1
|
Piazza M, Drury A. An integrative review of adult cancer patients' experiences of nursing telephone and virtual triage systems for symptom management. Eur J Oncol Nurs 2023; 67:102428. [PMID: 37952276 DOI: 10.1016/j.ejon.2023.102428] [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: 06/15/2023] [Revised: 09/21/2023] [Accepted: 09/29/2023] [Indexed: 11/14/2023]
Abstract
PURPOSE Telephone and virtual triage services are becoming increasingly common in ambulatory oncology settings. Few studies have evaluated their implementation from the perspective of service users. This study aims to evaluate the experiences of engaging with nurse-delivered telephone and virtual triage systems for symptom management among people undergoing cancer treatment. METHODS An integrative review was undertaken. MEDLINE, CINAHL, PsycInfo, Academic Search Complete and Scopus were systematically searched. Twelve publications met the inclusion criteria, and data related to cancer patients' perceptions of the triage process were extracted and analysed. RESULTS Telephone-based (n=7), app-based (n=5) and video-based teleconferencing (n=2) triage systems were evaluated positively overall, enhancing ease of health system navigation, avoidance of emergency department for consultation, and the information, reassurance and support provided to support self-management of symptoms. However, several factors influenced the users' engagement with triage services, including confidence to articulate symptoms, limited opening hours, waiting times for initial triage or follow-up and digital literacy. Collectively, these factors contributed to delayed reporting or under-reporting of symptoms, undermining the potential impact of services. Studies included variable reporting of intervention characteristics, including the qualification of nurses delivering and leading services. CONCLUSIONS Future evaluations of triage services must give greater consideration to the characterisation of interventions to ensure transferability, including nursing roles and qualifications. To ensure effective intervention and optimal supportive care for symptom management, patients must be prepared to engage triage services early. Future evaluations must ensure the impact of digital literacy on engagement with, and experience of, virtual triage is investigated.
Collapse
Affiliation(s)
- Martina Piazza
- Morgagni-Pierantoni Hospital (AUSL Romagna), 34, via Carlo Forlanini, Forlì, FC, 47121, Italy.
| | - Amanda Drury
- School of Nursing, Psychotherapy and Community Health, Dublin City University, Glasnevin, Dublin, 9, Ireland.
| |
Collapse
|
2
|
Nurse-led telehealth interventions for symptom management in patients with cancer receiving systemic or radiation therapy: a systematic review and meta-analysis. Support Care Cancer 2022; 30:7119-7132. [PMID: 35420331 PMCID: PMC9008678 DOI: 10.1007/s00520-022-07052-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Accepted: 04/06/2022] [Indexed: 11/16/2022]
Abstract
Purpose Patients receiving cancer treatments experience many treatment-related symptoms. Telehealth is increasingly being used to support symptom management. The overall aim was to determine the effectiveness of nurse-led telehealth symptom management interventions for patients with cancer receiving systemic or radiation therapy compared to usual care on health service use, quality of life, and symptom severity. Methods A systematic review was conducted following the Cochrane Handbook and PRISMA reporting guidelines. Five electronic databases were searched. Two independent reviewers screened articles and extracted data. Meta-analysis was performed if data were clinically and methodologically homogeneous. Subanalysis was conducted on reactive and scheduled telehealth interventions. Results Of 7749 citations screened, 10 studies were included (8 randomized control trials, 2 quasi-experimental). Five were reactive telehealth interventions with patient-initiated contact and five evaluated scheduled telehealth interventions initiated by nurses. Compared to usual care (typically patient-initiated calls), nurse-led telehealth interventions for symptom management showed no statistically significant difference in hospitalizations, emergency department visits, or unscheduled clinic visits. Two of three studies of reactive telehealth interventions showed improved quality of life. All telehealth interventions showed reduction in the severity of most symptoms. Pain severity was significantly reduced (standard mean difference − 0.54; 95% CI − 0.88, − 0.19). Significant heterogeneity prevented meta-analysis for most outcomes. Conclusion Few studies evaluated nurse-led telehealth interventions for cancer symptom management. Compared to usual care, patients exposed to telehealth interventions had reduced symptom severity and no difference in health services use. Future research should focus on better reporting intervention characteristics and consistently measuring outcomes. Supplementary Information The online version contains supplementary material available at 10.1007/s00520-022-07052-z.
Collapse
|
3
|
Delivery of cancer care via an outpatient telephone support line: a cross-sectional study of oncology nursing perspectives on quality and challenges. Support Care Cancer 2022; 30:9079-9091. [PMID: 35980464 PMCID: PMC9387415 DOI: 10.1007/s00520-022-07327-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2022] [Accepted: 08/09/2022] [Indexed: 01/05/2023]
Abstract
RATIONALE Patient support lines (PSLs) assist in triaging clinical problems, addressing patient queries, and navigating a complex multi-disciplinary oncology team. While providing support and training to the nursing staff who operate these lines is key, there is limited data on their experience and feedback. METHODS We conducted a cross-sectional study of oncology nurses' (ONs') perspectives on the provision of care via PSLs at a tertiary referral cancer center via an anonymous, descriptive survey. Measures collected included nursing and patient characteristics, nature of questions addressed, perceived patient and nursing satisfaction with the service, common challenges faced, and initiatives to improve the patient and nursing experience. The survey was delivered online, with electronic data collection, and analysis is reported descriptively. RESULTS Seventy-one percent (30/42) of eligible ONs responded to the survey. The most common disease site, stage, and symptom addressed by PSLs were breast cancer, metastatic disease, and pain, respectively. The most common reported issue was treatment-related toxicity (96.7%, 29/30). Sixty-seven percent (20/30) of respondents were satisfied with the care provided by the service; however, many areas for potential improvement were identified. Fifty-nine percent (17/29) of respondents recommended redefining PSLs' responsibilities for improved use, with 75% (6/8) ONs identifying high call volumes due to inappropriate questions as a barrier to care. Sixty percent (18/30) of ONs reported having hospital-specific management plans for common issues would improve the care provided by the PSL. CONCLUSION Despite high rates of satisfaction with the care provided by the PSL, our study identified several important areas for improvement which we feel warrant further investigation.
