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Tuca A, Viladot M, Carrera G, Llavata L, Barrera C, Chicote M, Marco-Hernández J, Padrosa J, Zamora-Martínez C, Grafia I, Pascual A, Font C, Font E. Evolution of Complexity of Palliative Care Needs and Patient Profiles According to the PALCOM Scale (Part Two): Pooled Analysis of the Cohorts for the Development and Validation of the PALCOM Scale in Advanced Cancer Patients. Cancers (Basel) 2024; 16:1744. [PMID: 38730696 PMCID: PMC11083064 DOI: 10.3390/cancers16091744] [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: 03/19/2024] [Revised: 04/19/2024] [Accepted: 04/26/2024] [Indexed: 05/13/2024] Open
Abstract
INTRODUCTION Identifying the complexity of palliative care needs is a key aspect of referral to specialized multidisciplinary early palliative care (EPC) teams. The PALCOM scale is an instrument consisting of five multidimensional assessment domains developed in 2018 and validated in 2023 to identify the level of complexity in patients with advanced cancer. (1) Objectives: The main objective of this study was to determine the degree of instability (likelihood of level change or death), health resource consumption and the survival of patients according to the level of palliative complexity assigned at the baseline visit during a 6-month follow-up. (2) Method: An observational, prospective, multicenter study was conducted using pooled data from the development and validation cohort of the PALCOM scale. The main outcome variables were as follows: (a) instability ratio (IR), defined as the probability of level change or death; (b) emergency department visits; (c) days of hospitalization; (d) hospital death; (e) survival. All the variables were analyzed monthly according to the level of complexity assigned at the baseline visit. (3) Results: A total of 607 patients with advanced cancer were enrolled. According to the PALCOM scale, 20% of patients were classified as low complexity, 50% as medium and 30% as high complexity. The overall IR was 45% in the low complexity group, 68% in the medium complexity group and 78% in the high complexity group (p < 0.001). No significant differences in mean monthly emergency department visits (0.2 visits/ patient/month) were observed between the different levels of complexity. The mean number of days spent in hospital per month was 1.5 in the low complexity group, 1.8 in the medium complexity group and 3.2 in the high complexity group (p < 0.001). The likelihood of in-hospital death was significantly higher in the high complexity group (29%) compared to the medium (16%) and low (8%) complexity groups (p < 0.001). Six-month survival was significantly lower in the high complexity group (24%) compared to the medium (37%) and low (57%) complexity groups (p < 0.001). CONCLUSION According to the PALCOM scale, more complex cases are associated with greater instability and use of hospital resources and lower survival. The data also confirm that the PALCOM scale is a consistent and useful tool for describing complexity profiles, targeting referrals to the EPC and managing the intensity of shared care.
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Affiliation(s)
- Albert Tuca
- Unit of Supportive Care in Cancer, Medical Oncology Department, Hospital Clinic and Translational Genomics and Targeted Therapies in Solid Tumors, IDIBAPS, University of Barcelona, 08036 Barcelona, Spain; (M.V.); (G.C.); (L.L.); (C.B.); (M.C.); (J.M.-H.); (J.P.); (C.Z.-M.); (I.G.); (A.P.); (C.F.); (E.F.)
- Psychosocial Support Team, “La Caixa” Foundation (EAPS), Clinic Hospital of Barcelona, 08036 Barcelona, Spain
- Chair of Palliative Care, University of Barcelona, 08036 Barcelona, Spain
| | - Margarita Viladot
- Unit of Supportive Care in Cancer, Medical Oncology Department, Hospital Clinic and Translational Genomics and Targeted Therapies in Solid Tumors, IDIBAPS, University of Barcelona, 08036 Barcelona, Spain; (M.V.); (G.C.); (L.L.); (C.B.); (M.C.); (J.M.-H.); (J.P.); (C.Z.-M.); (I.G.); (A.P.); (C.F.); (E.F.)
| | - Gemma Carrera
- Unit of Supportive Care in Cancer, Medical Oncology Department, Hospital Clinic and Translational Genomics and Targeted Therapies in Solid Tumors, IDIBAPS, University of Barcelona, 08036 Barcelona, Spain; (M.V.); (G.C.); (L.L.); (C.B.); (M.C.); (J.M.-H.); (J.P.); (C.Z.-M.); (I.G.); (A.P.); (C.F.); (E.F.)
| | - Lucia Llavata
- Unit of Supportive Care in Cancer, Medical Oncology Department, Hospital Clinic and Translational Genomics and Targeted Therapies in Solid Tumors, IDIBAPS, University of Barcelona, 08036 Barcelona, Spain; (M.V.); (G.C.); (L.L.); (C.B.); (M.C.); (J.M.-H.); (J.P.); (C.Z.-M.); (I.G.); (A.P.); (C.F.); (E.F.)
| | - Carmen Barrera
- Unit of Supportive Care in Cancer, Medical Oncology Department, Hospital Clinic and Translational Genomics and Targeted Therapies in Solid Tumors, IDIBAPS, University of Barcelona, 08036 Barcelona, Spain; (M.V.); (G.C.); (L.L.); (C.B.); (M.C.); (J.M.-H.); (J.P.); (C.Z.-M.); (I.G.); (A.P.); (C.F.); (E.F.)
- Chair of Palliative Care, University of Barcelona, 08036 Barcelona, Spain
| | - Manoli Chicote
- Unit of Supportive Care in Cancer, Medical Oncology Department, Hospital Clinic and Translational Genomics and Targeted Therapies in Solid Tumors, IDIBAPS, University of Barcelona, 08036 Barcelona, Spain; (M.V.); (G.C.); (L.L.); (C.B.); (M.C.); (J.M.-H.); (J.P.); (C.Z.-M.); (I.G.); (A.P.); (C.F.); (E.F.)
| | - Javier Marco-Hernández
- Unit of Supportive Care in Cancer, Medical Oncology Department, Hospital Clinic and Translational Genomics and Targeted Therapies in Solid Tumors, IDIBAPS, University of Barcelona, 08036 Barcelona, Spain; (M.V.); (G.C.); (L.L.); (C.B.); (M.C.); (J.M.-H.); (J.P.); (C.Z.-M.); (I.G.); (A.P.); (C.F.); (E.F.)
| | - Joan Padrosa
- Unit of Supportive Care in Cancer, Medical Oncology Department, Hospital Clinic and Translational Genomics and Targeted Therapies in Solid Tumors, IDIBAPS, University of Barcelona, 08036 Barcelona, Spain; (M.V.); (G.C.); (L.L.); (C.B.); (M.C.); (J.M.-H.); (J.P.); (C.Z.-M.); (I.G.); (A.P.); (C.F.); (E.F.)
| | - Carles Zamora-Martínez
- Unit of Supportive Care in Cancer, Medical Oncology Department, Hospital Clinic and Translational Genomics and Targeted Therapies in Solid Tumors, IDIBAPS, University of Barcelona, 08036 Barcelona, Spain; (M.V.); (G.C.); (L.L.); (C.B.); (M.C.); (J.M.-H.); (J.P.); (C.Z.-M.); (I.G.); (A.P.); (C.F.); (E.F.)
| | - Ignacio Grafia
- Unit of Supportive Care in Cancer, Medical Oncology Department, Hospital Clinic and Translational Genomics and Targeted Therapies in Solid Tumors, IDIBAPS, University of Barcelona, 08036 Barcelona, Spain; (M.V.); (G.C.); (L.L.); (C.B.); (M.C.); (J.M.-H.); (J.P.); (C.Z.-M.); (I.G.); (A.P.); (C.F.); (E.F.)
| | - Anais Pascual
- Unit of Supportive Care in Cancer, Medical Oncology Department, Hospital Clinic and Translational Genomics and Targeted Therapies in Solid Tumors, IDIBAPS, University of Barcelona, 08036 Barcelona, Spain; (M.V.); (G.C.); (L.L.); (C.B.); (M.C.); (J.M.-H.); (J.P.); (C.Z.-M.); (I.G.); (A.P.); (C.F.); (E.F.)
- Psychosocial Support Team, “La Caixa” Foundation (EAPS), Clinic Hospital of Barcelona, 08036 Barcelona, Spain
| | - Carme Font
- Unit of Supportive Care in Cancer, Medical Oncology Department, Hospital Clinic and Translational Genomics and Targeted Therapies in Solid Tumors, IDIBAPS, University of Barcelona, 08036 Barcelona, Spain; (M.V.); (G.C.); (L.L.); (C.B.); (M.C.); (J.M.-H.); (J.P.); (C.Z.-M.); (I.G.); (A.P.); (C.F.); (E.F.)
| | - Elena Font
- Unit of Supportive Care in Cancer, Medical Oncology Department, Hospital Clinic and Translational Genomics and Targeted Therapies in Solid Tumors, IDIBAPS, University of Barcelona, 08036 Barcelona, Spain; (M.V.); (G.C.); (L.L.); (C.B.); (M.C.); (J.M.-H.); (J.P.); (C.Z.-M.); (I.G.); (A.P.); (C.F.); (E.F.)
- Psychosocial Support Team, “La Caixa” Foundation (EAPS), Clinic Hospital of Barcelona, 08036 Barcelona, Spain
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Magee D, Barns M, Chau M, Bailey L, Yuminaga Y. Integration of an online application to optimise multi-disciplinary meetings: a retrospective analysis. Ir J Med Sci 2024:10.1007/s11845-024-03685-7. [PMID: 38619778 DOI: 10.1007/s11845-024-03685-7] [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: 03/07/2024] [Accepted: 04/01/2024] [Indexed: 04/16/2024]
Abstract
BACKGROUND Multi-disciplinary Meetings (MDM) play a crucial role in complex patient care, involving input from various specialties to formulate evidence-based management plans. However, traditional unidirectional approaches and reliance on manual processes have led to inefficiencies in the MDM pathway. AIMS This study identified and aimed to improve four critical moments where Information Communication Technologies (ICTs) could enhance the MDM process. Initial referral, information synthesis, meeting presentation and the creation of actionable/auditable items. METHODS Microsoft Office Forms, a customisable survey platform, was implemented to streamline MDM processes. Forms were created to gather patient information, develop agendas, and track outcomes. Automation through Excel scripting further optimised data organisation and agenda creation. RESULTS Referrals using Forms takes an average of 7 min and 21 s. Over 15 months the submission time has reduced and is trending towards under 5 min for each referral. The system's scalability has allowed 1744 cases to be discussed over a 15-month period. Active departments using Forms is expanding to seven from two prior to the pilot. CONCLUSION(S) Microsoft Office Forms proved to be a valuable and adaptable tool for MDMs, offering benefits such as streamlined information gathering, real-time collaboration, and scalability. The study highlights the potential of existing tools within Microsoft licenses for healthcare process optimisation, providing a cost-effective and customisable solution for MDM agendas. While recognising some limitations, the study concludes that leveraging Microsoft Office Forms can significantly improve system efficiency in a multi-disciplinary setting.
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Affiliation(s)
- Daniel Magee
- Urology Department Royal Perth Hospital, Level 11 North Block, Victoria Ave, Perth, 6000 WA, Australia.
- Sir Charles Gairdner Hospital, Hospital Avenue, Nedlands, Perth, 6008 WA, Australia.
| | - Mitchell Barns
- Urology Department Royal Perth Hospital, Level 11 North Block, Victoria Ave, Perth, 6000 WA, Australia
- Sir Charles Gairdner Hospital, Hospital Avenue, Nedlands, Perth, 6008 WA, Australia
| | - Matthew Chau
- Urology Department Royal Perth Hospital, Level 11 North Block, Victoria Ave, Perth, 6000 WA, Australia
- Sir Charles Gairdner Hospital, Hospital Avenue, Nedlands, Perth, 6008 WA, Australia
| | - Laura Bailey
- Urology Department Royal Perth Hospital, Level 11 North Block, Victoria Ave, Perth, 6000 WA, Australia
| | - Yuigi Yuminaga
- Urology Department Royal Perth Hospital, Level 11 North Block, Victoria Ave, Perth, 6000 WA, Australia
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Brick R, Hekman DJ, Werner NE, Rodakowski J, Cadmus-Bertram L, Fields B. Health system and patient-level factors associated with multidisciplinary care and patient education among hospitalized, older cancer survivors. PEC INNOVATION 2023; 3:100192. [PMID: 37502427 PMCID: PMC10369477 DOI: 10.1016/j.pecinn.2023.100192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 07/12/2023] [Accepted: 07/14/2023] [Indexed: 07/29/2023]
Abstract
Objective The purpose of this study was to examine system- and patient-level factors associated with the number of healthcare disciplines involved in delivery of patient education among hospitalized older cancer survivors. Methods We used electronic health record (EHR) data from a single institution documenting patient education among hospitalized older patients (≥65 years) with a history of cancer between 9/1/2018 and 10/1/2019. We used parametric ordinal logistic regression to assess the number of healthcare disciplines involved in documented education activities. Results The sample (n = 446) was predominantly male, White, and on average 74 years old. Adjusting for patient and system-level variables, men and larger department units had higher odds of receiving education from fewer healthcare disciplines. Patients with a history of breast or prostate cancer and longer lenths of stay had lower odds of receiving patient education from fewer healthcare disciplines. Conclusion Hospital size, severity of illness, and cancer type are associated with delivery of multidisciplinary education in this sample. Innovation EHR provides an opportunity to identify patterns in patient education among cancer survivors. Future research should investigate provider perspectives of the findings to inform provider- and system-level strategies to improve patient education.
