5 results on '"Smith, Thomas J."'
Search Results
2. Integrating Advance Care Planning Videos into Surgical Oncologic Care: A Randomized Clinical Trial.
- Author
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Aslakson, Rebecca A., Isenberg, Sarina R., Crossnohere, Norah L., Conca-Cheng, Alison M., Moore, Madeleine, Bhamidipati, Akshay, Mora, Silvia, Miller, Judith, Singh, Sarabdeep, Swoboda, Sandra M., Pawlik, Timothy M., Weiss, Matthew, Volandes, Angelo, Smith, Thomas J., Bridges, John F.P., and Roter, Debra L.
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SURGERY & psychology , *ACADEMIC medical centers , *CANCER patient medical care , *CONFIDENCE intervals , *INTEGRATED health care delivery , *MEDICAL care , *PALLIATIVE treatment , *PATIENT satisfaction , *PATIENTS , *PATIENT safety , *PHYSICIAN-patient relations , *PREOPERATIVE care , *SURGEONS , *VIDEO recording , *DECISION making in clinical medicine , *ADVANCE directives (Medical care) , *PSYCHOSOCIAL factors , *RANDOMIZED controlled trials , *DISEASE incidence , *PATIENT-centered care , *TERTIARY care , *STAKEHOLDER analysis ,TUMOR surgery - Abstract
Background: Preoperative advance care planning (ACP) may benefit patients undergoing major surgery. Objective: To evaluate feasibility, safety, and early effectiveness of video-based ACP in a surgical population. Design: Randomized controlled trial with two study arms. Setting: Single, academic, inner-city tertiary care hospital. Subjects: Patients undergoing major cancer surgery were recruited from nine surgical clinics. Of 106 consecutive potential participants, 103 were eligible and 92 enrolled. Interventions: In the intervention arm, patients viewed an ACP video developed by patients, surgeons, palliative care clinicians, and other stakeholders. In the control arm, patients viewed an informational video about the hospital's surgical program. Measurements: Primary Outcomes—ACP content and patient-centeredness in patient–surgeon preoperative conversation. Secondary outcomes—patient Hospital Anxiety and Depression Scale (HADS) score; patient goals of care; patient and surgeon satisfaction; video helpfulness; and medical decision maker designation. Results: Ninety-two patients (target enrollment: 90) were enrolled. The ACP video was successfully integrated with no harm noted. Patient-centeredness was unchanged (incidence rate ratio [IRR] = 1.06, confidence interval [0.87–1.3], p = 0.545), although there were more ACP discussions in the intervention arm (23% intervention vs. 10% control, p = 0.18). While slightly underpowered, study results did not signal that further enrollment would have yielded statistical significance. There were no differences in secondary outcomes other than the intervention video was more helpful (p = 0.007). Conclusions: The ACP video was successfully integrated into surgical care without harm and was thought to be helpful, although video content did not significantly change the ACP content or patient–surgeon communication. Future studies could increase the ACP dose through modifying video content and/or who presents ACP. Trial Registration: clinicaltrials.gov Identifier NCT02489799. [ABSTRACT FROM AUTHOR]
- Published
- 2019
- Full Text
- View/download PDF
3. Stakeholder Perspectives on the Use of Community Health Workers To Improve Palliative Care Use by African Americans with Cancer.
- Author
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Johnston, Fabian M., Neiman, Joseph H., Parmley, Lauren E., Conca-Cheng, Alison, Freund, Karen M., Concannon, Thomas W., Smith, Thomas J., and Cooper, Lisa A.
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TUMOR treatment , *HEALTH facility administration , *BLACK people , *CANCER patient psychology , *PSYCHOLOGY of caregivers , *COMMUNITY health workers , *CULTURE , *FOCUS groups , *HEALTH services accessibility , *HEALTH services administrators , *INTERVIEWING , *PHENOMENOLOGY , *RESEARCH methodology , *MEDICAL personnel , *PATIENT-professional relations , *ONCOLOGISTS , *PALLIATIVE treatment , *GENERAL practitioners , *STATISTICAL sampling , *SOCIAL norms , *ADVANCE directives (Medical care) , *SOCIAL support , *PATIENT-centered care , *PATIENTS' families , *STAKEHOLDER analysis , *PSYCHOLOGY - Abstract
Background: African Americans in the United States have worse end-of-life care and cancer outcomes than whites. Palliative care may improve this disparity. Community Health Workers may provide a means to improve palliative care disparities. Methods: Semistructured in-depth interviews (five) and stakeholder focus groups (four) were conducted with cancer patients, caregivers, health care administrators, oncologists, and community health workers (CHWs). Patients were recruited through snowball sampling. Three raters coded interviews independently. Data were analyzed using interpretative phenomenological analysis. Results: Seventy-one individuals were contacted to participate with 24 stakeholders (34%) participating in individual interviews or across 4 stakeholder engagements. Eleven constructs were identified and grouped in three broader themes: "hub of the wheel," understanding palliative care, and patient–provider relationships. Participants felt that the role of a CHW should be central, bridging patients with their providers, information, and resources, including psychosocial support and advance care planning documents. They also placed an emphasis on the background of CHWs, saying individuals selected should be familiar with the history, culture, and norms of the communities from which they operate. Stakeholders reported that a CHW could activate a patient to contact their primary care physician or oncologist who may refer to or provide palliative care. Stakeholders reported that given the barriers to palliative care, a CHW could contribute to patient-centered multidisciplinary care while addressing palliative care domains with patients and families in a culturally sensitive manner. Conclusion: Based on feedback from patients, caregivers, and providers, a culturally adapted CHW intervention may improve palliative care use for African American patients with advanced malignancies. [ABSTRACT FROM AUTHOR]
- Published
- 2019
- Full Text
- View/download PDF
4. Developing the Storyline for an Advance Care Planning Video for Surgery Patients: Patient-Centered Outcomes Research Engagement from Stakeholder Summit to State Fair.
