Good afternoon, and welcome to the IUPUI Center for Translating Research into Practice scholar of the Month Series. My name is Steve V Weg and I'm the Associate Director of the Center, and it's my pleasure to welcome you to this opportunity that was brainstormed and envisioned by our founder, doctor Sandra Prono who's a faculty Emeritus in communications, and a translational researcher herself. And one of the dreams she had way back when we started this whole endeavor at IUPUI was to have dialogue spaces, places on campus where we could get together, dive into some translational work and just share and talk about different ideas. And so today, we are delighted that we have the chance to share with you some information and an opportunity to talk with this month's scholar of the month, doctor Andrea oh. So as we get started, I'd like to just share a couple of housekeeping announcements with you. And first of all, some Zoom etiquette reminders, please keep your microphone muted. You're welcome to leave your camera on so we can see who you are. You can type your comments and questions into the chat. We'll monitor those as we go along, but we expect to have plenty of time to discuss your ideas and thoughts with doctor oh at the end of the presentation. We are recording this for future reference. So if you are uncomfortable being seen, then please make note of that and just leave your camera off. You will receive a post evaluation, and we do encourage you to take a couple of minutes to just answer a few questions to give us some feedback about this activity and what you liked and what we could do to make it better. We intend to continue these conversations over the next year. So if you are interested, we are now offering continuing education units for this series, and you can simply go to I U Expand to learn more and to sign up for that. You can always learn more about what's happening at the center by following us on social media. We have lots of ways that we engage with you. You can also visit our YouTube channel to see things in the past that have happened or some other information about our translational scholars. We're very excited to remind folks that you can check out our various scholars works on something called Scholar works. I UPI has put together this amazing opportunity where you can see our faculty's work easily, and at no cost. And the way you might access this is go to Andrew Hoge page on our website, and you can see under her listing the variety of publications that she's done with a simple link that will get you there at no cost, or you could go to the Scholar Works page to see Andreas and everybody's, less you can see quite the variety of publications that she has that's easily accessible for anyone to look at and may help you with your own work, but also in expanding opportunities we might collaborate and work together. Coming out, we want to make sure that you're aware that the November scholar of the month is coming up. It'll be early on the 12th. Because of the holiday coming up, but we're looking forward to hearing and talking with doctor Holly Cusack McVay. And that'll be talking about recovering the past, a collaborative approach to repatriation and social justice. But today, we are very excited to have doctor Andrea oh from the School of Nursing to come talk to us about her amazing work. I will stop there and ask her to turn on her camera and share her screen so that we can hear her work. Welcome, doctor Cohe. Thank you. Thank you so much for this opportunity to present my work today. And I appreciate everyone who was able to log in and join us. So do you see the right screen? Just getting started? Yes, we do. Carry. Okay. Fantastic. Okay. So my work has focused on partners and spouses of breast cancer survivors. So I'm going to give you a bit of background about the work where it came from and where I'm headed. And I wanted to take a minute to acknowledge my funding sources from the KL two program at the Indiana CTSI. And also, to thank my team. I have a fantastic group of people helping me along, including my project manager, Danielle Short, my research assistant, Jenny Alwin, and then an entire slew of mentors, doctor Victoria Champion, doctor Claire Drucker, and doctor Matt Allen. There are approximately 3.9 million people in the US living with a history of breast cancer. In addition to the long term physical consequences that we usually think about, like the fatigue or pain, breast cancer survivors suffer from a host of long term psychological problems from their cancer. These include depression, anxiety, and my most recent and biggest focus, fear that the cancer will come back. When I started my research, a lot of the literature focused on the survivors or if they included partners, we talked about how the partners could help the survivors or how their behaviors affected how the survivors were doing. And I did too. I thought that it was really interesting to examine the effects of how supportive or unsupportive a partner was and the effects that that might have on the survivor. But I didn't consider that the partners might have feelings and have an experience related to the cancer too. Specifically, and I'll talk about these concepts again and again. I started my research by focusing on social constraints or behaviors that limit how we talk about cancer and social support, which is more commonly talked about in lay terms and thinking about how these concepts affected the survivor. I found a theory that supported some of these ideas called social cognitive processing. Nurse scientists love to tap into theory to help us make sense of processes and experiences, and I am no different from my nursing