Impact Evaluation of Patient-Centered, Community-Engaged Health Modules for Homeless Pregnant Women.

PURPOSE: Pregnant women who experience homelessness are at a greater risk for poor birth outcomes than the general population. This pilot study describes results of a service-learning program informed by previously identified unmet perinatal health needs. In this patient-centered service-learning program, medical students partnered with homeless women currently residing in a shelter in Milwaukee, Wisconsin. METHODS: Medical students in the Health Advocacy in Pregnancy and Infancy (HAPI) project at the Medical College of Wisconsin developed and taught 6 service-learning modules to shelter residents: healthy cooking, mental health, perinatal nutrition, infant care/safety, breastfeeding, and contraception. Implemented between 2018 and 2021, modules were hosted in person and via electronic videoconferences. We gathered qualitative data on participants' perceived impact of the modules and used grounded theory analysis to examine written comments and verbal feedback. RESULTS: A total of 141 participants attended 42 learning sessions. Participants included pregnant and postpartum mothers and women interested in learning about pregnancy-related health. Qualitative analysis revealed 3 universal themes regarding the impact of the sessions on participants: "Knowledge," "Intention to Change," and "Empowerment." CONCLUSIONS: Our community-engaged health education partnership program between homeless pregnant women and medical students focused on perinatal health. This well-received, effective strategy cultivated new knowledge, empowering participants to not only change their own behaviors, but to teach and support others. This study demonstrates the ability of using community-based teaching sessions to enhance participants' understanding of pregnancy and postpartum health and empower others to implement changes.

Breast cancer-related lymphedema rates after modern axillary treatments: How accurate are our estimates?

BACKGROUND: Clinical trials have demonstrated methods to minimize the risk of breast cancer-related lymphedema while preserving regional control. We sought to determine the percent lifetime-risk of breast cancer-related lymphedema that surgeons and radiation oncologists discuss with patients before axillary interventions. METHODS: A nationwide survey of surgeons and radiation oncologists was performed from July to August 2020. Participants were asked to identify what number they discuss with patients when estimating the percent lifetime-risk of breast cancer-related lymphedema after different axillary interventions. RESULTS: Six hundred and eighty surgeons and 324 radiation oncologists responded (14% response rate). While the estimated rate after sentinel lymph node biopsy was clinically similar between surgeons and radiation oncologists, statistically surgeons quoted a higher percent lifetime-risk (5.7% vs 5.0%, P = .03). Surgeons estimated significantly higher rates of breast cancer-related lymphedema compared with radiation oncologists (P < .001) for axillary lymph node dissection (21.8% vs 17.5%), sentinel lymph node biopsy with regional nodal irradiation (14.1% vs 11.2%), and axillary lymph node dissection with regional nodal irradiation (34.8% vs 26.2%). CONCLUSION: There is variability in the estimated rates of breast cancer-related lymphedema providers discuss with patients. These findings highlight the need for physician education on the current evidence of percent lifetime-risk of breast cancer-related lymphedema to provide patients with accurate estimates before axillary interventions.