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Rousset-Jablonski C, Lortal B, Lantheaume S, Arnould L, Simon H, Tuszynski AS, Courtier M, Debbah S, Lefrançois M, Balbin S, Kably AS, Toledano A. French national survey on breast cancer care: caregiver and patient views. Breast Cancer 2024; 31:633-642. [PMID: 38635135 PMCID: PMC11194201 DOI: 10.1007/s12282-024-01576-4] [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: 10/19/2023] [Accepted: 03/24/2024] [Indexed: 04/19/2024]
Abstract
PURPOSE To improve the quality of care for patients with breast cancer, an analysis of the health-care pathway, considering feedback from both health-care practitioners (HCPs) and patients, is needed. METHODS Between 2020 and 2022, we conducted a survey at French breast cancer centers and analyzed information from questionnaires completed by HCPs and patients. We collected information on center organization, diagnostic processes, treatment decisions and modalities, supportive care, patient advocacy groups, and work issues. RESULTS Twenty-three breast cancer centers were included and questionnaires completed by 247 HCPs and 249 patients were analyzed. The centers closely followed the legal French framework for cancer treatments, which includes formal diagnostic announcements, multidisciplinary tumor boards, personalized treatment summaries, and supportive care access. HCPs and patients were satisfied with the time to diagnosis (≤ 2 weeks as evaluated by 75% of patients), time to surgery (mean 61 days), time between surgery and chemotherapy (mean 47 days), and time between surgery and radiotherapy (mean 81 days). Fertility preservation counseling for women under 40 years of age was systematically offered by 67% of the HCPs. The majority (67%) of the patients indicated that they had received a personalized treatment summary; the topics discussed included treatments (92%), tumor characteristics (84%), care pathways (79%), supportive care (52%), and breast reconstruction (33%). Among HCPs, 44% stated that reconstructive surgery was offered to all eligible patients and 57% and 45% indicated coordination between centers and primary care physicians for adverse effects management and access to supportive care should be improved, for chemotherapy and radiotherapy, respectively. Regarding patient advocacy groups, 34% of HCPs did not know whether patients had contact and only 23% of patients declared that they had such contact. For one-third of working patients, work issues were not discussed. Twenty-eight percent of patients claimed that they had faced difficulties for supportive care access. Among HCPs, 13% stated that a formal personalized survivorship treatment program was administered to almost all patients and 37% almost never introduced the program to their patients. Compliance to oral treatments was considered very good for 75-100% of patients by 62% of HCPs. CONCLUSIONS This study provides an updated analysis of breast cancer care pathways in France. Overall, the initial processes of diagnosis, announcement, and treatment were swift and were in agreement with the best care standards. No barriers to accessing care were identified. Based on the study findings, we proposed several strategies to improve the quality of care for patients in supportive care, coordination with primary care physicians, reconstructive surgery, and fertility preservation access.
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Affiliation(s)
- Christine Rousset-Jablonski
- Centre Léon Bérard, Lyon, France.
- Unité INSERM U1290 RESHAPE, Lyon, France.
- Hôpital Femme Mère Enfant, Bron, France.
| | | | | | | | | | | | | | | | | | | | | | - Alain Toledano
- Institut de Radiothérapie et de Radiochirurgie Hartmann - ELSAN, Levallois-Perret, France
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Tarver WL, Justice Z, Jonnalagadda P, Rahurkar S, Obeng-Gyasi S, Krok-Schoen JL, Petrecca A, Paskett ED. A scoping review of the evidence on survivorship care plans among minority, rural, and low-income populations. J Cancer Surviv 2024:10.1007/s11764-024-01609-z. [PMID: 38907799 DOI: 10.1007/s11764-024-01609-z] [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: 04/30/2023] [Accepted: 04/19/2024] [Indexed: 06/24/2024]
Abstract
PURPOSE Despite recent advances in cancer control and the number of cancer survivors increasing substantially over the past years, some cancer survivors continue to experience disparities due to barriers to recommended survivorship care. The use of survivorship care plans (SCPs) may be a way to help care for these individuals and their respective issues after they complete their primary treatment. The purpose of this scoping review is to understand the evidence on SCPs among minority, rural, and low-income populations: groups that experience disproportionately poorer cancer health outcomes. METHODS Computer-based searches were conducted in four academic databases. We included peer-reviewed studies published in the English language and conducted in the USA. We systematically extracted information from each paper meeting our inclusion criteria. RESULTS Our search identified 45 articles. The 4 major themes identified were (1) disparities in the receipt of SCPs where populations experience unmet needs; (2) benefits of SCPs, including improved care coordination and self-management of cancer; (3) needs and preferences for survivorship care; and (4) barriers and facilitators to using SCPs. CONCLUSIONS Despite the potential benefits, underserved cancer survivors experience disparities in the receipt of SCPs and continue to have unmet needs in their survivorship care. Survivorship care may benefit from a risk-stratified approach where SCPs are prioritized to survivors belonging to high-risk groups. IMPLICATIONS FOR CANCER SURVIVORS SCPs are a tool to deliver quality care for cancer survivors. While evidence is mixed on SCPs' benefits among the general population, SCPs show promise for underserved populations when it comes to proximal outcomes that contribute to disparities.
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Affiliation(s)
- Willi L Tarver
- James Comprehensive Cancer Center, The Ohio State University, Columbus, OH, USA.
- Division of Cancer Prevention and Control, Department of Internal Medicine, College of Medicine, The Ohio State University, Columbus, OH, USA.
- The Center for the Advancement of Team Science, Analytics, and Systems Thinking in Health Services and Implementation Science Research (CATALYST), College of Medicine, The Ohio State University, Columbus, OH, USA.
| | | | - Pallavi Jonnalagadda
- The Center for the Advancement of Team Science, Analytics, and Systems Thinking in Health Services and Implementation Science Research (CATALYST), College of Medicine, The Ohio State University, Columbus, OH, USA
| | - Saurabh Rahurkar
- The Center for the Advancement of Team Science, Analytics, and Systems Thinking in Health Services and Implementation Science Research (CATALYST), College of Medicine, The Ohio State University, Columbus, OH, USA
- Department of Biomedical Informatics, College of Medicine, The Ohio State University, Columbus, OH, USA
| | - Samilia Obeng-Gyasi
- Division of Surgical Oncology, Department of Surgery, The Ohio State University, Columbus, OH, USA
| | - Jessica L Krok-Schoen
- Division of Health Sciences, School of Health and Rehabilitation Sciences, The Ohio State University, Columbus, OH, USA
| | - Abigail Petrecca
- The Center for the Advancement of Team Science, Analytics, and Systems Thinking in Health Services and Implementation Science Research (CATALYST), College of Medicine, The Ohio State University, Columbus, OH, USA
| | - Electra D Paskett
- James Comprehensive Cancer Center, The Ohio State University, Columbus, OH, USA
- Division of Cancer Prevention and Control, Department of Internal Medicine, College of Medicine, The Ohio State University, Columbus, OH, USA
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Hayes BD, Young HG, Atrchian S, Vis-Dunbar M, Stork MJ, Pandher S, Samper S, McCorquodale S, Loader A, Voss C. Primary care provider-led cancer survivorship care in the first 5 years following initial cancer treatment: a scoping review of the barriers and solutions to implementation. J Cancer Surviv 2024; 18:352-365. [PMID: 36376712 DOI: 10.1007/s11764-022-01268-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: 06/02/2022] [Accepted: 10/04/2022] [Indexed: 11/16/2022]
Abstract
PURPOSE To synthesize the barriers to primary care provider (PCP)-led cancer survivorship care (≤ 5 years after initial cancer treatment) experienced by healthcare systems around the world, and to explore potential solutions that would succeed within a developed country. METHODS A scoping review of peer-reviewed articles and grey literature was conducted. Four electronic databases (Medline, Embase, Web of Science Core Collection, and Google Scholar) were searched for articles prior to April 2021. RESULTS Ninety-seven articles published across the globe (USA, Canada, Australia, European Union, and UK) met the review inclusion/exclusion criteria. The four most frequently discussed barriers to PCP-led survivorship care in healthcare systems were as follows: (1) insufficient communication between PCPs and cancer specialists, (2) limited PCP knowledge, (3) time restrictions for PCPs to provide comprehensive survivorship care, and (4) a lack of resources (e.g., survivorship care guidelines). Potential solutions to combat these barriers were as follows: (1) improving interdisciplinary communication, (2) bolstering PCP education, and (3) providing survivorship resources. CONCLUSIONS This scoping review identified and summarized key barriers and solutions to the provision of PCP-led cancer survivorship care. Importantly, the findings from this review provide insight and direction to guide optimization of cancer care practice within BC's healthcare system. IMPLICATIONS FOR CANCER SURVIVORS Optimizing the PCP-led survivorship care model will be a valuable contribution to the field of cancer survivorship care and will hopefully lead to more widespread use of this model, ultimately lessening the growing demand for cancer-specific care by cancer specialists.
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Affiliation(s)
- Brian D Hayes
- Southern Medical Program, Faculty of Medicine, University of British Columbia, Kelowna, Canada
| | - Hannah G Young
- Southern Medical Program, Faculty of Medicine, University of British Columbia, Kelowna, Canada
| | - Siavash Atrchian
- BC Cancer, Kelowna, Canada
- Department of Surgery, Division of Radiation Oncology and Developmental Therapeutics, Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | | | - Matthew J Stork
- Centre for Chronic Disease Prevention and Management, Faculty of Medicine, University of British Columbia, 1088 Discovery Avenue, Kelowna, BC, V1V 1V7, Canada
| | - Satvir Pandher
- Department of Family Practice, Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Sofia Samper
- Centre for Chronic Disease Prevention and Management, Faculty of Medicine, University of British Columbia, 1088 Discovery Avenue, Kelowna, BC, V1V 1V7, Canada
| | - Sarah McCorquodale
- Southern Medical Program, Faculty of Medicine, University of British Columbia, Kelowna, Canada
- Centre for Chronic Disease Prevention and Management, Faculty of Medicine, University of British Columbia, 1088 Discovery Avenue, Kelowna, BC, V1V 1V7, Canada
| | | | - Christine Voss
- Southern Medical Program, Faculty of Medicine, University of British Columbia, Kelowna, Canada.
- Centre for Chronic Disease Prevention and Management, Faculty of Medicine, University of British Columbia, 1088 Discovery Avenue, Kelowna, BC, V1V 1V7, Canada.
- Department of Pediatrics, Faculty of Medicine, University of British Columbia, Vancouver, Canada.
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Restrepo E, Ko N, Warner ET. An evaluation of readability and understandability of online education materials for breast cancer survivors. J Cancer Surviv 2024; 18:457-465. [PMID: 35913680 DOI: 10.1007/s11764-022-01240-w] [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: 03/24/2022] [Accepted: 07/22/2022] [Indexed: 10/16/2022]
Abstract
PURPOSE We aimed to determine the availability of existing web-based educational materials on breast cancer survivorship and assess their readability and understandability. METHODS We identified materials eligible for review in two ways: (1) reviews of websites of major cancer-related organizations (e.g., American Cancer Society); (2) Google searches for breast cancer survivorship, breast cancer, breast cancer follow-up care, and cancer survivorship. We measured Flesch-Kincaid and New Dale Readability of existing breast cancer and breast cancer survivorship materials. Readability grade levels 5 to 8 were considered ideal to acceptable. We used the Patient Education Materials Assessment Tool (PEMAT) to measure the understandability of 53 videos and 152 written materials, such as booklets and manuals. A resource was considered understandable and/or actionable if it scored ≥ 70% on either the understandability section or the actionability section of the PEMAT. RESULTS We identified a total of 205 existing materials including brochures, booklets, facts sheets, websites, and videos in English. The average Flesch-Kincaid grade score of written educational materials was 9.7 (range 3.5-16.4), which translates to a 9th grade reading level. According to the New Dale-Chall readability assessment, most of the materials were in the 9 to 10 grade level range. The average PEMAT score was 88.6% (range 56-100%). CONCLUSION Patient educational materials are available online as printable, written materials, and videos and they focus on a wide selection of survivorship-related topics. Most of the breast cancer educational materials that are available online were above an 8th grade reading level. The PEMAT results, however, suggest that materials are easy to understand regarding word choice and style, use of numbers, organization, layout and design, and use of visual aids. IMPLICATIONS FOR CANCER SURVIVORS Understandable patient education materials are essential for guiding breast cancer survivors towards improving their health outcomes and optimizing their quality of life.
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Affiliation(s)
- Emily Restrepo
- Department of Medicine, Mongan Institute, Clinical and Translational Epidemiology Unit, Massachusetts General Hospital, Boston, MA, USA.
| | - Naomi Ko
- Belkin Breast Health Center, Boston Medical Center, Boston, MA, USA
| | - Erica T Warner
- Department of Medicine, Mongan Institute, Clinical and Translational Epidemiology Unit, Massachusetts General Hospital, Boston, MA, USA
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Halpern M, Mollica MA, Han PK, Tonorezos ES. Myths and Presumptions About Cancer Survivorship. J Clin Oncol 2024; 42:134-139. [PMID: 37972343 PMCID: PMC10824378 DOI: 10.1200/jco.23.00631] [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: 03/22/2023] [Revised: 09/25/2023] [Accepted: 10/04/2023] [Indexed: 11/19/2023] Open
Abstract
Identifying cancer survivorship myths and presumptions perpetuated in survivorship circles.
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Affiliation(s)
- Michael Halpern
- Division of Cancer Control and Population Sciences, National Cancer Institute, National Institutes of Health, Rockville, MD
| | - Michelle A. Mollica
- Division of Cancer Control and Population Sciences, National Cancer Institute, National Institutes of Health, Rockville, MD
| | - Paul K.J. Han
- Division of Cancer Control and Population Sciences, National Cancer Institute, National Institutes of Health, Rockville, MD
| | - Emily S. Tonorezos
- Division of Cancer Control and Population Sciences, National Cancer Institute, National Institutes of Health, Rockville, MD
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Kelly KM, Rai P, Studts JL, Dickinson S, Henschel B, Dignan M, Chambers M, Hazard-Jenkins H. Communication with physicians and family about breast Cancer recurrence. PEC INNOVATION 2023; 3:100237. [PMID: 38148854 PMCID: PMC10750108 DOI: 10.1016/j.pecinn.2023.100237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Revised: 11/09/2023] [Accepted: 11/25/2023] [Indexed: 12/28/2023]
Abstract
Objective Adequate physician-patient communication about cancer recurrence is vital to quality of life and to informed decision-making related to survivorship care. The current study was guided by a cognitive-affective framework to examine communication with family and physicians about breast cancer recurrence risk. Methods A survey of recently-diagnosed, early-stage breast cancer patients in Appalachia investigated physician-patient and familial communication about breast cancer recurrence risk. Results Over 30% of participants reported not talking to family or physicians about breast cancer recurrence risk. Younger patients reported more conversations, and speaking with physicians was associated with greater perception risk factors associated with recurrence risk. Greater worry about recurrence was associated with more communication with family and plans to talk to family, physicians, and friends about recurrence risk in the future. Conclusion Additional supports for patients and physicians are needed to improve understanding of breast cancer recurrence risk and risk factors for recurrence. Innovation Family communication about breast cancer recurrence risk is understudied. The combination of physician and family communication adds novelty to our analysis.
