Carlton Haywood

Guidelines recommend that patients with sickle cell disease vaso-occlusive crises be treated promptly with pain medication with timely reassessment. To assess whether care in an infusion center or ... Visual Treating Acute Pain in Sickle Cell Disease in an Infusion Center vs. the ED. Guidelines recommend that patients with sickle cell disease vaso-occlusive crises be treated promptly wi... Background: Patients with sickle cell disease (SCD) have vaso-occlusive crises (VOCs). Infusion centers (ICs) are alternatives to emergency department (ED) care and may improve patient outcomes. Ob...

OBJECTIVE: To test the effect of 1 high-intensity, and 1 reduced-intensity, educational intervention designed to improve health care provider attitudes toward youth with sickle cell disease (SCD). METHODS: We exposed a regional sample of pediatric health care providers to a 2.5-day high-intensity educational and experiential intervention using videos about the SCD patient experience. Additionally, we traveled to a different set of regional health care institutions and offered pediatric providers a reduced-intensity intervention, consisting of a 90-minute lunchtime in-service centered on our same set of videos about the patient’s experience. We assessed the impact of both interventions by taking pre/post measurements of the negative and positive attitudes expressed by participating providers toward patients with SCD. RESULTS: Both interventions tested elicited improvements in the SCD attitudes expressed by the pediatric providers as suggested through a reduction in measured negative attitude scores (20.0 vs 12.1, P < .001), and an improvement in positive attitude scores (67.1 vs 72.2, P < .001). Further testing suggested that the high-intensity intervention elicited a stronger effect than the reduced-intensity intervention across multiple attitudinal domains. CONCLUSIONS: Video-based interventions can be used to improve the attitudes of pediatric providers toward patients with SCD. The availability of interventions of varying intensities provides greater flexibility in designing efforts to advance the quality of SCD care through the improvement of provider attitudes.

Patients with sickle cell disease (SCD) often seek care in the emergency department (ED) for pain associated with vaso-occlusive crises. Research has shown that negative provider attitudes serve as a barrier to care in this patient population. Our aim was to validate a survey that measures attitudes toward SCD patients among ED providers (nurses and physicians) and to compare differences in attitude scores between provider types. We administered the general perceptions about Sickle Cell Disease Patients Scale, previously validated among internal medicine providers, and the Medical Condition Regard Scale (MCRS) to ED nurses and physicians from two EDs. A total of 215 surveys were returned (63% response rate, 200 with attitude items completed). Three subscales were identified: Negative Attitudes, Uneasiness With Care, and Positive Attitudes. Cronbach's αs exceeded 0.81 for each subscale. Mean (SD) scores for the Negative, Uneasiness, and Positive subscales and MCRS were 61.5 (20.3), 66.1 (17.1), 41.2 (17.8), and 42.2 (8.9), respectively. Compared with physicians, nurses had significantly higher mean Negative Attitude scores and lower Uneasiness scores. A slightly modified version of the general perceptions about Sickle Cell Disease Patients Scale appears to be a valid measure of ED provider attitudes toward SCD patients. Among ED providers, this scale identified a dimension not observed in research with the original instrument among internal medicine providers. Provider attitudes influence patient–provider interactions and quality of care. The scale we present here has major clinical implications, particularly for advanced practice nurses, who can use the scale not only to assess providers' attitudes toward SCD patients but also to determine the effectiveness of tailored interventions to improve those attitudes.

Adults with sickle cell disease (SCD) report experiencing discriminatory behavior from some healthcare providers. The impact of discrimination on health outcomes in SCD, including adherence to physician recommendations, is not known.

Background: A substantial number of planned clinical trials for sickle cell disease (SCD) have terminated early due to insufficient patient enrollment. Purpose: To describe attitudes toward clinical trials among a sample of adults with SCD and identify patient-level factors associated with these attitudes. Methods: Our data came from a sample (N = 291) of primarily adults with SCD participating in the Improving Patient Outcomes with Respect and Trust (IMPORT) study, which is a federally funded observational study of SCD patient experiences in seeking healthcare. Attitudes toward clinical trials were assessed using items from the Perceptions of Participation in Clinical Research instrument. Patient factors examined as potential correlates of clinical trial attitudes were demographics, disease severity, engagement in self-care, trust, healthcare experience ratings, and prior history of participation in clinical trials. Multiple regression analyses were used to identify patient-level correlates of clinical trial attitudes. Results: Our sample of SCD patients expressed overwhelmingly favorable attitudes about clinical trials, with 77%–92% of our sample expressing agreement with a series of positive statements about clinical trials in general. Demographics, engagement in self-care, healthcare experience ratings, and prior trial participation each explained significant portions of the variability in clinical trial attitudes. Limitations: The generalizability of our results to the entire SCD population may be of concern as the study participants were all receiving care at comprehensive sickle cell centers and already participating in clinical research. Conclusion: Our results suggest that, in principle, adults with SCD enrolled in an observational study express very positive general attitudes about clinical trial participation and that specific factors attached to particular clinical trial opportunities may play a greater role in a SCD patient’s decision to participate than a general unwillingness to participate.