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Karen Bullock
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ABSTRACT: In their research, scholars have documented racial and ethnic differences in end-of-life care preferences, which have translated into cultural barriers. However, few studies have explained the racial differences. In the present study, focus groups with semi-structured follow-up interviews were utilized to elicit explanations for variance in decision making in a sample of Black and White community-dwelling residents. Participants identified specific cultural beliefs, values, and communication patterns that can be used to promote cultural competency among practitioners who provide care at end of life.
Journal of Social Work in End-of-Life & Palliative Care 01/2011; 7(1):83-98.
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ABSTRACT: To explore whether models of health behavior change can help to inform interventions for advance care planning (ACP).
Qualitative cross-sectional study.
Community.
Sixty-three community-dwelling persons aged 65 and older and 30 caregivers with experience as surrogate decision-makers.
In focus groups conducted separately with older persons and caregivers, participants were asked to discuss ways they had planned for future declines in health and why they had or had not engaged in such planning. Transcripts were analyzed using grounded theory.
Four themes illustrated the potential of applying models of health behavior change to improve ACP. (1) Participants demonstrated variable readiness to engage in ACP and could be in different stages of readiness for different components of ACP, including consideration of treatment goals, completion of advance directives, and communication with families and physicians. (2) Participants identified a wide range of benefits of and barriers to ACP. (3) Participants used a variety of processes of change to progress through stages of readiness, and ACP was only one of a broader set of behaviors that participants engaged in to prepare for declines in their health or for death. (4) Experience with healthcare decision-making for loved ones was a strong influence on perceptions of susceptibility and engagement in ACP.
The variability in participants' readiness, barriers and benefits, perceptions of susceptibility, and use of processes to increase readiness for participating in each component of ACP suggests the utility of customized, stage-specific interventions based on individualized assessments to improve ACP.
Journal of the American Geriatrics Society 09/2009; 57(9):1547-55. · 3.74 Impact Factor
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ABSTRACT: The taxanes docetaxel (Taxotere; Sanofi-Aventis U.S. LLC, Bridgewater, NJ) and paclitaxel (Taxol; Bristol-Myers Squibb, Princeton, NJ) are highly active agents in metastatic breast cancer and may represent a safer alternative to anthracycline-based regimens when combined with the human epidermal growth factor receptor (HER)-2-targeted agent trastuzumab (Herceptin(R); Genentech Inc., South San Francisco, CA). A number of preclinical and early clinical studies have evaluated the feasibility, duration, and appropriate dosing schedule(s) for taxane-trastuzumab combinations in HER-2-positive metastatic breast cancer. Preclinical studies of the taxanes in combination with trastuzumab demonstrate synergistic interactions of trastuzumab with docetaxel and additive interactions with paclitaxel. Even though not supported by head-to-head studies, clinical trial results indicate the response rates with docetaxel-trastuzumab combinations may be higher than those with paclitaxel-trastuzumab, although there is a lack of clear crosstrial differences in other clinical benefits. Weekly taxane-trastuzumab regimens have been shown to offer superior disease control. Results from two large, phase III trials that examined the addition of carboplatin to a taxane-trastuzumab doublet did not demonstrate a difference in survival with carboplatin. In one study, the addition of carboplatin to paclitaxel-trastuzumab therapy resulted in a higher response rate and longer progression-free survival time; in the second study, the docetaxel-trastuzumab and docetaxel-trastuzumab-carboplatin combinations were equally effective. Ongoing correlative studies of taxanes, as well as newer formulations such as nanoparticle albumin-bound paclitaxel, in combination with trastuzumab will inform clinical practice regarding the optimal agent, schedule, and use of these highly effective regimens.
The Oncologist 06/2008; 13(5):515-25. · 3.91 Impact Factor
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ABSTRACT: Older adults have been known to make sacrifices in their caregiving roles. Gerontology literature on custodial grandparents has primarily focused on grandmothers and the challenges they face when they assume primary care for grandchildren. Little is known about the risks that older men face when they become custodial grandparents. This article highlights types and warning signs of abuse, exploitation and neglect. Exploratory study was undertaken with a racially diverse group of custodial grandfathers to fill a gap in the literature about the vulnerability for elder abuse, exploitation and neglect as expressed by older Black, Latino and White custodial grandfathers. To provide a more inclusive understanding of elder abuse, areas of vulnerability were identified for consideration by practitioners, educators and researchers. The implications of this research point to the need to rethink elder abuse assessment, prevention and intervention strategies with older men.
Journal of Elder Abuse & Neglect 02/2007; 19(3-4):133-50.
