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Ridgeway JL, Cheville AL, Fischer KJ, Tesch NK, Austin JD, Minteer SA, Pachman DR, Chlan LL, Ruddy KJ, Griffin JM. Tracking activities and adaptations in a multi-site stepped wedge pragmatic trial of a cancer symptom management intervention. Contemp Clin Trials Commun 2024; 38:101269. [PMID: 38380342 PMCID: PMC10876585 DOI: 10.1016/j.conctc.2024.101269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Revised: 10/31/2023] [Accepted: 02/08/2024] [Indexed: 02/22/2024] Open
Abstract
Background Pragmatic trials may need to adapt interventions to enhance local fit, and adaptation tracking is critical to evaluation. This study describes the tracking approach for a multisite, stepped-wedge hybrid pragmatic trial testing implementation and effectiveness of a cancer symptom management intervention. Methods Study activities were documented in a spreadsheet by date and category. Intervention adaptations were tracked across multiple workgroups in a database structured around the Framework for Reporting Adaptations and Modifications-Expanded (FRAME) domains, e.g., reasons for change. Implementation strategies were tracked longitudinally and by cluster in a database using the Longitudinal Implementation Strategy Tracking System (LISTS) method. A logic model was created at the end of the study to describe core intervention components and implementation strategies with dates of adaptations. Results Between January 2019 and January 2023, 187 study activities were documented. Most intervention activities took place early, but there were important intervention refinements during the course of the trial, including the expansion of interventionist roles to add two new disciplines. Eleven intervention adaptations were documented. Most were unplanned and aimed at improving fit or increasing engagement. Thirty-three implementation strategies were documented, the largest number of which were related to educating stakeholders. Most (but not all) component and strategy additions were consistent with the mechanisms of change as hypothesized at trial launch. Conclusions A multifaceted approach to adaptation tracking, combined with a logic model, supported identification of meaningful changes for use in evaluation, but further work is needed to minimize burden and ensure robust and practical systems that inform both evaluation and timely decision-making. Trial Registration: ClinicalTrials.gov, NCT03892967. Registered on March 25, 2019. https://www.clinicaltrials.gov/.
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Affiliation(s)
- Jennifer L. Ridgeway
- Division of Health Care Delivery Research, Mayo Clinic, 200 First Street, SW, Rochester, MN, 55905, USA
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, 200 First Street, SW, Rochester, MN, 55905, USA
| | - Andrea L. Cheville
- Division of Medical Rehabilitation, Physical Medicine and Rehabilitation, Mayo Clinic, 200 First Street, SW, Rochester, MN, 55905, USA
| | - Kristin J. Fischer
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, 200 First Street, SW, Rochester, MN, 55905, USA
| | - Nathan K. Tesch
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, 200 First Street, SW, Rochester, MN, 55905, USA
| | - Jessica D. Austin
- Division of Epidemiology, Quantitative Health Sciences, Mayo Clinic, 13400 E. Shea Boulevard, Scottsdale, AZ, 85259, USA
| | - Sarah A. Minteer
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, 200 First Street, SW, Rochester, MN, 55905, USA
- Physical Medicine and Rehabilitation Research, Physical Medicine and Rehabilitation, Mayo Clinic, 200 First Street, SW, Rochester, MN, 55905, USA
| | - Deirdre R. Pachman
- Division of Community Internal Medicine, Geriatrics, and Palliative Care, Mayo Clinic, 200 First Street, SW, Rochester, MN, 55905, USA
| | - Linda L. Chlan
- Division of Nursing Research, Department of Nursing, Mayo Clinic, 200 First Street, SW, Rochester, MN, 55905, USA
| | - Kathryn J. Ruddy
- Division of Medical Oncology, Mayo Clinic, 200 First Street, SW, Rochester, MN, 55905, USA
| | - Joan M. Griffin
- Division of Health Care Delivery Research, Mayo Clinic, 200 First Street, SW, Rochester, MN, 55905, USA
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, 200 First Street, SW, Rochester, MN, 55905, USA
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Finney Rutten LJ, Ridgeway JL, Griffin JM. Advancing Translation of Clinical Research Into Practice and Population Health Impact Through Implementation Science. Mayo Clin Proc 2024; 99:665-676. [PMID: 38569814 DOI: 10.1016/j.mayocp.2023.02.005] [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: 05/04/2022] [Revised: 01/31/2023] [Accepted: 02/08/2023] [Indexed: 04/05/2024]
Abstract
Translational and implementation sciences aim to prioritize and guide efforts to create greater efficiency and speed of scientific innovation across the translational science continuum to improve patient and population health. Key principles and practices rooted in translational and implementation science may be incorporated into clinical trials research, particularly pragmatic trials, to improve the relevance and impact of scientific innovation. This thematic review intends to raise awareness on the value of translational and implementation science in clinical research and to encourage its use in designing and implementing clinical trials across the translational research continuum. Herein, we describe the gap in translating research findings into clinical practice, introduce translational and implementation science, and describe the principles and practices from implementation science that can be used in clinical trial research across the translational continuum to inform clinical practice, to improve population health impact, and to address health care inequities.
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Affiliation(s)
| | - Jennifer L Ridgeway
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN
| | - Joan M Griffin
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN
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Garcia SI, Finch AS, Ridgeway JL, Beckman TJ, Montori VM, Rivera M, Gajic O, Kennedy CC, Kelm DJ. Understanding Team Dynamics and Culture of Safety using Video Reflexive Ethnography during Real-Time Emergent Intubation. Ann Am Thorac Soc 2024. [PMID: 38470228 DOI: 10.1513/annalsats.202310-901oc] [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] [Received: 10/23/2023] [Accepted: 03/08/2024] [Indexed: 03/13/2024] Open
Abstract
RATIONALE Endotracheal intubation is the third most common bedside procedure in U.S. hospitals. In over 40% of intubations preventable complications attributable to human factors occur. A better understanding of team dynamics during intubation may improve patient safety. OBJECTIVE To explore team dynamics and safety-related actions during emergent endotracheal intubations in the emergency department (ED) and intensive care unit (ICU), and to engage members of the care team in reflection for process improvement through a novel video-based team debriefing technique. METHODS Video-reflexive ethnography involves in-situ video-recording and reflexive discussions with practitioners to scrutinize behaviors and to identify opportunities for improvement. In this study, real-time intubations were recorded in the ED and ICU at Mayo Clinic Rochester and facilitated video-reflexive sessions were conducted with the multidisciplinary procedural teams. Themes about team dynamics and safety-related action were identified inductively from transcriptions of recorded sessions. RESULTS Between December 2022 and January 2023, eight video-reflexive sessions were conducted with a total of 78 participants. Multidisciplinary members included nurses (n=23), respiratory therapists (n=16), pharmacists (n=7), advanced practitioners (n=5), and physicians (n=26). Video-reflexive discussions identified major safety gaps and proposed several solutions related to the use of a multidisciplinary intubation checklist, standardized communication and team positioning, developing a culture of safety, and routinely debriefing after the procedure. CONCLUSION The findings of this study may inform the development of a team supervision model for emergent endotracheal intubations. This approach could integrate key components such as a multidisciplinary intubation checklist, standardized communication and team positioning, a culture of safety, and debriefing as part of the procedure itself.
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Affiliation(s)
- Samuel I Garcia
- Mayo Clinic, 6915, Division of Pulmonary, Critical Care and Sleep Medicine, Rochester, Minnesota, United States
| | - Alexander S Finch
- Mayo Clinic, 6915, Department of Emergency Medicine, Rochester, Minnesota, United States
| | - Jennifer L Ridgeway
- Mayo Clinic Rochester, 384842, Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Rochester, Minnesota, United States
| | - Thomas J Beckman
- Mayo Clinic, 6915, Division of General Internal Medicine, Rochester, Minnesota, United States
| | - Victor M Montori
- Mayo Clinic, 6915, Division of Endocrinology, Rochester, Minnesota, United States
| | - Mariela Rivera
- Mayo Clinic, 6915, Department of Surgery, Rochester, Minnesota, United States
| | - Ognjen Gajic
- Mayo Clinic College of Medicine, Department of Internal Medicine, Division of Pulmonary and Critical Care Medicine, Rochester, Minnesota, United States
| | - Cassie C Kennedy
- Mayo Clinic, Division of Pulmonary and Critical Care Medicine, Rochester, Minnesota, United States
| | - Diana J Kelm
- Mayo Clinic, Division of Pulmonary and Critical Care Medicine, Rochester, Minnesota, United States;
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Griffin JM, Kroner BL, Wong SL, Preiss L, Wilder Smith A, Cheville AL, Mitchell SA, Lancki N, Hassett MJ, Schrag D, Osarogiagbon RU, Ridgeway JL, Cella D, Jensen RE, Flores AM, Austin JD, Yanez B. Disparities in electronic health record portal access and use among patients with cancer. J Natl Cancer Inst 2024; 116:476-484. [PMID: 37930884 PMCID: PMC10919330 DOI: 10.1093/jnci/djad225] [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: 07/20/2023] [Revised: 09/12/2023] [Accepted: 10/18/2023] [Indexed: 11/08/2023] Open
Abstract
BACKGROUND Electronic health record-linked portals may improve health-care quality for patients with cancer. Barriers to portal access and use undermine interventions that rely on portals to reduce cancer care disparities. This study examined portal access and persistence of portal use and associations with patient and structural factors before the implementation of 3 portal-based interventions within the Improving the Management of symPtoms during And following Cancer Treatment (IMPACT) Consortium. METHODS Portal use data were extracted from electronic health records for the 12 months preceding intervention implementation. Sociodemographic factors, mode of accessing portals (web vs mobile), and number of clinical encounters before intervention implementation were also extracted. Rurality was derived using rural-urban commuting area codes. Broadband access was estimated using the 2015-2019 American Community Survey. Multiple logistic regression models tested the associations of these factors with portal access (ever accessed or never accessed) and persistence of portal use (accessed the portal ≤20 weeks vs ≥21 weeks in the 35-week study period). RESULTS Of 28 942 eligible patients, 10 061 (35%) never accessed the portal. Male sex, membership in a racial and ethnic minority group, rural dwelling, not working, and limited broadband access were associated with lower odds of portal access. Younger age and more clinical encounters were associated with higher odds of portal access. Of those with portal access, 25% were persistent users. Using multiple modalities for portal access, being middle-aged, and having more clinical encounters were associated with persistent portal use. CONCLUSION Patient and structural factors affect portal access and use and may exacerbate disparities in electronic health record-based cancer symptom surveillance and management.
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Affiliation(s)
- Joan M Griffin
- Division of Health Care Delivery Research, Mayo Clinic, Rochester, MN, USA
- Robert E. and Patricia D. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA
| | - Barbara L Kroner
- Center for Clinical Research, RTI International, Research Triangle Park, NC, USA
| | - Sandra L Wong
- Department of Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
| | - Liliana Preiss
- Center for Clinical Research, RTI International, Research Triangle Park, NC, USA
| | - Ashley Wilder Smith
- Outcomes Research Branch, Healthcare Delivery Research Program, National Cancer Institute, Bethesda, MD, USA
| | - Andrea L Cheville
- Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, MN, USA
| | - Sandra A Mitchell
- Outcomes Research Branch, Healthcare Delivery Research Program, National Cancer Institute, Bethesda, MD, USA
| | - Nicola Lancki
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Michael J Hassett
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Deborah Schrag
- Department of Medical Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | | | - Jennifer L Ridgeway
- Division of Health Care Delivery Research, Mayo Clinic, Rochester, MN, USA
- Robert E. and Patricia D. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA
| | - David Cella
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
- Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, IL, USA
| | - Roxanne E Jensen
- Outcomes Research Branch, Healthcare Delivery Research Program, National Cancer Institute, Bethesda, MD, USA
| | - Ann Marie Flores
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
- Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, IL, USA
- Department of Physical Therapy and Human Movement Science, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Jessica D Austin
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, USA
| | - Betina Yanez
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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Eton DT, Yost KJ, Ridgeway JL, Bucknell B, Wambua M, Erbs NC, Allen SV, Rogers EA, Anderson RT, Linzer M. Development and acceptability of PETS-Now, an electronic point-of-care tool to monitor treatment burden in patients with multiple chronic conditions: a multi-method study. BMC Prim Care 2024; 25:77. [PMID: 38429702 PMCID: PMC10908048 DOI: 10.1186/s12875-024-02316-5] [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] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Accepted: 02/20/2024] [Indexed: 03/03/2024]
Abstract
BACKGROUND The aim of this study was to develop a web-based tool for patients with multiple chronic conditions (MCC) to communicate concerns about treatment burden to their healthcare providers. METHODS Patients and providers from primary-care clinics participated. We conducted focus groups to identify content for a prototype clinical tool to screen for treatment burden by reviewing domains and items from a previously validated measure, the Patient Experience with Treatment and Self-management (PETS). Following review of the prototype, a quasi-experimental pilot study determined acceptability of using the tool in clinical practice. The study protocol was modified to accommodate limitations due to the Covid-19 pandemic. RESULTS Fifteen patients with MCC and 18 providers participated in focus groups to review existing PETS content. The pilot tool (named PETS-Now) consisted of eight domains (Living Healthy, Health Costs, Monitoring Health, Medicine, Personal Relationships, Getting Healthcare, Health Information, and Medical Equipment) with each domain represented by a checklist of potential concerns. Administrative burden was minimized by limiting patients to selection of one domain. To test acceptability, 17 primary-care providers first saw 92 patients under standard care (control) conditions followed by another 90 patients using the PETS-Now tool (intervention). Each treatment burden domain was selected at least once by patients in the intervention. No significant differences were observed in overall care quality between patients in the control and intervention conditions with mean care quality rated high in both groups (9.3 and 9.2, respectively, out of 10). There were no differences in provider impressions of patient encounters under the two conditions with providers reporting that patient concerns were addressed in 95% of the visits in both conditions. Most intervention group patients (94%) found that the PETS-Now was easy to use and helped focus the conversation with the provider on their biggest concern (98%). Most providers (81%) felt they had learned something new about the patient from the PETS-Now. CONCLUSION The PETS-Now holds promise for quickly screening and monitoring treatment burden in people with MCC and may provide information for care planning. While acceptable to patients and clinicians, integration of information into the electronic medical record should be prioritized.
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Affiliation(s)
- David T Eton
- Outcomes Research Branch, Healthcare Delivery Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, 9169 Medical Center Drive, Rockville, MD, 20850, USA.
| | - Kathleen J Yost
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, USA
| | - Jennifer L Ridgeway
- Division of Health Care Delivery Research, Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA
| | - Bayly Bucknell
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, USA
| | - Mike Wambua
- Hennepin Healthcare Research Institute, Minneapolis, MN, USA
| | - Natalie C Erbs
- Department of Family Medicine, Mayo Clinic, Rochester, MN, USA
| | - Summer V Allen
- Department of Family Medicine, Mayo Clinic, Rochester, MN, USA
| | - Elizabeth A Rogers
- Departments of Medicine and of Pediatrics, University of Minnesota, Minneapolis, MN, USA
| | - Roger T Anderson
- Department of Public Health Sciences, University of Virginia, Charlottesville, VA, USA
| | - Mark Linzer
- Department of Medicine, Hennepin Healthcare and University of Minnesota, Minneapolis, MN, USA
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Austin JD, Jenkins SM, Suman VJ, Raygoza JP, Ridgeway JL, Norman A, Gonzalez C, Hernandez V, Ghosh K, Patel BK, Vachon CM. Breast Cancer Risk Perceptions Among Underserved, Hispanic Women: Implications for Risk-Based Approaches to Screening. J Racial Ethn Health Disparities 2024:10.1007/s40615-024-01949-7. [PMID: 38383839 DOI: 10.1007/s40615-024-01949-7] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Revised: 02/08/2024] [Accepted: 02/13/2024] [Indexed: 02/23/2024]
Abstract
BACKGROUND Understanding factors that shape breast cancer risk perceptions is essential for implementing risk-based approaches to breast cancer detection and prevention. This study aimed to assess multilevel factors, including prior screening behavior, shaping underserved, Hispanic women's perceived risk for breast cancer. METHODS Secondary analysis of survey data from Hispanic women (N = 1325, 92% Spanish speaking, 64% < 50) enrolled in a large randomized controlled trial. Analyses were performed in two cohorts to account for the role of age on screening guideline recommendations (< 50 and 50 +). For each cohort, we examined differences in three common measures of perceived risk of breast cancer (percent lifetime, ordinal lifetime, comparative) by participant factors with chi-square or Kruskal-Wallis tests, as appropriate. Multivariate analyses examined the association between mammography history with percent perceived lifetime risk (outcome > 10 vs ≤ 10%). RESULTS Overall, 75% reported a lifetime risk between 0 and 10%, 96% rated their ordinal risk as "not high," and 50% rated their comparative risk as "much lower." Women < 50 with a family history of breast cancer reported significantly higher levels of perceived risk across all three measures. Among women 50 + , those reporting lower levels of perceived risk were significantly more likely to be Spanish speaking. No significant association was observed between mammography history and percent lifetime risk of breast cancer. CONCLUSION Factors shaping breast cancer risk perceptions differ by age. Prior screening may play less of role in constructing risk perceptions. Research is needed to develop culturally and linguistically appropriate strategies to improve implementation of risk-based screening.
