Alla Sikorskii’s research while affiliated with Michigan State University and other places

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Publications (269)


A Cluster Randomized Controlled Trial of Visual Cues, Signage, and Spaced-Retrieval for Wayfinding within Long-Term Care Communities
  • Article

February 2025

The Gerontologist

Rebecca Davis

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Margaret Calkins

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Alla Sikorskii

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Jennifer Brush

Background and Objectives Wayfinding can be challenging in many long-term care communities (LTCCs) due to size, poor visibility, inadequate wayfinding design, as well as cognitive impairment of some residents. The purpose of this study was to investigate the effects of distinctive cues and signage placed at key points within care communities, with and without a trained memory strategy called spaced retrieval (SR), on wayfinding ability and life-space. Research Design and Methods Fifteen LTCCs were randomized to control (arm 1), cues (arm 2), or cues+SR (arm 3). Data were collected at baseline, and months 1, 3, 6 and 12. Wayfinding speed and accuracy (co-primary outcomes) were tested on three routes (simple, moderate, and complex) in each site. The secondary outcome was self-reported life-space. Longitudinal linear mixed effects and generalized linear mixed effects models were used to analyze repeated measures of the outcomes in relation to trial arm. Results Wayfinding speed was significantly greater on the simple route for the cues condition compared to control. On the moderate and complex routes, there were no differences in speed among trial arms. In terms of errors, participants in cues and cues+SR conditions performed significantly better than control participants, and arm cues+SR performed better than cues alone. There were no differences in life-space among arms. Discussion and Implications The addition of age-friendly signs and art cues assisted residents of LTCCs to find their way more effectively than no intervention, and there were fewer errors with spaced retrieval.


Employment productivity and cancer-related psychological symptoms among adult cancer dyads

January 2025

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1 Read

Journal of occupational and environmental medicine / American College of Occupational and Environmental Medicine

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Alla Sikorskii

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[...]

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Jessica Rainbow

Objective To explore cancer survivors’ and caregivers' presenteeism (work performance) and absenteeism (missed work), and associations with work performance in the prior year and psychological symptoms (depressive and anxiety symptoms, symptom severity). Methods Cross-sectional baseline data of a larger trial were analyzed to explore associations between absenteeism and presenteeism with prior work performance and psychological symptoms. Results Among survivors (N = 309) and caregivers (N = 306), increased depressive and anxiety symptoms were associated with decreased work performance; survivors’ anxiety was associated with absenteeism. Prior work performance was associated with better current work performance among survivors and caregivers. In survivors only, prior work performance was associated with reduced current absenteeism. Conclusions Experiencing depressive and anxiety symptoms may decrease survivors’ and caregivers’ work performance. Addressing these symptoms may help survivors and caregivers improve work performance.



The flow of participants through the study. *Most frequent reasons for attrition were not reached via telephone, too busy, symptom burden too high, no distress
Symptom management interventions influence unscheduled health services use among cancer survivors and caregivers
  • Article
  • Publisher preview available

November 2024

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3 Reads

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1 Citation

Journal of Cancer Survivorship

Purpose Three sequences of telephone symptom management interventions were tested on use of unscheduled health services among cancer survivors with depressive or anxiety symptoms during treatment (N = 334) and their informal caregivers (N = 333). Methods The three 12-week intervention sequences were as follows: (1) Symptom Management and Survivorship Handbook (SMSH), (2) a combined 8-week SMSH + Telephone Interpersonal Counseling (TIPC) followed by SMSH for 4 weeks, and (3) SMSH for 4 weeks followed by a combined SMSH + TIPC if no response to SMSH alone. Survivor-caregiver dyads were first randomized to SMSH or a combined SMSH + TIPC. If the survivor’s depressive or anxiety symptoms persisted after 4 weeks of SMSH alone, the dyad was randomized the second time to continue with SMSH alone or TIPC was added to SMSH. All participants were assessed at baseline and 13 and 17 weeks. Health service use was compared between randomized groups and among the three sequences. Results Survivors were 60.2 years of age, 79% were female, and 41% were Hispanic. Caregivers were 54.8 years of age; 67% were female. The significantly lower rate of emergency department (ED) or urgent care visits for survivors was found in the SMSH + TIPC intervention sequence compared to the SMSH alone in the second randomization and for the third intervention sequence compared to the first. Conclusions Adding TIPC to SMSH after week 4 when survivors experienced persisting depressive or anxiety symptoms reduced ED/urgent care visits compared to SMSH alone. Implications for Cancer Survivors Managing depression and anxiety symptoms may help prevent ED/urgent care visits and worsening of other symptoms.