colleagues. The theory states that when we are confronted by a trauma, we experience a trauma in our own lives like breast cancer, that our brain works to process and resolve those difficult emotions connected to it. The theory states that the way that we do this is cyclical. So we'll have thoughts of the trauma like cancer pop into our heads, and then we'll try very hard to push them away. And we cycle through that however many times we need to. So this is healthy in the short term and necessary for any sort of traumatic event. This is how you could see your own experience may be reflected in that cycling of having the thoughts pop up and pushing them away. Additionally, though, if a person is able to talk about these feelings with a supportive and loving partner, then they're able to process the trauma and move on. No that their fears go away, but being able to talk about it helps us process and incorporate it into the rest of our lives. However, if our attempts to talk about the trauma of cancer in this case are met with social constraints or behaviors that limit how we talk about cancer, then we get stuck. The trauma is unresolved. What are these limiting behaviors? As I mentioned two slides ago, just briefly, social constraints are the behaviors that limit discussions of cancer. This can happen several ways, such as avoiding conversations, so maybe steering the conversation away from cancer. Maybe by minimizing concerns, telling the person it's just not a big deal or you're okay. Let's not talk about it, or by expressing distant interest. We can express disinterest by changing the topic or just being quiet, not engaging in the conversation. I don't think that these behaviors are always meant to be hurtful. I think sometimes people think they're helping. Thinking about the minimizing concerns point here. It could be that a partner is hoping to say, you made it through cancer. You're okay. We made it. We don't have to worry about this anymore. And while well intended, that can shut down the conversation and doesn't let the person explore their own feelings about this terrible event. I've had survivors though, to say that when they were on the phone talking to a friend or family member about cancer, that as soon as cancer was brought up, their partner would stand up and leave the room. So it can really result from a whole host of issues and good or bad intentions, it doesn't really matter. They're still received primarily the same way. While it might not be surprising that the breast cancer survivors themselves felt constrained, We found that some partners do too. I've had partners say that the survivor doesn't think about herself as a breast cancer survivor and doesn't want to talk about the cancer anymore at all. But they're still scared. I had one partner say that his wife was diagnosed very early. She had very minimal treatment. She was fine. She doesn't talk about it or think about it anymore, but he got stuck in feeling like he could lose her or she could die or have a recurrence, and he really wasn't able to talk to her about those fears, and had a hard time with it. So social constraints, according to this theory, going back to that. If the person felt like they weren't able to talk about their breast cancer or their partner's breast cancer, then they weren't able to process those difficult feelings and really got stuck. So getting stuck then equates to or results in some of those negative psychological consequences that I mentioned earlier, like depression and fear of cancer occurrence. This is true for both the survivors and partners. Some partners want to talk more about the cancer, some survivors wanted to talk more about the cancer. But beyond social cognitive processing theory, when I started researching breast cancer survivors, there was a lot of research on what contributed to the survivor spear of recurrence and depression. But not much had been done on the partners, and I wanted to focus more on them. From my work and from others, we know that partners report really high rates of depression, anxiety, and fear of cancer occurrence. Often, we say that the partners report just as much, if not more distress than the survivors themselves. During the breast cancer survivors treatment, partners are three times more likely to be hospitalized with an effective disorder than partners of healthy women. And additionally, 14 years after the diagnosis of cancer, partners are more likely to be prescribed antidepressant medications than partners of healthy women. But beyond that, we don't have a ton of information about how breast cancer affects partners in the long term. So my most recent study that I did in collaboration with the KL two program and my mentors, we interviewed 25 partners of breast cancer survivors and asked about their challenges that they experienced during and following treatment, how they dealt with those difficulties, and how we as a healthcare system, could have helped them move through those challenges or how they needed more support. So we really focused on recruiting a diverse sample, and we're able to recruit 12 African American men, that's not entirely true. 12 African American participants. We had a few women, and then 12 White or Caucasian men and one Asian partner. So partners said that they went through five processes in regards to their survivor's breast cancer, and these findings are still under review, so take these with a grain of salt until it gets published. But they felt like each of these areas. There were opportunities for us as health care providers and researchers to find ways to support them and to intervene. So partners mentioned that they had difficulty or had to become