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•The National Academy of Medicine report, The Future of Nursing 2020-2030: Charting a Path to Achieve Health Equity calls for a series of policy reforms to unleash the potential of nurses to play greater roles in advancing health equity.•The report recommends that the systems that educate, pay and employ nurses: 1) permanently remove barriers to care; 2) value their contributions; 3) prepare nurses to tackle health equity; and 4) diversify the workforce. The need to fully support nurses is interwoven throughout the report.•All nurses should work in partnership with others to advance the nine major report recommendations. The National Academy of Medicine's long-anticipated report, The Future of Nursing 2020–2030: Charting a Path to Achieve Health Equity, offers an aspirational vision: the achievement of health equity in the United States built on strengthened nursing capacity, diversity, and expertise (Wakefield, 2021Wakefield M. Federally qualified health centers and related primary care workforce issues.Jama. 2021; 325: 1145-1146Crossref PubMed Scopus (10) Google Scholar). Released in May 2021, the report arrives at a critical moment for the profession. Many nurses are burned out, exhausted, and have experienced moral injury from caring for an unrelenting stream of patients with COVID-19. The pandemic has laid bare and further exacerbated long-existing health inequities. School closings during the pandemic similarly exacerbated educational disparities, and poor treatment of Black, Indigenous, and other people of color by police spotlighted inequities in law enforcement. Collectively, these inequities have resulted in renewed calls to dismantle structural, cultural, and interpersonal racism, including within nursing. This new report provides a roadmap for how the nursing profession can contribute its expertise to create a fairer, more just and healthier world. The report is the second collaboration between the Robert Wood Johnson Foundation (RWJF) and the National Academy of Medicine (NAM) on the future of nursing. The first report, released in 2010, re-conceptualized the role of nurses in transforming the healthcare system (Shalala et al., 2011Shalala D. Bolton L.B. Bleich M.R. Brennan T. Campbell R. Devlin L. The future of nursing: Leading change, advancing health. 10. The National Academy Press, Washington DC2011: 12956https://www.nap.edu/catalog/12956/the-future-of-nursing-leading-change-advancing-healthGoogle Scholar). RWJF and AARP formed The Future of Nursing: Campaign for Action, a nationwide initiative to advance the report recommendations. Over the past decade, the nursing field strengthened nursing education, advanced practice, promoted leadership, and increased workforce diversity. In doing so, the nursing field has built – and is continuing to build – its capacity to provide high-quality care to more Americans. As nursing built its capacity and as the evidence increasingly linked inequities to poorer health status, it became clear that nurses could do more to build healthier communities and advance equity. Nurses are the most trusted profession and the first point of contact for most people seeking health care. They are bridge builders and collaborators who engage and connect with people, communities, and organizations to promote health and well-being (Pittman, 2019Pittman, P. (2019,. March 12). Activating nursing to address the unmet needs of the 21st century: Background paper for the NAM Committee on Nursing 2030.Robert Wood Johnson Foundation. Available at: https://publichealth.gwu.edu/sites/default/files/downloads/HPM/Activating%20Nursing %20To%20Address%20Unmet%20Needs%20In%20The %2021st%20Century.pdfGoogle Scholar). Their expertise could be better used to combat the many shortcomings of the U.S. health system. The United States spends $3.5 trillion each year on health care (CMS, 2020) more than any other country in the world but ranks last compared with other high-income countries on equity, access to care, health care outcomes, and administrative efficiency (Schneider et al., 2021Schneider, E. et al.,(2021, August)) Mirror, Mirror 2021 — Reflecting Poorly: Health Care in the U.S. compared to other high-income countries (Commonwealth Fund). https://doi.org/10.26099/01dv-h208.Google Scholar). Life expectancy, infant mortality and maternal mortality are worse in the United States compared with other high-income nations. Disparities in health care access and outcomes related to race, income, geography and other social and environmental factors are also common. RWJF has long believed that nurses have enormous potential for tackling the shortcomings of health and health care in the United States and in 2019 asked the NAM to form a committee tasked with charting a path for the nursing profession to create a culture of health, reduce health disparities, and improve the health and well-being of the nation. As the committee was well into the process of reviewing evidence and preparing to write the report, the pandemic took hold across the country and shined a light on the nation's rampant health inequities. The committee delayed the report to incorporate the major lessons from the pandemic: its disproportionate and devastating toll on poor and marginalized populations that could largely be attributed to persistent health disparities; the need to fully support nurses; and better prepare the workforce for future disasters. Released in May 2021, the report called for a series of policy reforms to unleash the potential of nurses to play greater roles in advancing health equity. The report recommends that the systems that educate, pay, and employ nurses: (1) permanently remove barriers to care; (2) value their contributions; (3) prepare nurses to tackle health equity; and (4) diversify the workforce. The report underscores that prioritizing nurse well-being is paramount to advancing the recommendations. In addition, the report calls on national nursing organizations to develop a shared agenda for addressing the social determinants of health and achieving health equity. Finally, the committee prioritized research needs to build the evidence base to support nurses in advancing health equity. Each of these areas is discussed below. Far too often in the United States, people do not see a health care provider when they need one. Nearly 30 million people are uninsured in the United States, and roughly 40 million have health plans that leave them potentially underinsured (Collins et al., August 2020Collins, Sara R., Gunja, Munira Z., & Aboulafia, Gabriella N. (2020). U.S. Health insurance coverage in 2020: A looming crisis in affordability — findings from the Commonwealth Fund Biennial Health Insurance Survey, 2020.Commonwealth Fund. https://doi.org/10.26099/6aj3-n655.Google Scholar). In addition, timely access to health care is undermined due to the inability to pay; geographic inaccessibility to services and providers, particularly in rural and underserved urban areas; lack of health literacy; and fundamental mistrust of the health care system and providers. Research demonstrates that delays in obtaining care can lead people to experience worse symptoms and disease progression (Man et al., 2018Man R.X.G. Lack D.A. Wyatt C.E. Murray V. The effect of natural disasters on cancer care: A systematic review.The Lancet Oncology. 2018; 19: e482-e499https://doi.org/10.1016/S1470-2045(18)30412-1Abstract Full Text Full Text PDF PubMed Scopus (41) Google Scholar). Nurses can help to explicitly address these gaps in access to care. For example, about 70% to 80% of advanced-practice nurses work in primary care, including in pediatrics, adult practice, gerontology, and nurse midwifery. While the primary care nurse practitioner field has grown, the number of physicians entering primary care has stagnated or declined (Barnes et al., 2018Barnes H. Richards M.R. McHugh M.D. Martsolf G. Rural and nonrural primary care physician practices increasingly rely on nurse practitioners.Health Affairs. 2018; 37: 908-914https://doi.org/10.1377/hlthaff.2017.1158Crossref PubMed Scopus (127) Google Scholar; Barnes et al., 2018Xue Y. Ye Y. Brewer C. Spetz J. Impact of state nurse practitioner scope-of-practice regulation on health care delivery: Systematic review.Nursing outlook. 2016; 64: 71-85https://doi.org/10.1377/hlthaff.2017.1158Crossref PubMed Scopus (117) Google Scholar). Care provided by nurse practitioners has been found to be comparable to the care provided by physicians, according to numerous studies (Perloff et al., 2019Perloff J. Clarke S. DesRoches C.M. O'Reilly-Jacob M. Buerhaus P. Association of state-level restrictions in nurse practitioner scope of practice with the quality of primary care provided to Medicare beneficiaries.Medical Care Research and Review. 2019; 76: 597-626Crossref PubMed Scopus (24) Google Scholar; Yang et al., 2020Yang B.K. Johantgen M.E. Trinkoff A.M. Idzik S.R. Wince J. Tomlinson C. State Nurse Practitioner practice regulations and US health care delivery outcomes: A systematic review.Medical Care Research and Review. 2021; 78: 183-196https://doi.org/10.1177/1077558719901216Crossref PubMed Scopus (32) Google Scholar). They are less expensive to employ than physicians and are more likely to care for vulnerable populations, including those in rural areas (Perloff et al., 2016Perloff J. DesRoches C.M. Buerhaus P. Comparing the cost of care provided to Medicare beneficiaries assigned to primary care nurse practitioners and physicians.Health Services Research. 2016; 51: 1407-1423Crossref PubMed Scopus (83) Google Scholar). However, the ability of nurses to expand access to care is limited by state and federal laws, institutional barriers, and restrictive health systems policies that prohibit them from working to the full extent of their education and training (Wakefield et al., 2021Wakefield M.K. Williams D.R. Le Menestrel S. Flaubert J.L. The future of nursing 2020-2030: Charting a path to health equity. National Press, Google Scholar). The report calls for and organizations to remove these and as well as restrictive policies and In during the and provided full practice to nurse is just about the effect of the to expand scope of practice during the pandemic et al., R. Impact of pandemic on from a national 2021; Full Text Full Text PDF PubMed Scopus Google Scholar; et al., 19: for nurse practitioners to healthcare and for full practice 2021; PubMed Scopus (24) Google in the found that with to from The of nurse practitioner to reduce from the and Scholar). The report calls for these restrictions on scope of practice to be This to remove practice barriers the work of the first report, but it in more the need to barriers that and nurses from to the of their education and training to access to care and help to reduce health care inequities for populations to see a provider when they need one. that the care that and nurses provide restrictions on services and policies that nurses from care. nurses to practice to the full extent of their education and training is an policy to gaps in access to care. As the report the and systems do to reduce health inequities. This has been by the has its to health equity a in policy & E. M. D. et at the for Medicare and a for the 2021; Google Scholar). health care that health equity can a in The U.S. systems the care that nurses provide and the critical role that they can play in addressing to health equity. 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The of nurses needs to be well to promote health equity and improve the health and well-being of nurses need to and the social and environmental factors that health, care for an and more engage in new new with other and health equity and to a policy and collaboration with across the health care and health systems as well as of health care with organizations on social and be paramount during the the nursing field an in preparing the as an million nurses during the by This in an May as nursing education to nurses well to on and roles and to advance the NAM report recommendations. to prepare nurses to tackle health equity related to the social determinants of health, health and health are not into and nursing that nurses are to address the social determinants of health and advance health and healthcare equity. and should be throughout including need to the extent to they provide education in that provide with and from who with an of social needs as well as with communities with the social determinants of health (Wakefield et al., 2021Wakefield M.K. 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Journal of Palliative MedicineVol. 3, No. 1 Innovations in End-of-Life CareTaking a Spiritual History Allows Clinicians to Understand Patients More FullyDr. Christina Puchalski and Anna L. RomerDr. Christina Puchalski and Anna L. RomerPublished Online:19 Apr 2005https://doi.org/10.1089/jpm.2000.3.129AboutSectionsPDF/EPUB ToolsPermissionsDownload CitationsTrack CitationsAdd to favorites Back To Publication ShareShare onFacebookTwitterLinked InRedditEmail FiguresReferencesRelatedDetailsCited byVerbalizing spiritual needs in palliative care: a qualitative interview study on verbal and non-verbal communication in two Danish hospices4 January 2022 | BMC Palliative Care, Vol. 21, No. 1Implementation of an Educational Toolkit to Increase Nurse Competence in Spirituality and Spiritual Care of Oncology Patients8 November 2022 | Journal of Holistic Nursing, Vol. 5Posicionamento sobre a Saúde Cardiovascular nas Mulheres – 2022Arquivos Brasileiros de Cardiologia, Vol. 119, No. 5Experiences of German health care professionals with spiritual history taking in primary care: a mixed-methods process evaluation of the HoPES3 intervention15 October 2022 | Family Practice, Vol. 29Religious and spiritual journeys of LGBT older adults in rural Southern Appalachia25 October 2021 | Journal of Religion, Spirituality & Aging, Vol. 34, No. 4The CASH assessment tool: A window into existential suffering19 May 2021 | Journal of Health Care Chaplaincy, Vol. 28, No. 4Integrating religion/spirituality into professional social work practice27 July 2022 | Journal of Religion & Spirituality in Social Work: Social Thought, Vol. 41, No. 4The Concept of Spirituality in the Health Sector: Contributions from the Study of Religion27 September 2022 | International Journal of Latin American Religions, Vol. 12Systematic review: The relationship between religion, spirituality and mental health in adolescents who identify as transgender13 September 2022 | Journal of Gay & Lesbian Mental Health, Vol. 26„Des Lebens Ruf an uns wird niemals enden“ – Sinnzentrierte Interventionen im Überblick30 August 2022 | Zeitschrift für Palliativmedizin, Vol. 23, No. 05Case discussion: The critically ill older adult in spiritual distressGeriatric Nursing, Vol. 47Australian Patient Preferences for the Introduction of Spirituality into their Healthcare Journey: A Mixed Methods Study3 August 2022 | Journal of Religion and Health, Vol. 27Religion, Spirituality, and Ethics in Psychiatric Practice30 March 2022 | Journal of Nervous & Mental Disease, Vol. 210, No. 8Spiritual distress in dialysis: A case report21 July 2022 | Progress in Palliative Care, Vol. 211Interprofessional communication training to address spiritual aspects of cancer care19 July 2022 | Journal of Health Care Chaplaincy, Vol. 29Spirituality in Serious Illness and HealthJAMA, Vol. 328, No. 2What is the role of spiritual care specialists in teaching generalist spiritual care? 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The Influence of Mentee Professional Identity on Mentoring Dynamics and Personal Learning Outcomes18 April 2019 | Group & Organization Management, Vol. 44, No. 2Teenagers and Cannabis Use: Why It's a Problem and What Can Be Done About ItJournal of Psychosocial Nursing and Mental Health Services, Vol. 57, No. 3Haken und Ösen: Spiritualität in der klinischen PalliativversorgungWege zum Menschen, Vol. 71, No. 2Approaching Spirituality Using the Patient-Centered Clinical Method27 January 2018 | Journal of Religion and Health, Vol. 58, No. 1Medical Students’ (Dis)comfort with Assessing Religious and Spiritual Needs in a Standardized Patient Encounter10 October 2018 | Journal of Religion and Health, Vol. 58, No. 1Spirituality and Religiosity of Pharmacy Students1 February 2019 | American Journal of Pharmaceutical Education, Vol. 83, No. 1Interprofessional spiritual care in oncology: a literature review16 February 2019 | ESMO Open, Vol. 4, No. 1Physical, Psychological/Psychiatric, Social, and Spiritual Problems and Symptoms13 April 2019Spiritual Assessment in Healthcare: An Overview of Comprehensive, Sensitive Approaches to Spiritual Assessment for Use Within the Interdisciplinary Healthcare Team18 May 2019The Role of the Nurse in Providing Spiritual Care: A Case Study Approach to Exploring Specific Care Provision by Healthcare Workers in the Context of an Interdisciplinary Healthcare Team18 May 2019Teaching and Learning About Spirituality in Healthcare Practice Settings18 May 2019Religion and Spirituality Among Medical Students5 June 2019Spiritual Care: The Role of Health Care Chaplaincy4 September 2019End-of-life milieu of critically sick children admitted to a pediatric hospital: A comparative study of survivors versus nonsurvivorsIndian Journal of Palliative Care, Vol. 25, No. 4Incorporating and Teaching Spirituality into Medical Education: An Overview of the Field and Possible Educational Strategies4 September 2019Religion, Spirituality, and Stress6 March 2019Toward Comprehensive Medicine: Listening to Spiritual and Religious Needs of Patients26 April 2019 | Gerontology and Geriatric Medicine, Vol. 5Din ve Psikoloji Arasındaki Uçurum Gerçekten Ne Kadar Derin? Psikoterapilerdeki Dini İzler15 December 2018 | Cumhuriyet İlahiyat Dergisi, Vol. 22, No. 3Women's Perceptions of Using Short Films to Integrate Spirituality in TherapyJournal of Systemic Therapies, Vol. 37, No. 4Content Validation of Advanced Illness Criteria of a Palliative Care Screening Tool Lauren C. DiLello, Karen Mulvihill, Jennifer Delli Carpini, Riddhi Shah, Julia Hermanowski, and Damanjeet Chaubey29 October 2018 | Journal of Palliative Medicine, Vol. 21, No. 11Understanding, assessing, and in the spiritual of medical and October 2018 | Theology, Vol. 11, No. and of in Living with October 2018 | Journal of & Social Services, Vol. No. for the spirituality as October 2018 | Revista de Vol. 71, No. An of an aged psychiatry March 2018 | Psychiatry, Vol. 26, No. de de vida de de Vol. 25, No. support and with in Care in the Care A Narrative June | Journal of Care Medicine, Vol. No. Care in Cancer: in the of of Clinical Oncology Educational Vol. 3, No. religion/spirituality in clinical practice: A among social and and October | Journal of Clinical Psychology, Vol. 74, No. Spirituality in Care December | Journal of Religion and Health, Vol. 57, No. of to spiritual care at the of a phenomenological exploration from the of palliative care February 2018 | Journal for the Study of Spirituality, Vol. 8, No. Existential Distress in Pediatric Cancer December and Patient Spiritual in the through October of Spirituality in November Psychological/Psychiatric, Social, and Spiritual Problems and July and End-of-Life Care in Cancer in Oncology Nursing, Vol. No. Care in Hospice and Palliative Journal of Hospice and Palliative Care, Vol. 20, No. and Spirituality: Literature review and Journal of Counseling, Vol. 18, No. of the tool existential communication between and cancer August | European Journal of General Practice, Vol. 23, No. Education and of Christian Nursing, Vol. 34, No. Care Interventions in to and Therapy C. and D. September | Journal of Palliative Medicine, Vol. 20, No. in Patients with A Qualitative September | Journal of Research in Nursing and Vol. 14, No. theory on the and in an exploratory case study September | Vol. 69, No. of the of Spirituality and Palliative Care Research and of Pain and Symptom Management, Vol. No. of a spiritual care training program for staff on November | Palliative and Supportive Care, Vol. 15, No. 4Spiritual distress and spiritual care in advanced heart July | Reviews, Vol. and Spiritual Patient Simulation in Nursing, Vol. No. Vol. 42, No. 4The impact of a spiritual in patients with and and their support December | Vol. 26, No. 3The Importance of a Spiritual History in Healthcare Vol. No. About Substance Use DisordersJournal of Psychosocial Nursing and Mental Health Services, Vol. No. and Spiritual Beliefs of April | Journal of Religion and Health, Vol. No. Care Perceptions of and With of Hospice & Palliative Nursing, Vol. 19, No. in Substance Use What to Know to Practice30 November | in Mental Health Nursing, Vol. 38, No. End-of-Life Care to Religious and Vol. No. of Social Education, Vol. 53, No. Nursing Care and of Christian Nursing, Vol. 34, No. 1The of taking a religious and spiritual July | Psychiatry, Vol. 24, No. religion and spirituality in Vol. No. the role of religious in the at the of of Vol. No. care spiritual March | Supportive Care in Cancer, Vol. 24, No. Spiritual Care and the Role of An Review of Literature and April | Journal of Religion and Health, Vol. No. of the Spiritual Needs of of with Is in the June | Journal of Palliative Medicine, Vol. 19, No. Impact of a Tool for Comprehensive Assessment of Palliative Care on Assessment at and of Pain and Symptom Management, Vol. No. from Healthcare Students to Understand Spiritual Assessment in Clinical Practice29 October | Journal of Religion and Health, Vol. No. Spirituality in January | Journal of Religion and Health, Vol. No. 3Development and of to Assess Nurse Provision of Spiritual August 2014 | Journal of Holistic Nursing, Vol. 34, No. and Validation of the Practice Assessment September 2014 | Research on Social Practice, Vol. 26, No. and the Medical A of July | Journal of Health Care Chaplaincy, Vol. 22, No. history taking in palliative care: A controlled September | Palliative Medicine, Vol. 30, No. Is Is Using A and the Life With American in Spiritual March | Journal of in Mental Health, Vol. 11, No. and spiritual in September | International Journal of and Mental Health, Vol. No. 1The of Hospital to and Patients’ Spiritual A May | Journal for the Study of Spirituality, Vol. No. 1The and to March End-of-Life Spiritual March in Holistic Patient Journal of Nursing, Vol. No. of spiritual assessment for older September 2014 | and Vol. No. und der der Care, Vol. No. Spirituality and A for Holistic January | Journal of Religion and Health, Vol. No. and Belief, in Care spiritual history tool by C. M. Puchalski as an for an interdisciplinary in January | Journal for of and Social Vol. 21, No. the of Spiritual A Pain and Palliative Care Service Quality of Pain and Symptom Management, Vol. No. of Spiritual Assessment in September | Vol. No. the of Christian Nursing, Vol. 32, No. 4Spiritual care: is the assessment tool for palliative Journal of Palliative Nursing, Vol. 21, No. und Spiritualität in der September | Vol. 60, No. of September of spirituality assessment in palliative care patients in November 2014 | Progress in Palliative Care, Vol. 23, No. 4The for Spiritual A Mixed-Methods July | Oncology Nursing Vol. 42, No. 4The Integration of Religion and Spirituality in Social Practice: A May | Social Vol. 60, No. 3The and Educational of a Spiritual Life Review for Patients with and June 2014 | Journal of Cancer Education, Vol. 30, No. in Geriatric Palliative in Geriatric Medicine, Vol. No. An for Spiritual Well-Being May | Journal of Religion & Spirituality in Social Work: Social Thought, Vol. 34, No. Spiritual Assessment March | Journal of Health Care Chaplaincy, Vol. 21, No. American on Mental Health, and Help April | and Vol. 60, No. of Christian Nursing, Vol. 32, No. the Spiritual Needs and of Oncology Patients in Nursing Practice, Vol. 29, No. Care Training to Healthcare Professionals: A Systematic April | Journal of Pastoral Care & Counseling: Advancing theory and professional practice through scholarly and reflective publications, Vol. 69, No. analysis of spiritual

