Access to Care and Health Care Utilization Among Patients With Nephrolithiasis.

OBJECTIVE: To characterize the impact of nephrolithiasis diagnosis and treatment on health care utilization and identify predictors of barriers to care in the patient population. METHODS: We conducted a retrospective cohort study using the All of Us Database, a National Institutes of Health database targeting recruitment of underrepresented populations. Patients with a diagnosis of kidney stones were included and matched to a control group. Primary outcomes were patients' self-reported health care access and utilization. Univariable and multivariable regression analyses were performed. RESULTS: 9173 patients with a diagnosis of nephrolithiasis were included and matched to 9173 controls without a diagnosis of nephrolithiasis. Patients with kidney stones were less likely to have had >1 year since last provider visit (1.7% vs 3.8%, P <.001), but did not report increased delays obtaining care (31%), inability to afford care (11.4%), or higher likelihood of skipping medications (12.9%). Among patients with stones, 1208 (13.2%) had been treated surgically. On multivariable analysis, younger age, female sex, lower income, lower education, non-insured status, and lower physical and mental health were all associated with delays obtaining care, difficulty affording care, skipping medications, and/or prolonged time since seeing a provider. CONCLUSION: A diagnosis of nephrolithiasis and subsequent surgical intervention were not associated with an increase in patient-reported barriers to care. However, among patients with nephrolithiasis, younger, comorbid, female patients from lower socioeconomic status are at significant risk of being unable to access and utilize treatment.

Current Knowledge and Opinions of Medical Trainees Regarding PSA Screening.

After 2008 and 2012 USPSTF recommendations against PSA screening, studies revealed a decline in screening rates and trend towards more advanced disease at presentation. After revision of this recommendation in 2017, PSA screening guidelines remain inconsistent and controversy still exists about its clinical utility. We seek to better understand the knowledge of medical trainees regarding this fundamental controversy and gain better insight into what they are being taught regarding this topic. Participants were medical students (n = 66) and residents (n = 60) from a single institution. REDCap software was used for informed consent, survey distribution, and data collection. Variables measured included PSA clinical knowledge, awareness of the PSA guideline changes, and attitudes, confidence, and viewpoints on use of PSA screening in clinical practice. More than 60% of medical trainees reported little or no knowledge of PSA screening guidelines. Although residents reported more knowledge than medical students, actual assessed knowledge of PSA screening did not differ between groups. Trainees reported receiving education primarily from other healthcare professionals and didactics, with some self-learning online. Though confidence was low overall, residents were more confident than medical students in discussing PSA screening with patients. The majority of respondents wanted more information about PSA testing, with medical students particularly interested in diagnosis/detection, treatment, and survival. Overall, opinions towards PSA testing as an aid were generally positive. Better education about the current PSA screening guidelines for medical trainees is imperative, particularly given that shared decision-making is of great importance when counseling patients on cancer screening.

The Lack of Sexual Health Education in Medical Training Leaves Students and Residents Feeling Unprepared.

BACKGROUND: Despite physicians frequently caring for patients with sexual health issues, only 50% of United States medical schools require formal education in sexual medicine, and there are currently no guidelines pertaining to this with research which found that medical trainees are ill-equipped to provide sexual healthcare. AIM: This study aims to identify areas to improve sexual health training in order to increase physician confidence and competence in evaluating and training patients with sexual health problems. METHODS: A prospective survey was sent via REDCap to medical students (n = 190, 68.6%), residents (n = 75, 27.1%), and fellows (n = 11, 3.9%) via a known listserv. Participants (N = 276, ∼15% response rate) were asked to provide demographic information, whether they received sexual health training during medical school and rate their confidence in addressing patients' sexual health concerns. OUTCOMES: Medical students and residents currently do not receive sufficient education on sexual health and medicine, particularly in fields outside of OB-GYN and Urology, leaving them underqualified and less confident than needed for adequate patient care. RESULTS: 65.6% of trainees reported receiving formal sexual health education, while 13.9% received informal education, and 20.6% received no education during medical school. Although trainees desire to understand a patients' sexual health (P < .001), only residents in a relevant field (Urology, OB-GYN) felt confident in their ability to assist patients with a sexual health issue (P = .013). All other trainees lacked confidence in attending to sexual health concerns (P < .001), regardless of training level (P > .1). CLINICAL IMPLICATIONS: More efforts should be made to integrate sexual health education into medical school curriculum. STRENGTHS & LIMITATIONS: The strength of this study includes specific evaluation of medical student and resident confidence level with 15 individual sexual health topics. The limitations include that the demographic was regionally confined to the Midwest of the United States and women were more strongly represented among medical students. CONCLUSION: Due to the lack of standardized education, medical trainees (except for Urology and OB-GYN residents) feel unprepared to treat patients with sexual health issues, and medical schools should make sexual health education mandatory. Beebe S, Payne N, Posid T, et al. The Lack of Sexual Health Education in Medical Training Leaves Students and Residents Feeling Unprepared. J Sex Med 2021;18:1998-2004.

