Examining Potential Implicit Bias in Oncologist-Patient Communication (CONNECT): Protocol for an Observational 2-Site Study.

Background: Compared with White patients, minoritized patients (Black and Hispanic patients) have a higher incidence of advanced solid cancers and have a higher mortality. These patients also report poor patient-centered communication and worse pain assessment and management. Although many factors contribute to these disparities, physician implicit bias may be a contributing factor.

Evaluation of Reporting of Race and Ethnicity in Hospice and Palliative Care Research.

The disproportionate impact of the COVID-19 pandemic on marginalized communities due to structural racism has led to an increased focus on diversity, equity, and inclusion in medical literature. To assess pre-pandemic racial and ethnic representation among subjects in palliative care research, we examined the reporting of race and ethnicity in research presented at the American Academy of Hospice and Palliative Medicine and Hospice and Palliative Nurses Association State of the Science (SOS) plenary (2004-2019), as these articles frequently influence patient care and clinical practice. There were 126 articles identified and 88 met inclusion criteria.

The 2016 CDC Opioid Guideline and Analgesic Prescribing Patterns in Older Adults With Cancer.

Importance: In 2016, the Centers for Disease Control and Prevention (CDC) published guidelines cautioning against prescribing opioids for chronic noncancer pain. Little is known about unintended outcomes of this guideline on analgesic prescribing for older adults with cancer, who commonly require opioids as first-line pain treatment.

Objective: To determine whether the 2016 CDC guideline was associated with altered analgesic prescribing among older adults with cancer.

'A perfect match': how hematologists discuss donor options and risks with black and white patients considering allogeneic stem cell transplant.

Patients of racial minorities have lower chance of securing a suitable donor, essential part of successful allogeneic stem cell transplant. In this simulated interview study, we sought to examine how hematologists discuss donor options and risks with patients with high-risk myeloid neoplasm considering transplant. Thirty-seven US hematologists participated (65% male; 65% white, 24% Asian, none Black), randomly assigned to meet with a Black or white patient actor.

Early Specialist Palliative Care in Patients with Metastatic Cancer: A Population-Based Cohort Study.

Context: Although early integration of specialist palliative care (PC) is recommended for patients with advanced cancer, how frequently these guidelines are followed is unknown.

Objective: To examine use of early PC in real-world settings.

Methods: Retrospective cohort study of patients with a first diagnosis of metastatic cancer who received care in U.

Multidisciplinary clinician perceptions on utility of a machine learning tool (ALERT) to predict 6-month mortality and improve end-of-life outcomes for advanced cancer patients.

Background: There are significant disparities in outcomes at the end-of-life (EOL) for minoritized patients with advanced cancer, with most dying without a documented serious illness conversation (SIC). This study aims to assess clinician perceptions of the utility and challenges of implementing a machine learning model (ALERT) to predict 6-month mortality among patients with advanced solid cancers to prompt timely SIC.

Methods: One-on-one semi-structured interviews were conducted with oncology physicians, advanced practice providers, registered nurses, and social workers until knowledge saturation was reached (N = 19).

Impact of Patient and Caregiver Beliefs on Utilization of Hospice and Palliative Care in Diverse Patients With Advanced Lung Cancer.

Objectives: To evaluate the impact of patient and caregiver hospice care (HC) and palliative care (PC) beliefs and patient/caregiver belief-agreement on subsequent utilization of HC/PC among racially and ethnically diverse patients.

Methods: A prospective cohort study of newly diagnosed patients ≥18 years old with advanced lung cancer and their caregivers was conducted. Participants completed validated surveys at multiple points and electronic health records were reviewed to evaluate utilization.

Access to dermatologic care for cancer patients: employment of an oncodermatology referral system.

Purpose: Oncodermatology addresses skin conditions caused by cancer or its treatment, which can affect treatment decisions and quality of life. However, electronic health record (EHR)-related communication gaps and appointment wait times hinder timely care. This study assesses the effectiveness of an oncodermatology referral system implemented on March 1, 2023, within a large tertiary healthcare system.

Drivers of Palliative Care and Hospice Use Among Patients With Advanced Lung Cancer.

Purpose: Despite rigorous evidence of improved quality of life and longer survival, disparities in the utilization of palliative and hospice care persist for racial and ethnic minority patients with cancer. This study evaluated the impact of psychosocial factors on utilization of these services.

Methods: Patients with advanced lung cancer were recruited at a large academic urban hospital.

Financial Toxicity Among Patients With Advanced Solid Tumors Participating in Early-Phase Clinical Trials.

Purpose: Financial toxicity (FT) adversely influences patient quality of life and is a barrier to clinical trial enrollment. Early-phase clinical trials (EPCTs) recruit patients who may have high baseline FT and require additional visits and procedures, potentially increasing FT.

Methods: In this prospective survey study, we sought to assess FT at baseline and after 2 months among patients with advanced solid malignancies participating in EPCTs.

