Strategic Ethics: Physician Associations and Their Roles in Pursuing Racial Equity.

Since 2020, physician associations have become more vocal about confronting racism, initiating a wide range of advocacy efforts, making programming changes, and issuing public statements on the topic. However, associations have directed their enthusiasm about addressing racism toward an overly broad range of statements, initiatives, and legislative advocacy. In this essay, we provide some guidance regarding which race-based actions are best suited for physicians' professional associations. We describe traits of three types of physician associations in the United States-state, specialty, and affinity-highlighting characteristics of each and discussing their strengths and weaknesses regarding different types of action around racism. It is our hope that we might direct concerned physicians toward initiatives that draw upon association strengths and that can serve as the basis for association-specific advocacy niches-and away from initiatives that enable associations to signal that they are engaged in racial-equity work without accountability or efficacy.

Advocating with Community: A Community-Engaged Advocacy Curriculum for Internal Medicine Residents.

BACKGROUND: In 2022, the Accreditation Council for Graduate Medical Education updated its competencies for residents in all specialties to include health policy advocacy. A recent systematic review shows that while a growing number of residency curricula include policy advocacy, few programs join in policy advocacy efforts with community partners. AIM: To create a community-engaged advocacy curriculum for residents that is part of a mutually beneficial partnership with community-based organizations (CBOs). SETTING: A university-affiliated residency program and CBOs within a large US city. PARTICIPANTS: Eighty internal medicine residents and local CBO clients and staff. PROGRAM DESCRIPTION: The curriculum was delivered over 2 years and included advocacy skills sessions, service learning and reflection at the CBOs, and direct policy advocacy. PROGRAM EVALUATION: Residents and CBO partners were surveyed to gather quantitative and qualitative data. Residents perceived that the program enhanced their confidence and skills in community engagement and policy advocacy. All CBO staff agreed that the partnership advanced the CBO's mission, residents' volunteering provided beneficial service, and residents had a meaningful impact on their advocacy efforts. DISCUSSION: Our community-engaged advocacy curriculum successfully met its aims and has contributed to policy change. Future directions include building a statewide coalition of residents and CBOs.

Working Together to Promote Kidney Health.

The American Nephrology Nurses Association (ANNA) and American Society of Nephrology (ASN) have joined forces with the goal of advancing improvements in kidney care through transformative change. Through the integration of expertise, resources, and networks from both organizations, these collaborations have the potential to improve patient outcomes, advance clinical practice, and shape policy initiatives. In this article, we describe our focus on three areas: strengthening the nephrology and nephrology nursing workforce, championing health care equity, and advocating for kidney health.

Conceptualization and teaching health advocacy in undergraduate medical education: a document analysis.

BACKGROUND: Health advocacy is considered to be a core competence for physicians, but it remains unclear how the health advocacy role, despite being described in overarching competency frameworks, is operationalized in undergraduate medical education (UME). This study aimed to identify how health advocacy is conceptualized and taught in undergraduate medical curricula. METHODS: We performed a qualitative analysis of curriculum documents from all eight medical schools in the Netherlands, all of which offered competency-based UME. Thematic analysis was used to code all the documents and generate themes on health advocacy conceptualization and teaching. To categorize the emerging themes, we used the framework of Van Melle et al. for evaluating the implementation of competency-based medical educational programs. RESULTS: Health advocacy was mostly conceptualized in mission statements about social responsibility of future physicians, related to prevention and promoting health. We found key concepts of health advocacy to be taught mainly in public health and social medicine courses in the bachelor stage and in community-based clerkships in the master stage. Specific knowledge, skills and attitudes related to health advocacy were taught mostly in distinct longitudinal learning pathways in three curricula. CONCLUSION: Health advocacy is conceptualized mostly as related to social responsibility for future physicians. Its teaching is mostly embedded in public health and social medicine courses and community-based settings. A wider implementation is warranted, extending its teaching to the full width of medical teaching, with longitudinal learning pathways providing a promising route for more integrative health advocacy teaching.

