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Waller SF, O’Brien Y, Seah JA, McLachlan SA, Dowling AJ. Elective intensive care unit admissions for organ donation in patients with terminal brain glioma: Case report. SAGE Open Med Case Rep 2024; 12:2050313X241235009. [PMID: 38444694 PMCID: PMC10913499 DOI: 10.1177/2050313x241235009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Accepted: 02/07/2024] [Indexed: 03/07/2024] Open
Abstract
Despite being eligible, only 26 patients with primary brain cancer became organ donors from 2009 to 2018 in Australia. We describe two patients with high grade gliomas who successfully donated their organs after obtaining first-person consent in the outpatient setting by careful multidisciplinary planning and an elective intensive care unit admission for organ donation. Barriers and facilitators were examined based on these experiences and suggestions for future practices are explored. The recommended practices include: 1. Systematic incorporation of organ donation into advance care planning. 2. Integrating organ donation organisation coordinators into advance care planning. 3. Standardization of donor care and clear communication and collaboration between treatment teams. 4. Support and involvement of the medical treatment decision maker. 5. Identification of clinical triggers for admission to hospital and intensive care unit. These two cases illustrate that with careful coordination and involvement from a multidisciplinary team, successful organ transplantation outcomes are possible.
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Affiliation(s)
- Shohei F Waller
- Oncology Department, St.Vincent’s Hospital Melbourne, VIC, Australia
- Medical Oncology Department, The Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | - Yvette O’Brien
- Department of Critical Care Medicine, St.Vincent’s Hospital Melbourne, Fitzroy, VIC, Australia
- DonateLife Victoria, Australia
| | - Jo-An Seah
- Palliative Care Department, St.Vincent’s Hospital Melbourne, Fitzroy, VIC, Australia
- Oncology Department, Northern Health, Epping, VIC, Australia
| | - Sue-Anne McLachlan
- Oncology Department, St.Vincent’s Hospital Melbourne, VIC, Australia
- The Department of Medicine, The University of Melbourne, VIC, Australia
| | - Anthony J Dowling
- Oncology Department, St.Vincent’s Hospital Melbourne, VIC, Australia
- The Department of Medicine, The University of Melbourne, VIC, Australia
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2
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Tutty E, Horsley P, Forbes Shepherd R, Forrest LE. The art and science of recruitment to a cancer rapid autopsy programme: A qualitative study exploring patient and clinician experiences. Palliat Med 2021; 35:437-446. [PMID: 33126839 DOI: 10.1177/0269216320967595] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND CASCADE is a successful, Australia-first cancer rapid autopsy programme. Patients are recruited to the programme by their clinician once they understand that further treatment has only palliative intent. Despite its value, rapid autopsy is a rare research method owing partly to recruitment challenges. AIM This research aimed to explore (1) how, in practice, clinicians select and recruit patients to the programme and (2) patient experiences of this process. DESIGN This was a qualitative study grounded in phenomenology. CASCADE team members (clinicians and researchers) and patients participated in semi-structured interviews. Data were analysed using an inductive, team-based approach to thematic analysis. PARTICIPANTS Interviews were conducted with 31 participants (11 patients and 20 CASCADE team members). RESULTS Patient selection and recruitment to a rapid autopsy programme is both an art and science. In practice, patient selection is a subjective process that involves assessing a patient's psychosocial suitability for the programme. Trust and rapport are necessary for informing this assessment and to create an environment conducive to discussing rapid autopsy. Clinicians have also crafted their own ways of delivering information about CASCADE, with both clinicians and patients acknowledging that, if not handled sensitively, recruitment could cause distress. Overall, patients were satisfied with the way in which they were recruited. CONCLUSION Findings provide insight into how clinicians successfully select and recruit patients to a rapid autopsy programme and suggests that discussing such topics are acceptable to end-of-life patients. This research also raises thought-provoking questions about the 'gatekeeping' role of clinicians in recruitment.
