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  1. Article ; Online: “It’s a decision I have to make”

    Sara E. Golden / Liana Schweiger / Anne C Melzer / Sarah S. Ono / Santanu Datta / James M. Davis / Christopher G. Slatore

    Preventive Medicine Reports, Vol 30, Iss , Pp 102014- (2022)

    Patient perspectives on smoking and cessation after lung cancer screening decisions

    2022  

    Abstract: Few studies exist showing that involvement in lung cancer screening (LCS) leads to a change in rates of cigarette smoking. We investigated LCS longitudinally to determine whether teachable moments for smoking cessation occur downstream from the initial ... ...

    Abstract Few studies exist showing that involvement in lung cancer screening (LCS) leads to a change in rates of cigarette smoking. We investigated LCS longitudinally to determine whether teachable moments for smoking cessation occur downstream from the initial provider-patient LCS shared decision-making discussion and self-reported effects on smoking behaviors. We performed up to two successive semi-structured interviews to assess the experiences of 39 individuals who formerly or currently smoked cigarettes who underwent LCS decision-making discussions performed during routine care from three established US medical center LCS programs.The majority of those who remembered hearing about the importance of smoking cessation after LCS-related encounters did not report communication about smoking influencing their motivation to quit or abstain from smoking, including patients who were found to have pulmonary nodules. Patients experienced little distress related to LCS discussions. Patients reported that there were other, more significant, reasons for quitting or abstinence. They recommended clinicians continue to ask about smoking at every clinical encounter, provide information comparing the benefits of LCS with those of quitting smoking, and have clinicians help them identify triggers or other motivators for improving smoking behaviors. Our findings suggest that there may be other teachable moment opportunities outside of LCS processes that could be utilized to motivate smoking reduction or cessation, or LCS processes could be improved to integrate cessation resources.
    Keywords Medicine ; R
    Subject code 150
    Language English
    Publishing date 2022-12-01T00:00:00Z
    Publisher Elsevier
    Document type Article ; Online
    Database BASE - Bielefeld Academic Search Engine (life sciences selection)

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  2. Article ; Online: A Qualitative Study of VA Entrants’ Experiences Discussing Community Care With Veterans

    Sara E. Golden / Megan Lafferty / Anna Tyzik / Diana Govier / Jennifer Barton / Alan R. Teo / Samuel T. Edwards / Sarah S. Ono / Denise M. Hynes / Christopher G. Slatore

    SAGE Open, Vol

    2023  Volume 13

    Abstract: We conducted interviews with clinicians and staff involved in Veterans’ decisions about where to receive their health care to assess experiences with community care coordination and identify areas for improvement. Insufficient time and knowledge were ... ...

    Abstract We conducted interviews with clinicians and staff involved in Veterans’ decisions about where to receive their health care to assess experiences with community care coordination and identify areas for improvement. Insufficient time and knowledge were cited as barriers to assisting Veterans in making decisions about whether to use community care resources. Concerns regarding quality of community care and lack of patient understanding on the implications of accessing community care also arose. Clinicians need to be able to help Veterans make informed choices about where to receive their health care and may require decision support that integrates their informational needs with their values and preferences, clarity on the referral process, and improved ways to measure and describe quality of care to Veterans. VA has recognized issues with community care and established new initiatives but the rollout is complex and ongoing.
    Keywords History of scholarship and learning. The humanities ; AZ20-999 ; Social Sciences ; H
    Subject code 360
    Language English
    Publishing date 2023-10-01T00:00:00Z
    Publisher SAGE Publishing
    Document type Article ; Online
    Database BASE - Bielefeld Academic Search Engine (life sciences selection)

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  3. Article ; Online: Perspectives on advance care planning needs of persons with advanced dementia from their surrogates and clinicians

    Sara E. Golden / Felipe Rubim / Rekha Thammana / Natalie Disher / Kelly C. Vranas / Joan M. Teno / Seiko Izumi / Hyunjee Kim / Jennifer Tjia / Donald R. Sullivan

    PEC Innovation, Vol 3, Iss , Pp 100241- (2023)

    2023  

    Abstract: Objectives: This study was designed to understand the experience and needs surrounding advance care planning (ACP) discussions for surrogate decision-makers of persons with advanced dementia (PWAD). Methods: Semi-structured qualitative interviews based ... ...

