Publications by authors named "Christy J W Ledford"

82 Publications

Practical Clinical Topics, Digging Deeper into COVID-19, Social Determinants of Health, and Equity.

J Am Board Fam Med 2021 Sep-Oct;34(5):883-885

As a discipline, we continue to learn lessons from Coronavirus disease 2019 (COVID-19)-lessons for practice, systems, and patient care. This issue also includes articles focused on 2 other topics that attract increasing attention by family physicians. First, articles describe how the social determinants of health impact health and how family physicians can overcome those obstacles with their patients. Patients want assistance from health systems for 1 specific need related to social determinants of their health. Second, we see increasing evidence about opioid prescriptions in primary care. Multiple clinical articles are pertinent to family medicine, such as different implications of an elevated sedimentation rate compared with C-reactive protein, practice facilitation, adolescent vaccination, family physician accuracy with potentially malignant skin lesions, and more.
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http://dx.doi.org/10.3122/jabfm.2021.05.210303DOI Listing
September 2021

Correlates of COVID-19 Vaccine Hesitancy among a Community Sample of African Americans Living in the Southern United States.

Vaccines (Basel) 2021 Aug 8;9(8). Epub 2021 Aug 8.

Department of Family Medicine, Augusta University, Augusta, GA 30192, USA.

In the United States, African Americans (AAs) have been disproportionately affected by COVID-19 mortality. However, AAs are more likely to be hesitant in receiving COVID-19 vaccinations when compared to non-Hispanic Whites. We examined factors associated with vaccine hesitancy among a predominant AA community sample. We performed a cross-sectional analysis on data collected from a convenience sample of 257 community-dwelling participants in the Central Savannah River Area from 5 December 2020, through 17 April 2021. Vaccine hesitancy was categorized as resistant, hesitant, and acceptant. We estimated relative odds of vaccine resistance and vaccine hesitancy using polytomous logistic regression models. Nearly one-third of the participants were either hesitant ( = 40, 15.6%) or resistant ( = 42, 16.3%) to receiving a COVID-19 vaccination. Vaccine-resistant participants were more likely to be younger and were more likely to have experienced housing insecurity due to COVID-19 when compared to both acceptant and hesitant participants, respectively. Age accounted for nearly 25% of the variation in vaccine resistance, with 21-fold increased odds (OR: 21.93, 95% CI: 8.97-5.26-91.43) of vaccine resistance in participants aged 18 to 29 compared to 50 and older adults. Housing insecurity accounted for 8% of the variation in vaccine resistance and was associated with 7-fold increased odds of vaccine resistance (AOR: 7.35, 95% CI: 1.99-27.10). In this sample, AAs under the age of 30 and those experiencing housing insecurity because of the COVID-19 pandemic were more likely to be resistant to receiving a free COVID-19 vaccination.
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http://dx.doi.org/10.3390/vaccines9080879DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8402307PMC
August 2021

Family Medicine Research on Health Equity, Addiction, and Eating Breakfast-Just for Starters.

J Am Board Fam Med 2021 Jul-Aug;34(4):675-677

As usual, this issue of the journal delivers reports on a broad range of topics that can inform clinical practice. Several articles address equity, or the lack thereof, in health care. This includes research on the social determinants of health and how family medicine can contribute to redressing inequity. Another set of articles report on the ongoing wave of substance abuse. Additional training in addiction medicine for family physicians is 1 strategy for the United States to address this crisis. One of the most intriguing articles looks at the relationship between eating breakfast, amount of dietary fiber intake, and mortality. Several articles discuss ongoing changes or changes to family medicine on the horizon. Readers will find some well-written clinical reviews and an in-depth review of international practice-based research networks. Lastly, 2 great reads will remind readers how it feels to practice family medicine.
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http://dx.doi.org/10.3122/jabfm.2021.04.210199DOI Listing
July 2021

COVID-19 Pandemic Practices, Payment Models, and Publication Successes: Family Medicine Studies a Variety of Primary Care Questions.

