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King Z, Fraint E. Chimeric Antigen Receptor T-Cell Treatment in Children. Pediatr Rev 2024; 45:301-302. [PMID: 38689105 DOI: 10.1542/pir.2023-006126] [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] [Indexed: 05/02/2024]
Affiliation(s)
- Zoe King
- Division of Pediatric Hematology/Oncology and Cellular Therapy, Children's Hospital at Montefiore, Bronx, NY
| | - Ellen Fraint
- Division of Pediatric Hematology, Oncology, and Cellular Therapy, Nemours Children's Hospital, Wilmington, DE
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Demirhan S, King Z, Sohail SS, Merzel D, Lamson DM, Palezac L, Tanner TI, Loeb DM, Foca M. Human Adenovirus B3 Associated Colitis and Hemophagocytic Lymphohistiocytosis in 9-year-old Previously Healthy Girl. Pediatr Infect Dis J 2024:00006454-990000000-00796. [PMID: 38502897 DOI: 10.1097/inf.0000000000004328] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/21/2024]
Affiliation(s)
| | - Zoe King
- Division of Hematology and Oncology
| | | | - Deena Merzel
- Division of Gastroenterology Department of Pediatrics Children's Hospital at Montefiore and Albert Einstein College of Medicine Bronx, New York
| | - Daryl M Lamson
- Wadsworth Center, New York State Department of Health David Axelrod Institute Albany, New York
| | | | | | | | - Marc Foca
- Division of Infectious Diseases Department of Pediatrics Children's Hospital at Montefiore and Albert Einstein College of Medicine Bronx, New York
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Garcia RS, Hollis T, Baratta J, King Z, Faulks M, Ricketts M, Brown-Johnson C, Shankar M, Guerin A, Wong HN, Zulman DM, Floyd BD. Building Trust and Partnership with Black Pediatric Patients and their Caregivers. Acad Pediatr 2024; 24:216-227. [PMID: 37659602 DOI: 10.1016/j.acap.2023.08.016] [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: 04/05/2023] [Revised: 08/17/2023] [Accepted: 08/24/2023] [Indexed: 09/04/2023]
Abstract
Systemic racism embedded within the US health care system results in disproportionately worse health outcomes for Black pediatric patients and their caregivers. One meaningful mechanism through which these health disparities persist is through discriminatory treatment and anti-Black bias from clinicians. Strengthening care provided to Black pediatric patients and their caregivers requires that clinicians adopt culturally tailored communication strategies that promote health equity and counter racism. We conducted a scoping review of evidence-based communication practices in the medical literature that improve care for Black pediatric patients. We mapped the specific practices to the Presence 5 for Racial Justice framework and identified cross-cutting themes to describe practices across the five domains. There are three cross-cutting themes that underlie the recommended practices: 1) promote unbiased implementation of clinician communication strategies (eg, providing equitable recommendations for preventive care), 2) tailor care to Black pediatric patients (eg, explore the importance of the family unit), and 3) address racism experienced by Black pediatric patients and their caregivers (eg, acknowledge any previous negative experiences with the health care system). This review highlights communication practices that clinicians can adopt to build trusting relationships, empower Black families, and promote racial justice in clinical care. Future opportunities include expanding to system level change and validating these practices with patients and clinicians.
