Dana-Farber Cancer Institute, Boston, MA, USA.,Brigham and Women's Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Justin J Sanders
- Dana-Farber Cancer Institute, Boston, MA, USA.,Brigham and Women's Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
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19
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Sanders JJ, Gray TF, Sihlongonyane B, Durieux BN, Graham L. A Framework for Anti-Racist Publication in Palliative Care: Structures, Processes, and Outcomes. J Pain Symptom Manage 2022; 63:e337-e343. [PMID: 34662725 DOI: 10.1016/j.jpainsymman.2021.10.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Revised: 09/22/2021] [Accepted: 10/02/2021] [Indexed: 11/20/2022]
Abstract
Systemic or structural racism describes an embedded pattern of explicit and implicit racial biases that, through policy and action, systematically confer advantage to white people and disadvantage Black, indigenous, and other people of color. Hospice and palliative care journals participate in this broader system of racial discrimination. Building on palliative care's explicit focus on patients' goals and values, which may in and of itself comprise a form of social justice in healthcare, palliative care journals and their publishers have an opportunity to lead others in cultivating anti-racist practices and explicitly promoting equity. The publication life cycle of submission and solicitation, manuscript peer-review, and publication provide a framework for examining the structures, processes, and outcomes by which palliative care and other journals might address systemic racism. We describe the current academic publishing landscape, which diminishes the voices and experiences of racial and ethnic minority patients and undermines the careers of under-represented scholars. We then propose reforms that we believe will improve publication equity and quality as well as healthcare outcomes. These include an Equity in Publication checklist, solicitation of manuscripts on equity-relevant topics, promotion of scholars through editorial structures and peer review processes, and a standard Equity Rating for publications. Greater efforts to include non-dominant voices in every aspect of publication, through appropriate recognition of their scholarship and remuneration for their efforts, will drive equity in health outcomes. By pursuing an anti-racist and equity-focused publishing agenda, hospice and palliative medicine journals and their publishers have an opportunity to transform healthcare.
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Affiliation(s)
- Justin J Sanders
- Department of Family Medicine (J.J.S.), Palliative Care McGill, McGill University, Montreal, Quebec, Canada.
| | - Tamryn F Gray
- Harvard Medical School (T.F.G.), Boston, MA; Department of Psychosocial Oncology and Palliative Care (T.F.G., B.N.D.), Dana-Farber Cancer Institute, Boston, MA
| | | | - Brigitte N Durieux
- Department of Psychosocial Oncology and Palliative Care (T.F.G., B.N.D.), Dana-Farber Cancer Institute, Boston, MA
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20
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Rosa WE, Parekh de Campos A, Abedini NC, Gray TF, Huijer HAS, Bhadelia A, Boit JM, Byiringiro S, Crisp N, Dahlin C, Davidson PM, Davis S, De Lima L, Farmer PE, Ferrell BR, Hategekimana V, Karanja V, Knaul FM, Kpoeh JDN, Lusaka J, Matula ST, McMahon C, Meghani SH, Moreland PJ, Ntizimira C, Radbruch L, Rajagopal MR, Downing J. Optimizing the Global Nursing Workforce to Ensure Universal Palliative Care Access and Alleviate Serious Health-Related Suffering Worldwide. J Pain Symptom Manage 2022; 63:e224-e236. [PMID: 34332044 PMCID: PMC8799766 DOI: 10.1016/j.jpainsymman.2021.07.014] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [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: 03/04/2021] [Revised: 06/21/2021] [Accepted: 07/22/2021] [Indexed: 11/16/2022]
Abstract
CONTEXT Palliative care access is fundamental to the highest attainable standard of health and a core component of universal health coverage. Forging universal palliative care access is insurmountable without strategically optimizing the nursing workforce and integrating palliative nursing into health systems at all levels. The COVID-19 pandemic has underscored both the critical need for accessible palliative care to alleviate serious health-related suffering and the key role of nurses to achieve this goal. OBJECTIVES 1) Summarize palliative nursing contributions to the expansion of palliative care access; 2) identify emerging nursing roles in alignment with global palliative care recommendations and policy agendas; 3) promote nursing leadership development to enhance universal access to palliative care services. METHODS Empirical and policy literature review; best practice models; recommendations to optimize the palliative nursing workforce. RESULTS Nurses working across settings provide a considerable untapped resource that can be leveraged to advance palliative care access and palliative care program development. Best practice models demonstrate promising approaches and outcomes related to education and training, policy and advocacy, and academic-practice partnerships. CONCLUSION An estimated 28 million nurses account for 59% of the international healthcare workforce and deliver up to 90% of primary health services. It has been well-documented that nurses are often the first or only healthcare provider available in many parts of the world. Strategic investments in international and interdisciplinary collaboration, as well as policy changes and the safe expansion of high-quality nursing care, can optimize the efforts of the global nursing workforce to mitigate serious health-related suffering.
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Affiliation(s)
- William E Rosa
- Department of Psychiatry and Behavioral Sciences (W.E.R.), Memorial Sloan Kettering Cancer Center, New York, USA.
| | - Amisha Parekh de Campos
- University of Connecticut School of Nursing (A.P.D.C.), Storrs & Hospice Program, Middlesex Health, Connecticut, USA
| | - Nauzley C Abedini
- Division of Gerontology and Geriatric Medicine (N.C.A.), Department of Medicine, University of Washington, Seattle, Washington, USA
| | - Tamryn F Gray
- Harvard Medical School (T.F.G.), Department of Psychosocial Oncology and Palliative Care, Phyllis F. Cantor Center for Research in Nursing and Patient Care Services, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | | | - Afsan Bhadelia
- Harvard T.H. Chan School of Public Health (A.B.), Boston, Massachusetts, USA
| | | | - Samuel Byiringiro
- Johns Hopkins University School of Nursing (S.B.), Baltimore, Maryland, USA
| | - Nigel Crisp
- All-Party Parliamentary Group on Global Health (N.C.), House of Lords, Nursing Now Global Campaign, London, UK
| | | | - Patricia M Davidson
- The Vice-Chancellor's Unit (P.M.D.), University of Wollongong, New South Wales, Australia
| | - Sheila Davis
- Partners In Health (S.D., C.M.), Boston, Massachusetts, USA
| | - Liliana De Lima
- International Association for Hospice & Palliative Care (L.D.L.), Houston, Texas, USA
| | - Paul E Farmer
- Department of Global Health and Social Medicine (P.E.F.), Harvard Medical School, Boston, Massachusetts, USA
| | - Betty R Ferrell
- Division of Nursing Research and Education (B.R.F.), Department of Population Sciences, City of Hope Medical Center, Duarte, California, USA
| | - Vedaste Hategekimana
- Pain Free Hospital Initiative (V.H.), Rwanda Biomedical Center and Ministry of Health, Butaro, Rwanda
| | - Viola Karanja
- Partners In Health Liberia (V.K., J.D.N.K, J.L.), Harper, Maryland County, Liberia
| | - Felicia Marie Knaul
- University of Miami Institute for Advanced Study of the Americas (F.M.K.), Coral Gables, Florida, USA
| | - Julius D N Kpoeh
- Partners In Health Liberia (V.K., J.D.N.K, J.L.), Harper, Maryland County, Liberia
| | - Joseph Lusaka
- Partners In Health Liberia (V.K., J.D.N.K, J.L.), Harper, Maryland County, Liberia
| | - Samuel T Matula
- University of Botswana School of Nursing (S.T.M.), Gabarone, Botswana
| | - Cory McMahon
- Partners In Health (S.D., C.M.), Boston, Massachusetts, USA
| | - Salimah H Meghani
- University of Pennsylvania School of Nursing (S.H.M.), Philadelphia, Pennsylvania, USA
| | - Patricia J Moreland
- Emory University Nell Hodgson Woodruff School of Nursing (P.J.M.), Atlanta, Georgia, USA
| | | | - Lukas Radbruch
- Department of Palliative Medicine (L.R.), University Hospital Bonn, Bonn, Germany
| | - M R Rajagopal
- Trivandrum Institute of Palliative Sciences (M.R.R.), Trivandrum, Kerala, India
| | - Julia Downing
- International Children's Palliative Care Network (J.D.), Makerere University, Kampala, Uganda
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21
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Rubin BR, Chung M, Hasdianda MA, Gray TF, Aaronson EL, Dundin A, Egorova NA, Revette AC, Berry D, Ouchi K. Refinement of an Emergency Department-Based, Advance Care Planning Intervention for Nurses. J Palliat Med 2022; 25:650-655. [PMID: 35100041 PMCID: PMC8982111 DOI: 10.1089/jpm.2021.0398] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 12/29/2022] Open
Abstract
Background: Most older adults visit the emergency department (ED) near the end of life without advance care planning (ACP) and thus are at risk of receiving care that does not align with their wishes and values. ED GOAL is a behavioral intervention administered by ED clinicians, which is designed to engage seriously ill older adults in serious illness conversations in the ED. Seriously ill older adults found it acceptable in the ED. However, its potential to be used by nurses remains unclear. Objective: The aim of this study is to identify refinements to adapt an ED-based ACP intervention by eliciting the perspectives of nurses. Design: This is a qualitative study using semistructured interviews. Data were analyzed using axial coding methods. Setting/Subjects: We recruited a purposeful sample of ED nurses in one urban academic ED and one urban community ED in the northeastern region of the United States. Results: Twenty-five nurses were interviewed (mean age 46 years, 84% female, and mean clinical experience of 16 years). Emerging themes were identified within six domains: (1) nurses' prior experience with serious illness conversations, (2) overall impression of ED GOAL, (3) refinements to ED GOAL, (4) implementation of ED GOAL by ED nurses, (5) specially trained nursing model, and (6) use of telehealth with ED GOAL. Conclusions: ED nurses were generally supportive of using ED GOAL and provided insight into how to best adapt and implement it in their clinical practice. Empirical evidence for adapting ED GOAL to the nursing practice remains to be seen.
