ABSTRACT
Aim: As a brief psychotherapy for individuals facing mortal threat, Dignity Therapy (DT) effects on spiritual outcomes are unknown, especially as an intervention to support cancer health equity for racial minority patients. Our study aim was to compare usual outpatient palliative care and such care along with nurse-led or chaplain-led DT groups for main effects on dignity impact and the interaction of DT with race. Method(s): We conducted the 4-step, stepped-wedge randomized control trial at 4 NCI designated cancer centers and 2 academic cancer centers across the United States. Half of the sites were randomized to chaplain-led DT and half to nurse-led DT. Of the 645 recruited cancer patients (age >= 55 years) receiving outpatient palliative care, 579 (59% female, mean age 66.4+/-7.4 years, 78% White, 77% Christian religion, 62% stage 4 cancer) provided data for intent-totreat analysis. Over 6 weeks, patients completed pretest/posttest measures including the Dignity Impact Scale (DIS, primary outcome) ranging from low impact of 7 to highest impact of 35. In step 1-3, study procedures were completed in person. In step 4 (during the COVID-19 pandemic), when all sites were providing the intervention, study procedures were completed via Zoom. We used multiple imputation and regression analysis adjusting for pretest DIS, study site, and study step. Result(s): Of the 579 patients, 317 were in the DT group and 262 in the usual care group. The vast majority of the sample was White (n=448) along with 103 Blacks, 5 Asians, 2 Pacific Islanders, 1 Native American, 13 other races (all minorities were combined as Other Race), and 7 were missing race data. At pretest, the mean DIS score was 24.3+/-4.3 in the DT group and 25.9+/-4.3 in the usual care group. Adjusting for pretest DIS scores, study site, and study step, the chaplain-led (beta=1.7, p=.02) and nurse-led (beta=2.1, p=.005) groups reported significantly higher posttest DIS scores than the usual care groups. Adjusting for age, gender, race, education, and income, the effect on DIS scores remained significant for both DT groups. We then examined the interaction between race and DT with the entire sample and observed that the interaction was not significant (p=.73) and the sizes of DT effects were similar for White (beta=1.9, p=.005) and the Other Race (beta=1.6, p=.055) patients. Conclusion(s): Whether led by chaplains or nurses, DT was effective in improving dignity impact for older adult outpatient palliative care patients with cancer. DT, a patient-centered approach, has promise as an intervention to improve health equity in support of dignity for racial minorities. This rigorous trial of DT is a landmark step in gero-oncology palliative care and spiritual health services research focused on cancer health equity.
ABSTRACT
Objective: The COVID-19 pandemic triggered a worldwide need for telehealth services. Previously providing services in remote communities, virtual consultations were implemented to accommodate the needs of people with CF (pwCF) who were shielding and unable to attend faceto- face consultations. Method: This group has compiled a CF Physiotherapist’s toolkit of essential elements necessary to enable delivery and promotion of safe, equitable virtual sessions, specific to pwCF. Through international collaboration and shared experience, the toolkitwas developed to support physiotherapists working across paediatric and adults with CF. Results: Centres implementing telehealth into routine care need rigorous methods to evaluate safety and effectiveness ensuring optimal care. Using telehealth for joint sessions with shared care centres, or during transitional periods, should be considered ensuring equitable access and specialised care for all. The health benefits of telehealth, the coincident enhanced control of cross infection and resource savings, to the hospital and the person/family with CF in time and travel costs, are invaluable. A blend of virtual and faceto- face consultations could be the mainstay of future CF care. CFTR modulator therapy, improved specialised care, and improving life expectancy is compelling clinicians to review current services, improve efficiencies and continually optimise care and health outcomes. Telehealth, may provide an option for alternative models of care which may not be suitable for all but should be considered as an option in future CF services. Conclusions: Using this toolkit, the CF Physiotherapist is provided with relevant guidance and support for delivery of online/virtual respiratory review, spirometry assessment, evaluation of inhalation therapy, airway clearance and exercise opportunities. The toolkit promotes an equitable translation from face-to-face care to virtual care and includes strategies for risk mitigation in the virtual setting.
ABSTRACT
Objectives: COVID-19 has limited in-person networking opportunities worldwide. To address this, we formed a collaboration of representatives from Australia’s CFPhysio.com Inc, the UK’s Association of Chartered Physiotherapists in Cystic Fibrosis (CF) and US specialist CF physical therapists (PT) with the objective of creating a virtual international discussion forum. To ensure wider interest, views were gathered from international CF colleagues via a self-designed online survey. Here we present survey results and planned outcomes. Methods: Survey topics included respondent demographics;professional development and research priorities;and future forum interest. The online survey circulated between Oct-Dec 2021 via social media channels, established networks and targeted emails to international physio and PT groups. Results: Eighty-four people responded - 94% physio/PTs;74% hospitalbased;equal split between paediatrics and adults;30% currently researchactive. 100% of respondents were interested in attending virtual discussion forums, with 73% keen to plan sessions. The top 3 professional development and research priorities are described in the table. (Table Presented) Conclusions: Results indicate international CF PT/physio interest in a virtual discussion forum. In response to this interest, we developed our vision "To create a virtual space for clinicians and researchers across the globe, working in CF, to learn and to collaborate and deliver on innovative and robust research into the future." Quarterly virtual discussion forums start in Spring 2022, hosted and promoted by beamfeelgood.com (a global exercise and education platform for people with CF and their clinicians). Sessions address the top professional development priorities identified from survey results and aim to facilitate discussions between colleagues to enhance clinical practice and forge future research collaborations.