Frances Nedjat-Haiem | San Diego State University (original) (raw)

Papers by Frances Nedjat-Haiem

Journal of Gerontological Social Work, 2015

In the United States, military service encompasses the five branches of the Armed Forces and incl... more In the United States, military service encompasses the five branches of the Armed Forces and includes Active Duty, Reserve, and National Guard forces. Military service for many veterans occurred during wartime, including World War II, the Korean War, and the Vietnam War. Older military veterans-those aged 65 and older-comprise an estimated 43% of the 22 million living veterans in the United States (National Center for Veterans Analysis and Statistics, 2015). Veterans are defined as individuals who have served in active military service and were discharged or released under conditions other than dishonorable. These veterans are eligible for health benefits and services from the Department of Veterans Affairs (VA; U.S. Department of Veterans Affairs, 2015). The consequences of military service can be lifelong (Elder, 1986; MacLean & Elder, 2007), and are generally worse for combat veterans than noncombat veterans and nonveterans (Elder, 1987; MacLean & Elder, 2007), especially as they age. Recognized health and behavioral outcomes for aging veterans include, but are not limited to, increased likelihood of major depression and posttraumatic stress disorder (PTSD) and increased social difficulties (e.g., divorce, intimate partner violence behaviors, and social iso

Journal of palliative medicine, Jan 3, 2017

Older Latinos with serious medical conditions such as cancer and other chronic diseases lack info... more Older Latinos with serious medical conditions such as cancer and other chronic diseases lack information about advance care planning (ACP). ACP Intervention (ACP-I Plan) was designed for informational and communication needs of older Latinos to improve communication and advance directives (ADs). To determine the feasibility of implementing ACP-I Plan among seriously ill, older Latinos (≥50 years) in Southern New Mexico with one or more chronic diseases (e.g., cancer, heart disease, renal/liver failure, stroke, hypertension, diabetes, chronic obstructive pulmonary disease, and HIV/AIDS). We conducted a prospective, pretest/post-test, two-group, randomized, community-based pilot trial by using mixed data collection methods. Older Latino/Hispanic participants were recruited from community-based settings in Southern New Mexico. All participants received ACP education, whereas the intervention group added: (1) emotional support addressing psychological distress; and (2) systems navigatio...

OMEGA--Journal of Death and Dying, 2013

Research has demonstrated that limited dialogue in end-of-life (EOL) care can negatively impact d... more Research has demonstrated that limited dialogue in end-of-life (EOL) care can negatively impact decision-making and place of death. Furthermore, when vulnerable populations are faced with EOL cancer care, they experience issues resulting from previous gaps in services attributed to sociocultural and economic issues that influence EOL care. These conditions place an additional burden on disadvantaged populations which can cause distress, especially as disparate conditions continue to persist. Little is known about Latinos' psychosocial concerns that lead to distress in EOL care. The objective of this study is to explore Latinas' experiences with life-limiting cancer conditions to identify the EOL care concerns that impact their dying experience. This study used a phenomenological approach to explore the EOL care concerns of 24 Latinas receiving treatment for metastatic cancers in a public sector healthcare system in Los Angeles, California. In-depth interviews were recorded a...

American Journal of Hospice and Palliative Medicine®

Background: Financial hardship influences health-related quality of life (HRQoL) of older adults.... more Background: Financial hardship influences health-related quality of life (HRQoL) of older adults. However, little is known about the relationship between financial hardship and HRQoL among vulnerable populations. Objective: We examined the associations between financial hardship and HRQoL among older Latinos living with chronic disease, including cancer. Methods: This cross-sectional study included 68 Latinos (age range 50-87) with one or more chronic health conditions who participated in a pilot randomized clinical trial. Participants responded to 11 financial hardship questions. We used factor analysis to explore constructs of financial hardship. HRQoL was assessed using the 27-item Functional Assessment of Cancer Therapy-General (FACT-G). Multiple linear regression examined the associations between financial hardship and HRQoL subscales (physical, social/family, emotional, functional well-being). Results: The factor analysis revealed 3 constructs of financial hardship: medical co...