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Affiliation(s)
- Raquel S Garcia
- Division of Primary Care and Population Health (RS Garcia, T Hollis, J Baratta, Z King, M Faulks, C Brown-Johnson, and DM Zulman), Department of Medicine, Stanford University School of Medicine, Palo Alto, Calif; Department of Medicine (RS Garcia), Duke University School of Medicine, Durham, NC
| | - Taylor Hollis
- Division of Primary Care and Population Health (RS Garcia, T Hollis, J Baratta, Z King, M Faulks, C Brown-Johnson, and DM Zulman), Department of Medicine, Stanford University School of Medicine, Palo Alto, Calif; University of Alabama at Birmingham Heersink School of Medicine (T Hollis)
| | - Juliana Baratta
- Division of Primary Care and Population Health (RS Garcia, T Hollis, J Baratta, Z King, M Faulks, C Brown-Johnson, and DM Zulman), Department of Medicine, Stanford University School of Medicine, Palo Alto, Calif; Massachusetts Institute of Technology Sloan School of Management (J Baratta), Cambridge, Mass
| | - Zoe King
- Division of Primary Care and Population Health (RS Garcia, T Hollis, J Baratta, Z King, M Faulks, C Brown-Johnson, and DM Zulman), Department of Medicine, Stanford University School of Medicine, Palo Alto, Calif; Stanford Prevention Research Center (Z King), Stanford University School of Medicine, Palo Alto, Calif
| | - Melvin Faulks
- Division of Primary Care and Population Health (RS Garcia, T Hollis, J Baratta, Z King, M Faulks, C Brown-Johnson, and DM Zulman), Department of Medicine, Stanford University School of Medicine, Palo Alto, Calif
| | - Maya Ricketts
- Meharry Medical College School of Medicine (M Ricketts), Nashville, Tenn
| | - Cati Brown-Johnson
- Division of Primary Care and Population Health (RS Garcia, T Hollis, J Baratta, Z King, M Faulks, C Brown-Johnson, and DM Zulman), Department of Medicine, Stanford University School of Medicine, Palo Alto, Calif
| | - Megha Shankar
- Division of General Internal Medicine (M Shankar), Department of Medicine, University of California San Diego, La Jolla, Calif; Presence Center (M Shankar), Stanford University School of Medicine, Stanford, Calif
| | - Allison Guerin
- Department of Pediatrics (A Guerin), Office of Pediatric Education and Office of Diversity, Equity, Inclusion, and Justice in Pediatrics, Stanford University School of Medicine, Palo Alto, Calif
| | - Hong-Nei Wong
- Lane Medical Library (HN Wong), Stanford University School of Medicine, Stanford, Calif
| | - Donna M Zulman
- Division of Primary Care and Population Health (RS Garcia, T Hollis, J Baratta, Z King, M Faulks, C Brown-Johnson, and DM Zulman), Department of Medicine, Stanford University School of Medicine, Palo Alto, Calif
| | - Baraka D Floyd
- Department of Pediatrics (BD Floyd), Division of General Pediatrics and Office of Diversity Equity, Inclusion, and Justice in Pediatrics, Stanford University School of Medicine, Palo Alto, Calif.
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King Z, Zhang Q, Liang JW, Levy MS, Plowden TC, Jeelani R, Marshall AL, Barnett R, Caban-Martinez AJ, Brown A, Mueller CM, Brown-Johnson C, Salles A. Barriers to Family Building Among Physicians and Medical Students. JAMA Netw Open 2023; 6:e2349937. [PMID: 38153730 PMCID: PMC10755597 DOI: 10.1001/jamanetworkopen.2023.49937] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Accepted: 11/14/2023] [Indexed: 12/29/2023] Open
Abstract
Importance Physicians and medical students who desire to build families face significant barriers due to the structure and culture of medicine. Objective To understand the barriers and facilitators to family building for all people in medicine-not only individuals who can become pregnant-through an open-ended, qualitative analysis of survey responses. Design, Setting, and Participants This qualitative study used a survey conducted in April and May 2021 with a broad sample of physicians and medical students. Participants were recruited through social media, targeting physician and medical student communities. Physicians (residents, fellows, and physicians in independent practice) and medical students of all gender identities and sexual orientations were included. Informed by a postpositivist approach, coding reliability thematic analysis was performed on 3 open-ended survey questions on family-building experiences (what they would do differently, what advice they have for others, and anything else they wished to share). Main Outcomes and Measures Identified themes were mapped to the social-ecological model, a model used in public health to examine how a spectrum of factors is associated with health outcomes. Results A total of 2025 people (1860 [92%] women; 299 [15%] Asian, 151 [8%] Black, and 1303 [64%] White; 1730 [85%] heterosexual; and 1200 [59%] physicians who had completed training) responded to at least 1 of 3 open-ended questions. Themes mapped to social-ecological model levels included: (1) cultural, eg, medical training being at odds with family building; (2) organizational, eg, lack of institutional support for the range of family-building routes; (3) interpersonal, eg, impact of social support on family building; and (4) individual, eg, socioeconomic status and other individual factors that facilitate or inhibit family building. Recommendations to improve family-building experiences include implementing family-building curricula at medical schools, providing adequate parental leave for all physicians and medical students who become parents, and providing insurance coverage for all family-building routes. Conclusions and Relevance In this qualitative study of physicians and medical students, self-reported barriers to family building were identified at each level of the social-ecological model. Addressing these barriers is critical to creating a more equitable family-building environment for physicians and medical students.
