Purpose: To establish the validity and reliability of the Compassionate HEART Patient Questionnaire (CHPQ) for measuring relationship-centered care and exploring associations between patient ratings and mood state changes in patients with persistent pain. Methods: Thirty-nine adults with persistent pain (> 3 months) completed pre-/post-interaction Profile of Mood States assessments and rated providers using the Consultation and Relational Empathy (CARE) measure and the novel CHPQ following physical therapy evaluations. Psychometric properties were assessed through factor analysis, concurrent validity (correlation with CARE), and internal reliability (Cronbach's alpha). Pre-post mood changes were analyzed using Wilcoxon signed-rank test. Results: The CHPQ demonstrated good internal consistency (α = 0.86) and moderate correlation with CARE (r = 0.673, p < 0.001). Factor analysis revealed three factors explaining 85.9% of variance: Connected Compassionate Competence (54.3%), Genuine Therapeutic Presence (18.1%), and Relational Alliance (13.5%). Total Mood Disturbance decreased significantly post-interaction (-17.41 points, p < 0.001) with reductions in anger, tension, confusion, depression, and fatigue. Vigor also decreased significantly (-8.70, p < 0.001). CHPQ scores negatively correlated with fatigue reduction (r = -0.493, p = 0.001). Conclusions: The CHPQ shows promising psychometric properties as a comprehensive measure of relationship-centered care. The paradoxical vigor decrease alongside reduced negative affect suggests complex emotional processing during therapeutic encounters. The correlation between CHPQ scores and fatigue reduction indicates that compassionate care may mitigate specific distress aspects in patients with persistent pain. Future research should explore longitudinal outcomes and incorporate qualitative methods.
Purpose: (1) Identify what characteristics patients evaluate when choosing their primary care provider (PCP), (2) characterize how provider characteristics factor into patients’ choice of PCP, and (3) develop a list of features for a quantitative preference study in the form of a discrete choice experiment (DCE). Methods: We used a cross-sectional, qualitative study to accomplish the objectives. We recruited participants from an internal medicine clinic and the general public in North Carolina. We used convenience and purposive sampling to recruit participants as a single sample. All participants completed a semistructured interview. We then used a reflexive thematic analysis to analyze the data. We conducted a focus group to confirm and refine the interview findings. Finally, we created and prioritized a list of attributes and attribute levels for use in a future DCE study. Results: We conducted 12 interviews to reach data saturation. Participants mostly identified as female (75%, n = 9), white (67%, n = 8), and non-Hispanic/Latino (83%, n = 10), with a mean age of 39 years (SD = 15). Participants reported examining factors across several domains when deciding on their PCP: (1) knowledge/experience/age, (2) gender alignment, (3) convenience, and (4) cost. Based on the results of the interviews, we selected five preference-sensitive attributes and confirmed these with the focus group. Attributes that will be included in a future study include provider profession, provider race and gender, an attribute describing what the provider is known for, appointment availability, and driving time. Conclusions: We found that participants reported evaluating several important factors when deciding on selecting a PCP. Elucidating patients’ willingness to accept different types of PCPs has policy implications for provider integration, cost-savings, and workload optimization.
Purpose: To develop and report the psychometric properties of a comprehensive scale designed to measure stereotypes and attitudes of the general population towards people with Parkinson’s disease (PwP). Methods: The development and analysis of the Parkinson's Disease Stigma Perception scale (PDSP) included four phases: 1) literature review, 2) item development, 3) tests of validity and reliability, and 4) dissemination of a preliminary version. Internal consistency was assessed using Cronbach's alpha, exploratory factor analysis (EFA) to explore underlying structures, and confirmatory factor analysis to test the model's fit. Results: Six (2%) of the 294 survey respondents were disqualified because of incomplete data. The mean age was 38.3 ± 15.9 years, 70.1% were women, and mean education was 16.5 ± 3.37 years. EFA identified three factors with eigenvalues > 1 (social avoidance and negative attitudes, prejudice and discrimination, and stereotypes). A root mean square error of approximation of 0.07 indicated acceptable fit, while a comparative fit index of 0.90 suggested adequate fit. Cronbach's alpha and McDonald’s omega yielded 0.74 and 0.83, respectively, with low floor effects (2.4%) and no ceiling effect. Item-total correlations ranged from 0.30 to 0.60 (p < 0.001). Conclusions: The PDSP demonstrated reliability and validity in assessing stigmatizing attitudes towards PwP. Future studies can further explore the scale's impact and its applicability across various contexts.
