Faculty Bibliography

CONTEXT/BACKGROUND:During the COVID-19 pandemic, community-based research studies experienced prolonged shutdowns unless able to pivot to remote study procedures. OBJECTIVES/OBJECTIVE:To describe the revision of two National Institutes of Health funded community-based palliative-focused clinical trials serving underserved populations to accommodate remote subject enrollment and examine its impact. METHODS:Transitioning to remote processes required multiple protocol and procedural changes including: altering informed consent processes; reducing the number of surveys administered; adding internet access as an inclusion criterion. To understand technological challenges, a screening tool was developed for one study to identify potentially eligible subjects' technology abilities and accessibility. RESULTS:Subjects' limited access to the internet and internet-enabled devices and discomfort with technology led to changes in recruitment patterns. Lack of familiarity with technology increased the amount of time it took research team members and subjects to connect remotely. Patients with significant cognitive and/or sensory deficits were at higher risk of experiencing fatigue during remote study visits leading to streamlining of data collection. A researcher-developed technology screening tool found that potential subjects were not comfortable with videoconferencing through Zoom® expressing a preference for phone visits. Reduced travel time made scheduling remote study visits more efficient. CONCLUSION/CONCLUSIONS:Future community- and home-based palliative care trials must consider the best way to utilize remote recruitment, enrollment, and data collection processes to increase efficiency and reduce costs. Researchers should consider technology accessibility and train staff to ensure the greatest possible opportunity to recruit underserved populations who have traditionally been underrepresented in research studies.

CONTEXT/BACKGROUND:Evaluation of usability and mobile health content is critical for ensuring effective implementation of technology utilizing interventions tailored to the needs of hospice care providers for people living with dementia in community-based settings. OBJECTIVES/OBJECTIVE:To evaluate the usability, content, and "readiness to launch" of the Aliviado mobile health app for interdisciplinary team members participating in the Hospice Advanced Dementia Symptom Management and Quality of Life. METHODS:Usability of the Aliviado app was assessed in 86 respondents with an adapted IBM Computer Usability Satisfaction Questionnaire following Hospice Advanced Dementia Symptom Management and Quality of Life training and implementation of the mobile app. RESULTS:More than half of users receiving training employed the mobile app in practice. Users reported use as: Daily-6.3%, Weekly-39.6%, monthly-54.2%. The highest measured attributes were usefulness, value, and effectiveness. Over 90% deemed the app "ready to launch" with no or minimal problems. CONCLUSION/CONCLUSIONS:This study shows that a newly-developed mobile app is usable and can be successfully adopted for care of people living with dementia.

Background: Significant racial and ethnic disparities exist in the community in underprescribing analgesics for pain and overprescribing antipsychotics for behavioral symptoms in persons with dementia. In hospice these drugs are commonly used to provide comfort, but little is known about prescription patterns in minoritized populations. We aimed to identify prescribing patterns in minoritized racial and ethnic groups among persons with living advanced dementia in home hospice.
Method(s): A cross-sectional study of 6,874 participants with advanced dementia from eight hospices across the United States. Demographics, antipsychotic (typical, atypical) and analgesic (opioid, non-opioid) prescriptions at admission, days of prescription use in hospice and length of stay were collected from electronic records. Descriptive statistics were calculated and hurdle regression models estimated to examine the association between race/ethnicity and prescription rates for each drug (days of drug use per 100 person-days).
Result(s): Participants were 10.7% Black, 34.8% Hispanic, 51.1% white, and 3.3% from other racial and ethnic groups. On admission, Hispanics and Blacks had similar rates of antipsychotic prescription that were lower than whites (11.9% & 12.3% vs 16.8%) and Hispanics had substantially lower non-opioid analgesic prescription vs Blacks and whites (23.3% vs 36.0% & 37.3%); During the hospice stay, Hispanics were prescribed antipsychotics (atypical RR =1.03, 95 % CI: 1.02-1.04; typical RR:1.04, 95% CI: 1.01-1.07) and analgesics (opioid RR =1.03, 95% CI: 1.02-1.04; non-opioid RR = 1.03, 95% CI = 1.02-1.03) for more days than whites. Blacks were prescribed analgesics (opioid RR =1.09, 95% CI 1.08-1.11; non-opioid RR = 1.01, 95% CI: 1-1.02) for more days than whites.
Conclusion(s): Disparities in analgesic and antipsychotic use on admission amongst Blacks and Hispanics were found, yet hospice narrowed this gap significantly. While less likely to be prescribed opioids, Blacks and Hispanics had more person days on analgesics overall. However, there was divergence in antipsychotic use over time between groups that requires further investigation given the controversial role of antipsychotics in management of dementia symptoms

Background: Overlapping symptoms between delirium and behavioral and psychological symptoms of dementia (BPSD) often makes diagnosis of delirium superimposed on dementia (DSD) complex. This study aimed to examine differences in BPSD expression in PLWD with and without DSD at start of home healthcare (HHC) to help elucidate differences in expression.
Method(s): A cross-sectional analysis of baseline data from 107 PLWD (age 65+) enrolled into a semi-pragmatic, randomized controlled trial was performed. Baseline data were collected <=3 days of HHC admission. BPSD was measured by the Neuropsychiatric Inventory Questionnaire and delirium a modified 3-Mintue Diagnostic Interview for Confusion Assessment Method. Descriptive statistics and chi² or Fisher's exact tests were performed as appropriate to compare BPSD between groups.
Result(s): Of the 107 PLWD (mean age: 83 years; 61% female; 62% White; 14% Hispanic/Latino),19.6% had DSD; 93.5% had 1 BPSD; 79.4% had 3 BPSD. Of the 12 BPSD assessed, 10 were more prevalent in the DSD group: agitation, hallucinations, appetite changes, and delusions were >10% more prevalent; motor disturbance and nighttime behaviors were >20% more prevalent; motor disturbance was statistically significantly more prevalent (p=0.043). See Table 1.
Conclusion(s): Motor disturbance is statistically significantly more prevalent in DSD upon HHC admission; thus, if observed in PLWD, a follow-up DSD assessment may be warranted. Another 5 BPSD were >10%-20% more prevalent in DSD, though not statistically significant, the magnitude of the difference still suggests clinical importance