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ABSTRACT: This article is both a memoir of one social worker's professional collaboration with Zelda Foster and a tribute to Zelda's legacy in the form of an educational resource on end-of-life care. It reviews achievements of Zelda Foster in social work practice and teaching related to death and dying. Resources presented in this article were supported by the Soros Foundation's Project on Death in America, a funded grant project to which Zelda contributed. The end-of-life care education, training and informational tools discussed in this article are examples of ongoing efforts in the social work profession to improve the lives of the dying and bereaved.
Journal of Social Work in End-of-Life & Palliative Care 02/2007; 3(1):69-82.
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Karen Bullock
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ABSTRACT: Studies show that African Americans are less likely than other ethnic groups to complete advance directives. However, what influences African Americans' decisions to complete or not complete advance directives is unclear.
Using a faith-based promotion model, 102 African Americans aged 55 years or older were recruited from local churches and community-based agencies to participate in a pilot study to promote advance care planning. Focus groups were used to collect data on participants' preferences for care, desire to make personal choices, values and attitudes, beliefs about death and dying, and advance directives. A standardized interview was used in the focus groups, and the data were organized and analyzed using NUDIST 4 software (QRS Software, Victoria, Australia).
Three fourths of the participants refused to complete advance directives. The following factors influenced the participants' decisions about end-of-life care and completion of an advance directive: spirituality; view of suffering, death, and dying; social support networks; barriers to utilization; and mistrust of the health care system.
The dissemination of information apprises individuals of their right to self-determine about their care, but educational efforts may not produce a significant change in behavior toward completion of advance care planning. Thus, ongoing efforts are needed to improve the trust that African Americans have in medical and health care providers.
Journal of Palliative Medicine 03/2006; 9(1):183-95. · 1.85 Impact Factor
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ABSTRACT: In the Screening Older Minority Women project, the authors applied a community capacity-enhancement approach to promoting breast and cervical cancer screening among older women of color. Members of informal support networks were recruited for this health promotion intervention to empower Latina and African American women to engage in positive health behaviors. The authors describe the phases of the intervention and the experiences from the community. Guidelines are identified to help researchers and practitioners in planning and implementing community health promotion intervention with women of color.
Health & social work 03/2006; 31(1):16-25. · 0.94 Impact Factor
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Karen Bullock
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ABSTRACT: Objectives . The purpose of this study was to more fully understand the factors that motivate and influence kinship care provided by African American grandfathers who raise their grandchildren.
Methods . Data were gathered from a community sample of older men, age 65+, who were responsible for the care of at least one grandchild in a rural community in southeastern North Carolina. Fifty-four percent of the grandfathers were African American men who are the focus of the present analysis. Responses were analyzed using a qualitative content analysis mode and descriptive statistics.
Results . Five factors (obligation, lack of availability of other caregivers, family tradition, role modeling, care and concern) that influence their decision to assume the parenting role emerged and three areas (lack of resources, feelings of powerlessness, religious beliefs and spirituality) that impact their ability to continue providing care were identified.
Discussion . Findings indicate that practitioners seeking to understand kinship care and assist grandparents who are raising grandchildren must take into account the hardships these families face due to a lack of concrete services and the implications for mental health. Results affirm the need for special attention to grandfathers who provide kinship care. doi:10.1300/J045v22n03_12.
Journal of Health & Social Policy 02/2006; 22(3-4):181-97.
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ABSTRACT: To better understand what matters to African American elders who are faced with issues of death, dying, and end-of-life care, a qualitative study was conducted to elicit their perspective.
Focus groups were convened across the state of Connecticut. A total of 196 individuals participated in the 90-minute interview sessions. Using an interview guide, a trained moderator conducted the racially homogeneous discussion groups. Transcriptions of the group narratives with 22 older African Americans were coded to identify themes. Data were organized and analyzed using NUD-IST 4 and constant comparative method of qualitative data analysis.
Five major themes emerged from the focus group data on older African Americans: (1) spirituality, (2) burden on family, (3) trust, (4) health insurance coverage, and (5) cultural concerns.
Recommendations are made for outreach education, involvement of informal helpers, and a level of acceptability in practice for diverse care needs.
Journal of Social Work in End-of-Life & Palliative Care 02/2005; 1(3):3-19.
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ABSTRACT: To more completely understand the challenges African American families face when combining employment commitments and informal caregiving responsibilities, the authors used data from a community sample of 119 African American elder-caregiver dyads. This article examines the nature of caregiving relationships and extent to which caregivers' employment statuses affect the hours of care provided. The authors concluded that employed caregivers do not provide significantly less care than do unemployed caregivers, elderly people with employed caregivers are no more likely than those with unemployed caregivers to use formal services, and unemployed caregivers may remain unemployed partly because of caregiving responsibilities.
Social work 05/2003; 48(2):150-62. · 1.15 Impact Factor