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Affiliation(s)
- Kimberly M. Kelly
- Center for Innovation in Health Equity Research, University of Tennessee Health Science Center, 66 N. Pauline St, Memphis, TN, USA
- West Virginia University School of Pharmacy, HSC PO Box 9510, Morgantown, WV 26506, USA
| | - Pragya Rai
- Center for Innovation in Health Equity Research, University of Tennessee Health Science Center, 66 N. Pauline St, Memphis, TN, USA
| | - Jamie L. Studts
- University of Colorado School of Medicine, Aurora, CO 80045, USA
| | | | | | - Mark Dignan
- University of Kentucky, Lexington, KY 40505, USA
| | | | - Hannah Hazard-Jenkins
- West Virginia University School of Pharmacy, HSC PO Box 9510, Morgantown, WV 26506, USA
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Kim J, Linos E, Fishman DA, Dove MS, Hoch JS, Keegan TH. Factors Associated with Online Patient-Provider Communications Among Cancer Survivors in the United States during COVID: A Cross-Sectional Study. JMIR Cancer 2023; 9:e44339. [PMID: 37074951 DOI: 10.2196/44339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Revised: 04/05/2023] [Accepted: 04/17/2023] [Indexed: 04/20/2023] Open
Abstract
BACKGROUND Online Patient-Provider Communication (OPPC) is crucial in enhancing access to health information, self-care, and related health outcomes among cancer survivors. The necessity of OPPC increased during SARS/COVID-19 (COVID), yet investigations in vulnerable subgroups have been limited. OBJECTIVE Thus, this study aimed to assess the prevalence of OPPC and sociodemographic and clinical characteristics associated with OPPC among cancer survivors and adults without a history of cancer during COVID vs. pre-COVID. METHODS Nationally representative cross-sectional survey data (Health Information National Trends Survey, HINTS 5 2017-2020) was used among cancer survivors (n= 1,900) and adults without a history of cancer (n= 13, 292). COVID included data from February to June 2020. We calculated the prevalence of three types of OPPC, defined as using email/internet, tablet/smartphone, or Electronic Health Records (EHR) for patient-provider communication, in the past 12 months. To investigate the associations of sociodemographic and clinical factors with OPPC, multivariable-adjusted weighted logistic regression was performed to obtain odds ratios (OR) and 95% confidence intervals (95% CI). RESULTS The average prevalence of OPPC increased from pre-COVID to COVID among cancer survivors (39.7% vs. 49.7%, email/internet; 32.2% vs. 37.9%, tablet/smartphone; 19.0% vs. 30.0%, EHR). Cancer survivors (OR=1.32, 95% CI 1.06-1.63) were slightly more likely to use email/internet communications than adults without a history of cancer prior to COVID. Among cancer survivors, email/internet (OR=1.61, 1.08-2.40) and EHR (OR=1.92, 1.22-3.02) were more likely to be used during COVID than pre-COVID. During COVID, subgroups of cancer survivors, including Hispanics (OR=0.26, 0.09-0.71 vs. non-Hispanic Whites), or those with the lowest income (OR=6.14, 1.99-18.92 $50,000 to <$75,000; OR=0.42, 1.56-11.28 ≥ $75,000 vs. <$20,000), with no usual source of care (OR=6.17, 2.12-17.99), or reporting depression (OR=0.33, 0.14-0.78) were less likely to use email/internet and those who were the oldest (OR=9.33, 2.18-40.01 age 35-49; OR=3.58, 1.20-10.70 age 50-64; OR=3.09, 1.09-8.76 age 65-74 vs. ≥75), unmarried (OR=2.26, 1.06-4.86) or had public/no health insurance (ORs=0.19-0.21 Medicare, Medicaid, or Other, vs. private) were less likely to use tablet/smartphone to communicate with providers. Cancer survivors with a usual source of care (OR=6.23, 1.66-23.39) or healthcare office visits within a year (ORs=7.55-8.25) were significantly more likely to use EHR to communicate. While not observed in cancer survivors, lower education level was associated with lower OPPC among adults without a history of cancer during COVID. CONCLUSIONS Our findings identified vulnerable subgroups of cancer survivors who were left behind in online patient-provider communications which are becoming an increasing part of healthcare. Those vulnerable subgroups of cancer survivors with lower OPPC should be helped through multidimensional interventions to prevent further inequities. CLINICALTRIAL Not applicable.
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Affiliation(s)
- Jiyeong Kim
- Department of Public Health Sciences, School of Medicine, University of California, Davis, 1 Shields Ave, Davis, US
| | - Eleni Linos
- Department of Epidemiology and Population Health, School of Medicine, Stanford University, Stanford, US
- Department of Dermatology, School of Medicine, Stanford University, Stanford, US
| | - Debra A Fishman
- Health Management and Education, UC Davis Health Cardiac Rehabilitation, Davis, US
| | - Melanie S Dove
- Division of Health Policy and Management, Department of Public Health Sciences, University of California, Davis, Davis, US
| | - Jeffrey S Hoch
- Division of Health Policy and Management, Department of Public Health Sciences, Center for Healthcare Policy and Research, University of California, Davis, Davis, US
| | - Theresa H Keegan
- Division of Hematology and Oncology, UC Davis Comprehensive Cancer Center, Sacramento, US
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Carmen A, Anne O, Monika S, Daniel E, Johannes G, Verena M, Michael H, Christine B. Does the toxicity of endocrine therapy persist into long-term survivorship?: Patient-reported outcome results from a follow-up study beyond a 10-year-survival. Breast Cancer Res Treat 2023; 198:475-485. [PMID: 36418518 PMCID: PMC10036266 DOI: 10.1007/s10549-022-06808-9] [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: 04/09/2022] [Accepted: 11/09/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND Endocrine treatment (ET) is a highly effective breast cancer treatment but can distinctly impair breast cancer patients' quality of life (QOL). In a patient-reported outcome (PROs) study conducted by the authors in 2011, patients reported higher ET-induced symptom levels than known from the registration trials, and was underestimated. Based on these study results, we investigated the long-term sequelae of ET reported by breast cancer survivors (BCS) in a follow-up study conducted 5-10 years after an earlier assessment. METHODS BCS who had participated in the earlier study (n = 436) were approached for study participation either at one of their routine follow-up appointments or via mail; consenting patients were asked to completed the same PRO assessment used in the original study (FACT-B + ES). BCS with relapse/ progressive disease were excluded from the analysis. We compared long-term endocrine symptomatology and overall QOL outcome (i.e. FACT-G and -ES sum score). RESULTS A final sample of 268 BCS was included in the analysis. BCS reported a significant improvement of the overall endocrine symptomatology (baseline mean = 59 vs. follow-up mean = 62, p < 0.001), physical (baseline = 23.9 mean vs. follow-up mean = 24.8, p < 0.01) and functional well-being (baseline mean = 21.7 vs. follow-up mean = 22.7, p = 0.013) and overall QOL (mean baseline = 88.3 vs. mean follow-up = 90.9, p = 0.011). However, the prevalence of particular symptoms, well-known to be ET induced, did not change over time such as joint pain (baseline = 45.5% vs. 44.2%, n.s. difference), lack of energy (36.4% vs 33.8%, n.s. difference), weight gain (36.8% vs. 33.9%, n.s. difference) or vaginal dryness (30.2% vs. 33%, n.s. difference) and the proportion reporting lack of interest in sex increased (40.4% vs. 48.7%, p < 0.05). CONCLUSION Presented results indicate that BCS recover well in terms of overall endocrine symptomatology and quality of life but experience some clinically relevant and unfavorable ET-related long-term effects.
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Affiliation(s)
- Albertini Carmen
- Department of Obstetrics and Gynecology, Medical University of Innsbruck, Anichstrasse 35, A-6020, Innsbruck, Austria
| | - Oberguggenberger Anne
- Department of Psychiatry, Psychotherapy, Psychosomatics and Medical Psychology, CL Service, University Hospital of Psychiatry II, Medical University of Innsbruck, Innrain 52, A-6020, Innsbruck, Austria.
| | - Sztankay Monika
- Department of Psychiatry, Psychotherapy, Psychosomatics and Medical Psychology, CL Service, University Hospital of Psychiatry II, Medical University of Innsbruck, Innrain 52, A-6020, Innsbruck, Austria
| | - Egle Daniel
- Department of Obstetrics and Gynecology, Medical University of Innsbruck, Anichstrasse 35, A-6020, Innsbruck, Austria
| | - Giesinger Johannes
- Department of Psychiatry, Psychotherapy, Psychosomatics and Medical Psychology, CL Service, University Hospital of Psychiatry II, Medical University of Innsbruck, Innrain 52, A-6020, Innsbruck, Austria
| | - Meraner Verena
- Department of Psychiatry, Psychotherapy, Psychosomatics and Medical Psychology, CL Service, University Hospital of Psychiatry II, Medical University of Innsbruck, Innrain 52, A-6020, Innsbruck, Austria
| | - Hubalek Michael
- Department of Obstetrics and Gynecology, Medical University of Innsbruck, Anichstrasse 35, A-6020, Innsbruck, Austria
| | - Brunner Christine
- Department of Obstetrics and Gynecology, Medical University of Innsbruck, Anichstrasse 35, A-6020, Innsbruck, Austria
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Shirima S, Brazinskaite R, Killackey M, Sieloff BI, Cisneros C, Pratt-Chapman ML. Advancing Patient-Centered Cancer Survivorship Care: Evaluation of a Dissemination Project. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2023; 38:448-454. [PMID: 35037231 PMCID: PMC9288553 DOI: 10.1007/s13187-022-02138-y] [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] [Accepted: 01/12/2022] [Indexed: 05/20/2023]
Abstract
Care coordination among primary care providers and oncologists continues to be a challenge in cancer survivorship care. The Advancing Patient-Centered Cancer Survivorship Care Toolkit ("Toolkit") was developed to provide a "workshop in a box" for comprehensive cancer control (CCC) stakeholders to advance patient-centered cancer survivorship care in their region. The Toolkit was disseminated through an e-learning module, established webpages, an online forum, and social media. Toolkit dissemination was evaluated using the RE-AIM framework. For effectiveness, e-learning module and workshop participants were surveyed to assess changes in confidence in learning objectives. The Toolkit Web page received over 10,000 impressions. E-learning module participants (n = 212) reported statistically significant improvement (p < 0.001) between the pre- (M = 3.42, SD = 0.85) and post-test (M = 4.18, SD = 0.60) mean scores on self-confidence to describe patient-reported priorities for cancer survivorship care. Among virtual workshop trainees (n = 121), 28 participants completed paired pre- and post-workshop surveys. Among those with matched responses, there were statistically significant improvements from pre- to post-workshop self-reported knowledge on what patients want in cancer survivorship care (M = 2.5, SD = 1.0, vs. M = 3.3, SD = 1.0; p = 0.001); confidence in describing critical components of patient-centered cancer survivorship care (M = 3.1, SD = 1.2, vs. M = 4.2, SD = 0.5; p < 0.001); and confidence in describing patient priorities for cancer survivorship care (M = 3.0, SD = 1.1, vs. M = 4.1, SD = 0.6; p < 0.001). Provision of technical assistance resources in a variety of formats can successfully build capacity of healthcare providers and comprehensive cancer coalition stakeholders to feel more prepared to deliver patient-centered, coordinated cancer survivorship care.
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Affiliation(s)
- Sylvia Shirima
- School of Medicine and Health Sciences, George Washington University, 800 22nd Street NW, Suite 8000, Washington, D.C, 20052, USA
- Milken Institute School of Public Health, George Washington University, Washington, DC, USA
| | - Ruta Brazinskaite
- School of Medicine and Health Sciences, George Washington University, 800 22nd Street NW, Suite 8000, Washington, D.C, 20052, USA
| | - Maureen Killackey
- American College of Surgeons' Commission On Cancer, Chicago, IL, USA
- GW Cancer Center Community Advisory Board, Washington, DC, USA
| | - Beth I Sieloff
- GW Cancer Center Community Advisory Board, Washington, DC, USA
- Inter-Tribal Council of Michigan, Sault Ste. Marie, MI, USA
| | - Cindy Cisneros
- GW Cancer Center Community Advisory Board, Washington, DC, USA
| | - Mandi L Pratt-Chapman
- School of Medicine and Health Sciences, George Washington University, 800 22nd Street NW, Suite 8000, Washington, D.C, 20052, USA.
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Nguyen P, Azizi-Mehr P, Townsley C, Zahedi A. Outcomes of Early Transition of Low-Risk Thyroid Cancer Patients from Specialist to Primary Care. Curr Oncol 2022; 29:7672-7679. [PMID: 36290883 PMCID: PMC9600329 DOI: 10.3390/curroncol29100606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Revised: 09/29/2022] [Accepted: 10/11/2022] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Recently published clinical pathways for management of thyroid cancer outlined the criteria for transitioning low-risk patients to primary care within one to five years from diagnosis. However, discharge patterns among endocrinologists remain heterogeneous as there lacks a consensus regarding post-treatment care for thyroid cancer patients. OBJECTIVE This study described general characteristics and outcomes of thyroid cancer patients who were discharged from specialist care and transitioned to a primary care-based follow-up clinic. METHODS Thyroid cancer patients seen in the After Cancer Treatment Transition (ACTT) clinic at Women's College Hospital (Toronto, Canada) were included in the study. Electronic medical records were reviewed between May and October 2021 to collect patient characteristics and outcomes. Descriptive statistics were calculated. RESULTS The study cohort included 148 thyroid cancer patients and 76% were female. All cases were papillary thyroid cancer and most diagnoses were classified as T2 (42%), N0 (55%), M0 (91%), and stage 1 (83%). Nearly all patients (n = 147) had complete thyroidectomy. Levels of thyroglobulin and thyroglobulin antibodies (TgAb) were low overall, with only 5% of the study cohort deemed TgAb positive. Mean levels of thyroid stimulating hormone (TSH) measured at 2 time points (1.37 mIU/L, 1.42 mIU/L) were within normal range. About 91% of the study cohort had normal TSH levels and 82% met target TSH levels. There were 2 cases of recurrence; however, investigation determined that they were not initially appropriate candidates for transition to primary care. Nearly 99% (n = 146) of patients had excellent response to therapy, showed no evidence of disease recurrence, and have not required re-referral to specialist care. CONCLUSIONS These findings may reassure specialists that low-risk, stable thyroid cancer patients can be safely transitioned to primary care for post-treatment follow-up.
