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Fitchett G, Yao Y, Emanuel LL, Guay MOD, Handzo G, Hauser J, Kittelson S, O'Mahony S, Quest T, Rabow M, Schoppee TM, Solomon S, Wilkie DJ, Chochinov HM. Examining Moderation of Dignity Therapy Effects by Symptom Burden or Religious/Spiritual Struggles. J Pain Symptom Manage 2024; 67:e333-e340. [PMID: 38215893 PMCID: PMC10939845 DOI: 10.1016/j.jpainsymman.2024.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Revised: 12/18/2023] [Accepted: 01/03/2024] [Indexed: 01/14/2024]
Abstract
CONTEXT Dignity therapy (DT) is a well-researched psychotherapeutic intervention but it remains unclear whether symptom burden or religious/spiritual (R/S) struggles moderate DT outcomes. OBJECTIVE To explore the effects of symptom burden and R/S struggles on DT outcomes. METHODS This analysis was the secondary aim of a randomized controlled trial that employed a stepped-wedge design and included 579 participants with cancer, recruited from six sites across the United States. Participants were ages 55 years and older, 59% female, 22% race other than White, and receiving outpatient specialty palliative care. Outcome measures included the seven-item dignity impact scale (DIS), and QUAL-E subscales (preparation for death; life completion); distress measures were the Edmonton Symptom Assessment Scale (ESAS-r) (symptom burden), and the Religious Spiritual Struggle Scale (RSS-14; R/S). RESULTS DT effects on DIS were significant for patients with both low (P = 0.03) and moderate/high symptom burden (P = 0.001). They were significant for patients with low (P = 0.004) but not high R/S struggle (P = 0.10). Moderation effects of symptom burden (P = 0.054) and R/S struggle (P = 0.52) on DIS were not significant. DT effects on preparation and completion were not significant, neither were the moderation effects of the two distress measures. CONCLUSION Neither baseline symptom burden nor R/S struggle significantly moderated the effect of DT on DIS in this sample. Further study is warranted including exploration of other moderation models and development of measures sensitive to effects of DT and other end-of-life psychotherapeutic interventions.
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Affiliation(s)
- George Fitchett
- Department of Religion, Health and Human Values (G.F.), Rush University Medical Center, Chicago, Illinois, USA.
| | - Yingwei Yao
- Department of Biobehavioral Nursing Science, College of Nursing (Y.Y., T.M.S., D.J.W.), University of Florida, Gainesville, Florida, USA
| | - Linda L Emanuel
- Department of Medicine (L.L.E., J.H.), Northwestern University, Chicago, Illinois, USA; Mongan Institute (L.L.E.), Harvard University, Boston, Massachusetts, USA
| | - Marvin O Delgado Guay
- Department of Palliative, Rehabilitation, and Integrative Medicine (M.O.D.G.), MD Anderson Cancer Institute, Houston, Texas, USA
| | - George Handzo
- HealthCare Chaplaincy Network (G.H.), New York, New York, USA
| | - Joshua Hauser
- Department of Medicine (L.L.E., J.H.), Northwestern University, Chicago, Illinois, USA; Jesse Brown VA Medical Center (J.H.), Chicago, Illinois, USA
| | - Sheri Kittelson
- Department of Medicine (S.K.), University of Florida; Gainesville, Florida, USA
| | - Sean O'Mahony
- Department of Medicine (S.M.), Rush University Medical Center, Chicago, Illinois, USA
| | - Tammie Quest
- Department of Family and Preventive Medicine (T.Q.), Emory University, Atlanta, Georgia, USA
| | - Michael Rabow
- Department of Medicine (M.R.), University of California San Francisco, San Francisco, California, USA
| | - Tasha M Schoppee
- Department of Biobehavioral Nursing Science, College of Nursing (Y.Y., T.M.S., D.J.W.), University of Florida, Gainesville, Florida, USA; Community Hospice and Palliative Care (T.M.S.), Jacksonville, Florida, USA
| | - Sheldon Solomon
- Department of Psychology (S.S.), Skidmore College, Saratoga Springs, New York, USA
| | - Diana J Wilkie
- Department of Biobehavioral Nursing Science, College of Nursing (Y.Y., T.M.S., D.J.W.), University of Florida, Gainesville, Florida, USA
| | - Harvey Max Chochinov
- Department of Psychiatry and Cancer Care Manitoba Research Institute (H.M.C.), University of Manitoba, Winnipeg, Manitoba, Canada
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Wilkie DJ, Fitchett G, Yao Y, Schoppee T, Delgado Guay MO, Hauser J, Kittelson S, O'Mahony S, Rabow M, Quest T, Solomon S, Handzo G, Chochinov HM, Emanuel LL. Engaging Mortality: Effective Implementation of Dignity Therapy. J Palliat Med 2024; 27:176-184. [PMID: 37676977 PMCID: PMC10825264 DOI: 10.1089/jpm.2023.0336] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/26/2023] [Indexed: 09/09/2023] Open
Abstract
Background: Patients consider the life review intervention, Dignity Therapy (DT), beneficial to themselves and their families. However, DT has inconsistent effects on symptoms and lacks evidence of effects on spiritual/existential outcomes. Objective: To compare usual outpatient palliative care and chaplain-led or nurse-led DT for effects on a quality-of-life outcome, dignity impact. Design/Setting/Subjects: In a stepped-wedge trial, six sites in the United States transitioned from usual care to either chaplain-led or nurse-led DT in a random order. Of 638 eligible cancer patients (age ≥55 years), 579 (59% female, mean age 66.4 ± 7.4 years, 78% White, 61% stage 4 cancer) provided data for analysis. Methods: Over six weeks, patients completed pretest/posttest measures, including the Dignity Impact Scale (DIS, ranges 7-35, low-high impact) and engaged in DT+usual care or usual care. They completed procedures in person (steps 1-3) or via Zoom (step 4 during pandemic). We used multiple imputation and regression analysis adjusting for pretest DIS, study site, and step. Results: At pretest, mean DIS scores were 24.3 ± 4.3 and 25.9 ± 4.3 for the DT (n = 317) and usual care (n = 262) groups, respectively. Adjusting for pretest DIS scores, site, and step, the chaplain-led (β = 1.7, p = 0.02) and nurse-led (β = 2.1, p = 0.005) groups reported significantly higher posttest DIS scores than usual care. Adjusting for age, sex, race, education, and income, the effect on DIS scores remained significant for both DT groups. Conclusion: Whether led by chaplains or nurses, DT improved dignity for outpatient palliative care patients with cancer. This rigorous trial of DT is a milestone in palliative care and spiritual health services research. clinicaltrials.gov: NCT03209440.
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Affiliation(s)
- Diana J. Wilkie
- Department of Biobehavioral Nursing Science, College of Nursing, University of Florida, Gainesville, Florida, USA
| | - George Fitchett
- Department of Religion, Health and Human Values, Rush University Medical Center, Chicago, Illinois, USA
| | - Yingwei Yao
- Department of Biobehavioral Nursing Science, College of Nursing, University of Florida, Gainesville, Florida, USA
| | - Tasha Schoppee
- Department of Biobehavioral Nursing Science, College of Nursing, University of Florida, Gainesville, Florida, USA
- Community Hospice & Palliative Care, Jacksonville, Florida, USA
| | - Marvin O. Delgado Guay
- Department of Palliative, Rehabilitation, and Integrative Medicine, MD Anderson Cancer Institute, Houston, Texas, USA
| | - Joshua Hauser
- Department of Medicine, Northwestern University and Jesse Brown VA Medical Center, Chicago, Illinois, USA
| | - Sheri Kittelson
- Department of Medicine, University of Florida, Gainesville, Florida, USA
| | - Sean O'Mahony
- Department of Medicine, Rush University, Chicago, Illinois, USA
| | - Michael Rabow
- Department of Medicine, University of California San Francisco, San Francisco, California, USA
| | - Tammie Quest
- Department of Family and Preventive Medicine, Emory University, Atlanta, Georgia, USA
| | - Sheldon Solomon
- Department of Psychology, Skidmore College, Saratoga Springs, New York, USA
| | - George Handzo
- HealthCare Chaplaincy Network, New York, New York, USA
| | - Harvey Max Chochinov
- Department of Psychiatry and Cancer Care Manitoba Research Institute, University of Manitoba, Winnipeg, Canada
| | - Linda L. Emanuel
- Mongan Institute, Harvard University, Boston, Massachusetts, USA; Supportive Oncology, Robert H Lurie Comprehensive Cancer Center, Northwestern Medical Group, Feinberg School of Medicine, Northwestern University Chicago, Illinois, USA
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Berkman C, Stein GL, Javier NM, O'Mahony S, Maingi S, Godfrey D. Disrespectful and inadequate palliative care to transgender persons. Palliat Support Care 2024; 22:3-9. [PMID: 37448209 DOI: 10.1017/s1478951523001104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/15/2023]
Abstract
OBJECTIVES The purpose of this study was to describe disrespectful, inadequate, and abusive care to seriously ill patients who identify as transgender and their partners. METHODS A cross-sectional mixed methods study was conducted. The sample included 865 nurses, physicians, social workers, and chaplains. Respondents were asked whether they had observed disrespectful, inadequate, or abusive care due to the patient being transgender and to describe such care. RESULTS Of the 21.3% of participants who reported observing discriminatory care to a transgender patient, 85.3% had observed disrespectful care, 35.9% inadequate care, and 10.3% abusive care. Disrespectful care included insensitivity; rudeness, ridicule, and gossip by staff; not acknowledging or accepting the patient's gender identity or expression; privacy violations; misgendering; and using the incorrect name. Inadequate care included denying, delaying, or rushing care; ignorance of appropriate medical and other care; and marginalizing or ignoring the spouse/partner. SIGNIFICANCE OF RESULTS These findings illustrate discrimination faced by seriously ill transgender patients and their spouse/partners. Providers who are disrespectful may also deliver inadequate care to transgender patients, which may result in mistrust of providers and the health-care system. Inadequate care due to a patient's or spouse's/partner's gender identity is particularly serious. Dismissing spouses/partners as decision-makers or conferring with biological family members against the patient's wishes may result in unwanted care and constitute a Health Insurance Portability and Accountability Act of 1996 (HIPAA) violation. Institutional policies and practices should be assessed to determine the degree to which they are affirming to both patients and staff, and revised if needed. Federal and state civil rights legislation protecting the LGBTQ+ community are needed, particularly given the rampant transphobic legislation and the majority of states lacking civil rights laws protecting LGBTQ+ people. Training healthcare professionals and staff to become competent and comfortable treating transgender patients is critical to providing optimal care for these seriously ill patients and their spouse/partner.