Collapse
|
4
|
Cancer care in a time of COVID: lung cancer patient's experience of telehealth and connectedness. Support Care Cancer 2021; 30:1823-1830. [PMID: 34608533 PMCID: PMC8489791 DOI: 10.1007/s00520-021-06528-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2021] [Accepted: 08/29/2021] [Indexed: 10/29/2022]
Abstract
OBJECTIVE To explore lung cancer patient's experiences of telehealth during COVID-19 restrictions. METHODS Thirty patients with lung cancer were recruited. Data was collected using a qualitative exploratory design with semi-structured interviews. Transcripts were thematically coded using NVivo software. RESULTS Five key themes were identified: maintaining resilience, participants acknowledged that they were self-reliant prior to their diagnosis and that the sense of their own internal capabilities was a source of comfort for them; importance of pre-established relationships with healthcare professionals, the sense of connection established prior to the telehealth consultation supported participants to engage with healthcare professionals where the need for connectedness was amplified by a sense of isolation; seeking help, participants sought help from services that they perceived as being "expert"; convenience, factors such as costs and saving time were highlighted; and preferences for consultation type, majority of participants identified physical and emotional comfort being in their own space. For a small number of patients, continuing a face-to-face assessment was important due to expectation based on previous experience. CONCLUSION The use of telehealth was supported during the management of COVID-19. Connectedness and convenience were key to the level of comfort and confidence for patients with lung cancer using telehealth during "lockdown."
Collapse
|
5
|
Oncology Nursing Telephone Triage Workshop: Impact on Nurses' Knowledge, Confidence, and Skill. Cancer Nurs 2021; 45:E463-E470. [PMID: 34483280 DOI: 10.1097/ncc.0000000000000978] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Outpatient oncology nurses are responsible for symptom assessment/management and care coordination during telephone triage. Nursing telephone triage interventions can improve patient outcomes and clinical efficiency. Therefore, the lack of education and training in telephone triage can greatly impact patient care. OBJECTIVE Using a prospective pretest/posttest design, we sought to determine if a telephone triage educational workshop would improve oncology nurses' knowledge, confidence, and skill over 12 weeks. INTERVENTION/METHODS The educational intervention incorporated an online didactic lecture, group case scenario, and feedback on a virtual triage simulation. Evaluation was conducted before and after the intervention through an online, 13-item survey (knowledge and confidence) and simulation utilizing a 56-item checklist (skills). RESULTS Thirteen oncology nurses were enrolled; 54% did not have telephone triage experience before this job. A total of 12 participants completed the workshop. From pretest to posttest, there was a median 1.0 out of 5.0 (interquartile range, 2.8) improvement in confidence (P = .008) and a 26.3% (interquartile range, 15.2) improvement in skills (P = .002). There was no difference in knowledge scores from pretest to posttest (P = .11). CONCLUSIONS This workshop was associated with an improvement in oncology nurse confidence and skill, using telephone triage models. It benefits an existing process within the outpatient center and it highlights a new educational strategy that may optimize nursing practice and improve patient care and experience. IMPLICATIONS FOR PRACTICE This workshop contributes to existing evidence of telephone triage models and nursing education. The findings can guide future research, nursing orientation, and educational activities within the field of nursing and telehealth.
Collapse
|
6
|
Peckham A, Wright JG, Marani H, Abdelhalim R, Laxer D, Allin S, Alam N, Marchildon G. Putting the Patient First: A Scoping Review of Patient Desires in Canada. Healthc Policy 2021; 16:46-69. [PMID: 34129478 PMCID: PMC8200834 DOI: 10.12927/hcpol.2021.26499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Patient-centred care is a key priority for governments, providers and stakeholders, yet little is known about the care preferences of patient groups. We completed a scoping review that yielded 193 articles for analysis. Five health states were used to account for the diversity of possible preferences based on health needs. Five broad themes were identified and expressed differently across the health states, including personalized care, navigation, choice, holistic care and care continuity. Patients' perspectives must be considered to meet the diverse needs of targeted patient groups, which can inform health system planning, quality improvement initiatives and targeting of investments.
