Publications by authors named "Tamryn F Gray"

24 Publications

  • Page 1 of 1

Top Ten Tips Palliative Care Clinicians Should Know About Their Work's Intersection with Clinical Ethics.

J Palliat Med 2021 Nov 22. Epub 2021 Nov 22.

Department of Medical Ethics, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.

Palliative care (PC) subspecialists and clinical ethics consultants often engage in parallel work, as both function primarily as interprofessional consultancy services called upon in complex clinical scenarios and challenging circumstances. Both practices utilize active listening, goals-based communication, conflict mediation or mitigation, and values explorations as care modalities. In this set of tips created by an interprofessional team of ethicists, intensivists, a surgeon, an attorney, and pediatric and adult PC nurses and physicians, we aim to describe some paradigmatic clinical challenges for which partnership may improve collaborative, comprehensive care.
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http://dx.doi.org/10.1089/jpm.2021.0521DOI Listing
November 2021

A Framework for Anti-Racist Publication in Palliative Care: Structures, Processes, and Outcomes.

J Pain Symptom Manage 2021 Oct 15. Epub 2021 Oct 15.

Ariadne Labs, Boston, MA.

Systemic or structural racism describes an embedded pattern of explicit and implicit racial biases that, through policy and action, systematically confer advantage to white people and disadvantage Black, indigenous, and other people of color. Hospice and palliative care journals participate in this broader system of racial discrimination. Building on palliative care's explicit focus on patients' goals and values, which may in and of itself comprise a form of social justice in healthcare, palliative care journals and their publishers have an opportunity to lead others in cultivating anti-racist practices and explicitly promoting equity. The publication life cycle of submission and solicitation, manuscript peer-review, and publication provide a framework for examining the structures, processes, and outcomes by which palliative care and other journals might address systemic racism. We describe the current academic publishing landscape, which diminishes the voices and experiences of racial and ethnic minority patients and undermines the careers of under-represented scholars. We then propose reforms that we believe will improve publication equity and quality as well as healthcare outcomes. These include an Equity in Publication checklist, solicitation of manuscripts on equity-relevant topics, promotion of scholars through editorial structures and peer review processes, and a standard Equity Rating for publications. Greater efforts to include non-dominant voices in every aspect of publication, through appropriate recognition of their scholarship and remuneration for their efforts, will drive equity in health outcomes. By pursuing an anti-racist and equity-focused publishing agenda, hospice and palliative medicine journals and their publishers have an opportunity to transform healthcare.
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http://dx.doi.org/10.1016/j.jpainsymman.2021.10.001DOI Listing
October 2021

Association of Social Support With Overall Survival and Healthcare Utilization in Patients With Aggressive Hematologic Malignancies.

J Natl Compr Canc Netw 2021 Oct 15:1-7. Epub 2021 Oct 15.

1Division of Hematology and Oncology, Department of Medicine, Massachusetts General Hospital.

Background: Social support plays a crucial role for patients with aggressive hematologic malignancies as they navigate their illness course. The aim of this study was to examine associations of social support with overall survival (OS) and healthcare utilization in this population.

Methods: A cross-sectional secondary analysis was conducted using data from a prospective longitudinal cohort study of 251 hospitalized patients with aggressive hematologic malignancies at Massachusetts General Hospital from 2014 through 2017. Natural Language Processing (NLP) was used to identify the extent of patients' social support (limited vs adequate as defined by NLP-aided chart review of the electronic health record). Multivariable regression models were used to examine associations of social support with (1) OS, (2) death or readmission within 90 days of discharge from index hospitalization, (3) time to readmission within 90 days, and (4) index hospitalization length of stay.

Results: Patients had a median age of 64 years (range, 19-93 years), and most were White (89.6%), male (68.9%), and married (65.3%). A plurality of patients had leukemia (42.2%) followed by lymphoma (37.9%) and myelodysplastic syndrome/myeloproliferative neoplasm (19.9%). Using NLP, we identified that 8.8% (n=22) of patients had limited social support. In multivariable analyses, limited social support was associated with worse OS (hazard ratio, 2.00; P=.042) and a higher likelihood of death or readmission within 90 days of discharge (odds ratio, 3.11; P=.043), but not with time to readmission within 90 days or with index hospitalization length of stay.

