Quality of Life and Mental Health Outcomes in Implanted Cardioverter Defibrillator Treatment: Potential Effects of Informational Media History and Treatment Knowledge

Social workers in all care venues are increasingly responsible for clinical and case management services for people being treated with sophisticated medical interventions. Unfortunately, opportunities to aid in the promotion of quality of life (QOL), mental health, and informed consent are often not understood by social workers, other care providers, or patients. These missed opportunities may lead to attenuated effectiveness of medical interventions and negative impact on patients\u27 QOL. One such technological treatment is the implantable cardioverter defibrillator (ICD), a lifesaving therapy which carries risk to patients\u27 QOL. Moreover, patients frequently do not accurately understand the benefits, limitations, and possible risks associated with ICD therapy. A small body of literature exists addressing experimental and demographic groups at risk of QOL decrements among the ICD patient population, including those who have been shocked more than five times, older adults, female patients, and those who have experienced a life threatening cardiac event. A much more limited body of literature addresses the quality of some forms of patient educational activities and materials. No research to date has attempted to characterize potential relationships between patient information acquisition, treatment knowledge, and QOL/mental health outcomes in this patient group. Using a cross-sectional survey of ICD patients being treated at the University of Colorado Hospital (UCH), this dissertation project uses a social-ecological approach to describe the media through which ICD patients learn about device therapy, how well they understand their treatment, QOL and mental health outcomes, and any relationships between these constructs. The project was conducted in iterative phases, including the creation of two new measures assessing patient informational media history and ICD treatment knowledge, a pilot survey of 100 randomly selected patients to assess the quality of the new measures, and a larger survey of the remaining 655 potential ICD patient participants. A total of 205 ICD patients responded to the survey, with a mean age of 60.7 years (sd=14.53), 34.1% of whom identified as female, 10.2% of whom are African American, and 37.5% of whom live in a household with an annual income of less than $40,000. Findings from survey responses revealed both the viability of the new informational media history and ICD treatment knowledge measures, as well as broad use of a number of specific forms of media to learn about treatment. Older adult patients illustrated significantly lower treatment knowledge and use of fewer forms of informational media than their younger counterparts. Multiple regression analyses revealed significant relationships between patient history of having been shocked, health related depression, and QOL, but failed to replicate earlier findings linking these problems to demographic indicators. Each of these findings highlight opportunities for improved social work research and practice with ICD patients, including the need for improved patient education processes for older adults with these devices, and the importance of mental health status, particularly depression, to patient QOL

Dissemination and stakeholder engagement practices among dissemination & implementation scientists: Results from an online survey

IntroductionThere has been an increasing focus on disseminating research findings, but less about practices specific to disseminating and engaging non-researchers. The present project sought to describe dissemination practices and engagement of stakeholders among dissemination & implementation (D&I) scientists.MethodsMethods to disseminate to and engage non-research stakeholders were assessed using an online survey sent to a broad, diverse sample of D&I scientists.ResultsSurveys were received from 210 participants. The majority of respondents were from university or research settings in the United States. (69%) or Canada (13%), representing a mix of clinical (28%) and community settings (34%). 26% had received formal training in D&I. Respondents indicated routinely engaging in a variety of dissemination-related activities, with academic journal publications (88%), conference presentations (86%), and reports to funders (74%) being the most frequent. Journal publication was identified as the most impactful on respondents' careers (94%), but face-to-face meetings with stakeholders were rated as most impactful on practice or policy (40%). Stakeholder involvement in research was common, with clinical and community-based researchers engaging stakeholder groups in broadly similar ways, but with critical differences noted between researchers with greater seniority, those with more D&I training, those based in the United States vs. Canada, and those in community vs. clinical research settings.ConclusionsThere have been increases in stakeholder engagement, but few other practices since the 2012 survey, and some differences across subgroups. Methods to engage different stakeholders deserve more in-depth investigation. D&I researchers report substantial misalignment of incentives and behaviors related to dissemination to non-research audiences

Perspectives of scientists on disseminating research findings to non-research audiences