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Affiliation(s)
- Rachelle Brick
- Cancer Prevention Fellowship Program, Division of Cancer Prevention, National Cancer Institute, 9609 Medical Center Dr, Rockville, MD 20850, USA
| | - Daniel J. Hekman
- University of Wisconsin-Madison, Department of Emergency Medicine, 600 Highland Avenue Madison, WI 53792, USA
| | - Nicole E. Werner
- Indiana University, Department of Health & Wellness Design, 1025 E 7 St, Bloomington, IN 47405, USA
| | - Juleen Rodakowski
- University of Pittsburgh, Department of Occupational Therapy, Bridgeside Point I, 100 Technology Drive, Pittsburgh, PA 15219, USA
| | - Lisa Cadmus-Bertram
- University of Wisconsin-Madison, Department of Kinesiology, 2170 Medical Sciences Center, 1300 University Avenue, Madison, WI 53706, USA
| | - Beth Fields
- University of Wisconsin-Madison, Department of Kinesiology, 2170 Medical Sciences Center, 1300 University Avenue, Madison, WI 53706, USA
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Inam M, Ladak LA, Janjua M, Malik M, Ali F, Akmal Malik M. Health related quality of life in adults after late repair of tetralogy of fallot: experience from a low-middle income country. Qual Life Res 2023; 32:3063-3074. [PMID: 37318695 DOI: 10.1007/s11136-023-03453-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/26/2023] [Indexed: 06/16/2023]
Abstract
PURPOSE Without neonatal screening in low middle-income countries like Pakistan, Tetralogy of Fallot (TOF) is a congenital heart disease which frequently remains untreated beyond infancy. The purpose of this study is to determine and assess outcomes and health related quality of life (HRQOL) in patients who undergo complete repair of TOF as adults. METHODS 56 patients who underwent complete TOF repair after 16 years of age were included. Patient data was collected via retrospective chart review, and a semi structured interview along with Short-Form 36 (SF-36) questionnaire were used to assess HRQOL. RESULTS 66.1% of patients were male with the mean age at surgery of 22.3 ± 6.00. All patients had a post-operative NYHA Classification of I or II, 94.6% had an ejection fraction of ≥ 50% and 28.6% showed small residual lesions in follow-up echocardiograms. 32.1% of patients suffered post-operative morbidity. For the quantitative assessment using SF-36 scores, patients showed good scores of median 95 (65-100). A major cause of delay to treatment was lack of consensus between treatments offered by doctors in different parts of Pakistan. There was a pattern of 'inability to fit in' among patients who had had late TOF repair, despite self- reported improved HRQOL. CONCLUSION Our results indicate that even with a delayed diagnosis, surgical repair of TOF produces good functional results. However, these patients face significant psychosocial issues. While early diagnosis remains the ultimate goal, patients undergoing late repair should be managed in more holistic manner with attention to psychological impact of the disease as well.
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Affiliation(s)
- Maha Inam
- Medical College, Aga Khan University Hospital, Karachi, Pakistan
| | - Laila Akbar Ladak
- School of Nursing and Midwifery, Aga Khan University Hospital, Karachi, Pakistan
| | - Mahin Janjua
- Department of Surgery, Howard University College of Medicine, Washington, DC, USA
| | - Maarij Malik
- Medical College, Aga Khan University Hospital, Karachi, Pakistan
| | - Fatima Ali
- Department of Pediatrics, Aga Khan University Hospital, Karachi, Pakistan
| | - Mahim Akmal Malik
- Department of Cardiac Surgery, Rawalpindi Institute of Cardiology, Rawalpindi, Pakistan.
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Braulke F, Kober K, Rieken S, Brand T, Hartz T, Seipke S, Asendorf T, Haier J. Adherence to interdisciplinary tumor board recommendations as an expression of quality-assured patient care: results of a bicentric German analysis. J Cancer Res Clin Oncol 2023; 149:14775-14784. [PMID: 37592032 PMCID: PMC10602985 DOI: 10.1007/s00432-023-05253-5] [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: 06/15/2023] [Accepted: 08/04/2023] [Indexed: 08/19/2023]
Abstract
PURPOSE Interdisciplinary tumor boards (ITBs) represent a central part of standard cancer care defining a guidelines-guided treatment plan adapted to the patient's capabilities, comorbidities and wishes in a multi-professional team. The implementation rate of ITB recommendations can be monitored by structured adherence analyses. But (inter)national definitions how to measure the level of implementation are missing. Here, we present results of 4 years of ITB adherence analyses in a bicentric German Comprehensive Cancer Center (CCC). METHODS Between 2018 and 2021, for at least 1 month, the implementation rate of recommendations of 8 different ITBs of 2 CCC sites was evaluated manually according to harmonized criteria between both sites regarding the degree of implementation of ITB's recommendations. RESULTS In total, 1104 cases were analyzed (65% male, 35% female). Mean distance from patient's home to the CCC was 57 km (range 0.8-560.6 km). For 949 cases (86%) with known follow-up, the adherence rate was 91.9% (95% CI 0.9; 0.935). In 8.1%, ITB decisions were not implemented due to medical reasons (45.4%), patient's wish (35.1%) and unknown reasons (19.5%). Logistic regression revealed neither age (OR = 0.998, p = 0.90), nor gender (OR = 0.98, p = 0.92) or the distance from patient's home to the CCC (OR = 1.001, p = 0.54) were significantly associated with ITB adherence. CONCLUSION ITB adherences analyses can serve as a quality management tool to monitor the implementation rate of ITB recommendations and to stay in contact with practitioners, other hospitals and state cancer registries to share data and resources in accordance with data protection requirements for continuously improvement of quality management and patient care.
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Affiliation(s)
- Friederike Braulke
- Comprehensive Cancer Center, University Medical Center Göttingen, von-Bar-Str. 2/4, 37075, Göttingen, Germany.
| | - Kathrin Kober
- Comprehensive Cancer Center, University Medical Center Göttingen, von-Bar-Str. 2/4, 37075, Göttingen, Germany
| | - Stefan Rieken
- Department of Radiation Therapy and Radiooncology, University Medical Center Göttingen, Göttingen, Germany
| | - Tonia Brand
- Klinisches Krebsregister Niedersachsen, Hannover, Germany
| | - Tobias Hartz
- Klinisches Krebsregister Niedersachsen, Hannover, Germany
| | - Stefanie Seipke
- Comprehensive Cancer Center Hannover, Hannover Medical School, Hannover, Germany
| | - Thomas Asendorf
- Institute of Medical Statistics, University Medical Center Göttingen, Göttingen, Germany
| | - Jörg Haier
- Comprehensive Cancer Center Hannover, Hannover Medical School, Hannover, Germany
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Bednarski BK, Taggart M, Chang GJ. MDT-How it is important in rectal cancer. Abdom Radiol (NY) 2023; 48:2807-2813. [PMID: 37393382 DOI: 10.1007/s00261-023-03977-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2023] [Revised: 05/31/2023] [Accepted: 06/05/2023] [Indexed: 07/03/2023]
Abstract
The concept of multidisciplinary team discussion of patient's care has been a part of routine medical practice for several decades [Monson et al. in Bull Am Coll Surg 101:45-46, 2016; NHS. Improving outcomes in colorectal cancer-the manual. (Guidance on commissioning cancer services-improving outcomes). 1997.]. The idea of bringing multiple specialties and ancillary services together to help optimize patient outcomes has been implemented in several clinical arenas from burns to physical medicine and rehabilitation to oncology. In the oncology realm, multidisciplinary tumor boards (MDTs) originated as a broad-based meeting that would permit the review and discussion of cancer patients to optimize treatment strategies [Cancer Co. Optimal Resources for Cancer Care: 2020 Standards. Chicago, IL: 2019.]. Over time, as further specialization occurred and clinical treatment algorithms have become more complex, multidisciplinary tumor boards have become more disease site specific. In this article we will discuss the importance of MDTs, specifically focusing on rectal cancer MDTs including their impact on treatment planning as well as the unique interplay of clinical specialties that provide internal quality control and improvement. Additionally, we will discuss some of the potential benefits of MDTs beyond the direct impact on patient care and review some of the challenges of implementation.
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Affiliation(s)
- Brian K Bednarski
- Department of Colorectal Surgery, University of Texas MD Anderson Cancer Center, Houston, TX, USA.
- Department of Colorectal Surgery, University of Texas MD Anderson Cancer Center, 1400 Pressler, Unit 1484, Houston, TX, 77030, USA.
| | - Melissa Taggart
- Department of Pathology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - George J Chang
- Department of Colorectal Surgery, University of Texas MD Anderson Cancer Center, Houston, TX, USA
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Alfieri S, Brunelli C, Borreani C, Capri G, Angi M, Bianchi GV, Lo Dico S, Spada P, Fusetti V, Zecca E, Caraceni A. Characterizing Different Multidisciplinary Team Models Implemented Within One Comprehensive Cancer Center. J Multidiscip Healthc 2023; 16:1845-1855. [PMID: 37404961 PMCID: PMC10317525 DOI: 10.2147/jmdh.s402348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Accepted: 05/15/2023] [Indexed: 07/06/2023] Open
Abstract
Background The multidisciplinary approach is considered "best practice" in oncology. Multidisciplinary Teamwork (MDTW) can be broadly classified into Multidisciplinary Team Meetings (MDTM) and Multidisciplinary Cancer Clinics (MDCC; involving also patients), yet both models are heterogeneously implemented. Purpose This study aims at describing the different MDTW implemented models in a Comprehensive Cancer Center. Methods All clinical unit directors of the hospital were contacted to identify any MDTW activities the personnel of the unit were involved in. Structured interviews were carried out to collect MDTWs information, ie, type (MDTM vs MDCC), team composition, aims, disease phase, use of Patient Reported Outcome Measures (PROMs). Descriptive analyses and Social Network Analysis (SNA) were performed. Results Among 38 structured interviews, 25 concerned MDTMs and 13 in MDCCs. Responders were mainly surgeons (35%) and oncologists (29%), 35% of them were team leaders. Teams were mostly composed of physicians only (64% in MDTMs, 69% in MDCCs). Case managers (8% and 31%), palliative care specialists (12% and 23%) and psychologists (20% and 31%) were involved to a lesser extent, mainly when dealing with advanced disease. MDTWs were mainly aimed at integrating the skills of the different specialists (respectively 72% for MDTMs and 64% for MDCCs) and offering the best overall patient care pathway (64%, 61.5%). MDTWs were directed at patients in both diagnostic (72%, 61.5%) and locally advanced/metastatic (32%, 38.4%) disease. PROMs were seldom used (24%, 23%). SNA shows a similar density in the two MDTWs, but in the MDCCs two nodes remain isolated (pathologists and radiologists). Conclusion Despite a high number of MDTWs for advanced/metastatic disease, there is limited involvement of palliative care specialists, psychologists, and nurses.
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Affiliation(s)
- Sara Alfieri
- Clinical Psychology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Cinzia Brunelli
- Palliative Care, Pain Therapy and Rehabilitation Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Claudia Borreani
- Clinical Psychology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Giuseppe Capri
- Medical Oncology 1, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Martina Angi
- General Oncology Surgery 4, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Giulia V Bianchi
- Medical Oncology 1, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Silvia Lo Dico
- Palliative Care, Pain Therapy and Rehabilitation Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Pierangelo Spada
- Nursing, Technicians and Rehabilitation Management Service (SITRA), Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Viviana Fusetti
- Palliative Care, Pain Therapy and Rehabilitation Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
- Biomedicine and Prevention Department, University of Rome “Tor Vergata”, Rome, Italy
| | - Ernesto Zecca
- Palliative Care, Pain Therapy and Rehabilitation Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Augusto Caraceni
- Palliative Care, Pain Therapy and Rehabilitation Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
- Department of Clinical and Community Sciences, Università degli Studi, Milan, Italy
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Learning from patient experiences of projection imaging through the use of online feedback platforms. J Med Imaging Radiat Sci 2023; 54:73-82. [PMID: 36463092 DOI: 10.1016/j.jmir.2022.11.009] [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: 09/06/2022] [Revised: 11/02/2022] [Accepted: 11/11/2022] [Indexed: 12/03/2022]
Abstract
INTRODUCTION & BACKGROUND Projection radiography remains a well-used diagnostic tool in healthcare, and its use is continually increasing. The volume of feedback collected from patients has grown exponentially but is rarely analysed within the service to meaningfully underpin change. Professions such as nursing currently make use of patient feedback during training yet there is comparatively little use in diagnostic radiography. Research exists into the use of social media during radiotherapy treatment, highlighting how it could be embraced in future research. However, there remains a sparsity of publications discussing the experiences of patients with projection radiography despite its prominence within diagnostic imaging. Online platforms for feedback are available to most industries and readily embraced and used. They are also becoming increasingly available to healthcare providers. This study aimed to assess and analyse the patient experience of projection radiography using the stories of patients via an online platform. METHODOLOGY Recognising that humans do not experience healthcare in a binary way, the authors selected a narrative method as the most appropriate qualitative methodology to analyse and understand 181 patient stories relating to projection radiography from the Care Opinion UK website. Each story was read three times to establish codes and themes and to ensure author familiarity with the patient's words & descriptions. This resulted in 30 empirical codes with the most frequently used being split into three major themes for discussion RESULTS & CONCLUSION: The three major themes considered the radiography experience, the encounter with professionals and service provision. Online sources of feedback provide valuable data for health researchers and provide access to insights which might otherwise go unconsidered. Patients instinctively perceive radiological examinations to result in delays to their care and report surprise when discovering examinations are delivered swiftly, though it remains that innovations such as radiographer-led discharge could be better utilised to enhance the patient experience. In addition, it is evident that administrative functions in diagnostic radiology departments are considered poor and from the descriptions given in the study by patients, the administrative side of the service does not meet their needs. Patient stories demonstrate that radiography is not perceived as vital to patient care and is frequently devalued through the notion that health professions are limited to medical doctor and nurse. The work of radiographers is not valueless to the patient evidenced by their desire to thank staff for their work, but its value is poorly understood and could be further enhanced by embracing online feedback as part of continuing professional and service development.
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Walraven JEW, Verhoeven RHA, van der Meulen R, van der Hoeven JJM, Lemmens VEPP, Hesselink G, Desar IME. Facilitators and barriers to conducting an efficient, competent and high-quality oncological multidisciplinary team meeting. BMJ Open Qual 2023; 12:bmjoq-2022-002130. [PMID: 36759037 PMCID: PMC9923284 DOI: 10.1136/bmjoq-2022-002130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Accepted: 02/01/2023] [Indexed: 02/11/2023] Open
Abstract
BACKGROUND Optimal oncological care nowadays requires discussing every patient in a multidisciplinary team meeting (MDTM). The number of patients to be discussed is rising rapidly due to the increasing incidence and prevalence of cancer and the emergence of new multidisciplinary treatment options. This puts MDTMs under considerable time pressure. The aim of this study is therefore to identify the facilitators and barriers with regard to performing an efficient, competent and high-quality MDTM. METHODS Semistructured interviews were conducted with Dutch medical specialists and residents participating in oncological MDTMs. Purposive sampling was used to maximise variation in participants' professional and demographic characteristics (eg, sex, medical specialist vs resident, specialty, type and location of affiliated hospital). Interview data were systematically analysed according to the principles of thematic content analysis. RESULTS Sixteen medical specialists and 19 residents were interviewed. All interviewees agreed that attending and preparing MDTMs is time-consuming and indicated the need for optimal execution in order to ensure that MDTMs remain feasible in the near future. Four themes emerged that are relevant to achieving an optimal MDTM: (1) organisational aspects; (2) participants' responsibilities and requirements; (3) competences, behaviour and team dynamics and (4) meeting content. Good organisation, a sound structure and functioning information and communication technology facilitate high-quality MDTMs. Multidisciplinary collaboration and adequate communication are essential competences for participants; a lack thereof and the existence of a hierarchy are hindering factors. CONCLUSION Conducting an efficient, competent and high-quality oncological MDTM is facilitated and hindered by many factors. Being aware of these factors provides opportunities for optimising MDTMs, which are under pressure due to the increase in the number of patients to discuss.
