Jeffrey Silver Humanism in Healthcare Research Roundup – July 2022

The Jeffrey Silver Humanism in Healthcare Research Roundup features summaries of recently published studies on humanism in healthcare. To receive email notification of new studies once per month, enter your information here and select “Jeffrey Silver Research Roundup” from the checkboxes at the bottom. See previous posts in this series.

The Presence 5 for Racial Justice framework for anti-racist communication with Black patients Brown-Johnson C, Cox J, Shankar M, Baratta J, De Leon G, Garcia R, Hollis T, Verano M, Henderson K, Upchurch M, Safaeinili N, Shaw JG, Fortuna RJ, Beverly C, Walsh M, Somerville CS, Haverfield M, Israni ST, Verghese A, Zulman DM. Health Serv Res. 2022 Jun 28. doi: 10.1111/1475-6773.14015. Epub ahead of print. PMID: 35765147. Dr. Abraham Verghese is a former Gold Foundation Trustee and gave both the 2012 and 2005 Jordan J. Cohen Humanism in Medicine Lecture at the AAMC.
Effective communication that mitigates anti-Black racism is essential to the delivery of high-quality and equitable care. But which communication practices exactly can help clinicians address racism faced by Black patients, build trust, and empower Black patients? Dr. Cati Brown-Johnson and colleagues conducted a qualitative community-based participatory research project using human-centered design thinking to answer this question. They built upon the original Presence 5 framework, which was designed to foster meaningful clinician-patient connections. Through literature review; qualitative analysis of interviews and focus group discussions with 36 Black patients, 40 nonmedical professionals, and 24 clinicians; iterative discussions among investigators; and consultation with The Presence 5 Virtual National Community Advisory Board, they mapped out five practices. These are: (1) prepare with intention, including by reflecting on identity, bias, and power dynamics, (2) listen intently, including for potential impact of anti-Black racism on health and healthcare, (3) agree on what matters most by discussing patient goals, treatment, and referral planning, (4) connect with the patient’s story, and (5) explore emotional cues, including by naming patient emotions and considering how their experiences with racism might affect emotions. Altogether, these practices highlight opportunities for clinicians to address patient experiences with racism while fostering trust, empowerment, and connection. More information and resources, including discussion and facilitator guides, can be found on the Presence 5 for Racial Justice website.

Older adults with advanced cancer are selective in sharing and seeking information with social networks Kehoe L, Sanapala C, DiGiovanni G, Yousefi-Nooraie R, Yilmaz S, Bauer J, Loh KP, Norton S, Duberstein P, Kamen C, Gilmore N, Gudina A, Kleckner A, Mohile S, Epstein RM. Patient Educ Couns. 2022 Jun 9:S0738-3991(22)00276-2. doi: 10.1016/j.pec.2022.06.005. Epub ahead of print. PMID: 35717349. Dr. Ronald M. Epstein has been a Gold Foundation grantee and is co-founder of Mindful Practice, which collaborates with the Gold Foundation.
Social networks are important sources of support and information for patients and help patients make complex decisions regarding their healthcare. Social network members (NM) may include family members, friends, colleagues, peer groups, and healthcare team members. With respect to older adults with advanced cancer, little is known about how they interact with social network members. Dr. Lee Kehoe and colleagues sought to investigate this by conducting semi-structured interviews with 29 older adults with advanced cancer who were considering treatment and 18 of their social network members. Through thematic analysis, they identified eight themes centered on factors influencing communication processes and content. These include (1) selective sharing, (2) length of relationship, (3) geographic distance, (4) frequency of communication, (5) role of NM with medical background, (6) role of NM with cancer experience, (7) depth of conversations, and (8) decision-making. Altogether, this analysis shows how older adults with cancer engage in a ”selective sharing process.”  These insights, according to authors, can enable clinicians to more strategically and effectively communicate vital information regarding care and potentially improve patient outcomes.

