Disparities in prognosis communication among parents of children with cancer: The impact of race and ethnicity.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. 6562-6562
Author(s):  
Maya Ilowite ◽  
Angel M. Cronin ◽  
Tammy I Kang ◽  
Jennifer W. Mack
Keyword(s):  
Information Needs ◽  
Prognostic Information ◽  
Children With Cancer ◽  
Children's Hospital ◽  
Parental Preferences ◽  
White Parents ◽  
Race Ethnicity ◽  
Physician Beliefs ◽  
The Impact ◽  
Parent Race

6562 Background: Most parents of children with cancer say they want detailed prognostic information about their child’s cancer. However, prior work has been conducted in populations of limited diversity. We sought to evaluate the impact of parental race/ethnicity on prognosis communication experiences amongst parents of children with cancer. Methods: We surveyed 357 parents of children with cancer, and the children’s physicians at Dana-Farber Cancer Institute/Boston Children’s Hospital and Children’s Hospital of Philadelphia. Our outcome measures were parental preferences for prognostic information, physician beliefs about parental preferences, prognosis communication processes and communication outcomes. Except where noted, associations were assessed by logistic regression with generalized estimating equations to correct for physician clustering. Results: 87% of parents wanted as much detail as possible about their child’s prognosis, with no significant differences by race/ethnicity (P = .50). Physician beliefs about parental preferences for prognosis communication varied based on parent race/ethnicity. 60% of physicians for White parents reported they believed parents wanted as much detail as possible about their child’s prognosis, versus 36%, 38%, and 64% of physicians, respectively, for Black, Hispanic, and Asian/Other parents (P = .04). Parent race/ethnicity was not associated with actual prognostic disclosure as reported by parents (P = .79) or by physicians (P = .61). Accurate understanding of prognosis was higher amongst White (51%) versus non-White parents (range 22%-29%), although this difference was not statistically significant (P = .13, unadjusted). Conclusions: The majority of parents, regardless of racial and ethnic background, want detailed prognostic information about their child’s cancer. However, physicians rarely recognize the information needs of Black and Hispanic parents. Despite this discrepancy, prognosis communication outcomes were largely equivalent. Our findings suggest that in order to meet parents’ information needs, physicians should ask about the information preferences of parents of children with cancer prior to prognosis discussions.

Decisional Regret Among Parents of Children With Cancer

2016 ◽  
Vol 34 (33) ◽  
pp. 4023-4029 ◽  
Author(s):  
Jennifer W. Mack ◽  
Angel M. Cronin ◽  
Tammy I. Kang
Keyword(s):  
Decision Making ◽  
Cancer Treatment ◽  
Quality Information ◽  
Prognostic Information ◽  
High Quality ◽  
Children With Cancer ◽  
Children's Hospital ◽  
Children’S Hospital ◽  
High Quality Information ◽  
Decisional Regret

Purpose Decision making is one of the ways in which parents serve as stewards of their children with cancer, but barriers to informed decision making among parents of children with cancer have been identified. We sought to evaluate the extent to which parents feel satisfied with, or regretful of, decisions made for their child’s cancer treatment and to identify factors associated with heightened regret. Methods We surveyed 346 parents of children with cancer within 12 weeks of their initial cancer treatment decision and the children’s physicians at Dana-Farber Cancer Institute/Boston Children’s Hospital and the Children’s Hospital of Philadelphia. Our main outcome measure was heightened regret as measured by the Decisional Regret Scale. Results Sixteen percent of parents (N = 54) met our definition of heightened decisional regret. In a multivariable logistic regression model, race/ethnicity was associated with regret, with black (odds ratio [OR], 6.55; 95% CI, 2.30 to 18.7), Hispanic (OR, 2.15; 95% CI, .69 to 6.65), and other race parents (OR, 4.68; 95% CI, 1.58 to 13.8) at increased risk for regret relative to whites ( P = .001 across all categories). In contrast, parents who reported receiving high-quality information (OR, .45; 95% CI, .23 to .91; P = .03) and detailed prognostic information (OR, .48; 95% CI, .24 to .96; P = .04), who trusted the oncologist completely (OR, .32; 95% CI, .17 to .63; P = .001), and who held their ideal role in decision making (OR, .49; 95% CI, .25 to .95; P = .04) were less likely to experience regret. Conclusion Although many parents are satisfied with decisions made for their children with cancer, racial and ethnic minority parents are at heightened risk for regret. Clinicians may be able to reduce this risk by providing high-quality information, including prognostic information, involving parents in decision making in the ways they wish, and serving as trusted providers.