BMJ Open

ObjectivesHospice care (HC) is seen as a comprehensive approach, that enhances quality of end-of-... more ObjectivesHospice care (HC) is seen as a comprehensive approach, that enhances quality of end-of-life (EOL) care, for terminally ill patients. Despite its positive aspects, HC enrolment is disproportionate for rural patients, who are less likely to use HC in comparison to their urban counterparts. The purpose of this study was to explore decision-making experiences, related to utilisation of HC programmes from a retrospective perspective, with family caregivers (FCGs) in a rural US–Mexico border region.DesignThis qualitative study was conducted from May 2017 to January 2018 using semistructured face to face interviews with FCGs. Data were analysed using thematic analysis.SettingThe HC programme was situated at a local home health agency, located in rural Southern California, USA.ParticipantsTwenty-eight informal FCGs of patients who were actively enrolled in the HC programme agreed to participate in the study.ResultsConversation about HC as an option was initiated by home healthcare...

Innovation in Aging

Evidence suggests loneliness is associated with poorer health practices and fewer health promotin... more Evidence suggests loneliness is associated with poorer health practices and fewer health promoting behaviors, yet may be associated with greater use of the healthcare system. This dichotomy highlights the lack of understanding in the literature about the relationship between the experience of loneliness in early disease detection behaviors, such as prostate cancer screening and appropriate clinical interventions to support older men. Utilizing a series of logistic regression models, this investigation examined the relationship between loneliness and prostate cancer screening in 2008 and 2012 among White, Black, and non-Hispanic men, ages 50-74 years, (n= 4,875 for 2008 and 7.063 for 2012). The data source as the Health and Retirement Study. Findings indicate that White men were less likely to participate in PSA screening in 2008 if they felt left out or isolated. There was a reduced likelihood of screening among Black men who feel as though they have a lot in common with those aroun...

Journal of Immigrant and Minority Health

Latinos/as, the fastest-growing ethnic group in the United States, experience high cancer rates. ... more Latinos/as, the fastest-growing ethnic group in the United States, experience high cancer rates. Factors contributing to treatment decisions among Latinos diagnosed with cancer must be studied. This paper aims to identify treatment decisions among Latinos with cancer and examine factors influencing these decisions. A qualitative exploratory study using semi-structured interviews of 60 Latino/as diagnosed with cancer was conducted. Close-ended responses were analyzed using percentages and frequency distributions, while open-ended responses were analyzed using open coding and thematic categorization. Surgery was the most commonly chosen treatment among participants because it was perceived as providing the highest chance of prolonging life. Only 57% of participants were provided with treatment options. Latinos/as typically prefer modest, paternalistic patient-physician relationships. Therefore, providing culturally appropriate information is valuable. This study underscores the need for health providers to present all available treatment options to enhance cancer treatment outcomes.

Objective Gaps in end-of-life (EOL) care communication can cause problems with symptom management... more Objective Gaps in end-of-life (EOL) care communication can cause problems with symptom management, influence over-or under-use of medical treatment, and trigger psychological distress. In addition, disparities among minority populations complicate this care because underserved populations face subsequent barriers that further hinder effective communication that impacts care. Issues that influence EOL care discussions stem from healthcare system factors within an organization, from the people working within the system, as well as within the people needing care, for example, from patients and their family/friend support systems. However, we know very little about the gaps in EOL care communication in the public healthcare system that, in turn, influence unnecessary suffering and prompt requests to hasten death. The objective of this study was to evaluate the barriers to EOL care discussions as experienced by healthcare providers working in a public healthcare system in Los Angeles where the majority of their patients are low income and immigrant Latinos seeking medical treatment. Methods Forty-six semi-structured interviews were conducted with healthcare providers from different disciplines in

Journal of Psychosocial Oncology, 2014

The accuracy of the Content should not be relied upon and should be independently verified with p... more The accuracy of the Content should not be relied upon and should be independently verified with primary sources of information. Taylor and Francis shall not be liable for any losses, actions, claims, proceedings, demands, costs, expenses, damages, and other liabilities whatsoever or howsoever caused arising directly or indirectly in connection with, in relation to or arising out of the use of the Content.

