Papers by Tara J Schapmire
BACKGROUND Patients undergoing treatment for head and neck cancer commonly experience signicant ... more BACKGROUND Patients undergoing treatment for head and neck cancer commonly experience signicant changes in quality of life (QoL) and levels of symptom distress. It is not known if a telehealth intervention would mitigate these changes. OBJECTIVE To evaluate the impact of a telehealth intervention on QoL and symptom burden in patients undergoing initial treatment for head and neck cancers. METHODS A randomized clinical trial comparing the impact on QoL and symptom distress of telehealth intervention and standard care was conducted with 80 patients (45 treatment, 35 control) who had been diagnosed with head or neck cancer and were receiving 1 or more treatment modalities. Treatment group participants responded daily to symptom management algorithms using a simple telehealth messaging device. QoL was evaluated by the Functional Assessment of Cancer Therapy-Head and Neck Scale (FACTHN) and symptom burden by the Memorial Symptom Assessment Scale (MSAS). Control group participants comple...
The purpose of this phenomenological exploration was to describe the lived experiences of persons... more The purpose of this phenomenological exploration was to describe the lived experiences of persons diagnosed with advanced cancer who receive Medicaid. Themes emerged from the transcribed interviews of 10 participants in accordance with the cancer trajectory. Before diagnosis, participants were uninsured or underinsured and had more severe symptoms prior to late diagnosis. Upon diagnosis, they desired hopeful, respectful communication and experienced strong emotional reactions. There was also an abrupt change in the use of health care resources. During cancer treatment, they experienced social isolation from family and friends while receiving strong psychosocial support from the health care team. Throughout the cancer trajectory, they focused on living, reclaiming normalcy, and expressed resiliency and spirituality. Findings support the need to recognize the ‘‘fighting spirit’’ of patients regardless of prognosis or socioeconomic status; the impact of hopeful, respectful communicatio...
Palliative Medicine Reports
Background: The interprofessional education exchange (iPEX) provides education, training, and men... more Background: The interprofessional education exchange (iPEX) provides education, training, and mentoring to select interprofessional faculty trainee teams for development and implementation of interprofessional education (IPE) in palliative oncology. Objective: To evaluate the impact of the iPEX project on trainees' self-efficacy in IPE skills and IPE competencies. Design: A pre-/post-test design was used to evaluate trainees' progress. Trainees rated project components and developed IPE curricula in palliative oncology. Setting/Subjects: Sixteen United States-based faculty teams consisting of four to five members representing three or more disciplines completed the one-year faculty development project consisting of webinars, online interactive modules, a face-to-face workshop, mentoring, and assistance. The exchange of ideas, means for overcoming obstacles, collaborative teaching techniques, and curriculum development guidelines were integrated into the program. Measurements: Standardized measures of self-efficacy in IPE skills (Interprofessional Facilitation Skills Checklist) and IPE competencies (Core Competencies for Interprofessional Practice Individual Competency Assessment Tool) were used. Trainees rated the effectiveness of the project components on a scale of 1-5 (1 = not at all effective, 5 = extremely effective) and reported their plan for IPE palliative care curricula at their home institution. Results: Pre and post-paired samples t-test scores (n = 78) on both standardized instruments for IPE skills and competencies were significantly different (p < 0.001). Ratings of project components ranged from 3.97 to 4.90. Each team successfully developed a unique plan for IPE in palliative oncology. Conclusions: Multimodal faculty development and mentoring are successful means for improving self-assessed IPE skills and competencies.
Journal of Psychosocial Oncology
Journal of Interprofessional Care
International Journal of Environmental Research and Public Health
We describe an effort to improve the care of Medicaid and uninsured individuals through a three-w... more We describe an effort to improve the care of Medicaid and uninsured individuals through a three-way partnership between a Medicaid managed care insurer, front-line providers, and an academic university. The project provided annual funding over eleven years, for research, pilot programs, and demonstration projects. Projects were provider-driven in design and methods. The Medicaid-managed care insurer-funded proposals were vetted by a neutral university team experienced in grant writing and community-based research and scored by a community-based review panel. The grant program ran from 2007 to 2018, funding 41 projects, totaling USD 2,097,842. The partnership of an insurer, a university, and frontline providers was not only viable and sustainable for over a decade, but also flexible, free of project selection issues, and well-received by all stakeholders. Funded providers worked in both urban and rural settings and included hospitals, community non-profits, outpatient clinics, academ...