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Affiliation(s)
- Cathy Berkman
- Graduate School of Social Service, Fordham University, New York, NY, USA
| | - Gary L Stein
- Wurzweiler School of Social Work, Yeshiva University, New York, NY, USA
| | - Noelle Marie Javier
- Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Sean O'Mahony
- Department of Internal Medicine, Rush University Medical Center, Chicago, IL, USA
| | - Shail Maingi
- Medical Oncology, Dana Farber Brigham Cancer Center, South Weymouth, MA, USA
| | - David Godfrey
- Commission on Law and Aging, American Bar Association, Washington, DC, USA
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O'Mahony S, Collins NA, Doyle G, Gibney ER, Moore A. Supermarket availability and socio-economic deprivation in urban Ireland - CORRIGENDUM. Proc Nutr Soc 2023; 82:488. [PMID: 36305493 DOI: 10.1017/s0029665122002737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Affiliation(s)
- S O'Mahony
- Food Safety Authority of Ireland, The Exchange, Georges Dock, Dublin 1, Ireland
- University College Dublin, Belfield, Dublin 4, Ireland
| | - N A Collins
- Food Safety Authority of Ireland, The Exchange, Georges Dock, Dublin 1, Ireland
| | - G Doyle
- University College Dublin, Belfield, Dublin 4, Ireland
| | - E R Gibney
- University College Dublin, Belfield, Dublin 4, Ireland
| | - A Moore
- University of Ulster, Coleraine, Northern Ireland, BT52 1SA, UK
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Berkman C, Stein GL, Godfrey D, Javier NM, Maingi S, O'Mahony S. Disrespectful and inadequate palliative care to lesbian, gay, and bisexual patients. Palliat Support Care 2023; 21:782-787. [PMID: 37435654 DOI: 10.1017/s1478951523001037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/13/2023]
Abstract
OBJECTIVES The study aims to describe inadequate, disrespectful, and abusive palliative and hospice care received by lesbian, gay, and bisexual (LGB) patients and their spouses/partners due to their sexual orientation or gender identity. METHODS A national sample of 865 healthcare professionals recruited from palliative and hospice care professional organizations completed an online survey. Respondents were asked to describe their observations of inadequate, disrespectful, or abusive care to LGB patients and their spouses/partners. RESULTS There were 15.6% who reported observing disrespectful care to LGB patients, 7.3% observed inadequate care, and 1.6% observed abusive care; 43% reported discriminatory care toward the spouses/partners. Disrespectful care to LGB patients included insensitive and judgmental attitudes and behaviors, gossip and ridicule, and disrespect of the spouse/partner. Inadequate care included denial of care; care that was delayed incomplete, or rushed; dismissive or antagonistic treatment; privacy and confidentiality violations; and dismissive treatment of the spouse/partner. SIGNIFICANCE OF RESULTS These findings provide evidence of discrimination faced by LGB patients and partners while receiving care for serious illness. Hospice and palliative care programs should promote respectful, inclusive, and affirming care for the lesbian, gay, bisexual, transgender, and queer (LGBTQ) community, including policies and practices that are welcoming and supportive to both employees and patients. Staff at all levels should be trained to create safe and respectful environments for LGBTQ patients and their families.
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Affiliation(s)
- Cathy Berkman
- Graduate School of Social Service, Fordham University, New York, NY, USA
| | - Gary L Stein
- Wurzweiler School of Social Work, Yeshiva University, New York, NY, USA
| | - David Godfrey
- Commission on Law and Aging, American Bar Association, Washington, DC, USA
| | - Noelle Marie Javier
- Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Shail Maingi
- Medical Oncology, Dana-Farber Cancer Institute, South Weymouth, MA, USA
| | - Sean O'Mahony
- Department of Internal Medicine, Rush University Medical Center, Chicago, IL, USA
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Neugarten C, Baldeo R, Tian K, Piscitello G, O'Mahony S, Kaginele P, Wang DH. The value of embedded palliative care in the emergency department. Acad Emerg Med 2023; 30:870-873. [PMID: 36757676 DOI: 10.1111/acem.14684] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2022] [Revised: 01/15/2023] [Accepted: 02/02/2023] [Indexed: 02/10/2023]
Affiliation(s)
- Carter Neugarten
- Section of Palliative Care, Departments of Internal Medicine and Emergency Medicine, Rush University Medical Center, Chicago, Illinois, USA
| | - Ryan Baldeo
- Division of Palliative Medicine, Department of Internal Medicine, Mayo Clinic, Phoenix, Arizona, USA
| | - Katherine Tian
- Department of Internal Medicine, The South Bend Clinic, South Bend, Indiana, USA
| | - Gina Piscitello
- Section of Palliative Care and Medical Ethics, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Sean O'Mahony
- Section of Palliative Care, Department of Internal Medicine, Rush University Medical Center, Chicago, Illinois, USA
| | - Pranita Kaginele
- Department of Emergency Medicine, St. Barnabas Hospital, Bronx, New York, USA
| | - David H Wang
- Department of Palliative Medicine, Scripps Health, San Diego, California, USA
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Emanuel LL, Solomon S, Chochinov HM, Delgado Guay MO, Handzo G, Hauser J, Kittelson S, O'Mahony S, Quest TE, Rabow MW, Schoppee TM, Wilkie DJ, Yao Y, Fitchett G. Death Anxiety and Correlates in Cancer Patients Receiving Palliative Care. J Palliat Med 2023; 26:235-243. [PMID: 36067074 PMCID: PMC9894592 DOI: 10.1089/jpm.2022.0052] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/28/2022] [Indexed: 02/05/2023] Open
Abstract
Background: Death anxiety is powerful, potentially contributes to suffering, and yet has to date not been extensively studied in the context of palliative care. Availability of a validated Death Anxiety and Distress Scale (DADDS) opens the opportunity to better assess and redress death anxiety in serious illness. Objective: We explored death anxiety/distress for associations with physical and psychosocial factors. Design: Ancillary to a randomized clinical trial (RCT) of Dignity Therapy (DT), we enrolled a convenience sample of 167 older adults in the United States with cancer and receiving outpatient palliative care (mean age 65.9 [7.3] years, 62% female, 84% White, 62% stage 4 cancer). They completed the DADDS and several measures for the stepped-wedged RCT, including demographic factors, religious struggle, dignity-related distress, existential quality of life (QoL), and terminal illness awareness (TIA). Results: DADDS scores were generally unrelated to demographic factors (including religious affiliation, intrinsic religiousness, and frequency of prayer). DADDS scores were positively correlated with religious struggle (p < 0.001) and dignity-related distress (p < 0.001) and negatively correlated with existential QoL (p < 0.001). TIA was significantly nonlinearly associated with both the total DADDS (p = 0.007) and its Finitude subscale (p ≤ 0.001) scores. There was a statistically significant decrease in Finitude subscale scores for a subset of participants who completed a post-DT DADDS (p = 0.04). Conclusions: Findings, if replicable, suggest that further research on death anxiety and prognostic awareness in the context of palliative medicine is in order. Findings also raise questions about the optimal nature and timing of spiritual and psychosocial interventions, something that might entail evaluation or screening for death anxiety and prognostic awareness for maximizing the effectiveness of care.
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Affiliation(s)
- Linda L. Emanuel
- Mongan Institute, Massachusetts General Hospital, Boston, Massachusetts, USA
- Department of Medicine, Northwestern Medicine, Chicago, Illinois, USA
| | - Sheldon Solomon
- Department of Psychology, Skidmore College, Saratoga Springs, New York, USA
| | - Harvey Max Chochinov
- Department of Psychiatry, University of Manitoba, Winnipeg, Manitoba, Canada
- CancerCare Manitoba, Winnipeg, Manitoba, Canada
| | - Marvin Omar Delgado Guay
- Department of Palliative, Rehabilitation, and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - George Handzo
- Health Services Research and Quality, HealthCare Chaplaincy Network, New York, New York, USA
| | - Joshua Hauser
- Department of Medicine, Northwestern Feinberg School of Medicine, Chicago, Illinois, USA
- Jesse Brown VA Medical Center, Chicago, Illinois, USA
| | - Sheri Kittelson
- Division of Palliative Care, Department of Medicine and University of Florida, Gainesville, Florida, USA
| | - Sean O'Mahony
- Section of Palliative Medicine, Department of Internal Medicine and Health, and Human Values, Rush University Medical Center, Chicago, Illinois, USA
| | - Tammie E. Quest
- Department of Family and Preventive Medicine and Emory University School of Medicine, Atlanta, Georgia, USA
- Department of Emergency Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Michael W. Rabow
- Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, California, USA
| | - Tasha M. Schoppee
- Community Hospice and Palliative Care, Jacksonville, Florida, USA
- Center for Palliative Care Research and Education, University of Florida, Gainesville, Florida, USA
| | - Diana J. Wilkie
- Center for Palliative Care Research and Education, University of Florida, Gainesville, Florida, USA
| | - Yingwei Yao
- Center for Palliative Care Research and Education, University of Florida, Gainesville, Florida, USA
| | - George Fitchett
- Department of Religion, Health, and Human Values, Rush University Medical Center, Chicago, Illinois, USA
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Gerhart J, Ramos K, Porter LS, Ravyts S, Malhotra S, Mossman B, Eaton England A, Alonzi S, Peyser T, Kim S, O'Mahony S, Burns JW, Hoerger M. Top Ten Tips Palliative Care Clinicians Should Know About Behavioral Pain Management for Persistent Pain. J Palliat Med 2023. [PMID: 36706441 PMCID: PMC10398738 DOI: 10.1089/jpm.2022.0571] [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: 01/28/2023] Open
Abstract
Seriously ill patients often experience persistent pain. As a part of a comprehensive repertoire of pain interventions, palliative care clinicians can help by using behavioral pain management. Behavioral pain management refers to evidence-based psychosocial interventions to reduce pain intensity and enhance functional outcomes and quality of life. Conceptualized using the biopsychosocial model, techniques involve promoting helpful behaviors (e.g., activity pacing, stretching, and relaxation exercises) and modifying underlying patterns of thinking, feeling, and communicating that can exacerbate pain. The authors have expertise in pain management, clinical health psychology, geropsychology, behavioral science, and palliative medicine. The article reviews the current evidence for behavioral interventions for persistent pain and provides 10 recommendations for behavioral pain management.
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Affiliation(s)
- James Gerhart
- Department of Psychology, Central Michigan University, Mount Pleasant, Michigan, USA
| | - Katherine Ramos
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina, USA
| | - Laura S Porter
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina, USA
| | - Scott Ravyts
- Department of Physical Medicine and Rehabilitation, Johns Hopkins University, Baltimore, Maryland, USA
| | - Sonia Malhotra
- Department of Palliative and Supportive Medicine, University Medical Center, New Orleans, Louisiana, USA
| | - Brenna Mossman
- Department of Psychology, Tulane University, New Orleans, Louisiana, USA
| | - Ashley Eaton England
- Department of Psychology, Central Michigan University, Mount Pleasant, Michigan, USA
| | - Sarah Alonzi
- Department of Psychology, University of California-Los Angeles, Los Angeles, California, USA
| | - Tristen Peyser
- Department of Psychology, Tulane University, New Orleans, Louisiana, USA
| | - Seowoo Kim
- Department of Psychology, Tulane University, New Orleans, Louisiana, USA
| | - Sean O'Mahony
- Department of Internal Medicine, Rush University Medical Center, Chicago, Illinois, USA
| | - John W Burns
- Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, Chicago, Illinois, USA
| | - Michael Hoerger
- Department of Palliative and Supportive Medicine, University Medical Center, New Orleans, Louisiana, USA.,Department of Psychology, Tulane University, New Orleans, Louisiana, USA.,Department of Psychiatry and Medicine, Tulane University, New Orleans, Louisiana, USA
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Miller ML, Gerhart JI, Maffett AJ, Lorbeck A, England AE, O'Mahony S. Experiential Avoidance and Post-traumatic Stress Symptoms Among Child Abuse Counselors and Service Workers: A Brief Report. J Interpers Violence 2022; 37:NP10382-NP10392. [PMID: 33289447 DOI: 10.1177/0886260520976225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Professionals who counsel and serve survivors of childhood abuse may be at risk of experiencing symptoms of post-traumatic stress disorder (PTSD), which can be exacerbated by cognitive and emotional processes. It is hypothesized that (1) a significant proportion of professionals who primarily serve child abuse survivors experience elevated levels of PTSD symptoms and (2) elevated PTSD symptoms are associated with psychological inflexibility processes, specifically increased experiential avoidance, cognitive fusion, and emotion regulation difficulties. Child abuse counselors and service workers (N = 31) in a major metropolitan area were recruited for a small pilot study. Participants completed self-report measures of PTSD symptoms and levels of psychological flexibility processes. A significant proportion of counselors endorsed clinically significant PTSD symptoms (n = 13, 41.9%). PTSD symptoms were significantly associated with experiential avoidance (r = .54, p < .01) and emotion regulation difficulties (r = .51, p < .01). These associations remained significant after controlling for the personality trait of emotional stability/neuroticism. These findings suggest that PTSD symptoms may be common among child abuse counselors and service workers, and these symptoms tend to be of greater intensity when responded to in avoidant and inflexible ways.
