Shannon Swan received his bachelor's degree from Creighton University, obtained his medical training at the University of Nebraska, and did his residency in radiology at Indiana University Hospitals. Subsequently, he completed a fellowship in musculoskeletal imaging at the University of Wisconsin-Madison.
Dr. Swan accepted a staff position at the University of Wisconsin after his clinical fellowship. During his early career, he performed many investigations related to magnetic resonance angiography development, and eventually became interested in health services research due to the health policy implications of less invasive technologies. Dr. Swan is a past winner of the General Electric-Association of University Radiologists Research Academic Fellowship (GERRAF) in technology assessment and outcomes research. He received his research fellowship training under Dennis Fryback while at Wisconsin, with an emphasis on modeling preference-based quality of life.
Dr. Swan accepted a position at Indiana University in 1999 to begin a health services research effort in the Department of Radiology. During that appointment he laid the methodologic foundations for most of his current work.
He joined the MGH Institute for Technology Assessment in the fall of 2003. His major current interest is in the psychometrics of health utility indexes using structural equation modeling and related techniques, in addition to more traditional scaling methods including multiattribute utility theory.
Dr. Swan has extensive prior experience as a Principal Investigator. His first R01 grant explored initial applications of MR angiography in peripheral arterial disease, using a novel time-resolved pulse sequence developed by medical physicists at the University of Wisconsin. Within that grant, Swan also began implementing an original variant on the holistic time trade-off method, the waiting trade-off (WTO), to measure the short-term quality of life effects of medical testing. His second R01 grant further explored his original work with collaborators on the WTO and was funded by the Agency for Health Research and Quality. He was funded by the American Cancer Society Research Scholar Grant program to develop the Testing Morbidities Index (TMI). The TMI is designed to capture the morbidity of any diagnostic testing or screening experience, and can be scaled in multiple ways; it can be used as a summated profile, or as a utility index that can be weighted by the perspective of patients or members of the community. Dr. Swan's most recent prior funding came from an RFA from the American Cancer Society in Palliative Care. In this project he developed a quality of life index for lung cancer using Functional Assessment of Cancer Therapy (FACT) items, the FACT-L Utility Index (FACT-LUI). He continues research on the psychometrics of the FACT-LUI. He is also part of the multidisciplinary team funded by Dr. Carrie Cunningham's R01 grant which studies optimal care of patients with thyroid nodules and thyroid cancer. Drs. Cunningham and Swan have recently been awarded an American Cancer Society Research Scholar grant, wherein they will develop a quality of life index for thyroid cancer.
Selected Publications
Collins, Reagan A; Herman, Tianna; Snyder, Rebecca A; Haines, Krista L; Stey, Anne; Arora, Tania K; Geevarghese, Sunil K; Phillips, Joseph D; Vicente, Diego; Griggs, Cornelia L; McElroy, Imani E; Wall, Anji E; Hughes, Tasha M; Sen, Srijan; Valinejad, Jaber; Alban, Andres; Swan, J Shannon; Mercaldo, Nathaniel; Jalali, Mohammad S; Chhatwal, Jagpreet; Gazelle, G Scott; Rangel, Erika; Yang, Chi-Fu Jeffrey; Donelan, Karen; Gold, Jessica A; West, Colin P; Cunningham, Carrie
Unspoken Truths: Mental Health Among Academic Surgeons Journal Article
In: Ann Surg, vol. 279, iss. 3, pp. 429-436, 2024, ISSN: 1528-1140.
@article{pmid37991182,
title = {Unspoken Truths: Mental Health Among Academic Surgeons},
author = {Reagan A Collins and Tianna Herman and Rebecca A Snyder and Krista L Haines and Anne Stey and Tania K Arora and Sunil K Geevarghese and Joseph D Phillips and Diego Vicente and Cornelia L Griggs and Imani E McElroy and Anji E Wall and Tasha M Hughes and Srijan Sen and Jaber Valinejad and Andres Alban and J Shannon Swan and Nathaniel Mercaldo and Mohammad S Jalali and Jagpreet Chhatwal and G Scott Gazelle and Erika Rangel and Chi-Fu Jeffrey Yang and Karen Donelan and Jessica A Gold and Colin P West and Carrie Cunningham},
doi = {10.1097/SLA.0000000000006159},
issn = {1528-1140},
year = {2024},
date = {2024-03-01},
urldate = {2024-03-01},
journal = {Ann Surg},
volume = {279},
issue = {3},
pages = {429-436},
abstract = {OBJECTIVE: To characterize the current state of mental health within the surgical workforce in the United States (US).nnSUMMARY BACKGROUND DATA: Mental illness and suicide is a growing concern in the medical community; however, the current state is largely unknown.nnMETHODS: Cross-sectional survey of the academic surgery community assessing mental health, medical error, and suicidal ideation. The odds of suicidal ideation adjusting for sex, prior mental health diagnosis, and validated scales screening for depression, anxiety, post-traumatic stress disorder (PTSD), and alcohol use disorder were assessed.nnRESULTS: Of 622 participating medical students, trainees, and surgeons (estimated response rate=11.4-14.0%), 26.1% (141/539) reported a previous mental health diagnosis. 15.9% (83/523) of respondents screened positive for current depression, 18.4% (98/533) for anxiety, 11.0% (56/510) for alcohol use disorder, and 17.3% (36/208) for PTSD. Medical error was associated with depression (30.7% vs. 13.3%, P\<0.001), anxiety (31.6% vs. 16.2%, P=0.001), PTSD (12.8% vs. 5.6%, P=0.018), and hazardous alcohol consumption (18.7% vs. 9.7%, P=0.022). 13.2% (73/551) of respondents reported suicidal ideation in the past year and 9.6% (51/533) in the past two weeks. On adjusted analysis, a previous history of a mental health disorder (aOR: 1.97, 95% CI: 1.04-3.65, P=0.033), and screening positive for depression (aOR: 4.30, 95% CI: 2.21-8.29, P\<0.001) or PTSD (aOR: 3.93, 95% CI: 1.61-9.44, P=0.002) were associated with increased odds of suicidal ideation over the past 12 months.nnCONCLUSIONS: Nearly 1 in 7 respondents reported suicidal ideation in the past year. Mental illness and suicidal ideation are significant problems among the surgical workforce in the US.},