Knowledge is Key: Viewpoints of New Recurrent Urinary Tract Infections Guidelines.

OBJECTIVE: To evaluate management patterns, measure familiarity with the new guidelines, and gauge the level of education and confidence in treating rUTIs according to recent guidelines, specifically in the context of trainee education. Recurrent urinary tract infections (rUTI) are a common urologic complaint and a heavy burden on the healthcare system. Until recently, the AUA did not have a guideline on the management of rUTIs. METHODS: Participants were medical students (PGY3-4, n = 41), residents (n = 48), and fellows (n = 11) from a single institution (N = 100) from both urology and non-urology backgrounds. This prospective survey study measured demographic information, personal history of rUTI management, knowledge of the new guideline, personal practice patterns, and guideline education. RESULTS: Trainees reported that they felt "slightly unknowledgeable" (M = 2.6/4, P < .001) about rUTI treatment, although level of knowledge increased with increased training level. Participants were asked about the new rUTI guidelines that were published in 2019, with urology trainees (M = 83.3%) more aware (P < .001) of their recent release compared to non-urology residents and fellows (M = 12.2%) and medical students (M = 7.5%). When looking specifically at peri- and postmenopausal women, antibiotic treatment was the highest recommendation for rUTI in both peri- (70.6%), and post-menopausal women (68.2%), followed by cranberry juice/extract (43.5% vs 42.4%). Providers were more likely to recommend vaginal estrogens for post-menopausal (45.9%) compared to perimenopausal (28.2%, P < .05) women. CONCLUSION: Better trainee education about the current rUTI guidelines is warranted, including management of peri- and postmenopausal women which have specific guideline recommendations.

Does spiritual and religious orientation impact the clinical practice of healthcare providers?

The objective of the current study was to assess the religious and spiritual (R&S) beliefs and practices among healthcare providers, compare R&S among provider types, as well as examine the potential relationship between organized/nonorganized religious activities and intrinsic religiosity with the incorporation of R&S into clinical practice. A cross-sectional descriptive online survey methodology was used. There were 387 participants with an average age of 45.5 years. Providers included primary care providers (26.9%), nurses (27.1%), allied health (23.5%), and mental health professionals (22.5%). Most participants reported being "religious and spiritual" (42.9%) or "spiritual and not religious" (36.6%). There was a difference in R&S among provider types (x2(6) = 12.6, p = .05) with mental health providers more often identifying as spiritual, but not religious (46.6%) compared with other providers. No mental health professional indicated almost always/often/sometimes praying with patients versus 9.5% of primary providers, 14.8% of allied providers, and 18.1% of nurses. Results from structural equation modeling showed that intrinsic religiosity was most strongly associated with how a provider interacted with patients around R&S (ß = .644, p < .001) followed by non-organized religious activities (ß = .228, p < .001) and organized religious activities (ß = .092, p = .037). Understanding the role of R&S beliefs and behaviors of healthcare providers is important to patient-centered care.

Characterizing Perceptions Around the Patient-Oncologist Relationship: a Qualitative Focus Group Analysis.