J Am Board Fam Med 2021 May-Jun;34(3):459-461

This issue provides inspiring reports of family medicine during the Coronavirus disease 2019 (COVID-19) pandemic and the provision of just-in-time COVID-19 information for clinicians. Conversely, burnout - yes or no? The issue includes information that suggests the negative effects of social determinants are related to America's system of paying for medical care. The announcement of the availability of an on-line archive of the official first journal of family medicine gives us the chance to acclaim Dr. Geyman, who started the and was the first editor of this journal. And, as usual, there is more!
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http://dx.doi.org/10.3122/jabfm.2021.03.210099DOI Listing
July 2021

Being Brave.

Fam Med 2021 Jun;53(6):401-403

David Grant USAF Medical Center, Fairfield, CA.

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http://dx.doi.org/10.22454/FamMed.2021.580994DOI Listing
June 2021

Dissonance in the discourse of the duration of diabetes: A mixed methods study of patient perceptions and clinical practice.

Health Expect 2021 Aug 5;24(4):1187-1196. Epub 2021 May 5.

Department of Family Medicine, Madigan Army Medical Center, Tacoma, WA, USA.

Background: Remission of diabetes can be rewarding for patients and physicians, but there is limited study of how patients perceive the timeline of a disease along the continuum of glycaemic control.

Objective: To explore how patients perceive the timeline of diabetes along the continuum of glycaemic control and their goals of care and to identify whether family physicians communicate the principles of regression and remission of diabetes.

Design: Mixed methods approach of qualitative semi-structured interviews with purposive sampling followed by cross-sectional survey of physicians.

Participants: Thirty-three patients living with prediabetes (preDM) or type 2 diabetes mellitus (T2DM) at medical centres in Georgia and Nevada; and 387 family physicians providing primary care within the same health system.

Results: Patients described two timelines of diabetes: as a lifelong condition or as a condition that can be cured. Patients who perceived a lifelong condition described five treatment goals: reducing glucose-related laboratory values, losing weight, reducing medication, preventing treatment intensification and avoiding complications. For patients who perceived diabetes as a disease with an end, the goal of care was to achieve normoglycaemia. In response to patient vignettes that described potential cases of remission and regression, 38.2% of physician respondents would still communicate that a patient has preDM and 94.6% would tell the patient that he still had diabetes.

Conclusions: Most physicians here exhibited reluctance to communicate remission or regression in patient care. Yet, patients describe two different potential timelines, including a subset who expect their diabetes can be 'cured'. Physicians should incorporate shared decision making to create a shared mental model of diabetes and its potential outcomes with patients.

Patient Or Public Contribution: In this mixed methods study, as patients participated in the qualitative phase of this study, we asked patients to tell us what additional questions we should ask in subsequent interviews. Data from this qualitative phase informed the design and interpretation of the quantitative phase with physician participants.
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http://dx.doi.org/10.1111/hex.13245DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8369085PMC
August 2021

Keeping Patients at the Center of Family Medicine Scholarship.

J Am Board Fam Med 2021 Mar-Apr;34(2):249-250

In addition to the collection of veterans' health articles, this edition of the journal contains a wide range of family medicine research reports, commentaries, clinical reviews, and scholarly observations. These articles clearly exemplify a key strength of family medicine scholarship: the focus is on our patients. Two articles look at modern care of patients with venous thromboembolic disease-the first on acute management and the second on long-term care. Two other articles explore the role of pharmacists in an interdisciplinary team. A clever use of big databases provides a thought-provoking answer about the long-term health of patients with methicillin-resistant Three articles give us possible glimpses into the future of family medicine, exploring a potential payment reform model, suggesting an alternative approach to cancer screening guideline development, and considering how family physicians remain relevant in the technology-laden medical world of tomorrow.
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http://dx.doi.org/10.3122/jabfm.2021.02.210013DOI Listing
September 2021

A Stepwise Transition to Telemedicine in Response to COVID-19.

J Am Board Fam Med 2021 Feb;34(Suppl):S152-S161

From the Department of Family Medicine (SLS, CJW) and Family Medicine Residency Program (SLS), Uniformed Services University of the Health Sciences, Bethesda, MD; Family Medicine Residency Program, Eglin Air Force Base, FL (SLS, MNL).