Purpose: The aim of this study was to investigate treatment and outcomes differences, as well as predictors of early mortality, among early-onset pancreatic adenocarcinoma (EOPC, ≤ 50 years), average-onset pancreatic adenocarcinoma (AOPC, 51-69 years), and late-onset pancreatic adenocarcinoma (LOPC, ≥ 70 years). Methods: We retrospectively analyzed 333 patients with pancreatic adenocarcinoma at a multi-site center between 2011-2018. Clinical, demographic, and treatment variables were compared by age group. Predictors of early mortality (death ≤ 6 months from diagnosis) were assessed using multivariable logistic regression. Survival outcomes were evaluated using Kaplan-Meier analyses. Results: Among the 333 patients, 56% were male, and the mean age was 61.5 years. EOPC patients had higher rates of tobacco use (68% vs 54%, p = 0.0094) and higher histological grade (57% vs, 41%, p = 0.048) than older cohorts. In non-metastatic patients, EOPC patients were more likely to undergo curative intent surgery (70% vs 38%, p ≤ 0.0001) and receive adjuvant radiation (40% vs 15%, p = 0.002). Early mortality occurred in 28% of non-metastatic and 59% of metastatic patients, with lower rates in EOPC. Predictors of early mortality included older age, higher neutrophil-to-lymphocyte ratio, lack of surgery, and absence of radiation therapy in univariable analysis; however, none of these factors remained significant in multivariable analysis. Median survival was 11.1 months in EOPC, 8.7 months in AOPC, and 4.3 months in LOPC. Conclusions: EOPC patients demonstrate better survival and receive more treatments than older cohorts. Despite these differences, PC outcomes remain poor across all groups. Further research is warranted to validate early mortality predictors and inflammatory biomarkers in EOPC.
Higher education institutions are increasingly committed to recruiting more diverse students. As these efforts succeed, institutions face the parallel challenge of meeting an evolving student body's broader and more complex healthcare needs. This article highlights how student health insurance is a critical need that may be unmet by institutions traditionally designed for young, healthy, able-bodied students. Graduate and professional students are particularly vulnerable to a “health insurance trap”; they may discover, only after enrollment, that their plan does not cover essential care, they can no longer work full-time to gain commercial insurance, they have aged out or do not have access to their parent’s insurance, and they cannot afford care. This creates significant educational and financial risks that disproportionately affect students already marginalized in healthcare systems. We explore how this “higher education insurance trap” perpetuates health inequities and educational barriers. To address these challenges, we present institutional, policy, and research-based strategies to improve transparency, promote accountability, and expand access to comprehensive student coverage.
Pelvic Inflammatory Disease (PID) is an inflammatory syndrome of the upper female reproductive organs caused by infection, most commonly via Neisseria gonorrhoeae or Chlamydia trachomatis, spreading to one or more reproductive organs. With PID responsible for many of the major morbidities of sexually transmitted infections (STIs), such as ectopic pregnancy and chronic pelvic pain, the urgency is high to mitigate the impacts of untreated PID, especially in higher-risk populations. This paper discusses the current disparities in PID diagnosis, treatment, and management between Black and white women and proposes interventions to reduce health inequalities involving PID. To conduct this narrative review, a broad literature search was performed across the databases, PubMed and Google Scholar, using a combination of relevant keywords and headings. Current literature reports higher PID rates in Black versus white women, although disparities were shown to be attenuated after controlling for factors such as socioeconomic status and STI rate. These results may suggest that Black women are more likely to experience an asymptomatic or undiagnosed STI, supported by studies showing that Black women are less likely to report STI testing than white women. Public health efforts should focus on culturally sensitive messaging and interventions that improve sexual health awareness and behavior. Provider education interventions can also help mitigate bias and improve adherence to CDC guidelines for PID diagnosis and management, with the goal of reducing healthcare disparities and improving patient outcomes.
We are deeply grateful for our diverse pool of academic and clinical reviewers at the Journal of Patient-Centered Research and Reviews (JPCRR). When called upon, the experts listed below stepped up and generously volunteered their time to review and rigorously gatekeep our original manuscript submissions. These devoted reviewers are an invaluable part of JPCRR and greatly help us maintain the high quality of our articles and achieve our goal of advancing patient-centered practices, health outcomes, and patient experiences.