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Affiliation(s)
- Jessica D Austin
- Department of Quantitative Health Sciences, Division of Epidemiology, Mayo Clinic, 13400 E. Shea Blvd, Scottsdale, AZ, 85259, USA.
| | - Sarah M Jenkins
- Department of Quantitative Health Sciences, Division of Clinical Trials and Biostatistics, Mayo Clinic, Rochester, MN, USA
| | - Vera J Suman
- Department of Quantitative Health Sciences, Division of Clinical Trials and Biostatistics, Mayo Clinic, Rochester, MN, USA
| | - Jhenitza P Raygoza
- Department of Quantitative Health Sciences, Division of Epidemiology, Mayo Clinic, 13400 E. Shea Blvd, Scottsdale, AZ, 85259, USA
| | - Jennifer L Ridgeway
- Division of Health Care Delivery Research, Mayo Clinic, Rochester, MN, USA
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA
| | - Aaron Norman
- Department of Quantitative Health Sciences, Division of Clinical Trials and Biostatistics, Mayo Clinic, Rochester, MN, USA
| | - Crystal Gonzalez
- Department of Integrated Nutrition Services and Collaborative Research, Mountain Park Health Center, Phoenix, AZ, USA
| | - Valentina Hernandez
- Department of Integrated Nutrition Services and Collaborative Research, Mountain Park Health Center, Phoenix, AZ, USA
| | - Karthik Ghosh
- Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - Bhavika K Patel
- Department of Diagnostic Radiology, Mayo Clinic, Phoenix, AZ, USA
| | - Celine M Vachon
- Department of Quantitative Health Sciences, Division of Epidemiology, Mayo Clinic, Rochester, MN, USA
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Friedman CP, Lomotan EA, Richardson JE, Ridgeway JL. Socio-technical infrastructure for a learning health system. Learn Health Syst 2024; 8:e10405. [PMID: 38249851 PMCID: PMC10797563 DOI: 10.1002/lrh2.10405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Accepted: 12/12/2023] [Indexed: 01/23/2024] Open
Affiliation(s)
- Charles P. Friedman
- Department of Learning Health SciencesUniversity of MichiganAnn ArborMichiganUSA
| | - Edwin A. Lomotan
- Center for Evidence and Practice ImprovementAgency for Healthcare Research and QualityRockvilleMarylandUSA
| | | | - Jennifer L. Ridgeway
- Division of Health Care Delivery Research, Robert D. and Patricia E. Kern Center for the Science of Health Care DeliveryMayo ClinicRochesterMinnesotaUSA
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Smith JD, Norton WE, Mitchell SA, Cronin C, Hassett MJ, Ridgeway JL, Garcia SF, Osarogiagbon RU, Dizon DS, Austin JD, Battestilli W, Richardson JE, Tesch NK, Cella D, Cheville AL, DiMartino LD. The Longitudinal Implementation Strategy Tracking System (LISTS): feasibility, usability, and pilot testing of a novel method. Implement Sci Commun 2023; 4:153. [PMID: 38017582 PMCID: PMC10683230 DOI: 10.1186/s43058-023-00529-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Accepted: 11/09/2023] [Indexed: 11/30/2023] Open
Abstract
BACKGROUND Systematic approaches are needed to accurately characterize the dynamic use of implementation strategies and how they change over time. We describe the development and preliminary evaluation of the Longitudinal Implementation Strategy Tracking System (LISTS), a novel methodology to document and characterize implementation strategies use over time. METHODS The development and initial evaluation of the LISTS method was conducted within the Improving the Management of SymPtoms during And following Cancer Treatment (IMPACT) Research Consortium (supported by funding provided through the NCI Cancer MoonshotSM). The IMPACT Consortium includes a coordinating center and three hybrid effectiveness-implementation studies testing routine symptom surveillance and integration of symptom management interventions in ambulatory oncology care settings. LISTS was created to increase the precision and reliability of dynamic changes in implementation strategy use over time. It includes three components: (1) a strategy assessment, (2) a data capture platform, and (3) a User's Guide. An iterative process between implementation researchers and practitioners was used to develop, pilot test, and refine the LISTS method prior to evaluating its use in three stepped-wedge trials within the IMPACT Consortium. The LISTS method was used with research and practice teams for approximately 12 months and subsequently we evaluated its feasibility, acceptability, and usability using established instruments and novel questions developed specifically for this study. RESULTS Initial evaluation of LISTS indicates that it is a feasible and acceptable method, with content validity, for characterizing and tracking the use of implementation strategies over time. Users of LISTS highlighted several opportunities for improving the method for use in future and more diverse implementation studies. CONCLUSIONS The LISTS method was developed collaboratively between researchers and practitioners to fill a research gap in systematically tracking implementation strategy use and modifications in research studies and other implementation efforts. Preliminary feedback from LISTS users indicate it is feasible and usable. Potential future developments include additional features, fewer data elements, and interoperability with alternative data entry platforms. LISTS offers a systematic method that encourages the use of common data elements to support data analysis across sites and synthesis across studies. Future research is needed to further adapt, refine, and evaluate the LISTS method in studies with employ diverse study designs and address varying delivery settings, health conditions, and intervention types.
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Affiliation(s)
- Justin D Smith
- Department of Population Health Sciences, School of Medicine, University of Utah, Spencer Fox Eccles, Salt Lake City, UT, USA.
- Departments of Psychiatry and Behavioral Science and Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
| | - Wynne E Norton
- Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD, USA
| | - Sandra A Mitchell
- Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD, USA
| | - Christine Cronin
- Division of Population Sciences, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Michael J Hassett
- Departments of Medical Oncology and Quality & Patient Safety, Dana-Farber Cancer Institute, Boston, MA, 02215, USA
| | - Jennifer L Ridgeway
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery and Division of Health Care Delivery Research, Mayo Clinic, Rochester, MN, USA
| | - Sofia F Garcia
- Departments of Psychiatry and Behavioral Science and Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Raymond U Osarogiagbon
- Multidisciplinary Thoracic Oncology Program, Thoracic Oncology Research Group, Baptist Cancer Center, Memphis, TN, USA
| | - Don S Dizon
- Division of Hematology-Oncology, Department of Medicine, Legoretta Cancer Center, The Warren Alpert Medical School of Brown University, and Lifespan Cancer Institute, Providence, USA
| | - Jessica D Austin
- Division of Epidemiology, Department of Quantitative Health Sciences, Mayo Clinic, Scottsdale, AZ, USA
| | - Whitney Battestilli
- Center for Clinical Research Informatics, RTI International, Durham, NC, USA
| | - Joshua E Richardson
- Center for Health Informatics, RTI International, Research Triangle Park, Fayetteville, NC, USA
| | - Nathan K Tesch
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA
| | - David Cella
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine and Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, IL, USA
| | - Andrea L Cheville
- Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, MN, USA
| | - Lisa D DiMartino
- Peter O'Donnell Jr. School of Public Health, University of Texas Southwestern Medical Center, Dallas, TX, USA
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9
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Minteer SA, Cheville A, Tesch N, Griffin JM, Austin JD, Mitchell S, Leppin AL, Ridgeway JL. Implementing cancer symptom management interventions utilizing patient-reported outcomes: a pre-implementation evaluation of barriers and facilitators. Support Care Cancer 2023; 31:697. [PMID: 37962699 PMCID: PMC10645625 DOI: 10.1007/s00520-023-08114-6] [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: 06/14/2023] [Accepted: 10/10/2023] [Indexed: 11/15/2023]
Abstract
PURPOSE Symptoms can negatively impact quality of life for patients with a history of cancer. Digital, electronic health record (EHR)-integrated approaches to routine symptom monitoring accompanied by evidence-based interventions for symptom management have been explored as a scalable way to improve symptom management, particularly between clinic visits. However, little research has evaluated barriers and facilitators to implementing these approaches in real-world settings, particularly during the pre-implementation phase. Pre-implementation assessment is critical for informing the selection and sequencing of implementation strategies and intervention adaptation. Thus, this study sought to understand pre-implementation perceptions of a remote cancer symptom monitoring and management intervention that uses electronic patient-reported outcome measures for symptom assessment. METHODS We interviewed 20 clinical and administrative stakeholders from 4 geographic regions within an academic medical center and its affiliated health system during the months prior to initiation of a stepped-wedge, cluster randomized pragmatic trial. Transcripts were coded using the Consolidated Framework for Implementation Research [CFIR] 2.0. Two study team members reviewed coded transcripts to understand how determinants were relevant in the pre-implementation phase of the trial and prepared analytic memos to identify themes. RESULTS Findings are summarized in four themes: (1) ability of the intervention to meet patient needs [recipient characteristics], (2) designing with care team needs in mind [innovation design and adaptability], (3) fit of the intervention with existing practice workflows [compatibility], and (4) engaging care teams early [engaging deliverers]. CONCLUSION Attention to these aspects when planning intervention protocols can promote intervention compatibility with patients, providers, and practices thereby increasing implementation success.
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Affiliation(s)
- Sarah A Minteer
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA.
| | - Andrea Cheville
- Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, MN, USA
| | - Nathan Tesch
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA
| | - Joan M Griffin
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA
- Division of Health Care Delivery Research, Mayo Clinic, Rochester, MN, USA
| | - Jessica D Austin
- Department of Quantitative Health Sciences, Division of Epidemiology, Mayo Clinic Arizona, Scottsdale, AZ, USA
| | - Sandra Mitchell
- Healthcare Delivery Research Program, National Cancer Institute, Bethesda, MD, USA
| | - Aaron L Leppin
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA
- Division of Health Care Delivery Research, Mayo Clinic, Rochester, MN, USA
| | - Jennifer L Ridgeway
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA
- Division of Health Care Delivery Research, Mayo Clinic, Rochester, MN, USA
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Young NP, Ridgeway JL, Haddad TC, Harper SB, Philpot LM, Christopherson LA, McColley SM, Phillips SA, Brown JK, Zimmerman KS, Ebbert JO. Feasibility and Usability of a Mobile App-Based Interactive Care Plan for Migraine in a Community Neurology Practice: Development and Pilot Implementation Study. JMIR Form Res 2023; 7:e48372. [PMID: 37796560 PMCID: PMC10587810 DOI: 10.2196/48372] [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: 04/23/2023] [Revised: 08/23/2023] [Accepted: 08/24/2023] [Indexed: 10/06/2023] Open
Abstract
BACKGROUND Migraine is a common and major cause of disability, poor quality of life, and high health care use. Access to evidence-based migraine care is limited and projected to worsen. Novel mobile health app-based tools may effectively deliver migraine patient education to support self-management, facilitate remote monitoring and treatment, and improve access to care. The risk that such an intervention may increase the care team workload is a potential implementation barrier. OBJECTIVE This study aims to describe a novel electronic health record-integrated mobile app-based Migraine Interactive Care Plan (MICP) and evaluate its feasibility, usability, and impact on care teams in a community neurology practice. METHODS Consecutive enrollees between September 1, 2020, and February 16, 2022, were assessed in a single-arm observational study of usability, defined by 74.3% (127/171) completing ≥1 assigned task. Task response rates, rate and type of care team escalations, and patient-reported outcomes were summarized. Patients were prospectively recruited and randomly assigned to routine care with or without the MICP from September 1, 2020, to September 1, 2021. Feasibility was defined by equal to or fewer downstream face-to-face visits, telephone contacts, and electronic messages in the MICP cohort. The Wilcoxon rank-sum test was used to compare continuous variables, and the chi-square test was used for categorical variables for those with at least 3 months of follow-up. RESULTS A total of 171 patients were enrolled, and of these, 127 (74.3%) patients completed ≥1 MICP-assigned task. Mean escalations per patient per month was 0.9 (SD 0.37; range 0-1.7). Patient-confirmed understanding of the educational materials ranged from 26.6% (45/169) to 56.2% (95/169). Initial mean headache days per week was 4.54 (SD 2.06) days and declined to 2.86 (SD 1.87) days at week 26. The percentage of patients reporting favorable satisfaction increased from a baseline of 35% (20/57) to 83% (15/18; response rate of 42/136, 30.9% to 28/68, 41%) over the first 6 months. A total of 121 patients with MICP were compared with 62 patients in the control group. No differences were observed in the rate of telephone contacts or electronic messages. Fewer face-to-face visits were observed in the MICP cohort (13/121, 10.7%) compared with controls (26/62, 42%; P<.001). CONCLUSIONS We describe the successful implementation of an electronic health record-integrated mobile app-based care plan for migraine in a community neurology practice. We observed fewer downstream face-to-face visits without increasing telephone calls, medication refills, or electronic messages. Our findings suggest that the MICP has the potential to improve patient access without increasing care team workload and the need for patient input from diverse populations to improve and sustain patient engagement. Additional studies are needed to assess its impact in primary care.
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Affiliation(s)
- Nathan P Young
- Department of Neurology, Mayo Clinic, Rochester, MN, United States
- Integrated Community Specialty Practice, Mayo Clinic, Rochester, MN, United States
| | - Jennifer L Ridgeway
- Division of Health Care Delivery Research, Mayo Clinic, Rochester, MN, United States
| | - Tufia C Haddad
- Department of Oncology, Mayo Clinic, Rochester, MN, United States
- Center for Digital Health, Mayo Clinic, Rochester, MN, United States
| | - Sarah B Harper
- Center for Digital Health, Mayo Clinic, Rochester, MN, United States
| | - Lindsey M Philpot
- Community Internal Medicine, Mayo Clinic, Rochester, MN, United States
- Qualitative Health Sciences, Mayo Clinic, Rochester, MN, United States
| | | | - Samantha M McColley
- Center for Digital Health, Mayo Clinic, Rochester, MN, United States
- Clinical Informatics and Practice Support, Mayo Clinic, Rochester, MN, United States
| | - Sarah A Phillips
- Center for Digital Health, Mayo Clinic, Rochester, MN, United States
| | - Julie K Brown
- Center for Digital Health, Mayo Clinic, Rochester, MN, United States
| | - Kelly S Zimmerman
- Integrated Community Specialty Practice, Mayo Clinic, Rochester, MN, United States
| | - Jon O Ebbert
- Community Internal Medicine, Mayo Clinic, Rochester, MN, United States
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11
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Tran NH, Almodallal Y, Batheja M, Martin NA, Le-Rademacher J, Ridgeway JL, Sia IG, Jatoi A. Social determinants of health: a need for better data capture in Asian American patients with hepatocellular cancer. Support Care Cancer 2023; 31:543. [PMID: 37646853 DOI: 10.1007/s00520-023-08016-7] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Accepted: 08/23/2023] [Indexed: 09/01/2023]
Abstract
BACKGROUND Social determinants of health lead to better cancer care. This multi-site, single-institution study sought to capture data on social determinants of health data in Asian Americans with hepatocellular carcinoma; this group constitutes 60% of patients with this malignancy and are often undertreated or not treated at all. METHODS This study took advantage of an institutional initiative designed to capture and integrate social determinants of health data into the electronic medical record for all patients. Medical records of Asian Americans with hepatocellular cancer were reviewed to acquire data on housing instability, lack of transportation, financial concerns, and social isolation; a score of 1 indicated poor social determinants of health. RESULTS Of 112 adult Asian American patients with hepatocellular cancer, 22 (20%) were Southeast Asian, and 74 (67%) described English proficiency/preference. Total noncompletion per domain (no question answered within that domain) was observed in 90 patients (80%) for housing instability; 90 (80%) for lack of transportation; 92 (82%) for financial hardship; and 90 (80%) for social isolation. A score of 1 (highest risk) was observed in 1 patient (0.9%) for housing instability; 1 (0.9%) lack of transportation; no patient for financial hardship; and 1 (0.9%) for social isolation. Of note, institution-wide benchmark total noncompletion rates were 0.3%, 0.3%, 47%, and 39% for these respective domains. CONCLUSION High total noncompletion rates make social determinants of health data challenging to interpret and underscore the need for evidence-based guidelines on how best to capture such data in underserved patients.
