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Nash SH, Dilley J, Siekaniec C, O'Brien D, Avila R, Quinn J. Needs assessment of cancer survivors in Alaska. Cancer Causes Control 2022; 33:1453-1463. [PMID: 36183311 PMCID: PMC9526813 DOI: 10.1007/s10552-022-01636-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Accepted: 09/21/2022] [Indexed: 11/25/2022]
Abstract
Purpose Little is known about cancer survivors’ needs in Alaska. To address this knowledge gap, the Alaska Cancer Partnership conducted a needs assessment survey; our objectives were to identify unmet needs of Alaska’s cancer survivors; identify survivor sub-populations that might benefit from targeted interventions or programming; and develop recommendations for public health and community organizations and healthcare providers for addressing cancer survivors’ unmet needs. Methods Cancer survivors were identified using data from the Alaska Cancer Registry. A random sample of 2,600 individuals was selected to receive the survey, which assessed unmet needs across the following domains: information needs and medical care issues; quality of life; emotional and relationship issues related to cancer diagnoses; and support services. We calculated descriptive statistics for survey responses and assessed demographic predictors of unmet needs using Poisson regression. Results We received 335 survey responses, for a response of 13.7%. Only 29.9% of cancer survivors expressed that all their needs were met. The most highly ranked unmet needs were as follows: help to reduce stress in life; to know doctors were coordinating care; and managing concerns about cancer coming back. After adjustment, men, adults younger than 65 at diagnosis, Alaska Native people, survivors still receiving or who had recently received care, and people who had to travel 50+ miles for most of their care had significantly greater unmet needs than their comparison groups. Conclusion This assessment provided some of the first information regarding the needs of Alaska’s cancer survivors. These results will be used by Alaska Cancer Partnership members across the state to inform healthcare delivery, programs, and public health messaging to support survivors.
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Affiliation(s)
- Sarah H Nash
- Community Health Services, Alaska Native Tribal Health Consortium, Anchorage, AK, USA.
- Department of Epidemiology, University of Iowa, 145 N Riverside Drive, Iowa, IA, 52242, USA.
| | - Julia Dilley
- Multnomah County and Oregon Health Authority, Public Health Division, Program Design and Evaluation Services (PDES), Portland, OR, USA
| | - Claire Siekaniec
- Community Health Services, Alaska Native Tribal Health Consortium, Anchorage, AK, USA
| | - David O'Brien
- State of Alaska, Division of Public Health, Health Analytics and Vital Records Section, Anchorage, AK, USA
| | - Rosa Avila
- State of Alaska, Division of Public Health, Health Analytics and Vital Records Section, Anchorage, AK, USA
| | - Jessica Quinn
- State of Alaska, Division of Public Health, Section of Chronic Disease Prevention and Health Promotion, Anchorage, AK, USA
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Gough K, Bergin RJ, Drosdowsky A, Aranda S, Mileshkin L, Jackson M, Kinnane N, Bernshaw D, Juraskova I, White K, Mohamed M, Schofield P. Women with gynaecological cancer awaiting radiotherapy: Self-reported wellbeing, general psychological distress, symptom distress, sexual function, and supportive care needs. Gynecol Oncol 2022; 167:42-50. [PMID: 36064679 DOI: 10.1016/j.ygyno.2022.08.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Revised: 08/04/2022] [Accepted: 08/08/2022] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To better serve women with gynaecological cancers, we need a sound understanding of their health, wellbeing and needs. This study sought to explore these issues in a sample of Australian women before commencing curative radiotherapy. METHODS We undertook a secondary analysis of baseline data from a supportive care trial (n = 311). Descriptive statistics were used to summarise responses to measures of wellbeing, general psychological distress, symptom distress, sexual function and vaginal changes, and supportive care needs. Pre-specified regression models were used to examine sources of variation in wellbeing and sexual function. RESULTS Women reported lower emotional, functional and physical wellbeing than population norms (all p < 0.001). The prevalence of general psychological distress was 31% (95% CI 26-36%). Distress caused by physical symptoms was typically low. Health system and information needs comprised eight of the top ten moderate-to-high supportive care needs. Most women reported no change in interest for physical contact or sex compared to pre-diagnosis, but some sexually active women (16-24%) reported smaller vaginal size, increased dryness, and more pain on intercourse. General psychological distress was a robust marker of poorer wellbeing and sexual function. CONCLUSIONS Before radiotherapy, a substantial minority of women with gynaecological cancers experience general psychological distress, reduced wellbeing and moderate-to-high health system and information needs. A model of comprehensive care incorporating assessment of unmet needs, general psychological distress, and sexual issues is recommended. Healthcare providers may require training to elicit and respond to a constellation of interrelated issues and access relevant services for women requiring additional support.
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Affiliation(s)
- Karla Gough
- Department of Health Services Research, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia; Department of Nursing, Faculty of Medicine, Dentistry, and Health Sciences, University of Melbourne, Parkville, VIC 3052, Australia.
| | - Rebecca Jane Bergin
- Department of Health Services Research, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia; Cancer Epidemiology Division, Cancer Council Victoria, 615 St Kilda Road, Melbourne, Victoria, Australia; Department of General Practice and Centre for Cancer Research, The University of Melbourne, Parkville, Victoria, Australia
| | - Allison Drosdowsky
- Department of Health Services Research, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Sanchia Aranda
- Department of Health Services Research, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia; Department of Nursing, Faculty of Medicine, Dentistry, and Health Sciences, University of Melbourne, Parkville, VIC 3052, Australia
| | - Linda Mileshkin
- Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia; Sir Peter MacCallum Department of Oncology, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Parkville, Victoria, Australia
| | - Michael Jackson
- School of Clinical Medicine, Randwick Campus, UNSW Sydney, New South Wales, Australia
| | - Nicole Kinnane
- Gynaecology Services, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - David Bernshaw
- Department of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Ilona Juraskova
- Centre of Medical Psychology and Evidence-based Decision-making (CeMPED), School of Psychology, The University of Sydney, Camperdown, New South Wales, Australia
| | - Kate White
- Susan Wakil School of Nursing and Midwifery, The University of Sydney, Camperdown, New South Wales, Australia; Cancer Care Research Unit, Sydney Local Health District, New South Wales, Australia; The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council, New South Wales, Australia
| | - Mustafa Mohamed
- Department of Health Services Research, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Penelope Schofield
- Department of Health Services Research, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia; Sir Peter MacCallum Department of Oncology, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Parkville, Victoria, Australia; Department of Psychological Sciences, Iverson Health Innovation Research Institute, Swinburne University of Technology, Hawthorn, Victoria, Australia
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Nassiri AM, Saoji AA, DeJong MD, Tombers NM, Driscoll CLW, Neff BA, Haynes DS, Carlson ML. Implementation Strategy for Highly-Coordinated Cochlear Implant Care With Remote Programming: The Complete Cochlear Implant Care Model. Otol Neurotol 2022; 43:e916-e923. [PMID: 35970171 PMCID: PMC9394487 DOI: 10.1097/mao.0000000000003644] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To introduce and discuss implementation strategy for the Complete Cochlear Implant Care (CCIC) model, a highly-coordinated cochlear implant (CI) care delivery model requiring a single on-site visit for preoperative workup, surgery, and postoperative programming. STUDY DESIGN Prospective, nonrandomized, two-arm clinical trial. SETTING Tertiary referral CI center. PATIENTS Adults who meet audiologic criteria for cochlear implantation. INTERVENTIONS Cochlear implantation, coordinated care delivery, including remote programming. MAIN OUTCOME MEASURES Care delivery model feasibility and process implementation. RESULTS Patients determined to be likely CI candidates based on routine audiometry are eligible for enrollment. The CCIC model uses telemedicine and electronic educational materials to prepare patients for same-day on-site consultation with CI surgery, same or next-day activation, and postoperative remote programming for 12 months. Implementation challenges include overcoming inertia related to the implementation of a new clinical workflow, whereas scalability of the CCIC model is limited by current hardware requirements for remote programming technology. A dedicated CCIC process coordinator is critical for overcoming obstacles in implementation and process improvement through feedback and iterative changes. Team and patient-facing materials are included and should be tailored to fit each unique CI program looking to implement CCIC. CONCLUSION The CCIC model has the potential to dramatically streamline hearing healthcare delivery. Implementation requires an adaptive approach, as obstacles may vary according to institutional infrastructure and policies.
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Affiliation(s)
- Ashley M. Nassiri
- Department of Otolaryngology—Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota
| | - Aniket A. Saoji
- Department of Otolaryngology—Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota
| | - Melissa D. DeJong
- Department of Otolaryngology—Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota
| | - Nicole M. Tombers
- Department of Otolaryngology—Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota
| | - Colin L. W. Driscoll
- Department of Otolaryngology—Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota
| | - Brian A. Neff
- Department of Otolaryngology—Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota
| | - David S. Haynes
- Department of Otolaryngology—Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Matthew L. Carlson
- Department of Otolaryngology—Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota
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Zhang Y, Mezzacappa C, Shen L, Ivatorov A, Petukhova-Greenstein A, Mehta R, Ciarleglio M, Deng Y, Levin W, Steinhardt S, Connery D, Pineau M, Onyiuke I, Taylor C, Rose MG, Taddei TH. Cancer tracking system improves timeliness of liver cancer care at a Veterans Hospital: A comparison of cohorts before and after implementation of an automated care coordination tool. PLOS DIGITAL HEALTH 2022; 1:e0000080. [PMID: 36812575 PMCID: PMC9931271 DOI: 10.1371/journal.pdig.0000080] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Accepted: 06/26/2022] [Indexed: 12/24/2022]
Abstract
INTRODUCTION Hepatocellular carcinoma (HCC) requires complex care coordination. Patient safety may be compromised with untimely follow-up of abnormal liver imaging. This study evaluated whether an electronic case-finding and tracking system improved timeliness of HCC care. METHODS An electronic medical record-linked abnormal imaging identification and tracking system was implemented at a Veterans Affairs Hospital. This system reviews all liver radiology reports, generates a queue of abnormal cases for review, and maintains a queue of cancer care events with due dates and automated reminders. This is a pre-/post-intervention cohort study to evaluate whether implementation of this tracking system reduced time between HCC diagnosis and treatment and time between first liver image suspicious for HCC, specialty care, diagnosis, and treatment at a Veterans Hospital. Patients diagnosed with HCC in the 37 months before tracking system implementation were compared to patients diagnosed with HCC in the 71 months after its implementation. Linear regression was used to calculate mean change in relevant intervals of care adjusted for age, race, ethnicity, BCLC stage, and indication for first suspicious image. RESULTS There were 60 patients pre-intervention and 127 post-intervention. In the post-intervention group, adjusted mean time from diagnosis to treatment was 36 days shorter (p = 0.007), time from imaging to diagnosis 51 days shorter (p = 0.21), and time from imaging to treatment 87 days shorter (p = 0.05). Patients whose imaging was performed for HCC screening had the greatest improvement in time from diagnosis to treatment (63 days, p = 0.02) and from first suspicious image to treatment (179 days, p = 0.03). The post-intervention group also had a greater proportion of HCC diagnosed at earlier BCLC stages (p<0.03). CONCLUSIONS The tracking system improved timeliness of HCC diagnosis and treatment and may be useful for improving HCC care delivery, including in health systems already implementing HCC screening.
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Affiliation(s)
- Yapei Zhang
- Department of Medicine, Yale School of Medicine, New Haven, Connecticut, United States of America
- Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Catherine Mezzacappa
- Department of Medicine, Yale School of Medicine, New Haven, Connecticut, United States of America
| | - Lin Shen
- Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts, United States of America
| | - Amanda Ivatorov
- Yale University, New Haven, Connecticut, United States of America
| | - Alexandra Petukhova-Greenstein
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, Connecticut, United States of America
- Institute of Radiology, Charité Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität, and Berlin Institute of Health, Berlin, Germany
| | - Rajni Mehta
- VA Connecticut Healthcare System, West Haven, Connecticut, United States of America
| | - Maria Ciarleglio
- Yale Center for Analytical Sciences, Yale School of Public Health, New Haven, Connecticut, United States of America
| | - Yanhong Deng
- Yale Center for Analytical Sciences, Yale School of Public Health, New Haven, Connecticut, United States of America
| | - Woody Levin
- VA Connecticut Healthcare System, West Haven, Connecticut, United States of America
| | - Steve Steinhardt
- VA Connecticut Healthcare System, West Haven, Connecticut, United States of America
| | - Donna Connery
- VA Connecticut Healthcare System, West Haven, Connecticut, United States of America
| | - Michael Pineau
- VA Connecticut Healthcare System, West Haven, Connecticut, United States of America
| | - Ifeyinwa Onyiuke
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, Connecticut, United States of America
- VA Connecticut Healthcare System, West Haven, Connecticut, United States of America
| | - Caroline Taylor
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, Connecticut, United States of America
- VA Connecticut Healthcare System, West Haven, Connecticut, United States of America
| | - Michal G. Rose
- Department of Medicine, Yale School of Medicine, New Haven, Connecticut, United States of America
- VA Connecticut Healthcare System, West Haven, Connecticut, United States of America
| | - Tamar H. Taddei
- Department of Medicine, Yale School of Medicine, New Haven, Connecticut, United States of America
- VA Connecticut Healthcare System, West Haven, Connecticut, United States of America
- * E-mail:
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Hinds S, Miller J, Maccani M, Patino S, Kaushal S, Rieck H, Walker M, Brummett CM, Bicket MC, Waljee JF. Patient risk screening to improve transitions of care in surgical opioid prescribing: a qualitative study of provider perspectives. Reg Anesth Pain Med 2022; 47:475-483. [PMID: 35697386 PMCID: PMC9240329 DOI: 10.1136/rapm-2021-103304] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2021] [Accepted: 05/12/2022] [Indexed: 11/10/2022]
Abstract
Introduction In patients undergoing surgical procedures, transitions in opioid prescribing occur across multiple providers during the months before and after surgery. These transitions often result in high-risk and uncoordinated prescribing practices, especially for surgical patients with prior opioid exposure. However, perspectives of relevant providers about screening and care coordination to address these risks are unknown. Methods We conducted qualitative interviews with 24 surgery, primary care, and anesthesia providers in Michigan regarding behaviors and attitudes about screening surgical patients to inform perioperative opioid prescribing in relation to transitions of care. We used an interpretive description framework to topically code interview transcripts and synthesize underlying themes in analytical memos. Results Providers believed that coordinated, multidisciplinary approaches to identify patients at risk of poor pain and opioid-related outcomes could improve transitions of care for surgical opioid prescribing. Anesthesia and primary care providers saw value in knowing patients’ preoperative risk related to opioid use, while surgeons’ perceptions varied widely. Across specialties, most providers favored a screening tool if coupled with actionable recommendations, sufficient resources, and facilitated coordination between specialties. Providers identified a lack of pain specialists and a dearth of actionable guidelines to direct interventions for patients at high opioid-related risk as major limitations to the value of patient screening. Discussion These findings provide context to address risk from prescription opioids in surgical transitions of care, which should include identifying high-risk patients, implementing a coordinated plan, and emphasizing actionable recommendations.