BACKGROUND: Little is known about practices used to disseminate findings to non-research, practitioner audiences. This study describes the perspectives, experience and activities of dissemination & implementation (D&I) scientists around disseminating their research findings. METHODS: The study explored D&I scientists\u27 experiences and recommendations for assessment of dissemination activities to non-research audiences. Existing list serves were used to recruit scientists. Respondents were asked three open-ended questions on an Internet survey about dissemination activities, recommendations for changing evaluation systems and suggestions to improve their own dissemination of their work. RESULTS: Surveys were completed by 159 scientists reporting some training, funding and/or publication history in D&I. Three themes emerged across each of the three open-ended questions. Question 1 on evaluation generated the themes of: 1a) promotional review; 1b) funding requirements and 1c) lack of acknowledgement of dissemination activities. Question 2 on recommended changes generated the themes of: 2a) dissemination as a requirement of the academic promotion process; 2b) requirement of dissemination plan and 2c) dissemination metrics. Question 3 on personal changes to improve dissemination generated the themes of: 3a) allocation of resources for dissemination activities; 3b) emerging dissemination channels and 3c) identify and address issues of priority for stakeholders. CONCLUSIONS: Our findings revealed different types of issues D&I scientists encounter when disseminating findings to clinical, public health or policy audiences and their suggestions to improve the process. Future research should consider key requirements which determine academic promotion and grant funding as an opportunity to expand dissemination efforts

An Interactive Web-Based Lethal Means Safety Decision Aid for Suicidal Adults (Lock to Live): Pilot Randomized Controlled Trial

BACKGROUND: Counseling to reduce access to lethal means such as firearms and medications is recommended for suicidal adults but does not routinely occur. We developed the Web-based Lock to Live (L2L) decision aid to help suicidal adults and their families choose options for safer home storage. OBJECTIVE: This study aimed to test the feasibility and acceptability of L2L among suicidal adults in emergency departments (EDs). METHODS: At 4 EDs, we enrolled participants (English-speaking, community-dwelling, suicidal adults) in a pilot randomized controlled trial. Participants were randomized in a 13:7 ratio to L2L or control (website with general suicide prevention information) groups and received a 1-week follow-up telephone call. RESULTS: Baseline characteristics were similar between the intervention (n=33) and control (n=16) groups. At baseline, many participants reported having access to firearms (33/49, 67%), medications (46/49, 94%), or both (29/49, 59%). Participants viewed L2L for a median of 6 min (IQR 4-10 min). L2L also had very high acceptability; almost all participants reported that they would recommend it to someone in the same situation, that the options felt realistic, and that L2L was respectful of values about firearms. In an exploratory analysis of this pilot trial, more participants in the L2L group reported reduced firearm access at follow-up, although the differences were not statistically significant. CONCLUSIONS: The L2L decision aid appears feasible and acceptable for use among adults with suicide risk and may be a useful adjunct to lethal means counseling and other suicide prevention interventions. Future large-scale studies are needed to determine the effect on home access to lethal means. TRIAL REGISTRATION: ClinicalTrials.gov NCT03478501; https://clinicaltrials.gov/ct2/show/NCT03478501

The Advancing Understanding of Transportation Options (AUTO) study: design and methods of a multi-center study of decision aid for older drivers

Background: Decision-making about when to stop driving for older adults involves assessment of driving risk, availability of support or resources, and strong emotions about loss of independence. Although the risk of being involved in a fatal crash increases with age, driving cessation can negatively impact an older adult's health and well-being. Decision aids can enhance the decision-making process by increasing knowledge of the risks and benefits of driving cessation and improve decision quality. The impact of decision aids regarding driving cessation for older adults is unknown. Methods: The Advancing Understanding of Transportation Options (AUTO) study is a multi-site, two-armed randomized controlled trial that will test the impact of a decision aid on older adults' decisions about changes in driving behaviors and cessation. AUTO will enroll 300 drivers age ≥ 70 years with a study partner (identified by each driver); the dyads will be randomized into two groups (n = 150/group). The decision aid group will view the web-based decision aid created by Healthwise at baseline and the control group will review information about driving that does not include evidence-based elements on risks and benefits and values clarification about driving decisions. The AUTO trial will compare the effect of the decision aid, versus control, on a) immediate decision quality (measured by the Decisional Conflict Scale; primary outcome); b) longitudinal psychosocial outcomes at 12 and 24 months (secondary outcomes); and c) longitudinal driving behaviors (including reduction or cessation) at 12 and 24 months (secondary outcomes). Planned stratified analyses will examine the effects in subgroups defined by cognitive function, decisional capacity, and readiness to stop driving. Discussion: The AUTO study is the first large-scale randomized trial of a driving decision aid for older adults. Results from this study will directly inform clinical practice about how best to support older adults in decision-making about driving

Quality of Life and Mental Health Outcomes in Implanted Cardioverter Defibrillator Treatment: Potential Effects of Informational Media History and Treatment Knowledge

