Food Insecurity Status and Health Care Utilization Among COPD Patients: A Retrospective Study.

BACKGROUND: Government programs-targeting chronic disease patients with high health care costs-focus on clinical conditions, factors internal to the health care system, and individual patient education, not on addressing modifiable social determinants of health to reduce health care utilization. OBJECTIVE: To evaluate differences in sociodemographic variables and health care utilization between patients with chronic obstructive pulmonary disease (COPD) who reported food insecurity and those who did not. METHODS: This descriptive retrospective cross-sectional study used data from the electronic health records of a convenience sample of 854 participants with a discharge diagnosis of COPD or COPD with acute exacerbation, admitted via the emergency department of participating hospitals in Southern California. Chi-square (or Fisher's exact) tests and t tests were used to evaluate group differences, and multivariate (or Firth) logistic regression to identify factors that increased the odds of emergency department visits and hospitalizations. RESULTS: Significant differences between groups were identified for food insecurity (sometimes or often vs never insecure) and age (P < .001), race (P = .022), medical insurance (P < .001), zip code (P = .022), homeless status (P < .001), smoking status (P < .001), and emergency department visits (P = .033). No significant differences were found for food insecurity and hospitalizations (P = .592). CONCLUSION: This study contributes to the growing body of research supporting the association of upstream social factors (food insecurity, homelessness, zip code) and downstream health outcomes (repeated emergency room visits), and how existing programs can be effectively utilized to impact downstream health outcomes such as health care utilization.

Stigma, Communication, and Clinical Oncology Care: Three Case Studies.

BACKGROUND: Health-related stigma can contribute to health inequities and poor outcomes. To address stigma-related issues in clinical oncology care, healthcare providers can identify stigma in clinical practice and apply strategies that reduce stigma. OBJECTIVES: The aim is to identify stigma-related issues experienced by patients with cancer and to present strategies that address stigma-associated barriers to quality clinical oncology care. METHODS: This article presents three case studies that illustrate stigma-associated issues and strategies to address those issues in clinical oncology care. FINDINGS: Identifying intersectional stigmas in clinical care, each case study includes the patient's background information, a social assessment, and a clinical update, as well as an example of dialogue between the nurse and patient. Each case study ends with commentary and questions to further illustrate stigma-related issues in clinical oncology care. Finally, supporting the case studies, the toolbox includes inclusive language; principles of universal precautions to apply to stigma in clinical oncology care; and communication components, strategies, and resources to reduce stigma in clinical oncology care.

Palliative Care: Building a Foundation for Clinical Oncology Nursing Practice.

As we close out 2022, we offer knowledge and encouragement to oncology nurses to clarify gains, gaps, and guidelines in palliative care.

Oncology Nurse Navigator Effect on Emergency Department Visits and Hospital Admissions of Adults With Cancer Post-Outpatient Chemotherapy.

OBJECTIVES: To examine the effect of oncology nurse navigators (ONNs) on the number of emergency department (ED) visits and hospital admissions (HAs) of adults with cancer post-outpatient chemotherapy. SAMPLE & SETTING: 1,370 patients with cancer between January 1, 2018, and December 31, 2019, in a comprehensive community cancer center in southern California. METHODS & VARIABLES: A descriptive cross-sectional study was conducted using retrospective electronic health records. Primary analysis included bivariate and multiple linear regression to identify correlates of ED visits and HAs in terms of ONN involvement. RESULTS: About 35% of patients had an ED visit or HA. Anemia, dehydration, and pain were common diagnoses. No significant differences were found in ED visits and HAs by ONN group. Medicare and chemotherapy administration location contributed to the likelihood of ED visits; nausea, pain, and pneumonia contributed to the likelihood of HAs. IMPLICATIONS FOR NURSING: ED visits and HAs are not appropriate clinical outcomes to measure ONNs' efficacy. Further research is needed to understand the long-term fiscal and operational outcomes of ONNs.

Black Feminist Thought: A Paradigm to Examine Breast Cancer Disparities.

BACKGROUND: African American women (AAW) are diagnosed with more aggressive forms of breast cancer when compared to White women and are more likely to die before the age of 45 years. Researchers have suggested that psychological stress could be a precursor to breast cancer. AAW experience a unique form of stress that is a result of living at the intersection of socially constructed roles of race, gender, and class (intersectionality). No studies have used the paradigm of Black Feminist Thought to examine breast cancer disparities among AAW. OBJECTIVE: The purpose of this study was to examine how the intersection of race, gender, and class influences mental and physiological well-being among AAW with breast cancer. METHODS: A phenomenological design was used. Ten AAW ages 45-60 years were recruited from across the United States. Semistructured interviews were conducted and analyzed using a modified Husserlian approach of descriptive phenomenology. The interviews were audiotaped and transcribed verbatim, and themes were identified using Giorgi's method. RESULTS: Four themes emerged: (a) altruism (selfless giving and caring for others), (b) silent strength (strength in silence while enduring life in the intersection), (c) existential invisibility (an essential, obscured presence in society), and (d) marginalization (living at the margins of society). Marginalization manifested in two forms: (a) passive marginalization (circumstances in which women removed themselves mentally or physically from societal adversity) and (b) active marginalization (circumstances in which women were overlooked, devalued, or ostracized by others). DISCUSSION: This study supports the use of Black Feminist Thought to garner knowledge that adds to the discussion of breast cancer disparities. The themes identified suggest other upstream psychosocial risk factors for the development of breast cancer in AAW that stem from life within the societal intersection.

A systematic review of the use of the electronic health record for patient identification, communication, and clinical support in palliative care.

OBJECTIVES: Globally, healthcare systems are using the Electronic Health Record (EHR) and elements of clinical decision support (CDS) to facilitate palliative care (PC). Examination of published results is needed to determine if the EHR is successfully supporting the multidisciplinary nature and complexity of PC by identifying applications, methodology, outcomes, and barriers of active incorporation of the EHR in PC clinical workflow. METHODS: A systematic review using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The data sources PubMed, CINAL, EBSCOhost, and Academic Search Premier were used to identify literature published 1999 - 2017 of human subject peer-reviewed articles in English containing original research about the EHR and PC. RESULTS: The search returned 433 articles, 30 of which met inclusion criteria. Most studies were feasibility studies or retrospective cohort analyses; one study incorporated prospective longitudinal mixed methods. Twenty-three of 30 (77%) were published after 2014. The review identified five major areas in which the EHR is used to support PC. Studies focused on CDS to: identify individuals who could benefit from PC; electronic advanced care planning (ACP) documentation; patient-reported outcome measures (PROMs) such as rapid, real-time pain feedback; to augment EHR PC data capture capabilities; ,and to enhance interdisciplinary communication and care. DISCUSSION: Beginning in 2015, there was a proliferation of articles about PC and EHRs, suggesting increasing incorporation of and research about the EHR with PC. This review indicates the EHR is underutilized for PC CDS, facilitating PROMs, and capturing ACPs.