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Affiliation(s)
- Batsheva R Rubin
- Boston University School of Medicine, Boston, Massachusetts, USA
| | - Michelle Chung
- Department of Emergency Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Mohammad Adrian Hasdianda
- Department of Emergency Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA.,Department of Emergency Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Tamryn F Gray
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Emily L Aaronson
- Department of Emergency Medicine, Harvard Medical School, Boston, Massachusetts, USA.,Department of Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Andrew Dundin
- Department of Emergency Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Natasha A Egorova
- Department of Emergency Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Anna C Revette
- Survey and Data Management Core, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Donna Berry
- Department of Biobehavioral Nursing and Health Informatics, University of Washington School of Nursing, Seattle, Washington, USA
| | - Kei Ouchi
- Department of Emergency Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA.,Department of Emergency Medicine, Harvard Medical School, Boston, Massachusetts, USA.,Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts, USA.,Serious Illness Care Program, Ariadne Labs, Boston, Massachusetts, USA
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22
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Borstelmann NA, Gray TF, Gelber S, Rosenberg S, Zheng Y, Meyer M, Ruddy KJ, Schapira L, Come S, Borges V, Cadet T, Maramaldi P, Partridge AH. Psychosocial issues and quality of life of parenting partners of young women with breast cancer. Support Care Cancer 2022; 30:4265-4274. [PMID: 35091846 PMCID: PMC9701537 DOI: 10.1007/s00520-022-06852-7] [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] [Received: 09/24/2021] [Accepted: 01/19/2022] [Indexed: 10/19/2022]
Abstract
PURPOSE Data are lacking about the association between quality of life (QOL) and psychosocial issues of partners of young women with breast cancer who co-parent dependent children. METHODS We conducted a cross-sectional analysis of partners of women with breast cancer diagnosed at age ≤ 40. Among those partners reporting at least one dependent child under 18 years old at the time of diagnosis, we used multiple linear regression to examine associations between partner QOL and sociodemographic and psychosocial factors, and the patient's cancer stage and time since diagnosis. RESULTS Of the 219 parenting partners, all identified as male with a median age of 44 years; 96% (204/213) reported working full-time at the time of the survey. Fifty-four percent endorsed behaviors indicating maladaptive coping. In adjusted analyses, less than full-time employment (β = - 8.76; 95% CI = - 17.37, - 0.14), younger age (β = - 0.35; 95% CI = - 0.069, - 0.02), greater parenting concerns (β = 0.56; 95% CI = 0.36, 0.75), clinically relevant anxiety symptoms (β = 13.79; 95% CI = 10.24, 17.35), lower post-traumatic growth score (β = - 0.33; 95% CI = - 0.51, - 0.16), lower social support (β = - 0.21; 95% CI = - 0.29, - 0.12), lower sexual satisfaction (β = - 0.40; 95% CI = - 0.62, - 0.19), and breast cancer stages 3 (β = 7.61; 95% CI = 0.19, 15.02) and 4 (β = 12.63; 95% CI = 1.91, 23.34), when compared to stage 0, were associated with lower partner QOL. CONCLUSION Parenting partners of young women with breast cancer have substantial unmet psychosocial needs. Interventions are needed to enhance QOL and promote adaptive coping for this population.
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Affiliation(s)
| | - Tamryn F Gray
- Dana-Farber Cancer Institute, 450 Brookline Avenue, Boston, MA, 02215, USA.,Harvard Medical School, Boston, MA, USA
| | - Shari Gelber
- Dana-Farber Cancer Institute, 450 Brookline Avenue, Boston, MA, 02215, USA
| | - Shoshana Rosenberg
- Dana-Farber Cancer Institute, 450 Brookline Avenue, Boston, MA, 02215, USA.,Harvard Medical School, Boston, MA, USA
| | - Yue Zheng
- Dana-Farber Cancer Institute, 450 Brookline Avenue, Boston, MA, 02215, USA
| | - Meghan Meyer
- Dana-Farber Cancer Institute, 450 Brookline Avenue, Boston, MA, 02215, USA
| | | | | | - Steven Come
- Harvard Medical School, Boston, MA, USA.,Beth Israel Deaconess Medical Center, Boston, MA, USA
| | | | - Tamara Cadet
- Simmons College School of Social Work, Boston, MA, USA
| | - Peter Maramaldi
- Simmons College School of Social Work, Boston, MA, USA.,Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Ann H Partridge
- Dana-Farber Cancer Institute, 450 Brookline Avenue, Boston, MA, 02215, USA.,Harvard Medical School, Boston, MA, USA
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23
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Gray TF, Zanville N, Cohen B, Cooley ME, Starkweather A, Linder LA. Finding New Ground-Fostering Post-Traumatic Growth in Children and Adolescents After Parental Death From COVID-19. J Adolesc Health 2022; 70:10-11. [PMID: 34930565 PMCID: PMC8598317 DOI: 10.1016/j.jadohealth.2021.10.016] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Accepted: 10/09/2021] [Indexed: 11/25/2022]
Affiliation(s)
- Tamryn F. Gray
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts,Division of Palliative Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts,Department of Medicine, Harvard Medical School, Boston, Massachusetts,Phyllis F. Cantor Center for Research in Nursing and Patient Care Services, Dana-Farber Cancer Institute, Boston, Massachusetts,Address correspondence to: Tamryn F. Gray, Ph.D., R.N., M.P.H., Dana-Farber Cancer Institute, 450 Brookline Avenue, Boston, MA 02215
| | - Noah Zanville
- Center for Clinical Advancement, Mission Health, HCA Healthcare North Carolina Division, Asheville, North Carolina
| | - Bevin Cohen
- Center for Nursing Research and Innovation, The Mount Sinai Hospital, New York, New York
| | - Mary E. Cooley
- Phyllis F. Cantor Center for Research in Nursing and Patient Care Services, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Angela Starkweather
- The Center for Accelerating Precision Pain Self-Management (CAPPS-M), University of Connecticut School of Nursing, Storrs, Connecticut
| | - Lauri A. Linder
- Division of Acute and Chronic Care, University of Utah College of Nursing, Salt Lake City, Utah,Center for Cancer and Blood Disorders, Primary Children’s Hospital, Salt Lake City, Utah
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24
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Weaver MS, Boss RD, Christopher MJ, Gray TF, Harman S, Madrigal VN, Michelson KN, Paquette ET, Pentz RD, Scarlet S, Ulrich CM, Walter JK. Top Ten Tips Palliative Care Clinicians Should Know About Their Work's Intersection with Clinical Ethics. J Palliat Med 2021; 25:656-661. [PMID: 34807737 DOI: 10.1089/jpm.2021.0521] [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: 11/13/2022] Open
Abstract
Palliative care (PC) subspecialists and clinical ethics consultants often engage in parallel work, as both function primarily as interprofessional consultancy services called upon in complex clinical scenarios and challenging circumstances. Both practices utilize active listening, goals-based communication, conflict mediation or mitigation, and values explorations as care modalities. In this set of tips created by an interprofessional team of ethicists, intensivists, a surgeon, an attorney, and pediatric and adult PC nurses and physicians, we aim to describe some paradigmatic clinical challenges for which partnership may improve collaborative, comprehensive care.
