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Chen L, Sleeman KE, Bradshaw A, Sakharang W, Mo Y, Ellis-Smith C. The Use of Person-Centered Outcome Measures to Support Integrated Palliative Care for Older People: A Systematic Review. J Am Med Dir Assoc 2024; 25:105036. [PMID: 38796168 DOI: 10.1016/j.jamda.2024.105036] [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: 11/12/2023] [Revised: 04/09/2024] [Accepted: 04/10/2024] [Indexed: 05/28/2024]
Abstract
OBJECTIVES The aim was to synthesize evidence on the use of person-centered outcome measures to facilitate integrated palliative care for older people and build a logic model depicting the mechanisms through which person-centered outcome measures support integrated care. DESIGN Mixed methods systematic review using a data-based convergent synthesis design. SETTING AND PARTICIPANTS Older people aged ≥60 years who are approaching the end of their lives in multiple settings. METHODS The study was underpinned by a conceptual framework of integrated palliative care, which informed the search strategy, data extraction, analysis, and synthesis. A hybrid search strategy was implemented, with database searches (PsycINFO, MEDLINE, CINAHL, and ASSIA) complemented by snowball searches. Qualitative and quantitative data were analyzed by narrative synthesis to summarize and explain the findings. The findings informed a logic model depicting the mechanisms of using person-centered outcome measures to support integrated palliative care. RESULTS Twenty-six studies were included. Three mixed methods studies, 2 qualitative studies, and 21 quantitative studies were included. There was evidence that person-centered outcome measures could support integrated palliative care through informing palliative care policy development (n = 4), facilitating joint working across settings (n = 5), enabling close collaboration of multidisciplinary teams (n = 14), promoting joint education (n = 1), facilitating timing and specialist referral (n = 6), and enhancing patient-centered care (n = 3). CONCLUSIONS AND IMPLICATIONS This review makes an important, novel, and theoretically informed contribution to the delivery of scalable and sustainable integrated palliative care into the care of older people using person-centered outcome measures. The constructed logic model provides a conceptual framework and practical approach to how person-centered outcome measures support multilevel integration. A future area of research is the development of person-centered outcome measure interventions informed by the logic model to meet clinical needs.
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Affiliation(s)
- Linghui Chen
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, London, United Kingdom.
| | - Katherine E Sleeman
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, London, United Kingdom
| | - Andy Bradshaw
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, London, United Kingdom
| | - Wilailak Sakharang
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, London, United Kingdom
| | - Yihan Mo
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, London, United Kingdom
| | - Clare Ellis-Smith
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, London, United Kingdom
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Peuten S, Jaspers B, Hainsch-Müller I, Aulmann C, Schneider W, Radbruch L, Ateş G. [Concept-dependent and -independent care effects of site-specific care concepts using "pain" as an example]. Schmerz 2023:10.1007/s00482-023-00754-1. [PMID: 37773298 DOI: 10.1007/s00482-023-00754-1] [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: 05/30/2022] [Revised: 07/21/2023] [Accepted: 08/14/2023] [Indexed: 10/01/2023]
Abstract
BACKGROUND Structures of palliative care, cross-sectoral transitions and care pathways of patients with palliative care needs were investigated at two sites. The systematic comparison of similarities and differences using the topic of 'pain' as an example is intended to provide information on the extent to which these are related to site-specific palliative care concepts (integrated and cooperative). METHODS The study follows a mixed-methods design. In addition to a document analysis of anonymised patient records (n = 774), expert interviews (n = 20), as well as interviews with patients, relatives (n = 60) and focus groups (n = 12), were conducted. RESULTS The systematic comparative analysis provides evidence for concept-independent commonalities (e.g. sociodemographic distribution, aggravated pain treatment) as well as concept-dependent differences (e.g. care pathways, facilitated continuous symptom control through integrated care structures) in the context of integrated or cooperative palliative care. DISCUSSION Commonalities and differences with regard to the topic of pain, as focused on here, and its organisational management become tangible as effects of the respective organisational structure (= concept-dependent) as well as concept-independent external influencing factors.
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Affiliation(s)
- Sarah Peuten
- Institut für Sozialwissenschaften, Universität Augsburg, Universitätsstr. 10, 86159, Augsburg, Deutschland.
| | - Birgit Jaspers
- Klinik für Palliativmedizin, Georg-August-Universität Göttingen, Robert-Koch-Str. 40, 37075, Göttingen, Deutschland
- Klinik für Palliativmedizin, Universitätsklinikum Bonn, Venusberg-Campus 1, 53127, Bonn, Deutschland
| | - Irmtraud Hainsch-Müller
- Interdisziplinäres Zentrum für Palliativmedizin, Universitätsklinikum Augsburg, Stenglinstr. 2, 86156, Augsburg, Deutschland
| | - Christoph Aulmann
- Interdisziplinäres Zentrum für Palliativmedizin, Universitätsklinikum Augsburg, Stenglinstr. 2, 86156, Augsburg, Deutschland
| | - Werner Schneider
- Institut für Sozialwissenschaften, Universität Augsburg, Universitätsstr. 10, 86159, Augsburg, Deutschland
| | - Lukas Radbruch
- Klinik für Palliativmedizin, Universitätsklinikum Bonn, Venusberg-Campus 1, 53127, Bonn, Deutschland
| | - Gülay Ateş
- Klinik für Palliativmedizin, Universitätsklinikum Bonn, Venusberg-Campus 1, 53127, Bonn, Deutschland
- Institut für Digitale Allgemeinmedizin, Universitätsklinikum Rheinisch-Westfälische Technische Hochschule Aachen, Bahnhofstr. 14, 52064, Aachen, Deutschland
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Howard M, Hafid S, Isenberg SR, Webber C, Downar J, Gayowsky A, Jones A, Scott MM, Hsu AT, Conen K, Manuel D, Tanuseputro P. Physician continuity of care in the last year of life in community-dwelling adults: retrospective population-based study. BMJ Support Palliat Care 2023:spcare-2023-004357. [PMID: 37580116 DOI: 10.1136/spcare-2023-004357] [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: 04/27/2023] [Accepted: 07/25/2023] [Indexed: 08/16/2023]
Abstract
OBJECTIVE To describe the timing of involvement of various physician specialties over the last year of life across different levels of primary care physician continuity for differing causes of death. METHODS We conducted a retrospective cohort study of adults who died in Ontario, Canada, between 1 January 2013 and 31 December 2018, using linked population level health administrative data. Outcomes were median days between death and first and last outpatient palliative care specialist encounter, last outpatient encounter with other specialists and with the usual primary care physician. These were calculated by tertile of score on the Usual Provider Continuity Index, defined as the proportion of outpatient physician encounters with the patient's primary care physician. RESULTS Patients' (n=395 839) mean age at death was 76 years. With increasing category of usual primary care physician continuity, a larger proportion were palliative care generalists, palliative care specialist involvement decreased in duration and was concentrated closer to death, the primary care physician was involved closer to death, and other specialist physicians ceased involvement earlier. For patients with cancer, palliative care specialist involvement was longer than for other patients. CONCLUSIONS Compared with patients with lower continuity, those with higher usual provider continuity were more likely to have a primary care physician involved closer to death providing generalist palliative care.
