LIGHT: A Church-Based Curriculum for Training African American Lay Health Workers to Support Advance Care Planning and End-of-Life Decision-Making.

Purpose: African Americans with life-limiting illnesses experience significant health inequities. Lay health workers (LHWs) may help overcome existing challenges of communicating with African Americans about advance care planning (ACP) and end-of-life decision-making. Church-based LHWs have some advantages over other LHWs but no curriculum exists to fully prepare them. This article describes the development, content, format, and implementation of a curriculum designed to meet this need. Methods: We created a church-based curriculum to train African American, LHWs as communications-facilitators who can support persons with life-limiting illnesses, not only with ACP but also with issues that arise as illnesses progress. Learners are church members whom we call comfort care supporters. The curriculum organizes the LHW interactions with clients by the mnemonic LIGHT: Listening, Identifying, Guiding, Helping, and Translating. Results: The final curriculum consists of three parts: (1) a 26-h classroom component delivered in nine modules organized around eight themes: meaning and prognosis of a life-limiting illness, spirituality and the meaning of death, understanding the dying process, major decisions and choices, goals of care, end-of-life services, and resources, intrafamily communication, and role and activities of the LHW; (2) a visit component; and (3) experiential, case-based discussions during monthly meetings. Conclusions: LHWs may improve quality of care and thus reduce health inequities at the end-of-life. Preparing LHWs for conversations about ACP is necessary but insufficient. This curriculum also prepares LHWs to attend to the spiritual needs of clients and to support clients with their other needs as their illness progresses.

Engaging the African American Church to Improve Communication About Palliative Care and Hospice: Lessons From a Multilevel Approach.

BACKGROUND: As the spiritual family for many African Americans, the church presents an opportunity to improve communication about palliative care and hospice (PCH). However, sustainable change in church-based, practices related to PCH requires a compreshensive, multilevel approach. OBJECTIVES: Our primary goal was to encourage churches to embrace palliative care and hospice as acceptable alternatives for end-of-life care by creating venues to improve communications about PCH. This paper compares our experience in 5 churches, revealing lessons learned and the challenges of engaging, implementing, and maintaining a multilevel approach in the churches, and our strategies in response to those challenges. DESIGN: Descriptive study Settings/Subjects: We partnered with 5 African American Churches in the Philadelphia Region. We targeted pastors, other church leaders, and congregants. METHODS: We created 1) a leadership-education program, 2) an intensive training program for church-based lay companions (health visitors), and 3) messages and materials to increase knowledge and influence attitudes about PCH. RESULTS: We impacted church structures and policies as shown by: integration of the project activities into existing church structures, new church-based programs dedicated to training lay companions and church leaders, new roles for church members (church liaisons) dedicated to this project, and new materials and messages focusing on PCH for the general congregation. CONCLUSIONS: We demonstrated the feasibility of engaging the African American church in a comprehensive, multilevel process designed to improve communication about palliative care and hospice (PCH). Our success demonstrates the potential of the African American church as a community resource for lay education about PCH.

Interstitial recurrence, with chronic inguinodynia, after Lichtenstein herniorrhaphy.

Not long after Lichtenstein and Shulman (1986) introduced their subaponeurotic repair, Nyhus (1989) expressed concern regarding subprosthetic incarceration. Even though interstitial recurrence was not encountered over the subsequent decade or more, one of us (AIG) was referred three cases over the past 3 years. Two men and a woman suffered from chronic inguinodynia 1-6 years following a Lichtenstein procedure for unilateral primary inguinal herniation. A mass, in an unusual location (spigelian line) was palpated in one, the other two required ultrasound studies for diagnosis. All at surgery revealed indirect sacs, and one also had a separate protrusion in the lateral triangle of the groin. Two were repaired laparoscopically, the other using a bilayer connected prosthetic device. Our hypothesis is that this painful complication is now appearing because of recent modifications to the operative technique. An overlay lax dome-shaped prosthesis cannot be relied on to always initially collapse the inguinal canal. Mini-dissection, by limiting exposure, may prevent placement of the keyhole in the mesh close enough to the internal inguinal ring. Studies are under way to determine the validity of these conclusions.

Disaster and sexuality.

The hypothesis presented in this article is that fear of disaster and fear of certain modes of sexuality are intimately linked. Throughout most of human history, disaster was, in essence, the result of the actions of God or nature; either gratuitous or as a punishment for a sinning mankind. Sodom and Gommorah was the classic biblical example of this interrelationship. With the coming of the French and the Industrial Revolutions, man-caused disaster came to the center of the stage and this brought in its wake changing attitudes towards sexual deviant behavior. By examining the changing images of disaster the authors seek to explain the concern with sodomy and masturbation in the early and mid-nineteenth century.