Conclusions: In this cohort of hospitalized patients with aggressive hematologic malignancies, we found associations of limited social support with lower OS and a higher likelihood of death or readmission within 90 days of hospital discharge. These findings underscore the utility of NLP for evaluating the extent of social support and the need for larger studies evaluating social support in patients with aggressive hematologic malignancies.
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http://dx.doi.org/10.6004/jnccn.2021.7033DOI Listing
October 2021

The Dyadic Cancer Outcomes Framework: A general framework of the effects of cancer on patients and informal caregivers.

Soc Sci Med 2021 10 30;287:114357. Epub 2021 Aug 30.

Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, USA; Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, USA.

It is widely acknowledged that cancer affects not only patients but also their friends and family members who provide informal, and typically unpaid, care. Given the dual impact that cancer often has on patients and their informal caregivers (i.e., family members, partners, or friends), an expanded dyadic framework that encompasses a range of health and psychosocial outcomes and includes primary caregivers with a range of relationships to the patients is critically needed. Moreover, an emphasis on the role of social and contextual factors may help the framework resonate with a broader range of patient-caregiver relationships and allow for the development of more effective dyadic interventions. This article describes the development of the Dyadic Cancer Outcomes Framework, which was created to guide future research and intervention development. Using an iterative process, we conducted a conceptual review of currently used dyadic and/or caregiving models and frameworks and developed our own novel dyadic framework. Our novel Dyadic Cancer Outcomes Framework highlights individual- and dyad-level predictors and outcomes, as well as incorporating the disease trajectory and the social context. This framework can be used in conjunction with statistical approaches including the Actor Partner Interdependence Model to evaluate outcomes for different kinds of partner-caregiver dyads. This flexible framework can be used to guide intervention development and evaluation for cancer patients and their primary caregivers, with the ultimate goal of improving health, psychosocial, and relationship outcomes for both patients and caregivers. Future research will provide valuable information about the framework's effectiveness for this purpose.
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http://dx.doi.org/10.1016/j.socscimed.2021.114357DOI Listing
October 2021

An Integrative Review of the Role of Nurses in Fertility Preservation for Adolescents and Young Adults With Cancer.

Oncol Nurs Forum 2021 09;48(5):491-505

Dana-Farber Cancer Institute.

Problem Identification: Adolescents and young adults (AYAs) with cancer commonly report future fertility as an important issue in care. Despite long-standing guidelines on fertility counseling and the trusting relationship between nurses and patients, little is known about the nurse's role in fertility preservation (FP) for AYAs with cancer.

Literature Search: The authors conducted a literature search of articles published through 2020 focused on nursing involvement in FP for AYAs with cancer.

Data Evaluation: 85 studies were identified. In total, 11 articles met inclusion criteria and were critically appraised in the review.

Synthesis: Although well positioned to improve FP care among AYAs with cancer, nurses currently have a minimal role because of provider, institutional, and patient-related barriers.

Implications For Practice: Interventions to enhance nurses' knowledge about FP, improvements in electronic health record documentation, and facilitation of institutional support are needed to support the nurse's role in FP for AYAs with cancer.
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http://dx.doi.org/10.1188/21.ONF.491-505DOI Listing
September 2021

Optimizing the Global Nursing Workforce to Ensure Universal Palliative Care Access and Alleviate Serious Health-Related Suffering Worldwide.

J Pain Symptom Manage 2021 Jul 29. Epub 2021 Jul 29.

International Children's Palliative Care Network (J.D.), Makerere University, Kampala, Uganda.

Context: Palliative care access is fundamental to the highest attainable standard of health and a core component of universal health coverage. Forging universal palliative care access is insurmountable without strategically optimizing the nursing workforce and integrating palliative nursing into health systems at all levels. The COVID-19 pandemic has underscored both the critical need for accessible palliative care to alleviate serious health-related suffering and the key role of nurses to achieve this goal.

Objectives: 1) Summarize palliative nursing contributions to the expansion of palliative care access; 2) identify emerging nursing roles in alignment with global palliative care recommendations and policy agendas; 3) promote nursing leadership development to enhance universal access to palliative care services.

