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Atlas SJ, Haas JS, Perez GK, Park ER, Peppercorn JM. Engaging Patients, Oncologists, and Primary Care Clinicians in the Care of Cancer Survivors: A Coordinated Care Model With System-Level Technology to Move the Outcomes Needle. JCO Oncol Pract 2024:OP2300818. [PMID: 39088767 DOI: 10.1200/op.23.00818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Revised: 07/11/2024] [Accepted: 07/15/2024] [Indexed: 08/03/2024] Open
Affiliation(s)
- Steven J Atlas
- Massachusetts General Hospital and Harvard Medical School, Boston, MA
| | - Jennifer S Haas
- Massachusetts General Hospital and Harvard Medical School, Boston, MA
| | - Giselle K Perez
- Massachusetts General Hospital and Harvard Medical School, Boston, MA
| | - Elyse R Park
- Massachusetts General Hospital and Harvard Medical School, Boston, MA
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Elkefi S, Asan O. Validating the Effectiveness of the Patient-Centered Cancer Care Framework by Assessing the Impact of Work System Factors on Patient-Centered Care and Quality of Care: Interview Study With Newly Diagnosed Cancer Patients. JMIR Hum Factors 2024; 11:e53053. [PMID: 38656776 PMCID: PMC11079762 DOI: 10.2196/53053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2023] [Revised: 03/06/2024] [Accepted: 03/15/2024] [Indexed: 04/26/2024] Open
Abstract
BACKGROUND Patients with cancer who have recently been diagnosed have distinct requirements compared to cancer survivors. It is crucial to take into account their unique needs to ensure that they make informed decisions and are receptive to the care provided. OBJECTIVE This study suggested a framework titled Effectiveness of Patient-Centered Cancer Care that considers the needs of newly diagnosed patients with cancer and related work system factors. This study investigated how work system factors influence the perceptions of patient-centered care, quality of care, and associated outcomes among newly diagnosed patients with cancer. Patient-centered care is defined in terms of workload and communication considerations, whereas the quality of care is assessed through indicators such as trust in physicians, satisfaction with care, and perceptions of technology. METHODS This study used qualitative data collected through interviews with newly diagnosed patients with cancer (N=20) right after their first visits with their physicians. Thematic analysis was conducted to validate the 5 hypotheses of the framework, mapping the interactions among quality of care, patient-centered care, and work system factors. RESULTS We found that workload and patient-centered communication impact the quality of care and that the work system elements impact the patient-centeredness (workload and communication) and the quality of care (trust in physicians, satisfaction with care, and perception of technology use). CONCLUSIONS Qualitatively validating the proposed Effectiveness of Patient-Centered Cancer Care framework, this study demonstrated its efficacy in elucidating the interplay of various factors. The framework holds promise for informing interventions geared toward enhancing patients' experiences during their initial visits after diagnosis. There is a pressing need for heightened attention to the organizational design, patient processes, and collaborative efforts among diverse stakeholders and providers to optimize the overall patient experience.
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Affiliation(s)
- Safa Elkefi
- School of Nursing, Columbia University, New York, NY, United States
| | - Onur Asan
- School of Systems and Enterprises, Stevens Institute of Technology, Hoboken, NJ, United States
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Oh S, Sang E, Stawnychy MA, Garren P, You SB, O'Connor M, Hirschman KB, Hodgson N, Cranston T, Jablonski J, O'Brien K, Newcomb M, Spahr M, Bowles KH. Application of a Human Factors and Systems Engineering Approach to Explore Care Transitions of Sepsis Survivors From Hospital to Home Health Care. HUMAN FACTORS 2024:187208231222399. [PMID: 38171592 DOI: 10.1177/00187208231222399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/05/2024]
Abstract
STUDY AIM This study aims to describe the transition-in-care work process for sepsis survivors going from hospitals to home health care (HHC) and identify facilitators and barriers to enable practice change and safe care transitions using a human factors and systems engineering approach. BACKGROUND Despite high readmission risk for sepsis survivors, the transition-in-care work process from hospitals to HHC has not been described. METHODS We analyzed semi-structured needs assessment interviews with 24 stakeholders involved in transitioning sepsis survivors from two hospitals and one affiliated HHC agency participating in the parent implementation science study, I-TRANSFER. The qualitative data analysis was guided by the Systems Engineering Initiative for Patient Safety (SEIPS) framework to describe the work process and identify work system elements. RESULTS We identified 31 tasks characterized as decision making, patient education, communication, information, documentation, and scheduling tasks. Technological and organizational facilitators lacked in HHC compared to the hospitals. Person and organization elements in HHC had the most barriers but few facilitators. Additionally, we identified specific task barriers that could hinder sepsis information transfer from hospitals to HHC. CONCLUSION This study explored the complex transition-in-care work processes for sepsis survivors going from hospitals to HHC. We identified barriers, facilitators, and critical areas for improvement to enable implementation and ensure safe care transitions. A key finding was the sepsis information transfer deficit, highlighting a critical issue for future study. APPLICATION We recommend using the SEIPS framework to explore complex healthcare work processes before the implementation of evidence-based interventions.
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Tan SY, Dhillon HM, Mak C, Liang R, Kerin-Ayres K, Vuong K, Malalasekera A, Vardy JL. Utility of survivorship care plans: A mixed-method study exploring general practitioners' and cancer specialists' views. Asia Pac J Clin Oncol 2023. [PMID: 38051140 DOI: 10.1111/ajco.14038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Revised: 09/22/2023] [Accepted: 11/17/2023] [Indexed: 12/07/2023]
Abstract
PURPOSE Survivorship care plans (SCP) are recommended as integral to survivorship care but are not routinely provided in many centers. We explore whether SCP from the Sydney Cancer Survivorship Centre (SCSC) clinic was received by general practitioners (GP) and cancer specialists, and their views on SCP. METHODS A mixed-method study comprising a quality assurance audit, a questionnaire of GP practices and GP, and semi-structured interviews of cancer specialists who referred patients to the SCSC clinic between 2019-2020. Descriptive statistics were used for quantitative data and content analysis for qualitative data. RESULTS The audit found 153/190 (80.5%) SCSC attendees had SCP uploaded to hospital medical records. The response rate from GP practices was 41%; among the 55 responding practices, 38 (69%) did not receive the SCP. The response rate from GP was 19%; among the 29 responding GP, 25 (86%) indicated the SCP was worthwhile, especially follow-up plans and multidisciplinary team recommendations. Analysis of 14 cancer specialist interviews identified themes of 1) awareness of SCP; 2) access: SCP difficult to locate; 3) process: access and distribution require improvement; 4) systemic issues; 5) content and layout: more concise and better readability required; 6) value: mainly for GP and survivors; 7) use of SCP: limited; 8) recommendations: improve delivery process, enhance layout/content, more stakeholder input, more tailored information. CONCLUSION Although response rates from GP were low, those responding perceived SCP to be useful. Cancer specialists believed SCP were more valuable for GP and survivors. Process issues, especially SCP delivery, need to be improved.
