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Davis A, Bell JF, Reed SC, Kim KK, Stacey D, Joseph JG. Nurse-Led Telephonic Symptom Support for Patients Receiving Chemotherapy. Oncol Nurs Forum 2020; 47:E199-E210. [PMID: 33063775 DOI: 10.1188/20.onf.e199-e210] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PROBLEM STATEMENT The use of evidence-informed symptom guides has not been widely adopted in telephonic support. DESIGN This is a descriptive study of nurse-led support using evidence-based symptom guides during telephone outreach. DATA SOURCES Documentation quantified telephone encounters by frequency, length, and type of patient-reported symptoms. Nurse interviews examined perceptions of their role and the use of symptom guides. ANALYSIS Quantitative data were summarized using univariate descriptive statistics, and interviews were analyzed using directed descriptive content analysis. FINDINGS Symptom guides were viewed as trusted evidence-based resources, suitable to address common treatment-related symptoms. A threshold effect was a reported barrier of the guides, such that the benefit diminished over time for managing recurring symptoms. IMPLICATIONS FOR PRACTICE Telephone outreach using evidence-based symptom guides can contribute to early symptom identification while engaging patients in decision making. Understanding nurse activities aids in developing an economical and high-quality model for symptom support, as well as in encouraging nurses to practice at the highest level of preparation.
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102
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Doubova SV, Pérez-Cuevas R. Supportive care needs and quality of care of patients with lung cancer in Mexico: A cross-sectional study. Eur J Oncol Nurs 2020; 49:101857. [PMID: 33120212 DOI: 10.1016/j.ejon.2020.101857] [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: 06/02/2020] [Revised: 10/14/2020] [Accepted: 10/15/2020] [Indexed: 11/25/2022]
Abstract
PURPOSE To assess the supportive care needs (SC-needs), quality of patient-centered care (PCC), and factors associated with increased SC-needs of patients with lung cancer (LC) in Mexico. METHODS We conducted a cross-sectional survey in the main oncology hospital of the Mexican Institute of Social Security in Mexico City. The study included LC ambulatory patients aged ≥18 years with at least one hospitalization before the survey, ≤five years since diagnosis, and without memory loss. Participants answered SC-needs and quality of PCC questionnaires. We performed a multiple negative binomial regression analysis to evaluate the factors associated with an increased number of SC-needs. RESULTS One hundred twenty-eight LC patients participated. Most participants had adenocarcinoma (61.7%) and were at an advanced disease stage (92.1%). In the month preceding the survey, 3.9% had undergone surgery and 78.9% had been receiving chemotherapy and/or radiotherapy; 28.9% had symptoms of depression and 21.9% had anxiety. All patients reported one or more SC-needs-predominantly physical, daily living, information, and psychological needs. The significant gaps in PCC-quality were in the domains of care that addressed biopsychosocial needs and information for treatment decision-making. Factors that decreased the probability of SC-needs were respectful and coordinated care, high-school education, and older age. The factors increasing the likelihood of SCneeds were the type of LC (adenocarcinoma, mesenchymal tumors), chemotherapy and/or radiotherapy, and anxiety. CONCLUSION PCC improvement initiatives to address SC-needs of LC patients should be prioritized and focus on: (1) information on physical suffering relief and treatment; (2) psychological support; and (3) SC-needs monitoring.
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Affiliation(s)
- Svetlana V Doubova
- Epidemiology and Health Services Research Unit CMN Siglo XXI, Mexican Institute of Social Security, Av. Cuauhtemoc 330, Col. Doctores, Del. Cuauhtemoc, Mexico City, CP, 06720, Mexico.
| | - Ricardo Pérez-Cuevas
- Division of Social Protection and Health, Jamaica Country Office, Interamerican Development Bank, Kingston, Jamaica.
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103
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Patient experience and quality of life during neoadjuvant therapy for pancreatic cancer: a systematic review and study protocol. Support Care Cancer 2020; 29:3009-3016. [PMID: 33030596 DOI: 10.1007/s00520-020-05813-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Accepted: 10/02/2020] [Indexed: 12/15/2022]
Abstract
PURPOSE Neoadjuvant therapy (NT) is increasingly being offered to patients with pancreatic ductal adenocarcinoma (PDAC) prior to surgical resection. However, the experience and quality of life (QOL) of patients undergoing NT are poorly understood. METHODS A systematic review of the Cinahl, Embase, Medline, Pubmed, Scopus, and Web of Science databases was conducted to evaluate the available literature pertaining to the experience and QOL of patient's undergoing NT for PDAC. RESULTS Among 6041 articles screened, only six met criteria for full-text review including three prospective clinical trials of NT with QOL secondary endpoints. Overall, global QOL during or following NT did not significantly change from baseline. Pain scores seemed to improve during NT while the impact of NT on physical functioning varied across studies. No studies were identified evaluating other aspects of the patient experience. CONCLUSION Although NT appears to have a minor impact on the QOL of patients with PDAC, this systematic review identified significant evidence gaps in the literature. A protocol of a prospective observational cohort study utilizing a digital smartphone app that aims to evaluate the patient experience and longitudinal QOL of patients with PDAC undergoing NT is presented.
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Perceptions of care coordination in cancer patient-family caregiver dyads. Support Care Cancer 2020; 29:2645-2652. [PMID: 32970231 DOI: 10.1007/s00520-020-05764-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Accepted: 09/08/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE To examine cancer patients and their family caregivers' perspectives of care coordination (CC) using a dyadic research design. METHODS In this pilot cross-sectional study, 54 patient-family caregiver dyads completed a validated care coordination instrument (CCI) and its parallel family caregiver instrument (CCICG) from June to September 2019. The sample available for analysis included data from 32 dyads, which included patients receiving active therapy for any cancer type and their primary family caregivers aged 18 years or older. Mixed regression models were used to examine dyadic differences. RESULTS The overall family caregiver scores demonstrated a bimodal pattern; thus, we conducted analyses using aggregate data as well as by highCG and lowCG subgroups. Among dyads in the lowCG subgroup, family caregivers reported significantly lower scores than patients on the total CCI and the three CC domains: Communication, Navigation, and Operational. Caregiver gender, the absence of a patient navigator, and practice setting (hospital-based ambulatory) significantly predicted dyadic differences in the lowCG subgroup. In item-level analyses, family caregivers in the lowCG subgroup reported lower scores than patients on the items related to patient-physician communication. CONCLUSION A subgroup of family caregivers reported poorer perception of CC than patients, suggesting that those family caregivers and providers may benefit from intervention. Further understanding of patient-family caregiver dyads' perspectives of CC can inform development of strategies to integrate family caregivers into the cancer care team, develop effective CC interventions for family caregivers, and contribute to improved quality and value of cancer care.
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105
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Dessources K, Hari A, Pineda E, Amneus MW, Sinno AK, Holschneider CH. Socially determined cervical cancer care navigation: An effective step toward health care equity and care optimization. Cancer 2020; 126:5060-5068. [DOI: 10.1002/cncr.33124] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Revised: 05/05/2020] [Accepted: 05/07/2020] [Indexed: 11/07/2022]
Affiliation(s)
- Kimberly Dessources
- Department of Surgery Memorial Sloan Kettering Cancer Center New York New York
| | - Anjali Hari
- Department of Obstetrics and Gynecology Olive View–UCLA Medical Center Sylmar California
- Department of Obstetrics and Gynecology David Geffen School of Medicine University of California at Los Angeles Los Angeles California
| | - Elizabeth Pineda
- Department of Obstetrics and Gynecology Olive View–UCLA Medical Center Sylmar California
- Department of Obstetrics and Gynecology David Geffen School of Medicine University of California at Los Angeles Los Angeles California
| | - Malaika W. Amneus
- Department of Obstetrics and Gynecology Kaiser Permanente Panorama City Panorama City California
| | - Abdulrahman K. Sinno
- Department of Obstetrics and Gynecology Olive View–UCLA Medical Center Sylmar California
- Department of Obstetrics and Gynecology David Geffen School of Medicine University of California at Los Angeles Los Angeles California
| | - Christine H. Holschneider
- Department of Obstetrics and Gynecology Olive View–UCLA Medical Center Sylmar California
- Department of Obstetrics and Gynecology David Geffen School of Medicine University of California at Los Angeles Los Angeles California
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106
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Cohen-Mekelburg S, Saini SD, Krein SL, Hofer TP, Wallace BI, Hollingsworth JM, Bynum JPW, Wiitala W, Burns J, Higgins PDR, Waljee AK. Association of Continuity of Care With Outcomes in US Veterans With Inflammatory Bowel Disease. JAMA Netw Open 2020; 3:e2015899. [PMID: 32886122 PMCID: PMC7489806 DOI: 10.1001/jamanetworkopen.2020.15899] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
IMPORTANCE Health care fragmentation is associated with inefficiency and worse outcomes. Continuity of care (COC) models were developed to address fragmentation. OBJECTIVE To examine COC and selected outcomes in US veterans with inflammatory bowel disease (IBD). DESIGN, SETTING, AND PARTICIPANTS This retrospective cohort study used the Veterans Health Administration (VHA) Corporate Data Warehouse to identify veterans with IBD who received care in the VHA health care system between January 1, 2002, and December 31, 2014. Included patients were veterans with IBD who had a primary care physician and at least 4 outpatient visits with key physicians (gastroenterologist, primary care physician, and surgeon) within the first year after an index IBD encounter. Data were analyzed from November 2018 to May 2020. EXPOSURES Care continuity was measured with the Bice-Boxerman COC index to define care density and dispersion within year 1 after the initial presentation. MAIN OUTCOMES AND MEASURES A Cox proportional hazards regression model was used to quantify the association between a low level of COC in year 1 (defined as ≤0.25 on a 0 to 1 scale) and subsequent IBD-related outcomes in years 2 and 3 (outpatient flare, hospitalization, and surgical intervention). RESULTS Among the 20 079 veterans with IBD who met the inclusion criteria, 18 632 were men (92.8%) and the median (interquartile range [IQR]) age was 59 (48-66) years. In the first year of follow-up, substantial variation in the dispersion of care was observed (median [IQR] COC, 0.24 [0.13-0.46]). In a Cox proportional hazards regression model, a low level of COC was associated with a higher likelihood of outpatient flares that required corticosteroids (adjusted hazard ratio [aHR], 1.11; 95% CI, 1.01-1.22), hospitalizations (aHR, 1.25; 95% CI, 1.06-1.47), and surgical interventions (aHR, 1.72; 95% CI, 1.43-2.07). CONCLUSIONS AND RELEVANCE Results of this cohort study showed a wide variation in dispersion of IBD care and an association between a lower level of COC and active IBD and worse outcomes. The findings suggest that investigating the barriers to COC in integrated systems that have invested in care coordination is key to not only better understanding COC but also identifying opportunities to improve care fragmentation.
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Affiliation(s)
- Shirley Cohen-Mekelburg
- Division of Gastroenterology & Hepatology, Department of Internal Medicine, University of Michigan, Ann Arbor
- Center for Clinical Management Research, Ann Arbor Veterans Affairs Health System, Ann Arbor, Michigan
| | - Sameer D. Saini
- Division of Gastroenterology & Hepatology, Department of Internal Medicine, University of Michigan, Ann Arbor
- Center for Clinical Management Research, Ann Arbor Veterans Affairs Health System, Ann Arbor, Michigan
| | - Sarah L. Krein
- Center for Clinical Management Research, Ann Arbor Veterans Affairs Health System, Ann Arbor, Michigan
- Department of Internal Medicine, University of Michigan, Ann Arbor
| | - Timothy P. Hofer
- Center for Clinical Management Research, Ann Arbor Veterans Affairs Health System, Ann Arbor, Michigan
- Department of Internal Medicine, University of Michigan, Ann Arbor
| | - Beth I. Wallace
- Center for Clinical Management Research, Ann Arbor Veterans Affairs Health System, Ann Arbor, Michigan
- Division of Rheumatology, Department of Internal Medicine, University of Michigan, Ann Arbor
| | | | - Julie P. W. Bynum
- Division of Geriatrics, Department of Internal Medicine, University of Michigan, Ann Arbor
| | - Wyndy Wiitala
- Center for Clinical Management Research, Ann Arbor Veterans Affairs Health System, Ann Arbor, Michigan
| | - Jennifer Burns
- Center for Clinical Management Research, Ann Arbor Veterans Affairs Health System, Ann Arbor, Michigan
| | - Peter D. R. Higgins
- Division of Gastroenterology & Hepatology, Department of Internal Medicine, University of Michigan, Ann Arbor
| | - Akbar K. Waljee
- Division of Gastroenterology & Hepatology, Department of Internal Medicine, University of Michigan, Ann Arbor
- Center for Clinical Management Research, Ann Arbor Veterans Affairs Health System, Ann Arbor, Michigan
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Patients' Non-Medical and Organizational Needs during Cancer Diagnosis and Treatment. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17165841. [PMID: 32806666 PMCID: PMC7459913 DOI: 10.3390/ijerph17165841] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Revised: 08/07/2020] [Accepted: 08/10/2020] [Indexed: 01/07/2023]
Abstract
The aim of this cross-sectional study was to determine non-medical and organizational needs among cancer patients during diagnosis and treatment. The study included 384 cancer patients treated in five oncological centers in Poland. A questionnaire designed for the study was used. Most of the patients received psychological support from their partner/family/friends (88%), to a lesser extent from a psychologist (21%) and priests (4%). Forty-three percent of patients received social support from their partner/family/friends and only 7% of respondents received support from a social worker. Most patients stated they would like to have a professional who would help them with their non-medical problems during the diagnostic process and cancer treatment. The youth, with a higher education level who were professionally active and living in cities seemed to be more aware of their needs. Improvements to the oncological system in Poland should focus on expanding patient access to professional support of non-medical needs.