Leveraging clerkship experiences to address segregated care: A survey-based approach to student-led advocacy Wilkinson R, Huxley-Reicher Z, Fox GC, Feuerbach A, Tong M, Blum J, Pai A, Karani R, Muller D. Teach Learn Med. 2022 Jun 30:1-8. doi: 10.1080/10401334.2022.2088538. Epub ahead of print. PMID: 35770380. Dr. Reena Karani has been a Gold Foundation grantee.
Academic medical centers often participate inadvertently in “segregated care,” whereby publicly inured patients (who are more likely to be Black or Latino) are treated differently than those with private insurance. Medical students are often aware of this but feel barriers to speaking out for institutional change. To understand medical student perspectives, Dr. Rachel Wilkinson and colleagues designed and distributed a 16-item survey on segregated care to third-year medical students in New York City. Out of 140 students, 65 responded (46.4%). The majority of students reported witnessing separation of patient care or differences in patient care on the basis of insurance. Respondents felt that this contributed to their sense of cynicism and burnout. These results were then presented to school and hospital administrators, who viewed this as an opportunity for quality improvement. For example, the Department of Obstetrics and Gynecology launched a Clinical Transformation Taskforce to address these concerns. The authors conclude by noting the success of coupling student-led research with advocacy in their case, and express hope that others can use similar approaches to promote equity.

Trends in health care use among Black and White persons in the US, 1963-2019 Dickman SL, Gaffney A, McGregor A, Himmelstein DU, McCormick D, Bor DH, Woolhandler S. JAMA Netw Open. 2022 Jun 1;5(6):e2217383. doi: 10.1001/jamanetworkopen.2022.17383. PMID: 35699954; PMCID: PMC9198752. Free full text Dr. Danny McCormick has been a Gold Foundation grantee.
Despite decades of legislation aimed at expanding access to healthcare, there remain significant healthcare disparities in healthcare use between Black people and their white counterparts. To understand trends in healthcare usage, Dr. Samuel Dickman and colleagues analyzed 29 surveys conducted between 1963 and 2019. These surveys encompassed responses from 154,859 Black and 446,944 white (non-Hispanic) individuals, and included data such as annual per capita visit rates, inpatient hospitalization rates, and total per capita medical expenditures. They determined that the ratio of overall healthcare costs between white individuals and Black individuals initially narrowed, from 1.96 in the 1960s to 1.26 in the 1970s. However, the gap widened to 1.46 in the 1990s and has remained between 1.31 and 1.39 in the 2010s. According to authors, these results suggest the persistence of structural racism. They conclude by advocating not only for policies that equalize financial access, but also for measures that “help earn Black patients’ trust in health care,” such as investing in Black-serving medical facilities, increasing community outreach efforts, and addressing shortages of Black healthcare professionals and managers.

Elements influencing recruitment and retention of millennial hospitalists born in or after 1982: a survey-based study Singh A, Panek T, Tackett S, Paranji S, Gundareddy V, Kauffman R, Wright S, Bowling G, Torok H, Patel H, Alhadeff I, Nogi M, McIlraith T, Robertson T, Kisuule F. J Gen Intern Med. 2022 Jun 3:1–6. doi: 10.1007/s11606-022-07680-5. Epub ahead of print. PMID: 35657465; PMCID: PMC9165541. Free full text Dr. Scott Wright has been a Gold Professor.
Hospitalist turnover is high, with approximately 1 in 10 hospitalists leaving their job within a year. This may be even higher among early career hospitalists. After all, early career physicians report lower satisfaction with career choice, higher frequency of work-home conflicts, and higher rates of depersonalization. To understand how millennial hospitalists make decisions regarding recruitment and retention, Dr. Amteshwar Singh and colleagues conducted a survey of millennial hospitalists, i.e. those born in 1982 or later, from seven hospital medicine groups. Among the 145 hospitalists who responded (out of 235, response rate: 61%), the investigators found that the culture of practice was the most important reason for choosing and remaining at their job. More specifically, having a “cohesive workplace” and “having the leaders/practice values aligned with my own” were nearly universally rated as important factors in remaining (99% for both). Conversely, career advancement was the category that was least frequently rated as important (69%). The results of this survey highlight the need for organizational cultures to reflect millennial values. The authors concluded that data from this survey may empower hospital medicine groups in recruiting and retaining millennial hospitalists.