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Affiliation(s)
- Sim Yee Tan
- Concord Cancer Centre, Concord Hospital, Concord, Australia
- Nutrition and Dietetics Department, Concord Hospital, Concord, Australia
- Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Haryana M Dhillon
- Centre for Medical Psychology and Evidence-based Decision-making, University of Sydney, Sydney, Australia
| | - Channel Mak
- Nutrition and Dietetics Department, Concord Hospital, Concord, Australia
| | - Roger Liang
- Concord Cancer Centre, Concord Hospital, Concord, Australia
| | | | - Kylie Vuong
- School of Medicine and Dentistry, Griffith University, Gold Coast, Australia
- School of Population Health, University of New South Wales, Sydney, Australia
| | | | - Janette L Vardy
- Concord Cancer Centre, Concord Hospital, Concord, Australia
- Faculty of Medicine and Health, University of Sydney, Sydney, Australia
- Centre for Medical Psychology and Evidence-based Decision-making, University of Sydney, Sydney, Australia
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5
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Arafat W, Fu P, Wagner AJ, Osterman T, Martin DB, Sugalski J, Heinrichs T, Racz J, Tevaarwerk AJ. Clinician Perspectives Regarding the Impact of Information Technology on Multidisciplinary Tumor Boards: A National Comprehensive Cancer Network Survey. JCO Clin Cancer Inform 2023; 7:e2300056. [PMID: 37944060 DOI: 10.1200/cci.23.00056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Revised: 08/10/2023] [Accepted: 09/22/2023] [Indexed: 11/12/2023] Open
Abstract
PURPOSE Multidisciplinary tumor boards (MTBs) support high-quality cancer care. Little is known about the impact of information technology (IT) tools on the operational and technical aspects of MTBs. The National Comprehensive Cancer Network EHR Oncology Advisory Group formed a workgroup to investigate the impact of IT tools such as EHRs and virtual conferencing on MTBs. METHODS The workgroup created a cross-sectional survey for oncology clinicians (eg, pathology, medical, surgical, radiation, etc) participating in MTBs at 31 National Comprehensive Cancer Network member institutions. A standard invitation e-mail was shared with each EHR Advisory Group Member with a hyperlink to the survey, and each member distributed the survey to MTB participants at their institution or identified the appropriate person at their institution to do so. The survey was open from February 26, 2022, to April 26, 2022. Descriptive statistics were applied in the analysis of responses, and a qualitative thematic analysis of open-ended responses was completed. RESULTS Individuals from 27 institutions participated. Almost all respondents (99%, n = 764 of 767) indicated that their MTBs had participants attending virtually. Most indicated increased attendance (69%, n = 514 of 741) after virtualization with the same or improved quality of discussion (75%, n = 557 of 741) compared with in-person MTBs. Several gaps between the current and ideal state emerged regarding EHR integration: 57% (n = 433 of 758) of respondents noted the importance of adding patients for MTB presentation via the EHR, but only 40% (n = 302 of 747) reported being able to do so most of the time. Similarly, 87% (n = 661 of 760) indicated the importance of documenting recommendations in the EHR, but only 53% (n = 394 of 746) reported this occurring routinely. CONCLUSION Major gaps include the lack of EHR integration for MTBs. Clinical workflows and EHR functionalities could be improved to further optimize EHRs for MTB management and documentation.
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Affiliation(s)
- Waddah Arafat
- Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center, Dallas, TX
| | - Paul Fu
- City of Hope National Medical Center, Duarte, CA
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Cracchiolo JR, Arafat W, Atreja A, Bruckner L, Emamekhoo H, Heinrichs T, Raldow AC, Smerage J, Stetson P, Sugalski J, Tevaarwerk AJ. Getting ready for real-world use of electronic patient-reported outcomes (ePROs) for patients with cancer: A National Comprehensive Cancer Network ePRO Workgroup paper. Cancer 2023; 129:2441-2449. [PMID: 37224181 DOI: 10.1002/cncr.34844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
Electronic patient‐reported outcome (ePRO) programs may offer advantages for patients with cancer, clinicians, health care systems, payors, and society in general; but developing and maintaining an ePRO program will require cancer centers to navigate defining meaningful problems, collecting ePROs, implementing action when those ePROs require intervention without over‐burdening clinicians, and monitoring the successes and failures of their ePRO programs. Physician informaticists from the National Comprehensive Cancer Network Electronic Health Record Advisory Group offer 10 guiding principles to consider when contemplating, building, or refining an ePRO program for patients with cancer.
