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Papers by Wen Reagan

Critical care medicine, Jan 2, 2018

Little is known about the experience of financial stress for patients who survive critical illnes... more Little is known about the experience of financial stress for patients who survive critical illness or their families. Our objective was to describe the prevalence of financial stress among critically ill patients and their families, identify clinical and demographic characteristics associated with this stress, and explore associations between financial stress and psychologic distress. Secondary analysis of a randomized trial comparing a coping skills training program and an education program for patients surviving acute respiratory failure and their families. Five geographically diverse hospitals. Patients (n = 175) and their family members (n = 85) completed surveys within 2 weeks of arrival home and 3 and 6 months after randomization. We used regression analyses to assess associations between patient and family characteristics at baseline and financial stress at 3 and 6 months. We used path models and mediation analyses to explore relationships between financial stress, symptoms o...

Annals of the American Thoracic Society, Jan 9, 2017

The quality and patient-centeredness of intensive care unit (ICU)-based palliative care delivery ... more The quality and patient-centeredness of intensive care unit (ICU)-based palliative care delivery is highly variable. To develop and pilot an app platform for clinicians, ICU patients, and their family members that enhances the delivery of needs-targeted palliative care. In the Development Phase of the study, we developed an electronic health record (EHR) system-integrated mobile web app system prototype, PCplanner (Palliative Care Planner). PCplanner screens the EHR for ICU patients meeting any of five prompts ('triggers') for palliative care consultation, allows families to report their unmet palliative care needs, and alerts clinicians to these needs. The Evaluation Phase included a prospective before/after study conducted at a large academic medical center. Two control populations were enrolled in the before period to serve as context for the intervention. First, 25 ICU patients who received palliative care consults served as patient-level controls. Second, 49 family memb...

Thorax

BackgroundPatients who are sick enough to be admitted to an intensive care unit (ICU) commonly ex... more BackgroundPatients who are sick enough to be admitted to an intensive care unit (ICU) commonly experience symptoms of psychological distress after discharge, yet few effective therapies have been applied to meet their needs.MethodsPilot randomised clinical trial with 3-month follow-up conducted at two academic medical centres. Adult (≥18 years) ICU patients treated for cardiorespiratory failure were randomised after discharge home to 1 of 3 month-long interventions: a self-directed mobile app-based mindfulness programme; a therapist-led telephone-based mindfulness programme; or a web-based critical illness education programme.ResultsAmong 80 patients allocated to mobile mindfulness (n=31), telephone mindfulness (n=31) or education (n=18), 66 (83%) completed the study. For the primary outcomes, target benchmarks were exceeded by observed rates for all participants for feasibility (consent 74%, randomisation 91%, retention 83%), acceptability (mean Client Satisfaction Questionnaire 27...

Kate Bowler and Wen Reagan. 2014. "Bigger, Better, Louder: The Prosperity Gospel’s Impact on Cont... more Kate Bowler and Wen Reagan. 2014. "Bigger, Better, Louder: The Prosperity Gospel’s Impact on Contemporary Christian Worship." Religion and American Culture: A Journal of Interpretation, Vol. 24, Issue 2, pp. 186-230.

This article makes several claims about the relationship between praise and worship music and prosperity megachurches. First, it argues that the prosperity gospel has had a significant impact on contemporary worship music in America owing to its leadership in the twin rise of the megachurch and televangelism. Second, beginning in the 1990s, prosperity megachurches pioneered forms of worship music mimicking “arena rock” that capitalized on both the scale of their sanctuaries and the sophistication of their audio/visual production. The result was a progression toward music that would be a liturgy of timing, lighting, volume and performance designed for large venues. Finally, prosperity megachurches were ideally situated to benefit from this new music, both in the music industry and in their theology. Prosperity megachurches partnered with the expanding worship industry in the creation of new worship music, while the prosperity gospel theologically undergirded the affective power and performative pageantry of Christian arena rock, narrating worship music as a tool for releasing spiritual forces of prosperity. The result was a Sunday experience for the blessed that reinforced the celebration of God’s abundant blessings through music that was bigger, better, and louder.

In The Spirit of Praise: Music and Worship in Pentecostal-Charismatic Christianity, edited by Mon... more In The Spirit of Praise: Music and Worship in Pentecostal-Charismatic Christianity, edited by Monique Ingalls and Amos Yong. University Park, PA: Pennsylvania State University Press.

The Best Worship Music You Won't Hear on Christian Radio.

