Cannabis Use Behaviors and Desired Interventions Among Postpartum Individuals With Frequent Cannabis Use in Early Pregnancy: A Qualitative Study.

Background: Cannabis use among perinatal individuals has dramatically increased. Thus, it is crucial to understand postpartum individuals' experiences with cannabis use, particularly during breastfeeding, and desired postpartum interventions to improve the care and well-being of parents and their children. We aimed to understand motivations for postpartum cannabis use and desired interventions for new parents who frequently used cannabis in early pregnancy.

Mental health clinicians' perceptions on patient motivations and intervention engagement for prenatal cannabis use: A mixed methods study.

Background: Mental health clinicians are uniquely suited to support and provide important insights about substance use among pregnant patients. This mixed-methods study explored how mental health clinicians perceive and address prenatal cannabis use.

Methods: Participants were licensed mental health clinicians from Kaiser Permanente Northern California's Early Start perinatal substance use screening and counseling program.

Timing and Outcomes of Palliative Care Integration Into Care of Adolescents and Young Adults With Advanced Cancer.

Purpose: Adolescent and young adult (AYA) patients with cancer frequently receive intensive measures at the end of life; many also express care goals that align with a palliative approach. We sought to understand the extent to which AYAs are referred to palliative care before death, the timing of referrals, and associations between referral timing and end-of-life care outcomes.

Methods: Review of electronic health data and medical records for 1,918 AYAs age 12-39 years who died after receiving care at one of the three sites between 2003 and 2019.

Patterns of substance use and associations with mental health and interpersonal violence among adolescents.

Objective: To identify patterns of adolescent substance use and associated behavioral health characteristics among adolescents.

Methods: We conducted a cross-sectional study of 167,504 adolescents aged 13-17 who were screened for substance use, mental health symptoms, and interpersonal violence during well-check visits in a large healthcare system in California from 2021 to 2022. We conducted latent class analysis to identify patterns of substance use from four substance use behaviors (past-year alcohol, cannabis, other substance, and close friends' use).

The difference-making role of staff support in implementing nurse care management for opioid use disorder treatment: A configurational analysis.

Introduction: Understanding conditions in which interventions succeed or fail is critical. The PRimary care Opioid Use Disorders treatment (PROUD) trial, a cluster-randomized hybrid study, tested whether implementation of office-based addiction treatment supported by a nurse increased medication of OUD. Six health systems each provided two primary care (PC) clinics that were randomly assigned to implement the intervention or usual care.

Preferred and Actual Location of Death in Adolescents and Young Adults With Cancer.

Importance: Adolescent and young adult (AYA) patients with advanced cancer often die in hospital settings. Data characterizing the degree to which this pattern of care is concordant with patient goals are sparse.

Objective: To evaluate the extent of concordance between the preferred and actual location of death among AYA patients with cancer.

Evolution in Documented Goals of Care at End of Life for Adolescents and Younger Adults With Cancer.

Importance: Little is known about the nature of change in goals of care (GOC) over time among adolescents and younger adult (AYA) patients aged 12 to 39 years with cancer near the end of life. Understanding how GOC evolve may guide clinicians in supporting AYA patients in making end-of-life decisions.

Objective: To assess frequency, timing, and evolution of documented GOC among AYA patients with cancer in the last 90 days of life.

Clinician perspectives on barriers and facilitators to the treatment of adolescent cannabis use: A qualitative study.

Introduction: Cannabis use among adolescents is prevalent, and clinicians who work with adolescents have unique insights about how to treat cannabis use in this population.

Methods: This qualitative study interviewed 32 clinicians from addiction medicine recovery services (AMRS), the emergency department (ED), mental health (MH), and pediatrics in an integrated healthcare system to understand their perspectives and experiences regarding barriers and facilitators to treating adolescent cannabis use. The analysis was developed using thematic analysis of interviews.