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Affiliation(s)
| | - Waddah Arafat
- Simmons Comprehensive Cancer Center, The University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Ashish Atreja
- University of California-Davis Comprehensive Cancer Center, Sacramento, California, USA
| | - Lauren Bruckner
- Roswell Park Comprehensive Cancer Center, Buffalo, New York, USA
| | - Hamid Emamekhoo
- University of Wisconsin Carbone Cancer Center, Madison, Wisconsin, USA
| | - Tricia Heinrichs
- National Comprehensive Cancer Network, Plymouth Meeting, Pennsylvania, USA
| | - Ann C Raldow
- University of California-Los Angeles Jonsson Comprehensive Cancer Center, Los Angeles, California, USA
| | - Jeffrey Smerage
- University of Michigan Rogel Cancer Center, Ann Arbor, Michigan, USA
| | - Peter Stetson
- Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Jessica Sugalski
- National Comprehensive Cancer Network, Plymouth Meeting, Pennsylvania, USA
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Noyd DH, Chen S, Bailey A, Janitz A, Baker A, Beasley W, Etzold N, Kendrick D, Kibbe W, Oeffinger K. Informatics tools to implement late cardiovascular risk prediction modeling for population management of high-risk childhood cancer survivors. Pediatr Blood Cancer 2023; 70:e30474. [PMID: 37283294 PMCID: PMC11110462 DOI: 10.1002/pbc.30474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Revised: 05/04/2023] [Accepted: 05/17/2023] [Indexed: 06/08/2023]
Abstract
BACKGROUND Clinical informatics tools to integrate data from multiple sources have the potential to catalyze population health management of childhood cancer survivors at high risk for late heart failure through the implementation of previously validated risk calculators. METHODS The Oklahoma cohort (n = 365) harnessed data elements from Passport for Care (PFC), and the Duke cohort (n = 274) employed informatics methods to automatically extract chemotherapy exposures from electronic health record (EHR) data for survivors 18 years old and younger at diagnosis. The Childhood Cancer Survivor Study (CCSS) late cardiovascular risk calculator was implemented, and risk groups for heart failure were compared to the Children's Oncology Group (COG) and the International Guidelines Harmonization Group (IGHG) recommendations. Analysis within the Oklahoma cohort assessed disparities in guideline-adherent care. RESULTS The Oklahoma and Duke cohorts both observed good overall concordance between the CCSS and COG risk groups for late heart failure, with weighted kappa statistics of .70 and .75, respectively. Low-risk groups showed excellent concordance (kappa > .9). Moderate and high-risk groups showed moderate concordance (kappa .44-.60). In the Oklahoma cohort, adolescents at diagnosis were significantly less likely to receive guideline-adherent echocardiogram surveillance compared with survivors younger than 13 years old at diagnosis (odds ratio [OD] 0.22; 95% confidence interval [CI]: 0.10-0.49). CONCLUSIONS Clinical informatics tools represent a feasible approach to leverage discrete treatment-related data elements from PFC or the EHR to successfully implement previously validated late cardiovascular risk prediction models on a population health level. Concordance of CCSS, COG, and IGHG risk groups using real-world data informs current guidelines and identifies inequities in guideline-adherent care.
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Affiliation(s)
- David H. Noyd
- Department of Pediatrics, The University of Oklahoma Health Sciences Center, College of Medicine, Oklahoma City, Oklahoma, USA
| | - Sixia Chen
- Department of Biostatistics and Epidemiology, The University of Oklahoma Health Sciences Center, Hudson College of Public Health, Oklahoma City, Oklahoma, USA
| | - Anna Bailey
- Department of Biostatistics and Epidemiology, The University of Oklahoma Health Sciences Center, Hudson College of Public Health, Oklahoma City, Oklahoma, USA
| | - Amanda Janitz
- Department of Biostatistics and Epidemiology, The University of Oklahoma Health Sciences Center, Hudson College of Public Health, Oklahoma City, Oklahoma, USA
| | - Ashley Baker
- Department of Pediatrics, The University of Oklahoma Health Sciences Center, College of Medicine, Oklahoma City, Oklahoma, USA
| | - William Beasley
- Department of Pediatrics, The University of Oklahoma Health Sciences Center, College of Medicine, Oklahoma City, Oklahoma, USA
| | - Nancy Etzold
- Biostatistics and Epidemiology, The University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - David Kendrick
- Department of Medical Informatics, The University of Oklahoma Health Sciences Center, Tulsa, Oklahoma, USA
| | - Warren Kibbe
- Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, North Carolina, USA
| | - Kevin Oeffinger
- Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA
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Tevaarwerk AJ, Zhang X, Haine J, Norslien K, Henningfield MF, Stietz C, Hahn D, Sesto ME. Re-engineering Survivorship Care Plans to Support Primary Care Needs and Workflow: Results From an Engineering, Primary Care and Oncology Collaborative for Survivorship Health (EPOCH). JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2022; 37:1654-1661. [PMID: 33904117 PMCID: PMC8546004 DOI: 10.1007/s13187-021-02008-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 04/05/2021] [Indexed: 06/11/2023]
Abstract
Maintaining the health of survivors requires communication, collaboration and care coordination between oncology and primary care. Primary care clinicians have been acknowledged as important recipients of survivorship care plans (SCPs); however, current SCP templates have not been evaluated for usefulness in the primary care context. We surveyed and interviewed primary care clinicians from a rural research network regarding SCP content, format and layout (phase 1), and potential use and clinical workflows around SCPs (phase 2). Based on these data, an existing SCP template was iteratively redesigned to better support survivorship care in the primary care setting. A total of 13 clinicians (9 MDs, 4 APPs) participated. Interviewees advocated for maintaining a single SCP document shared by survivors and clinicians. Changes to the SCP template included prioritizing follow-up over summary of treatment and removing or down-playing screening recommendations not impacted by cancer or cancer treatment. The re-engineered SCP was regarded as highly relevant for survivors, but clinicians noted the significant effort to "disassemble" SCPs in order to enter the information into on the receiving health record. Primary care clinicians value the information in SCPs but had important recommendations regarding content, layout, and format. Additionally, a significant effort appears to be required by recipients in order to extract SCP information for future use.
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Affiliation(s)
- Amye J Tevaarwerk
- Division of Hematology/Oncology, University of Wisconsin, Madison, 6037 Wisconsin Institutes for Medical Research, 1111 Highland Ave, Madison, WI, 53705, USA.
- Carbone Cancer Center, Madison, WI, USA.