The American journal of hospice & palliative care, Jan 14, 2016

Numerous factors impede effective and timely end-of-life (EOL) care communication. These factors ... more Numerous factors impede effective and timely end-of-life (EOL) care communication. These factors include delays in communication until patients are seriously ill and/or close to death. Gaps in patient-provider communication negatively affect advance care planning and limit referrals to palliative and hospice care. Confusion about the roles of various health care providers also limits communication, especially when providers do not coordinate care with other health care providers in various disciplines. Although providers receive education regarding EOL communication and care coordination, little is known about the roles of all health care providers, including nonphysician support staff working with physicians to discuss the possibility of dying and help patients prepare for death. This study explores the perspectives of physicians, nurses, social workers, and chaplains on engaging seriously ill patients and families in EOL care communication. Qualitative data were from 79 (medical a...

CV indicates professional activities.

Efficacy of Motivational Interviewing to Enhance Advance Directive Completion in Latinos With Chronic Illness: A Randomized Controlled Trial, 2019

Background: End-of-life (EOL) care for Latinos with chronic illness is a critically important pro... more Background: End-of-life (EOL) care for Latinos with chronic illness is a critically important problem. Latinos with chronic illness suffer worse health outcomes and poorer quality of care due to various issues occurring in care delivery systems. Latinos are less likely than non-Hispanic whites to prepare an advance directive (AD) for health-care decision-making that impacts treatment decisions for when EOL is near. Advance care planning (ACP) interventions tailored specifically for Latinos have rarely been implemented. Objective: The primary aim examines whether a motivational interviewing (MI) intervention increased rates of AD documentation among older Latinos. The secondary aim was to examine whether MI improved communication with providers and family members. Methods: We pilot tested a randomized controlled trial with older Latinos >50 years with one or more chronic illnesses, including cancer. Participants were randomly assigned to usual care (UC) receiving ACP education alone versus treatment (TX), which received ACP education, plus MI counseling including interactive decisional support, emotional support, and barrier navigation. Results: Results of logistic regression indicate TX group participants were significantly more likely to document an AD than UC, however were less ready to talk with health-care providers or family members. Those reporting navigational barriers for talking about dying is difficult showed a significant negative relationship for AD completion even with significant intervention effects. Conclusion: When using MI to motivate individuals toward ACP EOL conversations other factors are important to consider. Further research is needed, especially among Latinos to understand best practices for ACP education and counseling for EOL care.

The purpose of this article is to synthesize and chronicle the authors' experiences as four bilin... more The purpose of this article is to synthesize and chronicle the authors' experiences as four bilingual and bicultural researchers, each experienced in conducting cross-cultural/cross-language qualitative research. Through narrative descriptions of experiences with Latinos, Iranians, and Hmong refugees, the authors discuss their rewards, challenges, and methods of enhancing rigor, trustworthiness, and transparency when conducting cross-cultural/cross-language research. The authors discuss and explore how to effectively manage cross-cultural qualitative data, how to effectively use interpreters and translators, how to identify best methods of transcribing data, and the role of creating strong community relationships. The authors provide guidelines for health care professionals to consider when engaging in cross-cultural qualitative research. Researchers conducting bilingual cross-cultural research might encounter several structural and methodological challenges when attempting to describe the meaning of phenomena. Specifically, in qualitative research, establishing and maintaining a rigorous process of data collection and data analysis becomes important to represent the voices of participants. Consequently, in bilingual cross-cultural research, the challenge to capture subjective meaning in social and cultural contexts has received limited attention in the literature.

Twitter LinkedIn Google+ Death isn't often an easy topic to discuss, but Frances Nedjat-Haiem, a ... more Twitter LinkedIn Google+ Death isn't often an easy topic to discuss, but Frances Nedjat-Haiem, a New Mexico State University social work associate professor, is working to change that.

