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Geng J, Li R, Wang X, Xu R, Liu J, Jiang H, Wang G, Hesketh T. Eliciting Older Cancer Patients' Preferences for Follow-Up Care to Inform a Primary Healthcare Follow-Up Model in China: A Discrete Choice Experiment. THE PATIENT 2024:10.1007/s40271-024-00697-4. [PMID: 38702574 DOI: 10.1007/s40271-024-00697-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 04/07/2024] [Indexed: 05/06/2024]
Abstract
BACKGROUND AND OBJECTIVES Increasing longevity and advances in treatment have increased the cancer burden in the elderly, resulting in complex follow-up care needs; however, in China, little is known about the follow-up care preferences of these patients. This study quantified older cancer patients' preferences for follow-up care and examined the trade-offs they are willing to make to accept an alternative follow-up model. METHODS A discrete choice experiment was conducted among inpatients aged over 60 years with breast, prostate, or colorectal cancer, at two large tertiary hospitals in Nantong, China. Preference weights for follow-up care were estimated using mixed logit analysis. Subgroup analysis and latent class analysis were used to explore preference heterogeneity. RESULTS Complete results were obtained from 422 patients (144 with breast cancer, 133 with prostate cancer, 145 with colorectal cancer), with a mean age of 70.81 years. Older cancer patients stated a preference for follow-up by specialists over primary healthcare (PHC) providers ( β = -1.18, 95% confidence interval -1.40 to -0.97). The provider of follow-up care services was the most valued attribute among patients with breast cancer (relative importance [RI] 37.17%), while remote contact services were prioritized by patients with prostate (RI 43.50%) and colorectal cancer (RI 33.01%). The uptake rate of an alternative care model integrating PHC increased compared with the baseline setting when patients were provided with preferred services (continuity of care, individualized care plans, and remote contact services). CONCLUSION To encourage older cancer patients to use PHC-integrated follow-up care, alternative follow-up care models need to be based on patients' preferences before introducing them as a routine option.
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Affiliation(s)
- Jiawei Geng
- Center for Global Health, School of Public Health, School of Medicine, Zhejiang University, Hangzhou, China
- Institute of Oncology, Affiliated Cancer Hospital of Nantong University, Nantong, China
| | - Ran Li
- Center for Global Health, School of Public Health, School of Medicine, Zhejiang University, Hangzhou, China
- Insititute of Global Health, University College London, London, UK
| | - Xinyu Wang
- School of Public Health, Nantong University, Nantong, China
| | - Rongfang Xu
- Department of Nursing, Affiliated Cancer Hospital of Nantong University, Nantong, China
| | - Jibin Liu
- Institute of Oncology, Affiliated Cancer Hospital of Nantong University, Nantong, China
| | - Haiyan Jiang
- Department of Health Management, Affiliated Hospital of Nantong University, Nantong, China
| | - Gaoren Wang
- Institute of Oncology, Affiliated Cancer Hospital of Nantong University, Nantong, China.
| | - Therese Hesketh
- Center for Global Health, School of Public Health, School of Medicine, Zhejiang University, Hangzhou, China.
- Insititute of Global Health, University College London, London, UK.
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Bender JL, Scruton S, Wong G, Abdelmutti N, Berlin A, Easley J, Liu ZA, McGee S, Rodin D, Sussman J, Urquhart R. Virtual follow-up care among breast and prostate cancer patients during and beyond the COVID-19 pandemic: Association with distress. Cancer Med 2024; 13:e6948. [PMID: 38466233 PMCID: PMC10926960 DOI: 10.1002/cam4.6948] [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: 08/04/2023] [Revised: 01/05/2024] [Accepted: 01/10/2024] [Indexed: 03/12/2024] Open
Abstract
BACKGROUND The purpose of this study was to investigate associations between self-reported distress (anxiety/depression) and satisfaction with and desire for virtual follow-up (VFU) care among cancer patients during and beyond the COVID-19 pandemic. METHODS Breast and prostate cancer patients receiving VFU at an urban cancer centre in Toronto, Canada completed an online survey on their sociodemographic, clinical, and technology, characteristics and experience with and views on VFU. EQ5D-5 L was used to assess distress. Statistical models adjusted for age, gender, education, income and Internet confidence. RESULTS Of 352 participants, average age was 65 years, 48% were women,79% were within 5 years of treatment completion, 84% had college/university education and 74% were confident Internet users. Nearly, all (98%) had a virtual visit via phone and 22% had a virtual visit via video. The majority of patients (86%) were satisfied with VFU and 70% agreed that they would like VFU options after the COVID-19 pandemic. Participants who reported distress and who were not confident using the Internet for health purposes were significantly less likely to be satisfied with VFU (OR = 0.4; 95% CI: 0.2-0.8 and OR = 0.19; 95% CI: 0.09-0.38, respectively) and were less likely to desire VFU option after the COVID-19 pandemic (OR = 0.49; 95% CI: 0.30-0.82 and OR = 0.41; 95% CI: 0.23-0.70, respectively). CONCLUSIONS The majority of respondents were satisfied with VFU and would like VFU options after the COVID-19 pandemic. Future research should determine how to optimize VFU options for cancer patients who are distressed and who are less confident using virtual care technology.