Conference Presentations by Wen Reagan

There is a high prevalence of psychological distress among intensive care unit (ICU) survivors an... more There is a high prevalence of psychological distress among intensive care unit (ICU) survivors and their family members. While Rationale psychological interventions can address this distress, there are many barriers that prevent ICU survivors from accessing these services that are traditionally delivered either in person or by phone. In the absence of methods to closely track users' symptoms and then adjust the intensity (i.e., dose), it is difficult to scale this potentially important class of interventions to the many thousands of patients who could possibly benefit from them. : This study was part of an ongoing 3-arm randomized clinical trial comparing a self-directed web-based mindfulness program, a Methods telephone-based mindfulness program, and usual care among ICU survivors from two academic medical centers. Using a multi-cycle iterative process involving experts in critical care, psychology, integrative health, app development, user experience, user interface, and health information technology, we developed a novel digital platform for delivering a mindfulness intervention and then collecting data entirely online through an integrated and automated electronic patient-reported outcomes (ePRO) system. : Our system contains a number of important innovations that are directly relevant to seriously ill and disabled patients, and also Results accommodate preferences for mobile viewing, convenience, and privacy. First, the system has embedded logic that will automatically trigger a phone call from a mental health provider if (a) symptoms of depression (PHQ-9 scale) or anxiety (GAD-7 scale) are higher than a pre-specified value, or (b) symptoms of depression or anxiety are not improving compared with the previous week's scale scores (see). Second, the system allows users to address their symptoms using a variety of self-directed audio, video, and graphical supports as Figure per their preference, and also empowers them to quickly contact staff for assistance the system requires very little clinical research coordinator effort—and for some users, possibly none. Third, the system automates weekly ePRO outcomes scale administration via text message links or email (per user preference) during the intervention period and then at specified times for long-term follow ups, thus minimizing the amount of effort required by research staff. : We formalized an innovative conceptual and technological approach: a scalable digital platform that can automate Conclusions psychological intervention delivery and outcome ascertainment. By the time of ATS 2016, we will have completed our usability testing among ICU survivors, finalized the mindfulness app intervention, and obtained preliminary evidence of acceptability and feasibility from ICU survivors themselves.

Intensive care unit (ICU)-based palliative care consultations triggered by patient characteristic... more Intensive care unit (ICU)-based palliative care consultations triggered by patient characteristics can assist with decision making Rationale and may reduce length of stay. Because trigger-based systems are used infrequently in many hospitals, we explored clinician attitudes toward published palliative care triggers in two academic medical centers that lack a robust trigger system. : In this ongoing cross-sectional study, written surveys were completed by attending and fellow physicians, advanced practice Methods providers (APPs), nurses, and social workers. Surveys assessed attitudes towards ICU-based specialist palliative care, acceptance of 23 published palliative care triggers, and queried enthusiasm for a proposed electronic health record (EHR)-based palliative care trigger system. : 124 participants were included: 57 (46%) nurses, 53 (42%) physicians, 12 (10%) APPs, and 2 (<1%) social workers; there were no Results refusals. Respondents worked in medical (52%), surgical (13%), or multiple ICUs (35%). 70% believed that palliative care consultation was underutilized, though nurses and APPs were more likely to express this than physicians (81% vs. 54%; p=0.002). Triggers were preferred (46%) to palliative care clinicians either rounding with ICU team (21%), asking the ICU team about eligible patients (17%), or to a standard consultative model (7%). Respondents believed that triggers should be based on patient/family need (34%) rather than prognosis (29%), diagnosis (24%), or LOS (12%). 56% were willing to have a protocolized system in which they did not have to approve consults; 80% desired a system in which both nurses and doctors could perform a trigger search. The most acceptable triggers were unrealistic goals of care, needing help with decision making, conflict, metastatic malignancy, and serious neurological diagnoses (). The least acceptable Table were refractory symptoms as well as either length of stay or advanced age alone. Open-ended responses expressed a range of reactions to triggers from strong support to concerns over such a system interfering with the physician-patient relationship. 70% stated that a proposed EHR-based trigger system would be viewed positively (vs. 8% negatively). : Trigger-based specialist palliative care consultation is largely acceptable to ICU clinicians, though with important caveats. Conclusions ICU clinicians appear to value PCC primarily for assistance with decision-making, and less so for symptom management. Triggers based on single characteristics lacking context (age, length of stay) were less well accepted. Many of the most favored triggers are difficult to automate within EHRs. Respondents were enthusiastic about exploring future EHR-based interventions designed to improve the efficiency of specialist palliative care in the ICU.

