Patient and physician factors associated with overuse and underuse of cancer screening: A factorial, cluster-randomized trial.

2014 ◽  
Vol 32 (30_suppl) ◽  
pp. 206-206 ◽  
Author(s):  
James Austin Talcott ◽  
Kelly A Cassano ◽  
Roy Cohen ◽  
Jessica Herzstein ◽  
Floyd Jackson Fowler ◽  
...  
Keyword(s):  
Cancer Screening ◽  
Randomized Trial ◽  
Primary Care Physicians ◽  
Medical Center ◽  
Academic Medical Center ◽  
Prospective Trial ◽  
Educational Interventions ◽  
Primary Data ◽  
Screening Guideline ◽  
Cluster Randomized

206 Background: Cancer screening, like other interventions, requires close patient-provider collaboration. By patient recall, key elements are often omitted from informed consent discussions. Most screening guideline compliance efforts focus on reducing underuse, but overuse is also harmful and may be influenced by distinct factors. Therefore, we are performing a prospective randomized trial of educational interventions to improve screening compliance for breast, cervical, colorectal, lung and prostate cancer at an urban academic medical center. Our hypothesis is that gender, age, prior screening experience, provider recommendations, anticipated benefit and distress, communication and informational support will affect compliance. Our primary data collection will be complete before the Symposium. Methods: We will enroll an age- and sex-stratified sample of 216 patients aged 40 to 89 years, 18 each treated by 12 primary care physicians at two affiliated hospitals, undergoing an annual physical examination in a cluster-randomized prospective trial of educational supports for screening. Screening guideline format (color-coding) and academic detailing will be randomly assigned independently. Patients and providers are surveyed immediately after the encounter to record their recollections of screening discussions and recommendations and their plans. Follow-up surveys at 3, 6 and 12 months assess concordance between expressed screening intentions and behaviors. Results: Pilot results indicate patient gender, age, anticipated screening-related distress and benefit, and prior screening experience affect screening recommendations and intentions. These factors vary by cancer. Patients recall less discussion than providers. Reasons not to screen are infrequently discussed. Conclusions: Cancer screening decisions are complex and vary by screening modality, patient and provider factors and communication. Improving underuse and overuse compliance may require distinct strategies. Screening overuse may be a “lower-stakes” environment to develop strategies to reduce overuse of cancer interventions of marginal or negative benefit, including treatment.

Do patients and physicians perceive PSA screening discussions the same?

2016 ◽  
Vol 34 (2_suppl) ◽  
pp. 160-160
Author(s):  
James Austin Talcott ◽  
Gina Aharonoff ◽  
Maureen Bezuhly ◽  
Michael P. Osborne
Keyword(s):  
Decision Making ◽  
Randomized Trial ◽  
Primary Care Physicians ◽  
Medical Center ◽  
Academic Medical Center ◽  
Specific Antigen ◽  
Educational Interventions ◽  
Screening Methods ◽  
Psa Screening ◽  
Psa Testing

160 Background: Shared decision making is recommended for prostate-specific antigen (PSA) screening. We are performing a prospective randomized trial of educational interventions to improve screening compliance at an urban academic medical center. We hypothesize that patient and provider characteristics providers will affect compliance. We report the first results for PSA screening. Methods: In a cluster-randomized trial of educational supports for providers, we are recruiting an age- and sex-stratified sample of 216 patients aged 30 to 89 years undergoing an annual physical examination, 18 patients of each of 12 primary care physicians at two affiliated hospitals. Screening guideline format (color-coding) and academic detailing were randomly assigned in a 2 x 2 design. Surveys occurred immediately post-encounter to record recollections of screening discussions, recommendations and plans. Results: We report on the first 44 of 108 planned male participants. Most were white (77%), had a college degree (83%), and currently married (59%). When providers reported a PSA discussion, 13% of patients disagreed, while 23% of patients disagreed when their provider reported a PSA discussion. Discrepancies also occurred on additional elements of informed decision-making (data not shown). Reports also disagreed on physician recommendations: 2 of 8 patients (25%) disagreed with the physician’s report of recommending screening and 6 of 12 patients (50%) disagreed with the physician’s report of not recommending it. Half of patients (49%) reported distress at getting PSA results, but only 5% reported “a lot” of distress. Over half (58%) reported that PSA testing protected against prostate cancer “a lot.” No physician reported recommending PSA testing to men under age 50 or over age 70, but 1 of 6 men under 50 and 3 of 3 men over 70 reported that their physician had recommended testing. Conclusions: In a highly educated population of men and physicians surveyed immediately after their encounter, reports of whether PSA screening had occurred, the information that had been discussed and the recommendation had important discrepancies. Important differences may exist between patients and physicians in perceptions of PSA screening discussions. Clinical trial information: NCT02430948.

