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Charters E, Ricketts V, Sharman AR, Clark J. Systematic review of adherence to swallow and trismus exercises during radiation therapy for head and neck cancer. Head Neck 2024. [PMID: 38895913 DOI: 10.1002/hed.27849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2024] [Revised: 05/06/2024] [Accepted: 06/08/2024] [Indexed: 06/21/2024] Open
Abstract
Understanding the barriers and facilitators for prophylactic swallowing and trismus exercises for patients undergoing radiation to the head and neck may help exercise adherence. The analysis reviews all published reports of exercise adherence with a critical appraisal following PRISMA guidelines. A total of 137 potential papers were identified; 20 studies met the inclusion criteria. The most commonly reported facilitators for swallowing and trismus exercises were regular clinician contact and online resources to reinforce instructions, set goals, and manage radiation toxicities. Social support and perceived benefit from exercises were also reported to be of help. The most common barriers to exercise were radiation toxicities, anxiety, feeling overwhelmed with information, and not understanding the reason for the exercises. Understanding facilitators and barriers to adherence is critical when designing exercise interventions for patients undergoing radiation for head and neck cancer.
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Affiliation(s)
- Emma Charters
- Department of Head and Neck Surgery, Chris O'Brien Lifehouse, Sydney, New South Wales, Australia
- School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Virginia Ricketts
- Department of Head and Neck Surgery, Chris O'Brien Lifehouse, Sydney, New South Wales, Australia
| | - Ashleigh R Sharman
- Department of Head and Neck Surgery, Chris O'Brien Lifehouse, Sydney, New South Wales, Australia
| | - Jonathan Clark
- Department of Head and Neck Surgery, Chris O'Brien Lifehouse, Sydney, New South Wales, Australia
- Royal Prince Alfred Institute of Academic Surgery, Sydney Local Health District, Sydney, New South Wales, Australia
- Sydney Medical School, Faculty of Medicine and Health Sciences, The University of Sydney, Sydney, New South Wales, Australia
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Watts T, Courtier N, Fry S, Gale N, Gillen E, McCutchan G, Patil M, Rees T, Roche D, Wheelwright S, Hopkinson J. Access, acceptance and adherence to cancer prehabilitation: a mixed-methods systematic review. J Cancer Surviv 2024:10.1007/s11764-024-01605-3. [PMID: 38709465 DOI: 10.1007/s11764-024-01605-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2024] [Accepted: 04/12/2024] [Indexed: 05/07/2024]
Abstract
PURPOSE The purpose of this systematic review is to better understand access to, acceptance of and adherence to cancer prehabilitation. METHODS MEDLINE, CINAHL, PsychINFO, Embase, Physiotherapy Evidence Database, ProQuest Medical Library, Cochrane Library, Web of Science and grey literature were systematically searched for quantitative, qualitative and mixed-methods studies published in English between January 2017 and June 2023. Screening, data extraction and critical appraisal were conducted by two reviewers independently using Covidence™ systematic review software. Data were analysed and synthesised thematically to address the question 'What do we know about access, acceptance and adherence to cancer prehabilitation, particularly among socially deprived and minority ethnic groups?' The protocol is published on PROSPERO CRD42023403776 RESULTS: Searches identified 11,715 records, and 56 studies of variable methodological quality were included: 32 quantitative, 15 qualitative and nine mixed-methods. Analysis identified facilitators and barriers at individual and structural levels, and with interpersonal connections important for prehabilitation access, acceptance and adherence. No study reported analysis of facilitators and barriers to prehabilitation specific to people from ethnic minority communities. One study described health literacy as a barrier to access for people from socioeconomically deprived communities. CONCLUSIONS There is limited empirical research of barriers and facilitators to inform improvement in equity of access to cancer prehabilitation. IMPLICATIONS FOR CANCER SURVIVORS To enhance the inclusivity of cancer prehabilitation, adjustments may be needed to accommodate individual characteristics and attention given to structural factors, such as staff training. Interpersonal connections are proposed as a fundamental ingredient for successful prehabilitation.
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Ewers C, Patterson J, Watson LJ. Patient experience of telehealth appointments in head and neck cancer services during the COVID-19 pandemic. INTERNATIONAL JOURNAL OF LANGUAGE & COMMUNICATION DISORDERS 2024; 59:991-1001. [PMID: 37929624 DOI: 10.1111/1460-6984.12974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Accepted: 10/06/2023] [Indexed: 11/07/2023]
Abstract
BACKGROUND The COVID-19 pandemic resulted in rapid changes to head and neck cancer (HNC) services. Multidisciplinary team (MDT) face-to-face appointments were converted to telehealth appointments (telephone and video-call) to reduce the risk of COVID-19 transmission. The literature exploring HNC patient experience of these appointment types is limited. AIMS To explore patient experience of telehealth appointments at one UK centre during the COVID-19 pandemic, as well as the variables that may influence patient preference for virtual or face-to-face appointments. METHODS & PROCEDURES A survey-based study design was used, with closed questions and open text options to capture the views of the participants. Quantitative data were analysed using descriptive statistics. Open text data was used to add depth to the findings. OUTCOMES & RESULTS A total of 23 participant surveys were returned. Six categories were identified: Usability; Information receiving & giving; Satisfaction; Emotions and comfort; Rapport; and Travel time and cost. Overall, participants gave positive responses to each category and indicated that telehealth appointments met their needs. Areas for clinical consideration are highlighted. Variables such as age, travel distance from hospital site, fear of COVID-19 and information technology (IT) access did not appear to influence patient preference for appointment type. CONCLUSIONS & IMPLICATIONS Going forward, telehealth may be considered for use in combination with face-to-face appointments in the HNC pathway. Areas for further development include a 'telehealth screening tool' that may help to identify those patients most appropriate for these appointment types, or who require support to access them. WHAT THIS PAPER ADDS What is already known on this subject The COVID-19 pandemic resulted in major disruption to HNC centres across the world. Services adapted to meet the needs of patients with many implementing telehealth into pathways. Studies exploring telehealth in speech and language therapy (SLT) services with the HNC population indicate positive results. It is clear telehealth has a role in modern healthcare and should not be viewed as a temporary solution to the pandemic. It is, however, recognized that embedding telehealth into pathways is not straightforward and requires ongoing review and evaluation, which includes patient and clinician perceptions. What this study adds to the existing knowledge The service evaluation gives insight into HNC patient experience of telehealth appointments for MDT clinics (led by SLT, dietician and clinical nurse specialist) during the COVID-19 pandemic. Overall, patients report a positive experience of telehealth in the HNC pathway and are willing to accept this platform into their healthcare. Areas for clinical consideration are highlighted. What are the actual and clinical implications of this work? This findings of this service evaluation can be used to support the co-design of HNC pathways which embed telehealth as an option for patients. Areas that were important to the participants are highlighted; this includes the timing of telehealth appointments in the pathway, the need to meet the MDT face to face and the positive benefit of cost savings. The authors suggest a telehealth appointment screening tool as an area for future development.
