The Impact of Palliative Care Consultation on Aggressive Medical Interventions in End-of-life Among Patients with Metastatic Breast Cancer: Insights from the U.S. National Patient Sample.

BACKGROUND: Advancement in treatment has led to prolonged survival and a rising number of women living with metastatic breast cancer (MBC) in the United States. Due to its high symptom burden, it is recommended that palliative care be integrated into the standard care to help improve quality of life. However, little is known about the use of palliative care among MBC patients in the nation. OBJECTIVES: To determine utilization of palliative care consult (PCC) after metastasis and the influence of PCC on healthcare utilization in the end of life among women living with MBC in the US. METHODS: This retrospective cohort study examined a national electronic health record database to quantify the PCC use after metastasis diagnosis until death and the associations of PCC with Emergency Department (ED), Intensive Care Unit (ICU), and chemotherapies in the end-of-life women (age ≥ 18 years) living with MBC. RESULTS: From a cohort of 2615 deceased MBC patients, 37% received PCC in the last 6 months of life. Patients who had received PCC in the end-of-life were more likely to be hospitalized, admitted to ED and ICU, and receive chemotherapies in the last 60 days before death. However, patients who had received end-of-life PCC had less hospital and ED visits and received less chemotherapies after PCC initiated. CONCLUSION: While PCC can reduce end-of-life aggressive interventions, it was underutilized among patients with MBC in the end-of-life. A myriad of clinical and patient factors may still challenge timely consultation. We urge for future endeavors in developing strategies to remove barriers in the implementation, especially earlier in the disease course, to assure timely PC treatments and reduce discomfort amid aggressive interventions for MBC.

Palliative Care and Mental Health among Pancreatic Cancer Patients in the United States: An Examination of Service Utilization and Health Outcomes.

INTRODUCTION: Palliative care (PC) utilization remains low among pancreatic cancer patients. This study explores the association of PC with mental health service and pharmacotherapy utilization among pancreatic cancer patients. METHODS: Retrospective analysis was conducted on a sample of patients in the United States with newly diagnosed pancreatic cancer using Electronic Health Record data from Optum's Integrated Claims-Clinical data set. Subsequent diagnoses of anxiety and depression and PC consultation encounters were determined using ICD-9/10 codes. Adjusted associations of mental health treatments with PC and patient characteristics were quantified using multiple logistic regression. RESULTS: Among newly diagnosed pancreatic cancer patients (n = 4029), those with PC consultations exhibited a higher prevalence of anxiety (33.9% vs. 22.8%) and depression (36.2% vs. 23.2%). Mental health service use and pharmacotherapy varied, with the highest utilization among patients having both anxiety and depression. Treatment pattern was also influenced by age (aOR 1.832 for age <55 vs. 65-70 years). Notably, PC consultations showed no significant effect on the likelihood of documented treatment. DISCUSSION: Our study emphasizes underutilization of PC and MH treatment for pancreatic cancer patients. These findings imply a crucial need for further investigation into palliative care's role in addressing mental health concerns among pancreatic cancer patients.

Unveiling Spatial Associations between COVID-19 Severe Health Index, Racial/Ethnic Composition, and Community Factors in the United States.

There are limited efforts to incorporate different predisposing factors into prediction models that account for population racial/ethnic composition in exploring the burden of high COVID-19 Severe Health Risk Index (COVID-19 SHRI) scores. This index quantifies the risk of severe COVID-19 symptoms among a county's population depending on the presence of some chronic conditions. These conditions, as identified by the Centers for Disease Control and Prevention (CDC), include Chronic Obstructive Pulmonary Disease (COPD), heart disease, high blood pressure, diabetes, and obesity. Therefore, the objectives of this study were (1) to investigate potential population risk factors preceding the COVID-19 pandemic that are associated with the COVID-19 SHRI utilizing non-spatial regression models and (2) to evaluate the performance of spatial regression models in comparison to non-spatial regression models. The study used county-level data for 3107 United States counties, utilizing publicly available datasets. Analyses were carried out by constructing spatial and non-spatial regression models. Majority White and majority Hispanic counties showed lower COVID-19 SHRI scores when compared to majority Black counties. Counties with an older population, low income, high smoking, high reported insufficient sleep, and a high percentage of preventable hospitalizations had higher COVID-19 SHRI scores. Counties with better health access and internet coverage had lower COVID-19 SHRI scores. This study helped to identify the county-level characteristics of risk populations to help guide resource allocation efforts. Also, the study showed that the spatial regression models outperformed the non-spatial regression models. Racial/ethnic inequalities were associated with disparities in the burden of high COVID-19 SHRI scores. Therefore, addressing these factors is essential to decrease inequalities in health outcomes. This work provides the baseline typology to further explore many social, health, economic, and political factors that contribute to different health outcomes.