Collapse
Affiliation(s)
- Allie Peckham
- Assistant Professor, Edson College of Nursing and Health Innovation, Arizona State University, Phoenix, AZ; North American Observatory on Health Systems and Policies, University of Toronto, Toronto, ON
| | - James G Wright
- Chief, Economics, Policy and Research, Ontario Medical Association, Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public HealthUniversity of Toronto, Toronto, ON
| | - Husayn Marani
- Research Assistant, North American Observatory on Health Systems and Policies, Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public HealthUniversity of Toronto, Toronto, ON
| | - Reham Abdelhalim
- Research Assistant, North American Observatory on Health Systems and Policies, Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public HealthUniversity of Toronto, Toronto, ON
| | - Dara Laxer
- Executive Director, Health Policy and Promotion, Ontario Medical Association, Toronto, ON
| | - Sara Allin
- Director of Operations, North American Observatory on Health Systems and Policies; Assistant Professor, Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON
| | - Nadia Alam
- Past President, Ontario Medical Association, Toronto, ON
| | - Greg Marchildon
- Director, North American Observatory on Health Systems and Policies; Professor, Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON
| |
Collapse
|
7
|
Jørgensen L, Jacobsen HR, Pedersen B. To see or not to see - or to wait and see: clinical decisions in an oncological emergency telephone consultation. Scand J Caring Sci 2020; 35:1259-1268. [PMID: 33349949 DOI: 10.1111/scs.12944] [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: 06/22/2020] [Accepted: 11/24/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND Cancer treatment is often given on an outpatient basis. An oncological emergency telephone line has been established to improve access to cancer care and prevent life-threatening side effects. However, healthcare professionals need to make clinical decisions without being able to assess patients face-to-face, which may be problematic. This study explores how healthcare professionals experience clinical decision-making in oncological emergency telephone consultations. METHODS An exploratory qualitative approach applying three focus groups with healthcare professionals from a Danish university hospital were undertaken. Data were analysed using inductive content analysis. RESULTS An overall theme elucidated how healthcare professionals ended up deciding during each call whether the problem could be solved on the phone or the patient had to come for a face-to-face consultation or to wait and see whether the condition changed. Some decisions were easy to make, while others were moderate or difficult. The decision was influenced by several factors that could be structured into three themes: reliance on one's own knowledge and experience, consideration of different perspectives and the influence of context. CONCLUSION This study demonstrated that clinical decision-making in oncological emergency telephone consultations includes three types of decisions that are intertwined with intra-personal, inter-professional and contextual factors such as personal knowledge, collaboration and workload. These factors are essential for the timely referral of patients to the right level of service.
Collapse
Affiliation(s)
- Lone Jørgensen
- Clinic for Surgery and Cancer Treatment, Aalborg University Hospital, Aalborg, Denmark.,Clinical Nursing Research Unit, Aalborg University Hospital, Aalborg, Denmark
| | | | - Birgith Pedersen
- Clinic for Surgery and Cancer Treatment, Aalborg University Hospital, Aalborg, Denmark.,Clinical Nursing Research Unit, Aalborg University Hospital, Aalborg, Denmark.,Clinical Cancer Research Centre, Aalborg University Hospital, Aalborg, Denmark
| |
Collapse
|
8
|
Stacey D, Jolicoeur L, Balchin K, Duke K, Ludwig C, Carley M, Jibb L, Kuziemsky C, Madore S, Rambout L, Romanick J, Vickers MM, Martelli L. Lien entre la qualité des interventions téléphoniques des infirmières auprès des adultes atteints de cancer et les visites évitables au service des urgences. Can Oncol Nurs J 2020; 30:200-207. [PMID: 33118987 DOI: 10.5737/23688076303200207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Affiliation(s)
- Dawn Stacey
- titulaire de la Chaire de recherche de l'Université d'Ottawa sur le transfert des connaissances aux patients, professeure au collège de la Société royale du Canada, École des sciences infirmières, Université d'Ottawa, avec nomination conjointe à l'École d'épidémiologie et de santé publique, et chercheuse principale, Institut de recherche de L'Hôpital d'Ottawa, Centre de recherche et d'innovation pratique Ottawa (Ontario)
| | - Lynne Jolicoeur
- gestionnaire clinique, Traitement systémique, programme régional de cancérologie, L'Hôpital d'Ottawa, Ottawa (Ottawa)
| | - Katelyn Balchin
- chef administrative et gestionnaire du Programme de greffe de sang et de moelle osseuse, programme régional de cancérologie, L'Hôpital d'Ottawa, Ottawa (Ontario)
| | - Kate Duke
- gestionnaire clinique, cliniques du campus Civic, Inscription des patients, L'Hôpital d'Ottawa, Ottawa (Ontario)
| | - Claire Ludwig
- doctorante, École des sciences infirmières, Faculté des sciences de la santé, Université d'Ottawa, pavillon Roger Guindon, Ottawa (Ontario)
| | - Meg Carley
- coordonnatrice de la recherche, Institut de recherche de L'Hôpital d'Ottawa, Centre de recherche et d'innovation pratique, Ottawa (Ontario)
| | - Lindsay Jibb
- professeure adjointe, Faculté des sciences infirmières Lawrence S. Bloomberg, Université de Toronto, Toronto (Ontario); Child Health Evaluative Sciences, Hospital for Sick Children, Peter Gilgan Centre for Research and Learning, Toronto (Ontario)
| | - Craig Kuziemsky
- vice-recteur associé à la recherche, MacEwan University, Edmonton (Alberta)
| | - Suzanne Madore
- directrice clinique, services périopératoires, programme de soins oculaires et douleurs chroniques, L'Hôpital d'Ottawa, Ottawa (Ontario)
| | - Lisa Rambout
- coordonnatrice, pratique professionnelle en oncologie, Pharmacie, L'Hôpital d'Ottawa, Ottawa (Ontario)
| | - Jackie Romanick
- infirmière en oncologie, L'Hôpital d'Ottawa, Ottawa (Ontario)
| | | | - Lorraine Martelli
- directrice du programme provincial de soins infirmiers oncologiques, Action Cancer Ontario, Toronto (Ontario)
| |
Collapse
|
9
|
Stacey D, Jolicoeur L, Balchin K, Duke K, Ludwig C, Carley M, Jibb L, Kuziemsky C, Madore S, Rambout L, Romanick J, Vickers MM, Martelli L. Quality of telephone nursing services for adults with cancer and related non-emergent visits to the emergency department. Can Oncol Nurs J 2020; 30:193-199. [PMID: 33118979 DOI: 10.5737/23688076303193199] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
A quality improvement project was conducted to determine the quality of telephone nursing for patients with cancer symptoms. Eligible patients were ones who telephoned the nurse about cancer symptom(s) within four weeks prior to an emergency department (ED) visit not requiring hospital admission. Experienced oncology nurses extracting data indicated appropriateness of ED visits and opportunities for improvement. The Symptom Management Analysis Tool was used to analyze nurse documentation. For 77 patients, 87% ED visits occurred within four days of calls about symptoms (e.g., pain, breathlessness, constipation, diarrhea, nausea/vomiting) and 91% could have been managed by more complete telephone assessment and/or an urgent clinic visit. Quality of nurse documentation revealed few patients were assessed adequately (38%), received any symptom-specific medication review (49%), or were guided in self-care strategies (17%). There was low-quality telephone symptom management by nurses and a need for alternative options for patients requiring urgent face-to-face assessments. Our findings highlight a gap in use of guidelines for informing telephone symptom management.