High levels of Patient Self Advocacy may confound clinical research in understudied patient populations.

OBJECTIVE: To examine the levels of patient self-advocacy in a sample of participants with Chiari Malformation (CM) and to explore how they relate to clinical outcomes. METHODS: As part of a larger clinical trial addressing chronic pain in patients with CM, 111 participants completed the Patient Self Advocacy Scale (PSAS), the Depression, Anxiety, and Stress Scale (DASS-21), and the Brief Pain Inventory (BPI). RESULTS: PSAS scores indicated a moderately high level of patient self-advocacy (Mean = 3.86 SD = 0.50). The PSAS was not related to depression, anxiety, stress, pain intensity, or pain interference. There were no differences in PSAS according to surgical status (t(61.25) = 0.44, p = 0.66) or use of pain medication (t(109) = 1.05, p = .29). DISCUSSION: Participants in a clinical trial for CM have high levels of pre-existing patient self-advocacy. Research is needed to understand how patient self-advocacy contributes to the management of CM and how it could impact research of individuals with understudied conditions. CLINICAL TRIALS REGISTRATION: NCT05581472.

Building Power for Health: The Grassroots Politics of Sustaining and Strengthening Medicaid.

CONTEXT: Notwithstanding an impressive corpus charting the politics of Medicaid, we have much to learn about the contemporary politics of sustaining, expanding, and protecting the program. There is especially scant scholarly evidence on the significance and function of grassroots political actors (i.e.,the communities and groups most directly affected by health policy). This paper explores the role such groups play in the politics of Medicaid. METHODS: This research is based on qualitative interviews with organizers and advocates working in the domain of health policy. FINDINGS: The power of grassroots actors in Medicaid politics is constrained by political and structural forces including philanthropic funding practices, racism, and partisan polarization. Nevertheless, when bottom-up actors effectively exercise power, their involvement in Medicaid politics can transform policy processes and outcomes. CONCLUSION: Grassroots actors-those who are part of, represent, organize, or mobilize people most affected by Medicaid policy-can play pivotal roles within Medicaid politics. While they do not yet have sufficient political wherewithal to consistently advance transformational policy change, ongoing political processes suggest that they hold promise for being an increasingly important political force.

Identifying and addressing the needs of caregivers of patients with cancer: evidence on interventions and the role of patient advocacy groups.

As the number of people with cancer increases, so does the number of informal caregivers. These caregivers frequently have multiple unmet needs and experience numerous burdens. Here we explore the crucial roles of these caregivers and categorize their unmet needs into four areas: information, relationship and communication, emotional support, and practical or financial needs. We provide evidence on emerging interventions aimed at supporting caregivers, including patient/caregiver assessments, education, collaborative care, financial assistance, wellness, informational programs, and an integrated caregiver clinic. Finally, we delve into the vital role that patient advocacy groups play in addressing the unmet needs of cancer patients and their caregivers by providing comprehensive support, including education, resources, counseling, guidance, and financial aid.

As the number of people living with cancer increases, the number of informal caregivers is also increasing. Most often, these caregivers are family members, friends, or spouses of the person with cancer. Caregivers of patients with cancer help with medical tasks and routine chores, like driving, and even personal care, such as bathing. Caregiving can be challenging, emotionally taxing, and time-consuming, all while being unpaid. In this review, we identify four unmet needs of caregivers of patients with cancer and examine how they are being addressed. First, caregivers need cancer care information that is presented in an understandable way. This will help the caregiver and the patient make better decisions about cancer care and treatment. Second, caregivers need better relationships and communication with the patient's clinicians. In addition, caregivers must also navigate, and sometimes mend, challenging relationships with the patients that they care for. Third, caregivers need more emotional support, including the option for counseling and therapy. Fourth, caregivers may need practical and financial support, particularly since the time demands and stress of caregiving can disrupt their ability to earn a living. Although many attempts have been made to address these caregiver needs, gaps still remain. Increasing awareness of information targeting caregivers and patients could reduce their uncertainty and help with decision-making. Even when resources are available, caregivers may not always be aware of or linked to them. Patient advocacy groups play a critical role in connecting caregivers with available resources. They also provide a variety of support services, including education, navigation, and financial assistance.