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Affiliation(s)
- Patricia Nguyen
- Peter Gilgan Centre for Women’s Cancers, Women’s College Hospital, Toronto, ON M5S 1B2, Canada
| | | | - Carol Townsley
- After Cancer Treatment Transition (ACTT) Program, Women’s College Hospital, Toronto, ON M5S 1B2, Canada
| | - Afshan Zahedi
- Thyroid Program, Women’s College Hospital, 76 Grenville Street, Toronto, ON M5S 1B2, Canada
- Correspondence:
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Goetzinger C, Alleaume C, Schritz A, Vrijens B, Préau M, Fagherazzi G, Huiart L. Analysing breast cancer survivors’ acceptance profiles for using an electronic pillbox connected to a smartphone application using Seintinelles, a French community-based research tool. Front Pharmacol 2022; 13:889695. [PMID: 36238564 PMCID: PMC9551449 DOI: 10.3389/fphar.2022.889695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Accepted: 09/05/2022] [Indexed: 11/13/2022] Open
Abstract
Introduction: Up to 50% of breast cancer (BC) survivors discontinue their adjuvant endocrine therapy (AET) before the recommended 5 years, raising the issue of medication non-adherence. eHealth technologies have the potential to support patients to enhance their medication adherence and may offer an effective way to complement the healthcare. In order for eHealth technologies to be successfully implemented into the healthcare system, end-users need to be willing and accepting to use these eHealth technologies. Aim: This study aims to evaluate the current usability of eHealth technologiesin and to identify differences in BC SURVIVORS BC survivors accepting a medication adherence enhancing eHealth technology to support their AET to BC survivors that do not accept such a medication adherence enhancing eHealth technology. Methods: This study was conducted in 2020 including volunteering BC survivors belonging to the Seintinelles Association. Eligible participants were women, diagnosed with BC within the last 10 years, and been exposed to, an AET. Univariable and multivariable logistic regression analyses were performed to investigate medication adherence enhancing eHealth technology acceptance profiles among BC survivors. The dependent variable was defined as acceptance of an electronic pillbox connected to a smartphone application (hereafter: medication adherence enhancing eHealth technology). Results: Overall, 23% of the participants already use a connected device or health application on a regular basis. The mean age of the participants was 52.7 (SD 10.4) years. In total, 67% of 1268 BC survivors who participated in the survey declared that they would accept a medication adherence enhancing eHealth technology to improve their AET. BC survivors accepting a medication adherence enhancing eHealth technology for their AET, are younger (OR = 0.97, 95% CI [0.95; 0.98]), do take medication for other diseases (OR = 0.31, 95% CI [0.13; 0.68]), already use a medication adherence enhancing eHealth technology or technique (OR = 1.74, 95% CI [1.06; 2.94]) and are willing to possess or currently possess one or more connected devices or health applications (OR = 2.89, 95% CI [2.01; 4.19]). Conclusion: Understanding acceptance profiles of BC survivors is fundamental for conceiving an effective eHealth technology enhancing AET among BC survivors. Hence, such profiling will foster the development of personalized medication adherence enhancing eHealth technology.
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Affiliation(s)
- Catherine Goetzinger
- Deep Digital Phenotyping Research Unit, Department of Precision Health, Luxembourg Institute of Health, Strassen, Luxembourg
- University of Luxembourg, Faculty of Science, Technology and Medicine, Esch-sur-Alzette, Luxembourg
- *Correspondence: Catherine Goetzinger,
| | | | - Anna Schritz
- Competence Center for Methodology and Statistics, Luxembourg Institute of Health, Strassen, Luxembourg
| | - Bernard Vrijens
- AARDEX Group & Department of Public Health, Liège University, Liège, Belgium
| | - Marie Préau
- Institut de Psychologie, Université Lumière Lyon 2, Lyon, France
| | - Guy Fagherazzi
- Deep Digital Phenotyping Research Unit, Department of Precision Health, Luxembourg Institute of Health, Strassen, Luxembourg
- University of Luxembourg, Faculty of Science, Technology and Medicine, Esch-sur-Alzette, Luxembourg
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12
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Fauer AJ, Ganz PA, Brauer ER. A mixed method study of medical oncologists' perceived barriers and motivators to addressing long-term effects in breast cancer survivors. Breast Cancer Res Treat 2022; 194:699-707. [PMID: 35767127 PMCID: PMC9287210 DOI: 10.1007/s10549-022-06657-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Accepted: 06/08/2022] [Indexed: 11/30/2022]
Abstract
Purpose The purpose of this study was to identify oncologist-reported barriers and motivators in addressing long-term effects with breast cancer survivors.
Methods This study is a secondary analysis of data from a survey of U.S. medical oncologists (n = 217) about breast cancer survivorship care in clinical practice. Using both closed- and open-ended questions, we asked oncologists to report barriers and motivators they perceived in addressing long-term effects with breast cancer patients. Descriptive statistics were used to summarize and rank items endorsed by oncologists in analyses of quantitative data; content analysis was used to identify salient categories of barriers and motivators in qualitative data. Results Key barriers to managing physical long-term effects included lack of time during appointments (n = 128 oncologists, 59%) and perceived lack of evidence-based interventions (n = 89, 41%). With respect to psychosocial effects, oncologists reported lack of knowledge (n = 88, 40.6%) and challenges making referrals to mental health providers (n = 115, 53%). From the qualitative data, three distinct barrier categories emerged: “Competing priorities during brief appointments;” “Discussing long-term effects—Who? What? When?;” and “Beyond my expertise and comfort level.” Two motivator categories emerged: “I owe it to them;” and “Giving people a life worth living.” Conclusion Oncologists’ key motivators for addressing long-term effects were focused on professional values, relationships with survivors, and their commitment to prioritizing patients' quality of life. Future efforts should leverage oncologists' professional and interpersonal motivators to enhance the delivery of survivorship care for breast cancer. Supplementary Information The online version contains supplementary material available at 10.1007/s10549-022-06657-6.
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Affiliation(s)
- Alex J Fauer
- Division of General Internal Medicine & Health Services Research, David Geffen School of Medicine, UCLA, Los Angeles, CA, USA
| | - Patricia A Ganz
- Department of Health Policy & Management, Fielding School of Public Health, UCLA, Los Angeles, CA, USA.,Center for Cancer Control and Prevention Research, Jonsson Comprehensive Cancer Center, UCLA, Los Angeles, CA, USA
| | - Eden R Brauer
- Center for Cancer Control and Prevention Research, Jonsson Comprehensive Cancer Center, UCLA, Los Angeles, CA, USA. .,School of Nursing, UCLA, 4-234 Factor Building, Box 956900, Los Angeles, CA, 90095-6900, USA.
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13
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Nguyen P, Heisey R, Quenneville C, Goulbourne E, Khan R, Rinaldo E, Chagigiorgis H, Shields R, Townsley C. An examination of depression, anxiety, and fear of recurrence among cancer survivors who participated in a virtual cognitive behavioral therapy (CBT)-based telephone coaching program. Support Care Cancer 2022; 30:7323-7332. [PMID: 35606479 DOI: 10.1007/s00520-022-07148-6] [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: 02/17/2022] [Accepted: 05/13/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Depression, anxiety, and fear of recurrence (FOR) are prevalent among cancer survivors, and it is recommended that they have access to supportive services and resources to address psychosocial needs during follow-up care. This study examined the impact of a virtual cognitive behavioral therapy (CBT)-based telephone coaching program (BounceBack®) on depression, anxiety, and FOR. METHOD Through the After Cancer Treatment Transition (ACTT) clinic at the Women's College Hospital (Toronto, Canada), eligible participants were identified, consented, and referred to the BounceBack® program. Program participation involved completion of self-selected online workbooks and support from trained telephone coaches. Measures of depression (PHQ-9), anxiety (GAD-7), and FOR (fear of cancer recurrence inventory, FCRI) were collected at pre-intervention (baseline) and post-intervention (6-month and 12-month time points). For each psychosocial measure, paired t-tests compared mean scores between study time points. Participant experiences and perceptions were collected through a survey. RESULTS Measures of depression and anxiety significantly improved among participants from pre-intervention to post-intervention. Scores for PHQ-9 and GAD-7 decreased from moderate to mild levels. Measure of FOR also significantly improved, while FCRI sub-scale scores significantly improved for 5 of the 7 factors that characterize FOR (triggers, severity, psychological distress, functional impairment, insight). Participants rated the intervention a mean score of 7 (out of 10), indicating a moderate level of satisfaction and usefulness. CONCLUSION This study suggested that a virtual CBT-based telephone coaching program can be an effective approach to managing depression, anxiety, and fear of recurrence in cancer survivors.
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Affiliation(s)
- Patricia Nguyen
- Peter Gilgan Centre for Women's Cancers, Women's College Hospital, ON, Toronto, Canada.
| | - Ruth Heisey
- Peter Gilgan Centre for Women's Cancers, Women's College Hospital, ON, Toronto, Canada.,Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
| | | | - Elaine Goulbourne
- Peter Gilgan Centre for Women's Cancers, Women's College Hospital, ON, Toronto, Canada
| | - Rumaisa Khan
- Peter Gilgan Centre for Women's Cancers, Women's College Hospital, ON, Toronto, Canada
| | - Emma Rinaldo
- Peter Gilgan Centre for Women's Cancers, Women's College Hospital, ON, Toronto, Canada
| | | | - Rebecca Shields
- Canadian Mental Health Association York Region and South Simcoe Branch, Newmarket, ON, Canada
| | - Carol Townsley
- After Cancer Treatment Transition Program, Women's College Hospital, Toronto, ON, Canada
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14
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Trajectories of Anxiety and Depression Symptoms over Five Years since Breast Cancer Diagnosis: Results of the NEON-BC Prospective Study. Healthcare (Basel) 2022; 10:healthcare10040661. [PMID: 35455838 PMCID: PMC9026220 DOI: 10.3390/healthcare10040661] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Revised: 03/23/2022] [Accepted: 03/29/2022] [Indexed: 02/01/2023] Open
Abstract
Anxiety and depression symptoms are frequent among patients with breast cancer (BCa) and may last after initial treatments. We aimed to identify five-year trajectories of anxiety and depression symptoms among women with BCa. Neuro-oncological complications of BCa (NEON-BC) cohort included 506 patients admitted at the Portuguese Institute of Oncology of Porto in 2012, who were evaluated with the Hospital Anxiety and Depression Scale before cancer treatment and after one, three, and five years (7.9% attrition rate). Mixed-effect models were used to model anxiety and depression scores over time and model-based clustering to identify the different trajectories. Three trajectories of anxiety symptoms were identified: (1) high scores at baseline and increasing over time (21.7%); (2) consistently low scores over time (63.6%); (3) mid-range scores at baseline, decreasing over time (14.6%). Three trajectories were identified for depression symptoms: (1) high scores at baseline and increasing over time (21.1%); (2) mid-range scores at baseline, which decreased afterward (58.7%); (3) consistently low levels over time (20.2%). Age, education, baseline, and one-year anxiety/depression status predicted the worst five-year trajectories. These results show that assessing anxiety and depression symptoms before treatment and after one year may contribute to identifying the patients who could benefit the most from psychological support.
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15
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Doescher MP, Nagykaldi Z, Zhao YD, Dwyer K. Oncology and Primary Care Provider Views on Cancer Survivorship Care: Mind the Gap. J Am Board Fam Med 2022; 35:329-340. [PMID: 35379720 PMCID: PMC10897935 DOI: 10.3122/jabfm.2022.02.210286] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Revised: 10/30/2021] [Accepted: 11/03/2021] [Indexed: 11/08/2022] Open
Abstract
CONTEXT Coordination between oncology and primary care practices in cancer survivorship is lacking. OBJECTIVE To identify cancer care coordination perceptions, knowledge, and practices in a sample of Oklahoma oncology care providers (ONCs) and primary care providers (PCPs) regarding post-treatment care of adult cancer survivors. DESIGN Cross-sectional, statewide survey by mail/web link in 2014/5. SETTING PCPs identified through a primary care research network, primary care organization membership lists; ONCs identified through www.Healthgrades.com. PARTICIPANTS Contacts who were clinically active and seeing cancer patients were eligible. The final sample size included 101 ONCs and 58 PCPs who reported actively seeing cancer patients. MEASURES Responses to predominately Likert scale or ranked-order questions derived from the Survey of Physician Attitudes Regarding the Care of Cancer Survivors. ANALYSES Chi square and t tests were performed to test bivariate associations between provider type and survey measures. RESULTS Statistically significant differences (P < .05) between ONC and PCP perceptions were observed for several questions on communication between the 2 provider types, ONC perceptions of PCP ability to address survivorship care, and responsibilities for post-treatment care. CONCLUSIONS Highly discrepant perspectives between ONCs and PCPs regarding communications and responsibilities for survivorship care may lead to adverse health outcomes. Interventions aimed at improving care coordination for cancer survivors should define each provider group's responsibilities in survivorship care, and create structures and processes that foster clear channels of communication between ONC and PCP practices.
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Affiliation(s)
- Mark P Doescher
- From Stephenson Cancer Center, College of Medicine, Department of Family and Preventive Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK (MPD); College of Medicine, Department of Family and Preventive Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK (ZN); Stephenson Cancer Center, Hudson College of Public Health, Department of Biostatistics and Epidemiology, University of Oklahoma Health Sciences Center, Oklahoma City, OK (YDZ); Fran and Earl Ziegler College of Nursing, University of Oklahoma Health Sciences Center, Oklahoma City, OK (KD).
| | - Zsolt Nagykaldi
- From Stephenson Cancer Center, College of Medicine, Department of Family and Preventive Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK (MPD); College of Medicine, Department of Family and Preventive Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK (ZN); Stephenson Cancer Center, Hudson College of Public Health, Department of Biostatistics and Epidemiology, University of Oklahoma Health Sciences Center, Oklahoma City, OK (YDZ); Fran and Earl Ziegler College of Nursing, University of Oklahoma Health Sciences Center, Oklahoma City, OK (KD)
| | - Yan Daniel Zhao
- From Stephenson Cancer Center, College of Medicine, Department of Family and Preventive Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK (MPD); College of Medicine, Department of Family and Preventive Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK (ZN); Stephenson Cancer Center, Hudson College of Public Health, Department of Biostatistics and Epidemiology, University of Oklahoma Health Sciences Center, Oklahoma City, OK (YDZ); Fran and Earl Ziegler College of Nursing, University of Oklahoma Health Sciences Center, Oklahoma City, OK (KD)
| | - Kathleen Dwyer
- From Stephenson Cancer Center, College of Medicine, Department of Family and Preventive Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK (MPD); College of Medicine, Department of Family and Preventive Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK (ZN); Stephenson Cancer Center, Hudson College of Public Health, Department of Biostatistics and Epidemiology, University of Oklahoma Health Sciences Center, Oklahoma City, OK (YDZ); Fran and Earl Ziegler College of Nursing, University of Oklahoma Health Sciences Center, Oklahoma City, OK (KD)
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16
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Ching SSY, Mok ESB. Adoption of healthy lifestyles among Chinese cancer survivors during the first five years after completion of treatment. ETHNICITY & HEALTH 2022; 27:137-156. [PMID: 31238712 DOI: 10.1080/13557858.2019.1634182] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/17/2018] [Accepted: 06/07/2019] [Indexed: 06/09/2023]
Abstract
Objectives: The number of cancer survivors is increasing as a result of advances in detection and treatment. Lifestyle is a significant modifiable factor in the development of cancer. Most studies on healthy lifestyles have been conducted in Western countries. Cultural influences on the pursuit of healthy lifestyles among Chinese cancer survivors remain largely unexplored. The objectives of this qualitative study are to explore the experiences of Chinese cancer survivors in adopting healthy lifestyles, with a focus on their goals, the challenges they face, and the influences of Chinese culture.Design: Thirty-two Chinese breast and colorectal cancer survivors in their first five years after treatment were recruited from a hospital in Hong Kong to participate in eight focus groups. Qualitative content analysis was adopted to analyse the data.Results: The adoption of a healthy lifestyle was a strategy through which the participants exercised choice to restore balance in their health after developing cancer. Diet, exercise, psychological well-being, the use of traditional Chinese medicine (TCM) and health/dietary supplements, and attending medical consultations/follow-up visits were the behaviours adopted by the participants, with the goal of improving their health, controlling their cancer and preventing relapse, and managing the residual physical symptoms of their illness. In adopting a healthy lifestyle, the participants encountered challenges such as a lack of reliable and practical instructions from healthcare professionals. Chinese cultural beliefs concerning the nature of food, TCM, minimizing social disturbances, and collaborative control influenced their lifestyle.Conclusions: The cancer survivors adopted a range of healthy lifestyles but encountered challenges. Clarifying the principles of food choice while addressing Chinese beliefs regarding therapeutic food and the use of TCM, clarifying queries about conflicting information, and developing plans according to the needs, and competing demands of survivors can facilitate collaborative control between healthcare professionals and cancer survivors.
