Faculty Bibliography

PURPOSE: Policy recommendations specify how academic medical centers should manage clinical conflicts of interest (CCOIs), including gifts and payments to physicians from pharmaceutical companies. However, no reliable data exist on the extent to which schools have policies to manage CCOIs. The authors sought to determine the extent and strength of medical schools' CCOI policies. METHOD: A survey asked compliance officers at 125 MD-granting medical schools in the United States to indicate whether their institutions had policies covering 11 areas of CCOI and to provide copies of relevant policies. Policies were scored as 0 (no policy), 1 (permissive), 2 (moderate), or 3 (stringent), based on published recommendations. Each school's scores were averaged to create a measure of overall policy strength. The authors also collected information on schools' public/private status, hospital ownership/affiliation, and NIH funding to determine whether these characteristics were associated with differences in policy strength. RESULTS: A representative sample of 77 of 125 (62%) medical schools responded between October 2007 and December 2008. Absence of policy was the most frequent finding in 7 of 11 CCOI areas. The mean score for overall policy strength was 1.2. Greater NIH funding was associated with stronger policies in 9 areas. CONCLUSIONS: This analysis provides a comprehensive overview of medical schools' CCOI policies. Wider adoption of CCOI policies is crucial to eliminate undue industry influence in clinical care and to preserve public trust in the medical profession. The authors close with a consideration of why so few medical schools have implemented strong policies.

PURPOSE: Adults aging with HIV/AIDS can experience resilience in spite of the deleterious affects of the disease. This study seeks to examine the lived experiences of older adults with HIV/AIDS as it relates to strengths and resilience in dealing with this devastating disease. DESIGN AND METHODS: Semistructured in-depth interviews were conducted with 25 adults, 50 years and older, living with HIV/AIDS. The interview transcripts were analyzed using constant comparative methodology following the tenets of adaptive theory. RESULTS: The majority of informants expressed experiences of resilience and strengths as related to living with HIV/AIDS. Seven major themes emerged from the analysis including self-acceptance, optimism, will to live, generativity, self-management, relational living, and independence. IMPLICATIONS: The research identified the importance of strengths and resilience among older adults living with HIV/AIDS. Further research is needed to explore these phenomena with larger samples. Practitioners should identify and implement methods for assessing resilience among older HIV-infected adults.

This study compares the self-assessments of 67 late-stage HIV/AIDS patients regarding their symptomatology, sense of self-worth, and several other aspects of their health-care situation, to assessments of that situation provided by their informal caregivers. As part of a dyadic study of care preferences, the patients and caregivers independently completed nearly identical versions of the Palliative Care Outcome Scale, a short 10-item measure of the patient's current health, social, and psychological status. The participants in the study were recruited from inpatient and outpatient services at an urban medical center. Substantial or moderate agreement, assessed by weighted kappa, was found between patient and caregiver assessments with regard to only four items assessing physical or emotional states of the patient (pain, other symptoms, anxiety, and life worthwhile). Fair or slight agreement was found for the six remaining items, including those assessing the patient's sense of self-worth, family/friends' anxiety, interactions with family/friends, and practical matters. Mean ratings of self-worth were significantly different for patients and caregivers. These findings underscore the clinical need to assess patient care outcomes directly, and they suggest the importance of facilitating more effective communication about relevant health issues among seriously ill patients, caregivers, and health-care providers.

Although social work has a long and distinctive tradition of practice-relevant research aimed at enhancing the health and well-being of older adults, the profession has been underrepresented among the ranks of academic researchers and the National Institutes of Health's (NIH) scientific endeavors. In this article, the inherent capacities of social workers to generate and disseminate empirical health-related knowledge are discussed and recent developments in social work's geriatric research infrastructure are described. Emerging domains for advancing the profession's contribution to practice-relevant geriatric research on the federal level are identified and the next steps toward advancing the field's research agenda are posed.

The occurrence of cancer is an event of significant importance to family functioning. The present analysis reports on an understudied group profoundly affected by this health event: older mothers caring for an adult child with cancer. As part of a study of breast cancer survivors and their family caregivers, a subsample (N = 13) of older caregiving mothers (mean age 68) participated in focused interviews. The interviews, conducted in English or Spanish, were audio-taped, transcribed, and subjected to content analysis. Analyses of the mothers' accounts elucidate complex psychosocial reactions to their adult daughters' cancer diagnosis that are informed by life-cycle considerations. These reactions, which include a reawakening of maternal behavior, a need to come to terms with the asynchronous nature of their daughters' health event, and an intense feeling of personal responsibility, illustrate the need for family-centered care in oncology

Even with advances in the medical management of HIV/AIDS, it remains an important cause of morbidity and mortality. Network members are a source of support and may be designated as the patient's surrogate therapeutic decision maker. However, little is known about the role of caregivers regarding highly active antiretroviral therapy (HAART) and adherence to medication, especially among low income and medically underserved HIV-infected individuals. The objective of this analysis was to explore patients and their caregivers' understanding, insight, and perceptions of HAART. This was a qualitative study conducted in an urban teaching hospital in the Bronx, NY, consisting of 144 adults with advanced HIV/AIDS and their informal/familial caregivers. Patients and caregivers completed in-depth interviews and brief questionnaires. The data were analyzed using standard qualitative techniques. Themes related to HAART efficacy, side effects, and adherence were identified in the discussions with both patients and their care providers. Looking for consistencies and discordant reports of patients-caregivers dyadic experience with HAART and their association with healthcare sentiment, it was found that the accounts of both members of the dyad were more likely to reflect positive feelings about the patient's healthcare experience when they shared perceptions about the treatment, and were more likely to have a negative viewpoint when the dyad was discordant about treatment. These findings support the importance for HIV healthcare providers to include both patients and their caregivers in discussions about HAART, in order to improve their understanding of and satisfaction with the medication, and, to ultimately contribute to patients' adherence. The study also suggests that healthcare teams may enhance dialog with patients and caregivers to create therapeutic decisions to accommodate the priorities and values of the patient and their family. Clinical, educational, and evaluating tools need to be further developed and evaluation to facilitate this process.

OBJECTIVE: To examine the associations between various patient, disease, situation, and caregiver characteristics (organized by five conceptual domains) and global self-esteem among caregiver daughters to parents with cancer. METHOD: Dyads comprised of 237 cancer outpatients and their adult caregiving daughter completed structured telephone interviews. RESULTS: Two of the five domains of potential correlates significantly predicted caregiving daughters' global self-esteem-daughters' sociodemographics and constraints on/facilitators of caregiving. Daughters' overall sense of self-worth was directly correlated with their household income and inversely correlated with greater depressive affect and the number of patient needs for which someone else provided assistance. It was also correlated with the daughters' other role obligations. A higher sense of self-worth was associated with either being employed or having to care for a child/grandchild; a lower sense of self-worth was associated with having a spouse/partner. DISCUSSION: The present analysis documents the complexity of social connectedness, demonstrating that various role obligations contribute to caregiving daughters' global self-esteem in different ways. In the context of assuming cancer careprovision, daughters' existing repertoire of social roles may possibly mediate the stress associated with their care involvement or serve as a buffer against the strain of the caregiving experience.