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Affiliation(s)
- Meaghann S Weaver
- Department of Pediatrics, University of Nebraska, Omaha, Nebraska, USA.,National Center for Ethics in Health Care, Washington, District of Columbia, USA
| | - Renee D Boss
- Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.,Berman Institute of Bioethics, Baltimore, Maryland, USA
| | | | - Tamryn F Gray
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Stephanie Harman
- Department of Medicine, Stanford University, Palo Alto, California, USA
| | - Vanessa N Madrigal
- Department of Pediatrics, Children's National Hospital, Washington, District of Columbia, USA
| | - Kelly N Michelson
- Department of Pediatrics, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA.,Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Erin T Paquette
- Department of Pediatrics, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA.,Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.,Northwestern Pritzker School of Law, Chicago, Illinois, USA
| | - Rebecca D Pentz
- Winship Cancer Institute, Atlanta, Georgia, USA.,Department of Hematology and Oncology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Sara Scarlet
- Surgical Critical Care, University of North Carolina Health Care, Chapel Hill, North Carolina, USA
| | - Connie M Ulrich
- NewCourtland Center for Transitions and Health, School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Department of Medical Ethics and Health Policy, Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Jennifer K Walter
- Department of Medical Ethics, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.,Department of Pediatrics and Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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25
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Johnson PC, Markovitz NH, Gray TF, Bhatt S, Nipp RD, Ufere N, Rice J, Reynolds MJ, Lavoie MW, Topping CEW, Clay MA, Lindvall C, El-Jawahri A. Association of Social Support With Overall Survival and Healthcare Utilization in Patients With Aggressive Hematologic Malignancies. J Natl Compr Canc Netw 2021:1-7. [PMID: 34653964 DOI: 10.6004/jnccn.2021.7033] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Accepted: 03/02/2021] [Indexed: 11/17/2022]
Abstract
BACKGROUND Social support plays a crucial role for patients with aggressive hematologic malignancies as they navigate their illness course. The aim of this study was to examine associations of social support with overall survival (OS) and healthcare utilization in this population. METHODS A cross-sectional secondary analysis was conducted using data from a prospective longitudinal cohort study of 251 hospitalized patients with aggressive hematologic malignancies at Massachusetts General Hospital from 2014 through 2017. Natural Language Processing (NLP) was used to identify the extent of patients' social support (limited vs adequate as defined by NLP-aided chart review of the electronic health record). Multivariable regression models were used to examine associations of social support with (1) OS, (2) death or readmission within 90 days of discharge from index hospitalization, (3) time to readmission within 90 days, and (4) index hospitalization length of stay. RESULTS Patients had a median age of 64 years (range, 19-93 years), and most were White (89.6%), male (68.9%), and married (65.3%). A plurality of patients had leukemia (42.2%) followed by lymphoma (37.9%) and myelodysplastic syndrome/myeloproliferative neoplasm (19.9%). Using NLP, we identified that 8.8% (n=22) of patients had limited social support. In multivariable analyses, limited social support was associated with worse OS (hazard ratio, 2.00; P=.042) and a higher likelihood of death or readmission within 90 days of discharge (odds ratio, 3.11; P=.043), but not with time to readmission within 90 days or with index hospitalization length of stay. CONCLUSIONS In this cohort of hospitalized patients with aggressive hematologic malignancies, we found associations of limited social support with lower OS and a higher likelihood of death or readmission within 90 days of hospital discharge. These findings underscore the utility of NLP for evaluating the extent of social support and the need for larger studies evaluating social support in patients with aggressive hematologic malignancies.
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Affiliation(s)
- P Connor Johnson
- 1Division of Hematology and Oncology, Department of Medicine, Massachusetts General Hospital
- 2Harvard Medical School
| | - Netana H Markovitz
- 1Division of Hematology and Oncology, Department of Medicine, Massachusetts General Hospital
| | - Tamryn F Gray
- 2Harvard Medical School
- 3Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute
| | - Sunil Bhatt
- 1Division of Hematology and Oncology, Department of Medicine, Massachusetts General Hospital
| | - Ryan D Nipp
- 1Division of Hematology and Oncology, Department of Medicine, Massachusetts General Hospital
- 2Harvard Medical School
| | - Nneka Ufere
- 2Harvard Medical School
- 4Division of Gastroenterology, Department of Medicine, Massachusetts General Hospital; and
| | - Julia Rice
- 5Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Matthew J Reynolds
- 5Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Mitchell W Lavoie
- 5Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Carlisle E W Topping
- 5Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Madison A Clay
- 5Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Charlotta Lindvall
- 2Harvard Medical School
- 3Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute
| | - Areej El-Jawahri
- 1Division of Hematology and Oncology, Department of Medicine, Massachusetts General Hospital
- 2Harvard Medical School
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26
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Thompson T, Ketcher D, Gray TF, Kent EE. The Dyadic Cancer Outcomes Framework: A general framework of the effects of cancer on patients and informal caregivers. Soc Sci Med 2021; 287:114357. [PMID: 34500320 DOI: 10.1016/j.socscimed.2021.114357] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [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] [Received: 05/07/2021] [Revised: 08/24/2021] [Accepted: 08/28/2021] [Indexed: 01/22/2023]
Abstract
It is widely acknowledged that cancer affects not only patients but also their friends and family members who provide informal, and typically unpaid, care. Given the dual impact that cancer often has on patients and their informal caregivers (i.e., family members, partners, or friends), an expanded dyadic framework that encompasses a range of health and psychosocial outcomes and includes primary caregivers with a range of relationships to the patients is critically needed. Moreover, an emphasis on the role of social and contextual factors may help the framework resonate with a broader range of patient-caregiver relationships and allow for the development of more effective dyadic interventions. This article describes the development of the Dyadic Cancer Outcomes Framework, which was created to guide future research and intervention development. Using an iterative process, we conducted a conceptual review of currently used dyadic and/or caregiving models and frameworks and developed our own novel dyadic framework. Our novel Dyadic Cancer Outcomes Framework highlights individual- and dyad-level predictors and outcomes, as well as incorporating the disease trajectory and the social context. This framework can be used in conjunction with statistical approaches including the Actor Partner Interdependence Model to evaluate outcomes for different kinds of partner-caregiver dyads. This flexible framework can be used to guide intervention development and evaluation for cancer patients and their primary caregivers, with the ultimate goal of improving health, psychosocial, and relationship outcomes for both patients and caregivers. Future research will provide valuable information about the framework's effectiveness for this purpose.
