21 research outputs found
Cancer Screening Benefits and Harms: News Coverage and Provider Perceptions
Background. Cancer screening poses both potential benefits and potential harms to patients. This dissertation explored news coverage and provider perceptions of screening by comparing colonoscopy, which results in net benefit for many adults, to the prostate-specific antigen (PSA) testing, which may do more harm than good. Methods. Study 1 data came from a 2012 survey of clinicians (n=126) from 24 family/internal medicine practices in North Carolina. Analyses examined clinicians' perceptions of screening benefits and harms and potential mediators of the relationship between screening test and clinicians' likelihood estimates. Study 2 data came from a content analysis of articles on PSA testing or colonoscopy in the top 10 U.S. print newspapers. Analyses examined whether newspapers' portrayal of screening changed after the 2008 U.S. Preventive Services Task Force recommendation changes. Results. In Study 1, we found that clinicians perceived PSA testing to have greater likelihood of harm than colonoscopy and lower likelihood of lengthening life. These associations were mediated by clinicians' gist of screening and perceived benefits, but not perceived harms. In Study 2, we found that mentions of PSA harms in newspapers were stable before 2008 but increased after that time. Mentions of PSA benefits and colonoscopy harms and benefits did not change over time. Discussion. Clinicians and the news media both fell short as sources of information on PSA testing and colonoscopy. Patients may be receiving imbalanced information on cancer screening. Thus, clinicians, experts in dissemination, and the USPSTF may face hurdles in communicating new recommendations to patients. Messages to clinicians intended to decrease over-recommendation of PSA testing may need to emphasize its relatively few benefits rather than its many harms.Doctor of Philosoph
Patient decision making in the face of conflicting medication information
When patients consult more than one source of information about their medications, they may encounter conflicting information. Although conflicting information has been associated with negative outcomes, including worse medication adherence, little is known about how patients make health decisions when they receive conflicting information. The objective of this study was to explore the decision making strategies that individuals with arthritis use when they receive conflicting medication information. Qualitative telephone interviews were conducted with 20 men and women with arthritis. Interview vignettes posed scenarios involving conflicting information from different sources (e.g., doctor, pharmacist, and relative), and respondents were asked how they would respond to the situation. Data analysis involved inductive coding to identify emergent themes and deductive contextualization to make meaning from the emergent themes. In response to conflicting medication information, patients used rules of thumb, trial and error, weighed benefits and risks, and sought more information, especially from a doctor. Patients relied heavily on trial and error when there was no conflicting information involved in the vignette. In contrast, patients used rules of thumb as a unique response to conflicting information. These findings increase our understanding of what patients do when they receive conflicting medication information. Given that patient exposure to conflicting information is likely to increase alongside the proliferation of medication information on the Internet, patients may benefit from assistance in identifying the most appropriate decision strategies for dealing with conflicting information, including information about best information sources
Fluid manipulation among individuals with lower urinary tract symptoms: a mixed methods study
To determine, qualitatively and quantitatively, how individuals use fluid manipulation to self-manage the urinary symptoms of daytime frequency, urgency and urine leakage and the underlying rationale for this behaviour
Moderating Perceptions of Bother Reports by Individuals Experiencing Lower Urinary Tract Symptoms
We compared reports of symptom bother for the same urinary symptoms to understand why symptom severity and bother do not correspond in a straightforward manner. We used a grounded theory approach to analyze qualitative data from 123 individual interviews and developed a conceptual framework, identifying three symptom perceptions that might “moderate” symptom bother: causal, relative, and uncertainty. Symptom bother was lower for respondents who viewed symptoms causally (symptoms seemed explainable or “normal”) or relatively (urinary symptoms were compared to other symptoms or conditions). Bother tended to be higher for respondents who viewed symptoms with uncertainty (when symptom etiology and course were unknown). A greater portion of respondents in the causal perception group had not sought health care for their symptoms. This conceptual framework is useful for understanding the relationship between reactions to and health care-seeking for other symptoms
Beyond incontinence: The stigma of other urinary symptoms
This paper is a report of a study conducted to characterize the stigma of urinary frequency and urgency and differentiate it from the stigma of incontinence and to describe race/ethnic and gender differences in the experience of stigma among a diverse sample of individuals
The impact of vasculitis on patients’ social participation and friendships
Objectives—Our objective is to explore how vasculitis, affects patients’ friendships and social
participation.
Methods—Vasculitis patients (n=221) completed an online questionnaire that asked if, and how,
relationships with friends have changed since receiving a vasculitis diagnosis. Participants’ written
responses were imported into Atlas.ti, and two independent researchers used both structured and
unstructured coding to identify themes. After reaching 100% consensus on the themes present in
each participant’s responses, the coders determined how themes were interrelated across
participants.
Results—Over half of patients (52%) expressed that vasculitis negatively impacted their
friendships and 25% noted a negative impact on their social participation. At limes, this negative
impact was related to structural changes in patients’ social networks due to loss of friendships.
Reduced social participation was also associated with friends’ inability to understand vasculitis
and its effects, vasculitis-related fatigue, and lifestyle changes such as not being able to drink
alcohol and avoiding infection-prone events. Additionally, patients withdrew from social
engagements due to fatigue or because of physical symptoms and side effects.
