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Baxter K, Agnew H, Morgan J, Holland C, Flynn D, Edmondson R. Patient and clinician priorities for information on treatment outcomes for advanced ovarian cancer: a Delphi exercise. J Gynecol Oncol 2024; 35:35.e63. [PMID: 38576342 DOI: 10.3802/jgo.2024.35.e63] [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: 10/19/2023] [Revised: 01/03/2024] [Accepted: 02/11/2024] [Indexed: 04/06/2024] Open
Abstract
OBJECTIVE Patients with advanced ovarian cancer face a range of treatment options, and there is unwarranted variation in treatment decision-making between UK providers. Decision support tools that produce data on treatment outcomes as a function of individual patient characteristics, would help both patients and clinicians to make informed, preference- and values-based choices. However, data on treatment outcomes to include in such tools are lacking. METHODS Following a literature review, a questionnaire was designed for use in a Delphi process to establish which treatment outcomes are important to both patients and clinicians in decision-making for treatment for advanced ovarian cancer. Patient and clinician panels were established. RESULTS Following 2 Delphi rounds, consensus was achieved for 7/11 items in the patient panel and 8/11 items in the clinician panel. Consensus across both panels was achieved for inclusion of both overall survival and progression free survival as important items in the decision-making process, although there remained differences of opinion as to whether these should be presented as relative or absolute values. CONCLUSION Information needs for treatment decision-making in ovarian cancer differ between and within patient and clinician groups. Whilst overall survival and progression free survival are universally accepted as important data items, decision support tools will need to be nuanced to allow presentation of a range of outcomes and associated probabilities, and in a range of formats, that can be tailored to the preferences of clinician and patients.
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Affiliation(s)
- Kathryn Baxter
- Division of Cancer Sciences, University of Manchester, Manchester, United Kingdom
- Department of Gynaecological Oncology, Manchester University NHS Foundation Trust, Manchester, United Kingdom
| | - Heather Agnew
- Division of Cancer Sciences, University of Manchester, Manchester, United Kingdom
- Department of Gynaecological Oncology, Manchester University NHS Foundation Trust, Manchester, United Kingdom
| | - Jennie Morgan
- Department of Gynaecological Oncology, Manchester University NHS Foundation Trust, Manchester, United Kingdom
| | - Cathrine Holland
- Department of Gynaecological Oncology, Manchester University NHS Foundation Trust, Manchester, United Kingdom
| | - Darren Flynn
- Department of Nursing, Midwifery and Health, University of Northumbria, Newcastle upon Tyne, United Kingdom
| | - Richard Edmondson
- Division of Cancer Sciences, University of Manchester, Manchester, United Kingdom
- Department of Gynaecological Oncology, Manchester University NHS Foundation Trust, Manchester, United Kingdom.
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Szamreta EA, Mulvihill E, Aguinaga K, Amos K, Zannit H, Salani R. Information needs during cancer care: Qualitative research with locally advanced cervical cancer patients in Brazil, China, Germany, & the US. Gynecol Oncol Rep 2024; 51:101321. [PMID: 38273935 PMCID: PMC10809109 DOI: 10.1016/j.gore.2023.101321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Revised: 12/21/2023] [Accepted: 12/23/2023] [Indexed: 01/27/2024] Open
Abstract
Objective This study aimed to identify the information needs and factors for making informed treatment decisions among a diverse group of locally advanced cervical cancer (LACC) patients. Methods Semi-structured interviews were conducted with LACC patients of diverse demographic and socioeconomic backgrounds within two years of their cancer diagnosis. Trained moderators asked open-ended questions about patients' cancer journeys. Transcripts were analyzed using NVivo software to identify emergent themes. Results In 2022, 92 LACC patients in the United States (n = 26), Brazil (n = 25), China (n = 25), and Germany (n = 16) participated in the study. Physicians were valued sources of information, providing patients with details on prognosis, treatment options, and side effects. While most patients trusted their physicians, one-third sought a second opinion to validate their diagnosis or find a more trusted physician.Most patients conducted their own research on treatment options, side effects, causes of LACC, symptoms, and others' experiences. Challenges to information searches included understanding medical terms, finding relevant information, and evaluating source credibility.Overall, patients felt knowledgeable enough to participate in treatment decisions, either by accepting the recommended treatment or collaborating with their physicians. Nearly one-third of patients desired a more significant role in the decision-making process. Conclusion This study highlights the importance of physicians providing LACC patients comprehensive and understandable information, while involving them in the decision-making process. Understanding LACC patients' motivations to seek information and their willingness to actively engage in treatment decisions can lead to improved patient satisfaction in their cancer care.
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Affiliation(s)
- Elizabeth A. Szamreta
- Center for Observational and Real-World Evidence (CORE), Merck & Co. Inc, 126 E. Lincoln Ave, Rahway, NJ 07065, USA
| | - Emily Mulvihill
- Oracle Life Sciences, 2800 Rock Creek Pkwy, North Kansas City, MO 64117, USA
| | - Katherine Aguinaga
- Oracle Life Sciences, 2800 Rock Creek Pkwy, North Kansas City, MO 64117, USA
| | - Kaitlan Amos
- Oracle Life Sciences, 2800 Rock Creek Pkwy, North Kansas City, MO 64117, USA
| | - Heather Zannit
- Oracle Life Sciences, 2800 Rock Creek Pkwy, North Kansas City, MO 64117, USA
| | - Ritu Salani
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, David Geffen School of Medicine, University of California, Los Angeles, 10833 Le Conte Avenue, Los Angeles, CA 90095, USA
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Tagliaferri L, Mancini S, Lancellotta V, Dinapoli L, Capocchiano N, Cornacchione P, Scalise S, Autorino R, Campitelli M, Colloca GF, Fionda B, Rovirosa A, Macchia G, Ferrandina G, Gambacorta MA. The Impact of HAPPY (Humanity Assurance Protocol in Interventional Radiotherapy) on the Psychological Well-being of Gynecological Cancer Patients. Curr Radiopharm 2024; 17:168-173. [PMID: 37807408 DOI: 10.2174/0118744710247426230925054848] [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: 02/24/2023] [Revised: 07/14/2023] [Accepted: 07/24/2023] [Indexed: 10/10/2023]
Abstract
BACKGROUND HAPPY (Humanity Assurance Protocol in Interventional Radiotherapy) reports the necessity for gynecological cancer patients to undergo interventional radiotherapy (IRT, also called brachytherapy). The present paper has evaluated how some precautions may improve the psychological well-being of the patients during IRT. METHODS Patients with gynecological cancer undergoing IRT-HDR were analyzed. Patients answered three questionnaires before the IRT procedure (T0) and at the end of IRT (T1): Distress Thermometer (DT), Numerical Rating Scale for IRT procedure distress (NRS), and Hospital Anxiety and Depression Scale (HADS). Correlations have been calculated pairwise through pandas. corrwith with a Pearson algorithm, and the p-values have been calculated through scipy.stats.pearsonr. Plots have been generated through seaborn and matplotlib. A Wilcoxon test was used. RESULTS 55 patients were selected for this study. The median age of the patients was 64 (range, 39-84) years. 52 patients were with stage I endometrial cancer, whereas 3/3 patients with cervical cancer had locally advanced stages (IIB-IVA). 26 patients had a high education level (47.3%), and 38 were married or with a partner (69.1%). Only 14/55 (25.45%) patients were working. The HADS, DT, and NRS averages before the IRT procedure (T0) were 10.2, 3.8, and 4.3, respectively. After applying the HAPPY protocol, the HADS, DT, and NRS averages after IRT (T1) were 9.4, 3.4, and 2.6, respectively. The Wilcoxon signed rank test analysis showed a significant improvement in NRS (p < 0.00001) and HADS (p = 0.034). Living with a partner, parents or relatives was the only parameter statistically significantly associated with better DT pre-IRT (p = 0.04), HADS pre-IRT (p = 0.01), DT post-IRT (p = 0.01), and HADS post-IRT (p = 0.04). CONCLUSION In our study, the HAPPY protocol was associated with a significant reduction in patients' distress, anxiety, and discomfort.
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Affiliation(s)
- Luca Tagliaferri
- Dipartimento di Diagnostica per Immagini, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, UOC Radioterapia Oncologica, Radioterapia Oncologica ed Ematologia, 00168, Rome, Italy
| | - Silvia Mancini
- Università Cattolica del Sacro Cuore Sede di Roma, 00168, Rome, Italy
| | - Valentina Lancellotta
- Dipartimento di Diagnostica per Immagini, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, UOC Radioterapia Oncologica, Radioterapia Oncologica ed Ematologia, 00168, Rome, Italy
| | - Loredana Dinapoli
- Dipartimento di Diagnostica per Immagini, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, UOC Radioterapia Oncologica, Radioterapia Oncologica ed Ematologia, 00168, Rome, Italy
- UOS Psicologia Clinica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Nikola Capocchiano
- Dipartimento di Diagnostica per Immagini, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, UOC Radioterapia Oncologica, Radioterapia Oncologica ed Ematologia, 00168, Rome, Italy
| | - Patrizia Cornacchione
- Dipartimento di Diagnostica per Immagini, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, UOC Radioterapia Oncologica, Radioterapia Oncologica ed Ematologia, 00168, Rome, Italy
| | - Sara Scalise
- Dipartimento di Diagnostica per Immagini, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, UOC Radioterapia Oncologica, Radioterapia Oncologica ed Ematologia, 00168, Rome, Italy
| | - Rosa Autorino
- Dipartimento di Diagnostica per Immagini, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, UOC Radioterapia Oncologica, Radioterapia Oncologica ed Ematologia, 00168, Rome, Italy
| | - Maura Campitelli
- Dipartimento di Diagnostica per Immagini, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, UOC Radioterapia Oncologica, Radioterapia Oncologica ed Ematologia, 00168, Rome, Italy
| | - Giuseppe Ferdinando Colloca
- Dipartimento di Diagnostica per Immagini, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, UOC Radioterapia Oncologica, Radioterapia Oncologica ed Ematologia, 00168, Rome, Italy
| | - Bruno Fionda
- Dipartimento di Diagnostica per Immagini, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, UOC Radioterapia Oncologica, Radioterapia Oncologica ed Ematologia, 00168, Rome, Italy
| | - Angeles Rovirosa
- Fonaments Clínics Department, University of Barcelona, 08036, Barcelona, Spain
- Radiation Oncology Department, Hospital Clínic Universitari, 08036, Barcelona, Spain
- Gynecologic Cancer Unit, Hospital Clínic Universitari, 08036, Barcelona, Spain
| | - Gabriella Macchia
- Gemelli Molise Hospital, Radiation Oncology Unit, Università Cattolica del Sacro Cuore, 86100, Campobasso, Italy
| | - Gabriella Ferrandina
- Università Cattolica del Sacro Cuore Sede di Roma, 00168, Rome, Italy
- Woman, Child and Public Health Department, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
| | - Maria Antonietta Gambacorta
- Dipartimento di Diagnostica per Immagini, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, UOC Radioterapia Oncologica, Radioterapia Oncologica ed Ematologia, 00168, Rome, Italy
- Università Cattolica del Sacro Cuore Sede di Roma, 00168, Rome, Italy
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Tilahun SW, Kitaw LD, Yusuf NT. Predictors of information needs among women with breast cancer receiving adjuvant therapy at Tikur Anbessa specialized hospital, Addis Ababa Ethiopia: a cross-sectional study. BMC Womens Health 2023; 23:659. [PMID: 38066595 PMCID: PMC10704721 DOI: 10.1186/s12905-023-02805-2] [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: 07/31/2023] [Accepted: 11/25/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND Women undergoing adjuvant therapy for breast cancer have diverse information needs that remain unfulfilled. Extensive research has shown that access to relevant information about their condition can significantly enhance the quality of life for these women, making it an essential part of cancer care. However, various clinical and socioeconomic factors influence the information needs of these women. Hence, the primary aim of this study is to identify predictors of the information needs of women undergoing adjuvant therapy for breast cancer. In addition, this study will also describe the preferred sources of information and the optimal timing for its acquisition. METHODS A facility-based cross-sectional study was undertaken at Tikur Anbessa Specialty Hospital, enlisting a cohort comprising 121 women undergoing adjuvant therapy for breast cancer. Trained interviewers administered an Amharic-translated Toronto information needs questionnaire specifically designed for breast cancer to assess the information needs of the study participants Statistical analysis was executed using the sophisticated software SPSS (version 25). Descriptive statistics were employed to summarize the variables of the study. A linear regression analyses was then carried out to identify notable predictors that significantly influenced the information needs of the women. RESULTS The total mean score for overall information needs in the current study was 194.30 (± 28.01), with a range scale of 142-260 and a standardized mean score of 3.74 (± 0.54). The disease and treatment domains had the highest information needs, with standardized mean scores (standard deviation) of 4.00 (± 0.54) and 3.77 (± 0.59), respectively. 95% of the participants sought information from healthcare professionals, and 67.7% of the women needed the information before beginning the treatments. Predictors of information needs were following a single treatment option (β = 12.68; 95% CI (0.68, 24.68); P = 0.039) and joining higher education and above (β = 17.1; 95% CI (1.47, 34.14); P = 0.033). CONCLUSION The women exhibited a substantial demand for information. Healthcare professionals need to consider the women's educational background and treatment status while delivering the needed information.
