Semi-structured Exit Interviews Research Articles

Tailored videoconferencing counselling program to support family carers of people living with dementia during the transition to permanent residential care: a pilot and feasibility randomised trial

BackgroundDecisions surrounding the permanent residential care placement of people living with dementia can be stressful and distressing; however, providing access to targeted information and support prior to placement may help carers better cope. This mixed methods study aimed to test the feasibility, acceptability, and potential benefits of providing a tailored, individual counselling program (the Residential Care Transition Module), delivered via videoconferencing, to Australian family carers of a relative with dementia during the transition to permanent residential care.MethodsA total of 18 family carers were randomly allocated to receive either the counselling intervention (six sessions delivered over 12 weeks) or a check-in call, delivered by a trained Transition Counsellor. Both groups received help-sheets about residential care, coping with placement, and managing feelings. Carers completed online surveys about stress, guilt, anxiety, depression, grief, and support for caring at baseline and four months post-baseline. Carers were also invited to participate in semi-structured exit interviews, conducted after follow-up surveys were completed. Process data relating to recruitment, retention, intervention dose and delivery were collected via logs. Quantitative data were analysed using descriptive statistics and repeated measures ANOVA. Qualitative data, relating to feasibility, acceptability, and perceived benefits of the program, were analysed using the ‘framework’ approach developed by the Medical Research Council to inform the process evaluation of complex interventions.ResultsQualitative findings indicated that delivery of the counselling program during the transition period was deemed by participants to be feasible and acceptable. Delivery via videoconferencing was deemed convenient and acceptable, with few technical issues. The skills and knowledge of the Transition Counsellor were perceived to be important mechanisms of impact. Though not statistically significant, promising quantitative findings were identified in terms of reduced carer stress and guilt and improved support for caring.ConclusionsDelivery of a tailored counselling program via videoconferencing to family carers of people living with dementia during the transition to residential care was feasible and acceptable. The program has the potential to improve transitional support to family carers.Trial registrationThis study was registered in the Australian New Zealand Clinical Trials Registry: ACTRN12621001462875.

Lessons Learned from a National Hospital Antibiotic Stewardship Implementation Project

BackgroundThe goal of antibiotic stewardship programs (ASPs) is to ensure patients receive effective therapy while minimizing adverse events. To overcome barriers commonly faced in implementing successful ASPs, AHRQ established a multifaceted, nationwide Safety Program for Improving Antibiotic Use in 2018. This report summarizes the lessons learned from the implementation of this initiative based on structured interviews with ASP leaders. MethodsAt the completion of the one-year initiative, semi-structured exit interviews were conducted with site leaders at 151 of the 402 hospitals that participated. These interviews consisted of open-ended questions about the perceived effectiveness of components of the Safety Program. Qualitative analyses incorporated both deductive coding themes (based on existing literature) and an iteratively developed inductive coding framework (based on salient themes that emerged from a subset of interviews). ResultsSeveral components of the Safety Program were identified as effective in expanding local stewardship activities, including techniques and strategies to implement sustainable ASPs, access to Implementation Advisors to keep sites engaged, provision of local benchmarked antibiotic use data to compare to similar hospitals, and Safety Program materials such as the antibiotic time-out tool to integrate stewardship techniques into daily work flows. The biggest challenges to greater effectiveness were suboptimal frontline staff engagement and difficulty changing antibiotic prescribing culture. Some approaches used to overcome these barriers (i.e., peer-to-peer communication and education through team huddles, identifying physician champions, informal rounds to enhance collegiality and buy-in, and engagement of hospital leadership) were also identified. ConclusionsLessons learned from the Safety Program can be applied by other teams looking to promote an effective ASP at their hospital or system. The themes that emerged in this study likely also have relevance across a wide range of large-scale quality improvement initiatives.

Promoting a more diverse and inclusive research workforce through the research scholars program