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Affiliation(s)
- Tess Thompson
- Washington University in St. Louis, Brown School of Social Work, One Brookings Drive, Campus Box 1196, St. Louis, MO, 63130, USA.
| | - Dana Ketcher
- Moffitt Cancer Center, Department of Health Outcomes and Behavior, Tampa, FL, USA
| | - Tamryn F Gray
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Institute, Boston, MA, USA; Phyllis F. Cantor Center for Research in Nursing & Patient Care Services, Dana-Farber Cancer Institute, Boston, MA, USA; Department of Medicine, Harvard Medical School, Boston, MA, USA
| | - Erin E Kent
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, USA; Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, USA
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Crespi C, Adams L, Gray TF, Azizoddin DR. An Integrative Review of the Role of Nurses in Fertility Preservation for Adolescents and Young Adults With Cancer. Oncol Nurs Forum 2021; 48:491-505. [PMID: 34411081 DOI: 10.1188/21.onf.491-505] [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: 11/17/2022]
Abstract
PROBLEM IDENTIFICATION Adolescents and young adults (AYAs) with cancer commonly report future fertility as an important issue in care. Despite long-standing guidelines on fertility counseling and the trusting relationship between nurses and patients, little is known about the nurse's role in fertility preservation (FP) for AYAs with cancer. LITERATURE SEARCH The authors conducted a literature search of articles published through 2020 focused on nursing involvement in FP for AYAs with cancer. DATA EVALUATION 85 studies were identified. In total, 11 articles met inclusion criteria and were critically appraised in the review. SYNTHESIS Although well positioned to improve FP care among AYAs with cancer, nurses currently have a minimal role because of provider, institutional, and patient-related barriers. IMPLICATIONS FOR PRACTICE Interventions to enhance nurses' knowledge about FP, improvements in electronic health record documentation, and facilitation of institutional support are needed to support the nurse's role in FP for AYAs with cancer.
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Waldman LP, Nelson AM, Jacobs JM, Gray TF, Clay M, Jagielo AD, Rice J, Traeger L, El-Jawahri A. Anxiety and Depression Symptoms in Caregivers Prior to Hematopoietic Stem Cell Transplantation (HCT). Transplant Cell Ther 2021; 27:517.e1-517.e5. [PMID: 33812804 PMCID: PMC8217210 DOI: 10.1016/j.jtct.2021.03.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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] [Received: 01/04/2021] [Revised: 02/15/2021] [Accepted: 03/01/2021] [Indexed: 11/25/2022]
Abstract
Family and friends caring for hematopoietic stem cell transplantation (HCT) recipients experience substantial disruptions in daily life as they prepare for transplant. These disruptions may increase their psychological distress, yet little research has described the extent of this distress. The goals of the present study were to characterize rates of anxiety and depression symptoms immediately prior to HCT and their relationship with modifiable caregiving domains. We conducted a secondary analysis of cross-sectional data of caregivers of patients undergoing HCT. Caregivers completed self-report measures to assess 8 domains of caregiving (Caregiver Oncology Quality of Life Questionnaire) and anxiety and depression symptoms (Hospital Anxiety and Depression Scale [HADS]) prior to transplant. Scores ≥8 on the HADS anxiety and depression subscales signified clinically significant symptoms. We used multivariable regression models adjusting for age, sex, caregiver relationship, and HCT type to examine the associations between caregiving domains and anxiety and depression symptoms. We enrolled 193 caregivers (median age = 60 years, 70.0% female, 52.3% allogeneic transplant). A majority of participants were providing care for a spouse (79.8%), followed by a child (7.8%) or parent (5.2%). On average, caregivers reported more anxiety (mean = 7.04, SD = 3.94) than depression symptoms (mean = 4.18, SD = 3.49), with 46.6% and 16.1% endorsing clinically significant anxiety and depression symptoms, respectively. Caregiver anxiety was associated with worse physical well-being, less leisure time, and poorer coping (Ps < .05). Caregiver depression symptoms were associated with worse physical well-being and less leisure time (Ps < .05). Caregivers of HCT recipients experience substantial psychological distress, particularly anxiety, prior to transplant. This distress is linked to modifiable caregiving domains. Study findings identify possible targets for psychosocial interventions aimed at managing caregiver anxiety and depression symptoms as well as highlight the need for intervention early during the course of transplant.
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Affiliation(s)
| | - Ashley M Nelson
- Massachusetts General Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts.
| | - Jamie M Jacobs
- Massachusetts General Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts
| | - Tamryn F Gray
- Harvard Medical School, Boston, Massachusetts; Dana Farber Cancer Institute, Boston, Massachusetts
| | - Madison Clay
- Massachusetts General Hospital, Boston, Massachusetts
| | | | - Julia Rice
- Massachusetts General Hospital, Boston, Massachusetts
| | - Lara Traeger
- Massachusetts General Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts
| | - Areej El-Jawahri
- Massachusetts General Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts
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Huang K, Gray TF, Romero-Brufau S, Tulsky JA, Lindvall C. Using nursing notes to improve clinical outcome prediction in intensive care patients: A retrospective cohort study. J Am Med Inform Assoc 2021; 28:1660-1666. [PMID: 33880557 PMCID: PMC8324216 DOI: 10.1093/jamia/ocab051] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Accepted: 03/08/2021] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVE Electronic health record documentation by intensive care unit (ICU) clinicians may predict patient outcomes. However, it is unclear whether physician and nursing notes differ in their ability to predict short-term ICU prognosis. We aimed to investigate and compare the ability of physician and nursing notes, written in the first 48 hours of admission, to predict ICU length of stay and mortality using 3 analytical methods. MATERIALS AND METHODS This was a retrospective cohort study with split sampling for model training and testing. We included patients ≥18 years of age admitted to the ICU at Beth Israel Deaconess Medical Center in Boston, Massachusetts, from 2008 to 2012. Physician or nursing notes generated within the first 48 hours of admission were used with standard machine learning methods to predict outcomes. RESULTS For the primary outcome of composite score of ICU length of stay ≥7 days or in-hospital mortality, the gradient boosting model had better performance than the logistic regression and random forest models. Nursing and physician notes achieved area under the curves (AUCs) of 0.826 and 0.796, respectively, with even better predictive power when combined (AUC, 0.839). DISCUSSION Models using only nursing notes more accurately predicted short-term prognosis than did models using only physician notes, but in combination, the models achieved the greatest accuracy in prediction. CONCLUSIONS Our findings demonstrate that statistical models derived from text analysis in the first 48 hours of ICU admission can predict patient outcomes. Physicians' and nurses' notes are both uniquely important in mortality prediction and combining these notes can produce a better predictive model.