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Affiliation(s)
| | - James I Gerhart
- Rush University Medical Center, Chicago, IL, USA
- Central Michigan University, Mount Pleasant, MI, USA
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10
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Kramer NM, O'Mahony S, Deamant C. Brain Death Determination and Communication: An Innovative Approach Using Simulation and Standardized Patients. J Pain Symptom Manage 2022; 63:e765-e772. [PMID: 35122961 DOI: 10.1016/j.jpainsymman.2022.01.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Revised: 01/20/2022] [Accepted: 01/21/2022] [Indexed: 11/24/2022]
Abstract
CONTEXT Palliative medicine clinicians in hospital settings are often involved in the care of patients dying in critical care settings, with a subset from brain death. Brain death is a complex concept, not only for families, but also for clinicians. There is wide variability in adhering to formalized guidelines for brain death determination. In addition, communication techniques regarding brain death determination are distinct from those used in shared decision-making. There is a need to obtain knowledge and practical skills in brain death determination, including examination and communication. Simulation can provide a low-stakes setting to practice the process of brain death determination and communication. OBJECTIVES Describe a novel approach using high-fidelity simulation to teach hospice and palliative medicine fellows the practical and nuanced aspects of brain death determination and communication. Discuss the impact on fellows' confidence and knowledge for this learning activity. INNOVATION/METHODS This three-hour workshop includes a didactic session followed by a single case conducted in three parts using standardized patient encounters and high-fidelity simulation with manikin. It is delivered annually, as part of the monthly core didactic conference for all hospice and palliative medicine fellows in the four fellowship programs in our region. OUTCOMES/RESULTS Pre- and post-intervention surveys were performed assessing perceived confidence and content-related knowledge, which showed significant improvement in both areas. COMMENTS/CONCLUSION Simulation is a practical and constructive method for teaching the challenging concepts and unique communication skills involved in brain death determination.
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Affiliation(s)
- Neha M Kramer
- Rush University Medical Center, Chicago, Illinois, USA.
| | - Sean O'Mahony
- Rush University Medical Center, Chicago, Illinois, USA
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11
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Vainberg N, Hadi R, Devlin A, Moloney A, Nabeel R, Copperthwaite K, O'Mahony S, Lannon F, Lee S, Turcu F, Siddiqu S, Murray T, Logan M, Kelada S, Gilligan P. Accuracy of Point-of-Care-Ultrasonography in Confirming Shoulder Reduction in Emergency Departments. Ir Med J 2022; 115:515. [PMID: 35279049] [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] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Aims Accurate identification of the successful reduction of a dislocated shoulder could avoid additional episodes of procedural sedation and repeated performance of X-rays. The objective of this study was to assess the diagnostic accuracy of point-of-care-ultrasound (POCUS) in the confirmation of a successful joint reduction in patients with shoulder dislocation. Methods This was a single-centre, prospective observational study set in an urban academic ED in Ireland, with a convenience sample of adult patients with shoulder dislocation on X-ray. Ultrasound was performed on participants before and after joint reduction using a posterior approach technique. The operator's confidence levels were recorded after image acquisition. Results Thirty-three subjects were recruited. All dislocations were correctly identified on pre-reduction US, indicating a sensitivity of 100% (CI 89.42 - 100). Post-reduction US confirmed successful reduction in 30 subjects that were subsequently reported as such on X-Ray, giving it a specificity of 100% (CI 88.43 - 100). Failure to achieve reduction was correctly identified on US in three cases, resulting in post-reduction US Sensitivity of 100% (CI 29.24 - 100) and 100% accuracy (CI 89.42 - 100). Conclusion This study has shown that POCUS, with a posterior approach technique, has 100% sensitivity and specificity in confirming successful shoulder reduction in the ED.
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Affiliation(s)
- N Vainberg
- Emergency Department, Beaumont Hospital, Dublin, Ireland
| | - R Hadi
- Emergency Department, Beaumont Hospital, Dublin, Ireland
| | - A Devlin
- Emergency Department, Beaumont Hospital, Dublin, Ireland
| | - A Moloney
- Emergency Department, Beaumont Hospital, Dublin, Ireland
| | - R Nabeel
- Emergency Department, Beaumont Hospital, Dublin, Ireland
| | | | - S O'Mahony
- Emergency Department, Beaumont Hospital, Dublin, Ireland
| | - F Lannon
- Emergency Department, Beaumont Hospital, Dublin, Ireland
| | - S Lee
- Emergency Department, Beaumont Hospital, Dublin, Ireland
| | - F Turcu
- Emergency Department, Beaumont Hospital, Dublin, Ireland
| | - S Siddiqu
- Emergency Department, Beaumont Hospital, Dublin, Ireland
| | - T Murray
- Emergency Department, Beaumont Hospital, Dublin, Ireland
| | - M Logan
- Emergency Department, Beaumont Hospital, Dublin, Ireland
| | - S Kelada
- Emergency Department, Beaumont Hospital, Dublin, Ireland
| | - P Gilligan
- Emergency Department, Beaumont Hospital, Dublin, Ireland
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12
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Piscitello GM, Lamadrid VJ, Post Z, Kaur R, Gulczynski B, Baldeo R, Hudoba C, O'Mahony S, Chen E, Greenberg J. The Effect of Triggered Palliative Medicine Consults on Nurse Moral Distress in the Medical Intensive Care Unit. Am J Hosp Palliat Care 2021; 39:1039-1045. [PMID: 34587825 DOI: 10.1177/10499091211049398] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
PURPOSE Moral distress in the intensive care unit contributes to negative emotional experiences in nurses and adversely affects patient care. This prospective cohort study evaluates an intervention designed to improve nurse moral distress in the medical intensive care unit and assesses patient outcomes which may improve moral distress. METHODS Nurse moral distress was measured before and after an intervention of triggered palliative consults and scheduled family meetings in the intensive care unit during the COVID-19 pandemic. Patient outcomes in the intervention medical intensive care unit were compared to a control group. RESULTS Forty-eight nurses (n = 48/78, 62%) completed the pre-intervention survey and 33 (n = 33/78, 42%) completed the post-intervention survey. Nurse moral distress using the MMD-HP scale pre- and post-intervention (122.5 vs. 134.0, P = 0.1210) was not statistically different. Intervention group patients (n = 57/64, 89%) had earlier transition to do not resuscitate status (hazard ratio 2.1, 95% CI 1.1-4.0, P = 0.0294), higher rate of documented alternate decision makers (100% vs. 61%, P < 0.0001), and higher rate discharged to a facility (28% vs. 14%) or hospice (19% vs. 7%) (P = 0.0090). Intervention group patients with a do not resuscitate (DNR) order had lower median length of stay in the intensive care unit (4 days vs. 13 days, P = 0.0004) and hospital (10 days vs. 21 days, P = 0.0005), and lower median total hospital costs per patient ($39,067 vs. $116,476, P = 0.0029) when compared control group patients with a DNR order. CONCLUSION Triggered palliative consults with scheduled family meetings were not associated with change in nurse moral distress. More research is needed to uncover methods to improve nurse moral distress in the intensive care unit.
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Affiliation(s)
- Gina M Piscitello
- Section of Palliative Medicine and Division of Hospital Medicine, Rush University Medical Center, Chicago, IL, USA
| | - Vivien Joy Lamadrid
- Medical Intensive Care Unit, Rush University Medical Center, Chicago, IL, USA
| | - Zoë Post
- Department of Medicine, Rush University Medical Center, Chicago, IL, USA
| | - Ramandeep Kaur
- Department of Cardiopulmonary Sciences, Rush University Medical Center, Chicago, IL, USA
| | - Barbara Gulczynski
- Medical Intensive Care Unit, Rush University Medical Center, Chicago, IL, USA
| | - Ryan Baldeo
- Section of Palliative Medicine and Division of Hospital Medicine, Rush University Medical Center, Chicago, IL, USA
| | - Christine Hudoba
- Section of Palliative Medicine and Division of Hospital Medicine, Rush University Medical Center, Chicago, IL, USA
| | - Sean O'Mahony
- Section of Palliative Medicine and Division of Hospital Medicine, Rush University Medical Center, Chicago, IL, USA
| | - Elaine Chen
- Section of Palliative Medicine and Division of Hospital Medicine, Rush University Medical Center, Chicago, IL, USA.,Section of Pulmonary and Critical Care Medicine, Rush University Medical Center, Chicago, IL, USA.,Are co-last authors
| | - Jared Greenberg
- Section of Pulmonary and Critical Care Medicine, Rush University Medical Center, Chicago, IL, USA.,Are co-last authors
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13
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Ansari A, Baron A, Nelson-Becker H, Deamant C, Fitchett G, Fister E, O'Mahony S, Levine S. Practice Improvement Projects in an Interdisciplinary Palliative Care Training Program. Am J Hosp Palliat Care 2021; 39:831-837. [PMID: 34490785 DOI: 10.1177/10499091211044689] [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: 11/15/2022] Open
Abstract
CONTEXT Demand for palliative care (PC) continues to increase with an insufficient number of specialists to meet the need. This requires implementation of training curricula to expand the workforce of interdisciplinary clinicians who care for persons with serious illness. OBJECTIVES To evaluate the impact of utilizing individual practice improvement projects (PIP) as part of a longitudinal PC curriculum, the Coleman Palliative Medicine Training Program (CPMTP-2). METHODS Participants developed their PIPs based on their institutional needs and through a mentor, and participated in monthly meetings and bi-annual conferences, thereby allowing for continued process improvement and feedback. RESULTS Thirty-seven interdisciplinary participants implemented 30 PIPs encompassing 7 themes: (1) staff education; (2) care quality and processes; (3) access to care; (4) documentation of care delivered; (5) new program development; (6) assessing gaps in care/patient needs; and (7) patient/family education. The majority of projects did achieve completion, with 16 of 30 projects reportedly being sustained several months after conclusion of the required training period. Qualitative feedback regarding mentors' expertise and availability was uniformly positive. CONCLUSION The CPMTP-2 demonstrates the positive impact of PIPs in the development of skills for interdisciplinary learners as part of a longitudinal training program in primary PC. Participation in a PIP with administrative support may lead to operational improvement within PC teams.
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Affiliation(s)
- Aziz Ansari
- Division of Hospital Medicine, Loyola University Medical Center, Maywood, IL, USA
| | - Aliza Baron
- University of Chicago Medicine, Chicago, IL, USA
| | | | - Catherine Deamant
- Rosalind Franklin University of Medicine and Sciences, North Chicago, IL, USA
| | | | - Erik Fister
- Rush University Medical Center, Chicago, IL, USA
| | - Sean O'Mahony
- Section of Palliative Medicine, Rush University Medical Center, Chicago, IL, USA
| | - Stacie Levine
- Section of Geriatrics and Palliative Medicine, University of Chicago Medicine, Chicago, IL, USA
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14
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Candrian C, O'Mahony S, Stein GL, Berkman C, Javier NM, Godfrey D, Thomson RM, Liantonio J, Maingi S. Let's Do This: Collecting Sexual Orientation and Gender Identity Data in Hospice and Palliative Care. J Palliat Med 2021; 24:1122-1123. [PMID: 34161145 DOI: 10.1089/jpm.2021.0160] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Carey Candrian
- Division of General Internal Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Sean O'Mahony
- Section of Palliative Medicine, Department of Internal Medicine, Rush Medical College, Chicago, Illinois, USA
| | - Gary L Stein
- Wurzweiler School of Social Work, Yeshiva University, New York, New York, USA
| | - Cathy Berkman
- Graduate School of Social Service, Fordham University, New York, New York, USA
| | | | | | | | - John Liantonio
- Department of Family and Community Medicine, Division of Geriatrics and Palliative Care, Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Shail Maingi
- St Peter's Health Partners Cancer Care, Albany, New York, USA
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15
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Maingi S, Radix A, Candrian C, Stein GL, Berkman C, O'Mahony S. Improving the Hospice and Palliative Care Experiences of LGBTQ Patients and Their Caregivers. Prim Care 2021; 48:339-349. [PMID: 33985709 DOI: 10.1016/j.pop.2021.02.012] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Primary care providers often express a desire to be more involved with their patients as they transition to hospice care. Given that these providers have a central role in the care of their patients, they have the potential to significantly improve the experiences of lesbian, gay, bisexual, transgender, and queer patients who face serious illnesses. This article discusses the barriers to quality hospice and palliative care experienced by many sexual and gender minorities, as well as specific ways in which primary care physicians can promote equitable end-of-life care.