| | | | - James Haine
- Division of Hematology/Oncology, University of Wisconsin, Madison, 6037 Wisconsin Institutes for Medical Research, 1111 Highland Ave, Madison, WI, 53705, USA
| | | | - Mary F Henningfield
- Division of Hematology/Oncology, University of Wisconsin, Madison, 6037 Wisconsin Institutes for Medical Research, 1111 Highland Ave, Madison, WI, 53705, USA
| | | | - David Hahn
- Division of Hematology/Oncology, University of Wisconsin, Madison, 6037 Wisconsin Institutes for Medical Research, 1111 Highland Ave, Madison, WI, 53705, USA
| | - Mary E Sesto
- Division of Hematology/Oncology, University of Wisconsin, Madison, 6037 Wisconsin Institutes for Medical Research, 1111 Highland Ave, Madison, WI, 53705, USA
- Carbone Cancer Center, Madison, WI, USA
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Emamekhoo H, Carroll CB, Stietz C, Pier JB, Lavitschke MD, Mulkerin D, Sesto ME, Tevaarwerk AJ. Supporting Structured Data Capture for Patients With Cancer: An Initiative of the University of Wisconsin Carbone Cancer Center Survivorship Program to Improve Capture of Malignant Diagnosis and Cancer Staging Data. JCO Clin Cancer Inform 2022; 6:e2200020. [PMID: 35802837 DOI: 10.1200/cci.22.00020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Structured data elements within electronic health records are health-related information that can be entered, stored, and extracted in an organized manner at later time points. Tracking outcomes for cancer survivors is also enabled by structured data. We sought to increase structured data capture within oncology practices at multiple sites sharing the same electronic health records. METHODS Applying engineering approaches and the Plan-Do-Study-Act cycle, we launched dual quality improvement initiatives to ensure that a malignant diagnosis and stage were captured as structured data. Intervention: Close Visit Validation (CVV) requires providers to satisfy certain criteria before closing ambulatory encounters. CVV may be used to track open clinical encounters and chart delinquencies to encourage optimal clinical workflows. We added two cancer-specific required criteria at the time of closing encounters in oncology clinics: (1) the presence of at least one malignant diagnosis on the Problem List and (2) staging all the malignant diagnoses on the Problem List when appropriate. RESULTS Six months before the CVV implementation, the percentage of encounters with a malignant diagnosis on the Problem List at the time of the encounter was 65%, whereas the percentage of encounters with a staged diagnosis was 32%. Three months after cancer-specific CVV implementation, the percentages were 85% and 75%, respectively. Rates had increased to 90% and 88% more than 2 years after implementation. CONCLUSION Oncologist performance improved after the implementation of cancer-specific CVV criteria, with persistently high percentages of relevant malignant diagnoses and cancer stage structured data capture 2 years after the intervention.
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Affiliation(s)
- Hamid Emamekhoo
- University of Wisconsin, Madison, WI.,Carbone Cancer Center, Madison, WI
| | | | | | | | | | | | - Mary E Sesto
- University of Wisconsin, Madison, WI.,Carbone Cancer Center, Madison, WI
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Stewart TP, Sesto ME, Haine JE, Henningfield MF, Norslien K, Zhang X, Hahn DL, Tevaarwerk AJ. Results of Engineering, Primary Care, Oncology Collaborative Regarding a Survey of Primary Care on a Re-Engineered Survivorship Care Plan. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2022; 37:23-29. [PMID: 32488627 PMCID: PMC7708524 DOI: 10.1007/s13187-020-01776-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Survivorship care plans (SCPs) may facilitate cancer survivorship care shared between oncologists and primary care, particularly for patients more likely to receive care across healthcare systems such as rural patients. However, limited research has addressed primary care clinicians' information or workflow needs with regard to SCPs. This study's objective was to assess primary care clinicians' perceived usefulness with a re-engineered SCP previously developed by applying engineering approaches and informed by primary care preferences. An emailed survey of primary care clinicians assessed perceived usefulness with the re-engineered SCP. Clinicians were recruited across the USA from primary care practice-based research networks (PBRNs) with high concentrations of rural practices. Over 90% of respondents (n = 111) agreed that (1) the re-engineered SCP was useful (n = 95) and (2) they would want to receive a similar SCP (n = 93). The majority demonstrated high agreement regarding the SCP's relevance, understandability, content, and ability to help provide better survivorship care. Perceived usefulness was consistent between rural and non-rural clinicians. Suggested improvements involved decreased length, addition of a bulleted list, and electronic health record integration. Results indicate that the majority of primary care clinicians perceive the re-engineered SCP as useful. However, primary care clinicians indicated continued barriers despite end-user specific alterations. Future research should investigate additional strategies to support primary care survivorship-related workload, provide essential SCP content, and improve survivorship care delivery.
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Affiliation(s)
- Taylor P Stewart
- Department of Medicine, Division of Hematology/Oncology, 6037 Wisconsin Institutes for Medical Research, University of Wisconsin, Madison, 1111 Highland Ave, Madison, WI, 53705, USA
| | - Mary E Sesto
- Department of Medicine, Division of Hematology/Oncology, 6037 Wisconsin Institutes for Medical Research, University of Wisconsin, Madison, 1111 Highland Ave, Madison, WI, 53705, USA
- Carbone Cancer Center, Madison, WI, USA
| | - James E Haine
- Department of Medicine, Division of Hematology/Oncology, 6037 Wisconsin Institutes for Medical Research, University of Wisconsin, Madison, 1111 Highland Ave, Madison, WI, 53705, USA
| | - Mary F Henningfield
- Department of Medicine, Division of Hematology/Oncology, 6037 Wisconsin Institutes for Medical Research, University of Wisconsin, Madison, 1111 Highland Ave, Madison, WI, 53705, USA
| | | | | | - David L Hahn
- Department of Medicine, Division of Hematology/Oncology, 6037 Wisconsin Institutes for Medical Research, University of Wisconsin, Madison, 1111 Highland Ave, Madison, WI, 53705, USA
| | - Amye J Tevaarwerk
- Department of Medicine, Division of Hematology/Oncology, 6037 Wisconsin Institutes for Medical Research, University of Wisconsin, Madison, 1111 Highland Ave, Madison, WI, 53705, USA.
- Carbone Cancer Center, Madison, WI, USA.
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11
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Morken C, Tevaarwerk AJ, Juckett MB, Swiecichowski AK, Haine JE, Zhang X, Williams ZT, Norslien K, Campbell B, Wassenaar T, Sesto ME. Barriers and facilitators to the use of survivorship care plans by hematopoietic stem cell transplant survivors and clinicians. Support Care Cancer 2022; 30:1323-1330. [PMID: 34482447 PMCID: PMC8732291 DOI: 10.1007/s00520-021-06492-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Accepted: 08/07/2021] [Indexed: 02/03/2023]
Abstract
PURPOSE Survivors of hematopoietic stem cell transplants (HSCT) have complex care needs for the remainder of their lives, known as the survivorship period. Survivorship care plans (SCPs) have been proposed to improve care coordination and ultimately survivorship outcomes. We explored the barriers and facilitators of SCP use among HSCT survivors and their clinicians in order to develop more useful SCPs for the HSCT context. METHODS Analogous surveys regarding perceived barriers to and facilitators of SCP use based on a sample SCP for a female allogenic HSCT survivor were administered to HSCT survivors and non-transplant oncology and primary care clinicians. RESULTS Twenty-seven HSCT survivors and 18 clinicians completed the survey. The main barriers to SCP use were lack of awareness of SCP existence, uncertainty regarding where to find SCP, unclear roles and responsibilities among healthcare teams, length of SCP, and difficultly understanding SCPs. The facilitators of SCP use were increased understanding of survivorship care needs, clarified roles and responsibilities of survivors and clinicians, SCPs that are readily available and searchable in electronic health record, increased awareness of SCP existence and provision to all survivors, and if the SCP is survivor-specific and up-to-date. CONCLUSIONS Much of the work regarding SCPs has looked at barriers to creation and provision; however, our study examines factors influencing use of SCPs. By determining the barriers and facilitators surrounding SCP use for HSCT survivors and their clinicians, we can create SCP templates and clinical workflows to optimize SCP use, ideally leading to better outcomes for HSCT survivors.
