Translational Medical Research Commons^™

Improving Empathy And Reducing Stigmatization In Pre-Clinical Physician Assistant Students Towards Patient Taking Opioids For Chronic Pain: The Feasibility Of A Perspective-Taking Peer Role-Play Intervention, Barbie Ann Seton Stephen

Doctor of Philosophy in Translational Health Sciences Dissertations

Background: Empathy has been identified as a crucial skill for all healthcare providers who treat patients with chronic pain. It has been directly linked to higher patient satisfaction and improved health outcomes. It has also been linked to reduced burnout, fewer medical errors, and improved job satisfaction among healthcare providers. Despite the many interventions that have been developed to promote empathy, the decline of empathy in healthcare providers and trainees continues to be of great concern, especially in pain management and opioid prescribing, thus affecting the quality of care given to these patients. In physician assistant students, this decline has …

Understanding Strategies To Translate Knowledge On Hookah Smoking: A Mixed Methods Study, Rabia Mir

Doctor of Philosophy in Translational Health Sciences Dissertations

Background: One tobacco trend of the 21 st century is smoking hookah or waterpipes. Hookah smoking is thriving on a false widespread belief that it is a safe alternate to smoking cigarettes when in fact it has adverse effects on health and is not safer. Hookah use has especially become popular for young adults and college students.

Study Objectives: The purpose of this study is to generate knowledge to inform university administration (health education personnel and campus policy makers) on what the psychosocial profile of a hookah smoker is, including risk factors, and how they can use messaging to reduce …

A Collective Case Study Of How Researchers Describe Their Experiences, Challenges, And Perceived Impact Of Patient Engagement, Lorna M. Richards

Doctor of Philosophy in Translational Health Sciences Dissertations

Background: Patient engagement (PE) in clinical research has become “extensively and internationally recognized as important and gained growing policy attention, supported by scientific evidence” (Al-Tannir et al., 2017, Background section). The proliferation of PE directives has driven the paradigm shift in drug development from a paternalistic approach to a more patient-centric approach influenced by regulatory agencies, funders, and academic initiatives (Bombak & Hanson, 2017). However, too often, PE activities are not well considered for discovering actionable insights but are merely an empty formality. For PE to be meaningful, patient involvement must be planned, supported, and valued by clinical researchers.

Objectives: …

Measuring What Matters To Patients: A Multiple Methods Sequential Study Of Disease Burden, Quality Of Life, And The Alignment Of Patient-Reported Outcome Measurements For High-Risk Myelodysplastic Syndrome And Acute Myelogenous Leukemia Patients, Anthony J. Messina

Doctor of Philosophy in Translational Health Sciences Dissertations

Background

High-risk myelodysplastic syndromes (MDS) and acute myeloid leukemia (AML) are aggressive hematologic malignancies with poor prognoses, where extending survival often comes at the cost of substantial morbidity. This study was grounded in the quality of survival (QoS) framework, which emphasizes that treatment outcomes should balance longevity with the health-related quality of life (HRQoL) experienced during the period of survival. In this context, patient-reported outcomes are crucial to capturing what truly matters to patients. However, existing patient-reported outcome measures (PROMs) used in MDS/AML clinical trials may not fully reflect patient priorities. A complementary Wilson–Cleary model perspective, linking biological factors to …

Evaluation Of The Etiology Of Recurrent Pregnancy Loss (Rpl): An Explanatory Mixed Methods Study Exploring Obstetrician Gynecologist Clinical Provider Behaviors And Factors Contributing To Incomplete Evaluations, Emelia Grant

Doctor of Philosophy in Translational Health Sciences Dissertations

Background: More than 50% of patients with recurrent pregnancy loss (RPL) are left without explanations for their losses. However, current research suggests that up to 90% of these individuals could receive explanations through evidence-based laboratory testing. Professional guidelines vary in their recommendations for laboratory testing and RPL evaluation, which can contribute to delayed or fragmented care and untreated maternal disease. Inequities in access to genetic testing further complicate the diagnostic landscape of RPL since payor policies often determine which tests are covered, leaving many patients without access due to financial constraints.