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Affiliation(s)
- Zoe King
- Division of Primary Care and Population Health, Department of Medicine, Stanford University School of Medicine, Palo Alto, California
- Stanford Prevention Research Center, Stanford University School of Medicine, Palo Alto, California
| | - Qiang Zhang
- University of California, Los Angeles David Geffen School of Medicine, Los Angeles
| | - Jane W. Liang
- Quantitative Sciences Unit, Department of Medicine, Stanford University School of Medicine, Palo Alto, California
| | - Morgan S. Levy
- University of Miami Miller School of Medicine, Miami, Florida
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, Florida
| | - Torie C. Plowden
- Department of Gynecologic Surgery and Obstetrics, Walter Reed National Military Medical Center, Bethesda, Maryland
| | - Roohi Jeelani
- Department of OB/GYN, Division of Reproductive Endocrinology and Infertility Wayne State University School of Medicine, Detroit, Michigan
- Kindbody Fertility Clinic, Chicago, Illinois
| | - Ariela L. Marshall
- Department of Medicine, Division of Hematology, Oncology, and Transplantation, University of Minnesota, Minneapolis
| | - Rebecca Barnett
- University of Miami Miller School of Medicine, Miami, Florida
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, Florida
| | - Alberto J. Caban-Martinez
- University of Miami Miller School of Medicine, Miami, Florida
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, Florida
| | - Alyssa Brown
- Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Claudia M. Mueller
- Department of Surgery, Stanford University School of Medicine, Palo Alto, California
| | - Cati Brown-Johnson
- Division of Primary Care and Population Health, Department of Medicine, Stanford University School of Medicine, Palo Alto, California
| | - Arghavan Salles
- Department of Medicine, Stanford University School of Medicine, Palo Alto, California
- Clayman Institute for Gender Research, Stanford University School of Medicine, Palo Alto, California
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Cains MG, Flora L, Taber D, King Z, Henshel DS. Defining Cyber Security and Cyber Security Risk within a Multidisciplinary Context using Expert Elicitation. Risk Anal 2022; 42:1643-1669. [PMID: 33586204 PMCID: PMC9543401 DOI: 10.1111/risa.13687] [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] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Revised: 11/18/2020] [Accepted: 01/06/2021] [Indexed: 05/20/2023]
Abstract
It is important to have and use standardized terminology and develop a comprehensive common understanding of what is meant by cyber security and cyber security risk given the multidisciplinary nature of cyber security and the pervasiveness of cyber security concerns throughout society. Using expert elicitation methods, collaborating cyber researchers from multiple disciplines and two sectors (academia, government-military) were individually interviewed and asked to define cyber security and cyber security risk. Data-driven thematic analysis was used to identify the most salient themes within each definition, sector, and cyber expert group as a whole with results compared to current standards definitions. Network analysis was employed to visualize the interconnection of salient themes within and across sectors and disciplines. When examined as a whole group, "context-driven," "resilient system functionality," and "maintenance of CIA (confidentiality, integrity, availability)" were the most salient themes and influential network nodes for the definition of cyber security, while "impacts of CIA vulnerabilities," "probabilities of outcomes," and "context-driven" were the most salient themes for cyber security risk. We used this expert elicitation process to develop comprehensive definitions of cyber security (cybersecurity) and cyber security risk that encompass the contextual frameworks of all the disciplines represented in the collaboration and explicitly incorporates human factors as significant cyber security risk factors.
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Affiliation(s)
- Mariana G. Cains
- O'Neill School of Public and Environmental AffairsIndiana UniversityBloomingtonINUSA
| | - Liberty Flora
- O'Neill School of Public and Environmental AffairsIndiana UniversityBloomingtonINUSA
| | - Danica Taber
- O'Neill School of Public and Environmental AffairsIndiana UniversityBloomingtonINUSA
| | - Zoe King
- O'Neill School of Public and Environmental AffairsIndiana UniversityBloomingtonINUSA
| | - Diane S. Henshel
- O'Neill School of Public and Environmental AffairsIndiana UniversityBloomingtonINUSA
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King Z, Lyerly AD, Knittel AK. Safekeeping of Pregnant People Experiencing Incarceration. Women Crim Justice 2022; 33:363-377. [PMID: 37789904 PMCID: PMC10545335 DOI: 10.1080/08974454.2022.2104986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/05/2023]
Abstract
Safekeeping involves transferring individuals from jails to prisons without the presence of a conviction. In North Carolina, safekeeping is used for pregnant people with the aim of providing better prenatal care. We interviewed 14 stakeholders in the safekeeping process including sheriffs, clinicians, advocates, and lawyers. Three key themes emerged: jails' inability to provide care for pregnant individuals; safekeeping as an additional punishment to incarceration; and differing attitudes on the necessity of safekeeping. Participants perceived that while there may be some benefits of safekeeping such as enhanced prenatal care, safekeeping can also lead to worsened conditions for pregnant people experiencing incarceration.