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Affiliation(s)
- Caroline Ewers
- South Tyneside and Sunderland NHS Foundation Trust, Sunderland, UK
| | - Jo Patterson
- School of Health Sciences, Institute of Population Health/Liverpool Head and Neck Centre, University of Liverpool, Liverpool, UK
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Dower K, Halkett GKB, Dhillon H, Naehrig D, O'Connor M. Eliciting the views of left breast cancer patients' receiving deep inspiration breath hold radiation therapy to inform the design of multimedia education and improve patient-centred care for prospective patients. J Med Radiat Sci 2024. [PMID: 38623813 DOI: 10.1002/jmrs.790] [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: 12/19/2023] [Accepted: 03/31/2024] [Indexed: 04/17/2024] Open
Abstract
INTRODUCTION The currently accepted best practice radiation treatment for left breast cancer patients is Deep Inspiration Breath Hold (DIBH) where patients hold a deep breath to reduce late cardiac and pulmonary effects from treatment. DIBH can be challenging and induce or exacerbate anxiety in patients due to the perceived pressure to reduce radiation treatment side effects. This study explored the experiences of patients treated with Deep Inspiration Breath Hold Radiation Therapy (DIBH-RT) to improve patient-centred care and inform the design of multimedia educational tools for future patients undergoing DIBH. METHODS This descriptive qualitative study was underpinned by a social constructivist approach to create new educational and patient care approaches based on previous patients' experiences. Semi-structured interviews were conducted with patients who had completed DIBH-RT for breast cancer. Data was analysed with reflexive thematical analysis. RESULTS Twenty-two patients were interviewed with five key themes identified: (1) informational needs, (2) care needs, (3) autonomy, (4) DIBH performance influencers and (5) other centredness. Recommendations were derived from these themes to improve future treatments of DIBH patients. These recommendations revolved around improvements to education, patient-centred care and strategies to improve self-efficacy with breath holding. CONCLUSION Patients offer a wealth of knowledge regarding their lived experiences with treatment which can enhance future patients' experiences if incorporated into their education and care. Eliciting patients' views of their DIBH-RT treatment highlighted the need to improve patient self-efficacy with DIBH through familiarity with their planned treatment from new multimedia education, and foster patient care to enhance their experience.
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Affiliation(s)
- Kathleene Dower
- North Coast Cancer Institute, Lismore, New South Wales, Australia
- Faculty of Health Sciences, Curtin University, Perth, Western Australia, Australia
| | - Georgia K B Halkett
- Faculty of Health Sciences, Curtin University, Perth, Western Australia, Australia
| | - Haryana Dhillon
- School of Psychology, The University of Sydney, Sydney, New South Wales, Australia
| | | | - Moira O'Connor
- Faculty of Health Sciences, Curtin University, Perth, Western Australia, Australia
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Loeliger J, Francis J, Kiss N, Stewart J, Chandler S, Donohoe K, Hughes V, Swan W, Kaegi K, Elliott A, McIntosh R. Enhancing the provision of cancer nutrition information to support care through experience-based co-design: a mixed-methods study. Support Care Cancer 2024; 32:257. [PMID: 38556587 DOI: 10.1007/s00520-024-08453-y] [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: 05/21/2023] [Accepted: 03/21/2024] [Indexed: 04/02/2024]
Abstract
PURPOSE Nutrition is essential within cancer care, yet patient and carer access to nutrition care and information is variable. This study aimed to (1) investigate patient and carer access and perceptions, and health professional views and practices, relating to cancer nutrition information and care; and (2) co-design interactive resources to support optimal nutrition care. METHODS Patients and carers completed a survey regarding access to nutrition care and information. Seven multidisciplinary health service teams were invited to participate in a survey and focus group to assess barriers and enablers in nutrition practices. Focus groups were recorded, transcribed and thematically analyzed. Eligible patients, carers, and health professionals were invited to four virtual workshops utilizing experience-based co-design methods to identify nutrition priority areas and design resources. Workshop participant acceptability of the resources was measured. RESULTS Of 104 consumer survey respondents (n = 97 patients, n = 7 carers), 61% agreed that it "took too much time to find evidence-based nutrition and cancer information", and 46% had seen a dietitian. Thirty-four of 38 health professionals completed the survey and 30 participated in a focus group, and it was identified the greatest barriers to delivering nutrition care were lack of referral services, knowledge or skill gaps, and time. Twenty participants (n = 10 patients and carers, n = 10 health professionals) attended four workshops and co-designed a suite of 46 novel resources rated as highly acceptable. CONCLUSION Improved communication, training, and availability of suitable resources could improve access to and support cancer nutrition information and care. New, co-designed cancer nutrition resources were created and deemed highly acceptable to patients, carers, and health professionals.
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Affiliation(s)
- Jenelle Loeliger
- Nutrition & Speech Pathology Department, Peter MacCallum Cancer Centre, 305 Grattan Street, Melbourne, VIC, 3000, Australia.
- School of Exercise and Nutrition Sciences, Deakin University, Deakin, VIC, Australia.