Purpose: The purpose of this study is to increase healthcare professions' understanding and c... more Purpose: The purpose of this study is to increase healthcare professions' understanding and conceptualization of patient advocacy. Health care providers have a professional duty to be patient advocates, to recognize and address gaps in patient care that particularly impact vulnerable populations (e.g., terminally ill minorities). The patient-provider relationship necessitates certain obligations for health care providers, requiring them to recognize their responsibility to serve the patient's interests based upon patient autonomy and self-determination. More than ever, concerns about ethical and social justice in healthcare settings challenge the traditional role of providers as patient advocates, especially when providing care for vulnerable, terminally ill patients. Methods: We explored providers' perception of patient advocacy as a means to remedy gaps in patient care that often involve ethical challenges and impact a vulnerable Latino population. This secondary quali...

International Psychogeriatircs

Background: Caregivers report early disturbances in social behavior among patients with behaviora... more Background: Caregivers report early disturbances in social behavior among patients with behavioral variant frontotemporal dementia (bvFTD); however, there are few direct observational studies of these social behavioral disturbances. This study aimed to identify social behavioral themes in bvFTD by direct observation in naturalistic interactions. The identification of these themes can help caregivers and clinicians manage the social behavioral disturbances of this disease.

Methods: Researchers observed 13 bvFTD patients in their homes and community-based settings and recorded field notes on their interpersonal interactions. A qualitative analysis of their social behavior was then conducted using ATLAS.ti application and a constant comparison method.

Results: Qualitative analysis revealed the following themes: (1) diminished relational interest and initiation, indicating failure to seek social interactions; (2) lack of social synchrony/intersubjectivity, indicating an inability to establish and maintain interpersonal relationships; and (3) poor awareness and adherence to social boundaries and norms. These themes corresponded with changes from caregiver reports and behavioral scales.

Conclusion: This analysis indicates that real-world observation validates the diagnostic
criteria for bvFTD and increases understanding of social behavioral disturbances in this
disorder. The results of this and future observational studies can highlight key areas for clinical assessment, caregiver education, and targeted interventions that enhance the
management of social behavioral disturbances in bvFTD.

Journal of Social Work in Public Health , Feb 9, 2014

The purpose of our article is to synthesize and chronicle our experiences as four bilingual and b... more The purpose of our article is to synthesize and chronicle our experiences as four bilingual and bicultural researchers, each experienced in conducting cross-cultural/cross language qualitative research. Through narrative descriptions of our experiences with Latinos, Iranians, and Hmong refugees, we discuss our rewards, our challenges, and our methods of enhancing rigor, trustworthiness, and transparency when conducting cross-cultural/cross language research. We
discuss and explore how to effectively manage cross-cultural qualitative data, how to effectively use interpreters and translators, how to identify best methods of transcribing data, and the role of creating strong community relationships. We provide guidelines for health care professionals to consider when engaging in cross-cultural qualitative research.

Multiple factors influence end-of-life (EOL) care discussions that occur in health care systems, ... more Multiple factors influence end-of-life (EOL) care discussions that occur in health care systems, within organizations, among individuals working within these systems and in patients and family/friend support networks. This study examined barriers to EOL care discussions as experienced by health care providers working in a public safety-net health care system where the majority of their patients were low-income and immigrant Latinos seeking medical treatment. Qualitative data were collected in South Central Los Angeles through semistructured interviews with 46 health care providers from different disciplines in medicine, nursing, social work, and chaplaincy. The themes indicated communication barriers in the public sector health care setting and sociocultural patient- and family-level factors. All providers made valuable contributions to clarify the complexity of the problems. Universal strategies are needed to improve communication.

Finally, thank you to all the AOSW members who responded to the online survey. The results of thi... more Finally, thank you to all the AOSW members who responded to the online survey. The results of this survey are presented to help AOSW with developing educational resources that support members understanding of distress screening and promote the delivery of quality cancer care.

