Physician Support Research Articles

Addressing Social Determinants of Health (SDoH) in Primary Care: A Pilot Study

The significant impact of social determinants of health (SDoH) on the health of Americans is increasingly being recognized. Within primary care, there are gaps in identifying SDoH needs and best practice on intervening in these situations. The aim of this pilot study was to assess how patient SDoH needs are identified and addressed by health care providers who are associated with representative primary care. A survey study design consisting of eight closed questions and two open-ended questions was distributed to health care providers practicing in the Maine Federally Qualified Health Centers. Data were analyzed using descriptive statistics. Results provided support for physicians and mid-level providers with how to identify SDoH needs of their patients. As the biggest barriers to identification were lack of time and support, institutions need to provide physicians with adequate time and resource support to complete this task. Addressing SDoH should be the responsibility of a Social Worker on the care team. One type of provider (i.e., social worker or a staff position that requires public health education) should be dedicated to finding resources, how to access them, and providing this detailed information to the physicians and mid-level providers. Each primary care practice is best positioned to make the decision as to which positions should be responsible for identifying and addressing SDOHs gaps for their patients. Creating a plan within health care organizations for identifying and addressing patient SDoH needs aids in mitigating patients’ risks and increases their health outcomes while improving quality of life.

Evolving pancreatic cancer treatment: From diagnosis to healthcare management.

The prognosis of pancreatic ductal adenocarcinoma is still the worst among solid tumors. In this review, a panel of experts addressed the main unanswered questions about the clinical management of this disease, with the aim of providing practical decision support for physicians. On the basis of the evidence available from the literature, the main topics concerning pancreatic cancer are discussed: the diagnosis, as the need for a pathological characterization and the role for germ-line and somatic molecular profiling; the therapeutic management of resectable disease, as the role of upfront surgery or neoadjuvant chemotherapy, the post-operative restaging and the optimal timing foradjuvant chemotherapy, the management of the borderline resectable and locally advanced disease; the metastatic disease and the role of surgery for the management of patients with isolated metastasis and the use of biomarkers of metastatic potential; the role of supportive care and the healthcare management of pancreatic ductal adenocarcinoma.

Impacting pediatric cardiologist burnout

Introduction: Burnout among physicians may impact productivity and result in suboptimal patient care. Studies looking at burnout in a specific pediatric subspecialty are extremely limited. In a previous study, the authors evaluated the work–life balance and burnout among pediatric cardiology attending at our institution. This demonstrated early signs of reduced work engagement and possible burnout in the near future. To address this, the authors implemented a number of targeted interventions and conducted a follow-up survey to assess the effects of such changes. The objective of this study was to evaluate the current status of work–life balance and burnout among pediatric cardiologists at the author's institution compared to the general population and to the prior survey. Materials and Methods: Pediatric cardiology attending physicians were surveyed at the author's institution to assess their perception of burnout and work–life balance using the Maslach burnout inventory and the areas of work–life survey. Results: Forty-seven of the 52 pediatric cardiologists responded to the survey. They were divided into groups by their respective subspecialty: interventional/electrophysiology (n = 2), cardiac intensive care unit/inpatient (n = 9), noninvasive imaging (n = 6), outpatient (n = 22), and other (n = 8). When compared to the previous survey, the Maslach burnout inventory scores were significantly lower in the area of emotional exhaustion. However, most scores in the areas of work–life survey were lower than the prior survey. Conclusion: This follow-up study focusing on pediatric cardiology attending physicians demonstrated worsening burnout and signs of reduced work engagement compared to the previous survey 4 years ago. Interventions did not include bolstering our physician support systems and developing resiliency training for our physicians, which is an area the authors are going to focus on going forward. The following core competencies are addressed in this article: Medical knowledge, Practice-based learning, Systems-based practice.