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Affiliation(s)
- Zoe King
- Duke University, Trinity College of Arts & Sciences; 117 Physics Building; 120 Science Dr.; Durham, NC 27708; United States
| | - Anne D. Lyerly
- University of North Carolina at Chapel Hill School of Medicine, Department of Social Medicine, 333 South Columbia St, 333 MacNider Hall, CB# 7240, Chapel Hill, NC 27599; United States
| | - Andrea K. Knittel
- University of North Carolina at Chapel Hill Department of Obstetrics and Gynecology; 3027 Old Clinic Building, CB#7570, Chapel Hill, NC 27599
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Huffstetler HE, Bandara S, Bharali I, Kennedy McDade K, Mao W, Guo F, Zhang J, Riviere J, Becker L, Mohamadi M, Rice RL, King Z, Farooqi ZW, Zhang X, Yamey G, Ogbuoji O. The Impacts of Donor Transitions on Health Systems in Middle-Income Countries: A Scoping Review. Health Policy Plan 2022; 37:1188-1202. [PMID: 35904274 PMCID: PMC9558870 DOI: 10.1093/heapol/czac063] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Revised: 05/21/2022] [Accepted: 07/29/2022] [Indexed: 11/30/2022] Open
Abstract
As countries graduate from low-income to middle-income status, many face losses in development assistance for health and must ‘transition’ to greater domestic funding of their health response. If improperly managed, donor transitions in middle-income countries (MICs) could present significant challenges to global health progress. No prior knowledge synthesis has comprehensively surveyed how donor transitions can affect health systems in MICs. We conducted a scoping review using a structured search strategy across five academic databases and 37 global health donor and think tank websites for literature published between January 1990 and October 2018. We used the World Health Organization health system ‘building blocks’ framework to thematically synthesize and structure the analysis. Following independent screening, 89 publications out of 11 236 were included for data extraction and synthesis. Most of this evidence examines transitions related to human immunodeficiency virus/Acquired Immune Deficiency Syndrome (AIDS; n = 45, 50%) and immunization programmes (n = 14, 16%), with a focus on donors such as the Global Fund to Fight AIDS, Tuberculosis and Malaria (n = 26, 29%) and Gavi, the Vaccine Alliance (n = 15, 17%). Donor transitions are influenced by the actions of both donors and country governments, with impacts on every component of the health system. Successful transition experiences show that leadership, planning, and pre-transition investments in a country’s financial, technical, and logistical capacity are vital to ensuring smooth transition. In the absence of such measures, shortages in financial resources, medical product and supply stock-outs, service disruptions, and shortages in human resources were common, with resulting implications not only for programme continuation, but also for population health. Donor transitions can affect different components of the health system in varying and interconnected ways. More rigorous evaluation of how donor transitions can affect health systems in MICs will create an improved understanding of the risks and opportunities posed by donor exits.
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Affiliation(s)
- Hanna E Huffstetler
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill.,Center for Policy Impact in Global Health, Duke Global Health Institute, Duke University
| | - Shashika Bandara
- Center for Policy Impact in Global Health, Duke Global Health Institute, Duke University.,Faculty of Medicine and Health Sciences, McGill University
| | - Ipchita Bharali
- Center for Policy Impact in Global Health, Duke Global Health Institute, Duke University
| | - Kaci Kennedy McDade
- Center for Policy Impact in Global Health, Duke Global Health Institute, Duke University
| | - Wenhui Mao
- Center for Policy Impact in Global Health, Duke Global Health Institute, Duke University
| | - Felicia Guo
- Center for Policy Impact in Global Health, Duke Global Health Institute, Duke University
| | - Jiaqi Zhang
- Center for Policy Impact in Global Health, Duke Global Health Institute, Duke University
| | - Judy Riviere
- Center for Policy Impact in Global Health, Duke Global Health Institute, Duke University
| | - Liza Becker
- Center for Policy Impact in Global Health, Duke Global Health Institute, Duke University
| | - Mina Mohamadi
- Department of Industrial and Systems Engineering, North Carolina State University
| | - Rebecca L Rice
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill
| | - Zoe King
- Center for Policy Impact in Global Health, Duke Global Health Institute, Duke University
| | - Zoha Waqar Farooqi
- Center for Policy Impact in Global Health, Duke Global Health Institute, Duke University
| | - Xinqi Zhang
- Center for Policy Impact in Global Health, Duke Global Health Institute, Duke University
| | - Gavin Yamey
- Center for Policy Impact in Global Health, Duke Global Health Institute, Duke University
| | - Osondu Ogbuoji
- Center for Policy Impact in Global Health, Duke Global Health Institute, Duke University