| | - Jill Francis
- School of Health Sciences, University of Melbourne, Parkville, VIC, Australia
- Sir Peter MacCallum Department of Oncology, The University of Melbourne, Victoria, 3010, Australia
- Department of Health Services Research & Implementation Science, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | - Nicole Kiss
- Institute for Physical Activity and Nutrition, Deakin University, VIC, Australia
| | - Jane Stewart
- Nutrition & Speech Pathology Department, Peter MacCallum Cancer Centre, 305 Grattan Street, Melbourne, VIC, 3000, Australia
| | | | | | - Vanessa Hughes
- Nutrition & Speech Pathology Department, Peter MacCallum Cancer Centre, 305 Grattan Street, Melbourne, VIC, 3000, Australia
| | - Wendy Swan
- Nutrition & Dietetics, Goulburn Valley Health, Shepparton, VIC, Australia
| | - Kate Kaegi
- Nutrition Department, Austin Health, Heidelberg, VIC, Australia
| | - Andrea Elliott
- Nutrition and Dietetics Department, Alfred Health, Melbourne, VIC, Australia
| | - Rebecca McIntosh
- Nutrition & Speech Pathology Department, Peter MacCallum Cancer Centre, 305 Grattan Street, Melbourne, VIC, 3000, Australia
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Day AT, Sood A, Emmet TR, Eary RL, Prestwood CA, Salley J, Huffman A, Doenges J, Mayfield Arnold E, Tiro JA, Lee SC. Supportive Care Needs Among Head and Neck Cancer Patients Prior to Oncologic Treatment: A Prospective, Nested Cross-Sectional Qualitative Analysis. Ann Otol Rhinol Laryngol 2023; 132:1443-1452. [PMID: 37005576 DOI: 10.1177/00034894231162686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2023]
Abstract
OBJECTIVES To qualitatively characterize pretreatment head and neck cancer (HNC) patients' supportive care (SC) needs, attitudes toward SC, and barriers to SC utilization. MATERIALS AND METHODS A prospective, nested, bi-institutional, cross-sectional pilot study design was employed. Participants were sub-selected from a representative sample of 50 patients newly diagnosed with mucosal or salivary gland HNC or sarcoma of the head and neck. Eligibility criteria included reporting ≥2 unmet needs (according to the Supportive Care Needs Survey-Short Form 34) or clinically-significant distress (National Comprehensive Cancer Network Distress Thermometer score ≥4). Semi-structured interviews were performed prior to initiation of oncologic treatment. Audio-recorded interviews were transcribed and thematically analyzed using NVivo 12.0 (QSR Australia). Thematic findings and representative quotes were interpreted by the entire research team. RESULTS Twenty-seven patients were interviewed. One-third were treated at the county safety-net hospital and the remainder were treated at the university health system. An equal proportion of patients presented with oral cavity, oropharyngeal, and laryngeal or other tumors. Two significant findings were identified on semi-structured interviews. First, patients did not perceive the relevance of SC prior to treatment. Second, anxiety surrounding the HNC diagnosis and impending treatment dominated in the pretreatment phase. CONCLUSION Improved HNC patient education about the relevance and importance of SC in the pretreatment setting is needed. Integration of social work or psychological services in HNC clinics is warranted to address patients' cancer-related worry-a discrete, dominant pretreatment SC need.
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Affiliation(s)
- Andrew T Day
- Department of Otolaryngology-Head and Neck Surgery, UT Southwestern Medical Center, Dallas, TX, USA
| | - Anubha Sood
- Department of Population and Data Sciences, UT Southwestern Medical Center, Dallas, TX, USA
| | - Thomas R Emmet
- Department of Otolaryngology-Head and Neck Surgery, UT Southwestern Medical Center, Dallas, TX, USA
| | - Rebecca L Eary
- Department of Family and Community Medicine, UT Southwestern Medical Center, Dallas, TX, USA
| | - Courtney A Prestwood
- Department of Otolaryngology-Head and Neck Surgery, UT Southwestern Medical Center, Dallas, TX, USA
| | - Jordan Salley
- Department of Otolaryngology-Head and Neck Surgery, UT Southwestern Medical Center, Dallas, TX, USA
| | - Alexandra Huffman
- Support Services, Simmons Comprehensive Cancer Center, Dallas, TX, USA
| | - Jacquelyn Doenges
- Department of Otolaryngology-Head and Neck Surgery, UT Southwestern Medical Center, Dallas, TX, USA
| | | | - Jasmin A Tiro
- Department of Population and Data Sciences, UT Southwestern Medical Center, Dallas, TX, USA
| | - Simon Craddock Lee
- Department of Population and Data Sciences, UT Southwestern Medical Center, Dallas, TX, USA
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Kelly R, Gordon P, Thompson R, Semple C. Availability and use of web-based interventions for patients with head and neck cancer: a scoping review. J Cancer Surviv 2023; 17:1309-1326. [PMID: 35088247 PMCID: PMC8794623 DOI: 10.1007/s11764-022-01168-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Accepted: 01/10/2022] [Indexed: 01/28/2023]
Abstract
PURPOSE To identify and review the nature, scope and use of web-based interventions for patients with head and neck cancer (HNC). METHOD A scoping review guided by the methodological framework described by the Joanna Briggs Institute was performed to review empirical studies and websites. Seven electronic databases (CINAHL, Medline, Scopus, Embase, Cochrane, PubMed and PsycInfo) were searched from 2010 to 2020, data extracted and synthesised using thematic analysis. The Google search engine was employed, identifying the first 100 websites, using the search term head and neck cancer. Websites meeting eligibility criteria were assessed using the QUEST analysis tool, and descriptively summarised. RESULTS Thirteen empirical studies and 32 websites were included. As identified by empirical studies, web-based interventions were developed to provide (1) patient information on HNC and related treatments, (2) advice and support during treatment and (3) management strategies promoting adjustment to life with and beyond HNC. The reviewed websites provided minimal information to aid shared decision-making and facilitate preparedness for treatment, with few utilising patient narratives. Web-based interventions for HNC patients were mainly text based and focused on survivorship. CONCLUSIONS There is a paucity of theory-based, co-designed web-based interventions using patient narratives. IMPLICATIONS FOR CANCER SURVIVORS As patients increasingly look to the internet for advice and support, healthcare professionals are in a position to provide high-quality web-based interventions. There is an opportunity to rigorously develop a web-based intervention, containing narratives of peoples' lives before and after HNC treatment, aiding decision-making, preparedness for treatment and self-management.
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Affiliation(s)
- Rosemary Kelly
- School of Nursing, Ulster University, Shore Road, Newtownabbey, Co Antrim BT37 0QB Ireland
| | - Peter Gordon
- South Eastern Health and Social Care Trust, Cancer Services, Ulster Hospital, Upper Newtownards Road, Belfast, BT16 1RH Ireland
| | - Ruth Thompson
- South Eastern Health and Social Care Trust, Cancer Services, Ulster Hospital, Upper Newtownards Road, Belfast, BT16 1RH Ireland
| | - Cherith Semple
- School of Nursing, Ulster University, Shore Road, Newtownabbey, Co Antrim BT37 0QB Ireland
- South Eastern Health and Social Care Trust, Cancer Services, Ulster Hospital, Upper Newtownards Road, Belfast, BT16 1RH Ireland
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Macdonald A, Kuberska K, Stockley N, Fitzsimons B. Using experience-based co-design (EBCD) to develop high-level design principles for a visual identification system for people with dementia in acute hospital ward settings. BMJ Open 2023; 13:e069352. [PMID: 37164451 PMCID: PMC10174034 DOI: 10.1136/bmjopen-2022-069352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/12/2023] Open
Abstract
OBJECTIVES We tested a modified co-design process to develop a set of high-level design principles for visual identification systems (VIS) for hospitalised people with dementia. DESIGN We designed and ran remote workshops in three phases with carers of people with dementia and healthcare staff. In phase 1 we presented participants with scenarios based on findings from prior research, prompting participants to discuss their own experiences of VIS. Phase 2 used more future-focused scenarios, prompting participants to co-design improved VIS. In phase 3, a set of provisional design principles developed from our analysis of phases 1 and 2 data were discussed. SETTING Online workshops. PARTICIPANTS A total of 26 carers and 9 healthcare staff took part in a pilot and three separate workshops. RESULTS We identified a set of six dementia-friendly design principles for improving the effectiveness of VIS: (1) The hospital trust provides a professionally-trained workforce and an appropriate culture of care; (2) the symbol is easily recognisable and well understood; (3) key personal information is readily available and accessible; (4) key personal information is integrated into the electronic patient record; (5) relatives and carers are involved in providing key information and monitoring care; (6) the principles need to function as a system to be successful. Participants suggested that, in addition to the use of an identifier and key personal information, professional standards training, effective information and records management and improved means to involve carers and/or families were key to the effective operation of VIS, leading us to expand a narrow understanding of a VIS. CONCLUSION Using a scenario-led co-design approach can help trigger useful discussions with staff and carer groups, identify current problems with VIS and develop a set of high-level design principles for their improvement. These principles reveal day-to-day frictions that require further attention and resolution.
