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Iranifard E, Ebrahimzadeh Zagami S, Amirian M, Ebrahimipour H, Latifnejad Roudsari R. A systematic review of assisted and third-party reproduction guidelines regarding management and care of donors. Reprod Health 2024; 21:75. [PMID: 38824591 PMCID: PMC11143578 DOI: 10.1186/s12978-024-01804-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2024] [Accepted: 05/01/2024] [Indexed: 06/03/2024] Open
Abstract
BACKGROUND Gamete and embryo donors face complex challenges affecting their health and quality of life. Healthcare providers need access to well-structured, evidence-based, and needs-based guidance to care for gamete and embryo donors. Therefore, this systematic review aimed to synthesize current assisted and third-party reproduction guidelines regarding management and care of donors. METHODS The databases of ISI, PubMed, Scopus, and websites of organizations related to the assisted reproduction were searched using the keywords of "third party reproduction", "gamete donation", "embryo donation", "guidelines", "committee opinion", and "best practice", without time limit up to July 2023. All the clinical or ethical guidelines and best practice statements regarding management and care for gamete and embryo donors written in the English language were included in the study. Quality assessment was carried using AGREE II tool. Included documents were reviewed and extracted data were narratively synthesized. RESULTS In this systematic review 14 related documents were reviewed of which eight were guidelines, three were practice codes and three were committee opinions. Five documents were developed in the United States, three in Canada, two in the United Kingdom, one in Australia, and one in Australia and New Zealand. Also, two guidelines developed by the European Society of Human Reproduction and Embryology were found. Management and care provided for donors were classified into four categories including screening, counseling, information provision, and ethical considerations. CONCLUSION While the current guidelines include some recommendations regarding the management and care of gamete/embryo donors in screening, counseling, information provision, and ethical considerations, nevertheless some shortcomings need to be addressed including donors' psychosocial needs, long-term effects of donation, donors' follow-up cares, and legal and human rights aspects of donation. Therefore, it is needed to conduct robust and well-designed research studies to fill the knowledge gap about gamete and embryo donors' needs, to inform current practices by developing evidence-based guidelines.
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Affiliation(s)
- Elnaz Iranifard
- Student Research Committee, Mashhad University of Medical Sciences, 9137913199, Mashhad, Iran
| | - Samira Ebrahimzadeh Zagami
- Nursing and Midwifery Care Research Center, Mashad University of Medical Sciences, 9177949025, Mashhad, Iran
- Department of Midwifery, School of Nursing and Midwifery, Mashhad University of Medical Sciences, 9137913199, Iran, Mashhad
| | - Malihe Amirian
- Department of Obstetrics and Gynecology, Fellowship of Infertility, School of Medicine, Milad Infertility Treatment Center of Mashhad, University of Medical Sciences, Mashhad, 9137913316, Iran
| | - Hossein Ebrahimipour
- Department of Health Economics and Management, School of Health, Mashhad University of Medical Sciences, 9196773113, Mashhad, Iran
- Health Sciences Research Center, Torbat Heydarieh University of Medical Sciences, 9519633787, Torbat heydarieh, Iran
| | - Robab Latifnejad Roudsari
- Nursing and Midwifery Care Research Center, Mashad University of Medical Sciences, 9177949025, Mashhad, Iran.
- Department of Midwifery, School of Nursing and Midwifery, Mashhad University of Medical Sciences, 9137913199, Iran, Mashhad.
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Grassi L, Watson M. Core-curriculum in psycho-oncology: Towards the certification of the psycho-oncologist profession. Psychooncology 2024; 33:e6285. [PMID: 38282216 DOI: 10.1002/pon.6285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2024]
Abstract
BACKGROUND Issues relating to certification of the Psycho-oncology profession require clarification in order to provide high quality comprehensive psychosocial care within oncology. We conducted a survey identifying existing training, professional registration requirements and accreditation programs, at national levels, for the specialty of psycho-oncology as well as the mandatory presence of this specialist in cancer teams. METHODS This survey was conducted within the International Psycho-Oncology Society Federation of psycho-oncology societies and included representatives of each national federated society and some countries not belonging to the Federation. Survey questions were emailed requesting specific details, from the registered contact person, for each country, about psycho-oncology training, professional registration and accreditation. RESULTS Of 43 countries contacted (34 Federated and 9 non-federated members), 39 replied and answered the questionnaire (90, 7%). Disparities were reported between countries, with details indicating differences from having no national program, to quite detailed and legally accredited requirements. The majority of countries had no formally recognized profession of "Psycho-oncologist," while some countries reported that it is mandatory (or recommended to have) a specialist in psycho-oncology in cancer centers and, thus, that an accredited, nationally recognized and certified training in this specialty exists. CONCLUSIONS The study underlines the need to create a curriculum for the specialty (certification and accreditation) for the profession of psycho-oncology. Given the lack of internationally recognized core standards, ideas and proposals for minimum standards of good care and the training required to deliver this, are explored to clarify who may use the designation "Clinical Psycho-oncologist."