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King Z, Kramer C, Latkin C, Sufrin C. Access to treatment for pregnant incarcerated people with opioid use disorder: Perspectives from community opioid treatment providers. J Subst Abuse Treat 2021; 126:108338. [PMID: 34116823 DOI: 10.1016/j.jsat.2021.108338] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Revised: 12/04/2020] [Accepted: 02/18/2021] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND AIMS Many jail facilities provide limited access to medications for opioid use disorder (MOUD) for pregnant people with opioid use disorder (OUD), despite it being the standard of care. We aim to explore the perspectives of opioid treatment providers (OTPs) on access to MOUD for pregnant people while incarcerated and postincarceration. METHODS We conducted 16 semistructured phone interviews with providers and administrators representing 16 unique OTPs in various U.S. states with high maternal opioid use rates. We developed the interview guide using the Consolidated Framework for Implementation Research, and we analyzed interview transcripts using a direct content analysis. RESULTS Nine participants reported having an arrangement with a carceral facility to provide care for pregnant people with OUD; however, others described how their local jail offered no OUD treatment for incarcerated pregnant people. Even if participants' clinics had arrangements to provide MOUD in a jail, most participants described significant barriers to continuity of care between jails and community providers as patients transition between jails and community settings. OTPs described their belief of how postincarceration, pregnant people experience barriers to OUD care such as lack of access to childcare, preparing for the baby, feeling unwell, in addition to the barriers that nonpregnant patients experience, such as transportation, housing, and financing. CONCLUSIONS OTPs perceive that pregnant people with OUD experience significant barriers to accessing treatment while incarcerated and in community settings due to discrimination, difficulties in continuity of care, and lack of treatment access while incarcerated. The implementation of evidence-based MOUD treatment for pregnant people in jail and continuation of treatment upon release is crucial to reduce health disparities.
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Affiliation(s)
- Zoe King
- Duke University, Trinity College of Arts & Sciences, 117 Physics Building, 120 Science Dr., Durham, NC 27708, United States.
| | - Camille Kramer
- Johns Hopkins University School of Medicine, Department of Gynecology and Obstetrics, Johns Hopkins Bayview Hospital, 4940 Eastern Ave, A121, Baltimore, MD 21224, United States.
| | - Carl Latkin
- Johns Hopkins University Bloomberg School of Public Health, Department of Health, Behavior and Society, 642 N Broadway, Baltimore, MD 21205, United States.
| | - Carolyn Sufrin
- Johns Hopkins University School of Medicine, Department of Gynecology and Obstetrics, Johns Hopkins Bayview Hospital, 4940 Eastern Ave, A121, Baltimore, MD 21224, United States; Johns Hopkins Bloomberg School of Public Health, Department of Health, Behavior and Society, 24 N. Broadway, Hampton House 737, Baltimore, MD 21205, United States.
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Sandhu S, King Z, Wong M, Bissell S, Sperling J, Gray M, Ratliff W, Herring K, LeBlanc TW. Implementation of Electronic Patient-Reported Outcomes in Routine Cancer Care at an Academic Center: Identifying Opportunities and Challenges. JCO Oncol Pract 2020; 16:e1255-e1263. [DOI: 10.1200/op.20.00357] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE: Electronic patient-reported outcomes (ePROs) can help clinicians proactively assess and manage their patients’ symptoms. Despite known benefits, there is limited adoption of ePROs into routine clinical care as a result of workflow and technologic challenges. This study identifies oncologists’ perspectives on factors that affect integration of ePROs into clinical workflows. METHODS: We conducted semistructured qualitative interviews with 16 oncologists from a large academic medical center, across diverse subspecialties and cancer types. Oncologists were asked how they currently use or could imagine using ePROs before, during, and after a patient visit. We used an inductive approach to thematically analyze these qualitative data. RESULTS: Results were categorized into the following three main themes: (1) selection and development of ePRO tool, (2) contextual drivers of adoption, and (3) patient-facing concerns. Respondents preferred diagnosis-based ePRO tools over more general symptom screeners. Although they noted information overload as a potential barrier, respondents described strong data visualization and ease of use as facilitators. Contextual drivers of oncologist adoption include identifying target early adopters, incentivizing uptake through use of ePRO data to support billing and documentation, and emphasizing benefits for patient care and efficiency. Respondents also indicated the need to focus on patient-facing issues, such as patient response rate, timing of survey distribution, and validity and reliability of responses. DISCUSSION: Respondents identified several barriers and facilitators to successful uptake of ePROs. Understanding oncologists’ perspectives is essential to inform both practice-level implementation strategies and policy-level decisions to include ePROs in alternative payment models for cancer care.
