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BackgroundFamily caregivers of individuals with gynecologic cancer experience high levels of distress. Web-based caregiver support interventions have demonstrated efficacy in improving caregiver outcomes. However, the lack of portability could be a limitation. Mobile health (mHealth) apps could fill this gap and facilitate communication between patient-caregiver dyads. ObjectiveWe sought to obtain information on desired usage and features to be used to design an mHealth self-management support app targeting both patients with gynecologic cancer and their caregivers. MethodsWe conducted Zoom focus groups with women who had been treated for gynecologic cancers (ovarian, fallopian, primary peritoneal, uterine, endometrial, cervical, and vulvar); patients were also asked to invite a self-identified “closest support person” (caregiver). A semistructured focus group guide was used to elicit information on patients’ and caregivers’ perceived gaps in information and support, desired features of an mHealth app, and interest in and preferences for app usage. After transcription, rapid qualitative analysis using a thematic matrix was used to identify common themes across groups. ResultsA total of 8 groups were held. The final sample included 41 individuals with gynecologic cancer and 22 support persons or caregivers (total n=63). Patients were aged between 32 and 84 years, and most (38/41, 93%) were White and married. For caregivers (n=22), 15 (68%) identified as male and 7 (32%) as female, with ages ranging between 19 and 81 years. Overall, 59% (n=13) of caregivers were spouses. Questions geared at eliciting 3 a priori topics yielded the following themes: topic 1—gaps in information and support: finding relevant information is time-consuming; patients and caregivers lack confidence in deciding the urgency of problems that arise and from whom to seek information and guidance; topic 2—desired features of the mHealth app: patients and caregivers desire centralized, curated, trustworthy information; they desire timely recommendations tailored to specific personal and cancer-related needs; they desire opportunities to interact with clinical and peer experts through the app; and topic 3—interest and preferences for app usage: need for private space in the app for patients and caregivers to get information and support without the others’ knowledge; patients and caregivers desire having control over sharing of information with other family members. ConclusionsDesigning a single mHealth app to be used by patients and caregivers presents unique challenges for intervention designers and app developers. Implications of the study suggest that app developers need to prioritize flexibility in app functionality and provide individuals the ability to control information sharing between patients and caregivers.

ObjectivesThe following scoping review aims to identify and map the existing evidence for HIT interventions among women with DV experiences in the United States. And provide guidance for future research, and facilitate clinical and technical applications for healthcare professionals.MethodsFive databases, PubMed, EBSCOhost CINAHL, Ovid APA PsycINFO, Scopus and Google Scholar, were searched from date of inception to May 2023. Reviewers extracted classification of the intervention, descriptive details, and intervention outcomes, including physical safety, psychological, and technical outcomes, based on representations in the included studies.ResultsA total of 24 studies were included, identifying seven web-based interventions and four types of abuse. A total of five studies reported safety outcomes related to physical health. Three studies reported depression, anxiety, and post-traumatic stress disorder as psychological health outcomes. The effectiveness of technology interventions was assessed in eight studies.ConclusionDomestic violence is a major public health issue, and research has demonstrated the tremendous potential of health information technology, the use of which can support individuals, families, and communities of domestic violence survivors.

BackgroundIntimate partner violence (IPV) is an underreported public health crisis primarily affecting women associated with severe health conditions and can lead to a high rate of homicide. Owing to the COVID-19 pandemic, more women with IPV experiences visited online health communities (OHCs) to seek help because of anonymity. However, little is known regarding whether their help requests were answered and whether the information provided was delivered in an appropriate manner. To understand the help-seeking information sought and given in OHCs, extraction of postings and linguistic features could be helpful to develop automated models to improve future help-seeking experiences. ObjectiveThe objective of this study was to examine the types and patterns (ie, communication styles) of the advice offered by OHC members and whether the information received from women matched their expressed needs in their initial postings. MethodsWe examined data from Reddit using data from subreddit community r/domesticviolence posts from November 14, 2020, through November 14, 2021, during the COVID-19 pandemic. We included posts from women aged ≥18 years who self-identified or described experiencing IPV and requested advice or help in this subreddit community. Posts from nonabused women and women aged