Introduction: With the emergence of COVID-19, many primary care offices closed their physical space to limit exposure. Despite decades of telemedicine in clinical practice, it is rare to find it used in small-metro and academic settings. Following the decision to limit face-to-face care, we tracked our practice's transition to telemedicine.

Methods: This was a prospective quality improvement project following Plan-Do-Study-Act (PDSA) cycles to optimize the use of telemedicine (both telephone and video in this practice) encounters. Central to the PDSA cycles was the use of a post-encounter questionnaire to track patient, appointment, and physician factors. Throughout the cycles, inferential statistics were used to inform process improvement.

Results: In Cycle 2, a logistic regression model showed length of encounter, need for physical examination, and physician satisfaction correctly predicted a physician's preferred medium (χ(3) = 40.56, In Cycle 3, a χ test showed the reason for visit predicted the preferred medium (χ(4) = 47.30, ). In cycle 4, week of telemedicine, need for physical examination, length of encounter and physician satisfaction predicted the preferred medium (χ(9) = 172.52, ).

Discussion: Using the variables that predicted preference for telemedicine, we were able to adjust our processes through PDSA cycles.

Conclusion: Early use of the PDSA cycle allows for informed quality improvement at the local level. Our findings highlight factors to consider when implementing telemedicine such as need for physical examination and type or length of encounter. In addition, physician satisfaction can encourage use of telemedicine, and tools for learning and practicing telemedicine should be available.
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http://dx.doi.org/10.3122/jabfm.2021.S1.200358DOI Listing
February 2021

Family communication central to mothers' type 2 diabetes self-management.

Fam Syst Health 2020 12;38(4):396-405

Uniformed Services University of the Health Sciences.

Introduction: How families function and provide support plays a central role in patients' self-management of Type 2 diabetes (T2DM) and prediabetes (preDM). Families would benefit from communication training, which is rarely incorporated into diabetes self-management education (DSME). Mothers are especially in need of this support. Women are at a higher risk of T2DM, and when mothers are patients, they can prioritize their family role and family's well-being over their personal needs as a patient.

Method: To identify family communication that affects mothers' ability to self-manage T2DM/preDM, we interviewed 17 mothers aged 36-64 (M = 56). Transcripts were thematically analyzed.

Results: Women described four family communication experiences affecting self-care: (a) family-of-origin communication (e.g., weight/diet messages during childhood), (b) communal coping communication (e.g., adopting healthy behaviors as a family), (c) communication inhibiting communal coping (e.g., negative response to mothers' lifestyle changes), and (d) mothers taking the lead (e.g., leading conversations or communicating control over family's lifestyle decisions).

Discussion: Findings highlight the need for a family systems approach to DSME. Communication from multiple bonds (e.g., spouse, children) and past family-of-origin experiences impact self-care. Communal coping (appraising diabetes as "our" problem) was critical to self-management as mothers struggled to balance their needs with family members' preferences/attitudes. When not supported, mothers who took the lead communicatively could facilitate communal coping or prioritize self-care needs. Findings can inform a family-centered approach to DSME that highlights the importance of communal coping, provides all members communication skills training, and addresses the need for mothers to prioritize personal well-being. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
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http://dx.doi.org/10.1037/fsh0000550DOI Listing
December 2020

How Family Physicians Practice the Principle of Remission Along the Glycemic Continuum.

J Prim Care Community Health 2020 Jan-Dec;11:2150132720977744

Uniformed Services University of the Health Sciences, Bethesda, MD, USA.

Introduction: Recent evidence reveals that diabetes and prediabetes (preDM) can be reversed to normal glucose regulation (NGR) through significant weight loss, but how physicians clinically identify the principles of partial and complete remission of diabetes is largely unknown.

Methods: As part of the cross-sectional omnibus survey conducted in March 2019 at a professional annual meeting in the United States, physician participants answered case scenario questions about the diagnosis and documentation of patients with preDM and type 2 diabetes (T2DM).