An Integrative Review of Response Rates in Nursing Research Utilizing Online Surveys.

BACKGROUND: Online surveys in nursing research have both advantages and disadvantages. Reaching a sample and attaining an appropriate response rate is an ongoing challenge and necessitates careful consideration when designing a nursing research study using an online survey approach. OBJECTIVE: In this study, we aimed to explore response rates and survey characteristics of studies by nurse researchers that used online methodologies to survey nurses, nursing students, and nursing faculty. METHODS: We conducted an integrative review of research studies that used online surveys for data collection published from 2011 to 2021. We examined response rates and survey characteristics such as recruitment method, use of incentives, question type, length of survey, time to complete the survey, and use of reminders. RESULTS: Our review included 51 studies published by nurses with target samples of nurses, nursing students, or nursing faculty. Study sample sizes ranged from 48 to 29,283, the number of respondents ranged from 29 to 3,607, and the response rates ranged from 3.4% to 98%, with an average of 42.46%. Few patterns emerged regarding recruitment or other factors to enhance response rates; only five studies used incentives. CONCLUSION: Response rates to online surveys are unlikely to reach the rates seen in older mailed surveys. Researchers need to design online survey studies to be easily accessible, concise, and appealing to participants.

Trends in Reasons for Human Papillomavirus Vaccine Hesitancy: 2010-2020.

OBJECTIVES: We sought to identify trends in the main reasons United States parents of unvaccinated children gave for not intending to vaccinate their adolescent children against HPV from 2010 to 2020. As interventions designed to increase vaccine uptake have been implemented across the United States, we predicted that reasons for hesitancy have changed over this period. METHODS: We analyzed data from the 2010 to 2020 National Immunization Survey-Teen, which included 119 695 adolescents aged 13 to 17 years. Joinpoint regression estimated yearly changes in the top five cited reasons for not intending to vaccinate using annual percentage changes. RESULTS: The five most frequently cited reasons for not intending to vaccinate included "not necessary," "safety concerns," "lack of recommendation," "lack of knowledge," and "not sexually active." Overall, parental HPV vaccine hesitancy decreased by 5.5% annually between 2010 and 2012 and then remained stable for the 9-year period of 2012 through 2020. The proportion of parents citing "safety or side effects" as a reason for vaccine hesitancy increased significantly by 15.6% annually from 2010 to 2018. The proportion of parents citing "not recommended," "lack of knowledge," or "child not sexually active" as reasons for vaccine hesitancy decreased significantly by 6.8%, 9.9%, and 5.9% respectively per year between 2013 and 2020. No significant changes were observed for parents citing "not necessary." CONCLUSIONS: Parents who cited vaccine safety as a reason for not intending to vaccinate their adolescent children against HPV increased over time. Findings support efforts to address parental safety concerns surrounding HPV vaccination.

Acute Pancreatitis Recurrences Augment Long-Term Pancreatic Cancer Risk.

INTRODUCTION: In animal models, inflammation caused by experimental acute pancreatitis (AP) promotes pancreatic carcinogenesis that is preventable by suppressing inflammation. Recent studies noted higher long-term risk of pancreatic ductal adenocarcinoma (PDAC) after AP. In this study, we evaluated whether the long-term PDAC risk after AP was influenced by the etiology of AP, number of recurrences, and if it was because of progression to chronic pancreatitis (CP). METHODS: This retrospective study used nationwide Veterans Administration database spanning 1999-2015. A 2-year washout period was applied to exclude patients with preexisting AP and PDAC. PDAC risk was estimated in patients with AP without (AP group) and with underlying CP (APCP group) and those with CP alone (CP group) and compared with PDAC risk in patients in a control group, respectively, using cause-specific hazards model. RESULTS: The final cohort comprised 7,147,859 subjects (AP-35,550 and PDAC-16,475). The cumulative PDAC risk 3-10 years after AP was higher than in controls (0.61% vs 0.18%), adjusted hazard ratio (1.7 [1.4-2.0], P < 0.001). Adjusted hazard ratio was 1.5 in AP group, 2.4 in the CP group, and 3.3 in APCP group. PDAC risk increased with the number of AP episodes. Elevated PDAC risk after AP was not influenced by the etiology of AP (gallstones, smoking, or alcohol). DISCUSSION: There is a higher PDAC risk 3-10 years after AP irrespective of the etiology of AP, increases with the number of episodes of AP and is additive to higher PDAC risk because of CP.