Medical Writings7 August 2001"Let Me See If I Have This Right …": Words That Help Build EmpathyJohn L. Coulehan, MD, Frederic W. Platt, MD, Barry Egener, MD, Richard Frankel, PhD, Chen-Tan Lin, MD, Beth Lown, MD, and William H. Salazar, MDJohn L. Coulehan, MDDr. Coulehan: State University of New York at Stony Brook; Stony Brook, NY 11794-8036Dr. Platt: University of Colorado Health Sciences Center; Denver, CO 80222Dr. Egener: American Academy on Physician and Patient; Portland, OR 97210Dr. Frankel: Highland Hospital; Rochester, NY 14620Dr. Lin: University of Colorado Health Sciences Center; Denver, CO 80222Dr. Lown: Mount Auburn Hospital; Cambridge, MA 02238Dr. Salazar: Medical College of Georgia; Augusta, GA 30902, Frederic W. Platt, MDDr. Coulehan: State University of New York at Stony Brook; Stony Brook, NY 11794-8036Dr. Platt: University of Colorado Health Sciences Center; Denver, CO 80222Dr. Egener: American Academy on Physician and Patient; Portland, OR 97210Dr. Frankel: Highland Hospital; Rochester, NY 14620Dr. Lin: University of Colorado Health Sciences Center; Denver, CO 80222Dr. Lown: Mount Auburn Hospital; Cambridge, MA 02238Dr. Salazar: Medical College of Georgia; Augusta, GA 30902, Barry Egener, MDDr. Coulehan: State University of New York at Stony Brook; Stony Brook, NY 11794-8036Dr. Platt: University of Colorado Health Sciences Center; Denver, CO 80222Dr. Egener: American Academy on Physician and Patient; Portland, OR 97210Dr. Frankel: Highland Hospital; Rochester, NY 14620Dr. Lin: University of Colorado Health Sciences Center; Denver, CO 80222Dr. Lown: Mount Auburn Hospital; Cambridge, MA 02238Dr. Salazar: Medical College of Georgia; Augusta, GA 30902, Richard Frankel, PhDDr. Coulehan: State University of New York at Stony Brook; Stony Brook, NY 11794-8036Dr. Platt: University of Colorado Health Sciences Center; Denver, CO 80222Dr. Egener: American Academy on Physician and Patient; Portland, OR 97210Dr. Frankel: Highland Hospital; Rochester, NY 14620Dr. Lin: University of Colorado Health Sciences Center; Denver, CO 80222Dr. Lown: Mount Auburn Hospital; Cambridge, MA 02238Dr. Salazar: Medical College of Georgia; Augusta, GA 30902, Chen-Tan Lin, MDDr. Coulehan: State University of New York at Stony Brook; Stony Brook, NY 11794-8036Dr. Platt: University of Colorado Health Sciences Center; Denver, CO 80222Dr. Egener: American Academy on Physician and Patient; Portland, OR 97210Dr. Frankel: Highland Hospital; Rochester, NY 14620Dr. Lin: University of Colorado Health Sciences Center; Denver, CO 80222Dr. Lown: Mount Auburn Hospital; Cambridge, MA 02238Dr. Salazar: Medical College of Georgia; Augusta, GA 30902, Beth Lown, MDDr. Coulehan: State University of New York at Stony Brook; Stony Brook, NY 11794-8036Dr. Platt: University of Colorado Health Sciences Center; Denver, CO 80222Dr. Egener: American Academy on Physician and Patient; Portland, OR 97210Dr. Frankel: Highland Hospital; Rochester, NY 14620Dr. Lin: University of Colorado Health Sciences Center; Denver, CO 80222Dr. Lown: Mount Auburn Hospital; Cambridge, MA 02238Dr. Salazar: Medical College of Georgia; Augusta, GA 30902, and William H. Salazar, MDDr. Coulehan: State University of New York at Stony Brook; Stony Brook, NY 11794-8036Dr. Platt: University of Colorado Health Sciences Center; Denver, CO 80222Dr. Egener: American Academy on Physician and Patient; Portland, OR 97210Dr. Frankel: Highland Hospital; Rochester, NY 14620Dr. Lin: University of Colorado Health Sciences Center; Denver, CO 80222Dr. Lown: Mount Auburn Hospital; Cambridge, MA 02238Dr. Salazar: Medical College of Georgia; Augusta, GA 30902Author, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-135-3-200108070-00022 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Consider these two physician–patient dialogues:1. Patient: You know, when you discover a lump in your breast, you kind of feel—well, kind of—(her speech tapers off; she looks down; tears form in her eyes).Dr. A: When did you actually discover the lump?Patient: (absently) I don't know. It's been a while.2. Patient: (same as above)Dr. B: That sounds frightening.Patient: Well, yeah, sort of.Dr. B: Sort of frightening?Patient: Yeah … and I guess I'm feeling like my life is over.Dr. B: I see. Worried and sad too.Patient: That's it, Doctor.Dr. A's patient ...References1. Konrad TR, Williams ES, Linzer M, McMurray J, Pathman DE, Gerrity M, et al . Measuring physician job satisfaction in a changing workplace and a challenging environment. SGIM Career Satisfaction Study Group. Society of General Internal Medicine. Med Care. 1999;37:1174-82. [PMID: 10549620] CrossrefMedlineGoogle Scholar2. Donelan K, Blendon RJ, Lundberg GD, Calkins DR, Newhouse JP, Leape LL, et al . The new medical marketplace: physicians' views. Health Aff Millwood. 1997;16:139-48. [PMID: 9314685] CrossrefMedlineGoogle Scholar3. Bates AS, Harris LE, Tierney WM, Wolinsky FD. Dimensions and correlates of physician work satisfaction in a midwestern city. Med Care. 1998;36:610-7. [PMID: 9544600] CrossrefMedlineGoogle Scholar4. McMurray JE, Williams E, Schwartz MD, Douglas J, Van Kirk J, Konrad TR, et al . Physician job satisfaction: developing a model using qualitative data. SGIM Career Satisfaction Study Group. J Gen Intern Med. 1997;12:711-4. [PMID: 9383141] CrossrefMedlineGoogle Scholar5. Beckman HB, Frankel RM. The effect of physician behavior on the collection of data. Ann Intern Med. 1984;101:692-6. [PMID: 6486600] LinkGoogle Scholar6. Marvel MK, Epstein RM, Flowers K, Beckman HB. Soliciting the patient's agenda: have we improved? JAMA. 1999;281:283-7. [PMID: 9918487] CrossrefMedlineGoogle Scholar7. Roter DL, Stewart M, Putnam SM, Lipkin M, Stiles W, Inui TS. Communication patterns of primary care physicians. JAMA. 1997;277:350-6. [PMID: 9002500] CrossrefMedlineGoogle Scholar8. White J, Levinson W, Roter D. "Oh, by the way …": the closing moments of the medical visit. J Gen Intern Med. 1994;9:24-8. [PMID: 8133347] CrossrefMedlineGoogle Scholar9. Nightingale SD, Yarnold PR, Greenberg MS. Sympathy, empathy, and physician resource utilization. J Gen Intern Med. 1991;6:420-3. [PMID: 1744756] CrossrefMedlineGoogle Scholar10. Levinson W, Stiles WB, Inui TS, Engle R. Physician frustration in communicating with patients. Med Care. 1993;31:285-95. [PMID: 8464246] CrossrefMedlineGoogle Scholar11. Levinson W, Gorawara-Bhat R, Lamb J. A study of patient clues and physician responses in primary care and surgical settings. JAMA. 2000;284:1021-7. [PMID: 10944650] CrossrefMedlineGoogle Scholar12. Suchman AL, Roter D, Green M, Lipkin M. Physician satisfaction with primary care office visits. Collaborative Study Group of the American Academy on Physician and Patient. Med Care. 1993;31:1083-92. [PMID: 8246638] CrossrefMedlineGoogle Scholar13. Cohen-Cole SA. The Medical Interview: The Three-Function Approach. St. Louis: Mosby; 1991. Google Scholar14. Coulehan JL, Block MR. The Medical Interview. Mastering Skills for Clinical Practice. 4th ed. Philadelphia: FA Davis; 2001. Google Scholar15. More ES. "Empathy" enters the profession of medicine.. In: More ES, Milligan MA, eds. The Empathic Practitioner. Empathy, Gender, and Medicine. New Brunswick, NJ: Rutgers Univ Pr; 1994:19-39. Google Scholar16. Basch MF. Empathic understanding: a review of the concept and some theoretical considerations. J Am Psychoanal Assoc. 1983;31:101-26. [PMID: 6681414] CrossrefMedlineGoogle Scholar17. Wispe L. History of the concept of empathy.. In: Eisenberg N, Strayer J, eds. Empathy and Its Development. Cambridge, UK: Cambridge Univ Pr; 1987:17-37. Google Scholar18. Book HE. Empathy: misconceptions and misuses in psychotherapy. Am J Psychiatry. 1988;145:420-4. [PMID: 3348445] CrossrefMedlineGoogle Scholar19. Buie DH. Empathy: its nature and limitations. J Am Psychoanal Assoc. 1981;29:281-307. [PMID: 7264177] CrossrefMedlineGoogle Scholar20. Wilmer HA. The doctor-patient relationship and the issues of pity, sympathy and empathy. Br J Med Psychol. 1968;41:243-8. [PMID: 5728595] CrossrefMedlineGoogle Scholar21. Strayer J. Affective and cognitive perspectives on empathy.. In: Eisenberg N, Strayer J, eds. Empathy and Its Development. Cambridge, UK: Cambridge Univ Pr; 1987:218-44. Google Scholar22. Brothers LA, Finch DM. Physiological evidence for an excitatory pathway from entorhinal cortex to amygdala in the rat. Brain Res. 1985;359:10-20. [PMID: 4075137] CrossrefMedlineGoogle Scholar23. Grattan LM, Eslinger PJ. Empirical study of empathy [Letter]. Am J Psychiatry. 1989;146:1521-2. [PMID: 2619825] CrossrefMedlineGoogle Scholar24. Katz RL. Empathy: Its Nature and Uses. New York: Free Press; 1963:26. Google Scholar25. Lief HI, Fox RC. Training for "detached concern" in medical students.. In: Lief HI, eds. The Psychological Basis of Medical Practice. New York: Harper & Row; 1963:12-35. Google Scholar26. Halpern J. Empathy: Using resonance emotions in the service of curiosity.. In: Spiro H, McCrea Curnen MG, Peschel E, St James D, eds. Empathy and the Practice of Medicine. New Haven, CT: Yale Univ Pr; 1993:160-73. Google Scholar27. Wispe L. The distinction between sympathy and empathy: to call forth a concept, a word is needed. Journal of Personality and Social Psychology. 1986;50:314-21. CrossrefGoogle Scholar28. Wilmer HA. The doctor-patient relationship and the issues of pity, sympathy and empathy. Br J Med Psychol. 1968;41:243-8. [PMID: 5728595] CrossrefMedlineGoogle Scholar29. Bertakis KD, Roter D, Putnam SM. The relationship of physician medical interview style to patient satisfaction. J Fam Pract. 1991;32:175-81. [PMID: 1990046] MedlineGoogle Scholar30. Roter D, Lipkin M, Korsgaard A. Sex differences in patients' and physicians' communication during primary care medical visits. Med Care. 1991;29:1083-93. [PMID: 1943269] CrossrefMedlineGoogle Scholar31. Levinson W, Roter D. Physicians' psychosocial beliefs correlate with their patient communication skills. J Gen Intern Med. 1995;10:375-9. [PMID: 7472685] CrossrefMedlineGoogle Scholar32. Spiro H. What is empathy and can it be taught? Ann Intern Med. 1992;116:843-6. [PMID: 1482433] LinkGoogle Scholar33. Brock CD, Salinsky JV. Empathy: an essential skill for understanding the physician–patient relationship in clinical practice. Fam Med. 1993;25:245-8. [PMID: 8319851] MedlineGoogle Scholar34. Platt FW, Keller VF. Empathic communication: a teachable and learnable skill. J Gen Intern Med. 1994;9:222-6. [PMID: 8014729] CrossrefMedlineGoogle Scholar35. Platt FW, Platt CM. Empathy: a miracle or nothing at all? Journal of Clinical Outcomes Management. 1998;5:30-3. Google Scholar36. Suchman AL, Markakis K, Beckman HB, Frankel R. A model of empathic communication in the medical interview. JAMA. 1997;277:678-82. [PMID: 9039890] CrossrefMedlineGoogle Scholar37. Charon R. The narrative road to empathy.. In: Spiro H, McCrea Curnen MG, Peschel E, St James D, eds. Empathy and the Practice of Medicine. New Haven, CT: Yale Univ Pr; 1993:147-59. Google Scholar38. Carson RA. Beyond respect to recognition and due regard.. In: Toombs SK, Barnard D, Carson RA, eds. Chronic Illness from Experience to Policy. Bloomington, IN: Indiana Univ Pr; 1995:105-28. Google Scholar39. Hunter KM, Charon R, Coulehan JL. The study of literature in medical education. Acad Med. 1995;70:787-94. [PMID: 7669155] MedlineGoogle Scholar40. Novack DH, Suchman AL, Clark W, Epstein RM, Najberg E, Kaplan C. Calibrating the physician. Personal awareness and effective patient care. Working Group on Promoting Physician Personal Awareness, American Academy on Physician and Patient. JAMA. 1997;278:502-9. [PMID: 9256226] CrossrefMedlineGoogle Scholar41. Coulehan JL. Tenderness and steadiness: emotions in medical practice. Lit Med. 1995;14:222-36. [PMID: 8558910] CrossrefMedlineGoogle Scholar42. Connelly J. Being in the present moment: developing the capacity for mindfulness in medicine. Acad Med. 1999;74:420-4. [PMID: 10219225] CrossrefMedlineGoogle Scholar43. Epstein RM. Mindful practice. JAMA. 1999;282:833-9. [PMID: 10478689] CrossrefMedlineGoogle Scholar44. Miller SZ, Schmidt HJ. The habit of humanism: a framework for making humanistic care a reflexive clinical skill. Acad Med. 1999;74:800-3. [PMID: 10429589] CrossrefMedlineGoogle Scholar45. Barrett-Lennard GT. The phases and focus of empathy. Br J Med Psychol. 1993;66 Pt 1 3-14. [PMID: 8485075] CrossrefMedlineGoogle Scholar46. Gallop R, Lancee WJ, Garfinkel PE. The empathic process and its mediators. A heuristic model. J Nerv Ment Dis. 1990;178:649-54. [PMID: 2230750] CrossrefMedlineGoogle Scholar47. Hall JA, Roter DL, Rand CS. Communication of affect between patient and physician. J Health Soc Behav. 1981;22:18-30. [PMID: 7240703] CrossrefMedlineGoogle Scholar48. Larsen KM, Smith CK. Assessment of nonverbal communication in the patient–physician interview. J Fam Pract. 1981;12:481-8. [PMID: 7462949] MedlineGoogle Scholar49. Suchman AL, Matthews DA. What makes the patient-doctor relationship therapeutic? Exploring the connexional dimension of medical care. Ann Intern Med. 1988;108:125-30. [PMID: 3276262] LinkGoogle Scholar50. Suchman AL. Control and Relation: Two Foundational Values and Their Consequences.. In: Suchman AL, Botelho RJ, Hinton-Walker P, eds. Partnerships in Healthcare: Transforming Relational Process. Rochester, NY: Univ of Rochester Pr; 1998. Google Scholar51. Branch WT, Malik TK. Using "windows of opportunities" in brief interviews to understand patients' concerns. JAMA. 1993;269:1667-8. [PMID: 8455300] CrossrefMedlineGoogle Scholar52. Pinderhughes EB. Teaching empathy: ethnicity, race and power at the cross-cultural treatment interface. American Journal of Social Psychology. 1984;4:5-12. Google Scholar53. Kleinman A, Eisenberg L, Good B. Culture, illness, and care: clinical lessons from anthropologic and cross-cultural research. Ann Intern Med. 1978;88:251-8. [PMID: 626456] LinkGoogle Scholar54. Platt FW, Gaspar DL, Coulehan JL, Fox L, Adler AJ, Weston WW, et al . "Tell me about yourself": the patient-centered interview. Ann Intern Med. 2001;134:1079-85. LinkGoogle Scholar Author, Article, and Disclosure InformationAffiliations: Dr. Coulehan: State University of New York at Stony Brook; Stony Brook, NY 11794-8036Dr. Platt: University of Colorado Health Sciences Center; Denver, CO 80222Dr. Egener: American Academy on Physician and Patient; Portland, OR 97210Dr. Frankel: Highland Hospital; Rochester, NY 14620Dr. Lin: University of Colorado Health Sciences Center; Denver, CO 80222Dr. Lown: Mount Auburn Hospital; Cambridge, MA 02238Dr. Salazar: Medical College of Georgia; Augusta, GA 30902Corresponding Author: John L. Coulehan, MD, Department of Preventive Medicine, HSC L3-086, State University of New York at Stony Brook, Stony Brook, NY 11794-8036; e-mail, [email protected]sunysb.edu.Current Author Addresses: Dr. Coulehan: Department of Preventive Medicine, HSC L3-086, State University of New York at Stony Brook, Stony Brook, NY 11794-8036.Drs. Platt and Lin: University of Colorado Health Sciences Center, 4200 East Ninth Avenue, Denver, CO 80222.Dr. Egener: American Academy on Physician and Patient, Legacy Clinic Northwest, 1130 NW 22nd Avenue, Suite 220, Portland, OR 97210.Dr. Frankel: Highland Hospital, 1000 South Avenue, Rochester, NY 14620.Dr. Lown: Mount Auburn Hospital, 300 Mt. Auburn Street, Cambridge, MA 02238.Dr. Salazar: Medical College of Georgia, 1120 15th Street, HS2010, Augusta, GA 30902. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics Cited ByHow does narrative medicine impact medical trainees' learning of professionalism? 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A meta-ethnography: BEME Guide No. 57Empathy in psychotherapy: Using conversation analysis to explore the therapists' empathic interaction with clientsThe Tinnitus Retraining Therapy Trial's Standard of Care Control Condition: Rationale and Description of a Patient-Centered ProtocolMultidisciplinary Teaming: Enhancing Collaboration through Increased UnderstandingCommunication in Health CareCommunication in Surgery for Patient SafetyAgents of empathy: How medical interpreters bridge sociocultural gaps in genomic sequencing disclosures with Spanish-speaking familiesThe development and psychometric validation of a Chinese empathy motivation scaleEmpathic and compassionate healthcare as a Christian spiritual practiceObesity bias among preclinical and clinical chiropractic students and faculty at an integrative health care institution: A cross-sectional studyEmpathy: From Attribute to RelationshipInfluences on students' empathy in medical education: an exploratory interview study with medical students in their third and last yearTeaching future doctors to communicate: a communication intervention for medical students in their clinical yearEmpathy in general practice: its meaning for patients and doctorsEmpathically designed responses as a gateway to advice in Dutch counseling callsAnnotating and modeling empathy in spoken conversationsEmpathy can make the difference. How?The Effect of Patient Participation through Physician's Resources on Experience and WellbeingDepression/AnxietySuffering, Hope, and HealingA Review of Empathy, Its Importance, and Its Teaching in Surgical TrainingAthletes' Perception of Athletic Trainer Empathy: How Important Is It?Empathy from the perspective of oncology nursesPatients' Trust in Physician, Patient Enablement, and Health-Related Quality of Life During Colon Cancer TreatmentMeasuring Medical Students' EmpathyEmpathy in the Clinician–Patient RelationshipComparing two types of perspective taking as strategies for detecting distress amongst parents of children with cancer: A randomised trialIf You Could Read My Mind: The Role of Healthcare Providers' Empathic and Communicative Competencies in Clients' Satisfaction with ConsultationsPatients who are anxious or fearfulFatigue: Has It Affected Your Compassion?Study on Empathy among Undergraduate Students of the Medical Profession in NepalPower Relations and Health Care Communication in Older Adulthood: Educating Recipients and ProvidersBreast Biopsies are Minimally Painful, Exceed Patient Expectations, and Do Not Represent a Genuine Lasting Harm for Most WomenSpirituality and Ubuntu as the foundation for building African institutions, organizations and leadersShowing you care: An empathetic approach to doctor–patient communicationEmpathy and affect: what can empathied bodies do?Computational Analysis and Simulation of Empathic Behaviors: a Survey of Empathy with in medical students and empathy is with differences in communication and in empathy: the to clinical and at the of Social of What it to of changing empathy and patient in healthcare to for and Chronic medical communication: the of by Care A and of the Therapy of undergraduate and students medical A longitudinal studyEmpathy: what does it for A qualitative empathic and compassionate patient care: education and to the Patient with and Student Empathy in Medical Students During a Clinical and patients' perspectives on empathy: of and treatment of Approaches to the of and of a Communication in for of Healthcare as a do primary care when patients during and of the of the in a general medicine Patient Satisfaction for the . . . of of Care in the development of doctor-patient a call and a care: Enhancing physician–patient communication and education in of to Hope, and of empathy in general practice: a systematic with of Cancer Patient: of an of empathy and correlates among types of in empathic in primary care for research and with an to patients in A new perspective on empathic A for about and in longitudinal study of in interaction in treatment of in empathy medical role of and in medical education: the as as the approach to an empathic understanding of among patients and in the of The of Role of Empathy in Therapy and the New Communication Skills Assessment by Patients and and EmpathyEmpathy and Its A Review of With Medical Students and the nature of in the for health and the does care of the of of a with by among and of A to for and to clinical empathic a of Empathy with Behavior Medical Communication in in for Communication to and Patient to and A of and Cancer the and of clinical empathy: A theoretical and a research of communication in the medical A review and Clinical Empathy: An about to Physician during Care MD, H. PhD, M. MD, and and role in education about care in Competencies in Care for and Communication in patients with in the Care of Cancer in of and of Empathic during When Being Not empathy learning for be and for effective the role of care in with and in the of the medicine and outcomes of physician empathy in A structural focus study of and perceptions of the of of Medical Student role of empathy in in the a new and in the a of the An or Do You to to Patients Do Not or with Challenges and a of of the of a for children with Care. A to in care: The role of perceptions in Older in Clinical during Health and H. or Not to Is That the Right empathy and sympathy: responses to troubles on a health care with to make the patient the Communication and With Patients in Your as a of The of Medicine, and How to and A Patient-Centered Communication Illness Using to Communication Care and Social in the office approach to the Words That in to and MD, M. MD, and Frederic Platt, I Student August August August by American College of