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Affiliation(s)
- Sosina W Tilahun
- Department of Nursing, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia.
| | - Leul D Kitaw
- Department of Nursing, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Nete T Yusuf
- Department of Nursing, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
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Information needs during cancer care: qualitative research with advanced cervical cancer patients in Brazil, China, Germany, and the United States. Gynecol Oncol Rep 2022. [DOI: 10.1016/j.gore.2022.101131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
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Schellenberger B, Heuser C, Diekmann A, Ernstmann N, Schippers A, Geiser F, Schmidt‐Wolf IGH, Scholl I, Ansmann L. How shared is decision‐making in multidisciplinary tumour conferences with patient participation? An observational study. Health Expect 2022; 25:3297-3306. [DOI: 10.1111/hex.13638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Revised: 09/29/2022] [Accepted: 10/10/2022] [Indexed: 11/04/2022] Open
Affiliation(s)
- Barbara Schellenberger
- Department for Psychosomatic Medicine and Psychotherapy, Center for Health Communication and Health Services Research (CHSR) University Hospital Bonn Bonn Germany
- Center for Integrated Oncology (CIO) University Hospital Bonn Bonn Germany
| | - Christian Heuser
- Department for Psychosomatic Medicine and Psychotherapy, Center for Health Communication and Health Services Research (CHSR) University Hospital Bonn Bonn Germany
- Center for Integrated Oncology (CIO) University Hospital Bonn Bonn Germany
| | - Annika Diekmann
- Department for Psychosomatic Medicine and Psychotherapy, Center for Health Communication and Health Services Research (CHSR) University Hospital Bonn Bonn Germany
- Center for Integrated Oncology (CIO) University Hospital Bonn Bonn Germany
| | - Nicole Ernstmann
- Department for Psychosomatic Medicine and Psychotherapy, Center for Health Communication and Health Services Research (CHSR) University Hospital Bonn Bonn Germany
- Center for Integrated Oncology (CIO) University Hospital Bonn Bonn Germany
| | - Anna Schippers
- Department for Psychosomatic Medicine and Psychotherapy, Center for Health Communication and Health Services Research (CHSR) University Hospital Bonn Bonn Germany
- Center for Integrated Oncology (CIO) University Hospital Bonn Bonn Germany
| | - Franziska Geiser
- Center for Integrated Oncology (CIO) University Hospital Bonn Bonn Germany
- Department for Psychosomatic Medicine and Psychotherapy, Faculty of Medicine University Hospital Bonn Bonn Germany
| | - Ingo G. H. Schmidt‐Wolf
- Center for Integrated Oncology (CIO) University Hospital Bonn Bonn Germany
- Department of Integrated Oncology University Hospital Bonn Bonn Germany
| | - Isabelle Scholl
- Department of Medical Psychology University Medical Center Hamburg‐Eppendorf Hamburg Germany
| | - Lena Ansmann
- Department of Health Services Research, School of Medicine and Health Sciences, Division for Organizational Health Services Research Carl von Ossietzky University Oldenburg Oldenburg Germany
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Lai J, Brettle A, Zhang Y, Zhou C, Li C, Fu J, Wu Y. Barriers to implementing evidence-based nursing practice from the hospitals' point of view in China: A regional cross-sectional study. NURSE EDUCATION TODAY 2022; 116:105436. [PMID: 35709543 DOI: 10.1016/j.nedt.2022.105436] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Revised: 04/17/2022] [Accepted: 06/07/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND There is a widespread international agreement that healthcare should be based on high-quality evidence; however, bridging the gap from evidence to practice is still problematic. Although barriers to the implementation of evidence-based nursing practice have been identified, most studies have focused on clinical nurses' perceptions of the barriers to evidence-based nursing practice, with a lack of investigation into barriers from the hospitals' viewpoint. OBJECTIVES To identify existing barriers to implementing evidence-based nursing practice from the hospitals' viewpoint. DESIGN A descriptive study employing a regional cross-sectional survey. SETTINGS AND PARTICIPANTS A convenience sample of 91 hospitals in Guangdong Province, China. METHODS The survey used an online questionnaire containing basic hospital information and an open-ended question. Descriptive statistics were used to analyse basic hospital data. Responses to the open-ended question were analysed with thematic analysis. RESULTS The sample consisted of 89 valid responses to the open-ended question. Five themes were identified: (1) knowledge (70.8 %); (2) environmental context and resources (42.7 %); (3) social influences (7.9 %); (4) intentions (7.9 %); and (5) beliefs about capabilities (1.1 %). CONCLUSION Introduced early in 2001, China has embraced evidence-based nursing for more than 20 years. However, lack of knowledge is still the top barrier to implementing evidence-based nursing practice in hospitals in China. The findings indicate a need for more evidence-based nursing practice teaching strategies towards further enhancing clinical nurses' and nursing managers' evidence-based nursing practice beliefs, knowledge, and skills.
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Affiliation(s)
- Jie Lai
- Nanfang Hospital, Southern Medical University, Guangzhou, PR China; School of Nursing, Southern Medical University, Guangzhou, PR China
| | - Alison Brettle
- School of Health & Society, University of Salford, Salford, UK
| | - Yingjie Zhang
- Nanfang Hospital, Southern Medical University, Guangzhou, PR China
| | - Chunlan Zhou
- Nanfang Hospital, Southern Medical University, Guangzhou, PR China
| | - Chaixiu Li
- Nanfang Hospital, Southern Medical University, Guangzhou, PR China; School of Nursing, Southern Medical University, Guangzhou, PR China
| | - Jiaqi Fu
- Nanfang Hospital, Southern Medical University, Guangzhou, PR China; School of Nursing, Southern Medical University, Guangzhou, PR China
| | - Yanni Wu
- Nanfang Hospital, Southern Medical University, Guangzhou, PR China.
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Chi Y, Thaker K, He D, Hui V, Donovan H, Brusilovsky P, Lee YJ. Knowledge Acquisition and Social Support in Online Health Communities: Analysis of an Online Ovarian Cancer Community (Preprint). JMIR Cancer 2022; 8:e39643. [PMID: 36099015 PMCID: PMC9516379 DOI: 10.2196/39643] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 07/08/2022] [Accepted: 07/10/2022] [Indexed: 11/13/2022] Open
Affiliation(s)
- Yu Chi
- School of Information Science, University of Kentucky, Lexington, KY, United States
| | - Khushboo Thaker
- School of Computing and Information, University of Pittsburgh, Pittsburgh, PA, United States
| | - Daqing He
- School of Computing and Information, University of Pittsburgh, Pittsburgh, PA, United States
| | - Vivian Hui
- School of Nursing, University of Pittsburgh, Pittsburgh, PA, United States
| | - Heidi Donovan
- School of Nursing, University of Pittsburgh, Pittsburgh, PA, United States
| | - Peter Brusilovsky
- School of Computing and Information, University of Pittsburgh, Pittsburgh, PA, United States
| | - Young Ji Lee
- School of Nursing, University of Pittsburgh, Pittsburgh, PA, United States
- Department of Biomedical Informatics, University of Pittsburgh, Pittsburgh, PA, United States
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Thaker K, Chi Y, Birkhoff S, He D, Donovan H, Rosenblum L, Brusilovsky P, Hui V, Lee YJ. Exploring Resource-Sharing Behaviors for Finding Relevant Health Resources: Analysis of an Online Ovarian Cancer Community. JMIR Cancer 2022; 8:e33110. [PMID: 35258465 PMCID: PMC9044146 DOI: 10.2196/33110] [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: 08/24/2021] [Revised: 01/28/2022] [Accepted: 02/19/2022] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Online health communities (OHCs) provide patients and survivors of ovarian cancer (OvCa) and their caregivers with help beyond traditional support channels, such as health care providers and clinicians. OvCa OHCs promote connections and exchanges of information among users with similar experiences. Users often exchange information, which leads to the sharing of resources in the form of web links. Although OHCs are important platforms for health management, concerns exist regarding the quality and relevance of shared resources. Previous studies have examined different aspects of resource-sharing behaviors, such as the purpose of sharing, the type of shared resources, and peer user reactions to shared resources in OHCs to evaluate resource exchange scenarios. However, there is a paucity of research examining whether resource-sharing behaviors can ultimately determine the relevance of shared resources. OBJECTIVE This study aimed to examine the association between OHC resource-sharing behaviors and the relevance of shared resources. We analyzed three aspects of resource-sharing behaviors: types of shared resources, purposes of sharing resources, and OHC users' reactions to shared resources. METHODS Using a retrospective design, data were extracted from the National Ovarian Cancer Coalition discussion forum. The relevance of a resource was classified into three levels: relevant, partially relevant, and not relevant. Resource-sharing behaviors were identified through manual content analysis. A significance test was performed to determine the association between resource relevance and resource-sharing behaviors. RESULTS Approximately 48.3% (85/176) of the shared resources were identified as relevant, 29.5% (52/176) as partially relevant, and 22.2% (39/176) as irrelevant. The study established a significant association between the types of shared resources (χ218=33.2; P<.001) and resource relevance (through chi-square tests of independence). Among the types of shared resources, health consumer materials such as health news (P<.001) and health organizations (P=.02) exhibited significantly more relevant resources. Patient educational materials (P<.001) and patient-generated resources (P=.01) were more significantly associated with partially relevant and irrelevant resources, respectively. Expert health materials, including academic literature, were only shared a few times but had significantly (P<.001) more relevant resources. A significant association (χ210=22.9; P<.001) was also established between the purpose of resource sharing and overall resource relevance. Resources shared with the purpose of providing additional readings (P=.01) and pointing to resources (P=.03) had significantly more relevant resources, whereas subjects for discussion and staying connected did not include any relevant shared resources. CONCLUSIONS The associations found between resource-sharing behaviors and the relevance of these resources can help in collecting relevant resources, along with the corresponding information needs from OvCa OHCs, on a large scale through automation. The results from this study can be leveraged to prioritize the resources required by survivors of OvCa and their caregivers, as well as to automate the search for relevant shared resources in OvCa OHCs.
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Affiliation(s)
- Khushboo Thaker
- School of Computing and Information, University of Pittsburgh, Pittsburgh, PA, United States
| | - Yu Chi
- School of Information Science, University of Kentucky, Lexington, KY, United States
| | - Susan Birkhoff
- School of Nursing, University of Pittsburgh, Pittsburgh, PA, United States
| | - Daqing He
- School of Computing and Information, University of Pittsburgh, Pittsburgh, PA, United States
| | - Heidi Donovan
- School of Nursing, University of Pittsburgh, Pittsburgh, PA, United States
| | - Leah Rosenblum
- School of Nursing, University of Pittsburgh, Pittsburgh, PA, United States
| | - Peter Brusilovsky
- School of Computing and Information, University of Pittsburgh, Pittsburgh, PA, United States
| | - Vivian Hui
- School of Nursing, University of Pittsburgh, Pittsburgh, PA, United States
| | - Young Ji Lee
- School of Nursing, University of Pittsburgh, Pittsburgh, PA, United States
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Navarro Jiménez JM, Cruzado JA, Dominguez Cruz A, García García B, Horando López Y, Boya Cristia MJ. Los deseos de información en pacientes con cáncer avanzado. PSICOONCOLOGIA 2022. [DOI: 10.5209/psic.80803] [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
Objetivo: Comprobar los deseos de información, y las variables asociadas a ello, en los pacientes con cáncer avanzado atendidos por un Equipo de Soporte Hospitalario de Cuidados Paliativos. Método: Noventa pacientes con cáncer avanzado, fueron evaluados, mediante una entrevista estructurada sobre si tenían información sobre su enfermedad de los siguientes tipos: diagnóstico, curación, gravedad, objetivos del tratamiento y final de vida, y de su deseo de tener información en cada uno de esto cinco tipos de información. Además, se recogieron los datos sociodemográficos y clínicos, y se administraron: la Escala de Capacidad Funcional, el Índice de Comorbilidad de Charlson, y la Escala de Ansiedad y Depresión Hospitalaria. Resultados. Los resultados muestraron que la mayoría de los pacientes estaban informados del diagnóstico, y de la gravedad, pero no de los objetivos de tratamiento, la curación y el final de vida. De los pacientes no informados el 77,8% (14) deseaban conocer el diagnostico, el 60,0% (11) la gravedad, el 77,8% (35) el objetivo del tratamiento, el 76,7% (24) la curación y un 34,4% (10) el final de vida. Las variables asociadas al deseo de: a) información diagnóstica fueron: tener un cuidador principal más joven (p=,023); con pareja (p=,018), no religiosos (p=,025) y mayor número de visitas a urgencias (p=,004); b) información sobre gravedad fueron: ser joven (p=,009); con pareja (p=,04), y mejor estado ánimo (p=,009); c). Información sobre objetivos del tratamiento: ser joven (p=,001), Con pareja (p=,04), mejor estado ánimo (p=,001). d) información sobre curación: ser hombre (p=,018), con pareja (p=,04), no religiosos (p=,023). En el caso de información sobre el tiempo de vida no se encontró ninguna diferencia significativa. Conclusiones: es necesario valorar los deseos información que tienen los pacientes de forma individualizada y en las diferentes variables de información, y por ello la creación de una herramienta estandarizada en futuras investigaciones es una prioridad. La mayoría de los pacientes con cáncer avanzado están informados del diagnóstico y gravedad, pero existe un déficit de información en curación, objetivos del tratamiento y especialmente en la información del final de vida y destaca más aun, que un alto porcentaje de los pacientes no informados sí desearían recibir información, principalmente sobre los objetivos del tratamiento, sobre todo los más jóvenes, con pareja y no religiosos y con mejor estado de ánimo. Una calidad asistencial óptima en pacientes con cáncer avanzado requiere cubrir sus deseos de información.
