Kelly E Irwin

Kelly E Irwin
Harvard Medical School | HMS · Department of Psychiatry

MD MPH

About

39
Publications
2,367
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829
Citations

Publications

Publications (39)
Article
Full-text available
We define cancer equity as all people having as the same opportunity for cancer prevention, treatment, and survivorship care. However, marginalized populations continue to experience avoidable and unjust disparities in cancer care, access to clinical trials, and cancer survival. Racial and ethnic minorities, and individuals with low socioeconomic s...
Article
Full-text available
The COVID-19 pandemic has necessitated a rapid shift to web-based or blended design models for both ongoing and future clinical research activities. Research conducted virtually not only has the potential to increase the patient-centeredness of clinical research but may also further widen existing disparities in research participation among underre...
Article
Objectives Inequities in cancer care contribute to higher rates of cancer mortality for individuals with significant mental health difficulties (SMHD) compared to the general population. The aim of the current systematic review was to identify, appraise and synthesise qualitative evidence of patient and clinician/system barriers and facilitators to...
Article
Engage diverse stakeholders and share narratives of those with lived experience Establish shared language, mission, and infrastructure to build trust Cultivate diverse partnerships to build bridges between fragmented systems Build stakeholder capacity to take action and track progress toward defined goals Create targeted dissemination strategies an...
Article
103 Background: Community health centers’ (CHCs) patients newly diagnosed with cancer often experience barriers to accessing timely treatment. Patient navigation decreases barriers to cancer screening and diagnostic care, but the exact impact on cancer treatment is unclear. We implemented patient navigation to provide underserved patients with supp...
Article
Purpose Individuals with serious mental illness (SMI) experience disparities in lung cancer mortality. Using a two-phase, mixed-methods approach, we developed a person-centered lung cancer screening (LCS) educational intervention (phase 1) for individuals with SMI (schizophrenia and bipolar disorder) and evaluated acceptability, feasibility, and ch...
Article
Full-text available
Women with cervical cancer, especially those with advanced disease, appear to experience suffering that is more prevalent, complex, and severe than that caused by other cancers and serious illnesses, and approximately 85% live in low- and middle-income countries where palliative care is rarely accessible. To respond to the highly prevalent and extr...
Article
Full-text available
The essential package of palliative care for cervical cancer (EPPCCC), described elsewhere, is designed to be safe and effective for preventing and relieving most suffering associated with cervical cancer and universally accessible. However, it appears that women with cervical cancer, more frequently than patients with other cancers, experience var...
Article
Full-text available
PURPOSE To enable design of optimum palliative care for women with cervical cancer, we studied the most common types of suffering and their severity, prevalence, and duration. METHODS We first reviewed the literature on the major types, severity, prevalence, and duration of suffering associated with cervical cancer. We then conducted a modified De...
Article
Full-text available
Distress management (DM) (screening and response) is an essential component of cancer care across the treatment trajectory. Effective DM has many benefits, including improving patients' quality of life; reducing distress, anxiety, and depression; contributing to medical cost offsets; and reducing emergency department visits and hospitalizations. Un...
Preprint
UNSTRUCTURED The COVID-19 pandemic has necessitated a rapid shift to web-based or blended design models for both ongoing and future clinical research activities. Research conducted virtually not only has the potential to increase the patient-centeredness of clinical research but may also further widen existing disparities in research participation...
Conference Paper
Patient navigation has been shown to improve cancer care in underserved populations. Since November 2017, we have enrolled newly diagnosed cancer patients from three community health centers into a patient navigation study. Most of our patients receive primary care in Chelsea, a city that had the highest rate of COVID-19 infection in Massachusetts....
Article
Importance Persistent smoking may cause adverse outcomes among patients with cancer. Many cancer centers have not fully implemented evidence-based tobacco treatment into routine care. Objective To determine the effectiveness of sustained telephone counseling and medication (intensive treatment) compared with shorter-term telephone counseling and m...
Article
82 Background: Individuals with serious mental illness (SMI) experience increased cancer mortality and are less likely to receive timely cancer care. Despite increasing recognition that psychosocial care is essential for quality cancer care, mental illness remains underrecognized and undertreated. Involving psychiatry early may prevent cancer care...
Article
HIV‐positive patients have been excluded from clinical trials evaluating chimeric antigen receptor (CAR) T‐cell therapies. Herein, the authors report on 2 patients with HIV/AIDS–associated, chemotherapy‐refractory, aggressive B‐cell lymphomas who were treated successfully with the anti‐CD19 CAR T‐cell product axicabtagene ciloleucel.