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OBJECTIVE: To characterize the current state of mental health within the surgical workforce in the United States (US).nnSUMMARY BACKGROUND DATA: Mental illness and suicide is a growing concern in the medical community; however, the current state is largely unknown.nnMETHODS: Cross-sectional survey of the academic surgery community assessing mental health, medical error, and suicidal ideation. The odds of suicidal ideation adjusting for sex, prior mental health diagnosis, and validated scales screening for depression, anxiety, post-traumatic stress disorder (PTSD), and alcohol use disorder were assessed.nnRESULTS: Of 622 participating medical students, trainees, and surgeons (estimated response rate=11.4-14.0%), 26.1% (141/539) reported a previous mental health diagnosis. 15.9% (83/523) of respondents screened positive for current depression, 18.4% (98/533) for anxiety, 11.0% (56/510) for alcohol use disorder, and 17.3% (36/208) for PTSD. Medical error was associated with depression (30.7% vs. 13.3%, P<0.001), anxiety (31.6% vs. 16.2%, P=0.001), PTSD (12.8% vs. 5.6%, P=0.018), and hazardous alcohol consumption (18.7% vs. 9.7%, P=0.022). 13.2% (73/551) of respondents reported suicidal ideation in the past year and 9.6% (51/533) in the past two weeks. On adjusted analysis, a previous history of a mental health disorder (aOR: 1.97, 95% CI: 1.04-3.65, P=0.033), and screening positive for depression (aOR: 4.30, 95% CI: 2.21-8.29, P<0.001) or PTSD (aOR: 3.93, 95% CI: 1.61-9.44, P=0.002) were associated with increased odds of suicidal ideation over the past 12 months.nnCONCLUSIONS: Nearly 1 in 7 respondents reported suicidal ideation in the past year. Mental illness and suicidal ideation are significant problems among the surgical workforce in the US.
Swan, J. Shannon; Langer, Michelle M.
Confirmatory Factor Analysis and Measurement Invariance of the Functional Assessment of Cancer Therapy Lung Cancer Utility Index (FACT-LUI) Journal Article
In: MDM Policy & Practice, vol. 8, no. 2, pp. 23814683231186992, 2023, ISSN: 2381-4683.
@article{Swan2023,
title = {Confirmatory Factor Analysis and Measurement Invariance of the Functional Assessment of Cancer Therapy Lung Cancer Utility Index (FACT-LUI)},
author = {J. Shannon Swan and Michelle M. Langer},
doi = {10.1177/23814683231186992},
issn = {2381-4683},
year = {2023},
date = {2023-08-27},
urldate = {2023-07-00},
journal = {MDM Policy \& Practice},
volume = {8},
number = {2},
pages = {23814683231186992},
publisher = {SAGE Publications},
abstract = {\<jats:p\> Background. A portion of the Functional Assessment of Cancer Therapy-Lung (FACT-L) instrument contributed to a previously published utility index, the FACT Lung Utility Index or FACT-LUI. Six FACT items representing lung cancer quality of life covered fatigue, pain, dyspnea, cough, anxiety, and depression. Two FACT items had been previously combined by the index authors into one for nausea and/or appetite loss, resulting in 7 final domains. Methods. The objective was to perform measurement invariance testing within a confirmatory factor analysis (CFA) framework to support the feasibility of using the FACT-LUI for non\textendashpreference-based psychometric applications. The original index patients comprised group 1, and similar FACT patient data ( n = 249) from another published study comprised group 2. One 2-factor model and two 1-factor CFA models were evaluated to assess measurement invariance across groups, using varying degrees of item parceling and a small number of residual covariances, all justified by the literature. Results. The 1-factor models were most optimal. A 1-factor model with 1 pair of items parceled showed invariance to the partial scalar level using usual fit criteria across groups, requiring 2 unconstrained intercepts. A 1-factor model with 3 pairs of justified parcels showed full configural, metric, and scalar invariance across groups. Conclusions. The FACT-LUI items fit a partially to fully invariant 1-factor model, suggesting feasibility for non\textendashpreference-based applications. Implications. Results suggest useful incorporation of the FACT-LUI into clinical trials with no substantial increased respondent burden, allowing preference-based and other psychometric applications from the same index items. \</jats:p\>\<jats:sec\>\<jats:title\>Highlights\</jats:title\>\<jats:p\> This work suggests that in addition to being originally designed for use as a utility index, the 7 FACT-LUI items together also fit simple CFA and measurement invariance models. This less expected result indicates that these items as a group are also potentially useful in non\textendashpreference-based applications. Clinical trials can make for challenging decisions concerning which patient-reported outcome measures to include without being burdensome. However, the literature suggests a need for improved reporting of quality of life in lung cancer in particular as well as cancer in general. Inclusion of more disease-specific items such as the FACT-LUI may allow for information gathering of both preference-based and non\textendashpreference-based data with less demand on patients, similar to what has been done with some generic instruments. \</jats:p\>\</jats:sec\>},