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Affiliation(s)
- Nguyen H Tran
- Department of Oncology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.
| | - Yahya Almodallal
- Department of Oncology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Mashal Batheja
- Division of Gastroenterology, Mayo Clinic, Phoenix, AZ, USA
| | - Nichole A Martin
- Department of Oncology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | | | | | - Irene G Sia
- Division of Infectious Diseases, Mayo Clinic, Rochester, MN, USA
| | - Aminah Jatoi
- Department of Oncology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
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Midthun WR, Benzo MV, Ridgeway JL, Benzo RP. Understanding the Patient Experience of Home-Based Pulmonary Rehabilitation with Health Coaching for COPD: A Qualitative Interview Study. Chronic Obstr Pulm Dis 2023; 10:224-233. [PMID: 37140957 PMCID: PMC10484487 DOI: 10.15326/jcopdf.2022.0384] [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] [Accepted: 04/17/2022] [Indexed: 05/05/2023]
Abstract
Background We recently reported on a randomized trial of home-based pulmonary rehabilitation (PR) for chronic obstructive pulmonary disease (COPD) that showed improvement in all domains of quality of life, accelerometry-measured physical activity, and self-management. In this current study, we used a theoretical framework to help us gain an in-depth understanding of how patients experience complex, multi-component programs to help uncover factors related to behavior change and to inform program scale-up in other populations. Study Design and Methods The parent trial was conducted with COPD patients receiving care at an academic medical center and a community health system in the upper Midwest. The 12-week PR intervention included 3 daily video-guided exercises, activity monitors, and weekly telephonic health coaching. Trial participants were eligible to participate in an individual phone interview about their experience if they completed the intervention within the prior 12 months.. Analysis of verbatim transcripts followed an inductive thematic approach followed by deductive categorization and interpretation using a theoretical model: the Capability, Opportunity, Motivation-Behavior (COM-B) model developed for linking intervention functions to aspects of behavioral change. Results Among 32 eligible program participants,32 were approached, and 15 completed interviews between October 19, 2021, and January 13, 2022. The COM-B model and recommendations for program improvement were observed in the primary findings. Discussion Participants' feedback highlighted how the health coaching bolstered skills and confidence among individuals with the poorest function at program enrollment and how improved physical function and mood led to motivation. It also highlighted the roles of technology and telephonic support in a home-based program. Suggestions for improvement included providing exercise variations.
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Affiliation(s)
- William R Midthun
- Mindful Breathing Laboratory, Division of Pulmonary, Critical Care and Sleep Medicine, Mayo Clinic, Rochester, Minnesota, United States
| | - Maria V Benzo
- Mindful Breathing Laboratory, Division of Pulmonary, Critical Care and Sleep Medicine, Mayo Clinic, Rochester, Minnesota, United States
| | - Jennifer L Ridgeway
- Division of Health Care Delivery Research, Mayo Clinic, Rochester, Minnesota, United States
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota, United States
| | - Roberto P Benzo
- Mindful Breathing Laboratory, Division of Pulmonary, Critical Care and Sleep Medicine, Mayo Clinic, Rochester, Minnesota, United States
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Duke JD, Moua T, Ridgeway JL, Roy M, Benzo M, Hoult J, Benzo R. Home-Based Pulmonary Rehabilitation and Health Coaching in Fibrotic Interstitial Lung Disease: IMPLEMENTATION AND QUALITATIVE ASSESSMENT OF A PILOT TELEHEALTH PROGRAM. J Cardiopulm Rehabil Prev 2023; 43:270-276. [PMID: 36728336 PMCID: PMC10290571 DOI: 10.1097/hcr.0000000000000766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
PURPOSE Pulmonary rehabilitation is a behavioral modification intervention shown to improve exercise tolerance and patient-reported quality of life in patients with fibrotic interstitial lung disease. Home-based rehabilitation may provide easier access for those who struggle to complete center-based rehabilitation programs due to increased symptom burden or frailty. METHODS We present the quantitative and qualitative findings of a pilot study of 21 patients with fibrotic interstitial lung disease who participated in a 12-wk home-based pulmonary rehabilitation program with activity monitoring and health coaching. RESULTS Pre- and post-intervention patient-reported outcome questionnaires suggested improvements in dyspnea and respiratory-related quality of life but were underpowered to meet statistical significance. Half had increases in mean daily step counts while a quarter declined because of disease progression. Qualitative analysis of semistructured participant interviews suggested a significant baseline disease burden with related secondary impacts, including anxiety regarding disease progression and prognosis. Many who participated had no specific program expectations or self-determined goals but still found the program impactful, particularly on their abilities to adapt and cope with the disease. CONCLUSION Our study suggests feasibility in a diverse set of patients with varying severity and diagnostic subtypes. We also provide quantitative and qualitative aspects of program impact on patient well-being and highlight the complex interaction between measured physical and self-reported outcomes and disease experience.
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Affiliation(s)
- Jennifer D. Duke
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN
| | - Teng Moua
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN
| | - Jennifer L. Ridgeway
- Robert D. and Patricia E. Kern Center for the Science of Healthcare Delivery, Mayo Clinic, Rochester, MN
| | - Madison Roy
- Department of Statistics, Mayo Clinic, Rochester, MN
| | - Maria Benzo
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN
| | - Johanna Hoult
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN
| | - Roberto Benzo
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN
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Ridgeway JL, Gerdes EOW, Dodge A, Liedl CP, Juntunen MB, Sundt WJS, Glasgow A, Lampman MA, Fink AL, Severson SB, Lin G, Sampson RR, Peterson RP, Murley BM, Klassen AB, Luke A, Friedman PA, Buechler TE, Newman JS, McCoy RG. Community paramedic hospital reduction and mitigation program: study protocol for a randomized pragmatic clinical trial. Trials 2023; 24:122. [PMID: 36805692 PMCID: PMC9940335 DOI: 10.1186/s13063-022-07034-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Accepted: 12/16/2022] [Indexed: 02/22/2023] Open
Abstract
BACKGROUND New patient-centered models of care are needed to individualize care and reduce high-cost care, including emergency department (ED) visits and hospitalizations for low- and intermediate-acuity conditions that could be managed outside the hospital setting. Community paramedics (CPs) have advanced training in low- and high-acuity care and are equipped to manage a wide range of health conditions, deliver patient education, and address social determinants of health in the home setting. The objective of this trial is to evaluate the effectiveness and implementation of the Care Anywhere with Community Paramedics (CACP) program with respect to shortening and preventing acute care utilization. METHODS This is a pragmatic, hybrid type 1, two-group, parallel-arm, 1:1 randomized clinical trial of CACP versus usual care that includes formative evaluation methods and assessment of implementation outcomes. It is being conducted in two sites in the US Midwest, which include small metropolitan areas and rural areas. Eligible patients are ≥ 18 years old; referred from an outpatient, ED, or hospital setting; clinically appropriate for ambulatory care with CP support; and residing within CP service areas of the referral sites. Aim 1 uses formative data collection with key clinical stakeholders and rapid qualitative analysis to identify potential facilitators/barriers to implementation and refine workflows in the 3-month period before trial enrollment commences (i.e., pre-implementation). Aim 2 uses mixed methods to evaluate CACP effectiveness, compared to usual care, by the number of days spent alive outside of the ED or hospital during the first 30 days following randomization (primary outcome), as well as self-reported quality of life and treatment burden, emergency medical services use, ED visits, hospitalizations, skilled nursing facility utilization, and adverse events (secondary outcomes). Implementation outcomes will be measured using the RE-AIM framework and include an assessment of perceived sustainability and metrics on equity in implementation. Aim 3 uses qualitative methods to understand patient, CP, and health care team perceptions of the intervention and recommendations for further refinement. In an effort to conduct a rigorous evaluation but also speed translation to practice, the planned duration of the trial is 15 months from the study launch to the end of enrollment. DISCUSSION This study will provide robust and timely evidence for the effectiveness of the CACP program, which may pave the way for large-scale implementation. Implementation outcomes will inform any needed refinements and best practices for scale-up and sustainability. TRIAL REGISTRATION ClinicalTrials.gov NCT05232799. Registered on 10 February 2022.
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Affiliation(s)
- Jennifer L. Ridgeway
- Division of Health Care Delivery Research, Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN USA
| | - Erin O. Wissler Gerdes
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN USA
| | - Andrew Dodge
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN USA
| | | | | | - Wendy J. S. Sundt
- Research Services – Clinical Trials Office, Mayo Clinic, Rochester, MN USA
| | - Amy Glasgow
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN USA
| | - Michelle A. Lampman
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN USA
| | - Angela L. Fink
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN USA
| | - Sara B. Severson
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN USA
| | - Grace Lin
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN USA
| | - Richard R. Sampson
- Department of Family Medicine, Mayo Clinic Health System - Northland, Barron, WI USA
| | - Robert P. Peterson
- Division of Hospital Internal Medicine, Mayo Clinic Health System - Northland, Barron, WI USA
| | | | - Aaron B. Klassen
- Department of Emergency Medicine, Mayo Clinic Ambulance, Rochester, MN USA
| | - Anuradha Luke
- Department of Emergency Medicine, Mayo Clinic Ambulance, Rochester, MN USA
| | - Paul A. Friedman
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN USA
| | | | - James S. Newman
- Division of Hospital Internal Medicine, Mayo Clinic, Rochester, MN USA
| | - Rozalina G. McCoy
- Division of Health Care Delivery Research, Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN USA
- Mayo Clinic Ambulance, Rochester, MN USA
- Department of Medicine, Division of Community Internal Medicine, Geriatrics, and Palliative Care, Rochester, MN USA
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15
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Cathcart-Rake EJ, Kling JM, Carroll EF, Davidge-Pitts C, Le-Rademacher J, Ridgeway JL, Gonzalez CA, Jatoi A. Understanding Disparities: A Case Illustrative of the Struggles Facing Transgender and Gender Diverse Patients With Cancer. J Natl Compr Canc Netw 2023; 21:227-230. [PMID: 36791758 DOI: 10.6004/jnccn.2023.7005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
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16
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Kunneman M, Branda ME, Ridgeway JL, Tiedje K, May CR, Linzer M, Inselman J, Buffington ALH, Coffey J, Boehm D, Deming J, Dick S, van Houten H, LeBlanc A, Liesinger J, Lima J, Nordeen J, Pencille L, Poplau S, Reed S, Vannelli A, Yost KJ, Ziegenfuss JY, Smith SA, Montori VM, Shah ND. Correction to: Making sense of diabetes medication decisions: a mixed methods cluster randomized trial using a conversation aid intervention. Endocrine 2023; 79:221-222. [PMID: 36357824 PMCID: PMC9813200 DOI: 10.1007/s12020-022-03240-3] [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: 11/12/2022]
Affiliation(s)
- Marleen Kunneman
- Knowledge and Evaluation Research Unit, Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Mayo Clinic, Rochester, MN, USA
- Medical Decision Making, Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, The Netherlands
| | - Megan E Branda
- Knowledge and Evaluation Research Unit, Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Mayo Clinic, Rochester, MN, USA
- Department of Biostatistics and Informatics, Colorado School of Public Health, University of Colorado-Denver Anschutz Medical Campus, Aurora, CO, USA
- Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| | - Jennifer L Ridgeway
- Division of Health Care Policy and Research, Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| | - Kristina Tiedje
- Laboratoire d'anthropologie des enjeux contemporains, Lyon, France
| | - Carl R May
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Mark Linzer
- Department of Medicine, Hennepin Healthcare and University of Minnesota, Minneapolis, MN, USA
| | - Jonathan Inselman
- Division of Health Care Policy and Research, Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
- Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Rochester, MN, USA
| | - Angela L H Buffington
- Department of Psychiatry and Psychology, Mayo Clinic Health System, Mankato, MN, USA
- Department of Family Medicine and Community Health, University of Minnesota Medical School, Minneapolis, MN, USA
| | - Jordan Coffey
- Practice-Based Research Network, Mayo Clinic, Rochester, MN, USA
- Center for Translational Science Activities, Mayo Clinic, Rochester, MN, USA
| | - Deborah Boehm
- Center for Patient and Provider Experience, Hennepin County Medical Center, Minneapolis, MN, USA
- School of Nursing, University of Minnesota, Minneapolis, MN, USA
- Decision Partners for Health, Richfield, MN, USA
| | - James Deming
- Mayo Clinic Health System Northwest Wisconsin, (dept) Home Health and Hospice, Eau Claire, WI, USA
| | - Sara Dick
- Knowledge and Evaluation Research Unit, Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Mayo Clinic, Rochester, MN, USA
| | - Holly van Houten
- Division of Health Care Policy and Research, Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| | - Annie LeBlanc
- Knowledge and Evaluation Research Unit, Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Mayo Clinic, Rochester, MN, USA
- Department of Family and Emergency Medicine, Faculty of Medicine, Laval University, Quebec, QC, Canada
| | - Juliette Liesinger
- Division of Health Care Policy and Research, Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
- Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Rochester, MN, USA
| | - Janet Lima
- Park Nicollet International Diabetes Center, St. Louis Park, MN, USA
| | | | - Laurie Pencille
- Knowledge and Evaluation Research Unit, Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Mayo Clinic, Rochester, MN, USA
- Kern Center for the Science of Health Care Deliver, Mayo Clinic, Rochester, MN, USA
| | - Sara Poplau
- Office of Professional Worklife, Hennepin Healthcare, Minneapolis, MN, USA
| | - Steven Reed
- Department of Internal Medicine, Park Nicollet Clinic, Brooklyn Center, MN, USA
| | - Anna Vannelli
- Park Nicollet International Diabetes Center, St. Louis Park, MN, USA
| | - Kathleen J Yost
- Division of Epidemiology, Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| | - Jeanette Y Ziegenfuss
- Division of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
- Center for Evaluation and Survey Research, HealthPartners Institute, Bloomington, IN, USA
| | - Steven A Smith
- Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Mayo Clinic, Rochester, MN, USA
| | - Victor M Montori
- Knowledge and Evaluation Research Unit, Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Mayo Clinic, Rochester, MN, USA
| | - Nilay D Shah
- Division of Health Care Policy and Research, Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA.
- Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Rochester, MN, USA.
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Dhruva SS, Ridgeway JL, Ross JS, Drozda, JP, Wilson NA. Exploring unique device identifier implementation and use for real-world evidence: a mixed-methods study with NESTcc health system network collaborators. BMJ Surg Interv Health Technol 2023; 5:e000167. [PMID: 36704544 PMCID: PMC9872505 DOI: 10.1136/bmjsit-2022-000167] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2022] [Accepted: 12/29/2022] [Indexed: 01/25/2023] Open
Abstract
Objectives To examine the current state of unique device identifier (UDI) implementation, including barriers and facilitators, among eight health systems participating in a research network committed to real-world evidence (RWE) generation for medical devices. Design Mixed methods, including a structured survey and semistructured interviews. Setting Eight health systems participating in the National Evaluation System for health Technology research network within the USA. Participants Individuals identified as being involved in or knowledgeable about UDI implementation or medical device identification from supply chain, information technology and high-volume procedural area(s) in their health system. Main outcomes measures Interview topics were related to UDI implementation, including barriers and facilitators; UDI use; benefits of UDI adoption; and vision for UDI implementation. Data were analysed using directed content analysis, drawing on prior conceptual models of UDI implementation and the Exploration, Preparation, Implementation, Sustainment framework. A brief survey of health system characteristics and scope of UDI implementation was also conducted. Results Thirty-five individuals completed interviews. Three of eight health systems reported having implemented UDI. Themes identified about barriers and facilitators to UDI implementation included knowledge of the UDI and its benefits among decision-makers; organisational systems, culture and networks that support technology and workflow changes; and external factors such as policy mandates and technology. A final theme focused on the availability of UDIs for RWE; lack of availability significantly hindered RWE studies on medical devices. Conclusions UDI adoption within health systems requires knowledge of and impetus to achieve operational and clinical benefits. These are necessary to support UDI availability for medical device safety and effectiveness studies and RWE generation.
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Affiliation(s)
- Sanket S. Dhruva
- Section of Cardiology, Department of Medicine, University of California San Francisco School of Medicine, San Francisco, California, USA
- San Francisco Veterans Affairs Medical Center, San Francisco, California, USA
| | - Jennifer L Ridgeway
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, and the Division of Health Care Delivery Research, Mayo Clinic, Rochester, Minnesota, USA
| | - Joseph S. Ross
- Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA
- Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, Connecticut, USA
| | | | - Natalia A Wilson
- Center for Healthcare Delivery and Policy, Arizona State University, Phoenix, Arizona, USA
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18
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Hartasanchez SA, Hargraves IG, Clark JE, Gravholt D, Brito JP, Branda ME, Gomez YL, Nautiyal V, Khurana CS, Thomas RJ, Montori VM, Ridgeway JL. The design and development of an encounter tool to support shared decision making about preventing cardiovascular events. Prev Med Rep 2022; 30:101994. [PMID: 36203943 PMCID: PMC9530931 DOI: 10.1016/j.pmedr.2022.101994] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Revised: 08/08/2022] [Accepted: 09/17/2022] [Indexed: 12/31/2022] Open
Abstract
Patients at high risk for cardiovascular disease (CVD) tend to receive less intensive preventive care. Clinical practice guidelines recommend shared decision making (SDM) to improve the quality of primary CVD prevention. There are tools for use during the clinical encounter that promote SDM, but, to our knowledge, there are no SDM encounter tools that support conversations about available lifestyle and pharmacological options that can lead to preventive care that is congruent with patient goals and CVD risk. Using the best available evidence and human-centered design (iterative design in the context of ultimate use with users), our team developed a SDM encounter tool, CV Prevention Choice. Each subsequent version during the iterative development process was evaluated in terms of content, usefulness, and usability by testing it in real preventive encounters. The final version of the tool includes a calculator that estimates the patient's risk of a major atherosclerotic CVD event in the next 10 years. Lifestyle and medication options are presented, alongside their pros, cons, costs, and other burdens. The risk reduction achieved by the selected prevention program is then displayed to support collaborative deliberation and decision making. A U.S. multicenter trial is estimating the effectiveness of CV Prevention Choice in achieving risk-concordant CV prevention while identifying the best strategies for increasing the adoption of the SDM encounter tool and its routine use in practice.