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Affiliation(s)
| | - Amye J Tevaarwerk
- University of Wisconsin, Madison, WI,Carbone Cancer Center, University of Wisconsin, Madison, WI
| | - Mark B Juckett
- University of Wisconsin, Madison, WI,Carbone Cancer Center, University of Wisconsin, Madison, WI
| | | | - James E Haine
- University of Wisconsin, Madison, WI,Carbone Cancer Center, University of Wisconsin, Madison, WI
| | - Xiao Zhang
- Carbone Cancer Center, University of Wisconsin, Madison, WI
| | | | | | | | | | - Mary E Sesto
- University of Wisconsin, Madison, WI,Carbone Cancer Center, University of Wisconsin, Madison, WI
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Hesse BW, Kwasnicka D, Ahern DK. Emerging digital technologies in cancer treatment, prevention, and control. Transl Behav Med 2021; 11:2009-2017. [PMID: 34850933 PMCID: PMC8824462 DOI: 10.1093/tbm/ibab033] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
The very first issue of the journal of Translational Behavioral Medicine (TBM) was dedicated, in part, to the theme of Health Information Technology as a platform for evidence implementation. The topic was timely: legislation in the USA was passed with the intent of stimulating the adoption of electronic health records; mobile smartphones, tablets, and other devices were gaining traction in the consumer market, while members within the Society of Behavioral Medicine were gaining scientific understanding on how to use these tools to effect healthy behavior change. For the anniversary issue of TBM, we evaluated the progress and problems associated with deploying digital health technologies to support cancer treatment, prevention, and control over the last decade. We conducted a narrative review of published literature to identify the role that emerging digital technologies may take in achieving national and international objectives in the decade to come. We tracked our evaluation of the literature across three phases in the cancer control continuum: (a) prevention, (b) early detection/screening, and (c) treatment/survivorship. From our targeted review and analyses, we noted that significant progress had been made in the adoption of digital health technologies in the cancer space over the past decade but that significant work remains to be done to integrate these technologies effectively into the cancer control systems needed to improve outcomes equitably across populations. The challenge for the next 10 years is inherently translational.
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Affiliation(s)
| | - Dominika Kwasnicka
- NHMRC CRE in Digital Technology to Transform Chronic Disease Outcomes, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia and Faculty of Psychology, SWPS University of Social Sciences and Humanities, Wrocław, Poland
| | - David K Ahern
- Digital Behavioral Health and Informatics Research Program, Department of Psychiatry, Brigham and Women’s Hospital, Boston, MA 02215, USA
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Mikles SP, Griffin AC, Chung AE. Health information technology to support cancer survivorship care planning: A systematic review. J Am Med Inform Assoc 2021; 28:2277-2286. [PMID: 34333588 PMCID: PMC8449616 DOI: 10.1093/jamia/ocab134] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Revised: 06/13/2021] [Accepted: 06/23/2021] [Indexed: 01/22/2023] Open
Abstract
OBJECTIVE The study sought to conduct a systematic review to explore the functions utilized by electronic cancer survivorship care planning interventions and assess their effects on patient and provider outcomes. MATERIALS AND METHODS Based on PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analysis) guidelines, studies published from January 2000 to January 2020 were identified in PubMed, CINAHL, EMBASE, PsychINFO, Scopus, Web of Science, and the ACM Digital Library . The search combined terms for cancer, survivorship, care planning, and health information technology (HIT). Eligible studies evaluated the effects of a HIT intervention on usability, knowledge, process, or health-related outcomes. A total of 578 abstracts were reviewed, resulting in 60 manuscripts describing 40 studies. Thematic analyses were used to define meta-themes of system functions, and Fisher's exact tests were used to examine associations between functions and outcomes. RESULTS Patients were the target end users for 18 interventions, while 12 targeted providers and 10 targeted both groups. Interventions used patient-reported outcomes collection (60%), automated content generation (58%), electronic sharing (40%), persistent engagement (28%), and communication features (20%). Overall, interventions decreased the time to create survivorship care plans (SCPs) and supported care planning knowledge and abilities, but results were mixed for effects on healthcare utilization, SCP sharing, and provoking anxiety. Persistent engagement features were associated with improvements in health or quality-of-life outcomes (17 studies, P = .003). CONCLUSIONS Features that engaged users persistently over time were associated with better health and quality-of-life outcomes. Most systems have not capitalized on the potential of HIT to share SCPs across a care team and support care coordination.
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Affiliation(s)
- Sean P Mikles
- Lineberger Comprehensive Cancer Outcomes Program, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Ashley C Griffin
- Carolina Health Informatics Program, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Arlene E Chung
- Lineberger Comprehensive Cancer Outcomes Program, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
- Carolina Health Informatics Program, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
- Division of General Medicine and Clinical Epidemiology, Department of Medicine, UNC School of Medicine, Chapel Hill, North Carolina, USA
- Division of General Pediatrics and Adolescent Medicine, Department of Pediatrics, UNC School of Medicine, Chapel Hill, North Carolina, USA
- Program on Health and Clinical Informatics, UNC School of Medicine, Chapel Hill, North Carolina, USA
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Alfano CM, Mayer DK, Beckjord E, Ahern DK, Galioto M, Sheldon LK, Klesges LM, Aronoff-Spencer E, Hesse BW. Mending Disconnects in Cancer Care: Setting an Agenda for Research, Practice, and Policy. JCO Clin Cancer Inform 2021; 4:539-546. [PMID: 32543897 DOI: 10.1200/cci.20.00046] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Cancer in the United States accounts for $600 billion in health care costs, lost work time and productivity, reduced quality of life, and premature mortality. The future of oncology delivery must mend disconnects to equitably improve patient outcomes while constraining costs and burden on patients, caregivers, and care teams. Embedding learning health systems into oncology can connect care, engaging patients and providers in fully interoperable data systems that remotely monitor patients; generate predictive and prescriptive analytics to facilitate appropriate, timely referrals; and extend the reach of clinicians beyond clinic walls. Incorporating functional learning systems into the future of oncology and follow-up care requires coordinated national attention to 4 synergistic strategies: (1) galvanize and shape public discourse to develop and adopt these systems, (2) demonstrate their value, (3) test and evaluate their use, and (4) reform policy to incentivize and regulate their use.