Cancer screening, patient characteristics, and shared decision making (SDM): A complicated equation.

2017 ◽  
Vol 35 (8_suppl) ◽  
pp. 164-164
Author(s):  
James Austin Talcott ◽  
Maureen Bezuhly ◽  
Gina Aharanoff ◽  
Danielle Seiden ◽  
Michael P. Osborne ◽  
...  
Keyword(s):  
Cancer Screening ◽  
Randomized Trial ◽  
Specific Antigen ◽  
Cluster Randomized Trial ◽  
Patient Characteristics ◽  
Clinical Decision ◽  
Educational Interventions ◽  
Highly Educated ◽  
Screening Guideline ◽  
Cluster Randomized

164 Background: SDM may vary by patient and clinical decision. In a randomized trial of physician (MD) educational interventions to improve cancer screening guideline compliance, we studied patient (PT) and MD recall of discussions and factors that affected recall. Methods: In a cluster-randomized trial of educational supports for MDs, we are enrolling an age- (30-89 years) and sex-stratified sample of 216 PTs who underwent a physical examination at 2 urban hospitals, 18 for each of 12 primary care MDs. Screening guideline formatting (color-coding) and academic detailing were randomly assigned in a 2x2 design. Immediate post-encounter surveys recorded PT and MD recall of screening discussions. Results: The first 174 participants were diverse (63% white) and highly educated (77% college degree). PTs and MDs differed in recall of screening discussions, and the differences varied by screening test. When MDs reported a colorectal cancer (CRC) screening discussion, 21% of PTs did not; 20% of MDs disagreed when PTs reported the discussion. The discrepancies were greater for prostate specific antigen (PSA) screening, 29% and 29%, respectively, but much less for mammograms (MAM), 8% and 5%, respectively. Recall of the MD recommendation also differed: 15% of PTs disagreed when their MD reported it, and 33% of MDs when their PT reported it. For PSA, disagreement was 26% and 33%, respectively, and for MAM, disagreement was 17% and 10%, respectively. Overall, agreement between all PTs and MDs on whether screening was recommended was fair for CRC, PSA and MAM: kappa = 0.33, 0.34 and 0.29, respectively. Older PT age ( > 70) sharply eroded agreement on recalled CRC and PSA recommendations (kappa = -0.02 and -0.03, respectively) but much higher for MAM (kappa = 0.39). Recall concordance improved when elements of SDM were recalled. For CRC, kappa rose from -0.12 to 0.52 if the MD recalled any MDM element. Conclusions: In a highly educated, diverse PT population, PTs and MDs surveyed immediately after their encounter often disagreed on what had occurred in screening discussions. Disagreement was greater for CRC and PSA vs. MAM, greater for older PTs but improved when SDM was recalled. Clinical trial information: NCT02430948.

Discussions of cancer screening: What do physicians say, what do patients hear, and how much shared decision making occurs?

2016 ◽  
Vol 34 (7_suppl) ◽  
pp. 180-180
Author(s):  
James Austin Talcott ◽  
Gina Aharonoff ◽  
Maureen Bezuhly ◽  
Jessica Herzstein ◽  
Michael P. Osborne ◽  
...  
Keyword(s):  
Decision Making ◽  
Cancer Screening ◽  
Shared Decision Making ◽  
Primary Care Physicians ◽  
Cluster Randomized Trial ◽  
Shared Decision ◽  
Screening Guidelines ◽  
Screening Guideline ◽  
Stratified Sample ◽  
Cluster Randomized

180 Background: Like other medical interventions, cancer screening requires shared decision-making (SDM). To better understand the process, we are performing a cluster-randomized trial of educational supports to improve screening guideline compliance for breast, cervical, colorectal, lung and prostate cancer at two urban academic medical centers. We present interim results that focus on recalled SDM discussions. Methods: We are enrolling an age- and sex-stratified sample of 216 patients aged 30 to 89 years, 18 treated by each of 12 primary care physicians at two affiliated hospitals before a periodic physical examination. Screening guideline format (color-coding) and academic detailing are independently assigned to providers. Patients and providers are surveyed immediately after the encounter to document SDM discussions, recommendations and beliefs. Screening guidelines (recommended, not or controversial) were determined by age, sex and risk factors. Results: The first 107 eligible enrolled patients were racially diverse (non-Hispanic Caucasian 65%) and well educated (college grad 84%). Patient-physician disagreement about whether screening had been discussed ranged from 6% (mammogram) to 36% (cervical cancer) and disagreement about whether the screening test had been recommended ranged from 17% (mammography) to 44% (PSA). In only 24 (12%) of 159 jointly recalled screening discussions did both patients and physicians agree that all 3 elements of SDM – reasons for screening, reasons against and that it is optional – were discussed, although patients and physicians separately reported all elements in 58 (36%) and 45 (28%), respectively. Conclusions: Even immediately after the encounter, many patients and physicians recalled whether screening had been discussed and recommendations differently, and most SDM discussions were incomplete. Clinical trial information: NCT02430948.