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Affiliation(s)
- Janneke E W Walraven
- Department of Medical Oncology, Radboudumc, Nijmegen, The Netherlands .,Department of Research & Development, IKNL, Utrecht, The Netherlands
| | - Rob H A Verhoeven
- Department of Research & Development, IKNL, Utrecht, The Netherlands,Department of Medical Oncology, University of Amsterdam, Amsterdam, The Netherlands
| | | | | | | | - Gijs Hesselink
- Department of Intensive Care, Radboudumc, Nijmegen, The Netherlands,Department of IQ healthcare, Radboud Institute for Health Sciences, Nijmegen, The Netherlands
| | - Ingrid M E Desar
- Department of Medical Oncology, Radboudumc, Nijmegen, The Netherlands
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10
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Plotkin A, Olkhov-Mitsel E, Gagliardi AR. The Impact of the Pathologist in Multidisciplinary Cancer Conferences on Patient Care. Am J Clin Pathol 2023; 159:352-357. [PMID: 36749312 DOI: 10.1093/ajcp/aqac164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Accepted: 11/30/2022] [Indexed: 02/08/2023] Open
Abstract
OBJECTIVES Multidisciplinary cancer conferences (MCCs) are important tools in the treatment of patients with complex health issues, helping clinicians achieve optimal outcomes in oncological practice. To explore the role of pathologists at MCCs, we conducted a review of prior research on this topic. METHODS We conducted a scoping review by searching MEDLINE, EMBASE, and the Cochrane Library for English-language qualitative, quantitative, or multiple/mixed methods studies on the role and impact of pathologists on MCCs. We used Microsoft Excel to extract data. RESULTS Of 76 research results, we included only 3 studies that involved review of cancer cases by pathologists for MCCs. All 3 studies showed that expert pathology review improved the accuracy of diagnosis and refined disease staging, leading to changes in the management of melanoma, breast cancer, and gynecologic cancer. No studies explored the barriers to pathologists participating in MCCs or the strategies or interventions employed to promote or support pathologist involvement. CONCLUSIONS We identified a paucity of studies on the role of pathologists in MCCs. Given the positive impact of MCCs involving pathologists on the accuracy of diagnosis and optimization of treatment, future research is warranted to further establish the role and impact of pathologists in MCCs and how to promote or support pathologists' involvement.
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Affiliation(s)
- Anna Plotkin
- Sunnybrook Health Sciences Center, University of Toronto, Toronto, Canada
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11
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Mott NM, Duncan ZN, Pesavento CM, Vastardis AF, Bredbeck BC, Harter CA, Dossett LA, Broman KK, Hughes TM. Implementation of melanoma guidelines in the multidisciplinary setting: A qualitative analysis. Am J Surg 2023; 225:335-340. [PMID: 36180302 DOI: 10.1016/j.amjsurg.2022.09.039] [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: 07/31/2022] [Revised: 09/11/2022] [Accepted: 09/20/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND Data suggest variation in utilization of completion lymph node dissection (CLND) and adjuvant systemic therapy (AT) for sentinel lymph node-positive melanoma. We aimed to explore how clinicians consider multidisciplinary treatment options. METHODS We conducted semi-structured interviews of surgical oncologists, medical oncologists, and otolaryngologists to produce a thematic analysis. RESULTS Participants (n = 26) described melanoma care as inherently "multidisciplinary," noting the importance of conversations facilitated by shared clinic days or space. Despite believing that their practice mirrored other clinicians, participants revealed diverging perspectives on CLND and AT. Multidisciplinary care presented challenges for surveillance as surgeons expressed desire to retain ownership of patients but did not feel comfortable overseeing AT needs. Participants questioned the fidelity of nodal ultrasounds, noted redundancy in their roles, and described a "surveillance burden" for patients. CONCLUSION Opportunities exist to improve multidisciplinary melanoma care through broader consensus of how to translate emerging data into patient care and delineating surveillance roles.
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Affiliation(s)
- Nicole M Mott
- University of Michigan Medical School, Ann Arbor, MI, USA; University of Michigan, Center for Healthcare Outcomes and Policy, Ann Arbor, MI, USA; University of Colorado Anschutz Medical Campus, Department of Surgery, Aurora, CO, USA.
| | - Zoey N Duncan
- The University of Alabama at Birmingham Heersink School of Medicine, Birmingham, AL, USA
| | | | | | - Brooke C Bredbeck
- University of Michigan, Center for Healthcare Outcomes and Policy, Ann Arbor, MI, USA; University of Michigan, Department of Surgery, Ann Arbor, MI, USA
| | | | - Lesly A Dossett
- University of Michigan, Center for Healthcare Outcomes and Policy, Ann Arbor, MI, USA; University of Michigan, Department of Surgery, Ann Arbor, MI, USA
| | - Kristy K Broman
- The University of Alabama at Birmingham, Birmingham, AL, USA
| | - Tasha M Hughes
- University of Michigan, Center for Healthcare Outcomes and Policy, Ann Arbor, MI, USA; University of Michigan, Department of Surgery, Ann Arbor, MI, USA.
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12
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Roberts TJ, Bailey AS, Tahir N, Jacobson JO. Care Fragmentation, Faulty Communication, and Documentation Lapses Derail a Treatment Plan. JCO Oncol Pract 2023; 19:37-44. [PMID: 36375113 DOI: 10.1200/op.22.00471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
This is the second Cancer Morbidity, Mortality, and Improvement Rounds, a series of articles intended to explore the unique safety risks experienced by oncology patients through the lens of quality improvement, systems and human factors engineering, and cognitive psychology. This case describes the care of a patient who was diagnosed with locally advanced lung cancer during the COVID-19 pandemic; it highlights how gaps in communication and care coordination caused the patient to receive care that did not reflect the consensus of his multidisciplinary team. The discussion highlights the importance of multidisciplinary care, particularly for patients with stage III non-small-cell lung cancer, discusses factors that led to communication gaps, and examines how we should assign accountability across dispersed health care systems.Cancer Morbidity, Mortality, and Improvement Rounds is a series of articles intended to explore the unique safety risks experienced by oncology patients through the lens of quality improvement, systems and human factors engineering, and cognitive psychology. For purposes of clarity, each case focuses on a single theme, although, as is true for all medical incidents, there are almost always multiple, overlapping, contributing factors. The quality improvement paradigm used here, which focuses on root cause analyses and opportunities to improve care delivery systems, was previously outlined in this journal.
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Affiliation(s)
- Thomas J Roberts
- Dana-Farber Cancer Institute, Boston, MA.,Massachusetts General Hospital, Boston, MA.,Harvard Medical School, Boston, MA
| | | | | | - Joseph O Jacobson
- Dana-Farber Cancer Institute, Boston, MA.,Harvard Medical School, Boston, MA
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13
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De Swart ME, Zonderhuis BM, Hellingman T, Kuiper BI, Dickhoff C, Heineman DJ, Hendrickx JJ, Kouwenhoven MC, Van Moorselaar RJA, Schuur M, Tenhagen M, Van Der Velde S, De Witt Hamer PC, Zijlstra JM, Kazemier G. Incomplete patient information exchange and unnecessary repeat diagnostics during oncological referrals in the Netherlands: exploring the role of information exchange. Health Informatics J 2023; 29:14604582231153795. [PMID: 36708072 DOI: 10.1177/14604582231153795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Data management in transmural care is complex. Without digital innovations like Health Information Exchange (HIE), patient information is often dispersed and inaccessible across health information systems between hospitals. The extent of information loss and consequences remain unclear. We aimed to quantify patient information availability of referred oncological patients and to assess its impact on unnecessary repeat diagnostics by observing all oncological multidisciplinary team meetings (MDTs) in a tertiary hospital. During 84 multidisciplinary team meetings, 165 patients were included. Complete patient information was provided in 17.6% (29/165, CI = 12.3-24.4) of patients. Diagnostic imaging was shared completely in 52.5% (74/141, CI = 43.9-60.9), imaging reports in 77.5% (100/129, CI = 69.2-84.2), laboratory results in 55.2% (91/165, CI = 47.2-62.8), ancillary test reports in 58.0% (29/50, CI = 43.3-71.5), and pathology reports in 60.0% (57/95, CI = 49.4-69.8). A total of 266 tests were performed additionally, with the main motivation not previously performed followed by inconclusive or insufficient quality of previous tests. Diagnostics were repeated unnecessarily in 15.8% (26/165, CI = 10.7-22.4) of patients. In conclusion, patient information was provided incompletely in majority of referrals discussed in oncological multidisciplinary team meetings and led to unnecessary repeat diagnostics in a small number of patients. Additional research is needed to determine the benefit of Health Information Exchange to improve data transfer in oncological care.
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Affiliation(s)
- Merijn E De Swart
- Department of Surgery, Cancer Center Amsterdam, Ringgold: 1209Amsterdam UMC, VU University Medical Center, The Netherlands
| | - Barbara M Zonderhuis
- Department of Surgery, Cancer Center Amsterdam, Ringgold: 1209Amsterdam UMC, VU University Medical Center, The Netherlands
| | - Tessa Hellingman
- Department of Surgery, Cancer Center Amsterdam, Ringgold: 1209Amsterdam UMC, VU University Medical Center, The Netherlands
| | - Babette I Kuiper
- Department of Surgery, Cancer Center Amsterdam, Ringgold: 1209Amsterdam UMC, VU University Medical Center, The Netherlands
| | - Chris Dickhoff
- Department of Surgery, Cancer Center Amsterdam, Ringgold: 1209Amsterdam UMC, VU University Medical Center, The Netherlands
| | - David J Heineman
- Department of Surgery, Cancer Center Amsterdam, Ringgold: 1209Amsterdam UMC, VU University Medical Center, The Netherlands
| | - Jan J Hendrickx
- Department of Otolaryngology-Head and Neck Surgery, Cancer Center Amsterdam, Ringgold: 1209Amsterdam UMC, VU University Medical Center, The Netherlands
| | - Mathilde Cm Kouwenhoven
- Department of Neurology, Cancer Center Amsterdam, Ringgold: 1209Amsterdam UMC, VU University Medical Center, The Netherlands
| | - R Jeroen A Van Moorselaar
- Department of Urology, Cancer Center Amsterdam, Ringgold: 1209Amsterdam UMC, VU University Medical Center, The Netherlands
| | - Maaike Schuur
- Department of Neurology, Cancer Center Amsterdam, Ringgold: 1209Amsterdam UMC, VU University Medical Center, The Netherlands
| | - Mark Tenhagen
- Department of Surgery, Cancer Center Amsterdam, Ringgold: 1209Amsterdam UMC, VU University Medical Center, The Netherlands
| | - Susanne Van Der Velde
- Department of Surgery, Cancer Center Amsterdam, Ringgold: 1209Amsterdam UMC, VU University Medical Center, The Netherlands
| | - Philip C De Witt Hamer
- Department of Neurosurgery, Cancer Center Amsterdam, Ringgold: 1209Amsterdam UMC, VU University Medical Center, The Netherlands
| | - Josée M Zijlstra
- Department of Hematology, Cancer Center Amsterdam, Ringgold: 1209Amsterdam UMC, VU University Medical Center, The Netherlands
| | - Geert Kazemier
- Department of Surgery, Cancer Center Amsterdam, Ringgold: 1209Amsterdam UMC, VU University Medical Center, The Netherlands
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14
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Braulke F, Kober K, Arndt A, Papendick M, Strauss A, Kramm CM, Thoms KM, König A, Gaedcke J, Gallwas J, Wulf S, Szuszies C, Wulf G, Rödel R, Wolfer S, Malinova V, Overbeck TR, Hinterthaner M, Lotz J, Nauck F, Ernst M, Stadelmann C, Ströbel P, Ellenrieder V, Asendorf T, Rieken S. Optimizing the structure of interdisciplinary tumor boards for effective cancer care. Front Oncol 2023; 13:1072652. [PMID: 37182140 PMCID: PMC10171921 DOI: 10.3389/fonc.2023.1072652] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Accepted: 03/31/2023] [Indexed: 05/16/2023] Open
Abstract
Introduction Multi-professional interdisciplinary tumor boards (ITB) are essential institutions to discuss all newly diagnosed, relapsed or complex cancer patients in a team of specialists to find an optimal cancer care plan for each individual patient with regard to national and international clinical practice guidelines, patient´s preference and comorbidities. In a high-volume cancer center, entity-specific ITBs take place at least once a week discussing a large number of patients. To a high level of expertise and dedication, this also requires an enormous amount of time for physicians, cancer specialists and administrative support colleagues, especially for radiologists, pathologists, medical oncologists and radiation oncologists, who must attend all cancer-specific boards according to certification requirements. Methods In this 15-month prospective German single-center analysis, we examined the established structures of 12 different cancer-specific ITBs at the certified Oncology Center and demonstrate tools helping to optimize processes before, during and after the boards for optimal, time-saving procedures. Results By changing pathways, introducing revised registration protocols and new digital supports we could show that the workload of preparation by radiologists and pathologists could be reduced significantly by 22.9% (p=<0.0001) and 52.7% (p=<0.0001), respectively. Furthermore, two questions were added to all registration forms about the patient´s need for specialized palliative care support that should lead to more awareness and early integration of specialized help. Discussion There are several ways to reduce the workload of all ITB team members while maintaining high quality recommendations and adherence to national and international guidelines.
