Evaluating implementation of a community-focused patient navigation intervention at an NCI-designated cancer center using RE-AIM.

BACKGROUND: Patient navigation is an evidence-based intervention that reduces cancer health disparities by directly addressing the barriers to care for underserved patients with cancer. Variability in design and integration of patient navigation programs within cancer care settings has limited this intervention's utility. The implementation science evaluation framework, RE-AIM, allows quantitative and qualitative examination of effective implementation of patient navigation programs into cancer care settings. METHODS: The Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework was used to evaluate implementation of a community-focused patient navigation intervention at an NCI-designated cancer center between June 2018 and October 2021. Using a 3-month longitudinal, non-comparative measurement period, univariate and bivariate analyses were conducted to examine associations between participant-level demographics and primary (i.e., barrier reduction) and secondary (i.e., patient-reported outcomes) effectiveness outcomes. Mixed methods analyses were used to examine adoption and delivery of the intervention into the cancer center setting. Process-level analyses were used to evaluate maintenance of the intervention. RESULTS: Participants (n = 311) represented a largely underserved population, as defined by the National Cancer Institute, with the majority identifying as Hispanic/Latino, having a household income of $35,000 or less, and being enrolled in Medicaid. Participants were diagnosed with a variety of cancer types and most had advanced staged cancers. Pre-post-intervention analyses indicated significant reduction from pre-intervention assessments in the average number of reported barriers, F(1, 207) = 117.62, p < .001, as well as significant increases in patient-reported physical health, t(205) = - 6.004, p < .001, mental health, t(205) = - 3.810, p < .001, self-efficacy, t(205) = - 5.321, p < .001, and satisfaction with medical team communication, t(206) = - 2.03, p = .029. Referral patterns and qualitative data supported increased adoption and integration of the intervention into the target setting, and consistent intervention delivery metrics suggested high fidelity to intervention delivery over time. Process-level data outlined a successful transition from a grant-funded community-focused patient navigation intervention to an institution-funded program. CONCLUSIONS: This study utilized the implementation science evaluation framework, RE-AIM, to evaluate implementation of a community-focused patient navigation program. Our analyses indicate successful implementation within a cancer care setting and provide a potential guide for other oncology settings who may be interested in implementing community-focused patient navigation programs.

The triad model of follower needs: theory and review.

Humans have an evolved flexible followership psychology that enables them to select different leaders in different contexts, depending on their needs. We distinguish a triad of follower needs: (i) guidance into a shared direction, (ii) active protection against threats, and (iii) judicious dispute settlement. These needs relate to critical group coordination challenges described in biology and anthropology and to different evolutionary leadership theories. We describe the contexts, in which these needs emerge, the characteristics of leaders who meet these needs, and the potential risks of following these leaders. We end by discussing the potential of our theory to aid the understanding of leadership in modern organizations, female leadership, leader manipulation of needs, and individual differences between followers.

Reactions to claimed and granted overinclusion: Extending research on the effects of claimball versus cyberball.

Social outcomes can result both from people's own behavior (claim process) and from the behavior of others (grant process). Prior research compared the effect of these two processes on people's experience of inclusion and outperformance, using two virtual ball-toss games: claimball and cyberball. We extend this work by using the same games to assess reactions to a third social outcome, overinclusion. Participants obtained the majority of the ball-tosses (overinclusion) or almost no ball-tosses (ostracism) in claimball or cyberball. Results showed that (1) overinclusion was more satisfying than ostracism, (2) especially when granted by others and less so when claimed for oneself. These results advance knowledge about people's experience of social outcomes, depending on the processes leading to them.

A Review of ex vivo Elemental Mapping Methods to Directly Image Changes in the Homeostasis of Diffusible Ions (Na+, K+, Mg2 +, Ca2 +, Cl-) Within Brain Tissue.

Diffusible ions (Na+, K+, Mg2+, Ca2+, Cl-) are vital for healthy function of all cells, especially brain cells. Unfortunately, the diffusible nature of these ions renders them difficult to study with traditional microscopy in situ within ex vivo brain tissue sections. This mini-review examines the recent progress in the field, using direct elemental mapping techniques to study ion homeostasis during normal brain physiology and pathophysiology, through measurement of ion distribution and concentration in ex vivo brain tissue sections. The mini-review examines the advantages and limitations of specific techniques: proton induced X-ray emission (PIXE), X-ray fluorescence microscopy (XFM), secondary ion mass spectrometry (SIMS), laser-ablation inductively coupled plasma mass spectrometry (LA-ICP-MS), and the sample preparation requirements to study diffusible ions with these methods.

