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Nanda A, Lam LL, Lynch J, Soudy H. Experiences and Satisfaction With Telehealth During the COVID-19 Pandemic: The Perspectives of Patients With Cancer in Australia. JCO Glob Oncol 2024; 10:e2400081. [PMID: 39088779 DOI: 10.1200/go.24.00081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2024] [Revised: 04/15/2024] [Accepted: 05/30/2024] [Indexed: 08/03/2024] Open
Abstract
PURPOSE There has been a significant rise in telehealth consultations across Australia since COVID-19 was declared a worldwide pandemic. We aimed to obtain patient feedback on telehealth, identify key strengths and weaknesses, and assess the feasibility of telehealth beyond the pandemic. METHODS A survey was developed to obtain patient feedback on telehealth. Patients attending medical oncology clinics at St George Hospital and Sutherland Hospital from April 1, 2020, to May 31, 2020, were identified. Patients who were reviewed via phone or videoconference were included in this study. Eligible patients were texted or emailed a survey link within a week of their telehealth consultation. Surveys were anonymous and completion of the survey implied informed consent. Patients who did not have a mobile number or e-mail were excluded from this study. RESULTS One thousand fifty-nine patients were reviewed during the study period, of whom 644 (60%) were reviewed via telehealth. The survey response rate was 36.3% (230 patients responded of 634 surveys sent). Ten telehealth patients did not have a mobile number or email and were excluded. Sixty-seven percent of telehealth consults were for active surveillance, 31% for prechemotherapy/treatment reviews, 1.6% for best supportive care, and 0.5% for new consults. Seventy percent of patients were satisfied that their medical needs were met via telehealth. Ninety percent wanted another telehealth consult, and 73% wanted telehealth to continue post resolution of the pandemic. Minimizing risk of exposure to COVID-19 and patient convenience were identified as key strengths of telehealth while absence of physical examination was the main disadvantage. CONCLUSION Majority of the patients surveyed were satisfied that telehealth safely met their medical needs. There is a considerable demand for telehealth to continue beyond the pandemic.
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Affiliation(s)
- Arnav Nanda
- Department of Medical Oncology, St George Hospital, Sydney, Australia
- Western Cancer Centre, Dubbo Base Hospital, Dubbo, Australia
| | - Lyn Ley Lam
- Department of Medical Oncology, St George Hospital, Sydney, Australia
| | - Jodi Lynch
- Department of Medical Oncology, St George Hospital, Sydney, Australia
| | - Hussein Soudy
- Department of Medical Oncology, St George Hospital, Sydney, Australia
- Department of Medical Oncology, Sutherland Hospital, Caringbah, Australia
- Faculty of Medicine, Cairo University, Cairo, Egypt
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Tam S, Neslund-Dudas C, Barrett AM, Barrow LCJ, Fridman I, Kinlaw AC, Puviindran P, Royce TJ, Smith AB, Stein JN, Wood WA, Elston Lafata J. The Perceived Usability of Virtual Visits Among Black Adults' Receiving Oncology Care: A Qualitative Analysis. Oncologist 2024; 29:e237-e247. [PMID: 37756655 PMCID: PMC10836309 DOI: 10.1093/oncolo/oyad260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Accepted: 08/21/2023] [Indexed: 09/29/2023] Open
Abstract
BACKGROUND With the COVID-19 pandemic came rapid uptake in virtual oncology care. During this, sociodemographic inequities in access to virtual visits (VVs) have become apparent. To better understand these issues, we conducted a qualitative study to describe the perceived usability and acceptability of VVs among Black adults diagnosed with cancer. METHODS Adults who self-identified as Black and had a diagnosis of prostate, multiple myeloma, or head and neck cancer were recruited from 2 academic medical centers, and their community affiliates to participate in a semi-structured interview, regardless of prior VV experience. A patient and family advisory board was formed to inform all components of the study. Interviews were conducted between September 2, 2021 and February 23, 2022. Transcripts were organized topically, and themes and subthemes were determined through iterative and interpretive immersion/crystallization cycles. RESULTS Of the 49 adults interviewed, 29 (59%) had participated in at least one VV. Three overarching themes were derived: (1) VVs felt comfortable and convenient in the right contexts; (2) the technology required for VVs with video presented new challenges, which were often resolved by an audio-only telephone call; and (3) participants reported preferring in-person visits, citing concerns regarding gaps in nonverbal communication, trusting providers, and distractions during VV. CONCLUSION While VVs were reported to be acceptable in specific circumstances, Black adults reported preferring in-person care, in part due to a perceived lack of interpersonal connectedness. Nonetheless, retaining reimbursement for audio-only options for VVs is essential to ensure equitable access for those with less technology savvy and/or limited device/internet capabilities.