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Affiliation(s)
| | | | - Ellen Beckjord
- Population Health and Clinical Affairs, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - David K Ahern
- Brigham and Women's Hospital, Boston, MA.,Connect2Health Task Force, Federal Communications Commission, Washington DC
| | - Michele Galioto
- ONS Center for Innovation at Oncology Nursing Society, Pittsburgh, PA
| | - Lisa K Sheldon
- ONS Center for Innovation at Oncology Nursing Society, Pittsburgh, PA
| | | | - Eliah Aronoff-Spencer
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St Louis, MO
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15
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Gilson AM, Xiong KZ, Stone JA, Jacobson N, Chui MA. A pharmacy-based intervention to improve safe over-the-counter medication use in older adults. Res Social Adm Pharm 2021; 17:578-587. [PMID: 32444347 PMCID: PMC8121184 DOI: 10.1016/j.sapharm.2020.05.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Revised: 04/28/2020] [Accepted: 05/06/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND For older adults, health risks from inappropriate use of over-the-counter (OTC) medications represent a prevalent clinical and public health challenge. Focus groups with pharmacists led to the identification of a number of systems barriers to pharmacists supporting the safe selection and use of OTC medications by this population. Such feedback informed the development of the Senior Section™, a physical redesign that located a curated inventory of lower-risk OTC medications proximal to the prescription department. OBJECTIVES To determine whether implementation of the Senior Section resulted in improvements to the ability of pharmacy staff to engage with older adult patients to support OTC medication safety issues. METHODS A qualitative approach, in which pharmacy staff from 4 pharmacies within a single chain participated in a semi-structured interview, was used to evaluate the implementation of the Senior Section in their pharmacies. Interview transcripts underwent a deductive and iterative content analysis. RESULTS Eight pharmacists and 5 technicians were interviewed. They viewed the Senior Section as contributing to notable improvements in proximity, medication safety, convenience, and patient selection behaviors. The Senior Section's safer OTC inventory and its sectional layout, its relationship to the prescription department, and its signage served to enhance its usefulness as an OTC safety improvement intervention. Moreover, it functioned beneficially while streamlining the coordination of services with between pharmacists and technicians, and did not interfere with existing pharmacy workflows. CONCLUSIONS Pharmacy staff believed that the Senior Section facilitated their ability to engage with older adults to support safe OTC selection and use and thus to reduce OTC-related harms.
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Affiliation(s)
- Aaron M Gilson
- Sonderegger Research Center, University of Wisconsin-Madison School of Pharmacy, 777 Highland Avenue, Madison, WI, 53705, USA.
| | - Ka Z Xiong
- Sonderegger Research Center, University of Wisconsin-Madison School of Pharmacy, 777 Highland Avenue, Madison, WI, 53705, USA.
| | - Jamie A Stone
- Sonderegger Research Center, University of Wisconsin-Madison School of Pharmacy, 777 Highland Avenue, Madison, WI, 53705, USA.
| | - Nora Jacobson
- Institute for Clinical and Translational Research, Community Academic Partnerships Program, University of Wisconsin-Madison School of Nursing, 701 Highland Ave, Madison, WI, 53705, USA.
| | - Michelle A Chui
- Sonderegger Research Center, University of Wisconsin-Madison School of Pharmacy, 777 Highland Avenue, Madison, WI, 53705, USA; Social and Administrative Sciences Division, University of Wisconsin-Madison School of Pharmacy, 777 Highland Avenue, Madison, WI, 53705, USA.
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16
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Design of a study to implement population-based risk assessment for hereditary cancer genetic testing in primary care. Contemp Clin Trials 2020; 101:106257. [PMID: 33373667 DOI: 10.1016/j.cct.2020.106257] [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] [Received: 09/18/2020] [Revised: 12/18/2020] [Accepted: 12/21/2020] [Indexed: 11/24/2022]
Abstract
Identifying patients with high genetic risk for cancer has important clinical ramifications, but hereditary cancer risk is often not identified because of testing barriers at both the provider and patient level. It is unknown how to best implement appropriate genetic testing and follow-up care into an operating primary care clinic. Implementation studies to date have been conducted in high resourced facilities under optimal conditions, often not at the clinic level. This study aims to compare and evaluate two population-wide engagement strategies for identifying members of a primary care clinic's population with a family or personal history of cancer and offering high-risk individuals genetic testing for cancer susceptibility mutations. The two engagement strategies are: 1) point of care screening (POC), conducted when a patient is scheduled for an appointment and 2) direct patient engagement (DPE), where outreach provides the patient an opportunity to complete screening online on their own time. The study will identify changes, problems, and inefficiencies in clinical flow during and after the implementation of risk assessment and genomic testing for cancer risk across primary care clinics. It will also evaluate the effects of the two engagement strategies on patient, provider, and clinic leader outcomes, including perceptions of benefits, harms, and satisfaction with the engagement strategy and process of cancer risk assessment and genetic testing, across gender, racial/ethnic, socioeconomic, and genetic literacy divides. Finally, the study will evaluate the cost-effectiveness and budget impact of each engagement strategy.
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Abstract
BACKGROUND Digital technologies provide a platform for accelerating science and broadening impact in behavioral medicine. PURPOSE The objective of this invited keynote presentation or paper is to offer a blueprint for navigating the rapidly changing waters of digital health. METHODS A strategic literature review on digital health technologies in behavioral medicine was combined with a review of relevant policy initiatives to yield insights on: (a) knowledge building, (b) collaboration, and (c) public health stewardship. RESULTS Digital platforms offer unprecedented leverage for accelerating science, facilitating collaboration, and advancing public health. Early successes in behavioral medicine demonstrated how digital platforms could extend the reach of theory-based behavioral therapeutics through increases in efficiency and scale. As medical investments in health information technology increased, the field of behavioral informatics emerged as the collaborative glue binding behavioral theory into a new generation of patient-facing applications, clinical decision support tools, evidence-based communication programs, and population health management strategies. As a leader within the interstitial space between medicine, psychology, and engineering, the Society of Behavioral Medicine is in a distinct position to exert influence on the ways in which our science is utilized to eliminate health disparities; improve support for patients, caregivers, and communities; to promote general health and well-being; and to offer relief when confronted with psychological pain or addiction. CONCLUSION Riding the wave of digital transformation has less to do with mastering the complexities of the latest technologies and more to do with adhering closely to established principles for navigating a rapidly changing information environment.