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Affiliation(s)
- Shelby Hinds
- Department of Anesthesia, University of Michigan Michigan Medicine, Ann Arbor, Michigan, USA
| | - Jacquelyn Miller
- Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor, Michigan, USA
- Michigan Opioid Prescribing Engagement Network, University of Michigan, Ann Arbor, Michigan, USA
| | - Merissa Maccani
- Michigan Opioid Prescribing Engagement Network, University of Michigan, Ann Arbor, Michigan, USA
| | - Sarah Patino
- University of Michigan School of Public Health, Ann Arbor, Michigan, USA
| | - Shivani Kaushal
- Michigan Opioid Prescribing Engagement Network, University of Michigan, Ann Arbor, Michigan, USA
| | - Heidi Rieck
- Michigan Opioid Prescribing Engagement Network, University of Michigan, Ann Arbor, Michigan, USA
| | - Monica Walker
- Michigan Opioid Prescribing Engagement Network, University of Michigan, Ann Arbor, Michigan, USA
| | - Chad M Brummett
- Department of Anesthesia, University of Michigan Michigan Medicine, Ann Arbor, Michigan, USA
- Michigan Opioid Prescribing Engagement Network, University of Michigan, Ann Arbor, Michigan, USA
| | - Mark C Bicket
- Department of Anesthesia, University of Michigan Michigan Medicine, Ann Arbor, Michigan, USA
- Michigan Opioid Prescribing Engagement Network, University of Michigan, Ann Arbor, Michigan, USA
| | - Jennifer F Waljee
- Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor, Michigan, USA
- Michigan Opioid Prescribing Engagement Network, University of Michigan, Ann Arbor, Michigan, USA
- Department of Surgery, University of Michigan Michigan Medicine, Ann Arbor, Michigan, USA
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Lefkowitz D. Black boxes and information pathways: An actor-network theory approach to breast cancer survivorship care. Soc Sci Med 2022; 307:115184. [PMID: 35853317 PMCID: PMC10403999 DOI: 10.1016/j.socscimed.2022.115184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Revised: 06/06/2022] [Accepted: 06/26/2022] [Indexed: 11/24/2022]
Abstract
Many women diagnosed with breast cancer today can expect to live long after completing their treatment. This growing population of survivors encounters distinct post-treatment health and information needs. Existing survivorship care models take information as a given, black boxing it. I use Actor-Network Theory to examine how information actually works for women after they complete breast cancer treatment, and how it shapes their understanding of survivorship. I draw on in-depth interviews with breast cancer survivors (n = 82) and a wide range of providers (n = 84) in a medically underserved region of Southern California. Black boxes and information pathways convey experiential dimensions of cancer care; they are also metaphoric constructs. The black box metaphor refers to the cancer experience as a container; the pathways metaphor refers to a journey. Each of these metaphors expresses salient dimensions of the cancer experience and has implications for post-treatment survivorship. When healthcare information flows smoothly and invisibly, its pathways become black boxed. Black boxes can be helpful when they function effectively. But since black boxes conceal their inner workings, it is challenging to intervene when difficulties arise. I provide three examples of difficulties that complicate women's transition to post-treatment survivorship: (1) when survivors fail to recognize treatment-related late effects, (2) do not understand they have a terminal diagnosis, or (3) worry that their treatment accomplished nothing. Contextualized within survivorship scholarship, this study recommends opening black boxes to examine how information pathways could connect women differently to improve survivorship care.
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Affiliation(s)
- Deborah Lefkowitz
- Center for Social Innovation, School of Public Policy, University of California, Riverside, CA, USA; School of Nursing, University of Victoria, Victoria, BC, Canada.
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Paluch J, Kohr J, Squires A, Loving V. Patient-centered Care and Integrated Practice Units: Embracing the Breast Care Continuum. JOURNAL OF BREAST IMAGING 2022; 4:413-422. [PMID: 38416987 DOI: 10.1093/jbi/wbac031] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Indexed: 03/01/2024]
Abstract
Patient-centered care is a health care approach optimized for the needs of the patient. As patients have sought more autonomy in recent years, this model has been more frequently adopted. Breast radiologists aspiring to advance patient-centered care should seek greater ownership of the breast diagnostic imaging and intervention workflows, helping their patients navigate the complex breast care landscape with patients' preferences taken into account. Applying this approach to breast radiology will increase patient satisfaction and compliance while also limiting wasted health care dollars, unnecessary diagnostic delays, and overall confusion. Herein, the benefits of patient-centered breast radiology are discussed, and numerous suggestions and case examples are provided to help readers reshape their practice toward the priorities of their patients.
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Affiliation(s)
- Jeremy Paluch
- Virginia Mason Medical Center, Department of Radiology, Seattle, WA, USA
| | - Jennifer Kohr
- Virginia Mason Medical Center, Department of Radiology, Seattle, WA, USA
| | | | - Vilert Loving
- Banner MD Anderson Cancer Center, Division of Diagnostic Imaging, Gilbert, AZ, USA
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Dyer SM, Suen J, Williams H, Inacio MC, Harvey G, Roder D, Wesselingh S, Kellie A, Crotty M, Caughey GE. Impact of relational continuity of primary care in aged care: a systematic review. BMC Geriatr 2022; 22:579. [PMID: 35836118 PMCID: PMC9281225 DOI: 10.1186/s12877-022-03131-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Accepted: 05/06/2022] [Indexed: 11/21/2022] Open
Abstract
Background Greater continuity of care has been associated with lower hospital admissions and patient mortality. This systematic review aims to examine the impact of relational continuity between primary care professionals and older people receiving aged care services, in residential or home care settings, on health care resource use and person-centred outcomes. Methods Systematic review of five databases, four trial registries and three grey literature sources to October 2020. Included studies (a) aimed to increase relational continuity with a primary care professional, (b) focused on older people receiving aged care services (c) included a comparator and (d) reported outcomes of health care resource use, quality of life, activities of daily living, mortality, falls or satisfaction. Cochrane Collaboration or Joanna Briggs Institute criteria were used to assess risk of bias and GRADE criteria to rate confidence in evidence and conclusions. Results Heterogeneity in study cohorts, settings and outcome measurement in the five included studies (one randomised) precluded meta-analysis. None examined relational continuity exclusively with non-physician providers. Higher relational continuity with a primary care physician probably reduces hospital admissions (moderate certainty evidence; high versus low continuity hazard ratio (HR) 0.94; 95% confidence interval (CI) 0.92–0.96, n = 178,686; incidence rate ratio (IRR) 0.99, 95%CI 0.76–1.27, n = 246) and emergency department (ED) presentations (moderate certainty evidence; high versus low continuity HR 0.90, 95%CI 0.89–0.92, n = 178,686; IRR 0.91, 95%CI 0.72–1.15, n = 246) for older community-dwelling aged care recipients. The benefit of providing on-site primary care for relational continuity in residential settings is uncertain (low certainty evidence, 2 studies, n = 2,468 plus 15 care homes); whilst there are probably lower hospitalisations and may be fewer ED presentations, there may also be an increase in reported mortality and falls. The benefit of general practitioners’ visits during hospital admission is uncertain (very low certainty evidence, 1 study, n = 335). Conclusion Greater relational continuity with a primary care physician probably reduces hospitalisations and ED presentations for community-dwelling aged care recipients, thus policy initiatives that increase continuity may have cost offsets. Further studies of approaches to increase relational continuity of primary care within aged care, particularly in residential settings, are needed. Review registration CRD42021215698. Supplementary Information The online version contains supplementary material available at 10.1186/s12877-022-03131-2.
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Affiliation(s)
- Suzanne M Dyer
- Flinders Health and Medical Research Institute, Flinders University, Adelaide, Australia.
| | - Jenni Suen
- Flinders Health and Medical Research Institute, Flinders University, Adelaide, Australia
| | | | - Maria C Inacio
- Registry of Senior Australians, South Australian Health and Medical Research Institute, Adelaide, Australia.,Allied Health and Human Performance, University of South Australia, Adelaide, Australia
| | - Gillian Harvey
- College of Nursing and Health Sciences, Flinders University, Adelaide, Australia
| | - David Roder
- Allied Health and Human Performance, University of South Australia, Adelaide, Australia.,South Australian Health and Medical Research Institute, Adelaide, Australia
| | - Steve Wesselingh
- South Australian Health and Medical Research Institute, Adelaide, Australia
| | | | - Maria Crotty
- Flinders Health and Medical Research Institute, Flinders University, Adelaide, Australia
| | - Gillian E Caughey
- Registry of Senior Australians, South Australian Health and Medical Research Institute, Adelaide, Australia.,Allied Health and Human Performance, University of South Australia, Adelaide, Australia
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Okado I, Pagano I, Cassel K, Su'esu'e A, Rhee J, Berenberg J, Holcombe RF. Clinical Research Professional Providing Care Coordination Support: A Study of Hawaii Minority/Underserved NCORP Community Site Trial Participants. JCO Oncol Pract 2022; 18:e1114-e1121. [PMID: 35294261 PMCID: PMC10530402 DOI: 10.1200/op.21.00655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Revised: 12/23/2021] [Accepted: 02/16/2022] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Although effective care coordination (CC) is recognized as a vital component of a patient-centered, high-quality cancer care delivery system, CC experiences of patients who enroll and receive treatment through clinical trials (CTs) are relatively unknown. Using mixed methods, we examined perceptions of CC among patients enrolled onto therapeutic CTs through the Hawaii Minority/Underserved National Cancer Institute Community Oncology Research Program. METHODS The Care Coordination Instrument, a validated instrument, was used to measure patients' perceptions of CC among CT participants (n = 45) and matched controls (n = 45). Paired t-tests were used to compare overall and three CC domain scores (Communication, Navigation, and Operational) between the groups. Semistructured focus group interviews were conducted virtually with 14 CT participants in 2020/2021. RESULTS CT participants reported significantly higher total CC scores than non-CT participants (P = .0008). Similar trends were found for Navigation and Operational domain scores (P = .007 and .001, respectively). Twenty-nine percent of CT participants reported receiving high-intensity CC assistance from their clinical research professionals (CRPs). Content analysis of focus group discussions revealed that nearly half of the focus group discussions centered on CRPs (47%), including CC support provided by CRPs (26%). Other key themes included general CT experiences (22%) and CRP involvement as an additional benefit to CT participation (15%). CONCLUSION Our results show that patients on CTs in this study had a more positive CC experience. This may be attributable in part to CC support provided by CRPs. These findings highlight both the improved experience of treatment for patients participating in a trial and the generally unrecognized yet integral role of CRPs as part of a cancer CT care team.
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Affiliation(s)
- Izumi Okado
- University of Hawaii Cancer Center, Honolulu, HI
| | - Ian Pagano
- University of Hawaii Cancer Center, Honolulu, HI
| | - Kevin Cassel
- University of Hawaii Cancer Center, Honolulu, HI
| | | | - Jessica Rhee
- University of Hawaii Cancer Center, Honolulu, HI
| | | | - Randall F. Holcombe
- University of Hawaii Cancer Center, Honolulu, HI
- Current Affiliation: University of Vermont Cancer Center, Burlington, VT
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Patient and Public Preferences for Coordinated Care in Switzerland: Development of a Discrete Choice Experiment. THE PATIENT - PATIENT-CENTERED OUTCOMES RESEARCH 2022; 15:485-496. [PMID: 35067858 PMCID: PMC9197802 DOI: 10.1007/s40271-021-00568-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 12/12/2021] [Indexed: 11/10/2022]
Abstract
Objective Our objective was to develop and test a discrete choice experiment (DCE) eliciting public and patient preferences for better-coordinated care in Switzerland. Methods We applied a multistage mixed-methods procedure using qualitative and quantitative approaches. First, to identify attributes, we performed a review of the DCE literature in healthcare with a focus on chronic care. Next, attribute selection involved stakeholders (N = 7) from various healthcare sectors to select the most relevant and actionable attributes, followed by three organized focus groups involving the general public and patients (N = 21) to verify the selection and the clarity of the DCE tasks and explanations. Finally, we conducted an online pilot in the target population to test the survey and obtain priors for a final six tested attributes to refine the final design of the experiment. Results After identifying an initial 33 attributes, a final list of six attributes was selected following stakeholder involvement and the three focus groups involving the target population. At the online pilot-testing stage with 301 participants, the majority of respondents found the DCE choice tasks socially relevant for Switzerland but challenging. The quality of the answers was relatively high. Most attributes had signs matching those in the literature and focus group discussions. Conclusion This article will be useful to researchers designing DCEs from a broad health policy perspective. The multistage approach involving a range of stakeholders was essential for the development of a DCE that is relevant for policy makers and well-accepted by the general public and patients. Supplementary Information The online version contains supplementary material available at 10.1007/s40271-021-00568-2.
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Eastman MR, Kalesnikava VA, Mezuk B. Experiences of care coordination among older adults in the United States: Evidence from the Health and Retirement Study. PATIENT EDUCATION AND COUNSELING 2022; 105:2429-2435. [PMID: 35331572 PMCID: PMC9203919 DOI: 10.1016/j.pec.2022.03.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Revised: 03/11/2022] [Accepted: 03/15/2022] [Indexed: 06/14/2023]
Abstract
INTRODUCTION The goal of this study was to examine variation in patient experiences and perceptions of care coordination across sociodemographic and health factors. METHODS Data come from the 2016 Health and Retirement Study (N = 1, 216). Three domains of coordination were assessed: 1) Perceptions (e.g., patient impressions of provider-provider communication), 2) Tangible supports (e.g., meeting with a care coordinator, being accompanied to appointments), and 3) Technical supports (e.g., use of a "patient portal"). Logistic regression was used to quantify the frequency of each domain and examine variation by racial minority status, socioeconomic status, and health status. RESULTS Approximately 42% of older adults perceived poor care coordination, including 14.8% who reported receiving seemingly conflicting advice from different providers. Only one-third had ever met with a formal care coordinator, and 40% were occasionally accompanied to appointments. Although racial minorities were less likely to have access to technical supports, they were more likely to use them. Better perceived coordination was associated with higher care satisfaction (Odds Ratio: 1.43, 95% CI: 1.27-1.61). CONCLUSIONS Important gaps in care coordination remain for older adults. PRACTICE IMPLICATIONS Providers should consider assessing patient perceptions of care coordination to address these gaps in an equitable manner.
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Affiliation(s)
- Marisa R Eastman
- Center for Social Epidemiology and Population Health, Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, MI, USA
| | - Viktoryia A Kalesnikava
- Center for Social Epidemiology and Population Health, Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, MI, USA
| | - Briana Mezuk
- Center for Social Epidemiology and Population Health, Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, MI, USA; Research Center for Group Dynamics, Institute for Social Research, University of Michigan, Ann Arbor, MI, USA.
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Coordination Models for Cancer Care in Low- and Middle-Income Countries: A Scoping Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19137906. [PMID: 35805565 PMCID: PMC9265683 DOI: 10.3390/ijerph19137906] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Revised: 06/20/2022] [Accepted: 06/21/2022] [Indexed: 02/04/2023]
Abstract
Background: The coordination of cancer care among multiple providers is vital to improve care quality and ensure desirable health outcomes across the cancer continuum, yet evidence is scarce of this being optimally achieved in low- and middle-income countries (LMICs). Objective: Through this scoping review, our objective was to understand the scope of cancer care coordination interventions and services employed in LMICs, in order to synthesise the existing evidence and identify key models and their elements used to manage and/or improve cancer care coordination in these settings. Methods: A detailed search strategy was conducted, aligned with the framework of Arksey and O’Malley. Articles were examined for evidence of coordination interventions used in cancer care in LMICs. We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Extension Guidelines for Scoping Reviews, which included a checklist and explanation. The PRISMA flow diagram was utilised to report the screening of results. Data were extracted, categorised and coded to allow for a thematic analysis of the results. Results: Fourteen studies reported on coordination interventions in cancer care in LMICs. All studies reported a positive impact of cancer coordination interventions on the primary outcome measured. Most studies reported on a patient navigation model at different points along the cancer care continuum. Conclusions: An evidence-based and culturally sensitive plan of care that aims to promote coordinated and efficient multidisciplinary care for patients with suspicion or diagnosis of cancer in LMICs is feasible and might improve the quality of care and efficiency.