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108
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Watson J, Broome ME, Schneider SM. Low-Dose Computed Tomography: Effects of Oncology Nurse Navigation on Lung Cancer Screening. Clin J Oncol Nurs 2020; 24:421-429. [PMID: 32678377 DOI: 10.1188/20.cjon.421-429] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Low-dose computed tomography (LDCT) lung cancer screening is an evidence-based and reimbursable strategy to decrease lung cancer and all-cause mortality in qualifying patients, but there remains low use and variation in providers' LDCT screening, ordering, and referring knowledge. OBJECTIVES The purpose of this quality improvement project was to examine the effects of oncology nurse navigation on assisting patients and ensuring optimal LDCT lung cancer screening. METHODS Oncology nurse navigators conducted LDCT provider education and navigated 133 eligible patients to LDCT during a five-month intervention time period. FINDINGS Provider education resulted in improved documented tobacco cessation discussions and increased LDCT screening ordering fidelity. Mean days from LDCT to provider notification and mean days from LDCT to patient notification improved significantly.
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109
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Esteve-Matalí L, Vargas I, Sánchez E, Ramon I, Plaja P, Vázquez ML. Do primary and secondary care doctors have a different experience and perception of cross-level clinical coordination? Results of a cross-sectional study in the Catalan National Health System (Spain). BMC FAMILY PRACTICE 2020; 21:135. [PMID: 32640991 PMCID: PMC7346358 DOI: 10.1186/s12875-020-01207-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/27/2019] [Accepted: 06/23/2020] [Indexed: 12/03/2022]
Abstract
BACKGROUND Clinical coordination across care levels is a priority for health systems around the world, especially for those based on primary health care. The aim of this study is to analyse the degree of clinical information and clinical management coordination across healthcare levels in the Catalan national health system experienced by primary (PC) and secondary care (SC) doctors and explore the associated factors. METHODS Cross-sectional study based on an online survey using the self-administered questionnaire COORDENA-CAT. DATA COLLECTION October-December 2017. STUDY POPULATION PC and SC (acute and long term) doctors of the Catalan national health system. Participation rate was 21%, with a sample of 3308 doctors. OUTCOME VARIABLES cross-level clinical information coordination, clinical management coordination, and perception of cross-level coordination within the area. Explanatory variables: socio-demographic, employment characteristics, attitude towards job, type of area (according to type of hospital and management), interactional factors, organizational factors and knowledge of existing coordination mechanisms. Stratification variable: level of care. Descriptive and multivariate analysis by logistic regression. RESULTS The degree of clinical coordination experienced across levels of care was high for both PC and SC doctors, although PC doctors experienced greater exchange and use of information and SC doctors experienced greater consistency of care. However, only 32.13% of PC and 35.72% of SC doctors found that patient care was coordinated across care levels within their area. In both levels of care, knowing the doctors of the other level, working in an area where the same entity manages SC and majority of PC, and holding joint clinical case conferences were factors positively associated with perceiving high levels of clinical coordination. Other associated factors were specific to the care level, such as being informed of a patient's discharge from hospital for PC doctors, or trusting in the clinical skills of the other care level for SC doctors. CONCLUSIONS Interactional and organizational factors are positively associated with perceiving high levels of clinical coordination. Introducing policies to enhance such factors can foster clinical coordination between different health care levels. The COORDENA questionnaire allows us to identify fields for improvement in clinical coordination.
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Affiliation(s)
- Laura Esteve-Matalí
- Health Policy and Health Services Research Group, Health Policy Research Unit, Consortium for Health Care and Social Services of Catalonia, Barcelona, Spain.
- Department for Paediatrics, Obstetrics and Gynaecology, Preventive Medicine, Universitat Autònoma de Barcelona, Catalonia, Spain.
| | - Ingrid Vargas
- Health Policy and Health Services Research Group, Health Policy Research Unit, Consortium for Health Care and Social Services of Catalonia, Barcelona, Spain
| | - Elvira Sánchez
- Grup de Recerca en Serveis Sanitaris i Resultats en Salut (GRESSIRES), Serveis de Salut Integrats Baix Empordà (SSIBE), Palamós, Spain
| | | | | | - María-Luisa Vázquez
- Health Policy and Health Services Research Group, Health Policy Research Unit, Consortium for Health Care and Social Services of Catalonia, Barcelona, Spain
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End-of-life care among patients with schizophrenia and cancer: a population-based cohort study from the French national hospital database. LANCET PUBLIC HEALTH 2020; 4:e583-e591. [PMID: 31677777 DOI: 10.1016/s2468-2667(19)30187-2] [Citation(s) in RCA: 50] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/19/2019] [Revised: 09/02/2019] [Accepted: 09/09/2019] [Indexed: 12/28/2022]
Abstract
BACKGROUND Patients with schizophrenia represent a vulnerable, underserved, and undertreated population who have been neglected in health disparities work. Understanding of end-of-life care in patients with schizophrenia and cancer is poor. We aimed to establish whether end-of-life care delivered to patients with schizophrenia and cancer differed from that delivered to patients with cancer who do not have diagnosed mental illness. METHODS We did a population-based cohort study of all patients older than 15 years who had a diagnosis of advanced cancer and who died in hospital in France between Jan 1, 2013, and Dec 31, 2016. We divided this population into cases (ie, patients with schizophrenia) and controls (ie, patients without a diagnosis of mental illness) and compared access to palliative care and indicators of high-intensity end-of-life care between groups. In addition to unmatched analyses, we also did matched analyses (matched in terms of age at death, sex, and site of primary cancer) between patients with schizophrenia and matched controls (1:4). Multivariable generalised linear models were done with adjustment for social deprivation, year of death, time from cancer diagnosis to death, metastases, comorbidity, and hospital type (ie, specialist cancer centre vs non-specialist centre). FINDINGS The main analysis included 2481 patients with schizophrenia and 222 477 controls. The matched analyses included 2477 patients with schizophrenia and 9896 controls. Patients with schizophrenia were more likely to receive palliative care in the last 31 days of life (adjusted odds ratio 1·61 [95% CI 1·45-1·80]; p<0·0001) and less likely to receive high-intensity end-of-life care-such as chemotherapy and surgery-than were matched controls without a diagnosis of mental illness. Patients with schizophrenia were also more likely to die younger, had a shorter duration between cancer diagnosis and death, and were more likely to have thoracic cancers and comorbidities than were controls. INTERPRETATION Our findings suggest the existence of disparities in health and health care between patients with schizophrenia and patients without a diagnosis of mental illness. These findings underscore the need for better understanding of health inequalities so that effective interventions can be developed for this vulnerable population. FUNDING Assistance Publique des Hôpitaux de Marseille and Aix-Marseille University.
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The Usefulness of Patient-Reported Outcomes and the Influence on Palliative Oncology Patients and Health Services: A Qualitative Study of the Prospective Outcomes and Support Initiative. Cancer Nurs 2020; 44:388-397. [PMID: 32568807 DOI: 10.1097/ncc.0000000000000840] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Through the British Columbia, Prospective Outcomes and Support Initiative (POSI), registered nurses collect patient-reported outcome (PRO) data during telephone follow-up with palliative oncology patients. OBJECTIVE The research objective was to describe the usefulness and influence of the nursing care provided through POSI follow-up on palliative patients and health services. METHODS We used a qualitative interpretive description approach involving the collection and analysis of semistructured interview data with 20 palliative patients and 12 oncology nurses. All participant data were subjected to an inductively derived coding framework. Analytic categories were identified and iteratively revised through constant comparative techniques to develop representative themes. RESULTS The accounts of patients and nurses suggest that telephone follow-up with PROs enabled the nurses to (1) focus on the priorities of patients experiencing complex health challenges, (2) manage complex symptoms, (3) ease the patient's transition home, and (4) improve access to and use of health services. Suggestions for improving POSI nurse follow-up centered on flexibility in the timing of the follow-up, creating dedicated POSI work assignments, and having additional time to personalize assessments and nursing care beyond the PRO questionnaires. CONCLUSIONS Nursing care employing PROs via telephone follow-up can improve palliative cancer patients' quality of life and health service use. IMPLICATIONS FOR PRACTICE Nurses are optimally positioned to use PROs following cancer treatment completion but require organizational resources and support to optimize patient and system outcomes.
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112
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Pfaff H, Braithwaite J. A Parsonian Approach to Patient Safety: Transformational Leadership and Social Capital as Preconditions for Clinical Risk Management-the GI Factor. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17113989. [PMID: 32512794 PMCID: PMC7312507 DOI: 10.3390/ijerph17113989] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 05/27/2020] [Accepted: 05/28/2020] [Indexed: 11/16/2022]
Abstract
The purpose of this study is to investigate the role of the combination of transformational leadership and social capital in safety capacity building. Drawing on the A-G-I-L concept of Talcott Parsons, we test a model for patient safety. The hypothesis is, that good safety management needs a combination of goal attainment (G) and integration (I), here called the GI factor. We tested this hypothesis by using transformational leadership as a surrogate for goal attainment and social capital as a surrogate for integration in a study of the perceptions of chief medical officers in 551 German hospitals. We conducted a cross-sectional hospital survey combined with secondary data analysis in all German hospitals with at least one internal medicine unit and one surgery unit (N = 1224 hospitals) in the year 2008 with a response rate of 45% (N = 551). The regression model explained 17.9% of the variance in perceived clinical risk management. We found that if both requirements for goal-oriented collective action-transformational leadership and social capital-are met, good safety management is more likely. The tentative conclusion is that it takes transformative leaders and cohesive followers together as a social basis to improve safety in hospitals.
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Affiliation(s)
- Holger Pfaff
- Institute of Medical Sociology, Health Services Research and Rehabilitation Science (IMVR), Faculty of Human Science and Faculty of Medicine, University of Cologne, Eupener Str. 129, 50933 Cologne, Germany
- Correspondence:
| | - Jeffrey Braithwaite
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, 75 Talavera Road, Sydney, NSW 2109, Australia;
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Chan RJ, Teleni L, McDonald S, Kelly J, Mahony J, Ernst K, Patford K, Townsend J, Singh M, Yates P. Breast cancer nursing interventions and clinical effectiveness: a systematic review. BMJ Support Palliat Care 2020; 10:276-286. [PMID: 32499405 DOI: 10.1136/bmjspcare-2019-002120] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Revised: 04/06/2020] [Accepted: 05/06/2020] [Indexed: 11/03/2022]
Abstract
OBJECTIVES To examine the effects of nurse-led interventions on the health-related quality of life, symptom burden and self-management/behavioural outcomes in women with breast cancer. METHODS Cochrane Controlled Register of Trials (CENTRAL), Cumulative Index to Nursing and Allied Health Literature (CINAHL), Medline and Embase databases were searched (January 1999 to May 2019) to identify randomised controlled trials (RCTs) and controlled before-and-after studies of interventions delivered by nurses with oncology experience for women with breast cancer. Risk of bias was evaluated using the revised Cochrane risk-of-bias tool for randomised trials. Intervention effects were synthesised by cancer trajectory using The Omaha System Intervention Classification Scheme. RESULTS Thirty-one RCTs (4651 participants) were included. All studies were at risk of bias mainly due to inherent limitations such as lack of blinding and self-report data. Most studies (71%; n=22) reported at least one superior intervention effect. There were no differences in all outcomes between those who receive nurse-led surveillance care versus those who received physical led or usual discharge care. Compared with control interventions, there were superior teaching, guidance and counselling (63%) and case management (100%) intervention effects on symptom burden during treatment and survivorship. Effects of these interventions on health-related quality of life and symptom self-management/behavioural outcomes were inconsistent. DISCUSSION There is consistent evidence from RCTs that nurse-led surveillance interventions are as safe and effective as physician-led care and strong evidence that nurse-led teaching, guidance and counselling and case management interventions are effective for symptom management. Future studies should ensure the incorporation of health-related quality of life and self-management/behavioural outcomes and consider well-designed attentional placebo controls to blind participants for self-report outcomes. PROTOCOL REGISTRATION The International Prospective Register of Systematic Reviews (PROSPERO): CRD42020134914).