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Affiliation(s)
- S S Y Ching
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong, People's Republic of China
| | - E S B Mok
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong, People's Republic of China
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17
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Angarita FA, Jedrzejko N, Eisen D, Muraca M, Ash M, Osman F. Primary Care Physicians' Perspectives in Leading Breast Cancer Follow-Up Care. Clin Breast Cancer 2021; 22:e497-e505. [PMID: 34955431 DOI: 10.1016/j.clbc.2021.11.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 10/24/2021] [Accepted: 11/27/2021] [Indexed: 11/03/2022]
Abstract
INTRODUCTION Limited data exist on the barriers associated with transitioning breast cancer follow-up care to primary care physicians (PCPs). This study aimed to describe the current perspectives of PCPs in managing breast cancer follow-up. METHOD An online survey was distributed to PCPs in Toronto, ON, Canada. Questions examined PCPs' view of transitioning breast cancer follow-up care to their practices. RESULTS Of 800 PCPs invited, 126 responded (response rate: 15.7%). The types of practice models amongst respondents included blended capitation (42.9%), blended salary (27%), and fee-for-service (17.5%). Seventy-seven percent of respondents stated they provided follow-up care. Approximately half of the respondents stated they were somewhat comfortable providing follow-up care. PCP-led follow-up care was considered either very (49.2%) or somewhat appropriate (30.2%). When asked about financial remuneration, 43.7% of respondents stated it was somewhat important. The factors that influenced the feasibility of PCP-led follow-up care included receipt of a detailed follow-up care plan provided by the specialist after discharge (81%), the ability to re-refer to specialists rapidly (56.3%), and the ability to obtain regular updates of best practice changes (59.5%). The preferred means of educational updates included E-mail (40.5%), continuing medical education events (30.2%), and electronic medical records (19.8%). When the fee model was taken into consideration there was no significant difference in opinions regarding follow-up care. CONCLUSIONS Transitioning to a PCP-led model was supported by most of the PCPs who participated in this study. Their perspective on PCP-led follow up care and barriers associated with implementation of this model of care needs to be further explored with future studies that include larger sample size and a more diverse PCP population.
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Affiliation(s)
- Fernando A Angarita
- Department of Surgical Oncology, Roswell Park Comprehensive Cancer Center, Buffalo, NY; Division of Surgical Oncology, Department of Surgery, Houston Methodist Hospital, Houston, TX, USA
| | - Nicole Jedrzejko
- Department of Surgery, Division of General Surgery, University of British Columbia, Vancouver, BC, Canada
| | - David Eisen
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
| | - Maria Muraca
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
| | - Marla Ash
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
| | - Fahima Osman
- Division of General Surgery, Department of Surgery, University of Toronto, Toronto, ON, Canada; Department of Surgery, North York General Hospital, Toronto, ON, Canada.
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Anderson JN, Graff C, Krukowski RA, Schwartzberg L, Vidal GA, Waters TM, Paladino AJ, Jones TN, Blue R, Kocak M, Graetz I. "Nobody Will Tell You. You've Got to Ask!": An Examination of Patient-Provider Communication Needs and Preferences among Black and White Women with Early-Stage Breast Cancer. HEALTH COMMUNICATION 2021; 36:1331-1342. [PMID: 32336140 PMCID: PMC7606266 DOI: 10.1080/10410236.2020.1751383] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/20/2023]
Abstract
Patient-provider communication is a critical component of healthcare and is associated with treatment quality and outcomes for women with breast cancer. This qualitative study examines similarities and differences in patient perspectives of communication needs between Black and White breast cancer survivors. We conducted four focus groups (N = 28) involving women with early-stage breast cancer on adjuvant endocrine therapy (AET), stratified by race and length of time on AET (< 6 months and >6 months). Each group was moderated by a race-concordant moderator and analyzed by emergent themes. Participants expressed common patient-provider communication needs, namely increased sensitivity from oncologists during the initial cancer diagnosis, personalized information to facilitate treatment decisions, emotional support during the transition from active treatment to maintenance, and rapid provider responses to mobile app-based queries. Communication differences by race also emerged. Black women were less likely than White women to describe having their informational needs met. White women praised longstanding relationships with providers, while Black women shared personal stories of disempowered interactions and noted the importance of patient advocates. White women more often reported privacy concerns about technology use. Unlike White women, Black women reported willingness to discuss sensitive topics, both online and offline, but believed those discussions made their providers feel uncomfortable. Early-stage breast cancer patients on AET, regardless of race, have similar needs for patient-centered communication with their oncologists. However, Black women were more likely to report experiencing poorer communication with providers than White women, which may be improved by technology and advocates.
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Affiliation(s)
- Janeane N. Anderson
- University of Tennessee Health Science Center, College of Medicine, Department of Preventive Medicine, 66 N. Pauline St., Ste. 633, Memphis, TN 38163
- University of Tennessee Health Science Center, College of Nursing, Department of Health Promotion and Disease Prevention, 920 Madison Avenue; Memphis, TN 38163
| | - Carolyn Graff
- University of Tennessee Health Science Center, College of Nursing, Department of Health Promotion and Disease Prevention, 920 Madison Avenue; Memphis, TN 38163
| | - Rebecca A. Krukowski
- University of Tennessee Health Science Center, College of Medicine, Department of Preventive Medicine, 66 N. Pauline St., Ste. 633, Memphis, TN 38163
| | - Lee Schwartzberg
- West Cancer Center Research Institute, 7945 Wolf River Blvd, Germantown, TN 38138
- University of Tennessee Health Science Center, College of Medicine, Division of Hematology/Oncology; 956 Court Avenue, Memphis, TN 38163
| | - Gregory A. Vidal
- West Cancer Center Research Institute, 7945 Wolf River Blvd, Germantown, TN 38138
- University of Tennessee Health Science Center, College of Medicine, Division of Hematology/Oncology; 956 Court Avenue, Memphis, TN 38163
| | - Teresa M. Waters
- University of Tennessee Health Science Center, College of Medicine, Department of Preventive Medicine, 66 N. Pauline St., Ste. 633, Memphis, TN 38163
- University of Kentucky, College of Public Health, Department of Health Management and Policy, 111 Washington Ave., Lexington, KY 40536
| | - Andrew J. Paladino
- University of Tennessee Health Science Center, College of Medicine, Department of Preventive Medicine, 66 N. Pauline St., Ste. 633, Memphis, TN 38163
- West Cancer Center Research Institute, 7945 Wolf River Blvd, Germantown, TN 38138
| | - Tameka N. Jones
- West Cancer Center Research Institute, 7945 Wolf River Blvd, Germantown, TN 38138
| | - Ryan Blue
- University of Tennessee Health Science Center, College of Nursing, Department of Health Promotion and Disease Prevention, 920 Madison Avenue; Memphis, TN 38163
| | - Mehmet Kocak
- University of Tennessee Health Science Center, College of Medicine, Department of Preventive Medicine, 66 N. Pauline St., Ste. 633, Memphis, TN 38163
| | - Ilana Graetz
- University of Tennessee Health Science Center, College of Medicine, Department of Preventive Medicine, 66 N. Pauline St., Ste. 633, Memphis, TN 38163
- Emory University, Rollins School of Public Health, Department of Health Policy and Management; 1518 Clifton Road NE, Atlanta, GA 30322
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19
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Papageorgiou V, Jones K, Halliday BP, Mindham R, Bruton J, Wassall R, Cleland JG, Prasad SK, Ward H. A qualitative exploration of participant and investigator perspectives from the TRED-HF trial. ESC Heart Fail 2021; 8:3760-3768. [PMID: 34390213 PMCID: PMC8497205 DOI: 10.1002/ehf2.13524] [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: 02/18/2021] [Revised: 05/03/2021] [Accepted: 07/05/2021] [Indexed: 11/16/2022] Open
Abstract
AIMS We explored the experiences and motivations of participants and staff who took part in the TRED-HF trial (Therapy withdrawal in REcovered Dilated cardiomyopathy). METHODS AND RESULTS We conducted a qualitative study, using semi-structured interviews, with participants (n = 12) and the research team (n = 4) from the TRED-HF trial. Interviews were carried out in 2019 and were audio-recorded and transcribed. Data were managed using NVivo and analysed using framework analysis. A patient representative provided guidance on the interpretation of findings and presentation of themes to ensure these remained meaningful, and an accurate representation, to those living with dilated cardiomyopathy. Three key themes emerged from the data: (i) perception of health; (ii) experiences and relationships with healthcare services and researchers; and (iii) perception of risk. Study participants held differing perceptions of their health; some did not consider themselves to have a heart condition or disagreed with the medical term 'heart failure'. Relationships between participants, research staff, and clinical management teams influenced participants' experiences and decision making during the trial, including following clinical advice. There were differences in participants' perceptions of risk and their decisions to take heart failure medication after the trial was completed. Although the original TRED-HF trial did not provide the results many had hoped for, a strong motivator for taking part was the opportunity to withdraw medication in a safely monitored environment which had been previously considered by some participants before. Investigators acknowledged that the insights gained from the study can now be used to support evidence-based conversations with patients. CONCLUSIONS For people whose dilated cardiomyopathy is in remission, decisions to continue, reduce, or stop their medication are influenced by perceptions of personal health, perceive risk and the important of work, employment, recreation, relationships, and long-term plans. The unique relationship between patient and cardiologist provides opportunities to promote honest discussion about adherence to medication and personalized long-term management.
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Affiliation(s)
- Vasiliki Papageorgiou
- Patient Experience Research Centre, School of Public HealthImperial College LondonLondonUK
| | - Kathryn Jones
- Patient Experience Research Centre, School of Public HealthImperial College LondonLondonUK
| | - Brian P. Halliday
- National Heart and Lung InstituteImperial College LondonLondonUK
- Cardiovascular Research Centre and Cardiovascular Magnetic Resonance UnitRoyal Brompton HospitalLondonUK
| | | | - Jane Bruton
- Patient Experience Research Centre, School of Public HealthImperial College LondonLondonUK
| | - Rebecca Wassall
- Cardiovascular Research Centre and Cardiovascular Magnetic Resonance UnitRoyal Brompton HospitalLondonUK
| | - John G.F. Cleland
- National Heart and Lung InstituteImperial College LondonLondonUK
- Cardiovascular Research Centre and Cardiovascular Magnetic Resonance UnitRoyal Brompton HospitalLondonUK
- Robertson Centre for BiostatisticsUniversity of GlasgowGlasgowUK
| | - Sanjay K. Prasad
- National Heart and Lung InstituteImperial College LondonLondonUK
- Cardiovascular Research Centre and Cardiovascular Magnetic Resonance UnitRoyal Brompton HospitalLondonUK
| | - Helen Ward
- Patient Experience Research Centre, School of Public HealthImperial College LondonLondonUK
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20
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Sella T, Snow C, Freeman H, Poorvu PD, Rosenberg SM, Partridge AH. Young, Empowered and Strong: A Web-Based Education and Supportive Care Intervention for Young Women With Breast Cancer Across the Care Continuum. JCO Clin Cancer Inform 2021; 5:933-943. [PMID: 34473546 DOI: 10.1200/cci.21.00067] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Patient-centered digital interventions may help empower young women to self-manage symptoms and psychosocial concerns and support informational needs often unaddressed in clinic. METHODS Young, Empowered and Strong (YES) is an interactive web-based intervention designed to engage young women with personalized education and symptom self-management resources on the basis of responses to patient-reported outcome-based questionnaires. We piloted YES among young women (< 45 years) with newly diagnosed early breast cancer (EBC) or metastatic breast cancer (MBC) and breast cancer survivors (BCSs). Assessments were deployed weekly (EBC and MBC) or every 4 weeks (BCSs) over 12 weeks. At study completion, use, feasibility, and acceptability of YES were evaluated via a survey and semistructured interview. RESULTS Thirty women were enrolled between April and June 2019: 10 EBC, 10 BCSs, and 10 MBC. The mean age at diagnosis and enrollment was 36 (range 25-44) and 39 (range 31-44) years, respectively. Most participants were actively treated (96%, 27 of 28) with endocrine therapy (54%, 15 of 28) or chemotherapy (43%, 12 of 28). Overall, 61% (180 of 296) of assessments were completed (EBC: 70%, BCSs: 63%, and MBC: 52%). Of 37 patient-reported outcome and need domains, the most frequently triggered were sexual health (EBC: 90%, BCSs: 90%, and MBC: 90%), anxiety (EBC: 80%, BCSs: 90%, and MBC: 90%), stress and mindfulness (EBC: 80%, BCSs: 90%, and MBC: 90%), and fatigue (EBC: 90%, BCSs: 80%, and MBC: 90%). On postpilot survey, participants reported that YES helped them to learn (50%, 7 of 14), monitor (43%, 6 of 14), and manage (57%, 8 of 14) their symptoms. CONCLUSION YES is a feasible and acceptable digital intervention to support young women across the breast cancer care continuum. The nearly universal triggering of sexual and mental health needs suggests suboptimal management in the clinical setting and the potential for self-management through a digital platform.