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Affiliation(s)
- Luigi Grassi
- Department of Neuroscience and Rehabilitation, Institute of Psychiatry, University of Ferrara, Ferrara, Italy
- University Hospital Psychiatry Section, Integrated Department of Mental Health, S. Anna and Local Health Trust, Ferrara, Italy
| | - Maggie Watson
- Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
- Onco-Genetics, Genetics and Epidemiology, Institute of Cancer Research, Sutton, UK
- Research and Innovation, University of Southern Queensland, Toowoomba, Queensland, Australia
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Markowitz JC, Hellerstein DJ, Falabella G, Lan M, Levenson J, Crew KD, Hershman DL. Psychopharmaphobia: Elevated fear of antidepressant medication among patients with major depression and breast cancer. Gen Hosp Psychiatry 2023; 83:117-122. [PMID: 37172545 DOI: 10.1016/j.genhosppsych.2023.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Revised: 05/02/2023] [Accepted: 05/03/2023] [Indexed: 05/15/2023]
Affiliation(s)
- John C Markowitz
- Columbia University Vagelos College of Physicians & Surgeons, New York, USA; New York State Psychiatric Institute, New York, USA.
| | - David J Hellerstein
- Columbia University Vagelos College of Physicians & Surgeons, New York, USA; New York State Psychiatric Institute, New York, USA
| | | | - Martin Lan
- Columbia University Vagelos College of Physicians & Surgeons, New York, USA; New York State Psychiatric Institute, New York, USA
| | - Jon Levenson
- Columbia University Vagelos College of Physicians & Surgeons, New York, USA
| | - Katherine D Crew
- Columbia University Vagelos College of Physicians & Surgeons, New York, USA
| | - Dawn L Hershman
- Columbia University Vagelos College of Physicians & Surgeons, New York, USA
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Hansen M, Schiele K, Schear RM, Richardson RN, Munoz RJ, Bourne G, Eckhardt SG, Kvale E. A comparative cohort study of gastrointestinal oncology patients: Impact of a shift to telehealth on delivery of interprofessional cancer care. J Telemed Telecare 2022:1357633X221122125. [PMID: 36071633 DOI: 10.1177/1357633x221122125] [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: 11/17/2022]
Abstract
Early studies of oncology visits performed via telehealth demonstrate patient and provider satisfaction; however, understanding of the impact of telehealth on clinic workflows is limited. The incorporation of telehealth visits into an interprofessional model of oncology care was evaluated to assess for changes in care delivery and patient engagement. New patients with a gastrointestinal cancer diagnosis who were actively undergoing treatment and followed for at least three months were divided into two cohorts based on telehealth utilization. Individual patient charts were reviewed by touchpoint, consisting of in-person visits, telehealth visits, phone calls, and patient portal messages. A total of 28 patient charts were analyzed, 11 pre-telehealth conventional care patients, and 17 telehealth patients. Telehealth cohort patients demonstrated an increased average number of total touchpoints when compared to the pre-telehealth cohort (p-value = 0.008) and had an increased number of patient portal and phone call touchpoints (p-value = 0.00 and 0.002). Telehealth provided more interactions between patients and providers demonstrating increased connectivity between a patient and their care team throughout their complex cancer journey. Clinic workflows may need to adjust to account for the increased demand of unscheduled patient interactions.
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Affiliation(s)
- Madison Hansen
- 377659Dell Medical School, The University of Texas at Austin, Austin, TX, USA
| | - Kristan Schiele
- 377659Dell Medical School, The University of Texas at Austin, Austin, TX, USA
| | - Rebekkah M Schear
- Livestrong Cancer Institutes, 377659Dell Medical School, The University of Texas at Austin, Austin, TX, USA
| | - Robin N Richardson
- Livestrong Cancer Institutes, 377659Dell Medical School, The University of Texas at Austin, Austin, TX, USA
| | - Rebecca J Munoz
- Robbins College of Health and Human Sciences, 303419Baylor University, Houston, TX, USA
| | - Garrett Bourne
- 377659Dell Medical School, The University of Texas at Austin, Austin, TX, USA
| | - S Gail Eckhardt
- Livestrong Cancer Institutes, 377659Dell Medical School, The University of Texas at Austin, Austin, TX, USA
| | - Elizabeth Kvale
- Livestrong Cancer Institutes, 377659Dell Medical School, The University of Texas at Austin, Austin, TX, USA
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Kusch M, Labouvie H, Schiewer V, Talalaev N, Cwik JC, Bussmann S, Vaganian L, Gerlach AL, Dresen A, Cecon N, Salm S, Krieger T, Pfaff H, Lemmen C, Derendorf L, Stock S, Samel C, Hagemeier A, Hellmich M, Leicher B, Hültenschmidt G, Swoboda J, Haas P, Arning A, Göttel A, Schwickerath K, Graeven U, Houwaart S, Kerek-Bodden H, Krebs S, Muth C, Hecker C, Reiser M, Mauch C, Benner J, Schmidt G, Karlowsky C, Vimalanandan G, Matyschik L, Galonska L, Francke A, Osborne K, Nestle U, Bäumer M, Schmitz K, Wolf J, Hallek M. Integrated, cross-sectoral psycho-oncology (isPO): a new form of care for newly diagnosed cancer patients in Germany. BMC Health Serv Res 2022; 22:543. [PMID: 35459202 PMCID: PMC9034572 DOI: 10.1186/s12913-022-07782-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Accepted: 03/15/2022] [Indexed: 11/15/2022] Open
Abstract
Background The annual incidence of new cancer cases has been increasing worldwide for many years, and is likely to continue to rise. In Germany, the number of new cancer cases is expected to increase by 20% until 2030. Half of all cancer patients experience significant emotional and psychosocial distress along the continuum of their disease, treatment, and aftercare, and also as long-term survivors. Consequently, in many countries, psycho-oncological programs have been developed to address this added burden at both the individual and population level. These programs promote the active engagement of patients in their cancer therapy, aftercare and survivorship planning and aim to improve the patients' quality of life. In Germany, the “new form of care isPO” (“nFC-isPO”; integrated, cross-sectoral psycho-oncology/integrierte, sektorenübergreifende Psycho-Onkologie) is currently being developed, implemented and evaluated. This approach strives to accomplish the goals devised in the National Cancer Plan by providing psycho-oncological care to all cancer patients according to their individual healthcare needs. The term “new form of care" is defined by the Innovation Fund (IF) of Germany's Federal Joint Committee as “a structured and legally binding cooperation between different professional groups and/or institutions in medical and non-medical care”. The nFC-isPO is part of the isPO project funded by the IF. It is implemented in four local cancer centres and is currently undergoing a continuous quality improvement process. As part of the isPO project the nFC-isPO is being