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Affiliation(s)
- Jacqueline L. Bender
- Cancer Rehabilitation and Survivorship, Department of Supportive CarePrincess Margaret Cancer CentreTorontoOntarioCanada
- Dalla Lana School of Public HealthUniversity of TorontoTorontoOntarioCanada
- Institute of Health Policy, Management and EvaluationUniversity of TorontoTorontoOntarioCanada
| | - Sarah Scruton
- Cancer Rehabilitation and Survivorship, Department of Supportive CarePrincess Margaret Cancer CentreTorontoOntarioCanada
| | - Geoff Wong
- Nuffield Department of Primary Care Health SciencesUniversity of OxfordOxfordUK
| | - Nazek Abdelmutti
- Cancer Quality Lab (CQual)Princess Margaret Cancer CentreTorontoOntarioCanada
- Cancer Digital IntelligencePrincess Margaret Cancer CentreTorontoOntarioCanada
| | - Alejandro Berlin
- Department of Radiation OncologyUniversity of TorontoTorontoOntarioCanada
- Radiation Medicine ProgramPrincess Margaret Cancer CentreTorontoOntarioCanada
| | - Julie Easley
- Department of Medical EducationHorizon Health NetworkFrederictonNew BrunswickCanada
| | - Zhihui Amy Liu
- Dalla Lana School of Public HealthUniversity of TorontoTorontoOntarioCanada
- Biostatistics DepartmentUniversity Health NetworkTorontoOntarioCanada
| | - Sharon McGee
- Division of Medical Oncology, Department of MedicineThe Ottawa Hospital and the University of OttawaOttawaOntarioCanada
| | - Danielle Rodin
- Department of Radiation OncologyUniversity of TorontoTorontoOntarioCanada
- Radiation Medicine ProgramPrincess Margaret Cancer CentreTorontoOntarioCanada
| | | | - Robin Urquhart
- Department of Community Health and EpidemiologyDalhousie UniversityHalifaxNova ScotiaCanada
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Magnani C, Smith AB, Rey D, Sarradon-Eck A, Préau M, Bendiane MK, Bouhnik AD, Mancini J. Fear of cancer recurrence in young women 5 years after diagnosis with a good-prognosis cancer: the VICAN-5 national survey. J Cancer Surviv 2023; 17:1359-1370. [PMID: 35318569 DOI: 10.1007/s11764-022-01193-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Accepted: 02/18/2022] [Indexed: 10/18/2022]
Abstract
PURPOSE Fear of cancer recurrence (FCR) is frequent in survivors, but less is known about FCR in long-term survivors with very low risk of relapse. Our aim was to estimate the prevalence and clinical and socio-behavioural factors associated with FCR in young women 5 years after diagnosis of a good-prognosis cancer. METHODS Using data from the VICAN-5 survey, conducted in 2015-2016 amongst a national representative French sample of cancer survivors, we included women with non-metastatic melanoma, breast, or thyroid cancer, aged 55 years or under at diagnosis, who experienced no disease progression in the 5 years post-diagnosis. Multinomial logistic regression was used to identify factors associated with FCR, characterised using a three-level indicator: no, mild, and moderate/severe FCR. RESULTS Amongst the 1153 women included, mean age was 44 years at diagnosis, and 81.8% had breast cancer, 12.5% thyroid cancer, and 5.8% melanoma. Five years after diagnosis, 35.4% reported no FCR, 46.0% mild FCR, and 18.6% moderate/severe FCR. Women with thyroid cancer were less likely to suffer from mild or moderate/severe FCR, while cancer-related treatment sequelae, fatigue, and anxiety were more likely. Limited health literacy was associated with mild FCR. Women who reported only occasionally consulting a general practitioner (GP) for the management of their cancer had a higher probability of FCR. CONCLUSION Moderate/severe FCR affected nearly 20% of young female long-term survivors diagnosed with a good-prognosis cancer, particularly those reporting cancer-related sequelae, suffering from fatigue or anxiety, with breast cancer or melanoma (versus thyroid cancer), and consulting a GP only occasionally for cancer management. IMPLICATIONS FOR CANCER SURVIVORS Given the recognised impact of FCR on quality of life, it is essential to detect it as early as possible, and to implement targeted interventions in routine care.