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Affiliation(s)
- Samantha Tam
- Department of Public Health Sciences, Henry Ford Health, Detroit, MI, USA
- Department of Otolaryngology, Henry Ford Health, Detroit, MI, USA
- Department of Surgery, College of Human Medicine, Michigan State University, East Lansing, MI, USA
| | - Christine Neslund-Dudas
- Department of Public Health Sciences, Henry Ford Health, Detroit, MI, USA
- Department of Epidemiology and Biostatistics, College of Human Medicine, Michigan State University, East Lansing, MI, USA
| | - Amy M Barrett
- University of North Carolina Eshelman School of Pharmacy, Chapel Hill, NC, USA
| | - Lauren C J Barrow
- University of North Carolina Eshelman School of Pharmacy, Chapel Hill, NC, USA
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Ilona Fridman
- University of North Carolina Lineberger Comprehensive Cancer Center, Chapel Hill, NC, USA
| | - Alan C Kinlaw
- University of North Carolina Eshelman School of Pharmacy, Chapel Hill, NC, USA
- Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Praveen Puviindran
- University of North Carolina Eshelman School of Pharmacy, Chapel Hill, NC, USA
| | - Trevor J Royce
- Department of Radiation, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Angela B Smith
- University of North Carolina Lineberger Comprehensive Cancer Center, Chapel Hill, NC, USA
- Department of Urology, University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | - Jacob N Stein
- Department of Urology, University of North Carolina School of Medicine, Chapel Hill, NC, USA
- Department of Medicine, University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | - William A Wood
- Department of Urology, University of North Carolina School of Medicine, Chapel Hill, NC, USA
- Department of Medicine, University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | - Jennifer Elston Lafata
- University of North Carolina Eshelman School of Pharmacy, Chapel Hill, NC, USA
- University of North Carolina Lineberger Comprehensive Cancer Center, Chapel Hill, NC, USA
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Winter N, McKenzie K, Spence D, Lane K, Ugalde A. The experience of bereaved cancer carers in rural and regional areas: The impact of the COVID-19 pandemic and the potential of peer support. PLoS One 2023; 18:e0293724. [PMID: 37934771 PMCID: PMC10629652 DOI: 10.1371/journal.pone.0293724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Accepted: 10/18/2023] [Indexed: 11/09/2023] Open
Abstract
BACKGROUND Caring for someone with cancer during end of life care can be a challenging and complex experience. Those living in rural and regional areas are less likely to have local healthcare services and may be physically isolated. Even where support services such as respite do exist, they may be less likely to be accessed due to the time burden in travelling to services. This was compounded by the COVID-19 pandemic. AIM To understand the potential benefits of peer support for bereaved carers of people with cancer from rural and regional locations during the COVID-19 period. METHODS Phone interviews were conducted with bereaved cancer carers living in rural and regional areas in Victoria. Semi-structured interviews were used, and participants were asked about their experience as a carer, bereavement and the potential for peer support. Interviews were audio recorded and transcribed verbatim; transcripts were coded and a thematic analysis was conducted. FINDINGS 12 interviews were conducted. Carers were mostly female (85%) and were on average 58 years of age (range 42-71). Interviews lasted an average of 58 minutes (range 53-91 minutes). Three themes were derived from the data; 1) Supportive care needs while caring and the impact of COVID-19; 2) Isolation during bereavement compounded by the COVID-19 pandemic; and 3) Peer support requires flexibility to meet diverse needs. CONCLUSION Peer support has potential to assist bereaved carers of people with cancer. A co-design approach may be beneficial for developing a flexible model for supporting and linking carers together.
