Browsing by Author "Burke, Emily"

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    Development Of A Brief Measure Of Communication Quality: The 5- And 10-Item Family Inpatient Communication Surveys
    (Oxford University Press, 2022) Burke, Emily; Slaven, James; Taylor, Tracy; Monahan, Patrick; Sachs, Greg; Torke, Alexia; Biostatistics and Health Data Science, Richard M. Fairbanks School of Public Health
    Communication quality between clinical care teams and families impacts important outcomes like satisfaction, depression, and anxiety. Assessment tools must be efficient and reliable to be useful in the clinical environment. We report the development of 5 and 10-item versions of the validated 30-item Family Inpatient Communication Survey (FICS). Data were from 364 surrogate decision makers (SDMs) for incapacitated older adults in the ICU. Most SDMs were adult children (66.8%). SDMs were 70.9% female, 68.9% white, with a mean age of 58.3. Exploratory factor analysis revealed high internal reliability for the single-factor FICS5 (α= .88) and two-factor FICS10 (α= .93). The FICS10 reliably measures two subscales: information (α= .91) and emotional support (α=.81). Good discriminant and predictive validity were demonstrated when comparing total scores to outcomes at 6-8 weeks after hospital discharge, including anxiety (correlation coefficient (ρ)= -.13; p=.0234 ), depression (ρ =-.15; p=.0076), decision regret (ρ =--.15; p=.0066), and satisfaction (ρ =-..48; p<.0001). Repeating analysis with a new sample (n=188) revealed similar results with Cronbach’s alpha ranging from .81 to .93. The FICS5 revealed significant associations (p<.05) at 6-8 weeks after discharge with distress (-.22), while the FICS10 demonstrated significant associations with distress (-.28), anxiety (-.20), depression (-.19) and decision regret (-.27). Confirmatory factor analysis indicated adequate fit (CFI: FICS5= .994, FICS10= .994; RMSEA: FICS5= .093, FICS10= .103). The FICS provides clinicians and interventionists with a reliable, low burden tool to evaluate communication quality and respond quickly, which could impact satisfaction and other important outcomes for patients and families.
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    The Family Navigator: A pilot intervention to support intensive care unit family surrogates
    (American Association of Critical Care Nurses, 2016-11) Torke, Alexia M.; Wocial, Lucia D.; Johns, Shelley A.; Sachs, Greg A.; Callahan, Christopher M.; Bosslet, Gabriel T.; Slaven, James E.; Perkins, Susan M.; Hickman, Susan E.; Montz, Kianna; Burke, Emily; Medicine, School of Medicine
    Background Although communication problems between family surrogates and intensive care unit (ICU) clinicians have been documented, there are few effective interventions. Nurses have the potential to play an expanded role in ICU communication and decision making. Objectives To conduct a pilot randomized controlled trial of the Family Navigator (FN), a distinct nursing role to address family members’ unmet communication needs early in an ICU stay. Methods An inter-disciplinary team developed the FN protocol. A randomized controlled pilot intervention trial of the FN was performed in a tertiary referral hospital ICU to test the feasibility and acceptability of the intervention. The intervention addressed informational and emotional communication needs through daily contact using structured clinical updates, emotional and informational support modules, family meeting support and follow-up phone calls. Results Twenty-six surrogate/patient pairs (13 per study arm) were enrolled. Surrogates randomized to the intervention had contact with the FN 90% or more of eligible patient days. All surrogates agreed or strongly agreed that they would recommend the FN to other families. Open-ended comments from both surrogates and clinicians were uniformly positive. For both groups, 100% of baseline data collection interviews and 81% of 6–8 week follow-up interviews were completed. Conclusions A fully integrated nurse empowered to facilitate decision making is a feasible intervention in the ICU setting. It is well-received by ICU families and staff. A larger randomized controlled trial is needed to demonstrate an impact on important outcomes, such as surrogate well-being and decision quality.
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    Feasibility Of Ecological Momentary Assessment Of Surrogates For Cognitively Impaired Icu Patients: A Pilot Study
    (Oxford University Press, 2022) Taylor, Tracy; Burke, Emily; Slaven, James; Pfeffer, Bruce; Varner Perez, Shelley; Banks, Sarah; Torke, Alexia; Biostatistics and Health Data Science, Richard M. Fairbanks School of Public Health
    We explore the feasibility of ecological momentary assessment (EMA) with surrogate decision makers (SDMs) of critically ill hospitalized adults, to obtain in-the-moment participant-reported data. In this small pilot, 23 SDMs were approached. 82.6% were white, 53.9% were female, and 53.9% were 55 years and older. 25% were spouse or partner, 25% were adult children, 30% were parents, and 20% were other relations. Average ICU length of stay was 13.46 days (range 1.73-77.79). 13 SDMs enrolled (56.52%). Using Twilio, an automated text was sent to SDMs containing a secure link to the surveys. Up to five questions about anxiety, depression, distress, communication, and spiritual well-being were sent up to twice per day. Most participants (84.62%) completed EMA surveys for 5 or more days. Most SDMs stated that the surveys were not burdensome. Of those who declined participation (n= 10), accessibility to a smartphone, stress, and availability to complete texted surveys were noted as barriers to participation. The data suggest that EMA is a valuable tool to inform clinical interventionists and care providers interacting with SDMs. Future research will assess EMA with a larger group of SDMs, utilizing questions that help identify gaps in communication and opportunities to provide support to SDMs. Although surrogates are often under high stress in the ICU setting, they are willing to provide real-time EMA feedback on their experiences. EMA can provide a “just in time” option for research and clinical intervention that focuses on bridging gaps that may contribute to better outcomes for SDMs.