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Affiliation(s)
- Kexin Huang
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Tamryn F Gray
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts, USA.,Phyllis F. Cantor Center for Research in Nursing and Patient Care Services, Dana-Farber Cancer Institute, Boston, Massachusetts, USA.,Division of Palliative Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA.,Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Santiago Romero-Brufau
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA.,Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - James A Tulsky
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts, USA.,Division of Palliative Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA.,Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Charlotta Lindvall
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts, USA.,Division of Palliative Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA.,Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA
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Hasdianda MA, Gray TF, Bello JL, Ballaron B, Egorova NA, Berry DL, Ouchi K. Nurses' Perceptions of Facilitating Advance Care Planning Conversations in the Emergency Department. Palliat Med Rep 2021; 2:65-70. [PMID: 34223506 PMCID: PMC8241390 DOI: 10.1089/pmr.2020.0116] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [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] [Accepted: 02/18/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Nurses are well positioned to initiate advance care planning (ACP) conversations because of their unique strength in communication and central patient-facing role in the interdisciplinary team. Nurse-led ACP conversations have demonstrated promising results in settings outside of the emergency department (ED). Understanding ED nurses' perspectives regarding ACP conversations is needed before implementing similar practices in the ED. Objective: To explore ED nurses' perception of facilitating ACP conversations. Design: We conducted a cross-sectional survey to assess ED nurses' perceptions of facilitating ACP conversations in the ED. Setting: ED nurses at one academic hospital and one community hospital located within the northeastern region of the United States. Results: Seventy-seven (53.1%) out of 145 eligible ED nurses completed the survey. All participants perceived ACP conversations in the ED as at least somewhat important. Forty (51.9%) felt somewhat comfortable in facilitating these conversations. The majority of participants (77.9%) agreed that a specially trained nurse consultation model might be helpful in the ED. We found a correlation between total clinical experience and interest in facilitating ACP conversations in the ED (p = 0.045). Conclusion: ED nurses are well positioned to help patients clarify their goals-of-care and end-of-life care preferences. They perceived ACP conversations to be important and felt comfortable to facilitate them in the ED. Additional studies are needed to empirically test its implementation.
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Affiliation(s)
- Mohammad Adrian Hasdianda
- Department of Emergency Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA.,Department of Emergency Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Tamryn F Gray
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts, USA.,Phyllis F. Cantor Center for Research in Nursing and Patient Care Services, Dana-Farber Cancer Institute, Boston, Massachusetts, USA.,Department of Medicine, Division of Palliative Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA.,Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Josephine Lo Bello
- University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina, USA
| | - Brittany Ballaron
- Department of Emergency Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Natasha A Egorova
- Department of Emergency Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Donna L Berry
- Phyllis F. Cantor Center for Research in Nursing and Patient Care Services, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Kei Ouchi
- Department of Emergency Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA.,Department of Emergency Medicine, Harvard Medical School, Boston, Massachusetts, USA.,Serious Illness Care Program, Ariadne Labs, Boston, Massachusetts, USA
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Zanville N, Cohen B, Gray TF, Phillips J, Linder L, Starkweather A, Yeager KA, Cooley ME. The Oncology Nursing Society Rapid Review and Research Priorities for Cancer Care in the Context of COVID-19. Oncol Nurs Forum 2021; 48:131-145. [PMID: 33600397 DOI: 10.1188/21.onf.131-145] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVES To identify research priorities addressing COVID-19 that build on the 2019-2022 Oncology Nursing Society (ONS) Research Agenda, in alignment with ONS's mission to promote excellence in oncology nursing and quality cancer care. METHODS & VARIABLES Priority areas were identified using a multistep approach combining rapid review of the literature; consultation with experts/stakeholders; and review of priorities from other funding agencies, public health, and cancer-focused organizations. RESULTS The rapid research response team identified five priority areas for research related to COVID-19. IMPLICATIONS FOR NURSING Oncology nurses are well positioned to address the research priorities and cross-cutting themes identified through this review. The use of innovative methodologic approaches and attention to disparities are necessary to advance cancer care related to COVID-19.
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Gray TF, Borstelmann N, Rosenberg S, Gelber S, Meyer ME, Ruddy KJ, Schapira L, Come S, Borges V, Cadet T, Maramaldi P, Partridge AH. Abstract PS9-08: The psychosocial impact of caregiving on partners of young women with breast cancer in treatment. Cancer Res 2021. [DOI: 10.1158/1538-7445.sabcs20-ps9-08] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
BackgroundCancer diagnosis and early treatment may have wide-ranging consequences for a woman’spartner (ie. spouse or significant other). In general, younger caregivers have been found to havegreater unmet needs and higher levels of distress compared to those who are older. To date,there is little known about the unmet needs and experiences of partners who care for youngwomen with breast cancer during active treatment.Trial Design: Cross-sectional survey of partners of young women with breast cancer.Eligibility Criteria: The current analysis focuses on a subset of respondent partners of womenwith breast cancer participating in the Young Womens Breast Cancer Study (NCT01468246)who met the following criteria: diagnosed at age < 40 years; time since diagnosis <12 months;and/or Stage IV disease (at diagnosis or in metastatic setting); and/or local recurrent disease< 12 months.Specific Aims: To explore the experience of partners of women in active treatment or havingvery recently completed treatment for breast cancer.Statistical Methods: We employed descriptive statistics to present sample characteristics,including means or medians for continuous variables and proportions for categorical variables.We assessed partners’ responses re: sociodemographics, perceived social support (MOS-Social Support Survey, Cancer Perceived Agents of Social Support), quality of life (QOL)(Caregiver QOL Index-Cancer), coping (Brief COPE), perceived financial security, perceivedparenting concerns (Parenting Concerns Questionnaire), anxiety and depression symptoms(Hospital Anxiety and Depression Scale), sexual satisfaction (Global Measure of SexualSatisfaction), posttraumatic growth (Posttraumatic Growth Inventory-Short Form), and an open-ended question to explore their experiences and needs.Accrual: 25 participants were included.Results: All partners were male (25/25; 100%), and most were white (n=23/25; 92%), workingfull-time (n=21/25; 91%); and college educated (n=19/25; 86%). Eighteen partners (n=18/25;72%) were parenting children <18 years old and 40% (n=10/25) were partnered with womenwith Stage 4 breast cancer. At the time of the survey, the median age of partners was 44 years(range, 28-69) and of patients was 38 years (range, 25-40). Many partners (57%) reportedsymptoms of anxiety (>8 on the HADS anxiety subscale), fewer (22%) were categorized ashaving symptoms of depression (>8 on the HADS depression subscale). Additionally, 39%reported not being sexually active; 41% reported maladaptive coping; 30% reported financialstrain;30% reported relationship strain. Reported caregiver QOL ranged from 22-116, with amean score of 52.5 (SD, 23.9), similar to population norms, with higher scores indicating lowerquality of life. Parenting concerns scores were generally low indicating less concern, with arange of 12-35, and mean of 20.5 (SD, 7.6). Post-traumatic growth ranged from 4-33, with amean score of 20.7 (SD, 7.4), with higher scores indicating greater personal growthexperienced. 44% (11/25) responded to the open-ended experiences and needs question.Common responses included feeling a lack of support, need for tailored and titrated information,and desire to connect with other men who faced similar experiences. Partners also reportedtheir struggles with uncertainty about the future.
Discussion: A subset of partners of young women in active treatment for breast cancerexpressed concerns related to relationship strain, sexuality, need for support, and finances.Future work designed to meet the needs of partners of breast cancer patients includinginformational and psychosocial supports may benefit them and the patients as they manage theprocess of ongoing treatment and challenges about the future.
Citation Format: Tamryn F Gray, Nancy Borstelmann, Shoshana Rosenberg, Shari Gelber, Meghan E Meyer, Kathryn J. Ruddy, Lidia Schapira, Steven Come, Virginia Borges, Tamara Cadet, Peter Maramaldi, Ann H. Partridge. The psychosocial impact of caregiving on partners of young women with breast cancer in treatment [abstract]. In: Proceedings of the 2020 San Antonio Breast Cancer Virtual Symposium; 2020 Dec 8-11; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2021;81(4 Suppl):Abstract nr PS9-08.
