Objective-We sought to test whether variations across regions in end-of-life (EOL) treatment intensity are associated with regional differences in patient preferences for EOL care.Research Design-Dual-language (English/Spanish) survey conducted March to October 2005, either by mail or computer-assisted telephone questionnaire, among a probability sample of 3480 Medicare part A and/or B eligible beneficiaries in the 20% denominator file, age 65 or older on July 1, 2003. Data collected included demographics, health status, and general preferences for medical care in the event the respondent had a serious illness and less than 1 year to live. EOL concerns and preferences were regressed on hospital referral region EOL spending, a validated measure of treatment intensity.Results-A total of 2515 Medicare beneficiaries completed the survey (65% response rate). In analyses adjusted for age, sex, race/ethnicity, education, financial strain, and health status, there were no differences by spending in concern about getting too little treatment (39.6% in lowest spending quintile, Q1; 41.2% in highest, Q5; P value for trend, 0.637) or too much treatment (44.2% Q1, 45.1% Q5; P = 0.797) at the end of life, preference for spending their last days in a hospital (8.4% Q1, 8.5% Q5; P = 0.965), for potentially life-prolonging drugs that made them feel worse all the time (14.4% Q1, 16.5% Q5; P = 0.326), for palliative drugs, even if they might be life-shortening (77.7% Q1, 73.4% Q5; P = 0.138), for mechanical ventilation if it would extend their life by 1 month (21% Q1, 21.4% Q5; P = 0.870) or by 1 week (12.1% Q1, 11.7%; P = 0.875).Conclusions-Medicare beneficiaries generally prefer treatment focused on palliation rather than life-extension. Differences in preferences are unlikely to explain regional variations in EOL spending. Previous studies have shown that regions with greater overall EOL spending do not have better outcomes; mortality, quality of care, and patient satisfaction among cohorts of patients with common serious conditions are sometimes worse, 2,3 as are perceptions of the quality of EOL care among bereaved family members. 4 In contrast, higher spending regions do have a greater regional supply of specialists, 5 hospital and ICU beds, 6-9 and other technologies. 10,11 Physicians who practice in high-intensity regions have a greater tendency to recommend tests, referrals, and treatments for patients described in structured vignettes and are less likely to refer to hospice. 12,13 It is unknown whether these differences in supply and physician practice style reflect differences in preferences for treatment among patients who reside in these highspending regions. Yet, the policy prescriptions for addressing these regional variations depend critically on whether they are the consequence of differences across regions in patient preferences, the consequence of physician "enthusiasm" or "supplier-induced demand," or other factors related to the supply of health care capacity. 14-16We sought to determine whether EOL tr...

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BACKGROUND: Studies using local samples suggest that racial minorities anticipate a greater preference for lifesustaining treatment when faced with a terminal illness. These studies are limited by size, representation, and insufficient exploration of sociocultural covariables.

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A number of wearable 'lifelogging' camera devices have been released recently, allowing consumers to capture images and other sensor data continuously from a first-person perspective. Unlike traditional cameras that are used deliberately and sporadically, lifelogging devices are always 'on' and automatically capturing images. Such features may challenge users' (and bystanders') expectations about privacy and control of image gathering and dissemination. While lifelogging cameras are growing in popularity, little is known about privacy perceptions of these devices or what kinds of privacy challenges they are likely to create.To explore how people manage privacy in the context of lifelogging cameras, as well as which kinds of first-person images people consider 'sensitive,' we conducted an in situ user study (N = 36) in which participants wore a lifelogging device for a week, answered questionnaires about the collected images, and participated in an exit interview. Our findings indicate that: 1) some people may prefer to manage privacy through in situ physical control of image collection in order to avoid later burdensome review of all collected images; 2) a combination of factors including time, location, and the objects and people appearing in the photo determines its 'sensitivity;' and 3) people are concerned about the privacy of bystanders, despite reporting almost no opposition or concerns expressed by bystanders over the course of the study.

Objective Widespread technological changes, like the rapid uptake of telehealth in the U.S. during the COVID-19 pandemic, risk creating or widening racial/ethnic disparities. We conducted a secondary analysis of a cross-sectional, nationally representative survey of Internet users to evaluate whether there were racial/ethnic disparities in self-reported telehealth use early in the pandemic. Materials and Methods The Pew Research Center fielded the survey March 19-24, 2020. Telehealth use because of the pandemic was measured by asking whether respondents (N = 10,624) “used the internet or email to connect with doctors or other medical professionals as a result of the coronavirus outbreak.” We conducted survey-weighted logistic regressions, adjusting for respondents’ socioeconomic characteristics and perceived threat of the pandemic to their own health (no threat, minor, major). Results Approximately 17% of respondents reported using telehealth because of the pandemic, with significantly higher unadjusted odds among Blacks, Latinos, and those identified with other race compared to White respondents. The multivariable logistic regressions and sensitivity analyses show Black respondents were more likely than Whites to report using telehealth because of the pandemic, particularly when perceiving the pandemic as a minor threat to their own health. Discussion Black respondents are most likely to report using telehealth because of the COVID-19 pandemic, particularly when they perceive the pandemic as a minor health threat. Conclusion The systemic racism creating health and health care disparities has likely raised the need for telehealth among Black patients during the pandemic. Findings suggest opportunities to leverage a broadly defined set of telehealth tools to reduce health care disparities post-pandemic.

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AIDS prevention efforts for injection drug users (IDUs) since 1988 in over 60 inner-city areas within the United States have been based on a “provider-client” model called “street-based outreach.” We document the research showing that these traditional outreach projects operate under conditions that cause hierarchy and supervision to break down easily. The result is an array of organizational problems that push outreach projects toward inertia, and invite high levels of mal- and nonperformance by outreach workers (OWs) as rational adaptations to their work conditions. Nevertheless, research has also documented that IDUs responded very impressively to the outreach services they received. Based on IDUs' responsiveness, we outline the operational features of a “Peer-Driven Intervention” (PDI) that relies on an active collaboration with IDUs in place of a “provider-client” model. Based on a comparative study in eastern Connecticut, we present preliminary impact data comparing the effectiveness of a PDI with a traditional outreach intervention in terms of recruitment power, educational effectiveness of IDUs in the community, and comparative intervention costs.