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Palmer NR, Smith AN, Campbell BA, Andemeskel G, Tahir P, Felder TM, Cicerelli B. Navigation programs relevant for African American men with prostate cancer: a scoping review protocol. Syst Rev 2022; 11:122. [PMID: 35701771 PMCID: PMC9195379 DOI: 10.1186/s13643-022-01993-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Accepted: 05/27/2022] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND The excess incidence and mortality due to prostate cancer that impacts African American men constitutes the largest of all cancer disparities. Patient navigation is a patient-centered healthcare system intervention to eliminate barriers to timely, high-quality care across the cancer continuum and improves health outcomes among vulnerable patients. However, little is known regarding the extent to which navigation programs include cultural humility to address prostate cancer disparities among African American men. We present a scoping review protocol of an in-depth examination of navigation programs in prostate cancer care-including navigation activities/procedures, training, and management-with a special focus on cultural context and humility for African American men to achieve health equity. METHODS We will conduct comprehensive searches of the literature in PubMed, Embase, Web of Science, and CINAHL Complete, using keywords and index terms (Mesh and Emtree) within the three main themes: prostate cancer, patient navigation, and African American men. We will also conduct a search of the gray literature, hand-searching, and reviewing references of included papers and conference abstracts. In a two-phase approach, two authors will independently screen titles and abstracts, and full-text based on inclusion/exclusion criteria. All study designs will be included that present detailed data about the elements of navigation programs, including intervention content, navigator training, and/or management. Data will be extracted from included studies, and review findings will be synthesized and summarized. DISCUSSION A scoping review focused on cultural humility in patient navigation within the context of eliminating disparities in PCa care among African American men does not yet exist. This review will synthesize existing evidence of patient navigation programs for African American prostate cancer patients and the inclusion of cultural humility. Results will inform the development and implementation of future programs to meet the unique needs of vulnerable prostate cancer patients in safety net settings. SYSTEMATIC REVIEW REGISTRATION PROSPERO 2021 CRD42021221412.
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Affiliation(s)
- Nynikka R. Palmer
- Division on General Internal Medicine at Zuckerberg San Francisco General Hospital, University of California San Francisco, 1001 Potrero Avenue, UCSF mailbox 1364, San Francisco, CA 94143 USA
| | - Ashley Nicole Smith
- Division on General Internal Medicine at Zuckerberg San Francisco General Hospital, University of California San Francisco, 1001 Potrero Avenue, UCSF mailbox 1364, San Francisco, CA 94143 USA
| | - Brittany A. Campbell
- University of California San Francisco, 1450 3rd Street, San Francisco, CA 94143 USA
| | | | - Peggy Tahir
- UCSF Library, University of California San Francisco, 530 Parnassus Ave, San Francisco, CA 94143 USA
| | - Tisha M. Felder
- College of Nursing, University of South Carolina, 1601 Greene Street, Room 620, Columbia, SC 29208 USA
| | - Barbara Cicerelli
- Zuckerberg San Francisco General Hospital, 995 Potrero Ave, Building 80, Room 8000N Lower Level, San Francisco, CA 94110 USA
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Types of usual sources of care and their association with healthcare outcomes among cancer survivors: a Medical Expenditure Panel Survey (MEPS) study. J Cancer Surviv 2022; 17:748-758. [PMID: 35687273 PMCID: PMC10016387 DOI: 10.1007/s11764-022-01221-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Accepted: 05/21/2022] [Indexed: 10/18/2022]
Abstract
PURPOSE To assess associations between usual source of care (USC) type and health status, healthcare access, utilization, and expenses among adult cancer survivors. METHODS This retrospective cross-sectional analysis using 2013-2018 Medical Expenditure Panel Survey included 2690 observations representing 31,953,477 adult cancer survivors who were currently experiencing cancer and reporting one of five USC types: solo practicing physician (SPP), a specific person in a non-hospital facility, a specific person in a hospital-based facility, a non-hospital facility, and a hospital-based facility. We used logistic regressions and generalized linear models to determine associations of USC type with health status, healthcare access, utilization, and expenses, adjusting for patient demographic and clinical characteristics. RESULTS All non-SPP USC types were associated with reporting more difficulties contacting USC by telephone during business hours (p < 0.05). Compared to SPP, non-hospital facility was associated with more difficulty getting needed prescriptions (OR: 1.81, p = 0.036) and higher annual expenses ($5225, p = 0.028), and hospital-based facility was associated with longer travel time (OR: 1.61, p = 048), more ED visits (0.13, p = 0.049), higher expenses ($6028, p = 0.014), and worse self-reported health status (OR: 1.93, p = 0.001), although both were more likely to open on nights/weekends (p < 0.05). Cancer survivors with a specific person in a hospital-based facility (vs. SPP) as USC were > twofold as likely (p < 0.05) to report difficulty getting needed prescriptions and contacting USC afterhours. CONCLUSIONS Among adult cancer survivors who were currently experiencing cancer, having a non-SPP type of UCS was associated with reporting more difficulties accessing care, worse health, more ED visits, and higher total expenses. IMPLICATIONS FOR CANCER SURVIVORS Transitioning to SPP type of USC may result in better healthcare outcomes.
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Yawn RJ, Nassiri AM, Harris JE, Manzoor NF, Godil S, Haynes DS, Bennett ML, Weaver SM. Reducing ICU Length of Stay: The Impact of a Multidisciplinary Perioperative Pathway in Vestibular Schwannoma. Skull Base Surg 2022; 83:e7-e14. [DOI: 10.1055/s-0040-1722666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Accepted: 11/01/2020] [Indexed: 10/22/2022]
Abstract
Abstract
Objective This study was aimed to evaluate the impact of a multidisciplinary perioperative pathway on length of stay (LOS) and postoperative outcomes after vestibular schwannoma surgery.
Setting This study was conducted in a tertiary skull base center.
Main Outcome Measures The impact of the pathway on intensive care unit (ICU) LOS was evaluated as the primary outcome measure of the study. Overall resource LOS, postoperative complications, and readmission rates were also evaluated as secondary outcome measures.
Methods Present study is a retrospective review.
Results A universally adopted perioperative pathway was developed to include standardization of preoperative education and expectations, intraoperative anesthetic delivery, postoperative nursing education, postoperative rehabilitation, and utilization of stepdown and surgical floor units after ICU stay. Outcomes were measured for 95 consecutive adult patients who underwent surgical resection for vestibular schwannoma (40 cases before implementation of the perioperative pathway and 55 cases after implementation). There were no significant differences in the two groups with regard to tumor size, operative time, or medical comorbidities. The mean ICU LOS decreased from 2.1 in the preimplementation group to 1.6 days in the postimplementation group (p = 0.02). There were no significant differences in overall resource LOS postoperative complications or readmission rates between groups.
Conclusion Multidisciplinary, perioperative neurotologic pathways can be effective in lowering ICU LOS in patients undergoing vestibular schwannoma surgery without compromising quality of care. Further research is needed to continue to sustain and continuously improve these and other measures, while continuing to provide high-quality care to this patient population.
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Affiliation(s)
- Robert J. Yawn
- Department of Otolaryngology, University of Tennessee Health Science Center, Memphis, Tennessee, United States
- Department of Neurosurgery, University of Tennessee Health Science Center, Memphis, Tennessee, United States
| | - Ashley M. Nassiri
- Department of Otolaryngology, Vanderbilt University Medical Center, Nashville, Tennessee, United States
| | - Jacqueline E. Harris
- Department of Otolaryngology, Vanderbilt University Medical Center, Nashville, Tennessee, United States
| | - Nauman F. Manzoor
- Department of Otolaryngology, Vanderbilt University Medical Center, Nashville, Tennessee, United States
| | - Saniya Godil
- Department of Neurosurgery, Vanderbilt University Medical Center, Nashville, Tennessee, United States
| | - David S. Haynes
- Department of Otolaryngology, Vanderbilt University Medical Center, Nashville, Tennessee, United States
| | - Marc L. Bennett
- Department of Otolaryngology, Vanderbilt University Medical Center, Nashville, Tennessee, United States
| | - Sheena M. Weaver
- Department of Anesthesiology and Critical Care Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, United States
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Fung-Kee-Fung M, Ozer RS, Davies B, Pick S, Duke K, Stewart DJ, Reaume MN, Ward M, Balchin K, MacRae RM, Nelson S, Renaud J, Garvin D, Madore S, Pantarotto JR. Cancer Clinic Redesign: Opportunities for Resource Optimization. Curr Oncol 2022; 29:3983-3995. [PMID: 35735427 PMCID: PMC9222188 DOI: 10.3390/curroncol29060318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Accepted: 05/26/2022] [Indexed: 11/16/2022] Open
Abstract
Ambulatory cancer centers face a fluctuating patient demand and deploy specialized personnel who have variable availability. This undermines operational stability through the misalignment of resources to patient needs, resulting in overscheduled clinics, budget deficits, and wait times exceeding provincial targets. We describe the deployment of a Learning Health System framework for operational improvements within the entire ambulatory center. Known methods of value stream mapping, operations research and statistical process control were applied to achieve organizational high performance that is data-informed, agile and adaptive. We transitioned from a fixed template model by an individual physician to a caseload management by disease site model that is realigned quarterly. We adapted a block schedule model for the ambulatory oncology clinic to align the regional demand for specialized services with optimized human and physical resources. We demonstrated an improved utilization of clinical space, increased weekly consistency and improved distribution of activity across the workweek. The increased value, represented as the ratio of monthly encounters per nursing worked hours, and the increased percentage of services delivered by full-time nurses were benefits realized in our cancer system. The creation of a data-informed demand capacity model enables the application of predictive analytics and business intelligence tools that will further enhance clinical responsiveness.
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Affiliation(s)
- Michael Fung-Kee-Fung
- The Ottawa Hospital, Ottawa, ON K1H 8L6, Canada; (B.D.); (S.P.); (K.D.); (D.J.S.); (M.N.R.); (M.W.); (K.B.); (R.M.M.); (S.N.); (J.R.); (D.G.); (S.M.); (J.R.P.)
- Division of Gynecologic Oncology, University of Ottawa, Ottawa, ON K1H 8M5, Canada
- Correspondence: (M.F.-K.-F.); (R.S.O.); Tel.: +613-737-8899 (ext. 71223) (M.F.-K.-F.)
| | - Rachel S. Ozer
- The Ottawa Hospital, Ottawa, ON K1H 8L6, Canada; (B.D.); (S.P.); (K.D.); (D.J.S.); (M.N.R.); (M.W.); (K.B.); (R.M.M.); (S.N.); (J.R.); (D.G.); (S.M.); (J.R.P.)
- Correspondence: (M.F.-K.-F.); (R.S.O.); Tel.: +613-737-8899 (ext. 71223) (M.F.-K.-F.)
| | - Bill Davies
- The Ottawa Hospital, Ottawa, ON K1H 8L6, Canada; (B.D.); (S.P.); (K.D.); (D.J.S.); (M.N.R.); (M.W.); (K.B.); (R.M.M.); (S.N.); (J.R.); (D.G.); (S.M.); (J.R.P.)
| | - Stephanie Pick
- The Ottawa Hospital, Ottawa, ON K1H 8L6, Canada; (B.D.); (S.P.); (K.D.); (D.J.S.); (M.N.R.); (M.W.); (K.B.); (R.M.M.); (S.N.); (J.R.); (D.G.); (S.M.); (J.R.P.)
| | - Kate Duke
- The Ottawa Hospital, Ottawa, ON K1H 8L6, Canada; (B.D.); (S.P.); (K.D.); (D.J.S.); (M.N.R.); (M.W.); (K.B.); (R.M.M.); (S.N.); (J.R.); (D.G.); (S.M.); (J.R.P.)
| | - David J. Stewart
- The Ottawa Hospital, Ottawa, ON K1H 8L6, Canada; (B.D.); (S.P.); (K.D.); (D.J.S.); (M.N.R.); (M.W.); (K.B.); (R.M.M.); (S.N.); (J.R.); (D.G.); (S.M.); (J.R.P.)
- Department of Medicine, University of Ottawa, Ottawa, ON K1H 8M5, Canada
| | - M. Neil Reaume
- The Ottawa Hospital, Ottawa, ON K1H 8L6, Canada; (B.D.); (S.P.); (K.D.); (D.J.S.); (M.N.R.); (M.W.); (K.B.); (R.M.M.); (S.N.); (J.R.); (D.G.); (S.M.); (J.R.P.)
- Department of Medicine, University of Ottawa, Ottawa, ON K1H 8M5, Canada
| | - Marcus Ward
- The Ottawa Hospital, Ottawa, ON K1H 8L6, Canada; (B.D.); (S.P.); (K.D.); (D.J.S.); (M.N.R.); (M.W.); (K.B.); (R.M.M.); (S.N.); (J.R.); (D.G.); (S.M.); (J.R.P.)
| | - Katelyn Balchin
- The Ottawa Hospital, Ottawa, ON K1H 8L6, Canada; (B.D.); (S.P.); (K.D.); (D.J.S.); (M.N.R.); (M.W.); (K.B.); (R.M.M.); (S.N.); (J.R.); (D.G.); (S.M.); (J.R.P.)
| | - Robert M. MacRae
- The Ottawa Hospital, Ottawa, ON K1H 8L6, Canada; (B.D.); (S.P.); (K.D.); (D.J.S.); (M.N.R.); (M.W.); (K.B.); (R.M.M.); (S.N.); (J.R.); (D.G.); (S.M.); (J.R.P.)
- Division of Radiation Oncology, University of Ottawa, Ottawa, ON K1H 8M5, Canada
| | - Shannon Nelson
- The Ottawa Hospital, Ottawa, ON K1H 8L6, Canada; (B.D.); (S.P.); (K.D.); (D.J.S.); (M.N.R.); (M.W.); (K.B.); (R.M.M.); (S.N.); (J.R.); (D.G.); (S.M.); (J.R.P.)
| | - Julie Renaud
- The Ottawa Hospital, Ottawa, ON K1H 8L6, Canada; (B.D.); (S.P.); (K.D.); (D.J.S.); (M.N.R.); (M.W.); (K.B.); (R.M.M.); (S.N.); (J.R.); (D.G.); (S.M.); (J.R.P.)
| | - Dennis Garvin
- The Ottawa Hospital, Ottawa, ON K1H 8L6, Canada; (B.D.); (S.P.); (K.D.); (D.J.S.); (M.N.R.); (M.W.); (K.B.); (R.M.M.); (S.N.); (J.R.); (D.G.); (S.M.); (J.R.P.)
| | - Suzanne Madore
- The Ottawa Hospital, Ottawa, ON K1H 8L6, Canada; (B.D.); (S.P.); (K.D.); (D.J.S.); (M.N.R.); (M.W.); (K.B.); (R.M.M.); (S.N.); (J.R.); (D.G.); (S.M.); (J.R.P.)
| | - Jason R. Pantarotto
- The Ottawa Hospital, Ottawa, ON K1H 8L6, Canada; (B.D.); (S.P.); (K.D.); (D.J.S.); (M.N.R.); (M.W.); (K.B.); (R.M.M.); (S.N.); (J.R.); (D.G.); (S.M.); (J.R.P.)