Methods: Empirical and policy literature review; best practice models; recommendations to optimize the palliative nursing workforce.

Results: Nurses working across settings provide a considerable untapped resource that can be leveraged to advance palliative care access and palliative care program development. Best practice models demonstrate promising approaches and outcomes related to education and training, policy and advocacy, and academic-practice partnerships.

Conclusion: An estimated 28 million nurses account for 59% of the international healthcare workforce and deliver up to 90% of primary health services. It has been well-documented that nurses are often the first or only healthcare provider available in many parts of the world. Strategic investments in international and interdisciplinary collaboration, as well as policy changes and the safe expansion of high-quality nursing care, can optimize the efforts of the global nursing workforce to mitigate serious health-related suffering.
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http://dx.doi.org/10.1016/j.jpainsymman.2021.07.014DOI Listing
July 2021

Nurses' Perceptions of Facilitating Advance Care Planning Conversations in the Emergency Department.

Palliat Med Rep 2021 12;2(1):65-70. Epub 2021 Mar 12.

Department of Emergency Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA.

Nurses are well positioned to initiate advance care planning (ACP) conversations because of their unique strength in communication and central patient-facing role in the interdisciplinary team. Nurse-led ACP conversations have demonstrated promising results in settings outside of the emergency department (ED). Understanding ED nurses' perspectives regarding ACP conversations is needed before implementing similar practices in the ED. To explore ED nurses' perception of facilitating ACP conversations. We conducted a cross-sectional survey to assess ED nurses' perceptions of facilitating ACP conversations in the ED. ED nurses at one academic hospital and one community hospital located within the northeastern region of the United States. Seventy-seven (53.1%) out of 145 eligible ED nurses completed the survey. All participants perceived ACP conversations in the ED as at least somewhat important. Forty (51.9%) felt somewhat comfortable in facilitating these conversations. The majority of participants (77.9%) agreed that a specially trained nurse consultation model might be helpful in the ED. We found a correlation between total clinical experience and interest in facilitating ACP conversations in the ED ( = 0.045). ED nurses are well positioned to help patients clarify their goals-of-care and end-of-life care preferences. They perceived ACP conversations to be important and felt comfortable to facilitate them in the ED. Additional studies are needed to empirically test its implementation.
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http://dx.doi.org/10.1089/pmr.2020.0116DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8241390PMC
March 2021

Using nursing notes to improve clinical outcome prediction in intensive care patients: A retrospective cohort study.

J Am Med Inform Assoc 2021 07;28(8):1660-1666

Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts, USA.

Objective: Electronic health record documentation by intensive care unit (ICU) clinicians may predict patient outcomes. However, it is unclear whether physician and nursing notes differ in their ability to predict short-term ICU prognosis. We aimed to investigate and compare the ability of physician and nursing notes, written in the first 48 hours of admission, to predict ICU length of stay and mortality using 3 analytical methods.

Materials And Methods: This was a retrospective cohort study with split sampling for model training and testing. We included patients ≥18 years of age admitted to the ICU at Beth Israel Deaconess Medical Center in Boston, Massachusetts, from 2008 to 2012. Physician or nursing notes generated within the first 48 hours of admission were used with standard machine learning methods to predict outcomes.

Results: For the primary outcome of composite score of ICU length of stay ≥7 days or in-hospital mortality, the gradient boosting model had better performance than the logistic regression and random forest models. Nursing and physician notes achieved area under the curves (AUCs) of 0.826 and 0.796, respectively, with even better predictive power when combined (AUC, 0.839).

Discussion: Models using only nursing notes more accurately predicted short-term prognosis than did models using only physician notes, but in combination, the models achieved the greatest accuracy in prediction.

Conclusions: Our findings demonstrate that statistical models derived from text analysis in the first 48 hours of ICU admission can predict patient outcomes. Physicians' and nurses' notes are both uniquely important in mortality prediction and combining these notes can produce a better predictive model.
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http://dx.doi.org/10.1093/jamia/ocab051DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8324216PMC
July 2021

Anxiety and Depression Symptoms in Caregivers Prior to Hematopoietic Stem Cell Transplantation (HCT).

Transplant Cell Ther 2021 06 5;27(6):517.e1-517.e5. Epub 2021 Mar 5.