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Affiliation(s)
- Raymond Javan Chan
- Division of Cancer Services, Princess Alexandra Hospital, Metro South Health, Woolloongabba, Queensland, Australia .,School of Nursing and Cancer and Palliative Care Outcomes Centre, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Laisa Teleni
- School of Nursing and Cancer and Palliative Care Outcomes Centre, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Suzanne McDonald
- School of Nursing and Cancer and Palliative Care Outcomes Centre, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Jaimon Kelly
- School of Medicine, Griffith University, Brisbane, Queensland, Australia
| | - Jane Mahony
- McGrath Foundation, North Sydney, New South Wales, Australia
| | - Kerryn Ernst
- McGrath Foundation, North Sydney, New South Wales, Australia
| | - Kerry Patford
- McGrath Foundation, North Sydney, New South Wales, Australia
| | - James Townsend
- McGrath Foundation, North Sydney, New South Wales, Australia
| | - Manisha Singh
- McGrath Foundation, North Sydney, New South Wales, Australia
| | - Patsy Yates
- School of Nursing and Cancer and Palliative Care Outcomes Centre, Queensland University of Technology, Brisbane, Queensland, Australia
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Ngo V, Matsumoto CG, Joseph JG, Bell JF, Bold RJ, Davis A, Reed SC, Kim KK. The Personal Health Network Mobile App for Chemotherapy Care Coordination: Qualitative Evaluation of a Randomized Clinical Trial. JMIR Mhealth Uhealth 2020; 8:e16527. [PMID: 32452814 PMCID: PMC7284410 DOI: 10.2196/16527] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2019] [Revised: 01/30/2020] [Accepted: 02/01/2020] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Cancer care coordination addresses the fragmented and inefficient care of individuals with complex care needs. The complexity of care coordination can be aided by innovative technology. Few examples of information technology-enabled care coordination exist beyond the conventional telephone follow-up. For this study, we implemented a custom-designed app, the Personal Health Network (PHN)-a Health Insurance Portability and Accountability Act-compliant social network built around a patient to enable patient-centered health and health care activities in collaboration with clinicians, care team members, caregivers, and others designated by the patient. The app facilitates a care coordination intervention for patients undergoing chemotherapy. OBJECTIVE This study aimed to understand patient experiences with PHN technology and assess their perspectives on the usability and usefulness of PHNs with care coordination during chemotherapy. METHODS A two-arm randomized clinical trial was conducted to compare the PHN and care coordination with care coordination alone over a 6-month period beginning with the initiation of chemotherapy. A semistructured interview guide was constructed based on a theoretical framework of technology acceptance addressing usefulness, usability, and the context of use of the technology within the participant's life and health care setting. All participants in the intervention arm were interviewed on completion of the study. Interviews were recorded and transcribed verbatim. A summative thematic analysis was completed for the transcribed interviews. Features of the app were also evaluated. RESULTS A total of 27 interviews were completed. The resulting themes included the care coordinator as a partner in care, learning while sick, comparison of other technology to make sense of the PHN, communication, learning, usability, and usefulness. Users expressed that the nurse care coordinators were beneficial to them because they helped them stay connected to the care team and answered their questions. They shared that the mobile app gave them access to the health information they were seeking. Users expressed that the mobile app would be more useful if it was fully integrated with the electronic health record. CONCLUSIONS The findings highlight the value of care coordination from the perspectives of cancer patients undergoing chemotherapy and the important role of technology, such as the PHN, in enhancing this process by facilitating better communication and access to information regarding their illness.
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Affiliation(s)
- Victoria Ngo
- Betty Irene Moore School of Nursing, University of California, Davis, Sacramento, CA, United States
| | - Cynthia G Matsumoto
- Betty Irene Moore School of Nursing, University of California, Davis, Sacramento, CA, United States
| | - Jill G Joseph
- Betty Irene Moore School of Nursing, University of California, Davis, Sacramento, CA, United States
| | - Janice F Bell
- Betty Irene Moore School of Nursing, University of California, Davis, Sacramento, CA, United States
| | - Richard J Bold
- Comprehensive Cancer Center, University of California Davis Health, Sacramento, CA, United States
| | - Andra Davis
- Washington State University College of Nursing - Vancouver, Vancouver, WA, United States
| | - Sarah C Reed
- Division of Social Work, California State University Sacramento, Sacramento, CA, United States
| | - Katherine K Kim
- Betty Irene Moore School of Nursing, University of California, Davis, Sacramento, CA, United States
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Pinheiro LC, Reshetnyak E, Safford MM, Nanus D, Kern LM. Differences in ambulatory care fragmentation between cancer survivors and noncancer controls. Cancer 2020; 126:3094-3101. [PMID: 32286692 PMCID: PMC7275891 DOI: 10.1002/cncr.32869] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Revised: 03/02/2020] [Accepted: 03/03/2020] [Indexed: 01/01/2023]
Abstract
BACKGROUND Patients with chronic conditions are treated by many providers, which can increase the risk of communication gaps across providers and potential harm to patients. However, to the authors' knowledge, the extent of fragmented care among this population is unknown. In the current study, the authors sought to determine whether cancer survivors have more fragmented care than noncancer controls and to quantify the extent of fragmentation. METHODS Data from the REasons for Geographic And Racial Differences in Stroke (REGARDS) study linked to Medicare claims were used. The authors included beneficiaries with continuous Part A and B coverage for 12 months at the time of their baseline REGARDS survey. The primary outcome of the current study was claims-based fragmentation over 12 months, which was calculated using the reversed Bice-Boxerman Index so a higher score reflected greater fragmentation. Unadjusted differences in fragmentation were compared between cancer survivors and controls. Beta regression models were used to estimate associations between cancer status and fragmentation, adjusting for potential confounders. RESULTS The authors included 4922 participants aged ≥65 years at baseline. Of these patients, approximately 21% were cancer survivors. Survivors had a median of 11 visits (interquartile range, 7-15 visits) with 5 providers compared with controls, who had a median of 9 visits (interquartile range, 6-14 visits) with 4 providers (P < .0001). Cancer survivors had significantly more fragmented care compared with controls (median reversed Bice-Boxerman Index, 0.80 vs 0.76; P < .0001). After adjusting for confounders, cancer survivors had an increased odds of having fragmented care (odds ratio, 1.08; 95% CI, 1.02-1.14). CONCLUSIONS Care fragmentation is more prevalent among cancer survivors compared with those without a history of cancer. Future studies should examine whether fragmentation puts survivors at risk of worse outcomes.
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Affiliation(s)
- Laura C Pinheiro
- Division of General Internal Medicine, Department of Medicine, Weill Cornell Medicine, New York, New York
| | - Evgeniya Reshetnyak
- Division of General Internal Medicine, Department of Medicine, Weill Cornell Medicine, New York, New York
| | - Monika M Safford
- Division of General Internal Medicine, Department of Medicine, Weill Cornell Medicine, New York, New York
| | - David Nanus
- Division of Hematology and Oncology, Department of Medicine, Weill Cornell Medicine, New York, New York
| | - Lisa M Kern
- Division of General Internal Medicine, Department of Medicine, Weill Cornell Medicine, New York, New York
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Ansmann L, Hower KI, Wirtz MA, Kowalski C, Ernstmann N, McKee L, Pfaff H. Measuring social capital of healthcare organizations reported by employees for creating positive workplaces - validation of the SOCAPO-E instrument. BMC Health Serv Res 2020; 20:272. [PMID: 32234055 PMCID: PMC7106807 DOI: 10.1186/s12913-020-05105-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Accepted: 03/12/2020] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND In highly segmented and complex healthcare organizations social capital is assumed to be of high relevance for the coordination of tasks in healthcare. So far, comprehensively validated instruments on social capital in healthcare organizations are lacking. The aim of this work is to validate an instrument measuring social capital in healthcare organizations. METHODS This validation study is based on a cross-sectional survey of 1050 hospital employees from 49 German hospitals which specialize in breast cancer care. Social capital was assessed by a six-item scale. Reliability analyses and confirmatory factor analyses were conducted to determine the content validity of items within the theory-driven one-dimensional scale structure. The scale's associations with measures of the social aspects of the work environment (identification, social support, open communication climate) were estimated to test convergent validity. Criterion-related validity was evaluated by conducting structural equation modelling to examine the predictive validity of the scale with measures of work engagement, well-being and burnout. RESULTS A one-dimensional structure of the instrument could be identified (CFI = .99; RMSEA = .06). Convergent validity was shown by hypothesis-consistent correlations with social support offered by supervisors and colleagues, a climate of open communication, and employee commitment to the organization. Criterion-related validity of the social capital scale was proved by its prediction of employee work engagement (R2 = .10-.13 for the three subscales), well-being (R2 = .13), and burnout (R2 = .06-.11 for the three subscales). CONCLUSIONS The confirmed associations between social capital and work engagement, burnout as well as well-being stress the importance of social capital as a vital resource for employee health and performance in healthcare organizations. In healthcare organizations this short instrument can be used as an efficient instrument to measure the organizations' social capital.
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Affiliation(s)
- Lena Ansmann
- Division for Organizational Health Services Research, Department of Health Services Research, School of Medicine and Health Sciences, Carl von Ossietzky University Oldenburg, Ammerländer Heerstraße 140, 26129, Oldenburg, Germany.
| | - Kira Isabel Hower
- Institute for Medical Sociology, Health Services Research and Rehabilitation Science, Faculty of Human Sciences and Faculty of Medicine, University of Cologne, Cologne, Germany
| | | | | | - Nicole Ernstmann
- Center for Health Communication and Health Services Research, Department of Psychosomatic Medicine and Psychotherapy, University Hospital Bonn, Bonn, Germany
| | - Lorna McKee
- Health Services Research Unit, University of Aberdeen, Aberdeen, Scotland
| | - Holger Pfaff
- Institute for Medical Sociology, Health Services Research and Rehabilitation Science, Faculty of Human Sciences and Faculty of Medicine, University of Cologne, Cologne, Germany
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Okado I, Cassel K, Pagano I, Holcombe RF. Assessing Patients' Perceptions of Cancer Care Coordination in a Community-Based Setting. JCO Oncol Pract 2020; 16:e726-e733. [PMID: 32216713 DOI: 10.1200/jop.19.00509] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Effective care coordination (CC) is a hallmark of a high-quality cancer care. However, efforts to improve cancer care delivery are limited by the lack of a clinically useful tool to assess CC. In this study, we examined patients' perceptions of cancer CC using a novel tool, the Care Coordination Instrument (CCI), and evaluated the quality of the CCI. METHODS The CCI is a 29-item patient questionnaire that assesses CC across varied practice settings and patient populations overall and for three critical domains of CC: communication, navigation, and operational. We conducted univariable and multivariable regression analyses to identify patient clinical and practice characteristics associated with optimal versus suboptimal CC. RESULTS Two hundred patients with cancer completed the CCI questionnaire between October 2018 and January 2019, of whom 189 were used for the analysis. The presence of a family caregiver and a diagnosis of a blood cancer were correlated with overall positive reports of CC (P < .001 and P < .05, respectively). Poorer perceptions of CC were associated with having a head and neck cancer and the absence of family caregiver support. The effects of cancer disease stage and having access to a patient navigator on CC were not statistically significant. CONCLUSION Integrating a patient-centered tool to assess cancer CC can be a strategy to optimize cancer care delivery. Understanding factors associated with effective and ineffective CC can help inform efforts to improve overall quality of care and care delivery.
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Affiliation(s)
- Izumi Okado
- University of Hawaii Cancer Center, Honolulu, HI
| | - Kevin Cassel
- University of Hawaii Cancer Center, Honolulu, HI
| | - Ian Pagano
- University of Hawaii Cancer Center, Honolulu, HI
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Affiliation(s)
- Masahito Jimbo
- University of Michigan Medical School Ann Arbor, Michigan
| | | | - Karen Kelly-Blake
- Michigan State University College of Human Medicine East Lansing, Michigan
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Shin J, Shin DW, Lee J, Hwang JH, Yoo JE, Ko H, Song YM. Association between perception of care coordination and health outcomes in Korean cancer survivors. Health Qual Life Outcomes 2020; 18:21. [PMID: 32019567 PMCID: PMC7001372 DOI: 10.1186/s12955-020-1279-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Accepted: 01/27/2020] [Indexed: 11/26/2022] Open
Abstract
Background To determine relationship between cancer survivors’ perception of care coordination and their health outcomes. Methods Study subjects were 1306 Korean adulthood cancer survivors who were enrolled in two academic hospital and completed a questionnaire consisting of questions asking two aspects of care coordination for cancer treatment they had received: 1) who played a main coordinator role and 2) whether care services had met their necessitated health concerns. We measured health outcomes including new comorbidity, number of clinic visits, health-related quality of life (HRQoL) and fear of cancer recurrence (FCR). Associations between the level of care coordination and health outcomes were evaluated by multiple logistic regression analysis after adjusting for covariates. Results Survivors with uncoordinated care were more likely to have more new comorbidities after cancer diagnosis, visit clinic more frequently and have worse HRQoL and higher FCR. Females and unmarried survivors were more likely to have received uncoordinated care than males and ever married survivors. Uncoordinated care group had an increased the risk of new comorbidity (odds ratio 1.73, [95% confidence interval] 1.02–2.92), multiple clinic visits (1.69, 1.00–2.88), severe FCR (2.28, 1.33–3.93), low EuroQoL Visual Analogue Scale (1.82, 1.28–2.60), low global health status (1.51, 1.04–2.21), and poor physical (2.00, 1.31–3.04), role (2.46, 1.69–3.56) and emotional function (2.62, 1.81–3.78). Conclusions Coordinated care of Korean cancer survivors was associated with their health outcomes, including new comorbidity, clinic visits, HRQoL and FCR. Good care coordination may be reinforced to improve outcomes of survivorship care.