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Affiliation(s)
| | - Allan Ben Smith
- Ingham Institute for Applied Medical Research, New South Wales, Sydney, Australia
- South Western Sydney Clinical School, University of New South Wales, New South Wales, Liverpool, Australia
| | - Dominique Rey
- Aix Marseille Univ, Inserm, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de L'Information Médicale, ISSPAM, Equipe CANBIOS Labellisée Ligue 2019, Marseille, France
| | - Aline Sarradon-Eck
- Aix Marseille Univ, Inserm, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de L'Information Médicale, ISSPAM, Equipe CANBIOS Labellisée Ligue 2019, Marseille, France
- Institut Paoli-Calmettes, SESSTIM, Marseille, France
| | - Marie Préau
- Unité UMR 1296 «Radiations: Défense, Santé, Environnement», Lyon, France
- Institut de Psychologie, Université Lumière Lyon 2, Bron, France
| | - Marc-Karim Bendiane
- Aix Marseille Univ, Inserm, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de L'Information Médicale, ISSPAM, Equipe CANBIOS Labellisée Ligue 2019, Marseille, France
| | - Anne-Déborah Bouhnik
- Aix Marseille Univ, Inserm, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de L'Information Médicale, ISSPAM, Equipe CANBIOS Labellisée Ligue 2019, Marseille, France.
| | - Julien Mancini
- Aix Marseille Univ, APHM, Inserm, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de L'Information Médicale, ISSPAM, Equipe CANBIOS Labellisée Ligue 2019, Hop Timone, BioSTIC, Biostatistique et Technologies de l'Information et de la Communication, Marseille, France
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Genie MG, Ryan M, Krucien N. Keeping an eye on cost: What can eye tracking tell us about attention to cost information in discrete choice experiments? HEALTH ECONOMICS 2023; 32:1101-1119. [PMID: 36737875 DOI: 10.1002/hec.4658] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 01/10/2023] [Accepted: 01/20/2023] [Indexed: 06/18/2023]
Abstract
Concern has been expressed about including a cost attribute within discrete choice experiments (DCEs) when individuals do not have to pay at the point of consumption. We use eye tracking to investigate attention to cost when valuing publicly financed health care. One-hundred and four individuals completed a DCE concerned with preferences for UK general practitioner appointments: 51 responded to a DCE with cost included and 53 to the same DCE without cost. Eye-movements were tracked whilst respondents completed the DCE. We assessed if respondents pay attention to cost. We then compare fixation time (FT) on attributes, eye movement patterns and mental effort across the experimental groups. Results are encouraging for the inclusion of cost in DCEs valuing publicly provided healthcare. Most respondents gave visual attention to the cost attribute most of the time. Average FT on multi-attribute tasks increased by 44% in the cost DCE, with attention to non-monetary attributes increasing by 22%. Including cost led to more structured decision-making and did not increase mental effort. Acceptability of the cost attribute and difficulty of choice tasks were predictors of cost information processing, highlighting the importance of both motivating the cost attribute and considering difficulty of the tasks when developing DCEs.
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Affiliation(s)
- Mesfin G Genie
- Health Economics Research Unit, Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
- Department of Health Outcomes Research and Policy, Auburn University, Alabama, Auburn, USA
- Value in Health Economics and Policy Group, University of Newcastle, Newcastle, Australia
| | - Mandy Ryan
- Health Economics Research Unit, Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
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Nicolet A, Perraudin C, Krucien N, Wagner J, Peytremann-Bridevaux I, Marti J. Preferences of older adults for healthcare models designed to improve care coordination: evidence from Western Switzerland. Health Policy 2023; 132:104819. [PMID: 37060718 DOI: 10.1016/j.healthpol.2023.104819] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2022] [Revised: 12/02/2022] [Accepted: 04/04/2023] [Indexed: 04/08/2023]
Abstract
Implementing innovations in care delivery in Switzerland is challenging due to the fragmented nature of the system and the specificities of the political process (i.e., direct democracy, decentralized decision-making). In this context, it is particularly important to account for population preferences when designing policies. We designed a discrete choice experiment to study population preferences for coordination-improving care models. Specifically, we assessed the relative importance of model characteristics (i.e., insurance premium, presence of care coordinator, access to specialists, use of EMR, cost-sharing for chronic patients, incentives for informal care), and predicted uptake under different policy scenarios. We accounted for heterogeneity in preferences for the status quo option using an error component logit model. Respondents attached the highest importance to the price attribute (i.e. insurance premium) (0.31, CI: 0.27- 0.36) and to the presence of a care coordinator (0.27, CI: 0.23 - 0.31). Policy scenarios showed for instance that gatekeeping would be preferred to free access to specialists if the model includes a GP or an interprofessional team as a care coordinator. Although attachment to the status quo is high in the studied population, there are potential ways to improve acceptance of alternative care models by implementation of positively valued innovations.