"I Know How to Get Around Your 'No'": A Follow-Up of the FACES Psychoeducational Intervention.

Black children and their families encounter systemic disadvantages in their journey to and through an autism diagnosis. Black families often experience social and systemic barriers to service use. Providing family-centered, psychoeducational interventions can reduce barriers to service access and utilization for Black families raising autistic children. Fostering Advocacy, Communication, Empowerment, and Support (FACES) has demonstrated preliminary efficacy in strengthening outcomes among Black families, yet little is known about the long-term impact of the intervention. The purpose of this qualitative interview study was to understand the experiences of FACES graduates 16 months after the intervention. Four major themes emerged: (a) strengthened advocacy, (b) strengthened empowerment, (c) systemic barriers, and (d) home and community barriers. We provide implications for research and practice.

Advocacy: A Reflection on my Thirty Years of Orthopaedic Practice.

As orthopedic surgeons, we have the responsibility for advocating for our patients and our profession, on the local, state, and federal levels. The American Academy of Orthopaedic Surgeons (AAOS) created the American Association of Orthopaedic Surgeons to allow for political advocacy. The Association Political Action Committee, OrthoPAC, was created in 1999 and has become an effective tool in our advocacy committee. The American Shoulder and Elbow Surgeons (ASES), along with many orthopedic subspecialty societies, has established an advocacy effort and works with the AAOS through the OrthoPAC as a member of the Advisor's Circle, which is designed to provide AAOS Members' group practices and specialty societies with a leadership role within the Political Action Committee of the American Association of Orthopaedic Surgeons (Orthopaedic PAC). If we are to preserve individual patient access to specialized musculoskeletal care, we must support state and federal advocacy efforts. This can be in the form of financial support or personal involvement in relationship building. I encourage all members of ASES, especially the younger ones, to support your state orthopedic societies, the ASES, and the AAOS in their advocacy efforts. The well-being of our patients and the future of our profession depend on you.

From Platelets to Preschoolers: The Pioneering Journey of Dr. Valentin Fuster in Cardiology and Global Health Education.

Dr. Valentin Fuster's career, blending pioneering research with global health education, has profoundly influenced cardiology and public health. From his early life in Barcelona's medical community to groundbreaking contributions at major institutions like Mount Sinai and Harvard, Dr. Fuster has led transformative research on cardiovascular diseases and their prevention. His work spans from detailed studies on platelets and aspirin's preventative roles to innovative uses of MRI for understanding atherosclerosis. Beyond academia, he has significantly impacted public health through educational programs like the character "Dr. Ruster" on Sesame Street, advocating heart-healthy lifestyles to preschoolers worldwide. Dr. Fuster's dual focus on advanced medical research and community health initiatives exemplifies an integrated approach to tackling heart disease on multiple fronts.

Consistent Nursing Presence Through Questionably Unprecedented Times.

Election season. Those words evoke sighs, spur eye rolls, emblazon debates, strain relationships, spark activism, and fan hope. The Clinical Journal of Oncology Nursing team works months ahead of each issue. By publication, A.

Appropriateness of Prior Authorization Requirements for Total Shoulder Arthroplasty: A Systematic Review.