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    Non-Traditional Surrogate Decision Makers for Hospitalized Older Adults
    (Lippincott, Williams & Wilkins, 2018-04) Comer, Amber R.; Slaven, James E.; Montz, Annie; Burke, Emily; Inger, Lev; Torke, Alexia; Robert H. Mckinney School of Law
    Background Without advanced preparation of legal documents, state law determines who may serve as a surrogate decision maker for patients in hospitals. Objectives To examine the relationship characteristics associated with traditional versus non-traditional healthcare surrogates who are making medical decisions for patients in hospitals. Research Design Secondary analysis of a baseline cross-sectional survey of a larger prospective observational study. Subjects 364 patient/ surrogate dyads consisting of patients age 65 years and older admitted to the medical or medical ICU services who lacked decision making capacity based on a physician assessment and also had a surrogate available. Results This study of surrogate decision makers for hospitalized older adults found that the relationships of non-traditional surrogates such as, nieces, nephews, and friends serving in the surrogate role is nearly identical to those of traditional, first degree relatives serving as a surrogate. Over two-thirds (71.2%) of non-traditional surrogates saw the patient in person at least weekly compared to 80.8% of legal surrogates (p-value .9023). Almost all traditional and non-traditional surrogates discussed the patient’s medical preferences with the patient (96.9% of legal surrogates and 89.2% of non-traditional surrogates; p=0.0510). Conclusion This study shows that both traditional and non-traditional surrogates, who are a patient’s primary care giver have similar relationships with patients. The findings of this study suggest that requiring family members such as grandchildren to take the extra step of formal appointment through a legal channel may not be necessary to protect patients. Therefore, broader state laws expanding the list of surrogates authorized by state statute to include more non-traditional surrogates may be necessary.
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    The Validity And Reliability Of The Distress Thermometer In Family Surrogates Of ICU Patients
    (Oxford University Press, 2022) O'Brien, Emma; Burke, Emily; Slaven, James; Taylor, Tracy; Torke, Alexia; Biostatistics and Health Data Science, Richard M. Fairbanks School of Public Health
    Brief, reliable assessment tools are highly valued in both research and clinical settings. The single-item Distress Thermometer (DT) asks participants to rank their overall level of distress from zero to ten. Similar measures of distress perform well in oncology populations, but the validity of the DT has not been well tested with other populations. To determine its validity and reliability, we analyzed data from family surrogates (n=188) of critically ill ICU patients. Surrogates were asked to rate their distress during the first four days of the patient’s ICU stay and 6-8 weeks after discharge (n=127). Data were analyzed using Spearman non-parametric correlation due to the distributions of the data. DT scores at both baseline and follow-up were significantly correlated with anxiety (GAD-7: correlation coefficient (ρ)=.527, p<.0001; ρ=.543, p<.0001, respectively), depression (PHQ-9: ρ=.480, p<.0001; ρ=.399, p=.0002), distress (Kessler-6: ρ=.477, p<.0001; ρ=.528, p<.0001), and negative religious coping (ρ=.149, p=.0426; ρ=.238, p=.0074). Results also indicated that spiritual well-being at baseline and follow-up (FACIT: ρ=-.391, p<.0001, ρ=-.443, p<.0001) and positive religious coping at baseline (RCOPE: ρ=-.164, p=.0253) have an inverse relationship with overall distress. At baseline, surrogates with better positive religious coping and/or more involvement in organizational religious activity (ρ=-.189, p=.0106) were more likely to report lower distress. The DT could be an efficient, single item predictor of outcomes that impact patient and family care. Future research could confirm its validity as a measure of distress, in a variety of clinical populations and environments that could inform clinical care for patients and families.
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    Validation of the Family Inpatient Communication Survey
    (Elsevier, 2017-01) Torke, Alexia M.; Monahan, Patrick; Callahan, Christopher M.; Helft, Paul R.; Sachs, Greg A.; Wocial, Lucia D.; Slaven, James E.; Montz, Kianna; Inger, Lev; Burke, Emily; Medicine, School of Medicine
    CONTEXT: Although many family members who make surrogate decisions report problems with communication, there is no validated instrument to accurately measure surrogate/clinician communication for older adults in the acute hospital setting. OBJECTIVES: The objective of this study was to validate a survey of surrogate-rated communication quality in the hospital that would be useful to clinicians, researchers, and health systems. METHODS: After expert review and cognitive interviewing (n = 10 surrogates), we enrolled 350 surrogates (250 development sample and 100 validation sample) of hospitalized adults aged 65 years and older from three hospitals in one metropolitan area. The communication survey and a measure of decision quality were administered within hospital days 3 and 10. Mental health and satisfaction measures were administered six to eight weeks later. RESULTS: Factor analysis showed support for both one-factor (Total Communication) and two-factor models (Information and Emotional Support). Item reduction led to a final 30-item scale. For the validation sample, internal reliability (Cronbach's alpha) was 0.96 (total), 0.94 (Information), and 0.90 (Emotional Support). Confirmatory factor analysis fit statistics were adequate (one-factor model, comparative fit index = 0.981, root mean square error of approximation = 0.62, weighted root mean square residual = 1.011; two-factor model comparative fit index = 0.984, root mean square error of approximation = 0.055, weighted root mean square residual = 0.930). Total score and subscales showed significant associations with the Decision Conflict Scale (Pearson correlation -0.43, P < 0.001 for total score). Emotional Support was associated with improved mental health outcomes at six to eight weeks, such as anxiety (-0.19 P < 0.001), and Information was associated with satisfaction with the hospital stay (0.49, P < 0.001). CONCLUSION: The survey shows high reliability and validity in measuring communication experiences for hospital surrogates. The scale has promise for measurement of communication quality and is predictive of important outcomes, such as surrogate satisfaction and well-being.