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<jats:p> Background. A portion of the Functional Assessment of Cancer Therapy-Lung (FACT-L) instrument contributed to a previously published utility index, the FACT Lung Utility Index or FACT-LUI. Six FACT items representing lung cancer quality of life covered fatigue, pain, dyspnea, cough, anxiety, and depression. Two FACT items had been previously combined by the index authors into one for nausea and/or appetite loss, resulting in 7 final domains. Methods. The objective was to perform measurement invariance testing within a confirmatory factor analysis (CFA) framework to support the feasibility of using the FACT-LUI for non–preference-based psychometric applications. The original index patients comprised group 1, and similar FACT patient data ( n = 249) from another published study comprised group 2. One 2-factor model and two 1-factor CFA models were evaluated to assess measurement invariance across groups, using varying degrees of item parceling and a small number of residual covariances, all justified by the literature. Results. The 1-factor models were most optimal. A 1-factor model with 1 pair of items parceled showed invariance to the partial scalar level using usual fit criteria across groups, requiring 2 unconstrained intercepts. A 1-factor model with 3 pairs of justified parcels showed full configural, metric, and scalar invariance across groups. Conclusions. The FACT-LUI items fit a partially to fully invariant 1-factor model, suggesting feasibility for non–preference-based applications. Implications. Results suggest useful incorporation of the FACT-LUI into clinical trials with no substantial increased respondent burden, allowing preference-based and other psychometric applications from the same index items. </jats:p><jats:sec><jats:title>Highlights</jats:title><jats:p> This work suggests that in addition to being originally designed for use as a utility index, the 7 FACT-LUI items together also fit simple CFA and measurement invariance models. This less expected result indicates that these items as a group are also potentially useful in non–preference-based applications. Clinical trials can make for challenging decisions concerning which patient-reported outcome measures to include without being burdensome. However, the literature suggests a need for improved reporting of quality of life in lung cancer in particular as well as cancer in general. Inclusion of more disease-specific items such as the FACT-LUI may allow for information gathering of both preference-based and non–preference-based data with less demand on patients, similar to what has been done with some generic instruments. </jats:p></jats:sec>
Roth, Eve M.; Lubitz, Carrie C.; Swan, J. Shannon; James, Benjamin Christopher
Patient-reported quality of life outcome measures in the thyroid cancer population. Journal Article
In: Thyroid : official journal of the American Thyroid Association, vol. 30, no. 10, pp. 1414-1431, 2020, ISSN: 1557-9077, ().
@article{Roth2020,
title = {Patient-reported quality of life outcome measures in the thyroid cancer population.},
author = {Eve M. Roth and Carrie C. Lubitz and J. Shannon Swan and Benjamin Christopher James},
url = {https://www.ncbi.nlm.nih.gov/pubmed/32292128},
doi = {10.1089/thy.2020.0038},
issn = {1557-9077},
year = {2020},
date = {2020-10-01},
journal = {Thyroid : official journal of the American Thyroid Association},
volume = {30},
number = {10},
pages = {1414-1431},
abstract = {Background - There is an escalating worldwide population of thyroid cancer survivors. In addition to conventional metrics of quality of care, quality of life (QoL) assessment in thyroid cancer patients is imperative. Thyroid cancer survivors face unique impediments to health-related QoL (HRQoL), including thyroid-specific symptoms and exposure to disease-related stressors-including fear of recurrence and financial toxicity-over a prolonged survival period. Survey instruments currently used to assess HRQoL in TC survivors may be insufficient to accurately capture the burden of disease in this population. We aimed to identify the HRQoL instruments in the literature which have been applied in the thyroid cancer survivor population, and to present the psychometric properties of the scales and indexes that have been used. We hypothesize that few instruments have shown evidence of validity in this population. Summary - Of the 927 articles identified by search criteria, only 28 studies using 15 HRQoL instruments met inclusion criteria. Of the 15 HRQoL instruments identified, 9 were psychometric health status instruments and 6 were preference-based indexes, but none had been validated in the thyroid cancer survivor population. While the majority of reviewed studies demonstrated impaired psychological and emotional well-being in thyroid cancer survivors, these findings were not uniformly demonstrated across studies, and the longevity of the impact of thyroid cancer on HRQoL was variably reported. Conclusions -- Discrepancies in the literature regarding the impact of thyroid cancer survivorship on HRQoL emphasize the challenges of accurately assessing patient perspectives, reinforcing the importance of using well-constructed instruments to measure patient-reported outcomes in the target population. Care providers involved in the treatment of thyroid cancer survivors should be aware of longitudinal effects on HRQoL, especially pertaining to chronic psychological debilitation. Further development and rigorous validation of thyroid cancer-specific instruments will allow for better data gathering and understanding of the barriers to achieving high long-term HRQoL in thyroid cancer survivors throughout their long post-survival treatment course.},