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BMI trajectories of each group created using GBTM. Within the multivariable models, groups were further adjusted by age.
Survival curves showing (a) all-cause mortality and (b) cancer-specific mortality.
Cohort characteristics.
Results of multivariable analysis of Cox PH with competing risk.
Cont.
Investigating the Obesity Paradox in Colorectal Cancer: An Analysis of Prospectively Collected Data in a Diverse Cohort

August 2024

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34 Reads

Simple Summary Obesity is a clear risk factor for future colorectal cancer (CRC), but its impact on mortality remains to be fully elucidated. Prior studies have had methodologic limitations, and key variables remain under-investigated. In this study of prospectively collected data from the Multiethnic Cohort, pre-diagnosis BMI trajectories were not associated with CRC-specific or all-cause mortality. Factors associated with mortality included African American race or Hawaiian ethnicity, smoking, and diabetes. Accounting for long-term BMI trajectories before diagnosis and other relevant factors demonstrates that obesity is not protective of mortality after CRC diagnosis. Abstract Background: Prior studies are inconclusive regarding the effect of obesity on mortality in persons with colorectal cancer (CRC). We sought to determine the association of pre-diagnosis body mass index (BMI) trajectories on mortality after CRC diagnosis. Methods: Utilizing the Multiethnic Cohort, we included adults aged 18–75 between 1 January 1993 and 1 January 2019 with a diagnosis of CRC and at least three available BMIs. The primary exposure, BMI, was subjected to group-based trajectory modeling (GBTM). We evaluated all-cause and CRC-specific mortality, using Cox proportional hazard (PH) models. Results: Of 924 persons, the median age was 60 years, and 54% were female. There was no statistically significant association between pre-cancer BMI trajectory and either all-cause or cancer-specific mortality. In competing risk analysis, the risk of CRC-specific mortality was higher for African Americans (HR = 1.56, 95% CI [1.00–2.43], p = 0.048) and smokers (HR = 1.59, 95% CI [1.10–2.32], p = 0.015). Risk of all-cause mortality was higher for Hawaiian persons (HR = 2.85, 95% CI [1.31–6.21], p = 0.009) and persons with diabetes (HR = 1.83, 95% CI [1.08–3.10], p = 0.026). Conclusions: Pre-diagnosis BMI trajectories were not associated with mortality after CRC diagnosis, whereas race/ethnicity, diabetes, and smoking were associated with an increased risk of death. Our findings suggest the obesity paradox alone does not account for mortality after CRC diagnosis.


Survivor-caregiver CONSORT chart. cg, caregiver
A sequential multiple assignment randomized trial of symptom management for cancer survivors during treatment and their informal caregivers