Collapse
Affiliation(s)
- Dawn Stacey
- Research Chair in Knowledge Translation to Patients Member, Royal Society of Canada's College Professor, School of Nursing, University of Ottawa Cross-Appointment, School of Epidemiology and Public Health, and Senior Scientist, Ottawa Hospital Research Institute, Centre for Practice Changing Research, Ottawa, ON
| | - Lynne Jolicoeur
- Clinical Manager Systemic Therapy, Regional Cancer Program, The Ottawa Hospital, Ottawa, ON K1H 8L6
| | - Katelyn Balchin
- Business Leader, Program Manager, Blood and Marrow Transplant Program, Regional Cancer Program, The Ottawa Hospital, Ottawa, ON
| | - Kate Duke
- Clinical Manager, TOHCC Clinics & New Patient Registration, The Ottawa Hospital, Ottawa, ON
| | - Claire Ludwig
- School of Nursing, Faculty of Health Sciences, University of Ottawa, Roger Guindon Hall, Ottawa, ON
| | - Meg Carley
- Research Coordinator, Ottawa Hospital Research Institute, Centre for Practice Changing Research, Ottawa, ON
| | - Lindsay Jibb
- Assistant Professor, Lawrence S. Bloomberg Faculty of Nursing, University of Toronto; Child Health Evaluative Sciences, Hospital for Sick Children, Peter Gilgan Centre for Research and Learning, Toronto, ON
| | - Craig Kuziemsky
- Associate Vice-President, Research, MacEwan University, Edmonton, AB
| | - Suzanne Madore
- Clinical Director, Perioperative Services, Eye Care Program and Chronic Pain, The Ottawa Hospital, Ottawa, ON
| | - Lisa Rambout
- Oncology Professional Practice Coordinator, Pharmacy, The Ottawa Hospital, Ottawa, ON
| | | | | | | |
Collapse
|
10
|
Northfield S, Button E, Wyld D, Gavin NC, Nasato G, Yates P. Taking care of our own: A narrative review of cancer care services-led models of care providing emergent care to patients with cancer. Eur J Oncol Nurs 2019; 40:85-97. [PMID: 31229211 DOI: 10.1016/j.ejon.2019.02.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2018] [Revised: 02/06/2019] [Accepted: 02/14/2019] [Indexed: 11/17/2022]
Abstract
PURPOSE To synthesise available evidence on cancer care services-led models of care in the acute care setting that aim to reduce emergency presentations and/or hospital admissions for patients with cancer. METHODS A narrative review of studies describing models of care for patients with cancer and emergent healthcare needs was undertaken. Four databases were searched using keywords to identify primary research or quality improvement articles published between January 2005-June 2017. RESULTS After a systematic search, 22 studies were included in the review. The methodological quality of the included studies was poor when assessed using the Mixed Methods Appraisal Tool. Most studies were retrospective and set in a single centre. The overarching outcomes associated with the most commonly described models of care (telephone advice services and/or unplanned care and assessment units) were improved coordination of care/continuity of care, prompt access to specialist care, reduced utilisation of emergency departments, fewer hospital admissions and reduced cost. At the time of this review, evaluation of Nurse Practitioner-led services and acute oncology services had been limited. CONCLUSIONS Findings indicate several models of care reduce emergency presentations and/or hospitalisations for those living with cancer and improve patient outcomes. What remains unclear is which underlying mechanisms reduce emergency presentations and/or hospitalisations for patients with cancer and whether successful models of care are uniquely suited to specific contexts of care or applicable across different healthcare settings. More research is needed to assist healthcare services to develop and evaluate models of care to address the emergent needs of people with cancer.
Collapse
Affiliation(s)
- Sarah Northfield
- Cancer Care Services, Royal Brisbane and Women's Hospital, Herston, Brisbane, Queensland, Australia.
