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Browsing by Author "Burgio, Kathryn L."

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    Enabling Advance Directive Completion Feasibility of a New Nurse-Supported Advance Care Planning Intervention
    (Slack, 2018) Hilgeman, Michelle M.; Uphold, Constance R.; Collins, Amber N.; Davis, Lori L.; Olsen, Douglas P.; Burgio, Kathryn L.; Gordon, Classie A.; Coleman, Tranace N.; DeCoster, Jamie; Gay, Whitney; Allen, Rebecca S.; Geriatric Research Education & Clinical Center; University of Florida; Michigan State University; US Department of Veterans Affairs; Veterans Health Administration (VHA); Veterans Affairs Medical Center - Birmingham; University of Alabama Birmingham; University of Virginia; University of Alabama Tuscaloosa
    Adults who complete an advance directive (AD) are not consistently offered information about the risks, benefits, or alternatives (RBA) of the life-sustaining medical procedures addressed on standardized forms. The current article describes a new patient-centered nurse-supported advance care planning (NSACP) intervention focused on providing information about RBA of life-sustaining procedures. Fifty participants (mean age = 50.26 years) at a Veterans Affairs medical center were randomized to the NSACP intervention or a comparison condition. Before randomization, 78% (n = 39) expressed interest in RBA information. Of participants in the NSACP group, 94% (n = 30) completed an AD. Participants who received NSACP made more decisions to decline life-sustaining treatment than those who were randomized to the comparison group. Promising feasibility data include brevity (mean = 46 minutes), high patient satisfaction, participant retention, and treatmentfidelity. The NSACP holds promise as a brief, educational intervention to support patients in completing an AD.
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    Influence of Diabetes-Related Support on Aerobic Activity Among Older African Americans With Type 2 Diabetes
    (Sage, 2019) McCaskill, Gina M.; Bowen, Pamela G.; Lee, Loretta T.; Burgio, Kathryn L.; Leeper, James; Clay, Olivio J.; Geriatric Research Education & Clinical Center; US Department of Veterans Affairs; Veterans Health Administration (VHA); Veterans Affairs Medical Center - Birmingham; University of Alabama Birmingham; University of Alabama Tuscaloosa
    The objective of this study was to examine the influence of diabetes-related support in promoting aerobic activity in a sample of older African Americans. A secondary data analysis was conducted based on a diabetes self-management study of community-dwelling older African Americans. Logistic regression was conducted to examine the influence of diabetes-related support on aerobic activity. The final model demonstrated that there was a strong relationship between having diabetes-related support and aerobic activity, odds ratio =6.56, 95% confidence interval [2.14, 20.11]. The final model also demonstrated a significant influence based on the total number of chronic health conditions on aerobic activity, odds ratio = 0.63, 95% confidence interval [0.498, 0.802]. Findings suggest that older African Americans with Type 2 diabetes and other chronic health conditions may engage in physical activity if they have diabetes-related support from their family and friends.
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    Racial Differences in Processes of Care at End of Life in VA Medical Centers: Planned Secondary Analysis of Data from the BEACON Trial
    (Mary Ann Liebert, 2016) Burgio, Kathryn L.; Williams, Beverly R.; Dionne-Odom, J. Nicholas; Redden, David T.; Noh, Hyunjin; Goode, Patricia S.; Kvale, Elizabeth; Bakitas, Marie; Bailey, F. Amos; Geriatric Research Education & Clinical Center; University of Alabama Birmingham; University of Alabama Tuscaloosa; University of Colorado Denver; University of Colorado Anschutz Medical Campus
    Background: Racial differences exist for a number of health conditions, services, and outcomes, including end-of-life (EOL) care. Objective: The aim of the study was to examine differences in processes of care in the last 7 days of life between African American and white inpatients. Methods: Secondary analysis was conducted of data collected in the Best Practices for End-of-Life Care for Our Nation's Veterans (BEACON) trial (conducted 2005-2011). Subjects were 4891 inpatient decedents in six Veterans Administration Medical Centers. Data were abstracted from decedents' medical records. Multi-variable analyses were conducted to examine the relationship between race and each of 18 EOL processes of care controlling for patient characteristics, study site, year of death, and whether the observation was pre- or post-intervention. Results: The sample consisted of 1690 African American patients (34.6%) and 3201 white patients (65.4%). African Americans were less likely to have: do not resuscitate (DNR) orders (odds ratio [ OR]: 0.67; p = 0.004), advance directives (OR: 0.71; p = 0.023), active opioid orders (OR: 0.64, p = 0.0008), opioid medications administered (OR: 0.61, p = 0.004), benzodiazepine orders (OR: 0.68, p < 0.0001), benzodiazepines administered (OR: 0.61, p < 0.0001), antipsychotics administered (OR: 0.73, p = 0.004), and steroids administered (OR: 0.76, p = 0.020). Racial differences were not found for other processes of care, including palliative care consultation, pastoral care, antipsychotic and steroid orders, and location of death. Conclusions: Racial differences exist in some but not all aspects of EOL care. Further study is needed to understand the extent to which racial differences reflect different patient needs and preferences and whether interventions are needed to reduce disparities in patient/family education or access to quality EOL care.