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Affiliation(s)
- Michelle Howard
- Family Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Shuaib Hafid
- Family Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Sarina Roslyn Isenberg
- Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
- Bruyère Research Institute, Ottawa, Ontario, Canada
| | - Colleen Webber
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - James Downar
- Division of Palliative Care, Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Anastasia Gayowsky
- McMaster University, Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
| | - Aaron Jones
- McMaster University, Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Mary M Scott
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Amy T Hsu
- Bruyère Research Institute, Ottawa, Ontario, Canada
- Department of Family Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Katrin Conen
- Walker Family Cancer Centre and Niagara Health Sciences, McMaster University Department of Medicine, Hamilton, Ontario, Canada
| | - Doug Manuel
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Department of Family Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Peter Tanuseputro
- Bruyère Research Institute, Ottawa, Ontario, Canada
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
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4
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Howard M, Hafid A, Webber C, Isenberg SR, Gayowsky A, Jones A, Scott M, Hsu AT, Conen K, Downar J, Manuel D, Tanuseputro P. Continuity of physician care over the last year of life for different cause-of-death categories: a retrospective population-based study. CMAJ Open 2022; 10:E971-E980. [PMID: 36347560 PMCID: PMC9648626 DOI: 10.9778/cmajo.20210294] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND The mix of care provided by family physicians, specialists and palliative care physicians can vary by the illnesses leading to death, which may result in disruptions of continuity of care at the end of life. We measured continuity of outpatient physician care in the last year of life across differing causes of death and assessed factors associated with higher continuity. METHODS We conducted a retrospective descriptive study of adults who died in Ontario between 2013 and 2018, using linked provincial health administrative data. We calculated 3 measures of continuity (usual provider, Bice-Boxerman and sequential continuity), which range from 0 to 1, from outpatient physician visits over the last year of life for terminal illness, organ failure, frailty, sudden death and other causes of death. We used multivariable logistic regression models to evaluate associations between characteristics and a continuity score of 0.5 or greater. RESULTS Among the 417 628 decedents, we found that mean usual provider, Bice-Boxerman and sequential continuity indices were 0.37, 0.30 and 0.37, respectively, with continuity being the lowest for those with terminal illness (0.27, 0.23 and 0.33, respectively). Higher number of comorbidities, higher neighbourhood income quintile and all non-sudden death categories were associated with lower continuity. INTERPRETATION We found that continuity of physician care in the last year of life was low, especially in those with cancer. Further research is needed to validate measures of continuity against end-of-life health care outcomes.
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Affiliation(s)
- Michelle Howard
- Departments of Family Medicine (Howard, Hafid), Medicine (Conen), and Health Research Methods, Evidence and Impact (Jones), McMaster University; ICES McMaster (Gayowsky); Hamilton, Ont.; Ottawa Hospital Research Institute (Webber, Scott, Hsu, Manuel, Tanuseputro); Bruyère Research Institute (Webber, Isenberg, Scott, Hsu, Manuel, Tanuseputro); Division of Palliative Care (Downar), and Departments of Medicine (Isenberg) and Family Medicine (Manuel), University of Ottawa; ICES uOttawa (Manuel, Tanuseputro), Ottawa, Ont.
| | - Abe Hafid
- Departments of Family Medicine (Howard, Hafid), Medicine (Conen), and Health Research Methods, Evidence and Impact (Jones), McMaster University; ICES McMaster (Gayowsky); Hamilton, Ont.; Ottawa Hospital Research Institute (Webber, Scott, Hsu, Manuel, Tanuseputro); Bruyère Research Institute (Webber, Isenberg, Scott, Hsu, Manuel, Tanuseputro); Division of Palliative Care (Downar), and Departments of Medicine (Isenberg) and Family Medicine (Manuel), University of Ottawa; ICES uOttawa (Manuel, Tanuseputro), Ottawa, Ont
| | - Colleen Webber
- Departments of Family Medicine (Howard, Hafid), Medicine (Conen), and Health Research Methods, Evidence and Impact (Jones), McMaster University; ICES McMaster (Gayowsky); Hamilton, Ont.; Ottawa Hospital Research Institute (Webber, Scott, Hsu, Manuel, Tanuseputro); Bruyère Research Institute (Webber, Isenberg, Scott, Hsu, Manuel, Tanuseputro); Division of Palliative Care (Downar), and Departments of Medicine (Isenberg) and Family Medicine (Manuel), University of Ottawa; ICES uOttawa (Manuel, Tanuseputro), Ottawa, Ont
| | - Sarina R Isenberg
- Departments of Family Medicine (Howard, Hafid), Medicine (Conen), and Health Research Methods, Evidence and Impact (Jones), McMaster University; ICES McMaster (Gayowsky); Hamilton, Ont.; Ottawa Hospital Research Institute (Webber, Scott, Hsu, Manuel, Tanuseputro); Bruyère Research Institute (Webber, Isenberg, Scott, Hsu, Manuel, Tanuseputro); Division of Palliative Care (Downar), and Departments of Medicine (Isenberg) and Family Medicine (Manuel), University of Ottawa; ICES uOttawa (Manuel, Tanuseputro), Ottawa, Ont
| | - Ana Gayowsky
- Departments of Family Medicine (Howard, Hafid), Medicine (Conen), and Health Research Methods, Evidence and Impact (Jones), McMaster University; ICES McMaster (Gayowsky); Hamilton, Ont.; Ottawa Hospital Research Institute (Webber, Scott, Hsu, Manuel, Tanuseputro); Bruyère Research Institute (Webber, Isenberg, Scott, Hsu, Manuel, Tanuseputro); Division of Palliative Care (Downar), and Departments of Medicine (Isenberg) and Family Medicine (Manuel), University of Ottawa; ICES uOttawa (Manuel, Tanuseputro), Ottawa, Ont
| | - Aaron Jones
- Departments of Family Medicine (Howard, Hafid), Medicine (Conen), and Health Research Methods, Evidence and Impact (Jones), McMaster University; ICES McMaster (Gayowsky); Hamilton, Ont.; Ottawa Hospital Research Institute (Webber, Scott, Hsu, Manuel, Tanuseputro); Bruyère Research Institute (Webber, Isenberg, Scott, Hsu, Manuel, Tanuseputro); Division of Palliative Care (Downar), and Departments of Medicine (Isenberg) and Family Medicine (Manuel), University of Ottawa; ICES uOttawa (Manuel, Tanuseputro), Ottawa, Ont
| | - Mary Scott
- Departments of Family Medicine (Howard, Hafid), Medicine (Conen), and Health Research Methods, Evidence and Impact (Jones), McMaster University; ICES McMaster (Gayowsky); Hamilton, Ont.; Ottawa Hospital Research Institute (Webber, Scott, Hsu, Manuel, Tanuseputro); Bruyère Research Institute (Webber, Isenberg, Scott, Hsu, Manuel, Tanuseputro); Division of Palliative Care (Downar), and Departments of Medicine (Isenberg) and Family Medicine (Manuel), University of Ottawa; ICES uOttawa (Manuel, Tanuseputro), Ottawa, Ont
| | - Amy T Hsu
- Departments of Family Medicine (Howard, Hafid), Medicine (Conen), and Health Research Methods, Evidence and Impact (Jones), McMaster University; ICES McMaster (Gayowsky); Hamilton, Ont.; Ottawa Hospital Research Institute (Webber, Scott, Hsu, Manuel, Tanuseputro); Bruyère Research Institute (Webber, Isenberg, Scott, Hsu, Manuel, Tanuseputro); Division of Palliative Care (Downar), and Departments of Medicine (Isenberg) and Family Medicine (Manuel), University of Ottawa; ICES uOttawa (Manuel, Tanuseputro), Ottawa, Ont
| | - Katrin Conen
- Departments of Family Medicine (Howard, Hafid), Medicine (Conen), and Health Research Methods, Evidence and Impact (Jones), McMaster University; ICES McMaster (Gayowsky); Hamilton, Ont.; Ottawa Hospital Research Institute (Webber, Scott, Hsu, Manuel, Tanuseputro); Bruyère Research Institute (Webber, Isenberg, Scott, Hsu, Manuel, Tanuseputro); Division of Palliative Care (Downar), and Departments of Medicine (Isenberg) and Family Medicine (Manuel), University of Ottawa; ICES uOttawa (Manuel, Tanuseputro), Ottawa, Ont