| | - Elise Button
- Cancer Care Services, Royal Brisbane and Women's Hospital, Herston, Brisbane, Queensland, Australia; School of Nursing, Queensland University of Technology, Kelvin Grove, Brisbane, Queensland, Australia
| | - David Wyld
- Cancer Care Services, Royal Brisbane and Women's Hospital, Herston, Brisbane, Queensland, Australia; School of Nursing, Queensland University of Technology, Kelvin Grove, Brisbane, Queensland, Australia; School of Medicine, University of Queensland, St Lucia, Brisbane, Queensland, Australia
| | - Nicole Claire Gavin
- Cancer Care Services, Royal Brisbane and Women's Hospital, Herston, Brisbane, Queensland, Australia; School of Nursing, Queensland University of Technology, Kelvin Grove, Brisbane, Queensland, Australia
| | - Gillian Nasato
- Cancer Care Services, Royal Brisbane and Women's Hospital, Herston, Brisbane, Queensland, Australia
| | - Patsy Yates
- Cancer Care Services, Royal Brisbane and Women's Hospital, Herston, Brisbane, Queensland, Australia; School of Nursing, Queensland University of Technology, Kelvin Grove, Brisbane, Queensland, Australia
| |
Collapse
|
11
|
Jibb LA, Stacey D, Carley M, Davis A, Graham ID, Green E, Jolicoeur L, Kuziemsky C, Ludwig C, Truant T. Research priorities for the pan-Canadian Oncology Symptom Triage and Remote Support practice guides: a modified nominal group consensus. Curr Oncol 2019; 26:173-182. [PMID: 31285662 PMCID: PMC6588050 DOI: 10.3747/co.26.4247] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Introduction The pan-Canadian Oncology Symptom Triage and Remote Support (costars) team is studying how to improve the quality and consistency of cancer symptom management. Methods A 1-day invitational meeting was held 24 October 2017 in Ottawa, Ontario, to review the current evidence from costars projects and to establish research priorities for a future largescale implementation study. The meeting included 36 participants who were clinicians from adult oncology, pediatric oncology, and homecare; policymakers from national, provincial, and regional organizations; researchers; and a patient. Half the day involved summarizing evidence from four costars studies and experiences with implementing the costars symptom practice guides. The second half of the day used a modified nominal group technique to generate research questions within small groups, presentation of research questions to all participants, and two rounds of voting to reach consensus on research priorities. Results Participants proposed 4 research categories:■ User-centred augmentation to enhance usability (for example, designing a mobile costars solution)■ Outcome measurement (for example, determining key competencies for clinicians)■ Regular renewal of costars to keep pace with evolving evidence (for example, updates for novel therapies)■ Integration into clinical practice (for example, meaningful engagement of patients and caregivers in study design). Conclusions Across categories, the top 3 priorities were effect on health services use, competency development, and a mobile costars solution. Future research will address identified priorities, reflecting the needs and perspectives of diverse stakeholders. Stakeholder collaboration will continue to guide our approach to operationalizing this priority research agenda.
Collapse
Affiliation(s)
- L A Jibb
- Faculty of Health Sciences, School of Nursing, University of Ottawa, Ottawa, ON
| | - D Stacey
- Faculty of Health Sciences, School of Nursing, University of Ottawa, Ottawa, ON
- Clinical Epidemiology Program, The Ottawa Hospital Research Institute, Ottawa, ON
| | - M Carley
- Clinical Epidemiology Program, The Ottawa Hospital Research Institute, Ottawa, ON
| | - A Davis
- Washington State University College of Nursing, Vancouver, WA, U.S.A
| | - I D Graham
- Faculty of Health Sciences, School of Nursing, University of Ottawa, Ottawa, ON
- Clinical Epidemiology Program, The Ottawa Hospital Research Institute, Ottawa, ON
- Faculty of Medicine, School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON
| | - E Green
- The Ottawa Hospital, Cancer Program, Ottawa, ON
| | - L Jolicoeur
- The Ottawa Hospital, Cancer Program, Ottawa, ON
| | - C Kuziemsky
- Telfer School of Management, University of Ottawa, Ottawa, ON
| | | | - T Truant
- BC Cancer, Education and Innovation, Vancouver, BC
| |
Collapse
|
12
|
Ludwig C, Renaud J, Barbera L, Carley M, Henry C, Jolicoeur L, Kuziemsky C, Patry A, Stacey D. Factors influencing the use by radiation therapists of cancer symptom guides: a mixed-methods study. Curr Oncol 2019; 26:56-64. [PMID: 30853800 PMCID: PMC6380628 DOI: 10.3747/co.25.4198] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Background Radiation therapists play an important role in helping patients to safely manage and triage potentially life-threatening symptoms. The purpose of the present study was to assess factors influencing the use by radiation therapists of evidence-informed symptom practice guides for patients experiencing cancer treatment-related symptoms. Methods In a mixed-methods descriptive study guided by the Knowledge-to-Action framework, interviews and a barriers survey were conducted. Two independent reviewers conducted a content analysis of interview transcripts. Barriers survey data were analyzed using frequency distributions and univariate descriptive statistics. Open-ended data from the surveys underwent content analysis and were triangulated with interview findings. Results Of 90 radiation therapists approached, 58 completed the survey (64%), and 14 were interviewed. Of the 98% who reported providing symptom management to patients undergoing radiation treatment, 53% used evidence-informed practice guidelines. Radiation therapists had moderate moral norms (4.6 of 7) and beliefs about the consequences of using costars (pan-Canadian Oncology Symptom Triage and Remote Support) practice guides (4.8), but neutral intention (3.4) and beliefs about their own capabilities (3.9). Environmental barriers included lack of time (2.0), lack of access (2.5), and neutral organizational support (3.0). Radiation therapists identified a need for training (5.5). Common unique barriers to practice guide use were lack of time during radiation treatments, unclear fit with scope of practice, disparate focus on site-specific symptoms, and lack of medication knowledge. Conclusions The symptom practice guides were perceived by the radiation therapists to benefit patients, enhance their own knowledge of symptom management, and promote consistent practice. Additional work is required to identify the scope of practice of radiation therapists within the interprofessional team.