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Affiliation(s)
- Jinyoung Shin
- Department of Family Medicine, Konkuk University Medical Center, Konkuk University School of Medicine, 120-1, Neungdong-ro, Gwangjin-gu, Seoul, 05030, South Korea
| | - Dong Wook Shin
- Department of Family Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, South Korea
| | - Jungkwon Lee
- Department of Family Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, South Korea
| | - Ji Hye Hwang
- Department of Physical and Rehabilitation Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Su Gangnam-gu, Seoul, 06351, South Korea
| | - Jung Eun Yoo
- Department of Family Medicine, Healthcare System Gangnam Center, Seoul National University Hospital, 152, Teheran-ro, Gangnam-gu, Seoul, 06236, South Korea
| | - Hyeonyoung Ko
- Department of Family Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, 29 Saemunan-ro, Jongno-gu, Seoul, 03181, South Korea
| | - Yun-Mi Song
- Department of Family Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, South Korea.
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Same-Day Patient Consultation and Cochlear Implantation: Innovations in Patient-Centered Health Care Delivery. Otol Neurotol 2020; 41:e223-e226. [DOI: 10.1097/mao.0000000000002478] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Garnett D, Hardy L, Fitzgerald E, Fisher T, Graham L, Overcash J. Nurse Case Manager: Measurement of Care Coordination Activities and Quality and Resource Use Outcomes When Caring for the Complex Patient With Hematologic Cancer. Clin J Oncol Nurs 2020; 24:65-74. [PMID: 31961839 DOI: 10.1188/20.cjon.65-74] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND The lack of coordination of care for complex patients in the hematology setting has prompted nurse case managers (NCMs) to coordinate that care. OBJECTIVES This article aimed to identify the frequency of NCM care coordination activities and quality and resource use outcomes in the complex care of patients in the hematology setting. METHODS NCM aggregate data from complex outpatients with hematologic cancer were retrieved from electronic health records at a comprehensive cancer center in the midwestern United States. Total volume of activities and outcomes were calculated as frequency and percentage. FINDINGS Care coordination activities included communicating; monitoring, following up, and responding to change; and creating a proactive plan of care. Quality outcomes included improving continuity of care and change in health behavior, and resource use outcomes most documented were patient healthcare cost savings.
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Affiliation(s)
- Doris Garnett
- Arthur G. James Cancer Hospital and Richard J. Solove Research Institute
| | | | | | - Taylor Fisher
- Arthur G. James Cancer Hospital and Richard J. Solove Research Institute
| | - Lisa Graham
- Arthur G. James Cancer Hospital and Richard J. Solove Research Institute
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Harvey A, Zhang Y, Phillips S, Suarez R, Dekle L, Villalobos A, Pratt-Chapman ML. Initial Outcomes of an Online Continuing Education Series Focused on Post-treatment Cancer Survivorship Care. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2020; 35:144-150. [PMID: 30488369 PMCID: PMC6774892 DOI: 10.1007/s13187-018-1453-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
There is a growing number of post-treatment cancer survivors in the USA. Cancer survivors can have a variety of care needs and health care professionals must be prepared to meet these needs. The American Cancer Society (ACS) and the George Washington University (GW) Cancer Center developed The Cancer Survivorship E-Learning Series for Primary Care Providers (E-Learning Series) to address the need for cancer survivorship training and education among health care professionals with a focus on primary care. The GW Cancer Center analyzed evaluation data from 1341 learners who voluntarily completed a module pre- and post-assessment between April 15, 2013, and December 31, 2017, to assess differences in self-rated confidence, on a five-point Likert scale, to meet learning objectives. Descriptive statistics characterize the sample and paired samples t tests were used to assess any statistically significant differences from pre to post (p < 0.05). Most learners were nurses (75.19%) and a majority of learners worked in oncology (74.68%) followed by primary care (11.60%). At pre-assessment, the module with the lowest mean self-confidence rating was 3.16 (SD = 0.81) and the highest was 3.60 (SD = 0.73). At post-assessment, module means in self-confidence rating ranged from 4.08 (SD = 0.46) to 4.26 (SD = 0.56). All differences were statistically significant (p < 0.0001). Results highlight gaps in confidence among health care professionals regarding cancer survivorship care and the need for continuing education. There is also a need for additional uptake of the E-Learning Series among primary care providers. Results suggest that the E-Learning Series is an effective educational tool that increases learners' confidence in providing cancer survivorship care.
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Affiliation(s)
- Allison Harvey
- Institute for Patient-Centered Initiatives and Health Equity, The George Washington University Cancer Center, 2600 Virginia Avenue NW, Suite 300, Washington, DC 20037 USA
| | - Yuqing Zhang
- Institute for Patient-Centered Initiatives and Health Equity, The George Washington University Cancer Center, 2600 Virginia Avenue NW, Suite 300, Washington, DC 20037 USA
| | - Serena Phillips
- Institute for Patient-Centered Initiatives and Health Equity, The George Washington University Cancer Center, 2600 Virginia Avenue NW, Suite 300, Washington, DC 20037 USA
| | - Rhea Suarez
- Institute for Patient-Centered Initiatives and Health Equity, The George Washington University Cancer Center, 2600 Virginia Avenue NW, Suite 300, Washington, DC 20037 USA
| | - Laura Dekle
- Institute for Patient-Centered Initiatives and Health Equity, The George Washington University Cancer Center, 2600 Virginia Avenue NW, Suite 300, Washington, DC 20037 USA
| | - Aubrey Villalobos
- Institute for Patient-Centered Initiatives and Health Equity, The George Washington University Cancer Center, 2600 Virginia Avenue NW, Suite 300, Washington, DC 20037 USA
| | - Mandi L. Pratt-Chapman
- Institute for Patient-Centered Initiatives and Health Equity, The George Washington University Cancer Center, 2600 Virginia Avenue NW, Suite 300, Washington, DC 20037 USA
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McDowell BD, Klemp J, Blaes A, Cohee AA, Trentham-Dietz A, Kamaraju S, Otte JL, Mott SL, Chrischilles EA. The association between cancer care coordination and quality of life is stronger for breast cancer patients with lower health literacy: A Greater Plains Collaborative study. Support Care Cancer 2020; 28:887-895. [PMID: 31168710 PMCID: PMC6893112 DOI: 10.1007/s00520-019-04894-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Accepted: 05/22/2019] [Indexed: 12/30/2022]
Abstract
PURPOSE Health literacy (HL) and cancer care coordination (CCC) were examined for their relationship to quality of life (QOL) among breast cancer survivors. CCC was hypothesized to have a stronger relationship to QOL for women with lower HL. METHODS Women (N = 1138) who had completed treatment for Stage 0-III, ductal carcinoma breast cancer between January 2013 and May 2014 at one of eight large medical centers responded to a mailed questionnaire. Responses to questions about survivorship care planning and presence of professional care coordinator were combined to form an index of CCC. An index of HL was also derived. QOL was measured using the Functional Assessment of Cancer Therapy-Breast (FACT-B) scales. RESULTS 74.3% (N = 845) of patients reported having a health professional coordinate their care during treatment and 78.8% (N = 897) reported receiving survivorship care planning. CCC was classified as none, partial, or high for 7.1%, 32.7%, and 60.2% of the patients, respectively. Except for emotional well-being, the interaction between HL and CCC was significant for all QOL domains (p < .05); the effect of CCC on FACT-B scores was largest for people with lower HL. For the 39.8% of patients with less than high CCC, 111 (27.3%) had a level of HL associated with clinically meaningful lower QOL. CONCLUSIONS The association between CCC and later QOL is strongest for people who have lower HL. Prioritizing care coordination for patients with lower health literacy may be an effective strategy in a setting of limited resources.
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Affiliation(s)
- Bradley D McDowell
- 5240 MERF, Holden Comprehensive Cancer Center, University of Iowa, Iowa City, IA, 52242, USA.
| | - Jennifer Klemp
- Department of Medicine, University of Kansas Medical Center and University of Kansas Cancer Center, Kansas City, KS, USA
| | - Anne Blaes
- Division of Hematology, Oncology and Transplantation, 420 Delaware St SE, MMC 480, Minneapolis, MN, 55455, USA
| | - Andrea A Cohee
- Community and Health Systems, Nursing W433, Indiana University, Indianapolis, IN, 47405, USA
| | - Amy Trentham-Dietz
- Carbone Cancer Center and Department of Population Health Sciences, School of Medicine and Public Health, University of Wisconsin-Madison, 610 Walnut St., WARF Room 307, Madison, WI, 53726, USA
| | - Sailaja Kamaraju
- Division of Hematology, Oncology and Transplantation, Medical College of Wisconsin, Watertown Plank Road, 4th Fl Cancer Center, Milwaukee, WI, 53226, USA
| | - Julie L Otte
- Science of Nursing Care, Nursing W401, Indiana University, Indianapolis, IN, 46220, USA
| | - Sarah L Mott
- N319 CPHB, Holden Comprehensive Cancer Center, University of Iowa, Iowa City, IA, 52242, USA
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Steitz BD, Unertl KM, Levy MA. Characterizing communication patterns among members of the clinical care team to deliver breast cancer treatment. J Am Med Inform Assoc 2020; 27:236-243. [PMID: 31682267 PMCID: PMC7647266 DOI: 10.1093/jamia/ocz151] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Revised: 07/19/2019] [Accepted: 07/31/2019] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE Research to date focused on quantifying team collaboration has relied on identifying shared patients but does not incorporate the major role of communication patterns. The goal of this study was to describe the patterns and volume of communication among care team members involved in treating breast cancer patients. MATERIALS AND METHODS We analyzed 4 years of communications data from the electronic health record between care team members at Vanderbilt University Medical Center (VUMC). Our cohort of patients diagnosed with breast cancer was identified using the VUMC tumor registry. We classified each care team member participating in electronic messaging by their institutional role and classified physicians by specialty. To identify collaborative patterns, we modeled the data as a social network. RESULTS Our cohort of 1181 patients was the subject of 322 424 messages sent in 104 210 unique communication threads by 5620 employees. On average, each patient was the subject of 88.2 message threads involving 106.4 employees. Each employee, on average, sent 72.9 messages and was connected to 24.6 collaborators. Nurses and physicians were involved in 98% and 44% of all message threads, respectively. DISCUSSION AND CONCLUSION Our results suggest that many providers in our study may experience a high volume of messaging work. By using data routinely generated through interaction with the electronic health record, we can begin to evaluate how to iteratively implement and assess initiatives to improve the efficiency of care coordination and reduce unnecessary messaging work across all care team roles.
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Affiliation(s)
- Bryan D Steitz
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Kim M Unertl
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Mia A Levy
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Department of Internal Medicine, Rush University Medical Center, Chicago, Illinois, USA
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125
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Okado I, Cassel K, Pagano I, Holcombe RF. Development and psychometric evaluation of a questionnaire to measure cancer patients' perception of care coordination. BMC Health Serv Res 2020; 20:52. [PMID: 31964391 PMCID: PMC6975072 DOI: 10.1186/s12913-020-4905-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Accepted: 01/13/2020] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Although the importance of care coordination (CC) is well-recognized, cancer patients often receive poorly coordinated care across varied care settings and different oncology providers. Efforts to improve cancer care are hampered by lack of adequate measures. In this two-part, mixed-method study, we describe the development, refinement, and validation of a new care coordination instrument (CCI) designed to assess cancer patients' perception of CC. METHODS In Study 1, an initial CCI was developed incorporating questions based on literature review. The items were then modified following four field tests conducted in a large academic hospital with oncology nurses (n = 20) and cancer patients (n = 120). This modified instrument was used to determine whether the CCI was able to distinguish CC between two practices (30 GI and 30 myeloma patients) within the same hospital setting. In Study 2, 68 patients receiving community-based care participated in seven focus groups. Based on these discussions, the CCI items were again refined, and psychometric evaluation was conducted to assess the quality of the instrument. RESULTS Based on field tests, 3 domains of the CCI, Communication, Navigation, and Operational, were defined as critical components of CC. The Operational domain evaluates efficiency of care and is unique to this CCI. The field test demonstrated that GI patients reported significantly better CC Overall and for the Communication and Navigation domains (all p < .05). In Study 2, patients expressed concordance with the CCI items and their CC experiences, establishing validity of the CCI. Qualitative analysis of the focus group discussions indicated that the items with the highest frequencies of participants' comments were related to the concepts of Navigator, Team, Survey, and Communication. Quantitative analysis identified items with a limited response range or high rates of "neutral" responses; accordingly, those items were removed. The final CCI survey is a 29 item, multiple-choice questionnaire with excellent reliability, Cronbach's α = .922. CONCLUSIONS We developed a novel, patient-centered tool with excellent psychometric properties that can be utilized across varied practice settings to assess patients' perception of cancer care coordination. TRIAL REGISTRATION Not required; retrospectively registered ClinicalTrials.gov NCT03594006 20 July 2018.