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11
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Older adults’ mental health information preferences: a call for more balanced information to empower older adults’ mental health help-seeking. AGEING & SOCIETY 2022. [DOI: 10.1017/s0144686x21001896] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Abstract
A small minority of older adults seek psychological help when they need it. Barriers to mental health service use among older adults include low mental health literacy and reduced opportunities for shared decision-making in health care. There is a gap in the literature examining the mental health information preferences of older adults. The objectives of this study were to describe the information preferences and predictors of preferences among older adults. In total, 229 adults aged 50 years and older in central Canada responded to a questionnaire investigating socio-demographic, psycho-social and health-related characteristics, as well as mental health information preferences. Descriptive analysis quantified participants’ ratings of information preferences and hierarchical linear regression analysis determined predictors of their preferences. Older adults rated all mental health content items as very important. Most participants preferred detailed information (two to six pages) on all treatment options (psychological, pharmacological, combined and self-help). Older adults significantly preferred discussion with a heath-care provider and written information, in comparison to other formats. Older adults also significantly preferred to consult family, friends and heath-care professionals over other sources. Socio-demographic and psycho-social characteristics accounted for some of the variance in predicting older adults’ information preferences. Findings highlight older adults’ desire to be involved in decisions concerning mental health supports. Providing balanced information concerning mental health treatment may increase empowerment in mental health help-seeking.
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12
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Pokhilenko I, van Esch TEM, Brabers AEM, de Jong JD. Relationship between trust and patient involvement in medical decision-making: A cross-sectional study. PLoS One 2021; 16:e0256698. [PMID: 34437626 PMCID: PMC8389380 DOI: 10.1371/journal.pone.0256698] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Accepted: 08/13/2021] [Indexed: 01/05/2023] Open
Abstract
Introduction Patients vary in their preferences regarding involvement in medical decision-making. Current research does not provide complete explanation for this observed variation. Patient involvement in medical decision-making has been found to be influenced by various mechanisms, one of which could be patients’ trust in physicians. The aim of this study was to examine whether trust in physicians fosters or impairs patient involvement in medical decision-making. This study also aimed to determine to what extent the relationship between trust and preferences regarding decision-making roles was influenced by the sociodemographic characteristics of the patients. We hypothesised that trust can both foster and impair patient involvement in medical decision-making. Materials and methods A survey was sent out to members of the Nivel Dutch Health Care Consumer Panel in February 2016 (response rate = 47%, N = 703). The Wake Forest Physician Trust Scale was used to measure trust. Patient involvement was measured using two items based on the study published by Flynn and colleagues in 2006. Multiple regression analysis was used to analyse the relationship between trust and patient involvement. Results We found a negative relationship between trust and patient involvement in medical decision-making in men. Women with high trust reported to be more involved in medical decision-making compared to men with high trust. Conclusion The results suggest that trust impairs involvement in medical decision-making for men but not for women. Further research could provide a more comprehensive explanation of the variation in patient preferences regarding involvement in medical decision-making to further elucidate which underlying mechanisms could enhance patient participation.
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Affiliation(s)
- Irina Pokhilenko
- Faculty of Health, Department of Health Services Research, Care and Public Health Research Institute, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
- * E-mail:
| | - Thamar E. M. van Esch
- Nivel, the Netherlands Institute for Health Services Research, Utrecht, The Netherlands
| | - Anne E. M. Brabers
- Nivel, the Netherlands Institute for Health Services Research, Utrecht, The Netherlands
| | - Judith D. de Jong
- Faculty of Health, Department of Health Services Research, Care and Public Health Research Institute, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
- Nivel, the Netherlands Institute for Health Services Research, Utrecht, The Netherlands
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13
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Yeganeh L, Johnston-Ataata K, Vincent AJ, Flore J, Kokanović R, Teede H, Boyle JA. Co-designing an Early Menopause Digital Resource: Model for Interdisciplinary Knowledge Translation. Semin Reprod Med 2021; 38:315-322. [PMID: 33738787 DOI: 10.1055/s-0041-1726273] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Early menopause/premature ovarian insufficiency is associated with negative health impacts, unmet information needs, delayed diagnosis, and variation in management. Co-designed digital resources for women with early menopause/premature ovarian insufficiency and health practitioners were developed to address information needs and support management. A five-phase mixed methods multidisciplinary research, co-design and translation process comprised: (1) survey/interviews with women and health practitioners to explore early menopause/premature ovarian insufficiency needs, experiences, and management; (2) appraisal of clinical guidelines to develop management algorithms; (3) digital resource development (https://healthtalkaustralia.org/early-menopause-experiences-and-perspectives-of-women-and-health-professionals/; (4) evaluation; and (5) dissemination/implementation. The digital resources included audio/video clips of women with early menopause/premature ovarian insufficiency and health practitioners providing early menopause/premature ovarian insufficiency care, a question prompt list, health practitioner algorithms, information links, and a list of services for women, achieving high satisfaction ratings from women and health practitioners. Engaging our stakeholder partners, multimodal dissemination has included community and conference presentations, social media, lay and professional publications, and webinars. This project provides a model for successful interdisciplinary co-design research translation to improve women's health.
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Affiliation(s)
- Ladan Yeganeh
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Clayton, Victoria, Australia
| | - Kate Johnston-Ataata
- Social and Global Studies Centre, School of Global, Urban and Social Studies, RMIT University, Melbourne, Victoria, Australia
| | - Amanda J Vincent
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Clayton, Victoria, Australia.,Department of Endocrinology, Monash Health, Clayton, Victoria, Australia
| | - Jacinthe Flore
- Social and Global Studies Centre, School of Global, Urban and Social Studies, RMIT University, Melbourne, Victoria, Australia
| | - Renata Kokanović
- Social and Global Studies Centre, School of Global, Urban and Social Studies, RMIT University, Melbourne, Victoria, Australia
| | - Helena Teede
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Clayton, Victoria, Australia.,Department of Endocrinology, Monash Health, Clayton, Victoria, Australia
| | - Jacqueline A Boyle
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Clayton, Victoria, Australia.,Department of Obstetrics and Gynaecology, Monash Health, Clayton, Victoria, Australia
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14
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Rydmark Kersley Å, Berterö C. Women's experiences of an enhanced recovery after surgery program: A qualitative study. Nurs Health Sci 2021; 23:263-272. [PMID: 33404177 DOI: 10.1111/nhs.12810] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2020] [Revised: 12/28/2020] [Accepted: 12/29/2020] [Indexed: 11/29/2022]
Abstract
The Enhanced Recovery After Surgery Program aims to transfer much of the responsibility for postoperative recovery to the patient and their next of kin. The aim of the study was to identify and describe women's experiences of care within this program in relation to gynecological abdominal surgery. A qualitative approach was used where 16 women were interviewed within 1 to 2 weeks of their surgery. A thematic analysis focusing on interpretation of latent content was performed. Three themes were identified: Empowerment, Self-care, and Participation. Empowerment represents aspects of the recovery program that strengthen self-efficacy, such as being seen, being given information, and continuity of care. Self-care identifies the practical implications of empowerment, namely internal resources, knowledge, and external resources. These two themes were identified as separate but interlinked through the theme Participation. Preoperative information, postoperative encouragement, and follow-up empowered the women in their recovery. Early discharge from hospital was beneficial for recovery if accompanied by social support and sufficient self-care ability. A desire for a person-centered approach in the preoperative meeting and in postoperative care was identified.
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Affiliation(s)
- Åsa Rydmark Kersley
- Department of Obstetrics and Gynaecology, Linköping University, Linköping, Sweden
| | - Carina Berterö
- Division of Nursing Sciences and Reproductive Health, Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
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15
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Monzani D, Vergani L, Pizzoli SFM, Marton G, Mazzocco K, Bailo L, Messori C, Pancani L, Cattelan M, Pravettoni G. Sexism Interacts with Patient-Physician Gender Concordance in Influencing Patient Control Preferences: Findings from a Vignette Experimental Design. Appl Psychol Health Well Being 2020; 12:471-492. [PMID: 31985173 PMCID: PMC7384069 DOI: 10.1111/aphw.12193] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Revised: 12/23/2019] [Accepted: 12/27/2019] [Indexed: 11/29/2022]
Abstract
BACKGROUND Patient preferences regarding their involvement in shared treatments decisions is fundamental in clinical practice. Previous evidences demonstrated a large heterogeneity in these preferences. However, only few studies have analysed the influence of patients' individual differences, contextual and situational qualities, and their complex interaction in explaining this variability. METHODS We assessed the role of the interaction of patient's sociodemographic and psychological factors with a physician's gender. Specifically, we focused on patient gender and attitudes toward male or female physicians. One hundred fifty-three people participated in this randomised controlled study and were randomly assigned to one of two experimental conditions in which they were asked to imagine discussing their treatment with a male and a female doctor. RESULTS Analyses showed an interplay between attitude towards women and the gender of patients and doctors, explaining interindividual variability in patient preferences. CONCLUSIONS In conclusion, patients' attitudes toward the physicians' gender constitutes a relevant characteristic that may influence the degree of control patients want to have and the overall patient-physician relationship.
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Affiliation(s)
- Dario Monzani
- Applied Research Division for Cognitive and Psychological Science, IEO, European Institute of Oncology IRCCS, Milan, Italy.,Department of Oncology and Hemato-oncology, University of Milan, Italy
| | - Laura Vergani
- Applied Research Division for Cognitive and Psychological Science, IEO, European Institute of Oncology IRCCS, Milan, Italy.,Department of Oncology and Hemato-oncology, University of Milan, Italy
| | - Silvia Francesca Maria Pizzoli
- Applied Research Division for Cognitive and Psychological Science, IEO, European Institute of Oncology IRCCS, Milan, Italy.,Department of Oncology and Hemato-oncology, University of Milan, Italy
| | - Giulia Marton
- Applied Research Division for Cognitive and Psychological Science, IEO, European Institute of Oncology IRCCS, Milan, Italy.,Department of Oncology and Hemato-oncology, University of Milan, Italy
| | - Ketti Mazzocco
- Applied Research Division for Cognitive and Psychological Science, IEO, European Institute of Oncology IRCCS, Milan, Italy.,Department of Oncology and Hemato-oncology, University of Milan, Italy
| | - Luca Bailo
- Applied Research Division for Cognitive and Psychological Science, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Chiara Messori
- Department of Oncology and Hemato-oncology, University of Milan, Italy
| | - Luca Pancani
- Department of Psychology, University of Milan - Bicocca, Milan, Italy
| | - Manuela Cattelan
- Department of Statistical Sciences, University of Padova, Padova, Italy
| | - Gabriella Pravettoni
- Applied Research Division for Cognitive and Psychological Science, IEO, European Institute of Oncology IRCCS, Milan, Italy.,Department of Oncology and Hemato-oncology, University of Milan, Italy
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16
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HAPPY - Humanity Assurance Protocol in interventional radiotheraPY (brachytherapy) - an AIRO Interventional Radiotherapy Study Group project. J Contemp Brachytherapy 2019; 11:510-515. [PMID: 31969908 PMCID: PMC6964336 DOI: 10.5114/jcb.2019.91222] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Accepted: 11/01/2019] [Indexed: 11/17/2022] Open
Abstract
Purpose Interventional procedures may produce emotional distress, particularly in interventional radiotherapy (IRT, brachytherapy - BT). This work would like to propose a series of recommendations/interventions to guarantee a human approach in order to favor the psychological well-being of the patient during interventional radiotherapy. Material and methods Thirty patients affected by gynecological cancer and treated with endovaginal high-dose-rate IRT (HDR-IRT) were selected from January to March 2019. A specific Multiprofessional Task Group (MTG) was defined in order to analyze the needs of patients. Each component of the task group spoke with the patients to examine their needs and to investigate their fears and perception. The results of the MTG were subjected to evaluation by an Expert Team (ET) of 4 physicians from 4 different institutions for a final evaluation. Both teams discussed the patient's needs to generate a list of necessary interventions to fulfill every single need in order to obtain their inner well-being. Another team (Master Team - MT) performed an independent check. Results All patients suggest that the main issue is the "lack of information and fear of the unknown". The fear of feeling pain was a significant source of concern, sadness, and vulnerability for the majority of the patients (76.6%). All patients do not appreciate the use of the word "bunker" to describe the treatment place. In 33.3% of patients the word "brachytherapy" (often unknown) determines insecurity while the term "interventional radiotherapy" reassures. Ninety percent of patients preferred to perform the external genital depilation at home and 80% of them would like the bladder catheter to be placed immediately before the procedure. MTG and ET defined nine "HAPPY recommendations". The MT approved the protocol without changes. Conclusions The aim of the present paper was to produce a protocol consisting in intervention that could improve the internal serendipity and emotional state of patients who underwent HDR-IRT.