caregivers for their breast cancer survivor. They said overnight they became nurses. And this ranged from making sure that she stayed ahead of her pain by keeping her on a schedule with pain medication after surgery or during chemotherapy, and also finding ways to reduce her risk of occurrence by encouraging healthy behaviors and helping her to get back on her feet. They also had to become health care advocates for the survivor. They wanted to be at the appointments and talk to the health care team to be that active team member. And for the partners that I interviewed whose survivor was diagnosed during COVID, and especially during the first shutdown, this was the area where they had the most trouble because partners weren't able to go to appointments or to the hospital and usually were only able to attend appointments by Facetime or video chat. And so they felt like they weren't able to be the active team member that they wanted to be. They also talked about having difficulty and having to figure out how to connect emotionally with the survivor. While some partners felt like they were able to provide a lot of support and be reassuring, a few of the partners said that they just didn't have the tools to talk about all of the fear that they felt and that the survivor felt. And one participant, I remember, said that he felt like he missed the mark, despite trying really hard, he just felt like he never got there and wasn't able to help her in the way she needed. But in addition to helping her with her feelings and connecting with a survivor about their own feelings, partners had difficulty managing their own painful emotions. So they needed to find ways to decompress or to get over over being stuck at home, feeling like they could go out and do something. But especially during the initial shutdown from COVID, felt like they didn't have an opportunity to leave home and go decompress somewhere. And then finally, they talked about how challenging it was to connect with others, both informally and formally in order to get support. So the partners talked about with their families and friends, they didn't feel like they could talk about breast cancer with them because it was so sensitive, and they didn't want any of their feelings to get back to the survivor. If a partner's having a really bad day and feels really tired or burdened or mad even at the cancer or doesn't understand what's going on with the survivor, they felt like they weren't able to say that to their friends and family, and they didn't have anyone to go to for advice. Many of them expressed that their wife was the first person they knew with breast cancer, and so they didn't have anyone to go to. And finally, they came up against a lot of stigma about what it meant to be a strong man in society. So this wasn't expressed by any of my female partners, but several of the men talked about how they had difficulty opening up and being vulnerable to other people. So where is my research now that we went through all of those interviews is that with the larger picture, there are no interventions available for partners that will address any of these issues. So we don't have things available to them to help them process and build skills for handling these difficult challenges. Additionally, we have no data on how distress reported by partners may or may not lead to them seeking care in the US. So while I mentioned those two studies earlier that included how frequently partners are hospitalized with effective disorders or their medication use years after diagnosis and treatment. Those are pretty much the only two articles that have been written about how partners are seeking care after or even during their breast cancer survivors treatment. My current work is both interventional and descriptive. In intervention that I submitted in June to the National Institute of Nursing Research was reviewed this week, so we'll wait to see what those comments say. But my team for this study was doctor Kevin Rand, doctor Katie Head, and doctor Kathy Miller, who really provided support for how did we take the information from the interviews that we conducted and make that into a meaningful intervention that could help partners. So the main outcome that we wanted to focus on was fear of cancer progression and recurrence. And I wanted to look at both progression and recurrence because partners said that they were often scared that at the end of treatment that there was still cancer lurking in there somewhere, that they hadn't gotten at all, or it was going to just show itself again in the months following the end of treatment. So we wanted to first help them build skills to improve self efficacy. And this is their confidence that they can handle all of those challenges that we talked about earlier. They need to or they needed to gain confidence in being able to meet all of these needs from the breast cancer survivor. They additionally needed to develop some communication skills. How do we open up and share our own painful feelings or vulnerable feelings? Then how did the survivor or how did they encourage their survivor to talk about the cancer too? Helping them gain some foundational skills where they could hopefully process the cancer together. My second current study right now is a large scale data collection, well, data analysis with doctor Costly Simon and doctor Suma Gupta. Both are professors of economics, and they have an entire wealth of knowledge that I had never considered to study myself. But using Optum Health Data, which is Optum Health is the largest health insurer in the US, private health insurer. In collaboration with doctor Cosi Simon and Smeda Gupta? We are going to analyze