July 2024

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27 Reads

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3 Citations

Supportive Care in Cancer

Context Many cancer survivors and their informal caregivers experience multiple symptoms during the survivor’s treatment. Objective Test relative effectiveness and optimal sequencing of two evidence-based interventions for symptom management. Methods In this sequential multiple assignment randomized trial (SMART), survivors of solid tumors with elevated depression or anxiety and their caregivers as dyads were initially randomized after baseline assessment in a 3:1 ratio to the Symptom Management and Survivorship Handbook (SMSH, N = 277 dyads) intervention or SMSH plus 8 weeks of telephone interpersonal counseling (TIPC, N = 97 dyads). After 4 weeks, survivors who were not responding (no improvement or worsening score on depression and/or anxiety item) to SMSH only and their caregivers were re-randomized to continue with SMSH alone (N = 44 dyads) to give it more time or to SMSH + TIPC (N = 44 dyads). Mixed effects and generalized linear models compared severity of depression, anxiety, and a summed index of 16 other symptoms over weeks 1–13 and week 17 between randomized groups and among three dynamic treatment regimes (DTRs). Dyads received SMSH only for 12 weeks (DTR1); SMSH for 12 weeks with 8 weeks of TIPC added from week 1 (DTR2); and SMSH for 4 weeks followed by the combined SMSH + TIPC for 8 weeks if no response at 4 weeks (DTR3). Results Survivors randomized initially to SMSH alone had significantly lower anxiety over weeks 1–13 compared to those randomized to the combined SMSH + TIPC. In comparing DTRs, survivor’s anxiety was significantly lower at week 13 for DTR1 compared to DTR2 with no other main effects for survivors or caregivers. Exploratory moderation analyses indicated a potential benefit of adding TIPC for caregivers of non-responders with elevated baseline symptoms. Conclusion SMSH + TIPC did not result in better symptom outcomes at week 17 than SMSH alone. Lower intensity SMSH may improve depression and anxiety symptoms for most survivors and their caregivers. Trial registration Clinicaltrails.gov ID number, NCT03743415; approved and posted on 11/16/2018.


Thresholds in PROMIS Scores Anchored to Subsequent Unscheduled Health Service Use Among People Diagnosed With Cancer

April 2024

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29 Reads

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5 Citations

JCO Oncology Practice

PURPOSE To establish thresholds in the Patient-Reported Outcomes Measurement Information System (PROMIS) pain interference, physical function, fatigue, and depression scores on the basis of their association with subsequent use of the emergency department (ED) or urgent care by people diagnosed with cancer. METHODS Retrospective data from 952 people seen at Henry Ford Cancer and insured through the Health Alliance Plan were analyzed using generalized linear mixed-effects models. The log odds of ED or urgent care use during 14 or 30 days after each patient-reported outcome (PRO) assessment were related to PRO scores, while adjusting for comorbidity, sociodemographic, and tumor characteristics. RESULTS Pain interference and physical function were associated with subsequent ED or urgent care visits, but fatigue and depression were not, and the results for 14- and 30-day visits were similar. Thresholds anchored in the likelihood of these visits differed according to cancer stage. For people with advanced cancer, a pain interference score of 60 or higher (odds ratio [OR] 3.75, [95% CI, 1.53 to 7.87]) and a physical function score lower than 40 (OR 2.94, [95% CI, 1.22 to 7.06]) produced the largest ORs with narrowest CIs for 30-day visits. For people with nonadvanced cancer, the thresholds of 65 for pain interference (OR 2.64, [95% CI, 1.40 to 5.01]) and 35 for physical function (OR 1.87, [95% CI, 1.01 to 3.45]) produced largest ORs with narrowest CIs for 30-day visits. CONCLUSION These anchor-based thresholds in PROMIS scores can inform clinicians' actions with the goal of preventing ED or urgent care visits.


Figures
Study protocol: Exploring the use of Family Health Histories in the African American community to reduce health disparities in Flint, Michigan

March 2024

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15 Reads

Background Health disparities are costly and preventable differences in disease progression that disproportionately affect minority communities such as African Americans. Practices to reduce health disparities can be rooted in prevention, particularly through screening tools. Family Health History tools are preventative screening mechanisms meant to explore family history to better understand how an individual’s health can potentially be predicted or impacted. These tools are underutilized in the African American community. Contributions to this underutilization include a lack of cultural tailoring in the tools, a lack of health literacy in community members, and a lack of effective health communication. The Family Health History Study will create a culturally appropriate Family Health History toolkit to increase family health history utilization and ultimately decrease health disparities. Methods The proposed sample will be composed of 195 African American adults ages 18 + who live in Genesee County, Michigan. The study consists of two phases: the development phase and the randomized pilot study phase. The goal of the development phase (n = 95) is to explore how Family Health History toolkits can be modified to better serve the African American community using a community based participatory research approach and to create a culturally tailored family health history toolkit. In the pilot study phase, 100 participants will be randomized to the culturally tailored toolkit or the current standard Family Health History toolkit. Outcomes will include feasibility and acceptability of the intervention. Discussion This study will result in a culturally appropriate Family Health History tool that is co-developed with community members that can be utilized by African American adults to better understand their family health histories. Trial Registration Clinicaltrials.gov: NCT05358964 Date: May 5, 2022