Telemedicine and e-HealthVol. 26, No. 9 OpinionFree AccessTechnology Literacy as a Barrier to Telehealth During COVID-19Austin J. Triana, Roman E. Gusdorf, Kaustav P. Shah, and Sara N. HorstAustin J. TrianaVanderbilt University School of Medicine, Nashville, Tennessee, USA.Search for more papers by this author, Roman E. GusdorfVanderbilt University School of Medicine, Nashville, Tennessee, USA.Search for more papers by this author, Kaustav P. ShahVanderbilt University School of Medicine, Nashville, Tennessee, USA.Search for more papers by this author, and Sara N. HorstAddress correspondence to: Sara N. Horst, MD, MPH, Department of Gastroenterology, Hepatology, and Nutrition, Vanderbilt University Medical Center, 1211 21st Avenue South, Medical Arts Building Suite 220, Nashville, TN 37232, USA E-mail Address: [email protected]Department of Gastroenterology, Hepatology, and Nutrition, Vanderbilt University Medical Center, Nashville, Tennessee, USA.Search for more papers by this authorPublished Online:10 Sep 2020https://doi.org/10.1089/tmj.2020.0155AboutSectionsPDF/EPUB Permissions & CitationsPermissionsDownload CitationsTrack CitationsAdd to favorites Back To Publication ShareShare onFacebookXLinked InRedditEmail During the ongoing COVID-19 pandemic, there have been many fundamental changes to the health care system, one of which has been the rapid adoption of telehealth.1 Despite technological capability for widespread implementation before the pandemic, telehealth remained limited in many areas of the United States due to state regulations and poor insurance reimbursement.2 When these policies changed in March 2020 with national widespread coverage for telemedicine, traditional clinical workflows attempted to rapidly shift to a virtual format to increase social distancing and protect vulnerable patients. At our institution alone, the number of telehealth visits increased from ∼15 per day to >2,000 per day in a matter of weeks.As the health care system rapidly reorganized and trained physicians on how to host videoconference visits, some patients have struggled to keep up. During these changes, providers reported that many patients were struggling to access their telemedicine appointments. Patients may have difficulty navigating their devices and entering the health care system virtually. Others simply do not have devices or a stable Wi-Fi to connect with providers from home. Technology literacy and access should be viewed as a major driver of health and needs to be on a large scale.As an example, Ms. P is a 70-year-old woman with diabetes and hypertension who knows she is high risk for complications from COVID-19. Taking extra precautions, she cancelled her in-person appointments and scheduled a telehealth visit with one of her providers. She spent an entire afternoon preparing her technology for the visit, but she could not connect to the virtual appointment. Despite a proactive mindset, she had difficulty downloading the necessary software. Recognizing this barrier to care Ms. P and other patients face, we started a medical student-led volunteer initiative to help patients set up and test devices for their telemedicine appointments. We rapidly created systematic processes for recruitment, volunteer training, clinic coverage, and operational support. A standardized phone script helped students guide patients as they downloaded the proper software and understood what to expect at the time of the visit.Within a month, we have had 135 medical student volunteers commit 1,300 h and assist >5,000 patients in preparing for upcoming telehealth visits. Along the way, we have seen a wide range of patient comfort with technology that has advanced our understanding of technology literacy. One patient, a computer programmer, initially scoffed when asked whether he needed help. However, he still appreciated the tip that he received about which web browser to use to access his visit, avoiding a glitch that kept some patients from connecting. For patients low self-reported technology literacy, our impact can be great. Many patients had never downloaded a smartphone application or used videoconferencing software before their first virtual appointment. Wary of hackers and scammers, another patient was strongly opposed to telehealth and wanted to cancel his visit, but after talking about the safety of the process with a student, he downloaded the software and had a successful telemedicine visit with his provider.If a patient cannot connect to the videoconference, the provider is forced to call the patient to troubleshoot over the phone, reschedule the appointment, or simply proceed without video. Prior work has shown that the video component significantly contributes to quality and satisfaction of the visit.3 In addition to the technology itself, patients need to know what to expect for their telehealth appointments. Ideally, a patient will have a medication list and be in a quiet and private location at the time of the visit. Therefore, it is important to communicate these expectations beforehand to avoid a visit that takes place from the grocery store or in the car.With the ability to see patients in their own environments, we also gain insight into their lives. Using videoconferencing, it is possible to see a patient's home, to contextualize their experiences, and to better utilize the biopsychosocial model of health. One patient was blind but wanted to use videoconferencing so that the provider could see him. A volunteer helped the patient and his able-sighted daughter navigate the telehealth process using accessibility features for blindness. As medical students who grew up immersed in technology, we have been humbled by the complexity of teaching others to navigate smartphones, web browsers, and applications, and we have seen the tremendous technology gaps in various patient populations.Outside the context of direct patient care, widespread adoption of telehealth has the potential to improve quality of life and health outcomes through additional synergies. Although many older adults perceive benefits from technology, common barriers include self-efficacy, cost, and privacy concerns.4 Prior research has shown that technology adoption can be improved through education and increasing perceived self-efficacy.5 If patients can better navigate their web browsers and applications, they may feel empowered to message their providers through the patient portal or look up healthy recipes online.Among the drastic changes in health care, we hope that updated regulations and improved insurance coverage will be permanent, improving access for patients by addressing issues related to distance, mobility, or health concerns. Licensure across state lines remains a big question that could drastically impact access for many patients. In addition, it is imperative to further understand and address how to help our patients access and use technology. The transition to telehealth requires time, patience, and resources—an investment that is crucial for patients who are at risk of being left behind.AcknowledgmentsWe thank Drs. Michelle Griffith and Eiman Jahangir for organizational support of this project as well as reviewing and editing drafts.Disclosure StatementNo competing financial interests exist.Funding InformationNo funding was received for this article.References1. Smith A, Thomas E, Snoswell C, Haydon H, Mehrotra A, Clemensen J, Caffery Lj. Telehealth for global emergencies: Implications for coronavirus disease 2019 (COVID-19). J Telemed Telecare. 2020. Available at: https://doi.org/10.1177/1357633X20916567 (last accessed May 15, 2020). Google Scholar2. Dorsey ER, Topol EJ. State of telehealth. N Engl J Med 2016;375:154–161. Crossref, Medline, Google Scholar3. McLendon SF. Interactive video telehealth models to improve access to diabetes specialty care and education in the rural setting: A systematic review. Diabetes Spectr 2017;30:124–136. Crossref, Medline, Google Scholar4. Scott Kruse C, Karem P, Shifflett K, Vegi L, Ravi K, Brooks M. Evaluating barriers to adopting telemedicine worldwide: A systematic review. J Telemed Telecare 2018;24:4–12. Crossref, Medline, Google Scholar5. Gatti FM, Brivio E, Galimberti C. "The future is ours too": A training process to enable the learning perception and increase self-efficacy in the use of tablets in the elderly. Educ Gerontol 2017;43:209–224. 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Triana, Roman E. Gusdorf, Kaustav P. Shah, and Sara N. Horst.Technology Literacy as a Barrier to Telehealth During COVID-19.Telemedicine and e-Health.Sep 2020.1118-1119.http://doi.org/10.1089/tmj.2020.0155Published in Volume: 26 Issue 9: September 10, 2020Online Ahead of Print:May 19, 2020 TopicsCOVID-19e-health and telehealth careTelehealth devices PDF download