Prognostic Understanding, Goals of Care, and Quality of Life in Hospitalized Patients with Leukemia or Multiple Myeloma.

Prior studies reveal a lack of illness understanding and prognostic awareness among patients with hematological malignancies. We evaluated prognostic awareness and illness understanding among patients with acute leukemia and multiple myeloma (MM) and measured patient-hematologist discordance. We prospectively enrolled patients with acute leukemia and MM at Mount Sinai Hospital or Yale New Haven Hospital between August 2015 and February 2020.

Fairness in Predicting Cancer Mortality Across Racial Subgroups.

Importance: Machine learning has potential to transform cancer care by helping clinicians prioritize patients for serious illness conversations. However, models need to be evaluated for unequal performance across racial groups (ie, racial bias) so that existing racial disparities are not exacerbated.

Objective: To evaluate whether racial bias exists in a predictive machine learning model that identifies 180-day cancer mortality risk among patients with solid malignant tumors.

Parent Perspectives on Communication Quality in the Neonatal Intensive Care Unit.

Background: Though prior literature has demonstrated that communication in the Neonatal Intensive Care Unit (NICU) needs to be improved, in-depth descriptions of parents' views of NICU communication are lacking.

Purpose: We sought (1) to explore parent perceptions of communication in the NICU and (2) to understand parents' communication needs and preferences.

Methods: We conducted in-depth semi-structured cognitive interviews utilizing concurrent probes with parents of 10 patients in our urban level IV Neonatal Intensive Care Unit over a period of 4 months (July 2021-October 2021).

Multi-cancer early detection (MCED) tests: prioritizing equity from bench to bedside.

Multi-cancer early detection (MCED) tests are blood-based tests designed to screen for signals of multiple cancers. There is growing interest and investment in examining the potential benefits and applications of MCED tests. If MCED tests are shown to have clinical utility, it is important to ensure that all people-regardless of their demographic or socioeconomic background-equitably benefit from these tests.

Longitudinal quality of life after sublobar resection and stereotactic body radiation therapy for early-stage non-small cell lung cancer.

Background: Many patients with early-stage lung cancer are not candidates for lobectomy because of various factors, with treatment options including sublobar resection or stereotactic body radiation therapy (SBRT). Limited information exists regarding patient-centered outcomes after these treatments.

Methods: Subjects with stage I-IIA non-small cell lung cancer (NSCLC) at high risk for lobectomy who underwent treatment with sublobar resection or SBRT were recruited from five medical centers.

Balancing risks and rewards: How hematologists discuss uncertainty in allogeneic hematopoietic cell transplantation outcomes.

Objective: Allogeneic hematopoietic cell transplant (alloHCT) offers many patients with blood cancers a chance of cure but carries risks. We characterized how hematologists discuss the high-risk, high-reward concept of alloHCT.

Methods: Qualitative analysis of video-recorded virtual encounters of hematologists who routinely perform alloHCT with actors portraying an older man recently diagnosed with high-risk myelodysplastic syndrome.

Communication Strategies of Transplant Hematologists in High-Risk Decision-Making Conversations.

Purpose: Shared decision making (SDM) is essential to empower patients with blood cancers to make goal-concordant decisions about allogeneic hematopoietic cell transplantation. This study characterizes communication strategies used by hematologists to discuss treatment options and facilitate SDM with patients in this high-risk, high-reward setting.

Methods And Materials: We recruited US hematologists who routinely perform allogeneic hematopoietic cell transplant through email.

Acceptability and usability of the Planning Advance Care Together (PACT) website for improving patients' engagement in advance care planning.

Objectives: Most prior advance care planning (ACP) interventions lack integration of the social context of patients' ACP process, which patients indicate is critically important. The current study developed the Planning Advance Care Together (PACT) website to foster inclusion of loved ones in the ACP process.

Methods: To provide feedback about the PACT website, patients with advanced cancer ( = 11), their caregivers ( = 11), and experts ( = 10) participated in semi-structured interviews.

NeoTalk: Communication Skills Training for Neonatal Clinicians.

Background: Despite proven benefit, pediatric subspecialists often have not been offered formal serious illness communication skills training. We sought to: 1) develop and evaluate the impact of a communication skills course, based on the VitalTalk framework, on Neonatal Intensive Care Unit (NICU) clinicians; 2) evaluate provider comfort with key serious illness communication skills and frequency of use of those skills, before and after "NeoTalk" and; 3) explore differences and similarities between adult and pediatric serious illness communication skills courses.

Methods: We developed a NICU specific communication skills course and surveyed course participants to evaluate comfort with key communication skills before and after course participation, and frequency of use of key skills before and 2 months after our course.

Benefits of an Early Mobility Program for Hospitalized Patients With Cancer.

Purpose: Patients with cancer are often hospitalized with complications from cancer and cancer treatment. Many experience a decline in physical functioning, including loss of mobility, which likely contributes to increased length of stay (LOS) and increased readmissions. We aimed to determine whether a mobility program would improve quality of care and decrease health care utilization.