Publications

BACKGROUND: Wearable devices are becoming more ubiquitous and are capable of capturing health-relevant information that patients may be interested in sharing with their providers. However, limited research has been conducted on oncology provider perspectives on how these data could be used to inform cancer care.

OBJECTIVE: The goal of this study was to understand oncology clinicians' preferences about which data would be most clinically valuable and in what clinical scenarios, the benefits and barriers to integrating wearable device data into cancer care, and perspectives on how wearable device data could impact decision-making using 3 clinical vignettes.

METHODS: A total of 13 oncology care clinicians completed an online questionnaire to assess the perceived value of different types of wearable device data in different clinical scenarios and participated in semistructured interviews to gather preferences around integrating these data into clinical workflows. During the interviews, providers were also presented with 3 clinical vignettes and asked for clinical recommendations both before and after seeing the patient's wearable device data. Descriptive statistics were calculated to summarize quantitative data from questionnaires and structured interview questions, and interviews were transcribed and coded using an iterative thematic analysis approach.

RESULTS: Survey responses indicated that providers were most interested in tracking vital sign metrics, followed by data related to falls and functioning, and then by data on sleep and activity. Clinicians thought that wearable device data might be especially useful for remotely monitoring patients at high-risk moments in their care trajectory, such as after an acute hospitalization or after starting a new outpatient treatment. Four main themes were discussed by providers in the interviews: (1) corroborating reports, (2) identifying new issues, (3) coordinating care, and (4) patient-provider communication. Although there were no statistically significant differences in clinical recommendations before and after viewing wearable device data for any vignette (all P>.25), all clinicians reported that the wearable device data impacted their decision-making confidence, and most rated the wearable device data as helpful.

CONCLUSIONS: Oncology providers highlighted the potential clinical value of vital sign and physical functioning data from wearable devices, particularly when outpatients might be at risk for readmissions or other acute deteriorations between clinic visits. Providers noted that the objective data captured by consumer wearable devices can be helpful complements to patient and caregiver subjective reports and that this information could improve patient-provider communication and care coordination. During the interviews, most providers found wearable device data to be helpful when making decisions. While there are challenges to address on how to integrate this information into the clinical workflow and communicate alerts with patients, there is cautious enthusiasm among clinicians about how these data could inform and improve cancer care.

Eating disorders (ED), particularly anorexia nervosa (AN), represent high-morbidity, high-mortality psychiatric illnesses with multisystem medical complications, frequent relapse, and substantial caregiver burden. As palliative care (PC) clinicians increasingly encounter patients with severe and enduring ED, they may be asked to help manage complex symptom distress, navigate treatment refusals, support families, and participate in values-based goals of care discussions amid prognostic uncertainty. At the same time, the emerging and contested discourse around "terminal anorexia nervosa" underscores the need for careful clinical reasoning, nuanced capacity assessment, and ethically rigorous, interdisciplinary deliberation. In this article, an interdisciplinary group of PC, psychiatry, psychology, and eating-disorder specialist clinicians presents a practical "Top Ten Tips" framework to support real-world care. Tips emphasize early recognition of countertransference and moral distress, medical severity assessment and refeeding risk, trauma-informed and harm-reduction approaches, task-specific decision-making capacity evaluations, communication strategies that prioritize values and meaning over labels, and collaboration with eating-disorder specialty teams, ethics consultation, and community resources. We aim to provide actionable guidance that strengthens PC clinicians' confidence and consistency when caring for patients with severe EDs.

BACKGROUND: Cancer care increasingly emphasizes holistic, patient-centered support across the disease trajectory; however, many health systems lack sufficient resources to address patients' physical, psychosocial, and logistical care needs, particularly in under-resourced settings. Patient navigation, delivered by trained non-clinician, peer, or community-based navigators, has demonstrated effectiveness in improving cancer screening and treatment initiation, yet its role in addressing the ongoing health and related care needs of people living with cancer remains less well characterized.

METHODS: This scoping review aimed to synthesize peer-reviewed and gray literature evaluating patient navigation interventions focused on the care needs of people living with cancer to summarize program characteristics, facilitators, and barriers. A search of Ovid MEDLINE (1990-June 2024) identified 4300 records.