More than with any other imaging modality, the medical use of ultrasound is highly operator-dependent. The potential for diagnostic error is magnified by the ongoing development of increasingly sophisticated equipment with extended applications. A gap is appearing between the sophistication of the most advanced machines and techniques and the skills of those expected to use them and interpret the images produced, due to a lack of training. Whilst many obstetricians and gynecologists in training attend courses addressing the finer points of, for example, cardiac Doppler, central nervous system posterior fossa imaging or three-dimensional endometrial visualization, relatively few are willing to attend courses on basic theoretical and practical ultrasound techniques. There are a few exceptions, for example in Scandinavia, where basic courses are mandatory. Are there steps missing in the training of doctors in the specialty? The impression we have is that there exists a relatively small number of talented and skilled ultrasound practitioners seeking to hone their skills ever more precisely, whilst many perfectly competent clinicians are perhaps less enthusiastic and more fearful of ultrasound as they have simply not been taught the basics. The answer should be yes. Modern obstetrics and gynecology practice is virtually impossible without the use of ultrasound. That does not mean that all obstetricians and gynecologists need to be experts in ultrasound. Certain aspects of the specialty require specific skills that are more important than ultrasound—for instance, gynecological oncology and urogynecology require surgical expertise, whilst maternal medicine requires specific medical knowledge. Nevertheless, it is clearly desirable for all obstetricians and gynecologists to have been trained robustly in basic sonographic skills so that their scanning in antenatal and gynecological clinics and on the labor ward is both safe and reproducible. Moreover, in order to gain maximum clinical benefit and to achieve optimal use of resources, there is a need for all ultrasound operators to have appropriate skills to perform and interpret ultrasound examinations. The European Board and College of Obstetrics and Gynaecology (EBCOG) has developed guidelines for basic education in obstetrics and gynecology (approved in June 2005). For ultrasound, the basic competence levels are defined only in broad terms. With respect to obstetric ultrasound, the trainee should have ‘detailed theoretical knowledge of the normal and abnormal anatomy of the fetus, placenta and amniotic fluid compartment, estimation of gestational age, fetal biometry, fetal growth and behaviour, [and] of the evaluation of fetal and uteroplacental blood flow’1. In gynecological ultrasound the trainee should have ‘detailed theoretical knowledge of ultrasonic aspects of normal pelvic anatomy; gynaecological disease; infertility and ultrasound guided invasive procedures’1. In addition, each trainee should have a log book listing 200 antenatal obstetric scans and 100 gynecological scans2. The European Federation of Societies for Ultrasound in Medicine and Biology (EFSUMB) is more detailed in its minimum training recommendations for the practice of medical ultrasound3. For Level 1 (basic competence level) in gynecological ultrasound, EFSUMB recommends that trainees should perform a minimum of 300 examinations under supervision and keep an illustrated log book of 20 documented cases. They should receive a minimum of 20 hours of theoretical tuition, preferably at the beginning of the training period. For Level 1 in obstetric ultrasound the recommendations are that the trainee performs a minimum of 500 examinations under supervision, producing a log book listing the types of examinations, and receives 30 hours of theoretical tuition3. In 1996, ISUOG (the International Society of Ultrasound in Obstetrics and Gynecology) Education Committee produced the most ambitious proposal in their ‘Update on proposed minimum standards for ultrasound training for residents in Ob/Gyn’4. This document describes the contents of a basic theory course and required practical skills. It recommends that for certification a trainee should have 100 hours of supervised scanning including 100 gynecological and 200 obstetric scans. A log book with 30 cases with ultrasound images (including 15 fetal anomalies) should be included. Theoretical (multiple choice or written exam of three or four cases) and practical (transvaginal and fetal anomaly scan—30 min for both) examinations were recommended. ISUOG may decide to update this proposal, but in the meantime its Clinical Standards Committee has provided practical advice in the form of guidelines for individual types of exam. The difficulty in creating consistency in training standards throughout Europe has led to the separate and independent development of ultrasound training approaches in individual countries. We have, through contact with colleagues in other countries, performed an informal survey comparing ultrasound training in obstetrics and gynecology in some European countries. The results are presented in Table 1, which demonstrates that European countries differ in their formal definitions and requirements for basic obstetric and gynecological ultrasound training. Theoretical knowledge is taught in basic and intermediate ultrasound courses. Some countries test the theoretical knowledge in course exams, whilst in the UK, membership of the Royal College of Obstetricians and Gynaecologists (MRCOG) requires an ‘overall’ exam including all subject areas, of which only a small fraction will include ultrasound. Some do not assess theoretical knowledge among trainees at all. Whilst most systems require formalized theoretical teaching, ‘hands-on’ practical supervision is rarely formalized. Yet, this is the most critical aspect of basic training. Most hands-on supervision for trainees is probably ad hoc in an opportunistic, unstructured way in clinics and wards, rather than being arranged in advance with clear educational goals. Log books and check lists are frequently used to document a certain number of scans, and the quality of images can be checked by a supervisor. However, achieving a particular number of scans does not equate to a certain level of competence. We suggest that four aspects should be discussed and decided upon: This has been proposed previously by EBCOG, EFSUMB and ISUOG. However, a problem is that definitions vary and do not seem to be implemented uniformly in European countries (Table 1). In the UK, basic ultrasound training for obstetric ultrasound (though not gynecological ultrasound) has recently become mandatory and comprises two modules. The goal of training is that each trainee should be able to carry out a dating scan at 8–12 weeks and to undertake some aspects of late pregnancy scanning, for example amniotic fluid index assessment, fetal presentation, placental site and aspects of basic fetal biometry. While these may appear to be modest goals for basic training, they are a marked improvement: now all UK trainees will be expected to achieve at least basic competence. Training must be offered and standards maintained, for which a robust assessment process is critical. However, the assessment process in European countries is variable (Table 1) and only a few countries have nationally applied assessment guidelines or tools. There are specific national considerations. In the UK, for example, objective and reproducible assessments are evidenced by RCOG (Royal College of Obstetricians and Gynaecologists) workplace-based assessments, which may be completed by medical or non-medical training supervisors. These include Objective Structured Clinical Examinations (OSCEs), Case Based Discussions (CBDs) and mini-CEXs (Clinical Examinations). Web-based resources to support trainers are available on the RCOG website5, along with the RCOG curriculum, assessment tools and information6. Both sonographers and obstetricians/gynecologists may, where appropriately qualified, perform assessments7. This is important because in the UK, the majority of obstetric ultrasound examinations are carried out by sonographers. Indication for ultrasound investigations, the sonographic appearance of normal anatomy in the standard planes, the correct settings of an ultrasound system as well as safety issues can easily be taught in conventional ways (lectures, books, videos), but the practical usage of an ultrasound system and, in particular, handling of the ultrasound probes (positioning, insonation angle) and adjustments for fetal movements and positional changes must be taught on a one-to-one basis. Once these basic abilities have been mastered, however, there are some other potentially useful educational tools: Online lectures. Several societies and dedicated individuals offer educational lectures on the Internet, ranging from basic to very advanced topics. ISUOG, for example, offers the contents of several ultrasound courses, covering both obstetric and gynecological topics, in full-media format (audio and video). While many of these lectures cover advanced topics, some also address concepts such as the fetal cardiac screening exam. These lectures are available for all members from ISUOG's website (www.isuog.org). In several European countries, trainees are able to access the ISUOG website through a free membership program. Multimedia-based self-study, using offline material (CD ROM). CD ROMS have been produced by various authors, including ISUOG, who offer an educational series of CD ROMS, some produced jointly with The Fetal Medicine Foundation, London (downloadable from ISUOG's website). Ultrasound simulators. Ultrasound simulators in basic obstetric and gynecological ultrasound training have been studied, but only sparsely, and their applicability for basic training has been disputed8, 9. However, once basic abilities (use of the ultrasound system, handling of the probes, acquisition of standard images) have been achieved by a trainee, there may be a possible role for digitally preserved pathological specimens both in basic and advanced training10, 11. EBCOG has representatives from all European countries and could agree on a structure for basic and intermediate ultrasound training, allowing harmonization between different European countries. The potential for putting together a joint course curriculum and for combining and sharing existing teaching material and expertise between the national societies is unarguable. ISUOG has come a long way in advanced women's imaging education, arranging well-attended, high-quality conferences, producing a top-ranked journal and providing a large and growing body of media-rich lectures and other tools on its website. The focus so far has, however, been on developing the skills of already competent ultrasound practitioners. We therefore suggest that the time is right to team up in order to craft a basic training program for ultrasound in obstetrics and gynecology that is geared towards residents' training. Without doctors being taught the basics, they are unlikely to become confident and competent advanced ultrasound practitioners. It is unrealistic to expect an overall and unified European ultrasound training scheme, though with increasing movement of doctors and patients within Europe this might be desirable. But there is no reason why a template for basic, intermediate and advanced training, both theoretical and practical, cannot be developed jointly between national bodies and supranational organizations. How this training is provided and assessed will differ from country to country, but a template may at least guide national societies to improve ultrasound education for all obstetricians/gynecologists. This will be rewarded by safer and more confident clinical management of patients in both obstetrics and gynecology. The Authors are very grateful to Kurt Biedermann, Gianluigi Pilu, Ann Tabor, Lil Valentin, Klaus Vetter and Yves Ville for provision of information used in the construction of Table 1 of this article.