Critical care medicine, Jan 2, 2018

Little is known about the experience of financial stress for patients who survive critical illnes... more Little is known about the experience of financial stress for patients who survive critical illness or their families. Our objective was to describe the prevalence of financial stress among critically ill patients and their families, identify clinical and demographic characteristics associated with this stress, and explore associations between financial stress and psychologic distress. Secondary analysis of a randomized trial comparing a coping skills training program and an education program for patients surviving acute respiratory failure and their families. Five geographically diverse hospitals. Patients (n = 175) and their family members (n = 85) completed surveys within 2 weeks of arrival home and 3 and 6 months after randomization. We used regression analyses to assess associations between patient and family characteristics at baseline and financial stress at 3 and 6 months. We used path models and mediation analyses to explore relationships between financial stress, symptoms o...

Annals of the American Thoracic Society, Jan 9, 2017

The quality and patient-centeredness of intensive care unit (ICU)-based palliative care delivery ... more The quality and patient-centeredness of intensive care unit (ICU)-based palliative care delivery is highly variable. To develop and pilot an app platform for clinicians, ICU patients, and their family members that enhances the delivery of needs-targeted palliative care. In the Development Phase of the study, we developed an electronic health record (EHR) system-integrated mobile web app system prototype, PCplanner (Palliative Care Planner). PCplanner screens the EHR for ICU patients meeting any of five prompts ('triggers') for palliative care consultation, allows families to report their unmet palliative care needs, and alerts clinicians to these needs. The Evaluation Phase included a prospective before/after study conducted at a large academic medical center. Two control populations were enrolled in the before period to serve as context for the intervention. First, 25 ICU patients who received palliative care consults served as patient-level controls. Second, 49 family memb...

Thorax

BackgroundPatients who are sick enough to be admitted to an intensive care unit (ICU) commonly ex... more BackgroundPatients who are sick enough to be admitted to an intensive care unit (ICU) commonly experience symptoms of psychological distress after discharge, yet few effective therapies have been applied to meet their needs.MethodsPilot randomised clinical trial with 3-month follow-up conducted at two academic medical centres. Adult (≥18 years) ICU patients treated for cardiorespiratory failure were randomised after discharge home to 1 of 3 month-long interventions: a self-directed mobile app-based mindfulness programme; a therapist-led telephone-based mindfulness programme; or a web-based critical illness education programme.ResultsAmong 80 patients allocated to mobile mindfulness (n=31), telephone mindfulness (n=31) or education (n=18), 66 (83%) completed the study. For the primary outcomes, target benchmarks were exceeded by observed rates for all participants for feasibility (consent 74%, randomisation 91%, retention 83%), acceptability (mean Client Satisfaction Questionnaire 27...

Kate Bowler and Wen Reagan. 2014. "Bigger, Better, Louder: The Prosperity Gospel’s Impact on Cont... more Kate Bowler and Wen Reagan. 2014. "Bigger, Better, Louder: The Prosperity Gospel’s Impact on Contemporary Christian Worship." Religion and American Culture: A Journal of Interpretation, Vol. 24, Issue 2, pp. 186-230.

This article makes several claims about the relationship between praise and worship music and prosperity megachurches. First, it argues that the prosperity gospel has had a significant impact on contemporary worship music in America owing to its leadership in the twin rise of the megachurch and televangelism. Second, beginning in the 1990s, prosperity megachurches pioneered forms of worship music mimicking “arena rock” that capitalized on both the scale of their sanctuaries and the sophistication of their audio/visual production. The result was a progression toward music that would be a liturgy of timing, lighting, volume and performance designed for large venues. Finally, prosperity megachurches were ideally situated to benefit from this new music, both in the music industry and in their theology. Prosperity megachurches partnered with the expanding worship industry in the creation of new worship music, while the prosperity gospel theologically undergirded the affective power and performative pageantry of Christian arena rock, narrating worship music as a tool for releasing spiritual forces of prosperity. The result was a Sunday experience for the blessed that reinforced the celebration of God’s abundant blessings through music that was bigger, better, and louder.

In The Spirit of Praise: Music and Worship in Pentecostal-Charismatic Christianity, edited by Mon... more In The Spirit of Praise: Music and Worship in Pentecostal-Charismatic Christianity, edited by Monique Ingalls and Amos Yong. University Park, PA: Pennsylvania State University Press.

The Best Worship Music You Won't Hear on Christian Radio.