Journal of Gerontological Social Work, 2015

In the United States, military service encompasses the five branches of the Armed Forces and incl... more In the United States, military service encompasses the five branches of the Armed Forces and includes Active Duty, Reserve, and National Guard forces. Military service for many veterans occurred during wartime, including World War II, the Korean War, and the Vietnam War. Older military veterans-those aged 65 and older-comprise an estimated 43% of the 22 million living veterans in the United States (National Center for Veterans Analysis and Statistics, 2015). Veterans are defined as individuals who have served in active military service and were discharged or released under conditions other than dishonorable. These veterans are eligible for health benefits and services from the Department of Veterans Affairs (VA; U.S. Department of Veterans Affairs, 2015). The consequences of military service can be lifelong (Elder, 1986; MacLean & Elder, 2007), and are generally worse for combat veterans than noncombat veterans and nonveterans (Elder, 1987; MacLean & Elder, 2007), especially as they age. Recognized health and behavioral outcomes for aging veterans include, but are not limited to, increased likelihood of major depression and posttraumatic stress disorder (PTSD) and increased social difficulties (e.g., divorce, intimate partner violence behaviors, and social iso

Journal of palliative medicine, Jan 3, 2017

Older Latinos with serious medical conditions such as cancer and other chronic diseases lack info... more Older Latinos with serious medical conditions such as cancer and other chronic diseases lack information about advance care planning (ACP). ACP Intervention (ACP-I Plan) was designed for informational and communication needs of older Latinos to improve communication and advance directives (ADs). To determine the feasibility of implementing ACP-I Plan among seriously ill, older Latinos (≥50 years) in Southern New Mexico with one or more chronic diseases (e.g., cancer, heart disease, renal/liver failure, stroke, hypertension, diabetes, chronic obstructive pulmonary disease, and HIV/AIDS). We conducted a prospective, pretest/post-test, two-group, randomized, community-based pilot trial by using mixed data collection methods. Older Latino/Hispanic participants were recruited from community-based settings in Southern New Mexico. All participants received ACP education, whereas the intervention group added: (1) emotional support addressing psychological distress; and (2) systems navigatio...

OMEGA--Journal of Death and Dying, 2013

Research has demonstrated that limited dialogue in end-of-life (EOL) care can negatively impact d... more Research has demonstrated that limited dialogue in end-of-life (EOL) care can negatively impact decision-making and place of death. Furthermore, when vulnerable populations are faced with EOL cancer care, they experience issues resulting from previous gaps in services attributed to sociocultural and economic issues that influence EOL care. These conditions place an additional burden on disadvantaged populations which can cause distress, especially as disparate conditions continue to persist. Little is known about Latinos' psychosocial concerns that lead to distress in EOL care. The objective of this study is to explore Latinas' experiences with life-limiting cancer conditions to identify the EOL care concerns that impact their dying experience. This study used a phenomenological approach to explore the EOL care concerns of 24 Latinas receiving treatment for metastatic cancers in a public sector healthcare system in Los Angeles, California. In-depth interviews were recorded a...

American Journal of Hospice and Palliative Medicine®

Background: Financial hardship influences health-related quality of life (HRQoL) of older adults.... more Background: Financial hardship influences health-related quality of life (HRQoL) of older adults. However, little is known about the relationship between financial hardship and HRQoL among vulnerable populations. Objective: We examined the associations between financial hardship and HRQoL among older Latinos living with chronic disease, including cancer. Methods: This cross-sectional study included 68 Latinos (age range 50-87) with one or more chronic health conditions who participated in a pilot randomized clinical trial. Participants responded to 11 financial hardship questions. We used factor analysis to explore constructs of financial hardship. HRQoL was assessed using the 27-item Functional Assessment of Cancer Therapy-General (FACT-G). Multiple linear regression examined the associations between financial hardship and HRQoL subscales (physical, social/family, emotional, functional well-being). Results: The factor analysis revealed 3 constructs of financial hardship: medical co...