- Division of Radiation Oncology, University of Ottawa, Ottawa, ON K1H 8M5, Canada
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Pinheiro LC, Cho J, Kern LM, Higgason N, O'Beirne R, Tamimi R, Safford M. Managing diabetes during treatment for breast cancer: oncology and primary care providers' views on barriers and facilitators. Support Care Cancer 2022; 30:6901-6908. [PMID: 35543819 PMCID: PMC9093555 DOI: 10.1007/s00520-022-07112-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Accepted: 05/02/2022] [Indexed: 11/26/2022]
Abstract
Purpose Diabetes is a prevalent comorbid condition among many women with breast cancer. The roles and responsibilities of managing diabetes during cancer care are unclear, as oncologists lack interest and clinical expertise and many patients stop seeing their primary care providers (PCPs). Uncertainty around who should manage diabetes for cancer patients can result in gaps in care for survivors. We sought to elicit the perspectives of providers about a novel diabetes care delivery intervention for women undergoing chemotherapy for breast cancer. Methods We conducted nominal group sessions with PCPs and breast oncologists across the USA. We introduced a novel care delivery model, which involved a nurse practitioner (NP) specifically trained in diabetes to work within the oncology team to manage diabetes for women during chemotherapy. PCPs and oncologists were asked to identify potential barriers and facilitators to the intervention’s success and then vote on the top three most important barriers and facilitators, separately. Votes were aggregated across sessions and presented as frequencies and weighted percentages. Results From November to December 2020, two 60-min sessions with PCPs and two 60-min sessions with breast oncologists were held virtually. In total, 29 providers participated, with 16 PCPs and 13 breast oncologists. At the health system level, financial support for the NP-led intervention was identified as the most important barrier across both provider types. Clearly defined roles for each care team member were identified as the most important facilitator at the care team level. At the patient level, lack of cancer-specific diabetes education was identified as an important barrier. Conclusion Our findings underscore the need to engage various stakeholders including policy makers, institutional leadership, care team members, and patients to improve diabetes care for patients undergoing chemotherapy for breast cancer. As such, multi-disciplinary interventions are warranted to increase awareness, engagement, and self-management practices among breast cancer patients with diabetes. Supplementary Information The online version contains supplementary material available at 10.1007/s00520-022-07112-4.
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Affiliation(s)
- Laura C Pinheiro
- Division of General Internal Medicine, Department of Medicine, Weill Cornell Medicine, 420 East 70th Street, 3rd Floor (LH359), New York, NY, 10021, USA. .,Population Health Sciences Department, Weill Cornell Medicine, New York, NY, USA.
| | - Jacklyn Cho
- Division of General Internal Medicine, Department of Medicine, Weill Cornell Medicine, 420 East 70th Street, 3rd Floor (LH359), New York, NY, 10021, USA
| | - Lisa M Kern
- Division of General Internal Medicine, Department of Medicine, Weill Cornell Medicine, 420 East 70th Street, 3rd Floor (LH359), New York, NY, 10021, USA
| | - Noel Higgason
- McGovern Medical School at the University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Ronan O'Beirne
- University of Alabama at Birmingham, Birmingham, AL, USA
| | - Rulla Tamimi
- Population Health Sciences Department, Weill Cornell Medicine, New York, NY, USA
| | - Monika Safford
- Division of General Internal Medicine, Department of Medicine, Weill Cornell Medicine, 420 East 70th Street, 3rd Floor (LH359), New York, NY, 10021, USA
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Time Spent Engaging in Health Care Among Patients With Left Ventricular Assist Devices. JACC. HEART FAILURE 2022; 10:321-332. [PMID: 35483794 PMCID: PMC9908068 DOI: 10.1016/j.jchf.2022.01.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Revised: 01/12/2022] [Accepted: 01/13/2022] [Indexed: 01/05/2023]
Abstract
OBJECTIVES This study aims to examine a novel patient-centered metric of time spent engaging in left ventricular assist device (LVAD)-related clinical care outside the home. BACKGROUND Although LVAD implantation can improve survival and functional capacity in patients with advanced heart failure, this may occur at the expense of significant time spent engaging in LVAD-related health care activities. METHODS The authors retrospectively assessed consecutive patients at a single center who received a continuous-flow LVAD between May 9, 2008, and December 31, 2019, and queried health care encounters after implantation, including all inpatient encounters and LVAD-related ambulatory encounters. Patient-level time metrics were determined, including the total number of days with any health care encounter, and the total estimated time spent receiving care. The primary outcome was the proportion (%) of days alive with an LVAD spent engaged in at least 1 health care encounter. The secondary outcome was the proportion (%) of total time alive with an LVAD spent receiving care. RESULTS Among 373 patients, the median number of days alive with LVAD was 390 (IQR: 158-840 days). Patients had a median number of 88 (IQR: 45-161) days with ≥1 health care encounter, accounting for 23.2% (IQR: 16.3%-32.4%) of their days alive with an LVAD. A median 6.0% (IQR: 2.1%-14.1%) and 15.0% (IQR: 10.7%-20.0%) of total days alive were spent in inpatient and ambulatory encounters, respectively. Patients spent a median of 592 (IQR: 197-1,257) hours receiving care, accounting for 5.6% (IQR: 2.2%-12.7%) of their total time alive with an LVAD. CONCLUSIONS LVAD patients spent more than 1 of every 5 days engaging in health care. Our findings may inform strategies to improve efficiency of postdischarge care delivery and expectations for post-treatment care.
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Rocque GB, Dionne-Odom JN, Stover AM, Daniel CL, Azuero A, Huang CHS, Ingram SA, Franks JA, Caston NE, Dent DAN, Basch EM, Jackson BE, Howell D, Weiner BJ, Pierce JY. Evaluating the implementation and impact of navigator-supported remote symptom monitoring and management: a protocol for a hybrid type 2 clinical trial. BMC Health Serv Res 2022; 22:538. [PMID: 35459238 PMCID: PMC9027833 DOI: 10.1186/s12913-022-07914-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Accepted: 04/06/2022] [Indexed: 12/31/2022] Open
Abstract
Background Symptoms in patients with advanced cancer are often inadequately captured during encounters with the healthcare team. Emerging evidence demonstrates that weekly electronic home-based patient-reported symptom monitoring with automated alerts to clinicians reduces healthcare utilization, improves health-related quality of life, and lengthens survival. However, oncology practices have lagged in adopting remote symptom monitoring into routine practice, where specific patient populations may have unique barriers. One approach to overcoming barriers is utilizing resources from value-based payment models, such as patient navigators who are ideally positioned to assume a leadership role in remote symptom monitoring implementation. This implementation approach has not been tested in standard of care, and thus optimal implementation strategies are needed for large-scale roll-out. Methods This hybrid type 2 study design evaluates the implementation and effectiveness of remote symptom monitoring for all patients and for diverse populations in two Southern academic medical centers from 2021 to 2026. This study will utilize a pragmatic approach, evaluating real-world data collected during routine care for quantitative implementation and patient outcomes. The Consolidated Framework for Implementation Research (CFIR) will be used to conduct a qualitative evaluation at key time points to assess barriers and facilitators, implementation strategies, fidelity to implementation strategies, and perceived utility of these strategies. We will use a mixed-methods approach for data interpretation to finalize a formal implementation blueprint. Discussion This pragmatic evaluation of real-world implementation of remote symptom monitoring will generate a blueprint for future efforts to scale interventions across health systems with diverse patient populations within value-based healthcare models. Trial registration NCT04809740; date of registration 3/22/2021. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-022-07914-6.
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Affiliation(s)
- Gabrielle B Rocque
- Department of Medicine, Division of Hematology and Oncology, University of Alabama at Birmingham, 1824 6th Avenue South, 35924-3300 - WTI 240E, Birmingham, AL, USA. .,Department of Medicine, Division of Gerontology, Geriatrics, and Palliative Care, University of Alabama at Birmingham, Birmingham, AL, USA. .,O'Neal Comprehensive Cancer Center, Birmingham, AL, USA.
| | - J Nicholas Dionne-Odom
- Department of Medicine, Division of Gerontology, Geriatrics, and Palliative Care, University of Alabama at Birmingham, Birmingham, AL, USA.,University of Alabama at Birmingham School of Nursing, Birmingham, AL, USA
| | - Angela M Stover
- University of South Alabama Mitchell Cancer Institute, Mobile, AL, USA
| | - Casey L Daniel
- Supportive Care, Princess Margaret Cancer Centre Research Institute, Toronto, Ontario, Canada
| | - Andres Azuero
- University of Alabama at Birmingham School of Nursing, Birmingham, AL, USA
| | - Chao-Hui Sylvia Huang
- Department of Medicine, Division of Gerontology, Geriatrics, and Palliative Care, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Stacey A Ingram
- Department of Medicine, Division of Hematology and Oncology, University of Alabama at Birmingham, 1824 6th Avenue South, 35924-3300 - WTI 240E, Birmingham, AL, USA
| | - Jeffrey A Franks
- Department of Medicine, Division of Hematology and Oncology, University of Alabama at Birmingham, 1824 6th Avenue South, 35924-3300 - WTI 240E, Birmingham, AL, USA
| | - Nicole E Caston
- Department of Medicine, Division of Hematology and Oncology, University of Alabama at Birmingham, 1824 6th Avenue South, 35924-3300 - WTI 240E, Birmingham, AL, USA
| | - D' Ambra N Dent
- Department of Medicine, Division of Hematology and Oncology, University of Alabama at Birmingham, 1824 6th Avenue South, 35924-3300 - WTI 240E, Birmingham, AL, USA
| | - Ethan M Basch
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, NC, Chapel Hill, USA
| | - Bradford E Jackson
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, NC, Chapel Hill, USA
| | - Doris Howell
- Supportive Care, Princess Margaret Cancer Centre Research Institute, Toronto, Ontario, Canada
| | - Bryan J Weiner
- Department of Health Systems and Population Health, University of Washington, Seattle, Washington, USA
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Ho D, Chan E, Izwan S, Ng J, Teng R, Swindon D, Chang J. Uptake of breast reconstruction following mastectomy: a Gold Coast experience. ANZ J Surg 2022; 92:3011-3016. [PMID: 35426189 DOI: 10.1111/ans.17703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Revised: 03/20/2022] [Accepted: 03/27/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND The breast reconstruction (BR) rate for women undergoing mastectomy for breast cancer management is 18% in Australia. The Australian Access to Breast Reconstruction Collaborative Group recommends that all women should have access to BR. This study presents BR uptake and outcomes from a breast surgical unit. METHODS A retrospective observational study identified women who had curative mastectomy for breast cancer between 1 January 2016 and 31 December 2021. Patient factors and surgical complications were compared between BR and no BR (NBR) patients. RESULTS Out of 929 women who had a curative mastectomy, 34% underwent reconstruction. Of this, 89% were immediate, and 11% were delayed. Reconstruction increased from 27% (2016) to 35% (2021). During this time, 588 women had a discussion for BR documented at their initial consultation, 58 after initial surgery and 283 were not documented. The rate of discussion prior to mastectomy increased from 38% to 74%. Women who had BR were more likely to be younger, premenopausal and less likely to be diabetic. Complications requiring return to theatre were higher in reconstructed women (13% vs. 7%). Overall, infected seroma, cellulitis requiring intravenous antibiotics and haematoma requiring drainage were comparable between both groups. CONCLUSION Our unit achieved a reconstruction rate of 34%, which is higher than national and international averages. Open discussion of reconstruction is crucial for women to make an informed decision. Further prospective studies exploring barriers to timely reconstruction will improve uptake of BR surgery and allow prioritization of BR services in Australia.
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Affiliation(s)
- Debbie Ho
- Department of Breast and General Surgery, Robina Hospital Gold Coast Hospital and Health Service Queensland Australia
- School of Medicine and Dentistry Griffith University Queensland Australia
| | - Erick Chan
- Department of Breast and General Surgery, Robina Hospital Gold Coast Hospital and Health Service Queensland Australia
- School of Medicine and Dentistry Griffith University Queensland Australia
| | - Sara Izwan
- Department of Breast and General Surgery, Robina Hospital Gold Coast Hospital and Health Service Queensland Australia
- School of Medicine and Dentistry Griffith University Queensland Australia
| | - Justin Ng
- Department of Breast and General Surgery, Robina Hospital Gold Coast Hospital and Health Service Queensland Australia
- Faculty of Health Sciences and Medicine Bond University Queensland Australia
| | - Roy Teng
- Department of Breast and General Surgery, Robina Hospital Gold Coast Hospital and Health Service Queensland Australia
- School of Medicine and Dentistry Griffith University Queensland Australia
| | - Daisy Swindon
- Department of Breast and General Surgery, Robina Hospital Gold Coast Hospital and Health Service Queensland Australia
- School of Medicine and Dentistry Griffith University Queensland Australia
| | - Jennifer Chang
- Department of Breast and General Surgery, Robina Hospital Gold Coast Hospital and Health Service Queensland Australia
- Faculty of Health Sciences and Medicine Bond University Queensland Australia
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Turcotte JJ, King PJ, Patton CM. Lower Extremity Osteoarthritis: A Risk Factor for Mental Health Disorders, Prolonged Opioid Use, and Increased Resource Utilization After Single-Level Lumbar Spinal Fusion. J Am Acad Orthop Surg Glob Res Rev 2022; 6:e21.00280. [PMID: 35303736 PMCID: PMC8932478 DOI: 10.5435/jaaosglobal-d-21-00280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Accepted: 01/12/2022] [Indexed: 06/14/2023]
Abstract
INTRODUCTION Few studies have examined the effect of hip or knee osteoarthritis, together described as lower extremity osteoarthritis (LEOA) on patient outcomes after lumbar fusion. The purpose of this study was to evaluate the effect of LEOA on postoperative outcomes and resource utilization in patients undergoing single-level lumbar fusion. METHODS Using a national deidentified database, TriNetX, a retrospective observational study of 17,289 patients undergoing single-level lumbar fusion with or without a history of LEOA before September 1, 2019, was conducted. The no-LEOA and LEOA groups were propensity score matched, and 2-year outcomes were compared using univariate statistical analysis. RESULTS After propensity score matching, 2289 patients with no differences in demographics or comorbidities remained in each group. No differences in the rate of repeat lumbar surgery were observed between groups (all P > 0.30). In comparison with patients with no LEOA, patients with LEOA experienced higher rates of overall and new onset depression or anxiety, prolonged opioid use, hospitalizations, emergency department visits, and ambulatory visits over the 2-year postoperative period (all P < 0.02). CONCLUSION Patients with LEOA undergoing single-level lumbar fusion surgery are at higher risk for suboptimal outcomes and increased resource utilization postoperatively. This complex population may benefit from additional individualized education and multidisciplinary management.