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Affiliation(s)
- Sandra A. Hartasanchez
- Knowledge and Evaluation Research Unit, Department of Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA
| | - Ian G. Hargraves
- Knowledge and Evaluation Research Unit, Department of Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA
| | - Jennifer E. Clark
- Knowledge and Evaluation Research Unit, Department of Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA
| | - Derek Gravholt
- Knowledge and Evaluation Research Unit, Department of Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA
| | - Juan P. Brito
- Knowledge and Evaluation Research Unit, Department of Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA
| | - Megan E. Branda
- Knowledge and Evaluation Research Unit, Department of Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA,Division of Clinical Trials and Biostatistics, Department of Quantitative Health Sciences, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA
| | - Yvonne L. Gomez
- Altru Health System, 1380 S. Columbia Road, Grand Forks, ND 58206, USA
| | - Vivek Nautiyal
- Wellstar Center for Cardiovascular Care, 55 Whitcher Street, NE, Suite 350, Marietta, GA 30060, USA
| | - Charanjit S. Khurana
- Virginia Hospital Center Physician Group-Cardiology, 1715 North George Mason Drive, Arlington, VA 22205, USA
| | - Randal J. Thomas
- Division of Preventive Cardiology, Department of Cardiovascular Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA
| | - Victor M. Montori
- Knowledge and Evaluation Research Unit, Department of Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA
| | - Jennifer L. Ridgeway
- Knowledge and Evaluation Research Unit, Department of Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA,Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA,Corresponding author at: 200 First Street SW, Rochester, MN 55905, USA.
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Mohamed AA, Ridgeway JL, Njeru JW, Molina LE, Ahmed YA, Goodson M, Osman A, Porraz Capetillo GD, Nur O, Sia IG, Wieland ML. The Recruitment to Dissemination Continuum in Community-based Participatory Research. Prog Community Health Partnersh 2022; 16:169-179. [PMID: 35662144 DOI: 10.1353/cpr.2022.0021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Dissemination of research findings to participants and communities, particularly among traditionally marginalized groups, is a systemic challenge. In community-based participatory research (CBPR), long-term partnerships may foster a link between recruitment to research studies, dissemination of results, and recruitment to future studies. OBJECTIVES To analyze the recruitment to dissemination continuum of a CBPR study and its potential impact on partnership processes and future research. METHODS We conducted a qualitative study with four focus groups with community members and academic partners who participated in the recruitment and the dissemination of research findings from a study of Hispanic and Somali social networks in Rochester, Minnesota. Thematic analysis and coding of focus group transcripts was conducted by investigators. The CBPR conceptual model for this partnership guided the analysis. RESULTS Trust, relationship building, and capacity building were key features for successful participant recruitment and research dissemination strategies. Strategies, resources, and relationships used or developed during the recruitment phase of research were directly applied to planning a dissemination event. Participants and members of their communities said they were more likely to participate in future research studies as a result of attending a dissemination event. CONCLUSIONS This study demonstrated the ways in which recruitment of marginalized populations to research studies and dissemination of study results can manifest as a continuum. This continuum is nurtured by trust, longitudinal relationships, and robust partnership dynamics. These factors fit well within an existing CBPR conceptual model.
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20
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DeStephano CC, Allyse MA, Abu Dabrh AMM, Ridgeway JL, Salinas M, Sherman ME, Spaulding AC. Pilot study of women's perspectives when abnormal uterine bleeding occurs during perimenopause. Climacteric 2022; 25:510-515. [PMID: 35652469 DOI: 10.1080/13697137.2022.2073810] [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: 11/03/2022]
Abstract
OBJECTIVE We gained insights into women's experiences and knowledge about the occurrence of vaginal bleeding during perimenopause requiring evaluation. METHODS Qualitative inquiry was chosen to explore topics in greater depth to understand individuals' experiences. Interviews with individuals were chosen due to the sensitive nature of gynecologic symptoms and management. Interviews were completed following gynecologic care to explore individuals' experiences with the evaluation and management of vaginal bleeding during perimenopause. RESULTS Twelve individuals were interviewed between December 2019 and March 2020. Patient uncertainty about the medical significance of developing vaginal bleeding during perimenopause was associated with self-appraisal and gathering information from multiple sources. This experience of seeking evaluation and treatment resulted in varying degrees of trust concerning information received within or outside the clinic. Regarding new technologies that could replace the current invasive tests performed for diagnosis (i.e. ultrasound, hysteroscopy and biopsy), most women preferred the smartphone app and tampon home collection option. CONCLUSIONS The experience of irregular or heavy vaginal bleeding during perimenopause is fraught with ambiguity, feelings of uncertainty about how to make sense of symptoms and inevitably begins with a period of self-appraisal.
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Affiliation(s)
- C C DeStephano
- Department of Medical and Surgical Gynecology, Mayo Clinic, Jacksonville, FL, USA.,Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Jacksonville, FL, USA
| | - M A Allyse
- Department of Clinical Genomics, Biomedical Ethics Research Program, Mayo Clinic, Jacksonville, FL, USA
| | - A M M Abu Dabrh
- Department of Integrative Medicine, Mayo Clinic, Jacksonville, FL, USA
| | - J L Ridgeway
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA
| | - M Salinas
- Center for Health Equity and Community Engaged Research, Mayo Clinic, Jacksonville, FL, USA
| | - M E Sherman
- Department of Quantitative Health Sciences, Mayo Clinic, Jacksonville, FL, USA
| | - A C Spaulding
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Jacksonville, FL, USA
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21
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Mohamed AA, Ridgeway JL, Njeru JW, Molina LE, Ahmed YA, Goodson M, Osman A, Porraz Capetillo GD, Nur O, Sia IG, Wieland ML. The Recruitment to Dissemination Continuum in Community-based Participatory Research. Prog Community Health Partnersh 2022. [DOI: 10.1353/cpr.2022.0016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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22
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Ridgeway JL, Jenkins S, Borah B, Suman VJ, Patel BK, Ghosh K, Rhodes DJ, Norman A, Ramos E, Jewett M, Gonzalez CR, Hernandez V, Singh D, Sosa M, Breitkopf CR, Vachon CM. Evaluating educational interventions to increase breast density awareness among Latinas: A randomized trial in a Federally Qualified Health Center. Cancer 2022; 128:1038-1047. [PMID: 34855208 PMCID: PMC8837698 DOI: 10.1002/cncr.34017] [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] [Received: 06/15/2021] [Revised: 10/08/2021] [Accepted: 10/12/2021] [Indexed: 12/14/2022]
Abstract
BACKGROUND The objective of this randomized trial was to evaluate the short-term effect of bilingual written and interpersonal education regarding mammographic breast density (MBD). METHODS Latinas aged 40 to 74 years who were presenting for screening mammography were recruited and randomized 1:1:1 to receive a letter with their mammogram and MBD results (usual care [UC]), a letter plus a brochure (enhanced care [ENH]), or a letter plus a brochure and telephonic promotora education (interpersonal care [INT]). Surveys were administered at enrollment (T0 ) and 2 weeks to 6 months after intervention delivery (T1 ). Differences were assessed with χ2 , Kruskal-Wallis, and McNemar tests and pairwise comparisons as appropriate. INT metrics and audio recordings were analyzed with descriptive statistics and qualitative content analysis. RESULTS Between October 2016 and October 2019, 943 of 1108 Latina participants (85%) completed both surveys. At T1 , INT participants were more likely (P < .001) to report seeing their MBD results in the letter (70.2%) than UC (53.1%) or ENH participants (55.1%). The percentage of INT women who reported speaking with a provider about MBD (29.0%) was significantly greater (P < .001) than the percentage of UC (14.7%) or ENH participants (15.6%). All groups saw significant (P < .001) but nondifferential improvements in their knowledge of MBD as a masking and risk factor. In the INT group, the promotora delivered education to 77.1% of the 446 participants randomized to INT and answered questions at 28.3% of the encounters for an average of $4.70 per participant. CONCLUSIONS Among Latinas in a low-resource setting, MBD knowledge may increase with written or interpersonal education, but with modest investment, interpersonal education may better improve MBD awareness and prompt patient-provider discussions.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | - Miranda Sosa
- University of Texas Rio Grande Valley, Edinburg and Brownsville, TX
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Kunneman M, Branda ME, Ridgeway JL, Tiedje K, May CR, Linzer M, Inselman J, Buffington ALH, Coffey J, Boehm D, Deming J, Dick S, van Houten H, LeBlanc A, Liesinger J, Lima J, Nordeen J, Pencille L, Poplau S, Reed S, Vannelli A, Yost KJ, Ziegenfuss JY, Smith SA, Montori VM, Shah ND. Making sense of diabetes medication decisions: a mixed methods cluster randomized trial using a conversation aid intervention. Endocrine 2022; 75:377-391. [PMID: 34499328 PMCID: PMC8428215 DOI: 10.1007/s12020-021-02861-4] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Accepted: 08/27/2021] [Indexed: 12/11/2022]
Abstract
PURPOSE To determine the effectiveness of a shared decision-making (SDM) tool versus guideline-informed usual care in translating evidence into primary care, and to explore how use of the tool changed patient perspectives about diabetes medication decision making. METHODS In this mixed methods multicenter cluster randomized trial, we included patients with type 2 diabetes mellitus and their primary care clinicians. We compared usual care with or without a within-encounter SDM conversation aid. We assessed participant-reported decisions made and quality of SDM (knowledge, satisfaction, and decisional conflict), clinical outcomes, adherence, and observer-based patient involvement in decision-making (OPTION12-scale). We used semi-structured interviews with patients to understand their perspectives. RESULTS We enrolled 350 patients and 99 clinicians from 20 practices and interviewed 26 patients. Use of the conversation aid increased post-encounter patient knowledge (correct answers, 52% vs. 45%, p = 0.02) and clinician involvement of patients (Mean between-arm difference in OPTION12, 7.3 (95% CI 3, 12); p = 0.003). There were no between-arm differences in treatment choice, patient or clinician satisfaction, encounter length, medication adherence, or glycemic control. Qualitative analyses highlighted differences in how clinicians involved patients in decision making, with intervention patients noting how clinicians guided them through conversations using factors important to them. CONCLUSIONS Using an SDM conversation aid improved patient knowledge and involvement in SDM without impacting treatment choice, encounter length, medication adherence or improved diabetes control in patients with type 2 diabetes. Future interventions may need to focus specifically on patients with signs of poor treatment fit. CLINICAL TRIAL REGISTRATION ClinicalTrial.gov: NCT01502891.
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Affiliation(s)
- Marleen Kunneman
- Knowledge and Evaluation Research Unit, Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Mayo Clinic, Rochester, MN, USA
- Medical Decision Making, Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, The Netherlands
| | - Megan E Branda
- Knowledge and Evaluation Research Unit, Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Mayo Clinic, Rochester, MN, USA
- Department of Biostatistics and Informatics, Colorado School of Public Health, University of Colorado-Denver Anschutz Medical Campus, Aurora, CO, USA
- Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| | - Jennifer L Ridgeway
- Division of Health Care Policy and Research, Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| | - Kristina Tiedje
- Laboratoire d'anthropologie des enjeux contemporains, Lyon, France
| | - Carl R May
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Mark Linzer
- Department of Medicine, Hennepin Healthcare and University of Minnesota, Minneapolis, MN, USA
| | - Jonathan Inselman
- Division of Health Care Policy and Research, Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
- Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Rochester, MN, USA
| | - Angela L H Buffington
- Department of Psychiatry and Psychology, Mayo Clinic Health System, Mankato, MN, USA
- Department of Family Medicine and Community Health, University of Minnesota Medical School, Minneapolis, MN, USA
| | - Jordan Coffey
- Practice-Based Research Network, Mayo Clinic, Rochester, MN, US
- Center for Translational Science Activities, Mayo Clinic, Rochester, MN, USA
| | - Deborah Boehm
- Center for Patient and Provider Experience, Hennepin County Medical Center, Minneapolis, MN, USA
- School of Nursing, University of Minnesota, Minneapolis, MN, USA
- Decision Partners for Health, Richfield, MN, USA
| | - James Deming
- Mayo Clinic Health System Northwest Wisconsin, (dept) Home Health and Hospice, Eau Claire, WI, USA
| | - Sara Dick
- Knowledge and Evaluation Research Unit, Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Mayo Clinic, Rochester, MN, USA
| | - Holly van Houten
- Division of Health Care Policy and Research, Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| | - Annie LeBlanc
- Knowledge and Evaluation Research Unit, Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Mayo Clinic, Rochester, MN, USA
- Department of Family and Emergency Medicine, Faculty of Medicine, Laval University, Quebec, QC, Canada
| | - Juliette Liesinger
- Division of Health Care Policy and Research, Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
- Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Rochester, MN, USA
| | - Janet Lima
- Park Nicollet International Diabetes Center, St. Louis Park, MN, USA
| | | | - Laurie Pencille
- Knowledge and Evaluation Research Unit, Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Mayo Clinic, Rochester, MN, USA
- Kern Center for the Science of Health Care Deliver, Mayo Clinic, Rochester, MN, USA
| | - Sara Poplau
- Office of Professional Worklife, Hennepin Healthcare, Minneapolis, MN, USA
| | - Steven Reed
- Department of Internal Medicine, Park Nicollet Clinic, Brooklyn Center, MN, USA
| | - Anna Vannelli
- Park Nicollet International Diabetes Center, St. Louis Park, MN, USA
| | - Kathleen J Yost
- Division of Epidemiology, Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| | - Jeanette Y Ziegenfuss
- Division of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
- Center for Evaluation and Survey Research, HealthPartners Institute, Bloomington, USA
| | - Steven A Smith
- Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Mayo Clinic, Rochester, MN, USA
| | - Victor M Montori
- Knowledge and Evaluation Research Unit, Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Mayo Clinic, Rochester, MN, USA
| | - Nilay D Shah
- Division of Health Care Policy and Research, Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA.
- Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Rochester, MN, USA.
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Patel BK, Ridgeway JL, Jenkins S, Rhodes DJ, Ghosh K, Borah B, Suman V, Norman A, Leaver J, Jewett M, Hruska C, Gonzalez C, Singh D, Vachon CM, Breitkopf CR. Breast Density Knowledge and Awareness Among Latinas in a Low-Resource Setting. J Am Coll Radiol 2022; 19:155-161. [PMID: 35033304 PMCID: PMC9896575 DOI: 10.1016/j.jacr.2021.08.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Accepted: 08/09/2021] [Indexed: 02/08/2023]
Abstract
PURPOSE Latinas in low-resource settings face additional barriers to understanding mammographic breast density (MBD) implications. The authors compared MBD awareness and knowledge in Latinas from a safety-net clinic in Arizona with a national sample. METHODS Latinas 40 to 74 years of age were recruited within a safety-net clinic during screening mammography appointments from 2016 to 2019 (AZ cohort) and from a nationally representative online panel in 2017 (NS cohort). Surveys completed in either English or Spanish assessed awareness and knowledge of MBD. Chi-square tests and logistic regression were used for comparisons. RESULTS The NS cohort (n = 152) was older, more educated, more likely to have undergone prior mammography, and more likely to prefer English compared with the AZ cohort (n = 1,327) (P ≤ .03 for all) The NS cohort was more likely to be aware of MBD (32.6% versus 20.7%). Of those aware, the NS cohort was more likely to understand MBD's effect on masking (67.8% versus 37.0%) and breast cancer risk (72.2% versus 32.6%) compared with the AZ cohort (P ≤ .001 for all). Adjusting for age, education, screening history, and language, MBD awareness was similar between the two cohorts (adjusted odds ratio [ORadj], 0.95; P = .83), but knowledge of MBD as a masking factor (ORadj, 2.8; P = .03) and risk factor (ORadj, 7.2; P < .001) remained higher in the NS cohort compared with the AZ cohort. CONCLUSIONS Differences in MBD awareness, but not knowledge, between Latinas in a low-resource setting compared with a national sample could be explained by age, education, screening history, and language preference, underscoring the need for tailored approaches to MBD education among Latinas.