Article
Full-text available
Objective: Individuals with schizophrenia experience increased lung cancer mortality and decreased access to cancer screening and tobacco cessation treatment. To promote screening among individuals with schizophrenia, it is necessary to investigate the proportion who meet screening criteria and examine smoking behaviors, cancer risk perception, an...
Article
Lung cancer continues to be the leading cause of cancer mortality in the United States across all races and ethnicities, but it does not affect everyone equally. Individuals with serious mental illness (SMI), including schizophrenia and bipolar disorder, experience two to four times greater lung cancer mortality in part due to high rates of smoking...
Article
Background: Individuals with serious mental illness (SMI) experience increased cancer mortality due to inequities in cancer treatment. Psychiatric care at cancer diagnosis may improve care delivery, yet models for integrating psychiatry and cancer care are lacking. We assessed the feasibility and acceptability of a person-centered collaborative ca...
Article
153 Background: Individuals with serious mental illness (SMI) diagnosed with cancer often have disruptions in treatment, leading to premature mortality compared to patients without SMI. To address such gaps in care, we developed and piloted a collaborative care intervention for patients with SMI and cancer (Bridge). We now propose a randomized cont...
Article
Background: Among patients with cancer, depressive symptoms are associated with worse clinical outcomes, including greater health care utilization. As use of antidepressant medications can improve depressive symptoms, we sought to examine relationships among depressive symptoms, antidepressant medications, and hospital length of stay (LOS) in pati...
Article
Full-text available
A psychiatrist and health services researcher, specializing in serious mental illness and cancer, discusses the need for the integration of mental health care and cancer care to promote equity in patient care.
Article
Background: Patients with schizophrenia experience markedly increased breast cancer mortality, yet reasons for this disparity are poorly understood. We sought to characterize disruptions in breast cancer care for patients with schizophrenia and identify modifiable predictors of those disruptions. Materials and methods: We performed a medical rec...
Article
10050 Background: Patients with cancer often experience depression, which is associated with worse outcomes, including longer hospital length of stay (LOS). Although antidepressant medication can improve depressive symptoms in patients with cancer, it is unclear whether their use translates into better outcomes. We sought to clarify the relationshi...
Article
Context: Patients with incurable cancer engage in several coping styles to manage the impact of cancer and its treatment. The Brief COPE is a widely used measure intended to capture multiple, distinct types of coping. The Brief COPE has not been validated among patients with incurable cancer. Objectives: We sought to validate seven subscales of...
Article
1270 T h e ne w e ngl a nd jou r na l o f m e dicine Pr esentation of C a se Dr. Daniel J. Daunis (Psychiatry): A 63-year-old woman with bipolar disorder, worsening depression, and multiple other medical conditions, including lung cancer and breast cancer, was admitted to the inpatient psychiatry service of this hospital for electroconvulsive thera...
Article
Administration of chemotherapy close to death is widely recognized as poor-quality care. Prior research has focused on predictors and outcomes of chemotherapy administration at the end of life. This study describes processes of chemotherapy discontinuation and examines their relationships with timing before death, hospice referral, and hospital dea...
Article
96 Background: Administration of chemotherapy close to death is widely recognized as poor quality care. The goals of this study were to describe the processes of how chemotherapy is discontinued and examine their relationships with timing before death, hospice referrals, and terminal hospitalizations. Methods: We reviewed electronic health records...
Article
Individuals with schizophrenia are a vulnerable population that has been relatively neglected in health disparities research. Despite having an equivalent risk of developing most cancers, patients with schizophrenia are more likely to die of cancer than the general population. Cancer care disparities are likely the result of patient-, provider-, an...
Article
Patients with advanced cancer experience a significant burden of physical symptoms and psychological distress at the end of life, and many elect to receive aggressive cancer-directed therapy. The goal of palliative care is to relieve suffering and promote quality of life (QOL) for patients and families. Traditionally, both the public and medical co...
Article
Full-text available
In the past decade studies have documented substantial suffering among children dying of cancer, prompting national attention on the quality of end-of-life care and the development of a palliative care service in our institutions. We sought to determine whether national and local efforts have led to changes in patterns of care, advanced care planni...
Article
Little is known about how couples care for the terminally ill child with cancer. We assessed both parents' understanding of prognosis and treatment goals for children with cancer and explored whether sex mediates these views. We also investigated whether discordance within couples regarding treatment goals was related to parental perception of the...

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