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Affiliation(s)
- Izumi Okado
- University of Hawai'i Cancer Center, 701 Ilalo St. 6th Floor, Honolulu, HI, 96813, USA.
| | - Kevin Cassel
- University of Hawai'i Cancer Center, 701 Ilalo St. 6th Floor, Honolulu, HI, 96813, USA
| | - Ian Pagano
- University of Hawai'i Cancer Center, 701 Ilalo St. 6th Floor, Honolulu, HI, 96813, USA
| | - Randall F Holcombe
- University of Hawai'i Cancer Center, 701 Ilalo St. 6th Floor, Honolulu, HI, 96813, USA
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Moser EC, Narayan G. Improving breast cancer care coordination and symptom management by using AI driven predictive toolkits. Breast 2020; 50:25-29. [PMID: 31978814 PMCID: PMC7375673 DOI: 10.1016/j.breast.2019.12.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Revised: 12/01/2019] [Accepted: 12/12/2019] [Indexed: 01/29/2023] Open
Abstract
Integrated breast cancer care is complex, marked by multiple hand-offs between primary care and specialists over an extensive period of time. Communication is essential for treatment compliance, lowering error and complication risk, as well as handling co-morbidity. The director role of care, however, becomes often unclear, and patients remain lost across departments. Digital tools can add significant value to care communication but need clarity about the directives to perform in the care team. In effective breast cancer care, multidisciplinary team meetings can drive care planning, create directives and structured data collection. Subsequently, nurse navigators can take the director’s role and become a pivotal determinant for patient care continuity. In the complexity of care, automated AI driven planning can facilitate their tasks, however, human intervention stays needed for psychosocial support and tackling unexpected urgency. Care allocation of patients across centres, is often still done by hand and phone demanding time due to overbooked agenda’s and discontinuous system solutions limited by privacy rules and moreover, competition among providers. Collection of complete outcome information is limited to specific collaborative networks today. With data continuity over time, AI tools can facilitate both care allocation and risk prediction which may unveil non-compliance due to local scarce resources, distance and costs. Applied research is needed to bring AI modelling into clinical practice and drive well-coordinated, patient-centric cancer care in the complex web of modern healthcare today.
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Affiliation(s)
- E C Moser
- UM-AI Coordinator Research, UM-AI LLC, 8 the Green. Suite #5064, Dover, DE, 19901, USA.
| | - Gayatri Narayan
- UM-AI Coordinator Research, UM-AI LLC, 8 the Green. Suite #5064, Dover, DE, 19901, USA.
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127
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Valverde PA, Burhansstipanov L, Patierno S, Gentry S, Dwyer A, Wysocki KL, Patterson AK, Krebs LU, Sellers J, Johnston D. Findings from the National Navigation Roundtable: A call for competency-based patient navigation training. Cancer 2019; 125:4350-4359. [PMID: 31503340 DOI: 10.1002/cncr.32470] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Revised: 06/07/2019] [Accepted: 06/12/2019] [Indexed: 12/12/2022]
Affiliation(s)
- Patricia A Valverde
- Department of Community and Behavioral Health, Colorado School of Public Health, Aurora, Colorado
| | | | | | | | - Andrea Dwyer
- University of Colorado Comprehensive Cancer Center, Aurora, Colorado
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128
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Lukács G, Kovács Á, Csanádi M, Moizs M, Repa I, Kaló Z, Vokó Z, Pitter JG. Benefits Of Timely Care In Pancreatic Cancer: A Systematic Review To Navigate Through The Contradictory Evidence. Cancer Manag Res 2019; 11:9849-9861. [PMID: 31819622 PMCID: PMC6875504 DOI: 10.2147/cmar.s221427] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Accepted: 10/15/2019] [Indexed: 11/23/2022] Open
Abstract
The evidence base of policies that improve the timeliness of cancer care is under ongoing debate. Pancreatic cancer is frequently diagnosed in a stage when curative therapy is not feasible; hence, it is an important target for timelier healthcare interventions. The objectives of our research were to identify all clinical studies on pancreatic cancer care delays via a systematic literature review, to assess the study methodologies for possible biases, to conclude on the available evidence, and to formulate research recommendations on evidence gaps. Nineteen studies were identified and eight reported multivariate analyses. Although many sources of bias shifted the results towards negative or paradoxical findings, a statistically significant association of shorter delays with better clinical outcomes was demonstrated in the majority of studies reporting multivariate analyses. Noninferiority analyses were not published. Further efforts to provide timely care for pancreatic cancer patients are encouraged, and studies on the associations of delay with patient experience and healthcare resource utilization are warranted.
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Affiliation(s)
- Gábor Lukács
- Móritz Kaposi General Hospital, Kaposvár, Hungary
- Doctoral School, Faculty of Health Sciences, University of Pécs, Pécs, Hungary
| | - Árpád Kovács
- Móritz Kaposi General Hospital, Kaposvár, Hungary
- Doctoral School, Faculty of Health Sciences, University of Pécs, Pécs, Hungary
| | | | | | - Imre Repa
- Móritz Kaposi General Hospital, Kaposvár, Hungary
- Doctoral School, Faculty of Health Sciences, University of Pécs, Pécs, Hungary
| | - Zoltán Kaló
- Syreon Research Institute, Budapest, Hungary
- Department of Health Policy and Health Economics, Eötvös Loránd University, Budapest, Hungary
| | - Zoltán Vokó
- Syreon Research Institute, Budapest, Hungary
- Department of Health Policy and Health Economics, Eötvös Loránd University, Budapest, Hungary
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129
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Kline RM, Rocque GB, Rohan EA, Blackley KA, Cantril CA, Pratt-Chapman ML, Burris HA, Shulman LN. Patient Navigation in Cancer: The Business Case to Support Clinical Needs. J Oncol Pract 2019; 15:585-590. [PMID: 31509483 PMCID: PMC8790714 DOI: 10.1200/jop.19.00230] [Citation(s) in RCA: 52] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/01/2019] [Indexed: 08/02/2023] Open
Abstract
PURPOSE Patient navigation (PN) is an increasingly recognized element of high-quality, patient-centered cancer care, yet PN in many cancer programs is absent or limited, often because of concerns of extra cost without tangible financial benefits. METHODS Five real-world examples of PN programs are used to demonstrate that in the pure fee-for-service and the alternative payment model worlds of reimbursement, strong cases can be made to support the benefits of PN. RESULTS In three large programs, PN resulted in increased patient retention and increased physician loyalty within the cancer programs, leading to increased revenue. In addition, in two programs, PN was associated with a reduction in unnecessary resource utilization, such as emergency department visits and hospitalizations. PN also reduces burdens on oncology providers, potentially reducing burnout, errors, and costly staff turnover. CONCLUSION PN has resulted in improved patient outcomes and patient satisfaction and has important financial benefits for cancer programs in the fee-for-service and the alternative payment model worlds, lending support for more robust staffing of PN programs.
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130
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Martin KL, Krechmer B, Boyajian RN, Reynolds MC, Cagney DN, Martin N. Advanced Practice Providers in Radiation Oncology. Pract Radiat Oncol 2019; 10:e192-e198. [PMID: 31629956 DOI: 10.1016/j.prro.2019.10.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Revised: 10/01/2019] [Accepted: 10/01/2019] [Indexed: 10/25/2022]
Abstract
PURPOSE The report highlights utilization of advanced practice providers (APPs) in an academic radiation oncology center and how their role benefits patient care and departmental workflow. METHODS AND MATERIALS A self-reported workflow analysis of department APPs was conducted across 5 disease sites. A review of electronic medical records was performed to determine the percent of APP follow-ups completed independently versus in a shared capacity with the radiation oncologist. A review of the APP's didactic and clinical training program was performed. RESULTS Across all disease sites, approximately 40% of the APP's time was spent on direct patient care, predominantly composed of independent follow-up visits (9%-35%) and telehealth (2%-30%). The breast malignancies group was an outlier with a higher focus on consults or shared visits (25%). Indirect patient care accounts for 30% to 50% of workflow with the focus on visit preparation or care coordination (13%-35%) and dictation (8%-13%). Administrative responsibilities including process improvement, research, education, and leadership account for the remainder (5%-26%) and are varied across disease sites. The central nervous system malignancies group and genitourinary malignancies group reported a greater percentage of their time (23%-26%) on administration compared with other groups (5%-9%). On average APPs see most of their visits independently from the physicians (86.41%) with 13.59% of visits being seen in a shared capacity. CONCLUSIONS APPs can positively affect the field of radiation oncology by augmenting clinical capacity, optimizing workflow and increasing department efficiency via both direct and indirect patient care and through involvement in administrative and leadership duties. By implementing an independent-to practice model, simultaneous APP and physician clinics run parallel to each other, limiting shared visits for complex cases. This promotes APP job satisfaction and provides greater access to patient care without compromising quality. This article highlights a model for the utilization of APPs, which can be implemented by other radiation oncology departments or practices.
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Affiliation(s)
- Kate L Martin
- Dana Farber/Brigham and Women's Cancer Center, Boston, Massachusetts.
| | - Betty Krechmer
- Dana Farber/Brigham and Women's Cancer Center, Boston, Massachusetts
| | | | | | - Daniel N Cagney
- Dana Farber/Brigham and Women's Cancer Center, Boston, Massachusetts; Harvard Medical School, Harvard University, Boston, Massachusetts
| | - Neil Martin
- Dana Farber/Brigham and Women's Cancer Center, Boston, Massachusetts; Harvard Medical School, Harvard University, Boston, Massachusetts
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131
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Colombani F, Sibé M, Kret M, Quintard B, Ravaud A, Saillour-Glénisson F. EPOCK study protocol: a mixed-methods research program evaluating cancer care coordination nursing occupations in France as a complex intervention. BMC Health Serv Res 2019; 19:483. [PMID: 31299966 PMCID: PMC6626323 DOI: 10.1186/s12913-019-4307-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Accepted: 06/28/2019] [Indexed: 12/20/2022] Open
Abstract
Background Facing the increasing cancer incidence and cancer survivorship, many national strategic cancer plans have identified cancer care coordination as a priority for health service improvement. However, the high variability of practices, the diversity of definitions and underlying concepts increases the existing difficulty to standardise, replicate, transpose and assess care coordination within the French health system context. The EPOCK national study aims at evaluating practices and the working context of hospital-based cancer care coordination nurses, based on a previously designed reference framework for care coordination within the French health system context. Methods EPOCK is based on a comprehensive evaluation of nursing professions in cancer care coordination, considered as a complex intervention. Phase 1 (theoretical phase) will define and design a theoretical reference framework for care coordination in France through an international literature review, aiming to identify relevant models and all components of the expected framework and a structured consensus method, the Nominal group technique, aiming to select and prioritise the most relevant components already found in the literature review with regard to the French healthcare system; phase 2 (Operational phase) will consist in an in-depth analysis of practices, contexts, perceptions and attitudes related to care coordination occupations by nurses in oncology and all stakeholders (related professionals, patients and their caregivers) through a multicentric cross-sectional mixed-method evaluative study. The observed practices and contexts will be finally compared with the theoretical reference framework using both inductive and deductive approaches. Discussion This study will result in an evaluation framework identifying key models and key elements relative to cancer care coordination interventions that can be used to guide management of cancer care coordination nursing occupations within the French healthcare system. EPOCK would also assist in public decision-making to identify optimal targets, skills profiles and scope of actions for cancer coordination professions. Finally, EPOCK will describe typology of nurse practices in cancer care coordination and thus obtain precise preliminary information essential for drafting a medico-economic evaluation study of these new nursing professions’ impact. Trial registration Clinicaltrial.gov registration: NCT03350776, 11/22/2017.