BackgroundPatients and caregivers widely use online health communities (OHCs) to acquire knowledge from peers. Questions posed in OHCs reflect participants’ learning objectives and differ in their level of cognitive complexity. However, little is known about the topics and levels of participants’ learning objectives and the corresponding support they receive from members of OHCs. ObjectiveThis study aimed to investigate the knowledge acquisition of patients and caregivers in an OHC. Specifically, we investigated the distribution and topics of posts with learning objectives at different cognitive complexity levels, the type and amount of social support provided to meet users’ learning objectives at different cognitive complexity levels, and the influence of social support on the change in learning objectives. MethodsWe collected 10 years of discussion threads from one of the most active ovarian cancer (OvCa) OHCs. A mixed methods approach was used, including qualitative content analysis and quantitative statistical analysis. Initial posts with questions were manually classified into 1 of the 3 learning objectives with increasing cognitive complexity levels, from low to high, based on the Anderson and Krathwohl taxonomy: understand, analyze, and evaluate. Manual content analysis and automatic classification models were used to identify the types of social support in the comments, including emotional support and 5 types of informational support: advice, referral, act, personal experience, and opinion. ResultsThe original data set contained 909 initial posts and 14,816 comments, and the final data set for the analysis contained 560 posts with questions and 3998 comments. Our results showed that patients with OvCa and their caregivers mainly used OHCs to acquire knowledge for low- to medium-level learning objectives. Of the questions, 82.3% (461/560) were either understand- or analyze-level questions, in which users were seeking to learn basic facts and medical concepts or draw connections among different situations and conditions. Only 17.7% (99/560) of the questions were at the evaluate level, in which users asked other OHC members to help them make decisions or judgments. Notably, OvCa treatment was the most popular topic of interest among all the questions, regardless of the level of learning objectives. Regarding the social support received for different levels of learning objectives, significant differences were found in the advice (F2437.84=9.69; P

BackgroundOnline health communities (OHCs) provide patients and survivors of ovarian cancer (OvCa) and their caregivers with help beyond traditional support channels, such as health care providers and clinicians. OvCa OHCs promote connections and exchanges of information among users with similar experiences. Users often exchange information, which leads to the sharing of resources in the form of web links. Although OHCs are important platforms for health management, concerns exist regarding the quality and relevance of shared resources. Previous studies have examined different aspects of resource-sharing behaviors, such as the purpose of sharing, the type of shared resources, and peer user reactions to shared resources in OHCs to evaluate resource exchange scenarios. However, there is a paucity of research examining whether resource-sharing behaviors can ultimately determine the relevance of shared resources. ObjectiveThis study aimed to examine the association between OHC resource-sharing behaviors and the relevance of shared resources. We analyzed three aspects of resource-sharing behaviors: types of shared resources, purposes of sharing resources, and OHC users’ reactions to shared resources. MethodsUsing a retrospective design, data were extracted from the National Ovarian Cancer Coalition discussion forum. The relevance of a resource was classified into three levels: relevant, partially relevant, and not relevant. Resource-sharing behaviors were identified through manual content analysis. A significance test was performed to determine the association between resource relevance and resource-sharing behaviors. ResultsApproximately 48.3% (85/176) of the shared resources were identified as relevant, 29.5% (52/176) as partially relevant, and 22.2% (39/176) as irrelevant. The study established a significant association between the types of shared resources (χ218=33.2; P

Abstract Introduction: Shared decision-making (SDM) is a critical component of delivering patient-centered care. Members of vulnerable populations may play a passive role in clinical decision-making; therefore, understanding their prior decision-making experiences is a key step to engaging them in SDM. Objective: To understand the previous healthcare experiences and current expectations of vulnerable populations on clinical decision-making regarding therapeutic options. Methods: Clients of a local food bank were recruited to participate in focus groups. Participants were asked to share prior health decision experiences, explain difficulties they faced when making a therapeutic decision, describe features of previous satisfactory decision-making processes, share factors under consideration when choosing between treatment options, and suggest tools that would help them to communicate with healthcare providers. We used the inductive content analysis to interpret data gathered from the focus groups. Results: Twenty-six food bank clients participated in four focus groups. All participants lived in areas of socioeconomic disadvantage. Four themes emerged: prior negative clinical decision-making experience with providers, patients preparing to engage in SDM, challenges encountered during the decision-making process, and patients’ expectations of decision aids. Participants also reported they were unable to discuss therapeutic options at the time of decision-making. They also expressed financial concerns and the need for sufficiently detailed information to evaluate risks. Conclusion: Our findings suggest the necessity of developing decision aids that would improve the engagement of vulnerable populations in the SDM process, including consideration of affordability, use of patient-friendly language, and incorporation of drug–drug and drug–food interactions information.

Background: In previous work, we reported that Korean Red Ginseng saponin fraction (RGSF) showed anti-inflammatory activities in vitro and in vivo. Methods: The present study investigated the radioprotective properties of RGSF by examining its effects on ionizing radiation (IR)-enhanced and lipopolysaccharide (LPS)-mediated inflammatory responses in murine macrophage cells. Results: RGSF induced strong downregulation of IR-enhanced and LPS-induced proinflammatory responses such as nitric oxide (NO) production (Inhibitory Concentration 50 (IC50) = 5.1 ± 0.8 μM) and interleukin-1β levels. RGSF was found to exert its radioprotective effects by inhibition of a signaling cascade that activated checkpoint kinase 2–nuclear factor-κB. In addition, RGSF strongly inhibited IR-enhanced LPS-induced expression of hemoxyganase-1, implying that the latter may be a potential target of RGSF. Conclusion: Taken together, our data suggest that RGSF can be considered and developed for use as an effective radioprotective agent with minimal adverse effects.