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Affiliation(s)
- Erin Tutty
- Parkville Familial Cancer Centre, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | - Philomena Horsley
- Parkville Familial Cancer Centre, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia.,Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Rowan Forbes Shepherd
- Parkville Familial Cancer Centre, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia.,Sir Peter MacCallum Department of Oncology, The University of Melbourne, Melbourne, VIC, Australia
| | - Laura E Forrest
- Parkville Familial Cancer Centre, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia.,Sir Peter MacCallum Department of Oncology, The University of Melbourne, Melbourne, VIC, Australia
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3
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Dankner M, Issa-Chergui B, Bouganim N. Post-mortem tissue donation programs as platforms to accelerate cancer research. JOURNAL OF PATHOLOGY CLINICAL RESEARCH 2020; 6:163-170. [PMID: 32198850 PMCID: PMC7339213 DOI: 10.1002/cjp2.159] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Revised: 12/17/2019] [Accepted: 01/15/2020] [Indexed: 12/16/2022]
Abstract
Given recent advances in the treatment of cancer, patients are surviving longer but frequently develop treatment-resistant and inoperable metastases. Biomedical research has advanced to the stage where in-depth study of these lesions is feasible, with the goal of further refining our understanding of metastatic dissemination, therapeutic resistance and inoperable tumors. However, there is a lack of tissue specimens derived from multiple metastatic sites within the same patient that would permit the study of these processes. Furthermore, patients with rapidly progressing or metastatic disease are rarely candidates for surgery, making those most in need of innovation and discovery extremely difficult to study. For this reason, post-mortem tissue donation programs are an approach that is quickly gaining traction in the cancer research community. Herein, we discuss what post-mortem tissue donation entails, attitudes towards these procedures, and highlight important studies already utilizing these resources. In addition, we propose future directions for use of this tissue that can directly improve clinical management of advanced cancer patients.
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Affiliation(s)
- Matthew Dankner
- Goodman Cancer Research Centre, McGill University, Quebec, Canada
| | - Badia Issa-Chergui
- Department of Pathology, McGill University, Quebec, Canada.,McGill University Health Centre, McGill University, Quebec, Canada
| | - Nathaniel Bouganim
- Division of Oncology, McGill University, Quebec, Canada.,McGill University Health Centre, McGill University, Quebec, Canada
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4
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Epstein AS, Hamilton JG, Shuk E, Romano DR, Lynch K, Khan E, Genoff M, Michael C, Iacobuzio-Donahue C. Stakeholders' Perceptions and Information Needs Regarding Research Medical Donation. J Pain Symptom Manage 2019; 58:792-804.e6. [PMID: 31302259 PMCID: PMC6853712 DOI: 10.1016/j.jpainsymman.2019.07.003] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Revised: 07/01/2019] [Accepted: 07/03/2019] [Indexed: 10/26/2022]
Abstract
CONTEXT Research Medical Donation (RMD), which entails collecting human tissue within hours after death, benefits cancer research but data are limited regarding barriers institutions face accruing patients to RMD programs. OBJECTIVES The objective of this study was to generate stakeholder perspectives to best inform the complex RMD process, which includes communicating with patients and their proxies and procuring tissue in a timely manner, all the while respecting end-of-life care sensitivities. METHODS We explored perceived core needs and challenges of RMD by engaging stakeholders (cancer clinicians, patients, and their caregivers) in eight teleconference focus groups. Breast, pancreatic, and lung cancer clinicians comprised two groups. Each cancer separately had two groups for patients and their caregivers combined. Qualitative analysis of focus group transcripts included identifying and reaching group consensus on transcript themes and establishing agreement on consensus templates to identify primary common and divergent themes. RESULTS A total of 45 people (13 clinicians, 24 patients, eight caregivers) participated in the groups. The themes identified were as follows: 1) clinicians and patients had limited previous knowledge about RMD; 2) RMD was perceived to mainly benefit research; 3) logistical and privacy questions arose; 4) introducing RMD was deemed sensitive, with patient-specific timing; 5) rare and/or virulent cancers appeared associated with willingness to participate in RMD. CONCLUSION Patients, families, and cancer clinicians have generally low knowledge of RMD but, upon learning about it, deem it valuable for scientific advancement (particularly for rare and virulent cancers), necessary to be carried out with individualized sensitivity to end-of-life issues, and through training programs with involved clinical staff.