Psychometric Testing of the Preceptor Self-Assessment Tool (PSAT)-40 for Nursing Preceptors.

Background The aim of this study was to complete the third phase of development of the Preceptor Self-Assessment Tool (PSAT). Method Psychometric testing was conducted via an online Qualtrics survey with a statewide sample of 320 nurse preceptors from July to September 2020. Exploratory factor analysis and internal consistency and scale reliability testing were conducted on the 64-item PSAT. Results Exploratory factor analysis identified three factors: (1) inter/intrapersonal skills and attitudes, (2) knowledge and understanding, and (3) administrative resources and support. Cronbach's alpha values for the PSAT-40 ranged from 0.978 to 0.998. Final scale reliability was excellent at 0.983. Conclusion The Preceptor Self-Assessment Tool, now in its final form as the PSAT-40, has established construct validity and reliability and can be used to assess competency as a preceptor. Nurse educators can use this instrument to assess the needs of nurse preceptors and develop strategic nursing preceptor education programs. [J Contin Educ Nurs. 2022;53(11):491-499.].

An electronic health record alert increases human immunodeficiency virus screening and case identification in a high-risk emergency department population.

Increased screening for HIV is required to reduce mortality and transmission. Patients with risk factors for HIV may lack access to routine care and emergency departments are an important site for screening and linkage to care. We implemented an electronic health record algorithm to identify patients meeting criteria for HIV screening. Compared to unstructured clinical judgement, the EHR alert increased the number of patients screened and case identification.

Incidence and Risk of Pancreatic Cancer in Patients with a New Diagnosis of Chronic Pancreatitis.

BACKGROUND: Chronic pancreatitis (CP) is a risk factor for pancreatic ductal adenocarcinoma (PDAC); nevertheless, the true incidence of PDAC in CP patients in the United States remains unclear. AIMS: We evaluated the risk of developing PDAC two or more years after a new diagnosis of CP. METHODS: Retrospective study of veterans from September 1999 to October 2015. A three-year washout period was applied to exclude patients with preexisting CP and PDAC. PDAC risk was evaluated in patients with new-diagnosis CP and compared with controls without CP using Cox-proportional hazards model. CP, PDAC, and other covariates were extracted using ICD-9 codes. RESULTS: After exclusions, we identified 7,883,893 patients [new-diagnosis CP - 21,765 (0.28%)]. PDAC was diagnosed in 226 (1.04%) patients in the CP group and 15,858 (0.20%) patients in the control group (p < 0.001). CP patients had a significantly higher PDAC risk compared to controls > 2 years [adjusted hazard ratio (HR) 4.28, 95% confidence interval (CI) 3.74-4.89, p < 0.001], 5 years (adjusted HR 3.32, 95% CI 2.75-4.00, p < 0.001) and 10 years of follow-up (adjusted HR 3.14, 95% CI 1.99-4.93, p < 0.001), respectively. By multivariable analysis, age (odds ratio 1.02, 95% CI 1.00-1.03, p = 0.03), current smoker (odds ratio 1.67, 95% CI 1.02-2.74, p = 0.042), current smoker + alcoholic (odds ratio 2.29, 95% CI 1.41-3.52, p < 0.001), and diabetes (odds ratio 1.51, 95% CI 1.14-1.99, p = 0.004) were the independent risk factors for PDAC. CONCLUSION: Our data show that after controlling for etiology of CP and other cofactors, the risk of PDAC increased in CP patients after two years of follow-up, and risk was consistent and sustained beyond 5 years and 10 years of follow-up.

Development of the Preceptor Self-Assessment Tool and Use of the Content Validity Index.