RESULTS: Following rigorous screening and data extraction, 17 studies met the inclusion criteria. Most studies were conducted in the United States (88%), and over half employed randomized or cohort designs. Navigation programs varied widely in patient populations, cancer types, intervention duration, delivery modality, and navigator training and roles. Nearly half of the studies targeted under-resourced or marginalized populations. Interventions commonly addressed unmet needs, symptom management, care coordination, survivorship, palliative and end-of-life care, insurance, or psychosocial support. Across heterogeneous outcomes, most studies reported statistically significant improvements in patient-reported outcomes (e.g., quality of life, self-efficacy, psychosocial well-being), navigation process outcomes (e.g., satisfaction, feasibility, navigator-patient relationships), and, less frequently, health-related outcomes such as health care access and utilization. Key facilitators included strong institutional infrastructure, integration within oncology teams, flexible and accessible delivery, cultural responsiveness, and robust navigator training and supervision. Barriers included limited perceived need among lower-acuity patients, role ambiguity, technological challenges, insufficient follow-up, reimbursement constraints, and mismatches between program intensity and patient or caregiver needs.

CONCLUSIONS: Findings highlight the importance of flexible, relationship-centered, and well-integrated patient navigation models and underscore the need for standardized training, sustainable reimbursement, and patient-driven programs designed to optimize impact and equity.

Oncology Advanced Practice Providers (APPs) including Advanced Practice Registered Nurses, Physician Assistants, and Clinical Pharmacists (CPs), play a vital role in delivering high-quality, patient-centered cancer care across the United States. Despite their widespread presence in oncology practices, APPs remain underutilized in cancer clinical research, representing a missed opportunity to expand trial access and improve patient outcomes. Clinical trials are essential to advancing oncology care, yet participation remains critically low among adult patients. Given Oncology APPs' and CPs' central role in cancer care delivery, their meaningful engagement in oncology clinical trial research is imperative as the standard of oncology care. This position paper, with contributions from five professional societies, presents solutions and resources to barriers limiting APPs' and CPs' involvement in cancer clinical research, including gaps in education, role expectations, limited protected time, restrictive policies, insufficient financial support, and under-recognition of contributions. Integrating APPs and CPs more fully into the clinical research enterprise is essential to improving trial access, patient outcomes, closing equity gaps, and accelerating innovation in oncology care.

BACKGROUND: Breast cancer survivors (BCS) experience persistent physical and psychological effects after treatment, with racially diverse groups demonstrating lower adherence to cancer-specific resistance exercise guidelines. Online resistance exercise interventions show promise for enhancing accessibility and health outcomes among BCS. However, evidence regarding their feasibility of implementation remains limited. Yet, such information is critical for assessing scalability and implementation in non-laboratory settings.

PURPOSE: Using the RE-AIM (reach, efficacy, adoption, implementation, and maintenance) framework, this study evaluated the reach, efficacy, adoption, and implementation of a 12-week, supervised, online resistance exercise intervention for racially diverse BCS.

METHODS: A mixed methods approach with a pre-post-study design was used. Quantitative outcomes included sociodemographic representativeness (reach), physical function (efficacy), and session fidelity (implementation). Qualitative interviews examined participant experiences, barriers, and facilitators (adoption).

RESULTS: The intervention enrolled a racially diverse BCS sample (N = 47; 57.4% White, 23.4% Black, 14.8% Asian) that was mostly representative of the host institution catchment area, though participants had higher education levels. The intervention group demonstrated statistically significant improvements in upper- (P = .009) and lower-body physical function (P = .003) versus control, only. Adoption facilitators included program convenience, accessibility of online delivery, and trainer support, while barriers were equipment challenges, competing priorities, and cancer-related side effects. Program implementation fidelity was high for core components.

CONCLUSIONS: Key factors contributed to the feasibility of implementation of the intervention. Future remote exercise interventions should address equipment needs, individualized support, and tailored recruitment to enhance adoption and facilitate scalability in non-laboratory settings.

CLINICAL TRIAL INFORMATION: The Clinical Trials Registration #NCT04562233.

BACKGROUND: To investigate the cumulative impact of individual- and neighborhood-level social determinants of health (SDoH) on patient-reported outcome measures (PROMs) among head and neck cancer (HNC) survivors.

METHODS: Among 93 survivors who underwent radiotherapy, associations between SDoH (independently and in a composite score) and validated PROMs were analyzed using univariable and multivariable regression models.