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Aslakson, Rebecca A., Schuster, Anne L.R., Lynch, Thomas J., Weiss, Matthew J., Gregg, Lydia, Miller, Judith, Isenberg, Sarina R., Crossnohere, Norah L., Conca-Cheng, Alison M., Volandes, Angelo E., Smith, Thomas J., and Bridges, John F.P.
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HEALTH outcome assessment , *PALLIATIVE treatment , *PATIENTS , *SURGERY , *SURGICAL clinics , *ADVANCE directives (Medical care) , *EXTENDED families , *SOCIAL learning theory , *PATIENTS' attitudes - Abstract
Background: Patient-centered outcomes research (PCOR) methods and social learning theory (SLT) require intensive interaction between researchers and stakeholders. Advance care planning (ACP) is valuable before major surgery, but a systematic review found no extant perioperative ACP tools. Consequently, PCOR methods and SLT can inform the development of an ACP educational video for patients and families preparing for major surgery. Objective: The objective is to develop and test acceptability of an ACP video storyline. Design: The design is a stakeholder-guided development of the ACP video storyline. Design-thinking methods explored and prioritized stakeholder perspectives. Patients and family members evaluated storyboards containing the proposed storyline. Setting/Subjects: The study was conducted at hospital outpatient surgical clinics, in-person stakeholder summit, and the 2014 Maryland State Fair. Measurements: Measurements are done through stakeholder engagement and deidentified survey. Results: Stakeholders evaluated and prioritized evidence from an environmental scan. A surgeon, family member, and palliative care physician team iteratively developed a script featuring 12 core themes and worked with a medical graphic designer to translate the script into storyboards. For 10 days, 359 attendees of the 2014 Maryland State Fair evaluated the storyboards and 87% noted that they would be 'very comfortable' or 'comfortable' seeing the storyboard before major surgery, 89% considered the storyboards 'very helpful' or 'helpful,' and 89% would 'definitely recommend' or 'recommend' this story to others preparing for major surgery. Conclusions: Through an iterative process utilizing diverse PCOR engagement methods and informed by SLT, storyboards were developed for an ACP video. Field testing revealed the storyline to be highly meaningful for surgery patients and family members. [ABSTRACT FROM AUTHOR]
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- 2018
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5. The “PSOST”: Providers' Signout for Scope of Treatment.
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Newport, Kristina Braine, Patel, Shejal, Lyckholm, Laurie, Bobb, Barton, Coyne, Patrick, and Smith, Thomas J.
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COMMUNICATION , *DECISION making , *MEDICAL protocols , *NURSING practice , *NURSING services administration , *PALLIATIVE treatment , *PATIENT satisfaction , *RECORDS , *TERMINALLY ill , *ADVANCE directives (Medical care) , *PEER relations - Abstract
Palliative care provides open and honest communication, medically appropriate goal setting, and meticulous attention to symptom assessment and control. The Physicians Orders for Life Sustaining Treatment (POLST) is a growing movement to allow health care providers to indicate, with their patients, what they want done in specific situations, such as feeding tubes, mechanical ventilation, or transfer to an intensive care unit. We have developed an internal signout tool used by palliative medicine fellows in our institution to specify similar interventions—or not—with seriously ill palliative care patients, the Providers Signout for Scope of Treatment (PSOST). We have found that this situation-specific tool enables smooth transitions of care on nights and weekends, especially when the patient is near death, and may help prevent both overescalation of care and underuse of life saving treatments such as resuscitation. The PSOST differs from other signout tools in that it gives clear direction regarding the patient's medical goals and desire for escalation of care, or not. We present it here for open access and use anywhere. This tool has also assisted in building team communication with the nursing shifts, especially nights and weekends, as all team members are able to deliver a consistent message, while meeting the goals of care for patients and families. We believe this tool could be useful with a broader patient population, outside of Palliative Medicine, to provide clearer direction for hospitalized or nursing home patients whose care is often directed by multiple providers. It could also be used as a template for signouts on other inpatient services, as care goals are important for all patients. [ABSTRACT FROM AUTHOR]
- Published
- 2010
- Full Text
- View/download PDF
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