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Mead KH, Raskin S, Willis A, Arem H, Murtaza S, Charney L, Pratt-Chapman M. Identifying patients' priorities for quality survivorship: conceptualizing a patient-centered approach to survivorship care. J Cancer Surviv 2020; 14:939-958. [PMID: 32607715 DOI: 10.1007/s11764-020-00905-8] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Accepted: 06/14/2020] [Indexed: 01/22/2023]
Abstract
PURPOSE This study explored cancer survivors' experiences with and priorities for cancer survivorship care to describe a patient-centered approach to quality survivorship care. METHODS We conducted 22 focus groups with 170 adult survivors of breast, prostate, and colorectal cancer from six cities across the country and online. We used thematic analysis to identify participants' principles and priorities for quality survivorship care. RESULTS Based on our analysis of a limited group of cancer survivors, we identified two core principles that underlie participants' expectations for survivorship care and 11 practice priorities that reflect opportunities to improve patient-centeredness at the individual, interpersonal, and organizational levels. The principles reflect participants' desire to be better prepared for and equipped to accept and manage their chronic care needs post-cancer treatment. The priorities reflect practices that patients, providers, and cancer centers can engage in to ensure survivors' goals for post-treatment care are met. CONCLUSIONS Results from the study suggest the need to expand conceptualization of high-quality survivorship care. The survivor principles and practice priorities identified in this study challenge the field to organize a more patient-centered survivorship care system that empowers and respects patients and provides a holistic approach to survivors' chronic and long-term needs. IMPLICATIONS FOR CANCER SURVIVORS Quality cancer survivorship care must reflect patients' priorities. The findings from this study can be used to develop a patient-centered framework for survivorship care that can be used in conjunction with quality guidelines to ensure survivorship care is organized to achieve both clinical and patient-centered outcomes.
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Affiliation(s)
- K Holly Mead
- Milken Institute School of Public Health, George Washington University, 950 New Hampshire Ave., Washington, DC, 20052, USA.
| | - Sarah Raskin
- L. Douglas Wilder School of Government and Public Affairs, Virginia Commonwealth University, 1001 W. Franklin St., Richmond, VA, 23284, USA
| | - Anne Willis
- Cystic Fibrosis Foundation, 4550 Montgomery Ave., Bethesda, MD, 20814, USA
| | - Hannah Arem
- Milken Institute School of Public Health, George Washington University, 950 New Hampshire Ave., Washington, DC, 20052, USA
| | - Sarah Murtaza
- Milken Institute School of Public Health, George Washington University, 950 New Hampshire Ave., Washington, DC, 20052, USA
| | - Laura Charney
- Milken Institute School of Public Health, George Washington University, 950 New Hampshire Ave., Washington, DC, 20052, USA
| | - Mandi Pratt-Chapman
- George Washington University Cancer Center, George Washington University, 2600 Virginia Ave., NW, #300, Washington, DC, 20037, USA
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Swoboda CM, Fareed N, Walker DM, Huerta TR. The effect of cancer treatment summaries on patient-centered communication and quality of care for cancer survivors: A pooled cross-sectional HINTS analysis. PATIENT EDUCATION AND COUNSELING 2020; 103:301-308. [PMID: 31477514 DOI: 10.1016/j.pec.2019.08.036] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Revised: 08/21/2019] [Accepted: 08/25/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVE Provision of cancer treatment summaries to patients is recommended to improve patient-centered communication (PCC). The objective of this study is to assess relationships between cancer treatment summary receipt, PCC, and quality of care (QOC). METHODS Linear and logistic regression of cross-sectional data from the Health Information National Trends Survey (HINTS) was conducted using data from years 2012, 2014, and 2017. The independent variable was receipt of treatment summary; the dependent variables were overall PCC score, six domains of PCC, and QOC. RESULTS In the pooled sample, 36.9% of patients with cancer treatment history reported receiving a treatment summary. There was a significant positive association between overall PCC score and treatment summary receipt, and higher odds of high scores for the PCC domains "responding to emotions" and "managing uncertainty." We did not observe significant associations between treatment summary receipt and other PCC domains or QOC. CONCLUSION Providing patients cancer treatment summaries may improve PCC, but fewer than half of patients reported receiving one of these summaries. PRACTICE IMPLICATIONS Providing cancer treatment summaries is important, however, providing them without engaging in additional communication may be insufficient to improve all patient-centered care domains or quality of care.
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Affiliation(s)
- Christine M Swoboda
- CATALYST - The Center for the Advancement of Team Science, Analytics, and Systems Thinking, College of Medicine, The Ohio State University, Columbus, OH, USA.
| | - Naleef Fareed
- CATALYST - The Center for the Advancement of Team Science, Analytics, and Systems Thinking, College of Medicine, The Ohio State University, Columbus, OH, USA; Department of Biomedical Informatics, College of Medicine, The Ohio State University, Columbus, OH, USA
| | - Daniel M Walker
- CATALYST - The Center for the Advancement of Team Science, Analytics, and Systems Thinking, College of Medicine, The Ohio State University, Columbus, OH, USA; Department of Biomedical Informatics, College of Medicine, The Ohio State University, Columbus, OH, USA; Department of Family Medicine, College of Medicine, The Ohio State University, Columbus, OH, USA
| | - Timothy R Huerta
- CATALYST - The Center for the Advancement of Team Science, Analytics, and Systems Thinking, College of Medicine, The Ohio State University, Columbus, OH, USA; Department of Biomedical Informatics, College of Medicine, The Ohio State University, Columbus, OH, USA; Department of Family Medicine, College of Medicine, The Ohio State University, Columbus, OH, USA
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20
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Galli BJ. The Application of Systems Engineering to Project Management. INTERNATIONAL JOURNAL OF SYSTEM DYNAMICS APPLICATIONS 2020. [DOI: 10.4018/ijsda.2020010105] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
This study investigated the application of systems engineering to project management. There is an increasing complexity to modern projects, and lifecycle-focused project management displays the inability to manage the risks associated with increased project complexity. A more adequate approach to these issues is presented in the systems engineering processes. It was proposed that the application of systems engineering concepts will allow improve the management of complex projects and the mitigation of risks. Additionally, qualitative research conducted via the collection and analysis of credible information yielded data that supported this proposition. Since systems engineering processes are adaptable, they are suited to manage complex problems. It was concluded that applying systems engineering to project management was beneficial, and the integration of methodologies was valuable to the successful completion of large scale, complex projects.