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Affiliation(s)
- Shail Maingi
- Department of Medical Oncology, St Peter's Health Partners Cancer Care, 315 South Manning Boulevard, Albany, NY 12208, USA.
| | - Asa Radix
- Callen-Lorde Community Health Center, NYU School of Medicine, 356 West 18th Street, New York, NY 10011, USA
| | - Carey Candrian
- University of Colorado School of Medicine, 12631 East 17th Avenue, Aurora, CO 80045, USA. https://twitter.com/CandrianCarey
| | - Gary L Stein
- Wurzweiler School of Social Work, Yeshiva University, 2495 Amsterdam Avenue, New York, NY 10033, USA
| | - Cathy Berkman
- Graduate School of Social Service, Fordham University, 113 West 60 Street, New York, NY 10023, USA
| | - Sean O'Mahony
- Section of Palliative Medicine, Department of Internal Medicine, Rush Medical College, 1725 West Harrison Street, Suite 955, Chicago, IL 60612, USA
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16
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O'Mahony S, Kittelson S, Barker PC, Delgado Guay MO, Yao Y, Handzo GF, Chochinov HM, Fitchett G, Emanuel LL, Wilkie DJ. Association of Race with End-of-Life Treatment Preferences in Older Adults with Cancer Receiving Outpatient Palliative Care. J Palliat Med 2021; 24:1174-1182. [PMID: 33760658 DOI: 10.1089/jpm.2020.0542] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background: End-of-life discussions and documentation of preferences are especially important for older cancer patients who are at high risk of morbidity and mortality. Objective: To evaluate influence of demographic factors such as religiosity, education, income, race, and ethnicity on treatment preferences for end-of-life care. Methods: A retrospective observational study was performed on baseline data from a multisite randomized clinical trial of Dignity Therapy in 308 older cancer patients who were receiving outpatient palliative care (PC). Interviews addressed end-of-life treatment preferences, religion, religiosity and spirituality, and awareness of prognosis. End-of-life treatment preferences for care were examined, including preferences for general treatment, cardiopulmonary resuscitation (CPR), and mechanical ventilation (MV). Bivariate associations and multiple logistic regression analysis of treatment preferences with demographic and other baseline variables were conducted. Results: Our regression models demonstrated that race was a significant predictor for CPR preference and preferences for MV, although not for general treatment goals. Minority patients were more likely to want CPR and MV than whites. Men were more likely to opt for MV, although not for CPR or overall aggressive treatment, than women. Higher level of education was a significant predictor for preferences for less aggressive care at the end-of-life but not for CPR or MV. Higher level of terminal illness awareness was also a significant predictor for preferences for CPR, but not MV or aggressive care at the end-of-life. Discussion: Race was significantly associated with all three markers for aggressive care in bivariate analysis and with two out of three markers in multiple regression analysis, with minorities preferring aggressive care and whites preferring less aggressive care. Contrary to our hypothesis, income was not significantly associated with treatment preferences, whereas religion was significantly associated with all markers for aggressive care in bivariate models, but not in multiple regression models. Clinical Trial Registration Number NCT03209440.
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Affiliation(s)
- Sean O'Mahony
- Department of Medicine, Rush University, Chicago, Illinois, USA
| | - Sheri Kittelson
- Department of Medicine, University of Florida, Gainesville, Florida, USA
| | - Paige C Barker
- Department of Medicine, University of Florida, Gainesville, Florida, USA
| | - Marvin O Delgado Guay
- Department of Palliative Care and Rehabilitation Medicine, MD Anderson Cancer Center, Houston, Texas, USA
| | - Yingwei Yao
- Department of Medicine, University of Florida, Gainesville, Florida, USA
| | - George F Handzo
- CSSBB Health Care Chaplaincy Network, New York, New York, USA
| | - Harvey M Chochinov
- Department of Psychiatry, FRSC University of Manitoba, Winnipeg, Manitoba, Canada
| | - George Fitchett
- Department of Medicine, Rush University, Chicago, Illinois, USA
| | - Linda L Emanuel
- Department of Medicine, Northwestern University, Evanston, Illinois, USA
| | - Diana J Wilkie
- Department of Medicine, University of Florida, Gainesville, Florida, USA
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17
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Samuels V, Schoppee TM, Greenlee A, Gordon D, Jean S, Smith V, Reed T, Kittelson S, Quest T, O'Mahony S, Hauser J, Guay MOD, Rabow MW, Emanuel L, Fitchett G, Handzo G, Chochinov HM, Yao Y, Wilkie DJ. Interim Analysis of Attrition Rates in Palliative Care Study on Dignity Therapy. Am J Hosp Palliat Care 2021; 38:1503-1508. [PMID: 33557587 DOI: 10.1177/1049909121994309] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
A routine threat to palliative care research is participants not completing studies. The purpose of this analysis was to quantify attrition rates mid-way through a palliative care study on Dignity Therapy and describe the reasons cited for attrition. Enrolled in the study were a total of 365 outpatients with cancer who were receiving outpatient specialty palliative care (mean age 66.7 ± 7.3 years, 56% female, 72% White, 22% Black, 6% other race/ethnicity). These participants completed an initial screening for cognitive status, performance status, physical distress, and spiritual distress. There were 76 eligible participants who did not complete the study (58% female, mean age 67.9 ± 7.3 years, 76% White, 17% Black, and 7% other race). Of those not completing the study, the average scores were 74.5 ± 11.7 on the Palliative Performance Scale and 28.3 ± 1.5 on the Mini-Mental Status Examination, whereas 22% had high spiritual distress scores and 45% had high physical distress scores. The most common reason for attrition was death/decline of health (47%), followed by patient withdrawal from the study (21%), and patient lost to follow-up (21%). The overall attrition rate was 24% and within the a priori projected attrition rate of 20%-30%. Considering the current historical context, this interim analysis is important because it will serve as baseline data on attrition prior to the outbreak of the COVID-19 pandemic. Future research will compare these results with attrition throughout the rest of the study, allowing analysis of the effect of the COVID-19 pandemic on the study attrition.
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Affiliation(s)
| | - Tasha M Schoppee
- University of Florida, Gainesville, FL, USA.,Community Hospice & Palliative Care, Jacksonville, FL, USA
| | | | | | | | | | - Tyra Reed
- University of Florida, Gainesville, FL, USA
| | | | - Tammie Quest
- Emory University School of Medicine, Atlanta, GA, USA
| | | | | | | | - Michael W Rabow
- University of California San Francisco, San Francisco, CA, USA
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18
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Chua IS, Zachariah F, Dale W, Feliciano J, Hanson L, Blackhall L, Quest T, Curseen K, Grey C, Rhodes R, Shoemaker L, Silveira M, Fischer S, O'Mahony S, Leventakos K, Trotter C, Sereno I, Kamdar M, Temel J, Greer JA. Early Integrated Telehealth versus In-Person Palliative Care for Patients with Advanced Lung Cancer: A Study Protocol. J Palliat Med 2020; 22:7-19. [PMID: 31486721 DOI: 10.1089/jpm.2019.0210] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Introduction: Early palliative care (PC) integrated with oncology care improves quality of life (QOL), depression symptoms, illness understanding, and end-of-life (EOL) care for patients with advanced lung cancer. The aims of this trial are to compare the effect of delivering early integrated PC through telehealth versus in-person on patient and caregiver outcomes. We hypothesize that both modalities for delivering early PC would be equivalent for improving patient QOL, communication about EOL care preferences with their oncologist, and length of stay in hospice. Methods: For this comparative effectiveness trial, we will enroll and randomize 1250 adult patients with advanced nonsmall cell lung cancer (NSCLC), who are not being treated with curative intent, to receive either early integrated telehealth or in-person PC at 20 cancer centers throughout the United States. Patients may also invite a family caregiver to participate in the study. Patients and their caregivers in both study groups meet at least every four weeks with a PC clinician from within 12 weeks of patient diagnosis of advanced NSCLC until death. Participants complete measures of QOL, mood, and quality of communication with oncologists at baseline before randomization and at 12, 24, 36, and 48 weeks. Information on health care utilization, including length of stay in hospice, will be collected from patients' health records. To test equivalence in outcomes between study groups, we will compute analysis of covariance and mixed linear models, controlling for baseline scores and study site. Study Implementation and Stakeholder Engagement: To ensure that this comparative effectiveness trial and findings are as patient centered and meaningful as possible, we have incorporated a robust patient and stakeholder engagement plan. Our stakeholder partners include (1) patients/families, (2) PC clinicians, (3) telehealth experts and clinician users, (4) representatives from health care systems and medical insurance providers, and (5) health care policy makers and advocates. These stakeholders will inform and provide feedback about every phase of study implementation.
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Affiliation(s)
- Isaac S Chua
- Dana-Farber Cancer Institute, Boston, Massachusetts
| | | | | | | | - Laura Hanson
- University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | | | | | | | - Carl Grey
- Wake Forest Baptist Health, Winston-Salem, North Carolina
| | - Ramona Rhodes
- University of Texas Southwestern Medical Center, Dallas, Texas
| | | | | | | | | | | | | | | | - Mihir Kamdar
- Massachusetts General Hospital, Boston, Massachusetts
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19
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O'Mahony S, Baron A, Ansari A, Deamant C, Nelson-Becker H, Fitchett G, Levine S. Expanding the Interdisciplinary Palliative Medicine Workforce: A Longitudinal Education and Mentoring Program for Practicing Clinicians. J Pain Symptom Manage 2020; 60:602-612. [PMID: 32276103 DOI: 10.1016/j.jpainsymman.2020.03.036] [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] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Revised: 03/22/2020] [Accepted: 03/27/2020] [Indexed: 11/19/2022]
Abstract
CONTEXT The disparity between gaps in workforce and availability of palliative care (PC) services is an increasing issue in health care. To meet the demand, team-based PC requires additional educational training for all clinicians caring for persons with serious illness. OBJECTIVES To describe the educational methodology and evaluation of an existing regional interdisciplinary PC training program that was expanded to include chaplain and social worker trainees. METHODS From 2015 to 2017, 26 social workers, chaplains, physicians, nurses, and advanced practice providers representing 22 health systems completed a two-year training program. The curriculum comprises biannual interdisciplinary conferences, individualized mentoring and clinical shadowing, self-directed e-learning, and profession-focused seminar series for social workers and chaplains. Site-specific practice improvement projects were developed to address gaps in PC at participating sites. RESULTS PC and program development skills were self-assessed before and after training. Among 12 skills common to all disciplines, trainees reported significant increases in confidence across all 12 skills and significant increases in frequency of performing 11 of 12 skills. Qualitative evaluation identified a myriad of program strengths and challenges regarding the educational format, mentoring, and networking across disciplines. CONCLUSION Teaching PC and program development knowledge and skills to an interdisciplinary regional cohort of practicing clinicians yielded improvements in clinical skills, implementation of practice change projects, and a sense of belonging to a supportive professional network.