optim health data from the last decade to answer the question of what the impact of cancer is on partners in terms of how they show up in the health care system. So first question is, are they showing up for emergency health services unexpectedly? Are they relying on the health care system through emergency departments to address some needs that have come up. The reason that we think this is important is that there is one school of thought that if partners have experienced a huge trauma like cancer in their spouse, then it might be possible that any acre pain would lead them to feel very nervous, very scared, that it's something big and would take them to the ER immediately. And so we're going to see if they are showing up unexpectedly in the emergency department. Also, we will see if those partners over the last decade, were diagnosed with one of the spade symptoms. Spade stands for sleep, pain, anxiety, depression, and low energy or fatigue. And those symptoms all really show up together in the literature and in patient populations. So if you're not sleeping well, then you'll have low energy or fatigue. You might not be sleeping well because you're depressed or anxious. And the pain really results from any of those psychological or physical issues that then are just compounded by, you know, being really distressed. So we're going to see if partners experience or diagnosed with those symptoms more frequently in the year after their breast cancer survivors diagnosis than in the year before. So to use them as their own control group to see if they are changing their behaviors or experiencing more symptoms after having experienced this trauma. And then finally, we're going to see if they were prescribed medications for any of those spade symptoms. So thank you very much to my fantastic project manager, Daniel Short, who pulled all of those codes on the ICD nine and ten codes for medications and the types of visits that these patients might be seen for. So my long term goal then is to expose those at compromised health risk and to help them or help identify the people to whom we need to dedicate resources. So if we can find that a certain group of partners is having a really hard time after breast cancer, then can we use some resources to address their needs? And then finally, I would like to design and implement interventions that can address these needs in both survivors and their partners. So I'm starting first with that intervention, I showed you briefly in figuring out if we can support partners in some of those areas where they need to build confidence. And then we'll expand that to say, how can we as a couple, or how can we as providers help the couple to move forward together? So thank you so much. That is the end of my presentation for today, but you can follow me on Twitter. If you have any questions, you are welcome to e mail me at the e mail address there. So I'll go ahead and stop sharing and then open it up for questions. Thank you, doctor oh. That's a lot of wonderful information. And so we will invite anybody who has a question or a comment to go ahead and show yourself on the screen, might raise your hands so we know you're interested in saying something and start some conversation. That's our goal. Does anyone have a question or a comment? Well while people are thinking about it, one thing that I was wondering about, especially as you were talking about the last pieces that you were covering about the spade. That, some of that sounded very similar to how I'm feeling after experiencing a pandemic. It may be wonder about the impact of the pandemic on this work too and how that might complicate the things that you're wondering about. It does complicate all of these issues, but I think we can use some of the same tools to meet those challenges too. So if partners or breast cancer survivors are feeling nervous or more distressed in light of the pandemic. Because I think too, a lot of partners and survivors are more nervous about the survivors risk of COVID and having negative outcomes because of their cancer survivor status. So while I can't help reduce their risk or the severity of COVID if they did contract it, we can help them figure out how to talk more openly about it. I will say that when I was doing these interviews during the pandemic, I was able to find partners who were pretty distressed and also willing to talk because I think they had been stuck at home or with limited social interaction. And so I had some great participants who really shared a lot of vulnerable information that they were finally able to talk to someone outside of the family outside of their friend group about how scared they were. I think sometimes validating people's feelings and helping them understand or telling them, Yes, your fears and concerns are valid. Like, it makes sense that you're scared that cancer will come back. It was a really scary, challenging situation. Even that is helpful for people and knowing that their fears aren't irrational. Well, it does strike me that in what you're talking about, the attributes, the things that go along with this. Not only the pandemic, but just the situation is that my sense is that in those scenarios, probably couples don't just talk about that with friends. It's not like a topic of conversation at dinner. And so you might feel pretty isolated. And so having that opportunity to talk with you might be very validating and important. And it makes me as the social worker here always wondering about where are the opportunities to support folks in these kinds of scenarios, and what could we do and how do you help lead them to those opportunities? Things that you're trying to study to work