Journal of Clinical Psychology in Medical Settings最新文献

Integrated Care (IC) models have increased, but the current mechanisms to analyze the efficacy and fidelity of behavioral interventions within IC models are limited. A mixed methods concurrent process evaluation was used within the context of a randomized clinical trial to assess intervention fidelity for a Solution-focused brief therapy (SFBT) intervention implemented within an IC model. A qualitative content analysis was conducted to develop a participant survey and charting template for the SFBT intervention. Quantitative data were collected through (1) participant surveys, (2) interventionist self-report surveys, and (3) data from participant charts. Descriptive statistics and repeated measures ANOVA were used to analyze quantitative data. Data triangulation was used to present findings. The average SFBT intervention was 24.6 min and 33/34 (97%) of participants in the intervention group completed all 3 SFBT sessions. Most visits were weekly follow-ups (53.9%), followed by biweekly (28.2%) and then 3-week follow-ups (5.1%). The interventionist used session templates and a self-report checklist to monitor intervention integrity. Those in the intervention group had increased growth regarding Solution-focused core constructs (a scale created by the authors) when compared to the treatment-as-usual group (F [1, 64] = 22.7, p < 0.001): mean difference, 15.1 [95% CI 11.2 to 18.9]. Our study examined fidelity comprehensively and provides a foundation for studies interested in fidelity monitoring of SFBT interventions as well as behavioral interventions within IC models. Trial Registration: The study was pre-registered at ClinicalTrials.gov Identifier: NCT05838222 on 01/05/2023.

Chronic orofacial pain (COFP; i.e., musculoskeletal, neurovascular, or neuropathic pain in the face, mouth, or jaw that lasts for at least 3 months) is prevalent and debilitating. Chronic pain and substance use frequently co-occur, and individuals with COFP face unique challenges (e.g., uncertainty about future pain episodes, difficulty eating, drinking and talking) that may influence substance use. Nevertheless, no work to date has comprehensively assessed substance use among individuals with COFP. Here, we examine the prevalence of substance use among adults with COFP. Participants included 246 adults with COFP who were recruited from the Facial Pain Association. Participants completed an online survey that included a comprehensive assessment of substance use (i.e., Alcohol, Smoking, and Substance Involvement Screening Test) between December 2023 and January 2024. Most participants (82.9%) have used ≥ 1 substance in their lifetime, over two-thirds (68.3%) currently use ≥ 1 substance, and nearly half (43.5%) engage in risky substance use. The most commonly used substances were alcohol, tobacco, cannabis, opioids, and sedatives. This study presents a comprehensive assessment of substance use among adults with COFP. Findings extend prior work documenting high rates of substance use among individuals with chronic pain to a sample of adults with COFP. Given that substance use can exacerbate chronic pain and interfere with pain management, findings underscore the importance of assessing and addressing substance use among individuals with COFP.

Chronic pain acceptance has been identified as a crucial determinant of functioning among individuals living with chronic pain. However, research examining the relationship between chronic pain acceptance and pain-related disability has revealed variability across studies. The aims of this meta-analysis were to synthesize associations between chronic pain acceptance and pain-related disability, and test the moderating influence of pain characteristics, demographic factors, and methodological variables. Searches of PubMed and PsycINFO electronic databases located 24 studies (N = 6072) reporting correlations between chronic pain acceptance and pain-related disability. Meta-analytic calculations were performed using random effects models. Results indicated a negative association between chronic pain acceptance and pain-related disability that can be characterized as moderate in magnitude (r = -.45) and was stable across pain characteristics and demographic factors. Moderator analyses suggested the association between chronic pain acceptance and pain-related disability may be sensitive to the measures used to assess these constructs. These findings underscore the role of chronic pain acceptance in pain-related disability and reinforce the clinical significance of acceptance-based approaches in enhancing functional outcomes among chronic pain patients.

Clinical practice guidelines indicate treatments for specific anxiety diagnoses. Misdiagnosing specific anxiety disorders as unspecified anxiety may prevent patients from receiving appropriate care. Provider knowledge and attitudes may influence diagnostic practices. This study evaluated provider knowledge of diagnostic criteria for anxiety disorders and attitudes toward diagnostic processes and the relevance of diagnosis to patients' treatment. This qualitative analysis of interviews included 32 Veterans Health Administration providers in Primary Care Behavioral Health and Specialty Mental Health. Interview guides were created using a framework that outlines barriers regarding provider knowledge, attitudes, and behaviors as they pertain to following clinical practice guidelines. Most providers described themselves as familiar with diagnostic criteria for anxiety disorders and discussed consulting the Diagnostic and Statistical Manual of Mental Disorders if unsure about criteria. Providers were divided on the relevance of diagnostic specificity to a patient's treatment plan and outcomes. In the Veterans Health Administration, providers across different settings, roles, and tendency toward assigning specific diagnosis disagree on the relevance of diagnostic specificity for a patient's treatment and outcomes. Future research should seek to understand this divide and evaluate methods for optimizing a patient's likelihood of receiving a proper, accurate diagnosis.

Objectives: For pediatric cancer survivors in the post-treatment, school-reintegration period, integrating multi-informant reports and promoting a mutual clinician-family-school understanding of the child's needs are critical for comprehensive care. This study evaluated patterns of agreement between child, parent, and teacher reports of psychosocial functioning in pediatric brain tumor survivors (PBTS) and non-CNS solid tumor survivors (PSTS).

Participants and methods: PBTS (n = 51) and PSTS (n = 34) age 7-14 who received tumor-directed therapy completed the study. Parents and teachers completed the CBCL/TRF and SSIS, and parents and children completed the PedsQL and PROMIS peer relationships. Intra-class correlation coefficients, % disagreements, t-tests, and correlations quantified inter-rater agreement.

