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Cancer Communication Research Center
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The promise of Strategic Science

Rabin

This past week we had the opportunity to interact with a distinguished guest at the Institute for Health Research at Kaiser Permanente Colorado (the home base for our Cancer Communication Research Center).

Dr. Kelly Brownell - the director of the Rudd Center for Food Policy and Obesity and the James Rowland Angell Professor of Psychology at Yale University has led a number of successful research efforts that led to substantial social and policy action including changes in labeling of foods in restaurants in New York and work around sugary beverages.

When describing the main ingredient of their success - he highlighted the importance of engaging in policy-driven strategic science instead of the more commonly practiced research-driven programmatic science.  His work can be characterized as proactive, forward thinking, at times risky, practically relevant, and informed by key stakeholders (i.e., legislators). The design of his research studies reflect his creative thinking process and often involve policy and media analysis and simple but clever observational studies. The results from these studies are communicated in ways that are relevant and easy to use for social and policy action.

His Center's website (http://www.yaleruddcenter.org/) hosts a number of excellent resources and examples for strategic science including a revenue calculator for sugar sweetened beverage taxes (http://www.yaleruddcenter.org/sodatax.aspx). 

Borsika Rabin
Staff Researcher/Research Coordinator
KPCO

Written by CCRC at 11:11

Research winding down, products gearing up!

Dearing

Sometimes when you conduct research the only results worth communicating get embedded in academic journal articles.  Other times, the research has meaningful "real-world" application for people who won't bother with reading academic journals.  Our center is approaching this latter situation.  We have a number of studies in their last stages and with very promising implications for healthcare organization leaders, managers, physicians and nurses.  So our research teams are now planning for the transition to creating, refining, and pre-testing "applied products" to help improve health and healthcare.  Some products will be simple:  Borchures, reminders that pop up in EMRs, checklists.  Simple can be good (and cheap).  Other products may be more involved such as training programs and CME courses.  This will be the focus of our 2013 annual meeting.  It's very cool when you work with researchers who really, really care about making a difference!  And there are lots of little roles for research expertise in the production process of applied products.  If you'd like to get involved, let me know. 

Jim Dearing
Director/PI, CCRC
KPCO

Written by CCRC at 09:07

Doctors, too, need to say good bye

Nekhlyudov

As a primary care provider with clinical and research interests in cancer survivorship, I am often in the company of my palliative care colleagues.  We share frustrations about the lack of conversations that occur between patients and their care providers at the end of life and how valuable palliative care consultations and planning may be.   Last week, I was suddenly thrust into a clinical situation that made me appreciate that palliative care impacts not only the patient and his/her family, but also the patients' primary healthcare providers.  

About seven years ago, I took over the care of a 65 year old man (let's call him Joe) whose former primary care physician retired.  Joe had poorly controlled diabetes, hypertension, and heart disease, among other medical conditions. While he was just mildly overweight, at his first visit with me, Joe announced that he had been working on gaining weight in order to qualify for a gastric bypass.   The rationale was that if he has a bypass, most of his chronic medical conditions would be resolved.   It took some convincing, but Joe ultimately realized that this was not a wise decision and gave up on intentionally gaining weight.  Unfortunately, this did not improve his adherence to a healthier diet and medications. 

For the next five years, he saw me regularly but insisted that he "was going to die soon anyway, so why bother changing now?"  Then he suddenly came to a surprising observation that despite his full expectation to die young, he was still alive.  "I should probably start doing something about it," he proclaimed.  He started insulin and began to be closely followed by an endocrinologist.  Over the next year, he made some progress but it was not until suffering another heart attack, being hospitalized for weeks at a time and staying in rehab, that he finally decided that it was now time to take care of himself.  And he did.  He was thrilled with the progress and his new outlook, and at his last appointment, he was full of life and even kissed his endocrinologist.  Unfortunately, I did not get to see this side of Joe as we did not manage to arrange an outpatient visit with me before he was admitted once again.   

