Dr. Maureen Lyon uses a variety of techniques, interventions, and processes that build on your strengths, so that you can develop the skills necessary to live the life you envision.
Dr. Lyon earned the highest level of credentialing possible for a psychologist from the American Board of Professional Psychology as a Health Psychologist. She is highly skilled in treating individuals with medical illnesses, such as eating disorders and fibromyalgia. She is a Board Member of the Washington Area Society for the Study of Eating Disorders and Obesity, a member of the Multiple Sclerosis Society, as well as other professional organizations.
Dr. Lyon graduated from the American University (AU) in Clinical Psychology in 1990. Her training at AU integrated the use of both cognitive-behavioral and interpersonal psychotherapy techniques.
Dr. Lyon's work as a certified yoga teacher provides an additional perspective on integrating the mind and body for healing. She also has a Masters degree in History. She is a former junior high school teacher of English, History and Science and continue to enjoy providing educational and psychological assessments.
Questions & Answers
Adaptations which could be made:
a. Drop Session 1, the Survey. We do not yet have study results, but my impression is that this could be dropped. Right now we are giving it to everyone at baseline on our newest study. The advantage of this session is it helps to “prime” the participants for the kinds of issues we will be discussing in Session 2. Disadvantage is that it is time consuming and some patients find it “cold.” I do think there needs to be some sort of activity to “break the ice”. As Respecting Choices has implemented the RC Next Step interview (Session 2) into clinical practice for adults, we provide some sort of introduction to the NS interview, for example we have a brochure that describes the NS interview and have provided scripting for the physicians/providers who often introduce NS planning
b. Session 3 where we used the Five Wishes, any advance directive used by the community or hospital could be substituted.
c. Session 2 should stay as is, although there may be specific diseases, such as Duchennes Muscular Dystrophy, where the Statement of Treatment Preferences may be adapted to have situations that are disease specific and most likely to arise at the end of life for teens with that condition. We in fact did adapt the Statement of Treatment Preferences (SOTP)and have an HIV version and a cancer version. Yes in the adult population, we have created several SOTP’s to apply to a specific disease trajectory that would also apply to the adolescent population, for example lung disease (e.g. cystic fibrosis) and neurodegenerative diseases. We have also adapted the SOTP for a different pediatric population, parents with children who have life-limiting illness. The NS interview does not change, but we use a more appropriate SOTP for this pediatric population
Facilitators to implementation – teens want to have a voice and their families want to know what their wishes are, if the worse were to happen. There is a consistent high satisfaction with the NS interview from patients, their families, and healthcare providers. The trained facilitators of the NS interview often comment that this is the most rewarding work they have ever done. Additionally, in clinical practice, physicians/providers feel this intervention assists them in providing improved patient-centered care as they become more aware of the patient’s goals, values, fears, and preferences.
Challenges --“Gatekeepers” may believe that to discuss worse outcome scenarios may take away hope or is inappropriate. For example, in the adult HIV/AIDS study I am conducting on advance care planning, one study site was told by the Chief of the division not to approach anyone under the age of 50 about the study, even though eligibility criteria by age was 21 years. So the idea that these conversations should start from the time of diagnosis or when first ill, which is what patients have told us in surveys and what policy recommendations are, is still not in practice. One of the greatest barriers we see in clinical implementation is the time it takes to train facilitators, and the resources to devote to this 90-minute intervention. It remains a non-reimbursable service, so selecting and recruiting the number of facilitators can be challenging. Additionally, this intervention is a great compliment to the team approach to the management of advanced illness. Therefore, securing commitment from these teams is important, as well as challenging
So depending on the site and practitioners, a grand rounds or lunchtime education about advance care planning and its potential benefits as well as video showing how it is done, can get “buy-in” or begin to change a culture where these conversations usually occur during a medical crisis. The latter is problematic, if the surrogate decision-maker does not know what the patient wants and the patient may not be able to communicate.
I would recommend that practitioners measure congruence in treatment preferences after the advance care planning conversation vs. before (Session 2). Also, can an advance directive be found in the electronic medical record once it is completed (as well as the completed SOTP)? FACE-TC facilitators take responsibility for ensuring that the patient/surrogate dyad has a copy, the treatment physician has an electronic copy and a copy is sent to medical records for scanning into the electronic medical record. Finally, we had a satisfaction questionnaire developed for the study and this could be used as a measure of quality outcome for patients.
a. The implementation plan for Respecting Choices works with practitioners and system-wide implementation strategies.
b. Benchmarks to indicate success could include:
- What percentage of the patients approached agreed to participate? (goal >50%)
- Of those who participate, what percentage attend all 3 sessions (goal would be >80%)? (We had 100% attendance).
- Among those who participate what is the rate of satisfaction on the satisfaction questionnaire with participation? (goal >90% overall satisfaction of patients; >90% overall satisfaction of surrogate decision-makers/legal guardians).
- Of those who participate, what percentage have an advance directive document in the electronic medical record as well as a Statement of Treatment Preferences (goal would be >80%)? (We had 100% ability to find the documents in the electronic medical record).
- Evaluation tools we provided – the Satisfaction Questionnaire. I would also recommend the free questionnaire by Curtis et al. Quality of End of Life Communication, which we adapted for our study with this permission. There are just 5 brief questions rating the facilitator.
4. My current research continues to focus on advance care planning. I currently have two longitudinal, multi-site clinical trials funded by the National Institute of Nursing Research/NIH, which are both focused on advance care planning with persons living with HIV/AIDS. The first is a study with adolescents with HIV/AIDS and the second with adults with HIV/AIDS. To the best of my knowledge these are the first studies to use multi-level model over time to examine the trajectory of congruence in treatment preferences, the impact of spiritual struggle over time on treatment choices and quality of life. We are using the same basic model of intervention as in FACE-TC. They are both registered on ClinicalTrials.gov
a. 1 R01NR012711-05 Longitudinal Pediatric Palliative Care: Quality of Life and Spiritual Struggle
b. 1 R01 NR014-052-03 Palliative Care in People Living with HIV/AIDS: Integrating into the Standard of Care
5. Pending research includes:
a. an R01 submitted to NINR to study FACE-TC using a longitudinal, multi-site design to work with implementing the intervention at two study sites, including a focus on systems issues related to electronic medical records;
b. PCORI application to study hospital wide implementation and comparative effectiveness of FACE vs. Voicing My Choices approaches to advance care planning;
c. An R01 submitted to NINR and NCCAM to study Visual arts in symptom management for teens with cancer, using the family centered approach/structure, we developed for our advance care planning studies, in order to understand the mechanisms underlying visual arts in palliative care.