Objectives: The following scoping review aims to identify and map the existing evidence for HIT interventions among women with DV experiences in the United States. And provide guidance for future research, and facilitate clinical and technical applications for healthcare professionals. Methods: Five databases, PubMed, EBSCOhost CINAHL, Ovid APA PsycINFO, Scopus and Google Scholar, were searched from date of inception to May 2023. Reviewers extracted classification of the intervention, descriptive details, and intervention outcomes, including physical safety, psychological, and technical outcomes, based on representations in the included studies. Results: A total of 24 studies were included, identifying seven web-based interventions and four types of abuse. A total of five studies reported safety outcomes related to physical health. Three studies reported depression, anxiety, and post-traumatic stress disorder as psychological health outcomes. The effectiveness of technology interventions was assessed in eight studies. Conclusion: Domestic violence is a major public health issue, and research has demonstrated the tremendous potential of health information technology, the use of which can support individuals, families, and communities of domestic violence survivors. [ABSTRACT FROM AUTHOR]

OvCa patients and caregivers perceived challenges in online health information seeking. The HELPeR recommendation system utilized digital twins to create personas reflecting real-world OvCa patients and caregivers. The aim of this study was to describe the creation of digital twins and demonstrate their use cases in the study. Digital twins of OvCa patients and caregivers were created by triangulating multiple sources, including online cancer forums, direct interviews with patients and caregivers, domain expert input, and clinical notes. 10 personas were created for both OvCa patients and caregivers who had a variety of cancer trajectories and information interests. These digital twins present a potential solution for training artificial intelligence models at the initial phase when there is a scarcity of user information. [ABSTRACT FROM AUTHOR]

Eukaryotic organisms have developed a variety of mechanisms to regulate translation post-transcriptionally, including but not limited to the use of miRNA silencing in many species. One method of post-transcriptional regulation is through miRNAs that bind to the 3' UTRs to regulate mRNA abundance and influence protein expression. Therefore, the diversity of mRNA 3' UTRs mediating miRNA binding sites influence miRNA-mediated regulation. Alternative polyadenylation, by shortening mRNA isoforms, increases the diversity of 3' UTRs; moreover, short mRNA isoforms elude miRNA-medicated repression. Because no current prediction methods for putative miRNA target sites consider whether or not 1) splicing-informed miRNA binding sites and/or 2) the use of 3' UTRs provide higher resolution or functionality, we sought to identify not only the genome-wide impact of using exons in mRNA 3' UTRs but also their functional connection to miRNA regulation and clinical outcomes in cancer. With a genome-wide expression of mRNA and miRNA quantified by 395 bladder cancer cases from The Cancer Genome Atlas (TCGA), we 1) demonstrate the diversity of 3' UTRs affecting miRNA efficiency and 2) identify a set of genes clinically associated with mRNA expression in bladder cancer. Knowledge of 3' UTR diversity will not only be a useful addition to current miRNA target prediction algorithms but also enhance the clinical utility of mRNA isoforms in the expression of mRNA in cancer. Thus, variability among cancer patient's variability in molecular signatures based on these exon usage events in 3' UTR along with miRNAs in bladder cancer may lead to better prognostic/treatment strategies for improved precision medicine.

Objective: When analyzing factors related to suicide, it is necessary to consider the regional characteristics of the areas where individuals live in addition to individual factors. This study aimed to investigate the spatiotemporal association between suicide rates and geographic features and the patterns of this association for all administrative areas in South Korea from 2009 to 2019. Methods: The data used in this study were obtained from the National Statistical Office of the Korean Statistical Information Service. For suicide rates, age-standardized mortality index data per 100 000 people were used. All administrative districts from 2009 to 2019 were divided into 229 regions. Emerging hotspot analysis was used for a 3-dimensional analysis to simultaneously evaluate temporal and spatial clusters. Results: In the 229 regions, there were 27 (11.8%) hotspots and 60 (26.2%) cold spots. Hotspot pattern analysis found 2 (0.9%) new spots, 1 (0.4%) persistent spot, 23 (10.0%) sporadic spots, and 1 (0.4%) oscillating spot. Conclusion: This study found geographic differences in the spatiotemporal patterns of suicide rates in South Korea. The utilization of national resources for suicide prevention should be selectively and intensively prioritized in 3 areas that exhibit unique spatiotemporal patterns [ABSTRACT FROM AUTHOR]

Ovarian cancer (OvCa) patients encounter complex treatment decisions, and often have difficulties in searching and integrating online health information to guide their treatment decision-making. The objective of this study was to explore the preference of online health information among OvCa patients and caregivers, by exploring their preferred content, format, and function features for the design of a personalized recommender system. This study used qualitative research methods to collect data through in-depth interviews with 18 OvCa patients and 2 caregivers. A total of (N=20) face-to-face interviews were conducted, and subsequently analyzed by audio recordings, verbatim transcription, and theory-driven approach with thematic analysis. A total of 5 themes were identified for content-related design, 4 themes identified for system function and one theme identified for frequency format. The results of this study inform the preference and therefore OvCa specific features can be tailor-made in a recommendation system. [ABSTRACT FROM AUTHOR]