Communication About Prognosis Between Parents and Physicians of Children With Cancer: Parent Preferences and the Impact of Prognostic Information

2006 ◽  
Vol 24 (33) ◽  
pp. 5265-5270 ◽  
Author(s):  
Jennifer W. Mack ◽  
Joanne Wolfe ◽  
Holcombe E. Grier ◽  
Paul D. Cleary ◽  
Jane C. Weeks
Keyword(s):  
Decision Making ◽  
Overall Response Rate ◽  
Outcome Measure ◽  
Prognostic Information ◽  
Parent Rating ◽  
Children With Cancer ◽  
Additional Information ◽  
Dana Farber Cancer Institute ◽  
Parent Preferences ◽  
The Impact

Purpose Concerns about the harms of prognostic information, including distress and loss of hope, cause some physicians to avoid frank disclosure. We aimed to determine parent preferences for prognostic information about their children with cancer and the results of receiving such information. Patients and Methods We surveyed 194 parents of children with cancer (overall response rate, 70%), treated at the Dana-Farber Cancer Institute and Children's Hospital (Boston, MA) and the children's physicians. Our main outcome measure was parent rating of prognostic information as extremely or very upsetting. Results The majority of parents desired as much information about prognosis as possible (87%) and wanted it expressed numerically (85%). Although 36% of parents found information about prognosis to be extremely or very upsetting, those parents were more likely to want additional information about prognosis than those who were less upset (P = .01). Parents who found information upsetting were no less likely to say that knowing prognosis was important (P = .39), that knowing prognosis helped in decision making (P = .40), or that hope for a cure kept them going (P = .72). Conclusion Although many parents find prognostic information about their children with cancer upsetting, parents who are upset by prognostic information are no less likely to want it. The upsetting nature of prognostic information does not diminish parents' desire for such information, its importance to decision making, or parents' sense of hope.

scholarly journals AB0142 SOCIOECONOMIC STATUS (SES) AND MEDICATION USE IN RHEUMATOID ARTHRITIS (RA): A SCOPING REVIEW

2021 ◽  
Vol 80 (Suppl 1) ◽  
pp. 1098.2-1099
Author(s):  
O. Russell ◽  
S. Lester ◽  
R. Black ◽  
C. Hill
Keyword(s):  
Rheumatoid Arthritis ◽  
Socioeconomic Status ◽  
Scoping Review ◽  
Research Training ◽  
Medication Use ◽  
Study Group ◽  
Knowledge Gaps ◽  
Coverage Area ◽  
Race Ethnicity ◽  
The Impact

Background:Socioeconomic status (SES) influences disease outcomes in rheumatoid arthritis (RA) patients. (1, 2) Differences in medication use could partly explain this association. (3) A scoping review was used to identify research conducted on this topic and determine what knowledge gaps remain.Objectives:To determine what research has been conducted on this topic, how this research has defined SES and medication use, and establish what knowledge gaps remain.Methods:MEDLINE, EMBASE and PsychInfo were searched from their inception until May 2019 for studies which assessed SES and medication use as outcome variables. Studies were included if they measured medication use and incorporated an SES measure as a comparator variable.SES was defined using any of the “PROGRESS” framework variables (4) including patients’ stated gender, age, educational attainment, employment, occupational class, personal income, marital status, health insurance coverage, area- (neighbourhood) level SES, or patients’ stated race and/or ethnicity. Medication use was broadly defined as either prescription or dispensation of a medicine, medication adherence, or delays in treatment. Data was extracted on studies’ primary objectives, measurement of specific SES measures, patients’ medication use, and whether studies assessed for differences in patients’ medication use according to SES variables.Results:1464 studies were identified by this search from which 74 studies were selected for inclusion, including 52 published articles. Studies’ publication year ranged from 1994-2019, and originated from 20 countries; most commonly from the USA.Studies measured a median of 4 SES variables (IQR 3-6), with educational achievement, area level SES and race/ethnicity the most frequently recorded.Likelihood of disease modifying antirheumatic drug (DMARD) prescription was the most frequent primary objective recorded.96% of studies reported on patients’ use of DMARDs, with glucocorticoids and analgesics being reported in fewer studies (51% and 23% respectively.)Most included studies found at least one SES measure to be significantly associated with differences in patients’ medication use. In some studies, however, this result was not necessarily drawn from the primary outcome and therefore may not have been adjusted for covariates.70% of published studies measuring patients’ income (n=14 of 20) and 58% of those that measured race/ethnicity (n=14 of 24) documented significant differences in patients’ medication use according to these SES variables, although the direction of this effect – whether it led to ‘greater’ or ‘lesser’ medication use – varied between studies.Conclusion:Multiple definitions of SES are used in studies of medication use in RA patients. Despite this, most identified studies found evidence of a difference in medication use by patient groups that differed by an SES variable, although how medication use differed was found to vary between studies. This latter observation may relate to contextual factors pertaining to differences in countries’ healthcare systems. Further prospective studies with clearly defined SES and medication use measures may help confirm the apparent association between SES and differences in medication use.References:[1]Jacobi CE, Mol GD, Boshuizen HC, Rupp I, Dinant HJ, Van Den Bos GA. Impact of socioeconomic status on the course of rheumatoid arthritis and on related use of health care services. Arthritis Rheum. 2003;49(4):567-73.[2]ERAS Study Group. Socioeconomic deprivation and rheumatoid disease: what lessons for the health service? ERAS Study Group. Early Rheumatoid Arthritis Study. Annals of the rheumatic diseases. 2000;59(10):794-9.[3]Verstappen SMM. The impact of socio-economic status in rheumatoid arthritis. Rheumatology (Oxford). 2017;56(7):1051-2.[4]O’Neill J, Tabish H, Welch V, Petticrew M, Pottie K, Clarke M, et al. Applying an equity lens to interventions: using PROGRESS ensures consideration of socially stratifying factors to illuminate inequities in health. J Clin Epidemiol. 2014;67(1):56-64.Acknowledgements:This research was supported by an Australian Government Research Training Program Scholarship.Disclosure of Interests:None declared