Journal of Clinical Oncology
Journal of Pain and Symptom Management
was dependent on sub-processes of (1) engaging and establishing connection and (2) sharing decisi... more was dependent on sub-processes of (1) engaging and establishing connection and (2) sharing decision-making. Connection was influenced by ethical behavior and emotional support, while decision-making was reliant on information and involvement. Achieving a shared view and moving to comfort-focused care led to preparation for dying and emphasis on relationships. Inability to achieve a shared view led to conflict and moral distress. A biomedical vs. person-centered context strongly affected the transition process. Conclusions and Implications for Practice, Policy, and Research. The findings provide a framework to guide clinicians in reducing conflict and facilitating a patient's transition to comfort-focused care when appropriate and congruent with patient goals as well as directions for needed research.
Journal of Cancer Education
In an effort to improve participation of younger breast cancer survivors in end of life (EOL) dis... more In an effort to improve participation of younger breast cancer survivors in end of life (EOL) discussions and planning, this study evaluated the impact of The Shady Pink Elephant EOL educational series on participants' knowledge, attitudes and behaviors towards palliative care and EOL wishes. Data was gathered at baseline (pre survey and registration) following each event (post survey) and 6 months after the series as intervention (post survey). A total of 36 women with breast cancer, averaging 40 years of age, participated in the first online event, 24 in the second and 22 in the third. A total of 20 completed the 6-month post survey. Significant improvement in scores occurred from baseline to 6 months for the following items: belief that palliative care is only for those at the EOL, belief that EOL discussions are only important for those at the EOL, comfort with talking about EOL issues, confidence that EOL wishes will be honored by one's health care power of attorney and knowledge of characteristics are important in the person assigned as a person's health care power of attorney. The Shady Pink Elephant EOL educational series is therefore a promising intervention for improving EOL knowledge, attitudes and behavior. Further research with larger sample sizes is needed regarding understanding and accessing palliative care and deciding upon and communicating EOL wishes in this patient population.
Journal of Thoracic Oncology
Background: Malnutrition and cachexia are commonly seen in cancer patients. The aim of this resea... more Background: Malnutrition and cachexia are commonly seen in cancer patients. The aim of this research was to assess overall risk of malnutrition in lung cancer patients. Methods: This prospective observational study that included hospitalized lung cancer patients was conducted in the Institute for pulmonary diseases of Vojvodina, Serbia. International questionnaire for nutrition screening was used for clinical assessment of malnutrition. Subjects were included in this study regardless of lung cancer type, stage of disease and therapy regiment. Results: Out of total 188 patients included, 76.1% were male and 23.9% female. Majority of patients were in ECOG performance status (PS) 1 (74.5%) with diagnosed lung cancer in stages III and IV (39.9% and 42.6% respectively). Most common lung cancer type was adenocarcinoma (50.0%) followed by squamous (35.6%), small-cell (10.6) and other hystologic types (3.7%). Majority of patients had Body Mass Index (BMI) >20 (87.8%). BMI<18 was observed in 7.4% of patients. Unplanned weight loss in past 3-6 months for more than 10% was present in 16.5% of patients. In this group of patients 20.7% were with high risk, 12.8% with medium risk and 66.5% with low risk of malnutrition. High risk of malnutrition was more frequent in stages III and IV of lung cancer (24.0% and 22.5% respectively) than in stages I and II (13.3% and 5.6% respectively). We observed statistically significant correlation between ECOG PS and risk of malnutrition (p¼0.001; r¼0.240). Patients with ECOG PS 0 are ten times less likely to have high risk of malnutrition than patients with poorer ECOG PS. Conclusion: This study showed that a significant percentage of lung cancer patient have a high risk of malnutrition therefore it would be advisable to routinely evaluate nutritional status of lung cancer patients regardless of stages and duration of disease.