BackgroundNovel and comprehensive approaches are needed to address shortcomings in the diversity and inclusiveness of the scientific workforce. In response to this need and informed by multiple programs and data sources, we created the Research Scholars Program (RSP). The RSP is a yearlong program for early-career faculty with an overall objective to overcome barriers to the academic success, retention, progression, and promotion of groups underrepresented in biomedical and behavioral research. The goal of the RSP is to increase research confidence and productivity, build a supportive research community, and reduce isolation by providing personal and group research enrichment to junior faculty through professional development, mentorship, and networking.MethodsWe adapted evidence-based approaches for our institutional context and vetted the RSP across our campus. The resulting RSP consists of three main elements: (1) five levels of Mosaic Mentorship; (2) group and tailored professional development programming; and (3) scientific and social networking. To determine the potential of the RSP to improve research confidence critical to success, we used a modified shortened version of the Clinical Research Appraisal Inventory (CRAI-12) to assess participants’ confidence in performing a variety of research tasks before and after program participation. We collected information about retention, promotion, and grants submitted and awarded. Additionally, we conducted semi-structured exit interviews with each scholar after program participation to identify programmatic strengths and areas for improvement. Data for Cohorts 1 and 2 (N = 12) were analyzed.ResultsOur assessment finds, with one exception, increasing confidence in participants’ research skills across all items, ranging from 0.4 (4.7%) to 2.6 (40.6%). In their exit interviews, the Research Scholars (RS) described their improved productivity and increased sense of belonging and support from others. Research Scholars noted numerous components of the RSP as strengths, including the Mosaic Mentorship model, professional development programming, and opportunities for both informal and formal interactions. Respondents identified time pressure, a lack of feedback, and unclear expectations of the various mentorship roles as areas in which the program can improve.ConclusionPreliminary findings indicate that the RSP is successful in building the research confidence of underrepresented and disadvantaged early-career faculty. While this report focuses on the development and protocol of the RSP, additional cohorts and data will provide the evidence base to support dissemination as a national model of research professional development. Such programming is critical to ensure sustainable support structures, institutional networks, infrastructure, and resources that will improve discovery and equity through inclusive excellence.

Acceptability and Feasibility of a Smartphone-Based Real-Time Assessment of Suicide Among Black Men: Mixed Methods Pilot Study.

Suicide rates in the United States have increased recently among Black men. To address this public health crisis, smartphone-based ecological momentary assessment (EMA) platforms are a promising way to collect dynamic, real-time data that can help improve suicide prevention efforts. Despite the promise of this methodology, little is known about its suitability in detecting experiences related to suicidal thoughts and behavior (STB) among Black men. This study aims to clarify the acceptability and feasibility of using smartphone-based EMA through a pilot study that assesses the user experience among Black men. We recruited Black men aged 18 years and older using the MyChart patient portal messaging (the patient-facing side of the Epic electronic medical record system) or outpatient provider referrals. Eligible participants self-identified as Black men with a previous history of STB and ownership of an Android or iOS smartphone. Eligible participants completed a 7-day smartphone-based EMA study. They received a prompt 4 times per day to complete a brief survey detailing their STB, as well as proximal risk factors, such as depression, social isolation, and feeling like a burden to others. At the conclusion of each day, participants also received a daily diary survey detailing their sleep quality and their daily experiences of everyday discrimination. Participants completed a semistructured exit interview of 60-90 minutes at the study's conclusion. In total, 10 participants completed 166 EMA surveys and 39 daily diary entries. A total of 4 of the 10 participants completed 75% (21/28) or more of the EMA surveys, while 9 (90%) out of 10 completed 25% (7/28) or more. The average completion rate of all surveys was 58% (20.3/35), with a minimum of 17% (6/35) and maximum of 100% (35/35). A total of 4 (40%) out of 10 participants completed daily diary entries for the full pilot study. No safety-related incidents were reported. On average, participants took 2.08 minutes to complete EMA prompts and 2.72 minutes for daily diary surveys. Our qualitative results generally affirm the acceptability and feasibility of the study procedures, but the participants noted difficulties with the technology and the redundancy of the survey questions. Emerging themes also addressed issues such as reduced EMA survey compliance and diminished mood related to deficit-framed questions related to suicide. Findings from this study will be used to clarify the suitability of EMA for Black men. Overall, our EMA pilot study demonstrated mixed feasibility and acceptability when delivered through smartphone-based apps to Black men. Specific recommendations are provided for managing safety within these study designs and for refinements in future intervention and implementation science research. RR2-10.2196/31241.

Taking a Break: The Effects of Partaking in a Two-Week Social Media Digital Detox on Problematic Smartphone and Social Media Use, and Other Health-Related Outcomes among Young Adults.

Despite their increasing popularity, especially among young adults, there is a dearth of research examining the effectiveness of digital detoxes focused on restricting or limiting social media use. As such, the purpose of this exploratory study was to create and carry out a social media digital detox among young adults and evaluate its effectiveness with regards to smartphone and social media addiction, as well as several health-related outcomes. Additionally, the study also sought to obtain an understanding of participants' experiences and perceptions regarding the digital detox via semi-structured exit interviews in order to improve and maximize the effectiveness of future social media digital detox interventions. Thirty-one young adults completed a two-week social media digital detox (preceded by a two-week baseline period and followed up by a two-week follow-up period), whereby their social media use was limited to 30 min per day. A series of one-way repeated measures analyses of variance revealed that a two-week social media detox improved smartphone and social media addiction, as well as sleep, satisfaction with life, stress, perceived wellness, and supportive relationships. Thematic analysis of exit interviews also revealed eight themes: feelings, effort to detox, adjustment period, the Goldilocks effect, screen to screen, post-detox binge, progress not perfection, and words of wisdom, all of which provide contextualization of the quantitative findings and valuable insights for future detoxes. In conclusion, the findings of this exploratory study provide initial support for the use of social media digital detoxes, suggesting that limiting usage can have beneficial effects with regards to smartphone and social media addiction, as well as many other health-related outcomes.

