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Background: In Israel, there is a need to improve quality of life and health outcomes among patients and families facing cancer. Increasing awareness of, literacy about, and availability of palliative care may further this goal. Aims: This study aimed to adapt a palliative care-focused cancer self- and family management intervention developed in the US for use in Israel. Methods: The Managing Cancer Care (MCC) psycho-educational intervention is comprised of Managing Cancer Care: A Personal Guide (MCC-PT©) for patients and Managing Cancer Care: A Caregiver's Guide (MCC-CG©) for family caregivers. Following translation into Hebrew, an expert panel of Israeli nurses edited the MCC tool for cultural relevance. The authors then conducted qualitative interviews with patients with breast cancer and their family caregivers to obtain feedback. Data were analysed using qualitative content analysis. Findings: Following recommendations from Israeli experts in oncology and/or palliative care (n=3), the authors revised intervention content specific to the US healthcare system and culture. Patients' (n=13) and family caregivers' (n=10) reported MCC as attractive (70%, 80%), topically relevant (80%, 70%), and culturally appropriate, but felt that palliative care resources should be more Israel-specific. Conclusion: The MCC tool is acceptable to potential users, warranting further pilot-testing.

Consequent to increasing COVID-19 infection rates, the Palliative Care (PC) service at a large New England hospital shifted from in-person to telehealth-delivered PC (TPC).We compared the quality of TPC to in-person PC during the early COVID-19 pandemic.We conducted an electronic health record review of PC consultations of patients hospitalized during three periods: pre-COVID January, 2020-February, 2020 (in-person); peak-COVID March, 2020-June, 2020 (majority TPC); and post-peak September, 2020-October, 2020 (majority in-person). We examined the relationship between these periods and PC delivery characteristics and quality measures using descriptive and bivariate statistics.Of 377 patients, 50 were pre-COVID (TPC=0%), 271 peak-COVID (TPC=79.3%), and 56 post-peak (TPC2%) (representation of PC consult: pre- and post-peak=samples; peak-COVID=all consults). Mean age was 69.3 years (standard deviation=15.5), with 54.9% male, 68.7% White, and 22.8% Black. Age and sex did not differ by period. PC consultations were more likely for goals of care (pre=30.0% vs. peak=53.9% vs. post=57.1%; P = 0.005) or hospice (4.0% vs. 14.4% vs. 5.4%, P = 0.031) during peak-COVID compared to pre-COVID. Rates of assessment of physical (98.0% vs. 63.5% vs. 94.6%, P0.001) and psychological symptoms (90.0% vs. 33.1% vs. 67.9%, P0.001) were lower during peak relative to pre-COVID and post-peak periods. There were no differences in assessment of patients' social needs, family burden, or goals of care across periods.The PC service provided high-quality inpatient PC using TPC despite significant strain during the early COVID-19 pandemic. Developing and testing strategies to promote comprehensive symptom control using TPC remains a priority to adjust to potential unmet PC needs.

Patients with limited English proficiency (LEP) experience worse outcomes compared with native English speakers. Communication errors are partly responsible for the disparities among this population. Medical interpreters improve communication and often assume multiple roles during clinical encounters. We sought to explore the perspectives of medical interpreters regarding their role within medical teams and ways to improve communication.We conducted a qualitative study using semistructured interviews with inpatient and outpatient medical interpreters at an academic medical center between March and August 2021. Interview questions explored interpreters' perceptions of their roles within the medical team and best practices to improve communication during encounters. Interview transcripts were analyzed using thematic analysis.Our sample consisted of 20 interpreters with a mean age of 48 years (SD: 14.3) and a mean experience of 16.3 years (SD: 10.6). Two main themes emerged from interviews: (1) the full spectrum of medical interpreters' role and (2) factors acting as barriers and facilitators of interpretation. Interpreters described their role as language interpreters, cultural mediators, and patient advocates. They also identified several factors that may enhance encounters, such as utilizing the teach-back method with patients and debriefing with interpreters.Interpreters view their role as extending beyond interpretation to include cultural mediation and patient advocacy. Addressing commonly encountered challenges and adopting some of the proposed solutions highlighted in this study may facilitate improved communication with LEP patients receiving care in healthcare systems.