scholarly journals Pediatric Surgical Reentry Strategy Following the COVID-19 Pandemic: A Tiered and Balanced Approach

2021 ◽  
pp. 000313482110111
Author(s):  
Ryan C. Pickens ◽  
Angela M. Kao ◽  
Mark A. Williams ◽  
Andrew C. Herman ◽  
Jeffrey S. Kneisl
Keyword(s):  
Pediatric Surgery ◽  
Elective Surgery ◽  
Surgical Care ◽  
Children's Hospital ◽  
Protocol Development ◽  
Balanced Approach ◽  
Projective Curves ◽  
Children’S Hospital ◽  
The Impact ◽  
Emergent Surgery

Background In response to the COVID-19 pandemic, children’s hospitals across the country postponed elective surgery beginning in March 2020. As projective curves flattened, administrators and surgeons sought to develop strategies to safely resume non-emergent surgery. This article reviews challenges and solutions specific to a children’s hospital related to the resumption of elective pediatric surgeries. We present our tiered reentry approach for pediatric surgery as well as report early data for surgical volume and tracking COVID-19 cases during reentry. Methods The experience of shutdown, protocol development, and early reentry of elective pediatric surgery are reported from Levine’s Children’s Hospital (LCH), a free-leaning children’s hospital in Charlotte, North Carolina. Data reported were obtained from de-identified hospital databases. Results Pediatric surgery experienced a dramatic decrease in case volumes at LCH during the shutdown, variable by specialty. A tiered and balanced reentry strategy was implemented with steady resumption of elective surgery following strict pre-procedural screening and testing. Early outcomes showed a steady thorough fluctuating increase in elective case volumes without evidence of a surgery-associated positive spread through periprocedural tracking. Conclusion Reentry of non-emergent pediatric surgical care requires unique considerations including the impact of COVID-19 on children, each children hospital structure and resources, and preventing undue delay in intervention for age- and disease-specific pediatric conditions. A carefully balanced strategy has been critical for safe reentry following the anticipated surge. Ongoing tracking of resource utilization, operative volumes, and testing results will remain vital as community spread continues to fluctuate across the country.

Handshake antimicrobial stewardship as a model to recognize and prevent diagnostic errors

Diagnosis ◽  
2020 ◽  
Vol 0 (0) ◽  
Author(s):  
Justin B. Searns ◽  
Manon C. Williams ◽  
Christine E. MacBrayne ◽  
Ann L. Wirtz ◽  
Jan E. Leonard ◽  
...  
Keyword(s):  
Antimicrobial Stewardship ◽  
Interrater Reliability ◽  
Diagnostic Errors ◽  
Diagnostic Error ◽  
Primary Treatment ◽  
Treatment Team ◽  
Children's Hospital ◽  
Children’S Hospital ◽  
The Impact ◽  
Made In