BMJ Open

ObjectivesHospice care (HC) is seen as a comprehensive approach, that enhances quality of end-of-... more ObjectivesHospice care (HC) is seen as a comprehensive approach, that enhances quality of end-of-life (EOL) care, for terminally ill patients. Despite its positive aspects, HC enrolment is disproportionate for rural patients, who are less likely to use HC in comparison to their urban counterparts. The purpose of this study was to explore decision-making experiences, related to utilisation of HC programmes from a retrospective perspective, with family caregivers (FCGs) in a rural US–Mexico border region.DesignThis qualitative study was conducted from May 2017 to January 2018 using semistructured face to face interviews with FCGs. Data were analysed using thematic analysis.SettingThe HC programme was situated at a local home health agency, located in rural Southern California, USA.ParticipantsTwenty-eight informal FCGs of patients who were actively enrolled in the HC programme agreed to participate in the study.ResultsConversation about HC as an option was initiated by home healthcare...

Innovation in Aging

Evidence suggests loneliness is associated with poorer health practices and fewer health promotin... more Evidence suggests loneliness is associated with poorer health practices and fewer health promoting behaviors, yet may be associated with greater use of the healthcare system. This dichotomy highlights the lack of understanding in the literature about the relationship between the experience of loneliness in early disease detection behaviors, such as prostate cancer screening and appropriate clinical interventions to support older men. Utilizing a series of logistic regression models, this investigation examined the relationship between loneliness and prostate cancer screening in 2008 and 2012 among White, Black, and non-Hispanic men, ages 50-74 years, (n= 4,875 for 2008 and 7.063 for 2012). The data source as the Health and Retirement Study. Findings indicate that White men were less likely to participate in PSA screening in 2008 if they felt left out or isolated. There was a reduced likelihood of screening among Black men who feel as though they have a lot in common with those aroun...

Journal of Immigrant and Minority Health

Latinos/as, the fastest-growing ethnic group in the United States, experience high cancer rates. ... more Latinos/as, the fastest-growing ethnic group in the United States, experience high cancer rates. Factors contributing to treatment decisions among Latinos diagnosed with cancer must be studied. This paper aims to identify treatment decisions among Latinos with cancer and examine factors influencing these decisions. A qualitative exploratory study using semi-structured interviews of 60 Latino/as diagnosed with cancer was conducted. Close-ended responses were analyzed using percentages and frequency distributions, while open-ended responses were analyzed using open coding and thematic categorization. Surgery was the most commonly chosen treatment among participants because it was perceived as providing the highest chance of prolonging life. Only 57% of participants were provided with treatment options. Latinos/as typically prefer modest, paternalistic patient-physician relationships. Therefore, providing culturally appropriate information is valuable. This study underscores the need for health providers to present all available treatment options to enhance cancer treatment outcomes.

Objective Gaps in end-of-life (EOL) care communication can cause problems with symptom management... more Objective Gaps in end-of-life (EOL) care communication can cause problems with symptom management, influence over-or under-use of medical treatment, and trigger psychological distress. In addition, disparities among minority populations complicate this care because underserved populations face subsequent barriers that further hinder effective communication that impacts care. Issues that influence EOL care discussions stem from healthcare system factors within an organization, from the people working within the system, as well as within the people needing care, for example, from patients and their family/friend support systems. However, we know very little about the gaps in EOL care communication in the public healthcare system that, in turn, influence unnecessary suffering and prompt requests to hasten death. The objective of this study was to evaluate the barriers to EOL care discussions as experienced by healthcare providers working in a public healthcare system in Los Angeles where the majority of their patients are low income and immigrant Latinos seeking medical treatment. Methods Forty-six semi-structured interviews were conducted with healthcare providers from different disciplines in

Journal of Psychosocial Oncology, 2014

The accuracy of the Content should not be relied upon and should be independently verified with p... more The accuracy of the Content should not be relied upon and should be independently verified with primary sources of information. Taylor and Francis shall not be liable for any losses, actions, claims, proceedings, demands, costs, expenses, damages, and other liabilities whatsoever or howsoever caused arising directly or indirectly in connection with, in relation to or arising out of the use of the Content.