There is a high prevalence of psychological distress among intensive care unit (ICU) survivors an... more There is a high prevalence of psychological distress among intensive care unit (ICU) survivors and their family members. While Rationale psychological interventions can address this distress, there are many barriers that prevent ICU survivors from accessing these services that are traditionally delivered either in person or by phone. In the absence of methods to closely track users' symptoms and then adjust the intensity (i.e., dose), it is difficult to scale this potentially important class of interventions to the many thousands of patients who could possibly benefit from them. : This study was part of an ongoing 3-arm randomized clinical trial comparing a self-directed web-based mindfulness program, a Methods telephone-based mindfulness program, and usual care among ICU survivors from two academic medical centers. Using a multi-cycle iterative process involving experts in critical care, psychology, integrative health, app development, user experience, user interface, and health information technology, we developed a novel digital platform for delivering a mindfulness intervention and then collecting data entirely online through an integrated and automated electronic patient-reported outcomes (ePRO) system. : Our system contains a number of important innovations that are directly relevant to seriously ill and disabled patients, and also Results accommodate preferences for mobile viewing, convenience, and privacy. First, the system has embedded logic that will automatically trigger a phone call from a mental health provider if (a) symptoms of depression (PHQ-9 scale) or anxiety (GAD-7 scale) are higher than a pre-specified value, or (b) symptoms of depression or anxiety are not improving compared with the previous week's scale scores (see). Second, the system allows users to address their symptoms using a variety of self-directed audio, video, and graphical supports as Figure per their preference, and also empowers them to quickly contact staff for assistance the system requires very little clinical research coordinator effort—and for some users, possibly none. Third, the system automates weekly ePRO outcomes scale administration via text message links or email (per user preference) during the intervention period and then at specified times for long-term follow ups, thus minimizing the amount of effort required by research staff. : We formalized an innovative conceptual and technological approach: a scalable digital platform that can automate Conclusions psychological intervention delivery and outcome ascertainment. By the time of ATS 2016, we will have completed our usability testing among ICU survivors, finalized the mindfulness app intervention, and obtained preliminary evidence of acceptability and feasibility from ICU survivors themselves.

Intensive care unit (ICU)-based palliative care consultations triggered by patient characteristic... more Intensive care unit (ICU)-based palliative care consultations triggered by patient characteristics can assist with decision making Rationale and may reduce length of stay. Because trigger-based systems are used infrequently in many hospitals, we explored clinician attitudes toward published palliative care triggers in two academic medical centers that lack a robust trigger system. : In this ongoing cross-sectional study, written surveys were completed by attending and fellow physicians, advanced practice Methods providers (APPs), nurses, and social workers. Surveys assessed attitudes towards ICU-based specialist palliative care, acceptance of 23 published palliative care triggers, and queried enthusiasm for a proposed electronic health record (EHR)-based palliative care trigger system. : 124 participants were included: 57 (46%) nurses, 53 (42%) physicians, 12 (10%) APPs, and 2 (<1%) social workers; there were no Results refusals. Respondents worked in medical (52%), surgical (13%), or multiple ICUs (35%). 70% believed that palliative care consultation was underutilized, though nurses and APPs were more likely to express this than physicians (81% vs. 54%; p=0.002). Triggers were preferred (46%) to palliative care clinicians either rounding with ICU team (21%), asking the ICU team about eligible patients (17%), or to a standard consultative model (7%). Respondents believed that triggers should be based on patient/family need (34%) rather than prognosis (29%), diagnosis (24%), or LOS (12%). 56% were willing to have a protocolized system in which they did not have to approve consults; 80% desired a system in which both nurses and doctors could perform a trigger search. The most acceptable triggers were unrealistic goals of care, needing help with decision making, conflict, metastatic malignancy, and serious neurological diagnoses (). The least acceptable Table were refractory symptoms as well as either length of stay or advanced age alone. Open-ended responses expressed a range of reactions to triggers from strong support to concerns over such a system interfering with the physician-patient relationship. 70% stated that a proposed EHR-based trigger system would be viewed positively (vs. 8% negatively). : Trigger-based specialist palliative care consultation is largely acceptable to ICU clinicians, though with important caveats. Conclusions ICU clinicians appear to value PCC primarily for assistance with decision-making, and less so for symptom management. Triggers based on single characteristics lacking context (age, length of stay) were less well accepted. Many of the most favored triggers are difficult to automate within EHRs. Respondents were enthusiastic about exploring future EHR-based interventions designed to improve the efficiency of specialist palliative care in the ICU.