Inequities in health information access contribute to disparities in health outcomes. Health recommender systems have emerged as a promising solution to help users find the right information. Despite their various applications, it remains understudied how these systems can aid cancer patients. In this paper, we introduce HELPeR, a recommender system designed to assist ovarian cancer patients with their information needs. The design addresses cold-start challenges, drawing input from health experts and ovarian cancer forum posts. We evaluated HELPeR with nurse practitioners in a cold-start scenario, highlighting its benefits and areas for future improvement. [ABSTRACT FROM AUTHOR]

Women with domestic violence experiences often refuse to seek help face-to-face due to embarrassment. They begin to share their emotions and seek help from online health communities. Understanding and responding to these posts can be crucial in providing timely support to the victims. We proposed a fine-tuned large language model (LLM) capable of accurately predicting the informational need based on the content of postings. We fine-tuned the LAMMA2-7B-chat model based on the guidance of identifying the information need and a dataset comprising 273 posts from Reddit, which are manually annotated by domain experts. Furthermore, we evaluated the performance of our model using a random sample of 15 posts, and 66.6% were accurately predicted. The results demonstrate that our model can rapidly capture the information needs expressed in the posts, enabling healthcare providers to provide timely and useful support based on our predictions. [ABSTRACT FROM AUTHOR]

The ability of medical students to form positive relationships with patients is influenced by the students’ personality. The psychological characteristics necessary for effective physician-patient interactions (PPIs) have not been identified. Methods: In August of 2012, 2013, and 2014, second-year medical students at Gyeongsang National University completed the Korean version of the Defense Style Questionnaire (K-DSQ). Following completion of their 2-year clerkships, the students completed the K-DSQ again. Of the 216 second-year students, 187 (94 males and 93 females) aged 24-38 years (mean, 28.9±2.8 years) completed the K-DSQ at year 4. PPIs were rated by standardized patients during practical examinations following the clerkships. Results: Female sex (β=-0.157, p=0.035) and a more immature defense style in year 2 (β=0.197, p=0.027) were significant predictors of better PPIs in year 4. An increase in humor during the clinical clerkship (β=0.171, p=0.030) and female sex (β=-0.170, p=0.023) were significant predictors of the year-4 PPI ratings. Conclusion: Female sex and a more immature defense style in the second year, as well as an increase in humor during clerkships predicted positive PPIs. [ABSTRACT FROM AUTHOR]

Objective: To define important aspects of survivorship care for the more than 1.2million survivors of gynecologic cancer currently living in the US. Data Sources: Research articles, reviews, position statements and white papers, and evidence-based guidelines. Conclusion: Survivorship care includes a coordinated plan of care, ongoing surveillance, health promotion support, and management of long-term and late effects of treatment. Implications for Nursing Practice: Nurses need to be aware of the current guidelines for post-treatment surveillance and health promotion recommendations for survivors of gynecologic cancers. Early identification of long-term and late effects of treatment followed by coordinated medical intervention and self-management education are essential to improve quality of life. [ABSTRACT FROM AUTHOR]

Objective: Using Failure Mode and Effects Analysis (FMEA) as an example quality improvement approach, our objective was to evaluate whether secondary use of orders, forms, and notes recorded by the electronic health record (EHR) during daily practice can enhance the accuracy of process maps used to guide improvement. We examined discrepancies between expected and observed activities and individuals involved in a high-risk process and devised diagnostic measures for understanding discrepancies that may be used to inform quality improvement planning. Methods: Inpatient cardiology unit staff developed a process map of discharge from the unit. We matched activities and providers identified on the process map to EHR data. Using four diagnostic measures, we analyzed discrepancies between expectation and observation. Results: EHR data showed that 35% of activities were completed by unexpected providers, including providers from 12 categories not identified as part of the discharge workflow. The EHR also revealed sub-components of process activities not identified on the process map. Additional information from the EHR was used to revise the process map and show differences between expectation and observation. Conclusion: Findings suggest EHR data may reveal gaps in process maps used for quality improvement and identify characteristics about workflow activities that can identify perspectives for inclusion in an FMEA. Organizations with access to EHR data may be able to leverage clinical documentation to enhance process maps used for quality improvement. While focused on FMEA protocols, findings from this study may be applicable to other quality activities that require process maps. [ABSTRACT FROM AUTHOR]

