It was found that patients with cancer who used spiritual coping to a greater extent were less likely to have a living will and more likely to desire life-sustaining measures. If efforts aimed at improving end-of-life care are to be successful, they must take into account the complex interplay of ethnicity and spirituality as they shape patients' views and preferences around end of life.
Although most patients and families endorse the primacy of the patient in decisions at end of life, the majority do not take supporting actions. Disagreements between patients and families about the use of life-sustaining measures in patients without LWs may result in patients' preferences being superseded at end of life.
Photo-elicitation is a qualitative interviewing technique that has gained popularity in recent years. It is the foundation for photovoice projects and is a tool well-suited for community-based participatory research. Photo-elicitation yields rich data, and interview participants say these interviews encourage community awareness and engagement. This article draws on 9 studies, conducted by researchers at 3 institutions (the University of Pennsylvania, the Philadelphia Veterans Affairs Medical Center, and the Geisel School of Medicine at Dartmouth) in partnership with community-based organizations and students, in which 303 participants completed photo-elicitation interviews. We offer 8 practical suggestions for overcoming challenges encountered during photo-elicitation research and for managing ethical concerns about the use of visual data in public health research. Our guidelines can inform study design, protocol development, and institutional review board approval.
Community‐engaged research (CEnR) engenders meaningful academic‐community partnerships to improve research quality and health outcomes. CEnR has increasingly been adopted by health care systems, funders, and communities looking for solutions to intractable problems.
It has been difficult to systematically measure CEnR's impact, as most evaluations focus on project‐specific outcomes. Similarly, partners have struggled with identifying appropriate measures to assess outcomes of interest.
To make a case for CEnR's value, we must demonstrate the impacts of CEnR over time. We compiled recent measures and developed an interactive data visualization to facilitate more consistent measurement of CEnR's theoretical domains.
Context
Community‐engaged research (CEnR) aims to engender meaningful academic‐community partnerships to increase research quality and impact, improve individual and community health, and build capacity for uptake of evidence‐based practices. Given the urgency to solve society's pressing public health problems and increasing competition for funding, it is important to demonstrate CEnR's value. Most evaluations focus on project‐specific outcomes, making it difficult to demonstrate CEnR's broader impact. Moreover, it is challenging for partnerships to identify assessments of interest beyond process measures. We conducted a mapping review to help partnerships find and select measures to evaluate CEnR projects and to characterize areas where further development of measures is needed.
Methods
We searched electronic bibliographic databases using relevant search terms from 2009 to 2018 and scanned CEnR projects to identify unpublished measures. Through review and reduction, we found 69 measures of CEnR's context, process, or outcomes that are potentially generalizable beyond a specific health condition or population. We abstracted data from descriptions of each measure to catalog purpose, aim (context, process, or outcome), and specific domains being measured.
Findings
We identified 28 measures of the conditions under which CEnR is conducted and factors to support effective academic‐community collaboration (context); 43 measures evaluating constructs such as group dynamics and trust (process); and 43 measures of impacts such as benefits and challenges of CEnR participation and system and capacity changes (outcomes).
Conclusions
We found substantial variation in how academic‐community partnerships conceptualize and define even similar domains. Achieving more consistency in how partnerships evaluate key constructs could reduce measurement confusion apparent in the literature. A hybrid approach whereby partnerships discuss common metrics and develop locally important measures can address CEnR's multiple goals. Our accessible data visualization serves as a convenient resource to support partnerships’ evaluation goals and may help to build the evidence base for CEnR through the use of common measures across studies.
Our pilot study suggests that telemedicine-based management of OSA patients is feasible in terms of patient functional outcomes and overall satisfaction with care. Future studies should include larger populations to further elucidate these findings while assessing provider- and patient-related cost effectiveness.
Pain, despite being an elemental bodily experience and the most common reason for seeking medical care, occupies a place of profound ontological and moral uncertainty in U.S. biomedicine. Taking seriously the highly charged emotions—frustration, anger, even disgust—frequently expressed by clinicians regarding their patients with pain, this article draws on ethnographic research to explore both the origins and the implications of such anxiously ambivalent responses to pain and pain medications among the clinicians charged with treating it. Set against the recent history of pain medicine as an emergent specialty in the highly fragmented landscape of U.S. biomedicine, we examine at close ethnographic range some of the key ways that U.S. clinicians frame the experience of contending with pain in their everyday practice. Emergent from these clinician experiences are the ways in which pain and pain medications remain both incompletely medicalized and ineffectively medicalizing in U.S. biomedicine, as well as the threatening effects on what we call the pharmaceutical subjectivity of clinicians themselves of this persistently ambivalent medicalization.
VIP represents the first evidence-based intervention that considers both the veteran with TBI and the family. VIP had a significant impact on family member well-being and thus addresses a large gap in previous research and services for families of veterans with TBI.
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