Kristin McIntire Kennedy

All Publications

• A prospective, observational study of a pediatric affect and cooperation scale (HRAD±) for vascular access procedures. The journal of vascular access Yun, R., Kennedy, K. M., Titzler, J., Ganesan, A., Yamaguchi, C., Zuniga-Hernandez, M., Renavikar, M., Brinda, R., Jackson, C., Rohovit, S., Caruso, T. J. 2024: 11297298241302897

  Abstract

  Anxiety is common in pediatric patients, especially during vascular access procedures. Most well-studied affect and anxiety scales, including the Observation Scale of Behavioral Distress-Revised (OSBD-r), the modified Yale Preoperative Anxiety Scale (mYPAS), and the modified Induction Compliance Checklist (mICC), are too cumbersome for clinical use outside of research settings. HRAD± (Happy, Relaxed, Anxious, Distressed with yes/no to cooperation) is a clinically-efficient observational scale that evaluates pediatric procedural affect and cooperation. This study examined the clinical utility of HRAD± during vascular access procedures in children. The aims were to investigate the correlation of HRAD± to highly reliable, research-based affect and cooperation scales and to assess inter-rater reliability (IRR) between observers in this setting.This was a prospective, observational study conducted at Lucile Packard Children's Hospital Stanford. Inpatient participants were 1 month to 25 years old and undergoing a peripheral intravenous insertion or phlebotomy. Two trained research assistants (RAs) scored each patient independently during the vascular access procedure using HRAD±, OSBD-r, mYPAS, and mICC. Correlation analyses computed the associations between HRAD± and reference scales. IRR between RAs and vascular access providers was calculated using Fleiss' Kappa.A total of 234 patients were included. HRAD± scores strongly correlated with OSBD-r and mYPAS (p < 0.0001, p < 0.0001, respectively). The cooperation assessment of HRAD± demonstrated strong correlation to mICC (p < 0.0001). IRR of HRAD± between research assistants and vascular access providers showed moderate agreement (p < 0.0001).HRAD± demonstrated strong correlation to the reference affect and cooperation scales. This study supports the utility of HRAD± for rapid assessment of pediatric procedural anxiety and cooperation during vascular access procedures. HRAD± can serve as a practical tool for facilitating clinical decisions, and its wider incorporation into healthcare settings would importantly guide targeted interventions to reduce patient anxiety.

  View details for DOI 10.1177/11297298241302897

  View details for PubMedID 39639512

• "Treatable not curable": trade-offs in the use of treatment-oriented language with patients who have incurable cancer. The oncologist Batten, J. N., Kennedy, K. M., Wong, B. O., Kraft, S. A., Hanks, W., Magnus, D., Schapira, L. 2024

  Abstract

  Treatment-oriented language is used by physicians to convey to patients that treatment is available for their cancer (eg, "our usual treatment for this is," "we can treat this," "your cancer is still treatable"). For patients who have incurable cancer, especially for patients with a poor prognosis or who are at the end of life, it is important to understand how physicians conceptualize and use this "everyday" clinical language. We conducted a qualitative interview study with a multidisciplinary group of physicians (n = 30) who may care for patients with cancer at different points in their clinical course, from diagnosis to end of life. Physicians report a wide range of reasons for using treatment-oriented language in conversations with patients who have incurable cancer. However, physicians also reported concerns that this language can be ambiguous, can convey unintended positive prognostic information, and can shift attention away from important matters such as the non-curative nature of treatment or the inevitability of death. On the basis of these concerns, physicians should (1) consider whether their aims in using treatment-oriented language can be better achieved using other evidence-based communication strategies, and (2) recognize and proactively mitigate potential adverse effects of treatment-oriented language, which may manifest much later in the patient's clinical course.

  View details for DOI 10.1093/oncolo/oyae296

  View details for PubMedID 39541263

• A technology acceptance model to predict anesthesiologists' clinical adoption of virtual reality. Journal of clinical anesthesia Wang, E. Y., Kennedy, K. M., Zhang, L., Zuniga-Hernandez, M., Titzler, J., Li, B. S., Arshad, F., Khoury, M., Caruso, T. J. 2024; 98: 111595