The purpose of the current study was to characterize the experiences of cancer patients and their caregiver/family members around their relationship with their oncologist, health care team, and the hospital environment. Participants were recruited from The Ohio State University Comprehensive Cancer Center. Participant sociodemographic factors were assessed. Focus groups were moderated and recorded by two members of the research team using a semi-structured interview format. The audio recordings were transcribed and uploaded to NViVO 11 for analyses. Four focus groups were conducted with 25 participants. The mean age of participants was 58.4 years (SD = 15.1, range 26.0-76.0). Participants who were identified as patients (84%) reported different malignancy types including breast (56%), gynecologic (16%), skin (6%) oral (6%), and non-Hodgkin's lymphoma (6%). Three major themes that emerged around the patient-oncologist relationship, include (1) choosing a physician and health care location, (2) relationship with the physician, health care team, and hospital environment; and (3) patient engagement and decision-making. Subthemes highlighted the importance of the flexible communication behaviors and trustworthiness of the oncologist, and the impact of other health care team members. Patients also reported the desire to be engaged in making treatment-related decisions and to include the caregiver/spouse in all stages of cancer care. Understanding the experience of cancer patients in a relationship with their oncologist in the context of the health care team and health care environment will be an important area of future research to provide optimal, tailored patient-centered cancer care.

Understanding the Type of Support Offered Within the Caregiver, Family, and Spiritual/Religious Contexts of Cancer Patients.

CONTEXT/OBJECTIVES: We sought to characterize patterns of social support types (i.e., emotional, informational, appraisal, and instrumental) within the caregiver/spouse, family, and spiritual/religious contexts for patients diagnosed with cancer. METHODS: Focus groups were conducted with mixed groups of patients with cancer and caregiver/family members at a Midwestern comprehensive cancer center. Participants completed brief demographic questionnaires. Focus groups were moderated using semistructured interviews. The 90-minute discussions were audio-recorded, transcribed, and uploaded into NVivo for analysis using a deductive approach based on four social support types and the constant comparative method. RESULTS: Four focus groups were conducted (n = 25). The average age was 58.4 years (SD = 15.1, range 26.0-76.0). Patient participants reported different malignancy types, including breast, gynecologic, skin, oral, and Non-Hodgkin's lymphoma. Participants acknowledged changes within their social network across the cancer journey. Overall, the caregiver/spouse fulfilled all types of social support. Spirituality/religion was often discussed as a form of appraisal social support. Fellow survivors were sources of informational support. Across groups, nondirective/emotional support was most frequently mentioned. CONCLUSION: Cancer is a unique experience, and understanding the importance of social support, including types of social support needed from different contexts to best meet the needs of the patient, may promote optimal, patient-centered care across the cancer trajectory.

Assessing structure and characteristics of social networks among cancer survivors: impact on general health.

PURPOSE: Robust social networks are associated with improved health and quality of life for cancer survivors. Certain cancer diagnoses are associated with higher levels of stigma than breast cancer. However, little is known about the differences in social networks depending on the type of malignancy. This study aims to assess the differences in social networks and general health between breast cancer and more stigmatized cancers. METHODS: Cancer survivors were recruited to participate in a cross-sectional online survey study. Social network size and satisfaction was measured using the Cancer Survivor Social Networks Measure. General health was measured with a five-point-Likert-style item. RESULTS: The average age of the sample (n = 99) was 57.6 years old (SD = 13.4) and the majority were female (67.7%). Breast cancer survivors had an average of 1.39 more members in their social network than other cancers (t(94) = 2.28, p = 0.025). There were no significant differences between groups in network satisfaction. Results of a binary logistic regression model explained 26.9% of the variance in general health (x2(5) = 18.35, p = 0.003). There was a significant association among formal support network satisfaction (ß = - 1.23, p = 0.021), formal support network size (ß = - 0.36, p = 0.019), malignancy type (breast vs. other) (ß = 1.05, p = 0.05), and better general health. CONCLUSIONS: The results suggest breast cancer survivors had more formal social supports then other malignancy types. An association among greater formal social network size and satisfaction, a diagnosis of breast instead of other cancers, and better general health was noted. Emphasizing formal support sources for all cancer survivors may improve their overall health.

Understanding patient expectations around therapeutic benefits, risks, and the chance of cure.

Conversations around surgical goals of care should focus on relational (e.g., empathy, trust, understanding) instead of transactional processes (e.g., communication). Rather than reducing the patient-surgeon relationship to isolated variables such as "communication," a "relational lens" that considers all the aspects of the patient-surgeon relationship and its dynamic processes is needed.