    Abstract Objectives: This study was designed to understand the experience and needs surrounding advance care planning (ACP) discussions for surrogate decision-makers of persons with advanced dementia (PWAD). Methods: Semi-structured qualitative interviews based on end-of-life communication models with a convenience sample of 17 clinicians, and 15 surrogates of PWAD. We used a hybrid approach of deductive and inductive thematic analysis. Results: Two main themes emerged. 1)Deficits in communication: Often surrogates did not fully comprehend the disease trajectory or medical treatments, like the likelihood of pneumonia and use of mechanical ventilation, nor concepts related to ACP, particularly legal documents and orders such as Do Not Hospitalize, which made decision-making challenging as perceived by clinicians. 2)Decision-making conflicts: Clinicians perceived a disconnect between surrogates' understanding of their loved one's preferences and knowing how or when to operationalize them. Conclusions: Significant gaps in knowledge surrounding disease trajectory and complications, such as pneumonia, and aspects of ACP, exist. These gaps create decision-making challenges for surrogates and clinicians alike. Innovation: This study assessed both clinicians and surrogate decision-makers' perspectives on communication and decision-making concerning care preferences, goals, and ACP. The study findings from a national cohort can inform decision-support interventions for clinicians and surrogate decision-makers of PWAD.
    Keywords Qualitative ; Long-term care ; Quality of life ; Surrogates ; Caregivers ; Public aspects of medicine ; RA1-1270
    Subject code 360
    Language English
    Publishing date 2023-12-01T00:00:00Z
    Publisher Elsevier
    Document type Article ; Online
    Database BASE - Bielefeld Academic Search Engine (life sciences selection)

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  4. Article ; Online: Show me the roads and give me a road map

    Sara E. Golden / Natalie Disher / Nathan F. Dieckmann / Karen B. Eden / Daniel Matlock / Kelly C. Vranas / Christopher G. Slatore / Donald R. Sullivan

    PEC Innovation, Vol 1, Iss , Pp 100094- (2022)

    Development of a patient conversation tool to improve lung cancer treatment decision-making

    2022  

    Abstract: Objective: Evidence-based decision support resources do not exist for persons with lung cancer. We sought to develop and refine a treatment decision support, or conversation tool, to improve shared decision-making (SDM). Methods: We conducted a multi- ... ...

    Abstract Objective: Evidence-based decision support resources do not exist for persons with lung cancer. We sought to develop and refine a treatment decision support, or conversation tool, to improve shared decision-making (SDM). Methods: We conducted a multi-site study among patients with stage I-IV non-small cell lung cancer (NSCLC) who completed or had ongoing lung cancer treatment using semi-structured, cognitive qualitative interviews to assess participant understanding of content. We used an integrated approach of deductive and inductive thematic analysis. Results: Twenty-seven patients with NSCLC participated. Participants with prior cancer experiences or those with family members with prior cancer experiences reported better preparedness for cancer treatment decision-making. All participants agreed the conversation tool would be helpful to clarify their thinking about values, comparisons, and goals of treatment, and to help patients communicate more effectively with their clinicians. Conclusion: Participants reported that the tool may empower them with confidence and agency to actively participate in cancer treatment SDM. The conversation tool was acceptable, comprehensible, and usable. Next steps will test effectiveness on patient-centered and decisional outcomes. Innovation: A personalized conversation tool using consequence tables and core SDM components is novel in that it can encourage a tailored, conversational dynamic and includes patient-centered values along with traditional decisional outcomes.
    Keywords Lung neoplasm ; Decision support techniques ; Qualitative research ; Public aspects of medicine ; RA1-1270
    Subject code 150
    Language English
    Publishing date 2022-12-01T00:00:00Z
    Publisher Elsevier
    Document type Article ; Online
    Database BASE - Bielefeld Academic Search Engine (life sciences selection)