Massachusetts General Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts.

Family and friends caring for hematopoietic stem cell transplantation (HCT) recipients experience substantial disruptions in daily life as they prepare for transplant. These disruptions may increase their psychological distress, yet little research has described the extent of this distress. The goals of the present study were to characterize rates of anxiety and depression symptoms immediately prior to HCT and their relationship with modifiable caregiving domains. We conducted a secondary analysis of cross-sectional data of caregivers of patients undergoing HCT. Caregivers completed self-report measures to assess 8 domains of caregiving (Caregiver Oncology Quality of Life Questionnaire) and anxiety and depression symptoms (Hospital Anxiety and Depression Scale [HADS]) prior to transplant. Scores ≥8 on the HADS anxiety and depression subscales signified clinically significant symptoms. We used multivariable regression models adjusting for age, sex, caregiver relationship, and HCT type to examine the associations between caregiving domains and anxiety and depression symptoms. We enrolled 193 caregivers (median age = 60 years, 70.0% female, 52.3% allogeneic transplant). A majority of participants were providing care for a spouse (79.8%), followed by a child (7.8%) or parent (5.2%). On average, caregivers reported more anxiety (mean = 7.04, SD = 3.94) than depression symptoms (mean = 4.18, SD = 3.49), with 46.6% and 16.1% endorsing clinically significant anxiety and depression symptoms, respectively. Caregiver anxiety was associated with worse physical well-being, less leisure time, and poorer coping (Ps < .05). Caregiver depression symptoms were associated with worse physical well-being and less leisure time (Ps < .05). Caregivers of HCT recipients experience substantial psychological distress, particularly anxiety, prior to transplant. This distress is linked to modifiable caregiving domains. Study findings identify possible targets for psychosocial interventions aimed at managing caregiver anxiety and depression symptoms as well as highlight the need for intervention early during the course of transplant.
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http://dx.doi.org/10.1016/j.jtct.2021.03.002DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8217210PMC
June 2021

The Oncology Nursing Society Rapid Review and Research Priorities for Cancer Care in the Context of COVID-19.

Oncol Nurs Forum 2021 03;48(2):131-145

Dana-Farber Cancer Institute.

Objectives: To identify research priorities addressing COVID-19 that build on the 2019-2022 Oncology Nursing Society (ONS) Research Agenda, in alignment with ONS's mission to promote excellence in oncology nursing and quality cancer care.

Methods & Variables: Priority areas were identified using a multistep approach combining rapid review of the literature; consultation with experts/stakeholders; and review of priorities from other funding agencies, public health, and cancer-focused organizations.

Results: The rapid research response team identified five priority areas for research related to COVID-19.

Implications For Nursing: Oncology nurses are well positioned to address the research priorities and cross-cutting themes identified through this review. The use of innovative methodologic approaches and attention to disparities are necessary to advance cancer care related to COVID-19.
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http://dx.doi.org/10.1188/21.ONF.131-145DOI Listing
March 2021

Church leaders and parishioners speak out about the role of the church in advance care planning and end-of-life care.

Palliat Support Care 2021 06;19(3):322-328

Professor, Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD.

Objective: Despite the increased focus on improving advance care planning (ACP) in African Americans through community partnerships, little published research focused on the role of the African American church in this effort. This study examines parishioner perceptions and beliefs about the role of the church in ACP and end-of-life care (EOLC).

Method: Qualitative interviews were completed with 25 church members (parishioners n = 15, church leader n = 10). The coding of data entailed a direct content analysis approach incorporating team experts for final themes.

Results: Seven themes emerged: (1) church role on end-of-life, (2) advocacy for health and well-being, (3) health literacy in EOLC, (4) lay health training on ACP and EOLC, (5) church recognized as a trusted source, (6) use of church ministries to sustain programs related to ACP and EOLC, and (7) community resources for EOLC needs.

Significance Of Results: The church has a central role in the African American Community. These findings suggest that involving African American churches in ACP and EOLC training can have a positive effect on facilitating planning and care during illness, dying, and death for their congregants.
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http://dx.doi.org/10.1017/S1478951520000966DOI Listing
June 2021

Prognostic Awareness in Caregivers of Patients with Incurable Cancer.