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Affiliation(s)
- Natalie Winter
- School of Nursing & Midwifery and Institute for Health Transformation, Deakin University, Geelong, Victoria, Australia
| | - Kerry McKenzie
- Strategy and Support Division, Cancer Council Victoria, Melbourne, Australia
| | - Danielle Spence
- Strategy and Support Division, Cancer Council Victoria, Melbourne, Australia
| | - Katherine Lane
- Strategy and Support Division, Cancer Council Victoria, Melbourne, Australia
| | - Anna Ugalde
- School of Nursing & Midwifery and Institute for Health Transformation, Deakin University, Geelong, Victoria, Australia
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Nguyen OT, Mason A, Khanna N, Charles D, Naso C, Hong YR, Sprow O, Alishahi Tabriz A, Turner K, Spiess P, Patel KB. Patient and caregiver experience with telehealth for surgical cancer care: A qualitative study. J Surg Oncol 2023; 127:1203-1211. [PMID: 36883752 DOI: 10.1002/jso.27228] [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: 02/09/2023] [Accepted: 02/18/2023] [Indexed: 03/09/2023]
Abstract
INTRODUCTION The COVID-19 pandemic led to telemedicine adoption for many medical specialties, including surgical cancer care. To date, the evidence for patient experience of telemedicine among patients with cancer undergoing surgery is limited to quantitative surveys. Thus, this study qualitatively assessed the patient and caregiver experience of telehealth visits for surgical cancer care. METHODS We conducted semistructured interviews with 25 patients with cancer and three caregivers who had completed a telehealth visit for preanesthesia or postoperative visits. Interviews covered visit descriptions, overall satisfaction, system experience, visit quality, what roles caregivers had, and thoughts on what types of surgery-related visits would be appropriate through telehealth versus in-person. RESULTS Telehealth delivery for surgical cancer care was generally viewed positively. Multiple factors influenced the patient experience, including prior experience with telemedicine, ease of scheduling visits, smooth connection experiences, having access to technical support, high communication quality, and visit thoroughness. Participants identified use cases on telehealth for surgical cancer care, including postoperative visits for uncomplicated surgical procedures and educational visits. CONCLUSIONS Patient experiences with telehealth for surgical care are influenced by smooth system experiences, high-quality patient-clinician communications, and a patient-centered focus. Interventions are needed to optimize telehealth delivery (e.g., improve telemedicine platform usability).
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Affiliation(s)
- Oliver T Nguyen
- Department of Health Outcomes and Behavior, H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida, USA
| | - Arianna Mason
- Research, Interventions, and Measurement Core, H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida, USA
| | - Neel Khanna
- Department of Biostatistics & Bioinformatics, Duke University School of Medicine, Durham, North Carolina, USA
| | - Dannelle Charles
- Research, Interventions, and Measurement Core, H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida, USA
| | - Cristina Naso
- Virtual Health Program, H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida, USA
| | - Young-Rock Hong
- Department of Health Services Research, Management, and Policy, University of Florida, Gainesville, Florida, USA
| | - Olivia Sprow
- Department of Epidemiology, University of Florida, Gainesville, Florida, USA
| | - Amir Alishahi Tabriz
- Department of Health Outcomes and Behavior, H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida, USA.,Department of Oncologic Science, University of South Florida, Tampa, Florida, USA.,Department of Gastrointestinal Oncology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida, USA
| | - Kea Turner
- Department of Health Outcomes and Behavior, H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida, USA.,Department of Oncologic Science, University of South Florida, Tampa, Florida, USA.,Department of Gastrointestinal Oncology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida, USA
| | - Philippe Spiess
- Virtual Health Program, H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida, USA.,Department of Genitourinary Oncology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida, USA
| | - Krupal B Patel
- Department of Head and Neck Endocrine Oncology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida, USA
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Gomes F, Taylor S, Scanlon L, Coombermoore J, Eastwood C, Stanworth M, Williamson A, Barnes C, Yorke J. The experience of patients with lung cancer during the COVID-19 pandemic and its importance for post-pandemic outpatient cancer care planning: A cross sectional study exploring the roles of age and frailty. J Geriatr Oncol 2023; 14:101449. [PMID: 36870223 PMCID: PMC9933321 DOI: 10.1016/j.jgo.2023.101449] [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: 07/25/2022] [Revised: 09/12/2022] [Accepted: 02/08/2023] [Indexed: 02/18/2023]
Abstract