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Affiliation(s)
- Justin J Turcotte
- From the Department of Orthopedics, Luminis Health Anne Arundel Medical Center, Annapolis, MD
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Nicolaisen A, Lauridsen GB, Haastrup P, Hansen DG, Jarbøl DE. Healthcare practices that increase the quality of care in cancer trajectories from a general practice perspective: a scoping review. Scand J Prim Health Care 2022; 40:11-28. [PMID: 35254205 PMCID: PMC9090364 DOI: 10.1080/02813432.2022.2036421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
OBJECTIVE General practice plays an important role in cancer trajectories, and cancer patients request the continuous involvement of general practice. The objective of this scoping review was to identify healthcare practices that increase the quality of care in cancer trajectories from a general practice perspective. DESIGN, SETTING, AND SUBJECTS A scoping review of the literature published in Danish or English from 2010 to 2020 was conducted. Data was collected using identified keywords and indexed terms in several databases (PubMed, MEDLINE, EBSCO CINAHL, Scopus, and ProQuest), contacting key experts, searching through reference lists, and reports from selected health political, research- and interest organizations' websites. MAIN OUTCOME MEASURES We identified healthcare practices in cancer trajectories that increase quality care. Identified healthcare practices were grouped into four contextual domains and allocated to defined phases in the cancer trajectory. The results are presented according to the Preferred Reporting Items for Systematic Reviews and Meta-analysis extension for scoping reviews (PRISMA-ScR). RESULTS A total of 45 peer-reviewed and six non-peer-reviewed articles and reports were included. Quality of care increases in all phases of the cancer trajectory when GPs listen carefully to the full story and use action plans. After diagnosis, quality of care increases when GPs and practice staff have a proactive care approach, act as interpreters of diagnosis, treatment options, and its consequences, and engage in care coordination with specialists in secondary care involving the patient. CONCLUSION This scoping review identified healthcare practices that increase the quality of care in cancer trajectories from a general practice perspective. The results support general practice in investigating own healthcare practices and identifying possibilities for quality improvement.KEY POINTSIdentified healthcare practices in general practice that increase the quality of care in cancer trajectories:Listen carefully to the full storyUse action plans and time-out-consultationsPlan and provide proactive careAct as an interpreter of diagnosis, treatment options, and its consequences for the patientCoordinate care with specialists, patients, and caregivers with mutual respectIdentified barriers for quality of care in cancer trajectories are:Time constraints in consultationsLimited accessibility for patients and caregiversHealth practices to increase the quality of care should be effective, safe, people-centered, timely, equitable, integrated, and efficient. These distinctions of quality of care, support general practice in investigating and improving quality of care in cancer trajectories.
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Affiliation(s)
- Anne Nicolaisen
- Research Unit for General Practice, Department of Public Health, University of Southern Denmark, Odense C, Denmark
- CONTACT Anne Nicolaisen Research Unit for General Practice, Department of Public Health, University of Southern Denmark, DK-5000Odense C, Denmark
| | - Gitte Bruun Lauridsen
- Research Unit for General Practice, Department of Public Health, University of Southern Denmark, Odense C, Denmark
| | - Peter Haastrup
- Research Unit for General Practice, Department of Public Health, University of Southern Denmark, Odense C, Denmark
| | - Dorte Gilså Hansen
- Research Unit for General Practice, Department of Public Health, University of Southern Denmark, Odense C, Denmark
- Center for Shared Decision Making, Lillebaelt Hospital, University Hospital of Southern Denmark, Vejle, Denmark
- The Department of Regional Health Research, University of Southern Denmark, Odense C, Denmark
| | - Dorte Ejg Jarbøl
- Research Unit for General Practice, Department of Public Health, University of Southern Denmark, Odense C, Denmark
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Albertson EM, Chuang E, O'Masta B, Miake-Lye I, Haley LA, Pourat N. Systematic Review of Care Coordination Interventions Linking Health and Social Services for High-Utilizing Patient Populations. Popul Health Manag 2022; 25:73-85. [PMID: 34134511 PMCID: PMC8861924 DOI: 10.1089/pop.2021.0057] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
Recognizing that social factors influence patient health outcomes and utilization, health systems have developed interventions to address patients' social needs. Care coordination across the health care and social service sectors is a distinct and important strategy to address social determinants of health, but limited information exists about how care coordination operates in this context. To address this gap, the authors conducted a systematic review of peer-reviewed publications that document the coordination of health care and social services in the United States. After a structured elimination process, 25 publications of 19 programs were synthesized to identify patterns in care coordination implementation. Results indicate that patient needs assessment, in-person patient contact, and standardized care coordination protocols are common across programs that bridge health care and social services. Publications discussing these programs often provide limited detail on other key elements of care coordination, especially the nature of referrals and care coordinator caseload. Additional research is needed to document critical elements of program implementation and to evaluate program impacts.
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Affiliation(s)
- Elaine Michelle Albertson
- University of California Los Angeles Center for Health Policy Research, Health Economics and Evaluation Research Program, Los Angeles, California, USA.,University of California Los Angeles Fielding School of Public Health, Department of Health Policy and Management, Los Angeles, California, USA.,Address correspondence to: Elaine Michelle Albertson, MPH, Department of Health Policy and Management, University of California Los Angeles Fielding School of Public Health, 650 Charles Young Drive S, Los Angeles, CA 90095, USA
| | - Emmeline Chuang
- University of California Los Angeles Fielding School of Public Health, Department of Health Policy and Management, Los Angeles, California, USA.,University of California Berkeley School of Social Welfare, Berkeley, California, USA
| | - Brenna O'Masta
- University of California Los Angeles Center for Health Policy Research, Health Economics and Evaluation Research Program, Los Angeles, California, USA
| | - Isomi Miake-Lye
- University of California Los Angeles Fielding School of Public Health, Department of Health Policy and Management, Los Angeles, California, USA.,VA Greater Los Angeles Healthcare System, Los Angeles, California, USA
| | - Leigh Ann Haley
- University of California Los Angeles Center for Health Policy Research, Health Economics and Evaluation Research Program, Los Angeles, California, USA
| | - Nadereh Pourat
- University of California Los Angeles Center for Health Policy Research, Health Economics and Evaluation Research Program, Los Angeles, California, USA.,University of California Los Angeles Fielding School of Public Health, Department of Health Policy and Management, Los Angeles, California, USA
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Brown ZJ, Labiner HE, Shen C, Ejaz A, Pawlik TM, Cloyd JM. Impact of care fragmentation on the outcomes of patients receiving neoadjuvant and adjuvant therapy for pancreatic adenocarcinoma. J Surg Oncol 2022; 125:185-193. [PMID: 34599756 PMCID: PMC9113396 DOI: 10.1002/jso.26706] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Accepted: 09/25/2021] [Indexed: 02/03/2023]
Abstract
INTRODUCTION Neoadjuvant therapy (NT) is increasingly used for localized pancreatic ductal adenocarcinoma (PDAC). The impact of care fragmentation during NT on the outcomes of patients with PDAC is unknown. METHODS Adult patients with Stage I-III PDAC who received NT and patients who underwent surgery first followed by adjuvant therapy (AT) between 2004 and 2016 were queried from the National Cancer Database. Short- and long-term outcomes were compared between patients who received fragmented care (FC; care provided at >1 hospital) versus integrated care (IC; care at a single institution). RESULTS Among 6522 patients who underwent NT before pancreatectomy, 3755 (57.6%) received FC and 2767 (42.4%) received IC. While patients who received FC had a longer time to initiation of treatment (33.2 vs. 29.7 days, p < 0.001), there was no difference in median overall survival (OS) (26.7 vs. 26.5 months, p = 0.6). Among patients who underwent upfront surgery followed by AT (n = 15 291), patients who received FC had a longer time from diagnosis to undergoing surgery but less time from surgery to AT and no difference in OS (24.0 vs. 24.0 months, p = 0.910). CONCLUSION Although care fragmentation was associated with slightly longer times to initiate and complete treatment among patients with localized PDAC, long-term survival outcomes were similar.
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Affiliation(s)
- Zachary J. Brown
- Division of Surgical Oncology, Department of Surgery The Ohio State University Wexner Medical Center Columbus Ohio USA
| | - Hanna E. Labiner
- Division of Surgical Oncology, Department of Surgery The Ohio State University Wexner Medical Center Columbus Ohio USA
| | - Chengli Shen
- Division of Surgical Oncology, Department of Surgery The Ohio State University Wexner Medical Center Columbus Ohio USA
| | - Aslam Ejaz
- Division of Surgical Oncology, Department of Surgery The Ohio State University Wexner Medical Center Columbus Ohio USA
| | - Timothy M. Pawlik
- Division of Surgical Oncology, Department of Surgery The Ohio State University Wexner Medical Center Columbus Ohio USA
| | - Jordan M. Cloyd
- Division of Surgical Oncology, Department of Surgery The Ohio State University Wexner Medical Center Columbus Ohio USA
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Billingsley KG. The Next Step in Tumor Board Evolution: Optimizing Care Coordination and Integration : Editorial on "Integrating a Disease-Focused Tumor Board as a Delivery-of-Care Model to Expedite Treatment Initiation for Patients with Liver Malignancies". Ann Surg Oncol 2022; 29:2146-2147. [PMID: 35084625 DOI: 10.1245/s10434-021-10992-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Accepted: 10/12/2021] [Indexed: 11/18/2022]
Affiliation(s)
- Kevin G Billingsley
- Department of Surgery, Yale University School of Medicine, Yale Cancer Center, 35 Park St, New Haven, CT, 06519, USA.
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Ratnapradipa KL, Ranta J, Napit K, Luma LB, Robinson T, Dinkel D, Schabloske L, Watanabe‐Galloway S. Qualitative analysis of cancer care experiences among rural cancer survivors and caregivers. J Rural Health 2022; 38:876-885. [PMID: 35381622 PMCID: PMC9492624 DOI: 10.1111/jrh.12665] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
PURPOSE Rural (vs urban) patients experience poorer cancer outcomes and are less likely to be engaged in cancer prevention, such as screening. As part of a community needs assessment, we explored rural cancer survivors' and caregivers' experiences, perceptions, and attitudes toward cancer care services. METHODS We conducted 3 focus groups (N = 20) in Spring 2021 in rural Nebraska. FINDINGS Three patterns of cancer diagnosis were regular care/screening without noticeable symptoms, treatment for symptoms not initially identified as cancer related, and symptom self-identification. Most participants, regardless of how diagnosis was made, had positive experiences with timely referral for testing (imaging and biopsy) and specialist care. Physician interpersonal skills set the tone for patient-provider communication, which colored the perception of overall care. Participants with physicians and care teams that were perceived as "considerate," "compassionate," and "caring" had positive experiences. Participants identified specific obstacles to care, including financial barriers, transportation, and lack of support groups, as well as more general cultural barriers. Survivors and caregivers identified organization-based supports that helped them address such barriers. CONCLUSIONS Rural populations have unique perspectives about cancer care. Our results are being used by the state cancer coalition, state cancer control program, and the National Cancer Institute-designated cancer center to prioritize outreach and interventions aimed to reduce rural cancer disparities, such as revitalizing lay cancer navigator programs, conducting webinars for primary care and cancer specialty providers to discuss these findings and identify potential interventions, and collaborating with national and regional cancer support organizations to expand reach in rural communities.
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Affiliation(s)
- Kendra L. Ratnapradipa
- Department of EpidemiologyCollege of Public HealthUniversity of Nebraska Medical CenterOmahaNebraskaUSA
| | - Jordan Ranta
- Sarpy/Cass Health DepartmentPapillionNebraskaUSA
| | - Krishtee Napit
- Department of EpidemiologyCollege of Public HealthUniversity of Nebraska Medical CenterOmahaNebraskaUSA
| | - Lady Beverly Luma
- Office of Community Outreach and EngagementFred & Pamela Buffett Cancer CenterOmahaNebraskaUSA
| | | | - Danae Dinkel
- School of Health & KinesiologyUniversity of Nebraska at OmahaOmahaNebraskaUSA
| | | | - Shinobu Watanabe‐Galloway
- Department of EpidemiologyCollege of Public HealthUniversity of Nebraska Medical CenterOmahaNebraskaUSA,Office of Community Outreach and EngagementFred & Pamela Buffett Cancer CenterOmahaNebraskaUSA
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Development of an evidence-based reference framework for care coordination with a focus on the micro level of integrated care: A mixed method design study combining scoping review of reviews and nominal group technique. Health Policy 2022; 126:245-261. [DOI: 10.1016/j.healthpol.2022.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Revised: 01/04/2022] [Accepted: 01/06/2022] [Indexed: 11/18/2022]
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OUP accepted manuscript. JNCI Cancer Spectr 2022; 6:6522128. [DOI: 10.1093/jncics/pkac008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 12/13/2021] [Accepted: 12/16/2021] [Indexed: 11/14/2022] Open
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Rodríguez-Fernández JM, Danies E, Hoertel N, Galanter W, Saner H, Franco OH. Telemedicine Readiness Across Medical Conditions in a US National Representative Sample of Older Adults. J Appl Gerontol 2021; 41:982-992. [PMID: 34855553 DOI: 10.1177/07334648211056231] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Telemedicine has provided older adults the ability to seek care remotely during the coronavirus disease (COVID-19) pandemic. However, it is unclear how diverse medical conditions play a role in telemedicine uptake. A total of 3379 participants (≥65 years) were interviewed in 2018 as part of the National Health and Aging Trends Study. We assessed telemedicine readiness across multiple medical conditions. Most chronic medical conditions and mood symptoms were significantly associated with telemedicine unreadiness, for physical or technical reasons or both, while cancer, hypertension, and arthritis were significantly associated with telemedicine readiness. Our findings suggest that multiple medical conditions play a substantial role in telemedicine uptake among older adults in the US. Therefore, comorbidities should be taken into consideration when promoting and adopting telemedicine technologies among older adults.
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Affiliation(s)
| | | | - Nicolas Hoertel
- 26930AP-HP. Centre-Université de Paris, Hôpital Corentin-Celton, DMU Psychiatrie et Addictologie, Issy-les-Moulineaux, France.,INSERM, Institut de Psychiatrie et Neurosciences de Paris, UMR_S1266, Paris, France.,Université de Paris, Faculté de Santé, UFR de Médecine, Paris, France
| | | | - Hugo Saner
- Institute of Social and Preventive Medicine (ISPM), 30317University of Bern, Bern, Switzerland
| | - Oscar H Franco
- Institute of Social and Preventive Medicine (ISPM), 30317University of Bern, Bern, Switzerland
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Kumar S, Wong R, Newberry C, Yeung M, Peña JM, Sharaiha RZ. Multidisciplinary Clinic Models: A Paradigm of Care for Management of NAFLD. Hepatology 2021; 74:3472-3478. [PMID: 34324727 DOI: 10.1002/hep.32081] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Revised: 06/16/2021] [Accepted: 07/15/2021] [Indexed: 12/12/2022]
Affiliation(s)
- Sonal Kumar
- Division of Gastroenterology and Hepatology, Weill Cornell Medicine, New York, NY
| | - Rochelle Wong
- Department of Medicine, NewYork Presbyterian-Weill Cornell Medical Center, New York, NY
| | - Carolyn Newberry
- Division of Gastroenterology and Hepatology, Weill Cornell Medicine, New York, NY
| | - Michele Yeung
- Division of Endocrinology, Weill Cornell Medicine, New York, NY
| | - Jessica M Peña
- Department of Medicine, NewYork Presbyterian-Weill Cornell Medical Center, New York, NY.,Dalio Institute of Cardiovascular Imaging, Department of Radiology, Weill Cornell Medicine and New York Presbyterian Hospital, New York, NY
| | - Reem Z Sharaiha
- Division of Gastroenterology and Hepatology, Weill Cornell Medicine, New York, NY
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81
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Kang JH, Jung CY, Park KS, Huh JS, Oh SY, Kwon JH. Community Care for Cancer Patients in Rural Areas: An Integrated Regional Cancer Center and Public Health Center Partnership Model. JOURNAL OF HOSPICE AND PALLIATIVE CARE 2021; 24:226-234. [PMID: 37674641 PMCID: PMC10180073 DOI: 10.14475/jhpc.2021.24.4.226] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/05/2021] [Revised: 09/21/2021] [Accepted: 09/22/2021] [Indexed: 09/08/2023]
Abstract
Purpose The accessibility of medical facilities for cancer patients affects both their comfort and survival. Patients in rural areas have a higher socioeconomic burden and are more vulnerable to emergency situations than urban dwellers. This study examined the feasibility and effectiveness of a cancer care model integrating a regional cancer center (RCC) and public health center (PHC). Methods This study analyzed the construction of a safety care network for cancer patients that integrated an RCC and PHC. Two public health institutions (an RCC in Gyeongnam and a PHC in Geochang County) collaborated on the development of the community care model. The study lasted 13 months beginning in February 2019 to February 2020. Results The RCC developed the protocol for evaluating and measuring 27 cancer-related symptoms, conducted education for PHC nurses, and administered case counseling. The staff at the PHC registered, evaluated, and routinely monitored patients through home visits. A smartphone application and regular video conferences were incorporated to facilitate mutual communication. In total, 177 patients (mean age 70.9 years; men 59%) were enrolled from February 2019 to February 2020. Patients' greatest unmet need was the presence of a nearby cancer treatment hospital (83%). In total, 28 (33%) and 44 (52%) participants answered that the care model was very helpful or helpful, respectively. Conclusion We confirmed that a combined RCC-PHC program for cancer patients in rural areas is feasible and can bring satisfaction to patients as a safety care network. This program could mitigate health inequalities caused by accessibility issues.