Objective: This study aimed to evaluate current practices of …

Exploring Negotiated Autonomy In The Physician–Physician Assistant Collaborative Dyad, Stephen Robie

Doctor of Philosophy in Translational Health Sciences Dissertations

Physician Assistants (PAs) are integral members of multidisciplinary medical care teams who practice medicine legally under the supervision of physicians. During medical care, supervision is a dynamic process of collaboration wherein a PA who displays competence is granted increasing independence by the supervising physician. This process has been referred to as negotiated autonomy. Despite being noted in work-force literature, the mechanics of how negotiated autonomy operates in real-time have not been described. As organizations increasingly work to integrate PAs into practice, new-hire training programs called ‘on-boarding’ have been implemented to accelerate PA professional development with a goal of increased efficiency …

Exploring Strategies To Increase Genomic Literacy And Integrate Genomic Medicine Education Into Graduate Medical Education Programs: A Multi-Case Qualitative Study, Vinaya S. Murthy

Doctor of Philosophy in Translational Health Sciences Dissertations

Background: Some predict that genomic sequencing will become fully integrated into standard medical care within the next ten years, making genomic testing as routine as complete blood counts (Green et al., 2020; McCauley et al., 2017). Non-geneticist physicians, whose practices are being increasingly influenced by genomic medicine (GM), need to be knowledgeable and confident in GM to bridge the gap in patient access and quality of care due to genomic workforce shortages.

Objective: The aim of this study was to identify ways to accelerate adoption of GM in clinical practice by studying graduate medical education (GME) training programs. …

An Explanatory Sequential Mixed Methods Study To Understand Stakeholder Collaboration In Precision Medicine, Worlanyo Sosu-Sedzorme

Doctor of Philosophy in Translational Health Sciences Dissertations

Background: Precision medicine is a promising approach to healthcare that can improve the diagnosis, treatment, and prevention of various health conditions. However, its implementation into clinical practice is complex and requires effective collaboration among multiple stakeholders. Unfortunately, the current state of stakeholder collaboration in precision medicine is poorly understood.

Objective: This study explored stakeholder collaboration in precision medicine to identify barriers and facilitators and propose recommendations for effective collaboration.

Study participants: The study recruited thirty-eight individuals involved in precision medicine, including providers, patients or guardians, administrative personnel, and researchers from multiple healthcare organizations, mainly in the mid-Atlantic …

Toward A Patient-Partnered Model Of Clinical Trial Design: A Qualitative Descriptive Case Study Of The Duchenne Muscular Dystrophy Clinical Research Partnership, Jennifer Catena Davis

Doctor of Philosophy in Translational Health Sciences Dissertations

To provide actionable information about the safety and efficacy of new medications, clinical trials should be designed to test outcomes that patients find meaningful. This imperative is increasingly acknowledged by the scientific community and regulatory authorities and in recent years has been enshrined in regulatory guidance documents for industry; however, clinical trials often fail to adequately address patient priorities. Evidence suggests that partnerships between researchers and patient communities may result in clinical trials that better reflect the patient experience, but there are few successful models of such partnerships. Within the clinical research landscape, the Duchenne Muscular Dystrophy (DMD) community has …

Neuroscience-Informed Art Therapy: A Knowledge Translation Toolkit For The Treatment Of Psychological Trauma, Juliet L. King

Doctor of Philosophy in Translational Health Sciences Dissertations

Background: While art therapy has shown value in treating mental health and physical concerns, the complexity of linking the arts to health outcomes poses difficulties. Health outcomes are multifaceted and challenging to quantify, an effort made more difficult with the inclusion of the arts. Engaging neuroscience offers critical insights concerning art therapy’s effectiveness in addressing trauma symptoms and sequela. The absence of scientifically informed practice strategies compromises the precision and generalizability of services, limits accessibility, and poses a barrier to accessible healthcare. Translating neuroscience insights into art therapy clinical practice strategies is an ethical obligation that supports effective trauma-informed …