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Affiliation(s)
- Friederike Braulke
- Comprehensive Cancer Center, University Medical Center Göttingen, Göttingen, Germany
| | - Kathrin Kober
- Comprehensive Cancer Center, University Medical Center Göttingen, Göttingen, Germany
| | - Andreas Arndt
- Comprehensive Cancer Center, University Medical Center Göttingen, Göttingen, Germany
| | - Maximilian Papendick
- Comprehensive Cancer Center, University Medical Center Göttingen, Göttingen, Germany
| | - Arne Strauss
- Department of Urology, University Medical Center Göttingen, Göttingen, Germany
| | - Christof Maria Kramm
- Division of Pediatric Hematology and Oncology, Department of Pediatrics and Adolescent Medicine, University Medical Center Göttingen, Göttingen, Germany
| | - Kai-Martin Thoms
- Department of Dermatology, Venereology and Allergology, University Medical Center Göttingen, Göttingen, Germany
| | - Alexander König
- Department of Gastroenterology, Gastrointestinal Oncology and Endocrinology, University Medical Center Göttingen, Göttingen, Germany
| | - Jochen Gaedcke
- Department of General, Visceral and Pediatric Surgery, University Medical Center Göttingen, Göttingen, Germany
| | - Julia Gallwas
- Department of Gynaecology and Obstetrics, University Medical Center Göttingen, Göttingen, Germany
| | - Svenja Wulf
- Department of Gynaecology and Obstetrics, University Medical Center Göttingen, Göttingen, Germany
| | - Christoph Szuszies
- Department of Hematology and Medical Oncology, University Medical Center Göttingen, Göttingen, Germany
| | - Gerald Wulf
- Department of Hematology and Medical Oncology, University Medical Center Göttingen, Göttingen, Germany
| | - Ralph Rödel
- Department of Otorhinolaryngology, University Medical Center Göttingen, Göttingen, Germany
| | - Susanne Wolfer
- Department of Oral and Maxillofacial Surgery, University Medical Center Göttingen, Göttingen, Germany
| | - Vesna Malinova
- Department of Neurosurgery, University Medical Center Göttingen, Göttingen, Germany
| | - Tobias R. Overbeck
- Department of Hematology and Medical Oncology, University Medical Center Göttingen, Göttingen, Germany
| | - Marc Hinterthaner
- Department of Thoracic and Cardiovascular Surgery, University Medical Center Göttingen, Göttingen, Germany
| | - Joachim Lotz
- Institute for Diagnostic and Interventional Radiology, University Medical Center Göttingen, Göttingen, Germany
| | - Friedemann Nauck
- Department of Palliative Medicine, University Medical Center Göttingen, Göttingen, Germany
| | - Marielle Ernst
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Göttingen, Göttingen, Germany
| | - Christine Stadelmann
- Institute of Neuropathology, University Medical Center Göttingen, Göttingen, Germany
| | - Philipp Ströbel
- Institute of Pathology, University Medical Center Göttingen, Göttingen, Germany
| | - Volker Ellenrieder
- Department of Gastroenterology, Gastrointestinal Oncology and Endocrinology, University Medical Center Göttingen, Göttingen, Germany
| | - Thomas Asendorf
- Department of Medical Statistics, University Medical Center Göttingen, Göttingen, Germany
| | - Stefan Rieken
- Department of Radiotherapy and Radiation Oncology, University Medical Center Göttingen, Göttingen, Germany
- *Correspondence: Stefan Rieken,
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15
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Sanchez JI, Doose M, Zeruto C, Chollette V, Gasca N, Verhoeven D, Weaver SJ. Multilevel factors associated with inequities in multidisciplinary cancer consultation. Health Serv Res 2022; 57 Suppl 2:222-234. [PMID: 35491756 PMCID: PMC9670237 DOI: 10.1111/1475-6773.13996] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
OBJECTIVE To assess changes in the prevalence of multidisciplinary cancer consultations (MDCc) over the last decade and examine patient, surgeon, hospital, and neighborhood factors associated with receipt of MDCc among individuals diagnosed with cancer. DATA SOURCE Surveillance, Epidemiology and End Results (SEER)-Medicare data from 2006 to 2016. STUDY DESIGN We used time-series analysis to assess change in MDCc prevalence from 2007 to 2015. We also conducted multilevel logistic regression with random surgeon- and hospital-level effects to assess associations between patient, surgeon, neighborhood, and health care organization-level factors and receipt of MDCc during the cancer treatment planning phase, defined as the 2 months following cancer diagnosis. DATA COLLECTION/EXTRACTION METHODS We identified Medicare beneficiaries >65 years of age with surgically resected breast, colorectal (CRC), or non-small cell lung cancer (NSCLC) stages I-III (n = 103,250). PRINCIPAL FINDINGS From 2007 to 2015, the prevalence of MDCc increased from 35.0% to 61.2%. Overall, MDCc was most common among patients with breast cancer compared to CRC and NSCLC. Cancer patients who were Black, had comorbidities, had dual Medicare-Medicaid coverage, were residing in rural areas or in areas with higher Black and Hispanic neighborhood composition were significantly less likely to have received MDCc. Patients receiving surgery at disproportionate payment-sharing or rural-designated hospitals had 2% (95% CI: -3.55, 0.58) and 17.6% (95% CI: -21.45, 13.70), respectively, less probability of receiving MDCc. Surgeon- and hospital-level effects accounted for 15% of the variance in receipt of MDCc. CONCLUSIONS The practice of MDCc has increased over the last decade, but significant geographical and health care organizational barriers continue to impede equitable access to and delivery of quality care across cancer patient populations. Multilevel and multicomponent interventions that target care coordination, health system, and policy changes may enhance equitable access to and receipt of MDCc.
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Affiliation(s)
- Janeth I. Sanchez
- Health Systems and Interventions Branch, Healthcare Delivery Research Program, Division of Cancer Control and Population SciencesNational Cancer InstituteRockvilleMarylandUSA
| | - Michelle Doose
- Division of Clinical and Health Services ResearchNational Institute on Minority Health and Health DisparitiesBethesdaMarylandUSA
| | - Chris Zeruto
- Information Management Services, Inc.CalvertonMarylandUSA
| | - Veronica Chollette
- Health Systems and Interventions Branch, Healthcare Delivery Research Program, Division of Cancer Control and Population SciencesNational Cancer InstituteRockvilleMarylandUSA
| | - Natalie Gasca
- School of Public Health, Department of BiostatisticsUniversity of WashingtonSeattleWashingtonUSA
| | - Dana Verhoeven
- Health Systems and Interventions Branch, Healthcare Delivery Research Program, Division of Cancer Control and Population SciencesNational Cancer InstituteRockvilleMarylandUSA
| | - Sallie J. Weaver
- Health Systems and Interventions Branch, Healthcare Delivery Research Program, Division of Cancer Control and Population SciencesNational Cancer InstituteRockvilleMarylandUSA
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16
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Davis CH, Ho J, Stephenson R, August DA, Gee H, Weiner J, Alexander HR, Pitt HA, Berger AC. Virtual Tumor Board Increases Provider Attendance and Case Presentations. JCO Oncol Pract 2022; 18:e1603-e1610. [DOI: 10.1200/op.22.00158] [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: Many cancer centers engage in multidisciplinary tumor board meetings to determine the optimal approach to complex cancer care. With the onset of the COVID-19 pandemic, many institutions changed the format of these meetings from in-person to virtual. The aim of this study was to determine if the change to a virtual meeting format had an impact on attendance and cases presented. METHODS: Tumor board records were analyzed to obtain attendance and case presentation information at a National Cancer Institute–designated Comprehensive Cancer Center. Twelve-month in-person tumor board data were compared with 12-month virtual tumor board data to assess for difference in attendance and case presentation patterns. RESULTS: Seven separate weekly tumor board meetings at the beginning of the study (breast, GI, gynecology, liver, lung, melanoma, and urology) were expanded to nine meetings on the virtual platform (+endocrine and pancreas). Overall attendance increased by 46% on the virtual platform compared with in-person meetings (4,030 virtual attendances v 2,753 in-person, P < .001). Increased attendance was present across all specialties on the virtual platform. In addition, the number of patient cases discussed increased from 2,127 in in-person meeting to 2,656 on the virtual platform (a 20% increase, P < .001). CONCLUSION: A significant increase was observed in overall tumor board attendance and in case presentations per meeting, requiring the expansion of additional weekly meetings. Furthermore, in a major cancer center with multiple community affiliates, virtual tumor boards may encourage increased participation from remote sites with the benefit of obtaining expert specialist advice as compared with geographically challenging in-person meetings.
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Affiliation(s)
- Catherine H. Davis
- Division of Surgical Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ
- Rutgers Robert Wood Johnson University Medical School, New Brunswick, NJ
| | - Jason Ho
- Rutgers Robert Wood Johnson University Medical School, New Brunswick, NJ
| | - Ryan Stephenson
- Rutgers Robert Wood Johnson University Medical School, New Brunswick, NJ
- Division of Medical Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ
| | - David A. August
- Division of Surgical Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ
- Rutgers Robert Wood Johnson University Medical School, New Brunswick, NJ
| | - Heather Gee
- Rutgers Robert Wood Johnson University Medical School, New Brunswick, NJ
| | - Joseph Weiner
- Rutgers Robert Wood Johnson University Medical School, New Brunswick, NJ
- Division of Radiation Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ
| | - H. Richard Alexander
- Division of Surgical Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ
- Rutgers Robert Wood Johnson University Medical School, New Brunswick, NJ
| | - Henry A. Pitt
- Division of Surgical Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ
- Rutgers Robert Wood Johnson University Medical School, New Brunswick, NJ
| | - Adam C. Berger
- Division of Surgical Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ
- Rutgers Robert Wood Johnson University Medical School, New Brunswick, NJ
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Wind A, van der Linden C, Hartman E, Siesling S, van Harten W. Patient involvement in clinical pathway development, implementation and evaluation - A scoping review of international literature. PATIENT EDUCATION AND COUNSELING 2022; 105:1441-1448. [PMID: 34666931 DOI: 10.1016/j.pec.2021.10.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Revised: 09/10/2021] [Accepted: 10/04/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVE Although various pathway design methods recognize patients as stakeholders, an overview of current practice is lacking. This article describes the results of a literature review assessing patient involvement in clinical cancer pathway development, implementation and evaluation. METHODS A scoping review was conducted following PRISMA-ScR. Two databases were searched to identify studies published in English between 2014 and 2021. RESULTS Of 12841articles identified 22 articles met the inclusion criteria and reported on one or more of the three phases: development phase (N = 2), implementation (N = 4), evaluation (N = 11), development/evaluation (N = 3), and implementation/evaluation (N = 2) of clinical pathways. The numbers of involved patients ranged from 10 to 793, and the reported methods varied considerably. CONCLUSION This review presents a synthesis of methods for involving patients in the clinical pathway lifecycle. No relationship was found between methods and the number of involved patients or between pathway complexity and methods. Although patients are seen as valuable stakeholders in the pathway design, to involve them in practice using the best practice can be improved. PRACTICE IMPLICATIONS The lack of a clear justification for the choice of methods and number of involved patients calls for further research and framework development to inform pathway developers.
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Affiliation(s)
- Anke Wind
- Rijnstate Hospital, Arnhem, the Netherland; Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands
| | | | - Elmar Hartman
- Rijnstate Hospital, Arnhem, the Netherland; Department of Health Technology and Services Research, University of Twente, Enschede, The Netherlands
| | - Sabine Siesling
- Department of Health Technology and Services Research, University of Twente, Enschede, The Netherlands; dept Research and Development, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, the Netherlands
| | - Wim van Harten
- Rijnstate Hospital, Arnhem, the Netherland; Department of Health Technology and Services Research, University of Twente, Enschede, The Netherlands; The Netherlands Cancer Institute, Amsterdam. The Netherlands.
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18
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Barrios C, Sánchez-Vanegas G, Villarreal-Garza C, Ossa A, Lombana MA, Monterrosa-Blanco A, Ferrigno AS, Castro CA. Barriers and facilitators to provide multidisciplinary care for breast cancer patients in five Latin American countries: A descriptive-interpretative qualitative study. LANCET REGIONAL HEALTH. AMERICAS 2022; 11:100254. [PMID: 36778924 PMCID: PMC9904076 DOI: 10.1016/j.lana.2022.100254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Background Multidisciplinary care (MDC) remains a cornerstone for breast cancer management as it is associated with improved quality of care and patient outcomes. However, the adoption of MDC practice is heterogeneous and has been poorly explored in Latin America. The objective was to describe barriers and possible facilitators for providing MDC to breast cancer patients in five Latin American countries. Methods A panel of experts with an active clinical practice in Bolivia, Colombia, Ecuador, Mexico, and Uruguay was convened to identify barriers and facilitators to MDC. This study is a qualitative synthesis of a structured discussion regarding the state of MDC in the setting of breast cancer. Findings Experts recognized that most oncology practices in Latin America do not apply a multidisciplinary approach for breast cancer patients. Predominant barriers for MDC are fragmentation of health services, being understaffed, inadequate infrastructure, and geographic disparities. Access to MDC varies widely in the region, with significant heterogeneity documented within countries. MDC practice was described as being more common in the private sector in Ecuador and Uruguay, while it is more widely implemented in public institutions of Colombia and Bolivia. Interpretation Establishing quality MDC remains a challenge for oncology practices in Latin America. Addressing regional issues and identifying specific local needs is warranted to encourage the adoption of an effective multidisciplinary approach and, consequently, improve clinical outcomes. Active involvement of all stakeholders is required to build locally solutions and should involve institutions, health professionals, and patients. Funding Research was funded by Productos Roche S.A.
