Publications by authors named "Erin Aakhus"

5 Publications

  • Page 1 of 1

Underrepresentation in Oncology: Identifying and Addressing Structural Barriers.

Oncologist 2021 08 19;26(8):630-634. Epub 2021 Apr 19.

Perelman School of Medicine, The University of Pennsylvania, Philadelphia, Pennsylvania, USA.

Underrepresentation of minority groups in the oncology physician workforce is a pressing issue that may contribute to disparities in cancer research, clinical care, and patient outcomes. To address this, we highlight the role of medical culture and institutions in perpetuating a range of barriers that lead to the persistent underrepresentation of minority medical trainees and physicians. These barriers include an exclusionary medical culture, bias in measures of merit, financial barriers to medical subspecialty training, underrecognition of achievement, and poor representation and satisfaction among underrepresented faculty. Furthermore, we suggest a more intentional approach to diversity that values both recruitment of underrepresented undergraduates and early medical students and retention of internal medicine trainees, hematology-oncology fellows, and faculty. To counteract deeply embedded structural racism that hampers diversity efforts, this multifaceted approach will require cultural transformation of our medical institutions at all levels, including increased institutional transparency, mandatory evidence-based bias training, acknowledgment of varied achievements, changes in recruitment practices, and reinvigoration of pipeline development programs with a focus on financial support. Taken in combination, programs should recognize the scope of deterrents to representation and develop program-specific, longitudinal interventions to promote more successful diversity initiatives within the field of oncology. IMPLICATIONS FOR PRACTICE: The medical profession recognizes the value of physician workforce diversity in improving the quality of both medical education and patient care. In return, medical schools and training programs invest in recruitment programs focused on candidates who are underrepresented in medicine. In the field of oncology, where stark racial and ethnic disparities in care and health outcomes are well-defined, measures of minority physician representation remain especially stagnant. This study clearly defines the barriers that limit the effectiveness of such programs and provides recommendations to achieve the necessary workforce diversity in oncology.
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August 2021

Preparing Trainees to Deliver High-Value and Cost-Conscious Care in Hematology.

Curr Hematol Malig Rep 2020 08;15(4):248-253

Department of Medicine, Division of Hematology and Oncology, Hospital of the University of Pennsylvania, Philadelphia, PA, USA.

Purpose Of Review: Despite national-level directives to reduce healthcare waste and promote high-value care (HVC), clinical educators struggle to equip trainees with the knowledge and skills needed to practice value-based care. In this review, we analyze ongoing efforts in graduate medical education (GME) to enhance trainee competence in delivery of high-value and cost-conscious care.

Recent Findings: Surveys of residents and program directors have shown that while many training programs want to offer formal training in high-value care delivery, few succeed. Although several studies suggest that trainees model stewardship behaviors after clinical preceptors, there remains a shortage of faculty role models skilled in providing HVC. Preparing future hematologist-oncologists to provide cost-conscious care will require significant cultural change at the institutional and program levels and will depend heavily on the development of skilled clinical role models.
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August 2020

Views From Patients With Cancer in the Setting of Unplanned Acute Care: Informing Approaches to Reduce Health Care Utilization.

JCO Oncol Pract 2020 11 23;16(11):e1291-e1303. Epub 2020 Jun 23.

Penn Center for Cancer Care Innovation at the Abramson Cancer Center, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA.

Purpose: New oncology care delivery models that avoid preventable acute care are needed, yet it is unclear which interventions best meet the needs of patients and caregivers. Perspectives from patients who experienced unplanned acute care events may inform the successful development and implementation of care delivery models.

Methods: We performed a qualitative interview study of patients with solid tumors on active treatment who experienced the following 3 types of unplanned acute care events: emergency department visits, first hospitalizations, and multiple hospitalizations. Patients were prospectively recruited within a large academic health system from August 2018 to January 2019. Interviews followed a semi-structured guide developed from the Consolidated Framework for Implementation Research. The constant comparative approach was used to identify themes.

Results: Forty-nine patients were interviewed; 51% were men, 75% were non-Hispanic White, and the mean age was 57.4 years (standard deviation, 1.9 years). Fifty-five percent of patients had metastatic disease, and 33% had an Eastern Cooperative Oncology Group performance status of 3-4. We identified the following key themes: drivers of the decision to seek acute care, patients' emotional concerns that influence interactions with the oncology team, and strategies used to avoid acute care. Patients' recommendations for interventions included anticipatory guidance, peer support, improved triage methods, and enhanced symptom management. Patients preferred options for virtual and home-based outpatient care.

Conclusion: Patient-centered care models should focus on early delivery of supportive interventions that help patients and caregivers navigate the unexpected issues that come with cancer treatment. Patients advocate for proactive, multidisciplinary supportive interventions that enable home-based care and are led by the primary oncology team.
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November 2020

Gender and Byline Placement of Co-first Authors in Clinical and Basic Science Journals With High Impact Factors.

JAMA 2018 02;319(6):610-611

Department of Medical Ethics and Health Policy, University of Pennsylvania Perelman School of Medicine, Philadelphia.

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February 2018

Patient Perspectives on the Ethical Implementation of a Rapid Learning System for Oncology Care.

J Oncol Pract 2017 03 24;13(3):e163-e175. Epub 2017 Jan 24.

University of Michigan, Ann Arbor, MI; American Society of Clinical Oncology, Alexandria, VA; and University of Pennsylvania, Philadelphia, PA.

Introduction: A rapid learning system (RLS) of health care harnesses data generated from routine patient care to create a virtuous cycle of data collection and analysis for quality improvement and research. The success of such systems depends on understanding patient perspectives regarding the ethical issues that arise from the ongoing implementation of this transformative concept.

Methods: An interview guide was designed to evaluate patient perspectives to inform the ethical implementation of an oncology RLS. A purposively selected, diverse sample of 32 patients with cancer was recruited from two institutions to participate in semistructured, in-depth interviews for formal qualitative analysis.

Results: The extent to which respondents expressed discomfort with more permissive system features (less formal notification/consent, broader uses/users, inclusion of sensitive data) reflected their trust, which in turn seemed to vary by sociodemographic features. It was also influenced by their familiarity with technology and their attitudes and beliefs regarding privacy and the use of electronic medical records more generally. Distrust of insurers and the pharmaceutical industry led subjects to desire greater oversight and restriction of these potential users of the system. Subjects were most comfortable when doctors were the primary users, engaged patients directly in the notification and consent discussion, and oversaw the system.

Conclusion: Those actively developing RLSs should recognize the critical importance of trust and the key role that doctors will need to play in order for such systems to be successful and to ensure that their implementation is ethically palatable to the patients whose data are being included.
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March 2017