Jamie L. Pomeranz

Barriers to cancer screening for people with disabilities: A literature review

BACKGROUND Over 50 million Americans are currently living with some form of disability. Studies have shown that people with disabilities are underinsured, have less access to health care, and are more likely to engage in risky health behavior. Routine preventive screenings for breast, cervical and colorectal cancer are recommended for all adults to improve early detection and treatment of cancer. Although early detection of cancer offers the best chances for treatment and survival, cancer screening has been limited for many people with disabilities. OBJECTIVE To present results of a scoping review of studies focused on barriers to cancer screening for people with disabilities. METHODS Online databases were searched for research articles on barriers to cancer screening (breast, cervical, prostate, and colorectal) in people with disabilities. RESULTS Thirty-five peer-reviewed articles met inclusion criteria. Existing research on cancer screenings, particularly prostate cancer, among people with disabilities is limited. Current studies suggest that those with advanced disabilities are not being screened for cancer as often as the able-bodied population with the exception of military veterans. Education, income, age, employment, screening history, tobacco use, activity level, disability level, and geography affected screening rates. CONCLUSIONS Barriers include cost, access, health care provider discomfort, and physical and cognitive restraints. Future interventions to improve routine preventive cancer screenings rates could include specialized health care provider training, community interventions, emphasis on the value of health promotion and the specific health care needs of people with disabilities.

Rasch Analysis as a Technique to Examine the Psychometric Properties of a Career Ability Placement Survey Subtest

Rasch analysis offers researchers an innovative method for developing and validating rehabilitation instruments. Despite the increased use of Rasch analysis by allied health researchers, this method continues to be underutilized by rehabilitation counseling professionals. In the rehabilitation counseling profession, vocational evaluators use various instruments, such as the Career Ability Placement Survey (CAPS), to determine client aptitudes and justify job placement recommendations. The purpose of this article is to introduce Rasch analysis as a method for analyzing vocational assessments by examining the psychometric properties of the Word Knowledge (WK) subtest of the CAPS. University undergraduate and graduate students (n = 227) completed the WK subtest as part of a classroom exercise. The analysis determined item hierarchy, item gaps and redundancies, item-fit statistics (unidimensionality), and person reliability and separation statistics. Although the WK construct demonstrates good psychometric characteristics relating to unidimensionality and to person reliability and separation statistics, several items deviated from the expected ordering pattern. The reordering of items revealed potential item gaps and redundancies as well as poor person—instrument match. Adding and removing items will improve the validity and reliability of the WK subtest psychometrics.

Management of problematic behaviours among individuals on long-term opioid therapy: protocol for a Delphi study

Introduction Given the sharp rise in opioid prescribing and heightened recognition of opioid addiction and overdose, opioid safety has become a priority. Clinical guidelines on long-term opioid therapy (LTOT) for chronic pain consistently recommend routine monitoring and screening for problematic behaviours. Yet, there is no consensus definition regarding what constitutes a problematic behaviour, and recommendations for appropriate management to inform front-line providers, researchers and policymakers are lacking. This creates a barrier to effective guideline implementation. Thus, our objective is to present the protocol for a Delphi study designed to: (1) elicit expert opinion to identify the most important problematic behaviours seen in clinical practice and (2) develop consensus on how these behaviours should be managed in the context of routine clinical care. Methods/analysis We will include clinical experts, defined as individuals who provide direct patient care to adults with chronic pain who are on LTOT in an ambulatory setting, and for whom opioid prescribing for chronic non-malignant pain is an area of expertise. The Delphi study will be conducted online in 4 consecutive rounds. Participants will be asked to list problematic behaviours and identify which behaviours are most common and challenging. They will then describe how they would manage the most frequently occurring common and challenging behaviours, rating the importance of each management strategy. Qualitative analysis will be used to categorise behaviours and management strategies, and consensus will be based on a definition established a priori. Ethics/dissemination This study has been approved by the Institutional Review Board (IRB) of the University of Alabama at Birmingham (UAB). This study will generate Delphi-based expert consensus on the management of problematic behaviours that arise in individuals on LTOT, which we will publish and disseminate to appropriate professional societies. Ultimately, our findings will provide guidance to front-line providers, researchers and policymakers.