Understanding How Patient Engagement Is Enacted Through Telehealth: A Grounded Theory Study, Patricia Deyo

Doctor of Philosophy in Translational Health Sciences Dissertations

Background: The COVID-19 pandemic forced a sudden shift in how healthcare was provided leading to a rapid implementation of telehealth in March 2020. While telehealth had been used in some populations and areas, it was not widely implemented throughout the U.S. Healthcare organizations were challenged to implement telehealth overnight for people to continue to seek medical care. Regulations related to reimbursement and medical licensing were loosened during the COVID-19 pandemic which removed some of the long-standing barriers to telehealth. As telehealth continued in practice, providers and practices were challenged to find new and creative ways to engage patients through telehealth. …

Virtual Education Implementation For Children With Autism Spectrum Disorders Amidst The Covid-19 Pandemic, Monika Sinha-Bhamra

Doctor of Philosophy in Translational Health Sciences Dissertations

Background: The COVID-19 pandemic led to widespread school closures in the Washington DC metropolitan region, necessitating a shift from traditional in-person education to virtual platforms. The context was significantly influenced by the evolving pandemic and its impact on the region's COVID-19 positive rates, with the Washington DC region facing some of the highest positive rates in 2020. These escalating positive rates posed substantial challenges to planning and implementing in-person learning, primarily driven by concerns for public health and safety. The region's persistently low percentages of in-person learning made it one of the worst in the country regarding the provision of …

Communicating Unexpected Genetic Information With Family Members: A Multimethod Study Of Secondary Findings Recipients, Julie Chevalier Sapp

Doctor of Philosophy in Translational Health Sciences Dissertations

Background: Medically-actionable secondary genomic findings (SF) can be life- preserving or life-prolonging for recipients but this benefit can only extend to family members if this information is shared with relatives. How SF recipients communicate this important genetic information with relatives, barriers and facilitators to this process, and SF recipients’ lived experiences in communicating about their results over time remain largely unknown. Family communication is required for relatives of SF recipients to access cascade testing and the potential benefits of enhanced screening and management. Applying behavioral and implementation science theories and providing rich and deep descriptions of SF recipients’ lived experiences …

Engaging Patients In Opioid Use Disorder Treatment: A Mixed Methods Study Investigating Primary Care Team Perspectives On Approaches, Barriers, And Facilitators, Elizabeth J. Austin, Ulrich Koch, Monica S. Ruiz, Anna D. Ratzliff, Emily C. Williams, Yavar Moghimi

Doctor of Philosophy in Translational Health Sciences Dissertations

Background: Harms from opioid use disorder (OUD) cause significant morbidity and mortality, responsible for over 107,000 overdose-related deaths in 2022 and igniting an urgency to expand access to OUD-related care to new settings such as primary care. A critical element of successful OUD care is engaging patients throughout the OUD care continuum and ongoing retention, yet OUD care engagement rates in outpatient settings are hugely variable, ranging from 4%-70% for initial (14-30 day) treatment engagement, and markedly diminishing over time. The barriers that patients cite to engagement point to the need to deliver more patient-centered OUD care, yet little …

Understanding Coordinated Specialty Care Best Practice Through Fidelity Practices: A Qualitative Exploration, Halley Read

Doctor of Philosophy in Translational Health Sciences Dissertations

Background: Coordinated Specialty Care (CSC) is a multidisciplinary care model for providing care to youth and young adults having their first episode of psychosis. While outcomes of CSC effectiveness are overwhelmingly positive, and widespread implementation has occurred in all US states and territories, what is CSC best practice regarding components and fidelity to the model is not clear. CSC implementation is well documented from a fidelity to the model standpoint, but the highly variable fidelity practices and versions of the model are not well understood. Nor are the experiences of those who deliver or receive care. Adding to the complexity …

A Mixed Methods Sequential Explanatory Design Study Exploring How Demographic Factors Contribute Individuals Presenting To The Emergency Department For Seizure Management, Radwa Aly Msc