PURPOSE: To investigate the efficacy and safety of long-term maintenance treatment with tacrolimus ointment in chronic ocular graft-vs-host disease (GVHD) with ocular surface inflammation. DESIGN: A retrospective interventional consecutive case series. METHOD: Long-term maintenance treatment (=6 months) with topical 0.02% tacrolimus ointment was applied to patients with chronic ocular GVHD with ocular surface inflammation (at least grade 2 inflammatory score). We evaluated the inflammatory score, steroid score and steroid use period of total duration, and numbers of inflammatory aggravations before and after tacrolimus treatment. The clinical outcomes were assessed by symptom score, ocular surface staining, Schirmer I test, tear break-up time (TBUT), and classification of chronic GVHD conjunctivitis at the initial and final examinations. RESULTS: Thirteen patients (24 eyes) were treated with tacrolimus ointment for up to 20 months (average 12.2 months). The ocular surface inflammatory score decreased from 2.8 to 0.6 (P = .001) within 2-8 weeks after starting tacrolimus ointment treatment. The numbers of inflammatory aggravation and the need for steroid treatment also decreased after initiating tacrolimus treatment. At the final follow-up, all patients reported improvement in clinical outcomes, compared to initial findings. Except for blurred vision or mild burning sensation, there were no reported side effects. CONCLUSION: Considering the chronic course of GVHD, long-term maintenance treatment with tacrolimus ointment could be useful and safe to locally treat ocular surface inflammation in chronic ocular GVHD. [ABSTRACT FROM AUTHOR]

Objective To visualize and describe collaborative electronic health record (EHR) usage for hospitalized patients with heart failure. Materials and methods We identified records of patients with heart failure and all associated healthcare provider record usage through queries of the Northwestern Medicine Enterprise Data Warehouse. We constructed a network by equating access and updates of a patient's EHR to a provider-patient interaction. We then considered shared patient record access as the basis for a second network that we termed the provider collaboration network. We calculated network statistics, the modularity of provider interactions, and provider cliques. Results We identified 548 patient records accessed by 5113 healthcare providers in 2012. The provider collaboration network had 1504 nodes and 83 998 edges. We identified 7 major provider collaboration modules. Average clique size was 87.9 providers. We used a graph database to demonstrate an ad hoc query of our provider-patient network. Discussion Our analysis suggests a large number of healthcare providers across a wide variety of professions access records of patients with heart failure during their hospital stay. This shared record access tends to take place not only in a pairwise manner but also among large groups of providers. Conclusion EHRs encode valuable interactions, implicitly or explicitly, between patients and providers. Network analysis provided strong evidence of multidisciplinary record access of patients with heart failure across teams of 100+ providers. Further investigation may lead to clearer understanding of how record access information can be used to strategically guide care coordination for patients hospitalized for heart failure. [ABSTRACT FROM AUTHOR]

* PURPOSE: To evaluate the therapeutic effects of topical tacrolimus ointment on refractory inflammatory ocular surface diseases. * DESIGN: Retrospective interventional consecutive case series. * METHODS: In Severance Hospital, Seoul, South Korea, 0.02%tacrolimus ointment was topically applied 1 to 3 times per day, depending on disease severity, for up to 31months in eyes of 12 consecutive patients with refractory inflammatory ocular surface diseases who had previously been treated with steroid therapy. Seven patients had chronic cicatrizing conjunctivitis (6 cases caused by Stevens - Johnson syndrome and 1 attributable to ocular cicatricial pemphigoid); 4 had scleritis (3 necrotizing scleritis, 1 recurrent nodular scleritis); and 1 patient had Mooren ulcer with corneal perforation. The therapeutic outcomes after tacrolimus treatment were evaluated according to the following criteria: change in clinical findings (eg, decrease of hyperemia, ocular pain, epithelial defect, and pseudomembrane), intraocular pressure (IOP), and need for steroid therapy. * RESULTS: In all 3 groups, tacrolimus showed an immunosuppressive effect, especially on scleritis and Mooren ulcer. These effects included suppression of corneoscleral melting and reduction of hyperemia. In chronic cicatrizing conjunctivitis, simultaneous topical tacrolimus while tapering steroid therapy suppressed inflammatory relapse. The elevated IOP in steroid responders recovered to normal range after successful tapering of steroid. No adverse side effects were noted after 1.5 to 31 months of continuous tacrolimus treatment. * CONCLUSION: The use of topical tacrolimus ointment is effective in controlling refractory inflammatory ocular surface disease, and can reduce the need for steroid use while reducing inflammation recurrence. [ABSTRACT FROM AUTHOR]