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Affiliation(s)
- Sahil Sandhu
- Trinity College of Arts and Sciences, Duke University, Durham, NC
| | - Zoe King
- Trinity College of Arts and Sciences, Duke University, Durham, NC
| | - Michelle Wong
- Trinity College of Arts and Sciences, Duke University, Durham, NC
| | - Sean Bissell
- Trinity College of Arts and Sciences, Duke University, Durham, NC
| | | | - Megan Gray
- Social Science Research Institute, Duke University, Durham, NC
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Crosbie PA, Balata H, Evison M, Atack M, Bayliss-Brideaux V, Colligan D, Duerden R, Eaglesfield J, Edwards T, Elton P, Foster J, Greaves M, Hayler G, Higgins C, Howells J, Irion K, Karunaratne D, Kelly J, King Z, Lyons J, Manson S, Mellor S, Miller D, Myerscough A, Newton T, O'Leary M, Pearson R, Pickford J, Sawyer R, Screaton NJ, Sharman A, Simmons M, Smith E, Taylor B, Taylor S, Walsham A, Watts A, Whittaker J, Yarnell L, Threlfall A, Barber PV, Tonge J, Booton R. Second round results from the Manchester 'Lung Health Check' community-based targeted lung cancer screening pilot. Thorax 2019; 74:700-704. [PMID: 30420406 PMCID: PMC6585285 DOI: 10.1136/thoraxjnl-2018-212547] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Revised: 10/12/2018] [Accepted: 10/22/2018] [Indexed: 12/02/2022]
Abstract
We report results from the second annual screening round (T1) of Manchester's 'Lung Health Check' pilot of community-based lung cancer screening in deprived areas (undertaken June to August 2017). Screening adherence was 90% (n=1194/1323): 92% of CT scans were classified negative, 6% indeterminate and 2.5% positive; there were no interval cancers. Lung cancer incidence was 1.6% (n=19), 79% stage I, treatments included surgery (42%, n=9), stereotactic ablative radiotherapy (26%, n=5) and radical radiotherapy (5%, n=1). False-positive rate was 34.5% (n=10/29), representing 0.8% of T1 participants (n=10/1194). Targeted community-based lung cancer screening promotes high screening adherence and detects high rates of early stage lung cancer.
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Affiliation(s)
- Phil A Crosbie
- Manchester Thoracic Oncology Centre, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK
- Division of Molecular and Clinical Cancer Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Haval Balata
- Manchester Thoracic Oncology Centre, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| | - Matthew Evison
- Manchester Thoracic Oncology Centre, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| | - Melanie Atack
- Manchester Clinical Commissioning Group, Macmillan Cancer Improvement Partnership, Manchester, UK
| | - Val Bayliss-Brideaux
- Manchester Clinical Commissioning Group, Macmillan Cancer Improvement Partnership, Manchester, UK
| | - Denis Colligan
- Manchester Clinical Commissioning Group, Macmillan Cancer Improvement Partnership, Manchester, UK
- Manchester Health and Care Commissioning, Manchester, UK
| | - Rebecca Duerden
- Manchester Thoracic Oncology Centre, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| | - Josephine Eaglesfield
- Manchester Clinical Commissioning Group, Macmillan Cancer Improvement Partnership, Manchester, UK
| | - Timothy Edwards
- Manchester Thoracic Oncology Centre, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| | - Peter Elton
- Greater Manchester, Lancashire, South Cumbria Strategic Clinical Network, Manchester, UK
| | | | - Melanie Greaves
- Manchester Thoracic Oncology Centre, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| | - Graham Hayler
- Manchester Clinical Commissioning Group, Macmillan Cancer Improvement Partnership, Manchester, UK
| | - Coral Higgins
- Manchester Health and Care Commissioning, Manchester, UK
| | - John Howells
- Department of Radiology, Royal Preston Hospital, Preston, UK
| | - Klaus Irion
- Department of Radiology, Manchester Royal Infirmary, Manchester University NHS Foundation Trust, Manchester, UK
| | - Devinda Karunaratne
- Department of Radiology, Manchester Royal Infirmary, Manchester University NHS Foundation Trust, Manchester, UK
| | - Jodie Kelly