RESULTS: For every 1-point increase in the composite SDoH score, indicating an increase in the number of adverse individual- and neighborhood-level factors, physical QoL decreased by 2.92 points (p = 0.010) and depression severity increased by 0.62 points (p = 0.018). Higher neighborhood deprivation and Medicaid/no insurance were associated with worse physical and social-emotional QoL, depression severity, and anxiety severity. Higher neighborhood deprivation was also associated with worse neck disability.

CONCLUSION: Accumulating adverse individual- and neighborhood-level SDoH collectively increase the risk of poorer PROMs. Multilevel SDoH interventions are needed to improve health outcomes and promote equitable care in HNC.

BACKGROUND: As syphilis cases increase across the U.S., the emergency department (ED) has emerged as a critical venue for screening. However, little is known about the current ED screening landscape. This study aims to evaluate the national landscape of ED syphilis screening, identify barriers to implementation, and characterize existing infrastructure that may support expansion of syphilis screening in the ED.

METHODS: Electronic surveys were distributed via email to 281 institutions with emergency medicine residency programs. Survey responses were also solicited from institutions both with and without residency programs utilizing relevant professional society listservs and in-person conference recruitment from October 2023 through May 2024. Responses were summarized using descriptive statistics and stratified by hospital type.

RESULTS: A total of 138 unique EDs responded (105 academic, 33 non-academic). Systematic syphilis screening was reported by only 12.6% of EDs and was more frequent in academic centers. Most screening protocols were risk-based; universal screening was rare. HIV screening programs were present in 60.0% of academic and 30.3% of non-academic EDs. Most EDs relied on designated staff for result review and patient notification, but more than one-quarter reported no defined treatment location for syphilis. Commonly cited facilitators to screening included standardized guidelines, electronic medical record integration, and additional staffing, while major barriers included time constraints, limited resources, and challenges with follow-up.

CONCLUSIONS: Despite rising syphilis rates, ED-based syphilis screening remains uncommon. Existing HIV and sexually transmitted infection screening and treatment infrastructure may provide a foundation for expanding syphilis screening through operationally feasible, guideline-supported approaches.

BACKGROUND: Although mobile health (mHealth) apps for tobacco cessation augment traditional cessation methods and have contributed to increases in cessation rates, Black adults are underrepresented in mHealth app studies for tobacco cessation. As a result, their mHealth app preferences are not well-known.

OBJECTIVE: Our goal was to identify features of mHealth apps for cessation that are important to Black adults who use tobacco products.

METHODS: We developed an online discrete choice experiment with 12 pairs of hypothetical mHealth apps for tobacco cessation. Inclusion criteria included being 21 years or older, current use of any tobacco product, and identifying as Black or African American. Participants had to be interested in tobacco cessation and have a history of mHealth app use or be willing to use one in the future. From each pair of hypothetical apps within the survey, participants had to choose the app they preferred. Each hypothetical app was made up of 7 features developed from existing mHealth literature and prior qualitative work: graphics, marketing, strategies for quitting, connection with others, personalization, benefits of quitting, and health information. Each feature had up to 4-5 levels (ie, variations of that attribute), and each hypothetical mHealth app was comprised of a random assortment of levels of features. Hierarchical Bayes estimation was used to determine the part-worth utility for each level within each feature for each participant, which was then used to calculate the importance score. Average importance scores across respondents were used to determine overall importance scores for each feature.

RESULTS: We had 901 adult participants. The mean age was 41 (SD 14.02) years, and about a third of participants (377/901, 42%) were female. Two-thirds of participants (549/901, 61%) had used an mHealth app in the past, and the great majority (786/901, 87%) indicated a willingness to use an app for health purposes in the future. The features had the following importance: graphics (16%), marketing (15%), strategies for quitting (15%), connection with others (14%), personalization (13%), benefits of quitting (13%), and health information (13%). Within features, strategies for quitting had the highest and third-highest levels of "making a step-by-step quit plan" and "recommendations to manage relapse or withdrawal," respectively. Marketing had the second-highest level of "Historically Black Colleges and Universities-endorsed app." Graphics had the fourth-highest level of "short video testimonials from people who successfully quit," while connection with others had the fifth-highest level of "quit buddy program for support and accountability."

CONCLUSIONS: This study identified features of mHealth apps important to Black adult tobacco users. To enhance the appeal of mHealth apps to such adults, prioritizing inclusion of highly preferred levels in apps may lead to higher use and improved cessation.