J Palliat Med 2021 04 30;24(4):561-569. Epub 2020 Sep 30.

Harvard Medical School, Boston, Massachusetts, USA.

Little is known about how patients with incurable cancer and caregivers differ in their prognostic awareness, and the relationship between caregiver prognostic awareness and their psychological distress. To investigate prognostic awareness in caregivers of patients with incurable cancer and prognostic discordance in patient-caregiver dyads and its association with psychological distress. This is a cross-sectional study. In total, subjects were 390 caregivers of adults with incurable lung, gastrointestinal, and brain cancers at a cancer center in the northeastern United States. The Prognosis and Treatment Perceptions Questionnaire was used to assess prognostic awareness and Hospital Anxiety and Depression Scale to assess psychological distress. In total, 39.7% ( = 147/370) and 17.3% ( = 64/370) caregivers reported clinically significant anxiety and depression symptoms. And 53.7% of caregivers reported the patients' cancer as "curable" and 44.1% reported the cancer was "not terminal." Caregivers' report of curability was not associated with their anxiety (odds ratio [OR] = 0.99,  = 0.93) or depression (OR = 1.05,  = 0.32) symptoms. Among 42.5% (124/292) and 26.0% (76/292) of dyads ( = 292), both patients and their caregivers agreed in their perception of the cancer as curable and incurable, respectively. In 19.9% of dyads ( = 58), patients reported their cancer as curable, while their caregivers reported it as incurable. In 11.6% of dyads ( = 34), patients reported the cancer as incurable while caregivers reported it as curable. More than half of caregivers have misperceptions about the patients' likelihood of cure, and one-third of patient-caregiver dyads have discordant perceptions. Supportive care interventions may facilitate conversations and enhance prognostic understanding in patients with incurable cancer and their caregivers.
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http://dx.doi.org/10.1089/jpm.2020.0236DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8182654PMC
April 2021

Caring for loved ones with cancer during the COVID-19 pandemic: A double hit risk for social isolation and need for action.

Psychooncology 2020 09 13;29(9):1418-1420. Epub 2020 Aug 13.

Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts, USA.

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http://dx.doi.org/10.1002/pon.5466DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7404735PMC
September 2020

Recommendations to Leverage the Palliative Nursing Role During COVID-19 and Future Public Health Crises.

J Hosp Palliat Nurs 2020 08;22(4):260-269

William E. Rosa, PhD, MBE, ACHPN, FAANP, FAAN, is Robert Wood Johnson Foundation Future of Nursing Scholar, University of Pennsylvania School of Nursing, Philadelphia. Tamryn F. Gray, PhD, RN, is research fellow, Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts. Kimberly Chow, RN, ANP-BC, ACHPN, is nurse practitioner, Supportive Care Service, Memorial Sloan Kettering Cancer Center, New York. Patricia M. Davidson, PhD, RN, FAAN, is dean and professor, Johns Hopkins University School of Nursing, Baltimore, Maryland. J. Nicholas Dionne-Odom, PhD, MSN, MA, ACHPN, FPCN, is assistant professor, University of Alabama at Birmingham School of Nursing; and codirector, Caregiver and Bereavement Support Services, UAB Center for Palliative and Supportive Care. Viola Karanja, BSN, RN, is deputy executive director, Partners in Health Liberia, Harper. Judy Khanyola, MSc, RCHN, is Chair, Nursing and Midwifery, University of Global Health Equity, Butaro, Rwanda. Julius D. N. Kpoeh, ASN, RN, is senior clinical mentor, Partners in Health Liberia, Harper. Joseph Lusaka, BSc HM, DCM, PA, is clinical manager, Pleebo Health Centre, Liberia. Samuel T. Matula, PhD, RN, PCNS-BC, is lecturer, University of Botswana, Gaborone. Polly Mazanec, PhD, AOCN, ACHPN, FPCN, FAAN, is research associate professor, Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, Ohio. Patricia J. Moreland, PhD, CPNP, FAAN, is assistant clinical professor, Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia. Shila Pandey, MSN, AGPCNP-BC, ACHPN, is nurse practitioner, Supportive Care Service, Memorial Sloan Kettering Cancer Center, New York. Amisha Parekh de Campos, PhD, MPH, CHPN, Robert Wood Johnson Foundation Future of Nursing Scholar, University of Connecticut, Storrs; quality and education coordinator, Hospice Program, Middlesex Health, Connecticut. Salimah H. Meghani, PhD, MBE, RN, FAAN, is professor and term chair of Palliative Care, University of Pennsylvania School of Nursing, Philadelphia.