BACKGROUND: Competency of staff nurse preceptors is an essential factor that determines the success of preceptorship experiences. Competency assessment is complex, and no self-assessment tool exists. METHOD: This article describes phase two of the development of the Preceptor Self-Assessment Tool (PSAT). A content validity index (CVI) survey was completed by 11 subject matter experts to determine relevance of items on the PSAT. RESULTS: The Scale-Level CVI (S-CVI) for the instrument was 0.91, and the items CVI ranged from 0.45 to 1.0; most were above 0.78. One item was dropped and three were collapsed, leaving the final number of items at 64. CONCLUSION: The items on the PSAT have undergone content validity and have been found to be highly relevant. Pilot testing in a large sample of preceptors is warranted to further refine the items on the tool. [J Contin Educ Nurs. 2020;51(10):469-476.].

Rural-Urban Differences in Human Immunodeficiency Virus Testing Among US Adults: Findings From the Behavioral Risk Factor Surveillance System.

Individuals in rural areas of the United States face barriers to human immunodeficiency virus (HIV)-related health care. We aim to assess differences in frequency of lifetime and past-year HIV testing, and differences in testing site location between rural and urban residents of the United States. METHODS: Data from the Behavioral Risk Factor Surveillance System 2015 were analyzed on 250,579 respondents 18 years or older. Weighted multinomial logistic regression analyses compared urban/rural differences in lifetime and past-year HIV testing. Weighted multinomial logistic regression compared urban/rural differences in HIV testing site. RESULTS: Overall, 26.9% of urban residents and 21.5% of rural residents reported testing for HIV in their lifetime. Of urban residents, 24.5% reported receiving an HIV test in the past year compared with 20.2% of rural residents. Living in a rural area was associated with lower odds of lifetime (odds ratio [OR], 0.85; 95% confidence interval [CI], 0.81-0.90) and past-year HIV testing (OR, 0.84; 95% CI, 0.74-0.95) compared with not testing. Rural residents had higher odds of receiving an HIV test at the hospital or emergency room (adjusted OR, 1.41; 95% CI, 1.23-1.62) or clinic (adjusted OR, 1.21; 95% CI, 1.02-1.24) than a doctor's office. CONCLUSIONS: This study highlights significant rural health disparities in rates of lifetime and past-year HIV testing. Targeted interventions are needed to remove structural barriers in rural communities, such as long distances to clinics and low availability of free HIV testing at clinics serving the uninsured or underinsured. Furthermore, rural providers should be encouraged to routinely offer HIV screening to their patients.

Rural-urban differences in human papillomavirus knowledge and awareness among US adults.

Rural residents of the United States have higher HPV-associated cancer incidence and mortality, and suboptimal HPV vaccine uptake compared to urban residents. This study aimed to assess differences in knowledge and awareness of HPV, the HPV vaccine, and HPV-associated cancers among rural and urban residents. We analyzed data from the Health Information National Trends Survey 2013-2017 on 10,147 respondents ages ≥18 years. Multivariable logistic regression analyses compared urban/rural differences in knowledge and awareness of HPV, associated cancers, and HPV vaccine. Models were adjusted for sex, age, race/ethnicity, education, household income, census region, health insurance, regular provider, internet use, and personal history of cancer. Overall, 67.2% and 65.8% of urban residents were aware of HPV and HPV vaccine, respectively, compared to only 55.8% and 58.6% of rural residents. Adjusted models illustrated that compared to urban residents, rural residents were less likely to be aware of HPV (OR = 0.68, 95% CI = 0.53-0.86) and HPV vaccine (OR = 0.78, 95% CI = 0.63-0.97). Among those who were aware of HPV, rural residents were less likely to know that HPV causes cervical cancer (OR = 0.62, 95% CI = 0.46-0.84) and that HPV can be transmitted through sexual contact (OR = 0.72, 95% CI = 0.56-0.94). No significant differences between rural and urban residents were noted for knowledge that HPV is transmitted sexually and that it causes oral, anal, and penile cancers. This study highlights significant rural health disparities in knowledge and awareness of HPV and the HPV vaccine compared to urban counterparts.

Correlates of Hookah Pipe Awareness and Perceived Harmfulness Among U.S. Adults.