| | - James Downar
- Departments of Family Medicine (Howard, Hafid), Medicine (Conen), and Health Research Methods, Evidence and Impact (Jones), McMaster University; ICES McMaster (Gayowsky); Hamilton, Ont.; Ottawa Hospital Research Institute (Webber, Scott, Hsu, Manuel, Tanuseputro); Bruyère Research Institute (Webber, Isenberg, Scott, Hsu, Manuel, Tanuseputro); Division of Palliative Care (Downar), and Departments of Medicine (Isenberg) and Family Medicine (Manuel), University of Ottawa; ICES uOttawa (Manuel, Tanuseputro), Ottawa, Ont
| | - Doug Manuel
- Departments of Family Medicine (Howard, Hafid), Medicine (Conen), and Health Research Methods, Evidence and Impact (Jones), McMaster University; ICES McMaster (Gayowsky); Hamilton, Ont.; Ottawa Hospital Research Institute (Webber, Scott, Hsu, Manuel, Tanuseputro); Bruyère Research Institute (Webber, Isenberg, Scott, Hsu, Manuel, Tanuseputro); Division of Palliative Care (Downar), and Departments of Medicine (Isenberg) and Family Medicine (Manuel), University of Ottawa; ICES uOttawa (Manuel, Tanuseputro), Ottawa, Ont
| | - Peter Tanuseputro
- Departments of Family Medicine (Howard, Hafid), Medicine (Conen), and Health Research Methods, Evidence and Impact (Jones), McMaster University; ICES McMaster (Gayowsky); Hamilton, Ont.; Ottawa Hospital Research Institute (Webber, Scott, Hsu, Manuel, Tanuseputro); Bruyère Research Institute (Webber, Isenberg, Scott, Hsu, Manuel, Tanuseputro); Division of Palliative Care (Downar), and Departments of Medicine (Isenberg) and Family Medicine (Manuel), University of Ottawa; ICES uOttawa (Manuel, Tanuseputro), Ottawa, Ont
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5
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Ni X, Lou Y, Hu W, Wang H, Xu H, Li S, Zhou Y, Ni Y. Development of mobile health-based self-management support for patients with lung cancer: A stepwise approach. Nurs Open 2022; 9:1612-1624. [PMID: 35128821 PMCID: PMC8994947 DOI: 10.1002/nop2.1185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Revised: 12/10/2021] [Accepted: 01/09/2022] [Indexed: 12/24/2022] Open
Abstract
Aim To develop self‐management support platform on mobile for Chinese patients with lung cancer. Design A stepwise approach with combination of methods. Methods Literature review was carried out to construct preliminary framework and develop detailed content for self‐management modules. A semistructured interview was conducted to elicit preference in the content and platform of self‐management modules with 15 patients with lung cancer. Delphi study was performed to evaluate and improve the content of modules with 13 experts. A pilot study was conducted to test the mobile health–based self‐management support modules with 13 patients with lung cancer. Results A social network software‐based WeChat public account “Symptom Self‐Management” for patients with lung cancer was developed and preliminarily tested with positive feedback. Three modules were designed and presented, including symptom management (cancer‐related fatigue, cough, dyspnoea, pain, nausea and vomiting), emotion management and role management. Conclusion This study showed that patients with lung cancer have diversified supportive care needs after discharge. A bottom‐up and stepwise approach to develop mobile health–based self‐management support tool has shown to be feasible and valuable. Theory guidance, user requirement exploration, evidence‐based information and expert evaluation are key elements of the process. Implications for Practice The WeChat Public Account “Symptom Self‐Management” could be used as sustainable platform to support patients with lung cancer in dealing with common challenges. It provides professional information, self‐assessment tools, self‐management skills and peer‐support platform. Information presented in both text and audio forms enables patients' easy access to the platform.
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Affiliation(s)
- Xiaosha Ni
- School of Nursing, Department of Medicine, Hangzhou Normal University, Hangzhou, China.,Department of Nursing, Hangzhou Ninth People's Hospital, Hangzhou, China
| | - Yan Lou
- School of Nursing, Department of Medicine, Hangzhou Normal University, Hangzhou, China
| | - Wenyi Hu
- Health Center, China Jiliang University, Hangzhou, China
| | - Hemei Wang
- Department of Follow-Up, Zhejiang Cancer Hospital (Cancer Hospital of the University of Chinese Academy of Sciences), Hangzhou, China
| | - Hong Xu
- School of Nursing, Department of Medicine, Hangzhou Normal University, Hangzhou, China
| | - Shuaini Li
- The Children's Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Yunxian Zhou
- School of Nursing, Zhejiang Chinese Medical University, Hangzhou, China
| | - Yisha Ni
- School of Nursing, Department of Medicine, Hangzhou Normal University, Hangzhou, China
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Krzyzanowska MK, Julian JA, Gu CS, Powis M, Li Q, Enright K, Howell D, Earle CC, Gandhi S, Rask S, Brezden-Masley C, Dent S, Hajra L, Freeman O, Spadafora S, Hamm C, Califaretti N, Trudeau M, Levine MN, Amir E, Bordeleau L, Chiarotto JA, Elser C, Husain J, Laferriere N, Rahim Y, Robinson AG, Vandenberg T, Grunfeld E. Remote, proactive, telephone based management of toxicity in outpatients during adjuvant or neoadjuvant chemotherapy for early stage breast cancer: pragmatic, cluster randomised trial. BMJ 2021; 375:e066588. [PMID: 34880055 PMCID: PMC8652580 DOI: 10.1136/bmj-2021-066588] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
OBJECTIVE To evaluate the effectiveness of remote proactive management of toxicities during chemotherapy for early stage breast cancer. DESIGN Pragmatic, cluster randomised trial. SETTING 20 cancer centres in Ontario, Canada, allocated by covariate constrained randomisation to remote management of toxicities or routine care. PARTICIPANTS All patients starting adjuvant or neoadjuvant chemotherapy for early stage breast cancer at each centre. 25 patients from each centre completed patient reported outcome questionnaires. INTERVENTIONS Proactive, standardised, nurse led telephone management of common toxicities at two time points after each chemotherapy cycle. MAIN OUTCOME MEASURES The primary outcome, cluster level mean number of visits to the emergency department or admissions to hospital per patient during the whole course of chemotherapy treatment, was evaluated with routinely available administrative healthcare data. Secondary patient reported outcomes included toxicity, self-efficacy, and quality of life. RESULTS Baseline characteristics of participants were similar in the intervention (n=944) and control arms (n=1214); 22% were older than 65 years. Penetration (that is, the percentage of patients who received the intervention at each centre) was 50-86%. Mean number of visits to the emergency department or admissions to hospital per patient was 0.91 (standard deviation 0.28) in the intervention arm and 0.94 (0.40) in the control arm (P=0.94); 47% (1014 of 2158 patients) had at least one visit to the emergency department or a hospital admission during chemotherapy. Among 580 participants who completed the patient reported outcome questionnaires, at least one grade 3 toxicity was reported by 48% (134 of 278 patients) in the intervention arm and by 58% (163 of 283) in the control arm. No differences in self-efficacy, anxiety, or depression were found. Compared with baseline, the functional assessment of cancer therapy trial outcome index decreased by 6.1 and 9.0 points in the intervention and control participants, respectively. CONCLUSIONS Proactive, telephone based management of toxicities during chemotherapy did not result in fewer visits to the emergency department or hospital admissions. With the rapid rise in remote care because of the covid-19 pandemic, identifying scalable strategies for remote management of patients during cancer treatment is particularly relevant. TRIAL REGISTRATION ClinicalTrials.gov NCT02485678.
