Online communication skill training of patients with cancer: A test of the behavioral intention predictive framework for communication skills.

Objective: To assess the Behavioral Intention Predictive Framework's utility in explaining variation in cancer patients' strong behavioral intention (SBI) to use LEAPS (Listen, Educate, Assess, Partner, Support) communication skills after viewing training videos. Methods: Ninety-eight patients were enrolled through anonymized online platforms to view LEAPS training videos, complete background and communication questionnaires and report their SBI to use LEAPS skills. Results: On average, patients indicated SBI to use 6 of 13 skills and 46% of patients expressed SBI across individual skills. The framework explained 27.7% of the adjusted variance in SBI with significant predictors of frequent past use of LEAPS-related shared decision-making behaviors, poor emotional health, being rarely accompanied to visits and positive ratings of narrative videos. Finally, 21.7% of the adjusted variance in problem communication was explained by infrequent use of LEAPS-related information behaviors, patient accompaniment of another adult and positive narrative scores. Conclusion: Patients SBI to use multiple LEAPS skills and past problem communication were explained by framework predictors. Innovation: Despite theoretical and empirical evidence that behavioral intention significantly predicts behavior, it has not been studied in patient communication research. Application of the novel framework to LEAPS training videos contributes an innovative address of this research gap.

Implementation Barriers and Recommendations for a Multisite Community Health Worker Intervention in Palliative Care for African American Oncology Patients: A Qualitative Study.

Background: Palliative care remains underutilized by African American patients with advanced cancer. Community health workers (CHWs) may help improve palliative care outcomes among this patient population. Objectives: To explore barriers to success of a proposed CHW intervention and synthesize design and implementation recommendations to both optimize our intervention and inform others working to alleviate palliative care disparities. Design: Semi-structured qualitative interviews. Setting/Subjects: Key informants were health care professionals across clinical, leadership, and community health fields. Participants were recruited through purposive sampling from Baltimore, Maryland; Birmingham, Alabama; and Salisbury, Maryland. Measurements: Interviewers used an interview guide grounded in established implementation science models. Data were analyzed through a combined abductive/deductive approach by independent coders. A framework methodology was used to facilitate thematic analysis. Results: In total, 25 professionals completed an interview. Key informants discussed multiple barriers, including at the patient level (lack of knowledge), clinician and facility level (decreased workflow efficiency), and health system level (limited funding). Recommendations related to the intervention's design included high quality preintervention CHW training and full integration of CHWs into the care team to "bridge" divides between outpatient, inpatient, and at-home settings. Intervention delivery recommendations included clearly defining care team roles and balancing flexibility and standardization in CHW support approaches. These recommendations were then used to adapt the planned intervention and its implementation process. Conclusions: Clinicians, cancer center leaders, and CHWs identified multilevel potential barriers to the intervention's success but also described recommendations that may mitigate these barriers. Key informant input represents an important step prior to initiating CHW-based interventions.

Evaluating potential overuse of surveillance care in cancer survivors.

BACKGROUND: Survivorship care plans (SCPs) communicate cancer-related information from oncology providers to patients and primary care providers. SCPs may limit overuse testing by specifying necessary follow-up care. From a randomized, controlled trial of SCP delivery, we examined whether cancer-related tests not specified in SCPs, but conducted after SCP receipt, were appropriate or consistent with overuse. METHODS: Survivors of breast, colorectal, or prostate cancer treated at urban-academic or rural-community health systems were randomized to one of three SCP delivery arms. Tests during 18 months after SCP receipt were classified as consistent with overuse if they were (1) not included in SCPs and (2) on a guideline-based predetermined list of "not recommended surveillance." After chart abstraction, physicians performed review and adjudication of potential overuse. Descriptive analyses were conducted of tests consistent with overuse. Negative binomial regression models determined if testing consistent with overuse differed across study arms. RESULTS: Among 316 patients (137 breast, 67 colorectal, 112 prostate), 140 individual tests were identified as potential overuse. Upon review, 98 were deemed to be consistent with overuse: 78 tumor markers and 20 imaging tests. The majority of overuse testing was breast cancer-related (95%). Across sites, 27 patients (9%) received ≥1 test consistent with overuse; most were breast cancer patients (22/27). Exploratory analyses of overuse test frequency by study arm showed no significant difference. CONCLUSIONS: This analysis identified practice patterns consistent with overuse of surveillance testing and can inform efforts to improve guideline-concordant care. Future interventions may include individual practice patterns and provider education.

A wearable multi-modal acoustic system for breathing analysis.

Chronic obstructive pulmonary disease (COPD) is the third leading cause of death worldwide with over 3 × 106 deaths in 2019. Such an alarming figure becomes frightening when combined with the number of lost lives resulting from COVID-caused respiratory failure. Because COPD exacerbations identified early can commonly be treated at home, early symptom detections may enable a major reduction of COPD patient readmission and associated healthcare costs; this is particularly important during pandemics such as COVID-19 in which healthcare facilities are overwhelmed. The standard adjuncts used to assess lung function (e.g., spirometry, plethysmography, and CT scan) are expensive, time consuming, and cannot be used in remote patient monitoring of an acute exacerbation. In this paper, a wearable multi-modal system for breathing analysis is presented, which can be used in quantifying various airflow obstructions. The wearable multi-modal electroacoustic system employs a body area sensor network with each sensor-node having a multi-modal sensing capability, such as a digital stethoscope, electrocardiogram monitor, thermometer, and goniometer. The signal-to-noise ratio (SNR) of the resulting acoustic spectrum is used as a measure of breathing intensity. The results are shown from data collected from over 35 healthy subjects and 3 COPD subjects, demonstrating a positive correlation of SNR values to the health-scale score.