Thriving in residency: a qualitative study Hyman JH, Doolittle B. J Gen Intern Med. 2022 Jun 16:1–7. doi: 10.1007/s11606-022-07504-6. Epub ahead of print. PMID: 35710670; PMCID: PMC9202965. Free full text
While there has been greater recognition of burnout among resident physicians in recent years, there has been less focus on resident physician “thriving.”  Thriving is a concept that goes beyond well-being into such domains as social connections, love of work, value-oriented practice, agency, and relationship with patients. To examine resident physician thriving, Joshua Hyman and Dr. Benjamin Doolittle conducted semi-structured interviews with 37 Internal Medicine, Pediatrics, and Internal Medicine/Pediatrics resident physicians at Yale University. They then narrowed the number to 24 resident physicians who did not meet criteria for burnout. Six key themes were identified: (1) program leadership, (2) learning climate, (3) connectedness, (4) joy in medicine, (5) life balance, and (6) intrinsic factors. These themes align with the principles of positive psychology, in which well-being goes beyond “mere” happiness and life satisfaction. Indeed, the authors conclude by emphasizing that “efforts to promote thriving in medicine are equally as important as efforts to mitigate burnout.”

An examination of the associations among USMLE Step 3 scores and likelihood of disciplinary action in practice Cuddy MM, Liu C, Ouyang W, Barone MA, Young A, Johnson DA. Acad Med. 2022 Jun 7. doi: 10.1097/ACM.0000000000004775. Epub ahead of print. PMID: 35675131. Dr. Monica Cuddy has been a Gold Foundation grantee.
The United States Medical Licensing Examination (USMLE) consists of three step examinations, of which the last, Step 3, assesses “for the unsupervised practice of medicine, with an emphasis on patient management in ambulatory settings.”  While Step 3 scores have previously been associated with future performance on in-training examination and board certification examination scores, it has been unclear how scores relate to future behavior in clinical practice. Dr. Monica Cuddy and colleagues sought to address this gap through the analysis of 275,392 board-certified physicians who passed the Step 3 between 2000 and 2017. Through cross-classified multilevel logistic regression models, they examined the likelihood of receiving a disciplinary action, controlling for scores from other USMLE Step examinations and accounting for jurisdiction and specialty. They determined that higher Step 3 scores were associated with decreased odds of receiving disciplinary action. In fact, for every 1-standard deviation increase in Step 3 scores, there was a 23% decreased likelihood of disciplinary action. According to the authors, these results provide “some validity evidence for the use of USMLE Step 3 scores for making medical licensure decisions in the United States.”

InspirE5: a participatory, internationally informed framework for health humanities curricula in health professions education Carr SE, Harris A, Scott K, Ani-Amponsah M, Hooker C, Phillips B, Noya F, Mavaddat N, Vuillermin DM, Reid S, Brett-MacLean P. BMC Med Educ. 2022 Jun 24;22(1):490. doi: 10.1186/s12909-022-03551-z. PMID: 35739520; PMCID: PMC9225807. Free full text Dr. Pamela Brett-MacLean has been a Gold Foundation grantee.
In recent years, there has been a proliferation in the creation and publication of health humanities-related curricula. However, these curricula have largely been “brief, episodic installments” and have lacked a wider, international perspective. To facilitate greater integration of health humanities as core curricula in health professions education, Dr. Sandra Carr and colleagues developed the InspirE5 model of curriculum design and evaluation framework. To do so, they engaged in a participatory action research project that consisted of three phases: perspective sharing and collaboration building, evidence gathering, and development of an internationally relevant curriculum and evaluation framework for health humanities. Through a series of virtual meetings and workshops, the investigators designed a framework that had five principal foci: (1) environment, (2) expectations, (3) experience, (4) evidence, and (5) enhancement. Additionally, 11 Graduate Capabilities of Health Humanities were suggested, to help guide curriculum development and assessment. The authors hope that this more standardized approach my help educators better describe and compare health humanities education so that initiatives can be adopted more easily.