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Affiliation(s)
- Monika K Krzyzanowska
- Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
- Institute for Clinical Evaluative Sciences, Toronto, ON, Canada
| | - Jim A Julian
- Ontario Clinical Oncology Group, McMaster University, Hamilton, ON, Canada
| | - Chu-Shu Gu
- Ontario Clinical Oncology Group, McMaster University, Hamilton, ON, Canada
| | - Melanie Powis
- Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Qing Li
- Institute for Clinical Evaluative Sciences, Toronto, ON, Canada
| | - Katherine Enright
- Trillium Health Partners, Credit Valley Hospital, Mississauga, ON, Canada
| | - Doris Howell
- Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Craig C Earle
- Institute for Clinical Evaluative Sciences, Toronto, ON, Canada
- Ontario Institute for Cancer Research, Toronto, ON, Canada
| | - Sonal Gandhi
- Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Sara Rask
- Simcoe Muskoka Regional Cancer Program, Royal Victoria Hospital, Barrier, ON, Canada
| | | | - Susan Dent
- Ottawa Hospital Cancer Centre, Ottawa, ON, Canada
| | - Leena Hajra
- Markham Stouffville Hospital, Markham, ON, Canada
| | - Orit Freeman
- Durham Regional Cancer Centre, Oshawa, ON, Canada
| | - Silvana Spadafora
- Algoma District Cancer Programme, Sault Area Hospital, Sault Ste Marie, ON, Canada
| | | | - Nadia Califaretti
- Grand River Hospital's Regional Cancer Centre, Kitchener, ON, Canada
| | - Maureen Trudeau
- Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Mark N Levine
- Ontario Clinical Oncology Group, McMaster University, Hamilton, ON, Canada
- Juravinski Cancer Centre, Hamilton, ON, Canada
| | - Eitan Amir
- Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | | | | | - Christine Elser
- Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Juhi Husain
- Brampton Civic Hospital, Brampton, ON, Canada
| | - Nicole Laferriere
- Regional Cancer Centre Northwest, Thunder Bay Regional Health Sciences Centre, Thunder Bay, ON, Canada
| | - Yasmin Rahim
- Stronach Regional Cancer Centre, Newmarket, ON, Canada
| | | | | | - Eva Grunfeld
- Ontario Institute for Cancer Research, Toronto, ON, Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
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7
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Christ SM, Ahmadsei M, Seiler A, Vlaskou Badra E, Willmann J, Hertler C, Guckenberger M. Continuity and coordination of care in highly selected chronic cancer patients treated with multiple repeat radiation therapy. Radiat Oncol 2021; 16:227. [PMID: 34819112 PMCID: PMC8611895 DOI: 10.1186/s13014-021-01949-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Accepted: 11/04/2021] [Indexed: 11/10/2022] Open
Abstract
Introduction and background As cancer is developing into a chronic disease due to longer survival, continuity and coordination of oncological care are becoming more important for patients. As radiation oncology departments are an integral part of cancer care and as repeat irradiation becomes more commonplace, the relevance of continuity and coordination of care in operating procedures is increasing. This study aims to perform a single-institution analysis of cancer patients in which continuity and coordination of care matters most, namely the highly selected group with multiple repeat course radiotherapy throughout their chronic disease. Materials and methods All patients who received at least five courses of radiotherapy at the Department of Radiation Oncology at the University Hospital Zurich from 2011 to 2019 and who were alive at the time of the initiation of this project were included into this study. Patient and treatment characteristics were extracted from the hospital information and treatment planning systems. All patients completed two questionnaires on continuity of care, one of which was designed in-house and one of which was taken from the literature. Results Of the 33 patients identified at baseline, 20 (60.6%) participated in this study. A median of 6 years (range 3–13) elapsed between the first and the last visit at the cancer center. The median number of involved primary oncologists at the radiation oncology department was two (range 1–5). Fifty-seven percent of radiation therapy courses were preceded by a tumor board discussion. Both questionnaires showed high levels of experienced continuity of care. No statistically significant differences in experienced continuity of care between groups with more or less than two primary oncologists was found. Discussion and conclusion Patients treated with multiple repeat radiation therapy at our department over the past decade experienced high levels of continuity of care, yet further efforts should be undertaken to coordinate care among oncological disciplines in large cancer centers through better and increased use of interdisciplinary tumor boards. Supplementary Information The online version contains supplementary material available at 10.1186/s13014-021-01949-5.
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Affiliation(s)
- Sebastian M Christ
- Department of Radiation Oncology, University Hospital Zurich, University of Zurich, Rämistrasse 100, 8091, Zurich, Switzerland.
| | - Maiwand Ahmadsei
- Department of Radiation Oncology, University Hospital Zurich, University of Zurich, Rämistrasse 100, 8091, Zurich, Switzerland
| | - Annina Seiler
- Department of Radiation Oncology, University Hospital Zurich, University of Zurich, Rämistrasse 100, 8091, Zurich, Switzerland.,Competence Center for Palliative Care, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Eugenia Vlaskou Badra
- Department of Radiation Oncology, University Hospital Zurich, University of Zurich, Rämistrasse 100, 8091, Zurich, Switzerland
| | - Jonas Willmann
- Department of Radiation Oncology, University Hospital Zurich, University of Zurich, Rämistrasse 100, 8091, Zurich, Switzerland
| | - Caroline Hertler
- Department of Radiation Oncology, University Hospital Zurich, University of Zurich, Rämistrasse 100, 8091, Zurich, Switzerland.,Competence Center for Palliative Care, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Matthias Guckenberger
- Department of Radiation Oncology, University Hospital Zurich, University of Zurich, Rämistrasse 100, 8091, Zurich, Switzerland
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8
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Chiew KL, Sundaresan P, Jalaludin B, Chong S, Vinod SK. Quality indicators in lung cancer: a review and analysis. BMJ Open Qual 2021; 10:bmjoq-2020-001268. [PMID: 34344690 PMCID: PMC8336169 DOI: 10.1136/bmjoq-2020-001268] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Accepted: 07/25/2021] [Indexed: 12/02/2022] Open
Affiliation(s)
- Kim-Lin Chiew
- Macarthur Cancer Therapy Centre, South Western Sydney Cancer Service, Campbelltown, New South Wales, Australia .,South Western Sydney Clinical School, University of New South Wales Faculty of Medicine, Sydney, New South Wales, Australia
| | - Puma Sundaresan
- Crown Princess Mary Cancer Centre, Westmead Hospital, Westmead, New South Wales, Australia.,Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
| | - Bin Jalaludin
- Population Health Intelligence, Healthy People and Places Unit, South Western Sydney Local Health District, Liverpool, New South Wales, Australia.,School of Public Health and Community Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Shanley Chong
- Population Health Intelligence, Healthy People and Places Unit, South Western Sydney Local Health District, Liverpool, New South Wales, Australia.,School of Public Health and Community Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Shalini K Vinod
- South Western Sydney Clinical School, University of New South Wales Faculty of Medicine, Sydney, New South Wales, Australia.,Liverpool Cancer Therapy Centre, South Western Sydney Cancer Service, Liverpool, New South Wales, Australia
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9
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Ekdahl A, Söderberg S, Rising-Holmström M. Living with an ever-present breathlessness: Women's experiences of living with chronic obstructive pulmonary disease stage III or IV. Scand J Caring Sci 2021; 36:1064-1073. [PMID: 34008226 DOI: 10.1111/scs.12998] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Revised: 04/08/2021] [Accepted: 04/18/2021] [Indexed: 01/26/2023]
Abstract
BACKGROUND Living with chronic obstructive pulmonary disease stage III or IV has a major impact on a person's everyday life. This qualitative study focuses on women with chronic obstructive pulmonary disease stage III or IV. AIM The aim of this study was to describe women's experiences of living with chronic obstructive pulmonary disease stage III or IV. METHOD A purposive sample of fifteen women with chronic obstructive pulmonary disease stage III or IV participated in the study. Data were collected through individual semi-structured interviews that were subjected to qualitative content analysis. FINDINGS One theme was identified, stabilizing an ever-present breathlessness by restoring strength, and three categories are as follows: managing a restricted everyday life as an expert of their illness, being afraid of contracting infections leading to suffocation and suffering and importance of continuous help and support from significant others and digital media. Breathlessness restricted women with chronic obstructive pulmonary disease, living with a body they have to wait for. Managing everyday life was adapted to their limited abilities and energy. This required detailed planning, good knowledge of their breathing and body. Women were afraid of contracting life-threatening infections that caused suffering, especially COVID-19. The fear leads to isolation and digital media was described as an important means of communication. Significant others gave support and help that was practical and emotional. Women with chronic obstructive pulmonary disease experienced lack of continuous help and support from healthcare professionals. CONCLUSION Stabilizing an ever-present breathlessness by restoring strength required women with chronic obstructive pulmonary disease stage III or IV to conduct detailed planning to manage everyday life. Being afraid of contracting infections and the consequences of suffocation had increased since the pandemic COVID-19 outbreak, which led to self-isolation and an inactive everyday life. To get help, support and socialize, women used digital media.