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Affiliation(s)
- Sean O'Mahony
- Rush University Medical Center, Chicago, Illinois, USA.
| | - Aliza Baron
- University of Chicago Medical Center, Chicago, Illinois, USA
| | - Aziz Ansari
- Loyola University Medical Center, Maywood, Illinois, USA
| | - Catherine Deamant
- Chicago Medical School-Rosalind Franklin University of Medicine and Science, North Chicago, Illinois, USA
| | - Holly Nelson-Becker
- Loyola University Medical Center, Maywood, Illinois, USA; Brunel University, London, UK
| | | | - Stacie Levine
- University of Chicago Medical Center, Chicago, Illinois, USA
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20
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Stein GL, Berkman C, O'Mahony S, Godfrey D, Javier NM, Maingi S. Experiences of Lesbian, Gay, Bisexual, and Transgender Patients and Families in Hospice and Palliative Care: Perspectives of the Palliative Care Team. J Palliat Med 2020; 23:817-824. [DOI: 10.1089/jpm.2019.0542] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Gary L. Stein
- Wurzweiler School of Social Work, Yeshiva University, New York, New York, USA
| | - Cathy Berkman
- Graduate School of Social Service, Fordham University, New York, New York, USA
| | - Sean O'Mahony
- Department of Internal Medicine, Rush University Medical Center, Chicago, Illinois, USA
| | - David Godfrey
- Commission on Law and Aging, American Bar Association, Washington, DC, USA
| | - Noelle Marie Javier
- Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Shail Maingi
- Department of Medical Oncology, St. Peter's Health Partners, Troy, New York, USA
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21
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Gerhart J, England AE, Perry L, O'Mahony S, Hoerger M. Depressive symptoms, fear of emotional expression, and less favorable attitudes toward palliative care. Psychooncology 2020; 29:1232-1234. [DOI: 10.1002/pon.5396] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Revised: 03/21/2020] [Accepted: 04/13/2020] [Indexed: 11/10/2022]
Affiliation(s)
- James Gerhart
- Department of PsychologyCentral Michigan University Mount Pleasant Michigan
- Department of Psychiatry and Behavioral ScienceRush University Chicago Illinois
| | | | - Laura Perry
- Department of PsychologyTulane University New Orleans Louisiana
| | - Sean O'Mahony
- Department of Internal Medicine, Palliative Care ServiceRush University Chicago Illinois
| | - Michael Hoerger
- Department of PsychologyTulane University New Orleans Louisiana
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22
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O'Mahony S, Maingi S, Scott BH, Raghuwanshi JS. Perspectives on Creating an Inclusive Clinical Environment for Sexual and Gender Minority Patients and Providers. J Pain Symptom Manage 2020; 59:e9-e11. [PMID: 31837452 DOI: 10.1016/j.jpainsymman.2019.11.025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2019] [Accepted: 11/26/2019] [Indexed: 10/25/2022]
Affiliation(s)
- Sean O'Mahony
- Rush University Medical Center, Chicago, Illinois, USA.
| | - Shail Maingi
- St. Peter's Health Partners Cancer Care, Troy, New York, USA
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23
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Gerhart J, Duberstein P, Paull D, O'Mahony S, Burns J, DeNicolo M, Hoerger M. Geopersonality of Preventable Death in the United States: Anger-Prone States and Opioid Deaths. Am J Hosp Palliat Care 2020; 37:624-631. [PMID: 32008364 DOI: 10.1177/1049909120902808] [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] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Opioid overdoses have reached epidemic levels in the United States and have clustered in Northeastern and "Rust Belt" states. Five Factor Model (FFM) personality traits also vary at the state level, with anger-prone traits clustered in the Northeast region. This study tested the hypothesis that state-level anger proneness would be associated with a greater increase in rates of opioid overdose death. METHODS This was a secondary analysis of state-level data on FFM traits, opioid overdose deaths, and other classes of preventable death. Robust mixed models tested whether change in rates of opioid overdose death from 2008 to 2016 was moderated by state-level anger proneness. RESULTS State-level anger proneness was significantly associated with greater increases in rates of opioid overdose deaths (B = 1.01, standard error = 0.19, P < .001, 95% confidence interval: 0.63-1.39). The slope of increase in opioid overdose death rates was 380% greater in anger-prone states and held after adjustment for potential confounders such as state-level prevalence of major depressive disorder, number of mental health facilities, and historical patterns of manufacturing decline. A similar pattern was observed between state-level anger proneness and benzodiazepine overdose deaths but was not significant for the latter after adjustment for potential confounders. CONCLUSION These findings suggest that states characterized as more anger prone have experienced greater increases in opioid overdose deaths.
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Affiliation(s)
- James Gerhart
- Department of Psychology, Central Michigan University, MI, USA
- Department of Behavioral Sciences, Rush University Medical Center, Chicago, IL, USA
| | - Paul Duberstein
- Department of Health Behavior, Society, and Policy, Rutgers University School of Public Health, New Brunswick, NJ, USA
| | - Danielle Paull
- Department of Psychology, Central Michigan University, MI, USA
| | - Sean O'Mahony
- Department of Internal Medicine, Palliative Medicine Service, Rush University Medical Center, Chicago, IL, USA
| | - John Burns
- Department of Behavioral Sciences, Rush University Medical Center, Chicago, IL, USA
| | | | - Michael Hoerger
- Department of Psychology, Tulane University, New Orleans, LA, USA
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Fitchett G, Hisey Pierson AL, Hoffmeyer C, Labuschagne D, Lee A, Levine S, O'Mahony S, Pugliese K, Waite N. Development of the PC-7, a Quantifiable Assessment of Spiritual Concerns of Patients Receiving Palliative Care Near the End of Life. J Palliat Med 2020; 23:248-253. [PMID: 31483184 PMCID: PMC6987727 DOI: 10.1089/jpm.2019.0188] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/08/2019] [Indexed: 11/12/2022] Open
Abstract
Background: Attending to the religious/spiritual (R/S) concerns of patients is a core component of palliative care. A primary responsibility of the chaplain is to conduct a thorough assessment of palliative care patients' R/S needs and resources. Problems with current approaches to spiritual assessment in all clinical contexts, including palliative care, include limited evidence for their validity, reliability, or clinical usefulness; narrative content; and lack of clinical specificity. Objectives: The aim of our work was to develop an evidence-based, quantifiable model for the assessment of unmet spiritual concerns of palliative care patients near the end of life. Design: The PC-7 model was developed by a team of chaplains working in palliative care. Phase 1 used literature in the field and the chaplains' clinical practice to identify key concerns in the spiritual care of palliative care patients. Phase 2 focused on developing indicators of those concerns and reliability in the chaplains' rating of them. Results: Key concerns in the model include the following. Need for meaning in the face of suffering; need for integrity, a legacy; concerns about relationships; concern or fear about dying or death; issues related to treatment decision making; R/S struggle; and other concerns. An approach to scoring the patients' degree of unmet spiritual concerns was adapted from the literature. Assessing cases from the chaplains' practice led to high levels of agreement (reliability). Conclusion: Using the PC-7 model, chaplains can describe and quantify the key spiritual concerns of palliative care patients. Further research is needed to test its validity, reliability, and clinical usefulness.
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Affiliation(s)
- George Fitchett
- Department of Religion, Health, and Human Values, Rush University Medical Center, Chicago, Illinois
| | | | | | - Dirk Labuschagne
- Department of Religion, Health, and Human Values, Rush University Medical Center, Chicago, Illinois
| | - Aoife Lee
- Spiritual Care, Rush Oak Park Hospital, Oak Park, Illinois
| | - Stacie Levine
- Section of Geriatrics and Palliative Medicine, Department of Medicine, University of Chicago Medicine, Chicago, Illinois
| | - Sean O'Mahony
- Section of Palliative Medicine, Department of Internal Medicine, Rush University Medical Center, Chicago, Illinois
| | - Karen Pugliese
- Spiritual Care and Education, Northwestern Medicine, Central DuPage Hospital, Winfield, Illinois
| | - Nancy Waite
- Evanston Hospital, NorthShore University Health System, Evanston, Illinois
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25
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Greenberg JA, Gerhart J, Horst JN, Chen E, Hunter RL, O'Mahony S, Yeow ME, Fosler L, LaGorio LA, Meksraityte E, Weiss TT, Nowak K, Geddes J, Lambe SS, Fenton K, Shah RC. A Multidisciplinary Team-Based Approach to Improve Communication With Surrogates of Patients With Chronic Critical Illness. Am J Hosp Palliat Care 2019; 37:214-221. [PMID: 31526015 DOI: 10.1177/1049909119876606] [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: 12/28/2022] Open
Abstract
BACKGROUND Clinicians need to deliver prognostic information to surrogates of nondecisional, critically ill patients so that surrogates can make informed medical decisions that reflect the patient's values. Our objective was to implement a new approach for communicating with surrogates of patients with chronic critical illness. METHODS Surrogate decision makers of patients who were difficult to liberate from mechanical ventilation were prospectively enrolled. Surrogates met with different members of the intensive care unit treatment team for sequential 15-minute appointments to receive patient-specific assessments and education on chronic critical illness. The feasibility and acceptability of this approach were determined. A 24-question comprehension instrument was developed to assess a participant's understanding that a family member was displaying features of chronic critical illness. Each question was scored from 1 to 5, with larger scores indicating greater comprehension. RESULTS Over a 15-week period, educational sessions for 9 mechanically ventilated patients were conducted. On average, 2 surrogates per patient (range: 1-4) and 6 members of the interdisciplinary team (range: 4-6) were at each meeting. Surrogates and clinicians had very positive impressions of the communication intervention. The average preintervention comprehension score was 85 of 120 (standard deviation [SD]: 8, range: 71-101). The postintervention comprehension score was greater by 5 points on average (SD: 9, range: -11 to +20 points, P = .04). CONCLUSIONS Surrogates of critically ill patients approved of this novel communication approach and had a greater understanding of the patient's medical condition after the intervention.
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Affiliation(s)
- Jared A Greenberg
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Rush University Medical Center, Chicago, IL, USA
| | - James Gerhart
- Department of Psychology, Central Michigan University, Mount Pleasant, MI, USA
| | - Jacqueline N Horst
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Rush University Medical Center, Chicago, IL, USA
| | - Elaine Chen
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Rush University Medical Center, Chicago, IL, USA.,Section of Palliative Medicine, Department of Medicine, Rush University Medical Center, Chicago, IL, USA
| | - Rebecca L Hunter
- Division of Bone Marrow Transplant & Cellular Therapy, Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, Chicago, IL, USA
| | - Sean O'Mahony
- Section of Palliative Medicine, Department of Medicine, Rush University Medical Center, Chicago, IL, USA
| | - Mei-Ean Yeow
- Center for Palliative Medicine, Mayo Clinic, Rochester, MN, USA
| | - Laura Fosler
- Section of Palliative Medicine, Department of Medicine, Rush University Medical Center, Chicago, IL, USA
| | - Lisa A LaGorio
- Department of Communication Disorders and Sciences, Rush University Medical Center, Chicago, IL, USA
| | - Edita Meksraityte
- Department of Respiratory Care, Edward Hines, Jr. VA Hospital, Hines, IL, USA
| | - Tyler T Weiss
- Department of Respiratory Care, Rush University Medical Center, Chicago, IL, USA
| | - Kristen Nowak
- Department of Clinical Nutrition, Rush University Medical Center, Chicago, IL, USA
| | - Jacqueline Geddes
- Department of Physical Therapy, Rush University Medical Center, Chicago, IL, USA
| | - Stacy S Lambe
- Department of Physical Therapy, Rush University Medical Center, Chicago, IL, USA
| | - Kara Fenton
- Department of Occupational Therapy, University of Illinois at Chicago, IL, USA
| | - Raj C Shah
- Department of Family Medicine and the Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, IL, USA
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26
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Perry LM, Hoerger M, Seibert K, Gerhart JI, O'Mahony S, Duberstein PR. Financial Strain and Physical and Emotional Quality of Life in Breast Cancer. J Pain Symptom Manage 2019; 58:454-459. [PMID: 31163258 PMCID: PMC6708751 DOI: 10.1016/j.jpainsymman.2019.05.011] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Revised: 05/12/2019] [Accepted: 05/20/2019] [Indexed: 10/26/2022]
Abstract
CONTEXT Few studies have examined the association between financial strain and quality of life outcomes in breast cancer. OBJECTIVES To examine the association between financial strain and key elements of physical and emotional quality of life among women with breast cancer. METHODS Across three geographically diverse samples (census regions: Northeast = 13.2%, Midwest = 26.8%, South = 35.5%, West = 17.4%; international = 7.1%), 309 women with a history of breast cancer completed online surveys including measures of financial strain, depression, anxiety, symptom burden, and perceived health. The third sample (N = 134) also reported financial toxicity that specifically documents financial strain because of medical care costs. Primary analyses assessed the association between financial strain and measures of emotional and physical quality of life. Sensitivity analyses examined associations using the measure of financial toxicity. All analyses were controlled for key covariates. RESULTS Results showed that 37.5% of women experienced financial strain (Samples 1-3), varying from 12.1% among older, married, and college-educated women to 81.0% among women who were younger, unmarried, and lacked a college education. In addition, 26.1% reported treatment-specific financial toxicity (Sample 3). Financial strain was associated with more severe symptoms of depression (P < 0.001) and anxiety (P < 0.001) and worse physical symptom burden (P < 0.001) and perceived health (P < 0.001). Observed effects were sustained in sensitivity analyses using the financial toxicity measure. CONCLUSIONS The present investigation illustrates the importance of financial strain in breast cancer. Healthcare systems are encouraged to expand interdisciplinary palliative and supportive care services that have the expertise necessary to help financially strained patients navigate the cancer care continuum.