- Manchester Thoracic Oncology Centre, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| | - Zoe King
- Manchester Clinical Commissioning Group, Macmillan Cancer Improvement Partnership, Manchester, UK
| | - Judith Lyons
- Manchester Thoracic Oncology Centre, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| | - Sarah Manson
- Manchester Thoracic Oncology Centre, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| | - Stuart Mellor
- Department of Radiology, Royal Blackburn Hospital, Blackburn, UK
| | | | - Amanda Myerscough
- Manchester Clinical Commissioning Group, Macmillan Cancer Improvement Partnership, Manchester, UK
| | - Tom Newton
- Department of Radiology, Royal Blackburn Hospital, Blackburn, UK
| | | | - Rachel Pearson
- Manchester Clinical Commissioning Group, Macmillan Cancer Improvement Partnership, Manchester, UK
- Manchester Health and Care Commissioning, Manchester, UK
| | | | - Richard Sawyer
- Manchester Thoracic Oncology Centre, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| | | | - Anna Sharman
- Manchester Thoracic Oncology Centre, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| | - Maggi Simmons
- Manchester Clinical Commissioning Group, Macmillan Cancer Improvement Partnership, Manchester, UK
| | - Elaine Smith
- Manchester Thoracic Oncology Centre, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| | - Ben Taylor
- Department of Radiology, Christie NHS Foundation Trust, Manchester, UK
| | - Sarah Taylor
- Manchester Clinical Commissioning Group, Macmillan Cancer Improvement Partnership, Manchester, UK
- Manchester Health and Care Commissioning, Manchester, UK
| | - Anna Walsham
- Department of Radiology, Salford Royal NHS Foundation Trust, Salford, UK
| | - Angela Watts
- Manchester Thoracic Oncology Centre, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| | - James Whittaker
- Department of Radiology, Stockport NHS Foundation Trust, Stockport, UK
| | - Laura Yarnell
- Manchester Clinical Commissioning Group, Macmillan Cancer Improvement Partnership, Manchester, UK
- Manchester Health and Care Commissioning, Manchester, UK
| | - Anthony Threlfall
- Manchester Clinical Commissioning Group, Macmillan Cancer Improvement Partnership, Manchester, UK
| | - Phil V Barber
- Manchester Thoracic Oncology Centre, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| | - Janet Tonge
- Manchester Clinical Commissioning Group, Macmillan Cancer Improvement Partnership, Manchester, UK
- Manchester Health and Care Commissioning, Manchester, UK
| | - Richard Booton
- Manchester Thoracic Oncology Centre, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK
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Crosbie PA, Balata H, Evison M, Atack M, Bayliss-Brideaux V, Colligan D, Duerden R, Eaglesfield J, Edwards T, Elton P, Foster J, Greaves M, Hayler G, Higgins C, Howells J, Irion K, Karunaratne D, Kelly J, King Z, Manson S, Mellor S, Miller D, Myerscough A, Newton T, O'Leary M, Pearson R, Pickford J, Sawyer R, Screaton NJ, Sharman A, Simmons M, Smith E, Taylor B, Taylor S, Walsham A, Watts A, Whittaker J, Yarnell L, Threlfall A, Barber PV, Tonge J, Booton R. Implementing lung cancer screening: baseline results from a community-based 'Lung Health Check' pilot in deprived areas of Manchester. Thorax 2019; 74:405-409. [PMID: 29440588 DOI: 10.1136/thoraxjnl-2017-211377] [Citation(s) in RCA: 143] [Impact Index Per Article: 28.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2017] [Revised: 01/15/2018] [Accepted: 01/22/2018] [Indexed: 11/03/2022]
Abstract
We report baseline results of a community-based, targeted, low-dose CT (LDCT) lung cancer screening pilot in deprived areas of Manchester. Ever smokers, aged 55-74 years, were invited to 'lung health checks' (LHCs) next to local shopping centres, with immediate access to LDCT for those at high risk (6-year risk ≥1.51%, PLCOM2012 calculator). 75% of attendees (n=1893/2541) were ranked in the lowest deprivation quintile; 56% were high risk and of 1384 individuals screened, 3% (95% CI 2.3% to 4.1%) had lung cancer (80% early stage) of whom 65% had surgical resection. Taking lung cancer screening into communities, with an LHC approach, is effective and engages populations in deprived areas.