Introduction and Objective Optimal patient-provider communication helps ensure that patients with ovarian cancer receive appropriate, evidence-based symptom management. However, patients struggle to communicate with their healthcare providers about their cancer- and treatmentrelated symptoms. The purpose of this study is to examine the frequency by which women with ovarian cancer communicate their priority cancer- and treatment-related symptoms with their healthcare providers and the longitudinal impact communication has on their symptom burden. Methods Women were recruited from 68 Gynecological Oncology Group (GOG) sites to the Written Representational Intervention to Ease (WRITE) Symptoms (GOG-0259) randomized clinical trial. All participants had a diagnosis of recurrent ovarian, fallopian tube, or primary peritoneal cancer and were experiencing ≥ 3 cancer- or treatment-related symptoms at baseline. Participants completed monthly questionnaires including the Symptom Representation Questionnaire rating the severity of 28 common ovarian cancer- and treatment-related symptoms on an 11-point scale. At baseline, they prioritized three symptoms over which they wanted to gain better control. A 4-item communication questionnaire assessed symptom communication with providers, and was dichotomized as appropriate or inappropriate based on patients' symptom severity score. We also included moderating variables for social support (Interpersonal Support Evaluation List), optimism (Life Orientation Test-Revised), and anxiety (State-Trait Anxiety Inventory). We first analyzed baseline data to determine the participant characteristics associated with varying levels of communication appropriateness with healthcare providers. We performed a stepwise binary logistic regression to develop a predictive model of appropriate or inappropriate symptom communication styles at baseline. Second, we analyzed the impact of communication on symptom burden overtime (baseline, 4, 8, and 12 weeks). We calculated Pearson product-moment correlations to measure the direction and magnitude of the linear relationship between symptom severity and communication appropriateness concurrently and overtime. Results Across participants' top three symptoms, 62.2-73.4% of participants reported having appropriate communication with their healthcare providers. Fatigue was the top symptom (n=80, 48.5%) followed by constipation (n=45, 27.3%) and peripheral neuropathy (n=41, 24.9%). Symptom severity was the only significant predictor of appropriate communication at baseline. Women with high symptom severity scores were 36-41% less likely to have appropriate communication at baseline compared to women with low symptom severity scores. Across all three symptoms, severity scores decreased over time, particularly at the 4-week time-point and appropriateness of communication increased over time. Significant negative correlations between severity and future communication existed indicating that women with more severe symptoms one month were less likely to have appropriate communication the following month. Discussion/Conclusion These results suggest the development of patterns of communication which impact longterm severity of cancer- and treatment-related symptoms. If women experienced appropriate communication with their healthcare provider, then they may have received symptom recommendations leading to continued decreased severity. If women did not experience appropriate communication, then they did not have the opportunity to receive recommendations and their communication did not improve overtime. This analysis underscores the need for developing strong initial symptom communication between patients and providers to ensure patients' priority symptoms are discussed and managed. [ABSTRACT FROM AUTHOR]

Background Social media has gained an attention as a source to learn the perspectives, values, and needs of patients and caregivers in naturalistic settings. A thorough understanding of their concerns and needs is the first step to develop interventions for the target population. Language written in the social media can be cues of needs, however, manually identifying those cues is time-consuming and labor-intensive. As a starting point, we propose a text classification machine learning model using simple natural language processing techniques, to identify language features that are associated with needs of ovarian cancer (OvCa) patients and caregivers on social media data. Methods Data were collected from the Cancer Survivors Network online peer-support forum (http://csn.cancer.org). This study included initial postings of patients and caregivers (n=855). First, we coded each posting with 12 types of needs based on the literature (physical; psychological/emotional; family-related; social; interpersonal/intimacy; practical; daily living; spiritual/existential; health information; patient-clinician communication; cognitive needs; miscellaneous), allowing multiple needs annotated for a posting. After excluding postings without needs assigned, we obtained 806 coded postings. We applied machine learning to build a computational model to decide whether a posting has the given need or not. In our model, we used bag-of-words (BOW) features, which consider each word in a posting as a feature to classify needs. Then, we performed chi-square-based feature selection to automatically identify more important features for each need category. After feature selection process, we trained a model using the selected features, and evaluated the model using the F1 score, a performance metric for classification. Results Top most frequently occurring needs across postings were social, health information, and psychological/emotional needs (n=686, 326, 266). We also found that 80% of postings described both psychological/emotional needs and social needs (n=216) in the same posting. Our initial model reported F1 scores of 0.92, 0.77, and 0.63 for social, health information, and psychological/emotional, respectively. Words that describe psychological states (e.g., "afraid", "anger", and "anxiety") were important features for the classification of psychological/emotional and social needs, and medical terms (e.g., "abdominal" and "ablation") for physical needs. Conclusion We developed an initial model for automatically classifying needs of OvCa patients and caregivers on social media data. Our initial results showed that even using only BOW features can detect needs with high accuracy, which suggests the potential of using multiple language features and classification methods to develop more sophisticated model. Our future work involves exploring other language features (e.g., groups of words clustered by using topic modeling techniques, taxonomies, etc.). We found out that some postings can indicate multiple needs in the same posting, thus, we plan to take into account correlations between different need categories. [ABSTRACT FROM AUTHOR]