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Affiliation(s)
- Carlos Barrios
- Oncoclinicas Group, Oncology Research Center, Hospital São Lucas, PUCRS Latin-American Cooperative Oncology Group (LACOG), Rio Grande do Sul, RS, Brazil
| | - Guillermo Sánchez-Vanegas
- Soluciones Integrales Para la Investigación y la Educación en Salud – SIIES Consultores, Cr 45ª #106ª-20, Bogotá, Cundinamarca, Colombia,Fundación Universtiaria de Ciencias de la Salud-FUCS, Bogotá, Colombia.,Corresponding author.
| | - Cynthia Villarreal-Garza
- Breast Cancer Center, Hospital Zambrano Hellion TecSalud, Tecnologico de Monterrey, San Pedro Garza García, Nuevo León, México
| | - Andrés Ossa
- Coordinator Breast Cancer Department Hospital General de Medellín, Medellín, Antioquia, Colombia
| | - Milton A. Lombana
- Scientific Medical Head at Comprehensive Cancer Center, Clinica de Occidente, Cali, Valle del Cauca, Colombia
| | - Angélica Monterrosa-Blanco
- Soluciones Integrales Para la Investigación y la Educación en Salud – SIIES Consultores, Cr 45ª #106ª-20, Bogotá, Cundinamarca, Colombia
| | - Ana S. Ferrigno
- Breast Cancer Center, Hospital Zambrano Hellion TecSalud, Tecnologico de Monterrey, San Pedro Garza García, Nuevo León, México
| | - Carlos Alberto Castro
- Soluciones Integrales Para la Investigación y la Educación en Salud – SIIES Consultores, Cr 45ª #106ª-20, Bogotá, Cundinamarca, Colombia,Fundación Universtiaria de Ciencias de la Salud-FUCS, Bogotá, Colombia
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Guilabert M, Prades J, Borras JM, Maestu I, Guerra JA, Fumadó L, Mira JJ. A Web-Based Self-assessment Model for Evaluating Multidisciplinary Cancer Teams in Spain: Development and Validation Pilot Study. J Med Internet Res 2022; 24:e29063. [PMID: 35266870 PMCID: PMC8949680 DOI: 10.2196/29063] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Revised: 08/02/2021] [Accepted: 08/12/2021] [Indexed: 11/17/2022] Open
Abstract
Background Tumor boards constitute the main consensus and clinical decision–making body of multidisciplinary teams (MDTs) in cancer care. With the increasing clinical complexity of treatment options (eg, targeted therapies, multimodal treatments) and the progressive incorporation of new areas of intervention (eg, survivorship care), tumor boards are now required to play a central role in all cancer processes. However, although frameworks are in place to evaluate MDT quality, only few web-based tools are available for this purpose; indeed, no web-based MDT evaluation tools have been developed for or adapted to the Spanish National Health System. Objective The first aim of this study was to develop a web-based self-assessment model (Autoevaluación de Equipos Multidisciplinares de Atención al Cáncer [AEMAC]) for evaluating multidisciplinary cancer teams in Spain and the second aim was to validate this tool by testing its metric properties, acceptability, and usability. Methods We designed and validated the AEMAC program in 3 stages. In the first stage (research), we reviewed the available scientific evidence and performed a qualitative case study of good practice in multidisciplinary care within the Spanish National Health System (n=4 centers and 28 health care professionals). The results were used to define the thematic areas and quality criteria for the self-evaluation model, which were then discussed and validated by a group of experts. The second stage (development) involved the technological development of a web app that would be accessible from any mobile device. In the third stage (piloting and validation), we conducted 4 pilot tests (n=15 tumor boards, 243 professionals) and used the results to analyze the acceptability and usefulness of the tool. Results We designed a self-assessment model based on 5 thematic areas encompassing a total of 25 quality components, which users rated on a 3-option development scale. The evaluation process, which was managed entirely from the web app, consisted of individual self-assessment, group prioritization, and creation of an improvement plan. Cronbach alpha (.86), McDonald’s omega (0.88), and various fit indices (comparative fit index between 0.95 and 1 and goodness-of-fit index between 0.97 and 0.99 for all 5 aspects) confirmed internal consistency. The mean rating for overall satisfaction with the tool and for consistency between the content of the tool and the reality of tumor boards was 7.6 out of 10. Conclusions The results obtained during the period of research and piloting of the AEMAC program showed that it has an appropriate structure and metric properties and could therefore be implemented in a real context and generalized to other hospitals. As a virtual tool, it helps to measure the key aspects of MDT quality, such as effectiveness of collaboration and communication, leadership, and the organizational environment.
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Affiliation(s)
| | - Joan Prades
- Department of Health, Catalonian Cancer Strategy, Barcelona, Spain.,Department of Clinical Sciences, University of Barcelona, Instituto de Investigación Biomédica de Bellvitge, Barcelona, Spain
| | - Josep M Borras
- Department of Health, Catalonian Cancer Strategy, Barcelona, Spain.,Department of Clinical Sciences, University of Barcelona, Instituto de Investigación Biomédica de Bellvitge, Barcelona, Spain
| | - Inmaculada Maestu
- Medical Oncology Service, Doctor Peset University Hospital, Valencia, Spain
| | - Juan Antonio Guerra
- Department of Hematology and Oncology, Fuenlabrada University Hospital, Fuenlabrada, Spain
| | - Lluís Fumadó
- Urological Cancer Functional Unit, Hospital del Mar-Parc de Salut Mar-IMIM, Barcelona, Spain
| | - José Joaquin Mira
- Health Psychology Department, Miguel Hernandez University, Elche, Spain.,Atenea Research Group, Foundation for the Promotion of Health and Biomedical Research, Sant Joan d'Alacant, Spain.,Alicante-Sant Joan Health Department, Alicante, Spain
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- see Authors' Contributions,
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20
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Building a Center for Abdominal Core Health: The Importance of a Holistic Multidisciplinary Approach. J Gastrointest Surg 2022; 26:693-701. [PMID: 35013880 DOI: 10.1007/s11605-021-05241-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Accepted: 12/31/2021] [Indexed: 01/31/2023]
Abstract
BACKGROUND This article seeks to be a collection of evidence and experience-based information for health care providers around the country and world looking to build or improve an abdominal core health center. Abdominal core health has proven to be a chronic condition despite advancements in surgical technique, technology, and equipment. The need for a holistic approach has been discussed and thought to be necessary to improve the care of this complex patient population. METHODS Literature relevant to the key aspects of building an abdominal core health center was thoroughly reviewed by multiple members of our abdominal core health center. This information was combined with our authors' experiences to gather relevant information for those looking to build or improve a holistic abdominal core health center. RESULTS An abundance of publications have been combined with multiple members of our abdominal core health centers members experience's culminating in a wide breadth of information relevant to those looking to build or improve a holistic abdominal core health center. CONCLUSIONS Evidence- and experience-based information has been collected to assist those looking to build or grow an abdominal core health center.
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21
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Nic Giolla Easpaig B, Tran Y, Winata T, Lamprell K, Fajardo Pulido D, Arnolda G, Delaney GP, Liauw W, Smith K, Avery S, Rigg K, Westbrook J, Olver I, Currow D, Karnon J, Ward RL, Braithwaite J. The complexities, coordination, culture and capacities that characterise the delivery of oncology services in the common areas of ambulatory settings. BMC Health Serv Res 2022; 22:190. [PMID: 35151314 PMCID: PMC8841048 DOI: 10.1186/s12913-022-07593-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Accepted: 02/02/2022] [Indexed: 11/16/2022] Open
Abstract
Background Relatively little is understood about real-world provision of oncology care in ambulatory outpatient clinics (OPCs). This study aimed to: 1) develop an understanding of behaviours and practices inherent in the delivery of cancer services in OPC common areas by characterising the organisation and implementation of this care; and 2) identify barriers to, and facilitators of, the delivery of this care in OPC common areas. Methods A purpose-designed ethnographic study was employed in four public hospital OPCs. Informal field scoping activities were followed by in-situ observations, key informant interviews and document review. A view of OPCs as complex adaptive systems was used as a scaffold for the data collection and interpretation, with the intent of understanding ‘work as done’. Data were analysed using an adapted “Qualitative Rapid Appraisal, Rigorous Analysis” approach. Results Field observations were conducted over 135 h, interviews over 6.5 h and documents were reviewed. Analysis found six themes. Staff working in OPCs see themselves as part of small local teams and as part of a broader multidisciplinary care team. Professional role boundaries could be unclear in practice, as duties expanded to meet demand or to stop patients “falling through the cracks.” Formal care processes in OPCs were supported by relationships, social capital and informal, but invaluable, institutional expertise. Features of the clinic layout, such as the proximity of departments, affected professional interactions. Staff were aware of inter- and intra-service communication difficulties and employed strategies to minimise negative impacts on patients. We found that complexity, coordination, culture and capacity underpin the themes that characterise this care provision. Conclusions The study advances understanding of how multidisciplinary care is delivered in ambulatory settings and the factors which promote or inhibit effective care practice. Time pressures, communication challenges and competing priorities can pose barriers to care delivery. OPC care is facilitated by: self-organisation of participants; professional acumen; institutional knowledge; social ties and relationships between and within professional groups; and commitment to patient-centred care. An understanding of the realities of ‘work-as-done’ may help OPCs to sustain high-quality care in the face of escalating service demand.
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22
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Perspectives on record-keeping practices in MDT meetings and meeting record utility. Int J Med Inform 2022; 161:104711. [DOI: 10.1016/j.ijmedinf.2022.104711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Revised: 01/17/2022] [Accepted: 01/27/2022] [Indexed: 11/24/2022]
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23
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The Effectiveness of e-Health Interventions on Caregiver Burden, Depression, and Quality of Life in Informal Caregivers of Patients with cancer: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Int J Nurs Stud 2022; 127:104179. [DOI: 10.1016/j.ijnurstu.2022.104179] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Revised: 01/07/2022] [Accepted: 01/11/2022] [Indexed: 01/19/2023]
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24
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Villegas MA, Okenfuss E, Savarirayan R, White K, Hoover-Fong J, Bober MB, Duker A, Legare JM. Multidisciplinary Care of Neurosurgical Patients with Genetic Syndromes. Neurosurg Clin N Am 2021; 33:7-15. [PMID: 34801144 DOI: 10.1016/j.nec.2021.09.002] [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: 12/19/2022]
Abstract
Neurosurgical patients with genetic syndromes often receive care from multidisciplinary teams. Successful models range from multiple providers in one clinic space seeing a patient together to specialists located at different institutions working together. Collaboration and bidirectional communication are key. Multidisciplinary care improves outcomes and patient satisfaction. Choosing the goal of the clinic, using ancillary staff, and obtaining institutional buy-in are important initial first steps to establishing a multidisciplinary team clinic. Multidisciplinary teams can leverage technology to expand care via telehealth in multidisciplinary clinics and more vitally communication between providers on the team.
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Affiliation(s)
- Melissa A Villegas
- University of Wisconsin School of Medicine and Public Health, 1500 Highland Avenue, Madison, WI 53705, USA
| | - Ericka Okenfuss
- Department of Genetics, Kaiser Permanente of Northern California, 1650 Response Road Kaiser, Sacramento, CA 95815, USA
| | - Ravi Savarirayan
- Victorian Clinical Genetics Services, Murdoch Children's Research Institute and University of Melbourne, Parkville, Victoria 3052, Australia
| | - Klane White
- Seattle Children's, 4800 Sand Point Way, OA.9.120, Seattle, WA 98105, USA
| | - Julie Hoover-Fong
- Greenberg Center for Skeletal Dysplasias, McKusick Nathans Department of Genetic Medicine, Johns Hopkins University, 600 N. Wolfe Street, Blalock 1008, Baltimore, MD 21287, USA
| | - Michael B Bober
- A.I. duPont Hospital for Children, 1600 Rockland Road, Wilmington, DE 19803, USA
| | - Angela Duker
- A.I. duPont Hospital for Children, 1600 Rockland Road, Wilmington, DE 19803, USA
| | - Janet M Legare
- University of Wisconsin School of Medicine and Public Health, 1500 Highland Avenue, Madison, WI 53705, USA.
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25
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Menke C, Lohmann S, Baehr A, Grauer O, Holling M, Brokinkel B, Schwake M, Stummer W, Schipmann S. Classical and disease-specific quality indicators in glioma surgery—Development of a quality checklist to improve treatment quality in glioma patients. Neurooncol Pract 2021; 9:59-67. [DOI: 10.1093/nop/npab063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
Background
There is a pressing demand for more accurate, disease-specific quality measures in the field of neurosurgery. Aiming at most adequately measuring and reflecting the quality of glioma therapy, we developed a novel quality indicator bundle in form of a checklist for all patients that are treated operatively for glioma.
Methods
On the basis of possible glioma-specific quality indicators retrieved from the literature and quality guidelines, a multidisciplinary team developed a checklist containing 13 patient-need-specific outcome measures. Subsequently, the checklist was prospectively applied to a total of 78 patients compared with a control group consisting of 322 patients. A score was generated based on the maximum of quality measures achieved.
Results
Significant improvements in quality after prospectively introducing the checklist were achieved for supplemental physical and occupational therapy during inpatient stay (89.4% vs 100%, P = .002), consultation of a social worker during inpatient stay (64% vs 92.3%, P < .001), psycho-oncological screening (14.3% vs 70.5%, P < .001), psycho-oncological consultation (31.1% vs 82.1%, P < .001), and consultation of the palliative care team (20% vs 40%, P = .031). Overall, after introduction of the checklist one-third (n = 23) of patients reached best-practice measures in all categories, and over half of the patients (n = 44) achieved above 90% with respect to the outcome measures.
Conclusions
Aiming at ensuring comprehensive, consistent, and timely care of glioma patients, the implementation of the checklist for routine use in glioma surgery represents an efficient, easily reproducible, and powerful tool for significant improvements.
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Affiliation(s)
- Christiane Menke
- Department of Neurosurgery, University Hospital Münster, Münster, Germany
| | - Sebastian Lohmann
- Department of Neurosurgery, University Hospital Münster, Münster, Germany
| | - Andrea Baehr
- Department of Radiation Oncology, University Hospital Münster, Münster, Germany
- Department of Neurosurgery, University Hospital Münster, Münster, Germany
| | - Oliver Grauer
- Department of Neurology with Institute of Translational Neurology, University Hospital Münster, Münster, Germany
| | - Markus Holling
- Department of Neurosurgery, University Hospital Münster, Münster, Germany
| | - Benjamin Brokinkel
- Department of Neurosurgery, University Hospital Münster, Münster, Germany
| | - Michael Schwake
- Department of Neurosurgery, University Hospital Münster, Münster, Germany
| | - Walter Stummer
- Department of Neurosurgery, University Hospital Münster, Münster, Germany
| | - Stephanie Schipmann
- Department of Neurosurgery, University Hospital Münster, Münster, Germany
- Department of Neurosurgery, Haukeland University Hospital Bergen, Bergen, Norway
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26
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Building a gender-affirming surgery service: The fundamentals. Surgery 2021; 171:498-503. [PMID: 34593253 DOI: 10.1016/j.surg.2021.08.043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 08/04/2021] [Accepted: 08/24/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND As the healthcare needs of transgender patients become increasingly recognized and supported, gender-affirming surgery services are in increasing demand. However, establishing a gender-affirming surgery service is unlike many other surgical specialties and requires unique expertise and administrative support. The aim of this article is to outline the considerations for starting a gender-affirming surgery service and identify pearls for success. METHODS In this article, we describe the critical components of building and maintaining a successful gender-affirming surgery service. We intersperse findings from our own experiences developing a gender-affirming surgery service. RESULTS A successful gender-affirming surgery service starts by developing a clear vision of the patient population within your hospital system's area, as well as the design of your center. Establishing a center relies on early engagement of hospital administration and its continued support. A multidisciplinary team with intensive interpersonal and operative training offers the best patient experience and surgical outcomes. By following these steps, our service has been able to provide gender-affirming surgery to more than 200 patients since its inception. Future goals entail partnerships with other institutions and continued outcomes evaluation to ensure sustained success of all gender-affirming surgery services. CONCLUSION Although there are unique challenges and considerations for establishing a gender-affirming surgery service, careful planning and stakeholder engagement allow providers to deliver high-quality care. We hope that our experience can serve as a model for future much needed gender-affirming surgery services.
