Public response to an anthrax attack: reactions to mass prophylaxis in a scenario involving inhalation anthrax from an unidentified source.

An attack with Bacillus anthracis ("anthrax") is a known threat to the United States. When weaponized, it can cause inhalation anthrax, the deadliest form of the disease. Due to the rapid course of inhalation anthrax, delays in initiation of antibiotics may decrease survival chances. Because a rapid response would require cooperation from the public, there is a need to understand the public's response to possible mass dispensing programs. To examine the public's response to a mass prophylaxis program, this study used a nationally representative poll of 1,092 adults, supplemented by a targeted focus on 3 metropolitan areas where anthrax attacks occurred in 2001: New York City (n=517), Washington, DC (n=509), and Trenton/Mercer County, NJ (n=507). The poll was built around a "worst-case scenario" in which cases of inhalation anthrax are discovered without an identified source and the entire population of a city or town is asked to receive antibiotic prophylaxis within a 48-hour period. Findings from this poll provide important signs of public willingness to comply with public health recommendations for obtaining antibiotics from a dispensing site, although they also indicate that public health officials may face several challenges to compliance, including misinformation about the contagiousness of inhalation anthrax; fears about personal safety in crowds; distrust of government agencies to provide sufficient, safe, and effective medicine; and hesitation about ingesting antibiotic pills after receiving them. In general, people living in areas where anthrax attacks occurred in 2001 had responses similar to those of the nation as a whole.

Patient perspectives of clinical care and patient navigation in follow-up of abnormal mammography.

BACKGROUND: Racial and ethnic disparities in cancer care and survival are well documented. Patient navigation has been shown to improve timely follow-up of abnormal breast screenings for underserved patients. Few studies showed the impact of navigation on patient experiences of care. OBJECTIVE: We compared the experiences of patients enrolled in a patient navigator program and non-navigated patients referred to a hospital breast center for follow-up of abnormal mammogram in an underserved community health center population. DESIGN: Group comparison study using data from a mail and telephone survey to measure the experience of navigated and non-navigated patients. PARTICIPANTS: English- and Spanish-speaking patients with abnormal mammography attending the Avon Breast Center between April 1, 2005 and April 30, 2007. Seventy-two navigated patients and 181 non-navigated patients completed surveys; the survey response rate was 53.6%. MAIN MEASURES: Timeliness of care, preparation for the visit to the breast center, ease of access, quality of care, provider communication, unmet need and patient satisfaction. KEY RESULTS: Most measures of the patient experience did not differ between navigated and non-navigated patients. Overall quality of care was rated as excellent (55% vs 62%, p = 0.294). Navigated patients were significantly more likely than non-navigated to 'definitely' understand what to expect at their visit (79% vs 60%, p = 0.003), to receive a reminder letter or telephone call (89% vs 77%, p = 0.029), and to feel welcome (89% vs 75%, p = 0.012). Navigated patients were less likely than non-navigated to rate the concern shown for their cultural/religious beliefs as excellent (45% vs 54%, p = 0.014). CONCLUSIONS: Assessing patient perspectives is essential to evaluate the success of quality improvement interventions. In our center, we measured few significant disparities in the perceptions of care of these two very different populations of patients, although, there are still areas in which our program needs improvement. Further research is needed to understand the effectiveness of patient navigation programs in reducing racial and ethnic disparities.

Experience with health coach-mediated physician referral in an employed insured population.

BACKGROUND: Given increasing interest in helping consumers choose high-performing (higher quality, lower cost) physicians, one approach chosen by several large employers is to provide assistance in the form of a telephonic "health coach" - a registered nurse who assists with identifying appropriate and available providers. OBJECTIVE: To evaluate the health coach's influence on provider choice and the quality of the user experience in the early introduction of this service. DESIGN: Cross-sectional survey of 3490 employees and covered dependents of a large national firm that offered health coach services to all employees and covered dependents. The survey began in September 2007 with proportionate stratified sampling of 1750 employees and covered dependents who used the services between October 2007 and February 2008, and 1740 non-users. PARTICIPANTS: Insured adults (ages 21-64) employed by a large national firm or covered dependents of employees. MEASUREMENTS: Awareness of the service, reason for using service, visits to providers recommended by service, use of health advice provided by service, user satisfaction. MAIN RESULTS: The primary reason for using the service was to obtain provider referrals (73%). Fifty-two percent of users sought a specialist referral, 33% a PCP referral and 9% a hospital referral. Eighty-nine percent of users seeking a provider referral were referred in-network; 81% of those referred visited the referred provider. Measures of satisfaction with both the service and the care delivered by recommended providers were over 70%. CONCLUSIONS: Customers largely follow the provider recommendation of the health coach. Users express general satisfaction with existing health coach services, but differences in performance between vendors highlight the need for the services to be well implemented.

Medical interpreter knowledge of cancer and cancer clinical trials.

BACKGROUND: Cancer patients with limited English proficiency may need specialized assistance to communicate with health professionals about cancer and clinical trials. METHODS: Medical interpreters working in several Boston-area hospitals were invited to participate in training sessions about cancer and cancer clinical trials. We did a pre and post survey-based assessment of knowledge of basic concepts in cancer and clinical trials, and post assessment of satisfaction, among 97 interpreters in cancer training and education sessions and 79 participants in clinical trial training and education sessions. RESULTS: Participants had a range of prior experience with interpretation in the context of cancer and clinical trials. Training increased mean accuracy from 49% to 72% in knowledge items about cancer, and from 72% to 78% in knowledge about clinical trials. Interpreters reported several areas of concern with respect to standards of practice. CONCLUSIONS: Pretest surveys of medical interpreters revealed several areas of important knowledge gaps about cancer and clinical trials. Posttest assessment showed that training can be useful to improving short-term accuracy, but that more work is needed to develop curricula and testing measures to address these knowledge gaps.

The forgotten team member: meeting the needs of oncology support staff.

INTRODUCTION: The impact of working in an oncology setting has been widely researched for physicians, nurses, social workers, and chaplains. The experiences of nonlicensed support staff in an oncology setting have rarely been acknowledged or addressed. Few studies have addressed support or education initiatives for support staff caring for oncology patients. The intent of this study was to understand the work experiences of oncology support staff. Emotional impact, patient relationships, and team relationships were addressed. These data would help shape the development of an oncology support staff program. METHODS: A qualitative and quantitative approach was used to explore the experiences of support staff. Seven focus groups and individual interviews were conducted addressing work life in a cancer center. The quantitative survey collected baseline data on job satisfaction, working relationships, patient relationships, burnout, and support programs. RESULTS: Four predominant themes emerged from the focus groups. These included: relationships with patients and families, coping with death and dying, value and recognition, and balancing function with emotion. The quantitative survey reported the highest satisfaction with patient relationships and the lowest satisfaction with job recognition and supervisor support. High personal accomplishment scores declined with duration of employment. Educational grand rounds were a high interest. DISCUSSION: This study provides insight into the impact of caring for oncology patients on support staff. Burnout and job satisfaction can be costly. Recognizing the challenges inherent in the oncology environment is essential to supporting a successful oncology practice for licensed and nonlicensed support staff.