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17
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Oskay-Özcelik G, Alavi S, Richter R, Keller M, Chekerov R, Cecere SC, Cormio G, Joly F, Kurtz JE, du Bois A, Maciejewski M, Jedryka M, Vergote I, Van Nieuwenhuysen E, Casado A, Mendiola C, Achimas-Cadariu P, Vlad C, Reimer D, Zeimet AG, Friedlander M, Sehouli J. Expression III: patients' expectations and preferences regarding physician-patient relationship and clinical management-results of the international NOGGO/ENGOT-ov4-GCIG study in 1830 ovarian cancer patients from European countries. Ann Oncol 2019; 29:910-916. [PMID: 29415128 DOI: 10.1093/annonc/mdy037] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Backround The primary aim of this study was to investigate information needs and treatment preferences of patients with ovarian cancer, focusing especially on physician-patient relationship and treatment. Patients and methods A questionnaire was developed based on the experiences of the national German survey 'Expression II', and was provided to patients with ovarian cancer either at initial diagnosis or with recurrent disease via Internet (online-version) or as print-out-version. Results From December 2009 to October 2012, a total of 1830 patients with ovarian cancer from eight European countries (Austria, Belgium, France, Germany, Italy, Poland, Romania, Spain) participated, 902 (49.3%) after initial diagnosis and 731 (39.9%) with recurrent ovarian cancer. The median age was 58 years (range 17-89). Nearly all patients (96.2%) had experienced upfront surgery followed by first-line chemotherapy (91.8%). The majority of patients were satisfied with the completeness and comprehensibility of the explanation about the diagnosis and treatment options. The three most important aspects, identified by patients to improve the treatment for ovarian cancer included: 'the therapy should not induce alopecia' (42%), 'there must be more done to counter fatigue' (34.5%) and 'the therapy should be more effective' (29.7%). Out of 659 (36%) patients, who were offered participation in a clinical trial, 476 (26%) were included. Conclusion This study underlines the high need of patients with ovarian cancer for all details concerning treatment options irrespective of their cultural background, the stage of disease and the patient's age. Increased information requirements regarding potential side effects and treatment alternatives were recorded. Besides the need for more effective therapy, alopecia and fatigue are the most important side effects of concern to patients.
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Affiliation(s)
- G Oskay-Özcelik
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Department of Gynecology, Charité European Competence Center for Ovarian Cancer, Berlin; North-Eastern German Society of Gynecological Oncology (NOGGO), Berlin, Germany
| | - S Alavi
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Department of Gynecology, Charité European Competence Center for Ovarian Cancer, Berlin; North-Eastern German Society of Gynecological Oncology (NOGGO), Berlin, Germany
| | - R Richter
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Department of Gynecology, Charité European Competence Center for Ovarian Cancer, Berlin
| | - M Keller
- North-Eastern German Society of Gynecological Oncology (NOGGO), Berlin, Germany
| | - R Chekerov
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Department of Gynecology, Charité European Competence Center for Ovarian Cancer, Berlin; North-Eastern German Society of Gynecological Oncology (NOGGO), Berlin, Germany
| | - S C Cecere
- Division of Medical Oncolog, Department of Uro-Gynaecological Oncology, Istituto Nazionale Tumori IRCCS "Fondazione G. Pascale", Naples, Italy
| | - G Cormio
- Department of Biomedical Science and Human Oncolog, Obstetrics and Gynecology Unit, University of Bari, Bari, Italy
| | - F Joly
- Department of Medical Oncolog, Centre Francois Baclesse, Universite Basse Normandie, Caen, France
| | - J E Kurtz
- Oncology and Hematology, Hôpitaux Universitaires de Strasbourg, Strasbourg
| | - A du Bois
- Deptartment of Gynecology and Gynecologic Oncology, Kliniken Essen Mitte (KEM), Essen, Germany
| | - M Maciejewski
- Dolnoslaskie Centrum onkologii/Oddzial Ginekologii Onkologicznej, Wroclaw, Poland
| | - M Jedryka
- Department of Oncology and Gynaecological Oncology Clinic, Wroclaw Medical University, Wroclaw, Poland
| | - I Vergote
- Division of Gynaecological Oncol, Leuven Cancer Institute, Department of Gynaecology and Obstetrics, Universitaire Ziekenhuizen Leuven, Katholieke Universiteit Leuven, Leuven, Belgium
| | - E Van Nieuwenhuysen
- Division of Gynaecological Oncol, Leuven Cancer Institute, Department of Gynaecology and Obstetrics, Universitaire Ziekenhuizen Leuven, Katholieke Universiteit Leuven, Leuven, Belgium
| | - A Casado
- Department of Medical Oncology, Hospital Clínico Universitario San Carlos, Madrid, Spain
| | - C Mendiola
- University Hospital 12 de Octubre, Madrid, Spain
| | - P Achimas-Cadariu
- Department of Surgery, The Oncology Institute Ion Chiricuţă, Cluj-Napoca, Romania; Department of Surgery and Gynecologic Oncology, Iuliu Hațieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - C Vlad
- Department of Surgery, The Oncology Institute Ion Chiricuţă, Cluj-Napoca, Romania; Department of Surgery and Gynecologic Oncology, Iuliu Hațieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - D Reimer
- Department of Obstetrics and Gynecology, Medical University of Innsbruck, Innsbruck, Austria
| | - A G Zeimet
- Department of Obstetrics and Gynecology, Medical University of Innsbruck, Innsbruck, Austria
| | - M Friedlander
- Prince of Wales Clinical School, University of New South Wales, Sydney, Australia
| | - J Sehouli
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Department of Gynecology, Charité European Competence Center for Ovarian Cancer, Berlin; North-Eastern German Society of Gynecological Oncology (NOGGO), Berlin, Germany.
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van Hoogdalem LE, Siemes C, Lugtenburg PJ, Busschbach JJV, Ismail SY. Patients' decision-making, experiences and preferences regarding pixantrone treatment in relapsed or refractory diffuse large B-cell lymphoma: study protocol for a longitudinal mixed methods study. BMJ Open 2019; 9:e026505. [PMID: 31122976 PMCID: PMC6538055 DOI: 10.1136/bmjopen-2018-026505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
INTRODUCTION There is a lot of speculation about why and how patients decide to use invasive treatment in an advanced stage of cancer, but the body of research is limited. The present longitudinal qualitative and quantitative study reflects real-life practice of pixantrone use and aims to collect data on patients' considerations for, expectations of and experiences with pixantrone and trajectories in their quality-of-life (QoL) values in a Dutch clinical setting. Hence, two questions emerge. Why do patients choose for this treatment, while the treatment success rate is limited and curation cannot be achieved? And second, once chosen, what conditions would patients like to satisfy and how do they experience the treatment? METHODS AND ANALYSIS This is a non-interventional longitudinal and multicentre study. Patients are eligible if they are >18 years, have never been treated with pixantrone before, have an Eastern Cooperative Oncology Group performance score ≤2, have a relapsed or refractory diffuse large B-cell lymphoma and have been treated with at least two prior regimens. The decision to treat patients with pixantrone has been taken by the treating physician before patients are asked to participate in the study. If patients refuse study participation after being informed by the investigator, reasons for refusal (if given) will be recorded. Participants will receive at least three interviews accompanied by three QOL questionnaires. Based on the required sample size, we aim to include 20 patients over a period of 2 years. ETHICS AND DISSEMINATION The Medical Ethical Committee of Erasmus MC, Rotterdam, The Netherlands, has approved this study. The results will be disseminated in peer-reviewed journals and major international conferences. The study is non-interventional and falls therefore not under Medical Research Involving Human Subjects Act (In Dutch: Wet medisch-wetenschappelijk onderzoek met mensen; WMO). Hence, this study is approved to be carried out in the Erasmus MC. Each other participating centre will receive this approval and will separately undergo the ethical approval to be able to participate. In addition to the ethical approval, the participating centres need to obtain written informed consent of their patients. Given the non-interventional nature of this study, a study registration was considered but deemed unnecessary. The study will be conducted in accordance with the Declaration of Helsinki (Tokyo, Venice, Hong Kong and Somerset West amendments). A sequential identification number will be automatically attributed to each patient that has given consent to participate in the study. This number will identify the patient and must be included on all documents. Only the main researcher can link the code to the patient's identity.
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Affiliation(s)
- Lothar E van Hoogdalem
- Department of Psychiatry, Section of Medical Psychology & Psychotherapy, Erasmus MC, Rotterdam, The Netherlands
| | - Claire Siemes
- Department of Hematology, Erasmus MC, Rotterdam, The Netherlands
| | | | - Jan J V Busschbach
- Department of Psychiatry, Section of Medical Psychology & Psychotherapy, Erasmus MC, Rotterdam, The Netherlands
| | - Sohal Y Ismail
- Department of Psychiatry, Section of Medical Psychology & Psychotherapy, Erasmus MC, Rotterdam, The Netherlands
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Nelson G, Bakkum-Gamez J, Kalogera E, Glaser G, Altman A, Meyer LA, Taylor JS, Iniesta M, Lasala J, Mena G, Scott M, Gillis C, Elias K, Wijk L, Huang J, Nygren J, Ljungqvist O, Ramirez PT, Dowdy SC. Guidelines for perioperative care in gynecologic/oncology: Enhanced Recovery After Surgery (ERAS) Society recommendations-2019 update. Int J Gynecol Cancer 2019; 29:651-668. [PMID: 30877144 DOI: 10.1136/ijgc-2019-000356] [Citation(s) in RCA: 391] [Impact Index Per Article: 78.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Accepted: 02/18/2019] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND This is the first updated Enhanced Recovery After Surgery (ERAS) Society guideline presenting a consensus for optimal perioperative care in gynecologic/oncology surgery. METHODS A database search of publications using Embase and PubMed was performed. Studies on each item within the ERAS gynecologic/oncology protocol were selected with emphasis on meta-analyses, randomized controlled trials, and large prospective cohort studies. These studies were then reviewed and graded according to the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) system. RESULTS All recommendations on ERAS protocol items are based on best available evidence. The level of evidence for each item is presented accordingly. CONCLUSIONS The updated evidence base and recommendation for items within the ERAS gynecologic/oncology perioperative care pathway are presented by the ERAS® Society in this consensus review.
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Affiliation(s)
- Gregg Nelson
- Division of Gynecologic Oncology, Tom Baker Cancer Centre, Calgary, Alberta, Canada
| | - Jamie Bakkum-Gamez
- Division of Gynecologic Oncology, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
| | - Eleftheria Kalogera
- Division of Gynecologic Oncology, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
| | - Gretchen Glaser
- Division of Gynecologic Oncology, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
| | - Alon Altman
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Larissa A Meyer
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Jolyn S Taylor
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Maria Iniesta
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Javier Lasala
- Department of Anesthesiology and Perioperative Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Gabriel Mena
- Department of Anesthesiology and Perioperative Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Michael Scott
- Department of Anesthesia, Virginia Commonwealth University Hospital, Richmond, Virginia, USA
| | - Chelsia Gillis
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Kevin Elias
- Division of Gynecologic Oncology, Brigham and Women's Hospital, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts, USA
| | - Lena Wijk
- Department of Obstetrics and Gynecology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Jeffrey Huang
- Department of Anesthesiology, Oak Hill Hospital, Brooksville, Florida, USA
| | - Jonas Nygren
- Departments of Surgery and Clinical Sciences, Ersta Hospital and Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Olle Ljungqvist
- Department of Surgery, Faculty of Medicine and Health, School of Health and Medical Sciences, Örebro University, Örebro, Sweden
| | - Pedro T Ramirez
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Sean C Dowdy
- Division of Gynecologic Oncology, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
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Shelton RC, Brotzman LE, Crookes DM, Robles P, Neugut AII. Decision-making under clinical uncertainty: An in-depth examination of provider perspectives on adjuvant chemotherapy for stage II colon cancer. PATIENT EDUCATION AND COUNSELING 2019; 102:284-290. [PMID: 30262401 PMCID: PMC6377327 DOI: 10.1016/j.pec.2018.09.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Revised: 08/22/2018] [Accepted: 09/14/2018] [Indexed: 05/05/2023]
Abstract
OBJECTIVE Decision-making about adjuvant chemotherapy (ACT) for stage II colon cancer is complex, particularly in light of clinical uncertainty regarding treatment benefits. Little is known about provider communication and factors influencing decision-making and recommendations in this setting. METHODS We recruited providers from six US cancer centers and hospitals who care for stage II colon cancer patients. Providers participated in a 30-45 minute interview. Transcripts of interviews were coded for qualitative analysis. RESULTS We interviewed 42 providers (Oncologists: 52%; surgeons: 24%; nurses: 14%). Though most providers were aware of stage II colon cancer treatment guidelines, their use and communication of recommended guidelines was limited. Most reported tailoring delivery and content of their communication, often based on perceived patient education level, but patient involvement in decision-making varied. Findings highlight the complexity of, ACT decision-making, including the central role of providers and family members. CONCLUSIONS Providers are not consistently following recommended guidelines for communicating about ACT among stage II colon cancer patients or eliciting patient preferences for involvement in treatment decisions. PRACTICE IMPLICATIONS Given clinical uncertainty surrounding use of ACT for stage II colon cancer, efforts are needed to enhance guideline implementation, provider education, and communication to facilitate decision-making.