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25
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Chlan LL, Ridgeway JL, Tofthagen CS, Hamann BR, Mele KE, Dozois D, Ness SM, Peterson LJ. Iterative development and pilot testing of an intervention fidelity monitoring plan for the enhanced, electronic health record-facilitated pragmatic clinical trial: Implications for training and protocol integrity. Contemp Clin Trials Commun 2021; 24:100868. [PMID: 34869939 PMCID: PMC8617340 DOI: 10.1016/j.conctc.2021.100868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 11/04/2021] [Accepted: 11/13/2021] [Indexed: 11/01/2022] Open
Abstract
Fidelity monitoring is the degree to which a clinical trial intervention is implemented as intended by a research protocol. Consistent implementation of research protocols supported with extant fidelity monitoring plans contribute rigor and validity of study results. Fidelity monitoring plans should be comprehensive yet practical to accommodate the realities of conducting research, particularly a pragmatic clinical trial, in dynamic settings with heterogeneous patient populations. The purposes of this paper are to describe the (1) iterative development and implementation of protocols for intervention fidelity monitoring, (2) pilot testing of the fidelity monitoring plan, (3) the identification of interventionist training deficiencies, and (4) opportunities to enhance protocol rigor for a cancer symptom management intervention delivered through the electronic health record patient portal and telephone as part of a complex, multi-component pragmatic clinical trial to uncover training deficits and bolster protocol integrity. The intervention focuses on prominent symptoms reported among medical oncology patients including sleep disturbance, pain, anxiety, depression, low energy (fatigue) and physical function. In this pragmatic trial, the role of interventionist is a registered nurse symptom care manager (RN SCM). A three-part fidelity monitoring plan with checklists audit: Part-1 RN SCM role training activities in research components, clinical training components, and protocol simulation training; Part-2 RN SCM adherence to the intervention core components delivered over the telephone; and Part-3 maintenance of adherence to core intervention components. The goal is ≥ 80% adherence to components of each of the three checklists. An initial pilot test of the fidelity monitoring plan was conducted to evaluate the checklists and the RN SCM adherence to core protocol components. RN SCM skills and training deficits were identified during the pilot phase, as were opportunities to improve protocol integrity. Overall, approximately 50% of the audited RN SCM telephone calls had ≥80% fidelity to the core components. There remains on-going need for RN SCM training and skill building in action planning. The content presented in this paper is intended to begin to fill the gap of fidelity monitoring plans for complex interventions tested in pragmatic clinical trials and delivered remotely in an effort to strengthen protocol integrity.
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Key Words
- E2C2, Enhanced Electronic Health Record-facilitated Cancer Symptom Control
- EHR, Electronic health record
- Electronic health record
- Intervention fidelity monitoring
- Nurse
- Patient-reported outcome measure
- RN, Registered Nurse
- SCM, Symptom Care Manager
- SMART, Specific-Measurable-Achievable-Relevant-Time limited
- SPADE, Sleep disturbance, Pain, Anxiety, Depression, Energy (fatigue)
- Self-management
- Symptom management
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Affiliation(s)
- Linda L Chlan
- Division of Nursing Research, Department of Nursing, Mayo Clinic 200 First St. SW, Rochester, MN, 55905, USA
| | - Jennifer L Ridgeway
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, USA
| | - Cindy S Tofthagen
- Division of Nursing Research, Department of Nursing, Mayo Clinic 4500 San Pablo Rd., Jacksonville, FL, 32224, USA
| | - Brianne R Hamann
- Division of Nursing Research, Department of Nursing, Mayo Clinic 200 First St. SW, Rochester, MN, 55905, USA
| | - Kendra E Mele
- Division of Nursing Research, Department of Nursing, Mayo Clinic 200 First St. SW, Rochester, MN, 55905, USA
| | - Donna Dozois
- Division of Nursing Research, Department of Nursing, Mayo Clinic 200 First St. SW, Rochester, MN, 55905, USA
| | - Sheryl M Ness
- Division of Nursing Research, Department of Nursing, Mayo Clinic 200 First St. SW, Rochester, MN, 55905, USA
| | - Laura J Peterson
- Division of Nursing Research, Department of Nursing, Mayo Clinic 200 First St. SW, Rochester, MN, 55905, USA
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Wintheiser GA, Ruddy KJ, Herrin J, Rahman PA, Pachman DR, Leppin AL, Rutten LJF, Lee MK, Griffin JM, Tofthagen C, Chlan LL, Ridgeway JL, Mitchell SA, Cheville AL. Receptivity to a Nurse-Led Symptom Management Intervention Amongst Highly Symptomatic Patients with Cancer. J Natl Cancer Inst 2021; 114:458-466. [PMID: 34508602 PMCID: PMC8902324 DOI: 10.1093/jnci/djab172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 07/09/2021] [Accepted: 09/08/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The symptom burden associated with cancer and its treatment can negatively impact patients' quality of life and survival. Symptom-focused collaborative care model (CCM) interventions can improve outcomes, but only if patients engage with them. We assessed the receptivity of severely symptomatic oncology patients to a remote nurse-led CCM intervention. METHODS In a pragmatic, cluster-randomized, stepped wedge trial conducted as part of the NCI IMPACT Consortium (E2C2, NCT03892967), patients receiving cancer care were asked to rate their sleep disturbance, pain, anxiety, emotional distress, fatigue, and limitations in physical function. Patients reporting at least one severe symptom (≥7/10) were offered phone consultation with a nurse symptom care manager (RN SCM). Initially, patients had to "opt-in" to receive a call, but the protocol was later modified so they had to "opt-out" if they did not want a call. We assessed the impact of opt-in vs. opt-out framing and patient characteristics on receptiveness to RN SCM calls. All statistical tests were 2-sided. RESULTS Of the 1204 symptom assessments (from 864 patients) on which at least one severe symptom was documented, 469 (39.0%) indicated receptivity to an RN SCM phone call. The opt-out period (odds ratio [OR] = 1.61, 95% confidence interval [CI] = 1.12 to 2.32, p=.01), receiving care at a tertiary care center (OR = 3.59, 95% CI = 2.18 to 5.91, p<.001), and having severe pain (OR = 1.80, 95% CI = 1.24 to 2.62, p=.002), were associated with statistically significantly greater willingness to receive a call. CONCLUSION Many severely symptomatic patients were not receptive to an RN SCM phone call. Better understanding of reasons for refusal and strategies for improving patient receptivity are needed.
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Affiliation(s)
| | - Kathryn J Ruddy
- Division of Medical Oncology, Mayo Clinic, Rochester, MN, USA
| | - Jeph Herrin
- Yale University School of Medicine, New Haven, CT, USA
| | - Parvez A Rahman
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA
| | | | - Aaron L Leppin
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA.,Division of Health Care Delivery Research, Mayo Clinic, Rochester, MN, USA
| | - Lila J Finney Rutten
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA.,Division of Health Care Delivery Research, Mayo Clinic, Rochester, MN, USA
| | - Minji K Lee
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA
| | - Joan M Griffin
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA.,Division of Health Care Delivery Research, Mayo Clinic, Rochester, MN, USA
| | - Cindy Tofthagen
- Department of Nursing, Nursing Research Division, Mayo Clinic, Jacksonville, FL, USA
| | - Linda L Chlan
- Department of Nursing, Nursing Research Division, Mayo Clinic, Rochester, MN, USA
| | - Jennifer L Ridgeway
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA
| | - Sandra A Mitchell
- Division of Cancer Control and Population Sciences, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Andrea L Cheville
- Division of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, MN, USA
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Colbenson GA, Ridgeway JL, Benzo RP, Kelm DJ. Examining Burnout in Interprofessional Intensive Care Unit Clinicians Using Qualitative Analysis. Am J Crit Care 2021; 30:391-396. [PMID: 34467381 DOI: 10.4037/ajcc2021423] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
BACKGROUND Health care professionals working in intensive care units report a high degree of burnout, but this topic has not been extensively studied from an interdisciplinary perspective. OBJECTIVE To characterize experiences of burnout among members of interprofessional intensive care unit teams and identify possible contributing factors. METHODS This qualitative study involved interviews of registered nurses, respiratory therapists, physicians, pharmacists, and a personal care assistant working in multiple intensive care units of a single academic medical center to assess work stressors. RESULTS Team composition was a factor in burnout, particularly when nonphysician team members felt that their opinions were not valued despite the institution's emphasis on a multidisciplinary team-based model of care. This was especially true when roles were not well defined at the outset of a code situation. Members of nearly all disciplines stated that there was not enough time in a day to complete all the required tasks. CONCLUSIONS Multiple factors contribute to work-related stress and burnout across different professions in the intensive care unit. Improved communication and increased receptivity to diverse opinions among members of the multidisciplinary team may help reduce stress.
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Affiliation(s)
- Gretchen A. Colbenson
- Gretchen A. Colbenson is a resident physician, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota
| | - Jennifer L. Ridgeway
- Jennifer L. Ridgeway is an assistant professor of health services and research, Kern Center for the Science of Health Care Delivery, Mayo Clinic
| | - Roberto P. Benzo
- Roberto P. Benzo is an associate professor of medicine, Division of Pulmonary and Critical Care Medicine, Mayo Clinic
| | - Diana J. Kelm
- Diana J. Kelm is an assistant professor of medicine, Division of Pulmonary and Critical Care Medicine, Mayo Clinic
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Ridgeway JL, Boardman LA, Griffin JM, Beebe TJ. Tracing the potential of networks to improve community cancer care: an in-depth single case study. Implement Sci Commun 2021; 2:92. [PMID: 34433489 PMCID: PMC8390226 DOI: 10.1186/s43058-021-00190-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Accepted: 07/25/2021] [Indexed: 11/11/2022] Open
Abstract
Background Despite overall declines in cancer mortality in the USA over the past three decades, many patients in community settings fail to receive evidence-based cancer care. Networks that link academic medical centers (AMCs) and community providers may reduce disparities by creating access to specialized expertise and care, but research on network effectiveness is mixed. The objective of this study was to identify factors related to whether and how an exemplar AMC network served to provide advice and referral access in community settings. Methods An embedded in–depth single case study design was employed to study a network in the Midwest USA that connects a leading cancer specialty AMC with community practices. The embedded case units were a subset of 20 patients with young-onset colorectal cancer or risk-related conditions and the providers involved in their care. The electronic health record (EHR) was reviewed from January 1, 1990, to February 28, 2018. Social network analysis identified care, advice, and referral relationships. Within-case process tracing provided detailed accounts of whether and how the network provided access to expert, evidence-based care or advice in order to identify factors related to network effectiveness. Results The network created access to evidence-based advice or care in some but not all case units, and there was variability in whether and how community providers engaged the network, including the path for referrals to the AMC and the way in which advice about an evidence-based approach to care was communicated from AMC specialists to community providers. Factors related to instances when the network functioned as intended included opportunities for both rich and lean communication between community providers and specialists, coordinated referrals, and efficient and adequately utilized documentation systems. Conclusions Network existence alone is insufficient to open up access to evidence-based expertise or care for patients in community settings. In-depth understanding of how this network operated provides insight into factors that support or inhibit the potential of networks to minimize disparities in access to evidence-based community cancer care, including both personal and organizational factors.
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Affiliation(s)
- Jennifer L Ridgeway
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, 55905, USA.
| | - Lisa A Boardman
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, 55905, USA
| | - Joan M Griffin
- Division of Health Care Delivery Research and Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, 55905, USA
| | - Timothy J Beebe
- Division of Health Policy and Management, University of Minnesota School of Public Health, Minneapolis, MN, 55455, USA
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Ridgeway JL, Njeru JW, Breitkopf CR, Mohamed AA, Quirindongo-Cedeño O, Sia IG, Wieland ML. Closing the Gap: Participatory Formative Evaluation to Reduce Cancer Screening Disparities among Patients with Limited English Proficiency. J Cancer Educ 2021; 36:795-803. [PMID: 32052262 DOI: 10.1007/s13187-020-01706-4] [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] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Patients with limited English proficiency (LEP) have disproportionately lower rates of cancer screening than English-proficient patients. Given the multifactorial nature of screening disparities, strategies to improve screening rates must address barriers within and outside of the clinic setting. The objectives of this study were to understand local barriers from multiple stakeholder perspectives, to identify potential multilevel intervention approaches, and to mobilize community-engaged intervention decision making and planning. This participatory formative evaluation approach employed needs assessment and user engagement in order to enhance intervention usefulness and relevance. The study took place in several stages and involved clinic and community partners in a small metropolitan area of the Midwest USA. Interviews were conducted with LEP patients (n = 9) who had not completed three recommended screenings (breast, cervical, and colorectal), primary care providers (n = 5), medical interpreter (n = 5), and community members (n = 3). These highlighted multilevel barriers including limited patient understanding of preventive health, time and cost constraints, and variable roles of language interpreters. The literature was also reviewed to identify interventions used with similar populations. Findings from this review suggest that interventions are largely focused on single population groups or address single screening barriers. Finally, a community-academic summit (n = 48 participants) was held to review results and develop recommendations for community and clinic interventions. Findings from this study indicate that it is possible to engage a diverse group of stakeholders in strategies that are responsive to health care providers and patients, including LEP patients from heterogeneous backgrounds.
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Affiliation(s)
- Jennifer L Ridgeway
- Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA
| | - Jane W Njeru
- Division of Community Internal Medicine, Mayo Clinic, 200 1st St. SW, Rochester, MN, 55905, USA
| | | | - Ahmed A Mohamed
- Division of Community Internal Medicine, Mayo Clinic, 200 1st St. SW, Rochester, MN, 55905, USA
| | | | - Irene G Sia
- Division of Infectious Diseases, Mayo Clinic, Rochester, MN, USA
| | - Mark L Wieland
- Division of Community Internal Medicine, Mayo Clinic, 200 1st St. SW, Rochester, MN, 55905, USA.
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Ridgeway JL, Branda ME, Gravholt D, Brito JP, Hargraves IG, Hartasanchez SA, Leppin AL, Gomez YL, Mann DM, Nautiyal V, Thomas RJ, Behnken EM, Torres Roldan VD, Shah ND, Khurana CS, Montori VM. Increasing risk-concordant cardiovascular care in diverse health systems: a mixed methods pragmatic stepped wedge cluster randomized implementation trial of shared decision making (SDM4IP). Implement Sci Commun 2021; 2:43. [PMID: 33883035 PMCID: PMC8058970 DOI: 10.1186/s43058-021-00145-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Accepted: 04/05/2021] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND The primary prevention of cardiovascular (CV) events is often less intense in persons at higher CV risk and vice versa. Clinical practice guidelines recommend that clinicians and patients use shared decision making (SDM) to arrive at an effective and feasible prevention plan that is congruent with each person's CV risk and informed preferences. However, SDM does not routinely happen in practice. This study aims to integrate into routine care an SDM decision tool (CV PREVENTION CHOICE) at three diverse healthcare systems in the USA and study strategies that foster its adoption and routine use. METHODS This is a mixed method, hybrid type III stepped wedge cluster randomized study to estimate (a) the effectiveness of implementation strategies on SDM uptake and utilization and (b) the extent to which SDM results in prevention plans that are risk-congruent. Formative evaluation methods, including clinician and stakeholder interviews and surveys, will identify factors likely to impact feasibility, acceptability, and adoption of CV PREVENTION CHOICE as well as normalization of CV PREVENTION CHOICE in routine care. Implementation facilitation will be used to tailor implementation strategies to local needs, and implementation strategies will be systematically adjusted and tracked for assessment and refinement. Electronic health record data will be used to assess implementation and effectiveness outcomes, including CV PREVENTION CHOICE reach, adoption, implementation, maintenance, and effectiveness (measured as risk-concordant care plans). A sample of video-recorded clinical encounters and patient surveys will be used to assess fidelity. The study employs three theoretical approaches: a determinant framework that calls attention to categories of factors that may foster or inhibit implementation outcomes (the Consolidated Framework for Implementation Research), an implementation theory that guides explanation or understanding of causal influences on implementation outcomes (Normalization Process Theory), and an evaluation framework (RE-AIM). DISCUSSION By the project's end, we expect to have (a) identified the most effective implementation strategies to embed SDM in routine practice and (b) estimated the effectiveness of SDM to achieve feasible and risk-concordant CV prevention in primary care. TRIAL REGISTRATION ClinicalTrials.gov, NCT04450914 . Posted June 30, 2020 TRIAL STATUS: This study received ethics approval on April 17, 2020. The current trial protocol is version 2 (approved February 17, 2021). The first subject had not yet been enrolled at the time of submission.
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Affiliation(s)
- Jennifer L Ridgeway
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.