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Peng X, Hui-Qin L, Xia H. Whether preferences of gastric cancer patients after surgery for follow-up change over time? Analysis based on discrete choice experiment. Support Care Cancer 2023; 31:234. [PMID: 36964800 DOI: 10.1007/s00520-023-07699-2] [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: 09/10/2022] [Accepted: 03/17/2023] [Indexed: 03/26/2023]
Abstract
PURPOSES The purposes of this discrete choice experiment are as follows: (1) quantify the relevant characteristics that may affect the follow-up selection of gastric cancer patients after surgery and (2) explore the differences in follow-up preferences of gastric cancer patients at different stages and reveal the change trend of preferences over time, thereby providing references for the formulation and optimization of follow-up strategies. METHODS A survey instrument that was developed using the design principle of a discrete choice experiment investigated gastric cancer patients on the day of discharge, and at 3 months, 6 months, and 12 months after discharge. In Stata 15.0, a mixed logit model was used to explore the preferences of gastric cancer patients after surgery at different stages, the willingness to pay was calculated, and the NLCOM command was used to simulate the follow-up uptake rates of different attribute levels at different stages. RESULTS On the day of discharge, and 3 months, 6 months, and 12 months after discharge, the most important attribute levels of gastric cancer patients after surgery were "thoroughness-very thorough," "method-face-to-face," "thoroughness-very thorough," and "provider-specialist nurse," respectively, and patients were willing to pay more for these services. Patients' preference for the attribute level "very thorough" decreased over time, while their preferences for "specialist doctors" as follow-up providers remained relatively stable. Furthermore, the attribute levels with the greatest effect on receiving the baseline follow-up program varied across stages. CONCLUSION The gastric cancer patients' preferences for follow-up change over time, and the time factor should be considered when developing follow-up strategies.
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Affiliation(s)
- Xie Peng
- Operating Room, West China Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu, 610041, Sichuan province, People's Republic of China
| | - Li Hui-Qin
- Mental Health Center, West China Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu, 610041, Sichuan province, People's Republic of China
| | - Huang Xia
- Mental Health Center, West China Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu, 610041, Sichuan province, People's Republic of China.
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Denise de Lima Bezerra A, Matias de Sousa I, Silva de Souza AP, Miranda de Carvalho AL, Trussardi Fayh AP. Early nutritional intervention does not prevent long-term adverse events in women with breast cancer: A pilot study. Clin Nutr ESPEN 2023; 53:268-273. [PMID: 36657923 DOI: 10.1016/j.clnesp.2022.12.013] [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: 07/03/2022] [Revised: 11/24/2022] [Accepted: 12/12/2022] [Indexed: 12/23/2022]
Abstract
AIM This study aims to evaluate the effect of early nutritional intervention on adverse clinical events in women with breast cancer undergoing neoadjuvant chemotherapy. DESIGN AND SETTINGS This is a randomized clinical trial performed at the beginning of neoadjuvant chemotherapy for women with breast cancer treated at an oncology referral center (Brazil) and followed until the end of radiotherapy period, at least. Registered under ClinicalTrials.gov Identifier no. RBR-3SHHXS. METHODS Participants were allocated to a control group - CG (nutritional guidance on healthy eating practices) or an intervention group - IC (nutritional guidance and individualized food plan). Chemotherapy toxicity (primary endpoint) was considered a precocious adverse clinical event and it was evaluated by self-reported gastrointestinal symptoms observed at any time during the first three cycles of treatment. Post-surgical complications, radiotherapy toxicity, and weight change were considered long-term adverse events. RESULTS 34 women (19 in the IG and 15 in the CG) were evaluated. The early nutritional intervention was associated with low gastrointestinal chemotoxicity (nausea, vomiting, and constipation, p < 0.001, p < 0.048, and p < 0.024, respectively). However, there were no statically significant differences between both groups in the presence of long-term adverse events (radiotherapy toxicity-88.2% vs 76.9%, weight loss-21.1% vs 26.7% for IC and CG respectively, p > 0.05 for both). CONCLUSION The early nutritional intervention was associated with a low frequency of precocious events, but not with long-term adverse events in women with breast cancer during treatment.
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Affiliation(s)
- Agnes Denise de Lima Bezerra
- Postgraduate Program in Health Sciences, Health Sciences Center, Federal University of Rio Grande do Norte, Natal, RN, Brazil
| | - Iasmin Matias de Sousa
- Postgraduate Program in Health Sciences, Health Sciences Center, Federal University of Rio Grande do Norte, Natal, RN, Brazil
| | - Ana Priscilla Silva de Souza
- Postgraduate Program in Health Sciences, Health Sciences Center, Federal University of Rio Grande do Norte, Natal, RN, Brazil
| | - Ana Lúcia Miranda de Carvalho
- Postgraduate Program in Health Sciences, Health Sciences Center, Federal University of Rio Grande do Norte, Natal, RN, Brazil; Liga Norteriograndense Contra o Câncer, Natal, RN, Brazil
| | - Ana Paula Trussardi Fayh
- Postgraduate Program in Health Sciences, Health Sciences Center, Federal University of Rio Grande do Norte, Natal, RN, Brazil; Postgraduate Program in Nutrition, Health Sciences Center, Federal University of Rio Grande do Norte, Natal, RN, Brazil.