Doctor of Philosophy in Translational Health Sciences Dissertations

Psychogenic nonepileptic seizures (PNES) mimic epileptic seizures in their clinical manifestations, but are not associated with an abnormal electrical discharge on electroencephalogram. PNES attacks are often treated and managed as likely epileptic seizures, subjecting the patient to unnecessary anti-seizure medications (ASM). Both epileptic seizures and PNES are common reasons for visiting the emergency department (ED), especially for patients without access to ambulatory care. There is growing evidence highlighting disparities in seizure care in the ED related to race, ethnicity, and socioeconomic status (SES). PNES is a significant burden to the patient and society because of the annual costs spent on …

Speech-Language Pathologists’ Perspectives On Evidence-Based Practice In The Healthcare Setting: A Qualitative Study, Rosalyn A. Davis M.S., M.A., Ccc-Slp, Shelley B. Brundage, Phd, Ccc-Slp, Matthew Garber Pt, Dsc, Joseph M. Bocchino Edd, Mba, Sarah M. Ginsberg Phd, Ccc-Slp

Doctor of Philosophy in Translational Health Sciences Dissertations

Background: Evidence-based practice (EBP) was introduced to the profession of speech-language pathology in 2004. However, the limited empirical and implementation literature on EBP in speech-language pathology suggests that the field lags behind other healthcare disciplines, including physical therapy, occupational therapy, and nursing. Additionally, the limited empirical literature on EBP in speech-language pathology identified a need to know how speech-language pathologists (SLPs) in healthcare 1) defined and described their use of EBP and 2) perceived barriers and facilitators to utilizing EBP in clinical practice. While in the clinical instructor role, SLPs are expected to integrate theoretical, evidence-based knowledge in their clinical …

The Neuroadvocacy Toolkit: A Knowledge Translation Strategy To Strengthen Food Fortification Policies To Prevent Neural Tube Defects In Latin American Countries. A Mixed-Method Study, Kemel A. Ghotme

Doctor of Philosophy in Translational Health Sciences Dissertations

Background. Neural tube defects are one of the leading congenital malformations that affect children in Latin America and worldwide, leading to pregnancy terminations, morbidity, mortality, and long-term disability. The most cost-effective and equitable way to prevent them is by implementing public health policies for food fortification with folic acid. However, a lack of knowledge translation strategies partly accounts for the incomplete enactment, enforcement, and scaling-up of mandatory fortification. There is no evidence in the scientific literature of studies attempting to identify the factors contributing to the development and implementation of knowledge translation strategies aiming to influence policymakers’ decisions regarding mandatory …

The Meaning Of Family-Derived Knowledge To Healthcare Providers Treating Children With Autism Spectrum Disorder, Brian Samsell

Doctor of Philosophy in Translational Health Sciences Dissertations

Background: Families receive guidance from healthcare providers on managing their children’s autism spectrum disorder (ASD); however, both parents and providers have reported that providers often have insufficient knowledge about ASD. Successfully managing ASD requires knowledge about both the real-world needs of families with children who have ASD and the ability to evaluate the real-world effectiveness of strategies designed to meet these needs. The incorporation by providers of knowledge that originated from the families of their pediatric patients with ASD, termed family-derived knowledge, could overcome this gap. This phenomenological study explored what family-derived knowledge means to healthcare providers treating children with …

Campaigners, Capitalizers, And Cooperators: A Typology Of Professional Identities Of Physician-Researchers Who Care For Patients While Recruiting Them To Industry-Sponsored Clinical Trials, Romiya Felecia Glover Barry

Doctor of Philosophy in Translational Health Sciences Dissertations

The critical phase for a successful clinical trial is timely accrual of research participants. Interventions to improve the outcome of recruiting activities have been developed to address the research structure of clinical trials, the administrative and design burdens of study protocols, the lack of awareness and acceptance of trials from patients and clinicians, and the insufficient research training for trial investigators. Engagement with potential clinical trial participants is lower than expected with a contributing factor being that investigators do not identify and approach all potential participants. The behaviors of physician-researchers responsible for recruiting and enrolling their patients into clinical trials …