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Affiliation(s)
| | | | | | | | | | | | | | - Steven Come
- 4Beth Israel Deaconess Medical Center, Boston, MA
| | | | - Tamara Cadet
- 6Simmons College School of Social Work, Boston, MA
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Cohen B, Cooley ME, Gray TF, Linder L, Phillips J, Starkweather A, Yeager KA, Zanville N. Nursing's seat at the research roundtable. Lancet 2020; 396:1397-1398. [PMID: 33065036 PMCID: PMC7553737 DOI: 10.1016/s0140-6736(20)32143-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Accepted: 09/30/2020] [Indexed: 11/22/2022]
Affiliation(s)
- Bevin Cohen
- Center for Nursing Research and Innovation, The Mount Sinai Hospital, New York, NY 10029, USA.
| | | | | | - Lauri Linder
- University of Utah College of Nursing, Salt Lake City, UT, USA
| | | | | | - Katherine A Yeager
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA, USA
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Abstract
Background: Little is known about how patients with incurable cancer and caregivers differ in their prognostic awareness, and the relationship between caregiver prognostic awareness and their psychological distress. Objective: To investigate prognostic awareness in caregivers of patients with incurable cancer and prognostic discordance in patient-caregiver dyads and its association with psychological distress. Design: This is a cross-sectional study. Setting/Subjects: In total, subjects were 390 caregivers of adults with incurable lung, gastrointestinal, and brain cancers at a cancer center in the northeastern United States. Measurements: The Prognosis and Treatment Perceptions Questionnaire was used to assess prognostic awareness and Hospital Anxiety and Depression Scale to assess psychological distress. Results: In total, 39.7% (n = 147/370) and 17.3% (n = 64/370) caregivers reported clinically significant anxiety and depression symptoms. And 53.7% of caregivers reported the patients' cancer as "curable" and 44.1% reported the cancer was "not terminal." Caregivers' report of curability was not associated with their anxiety (odds ratio [OR] = 0.99, p = 0.93) or depression (OR = 1.05, p = 0.32) symptoms. Among 42.5% (124/292) and 26.0% (76/292) of dyads (n = 292), both patients and their caregivers agreed in their perception of the cancer as curable and incurable, respectively. In 19.9% of dyads (n = 58), patients reported their cancer as curable, while their caregivers reported it as incurable. In 11.6% of dyads (n = 34), patients reported the cancer as incurable while caregivers reported it as curable. Conclusions: More than half of caregivers have misperceptions about the patients' likelihood of cure, and one-third of patient-caregiver dyads have discordant perceptions. Supportive care interventions may facilitate conversations and enhance prognostic understanding in patients with incurable cancer and their caregivers.
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Affiliation(s)
- Tamryn F Gray
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts, USA.,Division of Palliative Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA
| | - Deborah Forst
- Harvard Medical School, Boston, Massachusetts, USA.,Department of Neurology, Massachusetts General Hospital Cancer Center, Boston, Massachusetts, USA
| | - Ryan D Nipp
- Harvard Medical School, Boston, Massachusetts, USA.,Department of Medicine, Massachusetts General Hospital Cancer Center, Boston, Massachusetts, USA
| | - Joseph A Greer
- Harvard Medical School, Boston, Massachusetts, USA.,Department of Psychiatry, Massachusetts General Hospital Cancer Center, Boston, Massachusetts, USA
| | - Jennifer S Temel
- Harvard Medical School, Boston, Massachusetts, USA.,Department of Medicine, Massachusetts General Hospital Cancer Center, Boston, Massachusetts, USA
| | - Areej El-Jawahri
- Harvard Medical School, Boston, Massachusetts, USA.,Department of Medicine, Massachusetts General Hospital Cancer Center, Boston, Massachusetts, USA
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Sannes TS, Yeh IM, Gray TF. Caring for loved ones with cancer during the COVID-19 pandemic: A double hit risk for social isolation and need for action. Psychooncology 2020; 29:1418-1420. [PMID: 32658360 PMCID: PMC7404735 DOI: 10.1002/pon.5466] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 06/25/2020] [Accepted: 06/30/2020] [Indexed: 11/17/2022]
Affiliation(s)
- Timothy S Sannes
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA
| | - Irene M Yeh
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA.,Division of Palliative Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Tamryn F Gray
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA
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Rosa WE, Gray TF, Chow K, Davidson PM, Dionne-Odom JN, Karanja V, Khanyola J, Kpoeh JDN, Lusaka J, Matula ST, Mazanec P, Moreland PJ, Pandey S, de Campos AP, Meghani SH. Recommendations to Leverage the Palliative Nursing Role During COVID-19 and Future Public Health Crises. J Hosp Palliat Nurs 2020; 22:260-269. [PMID: 32511171 PMCID: PMC8018720 DOI: 10.1097/njh.0000000000000665] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [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] [Indexed: 01/03/2023]
Abstract
With the daily number of confirmed COVID-19 cases and associated deaths rising exponentially, social fabrics on a global scale are being worn by panic, uncertainty, fear, and other consequences of the health care crisis. Comprising more than half of the global health care workforce and the highest proportion of direct patient care time than any other health professional, nurses are at the forefront of this crisis. Throughout the evolving COVID-19 pandemic, palliative nurses will increasingly exercise their expertise in symptom management, ethics, communication, and end-of-life care, among other crucial skills. The literature addressing the palliative care response to COVID-19 has surged, and yet, there is a critical gap regarding the unique contributions of palliative nurses and their essential role in mitigating the sequelae of this crisis. Thus, the primary aim herein is to provide recommendations for palliative nurses and other health care stakeholders to ensure their optimal value is realized and to promote their well-being and resilience during COVID-19 and, by extension, in anticipation of future public health crises.
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Affiliation(s)
- William E Rosa
- William E. Rosa, PhD, MBE, ACHPN, FAANP, FAAN, is Robert Wood Johnson Foundation Future of Nursing Scholar, University of Pennsylvania School of Nursing, Philadelphia. Tamryn F. Gray, PhD, RN, is research fellow, Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts. Kimberly Chow, RN, ANP-BC, ACHPN, is nurse practitioner, Supportive Care Service, Memorial Sloan Kettering Cancer Center, New York. Patricia M. Davidson, PhD, RN, FAAN, is dean and professor, Johns Hopkins University School of Nursing, Baltimore, Maryland. J. Nicholas Dionne-Odom, PhD, MSN, MA, ACHPN, FPCN, is assistant professor, University of Alabama at Birmingham School of Nursing; and codirector, Caregiver and Bereavement Support Services, UAB Center for Palliative and Supportive Care. Viola Karanja, BSN, RN, is deputy executive director, Partners in Health Liberia, Harper. Judy Khanyola, MSc, RCHN, is Chair, Nursing and Midwifery, University of Global Health Equity, Butaro, Rwanda. Julius D. N. Kpoeh, ASN, RN, is senior clinical mentor, Partners in Health Liberia, Harper. Joseph Lusaka, BSc HM, DCM, PA, is clinical manager, Pleebo Health Centre, Liberia. Samuel T. Matula, PhD, RN, PCNS-BC, is lecturer, University of Botswana, Gaborone. Polly Mazanec, PhD, AOCN, ACHPN, FPCN, FAAN, is research associate professor, Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, Ohio. Patricia J. Moreland, PhD, CPNP, FAAN, is assistant clinical professor, Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia. Shila Pandey, MSN, AGPCNP-BC, ACHPN, is nurse practitioner, Supportive Care Service, Memorial Sloan Kettering Cancer Center, New York. Amisha Parekh de Campos, PhD, MPH, CHPN, Robert Wood Johnson Foundation Future of Nursing Scholar, University of Connecticut, Storrs; quality and education coordinator, Hospice Program, Middlesex Health, Connecticut. Salimah H. Meghani, PhD, MBE, RN, FAAN, is professor and term chair of Palliative Care, University of Pennsylvania School of Nursing, Philadelphia
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Gray TF, Temel JS, El-Jawahri A. Illness and prognostic understanding in patients with hematologic malignancies. Blood Rev 2020; 45:100692. [PMID: 32284227 DOI: 10.1016/j.blre.2020.100692] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [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] [Received: 11/24/2019] [Revised: 03/04/2020] [Accepted: 04/02/2020] [Indexed: 12/25/2022]
Abstract
It is critical for patients with hematologic malignancies to have an accurate understanding of their illness and prognosis to make informed treatment decisions. Illness and prognostic understanding have primarily been studied in patients with solid tumors, however, data in patients with hematologic malignancies are rapidly growing. Patients with hematologic malignancies often face a unique and unpredictable illness trajectory with the possibility of cure persisting even in relapsed and refractory settings. These patients often require intensive therapies such as high-dose chemotherapy, hematopoietic stem cell transplantation (HCT), or CAR T-cell therapy, which carry with them significant risk of morbidity, mortality, and prognostic uncertainty. In this review article, we first described the current literature on illness and prognostic understanding in patients with hematologic malignancies including 1) patients' varying desire for prognostic information; (2) patients' prognostic misperceptions, (3) the association between patients' prognostic understanding and their psychological outcomes; and (4) barriers to prognostic understanding. Next, we examined insights gained from the literature about illness and prognostic understanding in patients with solid tumors to guide our understanding of the research gaps in hematologic malignancies. Future studies are needed to better delineate the longitudinal relationship between prognostic understanding, psychological distress, and coping in patients with hematologic malignancies. Strategies such as communicating effectively about prognosis, cultivating adaptive coping in the face of a terminal prognosis, and integrating specialty palliative care for patients with hematologic malignancies have the potential to improve patients' prognostic understanding and their quality of life and care.