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Affiliation(s)
| | | | | | | | - Sean O'Mahony
- Rush University Medical Center, Chicago, Illinois, USA
| | - Paul R Duberstein
- Rutgers University School of Public Health, Piscataway, New Jersey, USA
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27
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Rhee C, McHugh M, Tun S, Gerhart J, O'Mahony S. Advantages and Challenges of an Interdisciplinary Palliative Care Team Approach to Surgical Care. Surg Clin North Am 2019; 99:815-821. [PMID: 31446910 DOI: 10.1016/j.suc.2019.05.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Palliative care is an interdisciplinary field that focuses on optimizing quality of life for patients with serious, life-limiting illnesses and includes aggressive management of pain and symptoms; psychological, social, and spiritual support; and discussions of advance care planning, including treatment decision making and complex care coordination. Early palliative care is associated with increased quality of life, decreased symptom burden, decreased health care expenditures, and improved caregiver outcomes. This article discusses integrating interdisciplinary palliative care into surgical practice, and some current models of using and expanding palliative care skill sets in surgery, including training initiatives for both physicians and nurses.
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Affiliation(s)
- Charles Rhee
- Section of Geriatrics & Palliative Medicine, University of Chicago, The University of Chicago Medicine, 5841 South Maryland Avenue, MC 6098, Chicago, IL 60637, USA.
| | - Marlene McHugh
- Department of Family and Social Medicine, Montefiore Medical Center, New York, NY, USA
| | - Sandy Tun
- Section of Geriatrics & Palliative Medicine, University of Chicago, Chicago, IL, USA
| | - James Gerhart
- Department of Psychology, Central Michigan University, Mount Pleasant, MI, USA
| | - Sean O'Mahony
- Section of Palliative Medicine, Rush Medical College, Chicago, IL, USA
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Abstract
The 'McNamara fallacy' (also known as quantitative fallacy) is named after the US Secretary of Defense during the Vietnam War. The fallacy consists of over-reliance on metrics, and may be summarised as: 'if it cannot be measured, it is not important'. This paper describes the McNamara fallacy as it applies to medicine and healthcare, taking as examples hospital mortality data, NHS targets and quality assurance.
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Affiliation(s)
- S O'Mahony
- S O'Mahony, Cork University Hospital, Wilton, Cork, Ireland.
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29
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Clevenger C, Pugliese K, O'Mahony S, Levine S, Fitchett G. Study of Shadowing Experiences among Chaplains in the Coleman Palliative Medicine Fellowship. J Health Care Chaplain 2019; 27:24-42. [PMID: 31032744 DOI: 10.1080/08854726.2019.1603917] [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: 10/26/2022]
Abstract
While shadowing is a relatively common practice in the education of many health professionals, it is not widely used in chaplaincy education. Findings from our qualitative study of 12 chaplains who participated in the Coleman Palliative Medicine Training Program suggest it may offer benefits for practicing chaplains. In interviews with seven fellows who shadowed more experienced palliative care (PC) chaplains and the five mentors who were shadowed at their work settings, participants reported opportunities for mutual learning, self-reflection, and collegiality. Fellows observed how members of a PC team collaborate and contribute equally to the care of patients. Mentors found shadowing was a rare opportunity to share their chaplaincy practice with colleagues. It helped them to appreciate different aspects of their work settings and to distinguish between PC and generalist chaplaincy. We discuss the challenges participants experienced while shadowing and offer recommendations for incorporating the practice more widely into chaplaincy education.
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Affiliation(s)
| | - Karen Pugliese
- Northwestern Medicine Central DuPage Hospital, Winfield, IL, USA
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30
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Kittelson S, Scarton L, Barker P, Hauser J, O'Mahony S, Rabow M, Delgado Guay M, Quest TE, Emanuel L, Fitchett G, Handzo G, Yao Y, Chochinov HM, Wilkie D. Dignity Therapy Led by Nurses or Chaplains for Elderly Cancer Palliative Care Outpatients: Protocol for a Randomized Controlled Trial. JMIR Res Protoc 2019; 8:e12213. [PMID: 30994466 PMCID: PMC6492061 DOI: 10.2196/12213] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Revised: 12/31/2018] [Accepted: 12/31/2018] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Our goal is to improve psychosocial and spiritual care outcomes for elderly patients with cancer by optimizing an intervention focused on dignity conservation tasks such as settling relationships, sharing words of love, and preparing a legacy document. These tasks are central needs for elderly patients with cancer. Dignity therapy (DT) has clear feasibility but inconsistent efficacy. DT could be led by nurses or chaplains, the 2 disciplines within palliative care that may be most available to provide this intervention; however, it remains unclear how best it can work in real-life settings. OBJECTIVE We propose a randomized clinical trial whose aims are to (1) compare groups receiving usual palliative care for elderly patients with cancer or usual palliative care with DT for effects on (a) patient outcomes (dignity impact, existential tasks, and cancer prognosis awareness); and (b) processes of delivering palliative spiritual care services (satisfaction and unmet spiritual needs); and (2) explore the influence of physical symptoms and spiritual distress on the outcome effects (dignity impact and existential tasks) of usual palliative care and nurse- or chaplain-led DT. We hypothesize that, controlling for pretest scores, each of the DT groups will have higher scores on the dignity impact and existential task measures than the usual care group; each of the DT groups will have better peaceful awareness and treatment preference more consistent with their cancer prognosis than the usual care group. We also hypothesize that physical symptoms and spiritual distress will significantly affect intervention effects. METHODS We are conducting a 3-arm, pre- and posttest, randomized, controlled 4-step, stepped-wedge design to compare the effects of usual outpatient palliative care and usual outpatient palliative care along with either nurse- or chaplain-led DT on patient outcomes (dignity impact, existential tasks, and cancer prognosis awareness). We will include 560 elderly patients with cancer from 6 outpatient palliative care services across the United States. Using multilevel analysis with site, provider (nurse, chaplain), and time (step) included in the model, we will compare usual care and DT groups for effects on patient outcomes and spiritual care processes and determine the moderating effects of physical symptoms and spiritual distress. RESULTS The funding was obtained in 2016, with participant enrollment starting in 2017. Results are expected in 2021. CONCLUSIONS This rigorous trial of DT will constitute a landmark step in palliative care and spiritual health services research for elderly cancer patients. TRIAL REGISTRATION ClinicalTrials.gov NCT03209440; https://clinicaltrials.gov/ct2/show/NCT03209440. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/12213.
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Affiliation(s)
- Sheri Kittelson
- Center for Palliative Care Research and Education, Department of Medicine, University of Florida, Gainesville, FL, United States
| | - Lisa Scarton
- Center for Palliative Care Research and Education, College of Nursing, University of Florida, Gainesville, FL, United States
| | - Paige Barker
- Center for Palliative Care Research and Education, Department of Medicine, University of Florida, Gainesville, FL, United States
| | - Joshua Hauser
- Buehler Center on Aging, Health and Society, Palliative Care, Northwestern Feinberg School of Medicine, Chicago, IL, United States
| | - Sean O'Mahony
- Palliative Medicine, Rush University Medical Center, Chicago, IL, United States
| | - Michael Rabow
- Helen Diller Family Comprehensive Cancer Center, Center for Educaiton in Palliative Care, University of California, San Francisco, San Francisco, CA, United States
| | - Marvin Delgado Guay
- Department of Palliative, Rehabilitation, and Integrative Medicine, The University of Texas MD Anderson Cancer Center, University of Texas, MD Anderson, Houson, TX, United States
| | - Tammie E Quest
- Buehler Center on Aging, Heatlh and Society, Northwestern Feinberg School of Medicine, Chicago, IL, United States
| | - Linda Emanuel
- Buehler Center on Aging, Heatlh and Society, Northwestern Feinberg School of Medicine, Chicago, IL, United States
| | - George Fitchett
- Department of Religion, Health and Human Values, Rush University Medical Center, Chicago, IL, United States
| | - George Handzo
- Health Services Research & Quality, HealthCare Chaplaincy Network, Caring for the Human Spirit TM, New York, NY, United States
| | - Yingewi Yao
- Center for Palliative Care Research and Education, College of Nursing, University of Florida, Gainesville, FL, United States
| | - Harvey Max Chochinov
- Research Institute of Oncology and Hematology, Cancer Care Manitoba, University of Manitoba, Winnipeg, MB, Canada
| | - Diana Wilkie
- Center for Palliative Care Research and Education, College of Nursing, University of Florida, Gainesville, FL, United States
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31
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Gerhart J, Hand D, Hoerger M, O'Mahony S. Single-Subject Designs and Practice-Based Research in Palliative Care: A Letter to the Editor. J Pain Symptom Manage 2019; 57:e3-e5. [PMID: 30557626 DOI: 10.1016/j.jpainsymman.2018.12.209] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2018] [Revised: 12/05/2018] [Accepted: 12/06/2018] [Indexed: 10/27/2022]
Affiliation(s)
- James Gerhart
- Department of Psychology, Central Michigan University, Mt. Pleasant, Michigan, USA.