Abstract A136: Perceptions of screening for and addressing food insecurity in cancer patients

Abstract Objectives: 1. To explore attitudes and perceptions of oncology providers and patients on food insecurity screening and ideas for future interventions. 2. To develop and pilot an unconditional cash transfer (UCT) intervention to address food insecurity among cancer patients. Background: The United States Department of Agriculture defines food insecurity as a lack of consistent access to enough food for every person in a household to live an active, healthy life. Food insecurity during cancer treatment negatively impacts treatment adherence and quality of life. Screening for and addressing food insecurity is not systematically or universally performed in oncology clinics. Food insecurity is a condition created by poverty. Increasing evidence supports the use of UCTs to address social needs, including food insecurity. We assessed institutional perspectives on food insecurity screening and developed and tested a UCT intervention. Methods: We conducted semi-structured interviews with interested parties in the clinic including patients (n=6) and providers (physicians, nurses, dieticians, research coordinators and patient support service support staff) (n=14). We collected information about the acceptability of implementing the Hunger VitalSignTM food insecurity screening tool in the clinic and ideas for addressing food insecurity among cancer patients. We then enrolled patients (n=19) into a randomized pilot trial to explore the effectiveness of a UCT of $100 a month for 3 months. Patients in the trial completed a series of surveys and a semi-structured exit interview. We iteratively coded and analyzed data from semi-structured interviews and exit interviews in Dedoose. Results: Qualitative interviews supported the acceptability and need for food insecurity screening by all participants. However, logistical concerns about ongoing staffing shortages and the ability to provide immediate access to resources for all patients identified as food insecure were common concerns. In addition, the need for staff training on screening implementation was emphasized as a concern. Of the 19 patients enrolled in the UCT trial, 14 completed an exit interview. Themes from the exit interviews included the challenges of accessing nutritious food, barriers to preparing food, and challenges navigating existing food resources. Patients expressed appreciation of the UCT and felt it positively impacted their ability to budget and meet their social needs. Conclusion: The food insecurity screening tool was considered acceptable and warranted by providers and patients, however additional research on implementation in understaffed and resource-constrained settings is needed. Investigation of the use of UCTs with cancer patients demonstrated strong potential for addressing social needs. Future trials are warranted to determine dimensions of implementation and the extent to which addressing social needs improves cancer outcomes. Citation Format: Kendal Jacobson, Shoshana Adler Jaffe, Dolores D. Guest, Andrew L. Sussman, Tori L. Shaver, Janet Page-Reeves, Prajakta Adsul, Bernard Tawfik, Jean A. McDougall. Perceptions of screening for and addressing food insecurity in cancer patients [abstract]. In: Proceedings of the 16th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2023 Sep 29-Oct 2;Orlando, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2023;32(12 Suppl):Abstract nr A136.

Experiences with Efanesoctocog Alfa: Exit Interviews with Caregivers of Previously Treated Patients with Hemophilia A from the XTEND-Kids Phase 3 Clinical Trial