Physician-Scientist, Academician and Published Research Author

Based largely on interest and preference, there are physician-scientists who are engaged in the dual work of being a clinician and researcher. Some of them have the added responsibility of also being academicians or members of medical faculties. The article, “Physician as a Clinician, Researcher and Academician” in this JMUST issue demonstrates the importance of organizational support and collaboration for physicians. The doctor has multiple roles to navigate through three settings: clinics, research centers, and classrooms to fulfill the mission of better public health. Research and dissemination of findings through publication are almost sine qua non when the physician blends the roles of clinician, researcher, and academician. Within the purview of translational research, the clinician is informed and applies the knowledge base for better patient care.

S2k-Guideline for Teledermatology.

S2k-Guideline for Teledermatology.

Breastfeeding Advocacy: A Look into the Gap Between Breastfeeding Support Guidelines and Personal Breastfeeding Experiences of Faculty Physicians.

Objectives: Despite increased lactation support for mothers over the past few decades, physician mothers still face considerable challenges to achieving their breastfeeding goals. Disparities in breastfeeding exist between physician and nonphysician mothers in the United States. To formulate an effective advocacy agenda for this population, we surveyed faculty physician mothers about their breastfeeding experiences. We hypothesized that identifying frequent, modifiable barriers to breastfeeding could generate ideas for improved lactation support for female physicians. Study Design: A deidentified breastfeeding survey was sent to female faculty physicians at an academic children's hospital in 2020. Inclusion criteria included female faculty physicians who had given birth within the past 5 years. The responses of those who selected "yes" when asked if they had breastfed were analyzed. Results: Fifteen percent of respondents stated that they did not meet their breastfeeding goals. The most prevalent theme for both positive and negative factors in the qualitative analysis was pumping breast milk. Physician mothers provided key insight into (1) the impact of their role as physicians on their breastfeeding experience, (2) impact of their return to work on breastfeeding, and (3) ideas for improved lactation support. Conclusion: This study highlights the need to improve maternal and infant health by advocating for faculty physicians who are providing breast milk for their children. Advocacy efforts should focus on improving conditions for breast milk pumping and for effective policies around return to work after delivery. Further development and study of individualized breastfeeding support plans for physician mothers is needed.

125. Antimicrobial Stewardship Hospital Activities to Promote Antibiotic Awareness Week 2019, Chicago, IL

BackgroundU.S. Antibiotic Awareness Week (USAAW) is an annual campaign to increase knowledge of antimicrobial resistance (AMR) threats and the importance of appropriate antibiotic use. USAAW will be observed November 18-24, 2021 in cadence with World Antimicrobial Awareness Week. MethodsIn October 2019, the Chicago Department of Public Health (CDPH) surveyed 25 Chicago acute care hospital (ACH) antimicrobial stewardship programs (ASPs) via REDCap, an electronic data capture system, to assess their planned activities for USAAW in November 2019. Survey results from 14 (56%) respondent ACHs were collated and disseminated to all 25 ACHs prior to USAAW. ResultsACH ASP survey responses were categorized by ACH size: smaller hospitals (SH) < 350 beds (n=7) and larger hospitals (LH) > 350 beds (n=7) and displayed in the Table. Nine respondents were Infectious Disease (ID) Pharmacists, 3 were ID Physicians, 1 was an Administrator and 1 was an Infection Prevention Nurse. Among SHs, the ASP was funded for an ID Pharmacist salaried position (FTE) < 0.5 at 4 ACHs, 0.5 in 2, and 1 FTE at 1 ACH. LHs reported ID Pharmacist funding ranging from < 0.5 – 2.5 FTE, with the majority with 1 FTE at 3 LHs. All ACHs reported 0.5 FTE or less ID Physician support for their ASPs. Eleven (79%) of respondent ACHs did not report an annual budget for ASP activities. Ten (71%) ACHs disagreed or strongly disagreed that funding was adequate in the outpatient setting compared to inpatient both for adult and pediatric ASP services. Types of planned activities for USAAW included social media posts, provider education, digital displays, and/or go-live with a new antimicrobial policy. Top three barriers to ASP advancements were financial considerations (n=9), competing responsibilities for ASP leads (n=7), and tied for third was personnel shortages (n=6) and other clinical initiatives with higher priority (n=6). ConclusionPublic Health Departments can facilitate assessment of ACH ASPs within their jurisdiction to identify ways to advance the ASP agenda and combat AMR. A variety of strategies were used by Chicago ACHs to promote ASP initiatives during USAAW. Challenges continue with inadequate funding, especially in outpatient settings.Disclosures All Authors: No reported disclosures