Breast cancer is the most prevalent cancer in Indonesia, 19.2% out of all cancers [1]. In 1992, most breast cancer patients (60-70%) sought medical treatment when the cancers were in late stages (stage III and IV) [2]. Thirty years later data collected from several teaching hospitals in Indonesia shows that 68- 73% of breast cancer patients come to medical centers in the late stages [3,4,5]. It is interesting to learn why the number of late-stage breast cancer patients in Indonesia remains the same despite the advancement in early detection and therapeutical measures. This editorial will mainly discuss one factor contributing to the diagnostic and treatment delay: patients’ accessibility to proper medical attention. Accessibility to proper medical attention for breast cancer patients in Indonesia depends on the number and distribution of trained oncologists, a concise referral system, and supportive regulation. Indonesia is a vast archipelago country with a population of more than 273 million people. In tertiary medical centers, breast cancer patients are attended by surgical oncologists since surgery is the main treatment. As per February 2002, there are only 233 surgical oncologists practicing. This number is far below the ratio proposed by the Indonesian Society of Surgical Oncologists (Perhimpunan Ahli Bedah Onkologi Indonesia/PERABOI) which is 0.2 per 100,000 population (546 surgical oncologists needed). This number is still below the ideal ratio which is twice as much. However, setting a goal too high would make the organization frustrated, hence the revised target. The role of oncologists is vital in breast cancer cases. A multinational analysis shows that being diagnosed with breast cancer by an oncologist correlates with shorter treatment delay [6]. It takes at least 6 years of general surgery training plus 2 more years of surgical oncology training to produce a surgical oncologist. This does not count the 2-5 years of working experience required before a general surgeon could apply for the surgical oncologist training. Acceleration is critical to producing more surgical oncologists, either by establishing more training centers or by modifying the training system. Establishing a surgical oncology training center is no simple procedure; especially since UU Pendidikan Kedokteran number 20/ 2013 mandates that medical specialist training must be university-based [7]. The government should consider the role of hospital-based training to accelerate the production of surgical oncologists. The revision of the law is underway that would recognize the role of professional society and collegium in medical specialist training. Acceleration can also be carried out through modifying the training system: from subspecialist training to specialist training. A general practitioner can enroll for the surgical oncology training without having to be a general surgeon first. The role of “collegium” is vital to ensure that the training curricula meet the requirement despite the cutting down of training time. Nevertheless, modification of the training system will take years unless there is government intervention to simplify the regulations. Another alternative to increase the number of competent surgeons attending breast cancer patients is by establishing a crash program in surgical oncology for general surgeons. The program would train general surgeons in early detection, proper treatment, and the vital knowledge of “when to refer” to tertiary medical centers so that the patients could have the best possible treatment. The lack in the number of surgical oncologists is worsened by the uneven distribution throughout the country. More than 50% practice in big cities in Java Island leaving some distant provinces with only one or two surgical oncologists. Distribution is vital so that expert medical advice is accessible throughout the country. The public health system and private insurance may cover the direct cost of breast cancer care but not the indirect costs such as traveling expenses to reach distant medical centers. The indirect cost is one factor contributing to patients’ delay to seek breast cancer care [8,9]. A study in Yogyakarta shows that various out-of-pocket expenses such as transportation and logistics linked to presentation, diagnosis, and subsequent breast cancer treatment remain a financial burden and hinder the patient from seeking early medical treatment [10]. The government needs to work closely together with the Society to regulate the distribution of surgical oncologists throughout the country. Indonesian Journal of Cancer, Vol 16(1), 1–2, March 2022 DOI: http://dx.doi.org/10.33371/ijoc.v16i1.920 www.indonesianjournalofcancer.or.id P-ISSN: 1978-3744 E-ISSN: 2355-6811 2 | A breast cancer referral system that concisely states “what and when” to refer to tertiary medical care is necessary to prevent referral delay. A study in a tertiary medical center in Surabaya shows that only 13,8% of the patient comes through the referral system [11]. This shows some dysfunctions in our country’s referral system. It is necessary to prepare a breast cancer referral guideline for physicians in primary and secondary medical centers. Lack of concise referral guidelines may result in some early breast cancer patients getting inadequate surgical oncology treatment in secondary medical centers and later coming to the tertiary medical center in a more advanced stage. Reformation of some regulations is imperative in ensuring patient access to proper medical attention. Laws that regulate medical specialist training need to be reformed in order to accelerate the production and national distribution of much demanded surgical oncologists. It is necessary to establish regulation on the breast cancer referral system to avoid referral delay in secondary medical centers. There is also an urgent need to re-evaluate the regulation of the national health financing system, which often contributes to hospital delay of breast cancer treatment. Aiming for reducing the number of late-stage breast cancer in Indonesia is a gigantic work. From the medical standpoint, it is crucial that breast cancer patients have access to proper medical attention as early as possible. Accelerating the production of surgical oncologists, ensuring their even distribution throughout the country, improving the breast cancer referral system, and reforming some regulations are indispensable measures to take. Thirty years ago, we had 60-70% late-stage breast cancer. Nowadays sadly we have similar numbers. And if we do not take necessary actions, thirty years from now we will not see much difference in the number. It would seem that breast cancer care in Indonesia is marching in place.