Purpose: Veterans with mental illness have high rates of tobacco use and psychiatric hospitalization in the Veterans Health Administration (VA). VA is smoke-free, and guidelines recommend that smoking cessation medication and counseling be delivered during and one month after hospitalization to sustain abstinence. Little is known about how patients experience this intervention. This pilot study evaluated the acceptability, feasibility, and efficacy of an evidence-informed, novel smoking intervention, StayQuit, for psychiatric inpatients. Methods: Participants were recruited from an inpatient VA psychiatric unit. Changes in self-reported cigarettes smoked per day, nicotine dependence, and abstinence self-efficacy were evaluated between baseline and 12-week follow up. Participants were interviewed about their experiences. Results: The sample (n = 26) was predominantly white, male, and diagnosed with a depressive disorder. Fifteen (58%) participants completed at least one counseling session and the follow-up assessment. Among them, there was a statistically significant reduction in mean cigarettes smoked per day and increase in abstinence self-efficacy. Participants appreciated the knowledge and supportiveness of interventionists and reported that StayQuit helped them make progress towards their smoking goals. Conclusions: Evidence-informed interventions like StayQuit are acceptable to Veterans, but implementation-focused research is needed to maximize feasibility in real-world settings.
Purpose: Older adults are among the highest users of the emergency department (ED), comprising over 50% of those discharged home from the ED. The Geriatric Emergency Department (GED) guidelines recommend addressing transitions of care that connect older adults with timely outpatient services to decrease adverse events. The purpose of outpatient follow up is to evaluate and adjust patient treatment, if necessary, following an ED visit to prevent adverse events. Methods: A prospective, descriptive pilot study was conducted to gather preliminary data on the potential impact of follow-up outpatient appointment coordination types (standard care, point-of-care scheduling, and portal reminder message). Older adults 65 years and over, who were discharged from six accredited GEDs within one healthcare system from October 2023 to May 2024, were included. The primary outcomes were follow up on outpatient appointment within 30 days. Secondary outcomes were 30-day ED revisit and 30-day unplanned hospitalization. Results: The point-of-care method/scheduling the outpatient appointment prior to GED discharge resulted in the highest outpatient follow up (63%) within 30 days of GED discharge compared to standard care (44%) and portal reminder message (35%). None of the coordination follow-up methods impacted 30-day GED revisits or hospital admission statistically. Conclusions: This study provided important preliminary data about the benefit of point-of-care scheduling for older adults. More research is needed to determine which older adults could benefit from point-of-care scheduling and the impact on healthcare utilization.
Purpose: Medically tailored meal (MTM) programs generally demonstrate meaningful health outcomes for patients. There is a need to evaluate novel MTM delivery methods to understand participant and organizational-level impacts. The objectives of this study were to assess a shipped MTM pilot intervention, including 1) initial and ongoing client reach, 2) effects on clients’ health and behaviors, and 3) staff members’ perceptions of factors that influence intervention maintenance. Methods: Based on the reach, effectiveness, adoption, implementation, maintenance (RE-AIM) framework, the mixed methods design included quantitative data collected from participants and qualitative data collected from MTM provider staff. The pilot took place in San Diego County, California, through one MTM provider. The 12-week pilot intervention included 21 MTMs per week and two virtual nutrition education sessions with a registered dietitian. Initial and ongoing reach measures included enrollment and completion rates, disenrollment rationale, and participant demographics. Measures of effectiveness included dietary patterns, chronic disease management, perceptions of food-related programming, and intervention satisfaction. Factors influencing intervention maintenance were assessed qualitatively. Results: The MTM provider surpassed their goal of enrolling > 50 clients, but only 40% completed at least nine weeks of the pilot. There were statistically significant increases in intake of vegetables excluding potatoes and number of meals per day from pre- to post-implementation. Clients perceived that MTMs and food-related programming helped them to achieve or maintain a healthy weight, eat healthier foods, improve their health, and feel better. Interview results with staff showed that some but not all factors leading to sustainability were present. Conclusions: Overall, this evaluation of a pilot MTM program in San Diego County revealed mixed findings in intervention reach, effectiveness, and potential intervention maintenance.