scholarly journals Creation of a dedicated line team for critically ill patients with COVID-19: A multidisciplinary approach to maximize resource utilization during the COVID-19 pandemic

2021 ◽  
pp. 112972982199175
Author(s):  
Pooja Nawathe ◽  
Robert Wong ◽  
Gabriel Pollock ◽  
Jack Green ◽  
Michael Kissen ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Resource Utilization ◽  
Vascular Access ◽  
Medical Center ◽  
Academic Medical Center ◽  
Target Population ◽  
Primary Data ◽  
Arterial Line ◽  
Central Venous ◽  
Development Organization

Background: Pandemics create challenges for medical centers, which call for innovative adaptations to care for patients during the unusually high census, to distribute stress and work hours among providers, to reduce the likelihood of transmission to health care workers, and to maximize resource utilization. Methods: We describe a multidisciplinary vascular access team’s development to improve frontline providers’ workflow by placing central venous and arterial catheters. Herein we describe the development, organization, and processes resulting in the rapid formation and deployment of this team, reporting on notable clinical issues encountered, which might serve as a basis for future quality improvement and investigation. We describe a retrospective, single-center descriptive study in a large, quaternary academic medical center in a major city. The COVID-19 vascular access team included physicians with specialized experience in placing invasive catheters and whose usual clinical schedule had been lessened through deferment of elective cases. The target population included patients with confirmed or suspected COVID-19 in the medical ICU (MICU) needing invasive catheter placement. The line team placed all invasive catheters on patients in the MICU with suspected or confirmed COVID-19. Results and conclusions: Primary data collected were the number and type of catheters placed, time of team member exposure to potentially infected patients, and any complications over the first three weeks. Secondary outcomes pertained to workflow enhancement and quality improvement. 145 invasive catheters were placed on 67 patients. Of these 67 patients, 90% received arterial catheters, 64% central venous catheters, and 25% hemodialysis catheters. None of the central venous catheterizations or hemodialysis catheters were associated with early complications. Arterial line malfunction due to thrombosis was the most frequent complication. Division of labor through specialized expert procedural teams is feasible during a pandemic and offloads frontline providers while potentially conferring safety benefits.

Long-Term Inhalative Sedation in Children With Pulmonary Diseases

2020 ◽  
pp. 088506662095339
Author(s):  
Jochen Meyburg ◽  
David Frommhold ◽  
Johann Motsch ◽  
Navina Kuss
Keyword(s):  
Side Effects ◽  
Lung Function ◽  
Medical Center ◽  
Academic Medical Center ◽  
Tertiary Care ◽  
Prospective Trial ◽  
Pediatric Intensive Care ◽  
Normal Lung ◽  
Beneficial Effects

Objectives: To describe safety and feasibility of long-term inhalative sedation (LTIS) in children with severe respiratory diseases compared to patients with normal lung function with respect to recent studies that showed beneficial effects in adult patients with acute respiratory distress syndrome (ARDS). Design: Single-center retrospective study. Setting: 12-bed pediatric intensive care unit (PICU) in a tertiary-care academic medical center in Germany. Patients: All patients treated in our PICU with LTIS using the AnaConDa® device between July 2011 and July 2019. Measurements and Main Results: Thirty-seven courses of LTIS in 29 patients were analyzed. LTIS was feasible in both groups, but concomitant intravenous sedatives could be reduced more rapidly in children with lung diseases. Cardiocirculatory depression requiring vasopressors was observed in all patients. However, severe side effects only rarely occured. Conclusions: In this largest cohort of children treated with LTIS reported so far, LTIS was feasible even in children with severely impaired lung function. From our data, a prospective trial on the use of LTIS in children with ARDS seems justified. However, a thorough monitoring of cardiocirculatory side effects is mandatory.

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