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Affiliation(s)
- Andrew S Epstein
- Memorial Sloan Kettering Cancer Center, New York, New York, USA; Weill Cornell Medical College, New York, New York, USA.
| | - Jada G Hamilton
- Memorial Sloan Kettering Cancer Center, New York, New York, USA; Weill Cornell Medical College, New York, New York, USA
| | - Elyse Shuk
- Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | | | - Kathleen Lynch
- Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Erva Khan
- Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Margaux Genoff
- Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Chelsea Michael
- Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Christine Iacobuzio-Donahue
- Memorial Sloan Kettering Cancer Center, New York, New York, USA; Weill Cornell Medical College, New York, New York, USA
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Dankner M, Senecal J, Neubarth NS, Bertos N, Park M, Issa-Chergui B, Asselah J, Siegel PM, Bouganim N. A survey of health care professionals and oncology patients at the McGill University Health Centre reveals enthusiasm for establishing a postmortem rapid tissue donation program. ACTA ACUST UNITED AC 2019; 26:e558-e570. [PMID: 31548825 DOI: 10.3747/co.26.4771] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background In the early developmental phase of a postmortem rapid tissue donation (rtd) program for patients with metastatic cancer, we surveyed health care professionals (hcps) and oncology patients at the McGill University Health Centre (muhc) to assess their knowledge and attitudes pertaining to rtd from metastatic cancer patients for research purposes. Methods A 23-item survey was developed and distributed to hcps at tumour board meetings, and a related 26-item survey was developed and distributed to oncology patients at the muhc Cedars Cancer Centre. Results The survey attracted participation from 73 hcps, including 37 attending physicians, and 102 oncology patients. Despite the fact that 88% of hcps rated their knowledge of rtd as none or limited, 42% indicated that they would feel comfortable discussing rtd with their cancer patients. Of the responding hcps, 67% indicated that their current knowledge of rtd would affect their decision to discuss such a program with patients, which implies the importance of education for hcps to facilitate enrolment of patients into a rtd program. Of responding patients, 78% indicated that they would not be uncomfortable if their doctor discussed rtd with them, and 61% indicated that they would like it if their doctor were to discuss rtd with them. The hcps and patients felt that the best time for patients to be approached about consenting to a rtd program would be at the transition to palliative care when no treatment options remain. Conclusions At the muhc, hcps and patients are generally enthusiastic about adopting a rtd program for patients with metastatic cancer. Education of hcps and patients will be an important determinant of the program's success.
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Affiliation(s)
- M Dankner
- Goodman Cancer Research Centre, Montreal, QC.,Department of Experimental Medicine, McGill University, Montreal, QC
| | - J Senecal
- Goodman Cancer Research Centre, Montreal, QC.,Department of Experimental Medicine, McGill University, Montreal, QC
| | - N S Neubarth
- Goodman Cancer Research Centre, Montreal, QC.,Department of Anatomy and Cell Biology, McGill University, Montreal, QC
| | - N Bertos
- Research Institute of the McGill University Health Centre, Montreal, QC
| | - M Park
- Goodman Cancer Research Centre, Montreal, QC.,Research Institute of the McGill University Health Centre, Montreal, QC.,Department of Pathology, McGill University, Montreal, QC.,Department of Biochemistry, McGill University, Montreal, QC
| | - B Issa-Chergui
- Department of Pathology, McGill University, Montreal, QC.,Cedars Cancer Centre, Montreal, QC
| | - J Asselah
- Cedars Cancer Centre, Montreal, QC.,McGill University Health Centre, Montreal, QC
| | - P M Siegel
- Goodman Cancer Research Centre, Montreal, QC.,Department of Experimental Medicine, McGill University, Montreal, QC.,Department of Anatomy and Cell Biology, McGill University, Montreal, QC.,Research Institute of the McGill University Health Centre, Montreal, QC.,Department of Biochemistry, McGill University, Montreal, QC
| | - N Bouganim
- Cedars Cancer Centre, Montreal, QC.,McGill University Health Centre, Montreal, QC
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Quinn GP, Pentz RD, Muñoz-Antonia T, Boyle TA, Schabath MB, Pratt CL, Shaffer A, Duarte LF, Bowman-Curci M, Antonia SJ, Chiappori AA, Creelan BC, Gray JE, Williams CC, Haura EB. Patient, caregiver and physician perspectives on participating in a thoracic rapid tissue donation program. PATIENT EDUCATION AND COUNSELING 2018; 101:703-710. [PMID: 29195718 PMCID: PMC5878993 DOI: 10.1016/j.pec.2017.11.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/16/2017] [Revised: 11/18/2017] [Accepted: 11/24/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVE The collection of posthumous tissue from advanced stage lung cancer patients is beneficial to medical science. Recruiting living patients to a Rapid Tissue Donation Program (RTD) poses several psychosocial challenges and little is known about perceptions of joining this type of program. This study qualitatively examined perceptions of advanced stage lung cancer patients (n=14) participating in a lung cancer RTD program, their NoK (n=11), and physicians (n=6) at the Thoracic Oncology Clinic at H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida USA. METHODS Semi-structured interviews were conducted with participants and interview transcripts were analyzed using the constant comparison method. RESULTS Majority of patients joined to give back to research, discussed participation with family members, and desired for family to receive information about the use of the tissue after their death. All participating NoK were supportive of their family member's decision. Physicians described the program as running smoothly, but provided suggestions for process improvements. CONCLUSION Participants joined with intention to give back to research community and families were supportive of loved one's participation in RTD. Physicians agreed with overall process. PRACTICE IMPLICATIONS Key factors for a successful RTD program is tailoring to institutional and individual needs.