A Convolutional Neural Network-Based Intelligent Medical System with Sensors for Assistive Diagnosis and Decision-Making in Non-Small Cell Lung Cancer.

In many regions of the world, early diagnosis of non-small cell lung cancer (NSCLC) is a major challenge due to the large population and lack of medical resources, which is difficult toeffectively address via limited physician manpower alone. Therefore, we developed a convolutional neural network (CNN)-based assisted diagnosis and decision-making intelligent medical system with sensors. This system analyzes NSCLC patients’ medical records using sensors to assist staging a diagnosis and provides recommended treatment plans to physicians. To address the problem of unbalanced case samples across pathological stages, we used transfer learning and dynamic sampling techniques to reconstruct and iteratively train the model to improve the accuracy of the prediction system. In this paper, all data for training and testing the system were obtained from the medical records of 2,789,675 patients with NSCLC, which were recorded in three hospitals in China over a five-year period. When the number of case samples reached 8000, the system achieved an accuracy rate of 0.84, which is already close to that of the doctors (accuracy: 0.86). The experimental results proved that the system can quickly and accurately analyze patient data and provide decision information support for physicians.

A modified Delphi approach to nurturing professionalism in postgraduate medical education in Singapore.

Nurturing professional identities instils behavioural standards of physicians, and this in turn facilitates consistent professional attitudes, practice and patient care. Identities are socioculturally constructed efforts; therefore, we must account for the social, cultural and local healthcare factors that shape physicians' roles, responsibilities and expectations. This study aimed to forward a programme to nurture professionalism among physicians in Singapore. A three-phase, evidenced-based approach was used. First, a systematic scoping review (SSR) was conducted to identify professionalism elements. Second, a questionnaire was created based on the findings of the SSR. Third, a modified Delphi approach, which involved local experts to identify socioculturally appropriate elements to nurture professionalism, was used. A total of 124 articles were identified from the SSR; these articles revealed definitions, knowledge, skills and approaches to nurturing professionalism. Through the modified Delphi approach, we identified professional traits, virtues, communication, ethical, self-care, teaching and assessment methods, and support mechanisms. The results of this study formed the basis for a holistic and longitudinal programme focused on instilling professional traits and competencies over time through personalised and holistic support of physicians. The findings will be of interest to medical communities in the region and beyond.

INNV-13. UNDERSTANDING FACTORS THAT INFLUENCE THE DECISION OF ACCEPTING TUMOR TREATING FIELDS (TTF) THERAPY

Abstract BACKGROUND Tumor Treating Fields (TTF) Therapy is an FDA-approved therapy in the first line and recurrent setting for glioblastoma. Despite Phase 3 evidence showing improved survival, it is not uniformly utilized despite its availability. This qualitative prospective study interviewed glioblastoma patients to better understand key driving factors for decision making. METHODS Adult glioblastoma patients who were offered TTF and who signed IRB approved consent were included. Patients participated in a one-time recorded interview with the researchers from the Northwestern University Department of Medical Social Sciences and were asked about factors shaping their decision to use or not use TTF. RESULTS 40 patients were enrolled with a mean age of 53 years, 92.5% were white and 60% were male. Of the 33 (82.5%) participants who accepted TTF, 23 (69.7%) reported their physician recommending TTF, 8 (24.2%) reported physician neutrality toward TTF, and 2 (6.1%) said their physician advised against TTF. Among the 7 (17.5%) participants who did not choose TTF, 4 (57.1%) reported physician neutrality, 2 (28.6%) reported that their physician advised against TTF, and 1 (14.3%) reported that their physician recommended TTF. Participants who decided against TTF stated that head shaving, appearing sick, and inconvenience of wearing/carrying the device most influenced their decision. For those choosing to use TTF, the most influential factors were extending life and following their doctor's opinion; other factors included level of familial support and the clinical evidence supporting TTF. DISCUSSION This clinical study was a collaboration with the Medical Social Sciences team to better understand the key factors that drive patient decision making with TTF. Findings suggest that physician support and positive Phase 3 results are among the key decision-making factors. Properly understanding the path to patients’ decision making is crucial in optimizing use of TTF and other therapeutic decisions for glioblastoma patients.