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Zhang N, Chang X, Liu R, Zheng C, Wang X, Birch S. General population preferences for cancer care in health systems of China: A discrete choice experiment. Cancer Med 2022; 12:7485-7497. [PMID: 36479927 PMCID: PMC10067129 DOI: 10.1002/cam4.5473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Revised: 10/13/2022] [Accepted: 11/13/2022] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND The increasing incidence of cancer in China has posed considerable challenges for cancer care delivery systems. This study aimed to determine the general population's preferences for cancer care, to provide evidence for building a people-centered integrated cancer care system. METHODS We conducted a discrete choice experiment that involved 1,200 participants in Shandong Province. Individuals were asked to choose between cancer care scenarios based on the type and level of hospitals, with various out-of-pocket costs, waiting time, and contact working in the hospitals. Individual preferences, willingness to pay, and uptake rate were estimated using a mixed-logit model. RESULTS This study included 848 respondents (70.67%). Respondents preferred county hospitals with shorter hospitalization waiting times and contact working in hospitals. Compared to the reference levels, the three highest willingness to pay values were related to waiting time for hospitalization (¥97,857.69-¥145411.70-¥212,992.10/$14512.70-$21565.16-$31587.61), followed by the county-level hospital (¥32,545.13/$4826.58). The preferences of the different groups of respondents were diverse. Based on a county-level general hospital with contact in the hospital, 50% out-of-pocket costs and a waiting time of 15 days, the probability of seeking baseline care was 0.37. Reducing the waiting time from 15 to 7, 3, and 0 days, increases the probability of choosing a county-level hospital from 0.37 to 0.58, 0.64, and 0.70, respectively. CONCLUSIONS This study suggests that there is a substantial interest in attending county-level hospitals and that reducing hospitalization waiting time is the most effective measure to increase the probability of seeking cancer care in county-level hospitals.
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Affiliation(s)
- Nan Zhang
- Center for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University Jinan China
- NHC Key Lab of Health Economics and Policy Research (Shandong University) Jinan China
- Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences Jinan China
| | - Xuan Chang
- Department of Publicity Shandong Provincial Hospital Affiliated to Shandong First Medical University Jinan China
| | - Ruyue Liu
- School of Public Health Weifang Medical University Weifang China
| | - Caiyun Zheng
- School of Public Health Sun Yat‐Sen University Guangzhou China
| | - Xin Wang
- School of Public Health Sun Yat‐Sen University Guangzhou China
| | - Stephen Birch
- Centre for the Business and Economics of Health, University of Queensland Brisbane Australia
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Karim S, Craig BM, Vass C, Groothuis-Oudshoorn CGM. Current Practices for Accounting for Preference Heterogeneity in Health-Related Discrete Choice Experiments: A Systematic Review. PHARMACOECONOMICS 2022; 40:943-956. [PMID: 35960434 DOI: 10.1007/s40273-022-01178-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 07/12/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Accounting for preference heterogeneity is a growing analytical practice in health-related discrete choice experiments (DCEs). As heterogeneity may be examined from different stakeholder perspectives with different methods, identifying the breadth of these methodological approaches and understanding the differences are major steps to provide guidance on good research practices. OBJECTIVES Our objective was to systematically summarize current practices that account for preference heterogeneity based on the published DCEs related to healthcare. METHODS This systematic review is part of the project led by the Professional Society for Health Economics and Outcomes Research (ISPOR) health preference research special interest group. The systematic review conducted systematic searches on the PubMed, OVID, and Web of Science databases, as well as on two recently published reviews, to identify articles. The review included health-related DCE articles published between 1 January 2000 and 30 March 2020. All the included articles also presented evidence on preference heterogeneity analysis based on either explained or unexplained factors or both. RESULTS Overall, 342 of the 2202 (16%) articles met the inclusion/exclusion criteria for extraction. The trend showed that analyses of preference heterogeneity increased substantially after 2010 and that such analyses mainly examined heterogeneity due to observable or unobservable factors in individual characteristics. Heterogeneity through observable differences (i.e., explained heterogeneity) is identified among 131 (40%) of the 342 articles and included one or more interactions between an attribute variable and an observable characteristic of the respondent. To capture unobserved heterogeneity (i.e., unexplained heterogeneity), the studies largely estimated either a mixed logit (n = 205, 60%) or a latent-class logit (n = 112, 32.7%) model. Few studies (n = 38, 11%) explored scale heterogeneity or heteroskedasticity. CONCLUSIONS Providing preference heterogeneity evidence in health-related DCEs has been found as an increasingly used practice among researchers. In recent studies, controlling for unexplained preference heterogeneity has been seen as a common practice rather than explained ones (e.g., interactions), yet a lack of providing methodological details has been observed in many studies that might impact the quality of analysis. As heterogeneity can be assessed from different stakeholder perspectives with different methods, researchers should become more technically pronounced to increase confidence in the results and improve the ability of decision makers to act on the preference evidence.