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Affiliation(s)
- Gwendolyn P Quinn
- Division of Population Science, H. Lee Moffitt Cancer Center & Research Institute, 12902 Magnolia Drive, Tampa, FL 33612, United States; New York University School of Medicine, 500 1st Ave, New York, NY 10012, United States.
| | - Rebecca D Pentz
- Winship Cancer Institute, Emory University School of Medicine, 1365 Clifton Rd., Atlanta, GA 30322, United States
| | - Teresita Muñoz-Antonia
- Morsani College of Medicine, Department of Oncologic Science, University of South Florida, 12901 Bruce B Downs Blvd., Tampa, FL 33612, United States; Tumor Biology Department, H. Lee Moffitt Cancer Center & Research Institute, 12902 Magnolia Drive, Tampa, FL 33612, United States
| | - Theresa A Boyle
- Morsani College of Medicine, Department of Oncologic Science, University of South Florida, 12901 Bruce B Downs Blvd., Tampa, FL 33612, United States; Anatomic Pathology Department, H. Lee Moffitt Cancer Center & Research Institute, 12902 Magnolia Drive, Tampa, FL 33612, United States
| | - Matthew B Schabath
- Division of Population Science, H. Lee Moffitt Cancer Center & Research Institute, 12902 Magnolia Drive, Tampa, FL 33612, United States; Morsani College of Medicine, Department of Oncologic Science, University of South Florida, 12901 Bruce B Downs Blvd., Tampa, FL 33612, United States
| | - Christie L Pratt
- Department of Thoracic Oncology, H. Lee Moffitt Cancer Center & Research Institute, 12902 Magnolia Drive, Tampa, FL 33612, United States
| | - Andrea Shaffer
- Department of Thoracic Oncology, H. Lee Moffitt Cancer Center & Research Institute, 12902 Magnolia Drive, Tampa, FL 33612, United States
| | - Luisa F Duarte
- Division of Population Science, H. Lee Moffitt Cancer Center & Research Institute, 12902 Magnolia Drive, Tampa, FL 33612, United States
| | - Meghan Bowman-Curci
- Division of Population Science, H. Lee Moffitt Cancer Center & Research Institute, 12902 Magnolia Drive, Tampa, FL 33612, United States
| | - Scott J Antonia
- Morsani College of Medicine, Department of Oncologic Science, University of South Florida, 12901 Bruce B Downs Blvd., Tampa, FL 33612, United States; Department of Thoracic Oncology, H. Lee Moffitt Cancer Center & Research Institute, 12902 Magnolia Drive, Tampa, FL 33612, United States
| | - Alberto A Chiappori
- Morsani College of Medicine, Department of Oncologic Science, University of South Florida, 12901 Bruce B Downs Blvd., Tampa, FL 33612, United States; Department of Thoracic Oncology, H. Lee Moffitt Cancer Center & Research Institute, 12902 Magnolia Drive, Tampa, FL 33612, United States
| | - Benjamin C Creelan
- Morsani College of Medicine, Department of Oncologic Science, University of South Florida, 12901 Bruce B Downs Blvd., Tampa, FL 33612, United States; Department of Thoracic Oncology, H. Lee Moffitt Cancer Center & Research Institute, 12902 Magnolia Drive, Tampa, FL 33612, United States
| | - Jhanelle E Gray
- Morsani College of Medicine, Department of Oncologic Science, University of South Florida, 12901 Bruce B Downs Blvd., Tampa, FL 33612, United States; Department of Thoracic Oncology, H. Lee Moffitt Cancer Center & Research Institute, 12902 Magnolia Drive, Tampa, FL 33612, United States
| | - Charles C Williams
- Morsani College of Medicine, Department of Oncologic Science, University of South Florida, 12901 Bruce B Downs Blvd., Tampa, FL 33612, United States; Department of Thoracic Oncology, H. Lee Moffitt Cancer Center & Research Institute, 12902 Magnolia Drive, Tampa, FL 33612, United States
| | - Eric B Haura
- Morsani College of Medicine, Department of Oncologic Science, University of South Florida, 12901 Bruce B Downs Blvd., Tampa, FL 33612, United States; Department of Thoracic Oncology, H. Lee Moffitt Cancer Center & Research Institute, 12902 Magnolia Drive, Tampa, FL 33612, United States