- Knowledge and Evaluation Research Unit, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.
| | - Megan E Branda
- Knowledge and Evaluation Research Unit, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
- Department of Biostatistics and Informatics, Colorado School of Public Health, University of Colorado-Denver Anschutz Medical Campus, 13001 East 17th Place, 3rd Floor, Mail Stop B119, Aurora, CO, 80045, USA
| | - Derek Gravholt
- Knowledge and Evaluation Research Unit, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Juan P Brito
- Knowledge and Evaluation Research Unit, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
- Division of Diabetes, Endocrinology, Metabolism, and Nutrition, Department of Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Ian G Hargraves
- Knowledge and Evaluation Research Unit, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Sandra A Hartasanchez
- Knowledge and Evaluation Research Unit, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Aaron L Leppin
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
- Knowledge and Evaluation Research Unit, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Yvonne L Gomez
- Altru Health System, 1380 S. Columbia Road, Grand Forks, ND, 58206, USA
| | - Devin M Mann
- Department of Population Health, NYU Grossman School of Medicine, 530 1st Avenue, New York, NY, 10016, USA
| | - Vivek Nautiyal
- Wellstar Cardiovascular Medicine, 55 Whitcher Street, NE, Suite 350, Marietta, GA, 30060, USA
| | - Randal J Thomas
- Division of Preventive Cardiology, Department of Cardiovascular Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Emma M Behnken
- Knowledge and Evaluation Research Unit, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Victor D Torres Roldan
- Knowledge and Evaluation Research Unit, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Nilay D Shah
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Charanjit S Khurana
- Virginia Hospital Center Physician Group-Cardiology, 1715 North George Mason Drive, Arlington, VA, 22205, USA
| | - Victor M Montori
- Knowledge and Evaluation Research Unit, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
- Division of Diabetes, Endocrinology, Metabolism, and Nutrition, Department of Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
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Rockey NG, Weiskittel TM, Linder KE, Ridgeway JL, Wieland ML. A mixed methods study to evaluate the impact of a student-run clinic on undergraduate medical education. BMC Med Educ 2021; 21:182. [PMID: 33766015 PMCID: PMC7992336 DOI: 10.1186/s12909-021-02621-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Accepted: 03/16/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND The purpose of this study was to evaluate the extent to which a longitudinal student-run clinic (SRC) is meeting its stated learning objectives, including providing critical community services and developing physicians who more fully appreciate the social factors affecting their patients' health. METHODS This was a mixed methods program evaluation of an SRC at Mayo Clinic Alix School of Medicine (MCASOM). A survey was conducted of medical students who had participated in the clinic and seven interviews and three focus groups were conducted with SRC patients, students, faculty, staff, and board members. Transcripts were coded for systematic themes and sub-themes. Major themes were reported. Survey and interview data were integrated by comparing findings and discussing areas of convergence or divergence in order to more fully understand program success and potential areas for improvement. RESULTS Greater than 85% of student survey respondents (N = 90) agreed or strongly agreed that the SRC met each of its objectives: to provide a vital community service, to explore social determinants of health (SDH), to understand barriers to healthcare access and to practice patience-centered examination. Qualitative data revealed that the SRC contextualized authentic patient care experiences early in students' medical school careers, but the depth of learning was variable between students. Furthermore, exposure to SDH through the program did not necessarily translate to student understanding of the impact of these social factors on patient's health nor did it clearly influence students' future practice goals. CONCLUSIONS The MCASOM SRC experience met core learning objectives, but opportunities to improve long-term impact on students were identified. Participation in the SRC enabled students to engage in patient care early in training that is representative of future practices. SRCs are an avenue by which students can gain exposure to real-world applications of SDH and barriers to healthcare access, but additional focus on faculty development and intentional reflection may be needed to translate this exposure to actionable student understanding of social factors that impact patient care.
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Affiliation(s)
- Nathan G. Rockey
- Mayo Clinic Alix School of Medicine, 200 First Street SW, Rochester, MN 55905 USA
| | - Taylor M. Weiskittel
- Mayo Clinic Graduate School of Biomedical Sciences, 200 First Street SW, Rochester, MN 55905 USA
| | - Katharine E. Linder
- Mayo Clinic Alix School of Medicine, 200 First Street SW, Rochester, MN 55905 USA
| | - Jennifer L. Ridgeway
- Center for the Science of Healthcare Delivery, Mayo Clinic, 200 First Street SW, Rochester, MN 55905 USA
| | - Mark L. Wieland
- Division of Community Internal Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN 55905 USA
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Moua T, Kubbara A, Novotny P, Ridgeway JL, Limper AH, Ryu JH, Clark MM, Benzo R. Patient-reported quality of life in fibrotic interstitial lung disease: novel assessments of self-management ability and affect. ERJ Open Res 2021; 7:00011-2021. [PMID: 33718495 PMCID: PMC7938053 DOI: 10.1183/23120541.00011-2021] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Accepted: 01/12/2021] [Indexed: 11/05/2022] Open
Abstract
Current medical therapy in the treatment of fibrotic interstitial lung disease (f-ILD) is focused on objective improvement or stabilisation of lung function decline as represented by raw or per cent predicted forced vital capacity (FVC % pred). Patient-reported quality of life (PR-QoL) outcomes, as measured from the viewpoint of how patients assess their own health-related well-being, have not been the primary targets of recent clinical trials. However, it has been reported that lung function (i.e. measured FVC % pred) in f-ILD correlates poorly with patient-reported well-being [1]. This study explored the degree to which two previously unassessed PR-QoL outcomes in f-ILD correlate with clinical and functional parameters, and a respiratory-related QoL instrument applied in a novel manner. Patient-reported outcomes in fibrotic interstitial lung disease may be additionally predicted by novel assessments of self-management ability and affecthttps://bit.ly/3iwP5M2
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Affiliation(s)
- Teng Moua
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN, USA
| | - Aahd Kubbara
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN, USA
| | - Paul Novotny
- Dept of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| | - Jennifer L Ridgeway
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA
| | - Andrew H Limper
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN, USA.,Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA
| | - Jay H Ryu
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN, USA
| | - Matthew M Clark
- Dept of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, USA
| | - Roberto Benzo
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN, USA
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Finney Rutten LJ, Zhu X, Leppin AL, Ridgeway JL, Swift MD, Griffin JM, St Sauver JL, Virk A, Jacobson RM. Evidence-Based Strategies for Clinical Organizations to Address COVID-19 Vaccine Hesitancy. Mayo Clin Proc 2021; 96:699-707. [PMID: 33673921 PMCID: PMC7772995 DOI: 10.1016/j.mayocp.2020.12.024] [Citation(s) in RCA: 166] [Impact Index Per Article: 55.3] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Accepted: 12/28/2020] [Indexed: 12/24/2022]
Abstract
The success of vaccination programs is contingent upon irrefutable scientific safety data combined with high rates of public acceptance and population coverage. Vaccine hesitancy, characterized by lack of confidence in vaccination and/or complacency about vaccination that may lead to delay or refusal of vaccination despite the availability of services, threatens to undermine the success of coronavirus disease 2019 (COVID-19) vaccination programs. The rapid pace of vaccine development, misinformation in popular and social media, the polarized sociopolitical environment, and the inherent complexities of large-scale vaccination efforts may undermine vaccination confidence and increase complacency about COVID-19 vaccination. Although the experience of recent lethal surges of COVID-19 infections has underscored the value of COVID-19 vaccines, ensuring population uptake of COVID-19 vaccination will require application of multilevel, evidence-based strategies to influence behavior change and address vaccine hesitancy. Recent survey research evaluating public attitudes in the United States toward the COVID-19 vaccine reveals substantial vaccine hesitancy. Building upon efforts at the policy and community level to ensure population access to COVID-19 vaccination, a strong health care system response is critical to address vaccine hesitancy. Drawing on the evidence base in social, behavioral, communication, and implementation science, we review, summarize, and encourage use of interpersonal, individual-level, and organizational interventions within clinical organizations to address this critical gap and improve population adoption of COVID-19 vaccination.
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Affiliation(s)
- Lila J Finney Rutten
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN; Division of Health Care Policy and Research, Mayo Clinic, Rochester, MN
| | - Xuan Zhu
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN; Division of Health Care Policy and Research, Mayo Clinic, Rochester, MN
| | - Aaron L Leppin
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN; Division of Health Care Policy and Research, Mayo Clinic, Rochester, MN
| | - Jennifer L Ridgeway
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN; Division of Health Care Policy and Research, Mayo Clinic, Rochester, MN
| | - Melanie D Swift
- Department of Health Sciences Research, Division of Infectious Diseases, Mayo Clinic, Rochester, MN
| | - Joan M Griffin
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN; Division of Health Care Policy and Research, Mayo Clinic, Rochester, MN
| | - Jennifer L St Sauver
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN; Division of Epidemiology, Mayo Clinic, Rochester, MN
| | - Abinash Virk
- Division of Preventive, Occupational, and Aerospace Medicine, Mayo Clinic, Rochester, MN
| | - Robert M Jacobson
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN; Division of Health Care Policy and Research, Mayo Clinic, Rochester, MN; Department of Medicine, and Division of Community Pediatric and Adolescent Medicine and Division of Pediatric Infectious Diseases, Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN.
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Carlson LM, Ridgeway JL, Asiedu GB, Wieland ML, Sia IG, Porraz Capetillo G, Bernard ME, Hanza MM, Njeru JW. Facilitated Stories for Change: Digital Storytelling as a Tool for Engagement in Facilitated Discussion for Reduction of Diabetes-Related Health Disparities Among Rural Latino Patients With Diabetes. J Transcult Nurs 2020; 32:707-715. [PMID: 33350356 DOI: 10.1177/1043659620980816] [Citation(s) in RCA: 2] [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: 11/15/2022] Open
Abstract
INTRODUCTION Latino populations, particularly those living in rural areas, experience a disproportionately high prevalence and poorer outcomes of type 2 diabetes mellitus (T2DM). The purpose of this study was to test the acceptability and perceived effectiveness of a group-based, facilitated digital storytelling intervention for T2DM self-management among rural Latino patients. METHOD Twenty Latino adults with T2DM participated in facilitated storytelling discussions at two primary clinics. Participants viewed a 12-minute T2DM self-management digital storytelling intervention, followed by a facilitated group discussion. Surveys, observations, and focus groups were used to assess for acceptability and perceived effectiveness of the intervention through descriptive and qualitative analysis, informed by narrative and social cognitive theory. RESULTS All participants found the intervention interesting and useful and reported improvement in confidence, motivation, and behavioral intentions for T2DM self-management. Themes mapped closely with narrative theory models, further suggestive of the behavior change potential. DISCUSSION Facilitated discussions may add value to viewing of digital stories and represent a scalable approach to provide culturally congruent health care for Latino patients with diabetes in rural settings. Within the paradigm of group-based diabetes educational programs, this lends itself well to critical transcultural nursing care.
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Ridgeway JL, Jenkins SM, Rhodes DJ, Patel BK, Ramos E, Borah B, Ghosh K, Suman VJ, Norman A, Singh D, Vachon CM. Abstract PO-245: Evaluating educational interventions to increase breast density awareness among Latinas: A randomized clinical trial in a Federally Qualified Health Center. Cancer Epidemiol Biomarkers Prev 2020. [DOI: 10.1158/1538-7755.disp20-po-245] [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] Open
Abstract
Abstract
Purpose: Among a Latina population in a low resource healthcare setting, to test the effectiveness of bilingual (Spanish/English) written and interpersonal educational interventions in increasing breast density (BD) awareness, knowledge, and conversations with healthcare providers, which are goals of BD notification mandates. Procedures: This randomized trial was conducted at a Federally Qualified Health Center (FQHC) in an urban community of the Southwest U.S. Women ages 40- 74 presenting for screening mammography were recruited and randomized 1:1:1 to usual care (mailed letter with mammogram and BD results), enhanced care (letter plus BD educational brochure), or interpersonal care (letter, brochure, and telephonic promotora education). The baseline survey was administered in person at enrollment prior to the mammogram. Follow-up surveys were by phone or mail after the mammography results letter was mailed and promotora delivery was complete (median days from baseline to follow-up survey = 97 days). Differences between groups at baseline or follow-up were assessed with chi-square tests. Logistic regression using generalized estimating equations to account for repeated data was used to assess differences by time (baseline to follow-up) within group, including a time-by-group interaction. Results: Between October 2016 and October 2019, 1377 women were enrolled. Of these, 1085 (79%) self-identified Latinas completed baseline and follow-up surveys. Median age was 47 years. Most (91%) reported speaking mostly Spanish, and 69.1% had less than a high school degree. At baseline, only 20.9% reported having heard of BD, and only 30.5% of those knew their personal BD category. At follow-up, women in the interpersonal group were more likely to report seeing their BD results in the notification letter compared to the usual care and enhanced groups (70.4% vs. 52.9% and 54.3%, p < 0.001) and to report having spoken with a provider about their BD (27.3% vs. 14.2% and 15.7%, p < 0.001). They also reported higher mean understanding of BD (7.7 on a 0-10 scale vs. 6.3 and 6.6, p < 0.001). There were no significant differences on these outcomes between the usual care and enhanced groups. All groups saw significant improvement in correct responses from baseline to follow-up for questions on the ability of BD to mask tumors on a mammogram and BD as a breast cancer risk factor (p < 0.001 all groups), but the degree of improvement in masking knowledge was significantly higher for the interpersonal vs usual care group [OR for a correct response in follow-up vs baseline: 6.4 (interpersonal) vs 3.7 (usual care), p=0.01].
Conclusion: Among a Latina population in a FQHC, telephonic promotora education was more effective than written notification alone or a mailed brochure on key goals of notification mandates. Adding a brochure does not appear to be more effective than sending a letter alone on key outcomes, but the interpersonal nature of promotora education may prompt attention to mailed information and provide an opportunity for questions.
Citation Format: Jennifer L. Ridgeway, Sarah M. Jenkins, Deborah J. Rhodes, Bhavika K. Patel, Edna Ramos, Bijan Borah, Karthik Ghosh, Vera J. Suman, Aaron Norman, Davinder Singh, Celine M. Vachon. Evaluating educational interventions to increase breast density awareness among Latinas: A randomized clinical trial in a Federally Qualified Health Center [abstract]. In: Proceedings of the AACR Virtual Conference: Thirteenth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2020 Oct 2-4. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(12 Suppl):Abstract nr PO-245.
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Leaver J, Patel BK, Ridgeway JL, Jenkins S, Suman V, Rhodes DJ, Norman A, Ghosh K, Borah B, Hruska C, Ramos E, Singh D, Jewett M, Radecki-Breitkof C, Vachon C. Abstract PO-238: Breast density knowledge and awareness among Latinas in a low-resource setting: A comparison nationally-representative sample of Latinas. Cancer Epidemiol Biomarkers Prev 2020. [DOI: 10.1158/1538-7755.disp20-po-238] [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] Open
Abstract
Abstract
Objective: Breast density notification laws aim to increase women’s awareness and knowledge about breast density (BD). This study’s aim was to compare BD knowledge and awareness in two Hispanic populations: a safety-net clinic serving Latina population in Maricopa County, Arizona (AZ) and a national sample of Hispanic women participating in an online research panel. Materials/Methods: Women ages 40-74 were recruited at the AZ clinic from 2016-2019 at a screening mammography appointment as part of a larger clinical trial (AZ cohort). Surveys were completed in person (English or Spanish) at enrollment to assess awareness of BD, understanding of BD risk, and mammography history. The same questions were asked in a nationally representative online panel survey conducted in 2017. All data from the national survey were weighted to adjust for probability of selection into the panel and post-stratified to match known U.S. Hispanic population distributions (NS cohort). Univariate comparisons between the clinic and the national panel were performed using Rao-Scott chi-square tests. Associations with awareness and correct knowledge were examined with multivariable logistic regression. All summaries and analyses are weighted, and were performed with SAS version 9.4 SURVEY procedures (SAS Institute Inc., Cary, NC). Results: The analysis included 1332 Hispanic women from the AZ clinic and 152 Hispanic women who completed the national survey. The AZ cohort was younger (mean age: 48.5 vs 52.8), had less education (less than high school: 68.7% vs 34.8% less than high school), more likely to prefer Spanish (92.3% vs 53.1%) and less likely to have had a prior mammogram as compared NS cohort (82.8% vs 90.4%) (all p≤ 0.03). NS cohort was more likely to have awareness of BD (32.6% vs 20.7%); correct understanding of the masking effect of BD, (67.8% vs 37.0%,) and breast cancer risk (72.2% vs 32.6%,), compared to the AZ cohort (all p < 0.004). When adjusted for differences in education, age, language, and screening mammography history, BD awareness was similar between the two cohorts (adjusted odds ratio [ORadj] 0.95, p=0.83). Awareness was positively associated with more education, previous mammogram history, and English language. However, differences in BD knowledge remained (ORadj=2.8 [p=0.03] and 7.2 [P<0.001] for knowledge of masking and risk, respectively). Conclusions: There were significant differences in BD awareness and knowledge between a nationally-representative sample of Latinas and Latinas in a low-resource setting. The differences in BD awareness, but not knowledge, could be explained by education, screening history and preferred language. These findings suggest that a one-size-fits-all approach to raising BD awareness and knowledge will not work. To ensure equitable dissemination of health care to Latina women undergoing screening mammography, future work should be aimed at developing effective tools and resources for educating Spanish-speaking women about BD and risk-based screening.
Citation Format: Jillian Leaver, Bhavika K. Patel, Jennifer L. Ridgeway, Sarah Jenkins, Vera Suman, Deborah J. Rhodes, Aaron Norman, Karthik Ghosh, Bijan Borah, Carrie Hruska, Edna Ramos, Davinder Singh, Matt Jewett, Carmen Radecki-Breitkof, Celine Vachon. Breast density knowledge and awareness among Latinas in a low-resource setting: A comparison nationally-representative sample of Latinas [abstract]. In: Proceedings of the AACR Virtual Conference: Thirteenth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2020 Oct 2-4. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(12 Suppl):Abstract nr PO-238.