Results: Of the registered conference attendees, 387 (72.7%) responded. When presented with the initial case of preDM, 201 physicians (70.8%) selected R73.03 Prediabetes. In a follow-up encounter with improved lab results, 118 physicians (58.7%) indicated that they would not chart any diabetes-related code and 62 (30.8%) would chart preDM again. When presented with the case of T2DM, 256 physicians (90.1%) indicated E11.0-E11.9 Type 2 Diabetes. In the follow-up encounter, only 38 (14.8%) coded a diagnosis reflecting remission from T2DM to prediabetes and 211 (82.4%) charted T2DM.

Conclusion: Physicians may be reluctant to document diabetes regression as there is little evidence for long-term outcomes and "downgrading" the diagnosis in the medical record may cause screenings to be missed. Documenting this regression in the medical record should communicate the accurate point on the continuum of glucose intolerance with both the patient and the care team.
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http://dx.doi.org/10.1177/2150132720977744DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7768828PMC
June 2021

"Miracle" or "Medicine": A Turning-Point Analysis of Patients' and Physicians' Shifting Views on Acupuncture.

Med Acupunct 2020 Oct 19;32(5):263-271. Epub 2020 Oct 19.

Department of Family Medicine, F. Edward Hebert School of Medicine, Military Primary Care Research Network, Uniformed Services University of the Health Sciences, Bethesda, MD, USA.

: Acupuncture is one of the most widely used treatments of complementary and alternative medicine (CAM) within the military's health system. The success of CAM integration is partially dependent on both providers' and patients' perceptions that acupuncture is health-promoting. The aim of this research was to identify turning points, or changes, across treatments that enhanced or inhibited physicians' and patients' perception of acupuncture as health-promoting. : Using a retrospective-interview approach, interviews were conducted with 15 family medicine physicians practicing medical acupuncture in a family medicine setting and with 17 patients ( = 32). Turning points were separated into 2 groups (health-promoting or health-inhibiting). Similarities and differences between perspectives were noted. : Patients and physicians identified two changes that enhanced their perspective of acupuncture as health-promoting: (1) observed health changes and (2) pain-medicine/narcotic reduction/elimination. Patients identified their ability to fulfill personal or professional roles, whereas physicians identified (1) training experiences and (2) enhanced relationships with patients. Health-inhibiting changes in perspective were identified as logistical constraints/barriers by both parties, although their perspectives differed to some degree. Turning points that were viewed as health-inhibiting treatment were identified as clinical challenges by physicians and as a lack of consistency in care by patients. : The insight from these findings can help identify areas where medical acupuncture can be improved to promote successful integration in conventional medicine settings, as well as how providers can tailor communication with patients about acupuncture.
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http://dx.doi.org/10.1089/acu.2020.1428DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7583341PMC
October 2020

Diabetes ROADMAP: Teaching Guideline Use, Communication, and Documentation When Delivering the Diagnosis of Diabetes.

MedEdPORTAL 2020 09 11;16:10959. Epub 2020 Sep 11.

Professor of Family Medicine, Military Primary Care Research Network, Uniformed Services University of the Health Sciences, and Nellis Air Force Base Family Medicine Residency.

Introduction: Most interventions to date regarding breaking bad news focus on late-stage disease or disclosing a cancer diagnosis. Little attention has been given to delivery of chronic metabolic disease diagnoses such as prediabetes/type 2 diabetes.

Methods: Informed by the American Diabetes Association standards of care and formative research conducted by our research team, we developed this curriculum through the six-step approach to curriculum development. The curriculum consists of a 2- or 3-hour intervention that teaches medical decision-making, interpersonal communication, and clinical documentation in the context of prediabetes and type 2 diabetes followed by role-play and clinical practice.

Results: Across three cohorts, 53 clinicians completed the curriculum. Across the three iterations, learners rated the curricular intervention as worthwhile and delivered at an appropriate level. In a community hospital setting, learners scored significantly higher on a knowledge check than did a control group of six clinicians ( < .001). Learners in the community hospital also indicated high response efficacy and self-efficacy. At the academic medical center, simulated patients indicated high measures on the Diabetes Health Threat Communication Questionnaire.

Discussion: The moment of diagnosis presents a key opportunity to affect patients' perceptions of the disease. This curriculum guides clinicians in making the most of diagnosis delivery. Pairing of qualitative, patient-centered research alongside the iterative curriculum design process allows the curriculum to be adaptable and scalable to multiple settings and learner types.
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http://dx.doi.org/10.15766/mep_2374-8265.10959DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7485911PMC
September 2020

Residency Leader Motivations to Engage Residents and Residency Faculty in Scholarship: A Qualitative Study.