Cryoablation has emerged as a promising treatment option for early-stage non-small cell lung cancer (NSCLC) and lung metastases. This narrative review examines recent literature on cryoablation's efficacy, safety, and outcomes in treating lung tumors. The review analyzes data from multiple clinical trials and observational studies, focusing on local tumor control rates, overall survival, and complications. Results indicate that cryoablation achieves high local tumor control rates, ranging from 85% to 97% at one year, for both primary NSCLC and pulmonary metastases. Overall survival rates are comparable to surgical resection, with one-year rates up to 97.7% reported in some studies. Cryoablation offers several advantages over traditional treatments, including cost-effectiveness, shorter hospital stays, and the ability to treat multiple tumors in a single session. It is particularly beneficial for patients who are poor surgical candidates or those who have previously undergone lung surgery. While pneumothorax remains a notable complication, its occurrence is generally manageable. The review concludes that cryoablation is a viable alternative to surgery and radiation therapy for select patients with lung tumors. However, further research is needed to establish its long-term efficacy and optimize patient selection criteria.
This abstract supplement includes findings presented through oral or poster presentations at the 51st annual Scientific Day event held on May 21, 2025. Scientific Day provides both an in-person and virtual forum for the sharing of research, quality improvement, and case studies conducted by Illinois- and Wisconsin-based faculty, fellows, residents, and other health professionals associated with Advocate Health.
Purpose:Patients undergoing lower extremity amputation often desire to take an active part in decision-making. The primary aim of this study was to explore patients' experiences of the care trajectory and information provided after a new care program was introduced. The secondary aim was to explore patients' perspectives of their involvement and participation in shared decision-making throughout the care process. The care program features new educational material, recommendations for the sagittal surgical technique, and information about a rigid removable dressing, early liner treatment, and a multidisciplinary team follow up three weeks after amputation. Methods:Fifteen participants who underwent transtibial amputation were included in the study and were interviewed two to three months post-surgery. Purposeful sampling was used, and data were analyzed with content analysis. Results:Three themes were identified: (1) the emotionally mixed experience of becoming a person with an amputation, (2) the need to be seen during the amputation process, and (3) the importance of being involved in care. Participants wanted to take a more active role in the decision-making process, and our multidisciplinary team follow up was an excellent example of shared decision-making. Printed information was appreciated, but the most crucial aspect was oral communication, given the gravity of the subject. Participants experienced a lack of continuity throughout the care trajectory. Conclusions:Individualized oral information and interaction with dedicated healthcare professionals are essential for participants undergoing transtibial amputation. Implementing a multidisciplinary team consultation pre-amputation may enhance patient involvement and promote shared decision-making.
Purpose:Myocardial infarction (MI) remains to be associated with a high risk of recurrent cardiovascular events and disease burden. This study assessed patient perspectives on the burden of disease and treatment in the first year post-MI. Methods:Data were collected via a self-administered online questionnaire posted on the Carenity patient platform in the United States (10/30/2022-12/30/2022). Only patients who had an MI in the prior year were eligible for inclusion. Results:A total of 151 patients completed the survey. The majority were men (69%), median age was 50 years, and 38% had an MI within the previous 90 days. Overall, post-MI complications were reported in 44% of the patients, including depression (23%), recurrent MI (7%), and stroke (7%). Follow-up care was provided by general/clinical cardiologists (67%), interventional cardiologists (38%), and general healthcare providers (59%). Most patients (80%) reported involvement in treatment decisions. The number of prescribed medications was considered the main contributor to post-MI treatment burden; approximately 42% of the patients found it tedious remembering to take their medications. The most commonly quoted post-MI treatment goal was recurrent MI risk reduction. Additionally, 73% of the patients considered improving quality of life to be a key goal. Overall, the patients' emotional well-being, physical well-being, and personal life were particularly impacted by MI. "Stress/anxiety/fear" was the most frequently reported emotion immediately post-MI, and one-third conveyed MI's negative impact on their employment status. MI impacted household finances in 74% of patients, with 38% losing income. Conclusions:MI places a substantial burden on patients. Understanding patient experiences post-MI may enhance patient-centered care.
This editorial provides an overview of large language models (LLMs), the risks associated with their use, and the challenges involved in using artificial intelligence (AI) to determine the extent to which LLMs have been used to write text, including articles for publication in medical journals. As narratives generated by LLMs become increasingly difficult to distinguish from human writing, concerns have emerged about their impact on scholarly communication, particularly in health and medicine. The medical community is becoming more aware of various tools that can detect AI-generated text; however, adopting these tools comes with unique challenges. The purpose of this article is to provide readers with an understanding of how AI text detectors work, the limitations of these tools, and recommendations for what medical editors, reviewers, and readers can do to navigate these challenges, along with future directions to help safeguard the integrity of scholarly work.