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Affiliation(s)
- Tal Sella
- Dana-Farber Cancer Institute, Boston, MA.,Harvard Medical School, Boston, MA
| | - Craig Snow
- Dana-Farber Cancer Institute, Boston, MA
| | | | - Philip D Poorvu
- Dana-Farber Cancer Institute, Boston, MA.,Harvard Medical School, Boston, MA.,Department of Medicine, Brigham and Women's Hospital, Boston, MA
| | | | - Ann H Partridge
- Dana-Farber Cancer Institute, Boston, MA.,Harvard Medical School, Boston, MA.,Department of Medicine, Brigham and Women's Hospital, Boston, MA
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21
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Developing a survivorship care plan (SCP) delivery process for patients and primary care providers serving poor, rural, and minority patients with cancer. Support Care Cancer 2021; 29:5021-5028. [PMID: 33587174 PMCID: PMC7883333 DOI: 10.1007/s00520-021-06043-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Accepted: 02/03/2021] [Indexed: 11/29/2022]
Abstract
Background Survivorship care plans (SCPs) summarize patients’ treatment and act as an education and communication tool between oncologists and primary care providers (PCPs). But creation and delivery of SCPs are challenging, labor intensive, and costly. The University of New Mexico Comprehensive Cancer Center (UNM CCC) treats a poor, rural, and minority patient population, and our purpose was to implement and evaluate a process to create and deliver SCPs to patients and PCPs. Methods Providers placed an electronic SCP order, basic information was imported, and staff compiled treatment details. Flagged SCPs were then ready for delivery, providers approved of and delivered the SCP at the next encounter, and the SCP was sent to the PCP. Results By April 2020, 283 SCPs were ordered, 241 (85.2%) were created by the designated staff, and 97 (34.2%) were given to patients after definitive therapy for breast cancer (59.1%), gynecological cancers (10.8%), prostate cancer (7.4%), colorectal cancer (5.1%), and lymphomas (4.8%). Of 97 SCPs eligible to be sent to PCPs, 75 (77.3%) were mailed or sent via EMR. Of the 41 (48.9%) SCPs sent via mail or fax, only 8 (8.3%) were received and 5 (5.2%) integrated. Conclusions This study shows that SCPs can be delivered to patients in a poor, rural, and minority patient population but that PCP receipt and integration of SCPs are poor. Future efforts need to ensure that an oncologist to PCP education and communication tool is able reach and be integrated by PCPs.
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22
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Krok-Schoen JL, Naughton MJ, Noonan AM, Pisegna J, DeSalvo J, Lustberg MB. Perspectives of Survivorship Care Plans Among Older Breast Cancer Survivors: A Pilot Study. Cancer Control 2020; 27:1073274820917208. [PMID: 32233798 PMCID: PMC7143997 DOI: 10.1177/1073274820917208] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
The Commission on Cancer’s standard 3.3 represents a paradigm shift in the care
of cancer survivors, recommending that survivors receive a treatment summary and
survivorship care plan (SCPs). A focus on older breast cancer survivors is
needed, as they are the majority of the breast cancer population and their
experiences and perspectives of SCPs is limited in the literature. This pilot
study utilized a mixed methods approach (focus groups and self-report
questionnaire data) to gather information on older (≥65 years) breast cancer
survivors’ perspectives of their SCPs, cancer survivorship, and communication
with their health-care providers. The questionnaire was completed individually
by the participants prior to the focus group and contained items on basic
demographics and their health status following cancer treatment. The focus
groups indicated that only a minority of women actually developed a SCP. Those
who developed a SCP in collaboration with their providers valued the personal
care and attention received. However, some participants reported poor
communication with their providers and within their health-care team, resulting
in frustration and confusion. Participants’ suggestions for ideal SCPs included
better education and personalization, particularly in appropriate nutrition and
exercise, and managing side effects and comorbidities. Lastly, the women
believed that additional long-term care resources, such as health coaches, were
important in improving their survivorship. These findings provide insight into
enhancing the content, communication, and application of SCPs to improve the
survivorship experience of older breast cancer survivors.
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Affiliation(s)
- Jessica L Krok-Schoen
- Division of Medical Dietetics and Health Sciences, School of Health and Rehabilitation Sciences, College of Medicine, The Ohio State University, Columbus, OH, USA.,Comprehensive Cancer Center, The Ohio State University, Columbus, OH, USA
| | - Michelle J Naughton
- Comprehensive Cancer Center, The Ohio State University, Columbus, OH, USA.,Department of Internal Medicine, College of Medicine, The Ohio State University, Columbus, OH, USA
| | - Anne M Noonan
- Comprehensive Cancer Center, The Ohio State University, Columbus, OH, USA
| | - Janell Pisegna
- Division of Medical Dietetics and Health Sciences, School of Health and Rehabilitation Sciences, College of Medicine, The Ohio State University, Columbus, OH, USA
| | - Jennifer DeSalvo
- College of Medicine, The Ohio State University, Columbus, OH, USA
| | - Maryam B Lustberg
- Comprehensive Cancer Center, The Ohio State University, Columbus, OH, USA.,College of Medicine, The Ohio State University, Columbus, OH, USA
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23
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Elhassan MM, Taha SI, Maatoug MM. Unplanned attendances of cancer patients to an outpatient unit in a low-income country: A prospective study from Sudan. SOUTH AFRICAN JOURNAL OF ONCOLOGY 2020. [DOI: 10.4102/sajo.v4i0.126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
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24
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Margariti C, Gannon KN, Walsh JJ, Green JSA. GP experience and understandings of providing follow-up care in prostate cancer survivors in England. HEALTH & SOCIAL CARE IN THE COMMUNITY 2020; 28:1468-1478. [PMID: 32106357 DOI: 10.1111/hsc.12969] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Revised: 01/29/2020] [Accepted: 02/11/2020] [Indexed: 05/26/2023]
Abstract
Survival times for prostate cancer have increased substantially, meaning more survivors will be discharged to General Practitioners' (GP) services. The detection of recurrence and monitoring of symptoms and long-term side-effects in prostate cancer survivors requires the active involvement of GPs in their follow-up care. In order to address this, the transition and discharge from hospital to primary care must be managed effectively. The objective of this study was to examine the preparedness, concerns and experiences of GPs in relation to their role in providing follow-up care to prostate cancer survivors. Purposive sampling was used to recruit GPs with experience in providing care to prostate cancer survivors. Twenty semi-structured telephone interviews were conducted with GPs across England. The interviews were audio-recorded, transcribed verbatim and analysed using thematic analysis. Participants described their current role in the follow-up pathway, a number of challenges and barriers in assuming this role, and potential ways to resolve these and improve their involvement. They expressed a range of views about their preparedness and willingness to take over follow-up care after discharge for this group of patients. GPs had reservations about workload, lack of resources, expertise and deficiencies in communication with hospitals. Findings from this study suggest that GPs will be ready to take over the follow-up care of prostate cancer survivors if better information, additional training and adequate resources are provided and communication lines with hospital specialists are clear. Understanding the issues faced by GPs and overcoming identified barriers to providing follow-up care to prostate cancer survivors will provide the insight necessary to make the process of transferring care from secondary to primary teams a more straightforward task for all stakeholders.
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Affiliation(s)
- Charikleia Margariti
- Research and Development Department, North East London NHS Foundation Trust, London, UK
| | - Kenneth N Gannon
- School of Psychology, Stratford Campus, University of East London, London, UK
| | - James J Walsh
- School of Psychology, Stratford Campus, University of East London, London, UK
| | - James S A Green
- Department of Urology, Barts Health NHS Trust, Whipps Cross Hospital, London, UK
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25
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Mead KH, Raskin S, Willis A, Arem H, Murtaza S, Charney L, Pratt-Chapman M. Identifying patients' priorities for quality survivorship: conceptualizing a patient-centered approach to survivorship care. J Cancer Surviv 2020; 14:939-958. [PMID: 32607715 DOI: 10.1007/s11764-020-00905-8] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Accepted: 06/14/2020] [Indexed: 01/22/2023]
Abstract
PURPOSE This study explored cancer survivors' experiences with and priorities for cancer survivorship care to describe a patient-centered approach to quality survivorship care. METHODS We conducted 22 focus groups with 170 adult survivors of breast, prostate, and colorectal cancer from six cities across the country and online. We used thematic analysis to identify participants' principles and priorities for quality survivorship care. RESULTS Based on our analysis of a limited group of cancer survivors, we identified two core principles that underlie participants' expectations for survivorship care and 11 practice priorities that reflect opportunities to improve patient-centeredness at the individual, interpersonal, and organizational levels. The principles reflect participants' desire to be better prepared for and equipped to accept and manage their chronic care needs post-cancer treatment. The priorities reflect practices that patients, providers, and cancer centers can engage in to ensure survivors' goals for post-treatment care are met. CONCLUSIONS Results from the study suggest the need to expand conceptualization of high-quality survivorship care. The survivor principles and practice priorities identified in this study challenge the field to organize a more patient-centered survivorship care system that empowers and respects patients and provides a holistic approach to survivors' chronic and long-term needs. IMPLICATIONS FOR CANCER SURVIVORS Quality cancer survivorship care must reflect patients' priorities. The findings from this study can be used to develop a patient-centered framework for survivorship care that can be used in conjunction with quality guidelines to ensure survivorship care is organized to achieve both clinical and patient-centered outcomes.
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Affiliation(s)
- K Holly Mead
- Milken Institute School of Public Health, George Washington University, 950 New Hampshire Ave., Washington, DC, 20052, USA.
| | - Sarah Raskin
- L. Douglas Wilder School of Government and Public Affairs, Virginia Commonwealth University, 1001 W. Franklin St., Richmond, VA, 23284, USA
| | - Anne Willis
- Cystic Fibrosis Foundation, 4550 Montgomery Ave., Bethesda, MD, 20814, USA
| | - Hannah Arem
- Milken Institute School of Public Health, George Washington University, 950 New Hampshire Ave., Washington, DC, 20052, USA
| | - Sarah Murtaza
- Milken Institute School of Public Health, George Washington University, 950 New Hampshire Ave., Washington, DC, 20052, USA
| | - Laura Charney
- Milken Institute School of Public Health, George Washington University, 950 New Hampshire Ave., Washington, DC, 20052, USA
| | - Mandi Pratt-Chapman
- George Washington University Cancer Center, George Washington University, 2600 Virginia Ave., NW, #300, Washington, DC, 20037, USA
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26
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Integrative review of breast cancer survivors’ transition experience and transitional care: dialog with transition theory perspectives. Breast Cancer 2020; 27:810-818. [DOI: 10.1007/s12282-020-01097-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Accepted: 04/15/2020] [Indexed: 12/16/2022]
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27
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Shin S, Wook Shin D, Young Cho I, Jeong SM, Jung H. Status of dyslipidemia management and statin undertreatment in Korean cancer survivors: A Korean National Health and Nutrition Examination Survey study. Eur J Prev Cardiol 2020; 28:864-872. [PMID: 34298552 DOI: 10.1177/2047487320905722] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Accepted: 01/21/2020] [Indexed: 01/06/2023]
Abstract
AIMS Due to improving cancer treatment results, non-cancer mortality is an important issue for cancer survivors. Cardiovascular diseases are the leading causes of death in Korea and globally. In addition to lowering the risk of cardiovascular disease, the use of statins has led to an overall reduction in cancer mortality in recent observational studies. We investigated the status of current dyslipidemia management in cancer survivors with reference to 2018 guidelines. METHODS The study is a cross-sectional analysis of 1460 cancer survivors aged from 40 to 75 years who participated in the Korean National Health and Nutrition Examination Survey from 2007 to 2016. Dyslipidemia management status among cancer survivors was assessed according to 2018 American College of Cardiology/American Heart Association guidelines and Korean Coronary Heart Disease Risk Score guidelines. RESULTS The rate of treatment for dyslipidemia was 8.5% for males, 13.8% for females, and 11.9% overall. Among cancer survivors who were not receiving treatment for dyslipidemia, 59.6% of males, 34.2% of females and 43.9% of total cancer survivors would have been eligible for statin therapy under the 2018 American College of Cardiology/American Heart Association guidelines and Korean Coronary Heart Disease Risk Score guidelines. The rate of undertreatment of dyslipidemia increased with age and length of time since cancer diagnosis. CONCLUSION Nearly 50% of cancer survivors remain untreated although they are eligible for statin therapy. This emphasizes the need for more attention to prevent atherosclerotic cardiovascular disease among cancer survivors.
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Affiliation(s)
- Sujeong Shin
- Department of Family Medicine and Supportive Care Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Republic of Korea
| | - Dong Wook Shin
- Department of Family Medicine and Supportive Care Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Republic of Korea.,Department of Digital Health, Samsung Advanced Institute of Health Science and Technology (SAIHST), Sungkyunkwan University, Republic of Korea
| | - In Young Cho
- Department of Family Medicine and Supportive Care Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Republic of Korea
| | - Su-Min Jeong
- Department of Family Medicine, Seoul National University Health Service Center, Republic of Korea
| | - Hyein Jung
- Endocrinology, Department of Internal Medicine, Yonsei University College of Medicine, Korea
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28
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Berry-Stoelzle MA, Mark AC, Kim P, Daly JM. Anxiety-Related Issues in Cancer Survivorship. J Patient Cent Res Rev 2020; 7:31-38. [PMID: 32002445 PMCID: PMC6988709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023] Open
Abstract
PURPOSE The purpose of this qualitative study was to examine patient opinions about anxiety in cancer survivorship, particularly the role of the primary care provider in management of anxiety related to the trajectory of long-term cancer survivorship. METHODS Respondents to a mass email (N=22,000) were invited to participate in 1 of 3 institutional review board-approved focus group meetings. Inclusion criteria were being an adult patient older than 25 years of age, having any type of cancer diagnosis, and being at least 18 months from treatment. The following specific issues were discussed: role of the primary care provider during and after therapy; the transition to primary care after therapy was finished; and advice the survivors would give to providers and cancer survivors. Focus group meetings were audio-recorded and later transcribed and reviewed by members of the research team using constant comparison methods. RESULTS Three 2-hour focus groups were conducted to interview 22 cancer survivors. We found 5 main themes related to anxiety in cancer survivorship: memory of anxiety; anxiety related to possible cancer recurrence; role of close relationship with the health care provider in anxiety management; frequency of communication in reduction of anxiety symptoms; and effect of anxiety on future health decisions posttreatment. CONCLUSIONS Survivors described anxiety persisting throughout cancer diagnosis and treatment and well into survivorship. They reported receiving care from primary care providers as well as oncologists. Anxiety was discussed by most participants as a significant part of their experience with cancer.