Fam Med 2020 09;52(8):581-585

Department of Family Medicine, F. Edward Hébert School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD.

Background And Objectives: Research shows that limited time, lack of funding, difficulty identifying mentors, and lack of technical support limit resident and faculty ability to fully participate in scholarly activity. Most research to date focuses on medical student and resident attitudes toward research. This study aimed to understand the underlying attitudes of family medicine residency (FMR) leaders toward scholarship.

Methods: Two focus groups of family medicine residency leaders were conducted in March 2018. The sample (N=19) was recruited through the membership directory of the Family Physicians Inquiry Network.

Results: Leaders shared positive attitudes toward scholarship; however, motivation to engage residents and residency faculty in scholarship diverged. Motivations for promoting scholarly activity among participants were either extrinsic (through ACGME, program graduation, or promotion requirements) or intrinsic (through personal interest and natural drive).

Conclusions: Emerging themes illustrate differences in how FMR program leaders perceive the role of scholarship in residency programs. As programs aim to increase research and scholarship, more attention must be paid to the motivating messages communicated by the program's leadership.
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http://dx.doi.org/10.22454/FamMed.2020.437433DOI Listing
September 2020

Toward a model of shared meaningful diagnosis.

Patient Educ Couns 2021 01 26;104(1):143-148. Epub 2020 Jul 26.

Uniformed Services University of the Health Sciences, Bethesda, MD, United States.

Objectives: The purpose was to explain the process of diabetes-related diagnosis that prompts patient action (behavior change or treatment adherence). A secondary purpose was to identify barriers/gaps that prevent those outcomes.

Methods: Using a grounded theory approach, we explored diagnosis from the patient's perspective and through the lens of the electronic health record (EHR). A thematic analysis was conducted on interview and EHR data from 28 patients, using the constant comparative method.

Results: The emerging model of shared meaningful diagnosis included four stages: stimulus to screen, medical decision making, medical information transfer, and patient sensemaking. Barriers to a meaningful diagnosis emerged in clinical documentation, clinician communication, and patient sensemaking.

Conclusions: This study expands current understanding of "diagnosis," suggesting additional stages between diagnostic labeling and disease management. The additional stages of medical information transfer and patient sensemaking are critical steps to a shared meaningful diagnosis that could enable teamwork among the patient and healthcare team.

Practice Implications: To sustain meaningful diagnosis for the patient, clinicians should document what language they used to explain the diagnosis to the patient so that subsequent clinicians can use similar language. Clinicians who work as a team should unify their approach to discussing prediabetes.
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http://dx.doi.org/10.1016/j.pec.2020.07.016DOI Listing
January 2021

A Clarion Call to Our Family Medicine Colleagues.

Fam Med 2020 06;52(7):471-473

Department of Family Medicine, F. Edward Hébert School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD.

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http://dx.doi.org/10.22454/FamMed.2020.806737DOI Listing
June 2020

A String of Pearls: Lessons for Medical Writing and Submitting for Publication.

PRiMER 2020 13;4. Epub 2020 Jan 13.

Department of Family Medicine, F. Edward Hébert School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD.

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http://dx.doi.org/10.22454/PRiMER.2020.574980DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7279110PMC
January 2020

Sexual Health Communication Strategies for Breast Cancer Survivors.

Am Fam Physician 2020 06;101(11):644

Bethesda, MD, USA.

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June 2020

Turning Points as Opportunities to Partner with Patients Living with type 2 Diabetes or Prediabetes.

J Am Board Fam Med 2020 Mar-Apr;33(2):211-219

From the Department of Family Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD (CJWL); College of Journalism & Communications, UF Health Cancer Center, UF Health Center for Arts in Medicine, University of Florida, Gainesville, FL (CLF); Henry M. Jackson Foundation, Military Primary Care Research Network, Uniformed Services University of the Health Sciences, Department of Family Medicine, Bethesda, MD (LAC, JTJ); Department of Family Medicine, Augusta University, Augusta, GA (DAS); Department of Family Medicine, Nellis Family Medicine Residency, Mike O'Callaghan Military Medical Center, Las Vegas, NV (PFC).