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Affiliation(s)
- Jung Hun Kang
- Department of Internal Medicine, College of Medicine, Gyeongsang National University, Jinju, Korea
| | - Chang Yoon Jung
- National Cancer Control Institute, National Cancer Center, Goyang, Korea
| | - Ki-Soo Park
- Department of Preventive Medicine, Institute of Health Sciences, College of Medicine, Gyeongsang National University, Jinju, Korea
| | - Jung Sik Huh
- Department of Urology, Jeju National University, Jeju, Korea
| | - Sung Yong Oh
- Department of Internal Medicine, College of Medicine, Dong-A University, Busan, Korea
| | - Jung Hye Kwon
- Department of Internal Medicine, College of Medicine, Chungnam National University, Daejeon, Korea
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O’Malley DM, Alfano CM, Doose M, Kinney AY, Lee SJC, Nekhlyudov L, Duberstein P, Hudson SV. Cancer prevention, risk reduction, and control: opportunities for the next decade of health care delivery research. Transl Behav Med 2021; 11:1989-1997. [PMID: 34850934 PMCID: PMC8634312 DOI: 10.1093/tbm/ibab109] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
In this commentary, we discuss opportunities to optimize cancer care delivery in the next decade building from evidence and advancements in the conceptualization and implementation of multi-level translational behavioral interventions. We summarize critical issues and discoveries describing new directions for translational behavioral research in the coming decade based on the promise of the accelerated application of this evidence within learning health systems. To illustrate these advances, we discuss cancer prevention, risk reduction (particularly precision prevention and early detection), and cancer treatment and survivorship (particularly risk- and need-stratified comprehensive care) and propose opportunities to equitably improve outcomes while addressing clinician shortages and cross-system coordination. We also discuss the impacts of COVID-19 and potential advances of scientific knowledge in the context of existing evidence, the need for adaptation, and potential areas of innovation to meet the needs of converging crises (e.g., fragmented care, workforce shortages, ongoing pandemic) in cancer health care delivery. Finally, we discuss new areas for exploration by applying key lessons gleaned from implementation efforts guided by advances in behavioral health.
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Affiliation(s)
- Denalee M O’Malley
- Department of Family Medicine and Community Health, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
- Rutgers Cancer Prevention and Control, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA
- Northwell Health Cancer Institute, New Hyde Park, NY, USA
| | - Catherine M Alfano
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
| | - Michelle Doose
- Health Systems and Interventions Research Branch, Healthcare Delivery Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Anita Y Kinney
- Department of Epidemiology and Biostatistics, Rutgers School of Public Health, Piscataway, NJ, USA
| | - Simon J Craddock Lee
- Harold C. Simmons Comprehensive Cancer Center, Department of Population and Data Sciences, UT-Southwestern, Dallas, TX, USA
| | - Larissa Nekhlyudov
- Harvard Medical School, Brigham & Womens’ Primary Care Medical Associates, Boston, MA, USA
| | - Paul Duberstein
- Department of Family Medicine and Community Health, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
- Rutgers Cancer Prevention and Control, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA
- Department of Health Behavior, Society, and Policy, Rutgers School of Public Health, Piscataway, NJ, USA
| | - Shawna V Hudson
- Department of Family Medicine and Community Health, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
- Rutgers Cancer Prevention and Control, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA
- Northwell Health Cancer Institute, New Hyde Park, NY, USA
- Department of Health Behavior, Society, and Policy, Rutgers School of Public Health, Piscataway, NJ, USA
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Solberg M, Berg GV, Andreassen HK. In Limbo: Seven Families' Experiences of Encounter with Cancer Care in Norway. Int J Integr Care 2021; 21:24. [PMID: 34899103 PMCID: PMC8622148 DOI: 10.5334/ijic.5700] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Accepted: 11/11/2021] [Indexed: 11/20/2022] Open
Abstract
INTRODUCTION Like many other countries, Norway has seen a shift from inpatient to outpatient cancer care, with pathways aimed at improving the integration and coordination of health services. This study explores the perspectives of seven patients and their family members in light of this change. We focus on one particular phase of the pathway: the first encounter. Our interviews were set in the period from referral until the start of treatment. METHODS Nineteen individual in-depth interviews were conducted in seven families. Seven patients with cancer and 12 family members were interviewed. RESULTS Three categories of experiences stood out in the empirical material: 'Being in between different health professionals', 'Overwhelmed by written and oral information' and 'Lack of involvement'. CONCLUSION This study provides insight into families' experiences with cancer care from referral until the start of treatment. Our findings indicate that families often experience cancer care as fragmented and confusing. Although evaluations have shown that the introduction of cancer pathways seems to have a positive effect on waiting times and standardization of examinations across hospitals and regions, there is still potential for improvement in coordination between services, family involvement, and emotional and practical support. We argue that our findings highlight the tension between two ideals of professional care: standardization and patient-centredness. The study illustrates shortcomings in translating the ideal of patient-centredness into professional practice.
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Affiliation(s)
- Monica Solberg
- Norwegian University of Science and Technology and Innlandet Hospital Trust, NO
| | - Geir Vegard Berg
- Norwegian University of Science and Technology and Innlandet Hospital Trust, NO
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84
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Mikles SP, Griffin AC, Chung AE. Health information technology to support cancer survivorship care planning: A systematic review. J Am Med Inform Assoc 2021; 28:2277-2286. [PMID: 34333588 PMCID: PMC8449616 DOI: 10.1093/jamia/ocab134] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Revised: 06/13/2021] [Accepted: 06/23/2021] [Indexed: 01/22/2023] Open
Abstract
OBJECTIVE The study sought to conduct a systematic review to explore the functions utilized by electronic cancer survivorship care planning interventions and assess their effects on patient and provider outcomes. MATERIALS AND METHODS Based on PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analysis) guidelines, studies published from January 2000 to January 2020 were identified in PubMed, CINAHL, EMBASE, PsychINFO, Scopus, Web of Science, and the ACM Digital Library . The search combined terms for cancer, survivorship, care planning, and health information technology (HIT). Eligible studies evaluated the effects of a HIT intervention on usability, knowledge, process, or health-related outcomes. A total of 578 abstracts were reviewed, resulting in 60 manuscripts describing 40 studies. Thematic analyses were used to define meta-themes of system functions, and Fisher's exact tests were used to examine associations between functions and outcomes. RESULTS Patients were the target end users for 18 interventions, while 12 targeted providers and 10 targeted both groups. Interventions used patient-reported outcomes collection (60%), automated content generation (58%), electronic sharing (40%), persistent engagement (28%), and communication features (20%). Overall, interventions decreased the time to create survivorship care plans (SCPs) and supported care planning knowledge and abilities, but results were mixed for effects on healthcare utilization, SCP sharing, and provoking anxiety. Persistent engagement features were associated with improvements in health or quality-of-life outcomes (17 studies, P = .003). CONCLUSIONS Features that engaged users persistently over time were associated with better health and quality-of-life outcomes. Most systems have not capitalized on the potential of HIT to share SCPs across a care team and support care coordination.
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Affiliation(s)
- Sean P Mikles
- Lineberger Comprehensive Cancer Outcomes Program, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Ashley C Griffin
- Carolina Health Informatics Program, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Arlene E Chung
- Lineberger Comprehensive Cancer Outcomes Program, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
- Carolina Health Informatics Program, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
- Division of General Medicine and Clinical Epidemiology, Department of Medicine, UNC School of Medicine, Chapel Hill, North Carolina, USA
- Division of General Pediatrics and Adolescent Medicine, Department of Pediatrics, UNC School of Medicine, Chapel Hill, North Carolina, USA
- Program on Health and Clinical Informatics, UNC School of Medicine, Chapel Hill, North Carolina, USA
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85
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Trosman JR, Weldon CB, Rapkin BD, Benson AB, Makower DF, Liang SY, Kulkarni SA, Perez CB, Lo SS, Krueger EA, Throckmorton AD, Gallagher C, Hoskins K, Schaeffer CM, Van Horn J, Schapira L, Ravelo A, Yu E, Gradishar WJ. Evaluation of the Novel 4R Oncology Care Planning Model in Breast Cancer: Impact on Patient Self-Management and Care Delivery in Safety-Net and Non-Safety-Net Centers. JCO Oncol Pract 2021; 17:e1202-e1214. [PMID: 34375560 DOI: 10.1200/op.21.00161] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
PURPOSE Optimal cancer care requires patient self-management and coordinated timing and sequence of interdependent care. These are challenging, especially in safety-net settings treating underserved populations. We evaluated the 4R Oncology model (4R) of patient-facing care planning for impact on self-management and delivery of interdependent care at safety-net and non-safety-net institutions. METHODS Ten institutions (five safety-net and five non-safety-net) evaluated the 4R intervention from 2017 to 2020 with patients with stage 0-III breast cancer. Data on self-management and care delivery were collected via surveys and compared between the intervention cohort and the historical cohort (diagnosed before 4R launch). 4R usefulness was assessed within the intervention cohort. RESULTS Survey response rate was 63% (422/670) in intervention and 47% (466/992) in historical cohort. 4R usefulness was reported by 79.9% of patients receiving 4R and was higher for patients in safety-net than in non-safety-net centers (87.6%, 74.2%, P = .001). The intervention cohort measured significantly higher than historical cohort in five of seven self-management metrics, including clarity of care timing and sequence (71.3%, 55%, P < .001) and ability to manage care (78.9%, 72.1%, P = .02). Referrals to interdependent care were significantly higher in the intervention than in the historical cohort along all six metrics, including primary care consult (33.9%, 27.7%, P = .045) and flu vaccination (38.6%, 27.9%, P = .001). Referral completions were significantly higher in four of six metrics. For safety-net patients, improvements in most self-management and care delivery metrics were similar or higher than for non-safety-net patients, even after controlling for all other variables. CONCLUSION 4R Oncology was useful to patients and significantly improved self-management and delivery of interdependent care, but gaps remain. Model enhancements and further evaluations are needed for broad adoption. Patients in safety-net settings benefited from 4R at similar or higher rates than non-safety-net patients, indicating that 4R may reduce care disparities.
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Affiliation(s)
- Julia R Trosman
- Center for Business Models in Healthcare, Glencoe, IL.,Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Christine B Weldon
- Center for Business Models in Healthcare, Glencoe, IL.,Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Bruce D Rapkin
- Montefiore Medical Center, Albert Einstein Cancer Center, Bronx, NY.,Department of Epidemiology and Population Health, Albert Einstein College of Medicine, New York, NY
| | - Al B Benson
- Northwestern Medicine, Chicago, IL.,Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL
| | | | - Su-Ying Liang
- Sutter Health-Palo Alto Medical Foundation Research Institute, Palo Alto, CA
| | - Swati A Kulkarni
- Northwestern Medicine, Chicago, IL.,Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL
| | | | - Shelly S Lo
- Loyola University Medical Center, Maywood, IL
| | | | | | | | - Kent Hoskins
- Division of Medical Oncology, University of Illinois at Chicago College of Medicine, Chicago, IL
| | - Cathleen M Schaeffer
- Division of Medical Oncology, University of Illinois at Chicago College of Medicine, Chicago, IL
| | - Jennifer Van Horn
- Banner MD Anderson Cancer Center, Loveland, CO, Formerly Cheyenne Regional Medical Center, Cheyenne, WY
| | - Lidia Schapira
- Stanford University and Stanford Cancer Institute, Stanford, CA
| | | | - Elaine Yu
- Genentech Inc, South San Francisco, CA
| | - William J Gradishar
- Northwestern Medicine, Chicago, IL.,Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL
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86
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Efstathiou N, Lock A, Ahmed S, Parkes L, Davies T, Law S. A realist evaluation of a "single point of contact" end-of-life care service. J Health Organ Manag 2021; ahead-of-print. [PMID: 32436670 DOI: 10.1108/jhom-07-2019-0218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE Following the development of a service that consisted of a "single point of contact" to coordinate end-of-life care (EoLC), including EoLC facilitators and an urgent response team, we aimed to explore whether the provision of coordinated EoLC would support patients being cared or dying in their preferred place and avoid unwanted hospital admissions. DESIGN/METHODOLOGY/APPROACH Using a realist evaluation approach, the authors examined "what worked for whom, how, in what circumstances and why". Multiple data were collected, including activity/performance indicators, observations of management meetings, documents, satisfaction survey and 30 interviews with service providers and users. FINDINGS Advance care planning (ACP) increased through the first three years of the service (from 45% to 83%) and on average 74% of patients achieved preferred place of death. More than 70% of patients avoided an emergency or unplanned hospital admission in their last month of life. The mechanisms and context identified as driving forces of the service included: 7/7 single point of contact; coordinating services across providers; recruiting and developing the workforce; understanding and clarifying new roles; and managing expectations. RESEARCH LIMITATIONS/IMPLICATIONS This was a service evaluation and the outcomes are related to the specific context and mechanisms. However, findings can be transferable to similar settings. PRACTICAL IMPLICATIONS "Single point of contact" services that offer coordinated EoLC can contribute in supporting people to be cared and die in their preferred place. ORIGINALITY/VALUE This paper provides an evaluation of a novel approach to EoLC and creates a set of hypotheses that could be further tested in similar services in the future.