With the daily number of confirmed COVID-19 cases and associated deaths rising exponentially, social fabrics on a global scale are being worn by panic, uncertainty, fear, and other consequences of the health care crisis. Comprising more than half of the global health care workforce and the highest proportion of direct patient care time than any other health professional, nurses are at the forefront of this crisis. Throughout the evolving COVID-19 pandemic, palliative nurses will increasingly exercise their expertise in symptom management, ethics, communication, and end-of-life care, among other crucial skills. The literature addressing the palliative care response to COVID-19 has surged, and yet, there is a critical gap regarding the unique contributions of palliative nurses and their essential role in mitigating the sequelae of this crisis. Thus, the primary aim herein is to provide recommendations for palliative nurses and other health care stakeholders to ensure their optimal value is realized and to promote their well-being and resilience during COVID-19 and, by extension, in anticipation of future public health crises.
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http://dx.doi.org/10.1097/NJH.0000000000000665DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8018720PMC
August 2020

Illness and prognostic understanding in patients with hematologic malignancies.

Blood Rev 2021 01 6;45:100692. Epub 2020 Apr 6.

Massachusetts General Hospital Cancer Center, Boston, MA, USA; Harvard Medical School, Boston, MA, USA. Electronic address:

It is critical for patients with hematologic malignancies to have an accurate understanding of their illness and prognosis to make informed treatment decisions. Illness and prognostic understanding have primarily been studied in patients with solid tumors, however, data in patients with hematologic malignancies are rapidly growing. Patients with hematologic malignancies often face a unique and unpredictable illness trajectory with the possibility of cure persisting even in relapsed and refractory settings. These patients often require intensive therapies such as high-dose chemotherapy, hematopoietic stem cell transplantation (HCT), or CAR T-cell therapy, which carry with them significant risk of morbidity, mortality, and prognostic uncertainty. In this review article, we first described the current literature on illness and prognostic understanding in patients with hematologic malignancies including 1) patients' varying desire for prognostic information; (2) patients' prognostic misperceptions, (3) the association between patients' prognostic understanding and their psychological outcomes; and (4) barriers to prognostic understanding. Next, we examined insights gained from the literature about illness and prognostic understanding in patients with solid tumors to guide our understanding of the research gaps in hematologic malignancies. Future studies are needed to better delineate the longitudinal relationship between prognostic understanding, psychological distress, and coping in patients with hematologic malignancies. Strategies such as communicating effectively about prognosis, cultivating adaptive coping in the face of a terminal prognosis, and integrating specialty palliative care for patients with hematologic malignancies have the potential to improve patients' prognostic understanding and their quality of life and care.
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http://dx.doi.org/10.1016/j.blre.2020.100692DOI Listing
January 2021

Palliative and End-of-Life Care for Patients With Hematologic Malignancies.

J Clin Oncol 2020 03 5;38(9):944-953. Epub 2020 Feb 5.

Duke University School of Medicine, Durham, NC.

Hematologic malignancies are a heterogeneous group of diseases with unique illness trajectories, treatment paradigms, and potential for curability, which affect patients' palliative and end-of-life care needs. Patients with hematologic malignancies endure immense physical and psychological symptoms because of both their illness and often intensive treatments that result in significant toxicities and adverse effects. Compared with patients with solid tumors, those with hematologic malignancies also experience high rates of hospitalizations, intensive care unit admissions, and in-hospital deaths and low rates of referral to hospice as well as shorter hospice length of stay. In addition, patients with hematologic malignancies harbor substantial misperceptions about treatment risks and benefits and frequently overestimate their prognosis. Even survivors of hematologic malignancies struggle with late effects, post-treatment complications, and post-traumatic stress symptoms that can significantly diminish their quality of life. Despite these substantial unmet needs, specialty palliative care services are infrequently consulted for the care of patients with hematologic malignancies. Several illness-specific, cultural, and system-based barriers to palliative care integration and optimal end-of-life care exist in this population. However, recent evidence has demonstrated the feasibility, acceptability, and efficacy of integrating palliative care to improve the quality of life and care of patients with hematologic malignancies and their caregivers. More research is needed to develop and test population-specific palliative and supportive care interventions to ensure generalizability and to define a sustainable clinical delivery model. Future work also should focus on identifying moderators and mediators of the effect of integrated palliative care models on patient-reported outcomes and on developing less resource-intensive integrated care models to address the diverse needs of this population.
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http://dx.doi.org/10.1200/JCO.18.02386DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8462532PMC
March 2020