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Affiliation(s)
| | - Anna C Mark
- Department of Family Medicine, University of Iowa Carver College of Medicine, Iowa City, IA
| | - Peter Kim
- Department of Family Medicine, University of Iowa Carver College of Medicine, Iowa City, IA
| | - Jeanette M Daly
- Department of Family Medicine, University of Iowa Carver College of Medicine, Iowa City, IA
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29
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Hershman DL, Accordino MK, Shen S, Buono D, Crew KD, Kalinsky K, Trivedi MS, Hur C, Hu J, Unger JM, Wright JD. Association between nonadherence to cardiovascular risk factor medications after breast cancer diagnosis and incidence of cardiac events. Cancer 2020; 126:1541-1549. [DOI: 10.1002/cncr.32690] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Revised: 11/10/2019] [Accepted: 11/24/2019] [Indexed: 01/27/2023]
Affiliation(s)
- Dawn L. Hershman
- Department of Medicine Columbia University Medical Center New York New York
- Department of Epidemiology, Herbert Irving Comprehensive Cancer Center Columbia University Medical Center New York New York
| | - Melissa K. Accordino
- Department of Medicine Columbia University Medical Center New York New York
- Department of Epidemiology, Herbert Irving Comprehensive Cancer Center Columbia University Medical Center New York New York
| | - Sherry Shen
- Department of Medicine Columbia University Medical Center New York New York
| | - Donna Buono
- Department of Medicine Columbia University Medical Center New York New York
| | - Katherine D. Crew
- Department of Medicine Columbia University Medical Center New York New York
- Department of Epidemiology, Herbert Irving Comprehensive Cancer Center Columbia University Medical Center New York New York
| | - Kevin Kalinsky
- Department of Medicine Columbia University Medical Center New York New York
- Department of Epidemiology, Herbert Irving Comprehensive Cancer Center Columbia University Medical Center New York New York
| | - Meghna S. Trivedi
- Department of Medicine Columbia University Medical Center New York New York
- Department of Epidemiology, Herbert Irving Comprehensive Cancer Center Columbia University Medical Center New York New York
| | - Chin Hur
- Department of Medicine Columbia University Medical Center New York New York
- Department of Epidemiology, Herbert Irving Comprehensive Cancer Center Columbia University Medical Center New York New York
| | - Jianhua Hu
- Department of Medicine Columbia University Medical Center New York New York
- Department of Epidemiology, Herbert Irving Comprehensive Cancer Center Columbia University Medical Center New York New York
| | - Joseph M. Unger
- Department of Biostatistics, SWOG Statistical Center Fred Hutchinson Cancer Research Center Seattle Washington
- Department of Gynecology Fred Hutchinson Cancer Research Center Seattle Washington
| | - Jason D. Wright
- Department of Medicine Columbia University Medical Center New York New York
- Department of Epidemiology, Herbert Irving Comprehensive Cancer Center Columbia University Medical Center New York New York
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30
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IJsbrandy C, van Harten WH, Gerritsen WR, Hermens RP, Ottevanger PB. Healthcare professionals' perspectives of barriers and facilitators in implementing physical activity programmes delivered to cancer survivors in a shared-care model: a qualitative study. Support Care Cancer 2019; 28:3429-3440. [PMID: 31792881 PMCID: PMC7256088 DOI: 10.1007/s00520-019-05108-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Accepted: 09/30/2019] [Indexed: 02/06/2023]
Abstract
BACKGROUND The positive impact of physical activity programmes has been recognised, but the current uptake is low. Authorities believe delivering these programmes in a shared-care model is a future perspective. The present study aimed to identify the barriers and facilitators affecting physical activity programme implementation in a shared-care model delivered with the cooperation of all the types of healthcare professionals involved. METHODS Thirty-one individual interviews with primary healthcare professionals (PHPs) and four focus group interviews with 39 secondary healthcare professionals (SHPs) were undertaken. We used Grol and Flottorp's theoretical models to identify barriers and facilitators in six domains: (1) physical activity programmes, (2) patients, (3) healthcare professionals, (4) social setting, (5) organisation and (6) law and governance. RESULTS In the domain of physical activity programmes, those physical activity programmes that were non-tailored to the patients' needs impeded successful implementation. In the domain of healthcare professionals, the knowledge and skills pertaining to physical activity programmes and non-commitment of healthcare professionals impeded implementation. HCPs expressed their concerns about the negative influence of the patient's social network. Most barriers occurred in the domain of organisation. The PHPs and SHPs raised concerns about ineffective collaboration and networks between hospitals. Only the PHPs raised concerns about poor communication, indeterminate roles, and lack of collaboration with SHPs. Insufficient and unclear insurance coverage of physical activity programmes was a barrier in the domain of law and governance. CONCLUSIONS Improving the domain of organisation seems the most challenging because the collaboration, communication, networks, and interactive roles between the PHPs and SHPs are all inadequate. Survivor care plans, more use of health information technology, improved rehabilitation guidelines, and better networks might benefit implementing physical activity programmes.
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Affiliation(s)
- Charlotte IJsbrandy
- Radboud Institute for Health Science (RIHS), Scientific Institute for Quality of Healthcare (IQ healthcare), Radboud University Medical Center Nijmegen, PO Box 9101, 6500 HB Nijmegen, The Netherlands
- Radboud Institute for Health Science (RIHS), Department of Medical Oncology, Radboud University Medical Center Nijmegen, PO Box 9101, 6500 HB Nijmegen, The Netherlands
- Radboud Institute for Health Science (RIHS), Department of Radiation Oncology, Radboud University Medical Center Nijmegen, PO Box 9101, 6500 HB Nijmegen, The Netherlands
| | - Wim H. van Harten
- Netherlands Cancer Institute, Division of Psychosocial Research and Epidemiology, Plesmanlaan 121, 1066 CX Amsterdam, The Netherlands
- Department of Health Technology and Services Research, University of Twente, MB-HTSR, PO Box 217, 7500 AE Enschede, The Netherlands
| | - Winald R. Gerritsen
- Radboud Institute for Health Science (RIHS), Department of Medical Oncology, Radboud University Medical Center Nijmegen, PO Box 9101, 6500 HB Nijmegen, The Netherlands
| | - Rosella P.M.G. Hermens
- Radboud Institute for Health Science (RIHS), Scientific Institute for Quality of Healthcare (IQ healthcare), Radboud University Medical Center Nijmegen, PO Box 9101, 6500 HB Nijmegen, The Netherlands
| | - Petronella B. Ottevanger
- Radboud Institute for Health Science (RIHS), Department of Medical Oncology, Radboud University Medical Center Nijmegen, PO Box 9101, 6500 HB Nijmegen, The Netherlands
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Talking about sexual health during survivorship: understanding what shapes breast cancer survivors' willingness to communicate with providers. J Cancer Surviv 2019; 13:932-942. [PMID: 31741248 DOI: 10.1007/s11764-019-00809-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2019] [Accepted: 09/21/2019] [Indexed: 10/25/2022]
Abstract
PURPOSE Breast cancer survivor (BCS)-provider communication about sexual health (SH) is often absent or inadequate. Patients report wanting providers to broach the topic, but providers cite barriers to initiating discussions. While the health care community works to address barriers, it is unrealistic to rely solely on provider initiation of SH conversations. This research investigates willingness to communicate about sexual health (WTCSH) to better understand what may interfere with survivors' ability to self-advocate and receive care for these concerns. METHODS (N = 305) BCSs completed online surveys. Hierarchical multiple regression determined the relationship between Sexual Quality of Life-Female (SQOL-F), which measures psychological and social dimensions of SH and WTCSH. Interviews were then conducted with forty BCSs. The constant comparative method was used to thematically analyze the transcripts. RESULTS The mean SQOL score was 53.4 out of 100. No statistically significant differences in SQOL or WTCSH were found by age or survivorship length. The positive relationship between WTCSH and SQOL was significant, F (6,266) = 4.92, p < .000, adj. R2 = .080). Five themes illustrated factors that shape WTCSH: (1) comfort discussing SH; (2) perception of demographic similarity/discordance; (3) patient-centered communication; (4) belief that SH is (un)treatable, and (5) ability to access timely/coordinated care. CONCLUSIONS Findings establish the significance of SH concerns and provide an in-depth understanding of intrapersonal, interpersonal, and organizational issues informing WTCSH. IMPLICATIONS FOR CANCER SURVIVORS Age and gender dynamics, perceptions of provider SQOL messaging, and futility influence survivor openness. Addressing these areas may encourage disclosure among women who would otherwise continue to suffer in silence.
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Williams PA, Hu J, Yang D, Cao S, Jennelle RL. The Cancer Bell: Too Much of a Good Thing? Int J Radiat Oncol Biol Phys 2019; 105:247-253. [PMID: 31300336 DOI: 10.1016/j.ijrobp.2019.06.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Revised: 05/31/2019] [Accepted: 06/03/2019] [Indexed: 10/26/2022]
Abstract
PURPOSE Patients around the world often ring a bell on the final day of radiation therapy (RT) to celebrate treatment completion. Patients appear to enjoy ringing the bell, but its psychological impact is unexamined. Applying a psychological principle named the "peak-end rule," we hypothesized that ringing the bell would improve patients' perceptions of the overall distress from cancer treatment. METHODS AND MATERIALS We enrolled 2 cohorts of patients completing definitive RT in a single-center outpatient radiation oncology clinic. Patients in the control arm completed treatment and filled out the survey mentioned below. A bell was then installed in the clinic, and patients in the intervention arm rang the bell on the final day of RT and filled out the same survey. Patients evaluated their overall distress from cancer treatment using a survey composed of an 11-point numerical rating scale in combination with the Verbal Rating Scale. At follow-up, a shorter survey was completed that asked the same questions about distress from cancer treatment. RESULTS Two hundred ten patients were enrolled, 107 in the bell group and 103 in the control group. One hundred sixty-three patients completed follow-up surveys, n = 86 (80%) and n = 77 (75%) in the bell and control groups, respectively. Demographics and treatment characteristics were well balanced. The bell group reported worse overall distress scores than those not ringing the bell (mean [standard deviation] 5.6 [2.8] vs 4.7 [2.7], P = .045). This difference worsened further at follow-up (6.4 [2.9] vs 5.1 [3.0], P = .009; mean 103 vs 130 days, P = .056). CONCLUSIONS Counter to our hypothesis, ringing the bell on the final day of RT worsens patients' evaluation of overall distress from cancer treatment, and this distress persists and even worsens in the months after treatment. Emotional arousal created by ringing the bell may magnify the distress from cancer treatment and subsequently worsen the perception of distress from treatment.
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Affiliation(s)
- Patrick A Williams
- Department of Radiation Oncology, Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, California.
| | - Jinxiang Hu
- Department of Biostatistics, School of Medicine, University of Kansas Medical Center, Kansas City, Kansas
| | - Dongyun Yang
- Biostatistics Core, Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, California
| | - Shu Cao
- Biostatistics Core, Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, California
| | - Richard L Jennelle
- Department of Radiation Oncology, Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, California
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Siew AL, Tay LH, Ang WHD, Lopez V. Survivorship Care Practices and Confidence of Oncology Nurses in Singapore: A Cross-Sectional Study. J Transcult Nurs 2019; 31:451-459. [PMID: 31526235 DOI: 10.1177/1043659619872792] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
Introduction: Cancer survivorship care is challenging because little is known about delivering comprehensive and coordinated survivorship care practices (SCP) to patients. The purpose of this study is to examine oncology nurses' perceptions of responsibilities of SCP, confidence levels of SCP, and factors that influence provisions of SCP. Method: A descriptive cross-sectional study was conducted using the Cancer Professional Questionnaire. Analysis was conducted using independent t-test and analysis of variance to examine the differences between variables. Results: Nurses (n = 147) agreed that it was their responsibilities to provide SCP, but the majority lacked the confidence to do so. Significant differences were found in the confidence levels of nurses with different education attainments (p = .004). A lack of time and educational resources were factors impeding SCP. Discussion: Organizational interventions and education programs are needed to ensure that oncology nurses are confident in providing culturally congruent survivorship care in a multicultural country such as Singapore.
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Abstract
Transition to cancer survivorship is frequent lexicon denoting the posttreatment phase of cancer treatment. The concept of being in transition to survivorship is not well defined. To critically analyze this concept, data sources (n = 63) (from 1985 to 2016) from nursing, sociology, medicine, and psychology were evaluated employing Rodgers evolutionary method. Transition to cancer survivorship is a turning point with a variable time period one passes through after treatment. It is an individualized experience with degrees of liminality, changes, and challenging consequences. Understanding this concept helps identify patient needs for targeted nursing interventions that can bridge safe passage to cancer survivorship.
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Keats MR, Shea K, Parker L, Stewart SA, Flanders A, Bernstein M. After Childhood Cancer: a Qualitative Study of Family Physician, Parent/Guardian, and Survivor Information Needs and Perspectives on Long-Term Follow-up and Survivorship Care Plans. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2019; 34:638-646. [PMID: 29552704 DOI: 10.1007/s13187-018-1349-1] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Despite support for the provision of a survivorship care plan (SCP) to every cancer survivor, there is a lack of understanding of the needs and preferences of key stakeholders. We examined perspectives of a novel personalized SCP for childhood cancer survivors (CCS), their family, and family physicians (FP). We conducted semi-structured telephone interviews with a purposefully selected sample of CCS, parents/guardians, and FPs. Data included responses to stakeholder cancer care information needs, concerns with or gaps in communication, the perceived role of the FP in the long-term management of CCS care, utility of the SCP, preferred format, and suggestions for improvement. A deductive content analysis was conducted. Twenty-four participants including 8 CCS, 10 parents/guardians, and 6 FPs completed an interview. Four main and several sub-categories emerged. Core categories were coded as (1) informative reference, (2) coordination of follow-up, (3) barriers to follow-up care, and (4) suggestions for improvement and future implementation. The majority of participants preferred an electronic- or web-based format. Overall, the SCP was seen as an informative and concise resource. The SCP was thought to be a valuable tool to foster communication and empower CCSs to become more fully engaged in their own cancer-related health care. FPs viewed the SCP as a useful resource to facilitate and guide the long-term management of the CCS. In addition to the treatment summary, a comprehensive follow-up timeline, personalized lifestyle information, and details on how to access additional psychosocial support were highlighted as important components.
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Affiliation(s)
- Melanie R Keats
- School of Health and Human Performance, Dalhousie University, PO Box 15000, 6230 South Street, Halifax, NS, B3H 4R2, Canada.
- Department of Pediatrics, Dalhousie University, Halifax, NS, Canada.
| | - Kelsey Shea
- School of Health and Human Performance, Dalhousie University, PO Box 15000, 6230 South Street, Halifax, NS, B3H 4R2, Canada
| | - Louise Parker
- Department of Pediatrics, Dalhousie University, Halifax, NS, Canada
- Department of Medicine, Dalhousie University, Halifax, NS, Canada
| | - Samuel A Stewart
- Department of Pediatrics, Dalhousie University, Halifax, NS, Canada
- Department of Community Health and Epidemiology, Dalhousie University, Halifax, NS, Canada
| | | | - Mark Bernstein
- Department of Pediatrics, Dalhousie University, Halifax, NS, Canada
- IWK Health Centre, Halifax, NS, Canada
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Corrigan M, Hirschfield G, Greenfield S, Parry J. Barriers to implementation of stratified care in primary biliary cholangitis: a scoping exercise. BMJ Open Gastroenterol 2019; 6:e000226. [PMID: 31321066 PMCID: PMC6596962 DOI: 10.1136/bmjgast-2018-000226] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Revised: 08/31/2018] [Accepted: 09/07/2018] [Indexed: 01/29/2023] Open
Abstract
Patients with primary biliary cholangitis (PBC) can be stratified into low-risk and high-risk groups based on their response to treatment. Newly published guidelines from the British Society of Gastroenterology suggest low-risk patients can be managed substantially in primary care. This represents a shift from existing practice and makes assumptions about service capacity and the willingness of both patients and health care practitioners (HCPs) to make this change. The aim of this paper is to identify possible barriers to the implementation of these new care pathways through review of the PBC-specific literature and by identifying the experiences of patients and HCPs managing a different condition with comparable patients and disease characteristics. Searches of MEDLINE, CINAHL and EMBASE were undertaken. Within the existing PBC literature there is little data surrounding stakeholder perspectives on place of care. Review of the breast cancer literature highlights a number of barriers to change including primary care practitioner knowledge and work load, communication between healthcare settings, and the significance of the established doctor-patient relationship. Further research is needed to establish the extent to which these barriers may surface when changing PBC care pathways, and the actions required to overcome them.