Assessment of knowledge, concerns and support of physicians towards bio banks in Pakistan, and their willingness to donate

Bio specimen collection and storage and bio bank data have numerous ethical issues. Stakeholders' views on these ethical problems are essential because they may assist establish ethical standards for bio banking. The aim of this research is to assess Pakistani doctors' views and knowledge regarding bio banking and willingness to donate. A cross-sectional online survey was conducted to poll Pakistani physicians’ attitudes and views regarding bio banks. Between January and April 2021.473 doctors completed the questionnaire. Participants had sufficient knowledge of bio banking. Of those, 74.2 "Human Genome Project," while 72.5% revealed that they were familiar with the term "bio banking." 61.5% of the participants showed their willingness to donate bio specimens. Marital status (0.001), faculty (0.001), involvement in research (0.038), blood and tissue testing in recent years (0.420) and demonstrated a significant relationship with willingness to donate. While general health status, recent hospitalization, family history of inherited diseases, incidence of chronic disease, and gender had no statistically significant associations with willingness to donate. Although65.8% agreed that bio banks should be able to exchange bio specimens with foreign research groups and only 49.5% agreed on collaboration with pharmaceutical companies.

Diversity, Equity, and Inclusion Perspectives Among Radiation Oncology Program Directors: A Knowledge, Attitudes, and Practices Survey

Diversity, Equity, and Inclusion Perspectives Among Radiation Oncology Program Directors: A Knowledge, Attitudes, and Practices Survey

Implementation of a Novel Radiation Oncology Physician Productivity Model

<h3>Purpose/Objective(s)</h3> Historical models of physician productivity in radiation oncology focus on external-beam (EBRT) volume. As the field has transitioned to hypofractionated regimens, stereotactic treatments, and an increase in radiation oncology procedures, this model has become outdated and no longer reflects physician work effort and productivity. Here we propose a new productivity model that takes into account technological advances in the field, work effort associated per plan, supervision requirements, and physician time for procedures. <h3>Materials/Methods</h3> An anonymous survey was completed by each faculty physician across an academic radiation oncology department that includes a main campus, proton center, and 3 community practices. Faculty were asked to assign the amount of time required to complete various activities, including but not limited to contouring tasks by modality (3D, intensity-modulated radiation therapy [IMRT], proton treatment), plan review, and amount of physician time required during procedures such as brachytherapy and radioembolization. <h3>Results</h3> All faculty physicians completed the 23-question survey. Mean time values were assigned to each activity. For example, contouring for 3D plans was assigned a smaller time value than IMRT; or a vaginal cylinder brachytherapy treatment was assigned a smaller time value than an interstitial implant. Each physician was evaluated on his/her annual volume of treatments and procedures, and this quantity was multiplied by the time modifier. Work effort was also assigned based on administrative roles, which often take physicians away from clinical work. When compared to EBRT, this model was more reflective of work effort and more accurately mirrored productivity and RVU generation. <h3>Conclusion</h3> Our physician productivity model was well accepted by faculty and unanimously deemed to be more reflective of physician productivity than EBRT volume. This model has allowed us to deploy physician support services more equitably across our varied practice sites. This model is now utilized as our primary means to assess physician productivity and associated supportive resource deployment. As our field of rapidly changing technology, procedures and administrative requirements evolve, so will such physician productivity models be required too.