evaluated by an independent institution: the Institute for Medical Sociology, Health Services Research, and Rehabilitation Science (IMVR), University of Cologne, Germany. The four-year isPO project was selected by the IF to be eligible for funding because it meets the requirements of the federal government's National Cancer Plan (NCP), in particular, the “further development of the oncological care structures and quality assurance" in the psycho-oncological domain. An independent evaluation is required by the IF to verify if the new form of care leads to an improvement in cross-sectoral care and to explore its potential for permanent integration into the German health care system. Methods The nFC-isPO consists of six components: a concept of care (C1), care pathways (C2), a psycho-oncological care network (C3), a care process organization plan (C4), an IT-supported documentation and assistance system (C5) and a quality management system (C6). The two components concept of care (C1) and care pathways (C2) represent the isPO clinical care program, according to which the individual cancer patients are offered psycho-oncological services within a period of 12 months after program enrolment following the diagnosis of cancer. The remaining components (C3-C6) represent the formal-administrative aspects of the nFC-isPO that are intended to meet the legally binding requirements of patient care in the German health care system. With the aim of systematic development of the nFC-isPO while at the same time enabling the external evaluators to examine its quality, effectiveness and efficiency under conditions of routine care, the project partners took into consideration approaches from translational psycho-oncology, practice-based health care research and program theory. In order to develop a structured, population-based isPO care program, reference was made to a specific program theory, to the stepped-care approach, and also to evidence-based guideline recommendations. Results The basic version, nFC-isPO, was created over the first year after the start of the isPO project in October 2017, and has since been subject to a continuous quality improvement process. In 2019, the nFC-isPO was implemented at four local psycho-oncological care networks in the federal state North Rhine-Westphalia, in Germany. The legal basis of the implementation is a contract for "special care" with the German statutory health insurance funds according to state law (§ 140a SCB V; Social Code Book V for the statutory health insurance funds). Besides the accompanying external evaluation by the IMVR, the nFC-isPO is subjected to quarterly internal and cross-network quality assurance and improvement measures (internal evaluation) in order to ensure continuous quality improvement process. These quality management measures are developed and tested in the isPO project and are to be retained in order to ensure the sustainability of the quality of nFC-isPO for later dissemination into the German health care system. Discussion Demands on quality, effectiveness and cost-effectiveness of in the German health care system are increasing, whereas financial resources are declining, especially for psychosocial services. At the same time, knowledge about evidence-based screening, assessment and intervention in cancer patients and about the provision of psychosocial oncological services is growing continuously. Due to the legal framework of the statutory health insurance in Germany, it has taken years to put sound psycho-oncological findings from research into practice. Ensuring the adequate and sustainable financing of a needs-oriented, psycho-oncological care approach for all newly diagnosed cancer patients, as required by the NCP, may still require many additional years. The aim of the isPO project is to develop a new form of psycho-oncological care for the individual and the population suffering from cancer, and to provide those responsible for German health policy with a sound basis for decision-making on the timely dissemination of psycho-oncological services in the German health care system. Trial registration The study was pre-registered at the German Clinical Trials Register (https://www.drks.de/DRKS00015326) under the following trial registration number: DRKS00015326; Date of registration: October 30, 2018.
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Affiliation(s)
- Michael Kusch
- Department of Internal Medicine I, Faculty of Medicine, Cologne University Hospital, University of Cologne, Cologne, Germany.
| | - Hildegard Labouvie
- Department of Internal Medicine I, Faculty of Medicine, Cologne University Hospital, University of Cologne, Cologne, Germany
| | - Vera Schiewer
- Department of Internal Medicine I, Faculty of Medicine, Cologne University Hospital, University of Cologne, Cologne, Germany
| | - Natalie Talalaev
- Department of Internal Medicine I, Faculty of Medicine, Cologne University Hospital, University of Cologne, Cologne, Germany
| | - Jan C Cwik
- Department of Clinical Psychology and Psychotherapy, Faculty of Human Sciences, University of Cologne, Cologne, Germany
| | - Sonja Bussmann
- Department of Clinical Psychology and Psychotherapy, Faculty of Human Sciences, University of Cologne, Cologne, Germany
| | - Lusine Vaganian
- Department of Clinical Psychology and Psychotherapy, Faculty of Human Sciences, University of Cologne, Cologne, Germany
| | - Alexander L Gerlach
- Department of Clinical Psychology and Psychotherapy, Faculty of Human Sciences, University of Cologne, Cologne, Germany
| | - Antje Dresen
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Institute of Medical Sociology Health Services Research, and Rehabilitation Science, Cologne, Germany
| | - Natalia Cecon
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Institute of Medical Sociology Health Services Research, and Rehabilitation Science, Cologne, Germany
| | - Sandra Salm
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Institute of Medical Sociology Health Services Research, and Rehabilitation Science, Cologne, Germany
| | - Theresia Krieger
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Institute of Medical Sociology Health Services Research, and Rehabilitation Science, Cologne, Germany
| | - Holger Pfaff
- University of Cologne, Faculty of Human Sciences & Faculty of Medicine and University Hospital Cologne, Institute of Medical Sociology Health Services Research, and Rehabilitation Science, Cologne, Germany
| | - Clarissa Lemmen
- Institute for Health Economics and Clinical Epidemiology (IGKE), Faculty of Medicine, University of Cologne, University Hospital Cologne, Cologne, Germany
| | - Lisa Derendorf
- Institute for Health Economics and Clinical Epidemiology (IGKE), Faculty of Medicine, University of Cologne, University Hospital Cologne, Cologne, Germany
| | - Stephanie Stock
- Institute for Health Economics and Clinical Epidemiology (IGKE), Faculty of Medicine, University of Cologne, University Hospital Cologne, Cologne, Germany
| | - Christina Samel
- Institute of Medical Statistics and Computational Biology, Faculty of Medicine, University of Cologne, Cologne, Germany