INTRODUCTION: Hookah smoking has recently become a common form of smoking, and its prevalence has increased worldwide. This study determined the prevalence and correlates of hookah awareness and perceived harmfulness among U.S. adults. METHODS: Weighted multivariable logistic regression analyses were performed on 6,711 adults aged ≥18 years collected from the 2013-2014 Health Information National Trends Survey (Cycles 3 and 4). Analysis was conducted in 2016. RESULTS: Overall, 74.3% were aware of hookah. Of these, 73.4% believed hookah pipes were equally harmful as cigarettes whereas 15.7% believed otherwise. Older (OR=0.13, 95% CI=0.09, 0.18), black (OR=0.51, 95% CI=0.38, 0.71), Hispanic (OR=0.52, 95% CI=0.37, 0.71), and less-educated (OR=0.42, 95% CI=0.27, 0.65) respondents had lower odds of being aware of hookah. Compared with non-smokers, former smokers had 83% (95% CI=1.44, 2.33) higher odds of hookah awareness. Among those aware of hookah, older (OR=0.44, 95% CI=0.31, 0.62), black (OR=0.64, 95% CI=0.43, 0.96), and less-educated (OR=0.55, 95% CI=0.33, 0.92) respondents had lower odds of perceiving hookah as less harmful than cigarettes. CONCLUSIONS: Most adults in U.S. are aware of hookah, but only 15.7% believe it is less harmful than cigarettes. This small proportion are mostly young, white, and college graduates. Targeted behavioral interventions will be necessary to increase individuals' perceived risk, knowledge, and perceived harmfulness of hookah smoking.

Assessing the infection prevention components of home health emergency management plans.

BACKGROUND: Home health emergency management plans are essential and must address infection prevention issues. Few home health planning documents exist, and many of those that have been developed do not address infection prevention issues, combine them with non-infection prevention issues, or are disease/event-specific. An all-encompassing home health infection prevention emergency management planning guide is needed. METHODS: A literature review and Internet search were conducted in the summer of 2010, and data from relevant sources were extracted. A spreadsheet was created delineating home health emergency management plan components related to infection prevention. RESULTS: Of the sources screened, 41 were deemed relevant. Ten domains were identified: (1) having a plan; (2) assessing agency readiness; (3) having infection prevention policies and procedures; (4) having occupational health policies and procedures; (5) conducting surveillance and triage; (6) reporting incidents, having a communication plan, and managing information; (7) addressing surge capacity issues; (8) having anti-infective therapy and/or vaccines; (9) providing infection prevention education; and (10) managing water and waste management issues. CONCLUSION: Home health disaster planners or managers should use this article as an assessment tool for evaluating their agency's emergency management plan and for developing policies and procedures that will decrease the risk of infection transmission during a mass casualty event.

A home health agency's pandemic preparedness and experience with the 2009 H1N1 pandemic.

BACKGROUND: Adequate pandemic preparedness is imperative for home health agencies. METHODS: A 23-item pandemic preparedness survey was administered to home health agencies in the spring of 2010. The Kruskal-Wallis (KW) test was used to evaluate the relationships between agency size and preparedness indicators. Significant findings were further analyzed by the Mann-Whitney (MW) U post hoc test. RESULTS: The response rate was 25% (526/2,119). Approximately one-third of respondents (30.4%; n = 131) reported experiencing trouble obtaining supplies during the 2009 H1N1 pandemic. Small agencies were significantly more likely (Krusal-Wallis [KW] = 9.2; P < .01) to report having trouble obtaining supplies than larger-sized agencies (Mann-Whitney [MW] = 14,080; P < .01). Most home health agencies (87.3%; n = 459) reported having a pandemic influenza plan. One-third (33.5%; n = 176) reported having no surge capacity; only 27.0% (n = 142) reported having at least a 20% surge capacity. The largest agencies were significantly more likely (KW = 138; P < .001) to report having at least 20% surge capacity than medium-sized agencies (MW = 7,812; P = .001) or small agencies (MW = 8,306; P < .001). Approximately 80% (n = 414) reported stockpiling personal protective equipment. Three-quarters (71.3%; n = 375) reported fit-testing staff, and half (49.2%; n = 259) reported participating in disaster drills. The majority of home health professionals (75.1%; n = 395) reported having a personal/family disaster plan in place. CONCLUSION: There are gaps in US home health agency pandemic preparedness, including surge capacity and participation in disaster drills, that need to be addressed.