| | - Dennis Hand
- Thomas Jefferson University, Philadelphia, Pennsylvania, USA
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32
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Gerhart JI, Gordon A, Roggenkamp B, Khosla P, Trosman JR, Martin J, Scheu A, Wiebe LA, Berardi R, Chow SLM, Pasquinelli M, Feldman LE, Dale W, O'Mahony S, Mumby PB, Deamant C, Weldon CB. Incorporating geriatric patient reported outcomes into novel screening tool of distress and supportive care concerns. J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.34_suppl.37] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
37 Background: The Institute of Medicine (IOM) 2013 Report recommends that supportive oncology care start at cancer diagnosis; the Commission on Cancer (CoC) Standard 3.2 requires distress screening and indicated action. The Supportive Oncology Collaborative, collaborative of 100+ clinicians funded by The Coleman Foundation, developed a patient-centric screening tool (CSOC-ST) adapted from ASCO Distress, NCCN Distress Problem List, IOM report and CoC standards, and other validated sub-tools (Weldon, ASCO-Q 2017). The Collaborative then revised the CSOC-ST tool to align with geriatric guidelines. Methods: Literature and guidelines review of geriatric screening, added items to CSOC-ST, and piloted at 4 sites. Descriptive statistics and Fisher’s exact test used. Results: 473 patients screened with added geriatric relevant items to CSOC-ST: self-care concerns (PROMIS Instrumental Support), living alone (ASCO Distress 2014), and memory / cognition (PROMIS item bank). Treatment/care concern items were revised to identify health care power of attorney and advance directive interest. Geriatric related items endorsed by patients, see Table. PHQ4, Anxiety and Depression, average score 2.4 (mild > 3). Higher scores on the PHQ-4 were significantly associated with each of the following: self-care concerns, memory/cognition concerns and specific treatment/care concerns (p < .0001). Conclusions: Pilot results and comparison to geriatric guidelines identified important items to support geriatric patient reported outcomes screening. After pilot, added 3 items for falls/frailty. Eight sites implementing this CSOC-ST.[Table: see text]
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Affiliation(s)
| | - Ana Gordon
- University of Illinois Hospital & Health Sciences System, Chicago, IL
| | | | | | | | | | | | | | | | | | - Mary Pasquinelli
- University of Illinois Hospital and Health Sciences System, Chicago, IL
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33
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Kiat C, O'Mahony S. Tackling the Epidemic: The Ncepod Report on Alcohol-Related Liver Disease and the Lancet Commission on Liver Disease. J R Coll Physicians Edinb 2018; 48:291-292. [DOI: 10.4997/jrcpe.2018.401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Affiliation(s)
- C Kiat
- Consultant Hepatologist, Department of Gastroenterology and Hepatology, Cork University Hospital, Cork, Ireland
| | - S O'Mahony
- Consultant Gastroenterologist, Department of Gastroenterology and Hepatology, Cork University Hospital, Cork, Ireland
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34
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Weldon CB, Martin J, Scheu A, Khosla P, Roggenkamp B, Berardi R, Chow SLM, Trosman JR, Pasquinelli M, Feldman LE, Dale W, O'Mahony S, Gerhart J, Mumby PB, Gordon A, Wiebe LA, Deamant C. Incorporating geriatric patient-reported outcomes into novel screening tool of distress and supportive care concerns. J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.30_suppl.198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
198 Background: The Institute of Medicine (IOM) 2013 Report recommends that supportive oncology care start at cancer diagnosis; the Commission on Cancer (CoC) Standard 3.2 requires distress screening and indicated action. The Supportive Oncology Collaborative, collaborative of 100+ clinicians funded by The Coleman Foundation, developed a patient-centric screening tool (CSOC-ST) adapted from ASCO Distress, NCCN Distress Problem List, IOM report and CoC standards, and other validated sub-tools (Weldon, ASCO-Q 2017). The Collaborative revised the CSOC-ST tool to align with ASCO geriatric guidelines. Methods: Literature and guidelines review of geriatric screening, added items to CSOC-ST, and piloted at 4 sites. Descriptive statistics and Fisher’s exact test used. Results: 473 patients screened with added geriatric relevant items to CSOC-ST: self-care concerns (PROMIS Instrumental Support), living alone (ASCO Distress 2014), and memory / cognition (PROMIS item bank). Treatment/care concern items were revised to identify health care power of attorney and advance directive interest. Geriatric related items endorsed by patients, see Table. PHQ4, Anxiety and Depression, average score 2.4 (mild > 3). Higher scores on the PHQ-4 were significantly associated with each of the following: self-care concerns, memory/cognition concerns and specific treatment/care concerns (p < .0001). Conclusions: Pilot results and comparison to ASCO geriatric guidelines identified important items to support geriatric patient reported outcomes screening. After pilot, added 3 items for falls/frailty. Eight sites implementing this CSOC-ST.[Table: see text]
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Affiliation(s)
| | | | | | | | | | | | | | | | - Mary Pasquinelli
- University of Illinois Hospital and Health Sciences System, Chicago, IL
| | | | | | | | | | | | - Ana Gordon
- University of Illinois Hospital & Health Sciences System, Chicago, IL
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35
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Damen A, Labuschagne D, Fosler L, O'Mahony S, Levine S, Fitchett G. What Do Chaplains Do: The Views of Palliative Care Physicians, Nurses, and Social Workers. Am J Hosp Palliat Care 2018; 36:396-401. [PMID: 30336692 DOI: 10.1177/1049909118807123] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
It is well accepted that attention to spiritual concerns is a core dimension of palliative care. It is similarly well accepted that chaplains are the spiritual care specialists who should address such concerns. However, what chaplains do when they provide care for patients and families is often poorly understood by their palliative care colleagues. Having a clear understanding of what chaplains do is important because it contributes to improved utilization of the spiritual care and other resources of the palliative care team and thereby to better care for patients and families. The aim of this study was to describe what palliative care physicians, nurses, and social workers understand about what chaplains do. Brief surveys were distributed to participants at 2 workshops for palliative care professionals in 2016. The survey was completed by 110 participants. The majority reported that they understood what chaplains do moderately well or very well. Thirty-three percent of the written comments about what chaplains do were very general; 25% were more specific. Only a small proportion of the participants were aware that chaplains provide care for the team, are involved in facilitating treatment decision-making, perform spiritual assessments, and bridge communication between the patient/family/team/community. Based on our survey, palliative care colleagues appear to have a broad understanding of what chaplains do but many may be unfamiliar with important contributions of chaplains to care for patients, families, and teams. These findings point to the need for ongoing education of palliative teams about what chaplains do in palliative care.
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Affiliation(s)
- Annelieke Damen
- 1 Care Ethics, University of Humanistic Studies, Utrecht, The Netherlands
| | - Dirk Labuschagne
- 2 School of Public Health, University of Illinois at Chicago, Chicago, IL, USA
| | - Laura Fosler
- 3 College of Nursing, Section of Palliative Medicine, Rush University Medical Center, Chicago, IL, USA
| | - Sean O'Mahony
- 4 Palliative Care, Rush University Medical Center, Chicago, IL, USA
| | | | - George Fitchett
- 6 Religion, Health and Human Values, Rush University Medical Center, Chicago, IL, USA
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36
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Gerhart J, Chen E, O'Mahony S, Burns J, Hoerger M. An Examination of State-Level Personality Variation and Physician Aid in Dying Legislation. J Pain Symptom Manage 2018; 56:385-389. [PMID: 29885459 DOI: 10.1016/j.jpainsymman.2018.05.023] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2018] [Revised: 05/29/2018] [Accepted: 05/30/2018] [Indexed: 11/28/2022]
Abstract
CONTEXT Physician aid in dying is a controversial topic in the U.S., and legislation exists in some states. Personality traits are associated with preferences for end-of-life care and also tend to cluster systematically across states and other geographic regions. Such clustering of personality traits could relate to legislation including physician aid in dying. OBJECTIVE To determine whether average levels of personality traits in each U.S. state differ between states with and without physician aid in dying legislation. METHODS This secondary analysis of national surveys included data on state demographics, political leanings, and state-level averages of Five-Factor Model personality traits. Wilcoxon tests and logistic regression tests were used to assess whether state-level averages in personality traits differed across states with and without physician aid in dying legislation. RESULTS States with physician aid in dying legislation had significantly higher average levels of the trait of openness and significantly lower average levels of the trait of neuroticism. The association with openness was no longer significant after accounting for state conservative advantage. CONCLUSION The social dialogue and potential controversy surrounding physician aid in dying may be linked to aggregate differences in state personality profiles. States with physician aid in dying legislation tend to be areas where constituents are on average more open minded and experience greater emotional stability. More work is needed to ascertain whether the experiences of receiving and providing end-of-life care may differ across these regions, particularly in relation to conversations around physician aid in dying.
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Affiliation(s)
- James Gerhart
- Department of Behavioral Sciences, Rush University Medical Center, Chicago, Illinois, USA.
| | - Elaine Chen
- Department of Internal Medicine, Palliative Care, Rush University Medical Center, Chicago, Illinois, USA
| | - Sean O'Mahony
- Department of Internal Medicine, Palliative Care, Rush University Medical Center, Chicago, Illinois, USA
| | - John Burns
- Department of Behavioral Sciences, Rush University Medical Center, Chicago, Illinois, USA
| | - Michael Hoerger
- Department of Psychology, Tulane University, New Orleans, Louisiana, USA; Department of Medicine, Section of Hematology and Medical Oncology, Tulane University, New Orleans, Louisiana, USA
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Weldon CB, Martin J, Scheu A, Khosla P, Roggenkamp B, Berardi R, Chow SLM, Trosman JR, Pasquinelli M, Feldman LE, Dale W, O'Mahony S, Gerhart J, Mumby PB, Gordon A, Wiebe LA, Deamant C. Incorporating geriatric patient reported outcomes into novel screening tool of distress and supportive care concerns. J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.15_suppl.10115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | | | | | | | | | | | | | | | - Mary Pasquinelli
- University of Illinois Hospital and Health Sciences System, Chicago, IL
| | | | | | | | | | | | - Ana Gordon
- University of Illinois Hospital & Health Sciences System, Chicago, IL
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Affiliation(s)
- Vyjeyanthi S Periyakoil
- Stanford University School of Medicine, Stanford, California; VA Palo Alto Health Care System, Palo Alto, California.
| | | | - Ronit Elk
- College of Nursing, University of South Carolina, Columbia, South Carolina
| | - Timothy Quill
- University of Rochester Medical Center, Rochester, New York
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Abstract
This quality improvement study examines the effectiveness of having a board-certified chaplain conduct advance care planning conversations and end of life preferences with patients at the time of a routine office visit with a physician.
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Affiliation(s)
| | | | - Stacie Levine
- The University of Chicago Medicine, Chicago, Illinois
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Maingi S, Bagabag AE, O'Mahony S. Current Best Practices for Sexual and Gender Minorities in Hospice and Palliative Care Settings. J Pain Symptom Manage 2018; 55:1420-1427. [PMID: 29288882 DOI: 10.1016/j.jpainsymman.2017.12.479] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2017] [Revised: 12/15/2017] [Accepted: 12/18/2017] [Indexed: 11/22/2022]
Abstract
Although several publications document the health care disparities experienced by sexual and gender minorities (SGMs), including lesbian, gay, bisexual, and transgender (LGBT) individuals,1e4 less is known about the experiences and outcomes for SGM families and individuals in hospice and palliative care (HPC) settings. This article provides a brief overview of issues pertaining to SGMs in HPC settings, highlighting gaps in knowledge and research. Current and best practices for SGM individuals and their families in HPC settings are described, as are recommendations for improving the quality of such care.
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Affiliation(s)
- Shail Maingi
- St. Peter's Health Partners Cancer Care, Troy, New York, USA.
| | | | - Sean O'Mahony
- Rush University Medical Center, Chicago, Illinois, USA
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Ensaff H, Bunting E, O'Mahony S. "That's His Choice Not Mine!" Parents' Perspectives on Providing a Packed Lunch for Their Children in Primary School. J Nutr Educ Behav 2018; 50:357-364.e1. [PMID: 29631705 DOI: 10.1016/j.jneb.2017.12.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/12/2017] [Revised: 12/15/2017] [Accepted: 12/17/2017] [Indexed: 06/08/2023]
Abstract
OBJECTIVE To examine factors influencing parents' selection of packed lunches over a school lunch, their choices in food preparation, and the role of children within these. DESIGN A qualitative approach using semistructured focus group and individual interviews. SETTING Four primary schools in a UK local authority. PARTICIPANTS Twenty parents providing a packed lunch for their children (aged 5-11 years). ANALYSIS An inductive thematic approach was used to identify categories and themes. The researchers maintained rigor in the data analysis through internal discussion and review until consensus was reached. RESULTS Children emerged as active decision makers exerting substantial power particularly in the initial decision to have a packed lunch, and then in influencing the lunch's contents. The packed lunch could be a source of anxiety for some parents; however, ultimately parents' attitudes and perceptions revolved around the key requirement that the lunch was eaten. Providing a packed lunch was a means of achieving this. CONCLUSIONS This study highlights children's growing authority over everyday food decisions. Further research is needed to explore children's perceptions of their role in food provision. The study's findings have implications for school food, nutrition education, and school-based interventions. Frameworks that look to improve children's nutrition in this area should reflect children's growing status as food decision makers and consider how this can be employed to support and sustain positive changes.