| | - Anna Hagemeier
- Institute of Medical Statistics and Computational Biology, Faculty of Medicine, University of Cologne, Cologne, Germany
| | - Martin Hellmich
- Institute of Medical Statistics and Computational Biology, Faculty of Medicine, University of Cologne, Cologne, Germany
| | - Bernd Leicher
- Department of Computer Science (Medical Informatics), University of Applied Sciences and Arts Dortmund, Dortmund, Germany
| | - Gregor Hültenschmidt
- Department of Computer Science (Medical Informatics), University of Applied Sciences and Arts Dortmund, Dortmund, Germany
| | - Jessica Swoboda
- Department of Computer Science (Medical Informatics), University of Applied Sciences and Arts Dortmund, Dortmund, Germany
| | - Peter Haas
- Department of Computer Science (Medical Informatics), University of Applied Sciences and Arts Dortmund, Dortmund, Germany
| | - Anna Arning
- Krebsgesellschaft Nordrhein-Westfalen E.V, Düsseldorf, Germany
| | - Andrea Göttel
- Krebsgesellschaft Nordrhein-Westfalen E.V, Düsseldorf, Germany
| | | | - Ullrich Graeven
- Krebsgesellschaft Nordrhein-Westfalen E.V, Düsseldorf, Germany
| | - Stefanie Houwaart
- House of the Cancer Patient Support Associations of Germany, Bonn, Germany
| | - Hedy Kerek-Bodden
- House of the Cancer Patient Support Associations of Germany, Bonn, Germany
| | - Steffen Krebs
- Department of Internal Medicine I, Faculty of Medicine, Cologne University Hospital, University of Cologne, Cologne, Germany
| | - Christiana Muth
- Department of Internal Medicine I, Faculty of Medicine, Cologne University Hospital, University of Cologne, Cologne, Germany
| | | | - Marcel Reiser
- PIOH Köln - Praxis Internistischer Onkologie Und Hämatologie, Cologne, Germany
| | - Cornelia Mauch
- Department of Internal Medicine I, Faculty of Medicine, Cologne University Hospital, University of Cologne, Cologne, Germany
| | | | | | | | | | | | | | | | | | | | | | | | - Jürgen Wolf
- Department of Internal Medicine I, Faculty of Medicine, Cologne University Hospital, University of Cologne, Cologne, Germany
| | - Michael Hallek
- Department of Internal Medicine I, Faculty of Medicine, Cologne University Hospital, University of Cologne, Cologne, Germany
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Lo SB, Conley CC, Brothers BM, Ryba MM, Frierson GF, Shelby RA, Thornton LM, Carpenter KM, Andersen BL. Replicating dissemination and identifying mechanisms of implementation of an empirically supported treatment. Health Psychol 2021; 40:450-458. [PMID: 34435796 DOI: 10.1037/hea0001094] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Implementation research is needed in cancer control. Replication of the dissemination of empirically supported treatments (ESTs) is important as is the identification of mechanisms by which dissemination leads to implementation. Addressing these gaps, Study 1 (Cohorts 3-6, N = 104) tests for replication of a successful dissemination to community providers (Brothers et al., 2015; Cohorts 1-2; N = 62) and Study 2 (Cohorts 1-6) tests providers' changes on dissemination outcomes as mechanisms of EST usage. METHOD The Biobehavioral Intervention (BBI), a psychological EST in cancer control, was disseminated to oncology mental health providers using manual provision, didactics, roleplays, and other strategies. Study 1 tested for pre/post changes in dissemination outcomes (BBI knowledge/skills and attitudes toward and self-efficacy to deliver ESTs/BBI) between cohorts (1-2 vs. 3-6) with repeated measures ANOVAs. In Study 2, the implementation outcome was providers' (N = 166) BBI usage with patients (percent treated). Structural equation models tested dissemination outcome changes as predictors of usage at 2- and 4-months. RESULTS Study 1 replicated high dissemination outcomes and significant gains in BBI knowledge (p < .001) in Cohorts 3-6. Unlike Cohorts 1-2, significant gains were observed in self-efficacy (ps < .001) but not attitudes toward ESTs (p = .523) in Cohorts 3-6. In Study 2, gains in providers' self-efficacy (ps < .05) and EST attitudes (p = .008) predicted greater 2-month (58.4% ± 35.5%) and 4-month (66.2% ± 35.0%) usage of the BBI with patients, respectively. CONCLUSIONS This is the only replication of a dissemination for a psychological EST in cancer control. Results reliably show disseminations enhancing providers' self-efficacy to use and positive attitudes toward ESTs as mechanisms for EST implementation. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
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Affiliation(s)
| | | | | | | | | | - Rebecca A Shelby
- Department of Psychiatry and Behavioral Sciences, Duke University
| | - Lisa M Thornton
- Department of Psychiatry and Behavioral Health, Ohio State University Wexner Medical Center
| | - Kristen M Carpenter
- Department of Psychiatry and Behavioral Health, Ohio State University Wexner Medical Center
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Polacek LC, Reisch S, Saracino RM, Pessin H, Breitbart W. Implementation of a Meaning-Centered Psychotherapy training (MCPT) program for oncology clinicians: a qualitative analysis of facilitators and barriers. Transl Behav Med 2021; 11:270-275. [PMID: 31595306 DOI: 10.1093/tbm/ibz138] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
The Meaning-Centered Psychotherapy training program (MCPT) is a multimodal, intensive, in-person program that trains cancer care providers in the evidence-based psychosocial treatment Meaning-Centered Psychotherapy (MCP). This analysis aimed to identify barriers and facilitators to clinical implementation (CI) at 1 year post-training. Trainee feedback regarding CI was collected via a mixed-methods questionnaire, including rating the ease of CI and free-text response identifying facilitators and barriers to CI. Descriptive statistics and thematic content analysis of follow-up data from the first five MCPT training cohorts (n = 55) were performed to assess CI and its facilitators and barriers. One third of participants indicated that it was at least somewhat difficult to implement MCP in clinical practice. Trainee-identified facilitators and barriers to CI were characterized within four main categories: program, patient, treatment, and institution. Within each of these factors, clinicians reported a variety of components that contributed to or hindered their ability to implement MCP. MCPT itself was reported as a facilitator. Patient access and interest were simultaneously identified as facilitators for some and barriers for others. Some trainees found the MCP treatment structure helpful in addressing important patient psychosocial needs, while others felt it was too restrictive. Institutional support played an important role in whether trainees felt hindered or helped to implement MCP. These initial results provide important insight into the program's strengths and have fostered improvements to the MCPT program to better facilitate CI. Further study of MCPT CI is warranted, and theme refinement will be possible with a larger sample.