keywords = {},
pubstate = {published},
tppubtype = {article}
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Background - There is an escalating worldwide population of thyroid cancer survivors. In addition to conventional metrics of quality of care, quality of life (QoL) assessment in thyroid cancer patients is imperative. Thyroid cancer survivors face unique impediments to health-related QoL (HRQoL), including thyroid-specific symptoms and exposure to disease-related stressors-including fear of recurrence and financial toxicity-over a prolonged survival period. Survey instruments currently used to assess HRQoL in TC survivors may be insufficient to accurately capture the burden of disease in this population. We aimed to identify the HRQoL instruments in the literature which have been applied in the thyroid cancer survivor population, and to present the psychometric properties of the scales and indexes that have been used. We hypothesize that few instruments have shown evidence of validity in this population. Summary - Of the 927 articles identified by search criteria, only 28 studies using 15 HRQoL instruments met inclusion criteria. Of the 15 HRQoL instruments identified, 9 were psychometric health status instruments and 6 were preference-based indexes, but none had been validated in the thyroid cancer survivor population. While the majority of reviewed studies demonstrated impaired psychological and emotional well-being in thyroid cancer survivors, these findings were not uniformly demonstrated across studies, and the longevity of the impact of thyroid cancer on HRQoL was variably reported. Conclusions -- Discrepancies in the literature regarding the impact of thyroid cancer survivorship on HRQoL emphasize the challenges of accurately assessing patient perspectives, reinforcing the importance of using well-constructed instruments to measure patient-reported outcomes in the target population. Care providers involved in the treatment of thyroid cancer survivors should be aware of longitudinal effects on HRQoL, especially pertaining to chronic psychological debilitation. Further development and rigorous validation of thyroid cancer-specific instruments will allow for better data gathering and understanding of the barriers to achieving high long-term HRQoL in thyroid cancer survivors throughout their long post-survival treatment course.
Bennett, Debbie L.; Swan, J. Shannon; Gazelle, G. Scott; Saksena, Mansi
Music during image-guided breast biopsy reduces patient anxiety levels. Journal Article
In: Clinical imaging, vol. 65, pp. 18–23, 2020, ISSN: 1873-4499, ().
@article{Bennett2020,
title = {Music during image-guided breast biopsy reduces patient anxiety levels.},
author = {Debbie L. Bennett and J. Shannon Swan and G. Scott Gazelle and Mansi Saksena},
url = {https://www.ncbi.nlm.nih.gov/pubmed/32353714},
doi = {10.1016/j.clinimag.2020.03.018},
issn = {1873-4499},
year = {2020},
date = {2020-09-01},
journal = {Clinical imaging},
volume = {65},
pages = {18--23},
abstract = {Interventions to decrease anxiety associated with image-guided breast biopsy are needed. Music intervention has been shown to be helpful in other outpatient procedural settings but data are limited regarding its effectiveness in the setting of breast biopsy. The purpose of this study was to determine whether listening to self-selected music during image-guided breast biopsy lowers anxiety. This randomized controlled trial was approved by the institutional review board and was HIPAA-compliant. 157 women between 18 and 75 (mean, 49.7 years) years of age, undergoing stereotactic or ultrasound-guided core biopsy, were enrolled in the study and were prospectively randomized to music or usual care. Patients in the music group listened to music of their choice during the biopsy. All patients completed the State Trait Anxiety Inventory (STAI) before and after the biopsy. Differences in pre-biopsy and post-biopsy anxiety levels were compared between the two groups using the Mann-Whitney U test. Baseline trait anxiety scores in the two groups were similar (34.0 music, 31.5 contro},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Interventions to decrease anxiety associated with image-guided breast biopsy are needed. Music intervention has been shown to be helpful in other outpatient procedural settings but data are limited regarding its effectiveness in the setting of breast biopsy. The purpose of this study was to determine whether listening to self-selected music during image-guided breast biopsy lowers anxiety. This randomized controlled trial was approved by the institutional review board and was HIPAA-compliant. 157 women between 18 and 75 (mean, 49.7 years) years of age, undergoing stereotactic or ultrasound-guided core biopsy, were enrolled in the study and were prospectively randomized to music or usual care. Patients in the music group listened to music of their choice during the biopsy. All patients completed the State Trait Anxiety Inventory (STAI) before and after the biopsy. Differences in pre-biopsy and post-biopsy anxiety levels were compared between the two groups using the Mann-Whitney U test. Baseline trait anxiety scores in the two groups were similar (34.0 music, 31.5 contro
Lee, Janie; Lowry, Kathryn; Chubiz, Jessica Cott; Swan, J. Shannon; Motazedi, Tina; Halpern, Elkan F.; Tosteson, Anna N A; Gazelle, G. Scott; Donelan, Karen
Breast cancer risk, worry, and anxiety: Effect on patient perceptions of false-positive screening results. Journal Article
In: Breast (Edinburgh, Scotland), vol. 50, pp. 104–112, 2020, ISSN: 1532-3080, ().
