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IntroductionReproductive injustices such as forced sterilization, preventable maternal morbidity and mortality, restricted access to family planning services, and policy-driven environmental violence undermine reproductive autonomy and health outcomes, with disproportionate impact on historically marginalized communities. However, curricula focused on reproductive justice (RJ) are lacking in medical education.MethodsWe designed a novel, interactive, case-based RJ curriculum for postclerkship medical students. This curriculum was created using published guidelines on best practices for incorporating RJ in medical education. The session included a prerecorded video on the history of RJ, an article, and four interactive cases. Students engaged in a 2-hour small-group session, discussing key learning points of each case. We evaluated the curriculum's impact with a pre- and postsurvey and focus group.ResultsSixty-eight students participated in this RJ curriculum in October 2020 and March 2021. Forty-one percent of them completed the presurvey, and 46% completed the postsurvey. Twenty-two percent completed both surveys. Ninety percent of respondents agreed that RJ was relevant to their future practice, and 87% agreed that participating in this session would impact their clinical practice. Most respondents (81%) agreed that more RJ content is needed. Focus group participants appreciated the case-based, interactive format and the intersectionality within the cases.DiscussionThis interactive curriculum is an innovative and effective way to teach medical students about RJ and its relevance to clinical practice. Walking alongside patients as they accessed reproductive health care in a case-based curriculum improved students' comfort and self-reported knowledge on several RJ topics.

Background: Little is known about financial toxicity in early‐phase clinical trial (EP‐CT) participants. This study sought to describe financial toxicity in EP‐CT participants and assess associations with patient characteristics and patient‐reported outcomes (PROs). Methods: Prospectively enrolled EP‐CT participants from were followed from April 2021 through January 2023. Participants completed the Comprehensive Score for Financial Toxicity (<26 = financial toxicity) at time of treatment. Quality of life (QOL), symptoms, coping, and resource concerns were surveyed. Associations of financial toxicity with patient characteristics, PROs, and clinical outcomes were explored. Results: Of 261 eligible patients, 197 completed baseline assessments (75.5%, median age = 63.4 years [31.8‐88.6], 57.4% female). Most common cancers were gastrointestinal (33.0%) and breast (20.8%). More than one third (34.0%) of patients reported financial toxicity. Patients with financial toxicity were more likely to be <65 years (70.2% vs 48.5%, p =.004), unemployed (45.5% vs 16.9%, p <.001), not have attended college (53.1% vs 26.4%, p =.002), and have income <$60,000 (59.7% vs 25.4%, p <.001). In adjusted models, patients with financial toxicity reported lower QOL (B = –6.66, p =.004) and acceptance (B = –0.78, p =.002), and increased self‐blame (B = 0.87, p <.001). They were more likely to have concerns regarding housing (10.6% vs 2.3%, p =.025), bills (31.8% vs 3.8%, p <.001), food (9.1% vs 0.8%, p =.006), and employment (21.2% vs 1.5%, p <.001). There was no difference in time on trial (hazard ratio, 1.03; p =.860) or survival (hazard ratio, 1.16; p =.496). Conclusions: More than one third of EP‐CT participants reported financial toxicity. Factors associated with financial toxicity and demonstrated novel associations among financial toxicity with QOL, coping, and resource concerns were identified, highlighting the need to address financial toxicity among this population. In this study of early‐phase clinical trial participants, more than one third report financial toxicity. Financial toxicity was associated with lower quality of life, impaired coping, and increased concerns regarding access to resources. [ABSTRACT FROM AUTHOR]

PURPOSE: Early-phase clinical trials (EP-CTs) are designed to determine optimal dosing, tolerability, and preliminary activity of novel cancer therapeutics. Little is known about the time that patients spend interacting with the health care system (eg, time toxicity) while participating in these studies. METHODS: We retrospectively reviewed the electronic health records of consecutive patients enrolled in EP-CTs from 2017 to 2019 to obtain baseline characteristics and number of health care–associated days, defined as all inpatient and outpatient visits while on trial. We used univariable and multivariable analyses to identify predictors of increased time toxicity, defined as the proportion of health care–associated days among total days on trial. For ease of interpretation, we created a dichotomous variable, with high time toxicity defined as ≥20% health care–associated days during time on trial and used regression models to evaluate relationships between time toxicity and clinical outcomes. RESULTS: Among 408 EP-CT participants (mean age, 60.5 years [standard deviation, SD, 12.6]; 56.5% female; 88.2% White; 96.0% non-Hispanic), patients had an average of 22.5% health care–associated days while on trial (SD, 13.8%). Those with GI (B = 0.07; P =.002), head/neck (B = 0.09; P =.004), and breast (B = 0.06; P =.015) cancers and those with worse performance status (B = 0.04; P =.017) and those receiving targeted therapies (B = 0.04; P =.014) experienced higher time toxicity. High time toxicity was associated with decreased disease response rates (odds ratio, 0.07; P <.001), progression-free survival (hazard ratio [HR], 2.10; P <.001), and overall survival (HR, 2.16; P <.001). CONCLUSION: In this cohort of EP-CT participants, patients spent more than one-fifth of days on trial with health care contact. We identified characteristics associated with higher time toxicity and found that high toxicity correlated with worse clinical outcomes. These data could help inform patient-clinician discussions about EP-CTs, guide future trial design, and identify at-risk patients. EP-CT patients spent 20% of days on trial with health care contact. High time toxicity correlated with worse outcomes. [ABSTRACT FROM AUTHOR]

Objectives: Termination of pregnancy after increased nuchal translucency (NT) is a common occurrence. This study aimed to identify characteristics of a cohort with a NT ≥3.0 mm who underwent a pregnancy termination ≥15 weeks compared with those who terminated <15 weeks. Methods: All NT ≥3.0 mm identified within our department over an 11‐year period (2010–2021) (n = 689) were retrospectively examined and characteristics of the cohort of increased NTs ending in termination were further categorized. Results: There were 221 (32.1%) individuals with an increased NT (≥3 mm) who underwent a termination of pregnancy within our study period (2010–2021). Pregnancy termination occurred at a gestational age <15 weeks in 162 (73.3%) and ≥15 weeks in 59 individuals. Pregnant individuals without positive NIPT for aneuploidy were at a higher risk for a ≥15‐week termination (p = 0.004). In 29% (17/59) of late terminations, there were additional imaging findings after the NT scan (ultrasound, echocardiogram, magnetic resonance imaging) that ultimately triggered the decision to pursue termination. Conclusions: As the options for workup of an increased NT expand, potential delays in decision‐making surrounding termination increase. This study identifies multiple reasons for delayed termination and proposes several approaches to care aimed at maximizing diagnostic information by imaging and diagnostic testing in an expedited manner. Highlights: What is already known about this topic? Termination of pregnancy after increased nuchal translucency (NT) is a common occurrence.Termination of pregnancy is safest at earlier gestational agesAs the options for workup of an increased NT evolve, there is more opportunity for delays in decision‐making surrounding termination What does this study add? Delays in termination due to increased NT come from a variety of factors including new imaging findings at follow‐up scans, patient decision‐making, later gestational age at initial NT scan, >1 week delay in termination scheduling, pending single‐gene testing, or inability to perform chorionic villus sampling.Approaches are proposed to increase access to timely information regarding abnormalities associated with increased NT. [ABSTRACT FROM AUTHOR]