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Affiliation(s)
- Margaret Corrigan
- University of Birmingham, NIHR Birmingham Biomedical Research Centre, Centre for Liver Research, Birmingham, UK
- Department of Liver medicine, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Gideon Hirschfield
- University of Birmingham, NIHR Birmingham Biomedical Research Centre, Centre for Liver Research, Birmingham, UK
- Department of Liver medicine, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Sheila Greenfield
- University of Birmingham, Institute of Applied Health Research, Birmingham, UK
| | - Jayne Parry
- University of Birmingham, Institute of Applied Health Research, Birmingham, UK
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Kwan JYY, Croke J, Panzarella T, Ubhi K, Fyles A, Koch A, Dinniwell R, Levin W, McCready D, Chung C, Liu F, Bender JL. Personalizing post-treatment cancer care: a cross-sectional survey of the needs and preferences of well survivors of breast cancer. ACTA ACUST UNITED AC 2019; 26:e138-e146. [PMID: 31043819 DOI: 10.3747/co.26.4131] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Background Improved treatments resulting in a rising number of survivors of breast cancer (bca) calls for optimization of current specialist-based follow-up care. In the present study, we evaluated well survivors of bca with respect to their supportive care needs and attitudes toward follow-up with various care providers, in varying settings, or mediated by technology (for example, videoconference or e-mail). Methods A cross-sectional paper survey of well survivors of early-stage pT1-2N0 bca undergoing posttreatment follow-up was completed. Descriptive and univariable logistic regression analyses were performed to examine associations between survivor characteristics, supportive care needs, and perceived satisfaction with follow-up options. Qualitative responses were analyzed using conventional content analysis. Results The 190 well survivors of bca who participated (79% response rate) had an average age of 63 ± 10 years. Median time since first follow-up was 21 months. Most had high perceived satisfaction with in-person specialist care (96%, 177 of 185). The second most accepted model was shared care involving specialist and primary care provider follow-up (54%, 102 of 190). Other models received less than 50% perceived satisfaction. Factors associated with higher perceived satisfaction with non-specialist care or virtual follow-up by a specialist included less formal education (p < 0.01) and more met supportive care needs (p < 0.05). Concerns with virtual follow-up included the perceived impersonal nature of virtual care, potential for inadequate care, and confidentiality. Conclusions Well survivors of bca want specialists involved in their follow-up care. Compared with virtual follow-up, in-person follow-up is perceived as more reassuring. Certain survivor characteristics (for example, met supportive care needs) might signal survivor readiness for virtual or non-specialist follow-up. Future work should examine multi-stakeholder perspectives about barriers to and facilitators of shared multimodal follow-up care.
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Affiliation(s)
- J Y Y Kwan
- Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, ON.,Department of Radiation Oncology, University of Toronto, Toronto, ON
| | - J Croke
- Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, ON.,Department of Radiation Oncology, University of Toronto, Toronto, ON
| | - T Panzarella
- Departments of Oncology and Biostatistics, Princess Margaret Cancer Centre and University of Toronto, Toronto, ON
| | - K Ubhi
- ellicsr Health, Wellness and Cancer Survivorship Centre, Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, ON
| | - A Fyles
- Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, ON.,Department of Radiation Oncology, University of Toronto, Toronto, ON
| | - A Koch
- Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, ON.,Department of Radiation Oncology, University of Toronto, Toronto, ON
| | - R Dinniwell
- Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, ON.,Department of Radiation Oncology, University of Toronto, Toronto, ON
| | - W Levin
- Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, ON.,Department of Radiation Oncology, University of Toronto, Toronto, ON
| | - D McCready
- Department of Surgical Oncology, Princess Margaret Hospital, University Health Network, Toronto, ON
| | - C Chung
- Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, ON.,Department of Radiation Oncology, University of Toronto, Toronto, ON
| | - F Liu
- Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, ON.,Department of Radiation Oncology, University of Toronto, Toronto, ON
| | - J L Bender
- ellicsr Health, Wellness and Cancer Survivorship Centre, Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, ON.,Dalla Lana School of Public Health, University of Toronto, Toronto, ON
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Conley CC, Andersen BL. Lemons to lemonade: Effects of a biobehavioral intervention for cancer patients on later life changes. Health Psychol 2019; 38:206-216. [PMID: 30762400 PMCID: PMC6464376 DOI: 10.1037/hea0000717] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
OBJECTIVE The sustainment of gains for cancer patients provided psychosocial interventions is unclear. Furthermore, it is unknown whether interventions also yield long-term positive changes. The present study experimentally tests if an intervention delivered at cancer diagnosis could yield broad, long-term, changes in domains such as relationships, worldview, priorities, and goals. It was hypothesized that the intervention group would report more positive and fewer negative life changes during survivorship versus the control group. METHOD Patients with Stage II/III breast cancer were randomized to biobehavioral intervention (BBI) or assessment only. At randomization, patients completed measures of cancer stress (Impact of Events Scale [IES]) and depressive symptoms (Center for Epidemiological Studies Depression scale [CES-D]). At the 24-month follow-up, survivors (N = 160) completed a thought listing task with 7 prompts (e.g., "relationships"). Patients listed thoughts about change since diagnosis and rated each for valence. Groups were compared on the frequency of positive/negative thoughts across prompts. Listed thoughts were content analyzed. RESULTS BBI survivors reported significantly more positive changes (p < .05), controlling for IES and CES-D. Groups did not differ on negative changes. Patients with higher IES/CES-D scores reported more negative changes at 24 months (ps < .05). Content analysis revealed a predominance (13/23) of positive thought categories. CONCLUSIONS Adding support for efficacy, BBI survivors reported significantly more positive life changes since diagnosis than survivors not receiving BBI. More generally, heightened stress/depressive symptoms at diagnosis foretold survivors' reporting of more negative changes. Thought listing is a strategy to obtain personalized accounts of life changes after breast cancer. (PsycINFO Database Record (c) 2019 APA, all rights reserved).
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Lefebvre H, Maddalena N, Proulx M. [The oncology care pathway and its transitions, an exploratory literature review]. SOINS; LA REVUE DE REFERENCE INFIRMIERE 2019; 64:58-62. [PMID: 30771854 DOI: 10.1016/j.soin.2018.12.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
A literature review was undertaken to describe the experience of people with cancer with regard to the different transitions of their care pathway. It enables all these transitions to be identified, documented and mapped out. The aim is to improve the quality of the care provided to this vulnerable population, all along the pathway.
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Affiliation(s)
- Hélène Lefebvre
- Faculté des sciences infirmières, Université de Montréal, CP. 6128 Succ. Centre-Ville Montreal, Québec, H3T3J7, Canada.
| | - Nadia Maddalena
- Direction des soins infirmiers, CIUSSS du Nord-de-L'Île de Montréal, 6767 Cartier St, Montreal, QC H2G 3G2, Canada
| | - Michelle Proulx
- Faculté des sciences infirmières, Université de Montréal, CP. 6128 Succ. Centre-Ville Montreal, Québec, H3T3J7, Canada
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40
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Chaput G, Med CP, Sussman J. Integrating primary care providers through the seasons of survivorship. ACTA ACUST UNITED AC 2019; 26:48-54. [PMID: 30853798 DOI: 10.3747/co.26.4687] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Traditionally, the role of primary care providers (pcps) across the cancer care trajectory has focused on prevention and early detection. In combination with screening initiatives, new and evolving treatment approaches have contributed to significant improvements in survival in a number of cancer types. For Canadian cancer survivors, the 5-year survival rate is now better than it was a decade ago, and the survivor population is expected to reach 2 million by 2031. Notwithstanding those improvements, many cancer survivors experience late and long-term effects, and comorbid conditions have been noted to be increasing in prevalence for this vulnerable population. In view of those observations, and considering the anticipated shortage of oncology providers, increasing reliance is being placed on the primary care workforce for the provision of survivorship care. Despite the willingness of pcps to engage in that role, further substantial efforts to elucidate the landscape of high-quality, sustainable, and comprehensive survivorship care delivery within primary care are required. The present article offers an overview of the integration of pcps into survivorship care provision. More specifically, it outlines known barriers and potential solutions in five categories: ■ Survivorship care coordination■ Knowledge of survivorship■ pcp-led clinical environments■ Models of survivorship care■ Health policy and organizational advocacy.
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Affiliation(s)
- G Chaput
- Department of Family Medicine, McGill University, Montreal, QC.,Department of Oncology, Division of Radiation Oncology, Supportive Cancer Care Research Unit, Hamilton, ON
| | - Cac Pall Med
- Department of Family Medicine, McGill University, Montreal, QC
| | - J Sussman
- Department of Oncology, Division of Radiation Oncology, Supportive Cancer Care Research Unit, Hamilton, ON
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Keesing S, Rosenwax L, McNamara B. The implications of women's activity limitations and role disruptions during breast cancer survivorship. ACTA ACUST UNITED AC 2019; 14:1745505718756381. [PMID: 29409399 PMCID: PMC5808959 DOI: 10.1177/1745505718756381] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Early survivorship is a time of critical transition for women survivors of breast cancer as they attempt to resume functional activities and important life roles. This study aimed to explore the challenges of women and their partners as they attempted to resume activities and roles, identify unmet needs and make recommendations regarding a suitable framework to support women and partners to recommence valued activities and important roles during early survivorship. Qualitative methods utilising in-depth interviews of women (n = 18) and their partners (n = 8), and two focus groups (n = 10) were completed in Perth, Western Australia, between June 2014 and April 2015. These methods were used to facilitate women and partners' views regarding the resumption of previously meaningful activities and important life roles during early survivorship. Questions addressed their individual and shared experiences concerning self-care, leisure, social and productive activities and important roles. Thematic analysis was employed to determine themes. Women and partners reported significant impact on their ability to engage in valued activities, resulting in changes to participation in meaningful roles. Three themes were determined: (1) ambiguity regarding survivorship prevents resumption of activities and previous roles, (2) breast cancer continues to impact a couples' relationship during survivorship, and (3) support is needed to assist women and partners to resume activities and important roles. This research provides evidence suggesting that the ongoing symptoms of breast cancer treatment continue to impact many women and their partners, as they attempt to resume functional activities and important life roles during early survivorship. Disruption to these valued activities and roles may influence women and their partner's health and well-being during early survivorship and extend beyond this period. Rehabilitation following cessation of treatment could be offered as required to facilitate access to multi-disciplinary services and supports for both individuals and couples.
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Affiliation(s)
- Sharon Keesing
- 1 School of Occupational Therapy and Social Work, Curtin University, Perth, WA, Australia
| | - Lorna Rosenwax
- 2 Faculty of Health Sciences, Curtin University, Perth, WA, Australia
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Cavers D, Habets L, Cunningham-Burley S, Watson E, Banks E, Campbell C. Living with and beyond cancer with comorbid illness: a qualitative systematic review and evidence synthesis. J Cancer Surviv 2019; 13:148-159. [PMID: 30685822 PMCID: PMC6394454 DOI: 10.1007/s11764-019-0734-z] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2018] [Accepted: 01/11/2019] [Indexed: 12/22/2022]
Abstract
Purpose To identify the qualitative evidence on the experience of cancer and comorbid illness from the perspective of patients, carers and health care professionals to identify psycho-social support needs, experience of health care, and to highlight areas where more research is needed. Methods A qualitative systematic review following PRISMA guidance. Relevant research databases were searched using an exhaustive list of search terms. Two reviewers independently screened titles and abstracts and discussed variations. Included articles were subject to quality appraisal before data extraction of article characteristics and findings. Thomas and Harden’s thematic synthesis of extracted findings was undertaken. Results Thirty-one articles were included in the review, covering a range of cancer types and comorbid conditions; with varying time since cancer diagnosis and apparent severity of disease for both cancer and other conditions. The majority of studies were published after 2010 and in high income countries. Few studies focused exclusively on the experience of living with comorbid conditions alongside cancer; such that evidence was limited. Key themes identified included the interaction between cancer and comorbid conditions, symptom experience, illness identities and ageing, self-management and the role of primary and secondary care. Conclusions In addition to a better understanding of the complex experience of cancer and comorbidity, the review will combine with research prioritisation work with consumers to inform an interview study with the defined patient group. Implications for Cancer Survivors Expanding this evidence base will help to illuminate developing models of cancer patient-centred follow-up care for the large proportion of patients with comorbid conditions. Electronic supplementary material The online version of this article (10.1007/s11764-019-0734-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Debbie Cavers
- Usher Institute, Medical School, University of Edinburgh, Teviot Place, Edinburgh, EH8 9AG, UK.
| | - Liset Habets
- Leiden University Medical Center, University of Leiden, Albinusdreef 2, 2333, Leiden, ZA, Netherlands
| | - Sarah Cunningham-Burley
- Medical and Family Sociology, Usher Institute, Medical School, University of Edinburgh, Teviot Place, Edinburgh, EH8 9AG, UK
| | - Eila Watson
- Supportive Cancer Care, Faculty of Health and Life Sciences, Oxford Brookes University, Jack Straws Lane, Marston, Oxford, OX3 0FL, UK
| | - Elspeth Banks
- , 1 Carnwath Lane, Carluke, South Lanarkshire, ML8 4QU, UK
| | - Christine Campbell
- Usher Institute, Medical School, University of Edinburgh, Teviot Place, Edinburgh, EH8 9AG, UK
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Shea KA, Steinberg DM, Santiago RA. Bridging the Gap: A Pilot Program to Understand and Meet the Needs of Pediatric Patients and Families as They Transition Off Cancer-Directed Therapy. J Pediatr Oncol Nurs 2018; 36:86-92. [PMID: 30584792 DOI: 10.1177/1043454218819452] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
Background: With improved curative therapies, over 80% of children and adolescent/young adults diagnosed with cancer are expected to live into adulthood. This population is at risk for increased morbidity and early mortality and requires ongoing health care and surveillance for late effects of treatment. This pilot study assessed the acceptability of a structured medical visit at the completion of cancer-directed therapy as well as patient/family's knowledge of diagnosis and other aspects of care. Method: Patients/families who were 0 to 6 months from completion of cancer-directed therapy attended a one-time transition visit during which they completed a series of questionnaires assessing knowledge about diagnosis, treatment, potential late effects, and duration of ongoing care. They were then given treatment summaries, a plan for follow-up care, information about care after treatment as well as late effects. They completed a questionnaire to assess their satisfaction with this visit. Results: The majority of patients/families knew their diagnosis and treatment modalities. Less knew that their treatment put them at risk for cardiac toxicity or problems with future fertility. A significant number thought follow-up care would continue for only 5 years. Overall participants were satisfied with the visit. Conclusion: The transition period from on to off therapy may be a critical time point to provide patients with cancer and their families with information regarding treatment, follow-up care and testing, and potential late effects. Future studies should assess if this intervention improves compliance with recommended care and surveillance, and improved outcomes.
