2019 CBSSM Colloquium Abstracts

She’s doing what?  Coworker Support and Stigma for Breastfeeding Women

Presenter: Elizabeth (Libby) Bogdan-Lovis, MA

Co-authors: Jie Zhuang, PhD; Mary Bresnahan, PhD; Yi Zh;, Xiaodi Yan; Joanne Goldbort, PhD; Steven Haider, PhD

This study assessed the impact of coworker support on lactating mothers’ breastfeeding self-efficacy after maternity leave.  A cross-sectional survey of 1000 working adults assessed effects of perception of fairness, coworkers’ support for breastfeeding colleagues, and ick response on willingness to help mothers needing breaks to pump breastmilk at work.  The study also examined how coworker support affected mothers’ self-efficacy to continue breastfeeding.  One out of four coworkers showed moderate to strong stigma, saw breaks to pump breastmilk as unfair, and showed less intention to help new mothers. These results suggest that while a majority of coworkers are generally supportive, lactating women are likely to encounter disapproving coworkers who may discourage them from continuing to breastfeed. The data showed that many organizations included in this study have only passively fostered mother friendly workplaces and could do more to encourage employees to be supportive of lactating colleagues.

 

From Narratives to Policy: How Women Physicians’ and Medical Trainees’ Experiences Inform Sexual Harassment Prevention

Presenter: Chithra R. Perumalswami, MD, MSc

Co-authors: Anitha Menon, BSE; Anna Morgan, BA; Reshma Jagsi, MD, DPhil

Background: The prevalence of sexual harassment of women physicians across all stages of training remains high. Sexual harassment harms its targets across multiple dimensions, exploits hierarchical power dynamics, and creates hostile work environments.  This unacceptably jeopardizes the health of healthcare teams and the care they provide to patients.

 Objective: To explore the narratives of women physicians and physicians-in-training (medical students and residents) who have endured sexual harassment in medicine and whose experiences have been shared with the public in narrative, interview, or news story form. 

Methods: We performed a qualitative document analysis of 14 published narratives between the years of 1991 and 2018 found in a literature search conducted in PubMed, PsychInfo, Web of Science, and gray literature using Google Scholar and the Twitter hashtag campaign #MeTooMedicine. Six of the 14 cases were authored anonymously. The narratives were double coded using inductive and deductive reasoning. Themes were determined by consensus.

Results: Several themes were identified within the following broader categories: Professional/Career, Personal, Patient Safety, and Bystanders. Subthemes included: (1) Hierarchical power dynamics between the target of sexual harassment and the harasser encourage silence and may amplify the negative outcomes of sexual harassment; (2) Ambiguous situations in medicine are high risk situations for sexual harassment; (3) Career impacts span from small to large, including attrition; (4) Sexual harassment can lead to questioning of one’s self-worth; (5) Tactics for coping include avoidance and situational acceptance; (6) Concerns for patient safety and protecting oneself are present simultaneously; and (7) Bystander situations abound in the context of medicine and bystanders can be empowered to act.

Conclusion: Understanding the perspectives of women physicians and physicians-in-training who have endured sexual harassment is critical to determining what measures may be effective in preventing sexual harassment, including policies that support a safe, civil, and inclusive environment in healthcare.

 

Parents’ Perspectives on Decision-Making for Critically Ill Neonates

Presenter: Chris D. Krenz, BA

Co-authors: Kayte Spector-Bagdady, JD, MBioethics; Raymond De Vries, PhD; Stephanie Kukora, MD

Guidelines from professional societies recommend that, in situations of critically ill neonatal patients, goals-of-care decisions be approached jointly by physicians and parents and be based on medical information and parents’ values. How to effectively engage in shared decision-making in this context is debated, however, and emerging evidence suggests that clinicians and parents perceive these decisions and their roles in decision-making very differently.

In this session, we will discuss findings from semi-structured interviews (n=15) with parents who have had a critically ill infant in the NICU in the past and faced difficult decisions about their child’s care goals. Their infants had a wide range of therapies and medical outcomes. A coding scheme was developed through an iterative process of reading transcripts and team meetings. Each transcript was then coded by two team members who met to reconcile discrepancies.

Parents reported many considerations when making goals-of-care decisions, including weighing the chances of survival and acceptable quality of life, avoiding suffering, desiring more time with their infant, ensuring that all options were tried, being a good parent, religious beliefs, and feelings of hope. Though most parents trusted their care team, many reported having conflicting values with their providers that impacted their decision-making experience and generated negative emotions and distrust.

These findings 1) highlight the importance of engaging parents, early and explicitly, in a discussion about their goals and values—both to facilitate shared decision making and avoid a degradation of patient trust—and 2) suggest potential topics for such discussions.

 

Patients' Perspectives on Enrollment in Research Using the Exception from Informed Consent: An Integrated Survey

Presenter: Victoria M. Scicluna, MD, MPH

Co-authors: Neal W. Dickert, MD, PhD; Deneil K. Harney, MPH; Elizabeth B. Jones, MD; Andrea R. Mitchell, MPH; Robert Silbergleit, MD; Candace D. Speight, MPH; David W. Wright, MD;, Rebecca D. Pentz, PhD

Introduction: It is important for researchers interested in trials using the exception from informed consent (EFIC) to understand the views and experiences of enrolled individuals. Prior studies have shown that patient/surrogate attitudes are generally positive. However, they were small, did not include pediatric patients, and interviews were often conducted long after trial enrollment.

Methods:  A 10-item paper and pencil survey was integrated into the Established Status Epilepticus Treatment Trial (ESETT), a randomized trial of three treatments for benzodiazepine-refractory status epilepticus in pediatric and adult patients.  Primary domains included attitudes toward trial enrollment, EFIC, and community consultation. Simple descriptive statistics, Chi-Square, and Fisher’s exact tests were conducted.

Results: Out of 317 patients/surrogates, only 9% disagreed with the statement “I am glad that I/my family member was included in the ESETT research study.” 27% disagreed with enrollment without prospective consent specifically.  Black participants disagreed with enrollment without prospective consent more frequently than white participants (36% vs. 23%). Participants indicated that patients (81%), their families (51%), and those at risk for seizures (51%) were most important to include in community consultation.

Conclusions: In the largest study to date of patient/surrogate perspectives on enrollment in an EFIC trial, rates of acceptance of trial enrollment were relatively high; acceptance of EFIC specifically was slightly lower, especially among Black participants. Our findings further support targeted community consultation focusing on those with connections to the disease under study.  Future research should focus on communication in the post-enrollment period, especially for those who may disagree with enrollment.

 

2019 Bishop Lecture in Bioethics:

Black Afterlives Matter: Reimagining Bioethics for an Ailing Body Politic

Presenter:  Ruha Benjamin, PhD  

In this talk, I expand the frame of health and illness and broaden the terrain of bioethics, moving beyond a focus on individual bodies to the social patterns and politics that produce premature death. By engaging the idiom of “afterlife” in relation to Black existence in the United States, this talk grapples with the multiple ways in which life after death and debt are stratified. Especially when it comes to Black maternal health -- so often the site of trauma and neglect – we must consider a full range of life-affirming practices that implicate the body politic writ large. In this way, I also want to shift from diagnosis to remedy. Yes, subordination, subjugation, subaltern, literally “under the earth,” racialized populations are buried people. But there is a lot happening underground. Not only coffins, but seeds, roots and rhizomes. And maybe even tunnels and other lines of flight to new worlds, where alternative forms of kinship and collective wellbeing have room to grow. Will you imagine with me?