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Affiliation(s)
- F Colombani
- Centre de Coordination en Cancérologie (3C), CHU de Bordeaux (Bordeaux University Hospital), Groupe hospitalier Saint-André, 1 rue Jean Burguet, F-33000, Bordeaux, France. .,Economie et Management des Organisations de Santé (EMOS), INSERM, ISPED, Centre INSERM U1219-Bordeaux Population Health, F-33000, Bordeaux, France.
| | - M Sibé
- Economie et Management des Organisations de Santé (EMOS), INSERM, ISPED, Centre INSERM U1219-Bordeaux Population Health, F-33000, Bordeaux, France.,ISPED (Bordeaux School of Public Health), Centre INSERM U1219-Bordeaux Population Health, Université de Bordeaux, F-33000, Bordeaux, France
| | - M Kret
- Service d'Information médicale, Unité de soutien méthodologique à la recherche clinique (USMR), CHU de Bordeaux, Pôle de Santé publique, F-33000, Bordeaux, France
| | - B Quintard
- Faculté de Psychologie, Laboratoire EA 4136 Handicap, Activité, Cognition, Santé, Université de Bordeaux, F-33000, Bordeaux, France
| | - A Ravaud
- Centre de Coordination en Cancérologie (3C), CHU de Bordeaux (Bordeaux University Hospital), Groupe hospitalier Saint-André, 1 rue Jean Burguet, F-33000, Bordeaux, France.,Pôle de cancérologie, Service d'Oncologie Médicale, CHU de Bordeaux, F-33000, Bordeaux, France
| | - F Saillour-Glénisson
- Economie et Management des Organisations de Santé (EMOS), INSERM, ISPED, Centre INSERM U1219-Bordeaux Population Health, F-33000, Bordeaux, France.,ISPED (Bordeaux School of Public Health), Centre INSERM U1219-Bordeaux Population Health, Université de Bordeaux, F-33000, Bordeaux, France.,Pôle de santé publique, Service d'Information Médicale, Unité Méthodes d'Evaluation en Santé, CHU de Bordeaux, F-33000, Bordeaux, France
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132
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Lelorain S, Moreaux C, Christophe V, Weingertner F, Bricout H. Cancer care continuity: A qualitative study on the experiences of French healthcare professionals, patients and family caregivers. INTERNATIONAL JOURNAL OF CARE COORDINATION 2019. [DOI: 10.1177/2053434519856866] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Introduction Continuity of care has many positive outcomes. Yet, in oncology, it may rapidly be disrupted. It is therefore essential to investigate the perceptions of users. Our aim was thus to describe and compare the perceptions of cancer care continuity of patients, family caregivers and various healthcare professionals involved in cancer care in France, one of the countries most affected by cancer. Methods The urology and senology cancer departments of two hospitals, as well as community physicians, were involved: 54 hospital healthcare professionals including mainly physicians, nurses and medical secretaries; 12 city physicians; 41 patients and their family caregivers. We carried out a qualitative study using N-Vivo® and a deductive approach to code the interviews into the following dimensions of continuity: informational, organisational and relational. Results Three different perspectives were highlighted: hospital healthcare professionals primarily focused on organisational aspects (71% of their discourse), city physicians on their need for information from hospitals (40% of their discourse) and patients/caregivers on relational aspects with professionals (51% of their discourse). However, the three dimensions of continuity were intertwined, as the major focus of each type of participant impacted their perspective of the other spheres of coordination. Discussion Working on the main perspective of each category of person involved in cancer care could improve, in turn, the other spheres of continuity for these people. For example, dealing with organisational issues with hospital physicians could be an indirect and original way to enhance their relationships with patients, which are so important to the latter.
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Affiliation(s)
- Sophie Lelorain
- Univ. Lille, CNRS, CHU Lille, UMR 9193 – SCALab – Sciences Cognitives et Sciences Affectives, Lille, France
| | | | - Véronique Christophe
- Univ. Lille, CNRS, CHU Lille, UMR 9193 – SCALab – Sciences Cognitives et Sciences Affectives, Lille, France
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Abstract
BACKGROUND Hospitals affiliated with Accountable Care Organizations (ACOs) may have a greater capacity to collaborate with providers across the care continuum to coordinate care, due to formal risk sharing and payment arrangements. However, little is known about the extent to which ACO affiliated hospitals implement care coordination strategies. OBJECTIVES To compare the implementation of care coordination strategies between ACO affiliated hospitals (n=269) and unaffiliated hospitals (n=502) and examine whether the implementation of care coordination strategies varies by hospital payment model types. MEASURES We constructed a care coordination index (CCI) comprised of 12 indicators that describe evidence-based care coordination strategies. Each indicator was scored on a 5-point Likert scale from 1="not used at all" to 5="used widely" by qualified representatives from each hospital. The CCI aggregates scores from each of the 12 individual indicators to a single summary score for each hospital, with a score of 12 corresponding to the lowest and 60 the highest use of care coordination strategies. RESEARCH DESIGN We used state-fixed effects multivariable linear regression models to estimate the relationship between ACO affiliation, payment model type, and the use care coordination strategies. RESULTS We found ACO affiliated hospitals reported greater use of care coordination strategies compared to unaffiliated hospitals. Fee-for-service shared savings and partial or global capitation payment models were associated with a greater use of care coordination strategies among ACO affiliated hospitals. CONCLUSION Our findings suggest ACO affiliation and multiple payment model types are associated with the increased use of care coordination strategies.
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134
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Racial and socioeconomic disparities in adherence to preventive health services for ovarian cancer survivors. J Cancer Surviv 2019; 13:512-522. [PMID: 31172430 DOI: 10.1007/s11764-019-00771-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2018] [Accepted: 05/24/2019] [Indexed: 10/26/2022]
Abstract
PURPOSE To examine ovarian cancer survivors' adherence to evidence-based guidelines for preventive health care. METHODS A case-control, retrospective study of Medicare fee-for-service beneficiaries diagnosed with stage I, II, or III epithelial ovarian cancer from 2001 to 2010 using the Surveillance, Epidemiology, and End Results-Medicare database. Survivors were matched 1:1 to non-cancer controls from the 5% Medicare Beneficiary file on age, race, state of residence, and follow-up time. Receipt of flu vaccination, mammography, and bone density tests were examined in accordance with national guidelines. Adherence was assessed starting 1 year after cancer diagnosis, across 2 years of claims. Interaction with the health care system, including outpatient and cancer surveillance visits, was tested as a potential mechanism for receipt of services. RESULTS 2437 survivors met the eligibility criteria (mean age, 75; 90% white). Ovarian cancer survivors were more likely to be adherent to flu vaccination (5 percentage points (pp); < 0.001) and mammography guidelines (10 pp.; < 0.001) compared to non-cancer controls, but no differences were found for bone density test guidelines (- 1 pp.; NS). Black women were less likely to be adherent to flu vaccination and bone density tests compared with white women. Women dually eligible for Medicare and Medicaid were less likely to be adherent compared to those without such support. Adherence was not influenced by measures of outpatient visits. CONCLUSION Ovarian cancer survivors are receiving preventive services with the same or better adherence than their matched counterparts. Minority and dual-eligible survivors received preventive services at a lower rate than white survivors and those with higher income. The number of outpatient visits was not associated with increased preventive health visits. IMPLICATIONS FOR CANCER SURVIVORS Ovarian cancer survivors are receiving adequate follow-up care to be adherent to preventive health measures. Efforts to improve care coordination post-treatment may help reduce minority and low SES disparities.
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135
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Westman B, Ullgren H, Olofsson A, Sharp L. Patient-reported perceptions of care after the introduction of a new advanced cancer nursing role in Sweden. Eur J Oncol Nurs 2019; 41:41-48. [PMID: 31358256 DOI: 10.1016/j.ejon.2019.05.009] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Revised: 05/15/2019] [Accepted: 05/31/2019] [Indexed: 10/26/2022]
Abstract
PURPOSE Extensive research results show quality improvements associated with advanced cancer nursing roles. Despite this, these roles are not implemented in many countries. The aim of this cross-sectional, population-based study was to compare patients' perception of care, before and after the introduction of a new advanced nursing role, the coordination contact nurse (CCN), in a region in Sweden. METHOD All patients (with gynaecological, haematological, Head & Neck, upper gastrointestinal cancers) diagnosed in the region the year prior and one-year post introducing the new CCN role were identified from the Swedish Cancer Register. Data were collected using the European Organization of Research and Treatment of Cancer [EORTC] Quality of Life Questionnaire (QLQ-C30 and QLQ-INFO25) and a study specific questionnaire. RESULT The results, based on baseline (n = 869) and follow-up data (n = 1003), show statistically significant patient-reported improvements after the introduction of the CCN role, regarding health-related patient information (EORTC QLQ- INFO25 global mean score increased from 41.23 to 44.16, p = 0.0006). We found statistically significant improvements related to availability of supportive care resources, e.g. increased reported access to contact nurse (from 53% to 66%, p ≤ 0.0001) and individual written care plans (from 40% to 54%, p < 0.0001). We also found some improvements related to patient involvement and care coordination, but also room for further developments. CONCLUSION The implementation of the new advanced cancer nursing role may have contributed to important improvements, but it has also identified areas in need of development. Further research with long-term evaluations of CCN roles in other contexts, are both needed and on-going.
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Affiliation(s)
- B Westman
- Regional Cancer Centre, Stockholm Gotland, 10239, Stockholm, Sweden.
| | - H Ullgren
- Regional Cancer Centre, Stockholm Gotland, 10239, Stockholm, Sweden; Karolinska University Hospital, Theme Cancer, Patient Area Airway, Lung and Skin Cancer, 17176, Stockholm, Sweden; Umeå University, Department of Nursing, 90187, Umeå, Sweden
| | - A Olofsson
- Regional Cancer Centre, Stockholm Gotland, 10239, Stockholm, Sweden
| | - L Sharp
- Regional Cancer Centre, Stockholm Gotland, 10239, Stockholm, Sweden; Karolinska Institutet, LIME, Division of Innovative Care Research, 17177, Stockholm, Sweden
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136
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Zullig LL, Ramos K, Berkowitz C, Miller JJ, Dolor RJ, Koontz BF, Yousuf Zafar S, Hutch Allen D, Tenhover JA, Bosworth HB. Assessing Key Stakeholders' Knowledge, Needs, and Preferences for Head and Neck Cancer Survivorship Care Plans. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2019; 34:584-591. [PMID: 29526021 PMCID: PMC8101022 DOI: 10.1007/s13187-018-1345-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/29/2023]
Abstract
Cancer survivorship care plans (SCPs) are endorsed to support quality care for cancer survivors, but uptake is slow. We assessed knowledge, needs, and preferences for SCP content and delivery from a wide variety of stakeholders. We focused SCP content for head and neck cancer as it is a disease prone to long-term side effects requiring management from multiple providers. We conducted telephone-based, qualitative interviews. We purposively sampled head and neck cancer survivors (n = 4), primary care physicians in the community (n = 5), and providers affiliated with a large academic medical center (n = 5) who treat head and neck cancer, cancer specialists (n = 6), and nurse practitioners/supportive care staff (n = 5). Interviews were recorded, transcribed, and analyzed using direct content analysis. Few participants reported personal experience with SCPs, but most supported the concept. Several key themes emerged: (1) perceived ambiguity regarding roles and responsibilities for SCPs, (2) a need to tailor the content and language based on the intended recipient, (3) documentation process should be as automated and streamlined as possible, (4) concerns about using the SCP to coordinate with outside providers, and (5) that SCPs would have added value as a "living document." We also report SCP-related issues that are unique to serving patients diagnosed with head and neck cancer. Effort is needed to tailor SCPs for different recipients and optimize their potential for successful implementation, impact on care outcomes, and sustainability. Many cancer survivors may not receive a SCP as part of routine care. Survivors could engage their health care team by requesting a SCP.
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Affiliation(s)
- Leah L Zullig
- Center for Health Services Research in Primary Care, Durham Veterans Affairs Health Care Center, Durham, NC, 27705, USA.
- Department of Population Health Sciences, Duke University Medical Center, Durham, NC, 27710, USA.