Introduction: Understanding patients' perspectives about their diabetes and what causes those perspectives to shift is critical to building a treatment strategy with the patient and facilitating patient self-management behavior. Key "turning points" can provide crucial opportunities to enact a change in perspective. The goal of this study is to identify "turning points" that have significance to diabetes-related health.

Methods: Research coordinators interviewed 33 patients aged 25 to 65 diagnosed with type 2 diabetes mellitus or prediabetes at medical centers in Augusta, Georgia, and Las Vegas, Nevada. Retrospective interview technique and turning point analysis was employed to plot health or diabetes management changes from diagnosis up to the present day. The constant comparative method was used to conduct a thematic analysis. Axial coding identified properties characterizing each turning point.

Results: Patients reported 5 interrelated turning points occurring at various times after diagnosis: 1) either through patients own research and/or a health care class; 2) including exercising and healthier eating; 3) including events that derailed healthy behavior, motivated health behavior, and removed barriers to enacting healthy behavior; 4) either through holding patients accountable or encouraging them to enact healthy behavior; and 5) such as medication changes or behavior changes critical to disease management.

Discussion: These turning points provide specific moments throughout diabetes care in which family physicians can effectively partner with patients. By prompting, facilitating, or attending to these turning points, family physicians can partner with patients throughout diabetes care.
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http://dx.doi.org/10.3122/jabfm.2020.02.190136DOI Listing
August 2021

How patients make sense of a diabetes diagnosis: An application of Weick's model of organizing.

Diabetes Res Clin Pract 2020 Apr 13;162:108117. Epub 2020 Mar 13.

Augusta University, Department of Family Medicine, 1120 15th Street, Augusta, GA, USA.

Aims: To identify communication cycles patients use to make sense of a diabetes diagnosis and barriers patients encounter in their sensemaking process.

Methods: Researchers conducted interviews with 33 participants with type 2 diabetes mellitus or prediabetes at medical centers in Georgia and Nevada. A thematic analysis using the constant comparative method identified communication cycles.

Results: Patients reported engaging three communication cycles to make sense of the diagnosis: (1) interacting with healthcare clinicians; (2) seeking information online; and (3) taking a nutrition/diabetes management class. Patients reported system-level barriers that impact sensemaking: (1) lack of consistent or routine care; and (2) lack of access to resources.

Conclusion: Results here reinforce the theoretical proposition that receiving a diagnosis is an equivocal process that requires patients to make sense of new information through communication cycles. Patients in this sample repeatedly described communication cycles to interpret this new information rather than relying on assembly rules. Clinicians can promote patient understanding of diabetes and self-management by taking time to explain the diagnosis, maintaining consistent care, providing guidance to online sources, and ensuring patients have access to diabetes education.
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http://dx.doi.org/10.1016/j.diabres.2020.108117DOI Listing
April 2020

Talking about sexual health during survivorship: understanding what shapes breast cancer survivors' willingness to communicate with providers.

J Cancer Surviv 2019 Dec 18;13(6):932-942. Epub 2019 Nov 18.

Department of Family Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD, USA.

Purpose: Breast cancer survivor (BCS)-provider communication about sexual health (SH) is often absent or inadequate. Patients report wanting providers to broach the topic, but providers cite barriers to initiating discussions. While the health care community works to address barriers, it is unrealistic to rely solely on provider initiation of SH conversations. This research investigates willingness to communicate about sexual health (WTCSH) to better understand what may interfere with survivors' ability to self-advocate and receive care for these concerns.

Methods: (N = 305) BCSs completed online surveys. Hierarchical multiple regression determined the relationship between Sexual Quality of Life-Female (SQOL-F), which measures psychological and social dimensions of SH and WTCSH. Interviews were then conducted with forty BCSs. The constant comparative method was used to thematically analyze the transcripts.