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Affiliation(s)
- Laura C Polacek
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, USA.,Department of Psychology, Fordham University, Bronx, USA
| | - Sally Reisch
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, USA
| | - Rebecca M Saracino
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, USA
| | - Hayley Pessin
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, USA
| | - William Breitbart
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, USA
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Ryba MM, Lo SB, Andersen BL. Sustainability of a biobehavioral intervention implemented by therapists and sustainment in community settings. Transl Behav Med 2021; 11:96-103. [PMID: 31793633 DOI: 10.1093/tbm/ibz175] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
The ultimate aim of dissemination and implementation of empirically supported treatments (ESTs) in behavioral medicine is (a) sustainability of the therapist/provider's EST usage and (b) sustainment of EST delivery in the setting. Thus far, sustainability has been understudied, and the therapist and setting variables that may be influential are unclear. The purpose of the study was to test the therapists' sustainability of a cancer-specific EST using a prospective longitudinal design and examine its predictors. Oncology mental health therapists (N = 134) from diverse settings (N = 110) completed training in the biobehavioral intervention (BBI) and were provided with 6 months of support for implementation, with no support thereafter. BBI usage (percent of patients treated) was reported at 2, 4, 6, and 12 months. Using a generalized estimating equation with a logistic link function, 12-month sustainability (a nonsignificant change in usage from 6 to 12 months) was studied along with therapist, supervisor, and setting variables as predictors. BBI usage increased through 6 months and, importantly, usage was sustained from 6 (68.4% [95% CI = 62.2%-73.9%]) to 12 months (70.9% [95% CI = 63.6%-77.3%]), with sustainment in 66 settings (60.0%). Predictors of implementation-to-sustainability usage were therapists' early intentions to use the BBI (p < .001) and from the setting, supervisors' positive attitudes toward ESTs (p = .016). Adding to the DI literature, a health psychology intervention was disseminated, implemented, and found sustainable across diverse therapists and settings. Therapists and setting predictors of usage, if modified, might facilitate future sustainability/sustainment of ESTs.
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Affiliation(s)
- Marlena M Ryba
- Department of Psychology, Coastal Carolina University, Conway, SC, USA
| | - Stephen B Lo
- Department of Psychology, Ohio State University, Columbus, OH, USA
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Andersen BL, Dorfman CS, Conley CC. Achieving oncology mental health providers' usage of an empirically supported treatment: Lessons learned. Psychooncology 2021; 30:794-803. [PMID: 33966323 PMCID: PMC8210804 DOI: 10.1002/pon.5699] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 03/19/2021] [Accepted: 04/07/2021] [Indexed: 11/12/2022]
Abstract
OBJECTIVE There is a need for oncology mental health providers to receive training to use empirically supported psychological treatments (ESTs) with their patients. The purpose of this editorial is to describe "lessons learned" from disseminating-conducting EST trainings-and supporting providers' capacity and confidence to use the EST. METHOD Processes and outcomes from conducting six, 3-days (18 h) EST training institutes from 2012-2016 are discussed. Institutes trained 166 full time oncology mental health providers from more than 100 different settings. The dissemination was intentionally designed to achieve EST implementation, i.e., therapists' sustained usage of the EST for at least 12 months post training. RESULTS Previously published discussion and findings show the effort was successful in achieving positive EST dissemination outcomes and sustained EST implementation by providers. Thus, "lessons learned" include discussions of (1) orientation to design education/training to achieve EST usage using theory based aims and outcomes of training efficacy; (2) multimodal, educational strategies used to achieve therapists' positive attitudes toward and self-efficacy to implement the EST; (3) guidance to therapists for adapting the EST to their practice settings while maintaining fidelity; (4) assistance to therapists to identify and problem solve implementation challenges; and (5) using patient reported outcome measures to determine clinical change. CONCLUSION Our discussion of the plan, methods, and goals of EST training contributes to the science of dissemination/implementation by providing support for (1) theory-informed EST dissemination, and (2) mechanisms of EST implementation. For researchers, our experience may guide future EST dissemination/implementation efforts in psycho-oncology. For therapists, lessons learned provide criteria for evaluating future continuing education options.