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Affiliation(s)
- H Ensaff
- School of Food Science and Nutrition, University of Leeds, Leeds, UK; Department of Nutrition and Dietetics, Leeds Beckett University, Leeds, UK.
| | - E Bunting
- Department of Nutrition and Dietetics, Leeds Beckett University, Leeds, UK
| | - S O'Mahony
- Health and Wellbeing Service, Children and Families Service, Leeds City Council, Leeds, UK
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O'Mahony S, Bines S, Gerhart J, Bagwell E, Marlene M, Card A. Managing Pain in Patients With Chronic Medical Illnesses and Serious Mental Illnesses. Am J Hosp Palliat Care 2017; 35:825-828. [PMID: 29088916 DOI: 10.1177/1049909117739300] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES This study investigated the use of opioid treatment plans that included the implementation of opioid dependence risk with a validated screening tool and opioid dependence risk tool (UDT) in a noncancer palliative pain clinic. METHODS We retrospectively reviewed the medical records for diagnostic information, information on analgesic medications, daily morphine equivalent dose, presence of pain management agreements and opioid dependence risk tools (ORT), and UDT. We recorded hospital days and emergency department visits. RESULTS Seventy-four patients were followed for a mean of 15.9 months. Ninety-three percent of patients had pain management agreements and 74% had ORT. The median score was 8: consistent with a high risk. More than half had UDT and 17.6% of patients had unexpected findings. Fifty-nine percent of patients had a psychiatric diagnosis. Hospital days and emergency department visits decreased by more than 30% ( P = .015 and P = .019). Significance of Findings: Both mental health problems and aberrant drug use were common in patients seen in a noncancer palliative care clinic. There were significant reductions in acute care utilization in the 12 months post intake in the clinic.
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Affiliation(s)
- Sean O'Mahony
- 1 Palliative Medicine Section, Department of Internal Medicine; Psychosocial Oncology Service, Department of Behavioral Health Rush University Medical Center, Chicago, IL, USA
| | - Steven Bines
- 1 Palliative Medicine Section, Department of Internal Medicine; Psychosocial Oncology Service, Department of Behavioral Health Rush University Medical Center, Chicago, IL, USA
| | - James Gerhart
- 1 Palliative Medicine Section, Department of Internal Medicine; Psychosocial Oncology Service, Department of Behavioral Health Rush University Medical Center, Chicago, IL, USA
| | - Erin Bagwell
- 1 Palliative Medicine Section, Department of Internal Medicine; Psychosocial Oncology Service, Department of Behavioral Health Rush University Medical Center, Chicago, IL, USA
| | - McHugh Marlene
- 2 Palliative Medicine Service, Department of Family Medicine Montefiore Medical Center, Bronx, NY, USA
| | - Ariel Card
- 1 Palliative Medicine Section, Department of Internal Medicine; Psychosocial Oncology Service, Department of Behavioral Health Rush University Medical Center, Chicago, IL, USA
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Lillis TA, Gerhart J, Bouchard LC, Cvengros J, O'Mahony S, Kopkash K, Kabaker KB, Burns J. Sleep Disturbance Mediates the Association of Post-Traumatic Stress Disorder Symptoms and Pain in Patients With Cancer. Am J Hosp Palliat Care 2017; 35:788-793. [PMID: 29084448 DOI: 10.1177/1049909117739299] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Sleep disturbance is a common complaint of patients with cancer and is well established in both pain conditions and post-traumatic stress disorder (PTSD). An estimated one-third of patients with cancer develop symptoms of PTSD at some point in their treatment. However, few studies have evaluated the contributions of PTSD and sleep disturbance to pain processes in cancer populations. The current study used mediation models to test the hypothesis that sleep disturbance would mediate the relationships between PTSD symptoms and pain intensity and PTSD symptoms and pain interference in a sample of patients with cancer. METHODS A cross-sectional, retrospective chart review was conducted of the electronic medical records of 85 adult patients with cancer (89.4% female; 59% white; 42% metastatic) who sought individual psychosocial support services at our institution. RESULTS Post-traumatic stress disorder symptoms, sleep disturbance, pain intensity, and pain interference were all positively correlated ( P < .01). Clinical levels of PTSD symptoms were reported by 30% to 60% of the sample. Even after controlling for metastatic disease, race, and cancer type, sleep disturbance mediated the relationships between PTSD symptoms and pain intensity ( B = 0.27; 95% CI: 0.10-0.44) and PTSD symptoms and pain-related interference ( B = 0.58; 95% CI: 0.28-0.87). CONCLUSIONS The relationships among PTSD symptoms, pain intensity, and pain interference could be explained by co-occurring sleep disturbance. Given the high frequency of PTSD symptoms among patients with cancer and PTSD's known links to sleep problems and pain, clinicians should be attentive to the role that traumatogenic processes may play in eliciting sleep and pain-related complaints among patients with cancer.
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Affiliation(s)
- Teresa A Lillis
- 1 Department of Behavioral Sciences, Rush University Medical Center, Chicago, IL, USA
| | - James Gerhart
- 1 Department of Behavioral Sciences, Rush University Medical Center, Chicago, IL, USA
| | - Laura C Bouchard
- 1 Department of Behavioral Sciences, Rush University Medical Center, Chicago, IL, USA
| | - Jamie Cvengros
- 1 Department of Behavioral Sciences, Rush University Medical Center, Chicago, IL, USA
| | - Sean O'Mahony
- 2 Palliative Medicine Section, Department of Internal Medicine, Rush University Medical Center, Chicago, IL, USA
| | - Katherine Kopkash
- 3 Department of General Surgery, Rush University Medical Center, Chicago, IL, USA
| | | | - John Burns
- 1 Department of Behavioral Sciences, Rush University Medical Center, Chicago, IL, USA
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Gerhart J, Vaclavik E, Lillis TA, Miner J, McFadden R, O'Mahony S. A daily diary study of posttraumatic stress, experiential avoidance, and emotional lability among inpatient nurses. Psychooncology 2017; 27:1068-1071. [DOI: 10.1002/pon.4531] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2017] [Revised: 06/15/2017] [Accepted: 08/11/2017] [Indexed: 11/07/2022]
Affiliation(s)
- James Gerhart
- Department of Behavioral Sciences; Rush University Medical Center; Chicago IL USA
| | - Elizabeth Vaclavik
- Department of Medical, Oncology and Cardiology Nursing; Rush University Medical Center; Chicago IL USA
| | - Teresa A. Lillis
- Department of Behavioral Sciences; Rush University Medical Center; Chicago IL USA
| | - Jacob Miner
- Department of Psychology; Illinois Institute of Technology; Chicago IL USA
| | - Rory McFadden
- Department of Internal Medicine, Palliative Medicine Section; Rush University Medical Center; Chicago IL USA
| | - Sean O'Mahony
- Department of Internal Medicine, Palliative Medicine Section; Rush University Medical Center; Chicago IL USA
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Abstract
Informal hospice caregivers play a key role in managing patients' pain at home, but lack of adherence to doctor-prescribed analgesic regimens and medication errors are significant barriers to truly effective pain management. A digital pain diary may improve caregiver management of pain at home; however, most digital pain tools available today were developed without input from patients or caregivers. Accordingly, the purpose of this study was to develop a digital pain application (1) for hospice caregivers to record patient pain and analgesic use and (2) for nurses to monitor administration of analgesics by caregivers. Using advisory group methods, nurse case managers (n = 6), and informal caregivers (n = 3) helped us to convert a paper-based pain and analgesic diary into a digital format-the e-PAIN Reporter-and to refine the application. The e-PAIN Reporter provides information on patient pain assessment and pain management and reports to nurses in real time. Further testing is now needed to determine (1) the feasibility of using the e-PAIN Reporter and (2) its effectiveness in improving pain management for hospice patients.
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Affiliation(s)
- Masako Mayahara
- 1 College of Nursing, Rush University, Chicago, Illinois, USA
| | - JoEllen Wilbur
- 1 College of Nursing, Rush University, Chicago, Illinois, USA
| | - Sean O'Mahony
- 1 College of Nursing, Rush University, Chicago, Illinois, USA.,2 Rush Medical College, Rush University, Chicago, Illinois, USA.,3 Palliative Medicine, Rush University Medical Center, Chicago, Illinois, USA
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47
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Affiliation(s)
- S O'Mahony
- S O'Mahony, Cork University Hospital, Wilton, Cork, Ireland. E-mail
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48
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Levine S, O'Mahony S, Baron A, Ansari A, Deamant C, Frader J, Leyva I, Marschke M, Preodor M. Training the Workforce: Description of a Longitudinal Interdisciplinary Education and Mentoring Program in Palliative Care. J Pain Symptom Manage 2017; 53:728-737. [PMID: 28062351 DOI: 10.1016/j.jpainsymman.2016.11.009] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2016] [Revised: 07/25/2016] [Accepted: 11/02/2016] [Indexed: 11/19/2022]
Abstract
CONTEXT The rapid increase in demand for palliative care (PC) services has led to concerns regarding workforce shortages and threats to the resiliency of PC teams. OBJECTIVES To describe the development, implementation, and evaluation of a regional interdisciplinary training program in PC. METHODS Thirty nurse and physician fellows representing 22 health systems across the Chicago region participated in a two-year PC training program. The curriculum was delivered through multiple conferences, self-directed e-learning, and individualized mentoring by expert local faculty (mentors). Fellows shadowed mentors' clinical practices and received guidance on designing, implementing, and evaluating a practice improvement project to address gaps in PC at their institutions. RESULTS Enduring, interdisciplinary relationships were built at all levels across health care organizations. Fellows made significant increases in knowledge and self-reported confidence in adult and pediatric PC and program development skills and frequency performing these skills. Fellows and mentors reported high satisfaction with the educational program. CONCLUSION This interdisciplinary PC training model addressed local workforce issues by increasing the number of clinicians capable of providing PC. Unique features include individualized longitudinal mentoring, interdisciplinary education, on-site project implementation, and local network building. Future research will address the impact of the addition of social work and chaplain trainees to the program.
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Affiliation(s)
| | - Sean O'Mahony
- Rush University Medical Center, Chicago, Illinois, USA
| | - Aliza Baron
- University of Chicago, Chicago, Illinois, USA
| | | | | | - Joel Frader
- Lurie Children's Hospital, Northwestern University, Chicago, Illinois, USA
| | - Ileana Leyva
- Northwestern Medicine Central DuPage Hospital, Winfield, Illinois, USA
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49
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Abstract
Ivan Illich's attack on modern medicine, Medical Nemesis, appeared in 1974. The book famously opened with the statement: 'The medical establishment has become a major threat to health.' Forty years after its publication, this paper examines the major themes of the book, and asks whether events since its publication have added weight to Illich's thesis.
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Affiliation(s)
- S O'Mahony
- S O'Mahony, Cork University Hospital, Wilton, Cork, Ireland, E-mail
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50
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O'Mahony S, Gerhart J, Abrams I, Greene M, McFadden R, Tamizuddin S, Levy MM. A Multimodal Mindfulness Training to Address Mental Health Symptoms in Providers Who Care for and Interact With Children in Relation to End-of-Life Care. Am J Hosp Palliat Care 2016; 34:838-843. [PMID: 27443283 DOI: 10.1177/1049909116660688] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
AIM Medical providers may face unique emotional challenges when confronted with the suffering of chronically ill, dying, and bereaved children. This study assessed the preliminary outcomes of participation in a group-based multimodal mindfulness training pilot designed to reduce symptoms of burnout and mental health symptoms in providers who interact with children in the context of end-of-life care. METHODS A total of 13 medical providers who care for children facing life-threatening illness or bereaved children participated in a 9-session multimodal mindfulness session. Mental health symptoms and burnout were assessed prior to the program, at the program midpoint, and at the conclusion of the program. RESULTS Participation in the pilot was associated with significant reductions in depressive and posttraumatic stress disorder (PTSD) symptoms among providers ( P < .05). CONCLUSION Mindfulness-based programs may help providers recognize and address symptoms of depression and PTSD. Additional research is needed to enhance access and uptake of programming among larger groups of participants.
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Affiliation(s)
- Sean O'Mahony
- 1 Palliative Care Service, Rush University Medical Center, Chicago, IL, USA
| | - James Gerhart
- 2 Department of Behavioral Sciences, Rush University Medical Center, Chicago, IL, USA
| | | | - Michelle Greene
- 2 Department of Behavioral Sciences, Rush University Medical Center, Chicago, IL, USA
| | - Rory McFadden
- 1 Palliative Care Service, Rush University Medical Center, Chicago, IL, USA
| | | | - Mitchell M Levy
- 5 Division of Pulmonary and Critical Care Medicine, Alpert Medical School at Brown University, Providence, RI, USA
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