Cystic fibrosis and the workplace: A review of the literature

OBJECTIVE To perform a comprehensive literature review pertaining to cystic fibrosis (CF) and employment. METHODS We performed extensive searches of the Pub Med and the EBSCOhost electronic databases to discover articles pertaining to CF and employment. RESULTS Nine journal articles published between 1979 and 2009 pertaining to CF and employment aspects were reviewed and analyzed. Strengths and limitations of the studies are discussed and recommendations for future research are provided. CONCLUSIONS There is limited psychosocial research in the area of CF and its employment aspects. The findings from this literature review indicate that maintaining employment depends on multiple variables. Further research on CF and employment is necessary to improve vocational outcomes. Understanding the interplay of CF and employment informs the rehabilitation knowledge base and is essential in order for professionals involved in employment outcomes such as rehabilitation counselors to deliver vocational services.

Tobacco Cessation Intervention for People With Disabilities: Survey of Center for Independent Living Directors

People with disabilities (PWD) are 50% more likely to smoke compared with the general population, yet interventions tailored to the needs of PWD remain limited. The authors surveyed directors from a leading disability service organization to assess their delivery of tobacco cessation interventions. Although tobacco cessation was identified as a high priority, directors reported that they are ill-equipped to deliver tobacco cessation interventions. To properly address the unique challenges that PWD face when quitting tobacco, disability sensitive cessation interventions are needed.

Development of an item bank for a computerised adaptive test of upper-extremity function.

Purpose. The purpose of this study was to determine the psychometric characteristics of an upper-extremity item bank as a precursor to developing a computer adaptive patient reported outcome instrument. The Activity dimension of the World Health Organizations International Classification of Functioning, Disability and Health (ICF) provided the conceptual framework for the items. Method. Factor and Rasch analyses were used to evaluate the psychometric properties of the item bank, including: monotonicity, local independence, dimensionality, item difficulty hierarchy and match between sample ability and item difficulty. Results. Monotonicity of the rating scale was supported. Nine item pairs were locally dependent, and thus one item from each pair was removed from subsequent analyses. There was evidence for two unidimensional constructs; gross upper-extremity and fine hand. Both constructs showed good internal consistency and person separation. In general, the order of item difficulty within each construct replicated the hypothesised item difficulty order. The fine hand construct had a ceiling effect. Conclusions. The above study of our newly developed upper-extremity item bank empirically verified the intended item difficulty order, identified separate constructs (i.e. gross upper-extremity and fine hand) and provided insights into eliminating the ceiling effect of one of the constructs. These findings are critical precursors to the development of upper-extremity components of the ICF Activity Measure, an ICF-based, CAT located on the web at: www.icfmeasure.phhp.ufl.edu.

Managing Concerning Behaviors in Patients Prescribed Opioids for Chronic Pain: A Delphi Study

Current guideline-recommended monitoring of patients prescribed long-term opioid therapy (LTOT) for chronic pain will likely result in increased identification of behaviors of concern for misuse and addiction, but there is a dearth of empiric evidence about how these behaviors should be managed. To establish expert consensus about treatment approaches for common and challenging concerning behaviors that arise among patients on LTOT. We used a Delphi approach, which allows for generation of consensus. Participants were clinical experts in chronic pain and opioid prescribing recruited from professional societies and other expert groups. The Delphi process was conducted online, and consisted of an initial brainstorming round to identify common and challenging behaviors, a second round to identify management strategies for each behavior, and two rounds to establish consensus and explore disagreement/uncertainty. Forty-two participants completed round 1, 22 completed round 2, 30 completed round 3, and 28 completed round 4. Half of round 1 participants were female (52%), and the majority were white (83%). Most (71%) were physicians, and most participants practiced in academic primary (40%) or specialty care (19%).The most frequently cited common and challenging behaviors were missing appointments, taking opioids for symptoms other than pain, using more opioid medication than prescribed, asking for an increase in opioid dose, aggressive behavior, and alcohol and other substance use. Across behaviors, participants agreed that patient education and information gathering were important approaches. Participants also agreed that stopping opioids is not important initially, but if initial approaches do not work, tapering opioids and stopping opioids immediately may become important approaches. This study presents clinical expert consensus on how to manage concerning behaviors among patients on LTOT. Future research is needed to investigate how implementing these management strategies would impact patient outcomes, practice and policy.BackgroundCurrent guideline-recommended monitoring of patients prescribed long-term opioid therapy (LTOT) for chronic pain will likely result in increased identification of behaviors of concern for misuse and addiction, but there is a dearth of empiric evidence about how these behaviors should be managed.ObjectiveTo establish expert consensus about treatment approaches for common and challenging concerning behaviors that arise among patients on LTOT.DesignWe used a Delphi approach, which allows for generation of consensus.ParticipantsParticipants were clinical experts in chronic pain and opioid prescribing recruited from professional societies and other expert groups.Main MeasuresThe Delphi process was conducted online, and consisted of an initial brainstorming round to identify common and challenging behaviors, a second round to identify management strategies for each behavior, and two rounds to establish consensus and explore disagreement/uncertainty.Key ResultsForty-two participants completed round 1, 22 completed round 2, 30 completed round 3, and 28 completed round 4. Half of round 1 participants were female (52%), and the majority were white (83%). Most (71%) were physicians, and most participants practiced in academic primary (40%) or specialty care (19%).The most frequently cited common and challenging behaviors were missing appointments, taking opioids for symptoms other than pain, using more opioid medication than prescribed, asking for an increase in opioid dose, aggressive behavior, and alcohol and other substance use. Across behaviors, participants agreed that patient education and information gathering were important approaches. Participants also agreed that stopping opioids is not important initially, but if initial approaches do not work, tapering opioids and stopping opioids immediately may become important approaches.ConclusionsThis study presents clinical expert consensus on how to manage concerning behaviors among patients on LTOT. Future research is needed to investigate how implementing these management strategies would impact patient outcomes, practice and policy.