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7
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Kerr A, Ross E, Jacques G, Cunningham‐Burley S. The sociology of cancer: a decade of research. SOCIOLOGY OF HEALTH & ILLNESS 2018; 40:552-576. [PMID: 29446117 PMCID: PMC5901049 DOI: 10.1111/1467-9566.12662] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
Biomedicine is often presented as the driving force behind improvements in cancer care, with genomics the latest innovation poised to change the meaning, diagnosis, treatment, prevention and lived experience of cancer. Reviewing sociological analyses of a diversity of patient and practitioner experiences and accounts of cancer during the last decade (2007-17), we explore the experiences of, approaches to and understandings of cancer in this period. We identify three key areas of focus: (i) cancer patient experiences and identities; (ii) cancer risk and responsibilities and (iii) bioclinical collectives. We explore these sociological studies of societal and biomedical developments and how sociologists have sought to influence developments in cancer identities, care and research. We end by suggesting that we extend our understanding of innovations in the fields of cancer research to take better account of these wider social and cultural innovations, together with patients, activists' and sociologists' contributions therein.
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Affiliation(s)
- Anne Kerr
- School of Sociology and Social PolicyUniversity of LeedsUK
| | - Emily Ross
- The Usher InstituteEdinburgh Medical SchoolUniversity of EdinburghUK
| | - Gwen Jacques
- School of Sociology and Social PolicyUniversity of LeedsUK
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8
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Metastatic breast cancer patients: attitudes toward tissue donation for rapid autopsy. Breast Cancer Res Treat 2015; 155:159-64. [DOI: 10.1007/s10549-015-3664-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2015] [Accepted: 12/14/2015] [Indexed: 11/26/2022]
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Quinn GP, Murphy D, Pratt C, Muñoz-Antonia T, Guerra L, Schabath MB, Leon ME, Haura E. Altruism in terminal cancer patients and rapid tissue donation program: does the theory apply? MEDICINE, HEALTH CARE, AND PHILOSOPHY 2013; 16:857-64. [PMID: 23539332 PMCID: PMC3735793 DOI: 10.1007/s11019-013-9480-6] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
Rapid tissue donation (RTD) is an advancing oncology research procedure for collecting tumors, metastases, and unaffected tissue 2-6 h after death. Researchers can better determine rates of progression, response to treatment, and polymorphic differences among patients. Cancer patients may inquire about posthumous body donation for research to offer a personal contribution to research; however, there are barriers to recruiting for an RTD program. Physicians must reassure the patient that their treatment options and quality of care will not be compromised due to participating in RTD. In this commentary we discuss how theories of altruism may explain cancer patients' desire to participate in an RTD program, the ethical concerns of health care professionals and patients and the use of altruism as a recruitment strategy. We offer recommendations for examining the cultural and ethical climate of the institution prior to initiating such a program such as examining the relationship of healthcare professionals and patients, identifying ethical concerns, and examining ways to promote acceptance and buy-in across professionals, patients, and families.
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Affiliation(s)
- Gwendolyn P Quinn
- H. Lee Moffitt Cancer Center and Research Institute, 12902 Magnolia Drive, MRC-CANCONT, Tampa, FL, 33612, USA,
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