Loneliness among cancer caregivers: A narrative review.

Palliat Support Care 2020 06;18(3):359-367

Assistant Professor, Johns Hopkins School of Nursing, Baltimore, MD21205.

Objective: Providing care to a loved one with cancer places demands on caregivers that result in changes to their daily routines and disruptions to their social relationships that then contribute to loneliness. Though caregivers' psychosocial challenges have been well studied, loneliness - a determinant of health - has not been well studied in this population. This narrative review sought to describe the current evidence on loneliness among caregivers of cancer patients. We aimed to (1) define loneliness, (2) describe its prevalence, (3) describe the association between loneliness and health outcomes, (4) describe risks and consequences of loneliness among cancer caregivers, (5) identify ways to assess loneliness, and (6) recommend strategies to mitigate loneliness in this unique population.

Method: We used evidence from articles listed in PubMed, PsycINFO, and Cumulative Index to Nursing and Allied Health Literature (CINAHL) databases, book chapters, and reports. Articles were reviewed for the following inclusion criteria: (1) published in English, (2) caregivers of cancer patients, (3) loneliness as a study variable, and (4) peer-reviewed with no restriction on the timeframe of publication. Caregivers were defined as relatives, friends, or partners who provide most of the care and support for someone with cancer.

Results: Eighteen studies met inclusion criteria and were included in the analysis. Caregivers' experiences of loneliness can contribute to negative effects on one's social, emotional, and physical well-being. Social support interventions may not be sufficient to address this problem. Existing recommendations to mitigate loneliness include cognitive and psychological reframing, one-on-one and group therapy, befriending, resilience training, and technology-based interventions.

Significance Of Results: Limited attention to loneliness in cancer caregivers poses a twofold problem that impacts patient and caregiver outcomes. Interventions are critically needed to address loneliness as a determinant of health in caregivers, given their pivotal role in providing care and impacting health outcomes for people with cancer.
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http://dx.doi.org/10.1017/S1478951519000804DOI Listing
June 2020

Patients as experts: characterizing the most relevant patient-reported outcomes after hematopoietic cell transplantation.

Bone Marrow Transplant 2020 01 27;55(1):242-244. Epub 2019 Mar 27.

Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA.

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http://dx.doi.org/10.1038/s41409-019-0518-0DOI Listing
January 2020

Burdened by a Secret: Caring for Older Adults With HIV in Critical Care.

Authors:
Tamryn F Gray

AACN Adv Crit Care Spring 2019;30(1):79-84

Tamryn F. Gray is a Postdoctoral Research Fellow, Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute and Harvard Medical School, 375 Longwood Avenue, Boston, MA 02215

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http://dx.doi.org/10.4037/aacnacc2019552DOI Listing
July 2019

The decision partner in healthcare decision-making: A concept analysis.

Int J Nurs Stud 2019 Apr 24;92:79-89. Epub 2019 Jan 24.

School of Nursing, Johns Hopkins University, Baltimore, MD, United States; Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, MD, United States.

Background: The decision partner concept emerged to describe someone who contributes to healthcare decision-making with a patient. There is a need for greater precision and consensus surrounding its conceptual definition and use in broader populations.

Objective: To define and describe the decision partner concept within the context of healthcare decision-making.

Design: A concept analysis.

Data Sources: We searched the following databases for articles published between 1990-2017: PsychINFO, PubMed, Embase, and CINAHL. We included qualitative, quantitative, or mixed methods studies that used the term decision partner in the context of healthcare decision-making.