Updated American Society of Clinical Oncology (ASCO) and National Comprehensive Cancer Network (NCCN) antiemetic guidelines recommend olanzapine for the prophylactic treatment of chemotherapy-induced nausea and vomiting (CINV) in highly emetogenic chemotherapy (HEC). Inadequate treatment of CINV can result in compounding physical sequelae, ultimately affecting patients' tolerance and recovery throughout chemotherapy treatment. Regional Michigan Oncology Quality Consortium (MOQC) data have identified a wide range of compliance rates in the appropriate prescribing of olanzapine. Literature has shown that olanzapine is safe and effective for the treatment of acute and delayed CINV. The purpose of this quality improvement (QI) project was to improve the compliance rate of appropriate prescribing of olanzapine for CINV for adult patients receiving HEC within the project site's outpatient oncology clinic. The project was based on the Plan-Do-Study-Act (PDSA) model and implemented in an outpatient oncology clinic in a Midwestern urban area over a 6-month time period. A multidisciplinary and interactive education program was delivered to providers. Pre- and post-intervention data were collected by impartial, independent auditors. At monthly provider staff meetings, a presentation was provided to prescribers supplying information on the updated antiemetic guideline recommendations and the pharmacodynamics of olanzapine. An olanzapine frequently asked questions (FAQ) sheet was also provided to reinforce the reviewed material. Data collected following implementation showed an increase in appropriate prescribing of olanzapine from 82.05% to 94.74% (n = 76). A standard deviation Z-test for two population proportions showed the positive change in compliance rate was statistically significant at p < .05 where p was calculated at .02852. A sustainability audit 1 year after completion showed the rate of appropriate prescribing of olanzapine at 92.59% (n = 27), representing a decrease of 2.15 percentage points. A standard deviation Z-test demonstrated the decrease in comparative compliance rates was not statistically significant at p < .05. Audit data obtained following the implementation of the QI project revealed a statistically significant improvement, which supported the hypothesis that providing education based on the PDSA model is an effective method to improve the compliance rate of appropriate olanzapine prescribing for CINV in patients receiving HEC. The result reflects the growing body of evidence confirming the validity of the PDSA model.