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Affiliation(s)
- Ann Ekdahl
- Department of Nursing, Mid Sweden University, Sundsvall, Sweden
| | - Siv Söderberg
- Department of Nursing, Mid Sweden University, Sundsvall, Sweden
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10
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Kuo TJ, Wu PC, Tang PL, Yin CH, Chu CH, Hung YM. Effects of continuity of care on the postradiotherapy survival of working-age patients with oral cavity cancer: A nationwide population-based cohort study in Taiwan. PLoS One 2019; 14:e0225635. [PMID: 31841525 PMCID: PMC6913929 DOI: 10.1371/journal.pone.0225635] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2019] [Accepted: 11/09/2019] [Indexed: 01/17/2023] Open
Abstract
Objectives Cancer of the oral cavity, a well-known global health concern, remains one of most common causes of cancer mortality. Continuity of care (COC), a measurement of the extent to which an individual patient receives care from a given provider over a specified period of time, can help cancer survivors process their experiences of dealing with the illness and recuperation; however, limited research has focused on the survival rate of working-age patients with oral cancer. Methods A total of 14,240 working-age patients (20 <age ≤65 years) with oral cavity cancer treated with radiotherapy (RT) during 2000–2013 were included in this study from a registry of patients with catastrophic illnesses maintained by the Taiwan National Health Insurance Research Database. We evaluated the effects of the Continuity of Care Index (COCI) proposed by Bice and Boxerman, sociodemographic factors, and comorbidities on the survival rate. This study categorized COC into three groups—low (COCI < 0.23), intermediate (COCI = 0.23–0.37), and high (COCI ≥ 0.38)—according to the distribution of scores in our sample. A multivariate Cox proportional hazards regression model was used to determine the demographic factors and comorbidities associated with the survival rate. Results Among all the relevant variables, low COCI, male sex, low socioeconomic status, no receipt of prior dental treatment before RT, residence outside northern Taiwan, chemotherapy receipt, and a history of diabetes increased the risk of mortality. Pre-RT dental evaluation and management was significantly associated with reduced post-RT mortality (adjusted hazard ratio [aHR] = 0.767, 95% confidence interval [CI] = 0.729–0.806, p < 0.001). Compared with patients with a high COCI, those with a low COCI exhibited an increased risk of mortality (aHR = 1.170, 95% CI = 1.093–1.252, p < 0.001). The mortality risk in the intermediate COC group was significantly higher than that in the high COC group (aHR = 1.194, 95% CI = 1.127–1.266, p < 0.001). To balance the distribution of the potential risk factors, propensity-score matching was used for the high COC (COCI > 0.38) and non-high COC (COCI ≤ 0.38) groups. After propensity-score matching, the mortality risk in the low and intermediate COC groups was also found to be significantly higher than that in the high COC group (aHR = 1.178, 95% CI = 1.074–1.292, p < 0.001 and aHR = 1.189, 95% CI = 1.107–1.277, p = 0.001, respectively). Conclusions In Taiwan, COC and prior dental treatment before RT significantly affected the survival rate of working-age patients with oral cancer. This result merits policymakers’ attention.
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Affiliation(s)
- Tsu Jen Kuo
- Department of Stomatology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan.,Department of Marine Biotechnology and Resources, National Sun Yat-sen University, Kaohsiung, Taiwan.,Department of Dental Technology, Shu-Zen junior College of Medicine and Management, Kaohsiung, Taiwan
| | - Pei Chen Wu
- Department of Molecular Biology and Human Genetics, Tzu Chi University, Hualien, Taiwan
| | - Pei Ling Tang
- Research Center of Medical Informatics, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan.,Department of Nursing, Meiho University, Pingtung, Taiwan.,College of Nursing, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Chun-Hao Yin
- Research Center of Medical Informatics, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Chi Hsiang Chu
- Clinical Trial Center, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan.,Institute of Statistics, National University of Kaohsiung, Kaohsiung, Taiwan
| | - Yao-Min Hung
- Department of Internal Medicine, Kaohsiung Municipal United Hospital, Kaohsiung, Taiwan.,School of Medicine, National Yang Ming University, Taipei, Taiwan.,Yuhing Junior College of Health Care and Management, Kaohsiung, Taiwan
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11
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Krzyzanowska MK, Julian JA, Powis M, Howell D, Earle CC, Enright KA, Mittmann N, Trudeau ME, Grunfeld E. Ambulatory Toxicity Management (AToM) in patients receiving adjuvant or neo-adjuvant chemotherapy for early stage breast cancer - a pragmatic cluster randomized trial protocol. BMC Cancer 2019; 19:884. [PMID: 31488084 PMCID: PMC6729066 DOI: 10.1186/s12885-019-6099-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Accepted: 08/27/2019] [Indexed: 01/16/2023] Open
Abstract
Background Population-based studies suggest that emergency department visits and hospitalizations are common among patients receiving chemotherapy and that rates in routine practice are higher than expected from clinical trials. Chemotherapy-related toxicities are often predictable and, consequently, acute care visits may be preventable with adequate treatment planning and support between visits to the cancer centre. We will evaluate the impact of proactive telephone-based toxicity management on emergency department visits and hospitalizations in women with early stage breast cancer receiving chemotherapy. Methods In this pragmatic covariate constraint-based cluster randomized trial, 20 centres in Ontario, Canada are randomly allocated to either proactive telephone toxicity management (intervention) or routine care (control). The primary outcome is the cluster-level mean number of ED + H visits per patient evaluated using Ontario administrative healthcare data. Participants are all patients with early stage (I-III) breast cancer commencing adjuvant or neo-adjuvant chemotherapy at participating institutions during the intervention period. At least 25 patients at each centre participate in a patient reported outcomes sub-study involving the collection of standardized questionnaires to measure: severity of treatment toxicities, self-care, self-efficacy, quality of life, and coordination of care. Patients participating in the patient reported outcomes (PRO) sub-study are asked to provide written consent to link their PRO data to administrative data. Unit costs will be applied to each per person resource utilized, and a total cost per population and patient will be generated. An incremental cost-effectiveness analysis will be undertaken to compare the incremental costs and outcomes between the intervention and control groups from the health system perspective. Discussion This study evaluates the effectiveness of a proactive toxicity management intervention in a routine care setting. The use of administrative healthcare data to evaluate the primary outcome enables an evaluation in a real world setting and at a much larger scale than previous studies. Trial registration Clinicaltrials.gov, NCT02485678. Registered 30 June 2015. Electronic supplementary material The online version of this article (10.1186/s12885-019-6099-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Monika K Krzyzanowska
- Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada. .,Department of Medicine, University of Toronto, Toronto, ON, Canada.
| | - Jim A Julian
- Ontario Clinical Oncology Group, McMaster University, Hamilton, ON, Canada
| | - Melanie Powis
- Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Doris Howell
- Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Craig C Earle
- Ontario Institute for Cancer Research, Toronto, ON, Canada
| | | | | | | | - Eva Grunfeld
- Ontario Institute for Cancer Research, Toronto, ON, Canada.,Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
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12
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Chen YY, Hsieh CI, Chung KP. Continuity of Care, Follow-Up Care, and Outcomes among Breast Cancer Survivors. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:E3050. [PMID: 31443512 PMCID: PMC6747467 DOI: 10.3390/ijerph16173050] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Revised: 08/19/2019] [Accepted: 08/19/2019] [Indexed: 12/17/2022]
Abstract
This retrospective cohort study examined the effects of care continuity on the utilization of follow-up services and outcome of breast cancer patients (stages I-III) in the post-treatment phase of care. Propensity score matching and generalized estimation equations were used in the analysis of data obtained from national longitudinal databases. The continuity of care index (COCI) was calculated separately for primary care physicians (PCP) and oncologists. Our results revealed that breast cancer survivors with a higher oncology COCI were more likely than those with a lower oncology COCI to use mammography or breast ultrasound during the follow-up period (OR = 1.26, 95% CI: 1.19-1.32; OR = 1.12, 95% CI: 1.06-1.18; respectively). In terms of health outcomes, a higher oncology COCI was associated with a lower likelihood of hospitalization (OR = 0.78, 95% CI: 0.71-0.85) and emergency department use (OR = 0.88, 95% CI: 0.82-0.95). A higher PCP COCI was also associated with a lower likelihood of hospitalization (OR = 0.77, 95% CI: 0.70-0.85) and emergency department use (OR = 0.75, 95% CI: 0.68-0.82). Overall, this study determined that ambulatory care continuity is positively associated with the likelihood of using recommended follow-up care services and negatively associated with adverse health events among breast cancer survivors.