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Affiliation(s)
- Rachel C Shelton
- Department of Sociomedical Sciences, Columbia University Mailman School of Public Health, New York, USA.
| | - Laura E Brotzman
- Department of Sociomedical Sciences, Columbia University Mailman School of Public Health, New York, USA
| | - Danielle M Crookes
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, USA
| | - Patrick Robles
- Department of Sociomedical Sciences, Columbia University Mailman School of Public Health, New York, USA
| | - AIfred I Neugut
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, USA
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Papadakos J, McQuestion M, Gokhale A, Damji A, Trang A, Abdelmutti N, Ringash J. Informational Needs of Head and Neck Cancer Patients. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2018; 33:847-856. [PMID: 28155041 DOI: 10.1007/s13187-017-1176-9] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
The patient journey with head and neck cancer (HNC) is particularly challenging given the physical and functional impact of the cancer and treatment. The ability to perform activities of daily living can be severely compromised and have a profound impact on psychosocial well-being. These complex and long-lasting effects can affect patient quality of life for months to years and the literature shows that information for HNC patients is often insufficient. This observational cross-sectional study utilized survey methodology to investigate the informational needs of HNC patients and the preferred modalities for delivery. This was done to inform the development of resources for HNC patients. Four hundred fifty surveys were analyzed. The median age was 61 years and 58% of the cohort was born in Canada. Most were Caucasian (72%), Chinese being the next largest ethnicity (12%). A third had less than high school education and most had cancer of the oral cavity (28%) and were in long-term follow-up (41%). Comparison of the percentage of items to which a patient responded "very important" across the six domains shows variation of importance by domain (overall mixed effects regression model p < 0.0001). Additionally, each domain was compared to the medical domain and all had significantly lower mean scores (all p < 0.0001) with the medical domain scoring highest (mean score 64.6). The top preferred education modalities were teaching with a healthcare professional and pamphlets. This study highlights the type of information that HNC patients want and the format they wish to receive it in. The design provides a comprehensive way to consult with patients toward building education that responds to their specific needs.
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Affiliation(s)
- Janet Papadakos
- Cancer Education Program, Princess Margaret Cancer Centre, 610 University Ave, Toronto, ON, M5G 2M9, Canada.
- ELLICSR: Health, Wellness & Cancer Survivorship Centre, Princess Margaret Cancer Centre, PMB ELLICSR, 585 University Avenue, Toronto, ON, M5G 2N2, Canada.
| | - Maurene McQuestion
- Radiation Medicine Program, Princess Margaret Cancer Centre, 610 University Ave, Toronto, ON, M5G 2M9, Canada
- Head and Neck Survivorship Program, Princess Margaret Cancer Centre, 610 University Ave, Toronto, ON, M5G 2M9, Canada
| | - Anandita Gokhale
- Cancer Education Program, Princess Margaret Cancer Centre, 610 University Ave, Toronto, ON, M5G 2M9, Canada
- Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Ali Damji
- Cancer Education Program, Princess Margaret Cancer Centre, 610 University Ave, Toronto, ON, M5G 2M9, Canada
- Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Aileen Trang
- Cancer Education Program, Princess Margaret Cancer Centre, 610 University Ave, Toronto, ON, M5G 2M9, Canada
| | - Nazek Abdelmutti
- Cancer Education Program, Princess Margaret Cancer Centre, 610 University Ave, Toronto, ON, M5G 2M9, Canada
| | - Jolie Ringash
- ELLICSR: Health, Wellness & Cancer Survivorship Centre, Princess Margaret Cancer Centre, PMB ELLICSR, 585 University Avenue, Toronto, ON, M5G 2N2, Canada
- Head and Neck Survivorship Program, Princess Margaret Cancer Centre, 610 University Ave, Toronto, ON, M5G 2M9, Canada
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Sheehy EM, Lehane E, Quinn E, Livingstone V, Redmond HP, Corrigan MA. Information Needs of Patients With Breast Cancer at Years One, Three, and Five After Diagnosis. Clin Breast Cancer 2018; 18:e1269-e1275. [PMID: 30153977 DOI: 10.1016/j.clbc.2018.06.007] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2018] [Revised: 05/24/2018] [Accepted: 06/11/2018] [Indexed: 10/28/2022]
Abstract
INTRODUCTION The information needs of breast cancer patients at diagnosis have been studied extensively. However, with cancer survival improving, the era of cancer care has entered a more chronic phase with an associated paucity of data related to longer term information requirements. The aim of the present study was to assess and compare the information needs of breast cancer patients during the first 5 years after the diagnosis. PATIENTS AND METHODS A total of 105 follow-up consecutive patients presenting to a tertiary referral breast cancer center from August to October 2017 were recruited. The patients were divided into groups by the years after the diagnosis (1, 3, and 5 years). Each patient completed the Toronto Information Needs Questionnaire for Breast Cancer. RESULTS The number of patients in each group was as follows: 23 at 1 year, 38 at 3 years, and 44 at 5 years after the initial diagnosis. The median Toronto Information Needs Questionnaire for Breast Cancer score was 4.15 on a 5-point Likert scale of breast cancer information needs (1, not important to 5, extremely important). No difference was found in the median scores at 1, 3, and 5 years. Information pertaining to the disease process was rated as most important (median, 4.50), and information regarding the psychosocial aspect of disease was ranked lowest (median, 3.75). CONCLUSION The information needs of patients with breast cancer remain high throughout the follow-up period after the diagnosis. In an era of prolonged survival, attention to the information needs of patients at follow-up examinations is as important as at the time of diagnosis and treatment.
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Affiliation(s)
- Eoin Michael Sheehy
- Cork Breast Research Centre, Cork University Hospital, Cork, Ireland; School of Medicine, University College Cork, Cork, Ireland
| | - Elaine Lehane
- Catherine McAuley School of Nursing and Midwifery, University College Cork, Cork, Ireland
| | - Edel Quinn
- Cork Breast Research Centre, Cork University Hospital, Cork, Ireland
| | - Vicki Livingstone
- Cork Breast Research Centre, Cork University Hospital, Cork, Ireland
| | - Henry Paul Redmond
- Cork Breast Research Centre, Cork University Hospital, Cork, Ireland; School of Medicine, University College Cork, Cork, Ireland
| | - Mark Anthony Corrigan
- Cork Breast Research Centre, Cork University Hospital, Cork, Ireland; School of Medicine, University College Cork, Cork, Ireland.
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Ehlers A, Makanjee CR. Exploration of gynaecological cancer high dose-rate brachytherapy treatment: a pilot study. Pan Afr Med J 2018; 30:27. [PMID: 30167054 PMCID: PMC6110560 DOI: 10.11604/pamj.2018.30.27.14608] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2017] [Accepted: 04/22/2018] [Indexed: 12/27/2022] Open
Abstract
INTRODUCTION Performing brachytherapy on female patients with gynaecological cancer is a sensitive procedure, apart from it being an intricate investigation. The aim of this study: establishing gynaecological cancer patients' expectations, experiences and understandings of the high dose-rate brachytherapy treatment procedure. Exploring these patients' life-worlds provides further insights into improving their preparedness and experiences. METHODS A qualitative research design with a descriptive phenomenological research approach was used. Recruitment entailed using purposive sampling. To obtain rich insights into the lived experiences, data was acquired through semi-structured interviews until data saturation. RESULTS Major challenges were experienced with mixed thoughts and feelings, from negative trauma to desires being fulfilled. These patients should have received more information regarding their upcoming brachytherapy treatment. This would have alleviated some of their fears and anxieties, which would in turn have provided them with a better brachytherapy treatment experience. Envisaged outcomes and desires are used to cope. Patients influence each other negatively, so they rather wanted to "see for themselves". CONCLUSION Despite some disappointments and negative experiences throughout the brachytherapy continuum, the patients were left with a positive outlook, saying that it is an excellent and necessary treatment. Further studies should be done to elaborate on fulfilments of recommendations in the brachytherapy department of radiation oncology.
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Affiliation(s)
- Alicia Ehlers
- Steve Biko Academic Hospital, Department of Oncology, Pretoria, South-Africa
- University of Pretoria, Department of Radiography, South-Africa
| | - Chandra Rekha Makanjee
- Department of Medical Radiation Sciences, Faculty of Health, University of Canberra, Bruce, ACT, Australia, 2617
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Papadakos J, Agarwal A, Charow R, Quartey NK, D'souza A, Giuliani M, Millar BA, Massey C, Shultz D, Chung C. Informational needs of brain metastases patients and their caregivers. Neurooncol Pract 2018; 6:47-60. [PMID: 31386069 DOI: 10.1093/nop/npy008] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background In response to a dearth of formal health information targeted towards patients with brain metastases and their caregivers, a formal informational and supportive care needs assessment was conducted. Methods Brain metastases patients and caregivers who attended a clinic focused on the treatment of brain metastases at a tertiary medical center completed a self-report survey to assess informational needs across 6 domains: medical, physical, practical, social, emotional, and spiritual informational needs. Univariate and multivariate analyses of associations between variables was conducted using linear regression models. Results A total of 109 patients and 77 caregivers participated. Patients and caregivers both prioritized medical and physical informational domains, with a large focus on symptoms and side-effect profiles, significance of brain metastases locations and their implications, available treatment options and their risks and benefits, prognoses and follow-ups if treatment is completed, and end-of-life experiences and supports. One-on-one counseling was preferred by both caregivers and patients for these domains, as well as for practical informational needs; while patients preferred pamphlets to address social, emotional and spiritual informational needs, caregivers preferred one-on-one counseling for the former two domains as well. Conclusions Brain metastases patients and their caregivers prioritize medical and physical informational needs, with one-on-one counseling and pamphlets being the most preferred modalities for information provision. Further exploration regarding existing non-validated resources and the development of tailored resources to address the unique needs of these patient and caregiver populations are warranted.
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Affiliation(s)
- Janet Papadakos
- Cancer Education Program, Princess Margaret Cancer Centre, Toronto, Ontario, Canada.,Patient Education, Cancer Care Ontario, Toronto, ON
| | - Arnav Agarwal
- Cancer Education Program, Princess Margaret Cancer Centre, Toronto, Ontario, Canada.,Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Rebecca Charow
- Cancer Education Program, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Naa Kwarley Quartey
- Cancer Education Program, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Anna D'souza
- Cancer Education Program, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Meredith Giuliani
- Cancer Education Program, Princess Margaret Cancer Centre, Toronto, Ontario, Canada.,Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.,Department of Radiation Oncology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada.,Department of Radiation Oncology, University of Toronto, Toronto, ON
| | - Barbara-Ann Millar
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.,Department of Radiation Oncology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada.,Department of Radiation Oncology, University of Toronto, Toronto, ON
| | - Christine Massey
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - David Shultz
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.,Department of Radiation Oncology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada.,Department of Radiation Oncology, University of Toronto, Toronto, ON
| | - Caroline Chung
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.,Division of Radiation Oncology, MD Anderson Cancer Centre, Houston, Texas
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Le Saux O, Lapotre-Aurelle S, Watelet S, Castel-Kremer E, Lecardonnel C, Murard-Reeman F, Ravot C, Falandry C. Systematic review of care needs for older patients treated with anticancer drugs. J Geriatr Oncol 2018; 9:441-450. [PMID: 29573968 DOI: 10.1016/j.jgo.2018.02.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2017] [Revised: 11/05/2017] [Accepted: 02/23/2018] [Indexed: 10/17/2022]
Abstract
OBJECTIVE When treated with anticancer therapies, a number of issues are raised for older patients such as physical needs (coping with symptoms and side-effects) or psychological needs. Geriatric tailored interventions addressing these needs may be effective in terms of improving quality of life of our patients. METHODS A systematic review was performed in September 2017 in MEDLINE. All reports assessing older patients with cancer care needs in the context of anticancer systemic therapy were reviewed. RESULTS A total of 357 articles were analyzed. From these, 35 studies were included in the analysis. Compared to younger patients, the elderly had less supportive care needs. While older patients asked for less information than their younger counterparts, they still requested information on diagnosis, seriousness of the disease, chances of cure, spread of the disease, recovery, courses of illness, possible consequences, treatment procedures, treatment options, possible side effects and how to deal with them, and what they could do in daily life. When taking into consideration the various needs as assessed by the "Supportive Care Needs Survey", physical and daily living were the most frequently reported needs with emphasis on nutrition, coping with physical symptoms, dealing with side effects of treatment, and performing usual physical tasks and activities. CONCLUSION Information demand seemed moderate but a great deal of attention was paid to nutrition and well-being.