Introduction and Objectives Incidence of chemotherapy-induced peripheral neuropathy (CIPN) often manifests as numbness/tingling (N/T) during front-line platinum/taxane therapy for ovarian cancer; prevalence estimates range from 51%-80%. Some women experience CIPN-related disability by the conclusion of chemotherapy, but it is unclear which women are at greatest risk. The aims of this prospective, daily symptom assessment pilot were to identify a) time to onset of CIPN, b) changes in average and peak CIPN severity over time, and c) whether time to CIPN onset is associated with disability after completion of chemotherapy. Methods Participants (n=30) were enrolled prior to first-line adjuvant or neoadjuvant chemotherapy for ovarian, fallopian, primary peritoneal, or uterine cancer. CIPN was assessed at baseline and daily during 6 cycles of chemotherapy using a single numbness/tingling (N/T) severity item (0=did not experience to 10=as bad as I can imagine). CIPN-related interference with daily life activities was assessed at the same intervals using MDASI Interference Scale (0=symptoms did not interfere to 10=interfered completely) for six life activities (general activity, mood, work, relations with others, walking, enjoyment of life). Number of days to CIPN onset and to continuous CIPN (>21 consecutive days of CIPN≥ 3) were determined; average, peak, and minimum N/T severity score for each cycle was calculated. Bivariate correlations were calculated between CIPN variables, Cycle 6 interference scores, age and comorbidities. Results Of the 30 women (mean age 59.6 years) enrolled, 25 completed at least 3 complete cycles of daily symptom diaries and are included in this analysis. Mean time to first occurrence of CIPN was 26.8 days (range 1-123 days). Mean N/T severity ranged from 1.18 (average), 2.43 (peak), and 1.27 (last day of cycle) during Cycle 1 to 3.05 (average), 4.26 (peak), and 2.95 (last day of cycle) during Cycle 6. N/T severity was highly variable across participants over time: 13 participants never experienced sustained (≥ 21 days) of continuous N/T severity ≥ 3. However, among the 12 participants who did, average time to continuous N/T was 35.0 days (range 0-87). Age was only associated with walking interference at Cycle 1 (0.455, p < .05); comorbidities and baseline interference scores were not associated with Cycle 6 interference scores. Earlier onset of continuous N/T was significantly associated with greater interference with general activities, walking, work, and overall mean interference with life (all p < .05) at Cycle 6. Discussion/Conclusions Time to onset, average, peak, and duration of CIPN is variable among women receiving neurotoxic chemotherapy. Over half of all women do not experience continuous (daily) N/T, returning to no or minimal severity (<3) prior to their next cycle. For the subset of women who experienced early onset, continuous N/T for ≥21 days, earlier onset was highly associated with disruptions in major life areas including general activities, walking, and work. These preliminary results highlight the importance of intensive, daily assessment for early identification of the subset of women who develop continuous N/T during treatment so that preventive rehabilitation can be initiated. [ABSTRACT FROM AUTHOR]

Background Uncontrolled cancer- and treatment-related symptoms severely affect quality of life (QOL) and function. Symptom burden is especially high in ovarian cancer (OvCa) patients, who experience an average of 10-12 concurrent symptoms with correspondingly low QOL. Symptom management could be improved with a better understanding of relationships among concurrent symptoms. Network analysis (NA) is a methodology that discovers and visualizes relationships among components of a phenomenon to identify influential components (e.g. based on connectedness to other components). Thus, the goal of this study is to apply NA to a sample of OvCa survivors to identify the most influential symptoms as priority symptoms for intervention development. Data Source Ancillary analysis of WRITE(Written Representational Intervention to Ease Symptoms), a longitudinal trial in which OvCa patients (n=497) reported severity of 28 cancer and/or treatment-related symptoms while participating in an online symptom management intervention. Participants completed the symptom assessment on average nine times over the course of 13 months. The mean age was 59.3 years (SD=9.2), and the median time since diagnosis was 37 months (range 7-303). 59.4% of participants had received 3 or more previous treatment regimens. 85% of participants were receiving chemotherapy at the time of enrollment. Method We analyzed symptom data collected at baseline (T1; n=497) and 4 months (T4; n=379) of WRITE. Participants rated the severity of each symptom at its worst in the past week on a 0(did not have the symptom) -10(as bad as I can imagine) scale. We dichotomized severity scores using a cut-point of <3 and ≥3. Then, we constructed a symptom network and visualized the relationship between symptoms. In this network, the node size represents frequency of each symptom. We added weight to network connections using co-occurrence of symptoms that may represent important relationships between symptoms. After constructing the network of symptoms, we compared T1 and T4 networks. Then, we calculated node-specific centrality measures of each network: betweenness, closeness, and eigenvector using R and the Organizational Risk Analyzer. Results A comparison of networks demonstrated no change in network topology; that is, nodes and links were consistent across networks. However, at T1, vomiting had the highest betweenness (0.537), while at T4, weight loss had the highest betweenness (0.387). This result suggests that vomiting and weight loss assert the highest influence over the severity of other concurrent symptoms (a symptom "gatekeeper"). At both T1 and T4, fatigue had the highest eigenvectors (0.450 and 0.527, respectively), indicating that it connects to the highest number of other symptoms. Discussion This study was the first to construct symptom networks for ovarian cancer patients. Overall, the structure of symptom networks at the two time points was similar although there were changes over time in network measures. Our result suggests that vomiting, weight loss, and fatigue are priority symptoms to be managed to decrease overall symptom burden in OvCa. Our work can guide symptom management interventions in the future by identifying symptoms that should be specifically targeted to maximize patient QOL and minimize nursing time and resources. [ABSTRACT FROM AUTHOR]