Over one-half of older adults are discharged to the community after emergency department (ED) visits, and studies have shown there is increased risk of adverse health outcomes in the immediate post-discharge period. Understanding the experiences of older adults during ED-to-community care transitions has the potential to improve geriatric emergency clinical care and inform intervention development. We therefore sought to assess barriers experienced by older adults during ED-to-community care transitions.We conducted a qualitative analysis of community-dwelling cognitively intact patients aged 65 years and older receiving care in four diverse EDs from a single U.S. healthcare system. We constructed a conceptual framework a priori to guide the development and iterative revision of a codebook, used purposive sampling, and conducted recorded, semi-structured interviews using a standardized guide. Two researchers coded the professionally transcribed data using a combined deductive and inductive approach and analyzed transcripts to identify dominant themes and representative quotations.Among 25 participants, 20 (80%) were women and 17 (68%) were white. We identified four barriers during the ED-to-community care transition: (1) ED discharge process was abrupt with missing information regarding symptom explanation and performed testing, (2) navigating follow-up outpatient clinical care was challenging, (3) new physical limitations and fears hinder performance of baseline activities, and (4) major and minor ramifications for caregivers impact an older adult's willingness to request or accept assistance.Older adults identified barriers to successful ED-to-community care transitions that can inform the development of novel and effective interventions.

The Self- and Family Management Framework (SFMF) identifies factors and outcomes of patient and family management of chronic illness. In a previous citation analysis, we reported the frequency and nature of use of the SFMF.We conducted a sub-analysis of quantitative articles in the citation analysis to examine testing of relationships depicted in the SFMF.We analyzed study purposes, independent and dependent variables, study implications, and text that referred to the SFMF in 40 articles.The SFMF has been used largely to explore factors affecting SFM behaviors, focusing on patient versus family self-management. Independent variables included all categories of facilitators/barriers specified in the SFMF. Dependent variables included all SFMF components (Facilitators/Barriers, Processes, Proximal and Distal Outcomes). Racial/ethnic diversity was limited among study participants. Study implications pertained mostly to psychosocial outcomes. Most studies referred to the SFMF generally.Findings will contribute to revision of the SFMF.

A key element in the comprehensive physical exam is the patient interview in which the nurse practitioner (NP) elicits information from the patient to help guide in the discovery of a health issue. Technologies that allow the NP student to view patient interviews from the patient's perspective may enhance interviewing techniques and promote therapeutic interview behaviors. We report the results of a pilot program for NP students enrolled in an advanced health assessment course. Student volunteers conducted interviews with patient actors. Actors wore Google Glass®, an optical head-mounted device with video-recording capabilities.

I read with interest Carlock and colleagues’ recent article,1 entitled “Developmental Outcomes in Duarte Galactosemia.” This study found that Duarte Galactosemia (DG) was not associated with adverse developmental outcomes in children ages 6–12 years compared with children without DG. The study also found that among children with DG, milk exposure during infancy was not associated with developmental outcomes. As a nurse practitioner, health outcomes researcher, and most importantly, a mother of a child with DG, this article provided much needed answers to the questions I have had about the potential developmental outcomes of my child since … E-mail: shelli.feder{at}yale.edu

Background: Among patients presenting with acute myocardial infarction (AMI), 30% are age 75 years or older. The Thrombolysis In Myocardial Infarction (TIMI) Risk Score is a commonly used, well-validated instrument developed to estimate mortality risk for patients with AMI. However, the TIMI risk stratification model was not specifically developed for older adults (≥75 years). Little is known about physicians’ perceptions of the value of the TIMI risk score in older AMI patients. Purpose: To describe physicians’ perceptions regarding the strengths and weaknesses of the TIMI Risk Score in older adults hospitalized with AMI. Methods: This study was part of the “Comprehensive Evaluation of Risk Factors in Older Patients with AMI” (“SILVER-AMI”, R01HL115295-01, PI Chaudhry), a multi-center, observational study designed to develop and validate a risk stratification model for older adults with AMI. This qualitative study included semi-structured telephone interviews with cardiologists and hospitalist physicians who care for older adults with AMI. The constant comparative method was used for analysis with results grouped by emergent themes. Results: Twenty-two physicians completed interviews ranging from 10-30 minutes (mean = 18 minutes). The mean age of the sample was 41 years, with an average of 16 years of experience after medical school. Reported strengths of the TIMI Risk Score included its ubiquitous presence among medical professionals, ease of use, and utility in guiding clinical management for general AMI populations. Perceived weaknesses included a lack of specific risk factors relevant to older adults, limited capacity for influencing clinical management beyond initial AMI care, and the inability to predict outcomes important for clinical decision-making in older adults with AMI (See Table). Conclusions & Implications: Physician respondents perceive the TIMI Risk Score as ill-suited for older adults with AMI because it neither incorporates risk factors nor predicts outcomes important for clinical decision-making post-AMI in this population. These results suggest that a new risk stratification model is needed that is better targeted towards older adults with AMI and can more thoroughly assess risk to guide treatment after AMI in this population.