Efficacy of a Patient Education Session for Cancer Patients Receiving Immunotherapy.

OBJECTIVES: Our research questions include: What are gaps in cancer patients' knowledge about immunotherapy? What is the efficacy of an education session in improving cancer patients' knowledge about immunotherapy and reducing inappropriate emergency department (ED) visits? DATA SOURCES: From July 2020 to September 2021, we invited cancer patients receiving immunotherapy to participate in a one-on-one patient education session and pre-test/post-test surveys. The patient education session included an oral presentation following National Comprehensive Cancer Network guidelines, video on immunotherapy mechanisms of action, and review of written materials and alert cards. The surveys assessed patient knowledge of immunotherapies' mechanisms of action, adverse effects and their management, and health literacy. Survey data were paired with data abstracted from the electronic health record on patient ED utilization and demographic characteristics. CONCLUSION: Before the education session, knowledge gaps about immunotherapy included understanding the medical term "itis," side effects of immunotherapy, and treatment for side effects of immunotherapy. Overall, the education session significantly improved cancer patients' knowledge about immunotherapy. The education session addressed knowledge gaps by significantly increasing patients' knowledge of immunotherapy mechanisms of action, recognition of side effects, and ability to define the medical term "itis". Because our sample had low inappropriate ED utilization, we could not assess the impact of the education session on inappropriate ED utilization. IMPLICATIONS FOR NURSING PRACTICE: A multicomponent strategy for patient education was effective in improving overall knowledge uptake, especially among patients who initially had the least knowledge. Future studies should continue to explore whether patient education decreases inappropriate ED utilization.

Organizational Directors' Perceptions About Awareness of Services Among Their Employees and the Older Adults They Serve.

Objectives: This study explores the extent to which directors of organizations perceive that (a) older adults are aware of and interested in using services, and (b) their employees are aware of complementary services in the community and are willing to coordinate care or refer older adults to these services. Method: We conducted 41 qualitative semistructured interviews with organizational directors who provide services to older adults. Results: Directors perceived that not only older adults but also some providers were unaware of services in the community. Directors reported that some older adults felt stigmatized and were unwilling to use services, but services providers implemented strategies to overcome these barriers. Discussion: Understanding the perceptions of organizational directors may help identify opportunities for older adults to learn about community services and for providers to better coordinate care.

Examining collaboration across organizations in an age-friendly community.

Collaboration among organizations is fundamental to promoting age-friendly environments. This study questions: To what extent do organizations collaborate with other organizations in age-friendly communities to provide services to older adults? This study draws on 48 semi-structured qualitative interviews with representatives of organizations that provide services to older adults in an age-friendly community. Findings demonstrated that organizations can engage in collaboration and cooperation across multiple sectors of service delivery and across multiple types of organizations. Nevertheless, some organizations were not collaborating; older adults receiving services at these organizations may miss opportunities to connect to complementary services that can meet their holistic needs.

Perceived Impact of Incentives for Chronic Disease Prevention.

INTRODUCTION: This study evaluates the effect of program and incentive characteristics on satisfaction with incentives and perceived impact of incentives on behavior change among Medicaid beneficiaries who participated in the Centers for Medicare and Medicaid Services Medicaid Incentives for Prevention of Chronic Diseases program. METHODS: In 2014-2015, an English- and Spanish-language survey was administered to Medicaid Incentives for Prevention of Chronic Diseases program participants about their satisfaction with incentives and perceived impact of incentives. Completed surveys were received from 2,276 eligible sample members (response rate=52.7%). In 2016-2017, multilevel, multivariable, ordinal logistic regression models were performed to examine program characteristics that predict outcomes, while controlling for respondent characteristics. RESULTS: Medicaid Incentives for Prevention of Chronic Diseases participants were satisfied with program incentives. Most survey respondents strongly agreed that they liked getting incentives for taking care of their health (78%), they were happy with the incentives overall (75%), the incentives were fair (73%), and they liked how often they received incentives (67%). Participants in programs delivered by telephone reported higher satisfaction with incentives compared with those in programs delivered in person. However, participants in programs delivered both in person and by telephone were more likely to perceive a positive impact of incentives. Incentive form was a significant predictor of satisfaction with incentives but not of incentive impact. Dollar amount of incentives influenced satisfaction with incentives and impact of incentives. CONCLUSIONS: Program delivery method, incentive form, and incentive magnitude are important characteristics to consider when designing incentive programs. Incentive programs can consider providing modest incentive amounts to achieve self-reported impact on behavior change.

Satisfaction with Financial Incentives for Chronic Disease Prevention.

ObjectiveWe examined Medicaid enrollees' experiences and satisfaction with financial incentives-based chronic disease prevention programs in 10 states. MethodsThis cross-site study of the Medicaid Incentives for Prevention of Chronic Diseases model used a mixed-methods approach to assess Medicaid enrollees' experiences and satisfaction with the incentive programs. We conducted 31 in-person focus groups with 212 program participants, followed by a mail survey in English and Spanish (N = 2274). We used both the qualitative focus group data and the quantitative survey data to examine participant satisfaction with the incentives, along with differences by program and incentive characteristics. ResultsOverall, focus group and survey findings aligned, with participants reporting satisfaction with program incentives. Participants felt that the incentives helped them make positive changes to improve their health. Nevertheless, satisfaction varied considerably depending on characteristics of the program, such as the form and magnitude of the incentive, health focus of the program, and program delivery method. ConclusionsProgram and incentive characteristics play key roles in participants' satisfaction and experience with incentive-based, chronic disease prevention programs. Further research is required to examine the optimal design of incentive programs to support sustained behavior change.