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Affiliation(s)
| | - Karolina Kuberska
- THIS Institute (The Healthcare Improvement Studies Institute), Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
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Addressing patients' concerns in speech and language therapy consultations following the diagnosis and treatment of head and neck cancer. Curr Opin Otolaryngol Head Neck Surg 2023; 31:159-164. [PMID: 36912235 DOI: 10.1097/moo.0000000000000881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/14/2023]
Abstract
PURPOSE OF REVIEW Head and neck cancer (HNC) and its treatment impacts profoundly on patients' functional abilities, emotional well being and social interactions. Communication and swallowing are fundamental to everyday life, and the Speech and Language Therapist (SLT) has a critical role for both patients and their carers. In clinical practice, patient-reported outcome measures (PROMs) are a key part of the armamentarium of the SLT. The purpose of the review is to summarize how these measures can be beneficial in the context of time pressured SLT outpatient consultations. RECENT FINDINGS Unmet needs in HNC are common and impact negatively on quality of life. There is an ever-increasing number of articles in this area, and it can be a challenge to identify, distil and summarize those specific to SLT. SUMMARY In this review, we discuss the scope of holistic evaluation, strengths and limitations of PROMs, the Patient Concerns Inventory-Head and Neck, barriers to the use of outcome measures, the carers perspective and surveillance. SLT are uniquely placed members of the multidisciplinary team and provide expert advice and intervention. The inclusion of PROMs in routine consultations provides a model of follow up, which helps address patients and carers complex and unmet needs, ultimately promoting better outcomes.
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Mondahl J, Thomsen TG, Hellesø R, Frederiksen K. A critical discourse analysis of the influence of organisational structures on inequality in head and neck cancer treatment in Denmark. Scand J Caring Sci 2023; 37:291-300. [PMID: 36111567 DOI: 10.1111/scs.13122] [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: 04/07/2022] [Revised: 08/23/2022] [Accepted: 09/03/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND Concern is growing about inequality in cancer treatment, and a call has been made for more knowledge of the underlying causes of this inequality. Studies show that patients with low socioeconomic status in general face a greater risk of inequality than patients with a high socioeconomic status. AIM The aim of the present study was to uncover how institutional factors may exacerbate inequality in cancer treatment for patients with low socioeconomic status exemplified by patients with head and neck cancer, most of whom have low socioeconomic status. METHOD Inspired by Fairclough, we undertook a critical discourse analysis investigating the treatment pathway of patients with head and neck cancer on the basis of policy papers. RESULTS These papers, which we conceived as formative instruments, harboured a discourse of efficiency and a discourse of participation, together carving out an effective cancer treatment pathway provided patients act in line with the recommendations. DISCUSSION The discourses of efficiency and participation are not unfamiliar in health care, and prior research shows that they may pose difficulties for patients with low socioeconomic status. CONCLUSION The discoursal framing of head and neck cancer treatment may exacerbate inequality because most patients with a low socioeconomic status fail to comprehend and act in accordance with these discourses.
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Affiliation(s)
- Julie Mondahl
- Department of Otorhinolaryngology and Maxillofacial Surgery, Zealand University Hospital, Koege, Denmark
| | - Thora Grothe Thomsen
- Department of Otorhinolaryngology and Maxillofacial Surgery, Zealand University Hospital, Koege, Denmark
| | - Ragnhild Hellesø
- Department of Nursing Science, Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Kirsten Frederiksen
- Section for Nursing, Department of Public Health, Aarhus University, Aarhus, Denmark
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Zhu J, Wang X, Chen S, Du R, Zhang H, Zhang M, Shao M, Chen C, Wang T. Improving compliance with swallowing exercise to decrease radiotherapy-related dysphagia in patients with head and neck cancer. Asia Pac J Oncol Nurs 2023; 10:100169. [PMID: 36583099 PMCID: PMC9792737 DOI: 10.1016/j.apjon.2022.100169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Accepted: 11/16/2022] [Indexed: 11/21/2022] Open
Abstract
Objective Dysphagia, one of the most common complications in head and neck cancer (HNC) treated with radiotherapy, can severely affect patients' quality of life. Currently, because no "gold standard" treatment exists, swallowing exercise remains the main rehabilitation strategy for dysphagia. However, patients' compliance with long-term swallowing exercise is only 40%, thus, greatly compromising outcomes. This article aims to analyze thefactors influencing swallowing exercise compliance in patients with HNC and explains strategies developed to date for improved rehabilitation outcomes. Methods Research studies published between 2005 and 2022 were retrieved from seven databases: PubMed, Cochrane Library, Embase, CINAHL, CNKI, Wan Fang Database, and VIP Database, and 21 articles were shortlisted and systematically reviewed. Results The swallowing exercise compliance in patients with HNC undergoing radiotherapy was affected by multiple factors, including socio-demographic factors, illness-associated factors, treatment-associated factors, and psychosocial factors. Regarding the interventions, current strategies mainly address psychosocial issues via developing various education programs. Conclusions Different factors influencing swallowing exercise compliance are important and should be observed. Measures including developing multidisciplinary teams, applying innovative equipment, refining the intervention procedure, and applying systematic theory frameworks should be performed to achieve better outcomes of compliance interventions.