Introduction Hemophilia A is a rare, genetic bleeding disorder that leads to recurrent hemarthrosis, causing debilitating pain and joint deterioration, and ultimately results in reduced mobility and a poor quality of life. The aim of this study was to gain insight into caregivers' perspectives on the impact of hemophilia and its treatment as well as experiences with efanesoctocog alfa prophylaxis, by conducting optional qualitative exit interviews with caregivers of children with severe hemophilia A exiting the XTEND-Kids study. Methods XTEND-Kids (NCT04759131) was a Phase 3, open-label, multicenter study evaluating the safety, efficacy, and pharmacokinetics of once-weekly efanesoctocog alfa (50 IU/kg) for 52 weeks, in previously treated children aged <12 years with severe hemophilia A. Semi-structured exit interviews were conducted with caregivers of children from 12 clinical sites across four countries (Canada, France, United Kingdom, and the United States) at their 52-week end-of-treatment (EOT) visit and before end-of-study (EOS) was declared. All caregivers of children across these countries were given the option of participating in the exit interviews. In addition to open-ended questions about the caregiver and their child's experience with hemophilia A, more targeted questions relating to hemophilia-related symptoms and experience with treatments before and during the XTEND-Kids study were queried (Yes/No; Likert Scale). Interviews were conducted by experienced moderators in each country's native language using translated guides where applicable and lasted approximately 60 minutes. Interviews were audio recorded and transcribed for analysis. Descriptive statistics of select items from the qualitative data were computed and summarized. Results Seventy-two children completed their Week 52 EOT or EOS visit; 19 caregivers (18 mothers; 1 father) of 20 children completed exit interviews (one caregiver was the parent of two children in the study). Mean (SD) age of the children was 6.5 (3.1) years, and all were male. All children were receiving FVIII replacement prophylaxis prior to study entry, except for one in the 6 to <12 years of age cohort who was receiving an on-demand regimen. Regarding pre-study treatment experiences, nine caregivers (47.4%) reported that their child's bleeds had a negative impact on their own day-to-day life and eight caregivers (42.1%) reported their child's bleeds had a negative impact on their own mood and emotions . According to caregivers, the most significant impact of hemophilia A and its treatment on their children was on mood and emotions (n=19/20 children; 95.0%) and their physical health/activity (n=14/20 children; 70.0%). When queried about what bothered their children most about their hemophilia and its treatment pre-study, caregivers reported that six children were most bothered about being more cautious or less active than other children due to their condition and 12 children were most bothered about the number of treatment infusions per week. In the XTEND-Kids study, all caregivers (n=19; 100%) reported at least one improvement in their child as a result of efanesoctocog alfa prophylaxis, with eight caregivers (40.0%) stating their child had longer or better protection due to higher factor levels. All caregivers (n=19; 100%) reported noticing a positive effect on their child's daily life and functioning, with most caregivers (n=18; 94.7%) reporting that treatment with efanesoctocog alfa had improved their child's mood and emotions (Figure 1). Efanesoctocog alfa prophylaxis also led to positive changes in caregivers' daily life and functioning, with improvements (out of those who reported the impact at baseline) seen by caregivers in managing treatment (n=16; 100%), impact on family (n=11; 100%), mood/emotions (n=15; 93.8%), and work (n=11; 91.7%) (Figure 2). All caregivers (n=19; 100%) preferred efanesoctocog alfa over their children's previous hemophilia treatment; 18 (94.7%) were “very satisfied”, with one (5.3%) caregiver “satisfied”. Conclusion Caregivers of children with severe hemophilia A reported major impacts at study baseline on both daily life and functioning with prior treatments. Efanesoctocog alfa prophylaxis provided improvements in both children and their caregiver's daily life and functioning, and all caregivers preferred efanesoctocog alfa to their child's previous treatment.

Move&Connect-Youth: A Virtual Group Intervention for Youth Experiencing Persisting Symptoms After Concussion

ABSTRACT Move&Connect-Youth (M&C-Y) is an interdisciplinary virtual group intervention for youth experiencing persisting symptoms after concussion (PSAC) that includes psychoeducation, active rehabilitation, and goal-setting. Using an intervention mapping framework, this paper describes the iterative development of M&C-Y and findings from initial feasibility testing. Ten youth participated in M&C-Y completing pre-intervention demographic questionnaires and semi-structured exit interviews to understand participants’ experience and gather feedback. M&C-Y was feasible based on apriori criteria and findings from interviews provided insights related to: (1) intervention structure, (2) intervention engagement, and (3) intervention takeaways. M&C-Y is a meaningful, feasible, and engaging intervention for youth with PSAC.

Feasibility and Acceptability of a Text Message Intervention to Promote Adherence to Nutrition and Physical Activity Guidelines in a Predominantly Hispanic Sample of Cancer Survivors and Their Informal Caregivers: Results from a Pilot Intervention Trial.

Hispanic cancer survivors face unique barriers to meeting American Cancer Society (ACS) nutrition and physical activity guidelines, which reduce the risk of cancer recurrence and mortality and improve quality of life. This pilot intervention trial evaluated the feasibility and acceptability of a two-week ACS guideline-based nutrition and physical activity text message intervention in a predominantly Hispanic sample of cancer survivors and their informal caregivers. A mixed methods approach was used to assess feasibility and acceptability of the intervention. Feasibility and acceptability were measured by meeting a-priori cut-offs of >80% for recruitment, retention, and text message response rate. Participants also completed a semi-structured exit interview by telephone that assessed intervention components. Thirteen cancer survivors and six caregivers (n = 19) participated in this pilot study; 78% self-identified as Hispanic. Mean time since treatment completion for survivors was 11.9 years (SD 8.4), and 67% had breast cancer. Cancer survivors had a higher acceptability rate for physical activity (94%) compared to nutrition messages (86%), whereas equal acceptability rates were observed for both types of messages among caregivers (91%). Texting interventions are a feasible, acceptable, and a cost-effective strategy that have the potential to promote lifestyle behavior change among Hispanic cancer survivors and caregivers.

Pilot implementation study of a default genetic referral process for patients with young-onset colorectal cancer.