Evaluating The Uptake Of Cotesting And Guideline Adherent Cervical Cancer Screening And Reported Barriers To Guideline Adherence In Academic And Community Practice Settings: A Mixed Methods Study, Shahnaz Khan

Doctor of Philosophy in Translational Health Sciences Dissertations

Background: Clinical practice screening guidelines recommend cotesting, a test that combines DNA Human Papillomavirus (HPV) testing with cervical cytology (also known as Pap testing) every 5-years, as a highly effective and preferred method for cervical cancer prevention among average-risk women aged 30-65. Up to date empirical data on the current uptake of this evidence-based intervention is sparse and does not allow for a complete understanding of the actual use of cotesting at the extended screening interval in practice among patients and providers in different types of practice settings. The 2012 national cervical cancer screening guidelines have further expanded in 2018 …

Addressing The Underdiagnosis Of Familial Hypercholesterolemia: A Mixed Methods Study Exploring The Knowledge And Practice Behaviors Of Cardiology Healthcare Providers, Isha Kalia Ms, Mph, Cgc

Doctor of Philosophy in Translational Health Sciences Dissertations

Background: Familial Hypercholesterolemia (FH) is a common genetic disorder that is vastly underdiagnosed and undertreated. FH causes lifelong elevated low-density lipoprotein cholesterol, resulting in an increased risk for coronary heart disease, myocardial infarctions, and sudden cardiac death. Cardiology healthcare providers (CHCPs) are in an ideal position to not only screen cardiology patients for FH but also to diagnose and manage FH patients.

Objectives: Describe the practice behaviors of CHCPs in the screening, diagnosis, and management of FH, as well as gain a deeper understanding of the perspectives of CHCPs regarding FH screening and diagnostic interventions that can be implemented in …

Management Of Non-Compressible Torso Hemorrhage Of The Abdomen In Austere/Remote Environments By Non-Surgeon Using Truncal Hemorrhage Control, Donald Adams Mpas, Pa-C

Doctor of Philosophy in Translational Health Sciences Dissertations

Background: Non-compressible torso hemorrhage (NCTH) of the abdomen is a potentially preventable cause of death due to injury. Over the last 26 years, the trauma community has not developed a temporizing or definitive intervention to preserve life in patients with non-compressible torso hemorrhage of the abdomen due to trauma. Individuals who sustain survivable injuries that are associated with non-compressible torso hemorrhage of the abdomen will, on average bleed out or hemorrhage within 30 minutes of sustaining injury. Truncal hemorrhage control is the intervention this research study would implement by non-surgeons managing patients with non-compressible torso hemorrhage of the abdomen in …

Lost In Translation? Communicating Nutrition Science, Lindsay Yarabek Datlow

Doctor of Philosophy in Translational Health Sciences Dissertations

Diet is directly correlated with overall health; therefore, nutrition is a critical piece of the obesity-epidemic puzzle. The news media has become a primary source for nutrition information yet results from International Food Information Council surveys indicate that the majority of Americans view the nutrition news they read as inconsistent and confusing. Very recent inquiry provides empirical evidence that nutrition confusion could be fueled by media. Nutrition confusion has been causally linked to “nutrition backlash,” which is complete disregard for even the most strongly supported nutrition advice. Understanding how nutrition research is translated in the news media and the mechanisms …

Characterization And Assessment Of Barriers And Facilitators To The Decision-Making Process For Blood And Blood Donor Safety In The United States: A Collective Case Study, Lauren A. Crowder

Doctor of Philosophy in Translational Health Sciences Dissertations

Background: Over 16 million blood components are transfused to patients in need every year in the United States (Jones et al., 2021). Because of the reliance on human blood donors, the donation and transfusion of blood will always be associated with some level of risk for both donors and recipients; the tolerability of these risks may vary from stakeholder to stakeholder. While the U.S. Food and Drug Administration (FDA) concedes that attaining a blood supply with zero risk for transmission of infectious diseases may be unattainable (U.S. Food and Drug Administration, 2019), they continue to strive for the lowest …