Adverse events (AEs) are unintended, harmful effects that occur in clinical trials, particularly in early-phase oncology clinical trials (EPOCT), where the risk of adverse effects from experimental therapies is high. Effective AE identification and management are essential for ensuring patient safety, improving outcomes, and advancing research. Advanced practice providers (APPs) play a key role in detecting and managing AEs, serving as a bridge between clinical care and research. However, their full impact on EPOCT remains underexplored. This integrative review examines existing literature on AE identification, reporting, and management in EPOCT. It explores the role of APPs in managing AEs, emphasizing their impact on patient outcomes, clinical trial efficiency, and oncology science. A systematic search of peer-reviewed literature from 2020 to 2025 was conducted using various databases. Inclusion criteria were studies addressing AE management in EPOCT, patient-reported outcomes (PROs), and APP roles. Studies unrelated to oncology, AE management, or health-care providers were excluded. Findings highlight the variability in AE reporting and the growing utility of electronic PRO tools in capturing timely and accurate data. Advanced practice providers contribute significantly to outpatient AE management, reducing emergency visits and improving treatment adherence. However, challenges remain, including underreporting with clinician-based tools, lack of standardized APP training, and limited comparison to physician-led AE management. APPs serve as key players in enhancing AE reporting and improving clinical trial processes. Future research should focus on standardizing structured training programs for APPs and comparative studies assessing the effectiveness of APP-led care.

The enormous discrepancy between the incidence of disabling physical impairments among individuals with cancer and the provision of medical rehabilitation services to address these problems has once again been documented by Cheville et al in this issue of Journal of Clinical Oncology. In particular, the difference between receipt of rehabilitation care during acute hospitalization and the extremely low rate for outpatients is impressive, but hardly surprising. The extent to which presence of advanced cancer has accentuated the magnitude of the differences between inpatient and outpatient rehabilitation service delivery is unclear, because similar trends would likely be found even among those with less extensive disease. In the inpatient setting, rehabilitation services such as physical and occupational therapy are often readily available, and are integral to the discharge-planning process to attain basic function sufficient for homegoing and avoid costly prolonged hospitalization. On the other hand, rehabilitation goals among outpatients are typically more varied and focused on specific impairments, such as lymphedema, contracture, motor-sensory deficits, deconditioning, and musculoskeletal pain syndromes. Active recognition of the impairments as remediable issues is required. Additional barriers not seen during inpatient care may be present, such as insurance authorization obstacles and inconvenience. The main problem, however, is that more effective systems are needed to recognize rehabilitation needs, provide rehabilitation care, and facilitate evidencebased outcomes of rehabilitation in the cancer population. Multiple studies have documented increased levels of disability among cancer patients and survivors. Yet, many gaps exist in our knowledge of how this broad-based information can be applied clinically. Which impairments justify vigilant screening? In which situations are the problems most remediable? What are best practices for treatment? How does the presence of advanced cancer affect appropriate rehabilitation management? Some cancer-related impairments, such as amputation, and conditions affecting the brain or spinal cord produce obvious and devastating clinical care needs. A wide range of treatable musculoskeletal disorders can also occur in the setting of cancer, a fact that is probably underappreciated, including among many rehabilitation practitioners. There is a need to more closely examine the extent of rehabilitation needs in historically elusive, yet common, cancer subpopulations, including those with advanced cancer. In depicting a model of rehabilitation care that has worked in a major cancer hospital, Grabois described “lessons learned,” including the need for a core triad of strong administrative support, a physiatrist as medical director of rehabilitation services, and effective marketing. Clinical service lines including inpatient, consultative, and outpatient rehabilitation should be present, as well as an emphasis on scientific productivity, and educational dimensions including medical student and resident rotations, sponsorship of seminars, and development of cancer rehabilitation fellowships. Significantly, Grabois also spoke of the real-world importance of having adequate staff capacity to minimize patient waiting times, and of maintaining a convenient location. Such a model immerses rehabilitation in the culture and workings of the facility. Despite examples such as this, integration of rehabilitation into cancer care remains problematic. In a survey of National Cancer Institute–designated cancer centers, 70% of facilities reported services to treat lymphedema, but there was little discussion of other mainstream rehabilitation services. Challenges are even greater in institutions that are not dedicated cancer hospitals, where the majority of cancer patients are treated, and where rehabilitation services simultaneously need to meet the needs of other patient populations. What specific strategies can be employed to improve rehabilitation access for oncology patients? Lehmann, O’Toole, and Mosvas describe consultative models to screen oncology patients for rehabilitation needs, such as assigning rehabilitation personnel to meet regularly with the oncology team or using information such as the Karnofsky score to trigger rehabilitation assessment. However, data on long-term results of such screening systems are highly limited. Among inpatients, including those with advanced cancer, gains in functional status have been reported with both traditional acute rehabilitation and with interdisciplinary rehabilitation provided on a consultative basis, suggesting that future efforts at optimizing the rehabilitation screening process among oncology inpatients would be highly worthwhile. Among outpatients, screening presents even greater challenges. For example, do best care outcomes and cost effectiveness happen when a physiatrist sees all at-risk patients and triages the rehabilitation interventions, or when the patients go directly to other rehabilitation disciplines such as physical or occupational therapy, with physiatrist care reserved for those with the most complicated needs? Empirically, successful outpatient programs have cultivated specific service lines and consistent processes. Historically, many programs have been directed towards lymphedema and postmastectomy management, or other postsurgical issues. But there are other problems, often more global, to which there is a need to respond, especially as the evidence grows stronger. For example, because multiple studies have shown that individuals with cancer benefit from exercise programs, processes that routinely expedite exercise are needed. Areas JOURNAL OF CLINICAL ONCOLOGY E D I T O R I A L VOLUME 26 NUMBER 16 JUNE 1 2008

Advanced practice providers (APPs), including physician associates (PAs) and nurse practitioners (NPs), are increasingly utilized in radiation oncology. However, radiation oncology-specific training for APPs is not standardized. This study elucidates the current role of US radiation oncology APPs by assessing clinical responsibilities. Radiation oncology APPs in the US were sent a survey examining demographics, training, practice structure, and clinical tasks using the framework of the 52 entrustable professional activities (EPAs) developed by the Radiation Oncology Education Collaborative Study Group (ROECSG). 37 PAs and 84 NPs participated. 53.7% practiced a different specialty previously. 63.6% had three or more APPs in the department, and 71.9% covered multiple physicians. 65.3% worked in a practice alongside radiation oncology residents, and 79.7% of these APPs worked directly with residents. 25.6% performed procedures. 95% completed follow-up/survivorship visits, 71% completed acute symptom visits, 65% completed ambulatory consults, 45% completed inpatient consults, and 38% completed on-treatment visits. 21.5% specialized in one disease site, 39.7% covered multiple disease sites, and 38.8% covered all disease sites. 22 of 52 ROECSG EPAs were performed by > 90% in some capacity. > 90% did not complete EPAs 15, 32, 33, 35, 36, 37, 38, 40, and 46. Only 2.5% of APPs received formal radiation oncology training during APP education. APPs perform many ROECSG EPAs, primarily during follow-up/survivorship visits. However, job responsibilities vary widely across radiation oncology clinics. Further definition of the APP role is essential to meet the growing demands of cancer care, support the evolution of radiation oncology, and enhance patient care.

Symptom burden is the primary driver for patients with indolent systemic mastocytosis (ISM) to seek medical care, whether or not they are diagnosed. This descriptive study aimed to describe the advanced practitioner (AP) and ISM patient perspective relative to the symptom burden of ISM, multidisciplinary diagnosis and management of ISM, barriers to symptom management, strategies for collaborative management of ISM, and communicative health literacy in patients with ISM. An ISM patient survey and AP survey were developed by an AP-led steering committee incorporating validated tools to measure symptom burden, symptom burden impact, barriers, and strategies for improving symptom burden. Surveys were embedded in Qualtrics and were deployed by Conexiant to a convenience sample of AP members of the Advanced Practitioner Society for Hematology/Oncology (APSHO), AP members of the American Initiative in Mast Cell Diseases, and patients affiliated with The Mast Cell Disease Society between December 22, 2024, and February 3, 2025. 50 APs and 53 ISM patients completed 100% of the questions on the corresponding surveys. The symptom burden described using the Indolent Systemic Mastocytosis Symptom Assessment Form (ISM-SAF) to identify the symptoms that are most common, most challenging, and have the greatest impact on quality of life aligns with published data for patients in this survey. Only 24% (n = 13) of ISM patients indicated their disease was well controlled, while 76% of APs indicated greater than 50% of their ISM patients had well-controlled disease (n = 38). Most APs (68%) in the survey indicated they saw one to five ISM patients per year but were comfortable with managing ISM-related symptoms (54%, n = 27). Practice patterns for triage, multidisciplinary management, and shared decision-making are described. This is the first ISM symptom burden-focused survey to provide a direct comparison of patient responses to those of APs in hematology/oncology and allergy and immunology. Indolent systemic mastocytosis symptom burden measurement and symptom burden reduction remain challenging, with several barriers and gaps identified in this study. The APSHO Toolkit for Systemic Mastocytosis, developed in parallel to this study, provides an AP-focused resource for overcoming some of the barriers and gaps identified in this study.