Collapse
Affiliation(s)
- C Ludwig
- School of Nursing, University of Ottawa, Ottawa, ON
| | | | - L Barbera
- Department of Radiation Oncology, University of Toronto, Toronto, ON
- Department of Radiation Oncology, Odette Cancer Centre, Toronto, ON
| | - M Carley
- The Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON
| | - C Henry
- Telfer School of Management, University of Ottawa, Ottawa, ON
| | | | - C Kuziemsky
- Telfer School of Management, University of Ottawa, Ottawa, ON
| | - A Patry
- The Ottawa Hospital, Ottawa, ON
| | - D Stacey
- School of Nursing, University of Ottawa, Ottawa, ON
- The Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON
| |
Collapse
|
13
|
Fallahzadeh R, Rokni SA, Ghasemzadeh H, Soto-Perez-de-Celis E, Shahrokni A. Digital Health for Geriatric Oncology. JCO Clin Cancer Inform 2018; 2:1-12. [DOI: 10.1200/cci.17.00133] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
In this review, we describe state-of-the-art digital health solutions for geriatric oncology and explore the potential application of emerging remote health-monitoring technologies in the context of cancer care. We also discuss the benefits and motivations behind adopting technology for symptom monitoring of older adults with cancer. We provide an overview of common symptoms and of the digital solutions–designed remote symptom assessment. We describe state-of-the-art systems for this purpose and highlight the limitations and challenges for the full-scale adoption of such solutions in geriatric oncology. With rapid advances in Internet-of-things technologies, many remote assessment systems have been developed in recent years. Despite showing potential in several health care domains and reliable functionality, few of these solutions have been designed for or tested in older patients with cancer. As a result, the geriatric oncology community lacks a consensus understanding of a possible correlation between remote digital assessments and health-related outcomes. Although the recent development of digital health solutions has been shown to be reliable and effective in many health-related applications, there exists an unmet need for development of systems and clinical trials specifically designed for remote cancer management of older adults with cancer, including developing advanced remote technologies for cancer-related symptom assessment and psychological behavior monitoring at home and developing outcome-oriented study protocols for accurate evaluation of existing or emerging systems. We conclude that perhaps the clearest path to future large-scale use of remote digital health technologies in cancer research is designing and conducting collaborative studies involving computer scientists, oncologists, and patient advocates.
Collapse
Affiliation(s)
- Ramin Fallahzadeh
- Ramin Fallahzadeh, Seyed Ali Rokni, and Hassan Ghasemzadeh, Washington State University, Pullman, WA; Enrique Soto-Perez-de-Celis, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico; and Armin Shahrokni, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Seyed Ali Rokni
- Ramin Fallahzadeh, Seyed Ali Rokni, and Hassan Ghasemzadeh, Washington State University, Pullman, WA; Enrique Soto-Perez-de-Celis, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico; and Armin Shahrokni, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Hassan Ghasemzadeh
- Ramin Fallahzadeh, Seyed Ali Rokni, and Hassan Ghasemzadeh, Washington State University, Pullman, WA; Enrique Soto-Perez-de-Celis, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico; and Armin Shahrokni, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Enrique Soto-Perez-de-Celis
- Ramin Fallahzadeh, Seyed Ali Rokni, and Hassan Ghasemzadeh, Washington State University, Pullman, WA; Enrique Soto-Perez-de-Celis, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico; and Armin Shahrokni, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Armin Shahrokni
- Ramin Fallahzadeh, Seyed Ali Rokni, and Hassan Ghasemzadeh, Washington State University, Pullman, WA; Enrique Soto-Perez-de-Celis, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico; and Armin Shahrokni, Memorial Sloan Kettering Cancer Center, New York, NY
| |
Collapse
|
14
|
Abstract
OBJECTIVES To describe pediatric palliative care (PPC) in pediatric oncology, the importance of PPC for pediatric oncology patients, disparities within pediatric palliative oncology, innovative strategies for improving PPC access in underserved populations, and implications for oncology nursing practice. DATA SOURCES Published pediatric oncology and palliative peer-reviewed articles and guidance documents. CONCLUSION Disparities exist within pediatric palliative oncology. There is much work needed to improve the reach and quality of PPC for pediatric oncology patients, especially those from underserved populations. IMPLICATIONS FOR NURSING PRACTICE Nurses serve a critical role in advocating for PPC for seriously ill pediatric cancer patients and their families.
Collapse
|
15
|
Fallahzadeh R, Ghasemzadeh H, Shahrokni A. Electronic Assessment of Physical Decline in Geriatric Cancer Patients. Curr Oncol Rep 2018; 20:26. [PMID: 29516212 PMCID: PMC7412116 DOI: 10.1007/s11912-018-0670-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
PURPOSE OF REVIEW The purpose of this review is to explore state-of-the-art remote monitoring and emerging new sensing technologies for in-home physical assessment and their application/potential in cancer care. In addition, we discuss the main functional and non-functional requirements and research challenges of employing such technologies in real-world settings. RECENT FINDINGS With rapid growth in aging population, effective and efficient patient care has become an important topic. Advances in remote monitoring and in its forefront in-home physical assessment technologies play a fundamental role in reducing the cost and improving the quality of care by complementing the traditional in-clinic healthcare. However, there is a gap in medical research community regarding the applicability and potential outcomes of such systems. While some studies reported positive outcomes using remote assessment technologies, such as web/smart phone-based self-reports and wearable sensors, the cancer research community is still lacking far behind. Thorough investigation of more advanced technologies in cancer care is warranted.