Simplifying Survivorship Care Planning: A Randomized Controlled Trial Comparing 3 Care Plan Delivery Approaches.

BACKGROUND: Survivorship care plans seek to improve the transition to survivorship, but the required resources present implementation barriers. This randomized controlled trial aimed to identify the simplest, most effective approach for survivorship care planning. METHODS: Stage 1-3 breast, colorectal, and prostate cancer patients aged 21 years or older completing treatment were recruited from an urban-academic and rural-community cancer center. Participants were randomly assigned, stratified by recruitment site and cancer type 1:1:1 to a mailed plan, plan delivered during a 1-time transition visit, or plan delivered during a transition visit plus 6-month follow-up visit. Health service use data were collected from participants and medical records for 18 months. The primary outcome, receipt of all plan-recommended care, was compared across intervention arms using logistic regression adjusting for cancer type and recruitment site, with P less than .05 considered statistically significant. RESULTS: Of 378 participants randomly assigned, 159 (42.1%) were breast, 142 (37.6%) prostate, and 77 (20.4%) colorectal cancer survivors; 207 (54.8%) from the academic site and 171 (45.2%) from the community site; 316 were analyzable for the primary outcome. There was no difference across arms in the proportion of participants receiving all plan-recommended care: 45.2% mail, 50.5% 1-visit, 42.7% 2-visit (2-sided P = .60). Adherence by cancer type for mail, 1-visit, and 2-visit, respectively, was 52.2%, 53.3%, and 40.0% for breast cancer; 48.6%, 64.1%, and 57.1% for prostate cancer; and 23.8%, 19.0%, and 26.1% for colorectal cancer. There were no statistically significant interactions by recruitment site or cancer type. CONCLUSIONS: This study did not find differences in receipt of recommended follow-up care by plan delivery approach. Feasibility and other factors may determine the best approach for survivorship care planning.

Adequacy of the Provider Workforce for Persons With Cardiopulmonary Disease.

BACKGROUND: Access and quality of health care for cardiopulmonary disease in the United States ranks poorly compared with economically similar nations. No recent comprehensive assessment of the cardiopulmonary workforce is available. This systematic review was conducted to evaluate current published evidence about the workforce caring for persons with cardiopulmonary disease. METHODS: This systematic review followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Structured searches of medical databases were conducted to find studies published from 2006 through 2016. Because of the paucity of quantitative data retrieved, a qualitative synthesis was conducted. Thematic analyses were performed on 15 identified articles through a process of open and axial coding. RESULTS: There is published evidence of current and projected workforce shortages in all clinical settings where care of persons with cardiopulmonary disease occurs. Advanced practice providers complete much of their cardiopulmonary training on the job. The aging population and the advent of new medical interventions are projected to increase growth in health-care demand. Some physicians limit hiring of advanced practice providers because of a deficiency in formal cardiopulmonary training. CONCLUSIONS: There is a gap in care between the needs of persons with cardiopulmonary disease and cardiopulmonary providers. Strategies resolving this problem may include one or more approaches that reduce the administrative burden associated with current care and assure the availability of suitably trained providers.

The Eastern Shore Collaborative for Interprofessional Education's Implementation and Impact over Five Years.

Health care professionals working collaboratively on interprofessional teams are essential to optimize patient-centered care. Collaboration and teamwork can be best achieved if interprofessional education (IPE) starts early for health professions students. This commentary describes the formation, implementation, impact, and lessons learned from students' curricular and co-curricular activities and faculty collaboration over a five-year trajectory of the Eastern Shore Collaborative for Interprofessional Education (ESCIPE). This collaborative is an inter-institutional, interprofessional team and includes 18 faculty members from nine health disciplines with administrative support to prepare practice-ready graduates through effective IPE curricular and co-curricular activities. This collaborative also serves as a resource for interprofessional education, research and scholarship initiatives for faculty members. Activities include educational programs such as an emergency preparedness point-of-dispensing (POD) drill, patient management laboratory simulation, geriatric assessment interdisciplinary team workshop, medical mission as public/global health rotation and service-learning program, rural health fair, and annual university health festival for community outreach. The ESCIPE has also facilitated interprofessional faculty assessment and development, research and scholarship opportunities.

Faculty Perceptions, Knowledge, and Attitudes Toward Interprofessional Education and Practice.

As interprofessional education (IPE) is incorporated into health professions programs, it is essential to understand faculty perceptions, knowledge, and attitudes about IPE and interprofessional practice (IPP). A descriptive, cross-sectional design was used. Seventy-one faculty from three campuses of two rural public universities representing seven different programs participated. Despite limited IPE experience, faculty appreciated IPE and IPP. Notably, many felt undervalued by other professions. Participants acknowledged the importance of working with other professions (mean 2.69±0.53), participating on IP teams (2.61±0.52), and integrating IPP in patient care (2.60±0.52). Faculty reported low IPE knowledge (1.74±0.66) and confidence in IPE teaching ability (1.74±0.67). These findings demonstrate a need for faculty development in both IPE and IPP across all health disciplines.

An interprofessional approach to undergraduate critical care education.

Published research suggests that the best outcomes in critical care clinical practice require an interprofessional (IP) collaborative approach to patient care. The Institute of Medicine has called for increased IP education. This article describes the development of an elective undergraduate IP critical care course. The course was developed to educate nursing and respiratory care students on the importance of IP practice, current evidence, and essentials of critical care. Several challenges were met in the development and implementation of the course. Various IP teaching strategies were used, including simulation, clinical observations, and student patient case presentations. An IP course provides a unique learning environment in which fundamental principles of critical care clinical practice and IP practice can be learned in an IP educational environment. There is a critical need to increase IP education and to conduct research related to IP education and its outcomes in preprofessional educational programs.