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Affiliation(s)
- Yun-Yi Chen
- Institute of Health Policy and Management, College of Public Health, National Taiwan University, Taipei 10055, Taiwan
| | - Cheng-I Hsieh
- Division of Hematology and Oncology, Department of Internal Medicine, Taipei Medical University Hospital, Taipei 11031, Taiwan
- Division of Hematology and Oncology, Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei 11031, Taiwan
| | - Kuo-Piao Chung
- Institute of Health Policy and Management, College of Public Health, National Taiwan University, Taipei 10055, Taiwan.
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13
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Cohen Castel O, Shadmi E, Keinan-Boker L, Granot T, Karkabi K, Dagan E. The association between patients' perceived continuity of care and beliefs about oral anticancer treatment. Support Care Cancer 2019; 27:3545-3553. [PMID: 30689046 DOI: 10.1007/s00520-019-04668-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2018] [Accepted: 01/21/2019] [Indexed: 12/27/2022]
Abstract
PURPOSE To explore factors associated with necessity beliefs and concerns among patients receiving oral anticancer therapy (OACT) and, specifically, to examine the relationship between continuity of care (COC) and patients' beliefs about OACT. METHODS A cross-sectional study was conducted among patients from four oncology centers receiving OACT (either targeted, hormonal, or chemotherapy). Two months after OACT initiation, patients were asked to participate in a face-to-face or telephone survey. The Beliefs about Medicines Questionnaire was used to examine patients' perceptions of their personal necessity for OACT and concerns about potential adverse effects. The Nijmegen Continuity Questionnaire was used to assess patients' perceived COC. Data on clinical characteristics were collected from medical records. RESULTS Participants' beliefs about OACT necessity (n = 91) were found to be associated with COC within the oncology team, and with COC between the oncology specialist and the primary care physicians (β = 0.27, p = 0.003; β = 0.22, p = 0.02, respectively), beyond age, depression, and cancer type (ΔR2 = 0.14, p < 0.001). Additionally, the difference between participants' beliefs about OACT necessity and their OACT-related concerns was associated with COC within the oncology team (β = 0.30, p = 0.001), beyond age, income, family status, and cancer type (ΔR2 = 0.09, p = 0.001). CONCLUSIONS This study shows that cancer patients' perceptions about the COC between care providers are related to their beliefs about OACT necessity, thus providing evidence for the importance of health care delivery approaches that support COC within the oncology team and between the oncology specialist and the primary care physician.
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Affiliation(s)
- Orit Cohen Castel
- The Cheryl Spencer Department of Nursing, Faculty of Social Welfare and Health Sciences, University of Haifa, 199 Aba Khoushy Ave., Mount Carmel, Haifa, Israel.
| | - Efrat Shadmi
- The Cheryl Spencer Department of Nursing, Faculty of Social Welfare and Health Sciences, University of Haifa, 199 Aba Khoushy Ave., Mount Carmel, Haifa, Israel
| | - Lital Keinan-Boker
- School of Public Health, Faculty of Social Welfare and Health Sciences, University of Haifa, 199 Aba Khoushy Ave., Mount Carmel, Haifa, Israel
| | - Tal Granot
- Davidoff Cancer Treatment and Research Center, Rabin Medical Center, 39 Jabotinski St, Petah Tikva, Israel
| | - Khaled Karkabi
- Department of Family Medicine, Clalit Health Services, Haifa & Western Galilee District, Ruth & Bruce Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, 6 Hashachaf Street, Haifa, Israel
| | - Efrat Dagan
- The Cheryl Spencer Department of Nursing, Faculty of Social Welfare and Health Sciences, University of Haifa, 199 Aba Khoushy Ave., Mount Carmel, Haifa, Israel
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14
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den Herder-van der Eerden M, Hasselaar J, Payne S, Varey S, Schwabe S, Radbruch L, Van Beek K, Menten J, Busa C, Csikos A, Vissers K, Groot M. How continuity of care is experienced within the context of integrated palliative care: A qualitative study with patients and family caregivers in five European countries. Palliat Med 2017; 31:946-955. [PMID: 28659022 DOI: 10.1177/0269216317697898] [Citation(s) in RCA: 64] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Patients with advanced diseases often experience deficient continuity of care. Although integrated palliative care promotes continuity of care, it is not clear how it can be optimized to improve continuity of care experiences. AIM To examine how relational, informational and management continuity of care are experienced by patients with advanced diseases and their family caregivers receiving care from several integrated palliative care initiatives in five European countries. DESIGN We adopted a longitudinal qualitative study design including two interviews (interval 3 months) with patients and family caregivers focusing on how health care professionals responded to their needs. Interviews were audio-recorded and transcribed verbatim. Analysis involved a two-step qualitative content approach. SETTING/PARTICIPANTS A total of 22 integrated palliative care initiatives (established local palliative care collaborations) were selected in Belgium, Germany, Hungary, the Netherlands and the United Kingdom. We recruited 152 patients (63% cancer, 24% chronic obstructive pulmonary disease, 13% heart failure; life expectancy <1 year; mean age 68 years, 56% female) and 92 family caregivers (mean age 61 years, 66% female). RESULTS Trusted relationships with a small number of key health care professionals to receive tailored care and easily access help were essential. Relational continuity was often deficient, especially with general practitioners. Although informational and management continuity was often lacking in care provision, collaborative integrated palliative care initiatives were related to consistent and coherent care. CONCLUSION Patients and family caregivers most likely experience continuity of care by having a small number of trusted health care professionals who are available, provide multidisciplinary care and regularly transfer information to all health care professionals involved. Optimizing continuity of care requires further integration of integrated palliative care initiatives with other health care professionals involved in the patients' care networks.
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Affiliation(s)
| | - Jeroen Hasselaar
- 1 Department of Anesthesiology, Pain and Palliative Care, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Sheila Payne
- 2 Division of Health Research, International Observatory on End of Life Care, Lancaster University, Lancaster, UK
| | - Sandra Varey
- 2 Division of Health Research, International Observatory on End of Life Care, Lancaster University, Lancaster, UK
| | - Sven Schwabe
- 3 Klinik für Palliativmedizin, Universitätsklinikum Bonn, Bonn, Germany
| | - Lukas Radbruch
- 3 Klinik für Palliativmedizin, Universitätsklinikum Bonn, Bonn, Germany
| | - Karen Van Beek
- 4 Department of Radiation Oncology and Palliative Care, University Hospital Leuven, Leuven, Belgium
| | - Johan Menten
- 4 Department of Radiation Oncology and Palliative Care, University Hospital Leuven, Leuven, Belgium
| | - Csilla Busa
- 5 Department of Primary Health Care, Medical School, University of Pecs (UP), Pécs, Hungary
| | - Agnes Csikos
- 5 Department of Primary Health Care, Medical School, University of Pecs (UP), Pécs, Hungary
| | - Kris Vissers
- 1 Department of Anesthesiology, Pain and Palliative Care, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Marieke Groot
- 1 Department of Anesthesiology, Pain and Palliative Care, Radboud University Medical Center, Nijmegen, The Netherlands
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15
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Voruganti T, Grunfeld E, Jamieson T, Kurahashi AM, Lokuge B, Krzyzanowska MK, Mamdani M, Moineddin R, Husain A. My Team of Care Study: A Pilot Randomized Controlled Trial of a Web-Based Communication Tool for Collaborative Care in Patients With Advanced Cancer. J Med Internet Res 2017; 19:e219. [PMID: 28720558 PMCID: PMC5539387 DOI: 10.2196/jmir.7421] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2017] [Revised: 05/05/2017] [Accepted: 05/26/2017] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND The management of patients with complex care needs requires the expertise of health care providers from multiple settings and specialties. As such, there is a need for cross-setting, cross-disciplinary solutions that address deficits in communication and continuity of care. We have developed a Web-based tool for clinical collaboration, called Loop, which assembles the patient and care team in a virtual space for the purpose of facilitating communication around care management. OBJECTIVE The objectives of this pilot study were to evaluate the feasibility of integrating a tool like Loop into current care practices and to capture preliminary measures of the effect of Loop on continuity of care, quality of care, symptom distress, and health care utilization. METHODS We conducted an open-label pilot cluster randomized controlled trial allocating patients with advanced cancer (defined as stage III or IV disease) with ≥3 months prognosis, their participating health care team and caregivers to receive either the Loop intervention or usual care. Outcome data were collected from patients on a monthly basis for 3 months. Trial feasibility was measured with rate of uptake, as well as recruitment and system usage. The Picker Continuity of Care subscale, Palliative care Outcomes Scale, Edmonton Symptom Assessment Scale, and Ambulatory and Home Care Record were patient self-reported measures of continuity of care, quality of care, symptom distress, and health services utilization, respectively. We conducted a content analysis of messages posted on Loop to understand how the system was used. RESULTS Nineteen physicians (oncologists or palliative care physicians) were randomized to the intervention or control arms. One hundred twenty-seven of their patients with advanced cancer were approached and 48 patients enrolled. Of 24 patients in the intervention arm, 20 (83.3%) registered onto Loop. In the intervention and control arms, 12 and 11 patients completed three months of follow-up, respectively. A mean of 1.2 (range: 0 to 4) additional healthcare providers with an average total of 3 healthcare providers participated per team. An unadjusted between-arm increase of +11.4 was observed on the Picker scale in favor of the intervention arm. Other measures showed negligible changes. Loop was primarily used for medical care management, symptom reporting, and appointment coordination. CONCLUSIONS The results of this study show that implementation of Loop was feasible. It provides useful information for planning future studies further examining effectiveness and team collaboration. Numerically higher scores were observed for the Loop arm relative to the control arm with respect to continuity of care. Future work is required to understand the incentives and barriers to participation so that the implementation of tools like Loop can be optimized. TRIAL REGISTRATION ClinicalTrials.gov NCT02372994; https://clinicaltrials.gov/ct2/show/NCT02372994 (Archived by WebCite at http://www.webcitation.org/6r00L4Skb).
