To identify the consequences of the coronavirus 2019 (COVID-19) pandemic for individuals with traumatic brain injury (TBI), with particular attention to unique effects for individuals with chronic disability. Design: Individuals with and without a history of TBI completed a web-based survey. Setting: Participants were recruited from the Vanderbilt Brain Injury Patient Registry in Nashville, TN, and completed the survey from their homes between May and June 2020, during social distancing related to the COVID-19 pandemic. Participants: Participants (NZ47) in the chronic phase of moderate-severe TBI (>6mo postinjury) and 51 noninjured comparison (NC) peers completed the survey. Interventions: Not applicable. Main Outcome Measures: Participants, or respondents, answered a mix of multiple choice and free text questions about how the COVID-19 pandemic has affected their work, education, medical care, social communication, sources of information and decision making, and mental and physical well-being. Individuals with TBI also answered questions about how TBI has affected their experiences of the pandemic. Results: As a group, respondents with TBI reported less pandemic-related behavior change (eg, daily habits, virtual social visits, and masking) than NC peers. Both NCs and respondents with TBI identified health care providers as trusted sources of public health information. One-third of individuals with TBI indicated that brain injury has made coping with the pandemic more difficult, and respondents identified mental health challenges and social isolation as key barriers. Conclusions: These results suggest that health care providers should look for ways to provide tailored education and reduce social isolation for individuals with disability during the ongoing COVID-19 pandemic. We discuss several direct suggestions from participant responses.

Background Delays in postoperative radiotherapy (PORT) for head and neck cancer (HNC) increase the risk for recurrence and mortality. The multifactorial nature of delays calls for an in‐depth understanding of potential contributors from the patient's and provider's perspectives. We sought to identify causes of delays in adjuvant radiotherapy initiation for HNC. Methods We performed a mixed‐methods study including patients with HNC care team members. Forty in‐depth interviews were performed (26 patients; 14 care team members). Timing and demographic data were collected from medical records. Results Median time from surgery to radiotherapy initiation was 45 days; 15 participants began after 42 days. Process delays and failure to communicate the urgency and significance of PORT initiation contributes to delays. Patients with a strong social support system experience less delays. Conclusions Achieving reductions in PORT initiation requires efficient care coordination, improved communication between interdisciplinary teams, and strengthening social support systems for patients with HNC.

Background Individuals with a history of traumatic brain injury (TBI) report fewer social contacts, less social participation, and more social isolation than noninjured peers. Cognitive-communication disabilities may prevent individuals with TBI from accessing the opportunities for social connection afforded by computer-mediated communication, as individuals with TBI report lower overall usage of social media than noninjured peers and substantial challenges with accessibility and usability. Although adaptations for individuals with motor and sensory impairments exist to support social media use, there have been no parallel advances to support individuals with cognitive disabilities, such as those exhibited by some people with TBI. In this study, we take a preliminary step in the development process by learning more about patterns of social media use in individuals with TBI as well as their input and priorities for developing social media adaptations. Objective This study aims to characterize how and why adults with TBI use social media and computer-mediated communication platforms, to evaluate changes in computer-mediated communication after brain injury, and to elicit suggestions from individuals with TBI to improve access to social media after injury. Methods We conducted a web-based survey of 53 individuals with a chronic history of moderate-to-severe TBI and a demographically matched group of 51 noninjured comparison peers. Results More than 90% of participants in both groups had an account on at least one computer-mediated communication platform, with Facebook and Facebook Messenger being the most popular platforms in both groups. Participants with and without a history of TBI reported that they use Facebook more passively than actively and reported that they most frequently maintain web-based relationships with close friends and family members. However, participants with TBI reported less frequently than noninjured comparison participants that they use synchronous videoconferencing platforms, are connected with acquaintances on the web, or use social media as a gateway for offline social connection (eg, to find events). Of the participants with TBI, 23% (12/53) reported a change in their patterns of social media use caused by brain injury and listed concerns about accessibility, safety, and usability as major barriers. Conclusions Although individuals with TBI maintain social media accounts to the same extent as healthy comparisons, some may not use them in a way that promotes social connection. Thus, it is important to design social media adaptations that address the needs and priorities of individuals with TBI, so they can also reap the benefits of social connectedness offered by these platforms. By considering computer-mediated communication as part of individuals’ broader social health, we may be able to increase web-based participation in a way that is meaningful, positive, and beneficial to broader social life.

Background Clinical practice guidelines recommend active surveillance as the preferred treatment option for low-risk prostate cancer, but only a minority of eligible men receive active surveillance, and practice variation is substantial. The aim of this study is to describe barriers to urologists’ recommendation of active surveillance in low-risk prostate cancer and explore variation of barriers by setting. Methods We conducted semi-structured interviews among 22 practicing urologists, evenly distributed between academic and community practice. We coded barriers to active surveillance according to a conceptual model of determinants of treatment quality to identify potential opportunities for intervention. Results Community and academic urologists were generally in agreement on factors influencing active surveillance. Urologists perceived patient-level factors to have the greatest influence on recommendations, particularly tumor pathology, patient age, and judgements about the patient’s ability to adhere to follow-up protocols. They also noted cross-cutting clinical barriers, including concerns about the adequacy of biopsy samples, inconsistent protocols to guide active surveillance, and side effects of biopsy procedures. Urologists had differing opinions on the impact of environmental factors, such as financial disincentives and fear of litigation. Conclusions Despite national and international recommendations, both academic and community urologists note a variety of barriers to implementing active surveillance in low risk prostate cancer. These barriers will need to be specifically addressed in efforts to help urologists offer active surveillance more consistently.