Journal of Hospice & Palliative Nursing
Journal of cancer education : the official journal of the American Association for Cancer Education, Jan 6, 2016
Family medicine, 2012
A fragmented workforce consisting of multiple disciplines with varying levels of training and lim... more A fragmented workforce consisting of multiple disciplines with varying levels of training and limited ability to work as a team often provides care to older adults. Interprofessional education (IPE) is essential for preparing practitioners for the effective teamwork required for community-based, holistic, person-centered care of the older adults. Despite numerous programs and offerings to advance education and interdisciplinary patient care, there is an unmet need for geriatric IPE, especially as it relates to community-dwelling older adults and caregivers in medically underserved areas. A core group of university faculty from multiple disciplines received funding from the Health Resources and Services Administration Geriatric Workforce Enhancement Program to collaborate with community-based providers from several Area Agencies on Aging in the creation and implementation of the Interprofessional Curriculum for the Care of Older Adults (iCCOA). This geriatric curriculum is interprofessional, comprehensive, and community-based. Learners include third-year nursing students, nurse practitioner students, third-year medical students, internal medicine and family medicine residents, master's level social work students, third-year pharmacy students, pharmacy residents, third-year dental students, dental hygiene students, community-based organization professionals, practicing community organizers, and community health navigators. This article describes the efforts, successes, and challenges experienced with this endeavor, including securing funding, ensuring equal representation of the disciplines, adding new components to already crowded curricula, building curriculum on best practices, improving faculty expertise in IPE, managing logistics, and ensuring comprehensive evaluation. The results summarize the iCCOA components, as well as the interprofessional domains, knowledge, and competencies.
Journal of psychosocial oncology
Data from the Health and Retirement Study were used to test a conceptual model integrating stress... more Data from the Health and Retirement Study were used to test a conceptual model integrating stress and coping, conservation of resources, and life-course theories, to investigate predictors of depression symptoms over 8 years among a nationally representative sample of older adults aged 50-91 years. The main investigative questions were: (1) Do older adults with cancer have a different 8-year symptomatic depression trajectory than those without cancer? (2) Do the differences in life-course factors, internal, external, and health-related resources within and between older adults have a differential effect on 8-year symptomatic depression trajectories for individuals with and without a cancer diagnosis? We used a two-level longitudinal panel design to test a multilevel growth model. We examined individual differences in depression symptoms between 2000 and 2008, and tested multiple potential predictors. All those with a first diagnosis of cancer in 1998-2000 were included in the study ...
Advances in Medical Education and Practice, 2016
The needs of an aging population and advancements in the treatment of both chronic and life-threa... more The needs of an aging population and advancements in the treatment of both chronic and life-threatening diseases have resulted in increased demand for quality palliative care. The doctors of the future will need to be well prepared to provide expert symptom management and address the holistic needs (physical, psychosocial, and spiritual) of patients dealing with serious illness and the end of life. Such preparation begins with general medical education. It has been recommended that teaching and clinical experiences in palliative care be integrated throughout the medical school curriculum, yet such education has not become the norm in medical schools across the world. This article explores the current status of undergraduate medical education in palliative care as published in the English literature and makes recommendations for educational improvements which will prepare doctors to address the needs of seriously ill and dying patients.
Journal of palliative medicine, 2014
Background: Interprofessional education is necessary to prepare students of the health profession... more Background: Interprofessional education is necessary to prepare students of the health professions for successful practice in today's health care environment. Because of its expertise in interdisciplinary practice and team-based care, palliative care should be leading the way in creating educational opportunities for students to learn the skills for team practice and provision of quality patient-centered care. Multiple barriers exist that can discourage those desiring to create and implement truly interdisciplinary curriculum. An interdisciplinary faculty team planned and piloted a mandatory interdisciplinary palliative oncology curriculum and responded to formative feedback. The project took place at a large public metropolitan university. Medical, nursing, and social work students and chaplains completing a clinical pastoral education internship participated in the curriculum. Formative feedback was received via the consultation of an interdisciplinary group of palliative educ...
Journal of Pain and Symptom Management, 2016
Uploads
Papers by Tara J Schapmire