AbstractObjectivesFew studies describe the impact of antimicrobial stewardship programs (ASPs) on recognizing and preventing diagnostic errors. Handshake stewardship (HS-ASP) is a novel ASP model that prospectively reviews hospital-wide antimicrobial usage with recommendations made in person to treatment teams. The purpose of this study was to determine if HS-ASP could identify and intervene on potential diagnostic errors for children hospitalized at a quaternary care children’s hospital.MethodsPreviously self-identified “Great Catch” (GC) interventions by the Children’s Hospital Colorado HS-ASP team from 10/2014 through 5/2018 were retrospectively reviewed. Each GC was categorized based on the types of recommendations from HS-ASP, including if any diagnostic recommendations were made to the treatment team. Each GC was independently scored using the “Safer Dx Instrument” to determine presence of diagnostic error based on a previously determined cut-off score of ≤1.50. Interrater reliability for the instrument was measured using a randomized subset of one third of GCs.ResultsDuring the study period, there were 162 GC interventions. Of these, 65 (40%) included diagnostic recommendations by HS-ASP and 19 (12%) had a Safer Dx Score of ≤1.50, (Κ=0.44; moderate agreement). Of those GCs associated with diagnostic errors, the HS-ASP team made a diagnostic recommendation to the primary treatment team 95% of the time.ConclusionsHandshake stewardship has the potential to identify and intervene on diagnostic errors for hospitalized children.

scholarly journals Conservation and natural resource management: where are all the women?

Oryx ◽  
2021 ◽  
pp. 1-8
Author(s):  
Robyn James ◽  
Bridget Gibbs ◽  
Laura Whitford ◽  
Craig Leisher ◽  
Ruth Konia ◽  
...  
Keyword(s):  
Resource Management ◽  
Literature Review ◽  
Natural Resource Management ◽  
Natural Resource ◽  
Positive Relationship ◽  
Cultural Norms ◽  
Conservation Actions ◽  
Race Ethnicity ◽  
Management Institutions ◽  
The Impact

Abstract There is evidence from the development and humanitarian sectors that purposeful engagement of women can increase the impact of development. We conducted a literature review to examine whether this is also evident in conservation and natural resource management. The following themes emerged from our review: existing societal and cultural norms affect and generally limit how women can engage in conservation and natural resource management; women interact differently with the environment than men, so if they are excluded, their knowledge and perspectives on particular resources may not be considered in conservation actions; and there is often a lack of resources or dedicated effort by conservation or natural resource management programmes to understand and address the barriers that prevent women's engagement. Although there was evidence of a positive relationship between the engagement of women and environmental outcomes, some studies showed that positive conservation outcomes do not necessarily benefit women, and when women are not considered, conservation activities can perpetuate existing inequities. We conclude that although the importance of integrating gender into conservation is acknowledged in the literature, there is a need to examine how women can be meaningfully engaged in conservation. This must go beyond treating women as a homogenous group, to consider intersectionality including race, ethnicity, age, religion, poverty and disability. In addition, conservation and natural resource management institutions need to address the inclusion of women in their own staff and programmes.

scholarly journals Racial Disparities in Virologic Failure and Tolerability During Firstline HIV Antiretroviral Therapy

2019 ◽  
Vol 6 (2) ◽  
Author(s):  
Priya Bhagwat ◽  
Shashi N Kapadia ◽  
Heather J Ribaudo ◽  
Roy M Gulick ◽  
Judith S Currier
Keyword(s):  
Antiretroviral Therapy ◽  
Adverse Events ◽  
Socioeconomic Factors ◽  
Ethnic Groups ◽  
Virologic Failure ◽  
Virologic Suppression ◽  
Factors Associated ◽  
Race Ethnicity ◽  
The Impact ◽  
Racial Ethnic

Abstract Background Racial/ethnic disparities in HIV outcomes have persisted despite effective antiretroviral therapy. In a study of initial regimens, we found viral suppression varied by race/ethnicity. In this exploratory analysis, we use clinical and socioeconomic data to assess factors associated with virologic failure and adverse events within racial/ethnic groups. Methods Data were from AIDS Clinical Trial Group A5257, a randomized trial of initial regimens with either atazanavir/ritonavir, darunavir/ritonavir, or raltegravir (each combined with tenofovir DF and emtricitabine). We grouped participants by race/ethnicity and then used Cox-proportional hazards regression to examine the impact of demographic, clinical, and socioeconomic factors on the time to virologic suppression and time to adverse event reporting within each racial/ethnic group. Results We analyzed data from 1762 participants: 757 self-reported as non-Hispanic black (NHB), 615 as non-Hispanic white (NHW), and 390 as Hispanic. The proportion with virologic failure was higher for NHB (22%) and Hispanic (17%) participants compared with NHWs (9%). Factors associated with virologic failure were poor adherence and higher baseline HIV RNA level. Prior clinical AIDS diagnosis was associated with virologic failure for NHBs only, and unstable housing and illicit drug use for NHWs only. Factors associated with adverse events were female sex in all groups and concurrent use of medications for comorbidities in NHB and Hispanic participants only. Conclusions Clinical and socioeconomic factors that are associated with virologic failure and tolerability of antiretroviral therapy vary between and within racial and ethnic groups. Further research may shed light into mechanisms leading to disparities and targeted strategies to eliminate those disparities.