Educating patients and their caregivers before oncology treatment commences is an accepted standard of care that typically consists of in-person oral and written information. However, caregivers may have different learning requirements in which they may benefit from an additional educational approach. Virtual reality (VR) could be an innovative educational modality to complement the delivery of standard pre-treatment information by offering an immersive experience. The purpose of this study was to describe caregivers' pre-treatment oncology education experiences and whether the addition of visual aids could improve their experiences. A qualitative descriptive study was conducted to guide the future development of a VR experience for caregivers. Participants responded to anonymous demographic and qualitative surveys posted on social media sites. These open-ended surveys were designed to elicit caregivers' experiences receiving pre-treatment education and whether visual aids, described as a video or model, could complement and enhance standard education. Demographic data were calculated using descriptive analyses and qualitative data were analyzed using an inductive coding approach. Participants (N=12) were mostly female (n=10, 83%), white (n=9, 75%), married (n=10, 83%), and well-educated (n=8, 67%). They categorically ranged in age from 26 years to above 65 years. Types of pre-treatment education received were in-person, oral, and written information. One participant received an immersive VR experience to complement pre-treatment preparation. Participants responded that visual aids could improve their experience receiving pre-treatment education by facilitating a better understanding of various procedures, creating a reduction of paperwork, and assisting them with the organization of information. The types of pre-treatment education caregivers received, such as in-person oral and written information, were congruent with standards of pre-treatment care. However, caregivers expressed a visual component could improve their ability to comprehend and organize information. This finding highlights the need to test different visual modalities that could better prepare and provide an enhanced experience for caregivers. VR could be an innovative visual aid immersing both patients and caregivers in the treatment environment. Incorporating different forms of visual technology could offer a robust and enhanced approach to standard pre-treatment education. In alignment with ONS' strategic priorities, exploring caregivers' pre-treatment experiences leads to opportunities to cultivate a spirit of inquiry in which VR could transform how educational content is delivered and reinforced. [ABSTRACT FROM AUTHOR]

BACKGROUND: In metastatic breast cancer (MBC), positive estrogen receptor (ER) and human epidermal growth factor receptor 2 (HER2) status allow for more long-term, sequential treatment options compared to ER-negative and HER2-negative diseases. It is unclear if end-of-life care (timely integration of palliative care, discontinuation of chemotherapy, and enrollment into hospice) in MBC is now tailored to the ER and HER2 status. OBJECTIVES: This article explores the association between ER and HER2 status and the quality of end-of-life care received among patients with MBC. METHODS: A 20-year MBC clinical database captured demographics, tumor characteristics, and treatment histories of deceased patients with MBC (N = 1,258) at a tertiary hospital located in Pittsburgh, Pennsylvania. Descriptive and inferential statistics were used. FINDINGS: Patients with ER-positive MBC had greater odds of receiving quality end-of-life care than those with ER-negative MBC. HER2 status was not associated with differences in the quality of end-of-life care. [ABSTRACT FROM AUTHOR]

Background: This analysis aimed to examine the factors predictive of service utilization among patients with anxiety and/or depression. Quick and appropriate treatment for anxiety and depression can reduce disease burden and improve social functioning. Currently, less than half of the population with comorbid anxiety and depression receives the recommended treatment., Aims: This analysis aims to identify factors predictive of utilizing mental health treatment for those with anxiety and/or depression by analyzing intrinsic, patient-centered factors., Methods: This study is a cross-sectional cohort analysis using National Health Interview Survey (NHIS) 2019 data. The sample size is 7,156 adults aged 18 to 64 with family incomes ≤100% of the federal poverty level. We used multivariate logistic regression analysis to identify factors predictive of care utilization in this population. Variables of interest include scores on Patient Health Questionnaire-8 (PHQ-8) and Generalized Anxiety Disorder-7 (GAD-7), service utilization, level of social functioning, having a usual source for care, and previous mental health care utilization. Additional covariates were age, gender, race, country of origin, education, marital status, and insurance coverage., Results: Twenty-one percent of respondents reported using mental health services. Factors predictive of care utilization were older age, female gender, limited social functioning, having a usual source of care, and insurance coverage., Conclusion: There are significant barriers to receiving quick and appropriate care for anxiety and/or depression. Strategies should focus on reducing barriers for young adults, men, and the uninsured/underinsured. Strategies for integrating mental health services into primary care could increase the percentage of people with anxiety and/or depression who receive services., Competing Interests: Declaration of Conflicting InterestsThe authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.