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Affiliation(s)
- Suzana Karim
- University of South Florida, 4202 E Fowler Ave, Tampa, FL, 33620, USA.
| | - Benjamin M Craig
- University of South Florida, 4202 E Fowler Ave, Tampa, FL, 33620, USA
| | - Caroline Vass
- RTI Health Solutions, Manchester, UK
- The University of Manchester, Manchester, UK
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Sandell T, Schütze H. Factors influencing the translation of shared cancer follow-up care into clinical practice: a systematic review. BMJ Open 2022; 12:e055460. [PMID: 36038175 PMCID: PMC9438010 DOI: 10.1136/bmjopen-2021-055460] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND The increasing incidence of cancer, coupled with improved survivorship, has increased demand for cancer follow-up care and the need to find alternative models of care. Shared cancer follow-up care in general practice is a safe option in terms of quality of life and cancer recurrence; however, there are barriers to translating this into practice. This review aimed to identify factors that influence the translation of shared cancer follow-up care into clinical practice. METHODS Systematic review. Seven electronic databases: MEDLINE, Science Citation Index, Academic Search Complete, CINAHL, APA Psychinfo, Health Source: Nursing/Academic Edition and Psychology and Behavioural Sciences Collection, were searched for published papers between January 1999 and December 2021. The narrative review included papers if they were available in full-text, English, peer-reviewed and focused on shared cancer follow-up care. RESULTS Thirty-eight papers were included in the final review. Five main themes emerged: (1) reciprocal clinical information sharing is needed between oncologists and general practitioners, and needs to be timely and relevant; (2) responsibility of care should be shared with the oncologist overseeing care; (3) general practitioners skills and knowledge to provide cancer follow-up care; (4) need for clinical management guidelines and rapid referral to support general practitioners to provide shared follow-up care and (5) continuity of care and satisfaction of care is vital for shared care. CONCLUSION The acceptability of shared cancer follow-up care is increasing. Several barriers still exist to translating this into practice. Work is required to develop a shared-care model that can support general practitioners, while the oncologist can oversee the care and implement two-way communication between general and oncologists' clinics. The move towards integrating electronic healthcare records and web-based platforms for information exchange provides a promise to the timely exchange of information. PROSPERO REGISTRATION NUMBER CRD42020191538.
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Affiliation(s)
- Tiffany Sandell
- School of Medicine, University of Wollongong Faculty of Science Medicine and Health, Wollongong, New South Wales, Australia
- Radiation Oncology, Illawarra Shoalhaven Local Health District, Wollongong, New South Wales, Australia
| | - Heike Schütze
- School of Medicine, University of Wollongong Faculty of Science Medicine and Health, Wollongong, New South Wales, Australia
- Centre for Primary Health Care and Equity, University of New South Wales Faculty of Medicine, Sydney, New South Wales, Australia
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11
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Patient and Public Preferences for Coordinated Care in Switzerland: Development of a Discrete Choice Experiment. THE PATIENT - PATIENT-CENTERED OUTCOMES RESEARCH 2022; 15:485-496. [PMID: 35067858 PMCID: PMC9197802 DOI: 10.1007/s40271-021-00568-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 12/12/2021] [Indexed: 11/10/2022]
Abstract
Objective Our objective was to develop and test a discrete choice experiment (DCE) eliciting public and patient preferences for better-coordinated care in Switzerland. Methods We applied a multistage mixed-methods procedure using qualitative and quantitative approaches. First, to identify attributes, we performed a review of the DCE literature in healthcare with a focus on chronic care. Next, attribute selection involved stakeholders (N = 7) from various healthcare sectors to select the most relevant and actionable attributes, followed by three organized focus groups involving the general public and patients (N = 21) to verify the selection and the clarity of the DCE tasks and explanations. Finally, we conducted an online pilot in the target population to test the survey and obtain priors for a final six tested attributes to refine the final design of the experiment. Results After identifying an initial 33 attributes, a final list of six attributes was selected following stakeholder involvement and the three focus groups involving the target population. At the online pilot-testing stage with 301 participants, the majority of respondents found the DCE choice tasks socially relevant for Switzerland but challenging. The quality of the answers was relatively high. Most attributes had signs matching those in the literature and focus group discussions. Conclusion This article will be useful to researchers designing DCEs from a broad health policy perspective. The multistage approach involving a range of stakeholders was essential for the development of a DCE that is relevant for policy makers and well-accepted by the general public and patients. Supplementary Information The online version contains supplementary material available at 10.1007/s40271-021-00568-2.