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Finney Rutten LJ, Ruddy KJ, Chlan LL, Griffin JM, Herrin J, Leppin AL, Pachman DR, Ridgeway JL, Rahman PA, Storlie CB, Wilson PM, Cheville AL. Pragmatic cluster randomized trial to evaluate effectiveness and implementation of enhanced EHR-facilitated cancer symptom control (E2C2). Trials 2020; 21:480. [PMID: 32503661 PMCID: PMC7275300 DOI: 10.1186/s13063-020-04335-w] [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] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Accepted: 04/21/2020] [Indexed: 01/01/2023] Open
Abstract
Background The prevalence of inadequate symptom control among cancer patients is quite high despite the availability of definitive care guidelines and accurate and efficient assessment tools. Methods We will conduct a hybrid type 2 stepped wedge pragmatic cluster randomized clinical trial to evaluate a guideline-informed enhanced, electronic health record (EHR)-facilitated cancer symptom control (E2C2) care model. Teams of clinicians at five hospitals that care for patients with various cancers will be randomly assigned in steps to the E2C2 intervention. The E2C2 intervention will have two levels of care: level 1 will offer low-touch, automated self-management support for patients reporting moderate sleep disturbance, pain, anxiety, depression, and energy deficit symptoms or limitations in physical function (or both). Level 2 will offer nurse-managed collaborative care for patients reporting more intense (severe) symptoms or functional limitations (or both). By surveying and interviewing clinical staff, we will also evaluate whether the use of a multifaceted, evidence-based implementation strategy to support adoption and use of the E2C2 technologies improves patient and clinical outcomes. Finally, we will conduct a mixed methods evaluation to identify disparities in the adoption and implementation of the E2C2 intervention among elderly and rural-dwelling patients with cancer. Discussion The E2C2 intervention offers a pragmatic, scalable approach to delivering guideline-based symptom and function management for cancer patients. Since discrete EHR-imbedded algorithms drive defining aspects of the intervention, the approach can be efficiently disseminated and updated by specifying and modifying these centralized EHR algorithms. Trial registration ClinicalTrials.gov, NCT03892967. Registered on 25 March 2019.
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Affiliation(s)
- Lila J Finney Rutten
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA. .,Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA.
| | - Kathryn J Ruddy
- Division of Medical Oncology, Mayo Clinic, Rochester, MN, USA
| | - Linda L Chlan
- Department of Nursing, Mayo Clinic, Rochester, MN, USA
| | - Joan M Griffin
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA.,Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA
| | - Jeph Herrin
- Yale University School of Medicine, New Haven, CT, USA
| | - Aaron L Leppin
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA.,Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, MN, USA
| | | | - Jennifer L Ridgeway
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA
| | - Parvez A Rahman
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA
| | - Curtis B Storlie
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| | - Patrick M Wilson
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA
| | - Andrea L Cheville
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA.,Division of Community Palliative Medicine, Mayo Clinic, Rochester, MN, USA
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Kelm DJ, Ridgeway JL, Ratelle JT, Sawatsky AP, Halvorsen AJ, Niven AS, Brady A, Hayes MM, McSparron JI, Ramar K, Beckman TJ. Characteristics of Effective Teachers of Invasive Bedside Procedures: A Multi-institutional Qualitative Study. Chest 2020; 158:2047-2057. [PMID: 32428512 DOI: 10.1016/j.chest.2020.04.060] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Revised: 04/20/2020] [Accepted: 04/26/2020] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Faculty supervision of invasive bedside procedures (IBPs) in the ICU may enhance procedural education and ensure patient safety. However, there is limited research on teaching effectiveness in the ICU, and there are no best teaching practices regarding the supervision of IBPs. RESEARCH QUESTION We conducted a multi-institutional qualitative study of pulmonary and critical care medicine faculty and fellows to better understand characteristics of effective IBP teachers. STUDY DESIGN AND METHODS Separate focus groups (FGs) were conducted with fellows and faculty at four large academic institutions that were geographically distributed across the United States. FGs were facilitated by a trained investigator, audio-recorded, and transcribed verbatim for analysis. Themes were identified inductively and compared with constructs from social and situated learning theories. Data were analyzed between and across professional groups. Qualitative research software (NVivo; QSR International) was used to facilitate data organization and create an audit trail of the analysis. A multidisciplinary research team was engaged to minimize interpretive bias. RESULTS Thirty-three faculty and 30 fellows participated. Inductive analysis revealed three categories of themes among successful IBP teachers: traits, behaviors, and context. Traits included calm demeanor, trust, procedural competence, and effective communication. Behaviors included leading preprocedure huddles to assess learners' experiences and define expectations; debriefing to provide feedback; and allowing appropriate autonomy. Context included learning climate, levels of distraction, patient acuity, and institutional culture. INTERPRETATION We identified specific traits and behaviors of effective IBP teachers that intersect with the practice environment, which highlights the challenge of teaching IBPs. Notably, FG participants emphasized interpersonal, more than technical, aspects of successful IBP teachers. These findings should inform future curricula on teaching IBPs in the ICU, standardize IBP teaching for pulmonary and critical care medicine fellows, and reduce patient injury from procedural complications.
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Affiliation(s)
- Diana J Kelm
- Division of Pulmonary Critical Care Medicine, Department of Medicine, Mayo Clinic, Rochester, MN.
| | - Jennifer L Ridgeway
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN
| | - John T Ratelle
- Division of Hospital Medicine, Department of Medicine, Mayo Clinic, Rochester, MN
| | - Adam P Sawatsky
- Division of General Internal Medicine, Department of Medicine, Mayo Clinic, Rochester, MN
| | - Andrew J Halvorsen
- Office of Educational Innovations, Internal Medicine Residency Program, Department of Medicine, Mayo Clinic, Rochester, MN
| | - Alexander S Niven
- Division of Pulmonary Critical Care Medicine, Department of Medicine, Mayo Clinic, Rochester, MN
| | - Anna Brady
- Division of Pulmonary Critical Care Medicine, Department of Medicine, Oregon Health and Science University, Portland, OR
| | - Margaret M Hayes
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA
| | - Jakob I McSparron
- Division of Pulmonary Critical Care Medicine, Department of Medicine, University of Michigan, Ann Arbor, MI
| | - Kannan Ramar
- Division of Pulmonary Critical Care Medicine, Department of Medicine, Mayo Clinic, Rochester, MN
| | - Thomas J Beckman
- Division of General Internal Medicine, Department of Medicine, Mayo Clinic, Rochester, MN
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Biggs BK, Tolleson E, Millerbernd J, Bronars C, Meiers SJ, Slowiak K, Olson M, Lebow J, Ridgeway JL, Patten CA, Clark MM, Sia IG, Wieland ML. Identifying Opportunities to Promote Physical Activity in a Diverse Low-Income Population: A Mixed-Method Study at a Boys & Girls Club Site. Child Youth Care Forum 2020; 49:171-200. [PMID: 33833490 PMCID: PMC8025775 DOI: 10.1007/s10566-019-09521-9] [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: 11/26/2022]
Abstract
BACKGROUND Prevalence and consequences of obesity and sedentary lifestyle are well-documented public health concerns for youth in the United State of America (U.S.A) that disproportionally affect children from low income and minority families. OBJECTIVE This mixed-method study focused on estimating levels of physical activity and sedentary behavior and prevalence of overweight and obesity among the child members served in one Boys and Girls Club in the Midwest U.S.A. We aimed to better understand opportunities for improving children's engagement in physical activity through focus groups with members, staff, and parents/caregivers of members. METHODS Social cognitive learning theory, the ecological model of health behavior, and community based participatory research principles provided the study framework. Members completed assessments of physical activity, sedentary activity, height, and weight. Focus groups with members, staff, and parents/caregivers identified barriers, facilitators, and opportunities for promoting physical activity. RESULTS: Nearly 50% of members were overweight or obese. Most (87%) participants reported at least 60 minutes physical activity every day across the 3-day recall. Fewer than half (41%) reported 2 hours or less of sedentary screen time every day across the 3 day recall. Focus group themes identified opportunities for addressing needs associated with health disparities in physical activity and pediatric obesity. CONCLUSIONS Findings suggest stakeholder interest in physical activity promotion through afterschool programs. We discuss study implications regarding needs specific to individuals from diverse, low-income households that may not be adequately addressed with existing empirically-supported treatments and opportunities to address health disparities in physical activity and pediatric obesity through afterschool programs.
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Cathcart-Rake E, O'Connor J, Ridgeway JL, Breitkopf CR, Kaur JS, Mitchell J, Leventakos K, Jatoi A. Patients' Perspectives and Advice on How to Discuss Sexual Orientation, Gender Identity, and Sexual Health in Oncology Clinics. Am J Hosp Palliat Care 2020; 37:1053-1061. [PMID: 32212925 DOI: 10.1177/1049909120910084] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE This study sought to understand the patients' perspective of what contributes to an absence of discussions of sexual orientation (SO), gender identity (GI), and sexual health in cancer care. METHODS Patients were recruited from oncology, gynecology, and a gender transition clinic to participate in semistructured interviews, which were analyzed with qualitative methods. RESULTS A total of 25 patients were interviewed, shedding light on 2 themes. The first was that these conversations are important but infrequent. One patient explained, "…. we know people who have had sex changes…[they] would have appreciated that question." In response to whether sexual health was ever brought up, one patient responded, "No doctor ever has." Patients described unaddressed issues: "There have been times, you know, we've wondered if it was okay to make love." The second theme consisted of 4 pragmatic, patient-provided points to facilitate discussions: (1) implementation of a scale of 1 to 10 (with 10 being comfortable) to first gauge patients' comfort in talking about SO, GI, and sexual health; (2) having the health-care provider explore the topic again over-time; (3) making sure the health-care provider is comfortable, as such comfort appears to enhance the patient's comfort ("I have a doctor here, a female doctor, who just matter of fact will ask if I get erections and so on because of the medication she's giving me);" and (4) eliminating euphemisms (one patient stated, "I don't know what you mean by 'sexual health'."). CONCLUSION Oncology health-care providers have a unique opportunity and responsibility to address SO, GI, and sexual health.
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Affiliation(s)
| | | | - Jennifer L Ridgeway
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, 6915Mayo Clinic, Rochester, MN, USA
| | | | - Judith S Kaur
- Department of Oncology, Mayo Clinic, Jacksonville, FL, USA
| | | | | | - Aminah Jatoi
- Department of Oncology, 4352Mayo Clinic, Rochester, MN, USA
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DeStephano CC, Bakkum-Gamez JN, Kaunitz AM, Ridgeway JL, Sherman ME. Intercepting Endometrial Cancer: Opportunities to Expand Access Using New Technology. Cancer Prev Res (Phila) 2020; 13:563-568. [PMID: 32047026 DOI: 10.1158/1940-6207.capr-19-0556] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Revised: 01/20/2020] [Accepted: 02/04/2020] [Indexed: 11/16/2022]
Abstract
Although endometrial cancer is often diagnosed at an early curable stage, the incidence and mortality from endometrial cancer is rising and minority women are particularly at risk. We hypothesize that delays in clinical presentation contribute to racial disparities in endometrial cancer mortality and treatment-related morbidity. Improved methods for endometrial cancer risk assessment and distinguishing abnormal uterine bleeding and postmenopausal bleeding from physiologic variation are needed. Accordingly, we propose a multipronged strategy that combines innovative patient education with novel early detection strategies to reduce health impacts of endometrial cancer and its precursors, especially among Black women. Futuristic approaches using gamification, smartphone apps, artificial intelligence, and health promotion outside of the physical clinic hold promise in preventing endometrial cancer and reducing morbidity and mortality related to the disease, but they also raise a number of questions that will need to be addressed by future research.
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Affiliation(s)
| | | | - Andrew M Kaunitz
- Department of Obstetrics and Gynecology, University of Florida College of Medicine, Jacksonville, Florida
| | - Jennifer L Ridgeway
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota
| | - Mark E Sherman
- Department of Health Sciences Research, Mayo Clinic, Jacksonville, Florida
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Patel BK, Ridgeway JL, Ghosh K, Rhodes DJ, Borah B, Jenkins S, Suman VJ, Norman A, Jewett M, Singh D, Vachon CM, Radecki Breitkopf C. Behavioral and psychological impact of returning breast density results to Latinas: study protocol for a randomized clinical trial. Trials 2019; 20:744. [PMID: 31852492 PMCID: PMC6921571 DOI: 10.1186/s13063-019-3939-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [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: 08/23/2019] [Accepted: 11/26/2019] [Indexed: 01/07/2023] Open
Abstract
Background Breast cancer is the most common cancer and the leading cause of cancer mortality among Latinas. As more is learned about the association between mammographic breast density (MBD) and breast cancer risk, a number of U.S. states adopted legislation and now a federal law mandates written notification of MBD along with mammogram results. These notifications vary in content and readability, though, which may limit their effectiveness and create confusion or concern, especially among women with low health literacy or barriers to screening. The purpose of this study is to determine whether educational enhancement of MBD notification results in increased knowledge, decreased anxiety, and adherence to continued mammography screening among Latina women in a limited-resources setting. Methods Latinas LEarning About Density (LLEAD) is a randomized clinical trial (RCT) comparing the impact of three notification approaches on behavioral and psychological outcomes in Latina women. Approximately 2000 Latinas undergoing screening mammography in a safety-net community clinic will be randomized 1:1:1 to mailed notification (usual care); mailed notification plus written educational materials (enhanced); or mailed notification, written educational materials, plus verbal explanation by a promotora (interpersonal). The educational materials and verbal explanations are available in Spanish or English. Mechanisms through which written or verbal information influences future screening motivation and behavior will be examined, as well as moderating factors such as depression and worry about breast cancer, which have been linked to diagnostic delays among Latinas. The study includes multiple psychological measures (anxiety, depression, knowledge about MBD, perceived risk of breast cancer, worry, self-efficacy) and behavioral outcomes (continued adherence to mammography). Measurement time points include enrollment, 2–4 weeks post-randomization, and 1 and 2 years post-randomization. Qualitative inquiry related to process and outcomes of the interpersonal arm and cost analysis related to its implementation will be undertaken to understand the intervention’s delivery and transferability. Discussion Legislation mandating written MBD notification may have unintended consequences on behavioral and psychological outcomes, particularly among Latinas with limited health literacy and resources. This study has implications for cancer risk communication and will offer evidence on the potential of generalizable educational strategies for delivering information on breast density to Latinas in limited-resource settings. Trial registration ClinicalTrials.gov, NCT02910986. Registered on 21 September 2016. Items from the WHO Trial Registration Data Set can be found in this protocol.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Matt Jewett
- Mountain Park Health Center, Phoenix, AZ, USA
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Butler Tobah YS, LeBlanc A, Branda ME, Inselman JW, Morris MA, Ridgeway JL, Finnie DM, Theiler R, Torbenson VE, Brodrick EM, Meylor de Mooij M, Gostout B, Famuyide A. Randomized comparison of a reduced-visit prenatal care model enhanced with remote monitoring. Am J Obstet Gynecol 2019; 221:638.e1-638.e8. [PMID: 31228414 DOI: 10.1016/j.ajog.2019.06.034] [Citation(s) in RCA: 119] [Impact Index Per Article: 23.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2018] [Revised: 06/05/2019] [Accepted: 06/13/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND Standard prenatal care, consisting of 12-14 visits per pregnancy, is expensive and resource intensive, with limited evidence supporting the structure, rhythm, or components of care. Some studies suggest a reduced-frequency prenatal care model is as safe as the standard model of care for low-risk pregnant women, but evidence is limited. We developed and evaluated an innovative, technology-enhanced, reduced prenatal visit model (OB Nest). OBJECTIVE To evaluate the acceptability and effectiveness of OB Nest, a reduced-frequency prenatal care model enhanced with remote home monitoring devices and nursing support. STUDY DESIGN A single-center randomized controlled trial, composed of pregnant women, aged 18-36 years, recruited from an outpatient obstetric tertiary academic center in the Midwest United States. OB Nest care consisted of 8 onsite appointments with an obstetric provider; 6 virtual visits consisting of phone or online communication with an assigned nurse, supplemented with fetal Doppler and sphygmomanometer home monitoring devices; and access to an online community of pregnant women. Usual care consisted of 12 prescheduled prenatal clinic appointments with obstetric providers. Acceptability of OB Nest was measured by validated surveys of patient satisfaction with care at 36 weeks; perception of stress at 14, 24, and 36 weeks; and perceived quality of care at 36 weeks of gestation. Effectiveness was analyzed by comparing adherence to the American College of Obstetricians and Gynecologists recommended routine prenatal and ancillary services, maternal and fetal safety outcomes, and healthcare utilization. RESULTS Three hundred pregnant women at <13 weeks of gestation were recruited and randomized to OB Nest or usual care (150 in each arm) using a minimization algorithm. Demographic characteristics were similar between groups. Compared to usual care, patients in OB Nest had higher satisfaction on a 100-point validated modified Littlefield and Adams Satisfaction scale (OB Nest = 93.9% vs usual care = 78.9%, P < .01). Pregnancy-related stress, measured, on a 0-2 point PreNatal Maternal Stress validated scale, with higher scores indicating higher levels of stress, was lower among OB Nest participants at 14 weeks (OB Nest = 0.32 vs usual care = 0.41, P < .01) and at 36 weeks of gestation (OB Nest = 0.34 vs usual care = 0.40, P < .03). There was no statistical difference in perceived quality of care. Adherence to the provision of American College of Obstetricians and Gynecologists prenatal services was similar in both arms. Maternal and fetal clinical outcomes were similar between groups. Total reported nursing time was higher in OB Nest (OB Nest = 171.2 minutes vs usual care = 108.2 minutes, 95% confidence interval, 48.7-77.4). CONCLUSION OB Nest is an innovative, acceptable, and effective reduced-frequency prenatal care model. Compared to routine prenatal care, OB Nest resulted in higher patient satisfaction and lower prenatal stress, while reducing the number of appointments with clinicians and maintaining care standards for pregnant women. This program is a step toward evidence-driven prenatal care that improves patient satisfaction.