429 Background: Young-onset colorectal cancer (yCRC) diagnosed under age 50 is increasing at alarming rates, with >75% of young-onset cases occurring in patients between 40-49 years old. Although national guidelines recommend germline genetic risk evaluations for all patients with yCRC, multiple studies have shown suboptimal rates of guideline-recommended genetic evaluations. Methods: We conducted a pilot implementation study of a default genetic referral process for patients diagnosed with CRC between ages 40-49 from 1/2019-4/2022 at five hospitals in an academic health system. Patients previously referred to genetics were analyzed as a historical comparator cohort. In the intervention cohort, a research coordinator notified patients and their oncologists of their eligibility for a default genetic referral via an electronic patient portal message or telephone call, after which all patients who did not opt out within two weeks were referred for genetic counseling, testing, and result disclosure as per usual care. The primary outcome was feasibility, defined as a ≥60% referral rate; secondary outcomes included the proportion of genetic referrals that were scheduled, completed, and resulted in testing within three months of referral. Semi-structured exit interviews were conducted with a subset of patients and oncologists to assess attitudes toward the default genetic referral process. Results: We identified 128 patients with yCRC; 75 (59%) had previously been referred to genetics and were assigned to the historical cohort. There were no significant differences in sex, race, or ethnicity between the historical and intervention cohorts. All 10 patients with mismatch repair deficient tumors had previously been referred to genetics. Of the 53 patients in the intervention cohort, 49 (92%) were referred to genetics after one oncologist opted out on behalf of an international patient due to financial concerns and three patients requested to discuss with their oncologist before being referred. Of the patients who were referred, 38 (78%) were scheduled, 22 (45%) completed genetic counseling, and 13 (27%) underwent testing within three months of referral. Reasons for failing to complete the germline genetic risk evaluation process included lack of interest, competing priorities, communication/scheduling challenges, and failure to return saliva-based genetic testing kits. In exit interviews with 10 patients who completed testing and 10 oncologists, participants reported finding the default genetic referral process to be acceptable and feasible to implement. Conclusions: A default genetic referral process is feasible and results in a high referral rate for patients with yCRC, but subsequent scheduling, evaluation, and testing rates remain suboptimal. Multilevel implementation strategies are needed to address the patient, clinician, and system barriers identified in this study. Clinical trial information: NCT05018156 .

It's time to address fear of cancer recurrence in family caregivers: usability study of an virtual version of the Family Caregiver-Fear Of Recurrence Therapy (FC-FORT).

Family caregivers of cancer survivors experience equal or greater levels of fear of cancer recurrence (FCR) than survivors themselves. Some interventions have demonstrated their ability to reduce FCR among cancer survivors and dyads (patient and caregivers). However, to date, no validated intervention exists to focus solely on family caregiver's FCR. This study aimed to (1) adapt the evidence-based in-person Fear Of Recurrence Therapy (FORT) for family caregivers (referred here in as FC-FORT) and to a virtual delivery format and (2) test its usability when offered virtually. The adaptation of FC-FORT was overseen by an advisory board and guided by the Information Systems Research Framework. Following this adaptation, female family caregivers and therapists were recruited for the usability study. Participants took part in 7 weekly virtual group therapy sessions, a semi-structured exit interview and completed session feedback questionnaires. Therapists were offered a virtual training and weekly supervision. Fidelity of treatment administration was assessed each session. Quantitative data were analyzed using descriptive statistics. Exit interviews were transcribed verbatim using NVivo Transcription and coded using conventional content analysis. Results were presented back to the advisory board to further refine FC-FORT. The advisory board (n = 16) met virtually on 7 occasions to adapt FC-FORT (i.e., patient manuals, virtual format) and discuss recruitment strategies. Minor (e.g., revised text, adapted materials to virtual format) and major adaptations (e.g., added and rearranged sessions) were made to FC-FORT and subsequently approved by the advisory board. Four family caregivers and three therapists took part in the first round of the usability testing. Six family caregivers and the same three therapists took part in the second round. Overall, participants were very satisfied with FC-FORT's usability. Qualitative analysis identified 4 key themes: usability of FC-FORT, satisfaction and engagement with content, group cohesion, and impact of FC-FORT. All participants indicated that they would recommend FC-FORT to others as is. Using a multidisciplinary advisory board, our team successfully adapted FC-FORT and tested its usability using videoconferencing. Results from this study indicate that the efficacy and acceptability of FC-FORT are now ready to be tested in a larger pilot study.