Barriers And Facilitators To Implementing Simulation-Based Translational Research: A Qualitative Study, Lisa Ann Paganotti

Doctor of Philosophy in Translational Health Sciences Dissertations

Translational simulation research has the potential to inform the way simulation is used to impact patient care and patient outcomes. Understanding how to approach translational simulation and the barriers and facilitators that can be used throughout the process can inform novice simulation and translational researchers. This qualitative dissertation sought to answer the following research questions: How do simulation experts describe the barriers and facilitators to implementing translational simulation programs? How do simulation experts describe their various approaches to implementing translational simulation programs? What recommendations do simulation experts describe for overcoming barriers to implementing translational simulation programs? The key findings include …

The Contribution Of Patient Reported Outcome Measures To Shared Decision-Making In Radiation Oncology At A Midwestern Comprehensive Cancer Center, Kellie Bodeker

Doctor of Philosophy in Translational Health Sciences Dissertations

Background. Chronic diseases, such as lung cancer, require a provider-patient relationship developed over time. This relationship fosters shared decision-making (SDM), a collaborative, dynamic information exchange and analysis between provider and patient regarding treatment and desired outcomes. Established benefits to SDM include an improved quality of life and decreased anxiety and depression. Despite established benefits, recent research suggests radiation oncologists are not engaging in SDM. A decision-aid tool utilizing patient reported outcome measures may increase SDM between radiation oncologists and patients with lung cancer. Patient-reported outcome measures, wherein the patient provides direct assessment of their health and quality of life, …

Facilitating Aging In Place And Community By Empowering Participation In Society: A Mixed Methods Study On The Co-Development Of A Theory Of Change With Suburban-Dwelling Older Adults, Emily Balog

Doctor of Philosophy in Translational Health Sciences Dissertations

Background: Baby boomers are steadily aging in America and represent an increased population in nearly every sector. In suburban communities today, older adults make up 51% of the population. Ninety-five percent of all older adults live in community settings and have expressed a desire to avoid costly institutionalization and to remain in their homes and communities, also called aging in place. Older adults in moderate income suburban communities are increasingly at a higher risk for institutionalization should their health or finances decline as the access to their wealth is within the home in which they dwell. This process …

Bridging The Knowledge-To-Action Gap: A Qualitative Description Of The Use Of Knowledge Translation In Entry-Level Doctor Of Occupational Therapy Capstones, Maria Martino

Doctor of Philosophy in Translational Health Sciences Dissertations

Although developments in the use of knowledge translation (KT) in occupational therapy practice and research are emerging, a gap in education remains. A recent revision of accrediting standards for doctor of occupational therapy (OTD) programs now specifies scholarly study that advances KT. However, little is understood of how this change in accreditation standards is being implemented, nor of its effect on OTD capstones. The purpose of this study was to describe how KT is reflected and can be promoted in entry-level OTD capstones. A descriptive qualitative design was used with semi-structured individual interviews of OTD faculty as well as content …

Assessing Pre-Exposure Prophylaxis Screening And Need Among Men Who Have Sex With Men And Transgender Persons Of Color: A Mixed Methods Case Study Of The Impact Dmv Demonstration Project, Brittany C. Wilbourn

Doctor of Philosophy in Translational Health Sciences Dissertations

Men who have sex with men (MSM) and transgender persons of color experience disproportionate, multi-level HIV risks. Pre-exposure prophylaxis (PrEP) is an evidence-based HIV prevention strategy; however, access to PrEP has been limited among this population. PrEP demonstration projects that target MSM and transgender persons and test the implementation of PrEP in real-world settings are underway. However, PrEP demonstration projects specific to MSM and transgender persons of color are limited and most demonstration projects do not consider the impact of the implementation process or organization contextual characteristics on PrEP outcomes. The Improve Measurable Participation and Access to Care and Treatment …