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Jefford M, Howell D, Li Q, Lisy K, Maher J, Alfano CM, Rynderman M, Emery J. Improved models of care for cancer survivors. Lancet 2022; 399:1551-1560. [PMID: 35430022 PMCID: PMC9009839 DOI: 10.1016/s0140-6736(22)00306-3] [Citation(s) in RCA: 76] [Impact Index Per Article: 38.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2021] [Revised: 01/23/2022] [Accepted: 02/10/2022] [Indexed: 12/24/2022]
Abstract
The number of survivors of cancer is increasing substantially. Current models of care are unsustainable and fail to address the many unmet needs of survivors of cancer. Numerous trials have investigated alternate models of care, including models led by primary-care providers, care shared between oncology specialists and primary-care providers, and care led by oncology nurses. These alternate models appear to be at least as effective as specialist-led care and are applicable to many survivors of cancer. Choosing the most appropriate care model for each patient depends on patient-level factors (such as risk of longer-term effects, late effects, individual desire, and capacity to self-manage), local services, and health-care policy. Wider implementation of alternative models requires appropriate support for non-oncologist care providers and endorsement of these models by cancer teams with their patients. The COVID-19 pandemic has driven some changes in practice that are more patient-centred and should continue. Improved models should shift from a predominant focus on detection of cancer recurrence and seek to improve the quality of life, functional outcomes, experience, and survival of survivors of cancer, reduce the risk of recurrence and new cancers, improve the management of comorbidities, and reduce costs to patients and payers. This Series paper focuses primarily on high-income countries, where most data have been derived. However, future research should consider the applicability of these models in a wider range of health-care settings and for a wider range of cancers.
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Affiliation(s)
- Michael Jefford
- Department of Health Services Research, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia; Australian Cancer Survivorship Centre, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia; Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, VIC, Australia.
| | - Doris Howell
- Princess Margaret Cancer Research Institute, Toronto, ON, Canada
| | - Qiuping Li
- Wuxi School of Medicine, Jiangnan University, Wuxi, China
| | - Karolina Lisy
- Department of Health Services Research, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia; Australian Cancer Survivorship Centre, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia; Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, VIC, Australia
| | | | - Catherine M Alfano
- Northwell Health Cancer Institute, Lake Success, NY, USA; Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA; Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY, USA
| | - Meg Rynderman
- Australian Cancer Survivorship Centre, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | - Jon Emery
- Centre for Cancer Research, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, VIC, Australia
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Wang W, Li H, Li Y, Fang S, Zhang S, Zhang X, Meng X, Su J, Sun J. Colorectal cancer survivors' experience of continuity of care provided by different health professionals: A qualitative evidence synthesis. J Clin Nurs 2022; 31:2985-2999. [PMID: 34985169 DOI: 10.1111/jocn.16189] [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: 07/03/2021] [Revised: 12/08/2021] [Accepted: 12/16/2021] [Indexed: 12/09/2022]
Abstract
AIMS AND OBJECTIVES To systematically identify, synthesise and characterise the available qualitative evidence on the experience of adult colorectal cancer survivors with continuity of care led by different health professionals. BACKGROUND The limited evidence base for effective continuity of care led by different medical staff who assist colorectal cancer survivors with their unique survivorship care hampers the development of effective interventions. Synthesising the data on survivors' experience of care led by different health professionals is critical to develop such interventions. DESIGN A qualitative evidence synthesis using the Thomas and Harden method and the PRISMA 2020 checklist provided by the EQUATOR network were used. METHODS PubMed, Web of Science, Embase, Cochrane, CINAHL and PsycINFO were searched through November 2020 for qualitative and mixed methods studies in English. JBI-QARI was used to undertake a quality review of the identified studies. The review findings were synthesised by a team of researchers, and the level of confidence was evaluated using GRADE-CERQual. RESULTS Eleven studies met the criteria for inclusion in the review. The identified analytical themes included experience of diversity, preference for health professionals and space for enhancement to facilitate improved medical care delivery. Colorectal cancer survivors report diverse experiences regarding continuity of care led by different providers. Specifically, they attach substantial importance to trusted relationships with providers that are closely associated with their overall care experience. CONCLUSION Effective communication and good rapport among stakeholders are cornerstones for addressing the complexity of ongoing care. Future interventions should include adjusting the percentage of care from different providers to deliver cost-effective and personalised continuity of care. RELEVANCE TO CLINICAL PRACTICE Synthesising data on survivors' experience facilitates the development of practical approaches to increase the quality of continuity of care and may also foster the integration of providers' advantages to enable more cost-effective intervention. The limited capacity of primary care providers may be enhanced by better cooperation and communication with specialists and by additional professional cancer-related training.