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Affiliation(s)
- Tamryn F Gray
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| | - Jennifer S Temel
- Massachusetts General Hospital Cancer Center, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| | - Areej El-Jawahri
- Massachusetts General Hospital Cancer Center, Boston, MA, USA; Harvard Medical School, Boston, MA, USA.
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El-Jawahri A, Nelson AM, Gray TF, Lee SJ, LeBlanc TW. Palliative and End-of-Life Care for Patients With Hematologic Malignancies. J Clin Oncol 2020; 38:944-953. [PMID: 32023164 PMCID: PMC8462532 DOI: 10.1200/jco.18.02386] [Citation(s) in RCA: 89] [Impact Index Per Article: 22.3] [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] [Accepted: 03/06/2019] [Indexed: 12/18/2022] Open
Abstract
Hematologic malignancies are a heterogeneous group of diseases with unique illness trajectories, treatment paradigms, and potential for curability, which affect patients' palliative and end-of-life care needs. Patients with hematologic malignancies endure immense physical and psychological symptoms because of both their illness and often intensive treatments that result in significant toxicities and adverse effects. Compared with patients with solid tumors, those with hematologic malignancies also experience high rates of hospitalizations, intensive care unit admissions, and in-hospital deaths and low rates of referral to hospice as well as shorter hospice length of stay. In addition, patients with hematologic malignancies harbor substantial misperceptions about treatment risks and benefits and frequently overestimate their prognosis. Even survivors of hematologic malignancies struggle with late effects, post-treatment complications, and post-traumatic stress symptoms that can significantly diminish their quality of life. Despite these substantial unmet needs, specialty palliative care services are infrequently consulted for the care of patients with hematologic malignancies. Several illness-specific, cultural, and system-based barriers to palliative care integration and optimal end-of-life care exist in this population. However, recent evidence has demonstrated the feasibility, acceptability, and efficacy of integrating palliative care to improve the quality of life and care of patients with hematologic malignancies and their caregivers. More research is needed to develop and test population-specific palliative and supportive care interventions to ensure generalizability and to define a sustainable clinical delivery model. Future work also should focus on identifying moderators and mediators of the effect of integrated palliative care models on patient-reported outcomes and on developing less resource-intensive integrated care models to address the diverse needs of this population.
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Affiliation(s)
- Areej El-Jawahri
- Massachusetts General Hospital, Boston, MA
- Harvard Medical School, Boston, MA
| | - Ashley M. Nelson
- Massachusetts General Hospital, Boston, MA
- Harvard Medical School, Boston, MA
| | - Tamryn F. Gray
- Harvard Medical School, Boston, MA
- Dana-Farber Cancer Institute, Boston, MA
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Gray TF. Burdened by a Secret: Caring for Older Adults With HIV in Critical Care. AACN Adv Crit Care 2019; 30:79-84. [PMID: 30842079 DOI: 10.4037/aacnacc2019552] [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: 11/01/2022]
Affiliation(s)
- Tamryn F Gray
- Tamryn F. Gray is a Postdoctoral Research Fellow, Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute and Harvard Medical School, 375 Longwood Avenue, Boston, MA 02215
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Leak Bryant A, Coffman EM, Phillips B, Gray TF, Knafl GJ, Klepin HD, Wood WA, Muss H, Reeve BB. Symptoms, Mobility and Function, and Quality of Life in Adults With Acute Leukemia During Initial Hospitalization. Oncol Nurs Forum 2019; 45:653-664. [PMID: 30118443 DOI: 10.1188/18.onf.653-664] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [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]
Abstract
OBJECTIVES To examine longitudinal symptoms, mobility and function, and quality of life (QOL) in adults newly diagnosed with acute leukemia. SAMPLE & SETTING 55 adults undergoing induction chemotherapy at the University of North Carolina Lineberger Comprehensive Cancer Center and the Duke Cancer Institute. METHODS & VARIABLES A prospective, longitudinal study with measures of mobility and function, global physical and mental health, cancer-related fatigue, anxiety, depression, sleep disturbance, pain intensity, and leukemia-specific QOL was conducted. Data were analyzed using descriptive statistics, linear mixed modeling, and one-way analysis of variance. RESULTS 49 adults with acute leukemia completed assessments during hospitalizations. Global mental health and pain intensity did not change significantly. Global physical health significantly improved. Fatigue, anxiety, depression, and sleep disturbance decreased significantly. QOL increased significantly. IMPLICATIONS FOR NURSING The significant decrease in anxiety and fatigue during hospitalization may be attributable to understanding of the disease process, familiarity with the staff, and ability to communicate concerns.
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Affiliation(s)
| | | | | | | | | | | | | | - Hyman Muss
- UNC Lineberger Comprehensive Cancer Center
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Solle JC, Steinberg A, Marathe P, Gray TF, Emmert A, Abel GA. Patients as experts: characterizing the most relevant patient-reported outcomes after hematopoietic cell transplantation. Bone Marrow Transplant 2019; 55:242-244. [DOI: 10.1038/s41409-019-0518-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Accepted: 03/17/2019] [Indexed: 11/09/2022]
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Gray TF, Nolan MT, Clayman ML, Wenzel JA. The decision partner in healthcare decision-making: A concept analysis. Int J Nurs Stud 2019; 92:79-89. [PMID: 30743199 DOI: 10.1016/j.ijnurstu.2019.01.006] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [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: 09/26/2018] [Revised: 01/08/2019] [Accepted: 01/14/2019] [Indexed: 12/24/2022]
Abstract
BACKGROUND The decision partner concept emerged to describe someone who contributes to healthcare decision-making with a patient. There is a need for greater precision and consensus surrounding its conceptual definition and use in broader populations. OBJECTIVE To define and describe the decision partner concept within the context of healthcare decision-making. DESIGN A concept analysis. DATA SOURCES We searched the following databases for articles published between 1990-2017: PsychINFO, PubMed, Embase, and CINAHL. We included qualitative, quantitative, or mixed methods studies that used the term decision partner in the context of healthcare decision-making. METHODS We applied the Walker and Avant method to identify the antecedents, attributes, related concepts, consequences, and empirical referents of the concept, with major themes identified. RESULTS From the 112 articles included in this concept analysis, 6 defining attributes of decision partner were identified: (1) has a relationship with the patient, (2) demonstrates a willingness to participate in decision-making, (3) articulates a clear understanding of both the patient's health condition and the decisions that must be made, (4) demonstrates decision-making self-efficacy; (5) exemplifies an emotional capacity to participate in decision-making, and (6) willing to fulfill several supportive roles including patient advocate and the "hub of information". CONCLUSIONS A unifying definition and discussion of the decision partner concept has been developed. Our findings: (1) offer insights into refining the concept across various diseases and healthcare encounters, (2) contribute to developing theoretical models and empirical research to refine antecedents, attributes, consequences, (3) serve as a foundation to develop instruments to measure the concept and (4) highlight the need to design interventions that include and support decision partners in healthcare decision-making.
