Psychosomatic in the USA: A Systemic Biopsychosocial Approach in Practice

Psychosomatic Medicine · 2026-01-01

Connect for caregivers: an exemplar using the NIH Stage Model for behavioral intervention development

Aging & Mental Health · 2025-11-06

OBJECTIVES: In this study, we adapted, refined, and tested feasibility of a card sort-based prioritization tool, Connect for Caregivers (C4C), to foster action planning for social connectedness in lonely family caregivers of persons living with dementia (PLWD). METHOD: = 5), refined based on their feedback, and then 5 additional caregivers completed C4C and feasibility measures. RESULTS: Barriers and goals to social connectedness were identified and incorporated into the C4C tool. Outcomes of the caregiver support staff focus group included recommendations for implementation. Prototype and feasibility testing with the final sample of caregivers indicated that the intervention was feasible and acceptable, and 4/5 completed their action plans. CONCLUSION: C4C is a promising behavioral intervention that should undergo further development and testing to improve social connectedness in family caregivers of PLWD. TRIAL REGISTRATION: https://classic.clinicaltrials.gov/ct2/show/NCT04919070.

Hospital Outcomes for Patients with Psychiatric Comorbidities: A Comparison of an Integrated Medical-Psychiatry Unit and Traditional Medical Units

Population Health Management · 2025-10-29

Patients with co-occurring medical and psychiatric conditions often face fragmented care and prolonged hospitalizations in traditional medical units (MUs). Integrated medical-psychiatry units (MPUs) offer a model of concurrent care that may better meet the needs of these patients, but limited data exist on which patient populations benefit most. This study retrospectively compared outcomes for patients with psychiatric conditions discharged from an MPU versus traditional MUs within a single academic medical center between 2019 and 2023. Subgroups included patients presenting with suicidal ideation (SI) or toxic overdose (OD). Primary outcomes were length of stay (LOS) and discharge to the community. MPU patients were younger, more likely to be on Medicaid, and had significantly higher rates of psychotic, mood, substance use, and cognitive disorders (all P < 0.001). Despite this higher psychiatric complexity, MPU patients had shorter LOS and higher rates of discharge to home than their counterparts on general MUs, even after adjusting for demographic and clinical differences. Among patients with SI, those on the MPU had an average LOS of 5.5 days compared to 6.7 days in traditional units ( P = 0.006). These findings highlight the effectiveness of MPUs in managing complex, high-need patients and support the broader implementation of integrated, interdisciplinary care models to improve hospital outcomes and care transitions for vulnerable populations.

Enhanced Primary Care for Severe Mental Illness Reduces Inpatient Admission and Emergency Room Utilization Rates

Population Health Management · 2024-10-02 · 2 citations

Cardiovascular disease (CVD) is a leading cause of premature mortality among patients with severe mental illness (SMI). Effective care delivery models are needed to address this mortality gap. This study examines the impact of an enhanced primary care (PC) program that specializes in the treatment of patients with SMI, called Medicine in Psychiatry Service-Primary Care (MIPS-PC). Using multipayer claims data in Western New York from January 1, 2016 to December 31, 2021, patients with SMI and CVD were identified using International Classification of Diseases, Tenth Revision codes. National Provider Identification numbers of MIPS-PC providers were then used to identify those patients who were treated by MIPS-PC during the period. These MIPS-PC-treated patients were compared against a cohort of one-to-one propensity score matched contemporaneous comparison group (ie, patients receiving PC from providers unaffiliated with MIPS-PC). A difference-in-difference approach was used to identify the treatment effects of MIPS-PC on all-cause emergency department (ED) visits and hospitalization rates. The MIPS-PC group was associated with a downtrend in the acute care utilization rates over a 3-year period following the index date (ie, date of first MIPS-PC or other PC provider encounter), specifically a lower hospitalization rate in the first year since the index date (25%; P < 0.001). ED visit rate reduction was significant in the third-year period (18%; P = 0.021). In summary, MIPS-PC treatment is associated with a decreasing trend in acute care utilization. Prospective studies are needed to validate this effect of enhanced PC in patients with SMI and CVD.