Shared decision-making for patients hospitalized with acute myocardial infarction: A randomized trial Branda ME, Kunneman M, Meza-Contreras AI, Shah ND, Hess EP, LeBlanc A, Linderbaum JA, Nelson DM, Mc Donah MR, Sanvick C, Van Houten HK, Coylewright M, Dick SR, Ting HH, Montori VM. Patient Prefer Adherence. 2022 Jun 1;16:1395-1404. doi: 10.2147/PPA.S363528. PMID: 35673524; PMCID: PMC9167591. Free full text Drs. Marleen Kunneman and Victor Montori have been Gold Foundation grantees.
Shared decision-making is the process by which clinicians and patients can co-create treatment plans. It has been associated with potential benefits for patients, including increased satisfaction, knowledge, and involvement. Yet rigorous randomized controlled trials evaluating SDM are rare. Dr. Megan Branda and colleagues sought to examine this in the context of acute myocardial infarction (AMI). They devised a randomized control trial, comparing (1) patient knowledge of expected survival benefit from taking medications, (2) satisfaction with knowledge transfer, and (3) adherence to medications between two groups: one control group (n=52) receiving usual care and the other, interventional group (n=53) utilizing the AMI Choice conversation tool. They determined that participants in the AMI choice group had significantly higher knowledge of expected survival benefit (62%) compared to those in the usual care group (16%). However, differences in medication adherence at 6 months and satisfaction with knowledge transfer were not statistically significant between the two groups. Based on these findings, the authors conclude that AMI Choice is a feasible and effective tool to support SDM. Yet they caution that more research is needed, particularly in its applicability for populations that are at high risk for nonadherence. Therefore, they mention that “our trial results do not constitute evidence for its adoption.”

“Room to Reflect”: A pilot workplace resiliency intervention for nurses Muir KJ, Webb-Jones J, Farish N, Barker K, Miller-Davis C, Galloway S. Int J Environ Res Public Health. 2022 Jun 14;19(12):7272. doi: 10.3390/ijerph19127272. PMID: 35742534; PMCID: PMC9224273.
Clinician well-being continues to be a pressing issue for the nursing workforce. Numerous interventions have been proposed to help support nurse well-being. Dr. K. Jane Muir and colleagues evaluated one such mobile workplace intervention utilizing Virtual Reality that they call “Room to Reflect” (R2R). R2R consists of two elements: a mobile toolbox and a pocket guide, and contains a variety of technological offerings to promote mindfulness and awareness practices. To measure the impact of R2R, the investigators implemented their intervention in seven healthcare units for 3 months. Pre- and post-questionnaires were distributed to assess for perceived resilience (using the Connor-Davidson Resilience scale), interventional feasibility, accessibility, and effectiveness. Comparing the 97 responses from the pre-intervention survey and the 57 responses from the post-intervention survey, they noticed an increase in resilience. Although space and time were the most common barriers to its use, staff nurses felt supported by managers to use the program and nurse managers felt that the program improved job satisfaction. The authors concluded that “this program establish[es] a groundwork for future development of well-being interventions integrating mobile and easy-to-use well-being technologies.”

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Bharat Kumar, MD

Humanism in Research Assistant Editor

Updates the staff, databases, and social media about new studies around humanism in healthcare; curates and compiles the monthly Jeffrey Silver Humanism in Healthcare Research Roundup.