scholarly journals Recognizing Human Races through Machine Learning—A Multi-Network, Multi-Features Study

Mathematics ◽  
2021 ◽  
Vol 9 (2) ◽  
pp. 195
Author(s):  
Adrian Sergiu Darabant ◽  
Diana Borza ◽  
Radu Danescu
Keyword(s):  
Race And Ethnicity ◽  
Large Scale ◽  
Recognition Rate ◽  
Social Signals ◽  
Image Characteristics ◽  
Race Effect ◽  
Race Ethnicity ◽  
The Impact ◽  
Facial Images ◽  
Ethnicity Classification

The human face holds a privileged position in multi-disciplinary research as it conveys much information—demographical attributes (age, race, gender, ethnicity), social signals, emotion expression, and so forth. Studies have shown that due to the distribution of ethnicity/race in training datasets, biometric algorithms suffer from “cross race effect”—their performance is better on subjects closer to the “country of origin” of the algorithm. The contributions of this paper are two-fold: (a) first, we gathered, annotated and made public a large-scale database of (over 175,000) facial images by automatically crawling the Internet for celebrities’ images belonging to various ethnicity/races, and (b) we trained and compared four state of the art convolutional neural networks on the problem of race and ethnicity classification. To the best of our knowledge, this is the largest, data-balanced, publicly-available face database annotated with race and ethnicity information. We also studied the impact of various face traits and image characteristics on the race/ethnicity deep learning classification methods and compared the obtained results with the ones extracted from psychological studies and anthropomorphic studies. Extensive tests were performed in order to determine the facial features to which the networks are sensitive to. These tests and a recognition rate of 96.64% on the problem of human race classification demonstrate the effectiveness of the proposed solution.

scholarly journals Physician beliefs about the impact of meaningful use of the EHR

2014 ◽  
Vol 05 (03) ◽  
pp. 789-801 ◽  
Author(s):  
D.Y. Ting ◽  
M. Healey ◽  
S.R. Lipsitz ◽  
A.S. Karson ◽  
J. S. Einbinder ◽  
...  
Keyword(s):  
Quality Of Care ◽  
Primary Care Physicians ◽  
Meaningful Use ◽  
The United States ◽  
Improve Quality ◽  
Cross Sectional ◽  
Incentive Program ◽  
Physician Beliefs ◽  
The Impact

SummaryBackground: As adoption and use of electronic health records (EHRs) grows in the United States, there is a growing need in the field of applied clinical informatics to evaluate physician perceptions and beliefs about the impact of EHRs. The meaningful use of EHR incentive program provides a suitable context to examine physician beliefs about the impact of EHRs.Objective: Contribute to the sparse literature on physician beliefs about the impact of EHRs in areas such as quality of care, effectiveness of care, and delivery of care.Methods: A cross-sectional online survey of physicians at two academic medical centers (AMCs) in the northeast who were preparing to qualify for the meaningful use of EHR incentive program.Results: Of the 1,797 physicians at both AMCs who were preparing to qualify for the incentive program, 967 completed the survey for an overall response rate of 54%. Only 23% and 27% of physicians agreed or strongly agreed that meaningful use of the EHR will help them improve the care they personally deliver and improve quality of care respectively. Physician specialty was significantly associated with beliefs; e.g., 35% of primary care physicians agreed or strongly agreed that meaningful use will improve quality of care compared to 26% of medical specialists and 21% of surgical specialists (p=0.009). Satisfaction with outpatient EHR was also significantly related to all belief items.Conclusions: Only about a quarter of physicians in our study responded positively that meaningful use of the EHR will improve quality of care and the care they personally provide. These findings are similar to and extend findings from qualitative studies about negative perceptions that physicians hold about the impact of EHRs. Factors outside of the regulatory context, such as physician beliefs, need to be considered in the implementation of the meaningful use of the EHR incentive program.Citation: Emani S, Ting DY, Healey M, Lipsitz SR, Karson AS, Einbinder JS, Leinen L, Suric V, Bates DW. Physician beliefs about the impact of meaningful use of the EHR: A cross-sectional study. Appl Clin Inf 2014; 5: 789–801http://dx.doi.org/10.4338/ACI-2014-05-RA-0050

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