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Affiliation(s)
| | - Caroline S. Dorfman
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, USA
| | - Claire C. Conley
- Department of Oncology, Georgetown University Medical Center, Washington, DC, USA
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10
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Dirkse D, Hadjistavropoulos HD, Alberts NA, Karin E, Schneider LH, Titov N, Dear BF. Making Internet-delivered cognitive behaviour therapy scalable for cancer survivors: a randomized non-inferiority trial of self-guided and technician-guided therapy. J Cancer Surviv 2020; 14:211-225. [PMID: 31853727 DOI: 10.1007/s11764-019-00810-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Accepted: 09/21/2019] [Indexed: 10/25/2022]
Abstract
PURPOSE To compare the effectiveness and acceptability of two low-intensity methods of offering a transdiagnostic Internet-delivered cognitive behaviour therapy (ICBT) intervention for treating symptoms of anxiety and depression among cancer survivors. METHODS Cancer survivors with symptoms of anxiety or depression (n = 86) were randomly assigned to receive a transdiagnostic ICBT programme (Wellbeing After Cancer) that was either guided by a technician (n = 42) or self-guided (n = 44). Measures of anxiety, depression, fear of cancer recurrence, and quality of life were completed at pre-treatment, post-treatment, and 4 weeks following treatment completion. RESULTS Large within-group effect sizes were observed on measures of depression, anxiety, and mental health-related quality of life (d range, 0.98-1.86) at post-treatment. Medium effects were found for reductions in fear of cancer recurrence (d range, 0.65-0.78). Non-inferiority was established for the primary outcome measures of anxiety and depression. All participants reported high satisfaction ratings of the programme; however, technician-guided participants were slightly more satisfied with their level of support (d = 0.57, p = .014). CONCLUSIONS The Wellbeing After Cancer Course was associated with improved levels of anxiety, depression, fear of cancer recurrence, and quality of life, regardless of how ICBT was offered. IMPLICATIONS FOR CANCER SURVIVORS ICBT is emerging as an accessible and effective treatment for depression, anxiety, and fear of cancer recurrence in cancer survivors. The success of non-therapist-guided options increases the potential scalability of ICBT, which is particularly valuable for cancer survivors from rural areas who have less access to mental health services.
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Affiliation(s)
- D Dirkse
- Department of Clinical Health Psychology, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, PZ 350 - 771 Bannatyne Avenue, Winnipeg, MB, R3E 3N4, Canada.
- Department of Psychology, University of Regina, 3737 Wascana Parkway, Regina, SK, S4S 0A2, Canada.
| | - H D Hadjistavropoulos
- Department of Psychology, University of Regina, 3737 Wascana Parkway, Regina, SK, S4S 0A2, Canada
| | - N A Alberts
- Department of Psychology, St. Jude Children's Research Hospital, 262 Danny Thomas Place, Memphis, TN, 38105-3678, USA
| | - E Karin
- eCentreClinic, Department of Psychology, Macquarie University, Sydney, Australia
| | - L H Schneider
- Department of Psychology, University of Regina, 3737 Wascana Parkway, Regina, SK, S4S 0A2, Canada
| | - N Titov
- eCentreClinic, Department of Psychology, Macquarie University, Sydney, Australia
| | - B F Dear
- eCentreClinic, Department of Psychology, Macquarie University, Sydney, Australia
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11
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Caruso R, Breitbart W. Mental health care in oncology. Contemporary perspective on the psychosocial burden of cancer and evidence-based interventions. Epidemiol Psychiatr Sci 2020; 29:e86. [PMID: 31915100 PMCID: PMC7214708 DOI: 10.1017/s2045796019000866] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Accepted: 11/30/2019] [Indexed: 12/18/2022] Open
Abstract
With cancer incidence increasing over time worldwide, attention to the burden of psychiatric and psychosocial consequences of the disease is now mandatory for both cancer and mental health care professionals. Psychiatric disorders have been shown to affect at least 30-35% of cancer patients during all phases of the disease trajectory, and differ in nature according to stage and type of cancer. Other clinically relevant distressing psychosocial and existential conditions (e.g. demoralisation, health anxiety, loss of meaning and existential distress) not included as 'disorders' in the usual diagnostic and nosological systems (i.e. meta-diagnostic conditions) have also been shown to be present in another 15-20% of cancer patients. In this editorial, we will present a summary of the extensive literature regarding the epidemiology of the several psychosocial disorders affecting cancer patients as a cause of distress and burden to be taken into consideration and addressed in cancer care through evidence-based intervention.
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Affiliation(s)
- R. Caruso
- Department of Biomedical and Specialty Surgical Sciences, Institute of Psychiatry, University of Ferrara, Ferrara, Italy
| | - W. Breitbart
- Department of Psychiatry & Behavioral Sciences, Jimmie C. Holland Chair in Psychiatric Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
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12
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An implementation science primer for psycho-oncology: translating robust evidence into practice. ACTA ACUST UNITED AC 2019. [DOI: 10.1097/or9.0000000000000014] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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13
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Ashmore JA, Ditterich KW, Conley CC, Wright MR, Howland PS, Huggins KL, Cooreman J, Andrews PS, Nicholas DR, Roberts L, Hewitt L, Scales JN, Delap JK, Gray CA, Tyler LA, Collins C, Whiting CM, Brothers BM, Ryba MM, Andersen BL. Evaluating the effectiveness and implementation of evidence-based treatment: A multisite hybrid design. AMERICAN PSYCHOLOGIST 2019; 74:459-473. [PMID: 30024215 PMCID: PMC6339615 DOI: 10.1037/amp0000309] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
The gap between treatment development and efficacy testing to scaled up implementations of evidence-based treatment (EBT) is an estimated 20 years, and hybrid research designs aim to reduce the gap. One was used for a multisite study in cancer control, testing coprimary aims: (a) determine the feasibility and utility of a flexible EBT implementation strategy and (b) determine the clinical effectiveness of an EBT as implemented by newly trained providers. Therapists from 15 diverse sites implemented the biobehavioral intervention (BBI) for cancer patients (N = 158) as part of standard care. For implementation, therapists determined treatment format, number of sessions, and so forth and reported session-by-session fidelity. Patients completed fidelity and outcome assessments. Results showed therapists BBI implementation was done with fidelity, for example, session "dose" (59%), core content coverage (60-70%), and others. Patient reported fidelity was favorable and comparable to the BBI efficacy trial. Effectiveness data show the primary outcome, patients' scores on the Profile of Mood States total mood disturbance, significantly improved (R² = 0.06, β = -0.24, p < .01) as did a secondary outcome, physical activity (R² = 0.02, β = 0.13, p < .05). This first use of a hybrid design in health psychology provided support for a novel strategy that allowed providers implementation flexibility. Still, the EBT was delivered with fidelity and in addition, therapists generated novel procedures to enhance setting-specific usage of BBI and its ultimate effectiveness with patients. This research is an example of translational research spanning theory and efficacy tests to dissemination and implementation. (PsycINFO Database Record (c) 2019 APA, all rights reserved).