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Affiliation(s)
- Jizhe Zhu
- College of Nursing and Health, Zhengzhou University, Zhengzhou, China
| | - Xin Wang
- College of Nursing and Health, Zhengzhou University, Zhengzhou, China
| | - Suxiang Chen
- Centre for Molecular Medicine and Innovative Therapeutics, Health Futures Institute, Murdoch University, Murdoch, WA, Australia
| | - Ruofei Du
- College of Nursing and Health, Zhengzhou University, Zhengzhou, China
- Academy of Medical Sciences of Zhengzhou University, Zhengzhou, China
| | - Haoning Zhang
- College of Nursing and Health, Zhengzhou University, Zhengzhou, China
| | - Menghan Zhang
- College of Nursing and Health, Zhengzhou University, Zhengzhou, China
| | - Mengwei Shao
- College of Nursing and Health, Zhengzhou University, Zhengzhou, China
| | - Changying Chen
- Department of Quality Control, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Tao Wang
- College of Nursing and Health, Zhengzhou University, Zhengzhou, China
- Telethon Kids Institute, Perth, WA, Australia
- Medical School, University of Western Australia, Perth, WA, Australia
- People’ s Hospital of Hebi, Hebi, China
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Loeliger J, Dewar S, Kiss N, Dumbrell J, Elliott A, Kaegi K, Kelaart A, McIntosh R, Swan W, Stewart J. Co-design of a cancer nutrition care pathway by patients, carers, and health professionals: the CanEAT pathway. Support Care Cancer 2023; 31:99. [PMID: 36609614 PMCID: PMC9825355 DOI: 10.1007/s00520-022-07558-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2022] [Accepted: 12/21/2022] [Indexed: 01/08/2023]
Abstract
PURPOSE Limited practical resources exist to guide optimal nutrition care for patients, carers, and health professionals (HPs). This study aimed to co-design a cancer nutrition care pathway to guide and improve the provision of consistent, evidence-based care with consumers and HPs. METHODS This study utilised an experienced-based co-design (EBCD) approach over five stages. Stage 1 involved stakeholder engagement and a literature review. Stage 2 included a survey and focus groups with patients/carers. Co-design workshops were conducted within stage 3, key stakeholder consultation within stage 4, and the finalisation and dissemination of the cancer nutrition care pathway formed stage 5. Results of stages 3 to 5 are the focus of this paper. RESULTS Two co-design workshops were held with patients, carers, and HPs (n = 32 workshop 1; n = 32 workshop 2), who collectively agreed on areas of focus and key priorities. Following this, a consultation period was completed with patients, carers, and HPs (n = 45) to refine the pathway. The collective outcome of all study stages was the co-design of a cancer nutrition care pathway (the CanEAT pathway) defining optimal cancer nutrition care that combines evidence-based practice tips into a centralised suite of resources, tools, and clinical guidance. CONCLUSION The CanEAT pathway was co-designed by patients, carers, and HPs. The EBCD approach is a meaningful way to develop targeted improvements in cancer care. The CanEAT pathway is freely available to guide and support patients, carers, and HPs to aid the implementation of optimal nutrition care into clinical practice.
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Affiliation(s)
- Jenelle Loeliger
- Nutrition & Speech Pathology Department, Peter MacCallum Cancer Centre, 305 Grattan Street, Melbourne, VIC 3000 Australia
| | - Sarah Dewar
- Nutrition & Speech Pathology Department, Peter MacCallum Cancer Centre, 305 Grattan Street, Melbourne, VIC 3000 Australia
- Dietetics Department, Eastern Health, Melbourne, VIC Australia
| | - Nicole Kiss
- Institute for Physical Activity and Nutrition, Deakin University, Geelong, VIC Australia
| | - Jodi Dumbrell
- Australian Cancer Survivorship Centre, Peter MacCallum Cancer Centre, Melbourne, VIC Australia
| | - Andrea Elliott
- Dietetics Department, Eastern Health, Melbourne, VIC Australia
| | - Kate Kaegi
- Nutrition Department, Austin Health, Heidelberg, VIC Australia
| | | | | | - Wendy Swan
- Nutrition & Dietetics, Goulburn Valley Health, Shepparton, VIC Australia
| | - Jane Stewart
- Nutrition & Speech Pathology Department, Peter MacCallum Cancer Centre, 305 Grattan Street, Melbourne, VIC 3000 Australia
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Co-designed weight management intervention for women recovering from oestrogen-receptor positive breast cancer. BMC Cancer 2022; 22:1202. [PMID: 36418985 PMCID: PMC9682743 DOI: 10.1186/s12885-022-10287-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Accepted: 10/06/2022] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Weight gain is commonly observed during and after breast cancer treatment and is associated with poorer survival outcomes, particularly in women with oestrogen receptor-positive (ER +) disease. The aim of this study was to co-design (with patients) a programme of tailored, personalised support (intervention), including high-quality support materials, to help female breast cancer patients (BCPs) with ER + disease to develop the skills and confidence needed for sustainable weight loss. METHODS: ER + BCPs were recruited from two UK National Health Service (NHS) Trusts. The selection criteria included (i) recent experience of breast cancer treatment (within 36 months of completing primary treatment); (ii) participation in a recent focus group study investigating weight management perceptions and experiences; (iii) willingness to share experiences and contribute to discussions on the support structures needed for sustainable dietary and physical activity behaviour change. Co-design workshops included presentations and interactive activities and were facilitated by an experienced co-design researcher (HH), assisted by other members of the research team (KP, SW and JS). RESULTS Two groups of BCPs from the North of England (N = 4) and South Yorkshire (N = 5) participated in a two-stage co-design process. The stage 1 and stage 2 co-design workshops were held two weeks apart and took place between Jan-March 2019, with each workshop being approximately 2 h in duration. Guided by the Behaviour Change Wheel, a theoretically-informed weight management intervention was developed on the basis of co-designed strategies to overcome physical and emotional barriers to dietary and physical activity behaviour change. BCPs were instrumental in designing all key features of the intervention, in terms of Capability (e.g., evidence-based information, peer-support and shared experiences), Opportunity (e.g., flexible approach to weight management based on core principles) and Motivation (e.g., appropriate use of goal-setting and high-quality resources, including motivational factsheets) for behaviour change. CONCLUSION This co-design approach enabled the development of a theoretically-informed intervention with a content, structure and delivery model that has the potential to address the weight management challenges faced by BCPs diagnosed with ER + disease. Future research is required to evaluate the effectiveness of the intervention for eliciting clinically-important and sustainable weight loss in this population.