Results: The mean SQOL score was 53.4 out of 100. No statistically significant differences in SQOL or WTCSH were found by age or survivorship length. The positive relationship between WTCSH and SQOL was significant, F (6,266) = 4.92, p < .000, adj. R = .080). Five themes illustrated factors that shape WTCSH: (1) comfort discussing SH; (2) perception of demographic similarity/discordance; (3) patient-centered communication; (4) belief that SH is (un)treatable, and (5) ability to access timely/coordinated care.

Conclusions: Findings establish the significance of SH concerns and provide an in-depth understanding of intrapersonal, interpersonal, and organizational issues informing WTCSH.

Implications For Cancer Survivors: Age and gender dynamics, perceptions of provider SQOL messaging, and futility influence survivor openness. Addressing these areas may encourage disclosure among women who would otherwise continue to suffer in silence.
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http://dx.doi.org/10.1007/s11764-019-00809-2DOI Listing
December 2019

When to Discuss Prostate Cancer Screening with Your Patients.

Am Fam Physician 2019 07;100(2):69-70

Bethesda, MD, USA.

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July 2019

Integrating Medical Acupuncture into Family Medicine Practice.

Am Fam Physician 2019 07;100(2):76-78

Mike O'Callaghan Military Medical Center, Nellis Air Force Base, NV, USA.

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July 2019

Communication with Diverse Patients: Addressing Culture and Language.

Pediatr Clin North Am 2019 08 23;66(4):791-804. Epub 2019 May 23.

Department of Family Medicine, Uniformed Services University, 4301 Jones Bridge Road, Bethesda, MD 20814, USA.

Effective communication is key when providing quality health care. The dynamics of communication within the health care team and with the patient and family can be challenging. These challenges stem from the sharing of complex information, highly emotional topics, and health literacy barriers. Linguistic and cultural barriers can further aggravate these challenges. This section provides an overview of linguistic and cultural challenges related to patient-provider communication, strategies for effective communication with patients with limited English Proficiency via the use of interpreter services, and tips for how to teach these skills to health care providers.
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http://dx.doi.org/10.1016/j.pcl.2019.03.006DOI Listing
August 2019

The relationship between patient perceptions of diabetes and glycemic control: A study of patients living with prediabetes or type 2 diabetes.

Patient Educ Couns 2019 11 27;102(11):2097-2101. Epub 2019 May 27.

Nellis Family Medicine Residency, Las Vegas, USA.

Objective: This study aims to identify differences in how patients living with prediabetes (preDM) or type 2 diabetes (T2DM) perceive their illness.

Methods: Following chart review, a cross-sectional survey was administered to patients diagnosed with preDM or T2DM at two US medical centers.

Results: Among 757 respondents, multivariate tests demonstrate that patients living with T2DM have an overall different personal model of disease than patients living with preDM. Patients who have been diagnosed with T2DM report a better understanding of their disease and perceive it to be more chronic in nature than patients living with preDM. Findings revealed a potential but less significant difference in perceived seriousness.

Conclusions: In this first application of personal models of disease to prediabetes, results inform implications for clinicians to talk with patients about preDM. Patients living with preDM indicate less understanding of the "disease" and perceive it to be less "chronic," which may result from unclear clinician communication about preDM.

Practice Implications: When clinicians talk to patients about prediabetes, they should present the risk factor within the spectrum of glucose tolerance. Although labeled a risk factor, clinicians should emphasize that prediabetes remains a serious concern that will not lessen without intervention.
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http://dx.doi.org/10.1016/j.pec.2019.05.023DOI Listing
November 2019

Geographic and Race/Ethnicity Differences in Patient Perceptions of Diabetes.

J Prim Care Community Health 2019 Jan-Dec;10:2150132719845819

3 Mike O'Callaghan Military Medical Center, Nellis Air Force Base, NV, USA.

Objectives: The present study takes a culture-centered approach to better understand how the experiences of culture affect patient's perception of type 2 diabetes mellitus (T2DM). This study explores personal models of T2DM and compares personal models across regional and race/ethnicity differences.

Methods: In a practice-based research network, a cross-sectional survey was distributed to patients diagnosed with T2DM at medical centers in Nevada and Georgia. In analyses of covariance, controlling for age, health literacy, and patient activation, geographic location, and race/ethnicity were tested onto 5 dimensions of illness representation.