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Affiliation(s)
| | - Kirk W. Ditterich
- Patient and Family Support Services, Tahoe Forest Cancer Center, Truckee, CA
| | | | | | | | | | - Jena Cooreman
- Department of Supportive Oncology, UC Davis Comprehensive Cancer Center, Davis, CA
| | | | - Donald R. Nicholas
- Department of Counseling Psychology, Social Psychology and Counseling, Ball State University, Muncie, IN
| | - Lind Roberts
- Providence St. John’s Cancer Center, Santa Monica, CA
| | - Larissa Hewitt
- Department of Pediatric Psychosocial Oncology, Dana Farber Cancer Institute, Boston, MA
| | - Joan N. Scales
- Psych-Oncology Services, University of Kentucky, Lexington, KY
| | - Jenny K. Delap
- Psych-Oncology Services, University of Kentucky, Lexington, KY
| | | | - Lynelle A. Tyler
- Patient and Family Support Services, Tahoe Forest Cancer Center, Truckee, CA
| | - Charlotte Collins
- Department of Adult Psychology and Behavioral Medicine, Geisinger Medical Center, Danville, PA
| | | | - Brittany M. Brothers
- Department of Psychological and Brain Sciences, Indiana University, Bloomington, IN
| | - Marlena M. Ryba
- Department of Psychology, Ohio State University, Columbus, OH
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14
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Wang D, Abrams M. Health Care Providers' Profiles and Evaluations of a Statewide Online Education Program for Dissemination of Clinical Evidence on HIV, Hepatitis C Virus, and Sexually Transmitted Disease: Cross-Sectional Study. JMIR MEDICAL EDUCATION 2019; 5:e10722. [PMID: 30920374 PMCID: PMC6458535 DOI: 10.2196/10722] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/06/2018] [Revised: 01/02/2019] [Accepted: 01/06/2019] [Indexed: 05/03/2023]
Abstract
BACKGROUND Timely and effective dissemination of the latest clinical evidence to health care providers is essential for translating biomedical research into routine patient care. Online platforms offer unique opportunities for dissemination of medical knowledge. OBJECTIVE In this study, we report the profiles of health care providers participating in the New York State HIV-HCV-STD Clinical Education Initiative online program and their evaluations of the online continuing professional development courses. METHODS We compiled professional and personal background information of the clinicians who completed at least one online course. We collected their self-reported program evaluation data with regard to the course content, format, knowledge increase, and impact on clinical practice. RESULTS We recorded a total of 4363 completions of 88 online courses by 1976 unique clinicians during a 12-month study period. The clinicians' background was diverse in terms of demographics, education levels, professional disciplines, practice years, employment settings, caseloads, and clinical services. The evaluation of online courses was very positive (usefulness/relevance, 91.08%; easy comprehension, 89.09%; knowledgeable trainer, 92.00%; appropriate format, 84.35%; knowledge increase, 48.52%; intention to use knowledge, 85.26%; and plan to change practice, 21.98%). Comparison with the reference data indicated that the online program successfully reached out to the primary care communities. Both the younger generation and the senior health care providers were attracted to the online program. High-quality multimedia resources, flexibility of access, ease of use, and provision of continuing professional development credits contributed to the initial success of this online clinical education program. CONCLUSIONS We have successfully characterized a diverse group of clinicians participating in a statewide online continuing professional development program. The evaluation has shown effective use of online resources to disseminate clinical evidence on HIV, hepatitis C virus, and sexually transmitted disease to primary care clinicians.
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Affiliation(s)
- Dongwen Wang
- Arizona State University, Scottsdale, AZ, United States
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15
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Kline RM, Arora NK, Bradley CJ, Brauer ER, Graves DL, Lunsford NB, McCabe MS, Nasso SF, Nekhlyudov L, Rowland JH, Schear RM, Ganz PA. Long-Term Survivorship Care After Cancer Treatment - Summary of a 2017 National Cancer Policy Forum Workshop. J Natl Cancer Inst 2018; 110:1300-1310. [PMID: 30496448 PMCID: PMC6658871 DOI: 10.1093/jnci/djy176] [Citation(s) in RCA: 75] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2018] [Revised: 07/31/2018] [Accepted: 08/31/2018] [Indexed: 12/17/2022] Open
Abstract
The National Cancer Policy Forum of the National Academies of Sciences, Engineering and Medicine sponsored a workshop on July 24 and 25, 2017 on Long-Term Survivorship after Cancer Treatment. The workshop brought together diverse stakeholders (patients, advocates, academicians, clinicians, research funders, and policymakers) to review progress and ongoing challenges since the Institute of Medicine (IOM)'s seminal report on the subject of adult cancer survivors published in 2006. This commentary profiles the content of the meeting sessions and concludes with recommendations that stem from the workshop discussions. Although there has been progress over the past decade, many of the recommendations from the 2006 report have not been fully implemented. Obstacles related to the routine delivery of standardized physical and psychosocial care services to cancer survivors are substantial, with important gaps in care for patients and caregivers. Innovative care models for cancer survivors have emerged, and changes in accreditation requirements such as the Commission on Cancer's (CoC) requirement for survivorship care planning have put cancer survivorship on the radar. The Center for Medicare & Medicaid Innovation's Oncology Care Model (OCM), which requires psychosocial services and the creation of survivorship care plans for its beneficiary participants, has placed increased emphasis on this service. The OCM, in conjunction with the CoC requirement, is encouraging electronic health record vendors to incorporate survivorship care planning functionality into updated versions of their products. As new models of care emerge, coordination and communication among survivors and their clinicians will be required to implement patient- and community-centered strategies.