Methods: We applied the Walker and Avant method to identify the antecedents, attributes, related concepts, consequences, and empirical referents of the concept, with major themes identified.

Results: From the 112 articles included in this concept analysis, 6 defining attributes of decision partner were identified: (1) has a relationship with the patient, (2) demonstrates a willingness to participate in decision-making, (3) articulates a clear understanding of both the patient's health condition and the decisions that must be made, (4) demonstrates decision-making self-efficacy; (5) exemplifies an emotional capacity to participate in decision-making, and (6) willing to fulfill several supportive roles including patient advocate and the "hub of information".

Conclusions: A unifying definition and discussion of the decision partner concept has been developed. Our findings: (1) offer insights into refining the concept across various diseases and healthcare encounters, (2) contribute to developing theoretical models and empirical research to refine antecedents, attributes, consequences, (3) serve as a foundation to develop instruments to measure the concept and (4) highlight the need to design interventions that include and support decision partners in healthcare decision-making.
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http://dx.doi.org/10.1016/j.ijnurstu.2019.01.006DOI Listing
April 2019

Symptoms, Mobility and Function, and Quality of Life in Adults With Acute Leukemia During Initial Hospitalization.

Oncol Nurs Forum 2018 09;45(5):653-664

Duke University.

Objectives: To examine longitudinal symptoms, mobility and function, and quality of life (QOL) in adults newly diagnosed with acute leukemia.

Sample & Setting: 55 adults undergoing induction chemotherapy at the University of North Carolina Lineberger Comprehensive Cancer Center and the Duke Cancer Institute.

Methods & Variables: A prospective, longitudinal study with measures of mobility and function, global physical and mental health, cancer-related fatigue, anxiety, depression, sleep disturbance, pain intensity, and leukemia-specific QOL was conducted. Data were analyzed using descriptive statistics, linear mixed modeling, and one-way analysis of variance.

Results: 49 adults with acute leukemia completed assessments during hospitalizations. Global mental health and pain intensity did not change significantly. Global physical health significantly improved. Fatigue, anxiety, depression, and sleep disturbance decreased significantly. QOL increased significantly.

Implications For Nursing: The significant decrease in anxiety and fatigue during hospitalization may be attributable to understanding of the disease process, familiarity with the staff, and ability to communicate concerns.
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http://dx.doi.org/10.1188/18.ONF.653-664DOI Listing
September 2018

Disparities in Cancer Screening Practices among Minority and Underrepresented Populations.

Semin Oncol Nurs 2017 05 6;33(2):184-198. Epub 2017 Apr 6.

Objectives: To review current evidence about cancer screening challenges that lead to cancer health disparities in minority populations.

Data Sources: Research reports, published journal articles, web sites, and clinical practice observations.

Conclusion: There are significant disparities that exist in cancer screening practices among racial and ethnic minority and underrepresented populations, resulting in disproportionately higher cancer mortality rates in these populations.

Implications For Nursing Practice: Nurses are positioned to lead in educating, promoting, and bringing awareness to cancer screening recommendationsand current cancer prevention guidelines for at-risk individuals, and help them to implement these guidelines to reduce incidence and mortality.
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http://dx.doi.org/10.1016/j.soncn.2017.02.008DOI Listing
May 2017

How Can I Change My Patients' Treatment Decision Making by Becoming a Nurse Scientist?
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Authors:
Tamryn F Gray

Clin J Oncol Nurs 2017 Apr;21(2):263

Johns Hopkins University.

"What would you do?" I have heard this question numerous times throughout my nursing career by patients and families affected by cancer. As a pediatric blood and marrow transplantation nurse, I have often seen patients and their families wrestle with difficult treatment decisions. I have witnessed parents struggle between beginning end-of-life care for their child, or pursuing a risky but potentially life-saving clinical trial. With science driving advances in cancer treatments and patients playing more active roles in their care, uncertainty around cancer treatment decisions will only become more complicated. For me, being a good nurse meant helping these patients navigate this uncertainty. I was compelled to pursue research to understand the process patients experience as they make treatment decisions, who they choose to involve in decision making, and what role the unique nurse-
patient relationship could play in facilitating patient-centered decisions.
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April 2017
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