Collapse
Affiliation(s)
- Ramin Fallahzadeh
- School of Electrical Engineering and Computer Science, Washington State University, 305 NE Spokane Street, DANA 118A, Pullman, WA, 99164-2752, USA
| | - Hassan Ghasemzadeh
- School of Electrical Engineering and Computer Science, Washington State University, 355 Spokane Street, EME 131, Pullman, WA, 99164-2752, USA
| | - Armin Shahrokni
- Geriatric Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, Box 205, 1275 York Ave., New York, NY, 10065, USA.
| |
Collapse
|
16
|
Ludwig C, Bennis C, Carley M, Gifford W, Kuziemsky C, Lafreniere-Davis N, McCrady K, Nichol K, Owens G, Roscoe D, Sandrelli T, Simmons H, Truant T, Verhaegen M, Stacey D. Managing Symptoms During Cancer Treatments: Barriers and Facilitators to Home Care Nurses Using Symptom Practice Guides. HOME HEALTH CARE MANAGEMENT AND PRACTICE 2017. [DOI: 10.1177/1084822317713011] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Nurses are instrumental in helping clients safely manage at home and triage potentially life-threatening symptoms from cancer. The purpose of this study was to assess factors influencing home care nurses’ use of 15 evidence-informed symptom practice guides for providing telephone or in-home nursing services to clients with cancer. A mixed-methods descriptive study was guided by the Knowledge-to-Action Framework. All six nursing agencies within a regional home care authority participated. Data collection included retrospective audit of symptom management in 50 patient records, 14 interviews, and barriers survey from 150 of 243 (61.7%) registered nurses and registered practical nurses providing cancer symptom support in home care. Chart audit revealed more than 80% of clients were on chemotherapy and common symptoms were nausea/vomiting (44%), constipation (32%), fatigue (32%), loss of appetite (32%), and pain (20%). Nurses had positive intentions ( M = 5.4 out of 7; SD = 1.3) and felt capable of using the symptom practice guides ( M = 5.4; SD = 1.0), held strong beliefs about the consequences ( M = 5.8; SD = 1.1) and moral norms of using them ( M = 5.7; SD = 1.1), and identified neutral to low social influence ( M = 3.0; SD = 1.6). Common barriers were inadequate time in practice, learning curve, need to integrate into documentation, and competing system changes. Common facilitators were being comprehensive, an evidence-based resource for use in practice, and having consistent symptom management guides across settings. Overall, the symptom guides were well received by the nurses. Interventions nurses identified to overcome barriers were education, clear organizational mandate for implementation, and integration with documentation.
Collapse
Affiliation(s)
- Claire Ludwig
- Champlain Community Care Access Centre, Ottawa, Ontario, Canada
| | | | - Meg Carley
- Ottawa Hospital Research Institute, Ontario, Canada
| | | | | | - Nicole Lafreniere-Davis
- client/caregiver representative, pan-Canadian Oncology Symptom Triage and Remote Support (COSTaRS) Homecare study
| | - Kate McCrady
- We Care Home Health Services, Ottawa, Ontario, Canada
| | | | - Glenda Owens
- Champlain Community Care Access Centre, Ottawa, Ontario, Canada
| | - Diane Roscoe
- Carefor Health & Community Services, Ottawa, Ontario, Canada
| | - Tami Sandrelli
- Access Healthcare Services Inc., Pembroke, Ontario, Canada
| | | | - Tracy Truant
- The University of British Columbia, Vancouver, Canada
| | - Melina Verhaegen
- client/caregiver representative, pan-Canadian Oncology Symptom Triage and Remote Support (COSTaRS) Homecare study
| | - Dawn Stacey
- Ottawa Hospital Research Institute, Ontario, Canada
- University of Ottawa, Ontario, Canada
| |
Collapse
|
17
|
Cox A, Lucas G, Marcu A, Piano M, Grosvenor W, Mold F, Maguire R, Ream E. Cancer Survivors' Experience With Telehealth: A Systematic Review and Thematic Synthesis. J Med Internet Res 2017; 19:e11. [PMID: 28069561 PMCID: PMC5259589 DOI: 10.2196/jmir.6575] [Citation(s) in RCA: 208] [Impact Index Per Article: 29.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2016] [Revised: 11/14/2016] [Accepted: 11/23/2016] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Net survival rates of cancer are increasing worldwide, placing a strain on health service provision. There is a drive to transfer the care of cancer survivors-individuals living with and beyond cancer-to the community and encourage them to play an active role in their own care. Telehealth, the use of technology in remote exchange of data and communication between patients and health care professionals (HCPs), is an important contributor to this evolving model of care. Telehealth interventions are "complex," and understanding patient experiences of them is important in evaluating their impact. However, a wider view of patient experience is lacking as qualitative studies detailing cancer survivor engagement with telehealth are yet to be synthesized. OBJECTIVE To systematically identify, appraise, and synthesize qualitative research evidence on the experiences of adult cancer survivors participating in telehealth interventions, to characterize the patient experience of telehealth interventions for this group. METHODS Medline (PubMed), PsychINFO, Cumulative Index for Nursing and Allied Health Professionals (CINAHL), Embase, and Cochrane Central Register of Controlled Trials were searched on August 14, 2015, and March 8, 2016, for English-language papers published between 2006 and 2016. Inclusion criteria were as follows: adult cancer survivors aged 18 years and over, cancer diagnosis, experience of participating in a telehealth intervention (defined as remote communication or remote monitoring with an HCP delivered by telephone, Internet, or hand-held or mobile technology), and reporting qualitative data including verbatim quotes. An adapted Critical Appraisal Skill Programme (CASP) checklist for qualitative research was used to assess paper quality. The results section of each included article was coded line by line, and all papers underwent inductive analysis, involving comparison, reexamination, and grouping of codes to develop descriptive themes. Analytical themes were developed through an iterative process of reflection on, and interpretation of, the descriptive themes within and across studies. RESULTS Across the 22 included papers, 3 analytical themes emerged, each with 3 descriptive subthemes: (1) influence of telehealth on the disrupted lives of cancer survivors (convenience, independence, and burden); (2) personalized care across physical distance (time, space, and the human factor); and (3) remote reassurance-a safety net of health care professional connection (active connection, passive connection, and slipping through the net). Telehealth interventions represent a convenient approach, which can potentially minimize treatment burden and disruption to cancer survivors' lives. Telehealth interventions can facilitate an experience of personalized care and reassurance for those living with and beyond cancer; however, it is important to consider individual factors when tailoring interventions to ensure engagement promotes benefit rather than burden. CONCLUSIONS Telehealth interventions can provide cancer survivors with independence and reassurance. Future telehealth interventions need to be developed iteratively in collaboration with a broad range of cancer survivors to maximize engagement and benefit.