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Affiliation(s)
- Ronald M Kline
- Center for Medicare & Medicaid Innovation, Centers for Medicare & Medicaid Services, Baltimore, MD
| | - Neeraj K Arora
- Healthcare Delivery and Disparities Research Program, Patient Centered Outcomes Research Institute, Washington, DC
| | - Cathy J Bradley
- Department of Health Systems, Management, and Policy, School of Public Health, University of Colorado, Denver, CO
| | - Eden R Brauer
- Jonsson Comprehensive Cancer Center, University of California – Los Angeles, Los Angeles, CA
| | - Darci L Graves
- Office of Minority Health, Centers for Medicare & Medicaid Services, Baltimore, MD
| | | | - Mary S McCabe
- Independent Consultant in Survivorship and Medical Ethics, Arlington, VA
| | | | - Larissa Nekhlyudov
- Department of Medicine, Brigham & Women's Hospital, Harvard Medical School, Boston, MA
| | - Julia H Rowland
- Office of Cancer Survivorship, Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD
- Smith Center for Healing and the Arts, Washington, DC
| | - Rebekkah M Schear
- LIVESTRONG Cancer Institutes at Dell Medical School, University of Texas at Austin, Austin, TX
- Department of Health Policy & Management and Medicine, Schools of Public Health and Medicine, Jonsson Comprehensive Cancer Center, University of California – Los Angeles, Los Angeles, CA
| | - Patricia A Ganz
- Jonsson Comprehensive Cancer Center, University of California – Los Angeles, Los Angeles, CA
- Department of Health Policy & Management and Medicine, Schools of Public Health and Medicine, Jonsson Comprehensive Cancer Center, University of California – Los Angeles, Los Angeles, CA
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16
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Ryba MM, Brothers BM, Andersen BL. Implementation of an evidence-based biobehavioral treatment for cancer patients. Transl Behav Med 2018; 7:648-656. [PMID: 28101728 DOI: 10.1007/s13142-016-0459-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
One aim of dissemination and implementation (DI) research is to study the translation of evidence-based treatments (EBTs) from the research environments of their development and testing to broader communities where they are needed. There are few behavioral medicine DI studies and none in cancer survivorship. A determinant model (Setting, Therapist, Education, imPlementation, and Sustainability (STEPS)) was used to conceptualize DI of mental health treatment and frame a longitudinal study of implementation of a behavioral medicine EBT-a biobehavioral intervention (BBI) for cancer patients. Using effective dissemination strategies, therapists were trained in the BBI and followed to determine if implementation occurred. Participants (N = 108) were psychologists, social workers, and other oncology mental health providers from diverse settings to whom the BBI had been disseminated. BBI trainers then provided 6 months of support for implementation (e.g., monthly conference calls). Therapists reported number of patients treated, with or without the BBI, at 2, 4, and 6 months; use of support strategies was tracked. Generalized linear mixed models show that the proportion of patients treated with BBI ranged from 58 to 68%, with a 2% increase across follow-ups. Therapist and setting characteristics did not predict usage. Implementation of a behavioral medicine EBT provides a "real-world" demonstration of a BBI moved from the research setting to diverse communities. As the first study in cancer, it is an encouraging example of training and supporting mental health providers to deliver evidence-based psychological treatment and finding their success in doing so.
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Affiliation(s)
- Marlena M Ryba
- Department of Psychology, The Ohio State University, Columbus, OH, USA.
| | - Brittany M Brothers
- Department of Psychological and Brain Sciences, Indiana University, Bloomington, IN, USA
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17
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Abstract
Cancer is a devastating disease causing significant psychological problems among patients and their families. In the past few decades, there have been growing implementation and dissemination of screening methods for the psychological consequences of cancer, including distress, depression, anxiety, post-traumatic stress, and demoralisation. Also, guidelines for the management of psychological distress have been developed and endorsed by a number of scientific cancer associations. This review examines some of the most significant related issues, also focusing on recent advances in psychosocial and psychopharmacological interventions as a part of a mandatory, integrated, and comprehensive approach to cancer care.
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Affiliation(s)
- Luigi Grassi
- University Hospital Psychiatric Unit, Integrated Department of Mental Health and Addictive Behavior, S. Anna University Hospital and Health Trust, Ferrara, Italy
- Institute of Psychiatry, Department of Biomedical and Specialty Surgical Sciences, University of Ferrara, Ferrara, Italy
| | - David Spiegel
- Department of Psychiatry & Behavioral Sciences, Stanford University School of Medicine, Stanford, California, USA
| | - Michelle Riba
- University of Michigan Comprehensive Cancer Center, Ann Arbor, Michigan, USA
- Department of Psychiatry, University of Michigan, Ann Arbor, Michigan, USA
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