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27
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Nandwani M, Dewan K, Starmer H, Kamal AN, Clarke JO. The Stanford Multidisciplinary Swallowing Disorders Center. Clin Gastroenterol Hepatol 2021; 19:1744-1747. [PMID: 33887474 DOI: 10.1016/j.cgh.2021.04.025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- Monica Nandwani
- Center for Advanced Practice, Stanford Health Care, Palo Alto, California.
| | - Karuna Dewan
- Department of Otolaryngology - Head and Neck Surgery, Stanford University, Palo Alto, California
| | - Heather Starmer
- Department of Otolaryngology - Head and Neck Surgery, Stanford University, Palo Alto, California
| | - Afrin N Kamal
- Division of Gastroenterology and Hepatology, Stanford University, Palo Alto, California
| | - John O Clarke
- Division of Gastroenterology and Hepatology, Stanford University, Palo Alto, California
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Rubagumya F, Mitera G, Ka S, Manirakiza A, Decuir P, Msadabwe SC, Adani Ifè S, Nwachukwu E, Ohene Oti N, Borges H, Mutebi M, Abuidris D, Vanderpuye V, Booth CM, Hammad N. Choosing Wisely Africa: Ten Low-Value or Harmful Practices That Should Be Avoided in Cancer Care. JCO Glob Oncol 2021; 6:1192-1199. [PMID: 32735489 PMCID: PMC7392774 DOI: 10.1200/go.20.00255] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
PURPOSE Choosing Wisely Africa (CWA) builds on Choosing Wisely (CW) in the United States, Canada, and India and aims to identify low-value, unnecessary, or harmful cancer practices that are frequently used on the African continent. The aim of this work was to use physicians and patient advocates to identify a short list of low-value practices that are frequently used in African low- and middle-income countries. METHODS The CWA Task Force was convened by the African Organization for Research and Training in Cancer and included representatives from surgical, medical, and radiation oncology, the private and public sectors, and patient advocacy groups. Consensus was built through a modified Delphi process, shortening a long list of practices to a short list, and then to a final list. A voting threshold of ≥ 60% was used to include an individual practice on the short list. A consensus was reached after a series of teleconferences and voting processes. RESULTS Of the 10 practices on the final list, one is a new suggestion and 9 are revisions or adaptations of practices from previous CW campaign lists. One item relates to palliative care, 8 concern treatment, and one relates to surveillance. CONCLUSION The CWA initiative has identified 10 low-value, common interventions in Africa’s cancer practice. The success of this campaign will be measured by how the recommendations are implemented across sub-Saharan Africa and whether this improves the delivery of high-quality cancer care.
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Affiliation(s)
- Fidel Rubagumya
- Rwanda Military Hospital, Kigali, Rwanda.,University of Global Health Equity, Burera, Rwanda
| | | | - Sidy Ka
- Joliot Curie Cancer Institute, Dakar, Senegal
| | | | | | | | | | | | | | | | | | - Dafalla Abuidris
- National Cancer Institute, University of Geriza, Wad Madani, Sudan
| | | | - Christopher M Booth
- Kingston Health Science Center, Queen's University, Kingston, Ontario, Canada
| | - Nazik Hammad
- Kingston Health Science Center, Queen's University, Kingston, Ontario, Canada
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Rascon J, Salasevicius L, Rutkauskiene G, Bien E, Vincerzevskiene I. The impact of incomplete registration on survival rate of children with very rare tumors. Sci Rep 2021; 11:14066. [PMID: 34234275 PMCID: PMC8263601 DOI: 10.1038/s41598-021-93670-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2020] [Accepted: 06/23/2021] [Indexed: 11/23/2022] Open
Abstract
Pediatric very rare tumors (VRTs) represent a heterogeneous subset of childhood cancers, with reliable survival estimates depending dramatically on each (un)registered case. The current study aimed to evaluate the number of VRTs among Lithuanian children, to assess the impact of the registration status on survival rates and to track changes in treatment outcomes over the 16-year study period. We performed a population-based retrospective study across children below 18 years old diagnosed with VRTs in Lithuania between the years 2000 and 2015. The identified cases were cross-checked with the Lithuanian Cancer Registry—a population-based epidemiology cancer registry—for the fact of registration and survival status. The overall survival was calculated in relation to the registration status and treatment period. Thirty-seven children with VRTs were identified within the defined time frame. Six of them (16.2%) were not reported to the Lithuanian Cancer Registry at diagnosis. The probability of overall survival at 5 years (OS5y) differed significantly between the registered (n = 31) and unregistered (n = 6) cohorts: 51.6% versus 100%, respectively (p = 0.049). A 5-year survival estimate for children diagnosed with a VRT at the age of 0–14 years differed by 10 percentage points according to the registration completeness: 52.1% calculated for the entire cohort versus 42.1% for registered patients only. The OS5y has not improved over the analyzed period: 61.1% in 2000–2007 versus 57.9% in 2008–2015 (p = 0.805). The survival continued to decline beyond 5 years post-diagnosis due to late cancer-related adverse events: 59.5% of patients were alive at 5 years as compared to 44.3% at 10 years. The OS5y of children affected by VRT was lower than in more common childhood cancers. The survival rate of the unregistered patients may lead to misinterpretation of treatment outcomes. Meticulous registration of VRTs is crucial for correct evaluation of treatment outcomes, especially across small countries with few cases.
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Affiliation(s)
- Jelena Rascon
- Center for Pediatric Oncology and Hematology, Vilnius University Hospital Santaros Klinikos, Santariškių 4, 08406, Vilnius, Lithuania. .,Faculty of Medicine, Vilnius University, M. K. Čiurlionio 21/27, 03101, Vilnius, Lithuania.
| | - Lukas Salasevicius
- Faculty of Medicine, Vilnius University, M. K. Čiurlionio 21/27, 03101, Vilnius, Lithuania
| | - Giedre Rutkauskiene
- Lithuanian University of Health Sciences, A. Mickevičiaus 9, 44307, Kaunas, Lithuania
| | - Ewa Bien
- Department of Pediatrics, Hematology and Oncology, Medical University of Gdansk, 7 Debinki Street; 80-211, Gdansk, Poland
| | - Ieva Vincerzevskiene
- National Cancer Institute, Cancer Registry, Santariškių 1, 08660, Vilnius, Lithuania
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30
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Edney LC, Gray J, Karnon J. A scoping review of the economics of multidisciplinary teams in oncology care. J Cancer Policy 2020. [DOI: 10.1016/j.jcpo.2020.100257] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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31
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Alizadehasl A, Amin A, Maleki M, Noohi F, Ghavamzadeh A, Farrashi M. Cardio-oncology discipline: focus on the necessities in developing countries. ESC Heart Fail 2020; 7:2175-2183. [PMID: 32602665 PMCID: PMC7524122 DOI: 10.1002/ehf2.12838] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Revised: 05/17/2020] [Accepted: 05/29/2020] [Indexed: 01/04/2023] Open
Abstract
Cardiovascular diseases constitute one of the main aetiologies of mortality among patients with cancer. Population ageing and cancer survival rate improvements have resulted in the coexistence of cardiovascular diseases and malignancies in an increasing number of patients. With the diversity in treatments and the introduction of new drug lines, multiple mechanisms of cardiovascular injury have been recognized in these patients. Cardio-oncology is an emerging entity introduced to provide a proper solution to the several challenges encountered in the management of patients with cancer and cardiac involvement. This review will assess the logical grounds for establishing a cardio-oncology unit, describe the main objectives and the detailed responsibilities in such systems, and outline the target population. Furthermore, the importance of research and appropriate data collection will be highlighted. Lastly, the special considerations and modifications required for setting up such centres in the developing countries are discussed.
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Affiliation(s)
- Azin Alizadehasl
- Cardio‐Oncology Research Center, Rajaie Cardiovascular Medical and Research CenterIran University of Medical SciencesTehranIran
| | - Ahmad Amin
- Rajaie Cardiovascular Medical and Research CenterIran University of Medical SciencesTehranIran
| | - Majid Maleki
- Echocardiography Research Center, Rajaie Cardiovascular Medical and Research CenterIran University of Medical SciencesTehranIran
| | - Feridoun Noohi
- Cardiovascular Intervention Research Center, Rajaie Cardiovascular Medical and Research CenterIran University of Medical SciencesTehranIran
| | - Ardeshir Ghavamzadeh
- Hematology, Oncology, and SCT Research CenterTehran University of Medical SciencesTehranIran
| | - Melody Farrashi
- Echocardiography Research Center, Rajaie Cardiovascular Medical and Research CenterIran University of Medical SciencesTehranIran
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32
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Reyes Veliz A, Gray J, Karnon J. Economics of multidisciplinary teams in oncology: a scoping review protocol. JBI Evid Synth 2020; 18:1285-1291. [PMID: 32813376 DOI: 10.11124/jbisrir-d-19-00103] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
OBJECTIVE The objective of this scoping review is to summarize the current literature on resource use, costs and economic evaluations of multidisciplinary teams in the field of oncology. INTRODUCTION Multidisciplinary teams are commonly considered best practice and are in widespread use in the field of oncology. However, multidisciplinary teams are expensive to provide, requiring significant clinician time and health care resources. Their effectiveness varies according to the type of cancer and stage of disease, and their cost-effectiveness has not been clearly established. INCLUSION CRITERIA Papers reporting on the costs of using multidisciplinary teams for the treatment of patients with cancer (at any age, level of care and in any country) will be included in the review. Costs may include the costs or resources used to provide the multidisciplinary teams (e.g. teleconference equipment, travel-time and clinician-time) or subsequent medical or non-medical costs of care. METHODS Databases, including PubMed, Embase, Cochrane Library, and the NHS Economic Evaluation Database (NHS EED), will be searched from inception. Citations and references of included studies will also be searched. Two reviewers will undertake title and abstract screening, followed by full text screening. Data extraction will be conducted using a customized form. Included studies will be summarized using narrative synthesis structured around intervention characteristics and the type of economic data presented. Additional narrative synthesis will be considered for specific subgroups (depending on numbers and variation).
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Affiliation(s)
- Amanda Reyes Veliz
- College of Medicine and Public Health, Flinders University, Adelaide, Australia
| | - Jodi Gray
- College of Medicine and Public Health, Flinders University, Adelaide, Australia.,Centre for Research Excellence in Implementation Science in Oncology, Macquarie University, Sydney, Australia
| | - Jonathan Karnon
- College of Medicine and Public Health, Flinders University, Adelaide, Australia
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Rankin NM, Fradgley EA, Barnes DJ. Implementation of lung cancer multidisciplinary teams: a review of evidence-practice gaps. Transl Lung Cancer Res 2020; 9:1667-1679. [PMID: 32953540 PMCID: PMC7481625 DOI: 10.21037/tlcr.2019.11.32] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Multidisciplinary care (MDC) is considered best practice in lung cancer care. Health care services have made significant investments in MDC through the establishment of multidisciplinary team (MDT) meetings. This investment is likely to be sustained in future. It is imperative that MDT meetings are efficient, effective, and sufficiently nimble to introduce new innovations to enable best practice. In this article, we consider the ‘evidence-practice gaps’ in the implementation of lung cancer MDC. These gaps were derived from the recurrent limitations outlined in existing studies and reviews. We address the contributions that implementation science and quality improvement can make to bridge these gaps by increasing translation and improving the uptake of innovations by teams.