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Affiliation(s)
- Olivia Le Saux
- Medical Oncology Department, Institut de Cancérologie des Hospices Civils de Lyon (IC-HCL), Pierre-Bénite, France; Lyon 1 University, EMR 3738, Faculté de Médecine Lyon-Sud, Oullins, France; Geriatric Oncology Department, Centre Hospitalier Lyon Sud, Pierre-Bénite, France.
| | | | - Sophie Watelet
- Geriatric Oncology Department, Centre Hospitalier Lyon Sud, Pierre-Bénite, France
| | | | - Clémence Lecardonnel
- Geriatric Oncology Department, Centre Hospitalier Lyon Sud, Pierre-Bénite, France
| | | | - Christine Ravot
- Geriatric Oncology Department, Centre Hospitalier Lyon Sud, Pierre-Bénite, France
| | - Claire Falandry
- Geriatric Oncology Department, Centre Hospitalier Lyon Sud, Pierre-Bénite, France; CarMen Biomedical Research Laboratory (Cardiovascular Diseases, Metabolism, Diabetology and Nutrition) INSERM UMR 1060, Université de Lyon, Oullins, France
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Rocque GB, Williams CP, Halilova KI, Borate U, Jackson BE, Van Laar ES, Pisu M, Butler TW, Davis RS, Mehta A, Knight SJ, Safford MM. Improving shared decision-making in chronic lymphocytic leukemia through multidisciplinary education. Transl Behav Med 2018; 8:175-182. [DOI: 10.1093/tbm/ibx034] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Gabrielle B Rocque
- Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, AL, USA
- Division of Hematology and Oncology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Courtney P Williams
- Division of Hematology and Oncology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Karina I Halilova
- Division of Hematology and Oncology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Uma Borate
- Knight Cancer Institute, Oregon Health and Sciences University, Oregan, OR, USA
| | | | | | - Maria Pisu
- Division of Preventive Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Thomas W Butler
- University of South Alabama Mitchell Cancer Institute, Mobile, AL, USA
| | - Randall S Davis
- Division of Hematology and Oncology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Amitkumar Mehta
- Division of Hematology and Oncology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Sara J Knight
- Division of Preventive Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Monika M Safford
- Weill Cornell Medical College, Cornell University, Ithaca, NY, USA
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Essential Elements of Multimodal Analgesia in Enhanced Recovery After Surgery (ERAS) Guidelines. Anesthesiol Clin 2017; 35:e115-e143. [PMID: 28526156 DOI: 10.1016/j.anclin.2017.01.018] [Citation(s) in RCA: 240] [Impact Index Per Article: 34.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Perioperative multimodal analgesia uses combinations of analgesic medications that act on different sites and pathways in an additive or synergistic manner to achieve pain relief with minimal or no opiate consumption. Although all medications have side effects, opiates have particularly concerning, multisystemic, long-term, and short-term side effects, which increase morbidity and prolong admissions. Enhanced recovery is a systematic process addressing each aspect affecting recovery. This article outlines the evidence base forming the current multimodal analgesia recommendations made by the Enhanced Recovery After Surgery Society (ERAS). We describe current evidence and important future directions for effective perioperative multimodal analgesia in enhanced recovery pathways.
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Pozzar RA, Berry DL. Patient-centered research priorities in ovarian cancer: A systematic review of potential determinants of guideline care. Gynecol Oncol 2017; 147:714-722. [PMID: 29029759 DOI: 10.1016/j.ygyno.2017.10.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2017] [Revised: 10/02/2017] [Accepted: 10/03/2017] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To (a) determine what is known about the individual and contextual factors that may influence whether a woman with ovarian cancer receives guideline care, and (b) identify patient-centered research priorities in ovarian cancer. METHODS A systematic review of the PubMed, MEDLINE, CINAHL Complete, and PsycInfo online databases. Eligible articles were published in English, described original research, and either (a) identified factors associated with the receipt of guideline care for ovarian cancer, or (b) described treatment decision making by women with ovarian cancer. Studies were excluded in which women with ovarian cancer did not comprise the entire sample of patient participants. Data were collected in accordance with Garrard's Matrix Method. Study quality was evaluated using the QualSyst tool for evaluating primary research papers. Relevant study findings were imported into NVivo Pro 11 for qualitative synthesis. RESULTS The search strategy yielded 502 unique citations, of which 78 full-text articles were reviewed. Thirty-three articles met the criteria for inclusion. Study quality was high overall. Factors associated with the receipt of guideline care included race and ethnicity, socioeconomic status, insurance type, age, comorbidity, disease stage, tumor characteristics, hospital volume, hospital type, physician volume, and geographic location. Influences on treatment decision making among women with ovarian cancer included the desire to prolong survival, the patient-provider relationship, perceived ability to participate in the treatment decision, values and preferences, information needs, side effects, cost of care, and past experiences with chemotherapy. CONCLUSIONS There is a need for further research that examines ovarian cancer treatment decision making from the perspective of the patient. Priority topics for future research may include the experiences of diverse women receiving treatment for ovarian cancer and the role of shared decision making with providers, referral networks, and practice patterns in the delivery of guideline care.
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Affiliation(s)
- Rachel A Pozzar
- Northeastern University, Bouvé College of Health Sciences, School of Nursing, 360 Huntington Avenue, Boston, MA 02115, United States; Dana-Farber Cancer Institute, Phyllis F. Cantor Center for Research in Nursing and Patient Care Services, 450 Brookline Avenue, LW 518; Boston, MA 02215, United States.
| | - Donna L Berry
- Northeastern University, Bouvé College of Health Sciences, School of Nursing, 360 Huntington Avenue, Boston, MA 02115, United States; Dana-Farber Cancer Institute, Phyllis F. Cantor Center for Research in Nursing and Patient Care Services, 450 Brookline Avenue, LW 518; Boston, MA 02215, United States
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What Do Ovarian Cancer Patients Expect From Treatment?: Perspectives From an Online Patient Community. Cancer Nurs 2017; 40:E17-E27. [PMID: 27454765 DOI: 10.1097/ncc.0000000000000415] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Advances in ovarian cancer treatment have improved outcomes. However, the gap between patients' hopes and expectations and their actual outcomes remains an understudied aspect of treatment decision making. This gap has been noted to be a predictor of poorer health-related quality of life. Incorporating patient hopes and expectations for treatment into clinical care may improve patient experiences. OBJECTIVES The aim of this study is to describe the hopes and expectations of ovarian cancer patients at diagnosis and throughout treatment transitions. METHODS This study sampled from an online community of patients with ovarian cancer. Thirty members completed an online qualitative survey about their diagnostic and treatment journey, including hopes and expectations around treatment. RESULTS Initially, ovarian cancer patients hoped for a complete cure or removal of cancer. As they progressed through treatment, hopes and expectations centered on issues related to living with ovarian cancer. A subset of patients emphasized a lack of information about treatment side effects. CONCLUSIONS The shift in expectations from survival to living with ovarian cancer may demonstrate an enhanced understanding of ovarian cancer prognosis as patients learn more about their condition. Patients underscored that a more involved discussion of side effect profiles with clinicians would enhance their treatment decision making and expectation setting process. IMPLICATIONS FOR PRACTICE Expectation setting may be improved by contextualizing treatment in terms of the transitions ovarian cancer patients experience. Providing relevant information that aligns with patient needs, desires, and concerns at critical transitions may improve clinical care and decision making.
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A systematic review of patient values, preferences and expectations for the treatment of recurrent ovarian cancer. Gynecol Oncol 2017; 146:392-398. [PMID: 28601379 DOI: 10.1016/j.ygyno.2017.05.039] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2017] [Revised: 05/26/2017] [Accepted: 05/29/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND AND OBJECTIVES It is our belief that patient preference should play a significant role in disease management of recurrent ovarian cancer. Since cure is seldom an endpoint in this circumstance, patients' attitudes toward the risks and benefits of chemotherapy versus palliation are relevant. METHODS Medline, Embase, CINAHL and PsycINFO from were searched from January 1, 2000 to December 13, 2016 for studies of values, preferences or expectations of women with platinum-sensitive recurrent or refractory ovarian cancer. RESULTS Ten studies representing five countries met inclusion criteria. Although there was regional variation in preference for palliation over treatment, certain themes emerged. 1) Patients, even in the context of counselling overestimated the curative capability of chemotherapy. In one study 92% of patients had high expectations of healing after completing an expectation of treatment checklist. Another study observed that patients are often overwhelmed by information provided at diagnosis and there can be a discrepancy between what patients report to have heard and what the clinicians said. 2) Patients who had previously tolerated chemotherapy well were more likely to be accepting of the side-effects of chemotherapy. 3) Patients were more willing to accept chemotherapy and the related side effects when treatment was of curative intent or when overall survival was increased. 4) Patients valued both overall and progression free survival. 5) A significant minority (24%) consistently chose treatment over palliation. 6) Patients were more willing to accept the side effects of chemotherapy than were their health care providers. CONCLUSIONS These findings, in aggregate, highlight the importance of communication with patients regarding prognosis, adverse effects and symptom management to help negotiate the decision making process. Chemotherapy in the recurrent setting should be managed on a case by case basis, combining both medical constraints and consideration to patient preferences.
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Wenzel L, Mukamel D, Osann K, Havrilesky L, Sparks L, Lipscomb J, Wright AA, Walker J, Alvarez R, Van Le L, Robison K, Bristow R, Morgan R, Rimel BJ, Ladd H, Hsieh S, Wahi A, Cohn D. Rationale and study protocol for the Patient-Centered Outcome Aid (PCOA) randomized controlled trial: A personalized decision tool for newly diagnosed ovarian cancer patients. Contemp Clin Trials 2017; 57:29-36. [PMID: 28330753 PMCID: PMC6198815 DOI: 10.1016/j.cct.2017.03.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2016] [Revised: 03/04/2017] [Accepted: 03/13/2017] [Indexed: 01/23/2023]
Affiliation(s)
- L Wenzel
- University of California, Irvine, United States.
| | - D Mukamel
- University of California, Irvine, United States
| | - K Osann
- University of California, Irvine, United States
| | | | - L Sparks
- Chapman University, United States
| | | | - A A Wright
- Dana Farber Cancer Institute, United States
| | - J Walker
- University of Oklahoma, United States
| | - R Alvarez
- Vanderbilt University, United States
| | - L Van Le
- University of North Carolina at Chapel Hill, United States
| | | | - R Bristow
- University of California, Irvine, United States
| | | | | | - H Ladd
- University of California, Irvine, United States
| | - S Hsieh
- University of California, Irvine, United States
| | - A Wahi
- University of California, Irvine, United States
| | - D Cohn
- Ohio State University, United States
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Guerra-Reyes L, Christie VM, Prabhakar A, Siek KA. Mind the Gap: Assessing the Disconnect Between Postpartum Health Information Desired and Health Information Received. Womens Health Issues 2017; 27:167-173. [PMID: 28063847 DOI: 10.1016/j.whi.2016.11.004] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2016] [Revised: 11/23/2016] [Accepted: 11/29/2016] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Seeking and receiving health information are critical aspects of prenatal and postpartum care; however, many informational sources lack postpartum content. This study explores the gaps between information desired and information received postpartum and identifies the sources women use for health information seeking, with an emphasis on emergent online and mobile phone-based resources. METHODS Participants were recruited from our community partners' client base for a cross-sectional study. Mothers (n = 77) of a child 48 months or younger completed a survey on health information seeking, health information needs, and technology use. Postpartum health information gaps were defined as topics about which a participant indicated that she wanted information, but did not receive information. Bivariate analyses assessed the association between demographic characteristics, sources of health information used during pregnancy, and postpartum information gaps. RESULTS Health care providers, Internet-based resources, and mobile applications were common sources of health information during pregnancy. Mental and sexual health were the most common types of postpartum health information gaps. In bivariate analyses, higher income and education were associated with postpartum information gaps in mental health and sexual health, respectively (p < .05). CONCLUSIONS Postpartum health information gaps were common in this sample, particularly for topics in mental and sexual health. Unexpected associations between higher levels of education and income and postpartum health information gaps were observed in bivariate analyses. Health educators have the opportunity to capitalize on high rates of Internet information seeking by providing health information online. Health care providers must incorporate mental and sexual health into routine postpartum care.
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Affiliation(s)
- Lucia Guerra-Reyes
- Indiana University-Bloomington School of Public Health, Bloomington, Indiana
| | - Vanessa M Christie
- Indiana University-Bloomington School of Public Health, Bloomington, Indiana.
| | - Annu Prabhakar
- Indiana University-Bloomington School of Informatics and Computing, Bloomington, Indiana
| | - Katie A Siek
- Indiana University-Bloomington School of Informatics and Computing, Bloomington, Indiana
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Pye K, Totton N, Stuart N, Whitaker R, Morrison V, Edwards RT, Yeo ST, Timmis LJ, Butterworth C, Hall L, Rai T, Hoare Z, Neal RD, Wilkinson C, Leeson S. Trial of Optimal Personalised Care After Treatment for Gynaecological cancer (TOPCAT-G): a study protocol for a randomised feasibility trial. Pilot Feasibility Stud 2016; 2:67. [PMID: 27965882 PMCID: PMC5154014 DOI: 10.1186/s40814-016-0108-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2016] [Accepted: 11/08/2016] [Indexed: 12/16/2022] Open
Abstract
Background Gynaecological cancers are diagnosed in over 1000 women in Wales every year. We estimate that this is costing the National Health Service (NHS) in excess of £1 million per annum for routine follow-up appointments alone. Follow-up care is not evidence-based, and there are no definitive guidelines from The National Institute for Health and Care Excellence (NICE) for the type of follow-up that should be delivered. Standard care is to provide a regular medical review of the patient in a hospital-based outpatient clinic for a minimum of 5 years. This study is to evaluate the feasibility of a proposed alternative where the patients are delivered a specialist nurse-led telephone intervention known as Optimal Personalised Care After Treatment for Gynaecological cancer (OPCAT-G), which comprised of a protocol-based patient education, patient empowerment and structured needs assessment. Methods The study will recruit female patients who have completed treatment for cervical, endometrial, epithelial ovarian or vulval cancer within the previous 3 months in Betsi Cadwaladr University Health Board (BCUHB) in North Wales. Following recruitment, participants will be randomised to one of two arms in the trial (standard care or OPCAT-G intervention). The primary outcomes for the trial are patient recruitment and attrition rates, and the secondary outcomes are quality of life, health status and capability, using the EORTC QLQ-C30, EQ-5D-3L and ICECAP-A measures. Additionally, a client service receipt inventory (CSRI) will be collected in order to pilot an economic evaluation. Discussion The results from this feasibility study will be used to inform a fully powered randomised controlled trial to evaluate the difference between standard care and the OPCAT-G intervention. Trial registration ISRCTN45565436.