- Duke Cancer Institute, Duke University Medical Center, Durham, NC, 27710, USA.
| | - Katherine Ramos
- Geriatric Research Education and Clinical Center, Durham Veterans Affairs Health Care Center, Durham, NC, 27705, USA
| | | | - Julie J Miller
- Department of Population Health Sciences, Duke University Medical Center, Durham, NC, 27710, USA
| | - Rowena J Dolor
- Division of General Internal Medicine, Duke University Medical Center, Durham, NC, 27710, USA
| | - Bridget F Koontz
- Duke Cancer Institute, Duke University Medical Center, Durham, NC, 27710, USA
- Department of Radiation Oncology, Duke University Medical Center, Durham, NC, 27710, USA
| | - S Yousuf Zafar
- Duke Cancer Institute, Duke University Medical Center, Durham, NC, 27710, USA
- Department of Medical Oncology, Duke University Medical Center, Durham, NC, 27710, USA
| | - D Hutch Allen
- Duke Cancer Institute, Duke University Medical Center, Durham, NC, 27710, USA
| | - Jennifer A Tenhover
- Duke Cancer Institute, Duke University Medical Center, Durham, NC, 27710, USA
| | - Hayden B Bosworth
- Center for Health Services Research in Primary Care, Durham Veterans Affairs Health Care Center, Durham, NC, 27705, USA
- Department of Population Health Sciences, Duke University Medical Center, Durham, NC, 27710, USA
- Duke Cancer Institute, Duke University Medical Center, Durham, NC, 27710, USA
- School of Nursing, Duke University Medical Center, Durham, NC, 27710, USA
- Department of Psychiatry and Behavioral Sciences, Duke University, Durham, NC, 27710, USA
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137
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Perpetua EM, Clarke SE, Guibone KA, Keegan PA, Speight MK. Surveying the Landscape of Structural Heart Disease Coordination: An Exploratory Study of the Coordinator Role. STRUCTURAL HEART 2019. [DOI: 10.1080/24748706.2019.1581962] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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138
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Cordasco KM, Frayne SM, Kansagara D, Zulman DM, Asch SM, Burke RE, Post EP, Fihn SD, Klobucar T, Meyer LJ, Kirsh SR, Atkins D. Coordinating Care Across VA Providers and Settings: Policy and Research Recommendations from VA's State of the Art Conference. J Gen Intern Med 2019; 34:11-17. [PMID: 31098966 PMCID: PMC6542870 DOI: 10.1007/s11606-019-04970-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Delivering well-coordinated care is essential for optimizing clinical outcomes, enhancing patient care experiences, minimizing costs, and increasing provider satisfaction. The Veterans Health Administration (VA) has built a strong foundation for internally coordinating care. However, VA faces mounting internal care coordination challenges due to growth in the number of Veterans using VA care, high complexity in Veterans' care needs, the breadth and depth of VA services, and increasing use of virtual care. VA's Health Services Research and Development service with the Office of Research and Development held a conference assessing the state-of-the-art (SOTA) on care coordination. One workgroup within the SOTA focused on coordination between VA providers for high-need Veterans, including (1) Veterans with multiple chronic conditions; (2) Veterans with high-intensity, focused, specialty care needs; (3) Veterans experiencing care transitions; (4) Veterans with severe mental illness; (5) and Veterans with homelessness and/or substance use disorders. We report on this workgroup's recommendations for policy and organizational initiatives and identify questions for further research. Recommendations from a separate workgroup on coordinating VA and non-VA care are contained in a companion paper. Leaders from research, clinical services, and VA policy will need to partner closely as they develop, implement, assess, and spread effective practices if VA is to fully realize its potential for delivering highly coordinated care to every Veteran.
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Affiliation(s)
- Kristina M Cordasco
- VA Health Services Research & Development (HSR&D) Center for the Study of Healthcare Innovation, Implementation, and Policy (CSHIIP), VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA. .,Department of Medicine, VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA. .,Department of Medicine, University of California Los Angeles (UCLA) Geffen School of Medicine, Los Angeles, CA, USA.
| | - Susan M Frayne
- VA HSR&D Center for Innovation to Implementation (Ci2i), VA Palo Alto Health Care System, Palo Alto, CA, USA.,Women's Health Section, VA Palo Alto Health Care System, Palo Alto, CA, USA.,Division of Primary Care and Population Health, Stanford University, Stanford, CA, USA
| | - Devan Kansagara
- VA Portland Healthcare System, Portland, OR, USA.,Department of Medicine, Oregon Health & Science University, Portland, OR, USA
| | - Donna M Zulman
- Women's Health Section, VA Palo Alto Health Care System, Palo Alto, CA, USA.,VA Portland Healthcare System, Portland, OR, USA
| | - Steven M Asch
- Women's Health Section, VA Palo Alto Health Care System, Palo Alto, CA, USA.,VA Portland Healthcare System, Portland, OR, USA
| | - Robert E Burke
- Center for Health Equity Research and Promotion, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA, USA.,Division of General Internal Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Edward P Post
- VA Center for Clinical Management Research, Ann Arbor, MI, USA.,University of Michigan Medical School, Ann Arbor, MI, USA
| | - Stephan D Fihn
- VA Office of Clinical System Development and Evaluation, Seattle, WA, USA.,VA Puget Sound Health Care System, Seattle, WA, USA.,Department of Health Services and Department of Medicine, University of Washington, Seattle, WA, USA
| | | | - Laurence J Meyer
- VA Office of Specialty Care Services, Washington, DC, USA.,VA Salt Lake City Health Care System, Salt Lake City, UT, USA.,University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Susan R Kirsh
- Office of Veterans Access to Care, Washington, DC, USA.,Louis Stokes Cleveland VA Medical Center, Cleveland, OH, USA.,Department of Medicine, School of Medicine, Case Western Reserve University, Cleveland, OH, USA
| | - David Atkins
- VA Office of Research and Development, Health Services Research and Development, Washington, DC, USA
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139
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Stout NL, Sleight A, Pfeiffer D, Galantino ML, deSouza B. Promoting assessment and management of function through navigation: opportunities to bridge oncology and rehabilitation systems of care. Support Care Cancer 2019; 27:4497-4505. [DOI: 10.1007/s00520-019-04741-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2018] [Accepted: 03/07/2019] [Indexed: 12/19/2022]
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140
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Aarhus R, Tjørnhøj-Thomsen T, Tarp B, Vedsted P, Andersen RS. Coordinating objects of care: Exploring the role of case managers as brokers in cancer patient pathways. Eur J Cancer Care (Engl) 2019; 28:e13017. [PMID: 30767292 DOI: 10.1111/ecc.13017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Revised: 11/03/2018] [Accepted: 01/17/2019] [Indexed: 11/27/2022]
Abstract
OBJECTIVE Healthcare systems increasingly make use of case managers to handle organisational complexity. In Danish cancer patient pathways, case managers handle the complexities of cancer diagnostics and treatment while adhering to pathway guidelines. This article explores how case managers handle their various responsibilities and focuses on the micro-politics of case management. METHODS An ethnographic study was carried out in three Danish cancer patient pathways. Interactions between patients and healthcare professionals were observed, including professionals with case management tasks. We interviewed 13 cancer diagnostic patients in their homes and 26 healthcare professionals during work hours, among other things about case management. RESULTS We found that the work of case managers differs between cancer patient pathways and settings but overall emphasises coordination of patient trajectories and being contact person. We argue that case managers, embodying the figure of the broker, handle their responsibilities by coordinating the following co-existing objects of care, each with different goals: the diseased body, the person, the organisation and the cancer patient pathway. CONCLUSION We conclude that case managers, in addition to being a response to the complexity of healthcare services, impact the implementation of cancer patient pathways and influence cancer diagnostic activities.
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Affiliation(s)
- Rikke Aarhus
- Diagnostic Centre, University Research Clinic for Innovative Patient Pathways, Silkeborg Regional Hospital, Silkeborg, Denmark.,Research Unit for General Practice, Research Centre for Cancer Diagnosis in Primary Care, Aarhus University, Aarhus C, Denmark
| | - Tine Tjørnhøj-Thomsen
- National Institute of Public Health, The University of Southern Denmark, Copenhagen K, Denmark
| | - Britta Tarp
- Diagnostic Centre, University Research Clinic for Innovative Patient Pathways, Silkeborg Regional Hospital, Silkeborg, Denmark
| | - Peter Vedsted
- Diagnostic Centre, University Research Clinic for Innovative Patient Pathways, Silkeborg Regional Hospital, Silkeborg, Denmark.,Research Unit for General Practice, Research Centre for Cancer Diagnosis in Primary Care, Aarhus University, Aarhus C, Denmark
| | - Rikke S Andersen
- Research Unit for General Practice, Research Centre for Cancer Diagnosis in Primary Care, Aarhus University, Aarhus C, Denmark
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141
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Blaschke SM, Gough KC, Chua BH, Francis PA, Cockerell R, Drosdowsky AF, Sheeran L, Krishnasamy M. Implementation of a Multidisciplinary Model of Care for Women With Metastatic Breast Cancer: Challenges and Lessons Learned. Clin Breast Cancer 2018; 19:e327-e336. [PMID: 30661949 DOI: 10.1016/j.clbc.2018.12.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2018] [Revised: 12/10/2018] [Accepted: 12/15/2018] [Indexed: 11/25/2022]
Abstract
INTRODUCTION The present study examined the feasibility and effects of integrating a multidisciplinary team (MDT) model of care for women with metastatic breast cancer (MBC) into a large Australian cancer center. The challenges encountered and lessons learned are described. PATIENTS AND METHODS In the present prospective, longitudinal, mixed-methods implementation study, the MDT model included face-to-face consultations with a breast care nurse and social worker, followed by a MDT case discussion and face-to-face delivery of a personalized management plan. Data were collected to describe the cohort of women living with MBC who had attended a specialist breast cancer service and their supportive care needs. RESULTS A total of 62 women with median age of 60 years (interquartile range [IQR], 37-82 years) participated. The median interval from the first breast cancer diagnosis was 5.7 years (IQR, 2.0-11.6 years), and the median interval from the diagnosis of MBC was 2.0 years (IQR, 0.9-3.6 years). The MDT care model required new resources and cross-sector participation. However, the participants indicated a preference for personalized needs assessment and care planning at the diagnosis of MBC. CONCLUSIONS The results highlight the challenges of implementing and evaluating an MDT care model for women with MBC. The model coordinated MDT collaboration to strengthen the delivery of complex care plans. Investment in cross-sector partnerships to optimize care coordination for women with MBC was needed.
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Affiliation(s)
- Sarah-May Blaschke
- Department of Cancer Experiences Research, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia.
| | - Karla C Gough
- Department of Cancer Experiences Research, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia; Department of Nursing, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, VIC, Australia
| | - Boon H Chua
- University of New South Wales, Sydney and Nelune Comprehensive Cancer Centre, Prince of Wales Hospital, Randwick, NSW, Australia
| | - Prudence A Francis
- Department of Medical Oncology, Peter MacCallum Cancer Centre, University of Melbourne, Melbourne, VIC, Australia
| | - Robyn Cockerell
- Faculty of Health, Queensland University of Technology, Brisbane, QLD, Australia
| | - Allison F Drosdowsky
- Department of Cancer Experiences Research, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | - Lisa Sheeran
- Breast Service, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | - Meinir Krishnasamy
- Department of Nursing, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, VIC, Australia; Victorian Comprehensive Cancer Centre, Parkville, VIC, Australia
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142
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Kenzik KM. Health care use during cancer survivorship: Review of 5 years of evidence. Cancer 2018; 125:673-680. [PMID: 30561774 DOI: 10.1002/cncr.31852] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2017] [Revised: 07/23/2018] [Accepted: 07/24/2018] [Indexed: 12/21/2022]
Abstract
Improvements in treatment strategies have resulted in increasing survival rates among patients diagnosed with cancer but also result in a growing population of individuals who have greater health care needs. These needs will persist from diagnosis throughout the continuing phase of care, or the survivorship phase. To better define models of survivorship care, there must be a strong evidence base in survivor health care use patterns. The objective of this review, which covers studies from 2012 to January 2018, was to evaluate the available evidence on patterns of health care visits among survivors of adult cancers and to understand what is known about the rate of health care visits, the physician specialties associated with these visits, and/or the types health care settings (eg, outpatient, emergency room). The findings underscore the importance of primary care, with the majority of studies reporting that >90% of survivors visited a primary care provider in the prior year. Visits to oncologists and/or other physician specialties were positively associated with receiving cancer screenings and obtaining quality care for noncancer-related conditions. High care density/low care fragmentation between physician specialties had lower costs and a lower likelihood of redundant health care utilization. The follow-up in almost all studies was 3 years, providing short-term evidence; however, as the survivorship period lengthens with improved treatments, longer follow-up will be required. The long-term patterns with which survivors of cancer engage the health care system are critical to designing long-term follow-up care plans that are effective in addressing the complex morbidity that survivors experience.
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Affiliation(s)
- Kelly M Kenzik
- Institute for Cancer Outcomes and Survivorship and Division of Hematology and Oncology, University of Alabama at Birmingham, Birmingham, Alabama
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143
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Shaw T, York S, White K, McGregor D, Rankin N, Hawkey A, Aranda S, Rushton S, Currow D. Defining success factors to describe coordinated care in cancer. Transl Behav Med 2018; 8:357-365. [PMID: 29800413 DOI: 10.1093/tbm/iby022] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Providing coordinated care remains a challenge for cancer services globally. There is a lack of consensus in the literature about what constitutes successful coordinated care. This study aimed to define and prioritize a set of consensus-driven success factors that can lead to coordinated care. A mixed-methods approach was used that included literature review, a broad call for submissions from relevant stakeholders, and a priority-setting process based on a modified nominal group technique. Thirty articles that related to success factors in coordinated care were identified in the literature. Twenty submissions were received from a broad range of stakeholders. From these sources, a set of 20 success factors was derived. Seventy stakeholders attended a series of workshops across New South Wales, Australia, to review and prioritize these 20 success factors against significance and measurability. Clear consensus was reached on prioritizing two success factors linked to improving coordinated care from first presentation to diagnosis and ensuring that patients are routinely screened for physical and supportive care needs. Other highly ranked factors included the need for a comprehensive care plan and the identification of patients at higher risk for disjointed care. This study defines and prioritizes a set of success factors related to coordinated care in cancer. These success factors will be used to guide the development of interventions that target improving coordinated care as well as supporting the development of new funding models based on performance indicators derived from these factors.