Winners, Losers, Insiders, and Outsiders: Comparing Hierometer and Sociometer Theories of Self-Regard.

What evolutionary function does self-regard serve? Hierometer theory, introduced here, provides one answer: it helps individuals navigate status hierarchies, which feature zero-sum contests that can be lost as well as won. In particular, self-regard tracks social status to regulate behavioral assertiveness, augmenting or diminishing it to optimize performance in such contests. Hierometer theory also offers a conceptual counterpoint that helps resolve ambiguities in sociometer theory, which offers a complementary account of self-regard's evolutionary function. In two large-scale cross-sectional studies, we operationalized theoretically relevant variables at three distinct levels of analysis, namely, social (relations: status, inclusion), psychological (self-regard: self-esteem, narcissism), and behavioral (strategy: assertiveness, affiliativeness). Correlational and mediational analyses consistently supported hierometer theory, but offered only mixed support for sociometer theory, including when controlling for confounding constructs (anxiety, depression). We interpret our results in terms of a broader agency-communion framework.

When status is grabbed and when status is granted: Getting ahead in dominance and prestige hierarchies.

What type of behaviour affords status, agentic, or communal? Research to date has yielded inconsistent answers. In particular, the conflict view holds that agentic behaviour permits the imperious to grab status through overt force, whereas the functional view holds that communal behaviour permits the talented to earn status through popular appeal. Here, we synthesize both views by taking into account the moderating role played by group hierarchy. Group hierarchy can range from being dominance based (where status is grabbed) to prestige based (where status is granted). In a field study (Study 1), and a laboratory experiment (Study 2), we demonstrate that in different groups, status can be achieved in different ways. Specifically, agentic behaviour promotes status regardless of hierarchy type, whereas the effect of communal behaviour on status is moderated by hierarchy type: it augments it in more prestige-based hierarchies but diminishes it in more dominance-based hierarchies.

When you don't quite get what you want: psychological and interpersonal consequences of claiming inclusion.

People's success or failure to gain inclusion in groups may result from their own actions or the actions of others. Two studies compared the personal and interpersonal consequences of inclusion and exclusion when they resulted from these two processes. People's own failure to "claim" inclusion in a computerized ballgame was equally detrimental for fundamental needs and made people equally unlikely to behave prosocially to group members, as being denied inclusion by others. In contrast, the beneficial effects of inclusion depended on the process with which it was obtained, and meta-perceptions of warmth mediated these differences; people who succeeded to claim inclusion thought their interaction partners liked them less than people who were granted inclusion, and as a result, their fundamental needs were satisfied less, and they behaved less prosocially.

Implementing team based learning in large classes: nurse educators' experiences.

Team-based learning (TBL) is an interactive teaching method promoted as an alternative to traditional lectures. TBL was implemented in four large second year classes in a baccalaureate nursing program but the implementation process was found to require much more effort than indicated in the literature. A predominant theme during the implementation phase was the importance of collegial support. Faculty workload increased significantly and they were challenged by occasional student confrontations and technological difficulties. The benefits for students included reduced attrition, reading workloads, and enhanced preparedness for classes, which allowed for more time to be spent in class discussing complex realistic nursing problems. Although TBL was not enthusiastically embraced by all of the students, the majority indicated that they liked and valued TBL, hence commitment to continuing to teach using the TBL method remains.

A Survey of Hospices Use of Complementary Therapy.

As people live longer with chronic illnesses, the need for hospice services will increase. Complementary therapies have been shown to increase ease, relieve pain, and improve quality of life; all relevant for people with chronic illness at the end of their lives. The first aim of this study was to identify complementary therapy services available to, and provided for, clients receiving hospice care in Nevada and Montana. The second aim was to identify differences in those therapies for urban and rural hospice clients. Using a descriptive survey design, data were collected from surveys sent to all hospice administrators in Nevada and Montana (N=54). A 50% (n=27) response rate was obtained. Most (70.4%, n=19) of the participating hospices offered complementary therapy; slightly more than half (52.9%, n=9) provided the services for less than 25% of their clients. No significant differences were found between rural and urban hospices.