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Tanay MAL, Armes J, Oakley C, Sage L, Tanner D, Roca J, Bryson L, Greenall B, Urwin L, Wyatt T, Robert G. Co-designing a cancer care intervention: reflections of participants and a doctoral researcher on roles and contributions. RESEARCH INVOLVEMENT AND ENGAGEMENT 2022; 8:36. [PMID: 35918715 PMCID: PMC9343815 DOI: 10.1186/s40900-022-00373-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Accepted: 07/23/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Patient and Public Involvement is most usually framed in the context of designing, conducting and/or disseminating research. Participatory methods such as Experience-Based Co-Design (EBCD) further allow service users to directly engage in developing, testing and implementing interventions and services alongside healthcare staff. This paper aims to explore how participants in an EBCD project came-over time-to perceive their role and involvement in co-designing a cancer care intervention. METHODS The findings are based on our reflections, a research diary, email correspondence and fieldnotes from co-design events. Co-design participants who attended most of the ten co-design events took part through written reflections or audio-recorded video calls. Ten reflective pieces were collected from clinicians (n = 4), PPI group members/patient participants (n = 4), a doctoral researcher (n = 1) and a visual illustrator (n = 1). Inductive data analysis of participant reflections was carried out using reflexive thematic analysis. Meeting fieldnotes, email correspondence and the researcher's diary were deductively analysed using the initial themes generated from this inductive analysis. RESULTS Five main themes were identified: (1) changing perception of roles during the co-design process, (2) defining a 'co-designer', (3) engagement and ownership, (4) role of the research facilitator in maintaining momentum, and (5) perceived benefits of involvement. CONCLUSION Our findings show the changing perceptions of roles and contributions among participants over time. Patients typically described their role as co-designers in terms simply of sharing their experiences. In contrast, clinicians perceived themselves as co-designers because they were working with patients who were actively involved in decision-making. Levels of engagement were affected by several factors such as time and facilitation, but most participants came to view themselves as co-owners of the intervention. Overall, participants perceived their involvement as a positive experience with clinicians also reporting wider positive impacts on their clinical practice.
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Affiliation(s)
- Mary Anne Lagmay Tanay
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, London, UK.
| | - Jo Armes
- School of Health Sciences, Faculty of Health and Medical Sciences, University of Surrey, Guildford, UK
| | | | | | | | - Jose Roca
- Guy's and St. Thomas' NHS Foundation Trust, London, UK
| | | | | | - Lauren Urwin
- Oncology and Haematology Rehabilitation Unit, Guy's and St. Thomas' NHS Foundation Trust, London, UK
| | - Toni Wyatt
- Oncology and Haematology Rehabilitation Unit, Guy's and St. Thomas' NHS Foundation Trust, London, UK
| | - Glenn Robert
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, London, UK
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Hardman JC, Harrington K, Roques T, Sood S, Jose J, Lester S, Pracy P, Simo R, Repanos C, Stafford F, Jennings C, Winter SC, Wheatly H, Homer J, Kumar BN, Paleri V. Methodology for the development of National Multidisciplinary Management Recommendations using a multi-stage meta-consensus initiative. BMC Med Res Methodol 2022; 22:189. [PMID: 35818027 PMCID: PMC9275134 DOI: 10.1186/s12874-022-01667-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Accepted: 06/27/2022] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Methods for developing national recommendations vary widely. The successful adoption of new guidance into routine practice is dependent on buy-in from the clinicians delivering day-to-day patient care and must be considerate of existing resource constraints, as well as being aspirational in its scope. This initiative aimed to produce guidelines for the management of head and neck squamous cell carcinoma of unknown primary (HNSCCUP) using a novel methodology to maximise the likelihood of national adoption. METHODS A voluntary steering committee oversaw 3 phases of development: 1) clarification of topic areas, data collection and assimilation, including systematic reviews and a National Audit of Practice; 2) a National Consensus Day, presenting data from the above to generate candidate consensus statements for indicative voting by attendees; and 3) a National Delphi Exercise seeking agreement on the candidate consensus statements, including representatives from all 58 UK Head and Neck Multidisciplinary Teams (MDT). Methodology was published online in advance of the Consensus Day and Delphi exercise. RESULTS Four topic areas were identified to frame guideline development. The National Consensus Day was attended by 227 participants (54 in-person and 173 virtual). Results from 7 new systematic reviews were presented, alongside 7 expert stakeholder presentations and interim data from the National Audit and from relevant ongoing Clinical Trials. This resulted in the generation of 35 statements for indicative voting by attendees which, following steering committee ratification, led to 30 statements entering the National Delphi exercise. After 3 rounds (with a further statement added after round 1), 27 statements had reached 'strong agreement' (n = 25, 2, 0 for each round, respectively), a single statement achieved 'agreement' only (round 3), and 'no agreement' could be reached for 3 statements (response rate 98% for each round). Subsequently, 28 statements were adopted into the National MDT Guidelines for HNSCCUP. CONCLUSIONS The described methodology demonstrated an effective multi-phase strategy for the development of national practice recommendations. It may serve as a cost-effective model for future guideline development for controversial or rare conditions where there is a paucity of available evidence or where there is significant variability in management practices across a healthcare service.
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Affiliation(s)
- John C Hardman
- Head and Neck Unit, The Royal Marsden NHS Foundation Trust, London, SW3 6JJ, UK
| | - Kevin Harrington
- Head and Neck Unit, The Royal Marsden NHS Foundation Trust, London, SW3 6JJ, UK
| | - Tom Roques
- Department of Oncology, Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UK
| | - Sanjai Sood
- Department of Otolaryngology, Head and Neck Surgery, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | - Jemy Jose
- Department of Otolaryngology, Head and Neck Surgery, Hull and East Yorkshire Hospitals NHS Trust, Hull, UK
| | - Shane Lester
- Department of Otolaryngology, Head and Neck Surgery, South Tees Hospitals NHS Foundation Trust, Middlesbrough, UK
| | - Paul Pracy
- Department of Otolaryngology, Head and Neck Surgery, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Ricard Simo
- Department of Otolaryngology, Head and Neck Surgery, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Costa Repanos
- Department of Otolaryngology, Head and Neck Surgery, Portsmouth Hospitals NHS Trust, Portsmouth, UK
| | - Frank Stafford
- Department of Otolaryngology, Head and Neck Surgery, South Tyneside and Sunderland NHS Foundation Trust, Sunderland, UK
| | - Chris Jennings
- Department of Otolaryngology, Head and Neck Surgery, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Stuart C Winter
- Department of Otolaryngology, Head and Neck Surgery, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Hugh Wheatly
- Department of Otolaryngology, Head and Neck Surgery, Gloucestershire Hospitals NHS Foundation Trust, Gloucester, UK
| | - Jarrod Homer
- Department of Otolaryngology, Head and Neck Surgery, Manchester University NHS Foundation Trust, Manchester, UK
| | - B Nirmal Kumar
- Department of Otolaryngology, Head and Neck Surgery, Wrightington Wigan & Leigh NHS Foundation Trust, Wigan, UK
| | - Vinidh Paleri
- Head and Neck Unit, The Royal Marsden NHS Foundation Trust, London, SW3 6JJ, UK.
