Beyond Race and Gender: Measuring Behavioral and Social Indicators of Pain Treatment Satisfaction in Older Black and White Cancer Patients

There are a number of factors that influence compliance with prescribed plans of care. However, there remains a need to identify the collective source health, behavioral, and social constructs have on treatment satisfaction. This study aimed to identify indicators of pain treatment satisfaction among older adults receiving outpatient treatment from a comprehensive cancer center in the southeast region of the United States. Data included a sample of 149 Black and White patients diagnosed with cancer, with the majority being White (85%) and female (57%). Patients were surveyed on questions assessing pain treatment satisfaction, pain severity, and additional social characteristics. A series of multivariate models were specified, whereby patients reporting multiple chronic conditions, poor communication, and perceived discrimination were less satisfied with treatment. Positive communication, higher self-efficacy, and fewer perceived discriminatory acts were significant among the female patients only. These findings suggest the need to develop clinical models that assess how these factors influence the degree of treatment satisfaction, while providing a comprehensive mechanism by which to service the long-term needs of older adults

The Early Impact of the Affordable Care Act upon Colorectal Cancer Screening Utilization in Florida

Background: Colorectal cancer is the second leading cause of cancer-related deaths in the United States. Although preventable and curable through screening, early detection and treatment, a lack of health insurance is a major obstacle to receiving colorectal cancer screening (CRCS). Despite the Affordable Care Act (ACA) increasing access to health insurance by mandating coverage of CRCS, disparities in utilization rates continue. Therefore, researchers sought to better understand ACA related facilitators and impediments that affect the utilization of CRCS and collect specific recommendations from healthcare professionals to increase screening utilization rates in Florida. Methods: Researchers conducted in-depth interviews with 22 healthcare professionals. Data were coded and analyzed using an applied thematic analysis approach and interpreted according to levels of the Social Ecological Model. Results: Eight physicians and nurses, 7 healthcare workers/care coordinators, 5 administrators and insurers, and 2 health advocates completed interviews. In their view, the early days of the ACA facilitated CRCS uptake through use of frontline staff, patient provider communication, and increased access to healthcare. Barriers that remained, included out of pocket patient costs, limited Medicaid expansion, acceptance of ACA plans by only certain providers and removal of patient incentives. Recommendations for increasing CRCS included more promotion and awareness, removing costs and ensuring patient navigation. Conclusions: The ACA offered increased access to healthcare coverage, utilization of CRCS and encouraged better communication between healthcare providers and patients. However, persistent barriers remain and include varied CRCS-related patient costs and restricted provider networks included in ACA sponsored plans. Continued healthcare policy reform is needed to make CRCS affordable for all Americans

Perspectives of older Blacks and Whites living with serious mental illness about outpatient mental health services

In the United States, over three million adults, age 50 and older, reported a diagnosis of serious mental illness (SMI) in the past year. Most of them live in community-settings and are less likely than younger adults to utilize mental health treatment. Lack of and insufficient treatment for SMI places them at increased risk of morbidity, earlier mortality, cognitive decline, and diminished quality of life. The current study aimed to: (1) examine the factors that influence Black and White older adults, who live with SMI, to seek and engage in outpatient mental health treatment; (2) identify the perspectives of Black and White older adults, who live with SMI, on the issues of accessibility, affordability, appropriateness, and availability of outpatient mental health services; and (3) determine whether the perspectives of Blacks and Whites are different on the issues of accessibility, affordability, appropriateness, and availability of outpatient mental health services. I developed a qualitative, interview-based study using the health belief model (HBM) as the theoretical framework. Individual semi-structured interviews were conducted with 19 participants, between the ages of 50-70 years (mean age 58.9), who had a clinical diagnosis of bipolar disorder, schizoaffective disorder, and schizophrenia. The interviews were audiotaped, transcribed verbatim, coded and analyzed using thematic analysis. Data themes related to factors that influenced outpatient mental health treatment and services were identified and organized based on the six HBM constructs. Perceived barriers to mental health treatment engagement included lack of knowledge about available treatment and services in the community, poor mental health literacy, and stigma. Improved sense of well-being and increased socialization were perceived benefits of mental health treatment engagement. Risk of homelessness emerged from the data as the main influence for Black and White older adults, who live with SMI, to seek and engage in outpatient mental health treatment. For all participants, access to and availability of mental health services were not current issues. All except one participant had some type of medical coverage for their treatment and most of them felt that their current treatment was appropriate. There were no differences between Black and White older adults on the issues of accessibility, affordability, appropriateness, and availability of outpatient mental health services. In addition, Black participants did not feel a need for mental health services to be specifically tailored to Black older adults, and instead indicated they saw no differences in Blacks and Whites related to mental health services. These findings are contrary to existing research and may be indicative of the gravity of mental illness-related stigma, compared to racial stigma. Better promotion of available mental health services in the community, mental health outreach, and community education about mental illness may be helpful for earlier identification of symptoms related to mental illness, earlier treatment and intervention, stigma reduction, and improved health and quality of life for community-residing older adults who live with SMI

Impact of Serious Mental Illness Online Training for Certified Nursing Assistants in Long Term Care

Certified nurse assistants (CNAs) spend the most staff time with nursing home residents, yet they receive little training in addressing the mental health needs of residents with serious mental illness (SMI). Forty CNAs from four long-term-care facilities took the online interactive CARES-® Serious Mental Illness™ training consisting of two modules guided by the Recovery Movement philosophy of care. Responses from pre–post testing, Likert-type items, and open-ended questions indicated that CNAs gained information, changed their perspectives, and had more confidence in dealing with SMI. Although there were minor concerns regarding length, clarity of content, and technical issues, CNAs found the online format acceptable and easy to use, and many said they would recommend the training. CARES Serious Mental Illness online training appears to be a viable way of helping CNAs address the mental health needs of long term care residents. Additional testing on CARES Serious Mental Illness is planned