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Affiliation(s)
- Teja Voruganti
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Eva Grunfeld
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
| | - Trevor Jamieson
- Division of General Internal Medicine, St. Michael's Hospital, Toronto, ON, Canada
- Institute for Health System Solutions and Virtual Care (WIHV), Women's College Hospital, Toronto, ON, Canada
- Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Allison M Kurahashi
- Temmy Latner Centre for Palliative Care, Mount Sinai Hospital, Toronto, ON, Canada
| | - Bhadra Lokuge
- Temmy Latner Centre for Palliative Care, Mount Sinai Hospital, Toronto, ON, Canada
| | - Monika K Krzyzanowska
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
- Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Muhammad Mamdani
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
- Department of Medicine, University of Toronto, Toronto, ON, Canada
- Li Ka Shing Centre for Healthcare Analytics Research and Training, St. Michael's Hospital, Toronto, ON, Canada
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON, Canada
- Institute of Clinical Evaluative Sciences, Toronto, ON, Canada
| | - Rahim Moineddin
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
- Institute of Clinical Evaluative Sciences, Toronto, ON, Canada
| | - Amna Husain
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
- Temmy Latner Centre for Palliative Care, Mount Sinai Hospital, Toronto, ON, Canada
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16
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Barton-Burke M, Ciccolini K, Mekas M, Burke S. Dermatologic Reactions to Targeted Therapy: A Focus on Epidermal Growth Factor Receptor Inhibitors and Nursing Care. Nurs Clin North Am 2017; 52:83-113. [PMID: 28189168 PMCID: PMC5645079 DOI: 10.1016/j.cnur.2016.11.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Cancer treatments usually have side effects of bone marrow depression, mucositis, hair loss, and gastrointestinal issues. Rarely do we think of skin side effects until patients have been treated successfully with epidermal growth factor receptor inhibitors (EGFRi). Those reactions include papulopustular rash, hair changes, radiation dermatitis enhancement, pruritus, mucositis, xerosis, fissures, and paronychia. This article discusses the common skin reactions seen when using EGFRi and presents an overview of skin as the largest and important organ of the body, including an overview of skin assessment, pathophysiology of the skin reactions, nursing care involved, and introduction to oncodermatology.
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Affiliation(s)
- Margaret Barton-Burke
- Immediate Past President, Oncology Nursing Society 2014-2016, Director, Nursing Research, Memorial Sloan-Kettering Cancer Center, 205 East 64th Street, Rm 251 Concourse Level, New York, NY 10065,
| | - Kathryn Ciccolini
- Department of Dermatology, Memorial Sloan Kettering Cancer Center, New York, New York,
| | - Maria Mekas
- Department of Dermatology, Memorial Sloan Kettering Cancer Center, New York, New York,
| | - Sean Burke
- Research Assistant, Nursing Research, Memorial Sloan Kettering Cancer Center, New York, New York,
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17
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Giuliani ME, Milne RA, Puts M, Sampson LR, Kwan JYY, Le LW, Alibhai SMH, Howell D, Abdelmutti N, Liu G, Papadakos J, Catton P, Jones J. The prevalence and nature of supportive care needs in lung cancer patients. ACTA ACUST UNITED AC 2016; 23:258-65. [PMID: 27536176 DOI: 10.3747/co.23.3012] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
PURPOSE In the present work, we set out to comprehensively describe the unmet supportive care and information needs of lung cancer patients. METHODS This cross-sectional study used the Supportive Care Needs Survey Short Form 34 (34 items) and an informational needs survey (8 items). Patients with primary lung cancer in any phase of survivorship were included. Demographic data and treatment details were collected from the medical charts of participants. The unmet needs were determined overall and by domain. Univariable and multivariable regression analyses were performed to determine factors associated with greater unmet needs. RESULTS From August 2013 to February 2014, 89 patients [44 (49%) men; median age: 71 years (range: 44-89 years)] were recruited. The mean number of unmet needs was 8 (range: 0-34), and 69 patients (78%) reported at least 1 unmet need. The need proportions by domain were 52% health system and information, 66% psychological, 58% physical, 24% patient care, and 20% sexuality. The top 2 unmet needs were "fears of the cancer spreading" [n = 44 of 84 (52%)] and "lack of energy/tiredness" [n = 42 of 88 (48%)]. On multivariable analysis, more advanced disease and higher MD Anderson Symptom Inventory scores were associated with increased unmet needs. Patients reported that the most desired information needs were those for information on managing symptoms such as fatigue (78%), shortness of breath (77%), and cough (63%). CONCLUSIONS Unmet supportive care needs are common in lung cancer patients, with some patients experiencing a very high number of unmet needs. Further work is needed to develop resources to address those needs.
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Affiliation(s)
- M E Giuliani
- Department of Radiation Oncology, Princess Margaret Cancer Centre, Toronto, ON
| | - R A Milne
- Department of Radiation Oncology, Princess Margaret Cancer Centre, Toronto, ON
| | - M Puts
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON
| | - L R Sampson
- Department of Radiation Oncology, Princess Margaret Cancer Centre, Toronto, ON
| | - J Y Y Kwan
- Department of Radiation Oncology, Princess Margaret Cancer Centre, Toronto, ON
| | - L W Le
- Department of Biostatistics, Princess Margaret Cancer Centre, Toronto, ON
| | - S M H Alibhai
- Department of Medicine, University of Toronto, Toronto, ON
| | - D Howell
- Oncology Nursing Research, Princess Margaret Cancer Centre, Toronto, ON
| | - N Abdelmutti
- Health Promotion and Wellness, Princess Margaret Cancer Centre, Toronto, ON
| | - G Liu
- Division of Medical Oncology, Princess Margaret Cancer Centre, Toronto, ON
| | - J Papadakos
- Department of Radiation Oncology, Princess Margaret Cancer Centre, Toronto, ON
| | - P Catton
- Department of Radiation Oncology, Princess Margaret Cancer Centre, Toronto, ON
| | - J Jones
- Cancer Survivorship Program, Princess Margaret Cancer Centre, Toronto, ON
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Yıldirim B, Yeniçeri EN, Tanrıverdi O, Ünaldı M, Başaran Ö, Alataş ÖD, Acar E. What else could be done for management of cancer patients in ED? Challenges and suggestions (cancer patients and emergency service). Am J Emerg Med 2015; 33:1518-9. [PMID: 26302941 DOI: 10.1016/j.ajem.2015.07.046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2015] [Revised: 07/20/2015] [Accepted: 07/21/2015] [Indexed: 02/05/2023] Open
Affiliation(s)
- Birdal Yıldirim
- Department of Emergency Medicine, Education and Research Hospital, Muğla Sıtkı Koçman University, Muğla, Turkey.
