The Perceived Usability of Virtual Visits Among Black Adults' Receiving Oncology Care: A Qualitative Analysis.

BACKGROUND: With the COVID-19 pandemic came rapid uptake in virtual oncology care. During this, sociodemographic inequities in access to virtual visits (VVs) have become apparent. To better understand these issues, we conducted a qualitative study to describe the perceived usability and acceptability of VVs among Black adults diagnosed with cancer. METHODS: Adults who self-identified as Black and had a diagnosis of prostate, multiple myeloma, or head and neck cancer were recruited from 2 academic medical centers, and their community affiliates to participate in a semi-structured interview, regardless of prior VV experience. A patient and family advisory board was formed to inform all components of the study. Interviews were conducted between September 2, 2021 and February 23, 2022. Transcripts were organized topically, and themes and subthemes were determined through iterative and interpretive immersion/crystallization cycles. RESULTS: Of the 49 adults interviewed, 29 (59%) had participated in at least one VV. Three overarching themes were derived: (1) VVs felt comfortable and convenient in the right contexts; (2) the technology required for VVs with video presented new challenges, which were often resolved by an audio-only telephone call; and (3) participants reported preferring in-person visits, citing concerns regarding gaps in nonverbal communication, trusting providers, and distractions during VV. CONCLUSION: While VVs were reported to be acceptable in specific circumstances, Black adults reported preferring in-person care, in part due to a perceived lack of interpersonal connectedness. Nonetheless, retaining reimbursement for audio-only options for VVs is essential to ensure equitable access for those with less technology savvy and/or limited device/internet capabilities.

Seeking Racial Equity in Hematology and Oncology: a Fellow-Led Educational Series to Promote Reflection and Action.

The USA is experiencing a reckoning with racial injustice and graduate medical education programs are seeking ways to address this important topic in training. Fellows in hematology/oncology at the University of North Carolina recognized this important gap and adapted a curriculum for medical residents on racial equity to a subspecialty audience. Aims were (1) to improve knowledge and awareness about implicit bias and systemic racism and (2) introduce methods to address racial inequities. We used lived experiences and collated materials from scientific literature and lay media to illustrate key points. The course explored the effects of implicit bias on individual, clinical, and health system levels, anchored in Kahneman's two-system theory. Videos, journal articles, and group discussion were employed to appeal to many learning styles. A post-curriculum survey assessed perceptions of racial inequality in medicine and the series' effects using a Likert scale. Twenty-nine participants completed the survey (12 fellows), 71% reported improved awareness of racial inequities, and 61% reported improved comfort level in addressing racial inequities. All participants recognized at least "some" racial inequity in medicine, and over 75% of participants indicated interest in further sessions. Formulation of an educational curriculum by fellows and delivered in a division-wide setting was feasible and well received by participants, filling a key educational gap. We encourage other institutions to take similar steps to highlight issues of systemic racism and move our field in the right direction.

Trends in the use of immunotherapy to treat soft tissue sarcoma.

BACKGROUND: The role of immune-oncology (IO) therapy in soft tissue sarcoma (STS) is underexplored. This study characterized IO use in STS. METHODS: This is a retrospective analysis of patients with a soft tissue mass in the National Cancer Database, 2011-2021. Patients were categorized by IO receipt status. Groupwise testing and proportional trend tests were performed with Chi-squared tests. Multivariate logistic regression was performed to assess factors associated with IO receipt. RESULTS: Of the 103,092 patients with STS, 1935 (1.9 â€‹%) received or were recommended IO therapy. IO use increased 10-fold (0.24 â€‹%-2.5 â€‹% from 2011 to 2021; p â€‹< â€‹0.0001). Patients had higher odds of receiving IO when having higher grade tumors and metastatic disease, and when treated at an academic research center (all p â€‹< â€‹0.001). CONCLUSIONS: IO use in STS is low but increasing and primarily used in the metastatic setting. Future studies should identify biomarkers of IO response and facilitators for treatment receipt.

Predicting Acute Care Events Among Patients Initiating Chemotherapy: A Practice-Based Validation and Adaptation of the PROACCT Model.