@article{JLee2020,
title = {Breast cancer risk, worry, and anxiety: Effect on patient perceptions of false-positive screening results.},
author = {Janie Lee and Kathryn Lowry and Jessica Cott Chubiz and J. Shannon Swan and Tina Motazedi and Elkan F. Halpern and Anna N A Tosteson and G. Scott Gazelle and Karen Donelan},
url = {https://www.ncbi.nlm.nih.gov/pubmed/32135458},
doi = {10.1016/j.breast.2020.02.004},
issn = {1532-3080},
year = {2020},
date = {2020-04-01},
journal = {Breast (Edinburgh, Scotland)},
volume = {50},
pages = {104--112},
abstract = {The impact of mammography screening recall on quality-of-life (QOL) has been studied in women at average risk for breast cancer, but it is unknown whether these effects differ by breast cancer risk level. We used a vignette-based survey to evaluate how women across the spectrum of breast cancer risk perceive the experience of screening recall. Women participating in mammography or breast MRI screening were recruited to complete a vignette-based survey. Using a numerical rating scale (0-100), women rated QOL for hypothetical scenarios of screening recall, both before and after benign results were known. Lifetime breast cancer risk was calculated using Gail and BRCAPRO risk models. Risk perception, trait anxiety, and breast cancer worry were assessed using validated instruments. The final study cohort included 162 women at low (n = 43, 26%), intermediate (n = 66, 41%), and high-risk (n = 53, 33%). Actual breast cancer risk was not a predictor of QOL for any of the presented scenarios. Across all risk levels, QOL ratings were significantly lower for the period during diagnostic uncertainty compared to after benign results were known (p 0.05). In multivariable regression analyses, breast cancer worry was a significant predictor of decreased QoL for all screening scenarios while awaiting results, including scenarios with non-invasive imaging alone or with biopsy. High trait anxiety and family history predicted lower QOL scores after receipt of benign test results (p 0.05). Women with high trait anxiety and family history may particularly benefit from discussions about the risk of recall when choosing a screening regimen.},
keywords = {},
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The impact of mammography screening recall on quality-of-life (QOL) has been studied in women at average risk for breast cancer, but it is unknown whether these effects differ by breast cancer risk level. We used a vignette-based survey to evaluate how women across the spectrum of breast cancer risk perceive the experience of screening recall. Women participating in mammography or breast MRI screening were recruited to complete a vignette-based survey. Using a numerical rating scale (0-100), women rated QOL for hypothetical scenarios of screening recall, both before and after benign results were known. Lifetime breast cancer risk was calculated using Gail and BRCAPRO risk models. Risk perception, trait anxiety, and breast cancer worry were assessed using validated instruments. The final study cohort included 162 women at low (n = 43, 26%), intermediate (n = 66, 41%), and high-risk (n = 53, 33%). Actual breast cancer risk was not a predictor of QOL for any of the presented scenarios. Across all risk levels, QOL ratings were significantly lower for the period during diagnostic uncertainty compared to after benign results were known (p 0.05). In multivariable regression analyses, breast cancer worry was a significant predictor of decreased QoL for all screening scenarios while awaiting results, including scenarios with non-invasive imaging alone or with biopsy. High trait anxiety and family history predicted lower QOL scores after receipt of benign test results (p 0.05). Women with high trait anxiety and family history may particularly benefit from discussions about the risk of recall when choosing a screening regimen.
Swan, J. Shannon; Lennes, Inga; Stump, Natalie; Temel, Jennifer S; Wang, David; Keller, Lisa; Donelan, Karen
A Patient-Centered Utility Index for Non-Small Cell Lung Cancer in the United States. Journal Article
In: MDM policy & practice, vol. 3, pp. 2381468318801565, 2018, ISSN: 2381-4683, ().