Social workers in all care venues are increasingly responsible for clinical and case management services for people being treated with sophisticated medical interventions. Unfortunately, opportunities to aid in the promotion of quality of life (QOL), mental health, and informed consent are often not understood by social workers, other care providers, or patients. These missed opportunities may lead to attenuated effectiveness of medical interventions and negative impact on patients’ QOL. One such technological treatment is the implantable cardioverter defibrillator (ICD), a lifesaving therapy which carries risk to patients’ QOL. Moreover, patients frequently do not accurately understand the benefits, limitations, and possible risks associated with ICD therapy. A small body of literature exists addressing experimental and demographic groups at risk of QOL decrements among the ICD patient population, including those who have been shocked more than five times, older adults, female patients, and those who have experienced a life threatening cardiac event. A much more limited body of literature addresses the quality of some forms of patient educational activities and materials. No research to date has attempted to characterize potential relationships between patient information acquisition, treatment knowledge, and QOL/mental health outcomes in this patient group. Using a cross-sectional survey of ICD patients being treated at the University of Colorado Hospital (UCH), this dissertation project uses a social-ecological approach to describe the media through which ICD patients learn about device therapy, how well they understand their treatment, QOL and mental health outcomes, and any relationships between these constructs. The project was conducted in iterative phases, including the creation of two new measures assessing patient informational media history and ICD treatment knowledge, a pilot survey of 100 randomly selected patients to assess the quality of the new measures, and a larger survey of the remaining 655 potential ICD patient participants. A total of 205 ICD patients responded to the survey, with a mean age of 60.7 years (sd=14.53), 34.1% of whom identified as female, 10.2% of whom are African American, and 37.5% of whom live in a household with an annual income of less than $40,000. Findings from survey responses revealed both the viability of the new informational media history and ICD treatment knowledge measures, as well as broad use of a number of specific forms of media to learn about treatment. Older adult patients illustrated significantly lower treatment knowledge and use of fewer forms of informational media than their younger counterparts. Multiple regression analyses revealed significant relationships between patient history of having been shocked, health related depression, and QOL, but failed to replicate earlier findings linking these problems to demographic indicators. Each of these findings highlight opportunities for improved social work research and practice with ICD patients, including the need for improved patient education processes for older adults with these devices, and the importance of mental health status, particularly depression, to patient QOL

Lethal Means Counseling for Suicidal Adults in the Emergency Department: A Qualitative Study

Introduction: Lethal means counseling (to reduce access to firearms or other suicide methods) is a recommended critical yet challenging component of care of suicidal patients. Questions remain about communication strategies for those in acute crisis.Method: This qualitative study was an analysis of semi-structured interviews with English-speaking, community-dwelling adults with a history of lived-experience of suicidal ideation or attempts in themselves or a family member. We used a mixed inductive and deductive approach to identify descriptive themes related to communication and decision-making.Results: Among 27 participants, 14 (52%) had personal and 23 (85%) had family experience with suicide ideation or attempts. Emergent themes fell into two domains: (1) communication in a state of high emotionality; and (2) specific challenges in communication: initiating, maintaining engagement, considering context.Conclusion: Engaging suicidal individuals in lethal means counseling may be more effective when messaging and approaches consider their emotional state and communication challenges

A comparative content analysis of newspaper coverage about extreme risk protection order policies in passing and non-passing US states.

BackgroundExtreme risk protection order (ERPO) laws are a tool for firearm violence prevention (in effect in 19 states), often enacted in the wake of a public mass shooting when media coverage of gun violence tends to spike. We compared news media framing of ERPOs in states that passed and those that considered but did not pass such laws after the 2018 mass shooting in Parkland, Florida.MethodsWe conducted a content analysis of 244 newspaper articles about ERPOs, published in 2018, in three passing (FL, VT, RI) and three non-passing states (PA, OH, CO). Measures included language used, stakeholders mentioned, and scientific evidence cited. We use chi-square tests to compare the proportion of articles with each measure of interest in passing versus non-passing states.ResultsCompared to newspaper coverage of non-passing states, news articles about ERPOs in passing states more often used only official policy names for ERPOs (38% vs. 23%, p = .03), used less restrictive language such as "prevent" to describe the process of suspending firearm access (15% vs. 3%, p < .01), mentioned gun violence prevention advocacy groups (41% vs. 28%, p = .08), and referenced research on ERPOs (17% vs. 7%, p = .03). Articles about passing states also more often explicitly stated that a violent event was or could have been prevented by an ERPO (20% vs. 6%, p < .01).ConclusionsMedia messaging that frames gun violence as preventable, emphasizes identifiable markers of risk, and draws on data in conjunction with community wisdom may support ERPO policy passage. As more states consider ERPO legislation, especially given endorsement by the Biden-Harris administration, deeper knowledge about successful media framing of these life-saving policies can help shape public understandings and support