Results: Analysis yielded poor-to-moderate ICC levels across measures. Parent-teacher agreement was higher for reports of externalizing symptoms. Parents had higher ratings of child-internalizing problems, but lower ratings of overall social skills than teacher ratings. Parents had higher ratings of child emotional functioning and social skills compared to self-reports.

Conclusions: Findings underscore the necessity for integrating multi-informant reports of psychosocial functioning in assessment for pediatric cancer survivors. Findings also highlight critical gaps in mutual parent-teacher-child understanding, indicating the need for increased collaboration in the post-treatment period.

As academic medical centers have moved away from using learner ratings of instruction as a demonstration of quality teaching in the promotion process, Indiana University School of Medicine sought to create a peer review of teaching system. We created our system in 2010 and have engaged in continuous quality improvement since. In these efforts, we sought to answer the question, "How can we create a system of peer review of teaching that provides high-quality feedback to faculty and encourages autonomy and growth?" Our peer review of teaching system includes a website, with a brief introduction to the concept of peer review, as well as a series of customizable forms that allows faculty and peer reviewers to choose items for observation and feedback based on teaching setting. This system, called the Peer Review Form Builder (PRFB), combines interactive technology with evidence-based faculty development and is innovative in structure and scope. On the macro level, departments and programs have seen success with the tool by engendering conversations on the values and effectiveness of teaching and education efforts. This systematic, tailored system of peer review of teaching has advanced the stature, quality, and innovation within all aspects of teaching throughout the institution. Further, we have incorporated these values into promotion and tenure documents, by encouraging consistent, systematic peer review as a primary source of evidence to demonstrate teaching effectiveness.

Mentoring plays an integral role in the success of faculty. This study explores faculty access to formal and informal mentorship and how mentorship impacts faculty engagement. Data are from 2020 to 2023 administrations of the StandPoint Faculty Engagement Survey. We compare clinically active faculty with a PhD or other health doctorate (OHD) in departments of psychiatry and neurology (Doctoral-PN) with both faculty with an MD or equivalent degree in those departments (Physician-PN), and with faculty with a PhD or OHD in other clinical departments (Doctoral-Other). Psychologists who are active in clinical care are represented in these departments although their representation likely varies by institution. Forty-four percent of Doctoral-PN faculty received formal mentoring and 65% received informal mentoring. Those receiving formal mentoring were more satisfied with professional development opportunities and reported increased understanding of promotion than those who were not. They were also more satisfied with their department and would recommend their medical school to others. The literature to date acknowledges the challenges to professional growth and advancement faced by Doctoral-PN faculty, including psychologists, practicing in academic health centers. This paper adds to previous research by presenting data on organizational outcomes associated with mentoring for these faculty.

Continual changes in organizational structures within medical schools have contributed to the expanded scope and the centralization of faculty affairs offices, which support faculty administration and supportive functions. Using qualitative interviews, we investigated the perspectives of academic medicine faculty affairs leaders regarding their offices' priorities in sustaining faculty vitality in the face of current and anticipated challenges. A semi-structured interview protocol based on the researchers' practical knowledge, informed by the study's research inquiries, and pertinent academic literature guided the interviews. Deductive thematic analysis approach was used to identify the patterns and themes across the interviews. Our analysis revealed a central theme: the pivotal nature of the leader's role in strengthening faculty identity. Additionally, three sub-themes emerged concerning the leader's role in nurturing faculty well-being within today's academic medicine context: redefining faculty role, acknowledging and appreciating faculty contributions, and maintaining faculty engagement through a whole-person approach. Faculty affairs leaders describe widening roles with an emerging focus on a whole-person approach valuing the diverse contributions of faculty across the academic mission, supporting professional development, reflecting the individual motivations of faculty, and championing institutional processes that holistically evaluate and recognize faculty contributions.

Leadership training helps position faculty to guide various aspects of health care and health professions education at academic medical centers. With the increasing complexity of these responsibilities, it is essential that academic medical centers provide leadership skill-development opportunities to faculty. This work describes the structure of two internal mid-career faculty leadership development programs that were created to cultivate future institutional leaders from within the organization. These year-long programs were each established in 2017 and have been implemented annually. Both programs use a developmental approach with project-based, experiential learning so that leadership skills are applied immediately and meaningfully. Internal leadership programs support context-specific skills, while creating a community of leaders and a culture of leadership across the institution. Multidisciplinary participants bring diverse perspectives, and intra-institutional interactions foster collaborations. Internal, longitudinal training also supports comprehensive development more than is typically possible with short-term, external leadership programs. Other organizations can use these program descriptions and insights to develop similar internal, mid-career leadership training opportunities. While the broader academic medicine community benefits from faculty advancement whether training is within the institution or elsewhere, internal leadership training promotes context-specific development at individual, interpersonal, and institutional levels.

Editing services within academic health centers are uncommon, and few studies have reported on their impact. In this article, we describe our medical writing center's editing service for faculty and trainees at a pediatric teaching hospital and associated outcomes of scholarly products (e.g., manuscripts and grants) over an 8-year period. Data for manuscripts and grant proposals edited by the writing center from 2015 through 2022 were collected electronically from our service request database. Outcome data on publications and grant proposals were regularly collected up to 12 months post-submission. Users were also asked if the writing center edits were helpful, improved readability, and if they planned to use the service in the future. From 2015 through 2022, the writing center received 697 requests, 88.4% to edit a document. Of the documents edited, 81.3% of manuscripts and 44.4% of grant proposals were successfully published or funded. When rating their experience, 97.8% of respondents rated the edits "helpful," 96.7% indicated the edits "improved readability," and 99.3% stated they planned to use the writing center in the future. Our results showed steady use of the writing center and high satisfaction with services. A writing center can be an effective tool to support psychology faculty development.