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    Inter-library loan at ZB MED

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  5. Article ; Online: A Brief Report of Smoking Behaviors in Patients with Incidental Pulmonary Nodules

    Anne C Melzer / Sara E Golden / Renda Soylemez Wiener / Jonathan M Iaccarino / Christopher G Slatore

    Tobacco Use Insights, Vol

    Associations with Communication and Risk Perception

    2019  Volume 12

    Abstract: Introduction: Incidental pulmonary nodules (IPNs) are commonly found on routine chest imaging. Little is known about smoking behaviors among patients with IPNs or characteristics of patient-clinician communication that may contribute to these behaviors. ... ...

    Abstract Introduction: Incidental pulmonary nodules (IPNs) are commonly found on routine chest imaging. Little is known about smoking behaviors among patients with IPNs or characteristics of patient-clinician communication that may contribute to these behaviors. We assessed the association of patient characteristics and communication quality with smoking behaviors and stage of change for tobacco cessation among patients with IPNs. Materials and methods: Prospective, repeated-measures, cohort study of current smokers and past-year quitters with IPNs treated within the Veterans Affairs Portland Health Care System. Eligible patients had newly reported, incidental nodules <3 cm planned for non-urgent computed tomography (CT) follow-up. Our primary outcomes were changes in amount smoked and stage of change for tobacco cessation throughout the follow-up period. We used multivariable-adjusted generalized estimating equations for analyses. Results: We identified 37 current smokers and 9 recent quitters. By the final visit, 8 of 36 (22%) baseline smokers had quit and 2 of 7 (29%) recent quitters had resumed smoking. Of 40 respondents, 23 (58%) reported receiving any tobacco treatment (recommendation to quit, medication, and/or behavioral treatment) at least once during follow-up. We found no significant associations of high-quality communication, patient distress, self-perceived risk of lung cancer, and self-reported clinician-recommended smoking cessation interventions with decrease in amount smoked or positive stage of change. Conclusions: Many smokers and recent quitters with IPNs quit during follow-up, though nearly half reported no quit support. We found no association between communication quality or quit support and decreased smoking. The intensity of tobacco treatment offered may have been insufficient to affect behavior.
    Keywords Public aspects of medicine ; RA1-1270
    Subject code 616
    Language English
    Publishing date 2019-04-01T00:00:00Z
    Publisher SAGE Publishing
    Document type Article ; Online
    Database BASE - Bielefeld Academic Search Engine (life sciences selection)

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  6. Article ; Online: Lung cancer specialists' opinions on treatment for stage I non-small cell lung cancer

    Austin Lammers, MD / Timur Mitin, MD, PhD / Drew Moghanaki, MD / Charles R. Thomas, Jr, MD / Robert Timmerman, MD / Sara E. Golden, MPH / Sujata Thakurta, MPA / Rafal Dziadziuszko, MD, PhD / Christopher G. Slatore, MD

    Advances in Radiation Oncology, Vol 3, Iss 2, Pp 125-

    A multidisciplinary survey

    2018  Volume 129

    Abstract: Purpose: The current standard of care for surgically eligible stage I non-small cell lung cancer (NSCLC) is surgical resection, but emerging data suggest that stereotactic body radiation therapy (SBRT) is potentially as effective as surgery. However, ... ...