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Affiliation(s)
- Phil A Crosbie
- Manchester Thoracic Oncology Centre, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK
- Division of Molecular and Clinical Cancer Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Haval Balata
- Manchester Thoracic Oncology Centre, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| | - Matthew Evison
- Manchester Thoracic Oncology Centre, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| | - Melanie Atack
- Macmillan Cancer Improvement Partnership, Manchester Clinical Commissioning Group, Manchester, UK
| | - Val Bayliss-Brideaux
- Macmillan Cancer Improvement Partnership, Manchester Clinical Commissioning Group, Manchester, UK
| | - Denis Colligan
- Macmillan Cancer Improvement Partnership, Manchester Clinical Commissioning Group, Manchester, UK
- Manchester Health and Care Commissioning, Manchester, UK
| | - Rebecca Duerden
- Manchester Thoracic Oncology Centre, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| | - Josephine Eaglesfield
- Macmillan Cancer Improvement Partnership, Manchester Clinical Commissioning Group, Manchester, UK
| | - Timothy Edwards
- Manchester Thoracic Oncology Centre, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| | - Peter Elton
- Greater Manchester, Lancashire, South Cumbria Strategic Clinical Network, Manchester, UK
| | | | - Melanie Greaves
- Manchester Thoracic Oncology Centre, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| | - Graham Hayler
- Macmillan Cancer Improvement Partnership, Manchester Clinical Commissioning Group, Manchester, UK
| | - Coral Higgins
- Manchester Health and Care Commissioning, Manchester, UK
| | - John Howells
- Department of Radiology, Royal Preston Hospital, Preston, UK
| | - Klaus Irion
- Department of Radiology, Manchester Royal Infirmary, Manchester University NHS Foundation Trust, Manchester, UK
| | - Devinda Karunaratne
- Department of Radiology, Manchester Royal Infirmary, Manchester University NHS Foundation Trust, Manchester, UK
| | - Jodie Kelly
- Manchester Thoracic Oncology Centre, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| | - Zoe King
- Macmillan Cancer Improvement Partnership, Manchester Clinical Commissioning Group, Manchester, UK
| | - Sarah Manson
- Manchester Thoracic Oncology Centre, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| | - Stuart Mellor
- Department of Radiology, Royal Blackburn Hospital, Blackburn, UK
| | | | - Amanda Myerscough
- Macmillan Cancer Improvement Partnership, Manchester Clinical Commissioning Group, Manchester, UK
| | - Tom Newton
- Department of Radiology, Royal Blackburn Hospital, Blackburn, UK
| | | | - Rachel Pearson
- Macmillan Cancer Improvement Partnership, Manchester Clinical Commissioning Group, Manchester, UK
- Manchester Health and Care Commissioning, Manchester, UK
| | | | - Richard Sawyer
- Manchester Thoracic Oncology Centre, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| | | | - Anna Sharman
- Manchester Thoracic Oncology Centre, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| | - Maggi Simmons
- Macmillan Cancer Improvement Partnership, Manchester Clinical Commissioning Group, Manchester, UK
| | - Elaine Smith
- Manchester Thoracic Oncology Centre, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| | - Ben Taylor
- Department of Radiology, Christie NHS Foundation Trust, Manchester, UK
| | - Sarah Taylor
- Macmillan Cancer Improvement Partnership, Manchester Clinical Commissioning Group, Manchester, UK
- Manchester Health and Care Commissioning, Manchester, UK
| | - Anna Walsham
- Department of Radiology, Salford Royal NHS Foundation Trust, Salford, UK
| | - Angela Watts
- Manchester Thoracic Oncology Centre, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| | - James Whittaker
- Department of Radiology, Stockport NHS Foundation Trust, Stockport, UK
| | - Laura Yarnell
- Macmillan Cancer Improvement Partnership, Manchester Clinical Commissioning Group, Manchester, UK
- Manchester Health and Care Commissioning, Manchester, UK
| | - Anthony Threlfall
- Macmillan Cancer Improvement Partnership, Manchester Clinical Commissioning Group, Manchester, UK
| | - Phil V Barber
- Manchester Thoracic Oncology Centre, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| | - Janet Tonge
- Macmillan Cancer Improvement Partnership, Manchester Clinical Commissioning Group, Manchester, UK
- Manchester Health and Care Commissioning, Manchester, UK
| | - Richard Booton
- Manchester Thoracic Oncology Centre, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK
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