Clinician perspectives on adolescent cannabis-related beliefs and behaviors following recreational cannabis legalization.

Background: As more states legalize cannabis, studies are needed to understand the potential impacts of recreational cannabis legalization (RCL) on adolescents from the perspective of clinicians who care for them.

Methods: This qualitative study characterized clinician perspectives on whether cannabis legalization is associated with changes in adolescents' cannabis use beliefs, behaviors, and consequences. Semi-structured qualitative interviews were conducted with 32 clinicians in a large healthcare organization from 9/6/2022-12/21/2022.

Intentions to Use Cannabis Postpartum: A Qualitative Study of Pregnant Individuals Who Used Cannabis During Early Pregnancy.

To examine plans for postpartum cannabis use among pregnant individuals who used cannabis during early pregnancy. Eighteen virtual focus groups were conducted from November 17, 2021, to December 17, 2021, with 23 Black and 30 White pregnant adults in Kaiser Permanente Northern California, who self-reported prenatal cannabis use during early pregnancy. Focus groups were recorded, transcribed, and analyzed using thematic analysis.

What Matters Most: The Documented Goals, Values and Motivators of Advanced Cancer Patients.

Background: Goals of care conversations are essential to delivery of goal concordant care. Infrequent and inconsistent goals of care documentation potentially limit delivery of goal concordant care.

Methods: At Kaiser Permanente San Francisco Cancer Center, a standardized documentation template was designed and implemented to increase goals of care documentation by oncologists.

Association of initial opioid prescription duration and an opioid refill by pain diagnosis: Evidence from outpatient settings in ten US health systems.

Objective: The Centers for Disease Control and Prevention's 2022 Clinical Practice Guideline for Prescribing Opioids for Pain cautioned that inflexible opioid prescription duration limits may harm patients. Information about the relationship between initial opioid prescription duration and a subsequent refill could inform prescribing policies and practices to optimize patient outcomes. We assessed the association between initial opioid duration and an opioid refill prescription.

What Constitutes Quality of Life? Perspectives of Adolescents and Young Adults With Advanced Cancer.

Background: Adolescents and young adults (AYAs) with advanced cancer identify maintaining a good quality of life (QoL) as a central goal of end-of-life care. QoL is a dynamic and subjective overarching concept that refers to an individual's relative satisfaction with their own life. Despite its importance to AYAs with advanced cancer, a patient-centered definition of QoL is lacking in this population.

Prescription Opioid Dose Reductions and Potential Adverse Events: a Multi-site Observational Cohort Study in Diverse US Health Systems.

Background: In response to the opioid crisis in the United States, population-level prescribing of opioids has been decreasing; there are concerns, however, that dose reductions are related to potential adverse events.

Objective: Examine associations between opioid dose reductions and risk of 1-month potential adverse events (emergency department (ED) visits, opioid overdose, benzodiazepine prescription fill, all-cause mortality).

Design: This observational cohort study used electronic health record and claims data from eight United States health systems in a prescription opioid registry (Clinical Trials Network-0084).

Nurse Care Management for Opioid Use Disorder Treatment: The PROUD Cluster Randomized Clinical Trial.

Importance: Few primary care (PC) practices treat patients with medications for opioid use disorder (OUD) despite availability of effective treatments.

Objective: To assess whether implementation of the Massachusetts model of nurse care management for OUD in PC increases OUD treatment with buprenorphine or extended-release injectable naltrexone and secondarily decreases acute care utilization.

Design, Setting, And Participants: The Primary Care Opioid Use Disorders Treatment (PROUD) trial was a mixed-methods, implementation-effectiveness cluster randomized clinical trial conducted in 6 diverse health systems across 5 US states (New York, Florida, Michigan, Texas, and Washington).

Quality of End-of-Life Care Among Adolescents and Young Adults With Cancer.

Adolescents, young adults with cancer receive limited psychosocial and spiritual support near death.