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Affiliation(s)
- Tamryn F Gray
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, United States.
| | - Marie T Nolan
- School of Nursing, Johns Hopkins University, Baltimore, MD, United States; Berman Institute of Bioethics, Johns Hopkins University, Baltimore, MD, United States
| | - Marla L Clayman
- American Institutes for Research, Chicago, IL, United States
| | - Jennifer A Wenzel
- School of Nursing, Johns Hopkins University, Baltimore, MD, United States; Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, MD, United States
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Sloan D, Gray TF, Bowie JV. ADVANCE CARE PLANNING ATTITUDES, BELIEFS, AND BARRIERS: PERSPECTIVES OF CAREGIVERS AND DECISION-MAKERS IN THE CHURCH. Innov Aging 2018. [DOI: 10.1093/geroni/igy023.1594] [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: 11/14/2022] Open
Affiliation(s)
- D Sloan
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland,United States
| | - T F Gray
- The University of North Carolina at Chapel Hill School of Nursing, Chapel Hill, NC, USA
| | - J V Bowie
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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Abstract
"What would you do?" I have heard this question numerous times throughout my nursing career by patients and families affected by cancer. As a pediatric blood and marrow transplantation nurse, I have often seen patients and their families wrestle with difficult treatment decisions. I have witnessed parents struggle between beginning end-of-life care for their child, or pursuing a risky but potentially life-saving clinical trial. With science driving advances in cancer treatments and patients playing more active roles in their care, uncertainty around cancer treatment decisions will only become more complicated. For me, being a good nurse meant helping these patients navigate this uncertainty. I was compelled to pursue research to understand the process patients experience as they make treatment decisions, who they choose to involve in decision making, and what role the unique nurse-
patient relationship could play in facilitating patient-centered decisions.
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Gray TF, Cudjoe J, Han HR, Wenzel J, Thorpe R, Murphy J. Abstract 5293: Have you checked? Disparities in cancer screening practices among minority populations. Cancer Res 2017. [DOI: 10.1158/1538-7445.am2017-5293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Objective: There is a disproportionately higher burden of cancer among racial and ethnic minorities, with the incidence only expected to increase significantly by 2050. These racial differences may be due to the quality of early detection screening among this population. The purpose of this research is to provide case study reports about cancer screening practices among at-risk populations as well as those from underrepresented racial and ethnic minority backgrounds as well as sexual and gender minorities in order to describe disparities in cancer screening practices. These five case studies reveal how racial disparities vary by cancer site. These case studies will share information about current cancer prevalence, current recommendations for cancer prevention, national guidelines about early detection for lung, colorectal, prostate, cervical and breast cancers, as well as discuss ways to reduce cancer health disparities and improve screening practices.
Methods: Data sources for these case studies include research reports, literature review, clinically-based articles, research articles, websites, as well as clinical practice observations and experiences.
Research Summary: These case studies contribute to the growing body of knowledge related to cancer health disparities, with a special emphasis on cancer screening behaviors among underrepresented, at-risk, and racial and ethnic minority backgrounds. Since cancer care is multidisciplinary, these case reports also highlight the role of oncology nurses in helping to lead in educating, promoting, and bringing awareness to cancer screening recommendations and current cancer prevention guidelines for individuals and their families. Nurses recognize that one of the biggest barriers to screening is when individual have unrelated health care priorities that overshadow priorities related to screening, such as food, shelter, and safety. Nurses are also positioned to provide cancer-specific screening guidelines and resources to help individuals implement these recommendations into their daily lives. Improving screening rates among minority populations requires collaborations with the health care systems and the community.
Conclusion: Evidence indicates that there are significant disparities that exist in cancer screening practices among minority populations as well as disproportionately higher cancer mortality rates in these populations. Barriers to screening include lack of access to high-quality health care, lack of health insurance, transportation issues, fear and lack of trust in the health care team, embarrassment, stigma related to sexual orientation or gender identity, discrimination in quality care and treatment, as well as lack of awareness about screening recommendations. Recognition of barriers to screening among minority populations is critical to developing targeted interventions that promote adherence and decrease risks of cancer-related mortality.
Citation Format: Tamryn F. Gray, Joycelyn Cudjoe, Hae Ra Han, Jennifer Wenzel, Roland Thorpe, Jeanne Murphy. Have you checked? Disparities in cancer screening practices among minority populations [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2017; 2017 Apr 1-5; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2017;77(13 Suppl):Abstract nr 5293. doi:10.1158/1538-7445.AM2017-5293
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Affiliation(s)
| | | | - Hae Ra Han
- 1Johns Hopkins University, Baltimore, MD
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Gray TF, Shea TC. Current status of peripheral blood progenitor cell transplantation. Semin Oncol 1994; 21:93-101. [PMID: 7992073] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Peripheral blood hematopoietic progenitor cells are primitive cells capable of both self-renewal and terminal differentiation. Cells can be collected in large numbers from the peripheral blood following their stimulation by cytokine administration or during the hematologic recovery phase following chemotherapy administration. Following their collection from the peripheral blood, these cells have been used both as a supplement and an alternative to bone marrow in providing hematologic reconstitution following high-dose chemotherapy and/or radiation. This article describes the biology of these cells, reviews current methods for their acquisition, and discusses the clinical applications in which they have been found useful.
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Affiliation(s)
- T F Gray
- Division of Medical Oncology, University of North Carolina at Chapel Hill 27599-7305
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Abstract
To test the hypothesis that hypertension diminishes pain perception, a study was made that evaluated the relation between arterial blood pressure and thermal pain perception in human subjects. The average mean arterial pressure in all 20 men studied (10 hypertensive, 10 normotensive) proved to be significantly related to both thermal pain threshold (p = 0.05) and tolerance (p = 0.003). The difference between normotensive and hypertensive groups in baseline and posttest plasma levels of beta endorphin was also significant (p = 0.02) and indicated an interaction between endogenous opioids and blood pressure. Other recent studies of hypertension in relation to hypalgesia were also reviewed. An increased pain threshold was found in hypertensive versus normotensive rats. In cats, electrical stimulation of vagal afferent nerves (cardiopulmonary baroreceptors) suppresses nociceptive responses, and both pharmacologic elevation of blood pressure and vascular volume expansion produce antinociception. Together with preliminary findings in human studies, these results indicate an interaction between pain-controlling and cardiovascular regulatory functions that is probably mediated by the baroreceptor system.
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Affiliation(s)
- D S Sheps
- University of North Carolina School of Medicine, Chapel Hill 27599-7075
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Affiliation(s)
- M K Roush
- University of North Carolina Hospitals, Chapel Hill
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Gray TF, Speaks CE. Ability of hearing-impaired listeners to understand connected discourse. J Am Audiol Soc 1977; 3:159-66. [PMID: 614327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Thirty-three hearing-impaired listeners estimated the intelligibility of connected discourse presented in quiet and in the presence of noise. Speech-understanding scores were compared to routine audiometric measures and the effects of both signal-to-noise ratio and level of amplification upon speech understanding were investigated. The listeners were able to estimate the intelligibility of connected discourse reliably. Measures of auditory sensitivity were correlated highly with percentage of understanding only when connected discourse was presented at a low level and a favorable signal-to-noise ratio. The relationship of routine measures and speech understanding was low. A method for obtaining estimates of the intelligibility of running speech is presented along with the results for a typical audiology clinic population.
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