Purpose:To gain insight into the self-management and support needs of patients experiencing persistent symptoms consistent with hypothyroidism, despite thyroid laboratory values within the normal range. Methods:A qualitative study using the phenomenological approach was conducted. Semi-structured interviews including 19 patients diagnosed with persistent symptoms consistent with hypothyroidism, despite receiving adequate replacement therapy, were performed. Respondents were recruited using purposive sampling via Schildklier Organisatie Nederland (Dutch Thyroid Organization) (www.schildklier.nl). After transcription and coding, a thematic analysis was performed. Results:All respondents reported that the persistent symptoms reduced their quality of life. The patients' main focus was on finding the cause of these symptoms and balancing activities in their personal, social, and professional lives. The most frequently mentioned support need was for physicians to pay more attention to patients' symptoms. Respondents expected that this would mainly improve their mental quality of life. Conclusions:Giving greater attention to persistent symptoms consistent with hypothyroidism in medical guidelines and (continuing) education might make general practitioners and internists more aware of these symptoms. This might help them better understand the impact of the persistent symptoms on quality of life and the support needs of patients, thereby improving the conversation between patients and physicians. This may reduce the perceived gap between patients' needs and what physicians (are able to) provide, which might support self-management of these persistent symptoms.
Clinicians routinely interpret statistical findings from medical research to inform patients of treatment benefits. Studies that use the hazard ratio present special challenges. Clinicians should not equate hazard ratios with risk ratios, ie, relative risks. However, clinicians can provide patients with a straightforward interpretation of the hazard ratio as an odds, as long as the ratio was calculated in a study in which the assumption of proportional hazards is justified. In such a case, the hazard ratio is equivalent to the odds that a person, who is randomly chosen from the group represented in the ratio’s numerator, experiences an event before a randomly chosen person from the group represented in the ratio’s denominator. A mathematical derivation for the equivalence is provided to further clarify this idea for clinicians.
During this unprecedented time of uncertainty and disruption, the 2025 Annual Conference of the Health Care Systems Research Network (HCSRN) took place on April 8 to 10, 2025, in St. Louis, Missouri, at the Marriott St. Louis Grand. Nearly 265 participants from 19 HCSRN member institutions came together to network, collaborate, and connect at the conference, which featured the theme, “Optimizing Collaborations to Advance Health in a Dynamic Research Landscape.”
Purpose: Atrial fibrillation (AF), the most common arrhythmia in older adults, is often treated with cryoballoon ablation (CBA) or laser balloon ablation (LBA) when refractory to medication. We used real-world patient data to investigate differences in arrhythmia-free survival, procedure and fluoroscopy times, and complications between these techniques. Methods: In this single-center, retrospective study of 178 patients with symptomatic paroxysmal AF referred for first-time pulmonary vein isolation (PVI), 103 underwent CBA, and 75 underwent LBA. Recurrence was defined as any atrial arrhythmia of > 30 seconds’ duration after a three-month blanking period. Complications at 30 days were recorded. Kaplan-Meier analysis was used to estimate arrhythmia-free survival at one year for both groups. Categorical variables were expressed as n (%) and continuous variables as mean ± standard deviation or median (Q1, Q3). Results: Baseline characteristics were similar between groups, with exception to left atrial volume index (CBA 32.2 ± 10.9 ml/m^2; LBA 36.0 ± 11.0 ml/m^2, p = 0.047). History of stroke was higher in CBA (13.6% vs 2.7%; p = 0.012), as was coronary artery disease (35.0% vs 14.7%, p = 0.002). Median fluoroscopy and procedure times (min) were significantly shorter in LBA (24.2 vs 31.6, p = 0.004; 141.0 vs 210.0, p < 0.0001, respectively). One-year arrhythmia-free survival rates were similar (CBA 79.1% vs LBA 78.7%, p = 0.934), as were total complication rates (21.4% vs 16.0%, p = 0.289), including rates of transient ischemic attack/stroke and vascular complications. Conclusions: In patients with paroxysmal AF undergoing PVI, CBA and LBA were equally efficacious at one year and demonstrated acceptably low complication rates. LBA was associated with reduced procedure time and fluoroscopy exposure.