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Affiliation(s)
- Nikolaos Efstathiou
- School of Nursing, College of Medical and Dental Sciences, Institute of Clinical Sciences, University of Birmingham, Birmingham, UK
| | - Anna Lock
- Connected Palliative Care, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, UK
| | - Suha Ahmed
- Connected Palliative Care, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, UK
| | - Linda Parkes
- Connected Palliative Care, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, UK
| | - Tammy Davies
- Connected Palliative Care, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, UK
| | - Susan Law
- Connected Palliative Care, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, UK
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Steitz BD, Sulieman L, Warner JL, Fabbri D, Brown JT, Davis AL, Unertl KM. Classification and analysis of asynchronous communication content between care team members involved in breast cancer treatment. JAMIA Open 2021; 4:ooab049. [PMID: 34396056 PMCID: PMC8358477 DOI: 10.1093/jamiaopen/ooab049] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 05/06/2021] [Accepted: 06/16/2021] [Indexed: 12/03/2022] Open
Abstract
OBJECTIVE A growing research literature has highlighted the work of managing and triaging clinical messages as a major contributor to professional exhaustion and burnout. The goal of this study was to discover and quantify the distribution of message content sent among care team members treating patients with breast cancer. MATERIALS AND METHODS We analyzed nearly two years of communication data from the electronic health record (EHR) between care team members at Vanderbilt University Medical Center. We applied natural language processing to perform sentence-level annotation into one of five information types: clinical, medical logistics, nonmedical logistics, social, and other. We combined sentence-level annotations for each respective message. We evaluated message content by team member role and clinic activity. RESULTS Our dataset included 81 857 messages containing 613 877 sentences. Across all roles, 63.4% and 21.8% of messages contained logistical information and clinical information, respectively. Individuals in administrative or clinical staff roles sent 81% of all messages containing logistical information. There were 33.2% of messages sent by physicians containing clinical information-the most of any role. DISCUSSION AND CONCLUSION Our results demonstrate that EHR-based asynchronous communication is integral to coordinate care for patients with breast cancer. By understanding the content of messages sent by care team members, we can devise informatics initiatives to improve physicians' clerical burden and reduce unnecessary interruptions.
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Affiliation(s)
- Bryan D Steitz
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Lina Sulieman
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Jeremy L Warner
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Division of Hematology/Oncology, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Daniel Fabbri
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - J Thomas Brown
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Alyssa L Davis
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Kim M Unertl
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
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Relationships between health literacy, having a cancer care coordinator, and long-term health-related quality of life among cancer survivors. Support Care Cancer 2021; 29:7913-7924. [PMID: 34191127 DOI: 10.1007/s00520-021-06356-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Accepted: 06/09/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE Care coordination is a strategy to reduce healthcare navigation challenges for cancer patients. The objectives of this study were to assess the association between having a cancer care coordinator (CCC) and long-term health-related quality of life (HRQoL), and to evaluate whether this association differed by level of health literacy. METHODS A population-based sample of survivors diagnosed with breast, prostate, or colorectal cancer in 2015 from the Iowa Cancer Registry participated in an online survey conducted in 2017-2018 (N = 368). Chi-squared tests and logistic regression were used to model the association between patient characteristics and having a cancer care coordinator. Linear regression was used to model the association between patient perception of having a cancer care coordinator and post-treatment physical or mental HRQoL by differing levels of health literacy while controlling for sociodemographic and clinical factors. RESULTS Most survivors (81%) reported having one healthcare professional who coordinated their cancer care. Overall, patient perception of having a coordinator was not significantly associated with physical HRQoL (p = 0.118). However, participants with low health literacy (21%) who had a coordinator had significantly higher physical HRQoL scores compared to those who did not (adjusted mean difference 5.2, p = 0.010), while not so for medium (29%) or high (51%) health literacy (p = 0.227, and p = 0.850, respectively; test for interaction p = 0.001). Mental HRQoL was not associated with having a coordinator in our analyses. CONCLUSION Findings suggest that care coordinators improved post-treatment physical HRQoL, particularly for participants with low health literacy. Care coordinators may be beneficial to the most vulnerable patients struggling to navigate the complex healthcare system during cancer treatment. Future research should focus on the mechanisms by which care coordination may affect post-treatment HRQoL.
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Kenzik KM, Williams GR, Bhakta N, Robison LL, Landier W, Goyal G, Mehta A, Bhatia S. Healthcare utilization and spending among older patients diagnosed with Non-Hodgkin lymphoma. J Geriatr Oncol 2021; 12:1225-1232. [PMID: 34176753 DOI: 10.1016/j.jgo.2021.06.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Revised: 06/15/2021] [Accepted: 06/18/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Developing appropriate care models for patients diagnosed with non-Hodgkin lymphoma (NHL) >65y require examination of current healthcare utilization patterns and cost, but non-malignant condition-specific utilization and Medicare spending among older patients has not been characterized. METHODS Using SEER-Medicare, 14,533 patients diagnosed with NHL at age > 65 between 2008 and 2015 and a comparable non-cancer cohort (n = 14,533) were identified. Hospitalizations and outpatient visits for 109 non-malignant conditions were grouped into ten categories, allowing condition-specific utilization and spending calculation from diagnosis to 5y, censoring at blood or marrow transplantation, 6mo prior to death or end (12/31/2016). Using the 90th percentile as a cut-off, factors associated with high-hospitalization rates and high-spending were evaluated. RESULTS Patients with NHL were 1.5-fold more likely to be hospitalized and 1.8-fold more likely to experience outpatient visits when compared with the non-cancer cohort. Patients with NHL had greater aging-related, cardiovascular, and gastrointestinal hospitalizations than controls (p < 0.001). Average Medicare spending/visit was higher for patients with NHL (hospitalization: $16,950 vs. $13,474, p < 0.001; outpatient: $1176 vs. $392, p < 0.001). Factors associated with high-utilization and high-spending included diffuse large B cell lymphoma subtype, non-white race, and residence in low-education area. CONCLUSIONS Older patients with NHL experienced higher utilization and higher spending per-utilization compared to a non-cancer cohort over five years from cancer diagnosis. Clinical and demographic sub-groups demonstrated increased risk for the highest spending and utilization. The substantial utilization and spending for non-malignant conditions among older patients with NHL provides quantifiable evidence for survivor-adapted healthcare management policies.
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Affiliation(s)
- Kelly M Kenzik
- Institute for Cancer Outcomes and Survivorship, University of Alabama at Birmingham, USA; Division of Hematology and Oncology, University of Alabama at Birmingham, USA.
| | - Grant R Williams
- Institute for Cancer Outcomes and Survivorship, University of Alabama at Birmingham, USA; Division of Hematology and Oncology, University of Alabama at Birmingham, USA
| | - Nickhill Bhakta
- Department of Global Pediatric Medicine, St. Jude Children's Research Hospital, USA; Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, USA
| | - Leslie L Robison
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, USA
| | - Wendy Landier
- Institute for Cancer Outcomes and Survivorship, University of Alabama at Birmingham, USA; Division of Pediatric Oncology, University of Alabama at Birmingham, USA
| | - Gaurav Goyal
- Division of Hematology and Oncology, University of Alabama at Birmingham, USA
| | - Amitkumar Mehta
- Division of Hematology and Oncology, University of Alabama at Birmingham, USA
| | - Smita Bhatia
- Institute for Cancer Outcomes and Survivorship, University of Alabama at Birmingham, USA; Division of Pediatric Oncology, University of Alabama at Birmingham, USA
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Cheung V, Siddiq N, Devlin R, McNamara C, Gupta V. Modèle de soins partagés pour les hémopathies malignes chroniques complexes. Can Oncol Nurs J 2021; 31:175-185. [PMID: 34036156 DOI: 10.5737/23688076312175185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Les néoplasies myéloprolifératives (NMP) sont des leucémies chroniques rares sans chromosome Philadelphie. L’expertise de cette maladie peu commune est limitée et concentrée dans des centres spécialisés où les patients doivent se rendre pour obtenir confirmation du diagnostic, prendre des décisions complexes, recevoir des soins de soutien et accéder à de nouveaux médicaments par la participation à des essais cliniques. Toutefois, les nombreux déplacements nécessaires pour ces rendez-vous représentent un poids pour les patients; ils augmentent le fardeau financier, accroissent le stress des proches aidants et nuisent à la qualité de vie. Pour s’attaquer à ce problème, le programme du Centre de cancérologie Princess Margaret (PM) dédié aux NMP a mis en place un modèle de soins partagés et a misé sur la collaboration avec les équipes soignantes locales afin d’offrir aux patients atteints de NMP une prise en charge continue et des soins de soutien plus accessibles. Ainsi, les patients se déplacent moins et reçoivent des soins de qualité axés sur leurs besoins. Le présent article décrit l’expérience de mise en œuvre du modèle de soins partagés au Centre Princess Margaret, expérience qui pourrait s’étendre à d’autres hémopathies malignes chroniques et maladies chroniques rares. L’objectif ultime des soins partagés n’est pas de centraliser les services, mais plutôt de bâtir une communauté de soins accessibles pour le patient.
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Affiliation(s)
- Verna Cheung
- infirmière clinicienne spécialisée, Centre de cancérologie Princess Margaret, Université de Toronto (Ontario)
| | - Nancy Siddiq
- en éducation, infirmière praticienne (adultes), Centre de cancérologie Princess Margaret, Université de Toronto (Ontario)
| | - Rebecca Devlin
- collaboratrice scientifique, programme des NMP Elizabeth and Tony Comper, Centre de cancérologie Princess Margaret, Université de Toronto (Ontario)
| | - Caroline McNamara
- hématologue titulaire, Centre de cancérologie Princess Margaret, Université de Toronto (Ontario)
| | - Vikas Gupta
- professeur de médecine, Centre de cancérologie Princess Margaret, Université de Toronto (Ontario)
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Higher Medicare Expenditures Are Associated With Better Integrated Care as Perceived by Patients. Med Care 2021; 59:565-571. [PMID: 33989247 DOI: 10.1097/mlr.0000000000001558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Integrated care that is continuous, coordinated and patient-centered is vital for Medicare beneficiaries, but its relationship to health care expenditures remains unclear. RESEARCH OBJECTIVE This study explores-for the first time-the relationship between integrated care, as measured from the patient's perspective, and health care expenditures. METHODS Subjects include a sample of continuously eligible fee-for-service Medicare beneficiaries (n=8807) in 2015. Analyses draw on 7 previously validated measures of patient-perceived integrated care from the 2015 Medicare Current Beneficiary Survey. These data are combined with 2015 administrative utilization data that measure health care expenditures. Relationships between patient-perceived integrated care and costs are assessed using generalized linear models with comprehensive control measures. RESULTS Patients who perceive more integrated care have higher expenditures for many, but not all, cost categories examined. Aspects of integrated care pertaining to primary provider and specialist care are associated with higher costs in several areas (particularly inpatient costs associated with specialist knowledge of the patient). Office staff members' knowledge of the patient's medical history is associated with lower home health costs. CONCLUSIONS Patients who experience their care as more integrated may have higher expenditures on average. Thoughtful policy choices, further research, and innovations that enable patients to perceive integrated care at lower or neutral cost are needed.
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Cancer care reform in South Africa: A case for cancer care coordination: A narrative review. Palliat Support Care 2021; 20:129-137. [PMID: 33952380 DOI: 10.1017/s1478951521000432] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE This review provides an overview of the existing literature on the importance of care coordination for lung cancer care and other cancers in general. The review is inclusive of the burden of cancer, with a special reference to lung cancer, as well as challenges and achievements relating to cancer care coordination. METHOD We conducted a search of online databases of peer-reviewed studies published in the English language. The analysis for this review has been packaged into themes in order to generate results that can inform researchers and cancer health professionals, on the existing gaps necessary for developing appropriate intervention strategies and policy guidelines. RESULTS Cancer is a complex condition that often requires multiple interventions provided by a variety of health professionals within the healthcare continuum. This paper reviewed research studies that explored the supportive care needs of cancer patients. The results are presented in three superordinate themes, namely (a) cancer as a healthcare priority in South Africa (SA), (b) making a case for coordinated cancer care in SA, and (c) care coordination: a poorly defined, yet complex concept. One major need identified was the requirement of informational support. Other essential needs included referral, emotional, and financial support. SIGNIFICANCE OF RESULTS The identification of current obstacles has the potential to guide the development of a model to improve quality coordinated cancer health care. It remains that limited research exists around cancer services and cancer care in the South African region. This narrative review identified common elements and barriers to care for lung cancer patients and survivors, and offers recommendations for developing clinical care models.
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Wu YL, Padmalatha K M S, Yu T, Lin YH, Ku HC, Tsai YT, Chang YJ, Ko NY. Is nurse-led case management effective in improving treatment outcomes for cancer patients? A systematic review and meta-analysis. J Adv Nurs 2021; 77:3953-3963. [PMID: 33942383 DOI: 10.1111/jan.14874] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Revised: 03/13/2021] [Accepted: 04/07/2021] [Indexed: 11/30/2022]
Abstract
AIMS To identify and synthesize the outcomes of nurse-led case management interventions for improving cancer treatment. DESIGN Systematic review with meta-analysis. DATA SOURCES PubMed, MEDLINE, CINAHL, EMBASE, Cochrane Library and CEPS were searched for articles published from inception till June 2019, and search was finalized in January 2020. REVIEW METHODS The review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement guidelines. The quality of evidence was assessed using Joanna Briggs Institute Critical Appraisal Tools. Outcomes were analysed by using a pool of data of 95% confidence intervals (CIs), p value and fitting model based on heterogeneity of test results. RESULTS Eleven articles were included in the meta-analysis. When compared with the regular care group, the nurse-led case management group had: 1) shorter time from diagnosis to treatment by 9.07 days, 2) an improved treatment completion rates (OR = 2.45) and 3) more number of patients received hormone therapy. CONCLUSION The synthesized results presented that nurse-led case management is more effective than regular care in improving treatment timeliness, treatment completion rates and hormone therapy rates.
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Affiliation(s)
- Yi Lin Wu
- Department of Nursing, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.,International Doctoral Program in Nursing, Department of Nursing, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Sriyani Padmalatha K M
- International Doctoral Program in Nursing, Department of Nursing, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Tsung Yu
- Department of Public Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Yi-Hsuan Lin
- Department of Nursing, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Han-Chang Ku
- International Doctoral Program in Nursing, Department of Nursing, College of Medicine, National Cheng Kung University, Tainan, Taiwan.,Department of Nursing, An Nan Hospital, China Medical University, Tainan, Taiwan
| | - Yi-Tseng Tsai
- International Doctoral Program in Nursing, Department of Nursing, College of Medicine, National Cheng Kung University, Tainan, Taiwan.,Department of Nursing, An Nan Hospital, China Medical University, Tainan, Taiwan
| | - Ying-Ju Chang
- Department of Nursing, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.,Department of Nursing, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Nai-Ying Ko
- Department of Nursing, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.,Department of Nursing, College of Medicine, National Cheng Kung University, Tainan, Taiwan
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94
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Cheung V, Siddiq N, Devlin R, McNamara C, Gupta V. Shared-care model for complex chronic haematological malignancies. Can Oncol Nurs J 2021; 31:165-174. [PMID: 34036155 DOI: 10.5737/23688076312165174] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Myeloproliferative neoplasms (MPNs) are a group of rare Philadelphia-negative chronic leukemias. Disease rarity has resulted in limited expertise concentrated in specialist centres. Patients are often referred to such expert centres for diagnostic issues, complex decision-making, access to novel drugs through clinical trials, and supportive care. Attending such appointments may increase financial and travel burden, increase caregiver stress, and negatively impact quality of life. To address this, the MPN program at Princess Margaret (PM) Cancer Centre has implemented a shared-care model, working with local healthcare providers to provide ongoing management, and supportive care for MPN patients closer to home. This decreases patient travel burden, while maintaining high-quality patient-centered care. In this article we share our experience implementing the shared-care model. This model is potentially applicable to other chronic hematological malignancies and rare chronic diseases. The ultimate goal of shared-care is not to centralize care, but instead to build a community of accessible care for the patient.