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Koh SJ, Choi Y, Cheon J, Kim CR, Kim JH, Kim J. Using a wireless touch screen tablet personal computer is feasible to assess the quality of Breast Cancer Survivorship. JOURNAL OF CANCER RESEARCH AND PRACTICE 2018. [DOI: 10.1016/j.jcrpr.2018.08.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
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Husain M, Nolan TS, Foy K, Reinbolt R, Grenade C, Lustberg M. An overview of the unique challenges facing African-American breast cancer survivors. Support Care Cancer 2018; 27:729-743. [PMID: 30460398 DOI: 10.1007/s00520-018-4545-y] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2018] [Accepted: 11/07/2018] [Indexed: 01/08/2023]
Abstract
PURPOSE The existence of cancer disparities is well known. Focus on alleviating such disparities centers on diagnosis, treatment, and mortality. This review surveyed current knowledge of health disparities that exist in the acute survivorship period (immediately following diagnosis and treatment) and their contributors, particularly for African-American breast cancer survivors (AA-BCS). METHODS Utilizing the ASCO four components of survivorship care, we explore disparities in surveillance and effects of cancer and therapies that AA-BCS face within the acute survivorship period (the years immediately following diagnosis). A literature review of PUBMED, Scopus, and Cochrane databases was conducted to identify articles related to AA-BCS acute survivorship. The search yielded 97 articles. Of the 97 articles, 38 articles met inclusion criteria. RESULTS AA-BCS experience disparate survivorship care, which negatively impacts quality of life and health outcomes. Challenges exist in surveillance, interventions for late effects (e.g., quality-of-life outcomes, cardiotoxicity, and cognitive changes), preventing recurrence with promotion of healthy living, and coordinating care among the healthcare team. CONCLUSIONS This overview identified current knowledge on the challenges in survivorship among AA-BCS. Barriers to optimal survivorship care inhibit progress in eliminating breast cancer disparities. Research addressing best practices for survivorship care is needed for this population. Implementation of culturally tailored care may reduce breast cancer disparities among AA-BCS.
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Affiliation(s)
- Marium Husain
- The Ohio State University, 320 W. 10th Ave, Suite A455, Columbus, OH, 43210, USA.
| | - Timiya S Nolan
- The Ohio State University, 320 W. 10th Ave, Suite A455, Columbus, OH, 43210, USA
| | - Kevin Foy
- The Ohio State University, 320 W. 10th Ave, Suite A455, Columbus, OH, 43210, USA
| | - Raquel Reinbolt
- Medical Oncology, The Ohio State University, 320 W. 10th Ave, Suite A455, Columbus, OH, 43210, USA
| | - Cassandra Grenade
- Medical Oncology, The Ohio State University, 320 W. 10th Ave, Suite A455, Columbus, OH, 43210, USA
| | - Maryam Lustberg
- Medical Oncology, The Ohio State University, 320 W. 10th Ave, Suite A455, Columbus, OH, 43210, USA
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Enright K, Desai T, Sutradhar R, Gonzalez A, Powis M, Taback N, Booth CM, Trudeau ME, Krzyzanowska MK. Factors associated with imaging in patients with early breast cancer after initial treatment. ACTA ACUST UNITED AC 2018; 25:126-132. [PMID: 29719428 DOI: 10.3747/co.25.3838] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Background Overuse of surveillance imaging in patients after curative treatment for early breast cancer (ebc) was recently identified as one of the Choosing Wisely Canada initiatives to improve the quality of cancer care. We undertook a population-level examination of imaging practices in Ontario as they existed before the launch of that initiative. Methods Patients diagnosed with ebc between 2006 and 2010 in Ontario were identified from the Ontario Cancer Registry. Records were linked deterministically to provincial health care databases to obtain comprehensive follow-up. We identified all advanced imaging exams [aies: computed tomography (ct), bone scan, positron-emission tomography] and basic imaging exams (bies: ultrasonography, chest radiography) occurring within the first 2 years after curative treatment. Poisson regression was used to assess associations between patient or provider characteristics and the rate of aies. Results Of 30,006 women with ebc, 58.6% received at least 1 bie, and 30.6% received at least 1 aie in year 1 after treatment. In year 2, 52.7% received at least 1 bie, and 25.7% received at least 1 aie. The most common aies were chest cts and bone scans. The rate of aies increased with older age, higher disease stage, comorbidity, chemotherapy exposure, and prior staging investigations (p < 0.001). Imaging was ordered mainly by medical oncologists (38%), followed by primary care physicians (23%), surgeons (13%), and emergency room physicians (7%). Conclusions Despite recommendations against its use, imaging is common in ebc survivors. Understanding the factors associated with aie use helps to identify areas for further research and is required to lower imaging rates and to improve survivorship care.
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Affiliation(s)
- K Enright
- Carlo Fidani Regional Cancer Centre, Trillium Health Partners- Credit Valley Hospital, Mississauga, ON
| | - T Desai
- University of Toronto, Toronto, ON
| | - R Sutradhar
- University of Toronto, Toronto, ON.,Institute for Clinical Evaluative Sciences, Toronto, ON
| | - A Gonzalez
- Institute for Clinical Evaluative Sciences, Toronto, ON
| | - M Powis
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, ON
| | - N Taback
- University of Toronto, Toronto, ON
| | - C M Booth
- Division of Cancer Care and Epidemiology, Cancer Research Institute at Queen's University, Kingston, ON
| | - M E Trudeau
- Sunnybrook Health Sciences Centre, Toronto, ON
| | - M K Krzyzanowska
- Institute for Clinical Evaluative Sciences, Toronto, ON.,Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, ON
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Lefebvre H, Brault I, Roy O, Levert MJ, Lecocq D, Larrivière M, Proulx M. Partenariat entre patients, leaders en soins infirmiers et chercheurs : résultats d’une stratégie web de transfert des connaissances pour planifier le congé d’hôpital et faciliter les transitions au cours des soins oncologiques. Can Oncol Nurs J 2018; 28:102-109. [PMID: 31148830 PMCID: PMC6516902 DOI: 10.5737/23688076282102109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Un projet de recherche a réuni des patients partenaires, des leaders en soins infirmiers de six milieux cliniques du Québec ainsi que des chercheurs en vue de développer et tester un outil web, le Portail d’échange des savoirs (PES), afin d’améliorer les pratiques de planification des congés et les transitions au cours des soins oncologiques. Le projet a débouché sur la création d’un PES axé sur l’oncologie ouvert à toute la francophonie. Il en a aussi émergé une stratégie novatrice de transfert des connaissances (TC) prenant appui sur le PES et alimentée par le travail collaboratif des différents partenaires, parmi lesquels les patients ont tenu un rôle essentiel. Les résultats ont mis en lumière l’importance, pour la recherche en santé, de donner la parole à des patients partenaires dans le cadre d’une étroite collaboration avec des cliniciens et des chercheurs, pour que les pratiques cliniques soient mieux adaptées aux besoins réels des patients et de leurs proches.
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Affiliation(s)
- Hélène Lefebvre
- Professeure titulaire, Faculté des sciences infirmières, Université de Montréal, C.P. 6128, succ. Centre-Ville Montréal (Québec) H3T 3J7; Courriel :
| | - Isabelle Brault
- Professeure agrégé, Faculté des sciences infirmières, Université de Montréal, C.P. 6128, succ. Centre-Ville Montréal (Québec) H3T 3J7; Courriel :
| | - Odette Roy
- Fondatrice et chercheure au Centre d'excellence en soins infirmiers de l'Hôpital Maisonneuve-Rosemont, fonction qu'elle occupait jusqu'en 2015. Professeure associée à la faculté des Hôpital Maisonneuve-Rosemont, Hôpital Maisonneuve-Rosemont, Professeure adjointe à la faculté des sciences infirmières de l'Université de Montréal C.P. 6128, succ. Centre-Ville Montréal (Québec) H3T 3J7; Courriel :
| | - Marie-Josée Levert
- Professeure agrégé, Faculté des sciences infirmières, Université de Montréal, Chercheure au Centre de recherche interdisciplinaire en réadaptation du Montréal métropolitain (CRIR), Chercheure pour le Groupe interréseau de recherche sur l'adaptation de la famille et de son environnement (GIRAFE), C.P. 6128, succ. Centre-Ville, Montréal (Québec) H3C 3J7; Courriel :
| | - Dan Lecocq
- Maître de conférences et chercheur, Option « sciences et clinique infirmières », École de santé publique, Université libre de Bruxelles; Courriel :
| | - Maryse Larrivière
- Coordonnatrice de projet, Faculté des sciences infirmières, Université de Montréal, C.P. 6128, succ. Centre-Ville, Montréal (Québec) H3C 3J7; Courriel :
| | - Michelle Proulx
- Professionnelle de recherche, Faculté des sciences infirmières, Université de Montréal, C.P. 6128, succ. Centre-Ville, Montréal (Québec) H3C 3J7; Courriel :
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Lefebvre H, Brault I, Roy O, Levert MJ, Lecocq D, Larrivière M, Proulx M. Partnership between patients, nurse leaders and researchers: Outcomes of a web-based KT strategy for hospital discharge planning and care transitions in oncology. Can Oncol Nurs J 2018; 28:110-117. [PMID: 31148819 PMCID: PMC6516913 DOI: 10.5737/23688076282110117] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
A research project brought together patient partners, nurse leaders from six clinical settings in Quebec and researchers to develop and test a web technology, the Forum for Knowledge Exchange (FKE), in order to improve discharge planning practices and oncological care transitions. The project led to the creation of a FKE accessible to the oncology sector of the Francophonie. It revealed an innovative strategy of knowledge transfer (KT) based on the FKE and was fed by collaborative work among partners, where the patient partners played a vital role. The results highlighted the importance, for health research, of giving a voice to patient partners in close collaboration with clinicians and researchers so that clinical practices are better adapted to the actual needs of patients and of their relatives.
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Affiliation(s)
- Hélène Lefebvre
- Full professor, Faculty of Nursing, Université de Montréal, C.P. 6128 Succ. Centre-Ville Montreal, QC H3T 3J7;
| | - Isabelle Brault
- Associate professor, Faculty of Nursing, Université de Montréal, CP. 6128 Succ. Centre-Ville, Montreal, QC H3T 3J7;
| | - Odette Roy
- Founder and researcher at the Maisonneuve-Rosemont Hospital Center of Excellence in Nursing, a position she held until 2015. Associate professor at the Faculty of Nursing, Université de Montréal, CP. 6128 Succ. Centre-Ville, Montreal, QC H3T 3J7; E-mail:
| | - Marie-Josée Levert
- Associate professor, Faculty of Nursing, Université de Montréal, Researcher, Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR), Researcher, Groupe inter-réseaux de recherche sur l'adaptation de la famille et de son environnement (GIRAFE), C.P. 6128, Succ. Centre-Ville, Montréal, QC H3C 3J7; Email :
| | - Dan Lecocq
- Maître de conférences & chercheur, option « sciences et clinique infirmières », École de santé publique, Université libre de Bruxelles; Email :
| | - Maryse Larrivière
- Project coordinator, Faculty of Nursing, Université de Montréal, C.P. 6128, Succ. Centre-Ville, Montréal, QC H3C 3J7; Email :
| | - Michelle Proulx
- Research professional, Faculty of Nursing, Université de Montréal, C.P. 6128, Succ. Centre-Ville, Montréal, QC H3C 3J7; Email :
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Hebdon M, Abrahamson K, Griggs R, McComb S. Shared mental models of cancer survivorship care. Eur J Cancer Care (Engl) 2018; 27:e12831. [PMID: 29419945 DOI: 10.1111/ecc.12831] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/09/2018] [Indexed: 11/28/2022]
Affiliation(s)
- M.C. Hebdon
- Radford University School of Nursing; Radford VA USA
| | - K. Abrahamson
- Purdue University School of Nursing; West Lafayette IN USA
| | - R.R. Griggs
- Purdue University School of Nursing; West Lafayette IN USA
| | - S.A. McComb
- Purdue University Schools of Nursing and Industrial Engineering; West Lafayette IN USA
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Tucholka JL, Jacobson N, Steffens NM, Schumacher JR, Tevaarwerk AJ, Anderson B, Wilke LG, Greenberg CC, Neuman HB. Breast cancer survivor's perspectives on the role different providers play in follow-up care. Support Care Cancer 2018; 26:2015-2022. [PMID: 29332175 DOI: 10.1007/s00520-018-4042-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2017] [Accepted: 01/03/2018] [Indexed: 01/06/2023]
Abstract
IMPORTANCE Significant variation in the number and types of oncologists that provide breast cancer follow-up exists. However, there is limited understanding regarding breast cancer survivors' preferences for who provides their follow-up. Our objective was to explore breast cancer survivors' perspectives on the goals of breast cancer follow-up, the preferred role for primary care providers, and the perceived roles of different types of oncologists during follow-up. METHODS A convenience sample of stage 0-III breast cancer survivors was identified and in-depth one-on-one interviews conducted. Data were analyzed using inductive content analysis. RESULTS Survivors cited a strong preference for oncology-based follow-up within the first 5 years after diagnosis, driven by their need for reassurance that cancer had not recurred. Survivors also thought that their primary care provider needed to be involved. Survivors assumed that oncology follow-up was directed by a standard protocol that included streamlining the follow-up team. Survivors recognized that patients with more complex cancers or challenging treatment courses may require more intensive follow-up and deviate from the standard protocol. Most survivors were comfortable deferring decisions regarding who participated in follow-up to the oncology team. CONCLUSIONS Most patients think a streamlined approach to oncology-based breast cancer follow-up already occurs, driven by a standard protocol. The use of a standard protocol to provide guidance for which types of oncology providers should participate in breast cancer follow-up will streamline care and represents a significant opportunity to reduce unnecessary variation. This approach is especially critical given patients' strong preferences for oncology-based follow-up.
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Affiliation(s)
- J L Tucholka
- Wisconsin Surgical Outcomes Research Program, Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - N Jacobson
- School of Nursing, Institute for Clinical and Translational Research, University of Wisconsin-Madison, Madison, WI, USA
| | - N M Steffens
- Denver Public Health, Denver Health and Hospital Authority, Denver, CO, USA
| | - J R Schumacher
- Wisconsin Surgical Outcomes Research Program, Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - A J Tevaarwerk
- University of Wisconsin Carbone Cancer Center, University of Wisconsin School of Medicine and Public Health, H4/726 CSC, 600 Highland Ave., Madison, WI, 53792-7375, USA.,Department of Medicine, Division of Hematology and Oncology, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - B Anderson
- Department of Human Oncology, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - L G Wilke
- Wisconsin Surgical Outcomes Research Program, Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA.,University of Wisconsin Carbone Cancer Center, University of Wisconsin School of Medicine and Public Health, H4/726 CSC, 600 Highland Ave., Madison, WI, 53792-7375, USA
| | - C C Greenberg
- Wisconsin Surgical Outcomes Research Program, Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA.,University of Wisconsin Carbone Cancer Center, University of Wisconsin School of Medicine and Public Health, H4/726 CSC, 600 Highland Ave., Madison, WI, 53792-7375, USA
| | - Heather B Neuman
- Wisconsin Surgical Outcomes Research Program, Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA. .,University of Wisconsin Carbone Cancer Center, University of Wisconsin School of Medicine and Public Health, H4/726 CSC, 600 Highland Ave., Madison, WI, 53792-7375, USA.
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