Evaluation and Refinement of a Prostate Cancer Treatment Seminar

Significance & Background: Prostate cancer survivors represent a large and growing group. Prostate cancer survivors have a variety of psychosocial and medical needs that change over time. In 2009, a seminar was developed by a multidisciplinary team at Roswell Park Cancer Institute (RPCI) to help prostate cancer patients and their families learn about and prepare for treatment and disease related issues. Purpose: To report on the lessons learned during the execution and evaluation of a newly develop prostate cancer treatment seminar. Program: The prostate cancer treatment seminar is 90 minutes long and is delivered by RPCI clinicians, allied health professionals and behavioral scientists. The seminar provides attendees with information on: social work assistance, patient navigation, physical therapy, nutrition, pastoral care, psychology services, and nursing/clinic services. Results: Survey results from a process evaluation indicated that a majority of seminar attendees were very satisfied with the seminar information and most attendees found the information useful. Process evaluation data also revealed that many eligible patients were not attending the seminar, particularly African Americans and Latinos. Interview data from non attendees revealed that transportation, competing schedules, and health issues were common barriers to attendance. In 2010, the seminar was video tape recorded and a DVD was created to expand the seminar’s reach. Conclusion: The addition of the DVD has resulted in a vast improvement in the numbers of prostate cancer patients who receive the seminar content. More than twice the amount of patients now receive the seminar information via DVD than in-person. In person attendees and DVD viewers have similar ratings regarding the seminar’s usefulness

Providers\u27 experiences caring for adolescents who smoke cigarettes.

OBJECTIVE: To describe providers\u27 experiences screening for and counseling adolescent patients who smoke cigarettes. DESIGN: Eight qualitative focus groups were conducted with 51 health care providers in primary care settings. Focus groups were video- and audiotaped; tapes were transcribed for coding by an interdisciplinary team using the constant comparative method. MAIN OUTCOME MEASURES: Providers reported experiences screening for and managing adolescent patients who reported smoking cigarettes. RESULTS: Providers expressed confidence in their ability to screen adolescent patients for tobacco use, particularly as part of regularly scheduled preventive and medical visits. Providers reported difficulty balancing screening for smoking with their concern for maintaining rapport with their adolescent patients. In addition, providers reported that adolescent smoking patterns differed from those of adults, and consequently, providers were not certain at what level of smoking an adolescent required intervention. Furthermore, providers were unclear regarding what interventions were recommended for and effective with adolescents. CONCLUSION: Providers are interested in adolescent evidence-based screening methods and cessation interventions that are supportive of a nonjudgmental and empathic approach to caring for adolescent smokers, particularly those with irregular and situational smoking patterns

Feasibility and Impact of an Internet-based Adolescent Psychiatric Assessment Administered by Clinical Staff in the Pediatric Emergency Department

Objective: Determine the adoption rate of the web-based Behavioral Health Screening- Emergency Department (BHS-ED) system into routine clinical practice in a pediatric emergency department (ED), and assess its impact on identification and assessment of psychiatric problems. Design: Descriptive design to evaluate feasibility of a clinical innovation. Setting: ED of an urban tertiary care children’s hospital. Participants: Non-acute, non-critical 14-18 year olds presenting with non-psychiatric complaints. Intervention: ED clinical staff initiated the BHS-ED which assesses depression, suicide, post-traumatic stress, substance use, and violence exposure. Treating clinicians reviewed results and followed routine care practices thereafter. Outcome Measures: Adoption rate of the BHS-ED by nursing staff, identification rates of occult psychiatric problems, and social worker or psychiatrist assessment. Data were collected for 19 months before and 9 months during implementation. Results: Of 3979 eligible patients, 1327 (33%) were approached by clinical staff to complete the BHS-ED; of these, 857 (64.6%) completed the BHS-ED, and 470 (35.4%) refused. During implementation, identification of adolescents with psychiatric problems significantly increased (4.2% vs. 2.5%, OR=1.70, 95% CI 1.38, 2.10) as did ED assessments by a social worker or psychiatrist (2.5% vs. 1.7%, OR 1.47, 95% CI 1.13, 1.90). Of the 857 subjects who completed the BHS-ED, 10.5% were identified (OR=4.58, 95% CI 3.53, 5.94) and 8.3% were assessed (OR 5.12, 95% CI 3.80, 6.88). Conclusions: In a busy pediatric ED, computerized, self-administered adolescent behavioral health screening can be incorporated into routine clinical practice and can lead to small but significant increases in the identification of unrecognized psychiatric problems