Short Report: Barriers and facilitators to parents' implementation of a transdiagnostic eHealth sleep intervention for children with neurodevelopmental disorders

BackgroundInsomnia is highly prevalent in children diagnosed with neurodevelopmental disorders (NDDs) and has negative effects on physical and mental health and wellbeing. Lack of evidence-based intervention programs and barriers to treatment (e.g., time/cost) reduce treatment access. To address these problems, the possibility was explored of modifying the Better Nights, Better Days intervention for typically developing (TD) children (BNBD-TD) to make it appropriate for children with NDD.AimsThe current study's aim was to examine qualitative data from exit interviews conducted during a usability study. Parents of children with NDD used BNBD-TD and reported on barriers and facilitators experienced while implementing the intervention.Methods/proceduresParticipants were 15 Canadian parents of children aged 4 to 10 years who were formally diagnosed with an NDD. Parents implemented the BNBD-TD intervention with their children and participated in a semi-structured exit interview to provide perspectives on their user experience.ResultsBased on an inductive thematic analysis, key facilitators included increased self-efficacy, positive outcomes for the family (e.g., improved sleep problems, parent validation), improved sleep related beliefs/attitudes, and increased motivation. Key barriers included time challenges, struggles when trying to improve sleep problems, and psychosocial factors with negative effects on implementation (e.g., burnout, stress, and/or exhaustion).Conclusions/implicationsBarriers and facilitators identified resulted in recommendations to include more program supports, including helping parents to plan for implementation success.

Experiencing COMFORT: Perceptions of Virtually-delivered Nonpharmacologic Therapies in Adults Prescribed Opioids for Chronic Pain

BackgroundAn opioid task force within an urban public health district sought to increase access to, and utilization of, non-opioid, nonpharmacologic alternatives for pain management. AimsThe COMFORT (Community-engaged Options to Maximize and Facilitate Opioid ReducTion) study was designed to provide virtual multidimensional integrated nonpharmacologic therapies via a cloud-based videoconferencing platform over six weeks to adults with chronic pain who were prescribed an opioid to investigate measurable health improvements. MethodsA qualitative descriptive analysis explored participants’ experiences of a novel pain management intervention. A total of 19 participants consented to participate in the study and 15 completed six virtual consultations with either yoga, massage, chiropractic, or physical therapists. Semi-structured exit interviews were conducted, and data analyzed using content analysis. ResultsFive main themes were identified, including unmet pain needs, self-care practices, incentive for participation, perception of a virtual environment, and benefits of the intervention. All participants reported at least minor benefits, with about half reporting improvement in pain levels, and some were able to reduce their opioid use. A virtual environment posed challenges for a few participants who found it more difficult to engage with than in-person therapy; others found the platform easy to navigate. ConclusionsParticipants with chronic pain were open and willing to try a novel way to access nonpharmacologic consultations to address unmet pain needs. Virtual consultations with pain management experts may increase access to, and utilization of, complementary and integrative treatment modalities.

An acceptance and commitment therapy-based intervention for opioid use disorder risk in individuals with cancer: A treatment development study

This paper describes the iterative development of an evidence-based behavioral intervention for individuals with cancer at risk for opioid use disorder, using the National Institutes of Health Stage Model for Behavioral Intervention Development. Adult patients with cancer from an outpatient palliative care clinic at an academic cancer center, with moderate to high risk of opioid misuse, were enrolled in a treatment development study that aimed to increase psychological flexibility. In this intervention, psychological flexibility is the posited mechanism of change for reduction of opioid use disorder risk. Patients completed baseline (pre-intervention) assessments, a six-session behavioral intervention based in Acceptance and Commitment Therapy, post-intervention assessments, and a semi-structured exit interview. Ten patients with moderate to high risk of opioid misuse completed the intervention. Patients rated the intervention as highly acceptable and were generally highly satisfied. Patients reported finding the coping skills helpful (e.g., mindfulness, cognitive defusion) and reported a preference for more sessions. These treatment development efforts have implications for the development and design of acceptance- and mindfulness-based, targeted interventions for individuals with cancer, receiving palliative care and at risk for opioid use disorder. Specifically, this six-session behavioral intervention to increase psychological flexibility was acceptable to patients and ready to be studied in a pilot RCT.

Barriers and Facilitators to Adherence to a Mediterranean Diet Intervention during Chemotherapy Treatment: A Qualitative Analysis

Patients undergoing chemotherapy are at risk for malnutrition and a high symptom burden, and nutritional interventions can address clinical and supportive care outcomes. Herein, we identified barriers and facilitators to adhering to a Mediterranean Diet (MedDiet) intervention during chemotherapy. Patients with cancer (any type) who were undergoing chemotherapy were enrolled into a clinical trial testing the effects of an 8-week MedDiet intervention on cancer-related fatigue. Participants were randomized 2:1, MedDiet:control. The intervention entailed food provision, education, a cookbook, a session with a nutritionist, and weekly check-ins. Post-intervention, all participants completed semi-structured exit interviews. The interviews were transcribed and open coding was conducted to describe the facilitators and barriers to MedDiet adherence. Participants (n = 29, n = 21 in the intervention group) were 51.0 ± 15.1 years old and 93.1% had breast cancer. Educational materials and convenient food delivery were the highest reported facilitators. Many patients offered that changing their diet gave a sense of control and empowerment. Barriers to adherence were that the frozen food was unappetizing, participants’ (or their spouse/children’s) food preferences did not align with the MedDiet, and chemotherapy-induced side effects that prevented food consumption (eg, mouth sores, lack of appetite). This project helps understand the patient experience within nutritional interventions to optimize dietary programs during chemotherapy treatment.