Factors influencing professional life satisfaction among neurologists.

BACKGROUND: Predicted shortages in the supply of neurologists may limit patients' access to and quality of care for neurological disorders. Retaining neurologists already in practice provides one opportunity to support the overall supply of practicing neurologists. Understanding factors associated with professional life satisfaction (and dissatisfaction) and implementing policies to enhance satisfaction may encourage neurologists to remain in clinical practice. In this paper, we present results from the first study examining factors associated with professional life satisfaction among a large sample of U.S, neurologists. METHODS: We collaborated with the AAN to survey a sample of U.S. neurologists about their professional life satisfaction. Analyses examined the association of physician and practice characteristics with aspects of professional life satisfaction, including satisfaction with their career in medicine, medical specialty, current position, relationship with colleagues, relationship with patients, work/life balance, and pay. RESULTS: The study population consisted of 625 neurologists. In multivariate regression analyses, no single group or population stratum indicated high (or low) responses to all aspects of satisfaction. Older neurologists reported higher satisfaction with career, specialty, and relationship with patients than younger neurologists. Female neurologists had significantly lower satisfaction with pay than male neurologists. Neurologists who spent more time in research and teaching had greater satisfaction with specialty, relationship with colleagues, and relationship with patients than those spending no time in research. Neurologists who practiced in small cities/rural areas reported lower satisfaction across multiple dimensions than those practicing in large urban areas. Neurologists in solo practice had greater satisfaction with the relationship with their patients, but lower satisfaction with pay. CONCLUSIONS: Satisfaction is a multidimensional construct that is associated with physician and practice characteristics. Enhancing professional life satisfaction among neurologists requires multiple strategies, such as promoting comparable wages for men and women, providing collaboration and research opportunities, and providing resources for small and rural practices.

Factors associated with interest in subspecialty training among neurology residents.

UNLABELLED: PHENOMENON: Previous studies have not explored factors associated with decisions among neurology residents to pursue subspecialty training within neurology. Understanding career choices among neurology residents, particularly decisions regarding subspecialty training, is critical, as neurologists with specialized knowledge can help meet the needs of patients with specific disease conditions. This study addresses the knowledge gap about subspecialty training decisions by examining factors associated with neurology residents' interest in pursuing subspecialty training and the types of subspecialty training neurology residents consider. APPROACH: We surveyed a geographically stratified sample of neurology residents in U.S. training programs using a two-stage survey design. In Stage 1, we randomly sampled half of the accredited neurology residency programs stratified by U.S. census region; Stage 2 involved a survey of neurology residents within these programs. FINDINGS: The majority (approximately 81%) of residents expressed interest in subspecialty training. Resident demographic characteristics and educational debt did not influence interest in pursuing subspecialty training. Residents were more likely to express interest in subspecialty training when they participated in any neurology research (odds ratio [OR] = 2.39), 95% confidence interval (CI) [1.13, 5.07], p = .02, and indicated more interest in careers involving teaching (OR = 8.33), 95% CI [1.64, 42.19], p = .01. Considering the "medical content of subspecialty" as a more important factor approached but did not reach statistical significance (OR = 3.12), 95% CI [0.97, 10.06], p = .06. Insights: Participation in any neurology research and interest in careers involving teaching are associated with interest in subspecialty training among neurology residents. Further research is needed to determine whether exposure to research and teaching stimulates interest in subspecialty training and whether residents believe that subspecialty training is instrumental in pursuing an academic career.

Factors Associated with Neurologists' Provision of MS Patient Care.

Neurologists are central to providing quality care for individuals with MS. However, neurologist shortages may restrict access to care for MS patients. To examine factors influencing neurologists' provision of MS care, we surveyed 1,700 US neurologists to assess demographic/practice characteristics, training, and attitudes toward MS care. The study population consisted of 573 respondents: 87 (15.2%) MS subspecialists and 486 (84.8%) "other neurologists," including subspecialists in other neurology areas (i.e., non-MS) and general neurologists. MS subspecialists indicating they "enjoy interacting with MS patients" had a significantly greater rate of MS patients seen per week. In separate analyses of the "other neurologists" group, the rate of MS patients seen was lower among neurologists in university-based groups or those practicing in major cities; female neurologists; and neurologists who indicated lack of sufficient knowledge regarding MS patient care. Rates of MS patients seen were significantly greater for other neurologists who agreed that MS care involved "ability to improve patient outcomes and quality of life"; "dynamic area with evolving treatment options"; and "enjoy interacting with MS patients." Understanding factors influencing MS patient care by neurologists and developing policies for appropriate access to care is critical for optimal outcomes among this population.