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Affiliation(s)
- Tim Shaw
- Faculty of Health Sciences, Charles Perkins Centre, University of Sydney, Sydney, Australia
| | - Sarah York
- Sydney Catalyst Translational Cancer Research Centre, University of Sydney, Sydney, Australia
| | | | - Deborah McGregor
- Faculty of Health Sciences, Charles Perkins Centre, University of Sydney, Sydney, Australia
| | - Nicole Rankin
- Sydney Catalyst Translational Cancer Research Centre, University of Sydney, Sydney, Australia.,Cancer Council NSW, Sydney, Australia
| | - Alex Hawkey
- Faculty of Health Sciences, Charles Perkins Centre, University of Sydney, Sydney, Australia.,Centre for Health Research, Western Sydney University, Sydney, Australia
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Ahluwalia SC, Chen C, Raaen L, Motala A, Walling AM, Chamberlin M, O'Hanlon C, Larkin J, Lorenz K, Akinniranye O, Hempel S. A Systematic Review in Support of the National Consensus Project Clinical Practice Guidelines for Quality Palliative Care, Fourth Edition. J Pain Symptom Manage 2018; 56:831-870. [PMID: 30391049 DOI: 10.1016/j.jpainsymman.2018.09.008] [Citation(s) in RCA: 83] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2018] [Accepted: 09/07/2018] [Indexed: 12/25/2022]
Abstract
CONTEXT Palliative care continues to be a rapidly growing field aimed at improving quality of life for patients and their caregivers. OBJECTIVES The purpose of this review was to provide a synthesis of the evidence in palliative care to inform the fourth edition of the National Consensus Project Clinical Practice Guidelines for Quality Palliative Care. METHODS Ten key review questions addressing eight content domains guided a systematic review focused on palliative care interventions. We searched eight databases in February 2018 for systematic reviews published in English from 2013, after the last edition of National Consensus Project guidelines was published, to present. Experienced literature reviewers screened, abstracted, and appraised data per a detailed protocol registered in PROSPERO. The quality of evidence was evaluated using the Grading of Recommendations, Assessment, Development and Evaluations criteria. The review was supported by a technical expert panel. RESULTS We identified 139 systematic reviews meeting inclusion criteria. Reviews addressed the structure and process of care (interdisciplinary team care, 13 reviews; care coordination, 18 reviews); physical aspects (48 reviews); psychological aspects (26 reviews); social aspects (two reviews); spiritual, religious, and existential aspects (11 reviews); cultural aspects (three reviews); care of the patient nearing the end of life (grief/bereavement programs, six reviews; final days of life, two reviews); ethical and legal aspects (36 reviews). CONCLUSION A substantial body of evidence exists to support clinical practice guidelines for quality palliative care, but the quality of evidence is limited.
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Affiliation(s)
- Sangeeta C Ahluwalia
- RAND Health, Santa Monica, California, USA; UCLA Fielding School of Public Health, Los Angeles, California, USA.
| | - Christine Chen
- Pardee RAND Graduate School, Santa Monica, California, USA
| | | | - Aneesa Motala
- Evidence based Practice Center, RAND Corp., Santa Monica, California, USA
| | - Anne M Walling
- RAND Health, Santa Monica, California, USA; Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine at University of California, Los Angeles, California, USA; Greater Los Angeles Veterans Affairs Healthcare System, Los Angeles, California, USA
| | | | | | - Jody Larkin
- Evidence based Practice Center, RAND Corp., Santa Monica, California, USA
| | - Karl Lorenz
- RAND Health, Santa Monica, California, USA; VA Palo Alto Health Care System, Center for Innovation to Implementation, Menlo Park, California, USA; Stanford University School of Medicine, Stanford, California, USA
| | | | - Susanne Hempel
- Evidence based Practice Center, RAND Corp., Santa Monica, California, USA
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145
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Bryant J, Smits R, Turon H, Sanson-Fisher R, Engel J. Optimal cancer care: what essential elements of care would help haematological cancer patients obtain and understand information about their disease and its treatment and impact? Support Care Cancer 2018; 26:2843-2849. [PMID: 29520441 PMCID: PMC6018600 DOI: 10.1007/s00520-018-4140-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Accepted: 03/02/2018] [Indexed: 11/28/2022]
Abstract
PURPOSE To describe the perceptions of haematological cancer patients about the components of care deemed essential to supporting them to obtain and understand information about their cancer, its treatment and its impact on their life. METHODS A cross-sectional survey was conducted with individuals diagnosed with haematological cancer. Eligible patients presenting for a scheduled outpatient appointment were invited to complete a pen-and-paper survey in the clinic waiting room while waiting for their appointment. Those who completed the survey were mailed a second survey approximately 4 weeks later. Participants provided data about their demographic and disease characteristics and perceptions of optimal care for haematological cancer patients. RESULTS A total of 170 patients completed both surveys and were included in the analysis. The items endorsed as essential components of care by the highest number of participants were being able to share accurate information about their disease, treatment and ongoing care with their GP/family doctor (49%); being able to obtain up-to-date information specific to their circumstances (43%); being able to obtain information in the amount of detail that they want (34%); being able to call a health care professional at the treatment centre where they are receiving care (34%) and being able to call an experienced health care professional who has knowledge of their disease and its treatment (34%). CONCLUSIONS Further research is needed to determine ways of meeting the preferences of haematological cancer patients and determining the associated impact on patient outcomes.
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Affiliation(s)
- Jamie Bryant
- Health Behaviour Research Collaborative, School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, 2308, Australia.
- Priority Research Centre for Health Behaviour, University of Newcastle, Callaghan, NSW, 2308, Australia.
- Hunter Medical Research Institute, New Lambton Heights, NSW, 2305, Australia.
| | - Rochelle Smits
- Health Behaviour Research Collaborative, School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, 2308, Australia
- Priority Research Centre for Health Behaviour, University of Newcastle, Callaghan, NSW, 2308, Australia
- Hunter Medical Research Institute, New Lambton Heights, NSW, 2305, Australia
| | - Heidi Turon
- Health Behaviour Research Collaborative, School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, 2308, Australia
- Priority Research Centre for Health Behaviour, University of Newcastle, Callaghan, NSW, 2308, Australia
- Hunter Medical Research Institute, New Lambton Heights, NSW, 2305, Australia
| | - Rob Sanson-Fisher
- Health Behaviour Research Collaborative, School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, 2308, Australia
- Priority Research Centre for Health Behaviour, University of Newcastle, Callaghan, NSW, 2308, Australia
- Hunter Medical Research Institute, New Lambton Heights, NSW, 2305, Australia
| | - Jennifer Engel
- Health Behaviour Research Collaborative, School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, 2308, Australia
- Priority Research Centre for Health Behaviour, University of Newcastle, Callaghan, NSW, 2308, Australia
- Hunter Medical Research Institute, New Lambton Heights, NSW, 2305, Australia
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146
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Abstract
BACKGROUND Care coordination occurs largely through care coordinators' interactions with patients and community partners to identify and address patients' individual needs. More frequent and higher-quality communication with each may enhance care coordination effectiveness. PURPOSE The purpose of this study was to understand (a) how care coordinator perceptions of interactions with patients and community partners, respectively, compared to each other group's perceptions of their interactions with care coordinators and (2) whether these dynamics between care coordinators and community partners changed over time. METHODOLOGY The research context was a comparative case study of provider-based care coordination projects funded through the Texas 1115(a) Medicaid waiver. The Relational Coordination instrument was administered through (a) two waves of in-person interviews with care coordinators (2014-2015 and 2015-2016) at a total of 10 sites across the state, (b) a single 2016 phone survey with 159 patients at nine of those sites, and (c) phone surveys with representatives of the community resources that care coordinators had identified as key partners in 2014-2015 and again in 2015-2016. RESULTS Care coordinators reported more frequently needing both patients and community partners than either other group reported relative to care coordinators. Frequency of need and mutual influence with community partners increased in the first 2 years of the care coordination programs' implementation. The perceived quality of interactions between care coordinators and both patients and community partners was positive, but with room for improvement. CONCLUSION Care coordination may entail limited interactions with patients and community partners, especially at program inception. As care coordination programs mature, interactions may become more frequent and influence with partners may expand. PRACTICE IMPLICATIONS Decision makers should support care coordinators in improving the quality of their communication with both patients and community partners, as well as allow time for these relationships to develop.
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147
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Using the Relational Coordination Instrument With a Diverse Patient Sample. Med Care 2018; 56:767-774. [PMID: 30015721 DOI: 10.1097/mlr.0000000000000964] [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 The Relational Coordination (RC) instrument has been used extensively in the context of health care interprofessional coordination. However, the instrument's applicability to patient experiences of their interactions with professionals is largely untested. OBJECTIVES This study's objectives were to determine: (1) whether the RC instrument could be modified for phone administration to yield internally consistent results when used with a diverse group of patients with complex health needs; and (2) whether the RC factor was invariant across patients of differing education, levels of emotional problems, race, and ethnicity, thereby showing similar interpretation of items across these groups. RESEARCH DESIGN The RC instrument was administered through a phone survey to patients in Texas (n=346) who reported receiving care coordination. Data collection occurred between 2014 and 2016. Cronbach α coefficients and confirmatory factor analysis were used to determine whether the original set of RC items could be used for phone surveys with patients. Factorial invariance testing was used to assess how consistently the instrument was interpreted across patient subgroups. RESULTS The RC scale generally met acceptable α statistic and confirmatory factor analysis thresholds for internal consistency. Factorial invariance results indicated that the scale also generally performed consistently across patient subgroups. CONCLUSIONS This study provides preliminary evidence that the RC instrument can be used for surveying diverse patient populations. Future use of this instrument with patients can better reflect their experiences as partners with professionals in improving their health.
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148
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Role of the geriatrician, primary care practitioner, nurses, and collaboration with oncologists during cancer treatment delivery for older adults: A narrative review of the literature. J Geriatr Oncol 2018; 9:398-404. [DOI: 10.1016/j.jgo.2018.04.008] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2017] [Revised: 03/09/2018] [Accepted: 04/25/2018] [Indexed: 12/20/2022]
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149
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Jetty A, Petterson S, Rabin DL, Liaw W. Privately insured adults in HDHP with higher deductibles reduce rates of primary care and preventive services. Transl Behav Med 2018; 8:375-385. [DOI: 10.1093/tbm/ibx076] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
| | | | - David L Rabin
- Department of Family Medicine, Georgetown University School of Medicine, Washington, DC, USA
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150
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Shahrokni A, Alexander K, Wildes TM, Puts MTE. Preventing Treatment-Related Functional Decline: Strategies to Maximize Resilience. Am Soc Clin Oncol Educ Book 2018; 38:415-431. [PMID: 30231361 DOI: 10.1200/edbk_200427] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
The majority of patients with cancer are older adults. A comprehensive geriatric assessment (CGA) will help the clinical team identify underlying medical and functional status issues that can affect cancer treatment delivery, cancer prognosis, and treatment tolerability. The CGA, as well as more abbreviated assessments and geriatric screening tools, can aid in the treatment decision-making process through improved individualized prediction of mortality, toxicity of cancer therapy, and postoperative complications and can also help clinicians develop an integrated care plan for the older adult with cancer. In this article, we will review the latest evidence with regard to the use of CGA in oncology. In addition, we will describe the benefits of conducting a CGA and the types of interventions that can be taken by the interprofessional team to improve the treatment outcomes and well-being of older adults.
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Affiliation(s)
- Armin Shahrokni
- From the Memorial Sloan Kettering Cancer Center, New York, NY; Washington University School of Medicine, St. Louis MO; Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON, Canada
| | - Koshy Alexander
- From the Memorial Sloan Kettering Cancer Center, New York, NY; Washington University School of Medicine, St. Louis MO; Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON, Canada
| | - Tanya M Wildes
- From the Memorial Sloan Kettering Cancer Center, New York, NY; Washington University School of Medicine, St. Louis MO; Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON, Canada
| | - Martine T E Puts
- From the Memorial Sloan Kettering Cancer Center, New York, NY; Washington University School of Medicine, St. Louis MO; Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON, Canada
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