The American journal of hospice & palliative care, Jan 14, 2016

Numerous factors impede effective and timely end-of-life (EOL) care communication. These factors ... more Numerous factors impede effective and timely end-of-life (EOL) care communication. These factors include delays in communication until patients are seriously ill and/or close to death. Gaps in patient-provider communication negatively affect advance care planning and limit referrals to palliative and hospice care. Confusion about the roles of various health care providers also limits communication, especially when providers do not coordinate care with other health care providers in various disciplines. Although providers receive education regarding EOL communication and care coordination, little is known about the roles of all health care providers, including nonphysician support staff working with physicians to discuss the possibility of dying and help patients prepare for death. This study explores the perspectives of physicians, nurses, social workers, and chaplains on engaging seriously ill patients and families in EOL care communication. Qualitative data were from 79 (medical a...

CV indicates professional activities.

Efficacy of Motivational Interviewing to Enhance Advance Directive Completion in Latinos With Chronic Illness: A Randomized Controlled Trial, 2019

Background: End-of-life (EOL) care for Latinos with chronic illness is a critically important pro... more Background: End-of-life (EOL) care for Latinos with chronic illness is a critically important problem. Latinos with chronic illness suffer worse health outcomes and poorer quality of care due to various issues occurring in care delivery systems. Latinos are less likely than non-Hispanic whites to prepare an advance directive (AD) for health-care decision-making that impacts treatment decisions for when EOL is near. Advance care planning (ACP) interventions tailored specifically for Latinos have rarely been implemented. Objective: The primary aim examines whether a motivational interviewing (MI) intervention increased rates of AD documentation among older Latinos. The secondary aim was to examine whether MI improved communication with providers and family members. Methods: We pilot tested a randomized controlled trial with older Latinos >50 years with one or more chronic illnesses, including cancer. Participants were randomly assigned to usual care (UC) receiving ACP education alone versus treatment (TX), which received ACP education, plus MI counseling including interactive decisional support, emotional support, and barrier navigation. Results: Results of logistic regression indicate TX group participants were significantly more likely to document an AD than UC, however were less ready to talk with health-care providers or family members. Those reporting navigational barriers for talking about dying is difficult showed a significant negative relationship for AD completion even with significant intervention effects. Conclusion: When using MI to motivate individuals toward ACP EOL conversations other factors are important to consider. Further research is needed, especially among Latinos to understand best practices for ACP education and counseling for EOL care.

The purpose of this article is to synthesize and chronicle the authors' experiences as four bilin... more The purpose of this article is to synthesize and chronicle the authors' experiences as four bilingual and bicultural researchers, each experienced in conducting cross-cultural/cross-language qualitative research. Through narrative descriptions of experiences with Latinos, Iranians, and Hmong refugees, the authors discuss their rewards, challenges, and methods of enhancing rigor, trustworthiness, and transparency when conducting cross-cultural/cross-language research. The authors discuss and explore how to effectively manage cross-cultural qualitative data, how to effectively use interpreters and translators, how to identify best methods of transcribing data, and the role of creating strong community relationships. The authors provide guidelines for health care professionals to consider when engaging in cross-cultural qualitative research. Researchers conducting bilingual cross-cultural research might encounter several structural and methodological challenges when attempting to describe the meaning of phenomena. Specifically, in qualitative research, establishing and maintaining a rigorous process of data collection and data analysis becomes important to represent the voices of participants. Consequently, in bilingual cross-cultural research, the challenge to capture subjective meaning in social and cultural contexts has received limited attention in the literature.

Twitter LinkedIn Google+ Death isn't often an easy topic to discuss, but Frances Nedjat-Haiem, a ... more Twitter LinkedIn Google+ Death isn't often an easy topic to discuss, but Frances Nedjat-Haiem, a New Mexico State University social work associate professor, is working to change that.

Purpose: The purpose of this study is to increase healthcare professions' understanding and c... more Purpose: The purpose of this study is to increase healthcare professions' understanding and conceptualization of patient advocacy. Health care providers have a professional duty to be patient advocates, to recognize and address gaps in patient care that particularly impact vulnerable populations (e.g., terminally ill minorities). The patient-provider relationship necessitates certain obligations for health care providers, requiring them to recognize their responsibility to serve the patient's interests based upon patient autonomy and self-determination. More than ever, concerns about ethical and social justice in healthcare settings challenge the traditional role of providers as patient advocates, especially when providing care for vulnerable, terminally ill patients. Methods: We explored providers' perception of patient advocacy as a means to remedy gaps in patient care that often involve ethical challenges and impact a vulnerable Latino population. This secondary quali...