@article{Swan2018,
title = {A Patient-Centered Utility Index for Non-Small Cell Lung Cancer in the United States.},
author = {J. Shannon Swan and Inga Lennes and Natalie Stump and Jennifer S Temel and David Wang and Lisa Keller and Karen Donelan},
url = {https://www.ncbi.nlm.nih.gov/pubmed/30349874},
doi = {10.1177/2381468318801565},
issn = {2381-4683},
year = {2018},
date = {2018-01-01},
journal = {MDM policy \& practice},
volume = {3},
pages = {2381468318801565},
abstract = {A preference-based quality-of-life index for non-small cell lung cancer was developed with a subset of Functional Assessment of Cancer Therapy (FACT)-General (G) and FACT-Lung (L) items, based on clinician input and the literature. A total of 236 non-small cell lung carcinoma patients contributed their preferences, randomly allocated among three survey groups to decrease burden. The FACT-L Utility Index (FACT-LUI) was constructed with two methods: 1) multiattribute utility theory (MAUT), where a visual analog scale (VAS)-based index was transformed to standard gamble (SG); and 2) an unweighted index, where items were summed, normalized to a 0 to 1.0 scale, and the result transformed to a scale length equivalent to the VAS or SG MAUT-based model on a Dead to Full Health scale. Agreement between patients' direct utility and the indexes for current health was assessed. The agreement of the unweighted index with direct SG was superior to the MAUT-based index (intraclass correlation for absolute agreement: 0.60 v. 0.35; mean difference: 0.03 v. 0.19; and mean absolute difference 0.09 v. 0.21, respectively). Mountain plots showed substantial differences, with the unweighted index demonstrating a median bias of 0.02 versus the MAUT model at 0.2. There was a significant difference ( = 0.0002) between early (I-II) and late stage (III-IV) patients, the mean difference for both indexes being greater than distribution-based estimates of minimal important difference. The population was limited to non-small cell lung cancer patients. However, most quality-of-life literature consulted and the FACT instruments do not differentiate between lung cancer cell types. Minorities were also limited in this sample. The FACT-LUI shows early evidence of validity for informing economic analysis of lung cancer treatments.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
A preference-based quality-of-life index for non-small cell lung cancer was developed with a subset of Functional Assessment of Cancer Therapy (FACT)-General (G) and FACT-Lung (L) items, based on clinician input and the literature. A total of 236 non-small cell lung carcinoma patients contributed their preferences, randomly allocated among three survey groups to decrease burden. The FACT-L Utility Index (FACT-LUI) was constructed with two methods: 1) multiattribute utility theory (MAUT), where a visual analog scale (VAS)-based index was transformed to standard gamble (SG); and 2) an unweighted index, where items were summed, normalized to a 0 to 1.0 scale, and the result transformed to a scale length equivalent to the VAS or SG MAUT-based model on a Dead to Full Health scale. Agreement between patients' direct utility and the indexes for current health was assessed. The agreement of the unweighted index with direct SG was superior to the MAUT-based index (intraclass correlation for absolute agreement: 0.60 v. 0.35; mean difference: 0.03 v. 0.19; and mean absolute difference 0.09 v. 0.21, respectively). Mountain plots showed substantial differences, with the unweighted index demonstrating a median bias of 0.02 versus the MAUT model at 0.2. There was a significant difference ( = 0.0002) between early (I-II) and late stage (III-IV) patients, the mean difference for both indexes being greater than distribution-based estimates of minimal important difference. The population was limited to non-small cell lung cancer patients. However, most quality-of-life literature consulted and the FACT instruments do not differentiate between lung cancer cell types. Minorities were also limited in this sample. The FACT-LUI shows early evidence of validity for informing economic analysis of lung cancer treatments.
Swan, J. Shannon; Furtado, Vanessa F; Keller, Lisa A; Lotti, Judith Borsody; Saltalamacchia, Catherine A; Lennes, Inga; Salazar, Gloria M
Pilot Study of a Patient-Centered Radiology Process Model Journal Article
In: Journal of the American College of Radiology : JACR, vol. 14, no. 2, pp. 274-281, 2017, ISSN: 1558-349X, ().
@article{Swan2016a,
title = {Pilot Study of a Patient-Centered Radiology Process Model},
author = {J. Shannon Swan and Vanessa F Furtado and Lisa A Keller and Judith Borsody Lotti and Catherine A Saltalamacchia and Inga Lennes and Gloria M Salazar},
url = {https://www.ncbi.nlm.nih.gov/pubmed/27927589},
doi = {10.1016/j.jacr.2016.08.024},
issn = {1558-349X},
year = {2017},
date = {2017-02-01},
journal = {Journal of the American College of Radiology : JACR},
volume = {14},
number = {2},
pages = {274-281},
abstract = {The Radiology Process Model (RPM) was previously described in terms of its conceptual basis and proposed survey items. The current study describes the first pilot application of the RPM in the field and the results of initial psychometric analysis. We used an Institutional Review Board-approved pilot RPM survey in 100 patients having outpatient interventional radiology procedures. The 24 survey items had 4 or 5 levels of severity. We assessed for missing data, items that patients found confusing, any suggestions by patients for additional items and clarity of items from patient feedback. Factor analysis was performed and internal consistency measured. Construct validity was assessed by correlation of patient responses to the items as a summated scale with a visual analog scale (VAS) they completed indicating their interventional radiology experience. The visual analog scale and the RPM summated scale were strongly correlated (r = 0.7). Factor analysis showed four factors: interactions with facility and doctors/staff, time-sensitive aspects, pain, and anxiety. The items showed high internal consistency (alpha: 0.86) as a group and approximately 0.7 to 0.9 by the factors. Analysis shows that two items could be deleted (cost and communication between radiologist and referrers). Revision of two items and potential addition of others are discussed. The RPM shows initial evidence of psychometric validity and internal consistency reliability. Minor changes are anticipated before wider use.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
The Radiology Process Model (RPM) was previously described in terms of its conceptual basis and proposed survey items. The current study describes the first pilot application of the RPM in the field and the results of initial psychometric analysis. We used an Institutional Review Board-approved pilot RPM survey in 100 patients having outpatient interventional radiology procedures. The 24 survey items had 4 or 5 levels of severity. We assessed for missing data, items that patients found confusing, any suggestions by patients for additional items and clarity of items from patient feedback. Factor analysis was performed and internal consistency measured. Construct validity was assessed by correlation of patient responses to the items as a summated scale with a visual analog scale (VAS) they completed indicating their interventional radiology experience. The visual analog scale and the RPM summated scale were strongly correlated (r = 0.7). Factor analysis showed four factors: interactions with facility and doctors/staff, time-sensitive aspects, pain, and anxiety. The items showed high internal consistency (alpha: 0.86) as a group and approximately 0.7 to 0.9 by the factors. Analysis shows that two items could be deleted (cost and communication between radiologist and referrers). Revision of two items and potential addition of others are discussed. The RPM shows initial evidence of psychometric validity and internal consistency reliability. Minor changes are anticipated before wider use.