A framework for testing non-inferiority in a three-arm, sequential, multiple assignment randomized trial

February 2024

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11 Reads

Sequential multiple assignment randomized trial design is becoming increasingly used in the field of precision medicine. This design allows comparisons of sequences of adaptive interventions tailored to the individual patient. Superiority testing is usually the initial goal in order to determine which embedded adaptive intervention yields the best primary outcome on average. When direct superiority is not evident, yet an adaptive intervention poses other benefits, then non-inferiority testing is warranted. Non-inferiority testing in the sequential multiple assignment randomized trial setup is rather new and involves the specification of non-inferiority margin and other important assumptions that are often unverifiable internally. These challenges are not specific to sequential multiple assignment randomized trial and apply to two-arm non-inferiority trials that do not include a standard-of-care (or placebo) arm. To address some of these challenges, three-arm non-inferiority trials that include the standard-of-care arm are proposed. However, methods developed so far for three-arm non-inferiority trials are not sequential multiple assignment randomized trial-specific. This is because apart from embedded adaptive interventions, sequential multiple assignment randomized trial typically does not include a third standard-of-care arm. In this article, we consider a three-arm sequential multiple assignment randomized trial from an National Institutes of Health-funded study of symptom management strategies among people undergoing cancer treatment. Motivated by that example, we propose a novel data analytic method for non-inferiority testing in the framework of three-arm sequential multiple assignment randomized trial for the first time. Sample size and power considerations are discussed through extensive simulation studies to elucidate our method.


Flow of participants through the study
Predictors of persistence of post-chemotherapy symptoms among survivors of solid tumor cancers

Quality of Life Research

Context Late or residual symptoms diminish quality of life for many cancer survivors after completion of treatment. Objectives Examine risk factors associated with persisting symptom burden after chemotherapy and the lack of symptom improvement over time. Methods Survivors who completed curative-intent chemotherapy within two years for solid tumors were enrolled into a symptom management trial. There were 375 survivors with two or more comorbid conditions or one comorbid condition and elevated depressive symptoms (pre-defined risk factors in the trial design) who received interventions and 71 survivors without these risk factors who did not receive interventions. For all survivors, symptoms were assessed at intake, 4, and 13 weeks and categorized as mild, moderate, or severe based on the interference with daily life. The probabilities of moderate or severe symptoms and symptom improvement were analyzed using generalized mixed-effects models in relation to comorbidity, depressive symptoms, age, sex, race/ethnicity, employment, time since chemotherapy completion, and physical function. Multiple symptoms were treated as nested within the survivor. Results Moderate or severe symptoms at baseline and the lack of improvement over time were associated with younger age and lower physical function over and above a greater number of comorbidities and elevated severity of depressive symptoms. Conclusion Risk factors identified in this research (younger age, lower physical function, greater comorbidity, and higher depressive symptoms) can be used to allocate resources for post-treatment symptom management for cancer survivors in order to relieve symptoms that do not necessarily resolve with time.


Citations (69)


... If the survivor's depressive or anxiety symptoms persisted after 4 weeks of SMSH alone, dyads were randomized the second time to continue with SMSH, or TIPC was added to SMSH. Both SMSH and TIPC have been tested previously against control conditions and shown to be efficacious in reducing depression, anxiety, and severity of multiple symptoms in cancer survivors and caregivers [24,30,31]. This research is particularly relevant to determining effective and efficient symptom management as the value-based care landscape evolves and symptom monitoring and behavioral management interventions [26,28,32,33] become more important in delivering quality cancer care. ...