International Psychogeriatircs

Background: Caregivers report early disturbances in social behavior among patients with behaviora... more Background: Caregivers report early disturbances in social behavior among patients with behavioral variant frontotemporal dementia (bvFTD); however, there are few direct observational studies of these social behavioral disturbances. This study aimed to identify social behavioral themes in bvFTD by direct observation in naturalistic interactions. The identification of these themes can help caregivers and clinicians manage the social behavioral disturbances of this disease.

Methods: Researchers observed 13 bvFTD patients in their homes and community-based settings and recorded field notes on their interpersonal interactions. A qualitative analysis of their social behavior was then conducted using ATLAS.ti application and a constant comparison method.

Results: Qualitative analysis revealed the following themes: (1) diminished relational interest and initiation, indicating failure to seek social interactions; (2) lack of social synchrony/intersubjectivity, indicating an inability to establish and maintain interpersonal relationships; and (3) poor awareness and adherence to social boundaries and norms. These themes corresponded with changes from caregiver reports and behavioral scales.

Conclusion: This analysis indicates that real-world observation validates the diagnostic
criteria for bvFTD and increases understanding of social behavioral disturbances in this
disorder. The results of this and future observational studies can highlight key areas for clinical assessment, caregiver education, and targeted interventions that enhance the
management of social behavioral disturbances in bvFTD.

Journal of Social Work in Public Health , Feb 9, 2014

The purpose of our article is to synthesize and chronicle our experiences as four bilingual and b... more The purpose of our article is to synthesize and chronicle our experiences as four bilingual and bicultural researchers, each experienced in conducting cross-cultural/cross language qualitative research. Through narrative descriptions of our experiences with Latinos, Iranians, and Hmong refugees, we discuss our rewards, our challenges, and our methods of enhancing rigor, trustworthiness, and transparency when conducting cross-cultural/cross language research. We
discuss and explore how to effectively manage cross-cultural qualitative data, how to effectively use interpreters and translators, how to identify best methods of transcribing data, and the role of creating strong community relationships. We provide guidelines for health care professionals to consider when engaging in cross-cultural qualitative research.

Multiple factors influence end-of-life (EOL) care discussions that occur in health care systems, ... more Multiple factors influence end-of-life (EOL) care discussions that occur in health care systems, within organizations, among individuals working within these systems and in patients and family/friend support networks. This study examined barriers to EOL care discussions as experienced by health care providers working in a public safety-net health care system where the majority of their patients were low-income and immigrant Latinos seeking medical treatment. Qualitative data were collected in South Central Los Angeles through semistructured interviews with 46 health care providers from different disciplines in medicine, nursing, social work, and chaplaincy. The themes indicated communication barriers in the public sector health care setting and sociocultural patient- and family-level factors. All providers made valuable contributions to clarify the complexity of the problems. Universal strategies are needed to improve communication.

Finally, thank you to all the AOSW members who responded to the online survey. The results of thi... more Finally, thank you to all the AOSW members who responded to the online survey. The results of this survey are presented to help AOSW with developing educational resources that support members understanding of distress screening and promote the delivery of quality cancer care.

Research Scholarship My research trajectory centers on the intersection between health, behaviora... more Research Scholarship My research trajectory centers on the intersection between health, behavioral health and disparities that impact vulnerable populations in the last phase of life. In the last few years, my research activities involve mixed methods: intervention modalities, community-based participatory research, exploratory and survey research to address optimum decision-making communication and psychosocial care delivery for those facing a serious, life-threatening medical condition for underserved populations. Although minority populations have an increased risk for negative behavioral and health outcomes, there is a paucity of research and interventions designed for them. Therefore, my research portfolio has focused on addressing this gap using mixed methods with focus groups, in-depth interviews, observational studies, survey methodology and intervention research.