on that might be helpful. I do wonder a lot if if it would be helpful to have a therapist, a social worker, a licensed clinical social worker who could provide additional support to the partners. What I am most curious about and still haven't figured out is where they fit in the healthcare system. So that's why we're doing the optim health data analysis? Because we want to see if they're showing up anywhere? If they are going to their physician more often, if they're going to the emergency department to seek care. Because otherwise, they're completely left out of the healthcare system. They're not addressed in the survivors oncology appointments as having needs. So how do we get them to interact with the healthcare team in a way that will be meaningful for their own outcomes? These are good questions. If you figure them out, you let me know. Well, this is a conversation just between the two of us. So folks, please join in. But I know there are some practices that have experimented with having a social worker on their team in some way to make that service available, in general, but I think that raises a very interesting question about how could we in a systemic way, ad that piece to make that connection for folks? Because it could be very helpful. Yes. At the right time, right? You know at a time where that would be how do you use that? And in very well resourced health care systems, that is the case. I remember in the hospital where I practiced as a bedside nurse. We did have daily rounds with the oncology physicians, and then Chaplain, social workers, psychologists and nurses. So the whole health team was involved in the care. So I don't know how to get those well resourced opportunities, but doctor Darker, I see your here. Yes. Let's please mute so we can hear you. Hello. Great talk, Andrea. Somewhat familiar with the work. So I did have a question related to the interviews, but also as you move forward into the intervention work. I know so much of it was gendered, right? That, you know, men don't have feelings. Men shouldn't, you know, seek psychological help, and all of those kinds of things. I mean, I think that really is a factor in a barrier. So I was just wondering if you could say a little bit more about that and how you would address that in an intervention because it seems like such a big piece of this work. So yeah, the whole gender piece of it seems really important. I think thank you, doctor Drucker. And I think gender and race both play a big role in this problem. I heard from a lot of the male partners that they did feel like they weren't allowed to have feelings about cancer. And I remember one of my Black participants said, I am a former football player. I am 65, a big guy, and nobody wants to see that guy breaking down. Nobody wants to see that big strong guy needing help. And so while that may be the case and how they interact socially or in their everyday lives, I think that there is potential for having a successful intervention. I mean, even the interviews, if I can get participants to open up that well and that fully in just an interview, I wonder how much better it could be in an intervention situation. So what I go back and forth between is is this an intervention that needs to be one on one? So do I need to have a person one on one and meet their needs specifically? Or would it be helpful to have them in a group setting where they can see they aren't the only ones that are distressed and having a hard time that they would be able to connect with other partners? But then I get stuck on yes, and they may not open up as much in front of other men. So I don't know where to go with that yet. I think there are a lot of layers we still have to peel away. And it might be as easy as framing it when presenting this to partners and saying, It's normal, and it is expected that you are going to have a hard time with this in one way or another. So we would like to get on board with you from the beginning and very early on so we can help head off some of these problems in the long run. I don't know how easy that would be, but I think we do have to get to the partners directly, and it can't be through the survivors. Some of my previous work looked at how the survivors can be a gatekeeper. They don't think that their spouse would be interested in the type of intervention that they would be interested in. And that just may very well not be the case. I know that even on my best days of guessing what my husband would want, and if he's on the call, I sorry, honey. But I missed the mark because I can't read his mind as much as I try, but that's true in any of our intimate relationships that we don't know exactly what that person really will want in any given moment. So because of that, I think we do have to find the partners directly. Thank you. As you were talking, one of the other thoughts that I had and we'll call on Stacey, who has a hand raised is the workforce piece of that too. I'm looking at the participants today. It's mostly women, and you're talking about the needs of men and then if you even think about Black men. I know I'm interested in how we address the workforce issues in the mental health field or in other helping fields to have a more representative workforce so that people feel comfortable. So that black man who was a football player would feel like I could talk to somebody who might look like me or have some similar experiences to me. Yes. And several of the partners said in the ideal situation, they would be set up with a knowledgeable guy who looked like them and would be able to help them process some of these feelings. I have an idea that we'll probably be able to get maybe a male nurse. If