Promoting Hand Hygiene During the COVID-19 Pandemic: Parallel Randomized Trial for the Optimization of the Soapp App

Hand hygiene is an effective behavior for preventing the spread of the respiratory disease COVID-19 and was included in public health guidelines worldwide. Behavior change interventions addressing hand hygiene have the potential to support the adherence to public health recommendations and, thereby, prevent the spread of COVID-19. However, randomized trials are largely absent during a pandemic; therefore, there is little knowledge about the most effective strategies to promote hand hygiene during an ongoing pandemic. This study addresses this gap by presenting the results of the optimization phase of a Multiphase Optimization Strategy of Soapp, a smartphone app for promoting hand hygiene in the context of the COVID-19 pandemic. This study aimed to identify the most effective combination and sequence of 3 theory- and evidence-based intervention modules (habit, motivation, and social norms) for promoting hand hygiene. To this end, 9 versions of Soapp were developed (conditions), and 2 optimization criteria were defined: the condition with the largest increase in hand hygiene at follow-up and condition with the highest engagement, usability, and satisfaction based on quantitative and qualitative analyses. This study was a parallel randomized trial with 9 intervention conditions defined by the combination of 2 intervention modules and their sequence. The trial was conducted from March to August 2021 with interested participants from the Swiss general population (N=232; randomized). Randomization was performed using Qualtrics (Qualtrics International Inc), and blinding was ensured. The duration of the intervention was 34 days. The primary outcome was self-reported hand hygiene at follow-up, which was assessed using an electronic diary. The secondary outcomes were user engagement, usability, and satisfaction assessed at follow-up. Nine participants were further invited to participate in semistructured exit interviews. A set of ANOVAs was performed to test the main hypotheses, whereas a thematic analysis was performed to analyze the qualitative data. The results showed a significant increase in hand hygiene over time across all conditions. There was no interaction effect between time and intervention condition. Similarly, no between-group differences in engagement, usability, and satisfaction emerged. Seven themes (eg, "variety and timeliness of the task load" and "social interaction") were found in the thematic analysis. The effectiveness of Soapp in promoting hand hygiene laid the foundation for the next evaluation phase of the app. More generally, the study supported the value of digital interventions in pandemic contexts. The findings showed no differential effect of intervention conditions involving different combinations and sequences of the habit, motivation, and social norms modules on hand hygiene, engagement, usability, and satisfaction. In the absence of quantitative differences, we relied on the results from the thematic analysis to select the best version of Soapp for the evaluation phase. ClinicalTrials.gov NCT04830761; https://clinicaltrials.gov/ct2/show/NCT04830761. RR2-10.1136/bmjopen-2021-055971.

Piloting HealthScore: Feasibility and acceptability of a clinically integrated health coaching program for people living with cancer.

Cancer supportive care interventions often have limited generalizability, goal misalignment, and high costs. We developed and piloted a health coaching intervention, UNC HealthScore, in patients undergoing cancer treatment (ClinicalTrials.gov identifier NCT04923997). We present feasibility, acceptability, and preliminary outcome data. HealthScore is a six-month, theory-based, multicomponent intervention delivered through participant-driven coaching sessions. For the pilot study, participants were provided a Fitbit, responded to weekly symptom and physical function digital surveys, and met with a health coach weekly to develop and monitor goals. Coaching notes were discussed in weekly interdisciplinary team meetings and provided back to the treating oncology team. Symptom alerts were monitored and triaged through a study resource nurse to relevant supportive care services. Feasibility was determined based on intervention enrollment and completion. Acceptability was based on satisfaction with coaching and Fitbit-wearing and was informed by semistructured exit interviews. Outcomes evaluated for signs of improvement included several PROMIS (Patient-Reported Outcomes Measurement Information System) measures, including the primary intervention target, physical function. From May 2020 to March 2022, 50 participants completed the single-arm pilot. Feasibility was high: 66% enrolled and 71% completed the full intervention. Participants reported an average of 4.8 and 4.7 (out of 5) on the acceptability of coaching calls and using the Fitbit, respectively. Physical function scores rose 3.1 points (SE=1.1) from baseline to 3months, and 4.3 (SE=1.0) from baseline to 6 months, above established minimal clinically important difference (MCID). Improvements above MCID were also evident in anxiety and depression, and smaller improvements were demonstrated for emotional support, social isolation, cognitive function, symptom burden, and self-efficacy. HealthScore shows feasibility, acceptability, and promising preliminary outcomes. Randomized studies are underway to determine the efficacy of preserving physical function in patients with advanced cancer.