Assessment of Knowledge, Concerns and Support of Physicians towards Bio banks in Pakistan, and their Willingness to Donate

Bio specimen collection and storage and bio bank data have numerous ethical issues. Stakeholders' views on these ethical problems are essential because they may assist establish ethical standards for bio banking. Physicians are key stakeholders because they may contact prospective participants and become bio bank users. The aim of this research is to assess Pakistani doctors' views and knowledge regarding bio banking and willingness to donate. A cross-sectional online survey was conducted to poll Pakistani physicians’ attitudes and views regarding bio banks. Between January and April 2021.473 doctors completed the questionnaire. Participants had sufficient knowledge of bio banking. Of those, 74.2 stated that they had heard of the term "Human Genome Project," while 72.5% revealed that they were familiar with the term "bio banking." 61.5% of the participants showed their willingness to donate bio specimens. Marital status (0.001), faculty (0.001), involvement in research (0.038), blood and tissue testing in recent years (0.420) and demonstrated a significant relationship with willingness to donate. While general health status, recent hospitalization, family history of inherited diseases, incidence of chronic disease, and gender had no statistically significant associations with willingness to donate. Although65.8% agreed that bio banks should be able to exchange bio specimens with foreign research groups and only 49.5% agreed on collaboration with pharmaceutical companies. Although more than half of Pakistani doctors heard of bio banking, the presence of bio banks in Pakistan was restricted. They were concerned about marketing, widespread consent and confidentiality. There is a great gap of knowledge and awareness among stakeholders that should encompass several educational initiatives. Community conversations on the problems of marketing and the return of research findings should begin to achieve an agreement.

Comparison of Perceptions and Smoking Cessation Experiences Between Smokers With and Without Serious Mental Illness in a Large Health Maintenance Organization

Objective Smoking prevalence is threefold higher among people with serious mental illness (PWSMI) than in the general population, yet smoking cessation rates for PWSMI are lower. Numerous reasons have been posited as to why tobacco use is higher and abstinence rates are lower among PWSMI. This study explores smoking cessation perceptions and experiences among PWSMI and people without serious mental illness (SMI). Methods Participants in this cross-sectional study were recruited from among members of a large health maintenance organization (HMO) in Israel who had registered for or commenced a smoking cessation program in 2015 through 2017. The sample comprised 208 PWSMI and a matched sample of people without SMI (N = 428). Telephone surveys were used to collect information about smoking status and smoking/cessation history, use of smoking cessation programs and aids (prescription medications, nicotine replacement therapy, electronic cigarettes), motivation and intention to quit, self-efficacy (to quit), smoking cessation outcome expectancies, physician support to quit, barriers and facilitators for those who had not quit, and reinforcements/challenges for those who had quit. Results Of those without SMI, 27% quit smoking compared to 20% of PWSMI (p = .051). Irrespective of mental health status, the most significant predictor of abstinence was the use of smoking cessation prescription medications. Family physicians were significantly less likely to inquire about motivation to quit, refer to smoking cessation programs, or prescribe smoking cessation medications for PWSMI than for people without SMI. Beyond these factors, no differences were noted between respondents with and without SMI regarding motivation to quit, intention to quit, and abstinence self-efficacy. PWSMI who had not quit were more likely to be concerned about how quitting might affect their functioning and how they would pass the time without cigarettes. Conclusions PWSMI have similar levels of motivation and intention to quit smoking as those without SMI. However, they are disadvantaged by the reduced support received from their family physicians and lower cessation medication usage. Efforts to promote the implementation of smoking cessation treatment guidelines will help promote smoking abstinence among PWSMI.

Physician perspectives on delays in cancer diagnosis in Alberta: a qualitative study.