we go a male nurse who specializes in oncology or a black male nurse who specializes in oncology, the sample is just so small. So unless I start recruiting undergrads to be trained up all the way through grad school. It's a tall order. Well, I was thinking of this as more as other opportunity to collaborate and work on activities because I think you're right. For the work that you're trying to do, you have to go with what you have. Yes. Stacy, you had your hand raised. I don't know if you had something you wanted to say or if that was a mistake or you were clapping? I'm not sure. But I did have Mason. Okay. Great. Please. Yes. Thank you for your presentation and I did arrive a little bit late, so I apologize if you've already answered this, but I also feel like your research would be applicable to partners of survivors for various types of cancers, not specifically just breast cancer. Do you have plans for your intervention strategies to be extended beyond partners of breast cancer survivors? Yes. So the The thoughts right now are in, do we match the breast cancer sample to primarily male driven cancer like prostate or protesticar cancer. So first, I would want to derive a sample that was pretty age matched because I would expect that in prostate survivors, we would have mostly female partners, and then with our breast cancer survivors have mostly male, If I'm going to study if these issues are salient for both of those populations, I would want to make sure they were matched in some way. So in terms of prognosis or age too. So thinking if I expand out to say, like pancreatic cancer that doesn't have a very good prognosis. It would be difficult to see if those same processes held up in that late stage or poor prognosis population compared to breast cancer, which has a pretty high survival rate above 90% at five years. So yes, these are the conversations that I have with my team of what I get to do after promotion and tenure. So right now, focus, and then doctor Drucker is laughing too because she's had to tell me this on several occasions. Focus now, we'll expand later. Thank you. I want to thank you Stacy for asking that very translational question because that's part of the conversation here is where are the opportunities? Maybe there is somebody within our conversation audience today that would have interest in partnering with doctor Cohe in figuring that out while she's preparing and getting some other information. B this is the idea. This is what I UPI is known for generating knowledge and using it in a variety of ways to help make the world a better place. So good. Yes, Jerry, you have a comment question. Yeah. It's kind of off the wall a little bit. I thought it was really fascinating that the participants might have been more open and vulnerable as a result of the pandemic. And when the pandemic started, a lot of us were thinking about their risks and benefits to research participants in the context of, will they be exposed to the virus? In this case, there's perhaps there were social psycho benefits or a risk to participating. And I don't get to submit to IRBs very much. So I was just wondering if people are starting to think about that in ethical reviews of potential research projects. So in all of the IRB applications that I submit, I do make note of the potential for these difficult feelings to really spark a lot of emotional distress. And that is why I always have psychologists and other mental health providers as a part of my team to say, a, if something did go terribly wrong, if a participant really became triggered in some way, then we would have resources available that they could access or we could get in touch with to meet those needs. I haven't yet had any participants who got to that level of distress, and most did say that this was a good opportunity to talk about it and not have to worry about the effect it was having on the other person. So I think there is a risk, but generally speaking, I think the benefit is much bigger. Hanks. Thanks, Jerry. That makes me think about the literature in the family world and the world of disability. Parents who have kids with a variety of different kinds of disabling or developmental conditions, the message that they share in their writing is that that what they're looking for perhaps in this kind of environment is acknowledgment and affirmation of their feelings. And I know we, maybe as the providers worry about them falling apart, we have to put them back together, and they're like, No, really, I don't need you for that. I just need to be heard. And that's what I hear you saying is that was one of the benefits, perhaps of the timing of your survey after a pandemic, is that it's isolating and people just want to be heard. I know I do, as a result of the pandemic. It's kind of been interesting to get back into the social world, and it's awkward. We don't know what to say to each other, but it's kind of nice to just be heard and have that social interaction. So Yeah. And I think this is Yeah. I think this is true in our social relationships, otherwise, that we aren't always looking for a solution. We aren't always looking for someone to fix the problem. We just want them to understand what we're going through, that we're having a hard time and that our feelings are valid. Yes. Yeah. And maybe that helps inform some of what your intervention might look like, right? As you're trying to think about what might that be? Yeah. Yes. I will take all opportunities for being informed of what the intervention should look like. I see doctor Petrono and doctor Bans have unmuted. Did you guys have a You're both gone now, but I know you're there. I have a question. Thank you very