Chimeric antigen receptor (CAR) T-cell therapy has emerged as a highly effective treatment for relapsed or refractory multiple myeloma (MM). However, manufacturing CAR T cells can take 3 to 4 weeks, leaving patients vulnerable to disease progression during this waiting period. Bridging therapy aims to address this gap by controlling disease and improving CAR T-cell efficacy. This review summarizes the role of bridging therapy in CAR T-cell therapy for MM, focusing on the rationale and goals of bridging therapy, timing of initiation, infection risk management, selection of bridging regimens, and clinical implications, including patient education and communication. Relevant literature on CAR T-cell therapy and bridging therapy in MM was reviewed, including clinical trials and real-world data. Bridging therapy may be crucial for some patients, particularly for those with rapidly progressive disease. The optimal timing for initiating bridging therapy remains under investigation, but it can begin as soon as leukapheresis is completed. Prophylactic antibiotics or antivirals and close monitoring are essential for preventing infections during this period. The choice of bridging regimen depends on individual patient characteristics and prior therapies. Effective patient education and communication between local oncology teams and CAR T-cell centers are critical. Bridging therapy plays a vital role in optimizing CAR T-cell therapy outcomes for MM patients. Further research is needed to define the optimal use of bridging therapy in this evolving treatment landscape.

Narratives are central to the practice of medicine. However, modern health care faces numerous new demands, including increased patient loads and professional commitments, which interfere with opportunities to listen to and tell stories. These challenges can negatively impact patient care and provider burnout. Narrative medicine has been proposed as an approach to overcome these difficulties. Through implementation of this technique, engaging with illness anecdotes can become a more integral clinical focus. Its main movements are attention, reflection, and affiliation. There are multiple styles proposed for its use, although they all assist in the exploration of meaning within illness narratives. Over the past several decades, a shift toward promoting these tools has led to more research in the field. Multiple studies demonstrate the benefits to patients, providers, and caregivers. Additionally, programs are expanding to further the development of these skills. With guidance and repetition, these abilities can foster better engagement and understanding between all those involved in health care. This article discusses the various principles of narrative medicine and the benefits of its incorporation into health care, specifically in the role of oncology advanced practitioners.

Oncology advanced practitioners (OAPs) play an important role in cancer care delivery. However, leadership in clinical research remains low among OAPs. Although OAPs often participate in patient care for early-phase clinical trials, they rarely have the opportunity to lead as a principal investigator (PI), despite being capable and effective PIs when provided education and mentoring. As cancer care needs continue to increase, there is a critical need for well-trained PIs and sub-investigators (sub-Is) to evaluate novel therapeutics. To address this need, an intensive 3.5-day educational course at HonorHealth Research Institute (HRI) was developed to provide education and guidance to OAPs who desire to learn and evolve into the role of a PI in clinical trials. The course involved lectures, roundtable discussions with physicians, and protocol synopsis workshops. Participants included 21 OAPs. Participants were given questionnaires to evaluate the impact of the course and assess knowledge retention. In lectures, 65% of questions answered demonstrated improvement. In course evaluations, 100% of participants agreed that the learning objectives were met. In follow-up surveys, 63% reported they had reviewed their drafted protocol synopsis with their mentor, while the majority felt at least somewhat confident that they would be able to move forward with their protocol synopsis. Overall, participants responded favorably to the course, which successfully provided foundational knowledge for OAPs to transition into clinical research leadership positions.

Patient access to clinical trials has been identified as a key measure for delivery of quality cancer care. Effective recruitment and retention strategies remain an issue. Furthermore, clinical trial participants historically lack diversity. This project focused on advanced practice provider (APP) mentorship and paired clinical research support to enhance minority accrual to supportive care trials in Hawai'i. Over a 1-year period, a formal mentorship program for six participating APPs and three clinical research coordinators (CRCs) in the Hawai'i Minority/Underserved National Cancer Institute Community Oncology Research Program (HI M/U NCORP) was implemented. An introductory meeting kicked off the project. The APP and CRC teams then met weekly for targeted screening and accrual to supportive care trials. Monthly meetings between the mentor and teams were conducted to discuss barriers, best practices, and problem solve issues. 26 unique accruals were obtained by the APP and CRC teams over the project period while increasing minority accrual. All six APPs are now actively enrolling to trials. Four of the six participating APPs are now reviewing protocols for the HI M/U NCORP for feasibility and scientific merit. Eight of the nine participating APPs and CRCs found the intervention to be acceptable and feasible. Mentorship of APP and CRC teams can be a successful strategy in increasing accrual and participation of APPs in clinical trial activities. Measuring minority accrual based on this strategy is more complex and dependent on the APP location, clinical trial portfolio, APP patient panel and clinical interest, as well as the expertise of the APP.

Patients with cancer frequently desire to incorporate integrative oncology (IO) practices into their care. However, patients are often uncertain about how to best access safe and effective IO practices and providers. The National Comprehensive Cancer Network (NCCN) Best Practices Committee (BPC), in collaboration with a National Cancer Institute (NCI)-Designated Comprehensive Cancer Center, sought information regarding IO practices of NCCN Member Institutions. The BPC conducted a survey of NCCN Member Institution IO practices, which was distributed via a web-based survey tool to a representative at each center. Results were compiled using descriptive statistics. Twenty-nine centers responded to the survey, with 100% of the responding institutions offering IO services. Services provided included nutritional/dietary services (97%), stress and anxiety management services (76%), mind-body practices (72%), physical therapy/occupational therapy (72%), acupressure/acupuncture (69%), and massage therapy (59%). While the mechanism for patient access varied, the most common was provider referral with some services available by self-scheduling. Twenty-one percent of centers used institutionally designed algorithms for referrals. Significant variation in funding for services existed between institutions, including combinations of self-pay, insurance-based, and philanthropically funded models. There was substantial variation in how NCCN Member Institutions deliver IO services. These results provide guidance for health-care organizations seeking to develop IO services and an opportunity to align best practices. As data were compiled solely from sites providing comprehensive cancer services, non-academic community settings may find similar implementation challenging. However, this information provides cancer providers insight into IO services most often sought by patients with cancer.

Monoclonal gammopathy of undetermined significance (MGUS) is characterized as a nonmalignant or premalignant state whereby monoclonal immunoglobulins are detected in plasma, urine, or both. Approximately 3% to 4% of the population over the age of 50 is diagnosed with MGUS. It is estimated that 1% will progress to multiple myeloma or lymphoma over 20 years and therefore require ongoing clinical monitoring. Monoclonal gammopathy of undetermined significance is categorized into three types that are determined by the paraprotein clone: immunoglobulin M (IgM) MGUS, non-IgM MGUS, and light chain MGUS. There are high-risk genetic, biochemical, and clinical factors that increase the risk of transformation to multiple myeloma or lymphoma. The incidence of MGUS is two- to threefold higher in the Black population compared with the White population, along with an earlier age of onset. Familial risk and modifiable lifestyle factors are also associated with the development of MGUS and multiple myeloma. Certain monoclonal gammopathies, known as monoclonal gammopathy of clinical significance (MGCS), are associated with various organs that are involved (kidney, brain, skin, lungs, liver, eyes, and heart). The most common MGCS are associated with renal and neurological abnormalities, and treatment may be considered. Early diagnosis and multidisciplinary approaches to mitigate organ damage and other complications are important for the recognition and management of MGCS. Monoclonal gammopathy of undetermined significance is monitored rather than treated unless there are clinical findings of progression or organ dysfunction. Ongoing research and clinical trials are essential to refine monitoring guidelines, develop targeted therapies, and explore preventive measures aimed at reducing progression to multiple myeloma and other malignancies.

We are honoured to be co-guest editors of this issue of CJNR focused on advanced practice nursing (APN). In Canada, advanced practice nurses include nurse practitioners (NPs) and clinical nurse specialists (CNSs) (Canadian Nurses Association [CNA], 2008). It is fitting that CJNR is publishing this APN-focused issue given the leadership that Moyra Allen, founding editor of the Journal, demonstrated in her early writings about “the expanded role in nursing” (Allen, 1977). The research pieces and feature articles in this issue reflect the growing contribution of APN roles to the health of Canadians and highlight areas where further work is required to maximize their integration into the health-care system. NPs are “registered nurses with additional educational preparation and experience who possess and demonstrate the competencies to autonomously diagnose, order and interpret diagnostic tests, prescribe pharmaceuticals and perform specific procedures within their legislated scope of practice” (CNA, 2009b, p. 1). Those who are registered as family/all-ages or primary health care NPs typically work in the community, in settings such as community health centres, family physician offices, and long-term-care facilities, with a focus on health promotion, preventive care, diagnosis and treatment of acute common illnesses and injuries, and monitoring and management of stable chronic diseases. Those who are registered as adult, pediatrics, or neonatal NPs (also known as acute-care NPs) typically provide advanced nursing care across the continuum of acute-care services for patients who are acutely, critically, or chronically ill with complex conditions. They work in areas such as oncology, neonatology, and cardiology. In 2008, there were 1,626 licensed NPs in Canada (Canadian Institute for Health Information [CIHI], 2010). CJNR 2010, Vol. 42 No 2, 3–8

Systematic reviews are a critical tool in oncology practice to facilitate informed clinical decision-making, synthesize current research, and guide practice policy. To facilitate early exploration of a literature query or topic, Scopus Artificial Intelligence (AI), which was introduced in 2024 and is subscription-based, provides a new tool for researchers and providers to access current data or begin a systematic review topic exploration. The following article is intended to familiarize advanced practice providers (APPs) with both the recently released AI tool of Scopus AI and associated AI interface capabilities with literature search methodologies. Scopus AI is embedded within the extensive resources of Scopus, an established search engine database. Scopus AI simplifies a topic search by allowing a user to enter the question or phrase in natural language, or ordinary spoken or written language. It then translates the query into a vector and/or keyword search. Scopus AI summarizes the output results to include bullet points, numbered highlights, and conclusions. Associated citations, with internal URL links to articles embedded within the Scopus database, allow for confidence in the output summary. Pivotal or landmark study foundational document citations are also listed. The utilization of AI tools can aid APP researchers and clinicians to expedite steps in the systematic review process. Multiple tools are available to assist the researcher; Scopus AI is one of the tools that can be used to assist in streamlining specific aspects such as the initial tasks and literature search steps of the systematic review development process.