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Affiliation(s)
- Verna Cheung
- Clinical Nurse Specialist, Princess Margaret Cancer Centre, University of Toronto, Toronto, ON
| | - Nancy Siddiq
- MSN in Education Nurse Practitioner (Adult), Princess Margaret Cancer Centre, University of Toronto, Toronto, ON
| | - Rebecca Devlin
- Scientific Associate, The Elizabeth and Tony Comper MPN Program, Princess Margaret Cancer Centre, University of Toronto, Toronto, ON
| | - Caroline McNamara
- Staff Hematologist, Princess Margaret Cancer Centre, University of Toronto, Toronto, ON
| | - Vikas Gupta
- Professor of Medicine, Princess Margaret Cancer Centre, University of Toronto, Toronto, ON
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95
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Oyer RA, Smeltzer MP, Kramar A, Boehmer LM, Lathan CS. Equity-Driven Approaches to Optimizing Cancer Care Coordination and Reducing Care Delivery Disparities in Underserved Patient Populations in the United States. JCO Oncol Pract 2021; 17:215-218. [PMID: 33974823 DOI: 10.1200/op.20.00895] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Randall A Oyer
- Ann B. Barshinger Cancer Institute, Penn Medicine Lancaster General Health, Lancaster, PA
| | - Matthew P Smeltzer
- Division of Epidemiology, Biostatistics, and Environmental Health, School of Public Health, The University of Memphis, Memphis, TN
| | - Amanda Kramar
- Association of Community Cancer Centers, Rockville, MD
| | | | - Christopher S Lathan
- Dana-Farber Cancer Institute at St Elizabeth's Medical Center, Boston, MA.,Harvard Medical School, Boston, MA
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96
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Verhoeven DC, Chollette V, Lazzara EH, Shuffler ML, Osarogiagbon RU, Weaver SJ. The Anatomy and Physiology of Teaming in Cancer Care Delivery: A Conceptual Framework. J Natl Cancer Inst 2021; 113:360-370. [PMID: 33107915 PMCID: PMC8599835 DOI: 10.1093/jnci/djaa166] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Revised: 09/22/2020] [Accepted: 10/08/2020] [Indexed: 12/18/2022] Open
Abstract
Care coordination challenges for patients with cancer continue to grow as expanding treatment options, multimodality treatment regimens, and an aging population with comorbid conditions intensify demands for multidisciplinary cancer care. Effective teamwork is a critical yet understudied cornerstone of coordinated cancer care delivery. For example, comprehensive lung cancer care involves a clinical "team of teams"-or clinical multiteam system (MTS)-coordinating decisions and care across specialties, providers, and settings. The teamwork processes within and between these teams lay the foundation for coordinated care. Although the need to work as a team and coordinate across disciplinary, organizational, and geographic boundaries increases, evidence identifying and improving the teamwork processes underlying care coordination and delivery among the multiple teams involved remains sparse. This commentary synthesizes MTS structure characteristics and teamwork processes into a conceptual framework called the cancer MTS framework to advance future cancer care delivery research addressing evidence gaps in care coordination. Included constructs were identified from published frameworks, discussions at the 2016 National Cancer Institute-American Society of Clinical Oncology Teams in Cancer Care Workshop, and expert input. A case example in lung cancer provided practical grounding for framework refinement. The cancer MTS framework identifies team structure variables and teamwork processes affecting cancer care delivery, related outcomes, and contextual variables hypothesized to influence coordination within and between the multiple clinical teams involved. We discuss how the framework might be used to identify care delivery research gaps, develop hypothesis-driven research examining clinical team functioning, and support conceptual coherence across studies examining teamwork and care coordination and their impact on cancer outcomes.
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Affiliation(s)
- Dana C Verhoeven
- Affiliations of authors: Division of Cancer Control and Population Sciences, Health Systems and Interventions Research Branch, Healthcare Delivery Research Program, National Cancer Institute, Rockville, MD, USA
| | - Veronica Chollette
- Affiliations of authors: Division of Cancer Control and Population Sciences, Health Systems and Interventions Research Branch, Healthcare Delivery Research Program, National Cancer Institute, Rockville, MD, USA
| | - Elizabeth H Lazzara
- Department of Human Factors and Behavioral Neurobiology, Embry-Riddle Aeronautical University, Daytona Beach, FL, USA
| | - Marissa L Shuffler
- Department of Psychology, College of Behavioral, Social, & Health Sciences, Clemson University, Clemson, SC, USA
| | | | - Sallie J Weaver
- Affiliations of authors: Division of Cancer Control and Population Sciences, Health Systems and Interventions Research Branch, Healthcare Delivery Research Program, National Cancer Institute, Rockville, MD, USA
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97
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Gallicchio L, Tonorezos E, de Moor JS, Elena J, Farrell M, Green P, Mitchell SA, Mollica MA, Perna F, Gottlieb Saiontz N, Zhu L, Rowland J, Mayer DK. Evidence Gaps in Cancer Survivorship Care: A Report from the 2019 National Cancer Institute Cancer Survivorship Workshop. J Natl Cancer Inst 2021; 113:1136-1142. [PMID: 33755126 DOI: 10.1093/jnci/djab049] [Citation(s) in RCA: 48] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Revised: 03/01/2021] [Accepted: 03/19/2021] [Indexed: 12/26/2022] Open
Abstract
Today, there are more than 16.9 million cancer survivors in the United States; this number is projected to grow to 22.2 million by 2030. While much progress has been made in understanding cancer survivors needs and in improving survivorship care since the seminal 2006 Institute of Medicine report From Cancer Patient to Cancer Survivor: Lost in Transition, there is a need to identify evidence gaps and research priorities pertaining to cancer survivorship. Thus, in April 2019, the National Cancer Institute convened grant-funded extramural cancer survivorship researchers, representatives of professional organizations, cancer survivors, and advocates for a one-day in-person meeting. At this meeting, and in a subsequent webinar aimed at soliciting input from the wider survivorship community, evidence gaps and ideas for next steps in the following six areas, identified from the 2006 Institute of Medicine report, were discussed: surveillance for recurrence and new cancers, management of long-term and late physical effects, management of long-term and late psychosocial effects, health promotion, care coordination, and financial hardship. Identified evidence gaps and next steps across the areas included the need to understand and address disparities among cancer survivors, to conduct longitudinal studies as well as longer-term (>5 years post-diagnosis) follow-up studies, to leverage existing data, and to incorporate implementation science strategies to translate findings into practice. Designing studies to address these broad evidence gaps, as well as those identified in each area, will expand our understanding of cancer survivors' diverse needs, ultimately leading to the development and delivery of more comprehensive evidence-based quality care.
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Affiliation(s)
- Lisa Gallicchio
- Clinical and Translational Epidemiology Branch, Epidemiology and Genomics Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute
| | - Emily Tonorezos
- Office of Cancer Survivorship, Division of Cancer Control and Population Sciences, National Cancer Institute
| | - Janet S de Moor
- Healthcare Delivery Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute
| | - Joanne Elena
- Clinical and Translational Epidemiology Branch, Epidemiology and Genomics Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute
| | - Margaret Farrell
- Division of Communications and Marketing, Office of the Director, National Institutes of Health
| | - Paige Green
- Basic Biobehavioral and Psychological Sciences Branch, Behavioral Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute
| | - Sandra A Mitchell
- Outcomes Research Branch, Health Delivery Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute
| | - Michelle A Mollica
- Outcomes Research Branch, Health Delivery Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute
| | - Frank Perna
- Health Behaviors Research Branch, Behavioral Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute
| | - Nicole Gottlieb Saiontz
- Office of the Director, Division of Cancer Control and Population Sciences, National Cancer Institute
| | - Li Zhu
- Statistical Research and Applications Branch, Surveillance Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute
| | - Julia Rowland
- Smith Center for Healing and the Arts, Washington DC
| | - Deborah K Mayer
- School of Nursing, University of North Carolina at Chapel Hill; University of North Carolina Lineberger Comprehensive Cancer Center
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98
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Griffin L, Patterson D, Mason TM, Vonnes C. Improving care coordination for patients 65 and older. Geriatr Nurs 2021; 42:610-612. [PMID: 33744007 DOI: 10.1016/j.gerinurse.2021.03.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Affiliation(s)
- Lisa Griffin
- H. Lee Moffitt Cancer Center, 12902 Magnolia Drive, Tampa, FL 33612, United States
| | - Dorothy Patterson
- H. Lee Moffitt Cancer Center, 12902 Magnolia Drive, Tampa, FL 33612, United States
| | - Tina M Mason
- H. Lee Moffitt Cancer Center, 12902 Magnolia Drive, Tampa, FL 33612, United States
| | - Cassandra Vonnes
- H. Lee Moffitt Cancer Center, 12902 Magnolia Drive, Tampa, FL 33612, United States.
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99
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Sauro K, Maini A, Machan M, Lorenzetti D, Chandarana S, Dort J. Are there opportunities to improve care as patients transition through the cancer care continuum? A scoping review protocol. BMJ Open 2021; 11:e043374. [PMID: 33495258 PMCID: PMC7839915 DOI: 10.1136/bmjopen-2020-043374] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION Transitions in Care (TiC) are vulnerable periods in care delivery associated with adverse events, increased cost and decreased patient satisfaction. Patients with cancer encounter many transitions during their care journey due to improved survival rates and the complexity of treatment. Collectively, improving TiC is particularly important among patients with cancer. The objective of this scoping review is to synthesise and map the existing literature regarding TiC among patients with cancer in order to explore opportunities to improve TiC among patients with cancer. METHODS AND ANALYSIS This scoping review will follow the Preferred Reporting Items for Systematic Reviews and Meta-Analysis-Scoping Review Extension and the Joanna Briggs Institute methodology. The PubMed cancer filter and underlying search strategy will be tailored to each database (Embase, Cochrane, CINAHL and PsycINFO) and combined with search terms for TiC. Grey literature and references of included studies will be searched. The search will include studies published from database inception until 9 February 2020. Quantitative and qualitative studies will be included if they describe transitions between any type of healthcare provider or institution among patients with cancer. Descriptive statistics will summarise study characteristics and quantitative data of included studies. Qualitative data will be synthesised using thematic analysis. ETHICS AND DISSEMINATION Our objective is to synthesise and map the existing evidence; therefore, ethical approval is not required. Evidence gaps around TiC will inform a programme of research aimed to improve high-risk transitions among patients with cancer. The findings of this scoping review will be published in a peer-reviewed journal and widely presented at academic conferences. More importantly, decision makers and patients will be provided a summary of the findings, along with data from a companion study, to prioritise TiC in need of interventions to improve continuity of care for patients with cancer.
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Affiliation(s)
- Khara Sauro
- Department of Community Health Sciences & O'Brien Institute for Public Health, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Department of Oncology & Arnie Charbonneau Cancer Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Department of Surgery, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Arjun Maini
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Matthew Machan
- Department of Community Health Sciences & O'Brien Institute for Public Health, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Diane Lorenzetti
- Department of Community Health Sciences & O'Brien Institute for Public Health, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Shamir Chandarana
- Department of Surgery, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Joseph Dort
- Department of Community Health Sciences & O'Brien Institute for Public Health, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Department of Oncology & Arnie Charbonneau Cancer Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Department of Surgery, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
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100
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Arditi C, Walther D, Gilles I, Lesage S, Griesser AC, Bienvenu C, Eicher M, Peytremann-Bridevaux I. Computer-assisted textual analysis of free-text comments in the Swiss Cancer Patient Experiences (SCAPE) survey. BMC Health Serv Res 2020; 20:1029. [PMID: 33172451 PMCID: PMC7654064 DOI: 10.1186/s12913-020-05873-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Accepted: 10/28/2020] [Indexed: 11/26/2022] Open
Abstract
Background Patient experience surveys are increasingly conducted in cancer care as they provide important results to consider in future development of cancer care and health policymaking. These surveys usually include closed-ended questions (patient-reported experience measures (PREMs)) and space for free-text comments, but published results are mostly based on PREMs. We aimed to identify the underlying themes of patients’ experiences as shared in their own words in the Swiss Cancer Patient Experiences (SCAPE) survey and compare these themes with those assessed with PREMs to investigate how the textual analysis of free-text comments contributes to the understanding of patients’ experiences of care. Methods SCAPE is a multicenter cross-sectional survey that was conducted between October 2018 and March 2019 in French-speaking parts of Switzerland. Patients were invited to rate their care in 65 closed-ended questions (PREMs) and to add free-text comments regarding their cancer-related experiences at the end of the survey. We conducted computer-assisted textual analysis using the IRaMuTeQ software on the comments provided by 31% (n = 844) of SCAPE survey respondents (n = 2755). Results We identified five main thematic classes, two of which consisting of a detailed description of ‘cancer care pathways’. The remaining three classes were related to ‘medical care’, ‘gratitude and praise’, and the way patients lived with cancer (‘cancer and me’). Further analysis of this last class showed that patients’ comments related to the following themes: ‘initial shock’, ‘loneliness’, ‘understanding and acceptance’, ‘cancer repercussions’, and ‘information and communication’. While closed-ended questions related mainly to factual aspects of experiences of care, free-text comments related primarily to the personal and emotional experiences and consequences of having cancer and receiving care. Conclusions A computer-assisted textual analysis of free-text in our patient survey allowed a time-efficient classification of free-text data that provided insights on the personal experience of living with cancer and additional information on patient experiences that had not been collected with the closed-ended questions, underlining the importance of offering space for comments. Such results can be useful to inform questionnaire development, provide feedback to professional teams, and guide patient-centered initiatives to improve the quality and safety of cancer care.
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Affiliation(s)
- Chantal Arditi
- Department of Epidemiology and Health Systems, Center for Primary Care and Public Health (Unisanté), University of Lausanne, Route de la Corniche 10, 1010, Lausanne, Switzerland.
| | - Diana Walther
- Department of Epidemiology and Health Systems, Center for Primary Care and Public Health (Unisanté), University of Lausanne, Route de la Corniche 10, 1010, Lausanne, Switzerland
| | - Ingrid Gilles
- Department of Epidemiology and Health Systems, Center for Primary Care and Public Health (Unisanté), University of Lausanne, Route de la Corniche 10, 1010, Lausanne, Switzerland
| | - Saphir Lesage
- Department of Epidemiology and Health Systems, Center for Primary Care and Public Health (Unisanté), University of Lausanne, Route de la Corniche 10, 1010, Lausanne, Switzerland
| | - Anne-Claude Griesser
- Medical Directorate, Lausanne University Hospital CHUV, rue du Bugnon 21, 1011, Lausanne, Switzerland
| | - Christine Bienvenu
- Department of Policlinics, Center for Primary Care and Public Health (Unisanté), Rue du Bugnon 44, 1011, Lausanne, Switzerland.,Swiss Cancer Patient Experiences (SCAPE) survey steering committee, Lausanne, Switzerland
| | - Manuela Eicher
- Institute of Higher Education and Research in Healthcare (IUFRS), Route de la Corniche 10, 1010, Lausanne, Switzerland.,Department of Oncology, Lausanne University Hospital, Rue du Bugnon 21, 1011, Lausanne, Switzerland
| | - Isabelle Peytremann-Bridevaux
- Department of Epidemiology and Health Systems, Center for Primary Care and Public Health (Unisanté), University of Lausanne, Route de la Corniche 10, 1010, Lausanne, Switzerland
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