Assessing Patient Preferences for Communication Companions in Primary Care

Introduction: Adults with communication impairments encounter obstacles in accessing high quality healthcare. While having a companion accompany a patient during clinic visits is a potential solution, the literature suggests that the efficacy of this strategy remains unclear. We sought to determine patient preferences regarding the roles of a communication companion and other approaches to overcoming communication challenges. Methods: The Patient-Provider-Companion survey was provided to adult primary care patients during check-in at five urban and rural practices in northern Vermont. The survey offered a checklist of options regarding the roles a companion may play to improve communication during a visit, including active roles such as speaking for the patient, or more passive roles such as taking notes. Other questions assessed how best to communicate health information after a visit. All responses were collected anonymously and analyzed using descriptive statistics. Results: Of the 179 survey respondents, the mean age was 55 (range 19-94), with 65% women. Eleven percent of respondents brought a companion to the visit, and the most highly endorsed companion roles were: “helping understand what the doctor says or means” (63%), and “prompt or remind to ask questions” (68%). Additionally, 105 patients provided their preferences for healthcare communication: 50% wanted key takeaways at the end of the visit, and 46% wanted time to summarize back what they heard. Fewer than 10% requested specific aids such as use of a clear mask or an amplifier. Among the 46 respondents who endorsed a method of keeping family up to date, the most common preference was to “read notes and instructions via the patient portal” (77%). Conclusions: Patient accompaniment to a primary care visit is common. Among accompanied patients, we identified preference for the roles a companion may play, which included strategies to help the patient understand as well as help with being understood. Asynchronous communication through the patient portal to the medical record is highly endorsed and deserves further exploration as an option for patients with communication disabilities. Bringing a companion and using the patient portal are customizable, patient-centered strategies that can be appropriate for people with unique and overlapping communication disabilities

Characterizing the Effects of Post-Translational Modifications on the Kinesin Motor Protein Kif18A During Cell Division

Eukaryotic cells go through a phase in the cell cycle called mitosis in which the duplicated genetic material of the cell, in the form of chromosomes, is separated equally into two daughter cells. Within mitotic cells, there are motor proteins of the kinesin family that walk along the microtubules of the mitotic spindle and are necessary to faithfully segregate chromosomes and avoid aneuploidy, a characteristic of cancer. A mitotic motor protein in the kinesin-8 family, called Kif18A, localizes to the ends of kinetochore-fibers, bundles of microtubules that attach chromosomes via the kinetochore protein complex to the mitotic spindle. Kif18A accumulates at the plus ends of kinetochore-fibers and is essential for the highly conserved process of chromosomal alignment during metaphase. However, it is not understood how Kif18A’s activity is regulated for this function. Proteomic analyses have identified post-translational modifications (PTMs) of Kif18A; however, nothing is known about the effect of PTMs on Kif18A activity. I have characterized the phosphorylation of Kif18A at S357, a serine residue in an important mechanical element of the protein called the neck linker. I hypothesized that a change in charge near the neck linker will disrupt Kif18A’s localization and function during mitosis by altering ATP-dependent conformational changes within the protein that are required for its movement along microtubules. We created a GFP-tagged phosphomimetic construct of Kif18A (S357D) and a non-phosphorylatable version at the same site (S357A). I found that there was a slight localization defect for the phosphomimetic construct and a small chromosomal alignment defect as measured from immunofluorescence in fixed cells. I also started to track mCherry-tagged kinetochore dynamics in live cells expressing these constructs and found that the alignment defect was even more exaggerated. I created new mCherry-tagged constructs so I could repeat these experiments with a finer kinetochore tracking ability. Future directions of my project include repeating the kinetochore tracking with GFP-tagged kinetochores expressing these mCherry-Kif18A constructs for finer tracking ability and determine the effects of the phosphomimetic on Kif18A processivity using in vitro single molecule TIRF microscopy. These findings demonstrate a role for PTM regulation on Kif18A and lay the groundwork for studying PTMs in kinesin motors