Results: Among 685 patients, race/ethnicity was significantly associated with lower reported understanding diabetes ( P < .01) and less perceived longevity of diabetes ( P < .001). Geographic location was significantly associated with seriousness of the disease ( P < .005) and impact of diabetes ( P < .001).

Conclusion: Non-Hispanic White Americans report greater understanding and perceive a longer disease course than non-Hispanic Black Americans and Asian Americans. Regionally, patients in Nevada perceive T2DM as more serious and having more impact on their lives than patients living in Georgia. Primary care physicians should elicit patient perceptions of diabetes within the context of the patient's ethnic and geographic culture group to improve discussions about diabetes self-management. Specifically, primary care physicians should address the seriousness of a diabetes diagnosis and the chronic nature of the disease with patients who belong to communities with a higher prevalence of the disease.
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http://dx.doi.org/10.1177/2150132719845819DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6537251PMC
June 2020

Exploring patient perspectives of prediabetes and diabetes severity: a qualitative study.

Psychol Health 2019 11 23;34(11):1314-1327. Epub 2019 Apr 23.

Family Medicine, Uniformed Services University of the Health Sciences , Bethesda , MD , USA.

This qualitative study sought to identify and describe patients' variant perceptions of disease severity after receiving a type 2 diabetes (T2DM) or prediabetes (preDM) diagnosis. Researchers interviewed 29 patients from two US medical centers to ascertain perceptions of severity. We used the constant comparative method from a grounded theory approach to identify themes from patients' perspectives that inform their disease severity. This approach was used to help translate research to practice and ultimately identify intervention strategies informed by authentic experiences of preDM and T2DM patients. Perceptions of disease severity fell into two groups: and Patients diagnosed with T2DM and preDM emerged in both groups and were comparative in terms of sample size, gender, and ethnic diversity. Several factors contributed to patients' beliefs, including what they were told about the disease, observations from experiences within their own social network, and information from formal diabetes classes and their own research. The two perspectives diverged when patients described how their belief was informed by three thematic properties or personal factors: (i) ; (ii) ; and (iii) . Beliefs about severity are influenced by patients' fears, interactions with clinicians, and experiences within their social networks. These findings show that when interacting with patients with T2DM or preDM, clinicians should elicit patient perceptions of disease severity so they may then tailor the discussion to address these perceptions and help patients grasp the severity of these conditions.
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http://dx.doi.org/10.1080/08870446.2019.1604955DOI Listing
November 2019

Relationship of Training in Acupuncture to Physician Burnout.

J Am Board Fam Med 2019 Mar-Apr;32(2):259-263

From the Department of Family Medicine, Uniformed Services University of the Health Services, Bethesda, MD (PFC, CJWL); Nellis Family Medicine Residency, Nellis Air Force Base, NV (PFC, JR); Military Primary Care Research Network, Bethesda (JTJ); Department of Osteopathic Manipulative Medicine, Ohio University Heritage College of Osteopathic Medicine, Athens, OH (SW).

Background: Physician burnout is an ongoing problem that affects both physician wellbeing and patient care. Burnout is characterized by emotional exhaustion and depersonalization. Studies have explored ways to prevent and alleviate burnout. Receiving training in acupuncture may reduce physician burnout.

Objective: The purpose of this study is to determine if acupuncture training is associated with less patient depersonalization and less emotional exhaustion among physicians.

Methods: These self-reported data were collected from a cross-sectional survey of family physicians at the Uniformed Services Academy of Family Physicians 2017 conference. Physicians answered questions regarding their level of acupuncture training as well as questions about burnout (depersonalization and emotional exhaustion).

Results: The overall response rate was 66% (325/492). Of these, 233 cases provided complete datasets. In a model controlling for years' practice and clinical pace, acupuncture training was significantly associated with decreased depersonalization, (1, 194) = 5.82, < .05.

Conclusion: Study data show an association between decreased physician depersonalization and acupuncture training, suggesting acupuncture training may be a helpful strategy to reduce family physicians' depersonalization of patients.
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http://dx.doi.org/10.3122/jabfm.2019.02.180204DOI Listing
April 2020
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