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Affiliation(s)
- Kirstie Pye
- North Wales Organisation for Randomised Trials in Health (NWORTH), IMSCaR, COHABS, Bangor University, Bangor, UK
| | - Nicola Totton
- North Wales Organisation for Randomised Trials in Health (NWORTH), IMSCaR, COHABS, Bangor University, Bangor, UK
| | | | | | - Val Morrison
- School of Psychology, COHABS, Bangor University, Bangor, UK
| | - Rhiannon Tudor Edwards
- Centre for Health Economics and Medicines Evaluation, IMSCaR, COHABS, Bangor University, Bangor, UK
| | - Seow Tien Yeo
- Centre for Health Economics and Medicines Evaluation, IMSCaR, COHABS, Bangor University, Bangor, UK
| | - Laura J Timmis
- Centre for Health Economics and Medicines Evaluation, IMSCaR, COHABS, Bangor University, Bangor, UK
| | | | - Liz Hall
- Betsi Cadwaladr University Health Board, Bangor, UK
| | - Tekendra Rai
- North Wales Organisation for Randomised Trials in Health (NWORTH), IMSCaR, COHABS, Bangor University, Bangor, UK
| | - Zoe Hoare
- North Wales Organisation for Randomised Trials in Health (NWORTH), IMSCaR, COHABS, Bangor University, Bangor, UK
| | - Richard D Neal
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Clare Wilkinson
- North Wales Centre for Primary Care Research, COHABS, Bangor University, Bangor, UK
| | - Simon Leeson
- Betsi Cadwaladr University Health Board, Bangor, UK
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Achimaş-Cadariu P, Iancu M, Kubelac P, Pop F, Braicu I, Vlad C, Oskay-Özcelik G, Sehouli J. Expectations and perspectives of ovarian cancer patients about cancer management in Romania. The international NOGGO-ENGOT trial: EXPRESSION III. Eur J Cancer Care (Engl) 2016; 26. [PMID: 27507600 DOI: 10.1111/ecc.12566] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/15/2016] [Indexed: 11/30/2022]
Abstract
We have investigated a relational model of expectations and preferences among ovarian cancer patients centred on physician-patient communication, treatment approach, and the need for information. Consecutive patients anonymously filled in the EXPRESSION III questionnaire between 2009 and 2012. Following descriptive statistics, structural equation modelling was used to analyse the relationships between physician's evaluation by the patient (PEP), result of therapy (RT), need for changes in treatment (NCT) and patient's desire to be informed (PD). From a total of 108 patients, 53 (49.1%) knew their disease stage, 103 (95.4%) underwent surgery, 91 (84.3%) had chemotherapy and 51 (46.3%) relapsed. The final model demonstrated a good fit of data with fit indices >0.90. There was a significant positive effect of PEP on RT and a significant negative effect of PEP on NCT, with the final model explaining 84% of the NCT variance. Physicians represent the main point of contact, not only as a source of information about the disease and various treatment options, but also in the coping processes. As patients benefit from completeness of medical consultations, their awareness of the treatment outcome increases, while a negative perception of the physician leads to a desire to make changes in therapy.
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Affiliation(s)
- P Achimaş-Cadariu
- Department of Surgery, The Oncology Institute Ion Chiricuţă, Cluj-Napoca, Romania.,Department of Surgery and Gynecologic Oncology, Iuliu Hațieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - M Iancu
- Department of Medical Informatics and Biostatistics, Faculty of Medicine, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - P Kubelac
- Department of Medical Oncology, The Oncology Institute Ion Chiricuţă, Cluj-Napoca, Romania
| | - F Pop
- Department of Psychology, The Oncology Institute Ion Chiricuţă, Cluj-Napoca, Romania
| | - I Braicu
- Department of Gynecology, Campus Virchow Klinikum, Charité Medical University, Berlin, Germany.,North-Eastern German Society of Gynecological Oncology (NOGGO), Berlin, Germany
| | - C Vlad
- Department of Surgery, The Oncology Institute Ion Chiricuţă, Cluj-Napoca, Romania.,Department of Surgery and Gynecologic Oncology, Iuliu Hațieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - G Oskay-Özcelik
- Department of Gynecology, Campus Virchow Klinikum, Charité Medical University, Berlin, Germany.,North-Eastern German Society of Gynecological Oncology (NOGGO), Berlin, Germany
| | - J Sehouli
- Department of Gynecology, Campus Virchow Klinikum, Charité Medical University, Berlin, Germany.,North-Eastern German Society of Gynecological Oncology (NOGGO), Berlin, Germany
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Oncologists' Perceptions of Recurrent Ovarian Cancer Patients' Preference for Participation in Treatment Decision Making and Strategies for When and How to Involve Patients in This Process. Int J Gynecol Cancer 2016; 25:1717-23. [PMID: 26501437 DOI: 10.1097/igc.0000000000000548] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVES The treatment decision-making (TDM) process in the medical encounter in ovarian cancer (OC) is directed by oncologists. There is little information on oncologists' perceptions of this process. Our objectives were to explore oncologists' perceptions concerning (1) patients' preference for involvement in TDM, (2) factors that affect when to introduce this discussion, and (3) strategies used for engaging women in TDM. METHODS We adopted a qualitative descriptive approach. Individual in-person interviews were used to collect data; themes were identified. RESULTS Fifteen gynecologic and 5 medical oncologists from Ontario, Canada, participated. We found that oncologists made the assumption that women with recurrent OC were interested in being involved in TDM but rarely reported attempting to validate this assumption. The oncologists timed the initiation of the TDM discussion based on their degree of certainty of recurrent OC and their perception of the patient's readiness to be involved in TDM. Oncologists reported using strategies to engage women such as getting the women to take ownership of the decision, verbalize their priorities, lead the discussions, and giving the opportunity to gather information. CONCLUSIONS Oncologists need to listen to each patient rather than make assumptions about the person based on her disease.
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Abstract
Drawing on in-depth interviews with patients and participant observation notes from a cancer support group and outpatients department, we analyse the experiences of Australian-born and immigrant women with gynaecological cancer to describe cancer diagnosis disclosures from the patients' perspectives and examine women's treatment decision-making. Data suggest that most women did not question the surgeon's recommendation and assumed a passive role in treatment decision-making. The contextual factors which impacted on this pattern were the unavailability of an alternative biomedical treatment path, the perception of the metropolitan hospital as a centre of clinical excellence with extensive experience in treating women with gynaecological cancer, and lay understandings of the nature of gynaecological cancer as 'a killer'. We also discuss the circumstances under which a few women took on the role of primary decision-maker.
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Long D, Friedrich-Nel HS, Joubert G. Patients' informational needs while undergoing brachytherapy for cervical cancer. Int J Qual Health Care 2016; 28:200-8. [PMID: 26803540 DOI: 10.1093/intqhc/mzv119] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/04/2015] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE To identify informational needs of South African women receiving intracavitary brachytherapy for locally advanced cervical cancer as part of a process to develop guidelines for quality patient-centred care. DESIGN A prospective, qualitative study with a phenomenological approach. SETTING Brachytherapy Unit, Department Oncology, Universitas Hospital, Bloemfontein, South Africa. PARTICIPANTS Purposive sampling was utilized to recruit patients undergoing brachytherapy for cervical cancer from July to December 2012. MAIN OUTCOME MEASURES Semi-structured, one-to-one interviews were conducted, guided by a theme list. Audio-recorded interviews were conducted in Sesotho, Afrikaans and English by an unaffiliated, multilingual interviewer. The interviews were transcribed, translated and thematic analysis performed. RESULTS Data saturation was achieved having interviewed 28 participants, aged 30-73 years. Four themes with sub-themes were identified: (i) informational needs, (ii) patient disposition towards treatment, (iii) psychological experience and (iv) physical experience. Findings on patients' informational needs were the overarching theme and form the focus of this article. These informational needs included: providing patients with disease- and treatment-related information in their home language; adequate information concerning possible side-effects, sexual intercourse and pre-treatment preparation; and providing patients with informative material as standard procedure. CONCLUSION The article has identified women's informational needs providing a focus for patient-centred care. Providing patients with sufficient and understandable information could lessen feelings of fear and anxiety towards treatment delivery. Guidelines with a patient-centred approach could thus be developed to be used as a tool to assist members of multidisciplinary teams in providing quality care to this group of women.
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Affiliation(s)
- Deirdré Long
- Department of Oncology, Universitas Academic Hospital Complex, Bloemfontein, Free State, South Africa
| | - Hester Sophia Friedrich-Nel
- Faculty of Health & Environmental Sciences, Central University of Technology, Bloemfontein, Free State, South Africa
| | - Georgina Joubert
- Faculty of Health Sciences, University of the Free State, Bloemfontein, Free State, South Africa
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McClellan MA, Karumur RP, Vogel RI, Petzel SV, Cragg J, Chan D, Jacko JA, Sainfort F, Geller MA. Designing an Educational Website to Improve Quality of Supportive Oncology Care for Women with Ovarian Cancer: An Expert Usability Review and Analysis. INTERNATIONAL JOURNAL OF HUMAN-COMPUTER INTERACTION 2016; 32:297-307. [PMID: 27110082 PMCID: PMC4838192 DOI: 10.1080/10447318.2016.1140528] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
A broad-based research team developed a Health Insurance Portability and Accountability Act (HIPAA)-compliant educational website for women with ovarian cancer to improve the quality of supportive oncology care. Prior to a randomized clinical trial of the website, initial usability testing was implemented to evaluate the website. The initial review found that 165/247 checklist items had sufficient information to allow for evaluation with the website achieving an overall score of 63%. By category, lowest scores were for the Home Page, Task Orientation, Page Layout & Visual Design, and Help, Feedback & Error Tolerance. Major issues thought to potentially impede actual usage were prioritized in redevelopment and the second usability review, conducted by the same expert, saw an improvement in scores. Incorporating usability concepts from the start of development, fulfilling the positive expectations of end-users and identifying technical and personal factors that optimize use may greatly enhance usage of health websites.
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Affiliation(s)
| | - Raghav Pavan Karumur
- Department of Computer Science and Engineering, University of Minnesota, Minneapolis, MN, USA
| | | | - Sue V. Petzel
- Department of Obstetrics, Gynecology and Women’s Health, Division of Gynecologic Oncology, University of Minnesota, Minneapolis, MN, USA
| | - Julie Cragg
- Institute for Health Informatics, University of Minnesota, Minneapolis, MN, USA
| | - Daniel Chan
- Division of Environmental Health Sciences, School of Public Health, University of Minnesota, Minneapolis, MN, USA
| | - Julie A. Jacko
- Division of Environmental Health Sciences, School of Public Health, University of Minnesota, Minneapolis, MN, USA
| | - François Sainfort
- Department of Urology, University of Minnesota, Minneapolis, MN, USA
- Division of Health Policy and Management, School of Public Health, University of Minnesota, Minneapolis, MN, USA
| | - Melissa A. Geller
- Department of Urology, University of Minnesota, Minneapolis, MN, USA
- Department of Obstetrics, Gynecology and Women’s Health, Division of Gynecologic Oncology, University of Minnesota, Minneapolis, MN, USA
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Guidelines for pre- and intra-operative care in gynecologic/oncology surgery: Enhanced Recovery After Surgery (ERAS®) Society recommendations--Part I. Gynecol Oncol 2015; 140:313-22. [PMID: 26603969 DOI: 10.1016/j.ygyno.2015.11.015] [Citation(s) in RCA: 288] [Impact Index Per Article: 32.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2015] [Revised: 10/19/2015] [Accepted: 11/17/2015] [Indexed: 02/06/2023]
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Developing an Evidence-Based, Nurse-Led Psychoeducational Intervention With Peer Support in Gynecologic Oncology. Cancer Nurs 2015; 39:E19-30. [PMID: 25881806 DOI: 10.1097/ncc.0000000000000263] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND The physical and psychosocial impact of radiotherapy for gynecologic cancer requires complex interventions to address treatment-related, psychosocial, and psychosexual and survivorship needs. A multidisciplinary approach is required to address these needs, but standard practice is varied and lacks a sound evidence base. OBJECTIVE The aim of this study was to describe the process of development and pilot testing of a novel evidence-based, complex psychoeducational intervention aiming to improve psychosocial outcomes for gynecologic-oncology patients treated curatively with radiotherapy. METHODS The intervention combines tailored nursing consultations with telephone peer support pretreatment, midtreatment, end of treatment, and posttreatment. The UK Medical Research Council framework for developing complex interventions was used to produce an evidence-based, feasible, and acceptable intervention. RESULTS Intervention manuals and study materials were informed by literature reviews of best-available evidence, relevant theory, and iterative consumer and expert consultations. The nurse manual specified content for consultations providing self-care information, coaching tailored to individual needs, and multidisciplinary care coordination. The peer manual described phone consultations aimed at providing psychosocial support and encouraging adherence to self-care strategies. Three peers and 1 nurse underwent rigorous skills and knowledge-based intervention delivery training. The intervention was pilot tested with 6 patients. Qualitative feedback led to minor design and content changes. CONCLUSIONS The intervention was found to be feasible, relevant, and acceptable to participants and clinicians and is currently being tested in a national randomized controlled trial (PeNTAGOn). IMPLICATIONS FOR PRACTICE The Medical Research Council framework is useful in developing nursing interventions. The specific methods and strategies described are useful for designing future complex studies targeting patient supportive care.