Collapse
Affiliation(s)
- Anna Cox
- School of Health Sciences, Faculty of Health and Medical Sciences, University of Surrey, Guildford, United Kingdom
| | - Grace Lucas
- School of Health Sciences, Faculty of Health and Medical Sciences, University of Surrey, Guildford, United Kingdom
| | - Afrodita Marcu
- School of Health Sciences, Faculty of Health and Medical Sciences, University of Surrey, Guildford, United Kingdom
| | - Marianne Piano
- School of Health Sciences, Faculty of Health and Medical Sciences, University of Surrey, Guildford, United Kingdom
| | - Wendy Grosvenor
- School of Health Sciences, Faculty of Health and Medical Sciences, University of Surrey, Guildford, United Kingdom
| | - Freda Mold
- School of Health Sciences, Faculty of Health and Medical Sciences, University of Surrey, Guildford, United Kingdom
| | - Roma Maguire
- School of Health Sciences, Faculty of Health and Medical Sciences, University of Surrey, Guildford, United Kingdom
| | - Emma Ream
- School of Health Sciences, Faculty of Health and Medical Sciences, University of Surrey, Guildford, United Kingdom
| |
Collapse
|
18
|
Cuppens K, Oyen C, Derweduwen A, Ottevaere A, Sermeus W, Vansteenkiste J. Characteristics and outcome of unplanned hospital admissions in patients with lung cancer: a longitudinal tertiary center study. Towards a strategy to reduce the burden. Support Care Cancer 2016; 24:2827-35. [PMID: 26816091 DOI: 10.1007/s00520-016-3087-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2015] [Accepted: 01/14/2016] [Indexed: 12/13/2022]
Abstract
BACKGROUND Unplanned hospital admissions (UHAs) are frequent in lung cancer, but literature on this topic is scarce. The aim of this study is to gain insight in the demographics, patterns of referral, causes, presenting symptoms, and final outcome of these UHAs. A strategy to improve quality of care and reduce the number and cost of UHAs was suggested based upon these findings. PATIENTS AND METHODS In retrospective analysis of all consecutive UHAs in a 6-month period in a tertiary center, demographics, pattern of referral, clinical data, tumor control status, final diagnosis, duration of hospitalization, and outcome were examined. RESULTS Two hundred seven UHAs were recorded. Male/female ratio was 185/62, mean age 65.5 years, performance status (PS) on admission 0-1 in 32 %, 2 in 37.2 %, and 3-4 in 30.8 % of patients. Patient referral occurred by general practitioner in 33.6 % or specialist in 25.5 % and in 40.9 % on own initiative. UHAs were therapy-related in 23.9 %, cancer-related in 47.4 %, comorbidity-related in 19.4 %, or of unclear nature in 9.3 %. Most frequent causes were infections (21.9 %) and respiratory problems (17.0 %). Mean length of stay was 9.5 days. Final outcome was 10.1 % mortality, 6.9 % hospice care transfers, and 79.4 % home returns (including 18.2 % same day returns). CONCLUSION UHAs in lung cancer were more cancer- than therapy-related. Majority of patients (2/3) were not seen by their general practitioner. A significant number of same day returns were noted. UHAs in patients with poor PS, uncontrolled cancer and cancer-related events had the worst outcome. This work is a first step in identifying specific characteristics of UHAs in lung cancer patients, which may lead to strategies to reduce the burden of UHAs.
Collapse
Affiliation(s)
- Kristof Cuppens
- Department of Pulmonology, Respiratory Oncology Unit, University Hospital KU Leuven, Herestraat 49, 3000, Leuven, Belgium
| | - Christel Oyen
- Department of Pulmonology, Respiratory Oncology Unit, University Hospital KU Leuven, Herestraat 49, 3000, Leuven, Belgium
| | - Aurélie Derweduwen
- Department of Pulmonology, Respiratory Oncology Unit, University Hospital KU Leuven, Herestraat 49, 3000, Leuven, Belgium
| | - Anouck Ottevaere
- Department of Pulmonology, Respiratory Oncology Unit, University Hospital KU Leuven, Herestraat 49, 3000, Leuven, Belgium
| | - Walter Sermeus
- Centre for Health Services and Nursing Research, Catholic University Leuven, Leuven, Belgium
| | - Johan Vansteenkiste
- Department of Pulmonology, Respiratory Oncology Unit, University Hospital KU Leuven, Herestraat 49, 3000, Leuven, Belgium.
| |
Collapse
|