Last week, Joe was admitted to a hospital with heart failure and was intubated.  Cardiology did not feel that his chances of recovery were likely and a palliative care team was called in.  The family was engaged, relaying that earlier in the day Joe motioned "I am done" and asked for the tube to be pulled.  The decision was immediate, the tube was pulled and Joe placed on a morphine drip.  Later that afternoon, the endocrinologist and I received an email from the cardiologist letting us know about the developments.  We were both surprised by this turn of events and independently rushed over to the hospital.   By the time we got there, Joe was on morphine, comfortable but non-responsive. 

We spoke with the family members and shared our stories with them, and they with us.  Yet we could not share the final laughs and cries with Joe.  Perhaps he heard us, but his stubbornness, his sense of humor and his charm were not there.  There is no doubt that Joe received tremendous care and benefited from the palliative care input.  But how about his outpatient medical team?  We missed out.  We did not get a chance to engage in the discussion with the family, but I think more importantly here, we missed an opportunity to see and spend time with the man that we got to know, appreciate and care for.  We never had a chance to say goodbye.   

Larissa Nekhlyudov, MD, MPH
Harvard Medical School/Harvard Vanguard Medical Associates

Written by CCRC at 09:28

A new beginning for the Cancer Research Network

Dearing

The set of researchers and their history of institutional agreements that comprise the Cancer Research Network in the U.S., embedded within the HMO Research Network, kicked off a fourth round of funding from the National Cancer Institute.  This new 5-year award represents a departure for the CRN.  Its previous awards from NCI supported research projects at CRN site healthcare organizations such as Group Health Research Institute in Seattle, with the promise of comparative studies across the 15 or so member HMOs.  The new CRN award is an infrastructure grant, meaning that those investigators and staff supported by the award have the responsibility of identifying, helping, and supporting other researchers from outside and inside the CRN to draft and submit new research proposals and then conduct those studies.

All sorts of cancer-related project ideas are going to be encouraged as long as they propose to take advantage of the CRN as a resource for conducting studies.  The big advantage of the CRN is that it is a window into large HMOs with very large patient populations, as well as the docs and staff who serve those patients.  So issues of cancer communication, both prevention and care, can move right to the forefront.  As can proposals for studying dissemination and implementation, either in observational or intervention designs. 

Since these HMOs are care organizations rather than research organizations, relationships have to be built to successfully meet the stakeholders, collaborate, and engage the care delivery systems at each site.  But the reward can be access to truly impressive data systems, since each of these HMOs has sophisticated electronic medical record systems that can be queried to immediately show every "touch" or communicative encounter between providers and patients longitudinally, and the complete patient record of disease, physical conditions, perscriptions, and behavior modifications. 

Have ideas?  Contact me:  james.w.dearing@kp.org 

Jim Dearing
Director/PI, CCRC
KPCO

Written by CCRC at 08:05

Is texting the new house call?

Henton

Last month, there was an article in the New York Times about doctors using text messaging to discuss health information with adolescent patients. Several doctors who were interviewed have found texting to be the most efficient form of communication with teens, who "live and die" for their cell phones. Cell phones are an important tool for teens in the following ways: 1. They allow teens to easily access information (one doctor had posters on her wall with QR codes that could be scanned and linked to websites); 2. They allow teens to discreetly discuss sensitive health information without embarrassment; and 3. Perhaps most important of all, it's convenient.

Of course, there are a lot of factors that go into texting patients, mainly pertaining to privacy and confidentiality. However, as people become more reliant on technology to find and transfer information, things have to change, and while the article focused only on teenagers, adults are just as tech savvy. Email has become very common in some health organizations to allow doctors and patients to communicate with each other without having to schedule an appointment. But as we continue to move more towards what is convenient for patients, as house calls were "back in the day," texting is an immediate, easy, and perhaps will be a common way doctors and patients communicate with each other.

Michelle Henton
Senior Research Assistant, CCRC
KPCO

Written by CCRC at 13:11

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