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Hanoch Y, Miron-Shatz T, Rolison JJ, Omer Z, Ozanne E. Shared decision making in patients at risk of cancer: the role of domain and numeracy. Health Expect 2014; 18:2799-810. [PMID: 25186806 DOI: 10.1111/hex.12257] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/06/2014] [Indexed: 10/24/2022] Open
Abstract
BACKGROUND Shared decision making has become an integral part of medical consultation. Research has, however, reported wide differences in individuals' desires to be involved in the decision-making process, and these differences in preferences are likely to be the result of a number of factors including age, education and numeracy. OBJECTIVE To investigate whether patients at genetic risk for cancer had preferences for shared decision making that differed depending on medical domain (general health vs. cancer) and whether decision preferences are linked to numeracy abilities. METHODS Four hundred and seventy-six women who consented to participate in response to an email sent by a local branch of the U.S.-based Cancer Genetics Network (CGN) to its members. Participants completed the Control Preference Scale, as well as an objective and subjective numeracy scales. RESULTS Decision domain (cancer vs. general health) was not associated with women's preferences for involvement in decision making. Objective and subjective numeracy predicted a preference for decision involvement in general, and only objective numeracy was predictive with regard to cancer. CONCLUSION Participants were equally likely to state they wanted to play an active, collaborative or passive role in both medical domains (general and cancer). High-numeracy participants were more likely to express a desire for an active role in general and in case they were diagnosed with cancer. PRACTICE IMPLICATIONS Health authorities' recommendations to clinicians to include patients in their medical decisions are supported by patients' desires, and clinicians should be cognizant of their patients' preferences as well as their numeracy skills.
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Affiliation(s)
- Yaniv Hanoch
- School of Psychology, Cognition Institute, University of Plymouth, Drake Circus, Plymouth, UK
| | - Talya Miron-Shatz
- Center for Medical Decision Making, Ono Academic College, Kiryat Ono, Israel
| | | | - Zehra Omer
- Massachusetts General Hospital-Institute for Technology Assessment, Boston, MA, USA
| | - Elisa Ozanne
- The Dartmouth Institute Geisel School of Medicine at Dartmouth, Centerra Parkway, Lebanon, NH, USA
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Mitochondrial and caspase pathways are involved in the induction of apoptosis by IB-MECA in ovarian cancer cell lines. Tumour Biol 2014; 35:11027-39. [PMID: 25095978 DOI: 10.1007/s13277-014-2396-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2014] [Accepted: 07/23/2014] [Indexed: 02/03/2023] Open
Abstract
A3 adenosine receptor agonist (IB-MECA) has been shown to play important roles in cell proliferation and apoptosis in a variety of cancer cell lines. The present study was designed to understand the mechanism underlying IB-MECA-induced apoptosis in human ovarian cancer cell lines. The messenger RNA (mRNA) and protein expression levels of A3 adenosine receptor were detected in OVCAR-3 and Caov-4 ovarian cancer cells. IB-MECA was capable of decreasing intracellular cyclic adenosine monophosphate (cAMP) that was the reason for the presence of functional A3 adenosine receptor on the cell lines. IB-MECA significantly reduced cell viability in a dose-dependent manner. Cytotoxicity of IB-MECA was suppressed by MRS1220, an A3 adenosine receptor antagonist. The growth inhibition effect of IB-MECA was related to the induction of cell apoptosis, which was manifested by annexin V-FITC staining, activation of caspase-3 and caspase-9, and loss of mitochondrial membrane potentials (ΔΨm). In addition, downregulation of the regulatory protein Bcl-2 and upregulation of Bax protein by IB-MECA were also observed. These findings demonstrated that IB-MECA induces apoptosis via the mitochondrial signaling pathway. These suggest that A3 adenosine receptor agonists may be a potential agent for induction of apoptosis in human ovarian cancer cells.
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McCallum M, Jolicoeur L, Lefebvre M, Babchishin LK, Robert-Chauret S, Le T, Lebel S. Supportive Care Needs After Gynecologic Cancer: Where Does Sexual Health Fit in? Oncol Nurs Forum 2014; 41:297-306. [DOI: 10.1188/14.onf.297-306] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Nam KP, Gong HS, Bae KJ, Rhee SH, Lee HJ, Baek GH. The effect of patient involvement in surgical decision making for carpal tunnel release on patient-reported outcome. J Hand Surg Am 2014; 39:493-8. [PMID: 24559626 DOI: 10.1016/j.jhsa.2013.12.025] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2013] [Revised: 12/19/2013] [Accepted: 12/19/2013] [Indexed: 02/02/2023]
Abstract
PURPOSE To investigate whether patient-reported outcomes are different according to patients' preference or experience in surgical decision making for carpal tunnel release. METHODS We preoperatively surveyed 85 patients who underwent carpal tunnel release regarding their preferred role in the process of surgical decision making and assessed their experienced role in the actual decision making 6 months after surgery using a Control Preference Scale. For patient-reported surgical outcomes, we used the Disabilities of the Arm, Shoulder, and Hand questionnaire. We compared these outcomes with those of patients having different preferences or experiences in surgical decision making and also compared the outcomes according to whether the preferred roles match the experienced roles. RESULTS The Disabilities of the Arm, Shoulder, and Hand scores were not significantly different between patients with different preferences for involvement in decision making for surgery or between those with different experiences in the actual decision making. However, those who experienced the same level of involvement as they had preferred were found to have better Disabilities of the Arm, Shoulder, and Hand scores than those who experienced a more active role or a more passive role than they had preferred. CONCLUSIONS This study demonstrates that patient-reported outcomes were not different between those with different preferences or experiences in surgical decision making for carpal tunnel release. However, this study suggests that patients whose experience in decision making matched with their preference may have better subjective outcomes after carpal tunnel release. This suggests that patients with carpal tunnel syndrome may benefit from physicians' efforts of identifying patients' preferences for involvement in decision making and matching the identified preferences to the decision-making process. TYPE OF STUDY/LEVEL OF EVIDENCE Prognostic II.
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Affiliation(s)
- Kyung Pyo Nam
- Department of Orthopedic Surgery, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Hyun Sik Gong
- Department of Orthopedic Surgery, Seoul National University Bundang Hospital, Seongnam, Korea.
| | - Kee Jeong Bae
- Department of Orthopedic Surgery, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Seung Hwan Rhee
- Department of Orthopedic Surgery, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Hyuk Jin Lee
- Department of Orthopedic Surgery, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Goo Hyun Baek
- Department of Orthopedic Surgery, Seoul National University Bundang Hospital, Seongnam, Korea
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Vogel RI, Petzel SV, Cragg J, McClellan M, Chan D, Dickson E, Jacko JA, Sainfort F, Geller MA. Development and pilot of an advance care planning website for women with ovarian cancer: a randomized controlled trial. Gynecol Oncol 2013; 131:430-6. [PMID: 23988413 DOI: 10.1016/j.ygyno.2013.08.017] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2013] [Revised: 08/16/2013] [Accepted: 08/19/2013] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Few available tools facilitate cancer patients and physicians' discussions of quality of life and end-of-life. Our objective was to develop a web-based tool to promote advance care planning for women with ovarian cancer. METHODS Women with ovarian cancer, their families, clinicians and researchers met to identify ways to improve cancer care. A prototype website was created to address advance care planning, focusing on advance healthcare directives (AHD) and palliative care consultation. Patients were recruited from a gynecologic oncology clinic for a pilot randomized controlled trial. Primary outcomes included completion of an AHD and palliative care consultation. RESULTS At study completion, 53 women with ovarian cancer were enrolled and 35 completed the study. The mean age at enrollment was 57.9 ± 9.5 years; most were newly diagnosed or at first recurrence. There were no statistical differences in completion of AHD (p=0.220) or palliative care consultation (p=0.440) between intervention and control groups. However, women in the intervention group showed evidence of moving toward decision making regarding AHD and palliative care and lower decisional conflict. Women assigned to the intervention, compared to control website, were highly satisfied with the amount (p=0.054) and quality (p=0.119) of information and when they accessed the website, used it longer (p=0.049). Overall website use was lower than expected, resulting from several patient-related and design barriers. CONCLUSIONS A website providing information and decisional support for women with ovarian cancer is feasible. Increasing frequency of website use requires future research.
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Hood KB, Hart A, Belgrave FZ, Tademy RH, Jones RA. The role of trust in health decision making among African American men recruited from urban barbershops. J Natl Med Assoc 2012; 104:351-9. [PMID: 23092050 DOI: 10.1016/s0027-9684(15)30176-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To examine factors within the patient-provider relationship that influence which role African American men aged 40-70 years prefer when making health care decisions. METHODS We recruited 40 African American men from barbershops in the Richmond, Virginia, metropolitan area to participate in semistructured interviews. At the completion of each interview, participants completed a brief self-administered demographic survey. The semistructured interviews were audiotaped and transcribed verbatim and then imported into a qualitative software program for organizing, sorting, and coding data. The principles of thematic analysis and template approach were used in this study. The survey data were analyzed using descriptive statistics. RESULTS Trust was a major theme that emerged from the semistructured interviews. The men listed trust in the health care provider as the primary reason for choosing a collaborative or active role in the decision-making process. Within the theme of trust, 4 subthemes emerged: expertise, information sharing, active listening, and relationship length. Thirty-five out of the 40 men interviewed preferred an active or collaborative role in the decision-making process; only 5 preferred passive decision making. CONCLUSIONS Trust emerged as an important factor that influenced role preference for African American men when making health care decisions in the context of the patient-provider relationship. Future studies that help identify which other factors influence health care decision-making roles among African American men may have implications for addressing health disparities among this population and improve the quality of their health care.
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Affiliation(s)
- Kristina B Hood
- Virginia Commonwealth University, Department of Psychology, PO Box 842018, Richmond, VA 23284-2018, USA.
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« Avoir le moral » après l’annonce d’un cancer : une étude auprès de personnes atteintes d’une tumeur cérébrale de haut grade. PSYCHO-ONCOLOGIE 2012. [DOI: 10.1007/s11839-012-0393-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Park MH, Jo C, Bae EY, Lee EK. A comparison of preferences of targeted therapy for metastatic renal cell carcinoma between the patient group and health care professional group in South Korea. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2012; 15:933-939. [PMID: 22999144 DOI: 10.1016/j.jval.2012.05.008] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/29/2011] [Revised: 05/22/2012] [Accepted: 05/28/2012] [Indexed: 06/01/2023]
Abstract
OBJECTIVES To evaluate the preferences of health care professional groups and patient groups with respect to efficacy, adverse events, and administration method for targeted agents of metastatic renal cell carcinoma. METHODS A total of 485 respondents including cancer patients and health care professionals (medical oncologists, nurses, and pharmacists) were surveyed by using a discrete choice experiment in South Korea. Through a literature review and expert consultation, six attributes--progression-free survival, four adverse events (bone marrow suppression, hand-foot skin reaction, gastrointestinal perforation, and bleeding), and administration--were selected. This study employed the conditional logit regression model. RESULTS The six attributes are statistically significant for the patient group and health care professional group. The two groups, however, present differences in progression-free survival, hand-foot skin reaction, gastrointestinal perforation, and administration. The relative importance of adverse events is greater for the patient group, while that of efficacy and administration is greater for the health professional group. For doctors, the relative importance of efficacy is as high as 31%, compared with 7% for the patient group. If progression-free survival is prolonged by 1 month, the acceptable level of bone marrow suppression is 1.3% for the patient group and 9.6% for doctors and that of hand-foot skin reaction is 1.0% and 11.8%, respectively, for the patient group and doctors. CONCLUSIONS This study demonstrates substantial differences in the preference for a targeted drug between the patient group and the health care professional group. Doctors prefer effective and orally administered drugs while patients show more reluctant attitudes about adverse events than do health care professionals.
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Affiliation(s)
- Mi-Hai Park
- School of Pharmacy, Sungkyunkwan University, Suwon, South Korea
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McCallum M, Lefebvre M, Jolicoeur L, Maheu C, Lebel S. Sexual health and gynecological cancer: conceptualizing patient needs and overcoming barriers to seeking and accessing services. J Psychosom Obstet Gynaecol 2012; 33:135-42. [PMID: 22901295 DOI: 10.3109/0167482x.2012.709291] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE The current study explored the subjective experiences of women treated for a gynecological cancer, with a focus on filling gaps in the current literature. Topics explored were: (1) women's own definitions of healthy sexuality; (2) services desired to meet needs; and (3) barriers to participation in sexual health-related services. METHODS Fifteen women participated in a one-on-one, semistructured interview. Data collection and analysis were based on guidelines of interpretive description. RESULTS Definitions of healthy sexuality included emotional intimacy, body image, sexual self-schema, and sexual response. Unmet sexual needs were reported when women's current sexual experiences did not correspond with their subjective perceptions of healthy sexuality. Most women desired informational services, delivered one-on-one or through written material. Younger women often did not utilize services due to practical barriers and emotional avoidance, while older women reported that shyness and stigma discouraged them from discussing sexuality with their health care team. CONCLUSIONS In order to understand patient needs and desire for help, health care providers should assess current sexual health and patient perceptions of healthy sexuality. To increase effectiveness of distress screening and treatment interventions, potential barriers must be evaluated and addressed.
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Affiliation(s)
- Megan McCallum
- Department of Clinical Psychology, University of Ottawa, Ottawa, Ontario, Canada.
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