SIOG2024-3-P-067 Social connection among older adults with breast cancer in a pilot trial of an intervention to mitigate cancer-related cognitive decline (CRCD)

Journal of Geriatric Oncology · 2024-10-01

Disentangling gender, sex, and biology: a mixed methods study of gender identity data collection tools

Patient Education and Counseling · 2024-10-16 · 3 citations

OBJECTIVES: We used community-based mixed methods to test whether transgender and gender diverse (TGD) people preferred gender identity questions developed by community members over current questions in use and generate hypotheses about data collection preferences. METHODS: We interviewed twenty TGD adults in English and Spanish, asking them to rate and discuss their responses to questions. We analyzed quantitative data with descriptive statistics and qualitative data with template analysis, then integrated them. RESULTS: More participants preferred gender identity questions that were currently in use. Themes: 1) TGD participants find questions about "gender" and related terminology unclear because of conflations of sex, gender, and other constructs. 2) TGD participants resist cisgenderism in questions about gender identity. 3) TGD people desire questions that allow for autonomy, privacy, and safety. 4) Contextual factors, particularly safety, influence whether and how TGD people answer questions about gender and sex. CONCLUSIONS: TGD people have varied concepts of sex and gender and preferences about data collection. Future research should investigate the impacts of disentangling gender, sex, and biological factors, which could decrease stigma for TGD people. PRACTICE IMPLICATIONS: Medical care that disentangles gender, sex, and biological factors could improve data collection effectiveness and the safety of TGD people.

SIOG2024-4-P-112 Impact of Memory Attention and Adaptation Training-Geriatrics (MAAT-G) on patients' confidence in cognitive abilities and relationship to performance on objective cognitive assessment

Journal of Geriatric Oncology · 2024-10-01

SIOG2024-1-OA-003 A randomized pilot study of memory and attention adaptation training-geriatrics (MAAT-G) To mitigate cancer related cognitive decline (CRCD) symptoms in older women with breast cancer

Journal of Geriatric Oncology · 2024-10-01

SIOG2024-4-P-113 Relationship between patients' perceived benefits from study participation and gratitude in older adults with cancer participating in a behavioral intervention clinical trial

Journal of Geriatric Oncology · 2024-10-01

Beliefs About Advanced Cancer Curability in Older Patients, Their Caregivers, and Oncologists

UNC Libraries · 2024-01-31

Background: Ensuring older patients with advanced cancer and their oncologists have similar beliefs about curability is important. We investigated discordance in beliefs about curability in patient-oncologist and caregiver-oncologist dyads. Materials and Methods: We used baseline data from a cluster randomized trial assessing whether geriatric assessment improves communication and quality of life in older patients with advanced cancer and their caregivers. Patients were aged ≥70 years with incurable cancer from community oncology practices. Patients, caregivers, and oncologists were asked: “What do you believe are the chances the cancer will go away and never come back with treatment?” Options were 100%, >50%, 50/50, <50%, and 0% (5-point scale). Discordance in beliefs about curability was defined as any difference in scale scores (≥3 points were severe). We used multivariate logistic regressions to describe correlates of discordance. Results: Discordance was present in 60% (15% severe) of the 336 patient-oncologist dyads and 52% (16% severe) of the 245 caregiver-oncologist dyads. Discordance was less common in patient-oncologist dyads when oncologists practiced longer (adjusted odds ratio [AOR] 0.90, 95% confidence interval [CI] 0.84–0.97) and more common in non-Hispanic white patients (AOR 5.77, CI 1.90–17.50) and when patients had lung (AOR 1.95, CI 1.29–2.94) or gastrointestinal (AOR 1.55, CI 1.09–2.21) compared with breast cancer. Severe discordance was more common when patients were non-Hispanic white, had lower income, and had impaired social support. Caregiver-oncologist discordance was more common when caregivers were non-Hispanic white (AOR 3.32, CI 1.01–10.94) and reported lower physical health (AOR 0.88, CI 0.78–1.00). Severe discordance was more common when caregivers had lower income and lower anxiety level. Conclusion: Discordance in beliefs about curability is common, occasionally severe, and correlated with patient, caregiver, and oncologist characteristics. Implications for Practice: Ensuring older patients with advanced cancer and their caregivers have similar beliefs about curability as the oncologist is important. This study investigated discordance in beliefs about curability in patient-oncologist (PO) and caregiver-oncologist (CO) dyads. It found that discordance was present in 60% (15% severe) of PO dyads and 52% (16% severe) of CO dyads, raising serious questions about the process by which patients consent to treatment. This study supports the need for interventions targeted at the oncologist, patient, caregiver, and societal levels to improve the delivery of prognostic information and patients’/caregivers’ understanding and acceptance of prognosis.