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Affiliation(s)
- Nicole M Rankin
- Faculty of Medicine and Health Sciences, University of Sydney, Camperdown, New South Wales, Australia
| | - Elizabeth A Fradgley
- University of Newcastle Priority Research Centre for Cancer Research, Innovation and Translation, Callaghan, New South Wales, Australia.,University of Newcastle Priority Research Centre for Health Behaviour, Callaghan, New South Wales, Australia.,School of Medicine & Public Health, University Drive, Callaghan, New South Wales, Australia
| | - David J Barnes
- Faculty of Medicine and Health Sciences, University of Sydney, Camperdown, New South Wales, Australia.,Sydney Local Health District, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
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Bouaud J, Pelayo S, Lamy JB, Prebet C, Ngo C, Teixeira L, Guézennec G, Séroussi B. Implementation of an ontological reasoning to support the guideline-based management of primary breast cancer patients in the DESIREE project. Artif Intell Med 2020; 108:101922. [DOI: 10.1016/j.artmed.2020.101922] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Revised: 02/25/2020] [Accepted: 07/01/2020] [Indexed: 10/23/2022]
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Abstract
BACKGROUND Patients seeking second opinions are a challenge for the colorectal cancer provider because of complexity, failed therapeutic relationship with another provider, need for reassurance, and desire for exploration of treatment options. OBJECTIVE The purpose of this study was to describe the patient and treatment characteristics of patients seeking initial and second opinions in colorectal cancer care at a multidisciplinary colorectal cancer clinic. DESIGN This was a retrospective cohort study. SETTINGS A prospectively collected clinical registry of a multidisciplinary colorectal cancer clinic was included. PATIENTS The study included patients with colon or rectal cancer seen from 2012 to 2017. MAIN OUTCOME MEASURES Data were analyzed for initial versus second opinion and demographic and clinical characteristics. RESULTS Of 1711 patients with colorectal cancer, 1008 (58.9%) sought an initial opinion and 700 (40.9%) sought a second opinion. As compared with initial-opinion patients, second-opinion patients were more likely to have stage IV disease (OR = 1.94 (95% CI, 1.47-2.58)), recurrent disease (OR = 1.67 (95% CI, 1.13-2.46)), and be ages 40 to 49 years (OR = 1.47 (95% CI, 1.02-2.12)). Initial- and second-opinion cohorts were similar in terms of sex, race, and proportion of colon versus rectal cancer. Among second-opinion patients, 246 (35%) transitioned their care to the multidisciplinary colorectal cancer clinic. LIMITATIONS We were unable to capture the final treatment plan for those patients who did not transfer care to the multidisciplinary colorectal cancer clinic. CONCLUSIONS Patients seeking a second opinion represent a unique subset of patients with colorectal cancer. In general, they are younger and more likely to have stage IV or recurrent disease than patients seeking an initial opinion. Although transfer of care to a multidisciplinary colorectal cancer clinic after second opinion is lower than for initial consultations, multidisciplinary colorectal cancer clinics provide an important role for patients with complex disease characteristics and treatment needs. See Video Abstract at http://links.lww.com/DCR/B192. CARACTERíSTICAS DE LOS PACIENTES QUE BUSCAN UNA SEGUNDA OPINIóN EN CLíNICAS MULTIDISCIPLINARIAS ESPECIALIZADAS EN CáNCER COLORECTAL: Los pacientes que buscan una segunda opinión son un desafío para el médico que trata el cáncer colorrectal debido a la complejidad de la situación, a la relación terapéutica fallida con otro especialista, a la necesidad de tranquilidad y el deseo de explorar otras opciones del tratamiento.El describir las características y el tratamiento de los pacientes que buscan opiniones iniciales y secundarias en la atención del cáncer colorrectal en una clínica especializada de manera multidisciplinaria en cáncer colorrectal.Este es un estudio de cohortes retrospectivo.Registro clínico de casos obtenidos prospectivamente en una clínica especializada de manera multidisciplinaria en cáncer colorrectal.Todos aquellos pacientes con cáncer de colon o recto examinados entre 2012-2017.Se analizaron los datos obtenidos en la opinión inicial y se compararon con la segunda opinión, se revisaron tanto sus características demográficas como clínicas.De 1711 pacientes con cáncer colorrectal, 1008 (58.9%) buscaron una opinión inicial, 700 (40.9%) buscaron una segunda opinión. En comparación con los pacientes de opinión inicial, los pacientes de segunda opinión presentaron más probabilidades de tener enfermedad en estadio IV (OR 1.94, IC 95% 1.47-2.58), enfermedad recurrente (OR 1.67, IC 95% 1.13-2.46) y tener edades entre 40 y 49 (O 1.47, IC 95% 1.02-2.12). Las cohortes iniciales y de segunda opinión fueron similares en términos de género, raza y proporción del cáncer de colon versus cáncer de recto. Entre los pacientes de segunda opinión, 246 (35%) transfirieron su tratamiento hacia una clínica multidisplinaria especializada en cáncer colorrectal.No se obtuvieron los planes del tratamiento final de aquellos pacientes que no transfirieron sus cuidados hacia una la clínica especializada en cáncer colorrectal.Los pacientes que buscan una segunda opinión representan un subconjunto único de personas con cáncer colorrectal. En general, son más jóvenes y tienen más probabilidades de tener enfermedad en estadio IV o recurrente, con relación a aquellos pacientes que buscan una opinión inicial. Aunque la transferencia de los cuidados hacia una clínica multidisciplinaria especializada en cáncer colorrectal después de una segunda opinión es menor que para las consultas iniciales. Las clínicas multidisciplinarias especializadas en cáncer colorrectal juegan un papel importante con los pacientes que tienen características complejas de enfermedad y necesidades particulares en el tratamiento. Consulte Video Resumen en http://links.lww.com/DCR/B192. (Traducción-Dr Xavier Delgadillo).
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Ding PQ, Batra A, Xu Y, McKinnon GP, Cheung WY. Obesity and Its Impact on Outcomes in Patients With Stage III Colon Cancer Receiving Adjuvant Chemotherapy. Clin Colorectal Cancer 2020; 19:209-218. [PMID: 32291245 DOI: 10.1016/j.clcc.2020.02.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Revised: 02/11/2020] [Accepted: 02/17/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Even though obesity is a well-established risk factor for developing colon cancer, its prognostic value is not very well understood. The present study elucidated the effect of obesity, as measured by the body mass index (BMI) and body surface area (BSA), on colon cancer outcomes. PATIENTS AND METHODS Patients with a diagnosis of stage III colon cancer from 2011 to 2016 who had undergone adjuvant chemotherapy in Alberta, Canada were identified. The demographic variables, treatment characteristics, and survival data were collected from the electronic medical records. Obesity was defined using the BMI in accordance with the World Health Organization criteria, and BSA was categorized as ≤ 2.0 m2 (low) and > 2.0 m2 (high). The effect of BMI and BSA on 5-year cancer-specific survival (CSS) and overall survival (OS) was analyzed using univariate and multivariate analysis. RESULTS A total of 915 patients were identified with a median age of 64 years. Of these, 37% were overweight or obese, and the BSA was high in 42% of the patients. The survival outcomes for the obese and underweight patients were not significantly different from those with a normal BMI (P = .61 and P = .30 for OS and CSS, respectively). Similarly, no correlation was found between BSA and OS or CSS. Although 21% of patients experienced a > 10-week delay in receiving adjuvant chemotherapy, neither BMI nor BSA correlated significantly with chemotherapy timing (P = .45). CONCLUSIONS Our results suggest that BMI and BSA do not correlate with survival outcomes in patients with stage III colon cancer. The role of a healthy lifestyle in an improved colon cancer prognosis might not be driven by its effects on obesity.
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Affiliation(s)
- Philip Q Ding
- Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada; Department of Molecular Genetics, Faculty of Medicine, University of Toronto, Toronto, ON, Canada; Tom Baker Cancer Centre, Alberta Health Services, Calgary, AB, Canada.
| | - Atul Batra
- Tom Baker Cancer Centre, Alberta Health Services, Calgary, AB, Canada; Department of Oncology, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Yuan Xu
- Department of Oncology, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada; Department of Surgery, Foothills Medical Centre, University of Calgary, Calgary, AB, Canada; Department of Community Health Science, Foothills Medical Centre, University of Calgary, Calgary, AB, Canada
| | | | - Winson Y Cheung
- Tom Baker Cancer Centre, Alberta Health Services, Calgary, AB, Canada; Department of Oncology, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
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Abstract
BACKGROUND The organization of psychosocial care is rather complex, and its provision diverse. Access is affected by the acceptance and attitude of patients and professional caregivers toward psychosocial care. OBJECTIVES The aims of this study were to examine when patients with cancer experience quality psychosocial care and to identify circumstances in collaboration that contribute to patient-perceived positive psychosocial care. METHODS This study used a qualitative design in which semistructured interviews were conducted with patients, hospital workers, and primary health professionals. RESULTS Psychosocial care is often requested but also refused by patients with cancer. Based on this discrepancy, a distinction is made between psychosocial support and psychosocial interventions. Psychosocial support aims to reduce the chaos in patients' lives caused by cancer and is not shunned by patients. Psychosocial interventions comprise the formal care offered in response to psychosocial problems. Numerous patients are reluctant to use psychosocial interventions, which are often provided by psychologists. CONCLUSION Psychosocial care aims to assist patients in bearing the difficulties of cancer and its treatment. Patients prefer informal support, given often in conjunction with physical care. IMPLICATIONS FOR PRACTICE This study confirms the important role of nurses in promoting psychosocial care. Patients perceive much support from nurses, although nurses are not considered to be professional psychosocial caregivers. Being perceived as approachable and trustworthy offers nurses a significant opportunity to bring more intense psychosocial interventions within reach of cancer patients.
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Rai Y, Zheng S, Chappell H, Pulandiran M, Jones J. Kidney cancer survivorship care: Patient experiences in a Canadian setting. Can Urol Assoc J 2019; 14:E560-E567. [PMID: 32520710 DOI: 10.5489/cuaj.6217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
INTRODUCTION The incidence of kidney cancer (KCa) in Canada is rising. Despite this, there is a shortage of research assessing KCa care experiences. This study aims to explore the current experiences of KCa survivors related to treatment and management, information provision, and barriers to care. METHODS A cross-sectional, descriptive study of KCa patients was conducted online and through various cancer centers across Canada. English- and French-speaking adults who received a KCa diagnosis and were currently undergoing treatment or had completed treatment in Canada were eligible to participate. RESULTS In total, 368 surveys were completed. Ten percent of respondents had not yet received treatment, 29% were receiving treatment, and 56% had completed treatment. Most respondents (72%) had localized KCa (stage 0-3) at diagnosis. Sixty-one percent of respondents reported that their doctors discussed various treatment options with them and 24% reported discussing applicable clinical trials. Most (85%) respondents received information about their KCa and 36% discussed where to get information about their disease and support. The most commonly reported barriers to care were side effects (26%), system delays (26%), not having access to certain treatments (25%), and financial burden (24%). More participants in Central Region and Quebec (p=0.004) and rural/suburban (p=0.014) areas reported lacking access to certain treatments and KCa experts. CONCLUSIONS This was the first large-scale study to explore access to care experiences of Canadian KCa survivors. Results show examples of good patient-centered care and provide new practical information that can inform efforts to improve patient-centered care for KCa patients.
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Affiliation(s)
- Yeshith Rai
- Faculty of Medicine, University of Toronto, Toronto, ON, Canada.,Cancer Rehabilitation and Survivorship Program, Princess Margaret Cancer Centre (University Health Network), Toronto, ON, Canada
| | - Shiyu Zheng
- Faculty of Medicine, University of Toronto, Toronto, ON, Canada.,Cancer Rehabilitation and Survivorship Program, Princess Margaret Cancer Centre (University Health Network), Toronto, ON, Canada
| | | | - Menaka Pulandiran
- Clinical Research Support Systems, University Health Network, Toronto, ON, Canada
| | - Jennifer Jones
- Cancer Rehabilitation and Survivorship Program, Princess Margaret Cancer Centre (University Health Network), Toronto, ON, Canada
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Walraven J, Desar I, Hoeven van der J, Aben K, Hillegersberg van R, Rasch C, Lemmens V, Verhoeven R. Analysis of 105.000 patients with cancer: have they been discussed in oncologic multidisciplinary team meetings? A nationwide population-based study in the Netherlands. Eur J Cancer 2019; 121:85-93. [DOI: 10.1016/j.ejca.2019.08.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Revised: 08/14/2019] [Accepted: 08/14/2019] [Indexed: 12/24/2022]
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Pramesh CS, Chaturvedi H, Reddy VA, Saikia T, Ghoshal S, Pandit M, Babu KG, Ganpathy KV, Savant D, Mitera G, Sullivan R, Booth CM. Choosing Wisely India: ten low-value or harmful practices that should be avoided in cancer care. Lancet Oncol 2019; 20:e218-e223. [PMID: 30857957 DOI: 10.1016/s1470-2045(19)30092-0] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Revised: 01/28/2019] [Accepted: 01/29/2019] [Indexed: 12/14/2022]
Abstract
The Choosing Wisely India campaign was an initiative that was established to identify low-value or potentially harmful practices that are relevant to the Indian cancer health-care system. We undertook a multidisciplinary framework-driven consensus process to identify a list of low-value or harmful cancer practices that are frequently undertaken in India. A task force convened by the National Cancer Grid of India included Indian representatives from surgical, medical, and radiation oncology. Each specialty had representation from the private and public sectors. The task force included two representatives from national patient and patient advocacy groups. Of the ten practices that were identified, four are completely new recommendations, and six are revisions or adaptations from previous Choosing Wisely USA and Canada lists. Recommendations in the final list pertain to diagnosis and treatment (five practices), palliative care (two practices), imaging (two practices), and system-level delivery of care (two practices). Implementation of this list and reporting of concordance with its recommendations will facilitate the delivery of high-quality, value-based cancer care in India.
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Affiliation(s)
- C S Pramesh
- Department of Surgical Oncology, Tata Memorial Centre, Mumbai, India.
| | | | - Vijay Anand Reddy
- Department of Radiation Oncology, Apollo Hospitals, Hyderabad, India
| | - Tapan Saikia
- Department of Medical Oncology, Prince Aly Khan Hospital, Mumbai, India
| | - Sushmita Ghoshal
- Department of Radiation Oncology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | | | - K Govind Babu
- Department of Medical Oncology, Kidwai Memorial Institute of Oncology, Bengaluru, India
| | - K V Ganpathy
- Jeet Association for Support to Cancer Patients, Mumbai, India
| | | | - Gunita Mitera
- Department of Health Policy, Management and Evaluation, University of Toronto, Canada
| | - Richard Sullivan
- Institute of Cancer Policy, King's College London, and King's Health Partners Comprehensive Cancer Centre, London, UK
| | - Christopher M Booth
- Department of Cancer Care and Epidemiology, Queen's University Cancer Research Institute, Kingston, ON, Canada
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Wakeam E, Odell D, Samson P. Measuring the quality of multi-disciplinary thoracic oncology care. J Thorac Dis 2019; 11:S562-S565. [PMID: 31032074 PMCID: PMC6465433 DOI: 10.21037/jtd.2019.02.72] [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: 11/08/2018] [Accepted: 02/25/2019] [Indexed: 11/06/2022]
Abstract
As a result of the rapid acceleration in new treatment advances in thoracic oncology, coordination and tailored selection of treatment modalities has become complex. This increasing complexity mandates multidisciplinary input and coordinated management. However, quality of care in the domain of multidisciplinary thoracic oncology has yet to be purposefully defined, and as a result the science of performance measurement has yet to be applied to this area. In this review we discuss the role of multi-disciplinary care in thoracic oncology, and outline its definitions as proposed in the literature. We review various metrics of quality in complex multidisciplinary thoracic oncology care, and future directions for quality and performance measurement.
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Affiliation(s)
- Elliot Wakeam
- Division of Thoracic Surgery, Toronto General Hospital, University of Toronto, Toronto, ON, Canada
| | - David Odell
- Division of Thoracic Surgery, Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine. Chicago, IL, USA
- Surgical Outcomes and Quality Improvement Center, Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine. Chicago, IL, USA
| | - Pamela Samson
- Department of Radiation Oncology, Washington University in St. Louis, St. Louis, MO, USA
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Corter AL, Speller B, Wright FC, Quan ML, Baxter NN. Taking the pulse of multidisciplinary cancer conferences for breast cancer care in Canada: A stocktake of current practice. Breast 2019; 44:101-107. [PMID: 30711773 DOI: 10.1016/j.breast.2019.01.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2018] [Revised: 01/15/2019] [Accepted: 01/24/2019] [Indexed: 12/24/2022] Open
Abstract
AIM International guidelines highlight the importance of implementation supports and quality monitoring of multidisciplinary care for breast cancer. In Canada, Ontario has standards for formal multidisciplinary cancer conferences (MCCs), but other provinces/territories do not. This study aimed to stocktake MCCs for breast cancer in Canadian sites participating in the RUBY cohort study (Reducing the Burden of Breast Cancer in Young Women) to better understand variations in multidisciplinary care across Canada and to add to the international literature. METHODS A cross-sectional survey was conducted with surgeons and surgical oncologists representing 34 clinical centres participating in RUBY. Questions were grouped according to: type of multidisciplinary care, implementation, function, practice, participation and presentation, operation, and demographics, and included a mix of Likert-based, tick box and open-ended questions. RESULTS Twenty-two responses (65%) were received. 91% of respondents reported that formal MCCs are part of regular practice. However, variation exists in the supports in place for ongoing implementation of MCCs, the understanding of the functions of MCCs, and the patients presented for discussion. Results also suggest less formalized processes for MCC in provinces without practice standards. CONCLUSIONS Response differences between Ontario and elsewhere suggest that standards for MCC and supports for their implementation make a positive difference in their operation. However, ongoing operational challenges and issues with attendance exist for all sites and suggest that along with development of practice standards, incentives for participation and further education on benefits and function of MCC may support uptake of MCCs in clinical practice.