INTRODUCTION: Total shoulder arthroplasty (TSA) has become increasingly utilized for managing glenohumeral osteoarthritis (GHOA), with procedure rates expected to rise. Consequently, there has been a surge in prior authorization (PA) requests for TSA, imposing a substantial administrative burden and highlighting the need for physician advocates to challenge the current PA system. A notable PA requirement is preoperative physical therapy (PT), a treatment modality for GHOA that has not been extensively studied and is not endorsed by the American Academy of Orthopedic Surgery (AAOS) as necessary for the treatment for GHOA. METHODS: We conducted a systematic literature search using PubMed, Embase, and Medline, adhering to PRISMA guidelines. Our search focused on studies with level IV evidence or higher that examined the efficacy preoperative PT for patients with GHOA. RESULTS: We found 210 studies of which three met our inclusion criteria. Our results were mixed, with two of the three studies supporting the use of preoperative PT. Only one study employed a randomized controlled trial (RCT) design, underscoring the need for more high-quality studies in this area. DISCUSSION/CONCLUSION: Our findings suggest that there is limited evidence for the benefit of preoperative PT in GHOA. This contradicts the current PA requirements which require patients to undergo preoperative PT to receive coverage for treatment. This review highlights the need for physician engagement in advocacy efforts to challenge these current requirements and improve patient care.

Orthopedic Advocacy: A Starter's Guide for Optimizing Physician Engagement and Public Awareness.

Orthopedic advocacy is an indispensable tool for surgeons to help shape healthcare policies and address the mounting challenges they face in providing quality care to patients and maintaining a sustainable practice. Healthcare advocacy embodies a commitment to fair healthcare access and provider autonomy, employs diverse strategies to amplify patient and doctor voices, and advances public health imperatives. Orthopedic advocacy confronts a myriad of legislative challenges specific to the orthopedic specialty, from reimbursement complexities to regulatory burdens. This necessitates strategic alliances and grassroots engagement to effectuate meaningful change. By fostering public awareness and legislative engagement, individual surgeons can drive transformative reforms, ensuring orthopedic practice aligns with patient needs and advances healthcare impartiality. The American Academy of Orthopedic Surgeons (AAOS) advocacy program along with its sub-specialty affiliates, such as the American Shoulder and Elbow Surgeons (ASES) political advocacy committee, have a structured approach to advocacy comprising government relations, grassroots mobilization, and educational initiatives. This review explores the basis of healthcare advocacy including the structure of the AAOS advocacy program. In addition to highlighting key legislative issues facing front-line orthopedic surgeons, this manuscript provides some provisional insights on how individual surgeons can engage in orthopedic advocacy to drive positive change.

Zero-covid advocacy during the COVID-19 pandemic: a case study of views on Twitter/X.

During the COVID-19 pandemic, many advocacy groups and individuals criticized governments on social media for doing either too much or too little to mitigate the pandemic. In this article, we review advocacy for COVID-19 elimination or "zero-covid" on the social media platform X (Twitter). We present a thematic analysis of tweets by 20 influential co-signatories of the World Health Network letter on ten themes, covering six topics of science and mitigation (zero-covid, epidemiological data on variants, long-term post-acute sequelae (Long COVID), vaccines, schools and children, views on monkeypox/Mpox) and four advocacy methods (personal advice and promoting remedies, use of anecdotes, criticism of other scientists, and of authorities). The advocacy, although timely and informative, often appealed to emotions and values using anecdotes and strong criticism of authorities and other scientists. Many tweets received hundreds or thousands of likes. Risks were emphasized about children's vulnerability, Long COVID, variant severity, and Mpox, and via comparisons with human immunodeficiency viruses (HIV). Far-reaching policies and promotion of remedies were advocated without systematic evidence review, or sometimes, core field expertise. We identified potential conflicts of interest connected to private companies. Our study documents a need for public health debates to be less polarizing and judgmental, and more factual. In order to protect public trust in science during a crisis, we suggest the development of mechanisms to ensure ethical guidelines for engagement in "science-based" advocacy, and consideration of cost-benefit analysis of recommendations for public health decision-making.

The evolution of evidence-based medicine.

In an effort to expedite the publication of articles, AJHP is posting manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time.