INTRODUCTION The COVID-19 pandemic impacted the care and experiences of people with cancer, but it presented an opportunity to improve the delivery of outpatient care post-pandemic. MATERIALS AND METHODS We performed an observational cross-sectional study with people with lung cancer throughout the COVID-19 pandemic. A survey investigated patients' experiences and preferences regarding the delivery of cancer care to plan for post-pandemic care, as well as the pandemic's impact on their functional status (physical and psycho-social), exploring the role of age and frailty. RESULTS Amongst 282 eligible participants, 88%, 86%, and 59% of patients reported feeling appropriately supported during the pandemic by their cancer centre, friends/family, and primary care services, respectively. Remote oncology consultations were delivered to 90% of patients during the pandemic, of which 3% did not meet patients' expectations. Regarding post-pandemic outpatient care preferences, face-to-face appointments were preferred by 93% for the first appointment, by 64% when discussing imaging results, and by 60% for reviews during anti-cancer treatments. Older patients aged 70 years and above were more likely to favour face-to-face appointments (p = 0.007), regardless of their frailty status. Patient preferences changed over time, with the more recent participants preferring remote appointments during anti-cancer treatments (p = 0.0278). Regarding the pandemic's impact, abnormal levels of anxiety and depression were found in 16% and 17% of patients, respectively. Younger patients experienced higher abnormal levels of anxiety and depression (p = 0.036, p = 0.021). Amongst the older sub-group, those with frailty had higher levels of anxiety and depression (p < 0.001). Amongst all participants, 54% reported a considerable negative impact from the pandemic on different aspects of their daily life, particularly emotional and psychological health and sleep patterns, which were more marked in younger patients and the older sub-group with frailty. Older patients without frailty reported the least impact on their functional status. DISCUSSION There is a need for more personalised outpatient consultation options during cancer care. Whilst there is a preference for face-to-face consultations for older patients, following the pandemic there is a growing acceptance of remote consultations particularly during anti-cancer treatment. Older patients with lung cancer without frailty were less affected by the pandemic than those with frailty and younger patients, requiring less support from healthcare services.
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Affiliation(s)
- Fabio Gomes
- Medical Oncology Department, The Christie NHS Foundation Trust, Wilmslow Road, Manchester M20 4BX, UK; Christie Patient Centred Research, The Christie NHS Foundation Trust, Wilmslow Road, Manchester M20 4BX, UK; Clinical Outcomes Unit, The Christie NHS Foundation Trust, Wilmslow Road, Manchester M20 4BX, UK.
| | - Sally Taylor
- Christie Patient Centred Research, The Christie NHS Foundation Trust, Wilmslow Road, Manchester M20 4BX, UK; School of Nursing and Midwifery, The University of Manchester, Oxford Road, Manchester M13 9PL, UK
| | - Lauren Scanlon
- Clinical Outcomes Unit, The Christie NHS Foundation Trust, Wilmslow Road, Manchester M20 4BX, UK
| | - Jake Coombermoore
- Christie Patient Centred Research, The Christie NHS Foundation Trust, Wilmslow Road, Manchester M20 4BX, UK
| | - Charlotte Eastwood
- Christie Patient Centred Research, The Christie NHS Foundation Trust, Wilmslow Road, Manchester M20 4BX, UK
| | - Melissa Stanworth
- Christie Patient Centred Research, The Christie NHS Foundation Trust, Wilmslow Road, Manchester M20 4BX, UK
| | - Andrew Williamson
- Medical Oncology Department, The Christie NHS Foundation Trust, Wilmslow Road, Manchester M20 4BX, UK
| | - Claire Barnes
- Christie Patient Centred Research, The Christie NHS Foundation Trust, Wilmslow Road, Manchester M20 4BX, UK
| | - Janelle Yorke
- Christie Patient Centred Research, The Christie NHS Foundation Trust, Wilmslow Road, Manchester M20 4BX, UK; School of Nursing and Midwifery, The University of Manchester, Oxford Road, Manchester M13 9PL, UK
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Cancer nursing research priorities: A rapid review. Eur J Oncol Nurs 2023; 63:102272. [PMID: 36827837 DOI: 10.1016/j.ejon.2023.102272] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Accepted: 01/22/2023] [Indexed: 01/31/2023]
Abstract
PURPOSE Identifying cancer nursing research priorities is central to influencing the direction of cancer care research. The aim of this rapid review was to explore research priorities identified by oncology nurses for cancer care delivery between 2019 and 2022. METHODS The Preferred Reporting Items for Systematic Reviews and Meta-Analysis informed the design of the rapid review. MEDLINE, CINAHL, PUBMED, Web of Science, and Cochrane databases were searched for studies published between December 1st, 2018, and September 30th, 2022. This timeframe was chosen to account for the latest relevant evidence synthesis, as well as changes in cancer care necessitated by the COVID-19 pandemic. The Quality Assessment of Diverse Studies tool was used to appraise quality. RESULTS Four studies met the inclusion criteria. Many of the research priorities identified were influenced by the COVID-19 pandemic. The top cancer nursing research priority identified was the role of technology in improving patient and caregiver symptoms and health outcomes. Other most prevalent research priorities were focused on symptom management, culturally sensitive palliative and psychosocial care, early/integrated palliative care, financial toxicity, modifiable risk factors related to social determinants of health, public and patient involvement in research, and oncology nurses' well-being and scope of practice. CONCLUSION The findings indicate a need to steer a strategic programme of cancer nursing research towards digitalisation in cancer care to meet the current needs of people living with cancer and their caregivers. However, cancer nurses' burnout, staff shortages and disparities in specialist education will hinder the implementation of certain models of care.