Lubitz, Carrie C.; Gregorio, Lucia De; Fingeret, Abbey L; Economopoulos, Konstantinos; Teremzawi, Diana; Hassan, Mursal; Parangi, Sareh; Stephen, Antonia; Halpern, Elkan F.; Donelan, Karen; Swan, J. Shannon
Measurement and Variation in Estimation of Quality of Life Effects of Patients Undergoing Treatment for Papillary Thyroid Carcinoma Journal Article
In: Thyroid : official journal of the American Thyroid Association, vol. 27, no. 2, pp. 197-206, 2017, ISSN: 1557-9077, ().
@article{Lubitz2016b,
title = {Measurement and Variation in Estimation of Quality of Life Effects of Patients Undergoing Treatment for Papillary Thyroid Carcinoma},
author = {Carrie C. Lubitz and Lucia De Gregorio and Abbey L Fingeret and Konstantinos Economopoulos and Diana Teremzawi and Mursal Hassan and Sareh Parangi and Antonia Stephen and Elkan F. Halpern and Karen Donelan and J. Shannon Swan},
url = {http://www.ncbi.nlm.nih.gov/pubmed/27824301},
doi = {10.1089/thy.2016.0260},
issn = {1557-9077},
year = {2017},
date = {2017-02-01},
journal = {Thyroid : official journal of the American Thyroid Association},
volume = {27},
number = {2},
pages = {197-206},
abstract = {Thyroid cancer incidence is increasing. The effect of diagnosis and treatment on health related quality of life (HRQoL) is an essential variable given no change in life span for the majority of patients. HRQoL instruments, with data useful for between-disease comparisons, are being increasingly used for health policy and outcomes evaluation. Variation exits among the instruments based on the impact of a specific disease. We assessed which of four well-validated preference-based surveys detect changes in health and clinical intervention in patients diagnosed with the papillary thyroid cancer (PTC). Four commonly used HRQoL questionnaires (Short Form-12v2® (SF6D), EuroQol-5D (EQ5D), and Health Utilities Index Mark 2 and 3 (HUI2, HUI3) were administered to patients with the diagnosis of PTC at three perioperative time points during the first year of treatment. Clinicopathological and treatment course data were assessed for HRQoL impact including complications from surgery, re-operation for persistence/early recurrence, and adjuvant radioactive iodine treatment. We compared standard metrics, including ceiling effect, intraclass correlation coefficient, effect sizes, and quality-adjusted life-years (QALYs) among the four instruments. Of 117 patients, 27% had a preoperative diagnosis of anxiety or depression, 41% had regional lymph node metastases, three had distant metastases and 49% underwent adjuvant radioactive iodine treatment. The ceiling effect (i.e. proportion with a perfect score) was greatest with the EQ5D and least with the SF6D. Index scores ranged from 0.77 (SF6D) to 0.90 (EQ5D). All scores declined at 2 weeks' post-op, and returned to pretreatment at six-months. The SF6D was the only instrument to exceed the conventional minimal-important difference between all three time points. QALYs were as follows: SF6D - 0.79, EQ5D - 0.90, HUI2 - 0.88, HUI3 - 0.86. Our results reflect the general good health of PTC patients. The effect on quality of life is primarily related to emotional and social impacts of treatment. The results support the measurement of a similar underlying construct, although variation in detecting changes in health exists between the instruments. Of the instruments assessed, the SF6D is the most responsive to treatment effects and should be utilized in future economic analyses in this patient population.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Thyroid cancer incidence is increasing. The effect of diagnosis and treatment on health related quality of life (HRQoL) is an essential variable given no change in life span for the majority of patients. HRQoL instruments, with data useful for between-disease comparisons, are being increasingly used for health policy and outcomes evaluation. Variation exits among the instruments based on the impact of a specific disease. We assessed which of four well-validated preference-based surveys detect changes in health and clinical intervention in patients diagnosed with the papillary thyroid cancer (PTC). Four commonly used HRQoL questionnaires (Short Form-12v2® (SF6D), EuroQol-5D (EQ5D), and Health Utilities Index Mark 2 and 3 (HUI2, HUI3) were administered to patients with the diagnosis of PTC at three perioperative time points during the first year of treatment. Clinicopathological and treatment course data were assessed for HRQoL impact including complications from surgery, re-operation for persistence/early recurrence, and adjuvant radioactive iodine treatment. We compared standard metrics, including ceiling effect, intraclass correlation coefficient, effect sizes, and quality-adjusted life-years (QALYs) among the four instruments. Of 117 patients, 27% had a preoperative diagnosis of anxiety or depression, 41% had regional lymph node metastases, three had distant metastases and 49% underwent adjuvant radioactive iodine treatment. The ceiling effect (i.e. proportion with a perfect score) was greatest with the EQ5D and least with the SF6D. Index scores ranged from 0.77 (SF6D) to 0.90 (EQ5D). All scores declined at 2 weeks' post-op, and returned to pretreatment at six-months. The SF6D was the only instrument to exceed the conventional minimal-important difference between all three time points. QALYs were as follows: SF6D - 0.79, EQ5D - 0.90, HUI2 - 0.88, HUI3 - 0.86. Our results reflect the general good health of PTC patients. The effect on quality of life is primarily related to emotional and social impacts of treatment. The results support the measurement of a similar underlying construct, although variation in detecting changes in health exists between the instruments. Of the instruments assessed, the SF6D is the most responsive to treatment effects and should be utilized in future economic analyses in this patient population.