Conclusion—The unique circumstances associated with a rare chronic illness like vasculitis can
create significant barriers to friendships, including loss of these relationships. Interventions
designed to help patients cope with the social impact of vasculitis are implicated, especially if they
increase patients’ ability to engage in dialogue about their illness with their friends
Peer support of complex health behaviors in prevention and disease management with special reference to diabetes: systematic reviews
Abstract Objectives Examine Peer Support (PS) for complex, sustained health behaviors in prevention or disease management with emphasis on diabetes prevention and management. Data sources and eligibility PS was defined as emotional, motivational and practical assistance provided by nonprofessionals for complex health behaviors. Initial review examined 65 studies drawn from 1442 abstracts identified through PubMed, published 1/1/2000–7/15/2011. From this search, 24 reviews were also identified. Extension of the search in diabetes identified 30 studies published 1/1/2000–12/31/2015. Results In initial review, 54 of all 65 studies (83.1%) reported significant impacts of PS, 40 (61.5%) reporting between-group differences and another 14 (21.5%) reporting significant within-group changes. Across 19 of 24 reviews providing quantifiable findings, a median of 64.5% of studies reviewed reported significant effects of PS. In extended review of diabetes, 26 of all 30 studies (86.7%) reported significant impacts of PS, 17 (56.7%) reporting between-group differences and another nine (30.0%) reporting significant within-group changes. Among 19 of these 30 reporting HbA1c data, average reduction was 0.76 points. Studies that did not find effects of PS included other sources of support, implementation or methodological problems, lack of acceptance of interventions, poor fit to recipient needs, and possible harm of unmoderated PS. Conclusions Across diverse settings, including under-resourced countries and health care systems, PS is effective in improving complex health behaviors in disease prevention and management including in diabetes
The relationship between partner information-seeking, information-sharing, and patient medication adherence
We describe the medication information-seeking behaviors of arthritis patients’ partners and explore whether partner medication information-seeking and information-sharing are associated with patient medication adherence
Composite measures of multi-joint symptoms, but not of radiographic osteoarthritis, are associated with functional outcomes: the Johnston County Osteoarthritis Project
To determine associations between multiple joint symptoms and radiographic osteoarthritis (rOA) and functional outcomes
Mortality from gastrointestinal congenital anomalies at 264 hospitals in 74 low-income, middle-income, and high-income countries: a multicentre, international, prospective cohort study
Summary
Background Congenital anomalies are the fifth leading cause of mortality in children younger than 5 years globally.
Many gastrointestinal congenital anomalies are fatal without timely access to neonatal surgical care, but few studies
have been done on these conditions in low-income and middle-income countries (LMICs). We compared outcomes of
the seven most common gastrointestinal congenital anomalies in low-income, middle-income, and high-income
countries globally, and identified factors associated with mortality.
Methods We did a multicentre, international prospective cohort study of patients younger than 16 years, presenting to
hospital for the first time with oesophageal atresia, congenital diaphragmatic hernia, intestinal atresia, gastroschisis,
exomphalos, anorectal malformation, and Hirschsprung’s disease. Recruitment was of consecutive patients for a
minimum of 1 month between October, 2018, and April, 2019. We collected data on patient demographics, clinical
status, interventions, and outcomes using the REDCap platform. Patients were followed up for 30 days after primary
intervention, or 30 days after admission if they did not receive an intervention. The primary outcome was all-cause,
in-hospital mortality for all conditions combined and each condition individually, stratified by country income status.
We did a complete case analysis.
Findings We included 3849 patients with 3975 study conditions (560 with oesophageal atresia, 448 with congenital
diaphragmatic hernia, 681 with intestinal atresia, 453 with gastroschisis, 325 with exomphalos, 991 with anorectal
malformation, and 517 with Hirschsprung’s disease) from 264 hospitals (89 in high-income countries, 166 in middleincome
countries, and nine in low-income countries) in 74 countries. Of the 3849 patients, 2231 (58·0%) were male.
Median gestational age at birth was 38 weeks (IQR 36–39) and median bodyweight at presentation was 2·8 kg (2·3–3·3).
Mortality among all patients was 37 (39·8%) of 93 in low-income countries, 583 (20·4%) of 2860 in middle-income
countries, and 50 (5·6%) of 896 in high-income countries (p<0·0001 between all country income groups).
Gastroschisis had the greatest difference in mortality between country income strata (nine [90·0%] of ten in lowincome
countries, 97 [31·9%] of 304 in middle-income countries, and two [1·4%] of 139 in high-income countries;
p≤0·0001 between all country income groups). Factors significantly associated with higher mortality for all patients
combined included country income status (low-income vs high-income countries, risk ratio 2·78 [95% CI 1·88–4·11],
p<0·0001; middle-income vs high-income countries, 2·11 [1·59–2·79], p<0·0001), sepsis at presentation (1·20
[1·04–1·40], p=0·016), higher American Society of Anesthesiologists (ASA) score at primary intervention
(ASA 4–5 vs ASA 1–2, 1·82 [1·40–2·35], p<0·0001; ASA 3 vs ASA 1–2, 1·58, [1·30–1·92], p<0·0001]), surgical safety
checklist not used (1·39 [1·02–1·90], p=0·035), and ventilation or parenteral nutrition unavailable when needed
(ventilation 1·96, [1·41–2·71], p=0·0001; parenteral nutrition 1·35, [1·05–1·74], p=0·018). Administration of
parenteral nutrition (0·61, [0·47–0·79], p=0·0002) and use of a peripherally inserted central catheter (0·65
[0·50–0·86], p=0·0024) or percutaneous central line (0·69 [0·48–1·00], p=0·049) were associated with lower mortality.
Interpretation Unacceptable differences in mortality exist for gastrointestinal congenital anomalies between lowincome,
middle-income, and high-income countries. Improving access to quality neonatal surgical care in LMICs will
be vital to achieve Sustainable Development Goal 3.2 of ending preventable deaths in neonates and children younger
than 5 years by 2030