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Cathcart-Rake E, O'Connor JM, Ridgeway JL, Breitkopf CR, Guire LJM, Olson EA, Kaur JS, Leventakos K, Jatoi A. Querying Patients With Cancer About Sexual Health and Sexual and Gender Minority Status: A Qualitative Study of Health-Care Providers. Am J Hosp Palliat Care 2019; 37:418-423. [PMID: 31601116 DOI: 10.1177/1049909119879129] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Although national organizations advocate that health-care providers ask patients about sexual health and sexual and gender minority status-to learn, for example, about side effects of treatment and to understand patients' social support-these conversations often do not occur. This study explored health-care providers' reasons for having/not having these conversations. METHODS This single-institution study recruited health-care providers from medical oncology, hematology, radiation oncology, and gynecology. Face-to-face interviews were recorded, transcribed, and analyzed qualitatively. RESULTS Three main themes emerged: (1) patient-centric reasons for discussing/not discussing sexual health and sexual and gender minority status ("So I think just the holistic viewpoint is important"); (2) health-care provider-centric reasons for discussing/not discussing these issues ("That's going to take more time to talk about and to deal with…" or "I was raised orthodox, so this is not something we talk about…"; and (3) reasons that appeared to straddle both of the above themes (eg, acknowledgment of the sometimes taboo nature of these topics). CONCLUSION Although many health-care providers favor talking with patients with cancer about sexual health and sexual and gender minority status, limited time, personal reluctance, and the taboo nature of these topics appear at times to hamper the initiation of these conversations.
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Affiliation(s)
| | | | - Jennifer L Ridgeway
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA
| | | | | | - Eric A Olson
- Department of Oncology, Mayo Clinic, Rochester, MN, USA
| | - Judith S Kaur
- Division of Hematology/Oncology, Mayo Clinic, Jacksonville, FL, USA
| | | | - Aminah Jatoi
- Department of Oncology, Mayo Clinic, Rochester, MN, USA
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Cathcart-Rake EJ, Breitkopf CR, Kaur J, O'Connor J, Ridgeway JL, Jatoi A. Teaching Health-Care Providers to Query Patients With Cancer About Sexual and Gender Minority (SGM) Status and Sexual Health. Am J Hosp Palliat Care 2019; 36:533-537. [PMID: 30599758 DOI: 10.1177/1049909118820874] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [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: 01/24/2023] Open
Abstract
End of life is difficult for all patients but sexual and gender minorities (SGM) are prone to isolation and loneliness, especially if their SGM status is unknown or unaccepted. In oncology clinics, where goals of care discussions about end of life are integral and frequent, querying patients about their SGM status and sexual health is of particular importance. The American Society of Clinical Oncology recently released a position statement that called for greater focus on SGM populations with the goal of reducing and eventually eliminating disparities in cancer care within this group. An important first step in addressing such disparities is learning how best to train cancer health-care providers to ask patients about their SGM status and about sexual health in general. This article summarizes the mandate for understanding cancer issues in SGM populations and the dearth of cancer-related data within this group. This article also describes an ongoing 3-part study intended to build a mini curriculum with the goal of helping cancer health-care providers to ask patients with cancer about SGM status and to ask all patients with cancer about sexual health issues. The results of this ongoing study could potentially improve end-of-life care for subgroups of patients.
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Affiliation(s)
| | | | - Judith Kaur
- 3 Department of Medical Oncology, Mayo Clinic, Jacksonville, FL, USA
| | - Jennifer O'Connor
- 4 Department of Medical Oncology Clinical Research, Mayo Clinic, Rochester, MN, USA
| | - Jennifer L Ridgeway
- 5 Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA
| | - Aminah Jatoi
- 1 Department of Medical Oncology, Mayo Clinic, Rochester, MN, USA
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Asiedu GB, Ridgeway JL, Carroll K, Jatoi A, Radecki Breitkopf C. "Ultimately, mom has the call": Viewing clinical trial decision making among patients with ovarian cancer through the lens of relational autonomy. Health Expect 2018; 21:981-989. [PMID: 29655265 PMCID: PMC6250882 DOI: 10.1111/hex.12691] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/09/2018] [Indexed: 02/02/2023] Open
Abstract
OBJECTIVE This study employs the concept of relational autonomy to understand how relational encounters with family members (FMs) and care providers may shape decisions around ovarian cancer patients' clinical trial (CT) participation. The study also offers unique insights into how FMs view patients' decision making. METHODS In-depth interviews were conducted with 33 patients with ovarian cancer who had been offered a CT and 39 FMs. Data were inductively analysed using a thematic approach and deductively informed by constructs derived from the theory of relational autonomy (RA). RESULTS Patients' relationships, experiences and social status were significant resources that shaped their decisions. Patients did not give equal weight to all relationships and created boundaries around whom to include in decision making. Doctors' recommendations and perceived enthusiasm were described as influential in CT decisions. Both patients with ovarian cancer and their FMs maintained that patients have the "final say," indicating an individualistic autonomy. However, maintaining the "final say" in the decision-making process is constitutive of patients' relationships, emphasizing a relational approach to autonomy. FMs support patients' autonomy and they do so particularly when they believe the patient is capable of making the right choices. CONCLUSIONS Although ethical principles underlying informed consent for CT participation emphasize individual autonomy, greater attention to relational autonomy is warranted for a more comprehensive understanding of CT decision making.
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Affiliation(s)
- Gladys B. Asiedu
- Robert D. and Patricia E. Kern Center for the Science of Health Care DeliveryMayo ClinicRochesterMNUSA
- Department of Health Sciences ResearchMayo ClinicRochesterMNUSA
| | - Jennifer L. Ridgeway
- Robert D. and Patricia E. Kern Center for the Science of Health Care DeliveryMayo ClinicRochesterMNUSA
| | - Katherine Carroll
- Robert D. and Patricia E. Kern Center for the Science of Health Care DeliveryMayo ClinicRochesterMNUSA
- College of Arts and Social SciencesAustralian National UniversityCanberraACTAustralia
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Kvrgic Z, Asiedu GB, Crowson CS, Ridgeway JL, Davis JM. "Like No One Is Listening to Me": A Qualitative Study of Patient-Provider Discordance Between Global Assessments of Disease Activity in Rheumatoid Arthritis. Arthritis Care Res (Hoboken) 2018; 70:1439-1447. [PMID: 29266857 PMCID: PMC6013318 DOI: 10.1002/acr.23501] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [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: 05/18/2017] [Accepted: 12/12/2017] [Indexed: 12/22/2022]
Abstract
OBJECTIVE To explore the perspectives and experiences of patients with rheumatoid arthritis (RA) whose assessments of their disease differ from those of their rheumatology care provider. METHODS A total of 20 adult RA patients with patient-provider discordance at their most recent rheumatology appointment (within 4 weeks) were recruited. Discordance was defined by an absolute difference of 25 or more between patient and provider global assessments on a visual analog scale (VAS) of disease activity. For descriptive purposes, participants completed the Health Assessment Questionnaire II, pain VAS, and Patient Health Questionnaire 9 depression scale. Interviews were conducted in person and individually with each patient with a semistructured interview guide. Topics ranged widely, including participants' perspectives and experiences with living with RA, clinical disease assessments, patient-provider communication, and psychosocial or other needs. Data from the interviews were analyzed using interpretive phenomenological analysis. RESULTS Six major themes emerged from the patient interviews describing patient-provider discordance and disease assessment: being misunderstood by others, limitations of provider assessments, discrepancy with provider findings, inadequate active listening on the part of health care providers, unmet psychosocial needs, and lack of patient empowerment. CONCLUSION Patients described discordance in terms of symptom assessment and understanding how RA affects everyday life. Typical clinical assessments did not capture their experience. The resulting conceptual framework should inform future interventional studies seeking to enhance concordance of patient-physician communication and to optimize satisfaction with care and health-related quality-of-life outcomes for patients with RA.
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Kelm DJ, Ridgeway JL, Gas BL, Mohan M, Cook DA, Nelson DR, Benzo RP. Mindfulness Meditation and Interprofessional Cardiopulmonary Resuscitation: A Mixed-Methods Pilot Study. Teach Learn Med 2018; 30:433-443. [PMID: 29775080 PMCID: PMC6240489 DOI: 10.1080/10401334.2018.1462186] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/08/2023]
Abstract
PROBLEM Mindfulness training includes mindfulness meditation, which has been shown to improve both attention and self-awareness. Medical providers in the intensive care unit often deal with difficult situations with strong emotions, life-and-death decisions, and both interpersonal and interprofessional conflicts. The effect of mindfulness meditation training on healthcare providers during acute care tasks such as cardiopulmonary resuscitation remains unknown. Mindfulness meditation has the potential to improve provider well-being and reduce stress in individuals involved in resuscitation teams, which could then translate into better team communication and delivery of care under stress. A better understanding of this process could lead to more effective training approaches, improved team performance, and better patient outcomes. INTERVENTION All participants were instructed to use a mindfulness meditation device (Muse™ headband) at home for 7 min twice a day or 14 min daily over the 4-week training period. This device uses brainwave sensors to monitor active versus relaxing brain activity and provides real-time feedback. CONTEXT We conducted a single-group pretest-posttest convergent mixed-methods study. We enrolled 24 healthcare providers, comprising 4 interprofessional code teams, including physicians, nurses, respiratory therapists, and pharmacists. Each team participated in a simulation session immediately before and after the mindfulness training period. Each session consisted of two simulated cardiopulmonary arrest scenarios. Both quantitative and qualitative outcomes were assessed. OUTCOME The median proportion of participants who used the device as prescribed was 85%. Emotional balance, as measured by the critical positivity ratio, improved significantly from pretraining to posttraining (p = .02). Qualitative findings showed that mindfulness meditation changed how participants responded to work-related stress, including stress in real-code situations. Participants described the value of time for self-guided practice with feedback from the device, which then helped them develop individual approaches to meditation not reliant on the technology. Time measures during the simulated scenarios improved, specifically, time to epinephrine in Scenario 1 (p = .03) and time to defibrillation in Scenario 2 (p = .02), improved. In addition, team performance, such as teamwork (p = .04), task management (p = .01), and overall performance (p = .04), improved significantly after mindfulness meditation training. Physiologic stress (skin conductance) improved but did not reach statistical significance (p = .11). LESSONS LEARNED Mindfulness meditation practice may improve individual well-being and team function in high-stress clinical environments. Our results may represent a foundation to design larger confirmatory studies.
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Affiliation(s)
- Diana J Kelm
- a Department of Internal Medicine; Division of Pulmonary and Critical Care Medicine , Mayo Clinic Minnesota , Rochester , Minnesota , USA
| | - Jennifer L Ridgeway
- b Center for the Science of Health Care Delivery, Mayo Clinic Minnesota , Rochester , Minnesota , USA
| | - Becca L Gas
- c General Surgery Education, Mayo Clinic Minnesota , Rochester , Minnesota , USA
| | - Monali Mohan
- d Division of General Surgery, Mayo Clinic Minnesota , Rochester , Minnesota , USA
| | - David A Cook
- e Department of Internal Medicine , Division of General Internal Medicine, Mayo Clinic Minnesota , Rochester , Minnesota , USA
| | - Darlene R Nelson
- a Department of Internal Medicine; Division of Pulmonary and Critical Care Medicine , Mayo Clinic Minnesota , Rochester , Minnesota , USA
| | - Roberto P Benzo
- a Department of Internal Medicine; Division of Pulmonary and Critical Care Medicine , Mayo Clinic Minnesota , Rochester , Minnesota , USA
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Radecki Breitkopf C, Williams KP, Ridgeway JL, Parker MW, Strong-Simmons A, Hayes SN, Halyard MY. Linking Education to Action: A Program to Increase Research Participation Among African American Women. J Womens Health (Larchmt) 2018; 27:1242-1249. [PMID: 29975586 DOI: 10.1089/jwh.2017.6791] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [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: 02/05/2023] Open
Abstract
BACKGROUND Underrepresentation of African American women as research participants contributes to health disparities. Contemporary studies have focused on clinical trial (CT) participation; epidemiologic and genetic studies utilizing medical records and/or biological samples have received less attention. In partnership with The Links, Incorporated (The Links), a national service organization of professional African American women, this study sought to examine attitudes regarding chart review (CR) studies, genetic studies/biobanking (GEN), and CTs; develop; and evaluate an online education-to-action program. METHODS In phase 1, focus groups were convened with members of The Links to inform the content and format of the program. Phases 2 and 3 involved designing and evaluating the program, respectively. RESULTS Thirty-four women across three focus groups shared attitudes and perceptions regarding research and provided guidance for program development. Subsequently, 244 women completed the program (77% response rate), including pre- and post-assessments. Participants indicating that they "definitely" or "probably" (responses combined) intend to participate in research increased from 36.5% to 69.3% (pre/post-program). Agreement with the statement "research in the U.S. is ethical" increased (52.9% to 74.4%) as did factual knowledge regarding each of the study types. There was a decrease in reporting "little or no understanding" of study types (Pre/Post: GEN: 66%/24.9%, CR: 62.9%/18.4%, CTs: 40.7%/15.5%). Pre-program, few were "very positive" about the study types (14.3% GEN, 15.0% CR, 28.6% CTs); post-program ratings increased and equalized (42.8% GEN, 43.0% CR, 42.5% CTs). CONCLUSIONS An online education-to-action program targeting professional African American women improved knowledge, perceptions of ethics, and intent to participate in biomedical research.
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Affiliation(s)
| | - Karen Patricia Williams
- 2 College of Nursing, The Ohio State University , Columbus, Ohio.,3 The Links, Incorporated, Washington, Distict of Columbia
| | - Jennifer L Ridgeway
- 4 Kern Center for the Science of Health Care Delivery, Mayo Clinic , Rochester, Minnesota
| | - Monica W Parker
- 3 The Links, Incorporated, Washington, Distict of Columbia.,5 Department of Neurology, Emory University , Atlanta, Georgia
| | | | - Sharonne N Hayes
- 6 Department of Medicine, Division of Cardiovascular Diseases, Mayo Clinic , Rochester, Minnesota
| | - Michele Y Halyard
- 3 The Links, Incorporated, Washington, Distict of Columbia.,7 Department of Radiation Oncology, Mayo Clinic , Scottsdale, Arizona
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Bartlett DJ, Childs DS, Breitkopf CR, Grudem ME, Mitchell JL, Looker SA, Ridgeway JL, Lee JL, Butterfield JH, Weroha SJ, Jatoi A. Chemotherapy Acute Infusion Reactions: A Qualitative Report of the Perspectives of Patients With Cancer. Am J Hosp Palliat Care 2018; 35:1384-1389. [PMID: 29724109 DOI: 10.1177/1049909118773995] [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] Open
Abstract
OBJECTIVE A growing number of cancer antineoplastic agents can cause life-threatening acute infusion reactions. Because previous studies have not studied these reactions from the perspective of patients, this study was undertaken with that objective in mind. METHODS Patients who had an acute infusion reaction were interviewed based on the Leventhal model. Once saturation of content was achieved, interviews were transcribed and analyzed with qualitative methodology. RESULTS Twenty-one patients were enrolled. Most were women (n = 15); the median age was 58 years, and paclitaxel was the most common inciting agent. Three themes emerged. First, these reactions are frightening; patients made remarks such as "I was just thinking oh my God, I am dying." Second, prior education about these reactions seemed to mitigate this fear, "Basically everything the nurses told me potentially could happen, like happened. So, I was prepared." Third, when health-care providers were prompt and attentive during the reaction, patients described less fear with future chemotherapy, "So no, I'm really not fearful about going in tomorrow because I know they'll be there and they'll be watching me." CONCLUSION These reactions evoke fear which can be mitigated with education prior to and with prompt responsiveness during the acute infusion reaction.
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Affiliation(s)
| | | | | | - Megan E Grudem
- 3 Department of Oncology, Mayo Clinic, Rochester, MN, USA
| | | | | | - Jennifer L Ridgeway
- 4 Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA
| | - Jennifer L Lee
- 3 Department of Oncology, Mayo Clinic, Rochester, MN, USA
| | | | - S John Weroha
- 3 Department of Oncology, Mayo Clinic, Rochester, MN, USA
| | - Aminah Jatoi
- 3 Department of Oncology, Mayo Clinic, Rochester, MN, USA
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