| | - Emine Nese Yeniçeri
- Department of Family Medicine, Faculty of Medicine, Muğla Sıtkı Koçman University, Muğla, Turkey
| | - Ozgur Tanrıverdi
- Department of Medical Oncology, Faculty of Medicine, Muğla Sıtkı Koçman University, Muğla, Turkey
| | - Mehmet Ünaldı
- Emergency Department, Goztepe Training and Research Hospital, Medeniyet University, Istanbul, Turkey
| | - Özcan Başaran
- Department of Cardiology, Faculty of Medicine, Muğla Sıtkı Koçman University, Muğla, Turkey
| | - Ömer Doğan Alataş
- Department of Emergency Medicine, Education and Research Hospital, Muğla Sıtkı Koçman University, Muğla, Turkey
| | - Ethem Acar
- Department of Emergency Medicine, Education and Research Hospital, Muğla Sıtkı Koçman University, Muğla, Turkey
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Fradgley EA, Paul CL, Bryant J. A systematic review of barriers to optimal outpatient specialist services for individuals with prevalent chronic diseases: what are the unique and common barriers experienced by patients in high income countries? Int J Equity Health 2015; 14:52. [PMID: 26051244 PMCID: PMC4464126 DOI: 10.1186/s12939-015-0179-6] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2014] [Accepted: 04/29/2015] [Indexed: 02/21/2023] Open
Abstract
Health utilization and need assessment data suggest there is considerable variation in access to outpatient specialist care. However, it is unclear if the types of barriers experienced are specific to chronic disease groups or experienced universally. This systematic review provides a detailed summary of common and unique barriers experienced by chronic disease groups when accessing and receiving care, and a synthesized list of possible health service initiatives to improve equitable delivery of optimal care in high-income countries. Quantitative articles describing barriers to specialist outpatient services were retrieved from CINAHL, MEDLINE, Embase, and PyscINFO. To be eligible for review, studies: were published from 2002 to May 2014; included samples with cancer, diabetes mellitus, osteoporosis, arthritis, ischaemic heart disease, stroke, asthma, chronic pulmonary disorder (COPD) or depression; and, were conducted in high-income countries. Using a previously validated model of access (Penchansky and Thomas' model of fit), barriers were grouped according to five overarching domains and defined in more detail using 33 medical subject headings. Results from reviewed articles, including the scope and frequency of reported barriers, are conceptualized using thematic analysis and framed as possible health service initiatives. A total of 3181 unique records were screened for eligibility, of which 74 studies were included in final analysis. The largest proportion of studies reported acceptability barriers (75.7 %), of which demographic disparities (44.6 %) were reported across all diseases. Other frequently reported barriers included inadequate need assessment (25.7 %), information provision (32.4 %), or health communication (20 %). Unique barriers were identified for oncology, mental health, and COPD samples. Based on the scope, frequency and measurement of reported barriers, eight key themes with associated implications for health services are presented. Examples include: common accommodation and accessibility barriers caused on service organization or physical structure, such as parking and appointment scheduling; common barriers created by poor coordination of care within the healthcare team; and unique barriers resulting from inadequate need assessment and referral practices. Consideration of barriers, across and within chronic diseases, suggests a number of specific initiatives are likely to improve the delivery of patient-centered care and increase equity in access to high-quality health services.
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Affiliation(s)
- Elizabeth A Fradgley
- Priority Research Centre for Health Behaviour and Hunter Medical Research Institute, School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, 2305, Australia.
| | - Christine L Paul
- Priority Research Centre for Health Behaviour and Hunter Medical Research Institute, School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, 2305, Australia.
| | - Jamie Bryant
- Priority Research Centre for Health Behaviour and Hunter Medical Research Institute, School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, 2305, Australia.
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20
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Lorhan S, Dennis D, van der Westhuizen M, Hodgson S, Berrang T, Daudt H. The experience of people with lung cancer with a volunteer-based lay navigation intervention at an outpatient cancer center. PATIENT EDUCATION AND COUNSELING 2014; 96:237-248. [PMID: 24862912 DOI: 10.1016/j.pec.2014.05.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/12/2013] [Revised: 04/10/2014] [Accepted: 05/01/2014] [Indexed: 06/03/2023]
Abstract
OBJECTIVE To describe the experiences of patients with lung cancer with a volunteer-based lay navigation intervention. METHODS Forty patients with newly diagnosed lung cancer enrolled in a three-step navigation intervention delivered by trained volunteer lay navigators (VLNs), beginning prior to their first oncologist's appointment and ending before the start of treatment. Methodological triangulation of data was used in a mixed method study design. Cases were categorized based on the predominant needs met by the VLN: emotional, practical/informational, family, and complex. Data were analyzed using framework analysis. RESULTS The provision of emotional support, information, and referrals to other services by the VLN were of particular benefit to the patient and their families. Satisfaction with the program and its timing was high; it was considered an effective means for patients to share concerns and have their needs attended to before starting treatment. CONCLUSION This study demonstrates capacity for lay volunteers to address the multifaceted needs of lung cancer patients during their transition from primary care in the diagnosis to treatment phase. PRACTICE IMPLICATIONS Using volunteers as navigators offers an opportunity to meet patient needs with minimal resources, increase access to services for patients, and improve the sustainability of the program.
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Yokoo M, Akechi T, Takayama T, Karato A, Kikuuchi Y, Okamoto N, Katayama K, Nakanotani T, Ogawa A. Comprehensive assessment of cancer patients' concerns and the association with quality of life. Jpn J Clin Oncol 2014; 44:670-6. [PMID: 24829467 DOI: 10.1093/jjco/hyu060] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE Comprehensive assessment of perceived concerns can be used to guide supportive care appropriate to individual cancer patients. This study sought to determine the prevalence of cancer patients' concerns and the degree to which these concerns contribute to patients' quality of life. METHODS Participants were patients with all types of cancer, who completed an Internet survey questionnaire regarding comprehensive concerns about physical, psychological, psychosocial and economic aspects of having cancer. The questionnaire was based on the newly developed Comprehensive Concerns Assessment Tool and the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire. RESULTS We obtained complete data from 807 patients. Factors related to 'self-management' concerns were the most common (61.2%), followed by concerns about 'psychological symptoms' (48.5%), 'medical information' (46.2%), 'daily living' (29.9%), 'pain' (17.6%), 'constipation' (15.6%) and other 'physical symptoms' (15.2%). Multiple regression analysis revealed that all concerns except those about 'medical information' significantly contributed to quality of life. CONCLUSIONS Cancer patients' concerns were shown to be multidimensional and significantly associated with quality of life. Thus, assessment of patients' concerns should be multidimensional in nature, and a multidisciplinary care team should help patients improve their quality of life.
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Affiliation(s)
- Minori Yokoo
- Psycho-Oncology Division, Research Center for Innovative Oncology, National Cancer Center East Hospital, Kashiwa, Chiba
| | - Tatsuo Akechi
- Department of Psychiatry and Cognitive-Behavioral Medicine, Nagoya City Graduate School of Medical Sciences, Nagoya, Aichi
| | - Tomoko Takayama
- Cancer Information Service Division, Center for Cancer Control and Information Service, National Cancer Center, Tsukiji, Tokyo
| | - Atsuya Karato
- Patient Support Center, The Cancer Institute Hospital of Japanese Foundation for Cancer Research, Ariake, Tokyo
| | - Yuki Kikuuchi
- Department of Patient and Family Support, Shikoku Cancer Center, Matsuyama, Ehime
| | - Naoyuki Okamoto
- Cancer Prevention and Cancer Control Division, Kanagawa Cancer Center Research Institute, Yokohama, Kanagawa, Japan
| | - Kayoko Katayama
- Cancer Prevention and Cancer Control Division, Kanagawa Cancer Center Research Institute, Yokohama, Kanagawa, Japan
| | - Takako Nakanotani
- Psycho-Oncology Division, Research Center for Innovative Oncology, National Cancer Center East Hospital, Kashiwa, Chiba
| | - Asao Ogawa
- Psycho-Oncology Division, Research Center for Innovative Oncology, National Cancer Center East Hospital, Kashiwa, Chiba
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