Rose C. Maly

A Randomized Clinical Trial of Outpatient Comprehensive Geriatric Assessment Coupled with an Intervention to Increase Adherence to Recommendations

BACKGROUND: Although comprehensive geriatric assessment (CGA) has been demonstrated to confer health benefits in some settings, its value in outpatient or office settings is uncertain.

Coping with breast cancer in later life: the role of religious faith.

Purpose: To identify and examine religious and spiritual coping strategies among elderly women with newly diagnosed breast cancer.

Breast Cancer Treatment in Older Women: Impact of the Patient-Physician Interaction

Objectives: To assess the impact of the patient‐physician interaction on breast cancer care in older women.

Determinants of Breast Cancer Knowledge Among Newly Diagnosed, Low-income, Medically Underserved Women With Breast Cancer

Among women with breast cancer (BC), greater BC knowledge has been associated with greater participation in treatment decision‐making, patient satisfaction, and survival. The objective of this study was to identify modifiable determinants associated with BC knowledge.

Racial/Ethnic Differences in Breast Cancer Outcomes among Older Patients: Effects of Physician Communication and Patient Empowerment

OBJECTIVES To examine racial/ethnic disparities in older womens health-related quality of life (QoL) and type of breast cancer treatment as mediated by physician-level and individual-level variables. METHODS A cross-sectional survey of a population-based, consecutive sample identified through the Los Angeles Cancer Surveillance Program of Latina (n = 99), African American (n = 66), and White (n = 92) women aged 55 years or older (N = 257) between 3 and 9 months after primary breast cancer diagnosis and at least 1 month posttreatment. An exploratory, empirically developed latent variable model tested the relationships among demographic and physician-related variables, patient attitudes, and health-related outcomes. Health-related outcomes included QoL measures and receipt of breast conserving surgery (BCS). RESULTS Latinas reported less BCS and poorer QoL compared with Whites. Physician communication that can empower patients, in terms of patient efficacy in patient?physician interactions and breast cancer knowledge, mitigated racial/ethnic disparities in receipt of BCS. Physician emotional support was not related to patient cognitive empowerment and treatment outcomes. Medical mistrust in minority women was related to less self-efficacy and less positive coping, as well as, both directly and indirectly, to reduced QoL. Latinas reported poorer QoL in the tested model. CONCLUSION Physician communication style, specifically information giving and participatory decision making, may empower older women with breast cancer and help mitigate racial/ethnic disparities in surgical treatment received.

Cost-effectiveness of outpatient geriatric assessment with an intervention to increase adherence.

BACKGROUND Comprehensive geriatric assessment (CGA) can be effective in inpatient units, but such inpatient settings are prohibitively expensive. If similar benefits could be obtained in outpatient settings, CGA might be a more attractive option. OBJECTIVES To assess the cost-effectiveness (CE) of an outpatient geriatric assessment with an intervention to increase adherence. SUBJECTS Three hundred fifty-one community-dwelling, elderly subjects with at least one of four geriatric conditions. MEASURES In addition to the measures of functioning, we collected data on the costs of the intervention itself and on the use of medical services in the 64 weeks after the intervention. RESULTS The intervention, which prevented functional decline, cost

Return to work in low-income Latina and non-Latina white breast cancer survivors: a 3-year longitudinal study.

273 per participant. The intervention group averaged three more visits than the control group in the first 32 weeks after the intervention, but only 1.2 extra visits in the next 32 weeks. We estimate that the costs of these additional medical services would be

Managing Geriatric Syndromes: What Geriatric Assessment Teams Recommend, What Primary Care Physicians Implement, What Patients Adhere To

473 for the 5 years after the intervention, leading to a total cost per Quality Adjusted Life Year (QALY) of

Depression and Sexual Adjustment Following Breast Cancer in Low-income Hispanic and non-Hispanic White women

10,600. CONCLUSIONS The CE of this program compares favorably with many common medical interventions. Whether investments should be made in health care resources on treatments that lead to modest improvements in the functioning of community-dwelling elderly people remains a societal decision.

Belief in Divine Control, Coping, and Race/Ethnicity among Older Women with Breast Cancer

Previous research has found an 80% return‐to‐work rate in mid‐income white breast cancer survivors, but little is known about the employment trajectory of low‐income minorities or whites. We set out to compare the trajectories of low‐income Latina and non‐Latina white survivors and to identify correlates of employment status.