    Abstract Purpose: The current standard of care for surgically eligible stage I non-small cell lung cancer (NSCLC) is surgical resection, but emerging data suggest that stereotactic body radiation therapy (SBRT) is potentially as effective as surgery. However, specialist views of the current evidence about SBRT and how they would incorporate a randomized controlled trial (RCT) into practice is unclear. We sought to understand specialist opinions about evidence regarding treatment of stage I NSCLC and how this translates into practice and clinical trial implementation. Methods and materials: We used a 28-item, web-based survey that invited all participating providers from the American Society for Radiation Oncology, American Thoracic Society Thoracic Oncology Assembly, and the International Association for the Study of Lung Cancer to share opinions regarding practice beliefs, treatment of stage I NSCLC, and a clinical trial scenario. Results: A total of 959 surveys were completed; 64% were from radiation oncologists (ROs) and 49% were from outside the United States. The majority of ROs (80%) reported that current evidence indicates that SBRT has the same or a better benefit compared with surgery for surgically eligible patients with stage I NSCLC; 28% of non–radiation oncologists (NROs) indicated the same (P < .01). Almost all ROs (94%), compared with 62% of NROs, would permit surgically eligible patients to enroll in an RCT of SBRT versus surgery (P < .01). Most ROs (82%) and NROs (87%) believed that changing practice in thoracic surgery would be somewhat difficult, very difficult, or impossible (P = .066) even if an RCT showed better survival with SBRT. Conclusions: NROs believe that SBRT is much less effective than surgery, contrary to ROs, who believe that they are similar. Most would support an RCT, but NROs would do so less. Changes in surgical practice may be challenging even if an RCT shows better mortality and quality of life with SBRT. These results are helpful in the creation and dissemination of RCTs that ...
    Keywords Medical physics. Medical radiology. Nuclear medicine ; R895-920 ; Neoplasms. Tumors. Oncology. Including cancer and carcinogens ; RC254-282
    Subject code 616
    Language English
    Publishing date 2018-04-01T00:00:00Z
    Publisher Elsevier
    Document type Article ; Online
    Database BASE - Bielefeld Academic Search Engine (life sciences selection)

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  7. Article ; Online: “It wasn’t as bad as I thought it would be”

    Sara E. Golden / Charles R. Thomas / Mark E. Deffebach / Mithran S. Sukumar / Paul H. Schipper / Brandon H. Tieu / Andrew Y. Kee / Andrew C. Tsen / Christopher G. Slatore / For the Early Stage Lung Cancer Comparative Effectiveness Research Consortium

    BMC Research Notes, Vol 10, Iss 1, Pp 1-

    a qualitative study of early stage non-small cell lung cancer patients after treatment

    2017  Volume 7

    Abstract: Abstract Objective While surgical resection is recommended for most patients with early stage lung cancer, stereotactic body radiotherapy (SBRT) is being increasingly utilized. Provider-patient communication regarding risks/benefits of each approach may ... ...

    Abstract Abstract Objective While surgical resection is recommended for most patients with early stage lung cancer, stereotactic body radiotherapy (SBRT) is being increasingly utilized. Provider-patient communication regarding risks/benefits of each approach may be a modifiable factor leading to improved patient-centered outcomes. Our objective was to determine a framework and recommended strategies on how to best communicate with patients with early stage non-small cell lung cancer (NSCLC) in the post-treatment setting. We qualitatively evaluated the experiences of 11 patients with early clinical stage NSCLC after treatment, with a focus on treatment experience, knowledge obtained, communication, and recommendations. We used conventional content analysis and a patient-centered communication theoretical model to guide our understanding. Results Five patients received surgery and six received SBRT. Both treatments were generally well-tolerated. Few participants reported communication deficits around receiving follow-up information, although several had remaining questions about their treatment outcome (mainly those who underwent SBRT). They described feeling anxious regarding their first surveillance CT scan and clinician visit. Overall, participants remained satisfied with care because of implicit trust in their clinicians rather than explicit communication. Communication gaps remain but may be addressed by a trusting relationship with the clinician. Patients recommend clinicians give thorough explanations and personalize when possible.
    Keywords Thoracic diseases ; Patient-centered outcomes ; Communication ; Medicine ; R ; Biology (General) ; QH301-705.5 ; Science (General) ; Q1-390
    Subject code 616
    Language English
    Publishing date 2017-11-01T00:00:00Z
    Publisher BMC
    Document type Article ; Online
    Database BASE - Bielefeld Academic Search Engine (life sciences selection)

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