Creating a Tobacco Cessation Program for People with Disabilities: A Community Based Participatory Research Approach

Introduction: Smoking is the single most preventable cause of morbidity and mortality, accountable for one out of every five fatalities in the United States annually. Fifty million Americans (22%) suffer from some form of disability, with evidence suggesting that smoking rates within the disabled community are double that of the general population. Methods: The purpose of this study was to develop a tobacco cessation program designed by and for people with disabilities (PWD). Limited research data regarding tobacco interventions suggest that both adapting treatment methods and developing novel approaches may be effective in establishing cessation programs for low-income populations. Community-Based Participatory Research (CBPR) was conducted to develop a tobacco cessation group treatment program for PWD. Consumers with disabilities who use tobacco were recruited from a large population of PWD utilizing services at multiple centers for independent living (CIL) within North Central Florida. Results: Following qualitative interviews, multiple Community Advisory Board (CAB) meetings, and expert panel review, the tobacco cessation program was modified across several areas including: updating epidemiological data, decreasing text density, adding personal vignettes from PWD, adjusting for person-first language, adding disability-specific issues, and incorporating appropriate counseling strategies. Conclusions: Study findings suggest that CBPR-based methods are useful when developing tobacco cessation programs for persons with disability. Forty-two changes were recommended for the resulting LIFT Curriculum. Next steps include pilot testing the curriculum among individuals with disability and comparing results to a standard tobacco cessation curriculum.

Nutrition interventions for people with disabilities: A scoping review

BACKGROUND Approximately 19 percent of Americans have a disability. People with disabilities are at greater risk for obesity and poor nutrition, as well as resulting secondary conditions. CDC recommends interventions for this population to address this disparity. OBJECTIVE The purpose of this article is to present the results of a scoping review of studies pertaining to community-based nutrition interventions among adults with disabilities. METHODS Electronic databases were searched to discover articles pertaining to community-based nutrition interventions for people with disabilities. RESULTS Sixteen journal articles published between 2002 and 2012 were reviewed. The reviewed community based nutrition interventions for adults with disabilities showed some success in improving health outcomes. CONCLUSIONS There is a need for future research, particularly interventions with objective outcome measures and including people with disabilities throughout the development and implementation of programs.

Applying a Social-Ecological Framework to Factors Related to Nicotine Replacement Therapy for Adolescent Smoking Cessation.

Objective: This systematic review synthesizes factors related to nicotine replacement therapy (NRT) use among adolescents seeking to quit smoking, using the social–ecological model as a guiding framework. Data Source: Searches of PubMED, ProQuest, EBSCOhost, and ERIC were conducted in July 2016. Study Inclusion and Exclusion Criteria: Original studies of cigarette smokers younger than 18 years that discussed NRT were included. Data Extraction: Two reviewers individually extracted study purpose, sample, design, and results. Data Synthesis: Factors were categorized by social–ecological model level and summarized. Results: A total of 103 907 articles were identified during initial search. After narrowing to peer-reviewed articles in English and eliminating reviews and adult-only studies, we reviewed 51 articles. These 51 articles identified factors from studies at each level of the social–ecological model: intrapersonal (k = 20), interpersonal (k = 2), organizational (k = 7), community (k = 11), and public policy (k = 14). Conclusion: Findings provide insight into the applicability of NRT for adolescent smoking cessation, and factors by social–ecological model level highlight areas for additional research. Future adolescent NRT studies should assess factors at the interpersonal, organizational, and community levels, as well as the interactions between levels.