  Abstract

  Virtual reality (VR) is a novel tool with demonstrated applications within healthcare; however its integration within clinical practice has been slow. Adoption patterns can be evaluated using a technology acceptance model (TAM). The primary study aim was to use VR TAM to assess factors that influence anesthesiologists' acceptance of VR for preoperative anxiolysis. The secondary aim assessed the model's reliability.109 clinical anesthesiologists at Stanford were exposed to a VR application developed as a distraction tool to reduce preoperative patient anxiety. Anesthesiologists were surveyed about their attitudes, beliefs, and behaviors as predictors of their likelihood to clinically use VR. The primary outcome assessed predictive validity using descriptive statistics, construct validity using confirmatory factor analysis, and standardized estimates of model relationships. The secondary outcome assessed reliability with Cronbach's α and composite reliability.Construct validity and reliability was assessed, where all values established acceptable fit and reliability. Hypothesized predictors of consumer use were evaluated with standardized estimates, looking at perceptions of usefulness, ease of use, and enjoyment in predicting attitudes and intentions toward using and purchasing. Past use and price willing to pay did not predict perceived usefulness. Participants in lower age ranges had higher levels of perceived ease of use than those >55 years.All confirmatory factor analysis testing for construct validity had good fit. Perceptions of usefulness and enjoyment predicted an anesthesiologist's attitude toward using and intention to purchase, while perceived ease of use predicted perceived usefulness and enjoyment, attitude toward purchasing and using, and intention to use. Past use and price willing to pay did not influence perceptions of usefulness. Lower age predicted greater perceived ease of use. All scales in the model demonstrated acceptable reliability. With good validity and reliability, the VR-TAM model demonstrated factors predictive of anesthesiologist's intentions to integrate VR into clinical settings.

  View details for DOI 10.1016/j.jclinane.2024.111595

  View details for PubMedID 39213811

• Predicting pediatric healthcare provider use of virtual reality using a technology acceptance model. JAMIA open Wang, E. Y., Kennedy, K. M., Zhang, L., Qian, D., Forbes, T., Zuniga-Hernandez, M., Li, B. S., Domingue, B., Caruso, T. J. 2023; 6 (3): ooad076

  Abstract

  The primary aim of this study was to apply a novel technology acceptance model (TAM) for virtual reality (VR) in healthcare. The secondary aim was to assess reliability of this model to evaluate factors that predict the intentions of pediatric health providers' use of VR as an anxiolytic for hospitalized pediatric patients.Healthcare providers that interacted with pediatric patients participated in a VR experience available as anxiolysis for minor procedures and then completed a survey evaluating attitudes, behaviors, and technology factors that influence adoption of new technologies.Reliability for all domain measurements were good, and all confirmatory factor analysis models demonstrated good fit. Usefulness, ease of use, curiosity, and enjoyment of the VR experience all strongly predict intention to use and purchase VR technologies. Age of providers, past use, and cost of technology did not influence future purchase or use, suggesting that VR technologies may be broadly adopted in the pediatric healthcare setting.Previous VR-TAM models in non-healthcare consumers formulated that age, past use, price willing to pay, and curiosity impacted perceived ease of use. This study established that age, past use, and cost may not influence use in healthcare. Future studies should be directed at evaluating the social influences and facilitating conditions within healthcare that play a larger influence on technology adoption.The VR-TAM model demonstrated validity and reliability for predicting intent to use VR in a pediatric hospital.

  View details for DOI 10.1093/jamiaopen/ooad076

  View details for PubMedID 37693368

  View details for PubMedCentralID PMC10483581

• Assessing Pediatric Perioperative Affect: A Concise Review of Research and Clinically Relevant Scales. Paediatric anaesthesia Yun, R., Hess, O., Kennedy, K., Stricker, P. A., Blake, L., Caruso, T. J. 2022

  View details for DOI 10.1111/pan.14568

  View details for PubMedID 36178764

• Exploration of Clinician Perspectives on Multidisciplinary Tumor Board Function Beyond Clinical Decision-making. JAMA oncology Wong, B. O., Blythe, J. A., Wu, A., Batten, J. N., Kennedy, K. M., Kouaho, A. S., Wren, S. M. 2022

  View details for DOI 10.1001/jamaoncol.2022.1763

  View details for PubMedID 35653129

• Perioperative Pediatric Anxiety: A Cry for Universal Scale Adoption. Pediatric quality & safety Yun, R., Kennedy, K. M., Caruso, T. J. 2022; 7 (2): e542

  View details for DOI 10.1097/pq9.0000000000000542

  View details for PubMedID 35369415

• Development and assessment of an efficient pediatric affect and cooperation scale. Journal of clinical anesthesia Kennedy, K., Wang, E., Rodriguez, S. T., Qian, J., Khoury, M., Kist, M. N., Jackson, C., Yun, R., Caruso, T. J. 2021; 76: 110569