Swan, J. Shannon; Pandharipande, Pari; Salazar, Gloria M.
Developing a Patient-Centered Radiology Process Model Journal Article
In: J Am Coll Radiol, vol. 13, no. 5, pp. 510-6, 2016, ().
@article{Swan2016,
title = {Developing a Patient-Centered Radiology Process Model},
author = {J. Shannon Swan and Pari Pandharipande and Gloria M. Salazar},
url = {http://www.ncbi.nlm.nih.gov/pubmed/26833030},
doi = {10.1016/j.jacr.2015.11.022},
year = {2016},
date = {2016-05-01},
urldate = {2016-05-01},
journal = {J Am Coll Radiol},
volume = {13},
number = {5},
pages = {510-6},
institution = {Harvard Medical School, Boston, Massachusetts; Division of Interventional Radiology, Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts.},
abstract = {There has been increasing interest in the process of care that patients experience. To keep step with the rest of medicine, our specialty should be designing metrics that assess the overall experience of patients seeking care in radiology departments. A recent memo from the ACR chair calls for more work in this area. The aim of this study was to develop a patient-centered model for the experience of radiologic care, which may be helpful in addressing this need.Using principles of multiattribute utility theory and psychometric theory as well as recent literature, a model was developed for a patient-centered index that could be used in radiology facilities.A model was developed that concisely incorporates patient-centeredness of both radiologists and staff members (communication with patient and referrers, competence, and pain control) as well as patient- and process-related issues such as costs, procedural morbidity, access to care, appointment duration, waiting, timing of appointments, cleanliness of facility, and coordination with clinical services. The overall radiology process model was constructed as a set of nested models, which allow more integrated detail within the domains of patient experience.This model and others like it may help the ACR develop quality metrics to reasonably quantify the patient experience.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
There has been increasing interest in the process of care that patients experience. To keep step with the rest of medicine, our specialty should be designing metrics that assess the overall experience of patients seeking care in radiology departments. A recent memo from the ACR chair calls for more work in this area. The aim of this study was to develop a patient-centered model for the experience of radiologic care, which may be helpful in addressing this need.Using principles of multiattribute utility theory and psychometric theory as well as recent literature, a model was developed for a patient-centered index that could be used in radiology facilities.A model was developed that concisely incorporates patient-centeredness of both radiologists and staff members (communication with patient and referrers, competence, and pain control) as well as patient- and process-related issues such as costs, procedural morbidity, access to care, appointment duration, waiting, timing of appointments, cleanliness of facility, and coordination with clinical services. The overall radiology process model was constructed as a set of nested models, which allow more integrated detail within the domains of patient experience.This model and others like it may help the ACR develop quality metrics to reasonably quantify the patient experience.
Daignault, Cory P.; Palmer, Edwin L.; Scott, James A.; Swan, J. Shannon; Daniels, Gilbert H.
Papillary Thyroid Carcinoma Metastasis to the Lumbar Spine Masquerading as a Schmorl's Node Journal Article
In: Nucl Med Mol Imaging, vol. 49, no. 3, pp. 217–222, 2015, ().
@article{Daignault2015,
title = {Papillary Thyroid Carcinoma Metastasis to the Lumbar Spine Masquerading as a Schmorl's Node},
author = {Cory P. Daignault and Edwin L. Palmer and James A. Scott and J. Shannon Swan and Gilbert H. Daniels},
url = {http://www.ncbi.nlm.nih.gov/pubmed/26279695},
doi = {10.1007/s13139-015-0320-x},
year = {2015},
date = {2015-09-01},
urldate = {2015-09-01},
journal = {Nucl Med Mol Imaging},
volume = {49},
number = {3},
pages = {217--222},
institution = {Thyroid Unit and Department of Medicine, Massachusetts General Hospital, 55 Fruit St, Boston, MA 02114 USA.},
abstract = {A Schmorl's node is a common incidental finding encountered during radiologic imaging. Despite the vertebral body being a common site of metastatic disease, a lytic lesion adjacent to an endplate with typical imaging features can often confidently be called a Schmorl's node. This is a case report of a patient with a single well-defined FDG-avid papillary thyroid carcinoma metastasis to the spine that had imaging findings characteristic of a Schmorl's node on CT and MRI. This case is important to consider as it demonstrates that the imaging characteristics of metastatic disease and Schmorl's nodes can overlap.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
A Schmorl's node is a common incidental finding encountered during radiologic imaging. Despite the vertebral body being a common site of metastatic disease, a lytic lesion adjacent to an endplate with typical imaging features can often confidently be called a Schmorl's node. This is a case report of a patient with a single well-defined FDG-avid papillary thyroid carcinoma metastasis to the spine that had imaging findings characteristic of a Schmorl's node on CT and MRI. This case is important to consider as it demonstrates that the imaging characteristics of metastatic disease and Schmorl's nodes can overlap.