Peer mentoring to support career advancement among underrepresented minority faculty in the programs to increase diversity among individuals engaged in health-related research (PRIDE).

Although mentoring is critical for career advancement, underrepresented minority (URM) faculty often lack access to mentoring opportunities. We sought to evaluate the impact of peer mentoring on career development success of URM early career faculty in the National Heart Lung and Blood Institute-sponsored, Programs to Increase Diversity Among Individuals Engaged in Health-Related Research-Functional and Translational Genomics of Blood Disorders (PRIDE-FTG). The outcome of peer mentoring was evaluated using the Mentoring Competency Assessment (MCA), a brief open-ended qualitative survey, and a semi-structured exit interview. Surveys were completed at baseline (Time 1), 6 months, and at the end of PRIDE-FTG participation (Time 2). The following results were obtained. Between Time 1 and Time 2, mentees' self-assessment scores increased for the MCA (p < 0.01) with significant increases in effective communication (p < 0.001), aligning expectations (p < 0.05), assessing understanding (p < 0.01), and addressing diversity (p < 0.002). Mentees rated their peer mentors higher in the MCA with significant differences noted for promoting development (p < 0.027). These data suggest that PRIDE-FTG peer mentoring approaches successfully improved MCA competencies among URM junior faculty participants with faculty ranking peer mentors higher than themselves. Among URM faculty, peer mentoring initiatives should be investigated as a key strategy to support early career scholar development.

A Portfolio Coach-Informed Professional Development Framework.

A majority of US medical schools have incorporated faculty coach-supported educational portfolios into the curriculum. Existing research describes coach professional development, competencies, and program perceptions. However, limited research exists on how programs address coach professional development needs. Our sequential objectives were to (1) explore faculty coach professional development experiences within medical student coaching programs and (2) develop a preliminary framework for medical faculty coach professional development. Faculty portfolio coaches who completed 4 years of a longitudinal coaching program were recruited to complete a semi-structured exit interview. Interviews were transcribed using detailed transcription. Two analysts inductively generated a codebook of parent and child codes to identify themes. They compared themes to the professional development model proposed by O'Sullivan and Irby. Of the 25 eligible coaches, 15 completed the interview. Our team organized themes into two broad domains paralleling the established model: program-specific professional development and career-relevant professional development. Four program-specific professional development themes emerged: doing; modeling; relating; and hosting. Three career-relevant professional development themes emerged: advancement; meaning; and understanding. We then applied themes within each domain to propose strategies to optimize coach professional development and develop a framework modeled after O'Sullivan and Irby. To our knowledge, we propose the first portfolio coach-informed framework for professional development. Our work builds on established standards, expert opinion, and research responsible for portfolio coach professional development and competencies. Allied health institutions with portfolio coaching programs can apply the framework for professional development innovation.

ACCEPTABILITY OF A TAILORED MUSIC LISTENING INTERVENTION FOR SLEEP IN OLDER ADULTS WITH DEMENTIA

Abstract There is a lack of non-pharmacological interventions aimed at improving sleep disturbances among persons living with dementia (PLWD). In this randomized clinical trial, we examined the acceptability of a tailored music listening intervention on sleep disturbances in PLWD. We recruited 33 PLWD age &amp;gt;60 and their care partners (‘dyad’); 30 dyads completed the study. Dyads were randomly assigned to a wait-list control or intervention group, which included listening to tailored sleep-inducing music 30 minutes every night for 4 weeks. Acceptability outcomes included a questionnaire of perceived benefits and satisfaction with study participation; and a single item examining the PLWD’s level of enjoyment while listening to music. In addition, we conducted semi-structured exit interviews. We used descriptive statistics and conventional content analysis to examine the qualitative data. Most PLWD and care partners identified themselves as female, Black and non-Hispanic. One third responded that the study benefited care partners (n=11, 36.7%) and helped improve PLWD quality of life (n=11, 37.9%). The majority (n=28, 93.3%) felt that this study was clearly explained to them, while a third felt that the study required too much work (n=10, 33.3%). Most dyads enjoyed listening to music that was selected for them (n=38, 93.3%) and reported that the intervention and music selection was acceptable. We identified four themes regarding the music selections: music was relaxing, enjoyable, promoted sleep, and brought back memories. Overall, this intervention shows promise for decreasing sleep disturbances among PLWD. Future studies involving music interventions for sleep should examine the mechanism of action.