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Banbury A, Smith AC, Taylor ML, Der Vartanian C, Ng K, Vitangcol K, Haydon HM, Thomas EE, Caffery LJ. Cancer care and management during COVID-19: A comparison of in-person, video and telephone consultations. J Telemed Telecare 2022; 28:733-739. [PMID: 36346931 PMCID: PMC9646900 DOI: 10.1177/1357633x221123409] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Accepted: 07/27/2022] [Indexed: 09/16/2023]
Abstract
In Australia, the COVID-19 pandemic has resulted in the exponential growth in the delivery of telehealth services. Medicare data indicates that the majority of telehealth consultations have used the telephone, despite the known benefits of using video. The aim of this study was to understand the perceived quality and effectiveness of in-person, telephone and videoconsultations for cancer care. Data was collected via online surveys with consumers (n = 1162) and health professionals (n = 59), followed by semi-structured interviews with telehealth experienced health professionals (n = 22) and consumers (n = 18). Data were analysed using descriptive statistics and significance was tested using the chi-square test. A framework analysis and thematic analysis were used for qualitative data. Results indicate telehealth is suitable for use across the cancer care pathway. However, consumers and health professionals perceived videoconsultations facilitated visual communication and improved patients' quality of care. The telephone was appropriate for short transactional consultations such as repeat prescriptions. Consumers were rarely given the choice of consultation modality. The choice of modality depended on a range of factors such as the type of consultation and stage of cancer care. Hybrid models of care utilising in-person, video and telephone should be developed and requires further guidance to promote the adoption of telehealth in cancer care.
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Affiliation(s)
- Annie Banbury
- Centre for Online Health, The University of
Queensland, Brisbane, Australia
- Centre for Health Services Research, The University of
Queensland, Brisbane, Australia
| | - Anthony C Smith
- Centre for Online Health, The University of
Queensland, Brisbane, Australia
- Centre for Health Services Research, The University of
Queensland, Brisbane, Australia
- Centre for Innovative Medical
Technology, University of Southern Denmark, Odense, Denmark
| | - Monica L Taylor
- Centre for Online Health, The University of
Queensland, Brisbane, Australia
- Centre for Health Services Research, The University of
Queensland, Brisbane, Australia
| | | | - Kawai Ng
- Cancer Australia, Sydney, Australia
| | - Kathryn Vitangcol
- Centre for Online Health, The University of
Queensland, Brisbane, Australia
- Centre for Health Services Research, The University of
Queensland, Brisbane, Australia
| | - Helen M Haydon
- Centre for Online Health, The University of
Queensland, Brisbane, Australia
- Centre for Health Services Research, The University of
Queensland, Brisbane, Australia
| | - Emma E Thomas
- Centre for Online Health, The University of
Queensland, Brisbane, Australia
- Centre for Health Services Research, The University of
Queensland, Brisbane, Australia
| | - Liam J Caffery
- Centre for Online Health, The University of
Queensland, Brisbane, Australia
- Centre for Health Services Research, The University of
Queensland, Brisbane, Australia
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