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Affiliation(s)
- Brian J. Galli
- Department of Engineering, Hofstra University, Hempstead, USA
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21
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Hesse BW. Role of the Internet in Solving the Last Mile Problem in Medicine. J Med Internet Res 2019; 21:e16385. [PMID: 31661078 PMCID: PMC6914237 DOI: 10.2196/16385] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Accepted: 10/12/2019] [Indexed: 11/13/2022] Open
Abstract
Internet-augmented medicine has a strong role to play in ensuring that all populations benefit equally from discoveries in the medical sciences. Yet, data from the Centers for Disease Control and Prevention collected from 1999 to 2014 suggested that during the first phase of internet diffusion, progress against mortality has stalled, and in some cases, receded in rural areas that are traditionally underserved by medical and broadband resources. This problem of failing to extend the benefits of extant medical knowledge equitably to all populations regardless of geography can be framed as the "last mile problem in health care." In theory, the internet should help solve the last mile problem by making the best knowledge in the world available to everyone worldwide at a low cost and no delay. In practice, the antiquated supply chains of industrial age medicine have been slow to yield to the accelerative forces of evolving internet capacity. This failure is exacerbated by the expanding digital divide, preventing residents of isolated, geographically distant communities from taking full advantage of the digital health revolution. The result, according to the Federal Communications Commission's (FCC's) Connect2Health Task Force, is the unanticipated emergence of "double burden counties," ie, counties for which the mortality burden is high while broadband access is low. The good news is that a convergence of trends in internet-enabled health care is putting medicine within striking distance of solving the last mile problem both in the United States and globally. Specific trends to monitor over the next 25 years include (1) using community-driven approaches to bridge the digital divide, (2) addressing structural disconnects in care through P4 Medicine, (3) meeting patients at "point-of-need," (4) ensuring that no one is left behind through population management, and (5) self-correcting cybernetically through the learning health care system.
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22
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Morken CM, Tevaarwerk AJ, Swiecichowski AK, Haine JE, Williams ZT, Norslien K, Arroyo N, Zhang X, Campbell B, Mendonca EA, Juckett MB, Sesto ME. Survivor and Clinician Assessment of Survivorship Care Plans for Hematopoietic Stem Cell Transplantation Patients: An Engineering, Primary Care, and Oncology Collaborative for Survivorship Health. Biol Blood Marrow Transplant 2019; 25:1240-1246. [PMID: 30763727 DOI: 10.1016/j.bbmt.2019.02.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Accepted: 02/04/2019] [Indexed: 11/26/2022]
Abstract
The long-term care of hematopoietic stem cell transplantation (HSCT) survivors poses special challenges owing to a myriad of possible chronic and/or late complications. Survivorship care plans (SCPs) have been proposed as tools to communicate information on the late effects of treatment and recommended follow-up care to clinicians and survivors. The primary aims of this study were to determine SCP content and format, as well as to assess the preferred timing of SCP provision following HSCT. HSCT survivors and nontransplantation clinicians (oncologists and primary care physicians) were invited to participate in a survey evaluating the usefulness and utility of a sample HSCT-specific SCP with a treatment summary generated by autopopulation from an electronic health record (EHR). All participating HSCT survivors (n = 29) and clinicians (n = 18) indicated a desire to receive an SCP. More than 85% of the participants perceived information about treatments received, recommended follow-up and health maintenance including vaccinations, survivor and clinician resources, and graft-versus-host disease and other late/chronic side effects to be useful. The majority of survivors also believed that care team contact information was useful. In addition, >85% of survivors and clinicians agreed that the SCP increased their understanding of treatments and chronic/late side effects, improved health care provided, and were satisfied with the SCP and found it understandable and easy to use. The majority of survivors indicated that additional information should be added to the SCP, whereas some clinicians deemed the SCP too long. Survivors preferred to receive the SCP as a paper document at the end of a regular follow-up visit and review it with a cancer clinician, whereas clinicians preferred to receive the SCP through the EHR. These findings will help improve the design of future SCPs for use by HSCT survivors and clinicians. Future work will include leveraging the EHR to ease the burden of creating user-centered documents.
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Affiliation(s)
- Colleen M Morken
- Division of Hematology/Oncology, Department of Medicine, University of Wisconsin, Madison, Wisconsin
| | - Amye J Tevaarwerk
- Division of Hematology/Oncology, Department of Medicine, University of Wisconsin, Madison, Wisconsin; Carbone Cancer Center, University of Wisconsin, Madison, Wisconsin
| | | | - James E Haine
- Division of General Internal Medicine, University of Wisconsin, Madison, Wisconsin
| | | | | | - Natalia Arroyo
- Carbone Cancer Center, University of Wisconsin, Madison, Wisconsin
| | - Xiao Zhang
- Carbone Cancer Center, University of Wisconsin, Madison, Wisconsin
| | | | - Eneida A Mendonca
- Department of Biostatistics and Medical Informatics and Department of Pediatrics, University of Wisconsin, Madison
| | - Mark B Juckett
- Division of Hematology/Oncology, Department of Medicine, University of Wisconsin, Madison, Wisconsin; Carbone Cancer Center, University of Wisconsin, Madison, Wisconsin
| | - Mary E Sesto
- Division of Hematology/Oncology, Department of Medicine, University of Wisconsin, Madison, Wisconsin; Carbone Cancer Center, University of Wisconsin, Madison, Wisconsin.
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Trosman J, Weldon C, Kircher S, Gradishar W, Benson A. Innovating Cancer Care Delivery: the Example of the 4R Oncology Model for Colorectal Cancer Patients. Curr Treat Options Oncol 2019; 20:11. [DOI: 10.1007/s11864-019-0608-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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