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Affiliation(s)
- A L Corter
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, 30 Bond St, Toronto, M5B 1W8, Canada.
| | - B Speller
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, 30 Bond St, Toronto, M5B 1W8, Canada.
| | - F C Wright
- Department of Surgery, Sunnybrook Hospital, 2075 Bayview Ave T2-057, Toronto, ON, M4N 3M5, Canada.
| | - M L Quan
- Department of Surgery, Foothills Medical Centre, 1403 29 St NW, Calgary, AB, T2N 2T9, Canada.
| | - N N Baxter
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, 30 Bond St, Toronto, M5B 1W8, Canada; Dalla Lana School of Public Health, University of Toronto, 155 College ST, Toronto, ON, M5T 3M7, Canada; Division of General Surgery, Department of Surgery, University of Toronto, 149 College St, Toronto, M5T 1P5, Canada.
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Oberst S. Bridging research and clinical care - the comprehensive cancer centre. Mol Oncol 2019; 13:614-618. [PMID: 30628155 PMCID: PMC6396367 DOI: 10.1002/1878-0261.12442] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Revised: 12/14/2018] [Accepted: 12/21/2018] [Indexed: 12/29/2022] Open
Abstract
Comprehensive cancer centres (CCCs) are at the heart of the landscape of cancer research, education and care in Europe. They are vital hubs where the historic gaps in the research to clinical care continuum are bridged. CCCs have established hallmarks, but a greater emphasis is needed in Europe to create more effective CCCs using the partnership model of university medical centres and university research departments and institutes. This review will summarise the organisational structures and processes essential for producing quality outcomes for patients and effectiveness in the translational process. The Organisation of European Cancer Institutes and European Academy of Cancer Sciences have established complementary quality accreditations systems to test the clinical and research excellence of CCCs. The EU should have an ambition to create more CCCs based on university hospitals, for each 5-10 million population and in every Member State.
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Kreyer J, Ranft A, Timmermann B, Juergens H, Jung S, Wiebe K, Boelling T, Schuck A, Vieth V, Streitbuerger A, Hardes J, Heinemann M, Dirksen U. Impact of the Interdisciplinary Tumor Board of the Cooperative Ewing Sarcoma Study Group on local therapy and overall survival of Ewing sarcoma patients after induction therapy. Pediatr Blood Cancer 2018; 65:e27384. [PMID: 30084137 DOI: 10.1002/pbc.27384] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2018] [Revised: 06/18/2018] [Accepted: 07/06/2018] [Indexed: 11/06/2022]
Abstract
BACKGROUND The Interdisciplinary Tumor Board (ITB) of the Cooperative Ewing Sarcoma Study (CESS) Group was investigated to assess its impact on the overall survival (OAS) of Ewing sarcoma (EwS) patients. The ITB functions as a reference center for the international institutions participating in the clinical trials of the CESS group, but is also available internationally to patients who have not been treated within an appropriate clinical trial. The value of tumor boards in terms of benefit for the patients and the health care system in general is not well documented and is also the subject of controversial discussions. A review of the representative literature is included. METHODS Data were analyzed from 481 patients who had been registered into the European Ewing Tumor Working Initiative of National Groups (EURO E.W.I.N.G.-99) clinical trial via the CESS data center between 2006 and 2009; this included 331 patients with localized disease and another 150 individuals with metastases at diagnosis. Median follow-up time was 3.2 years. RESULTS Improved OAS was observed for patients with metastases who had received recommendations from the ITB compared with those who had not received recommendations. In patients with localized disease, a recommendation from the ITB had no influence on OAS. CONCLUSION As a reference center for a rare disease, recommendations from our ITB impacted local therapy and led to higher OAS in patients with metastatic disease. To our knowledge, this is the first analysis that examines the value of a reference tumor board on a rare disease.
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Affiliation(s)
- Justus Kreyer
- Department of Orthopaedic and Trauma Surgery, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Andreas Ranft
- Department of Pediatrics III, West German Cancer Centre, German Cancer Research Centre, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Beate Timmermann
- Particle Therapy Clinic at West German Proton Therapy Centre Essen, University Hospital, University of Duisburg-Essen, Essen, Germany
| | | | - Susanne Jung
- Oral and Maxillofacial Surgery Clinics, University Hospital Muenster, Muenster, Germany
| | - Karsten Wiebe
- Department of Cardiothoracic Surgery, University Hospital Muenster, Muenster, Germany
| | - Tobias Boelling
- Department Osnabrueck, Center for Radiotherapy Rheine-Osnabrueck, Osnabrueck, Germany
| | - Andreas Schuck
- Department of Radiotherapy and Radiation Oncology, Klinikum Ingolstadt, Ingolstadt, Germany
| | - Volker Vieth
- Department of Clinical Radiology, Klinikum Ibbenbüren, Ibbenbüren, Germany
| | - Arne Streitbuerger
- Department of Tumor Orthopedics and Sarcoma Surgery, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Jendrik Hardes
- Department of Tumor Orthopedics and Sarcoma Surgery, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Melina Heinemann
- Department of Internal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Uta Dirksen
- Department of Pediatrics III, West German Cancer Centre, German Cancer Research Centre, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
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Integration of oncology and palliative care: a Lancet Oncology Commission. Lancet Oncol 2018; 19:e588-e653. [DOI: 10.1016/s1470-2045(18)30415-7] [Citation(s) in RCA: 297] [Impact Index Per Article: 49.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2018] [Revised: 05/16/2018] [Accepted: 05/22/2018] [Indexed: 02/06/2023]
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Corter AL, Quan ML, Wright FL, Kennedy ED, Simunovic MR, Shao J, Baxter NN. Scoping clinicians' perspectives on pre-treatment multidisciplinary care for young women with breast cancer. J Multidiscip Healthc 2018; 11:547-555. [PMID: 30349286 PMCID: PMC6183552 DOI: 10.2147/jmdh.s173735] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Young women with breast cancer (YWBC) experience worse medical and psychosocial outcomes than their older counterparts. Early input from a multidisciplinary team via pre-treatment multidisciplinary cancer conferences (pMCCs) may be important for addressing the complex needs of YWBC. However, pMCCs are not common. This study has two parts: a survey and workshop aimed at assessing clinicians' perspectives on pMCCs, including the importance of pMCCs in the care of YWBC, as well as barriers to, and strategies for supporting their implementation. METHODS Survey results highlight variability across sites in the delivery of multidisciplinary care in general. However, both survey and workshop results emphasize clinicians' agreement on the importance of pMCCs and suggest that numerous practical and systems levels barriers be addressed before pMCCs can be implemented. CONCLUSIONS pMCCs have the potential to improve surgical treatment and psychosocial outcomes for YWBC. A combined practical and policy approach to their implementation, which sees extension of existing standards to include pMCCs, may support their adoption and subsequent audit practices to assess the effect of pMCCs on outcomes for YWBC.
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Affiliation(s)
- Arden L Corter
- Department of Surgery, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Canada,
| | - May Lynn Quan
- Department of Surgery and Oncology, University of Calgary, Calgary, Canada
| | | | - Erin D Kennedy
- Division of General Surgery, University Health Network, Mount Sinai Hospital, Toronto, Canada
| | | | - Juliet Shao
- Department of Surgery, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Canada,
| | - Nancy N Baxter
- Department of Surgery, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Canada,
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada,
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Outcomes of multidisciplinary treatment planning in US cancer care settings. Cancer 2018; 124:3656-3667. [DOI: 10.1002/cncr.31394] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2017] [Revised: 01/02/2018] [Accepted: 01/08/2018] [Indexed: 12/24/2022]
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Taggar AS, Martell K, Husain S, Peacock M, Sia M, Gotto G. Exposure to radiation and medical oncology training: A survey of Canadian urology residents and fellows. Can Urol Assoc J 2018; 12:321-325. [PMID: 29989919 DOI: 10.5489/cuaj.5147] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Residency experiences and teaching in oncology among urology residents are variable across Canada. We sought to identify how radiation and medical oncology concepts, as they pertain to genitourinary malignancies, are taught to urology residents. METHODS A total of 190 trainees enrolled in Canadian urology residency training programs were invited to participate in the study from January 2016 to June 2016. Participants completed an online questionnaire addressing the training they received. RESULTS The overall response rate was 32%. Twenty-three percent of respondents were in their fellowship year; 17%, 20%, 10%, 17%, and 12% were first-, second-, third-, fourth-, and fifth-year residents, respectively, with a median of four (range 1-9) respondents from each training program. Ninety-five percent of respondents had academic half-day (AHD) as part of their training that included radiotherapy (61%) and chemotherapy (51%) teaching. Most respondents indicated their main exposure to chemotherapy and radiation came from informal teaching in urology clinics. Twenty-nine percent and 41%, of participants had mandatory rotations in radiation and medical oncology, respectively. Only 6% of respondents used their voluntary elective time in these disciplines and most voluntary electives were of 1-2-week duration. Despite this, 90% of respondents preferred some mandatory radiation and medical oncology training. CONCLUSIONS Most of the limited exposure that urology residents have to medical and radiation oncology is through AHD or informal urology clinics, despite a desire among current urology trainees to have clinical exposure in these areas. Moving forward, urology residency programs should consider integrating medical and radiation oncology rotations into the residency program curriculum.
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Affiliation(s)
- Amandeep S Taggar
- Department of Radiation Oncology, Sunnybrook Odette Cancer Centre, University of Toronto, Toronto, ON, Canada
| | - Kevin Martell
- Department of Radiation Oncology, Tom Baker Cancer Centre, Calgary, AB, Canada
| | - Siraj Husain
- Department of Radiation Oncology, Tom Baker Cancer Centre, Calgary, AB, Canada
| | - Michael Peacock
- Department of Radiation Oncology, BC Cancer Agency, Vancouver, BC, Canada
| | - Michael Sia
- Department of Radiation Oncology, BC Cancer Agency, Vancouver, BC, Canada
| | - Geoffrey Gotto
- Department of Surgery, Division of Urology, University of Calgary, Calgary, AB, Canada
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Gagliardi A, Honein‐AbouHaidar G, Stuart‐McEwan T, Smylie J, Arnaout A, Seely J, Wright F, Dobrow M, Brouwers M, Bukhanov K, McCready D. How do the characteristics of breast cancer diagnostic assessment programmes influence service delivery: A mixed methods study. Eur J Cancer Care (Engl) 2018; 27:e12727. [PMID: 28639355 PMCID: PMC5900983 DOI: 10.1111/ecc.12727] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/16/2017] [Indexed: 12/01/2022]
Abstract
Diagnostic assessment programmes (DAPs) coordinate multidisciplinary teamwork (MDT), and improve wait times and patient satisfaction. No research has established optimal DAP design. This study explored how DAP characteristics influence service delivery. A mixed methods case study of four breast cancer DAPs was conducted including qualitative interviews with health-care providers and retrospective chart review. Data were integrated using multiple approaches. Twenty-three providers were interviewed; 411 medical records were reviewed. The number of visits and wait times from referral to diagnosis and consultation were lowest at a one-stop model. DAP characteristics (rural-remote region, human resources, referral volume, organisation of services, adherence to service delivery targets and one-stop model) may influence service delivery (number of visits, wait times). MDT, influenced by other DAP characteristics (co-location of staff, patient navigators, team functioning), may also influence service delivery. While the one-stop model may be ideal, all sites experienced similar and unique challenges. Further research is needed to understand how to optimise the organisation and delivery of DAP services. Measures reflecting individual, team and patient-reported outcomes should be used to assess the effectiveness and impact of DAPs in addition to more traditional measures such as wait times.
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Affiliation(s)
| | | | | | | | | | | | - F.C. Wright
- Sunnybrook Health Sciences CentreTorontoCanada
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Guttmann DM, Kobie J, Grover S, Lin A, Lukens JN, Mitra N, Rhodes KV, Feng W, Swisher-McClure S. National disparities in treatment package time for resected locally advanced head and neck cancer and impact on overall survival. Head Neck 2018; 40:1147-1155. [PMID: 29394465 DOI: 10.1002/hed.25091] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2017] [Revised: 10/05/2017] [Accepted: 12/20/2017] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND The purpose of this study was to determine national disparities in head and neck cancer treatment package time (the time interval from surgery through the completion of radiation) and the associated impact on survival. METHODS We conducted an observational cohort study using the National Cancer Database of 15 234 patients with resected head and neck cancer who underwent adjuvant radiotherapy from 2004-2012. Predictors of prolonged package time were identified by multivariable linear regression. Survival outcomes were assessed using a multivariable Cox model. RESULTS Mean package time was 100 days (SD 23). Package time was 7.52 days (95% confidence interval [CI] 6.23-8.81; P < .001) longer with Medicaid versus commercial insurance. Low income and African American race also predicted for longer package times. All-cause mortality increased an average of 4% with each 1 week increase in treatment package time (hazard ratio [HR] 1.04; 95% CI 1.03-1.05; P < .001). CONCLUSION Significant national socioeconomic disparities exist in treatment package time. Treatment delays in this setting may contribute to worse survival outcomes.
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Affiliation(s)
- David M Guttmann
- Department of Radiation Oncology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Julie Kobie
- Department of Biostatistics and Epidemiology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Surbhi Grover
- Department of Radiation Oncology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Alexander Lin
- Department of Radiation Oncology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - John N Lukens
- Department of Radiation Oncology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Nandita Mitra
- Department of Biostatistics and Epidemiology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Karin V Rhodes
- Department of Emergency Medicine, Hofstra Northwell Medical School, Hempstead, New York.,Department of Psychiatry and Leonard Davis Institute of Health Economics University of Pennsylvania, Philadelphia, Pennsylvania
| | - Weiwei Feng
- Department of Biostatistics and Epidemiology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Samuel Swisher-McClure
- Department of Radiation Oncology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
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