Real-World Use of Electronic Patient-Reported Outcome (ePRO) Tools Integrated in the Electronic Medical Record During Radiation Therapy for Head and Neck Cancer: Feasibility Study.

Purpose Use of electronic patient-reported outcome (ePRO) tools in routine oncology practice can be challenging despite evidence showing they can improve survival, improve patient and practitioner satisfaction, and reduce medical resource utilization. Head and neck cancer (HNC) patients receiving radiation therapy (RT) may be a group that would particularly benefit from interventions focused on early symptom management. Methods Patients undergoing definitive RT for HNC were enrolled in a feasibility study and received ePRO surveys integrated within the electronic medical record (EMR) on a weekly basis during RT.

Discussions About Goals of Care and Advance Care Planning Among Adolescents and Young Adults With Cancer Approaching the End of Life.

Purpose: Adolescents and young adults (AYAs) with cancer receive high rates of medically intensive measures at the end of life. This study aimed to characterize the prevalence and timing of conversations about goals of care and advance care planning among AYAs at the end of life as one potential influence on care received.

Methods: This was a review of electronic health data and medical records for 1,929 AYAs age 12-39 years who died after receiving care at one of three sites between 2003 and 2019, including documented conversations about goals of care and advance care planning, and care received.

Patient Perceptions of Prenatal Cannabis Use and Implications for Clinicians.

Objective: To understand pregnant patients' reasons for prenatal cannabis use and perceptions of safety, desired and undesirable health care experiences, and desired information about prenatal cannabis use and secondarily to understand racial differences in these perceptions and preferences.

Methods: We conducted a qualitative study including 18 semi-structured, race-concordant virtual focus groups with pregnant individuals who self-reported cannabis use at prenatal care entry in a large integrated health care system in Northern California from November 2021 to December 2021. The focus groups included semi-structured questions that were recorded, transcribed, and coded by the research team.

Patient, Caregiver, and Clinician Perspectives on Core Components of Therapeutic Alliance for Adolescents and Young Adults With Advanced Cancer: A Qualitative Study.

Importance: The patient-clinician therapeutic alliance is an important aspect of high-quality cancer care. However, components of the therapeutic alliance in adolescents and young adults (AYAs, aged 12-39 years) with cancer have not been defined.

Objective: To identify components of and barriers to the therapeutic alliance between AYAs, caregivers, and clinicians from the perspective of all key stakeholders.

Exploring preferences for different modes of cannabis use during early pregnancy: A qualitative study.

Objective: Rates of prenatal cannabis use are rising, yet little is known about modes of cannabis use during pregnancy. This focus group study with pregnant individuals aimed to examine use patterns and perceptions regarding common modes of prenatal cannabis use.

Method: Kaiser Permanente Northern California pregnant adult patients who identified as White or Black and self-reported cannabis use during pregnancy were recruited to participate (N = 53; 40% Black, 60% White; Mean = 30.

The implementation checklist: A pragmatic instrument for accelerating research-to-implementation cycles.

Introduction: Learning health systems require rapid-cycle research and nimble implementation processes to maximize innovation across disparate specialties and operations. Existing detailed research-to-implementation frameworks require extensive time commitments and can be overwhelming for physician-researchers with clinical and operational responsibilities, inhibiting their widespread adoption. The creation of a short, pragmatic checklist to inform implementation processes may substantially improve uptake and implementation efficiency across a variety of health systems.

Mental health and substance use screening in HIV primary care before and during the early COVID-19 pandemic.

Background: Mental health and substance use disorders disproportionately affect people with HIV (PWH), and may have been exacerbated during COVID-19. The Promoting Access to Care Engagement (PACE) trial was designed to assess the effectiveness of electronic screening for mental health and substance use in HIV primary care and enrolled PWH from October 2018 to July 2020. Our objective here was to compare screening rates and results for PWH before (October 2018 - February 2020) and early in the COVID-19 pandemic (March-July 2020).