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Brady G, Ashforth K, Cowan-Dickie S, Dewhurst S, Harris N, Monteiro A, Sandsund C, Roe J. An evaluation of the provision of oncology rehabilitation services via telemedicine using a participatory design approach. Support Care Cancer 2022; 30:1655-1662. [PMID: 34554280 PMCID: PMC8458557 DOI: 10.1007/s00520-021-06552-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Accepted: 09/07/2021] [Indexed: 01/09/2023]
Abstract
BACKGROUND The COVID-19 pandemic has fundamentally impacted the delivery of healthcare services globally. In line with UK government guidelines on social distancing, the use of telemedicine was implemented to facilitate the ongoing provision of cancer rehabilitation. PURPOSE We sought to evaluate and co-design telemedicine services to meet the complex needs of our patients and carers at a tertiary cancer centre. METHODS Experience-based co-design methodology was adapted to include virtual methods. Staff members (n = 12) and patients (n = 11) who had delivered or received therapies services at our UK cancer centre since March 2020 were recruited to take part in one-to-one virtual interviews. Patient interviews were video recorded, analysed and edited to a 30-min "trigger film". Patient and staff virtual events were undertaken thereafter. A joint virtual patient and staff event occurred. Staff and patients watched the trigger film and as partners, agreed areas for change and developed groups for service co-design. RESULTS Positive aspects regarding telemedicine provision were highlighted including reduced financial and time burden on patients, and increased flexibility for both staff and patients. The key concerns included digital exclusion, safety, communication and patient choice. Four co-design groups have been established to enact changes in these priority areas. CONCLUSION Using a participatory design approach, we have worked in partnership with patients and staff to ensure the safe, acceptable and effective delivery of rehabilitation services with integrated telemedicine.
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Affiliation(s)
- Grainne Brady
- grid.5072.00000 0001 0304 893XTherapies Department, The Royal Marsden NHS Foundation Trust, London, UK ,grid.7445.20000 0001 2113 8111Department of Surgery & Cancer, Imperial College London, London, UK
| | - Kate Ashforth
- grid.5072.00000 0001 0304 893XTherapies Department, The Royal Marsden NHS Foundation Trust, London, UK
| | - Siobhan Cowan-Dickie
- grid.5072.00000 0001 0304 893XTherapies Department, The Royal Marsden NHS Foundation Trust, London, UK
| | - Sarah Dewhurst
- grid.5072.00000 0001 0304 893XTherapies Department, The Royal Marsden NHS Foundation Trust, London, UK
| | - Natalie Harris
- grid.5072.00000 0001 0304 893XTherapies Department, The Royal Marsden NHS Foundation Trust, London, UK
| | - Alline Monteiro
- grid.5072.00000 0001 0304 893XTherapies Department, The Royal Marsden NHS Foundation Trust, London, UK
| | - Catherine Sandsund
- grid.5072.00000 0001 0304 893XTherapies Department, The Royal Marsden NHS Foundation Trust, London, UK
| | - Justin Roe
- grid.5072.00000 0001 0304 893XTherapies Department, The Royal Marsden NHS Foundation Trust, London, UK ,grid.7445.20000 0001 2113 8111Department of Surgery & Cancer, Imperial College London, London, UK ,grid.417895.60000 0001 0693 2181Department of Otolaryngology, Head and Neck Surgery, Imperial College Healthcare NHS Trust, London, UK
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Anemaat L, Palmer VJ, Copland DA, Mainstone K, Druery K, Druery J, Aisthorpe B, Binge G, Mainstone P, Wallace SJ. Using experience-based codesign to coproduce aphasia rehabilitation services: study protocol. BMJ Open 2021; 11:e047398. [PMID: 34794985 PMCID: PMC8603293 DOI: 10.1136/bmjopen-2020-047398] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Aphasia is an impairment of language that occurs in 30%-40% of stroke survivors. This often chronic condition results in poor outcomes for the individual with aphasia and their family. Long-term aphasia management is limited, with few people receiving sufficient services by 6-12 months postonset. We present a protocol for the development of coproduced aphasia service elements. We will use experience-based codesign (EBCD), an approach that enables service users and providers to collaboratively develop services and care pathways. Drawing on the experiences of people with aphasia, their families and clinicians we will establish priorities for the development of new services and later work together to codesign them. METHODS AND ANALYSIS This research will be coproduced with people with aphasia (n=30-60), their families (n=30-60) and speech pathologists (n=30-60) in Queensland, Australia, using EBCD. A consumer advisory committee will provide oversight and advice throughout the research. In phase 1, we will use semistructured interviews and the nominal group technique to explore experiences and unmet needs in aphasia rehabilitation. Data will be analysed using thematic analysis and the resulting themes will be prioritised in multistakeholder focus groups. Outcomes of phase 1 will inform future research (phase 2) to codesign services. Financial costs and participant experiences of EBCD will be measured. ETHICS AND DISSEMINATION Human Research Ethics Committee approval for phase 1 has been obtained (HREC/2020/QRBW/61368). Results will be reported in peer-reviewed journal articles, presented at relevant conferences and, following EBCD suggested best practice, fed back to participants and community members at a celebratory event at completion of the project. The inclusion of service users in all stages of research will facilitate an integrated approach to knowledge translation. A summary of research findings will be made available to participating sites.
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Affiliation(s)
- Lisa Anemaat
- School of Health and Rehabilitation Sciences, The University of Queensland, Saint Lucia, Queensland, Australia
- Queensland Aphasia Research Centre, The University of Queensland, Herston, Queensland, Australia
| | - Victoria J Palmer
- The ALIVE National Centre for Mental Health Research Translation, The University of Melbourne, Melbourne, Victoria, Australia
| | - David A Copland
- School of Health and Rehabilitation Sciences, The University of Queensland, Saint Lucia, Queensland, Australia
- Queensland Aphasia Research Centre, The University of Queensland, Herston, Queensland, Australia
| | - Kathryn Mainstone
- Queensland Aphasia Research Centre, The University of Queensland, Herston, Queensland, Australia
| | - Kent Druery
- Queensland Aphasia Research Centre, The University of Queensland, Herston, Queensland, Australia
| | - Julia Druery
- Queensland Aphasia Research Centre, The University of Queensland, Herston, Queensland, Australia
| | - Bruce Aisthorpe
- Queensland Aphasia Research Centre, The University of Queensland, Herston, Queensland, Australia
| | - Geoffrey Binge
- Queensland Aphasia Research Centre, The University of Queensland, Herston, Queensland, Australia
| | - Penelope Mainstone
- Queensland Aphasia Research Centre, The University of Queensland, Herston, Queensland, Australia
| | - Sarah J Wallace
- School of Health and Rehabilitation Sciences, The University of Queensland, Saint Lucia, Queensland, Australia
- Queensland Aphasia Research Centre, The University of Queensland, Herston, Queensland, Australia
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Griffioen IPM, Rietjens JAC, Melles M, Snelders D, Homs MYV, van Eijck CH, Stiggelbout AM. The bigger picture of shared decision making: A service design perspective using the care path of locally advanced pancreatic cancer as a case. Cancer Med 2021; 10:5907-5916. [PMID: 34328273 PMCID: PMC8419747 DOI: 10.1002/cam4.4145] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2021] [Revised: 06/14/2021] [Accepted: 06/29/2021] [Indexed: 11/09/2022] Open
Abstract
PURPOSE Solutions to improve the implementation of shared decision making (SDM) in oncology often focus on the consultation, with limited effects. In this study, we used a service design perspective on the care path of locally advanced pancreatic cancer (LAPC). We aimed to understand how experiences of patients, their significant others, and medical professionals over the entire care path accumulate to support their ability to participate in SDM. PARTICIPANTS AND METHODS We used qualitative interviews including design research techniques with 13 patients, 13 significant others, and 11 healthcare professionals, involved in the diagnosis or treatment of LAPC. The topic list was based on the literature and an auto-ethnography of the illness trajectory by a caregiver who is also a service design researcher. We conducted a thematic content analysis to identify themes influencing the ability to participate in SDM. RESULTS We found four interconnected themes: (1) Decision making is an ongoing and unpredictable process with many decision moments, often unannounced. The unpredictability of the disease course, tumor response to treatment, and consequences of choices on the quality of life complicate decision making; (2) Division of roles, tasks, and collaboration among professionals and between professionals and patients and/or their significant others is often unclear to patients and their significant others; (3) It involves "work" for patients and their significant others to obtain and understand information; (4) In "their disease journey," patients are confronted with unexpected energy drains and energy boosts, that influence their level of empowerment to participate in SDM. CONCLUSION The service design perspective uncovered how the stage for SDM is often set outside the consultation, which might explain the limited effect currently seen of interventions focusing on consultation itself. Our findings serve as a starting point for (re)designing care paths to improve the implementation of SDM in oncology.