much first for this. This was tremendously important and frankly, shocking to me, as a lay person, I'm not a researcher, I'm not a health specialist, but I was shocked that there weren't support programs. And I and you provided one of the explanations why I was so shocked, which is well resourced places have programs. So I immediately when you were describing that, remember my mother dealt with my father's heart problems for more than a decade. And as she said, learned that she could get him in an emergency room anywhere and get treated in acute cardiac distress. The point is, at one point, my sister lived in Rochester, Minnesota. So he got into stress, and she was in the Mayo Hospital system. And they had a huge program for the spouses. And she's talking about this, and it was the first time she'd had that level of experience. And we're talking my father passed away in 2083. Okay. So this is ages ago. But she talked about it and the sense that she gave me as a woman in her 60s, Yes. Was she was lucky. She knew how to deal with it. And the young women who were experiencing a 35-year-old heart attack husband. And it was an interesting dynamic. And some of what Steve and you are talking about, I now I'm listening to and saying, that's what she was doing. She was having the experience of understanding where she fit in the kind of issues. But that was at the male clinic. You know, world class supportive system. And so am I hearing you say the only places that you've seen something like this in cancer have been in places like that, is that what you're saying? I in fact practiced as a bedside nurse at Mayo Clinic in Rochester, Minnesota. So my experience in working with patients and their spouses does come directly from that. And when I came back to Indiana to work on my PhD, I met with several hospital managers in oncology around the city. And when I told them what my experience was like at Mayo, I did have one nurse manager say, you will not be happy as a bedside nurse here because the structure isn't the same. And the relationships between the healthcare providers isn't such that on rounds every day, you have an oncologist, a social worker, a nurse, a psychologist, a chaplain, and the nursing manager for the unit. It's just not the way it is here. So in Indianapolis, specifically, I can tell you that at the Cancer Center and several local organizations, they do have support groups for partners. They also have education for some of these issues, so in managing the stress, but those aren't necessarily evidence based. They aren't necessarily tested and tried interventions. So there's a lot of work being done that is practical work, but not research based. So that's the ounity is in Indiana is going to be to try and provide that to those self, you know, operating groups. W fun place that the social workers probably could be really helpful in diffusion that information results. Yes. And I've I've been working with some community organizations such as Pink Fever in the Indianapolis area that serves Black women and their families. And then working with the Cancer Center to find what are the other community partnerships that we already have established through the Cancer Center, and how can we continue to grow those in a more holistic fashion. But the fact is that that isn't housed within the Cancer Center. It's going to be housed in community partnerships. So I think about like Lif Strong at the Y, which provides exercise support for cancer survivors, people going through treatment. Okay. Well, is there an opportunity to collaborate with Lif Strong at the Y to provide some services to the partners as well. And a quick comment from Evelyn is that keep in mind that a lot of today's breast cancer treatment and care is done on a help patient basis, and not necessarily in houseware there would be rounds. It requires even yet another level of thinking about intervention and how that might work. Yeah. Yeah. It's very complicated. It is. Everything is complicated. That's always a message. But thank you so much for taking some time today to share your research and your ideas. And you can see where there's lots of connections and opportunities. And I hope you take away some of that, doctor oh, but also the rest of us, some ideas of things that we could do, whatever it is, our own information or ideas for our own research and opportunities to to cooperate and collaborate. And I want to thank doctor Petronio, who's here today for the brain child to actually have these kinds of conversations. Isn't this wonderful that we could just have a dialogue space and dig a little deeper into somebody's translational research. So we appreciate being able to do that. I do want to remind everybody that coming up next month on November 12. Again, our next scholar of the month conversation is with doctor Cusick McVay, and we'll be talking about recovering the past, a collaborative approach to repatriation and social justice. And so then thank you today again, doctor oh, for taking some time out of your schedule and sharing with us and giving up this opportunity to share information and to think about how we could translate research into practice. And we want to honor your time. We know you did this over lunch, and you probably have a 1:00 appointment. So we're going to end our meeting now. We'll just hang on here if anybody has a last minute question or so, and you want to say something to doctor oh. We'll stay here, but we'll officially end the program now and let you go to get refreshed for your 1:00 meeting, and we'll look forward to seeing you on the 12th. Please tell all your friends, have them come and join us. Thank you so much and have a great day.