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.