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Affiliation(s)
- Ingeborg P M Griffioen
- Medical Decision Making, Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, the Netherlands.,Faculty of Industrial Design Engineering, Delft University of Technology, Delft, the Netherlands
| | - Judith A C Rietjens
- Department of Public Health, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Marijke Melles
- Faculty of Industrial Design Engineering, Delft University of Technology, Delft, the Netherlands
| | - Dirk Snelders
- Faculty of Industrial Design Engineering, Delft University of Technology, Delft, the Netherlands
| | - Marjolein Y V Homs
- Department of Medical Oncology, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Casper H van Eijck
- Department of Surgery, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Anne M Stiggelbout
- Medical Decision Making, Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, the Netherlands
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Not Just Dyspnoea: Swallowing as a Concern for Adults with Laryngotracheal Stenosis Undergoing Airway Reconstruction. Dysphagia 2021; 37:365-374. [PMID: 33830348 PMCID: PMC8948149 DOI: 10.1007/s00455-021-10287-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Accepted: 03/16/2021] [Indexed: 10/25/2022]
Abstract
Acquired laryngotracheal stenosis (LTS) is a rare condition causing dyspnea and stridor. Patients often require multiple surgical procedures with no guarantee of a definitive outcome. Difficulty swallowing is a recognised problem associated with LTS and the reconstructive surgeries required to manage the condition. The breathlessness patient's experience impacts on swallowing, and the vulnerable structures of the larynx are implicated during complex surgeries. This leads to dysphagia post-surgery, with some patients experiencing more chronic symptoms depending on the biomechanical impact of the surgery, or a pre-existing dysphagia. Despite this there is limited observational research about the dysphagia associated with LTS, with no exploration of the patient experience. Our aim was to investigate patient experience of living with LTS focussing on dysphagia in order to guide clinical practice. A qualitative study was completed using focus groups and semi-structured interviews with 24 patients who have had reconstructive surgery for LTS. Thematic analysis was used to identify three over-arching themes: The Physical Journey, The Emotional Journey and The Medical Journey. Key sub-themes included the importance of self-management and control, presence of symptoms, benefits of therapy, living with a life-long condition, fear and anxiety, autonomy, medicalisation of normal processes and the dichotomy between staff expertise and complacency. Swallowing was connected to all themes. The results are reviewed with consideration of the wider literature of lived experience particularly in relation to other chronic conditions and those that carry a high symptom burden such as head and neck cancer. Future clinical and research recommendations have been made. Akin to other clinical groups, adults with LTS are keen that management of their swallowing is person-centred and holistic.
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Patient and carer experiences of nutrition in cancer care: a mixed-methods study. Support Care Cancer 2021; 29:5475-5485. [PMID: 33710413 DOI: 10.1007/s00520-021-06111-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2020] [Accepted: 02/24/2021] [Indexed: 01/06/2023]
Abstract
PURPOSE Evidence-based guidelines exist to guide health professionals and services about cancer nutrition care; however, the views of cancer patients and carers are not well understood. This study aimed to understand the experience and needs of cancer patients and carers regarding nutrition care across the care continuum. METHODS Using a mixed-methods approach, cancer patients and carers completed a cross-sectional online survey and focus groups. Participants were recruited through health services and cancer organisation consumer networks via email distribution lists, e-newsletters, and social media. Focus groups were audio-recorded, transcribed, and analysed using content analysis. RESULTS Of 165 survey respondents, only 51% (n=84) reported they talked to a health professional about their nutrition care at any time-point, and only 32% with a dietitian. The majority (84%) of patients and carers felt nutrition was important at one or more time-points in their cancer path, indicating during and after cancer treatment the most important. However, perceived support from health professionals for nutrition care was deemed low at all time-points. Five focus groups were held (n=20; 16 patients, 2 carers, 2 both patients/carers) and five themes emerged: nutrition information, experiences and need; control over diet and nutrition; importance and value of nutrition; access to support; what optimal nutrition care looks like. CONCLUSION Patients and carers felt nutrition was important during their cancer path, but perceived support from health professionals for nutrition care was low. This study has highlighted patient and carer nutrition experiences that will inform development of a co-designed optimal cancer nutrition care pathway.
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Abstract
Many perioperative clinical pathways, and therefore patient journeys, are focused around provider, rather than patient, convenience. Business process re-engineering (BPRE) offers a framework for transformative process-change with the aim of improving 'consumer experience' and efficiency and may be an effective driver for improving patient experience and value within healthcare. Involvement of patients in service and pathway design, through experience-based codesign, is increasingly prevalent and may be an effective complement to BPRE. The elective perioperative pathway offers an opportunity to rethink the patient journey with the aim of maximising opportunities for effective shared decision making and improving preparation for surgery through prehabilitation and management of long-term conditions (comorbidity/multimorbidity management). Additional opportunities include improved management of transitions of care and effective medicines management to minimise polypharmacy. Pathway mapping, deconstruction and reconstruction enables such changes and is a method of service transformation that may have relevance for a spectrum of other elective/scheduled pathways.
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Affiliation(s)
- Michael Pw Grocott
- University of Southampton, Southampton, UK and Acute, Critical and Perioperative Care Research Group, Southampton, UK
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