Reference:

Symptom management interventions influence unscheduled health services use among cancer survivors and caregivers
A sequential multiple assignment randomized trial of symptom management for cancer survivors during treatment and their informal caregivers

Supportive Care in Cancer

... Since 2014, the National Cancer Institute and Office of Emergency Care Research have collaborated to address the paucity of evidence surrounding ED visits and determine what potential interventions could be used to reduce ED visits. Often, symptom burden is the driving factor for unscheduled health service use [14][15][16][17]. Cancer survivors and their caregivers report multiple symptoms, including fatigue, pain, insomnia, and psychological distress (depression, anxiety) [18][19][20][21]. ...

Thresholds in PROMIS Scores Anchored to Subsequent Unscheduled Health Service Use Among People Diagnosed With Cancer
  • Citing Article
  • April 2024

JCO Oncology Practice

... On the other hand, our results are in line with previous systematic reviews with meta-analyses concluding that isolated osteopathic interventions, such as visceral osteopathy [16,50,51] or cranial osteopathy [17,[52][53][54], have no clinical effects on musculoskeletal pathologies. Yet, previous studies have shown that OMT is more effective than no intervention in patients with NP [55,56] or LBP [12,57,58]; however, when compared to other interventions, the effects appear to be smaller. These results are likely due to placebo rather than the specific effects of OMT. ...

The effects of osteopathic manipulative treatment on pain and disability in patients with chronic low back pain: a single-blinded randomized controlled trial

... While prior research has focused on the association between psychological distress experienced by FCGs and various factors, including caregiver burden, resilience, functional limitations and other social determinants of health [3,15], few studies have investigated the association between FCG loneliness and psychological distress symptoms [9]. Additionally, there is limited available data on the moderating effect that positive aspects of caregiving may have on the relationship between loneliness and psychological distress symptoms in the cancer caregiver population. ...

Social determinants of health, psychological distress, and caregiver burden among informal cancer caregivers of cancer survivors during treatment

Journal of Psychosocial Oncology

... Due to the complicated structure of the transition density of heavy-tailed Pearson diffusions, this problem requires serious further research in order to be answered properly. However, to illustrate the application of multimodal diffusions in EEG signal modeling, we provide a recent reference [61] based on a stationary diffusion whose invariant distribution is a mixture of generalized Gaussian distributions. ...

Multimodal diffusion model for increments of electroencephalogram data

Stochastic Environmental Research and Risk Assessment

... Inclusion criteria were for the agency itself; once the agency was included, agencies chose who received ROSE. Most agencies (~70%) provided or offered ROSE to everyone [29]. ...

Study protocol for the ROSE Scale-Up Study: Informing a decision about ROSE as universal postpartum depression prevention
  • Citing Article
  • July 2023

Contemporary Clinical Trials

... Major depressive disorder (MDD) is a severe and recurrent medical condition that negatively affects psychological systems, leading to persistent sadness and loss of interest (Brewer et al., 2023). This psychiatric disorder has had increased attention over the last 15 years. ...

Perinatal HIV exposure and infection and caregiver depressive symptoms
  • Citing Article
  • June 2023

... Summary of Findings: Based on the findings outlined above, the following qualitative summaries are produced to present the relevant essential themes [29]. ...

Beyond burnout: a four-year survey of osteopathic medical student mental health and the implications for the development of wellness and mental health programs

... This report examines the effects of sequences of telephone-based symptom management interventions on unscheduled health service use (defined as hospitalizations, ED, or urgent care visits) for cancer survivors during treatment and their caregivers. Unscheduled health service use was a secondary outcome in a recently completed sequential multiple assignment randomized trial (SMART) [29,30] testing three 12-week symptom management intervention sequences, also called dynamic treatment regimes (DTRs): ...

A Sequential Multiple Assignment Randomized Trial of Symptom Management After Chemotherapy

Journal of Pain and Symptom Management

... Previous research has identified risk factors for GI distress in cancer survivors [7,8], but these studies did not explore the associations of TL and SDOH with GI distress. Emerging evidence supports the impact of SDOH [55,56] and biological age [56,57] on symptom disparities and HRQOL in cancer survivors. Our study addresses this gap by demonstrating the feasibility of using ML approaches to classify GI health. ...

Social Determinants of Health and Symptom Burden During Cancer Treatment

Nursing Research