Background:Delays in cancer diagnosis have been associated with reduced survival, decreased quality of life after treatment, and suboptimal patient experience. The objective of the study was to explore the perspectives of a group of family physicians and other specialists regarding potentially avoidable delays in diagnosing cancer, and approaches that may help expedite the process.Methods:We conducted a qualitative study using interviews with physicians practising in primary and outpatient care settings in Alberta between July and September 2019. We recruited family physicians and specialists who were in a position to discuss delays in cancer diagnosis by email via the Cancer Strategic Clinical Network and the Alberta Medical Association. We conducted semistructured interviews over the phone, and analyzed data using thematic analysis.Results:Eleven family physicians and 22 other specialists (including 7 surgeons or surgical oncologists, 3 pathologists, 3 radiologists, 2 emergency physicians and 2 hematologists) participated in interviews; 22 were male (66.7%). We identified 4 main themes describing 9 factors contributing to potentially avoidable delays in diagnosis, namely the nature of primary care, initial presentation, investigation, and specialist advice and referral. We also identified 1 theme describing 3 suggestions for improvement, including system integration, standardized care pathways and a centralized advice, triage and referral support service for family physicians.Interpretation:These findings suggest the need for enhanced support for family physicians, and better integration of primary and specialty care before cancer diagnosis. A multifaceted and coordinated approach to streamlining cancer diagnosis is required, with the goals of enhancing patient outcomes, reducing physician frustration and optimizing efficiency.

The Disease Process Experiences of Women Diagnosed with Breast Cancer in the Psycho-Social Context

This study aims to reveal how women diagnosed with breast cancer experience the disease process in the psychosocial context. The participants of the phenomenological designed study consisted of 10 women diagnosed with breast cancer. The findings that were obtained through semi-structured interviews centered around the themes of responses to the disease, coping strategies, sources of social support, and existential reflections. With regards to the responses to the disease, the participants’ responses when diagnosed with breast cancer were under the sub-themes of shock, emptiness, mental breakdown, inability to accept the diagnosis, despair, seeking social support, anxiety, and self-blame; and after the diagnosis, they were under the sub-themes of acceptance, anxiety, sadness, and helplessness. The coping strategies used by the women included the sub-themes of coping through spirituality, social support, obtaining information, exercise, and nutrition. The social support sources of women fell under the sub-themes of spouse support, friend support, support of other family members, and physician support. In terms of existential reflections, the women were found to have experienced the sub-themes of maturing, re-interpreting life, and facing death.

Introduction: Women in Medicine.

Introduction: Women in Medicine.

Physician perceived barriers and facilitators for self-measured blood pressure monitoring- a qualitative study

Improving hypertension management is a national priority that can decrease morbidity and mortality. Evidence-based hypertension management guidelines advocate self-measured BP (SMBP), but widespread implementation of SMBP is lacking. The purpose of this study was to describe the perspective of primary care physicians (PCPs) on SMBP to identify the barriers and facilitators for implementing SMBP. We collected data from PCPs from a large health system using semi-structured interviews based on the Theoretical Domains Framework (TDF). Responses were recorded, transcribed, and qualitatively analyzed into three overarching TDF domains based on the Behavior Change Wheel (BCW): 1) Motivation 2) Opportunity and 3) Capabilities. The sample size was based on theme saturation. All 17 participating PCPs believed that SMBP is a useful, but underutilized tool. Although individual practices varied, most physicians felt that the increased data points from SMBP allowed for better hypertension management. Most felt that overcoming existing barriers would be difficult, but identified several facilitators: physician support of SMBP, the possibility of having other trained health professionals to assist with SMBP and patient education; improving patient engagement and empowerment with SMBP, and the interest of the health system in using technology to improve hypertension management. PCPs believe that SMBP can improve hypertension management. There are numerous barriers and facilitators for implementing SMBP. Successful implementation in clinical practice will require implementation strategies targeted at increasing patient acceptability and reducing physician workload. This may need a radical change in the current methods of managing hypertension.

There Is No Place Like Assisted Living: Can the Setting Evolve While Staying True to Itself?

There Is No Place Like Assisted Living: Can the Setting Evolve While Staying True to Itself?