  Abstract

  STUDY OBJECTIVE: HRAD± was developed to quickly evaluate pediatric preprocedural affect and cooperativity during mask induction of anesthesia and peripheral intravenous (PIV) placement. HRAD± represents: Happy, Relaxed, Anxious, Distressed, with a yes/no answer to cooperativity. The primary aim of this study was to compare HRAD± to previously published scales.DESIGN: We conducted an observational study.SETTING: Videos of pediatric patients were collected in the perioperative environment.PATIENTS: Twenty-four children, twenty-one pediatric anesthesiologists and twenty pediatric perioperative providers were included.INTERVENTIONS: To assess the reliability of HRAD±, standard patient videos were created. Children underwent mask induction or PIV placement, and these interventions were video recorded. Mask induction and PIV placement videos were rated by pediatric anesthesiologists and perioperative non-physician providers respectively using HRAD±.MEASUREMENTS: Two trained researchers provided the modified Yale Preoperative Anxiety Scale (mYPAS), Observation Scale of Behavioral Distress (OSBD), and Induction Compliance Checklist (ICC) scores, and we calculated correlations to HRAD±, inter-rater reliability, and intra-rater reliability.MAIN RESULTS: HRAD± scores strongly correlated with mYPAS (r=0.846, p<0.0001) and OSBD scores (r=0.723, p<0.0001). Cooperativity scores correlated strongly with ICC scores in the mask induction group (r=-0.715, p<0.0001) and in the PIV group (r=-0.869, p<0.0001). HRAD± inter-rater reliability for mask induction was 0.414 (p<0.0001) and for PIV assessment was 0.378 (p<0.0001). Inter-rater reliability for cooperativity on mask induction was 0.797 (p<0.0001) and PIV assessment was 0.683 (p<0.0001). Intra-rater reliability for mask induction was 0.675 and PIV assessments was 0.678. Intra-rater reliability for cooperativity for mask induction was 0.894 and for PIV assessments was 0.765.CONCLUSIONS: HRAD± is an efficient and reliable scale that serves as a practical alternative for measuring pediatric affect during mask induction and PIV placement. The results demonstrate strong correlation with commonly utilized yet more complex affect scales.

  View details for DOI 10.1016/j.jclinane.2021.110569

  View details for PubMedID 34739949

• Development and Validation of an Efficient Pediatric Affect Scale Kennedy, K. M., Khoury, M., Kist, M., Wang, E., Rodriguez, S., Jackson, C., Yuan, J. C., Caruso, T. LIPPINCOTT WILLIAMS & WILKINS. 2021: 751-752

  View details for Web of Science ID 000752526600326

• Virtual reality for pediatric periprocedural care. Current opinion in anaesthesiology Wang, E. n., Thomas, J. J., Rodriguez, S. T., Kennedy, K. M., Caruso, T. J. 2021; 34 (3): 284–91

  Abstract

  Commercial availability of virtual reality headsets and software has exponentially grown over the last decade as it has become more sophisticated, less expensive, and portable. Although primarily used by the general public for entertainment, virtual reality has been adopted by periprocedural clinicians to improve patient experiences and treatments. The purpose of this review is to explore recently reported evidence for virtual reality effectiveness for pediatric periprocedural care and discuss considerations for clinical implementation.In the preprocedure setting, practitioners use virtual reality to introduce children to periprocedural environments, distract attention from preprocedural vascular access, and increase cooperation with anesthesia induction. Intraprocedure, virtual reality decreases sedation requirements, and in some instances, eliminates anesthesia for minor procedures. Virtual reality also augments pain reduction therapies in the acute and extended rehabilitation periods, resulting in faster recovery and improved outcomes. Virtual reality seems to be well treated for pediatric use, given close clinical care and carefully curated content.Given the multiple clinical applications of virtual reality to supplement pediatric periprocedural care, practitioners should consider developing clinical programs that reliably provide access to virtual reality. Future research should focus on identification of patient characteristics and types of software that yield optimal patient outcomes.

  View details for DOI 10.1097/ACO.0000000000000983

  View details for PubMedID 33935176

• META-ANALYSIS OF SURVIVAL TRENDS IN GLIOBLASTOMA IN TEMOZOLOMIDE TREATED PATIENTS FROM 2004 TO 2016: NO EVIDENCE FOR INCREASE IN SURVIVAL BENEFIT OVER TIME McIntire, K., Wong, A. OXFORD UNIV PRESS INC. 2017: 108

  View details for Web of Science ID 000415152502052