Browsing by Author "Stout, Madison"

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    Incorporating PROMIS Symptom Measures into Primary Care Practice-a Randomized Clinical Trial
    (Springer Nature, 2018-08) Kroenke, Kurt; Talib, Tasneem L.; Stump, Timothy E.; Kean, Jacob; Haggstrom, David A.; DeChant, Paige; Lake, Kittie R.; Stout, Madison; Monahan, Patrick O.; Biostatistics, School of Public Health
    BACKGROUND: Symptoms account for more than 400 million clinic visits annually in the USA. The SPADE symptoms (sleep, pain, anxiety, depression, and low energy/fatigue) are particularly prevalent and undertreated. OBJECTIVE: To assess the effectiveness of providing PROMIS (Patient-Reported Outcome Measure Information System) symptom scores to clinicians on symptom outcomes. DESIGN: Randomized clinical trial conducted from March 2015 through May 2016 in general internal medicine and family practice clinics in an academic healthcare system. PARTICIPANTS: Primary care patients who screened positive for at least one SPADE symptom. INTERVENTIONS: After completing the PROMIS symptom measures electronically immediately prior to their visit, the 300 study participants were randomized to a feedback group in which their clinician received a visual display of symptom scores or a control group in which scores were not provided to clinicians. MAIN MEASURES: The primary outcome was the 3-month change in composite SPADE score. Secondary outcomes were individual symptom scores, symptom documentation in the clinic note, symptom-specific clinician actions, and patient satisfaction. KEY RESULTS: Most patients (84%) had multiple clinically significant (T-score ≥ 55) SPADE symptoms. Both groups demonstrated moderate symptom improvement with a non-significant trend favoring the feedback compared to control group (between-group difference in composite T-score improvement, 1.1; P = 0.17). Symptoms present at baseline resolved at 3-month follow-up only one third of the time, and patients frequently still desired treatment. Except for pain, clinically significant symptoms were documented less than half the time. Neither symptom documentation, symptom-specific clinician actions, nor patient satisfaction differed between treatment arms. Predictors of greater symptom improvement included female sex, black race, fewer medical conditions, and receiving care in a family medicine clinic. CONCLUSIONS: Simple feedback of symptom scores to primary care clinicians in the absence of additional systems support or incentives is not superior to usual care in improving symptom outcomes.
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    Pain-Related Rumination, But Not Magnification or Helplessness, Mediates Race and Sex Differences in Experimental Pain
    (Elsevier, 2017-03) Meints, Samantha M.; Stout, Madison; Abplanap, Samuel; Hirsh, Adam T.; Department of Psychology, School of Science
    Compared with white individuals and men, black individuals and women show a lower tolerance for experimental pain stimuli. Previous studies suggest that pain catastrophizing is important in this context, but little is known about which components of catastrophizing contribute to these race and sex differences. The purpose of the current study was to examine the individual components of catastrophizing (rumination, magnification, and helplessness) as candidate mediators of race and sex differences in experimental pain tolerance. Healthy undergraduates (N = 172, 74% female, 43.2% black) participated in a cold pressor task and completed a situation-specific version of the Pain Catastrophizing Scale. Black and female participants showed a lower pain tolerance than white (P < .01, d = .70) and male (P < .01, d = .55) participants, respectively. Multiple mediation analyses indicated that these race and sex differences were mediated by the rumination component of catastrophizing (indirect effect = −7.13, 95% confidence interval (CI), −16.20 to −1.96, and 5.75, 95% CI, .81–15.57, respectively) but not by the magnification (95% CI, −2.91 to 3.65 and −1.54 to 1.85, respectively) or helplessness (95% CI, −5.53 to 3.31 and −.72 to 5.38, respectively) components. This study provides new information about race and sex differences in pain and suggests that treatments targeting the rumination component of catastrophizing may help mitigate pain-related disparities.