PURPOSE: Acute care events (ACEs), comprising emergency department visits and hospitalizations, are a priority area for reduction in oncology. Prognostic models are a compelling strategy to identify high-risk patients and target preventive services, but have yet to be broadly implemented, partly because of challenges with electronic health record (EHR) integration. To facilitate EHR integration, we adapted and validated the previously published PRediction Of Acute Care use during Cancer Treatment (PROACCT) model to identify patients at highest risk for ACEs after systemic anticancer treatment. METHODS: A retrospective cohort of adults with a cancer diagnosis starting systemic therapy at a single center between July and November 2021 was divided into development (70%) and validation (30%) sets. Clinical and demographic variables were extracted, limited to those in structured format in the EHR, including cancer diagnosis, age, drug category, and ACE in prior year. Three logistic regression models of increasing complexity were developed to predict risk of ACEs. RESULTS: Five thousand one hundred fifty-three patients were evaluated (3,603 development and 1,550 validation). Several factors were predictive of ACEs: age (in decades), receipt of cytotoxic chemotherapy or immunotherapy, thoracic, GI or hematologic malignancy, and ACE in the prior year. We defined high-risk as the top 10% of risk scores; this population had 33.6% ACE rate compared with 8.3% for the remaining 90% in the low-risk group. The simplest Adapted PROACCT model had a C-statistic of 0.79, sensitivity of 0.28, and specificity of 0.93. CONCLUSION: We present three models designed for EHR integration that effectively identify oncology patients at highest risk for ACE after initiation of systemic anticancer treatment. By limiting predictors to structured data fields and including all cancer types, these models offer broad applicability for cancer care organizations and may offer a safety net to identify and target resources to this high risk.

Communicating with Vulnerable Patient Populations: A Randomized Intervention to Teach Inpatients to Use the Electronic Patient Portal.

BACKGROUND: Patient portals are expanding as a means to engage patients and have evidence for benefit in the outpatient setting. However, few studies have evaluated their use in the inpatient setting, or with vulnerable patient populations. OBJECTIVE: This article assesses an intervention to teach hospitalized vulnerable patients to access their discharge summaries using electronic patient portals. METHODS: Patients at a safety net hospital were randomly assigned to portal use education or usual care. Surveys assessed perceptions of discharge paperwork and the electronic portal. RESULTS: Of the 202 prescreened eligible patients (e.g., deemed mentally competent, spoke English, and had a telephone), only 43% had working emails. Forty-four percent of participants did not remember receiving or reading discharge paperwork. Patients trained in portal use (n = 47) or receiving usual care (n = 23) preferred hospitals with online record access (85 and 83%, respectively), and felt that online access would increase their trust in doctors (85 and 87%) and satisfaction with care (91% each). Those who received training in portal use were more likely to register for the portal (48% vs. 11%; p < 0.01). CONCLUSION: Patients had positive perceptions of portals, and education increased portal use. Lack of email access is a notable barrier to electronic communication with vulnerable patients.

Orthostatic hypotension in young adults with and without posttraumatic stress disorder.

The purpose of this research is (a) to evaluate differences in orthostatic hypotension (OH) among young adults with and without posttraumatic stress disorder (PTSD) and (b) to examine whether group differences may be attributable to behavioral risk factors frequently associated with PTSD. Volunteers and U.S. veterans 18 to 39 years old (N = 222) completed a semistructured interview assessment of PTSD status. Direct measurements were obtained for supine and standing systolic and diastolic blood pressure at study visits, as well as height and weight, from which body mass index (BMI) was calculated. After controlling for use of psychotropic medications, a logistic regression model revealed that PTSD status was positively associated with OH, such that participants with PTSD were at 4.51 greater odds of having OH than control participants. Moreover, this effect was partially mediated by lifetime alcohol dependence (bootstrapped 95% confidence interval [-0.83, -0.20]). Overall, PTSD may pose a significant risk for OH among younger adults. In the present sample, this relationship was primarily driven by the disproportionately high history of alcohol dependence among individuals with PTSD. These results suggest that traditional therapy for PTSD should be coupled with treatment for alcohol dependency, when applicable, to reap both psychological and physiological benefits.

Experience of the school-aged child with tracheostomy.

BACKGROUND: Little is known about the school experience of children with tracheostomy tubes. These children may represent a population that qualifies for special services in school. Understanding how tracheostomy affects school-aged children may provide information needed to develop programs that provide these children with invaluable experiences. OBJECTIVE: To understand what children with tracheostomies experience in school as it relates to tracheostomy care and how their condition affects academic achievement and social adjustment. METHODS: We identified a cohort of 38 eligible school-aged children with indwelling tracheostomy tubes for ongoing upper airway obstruction through the North Carolina Children's Airway Center. A questionnaire was developed to assess support of their medical condition throughout the school day. Twenty-three patients responded to the questionnaire. RESULTS: School experience for a child with a tracheostomy varied. Approximately half the children attended special needs classes, the other half were in mainstream classrooms. Speech services and Passy-Muir valves were used in 43% and 57% of cases, respectively. Over half the students were excluded from physical activity because of the tracheostomy. Most students missed at least 10 days of school for medical care in an academic year. Fifty percent of the students reported attending schools where school personnel had no training in tracheostomy care. In some cases, a trained nurse accompanied the child to school to help with tracheostomy care. In other cases, the child coped with tracheostomy care alone. CONCLUSIONS: As children with special medical needs are increasingly incorporated into mainstream schools, it is important to understand the potential hurdles they face in managing tracheostomies. In particular, school personnel should have the ability to provide basic care for students with tracheostomies. Student speech and educational outcomes require further investigation and analysis.