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Affiliation(s)
- Wenxia Wang
- Basic Nursing Department, School of Nursing, Jilin University, Changchun, China
| | - Huanhuan Li
- Basic Nursing Department, School of Nursing, Jilin University, Changchun, China
| | - Yijing Li
- Basic Nursing Department, School of Nursing, Jilin University, Changchun, China
| | - Shuyan Fang
- Basic Nursing Department, School of Nursing, Jilin University, Changchun, China
| | - Shuang Zhang
- Basic Nursing Department, School of Nursing, Jilin University, Changchun, China
| | - Xu Zhang
- Basic Nursing Department, School of Nursing, Jilin University, Changchun, China
| | - Xiangfei Meng
- Basic Nursing Department, School of Nursing, Jilin University, Changchun, China
| | - Jianping Su
- Basic Nursing Department, School of Nursing, Jilin University, Changchun, China
| | - Jiao Sun
- Basic Nursing Department, School of Nursing, Jilin University, Changchun, China
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Kimachi M, Omae K, Kamitani T, Fukuma S. Primary care physicians' perceptions concerning engagement in cancer survivor care. J Gen Fam Med 2021; 23:149-157. [PMID: 35509332 PMCID: PMC9062547 DOI: 10.1002/jgf2.515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Revised: 10/19/2021] [Accepted: 12/06/2021] [Indexed: 12/05/2022] Open
Abstract
Background Given the growing diversity among cancer survivors and the fact that oncologists typically do not perform long‐term care, the expected role of primary care physicians (PCPs) in survivor care is expanding. However, communication and collaboration between oncologists and PCPs are lacking. Therefore, we assessed the perception of cancer survivor care among PCPs. Methods We sent a questionnaire to 767 Japanese Board–certified PCPs, regardless of facility type (clinics and hospitals), inquiring about PCPs' perceptions of their role in survivor care. Additionally, we included vignette‐based scenarios focused on colorectal and prostate cancer survivors to explore factors associated with their clinical decisions. Results We obtained 91 replies (response rate: 11.9%). A total of 75% of PCPs had encountered at least 1 cancer patient in actual practice. Even for patients actively receiving cancer treatment, >70% of PCPs reported that they were willing to engage in comprehensive survivor care, except for the administration of anticancer drugs. Further, 49% of PCPs considered that both PCPs and oncologists were suited to performing regular screening for cancer recurrence in high‐risk patients. Multivariable logistic regression analyses revealed that clinic PCPs were less inclined to conduct screening for recurrence than hospital PCPs in both colorectal (odds ratio, 3.85 [95% confidence interval 1.40–10.6]) and prostate (4.36 [95% confidence interval 1.51–12.6]) cancer scenarios. Conclusions Our findings suggest that Japanese PCPs are willing to engage in survivor care and encourage closer collaboration between oncologists and PCPs. However, oncologists might need to request cooperation, considering the facility type with which PCPs are affiliated. The present study revealed that Japanese primary care physicians (PCPs) were willing to engage in comprehensive survivor care, except for the administration of anticancer drugs. Further, most PCPs were willing to engage in psychosocial support to relieve survivors' anxiety and manage work‐related issues, but they have few opportunities to collaborate with oncologists. Oncologists and PCPs need to engage in more communication and conduct cancer survivor care while capitalizing on PCPs' willingness and capability.![]()
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Affiliation(s)
- Miho Kimachi
- Human Health Sciences Kyoto University Graduate School of Medicine Kyoto Japan
| | - Kenji Omae
- Department of Innovative Research and Education for Clinicians and Trainees (DiRECT) Fukushima Medical University Fukushima Japan
- Department of Healthcare Epidemiology School of Public Health in the Graduate School of Medicine Kyoto University Kyoto Japan
| | - Tsukasa Kamitani
- Department of Healthcare Epidemiology School of Public Health in the Graduate School of Medicine Kyoto University Kyoto Japan
| | - Shingo Fukuma
- Human Health Sciences Kyoto University Graduate School of Medicine Kyoto Japan
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Preferences of gastric cancer survivors for follow-up care-a multicenter discrete choice experiment study. Support Care Cancer 2021; 30:1221-1229. [PMID: 34455494 DOI: 10.1007/s00520-021-06505-1] [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: 01/26/2021] [Accepted: 08/11/2021] [Indexed: 12/24/2022]
Abstract
PURPOSES The purposes of this discrete choice experiment are as follows: (1) to investigate the preferences of gastric cancer survivors for follow-up care, and (2) to quantify the importance of follow-up care-related characteristics that may affect the gastric cancer survivors' choices of their follow-up, so as to provide references for the development of the follow-up strategy of gastric cancer survivors. METHODS Discrete choice experimental design principle was applied to develop the survey instrument. All questionnaires were filled out by the respondents and collected on site. A mixed logit model was used to estimate gastric cancer survivors' preferences. Willingness to pay estimates and simulations of follow-up uptake rates were calculated. RESULTS All six attributes are significantly important for the follow-up care of gastric cancer survivors (p < 0.05). Achieving very thorough follow-up contents was the most valued attribute level (coefficient = 1.995). Specialist doctors are the most preferred providers followed by specialist nurses, and gastric cancer survivors were willing to pay more for these attribute levels. Changes in attribute levels affected uptake rate of follow-up. When the multiple attribute levels were changed at the same time, a very thorough follow-up content was provided by the same specialist doctor (specialist nurse), and the probability of receiving follow-up increases by 95.82% (94.90%). CONCLUSIONS The characteristics of follow-up care in our study reflect the health management services' expectations of gastric cancer survivors. A dedicated specialist nurse involved in follow-up care should be developed to contribute to solve the complex and multifaceted personal needs of gastric cancer survivors.
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Sagar A, Mai D, Rumy N, Al-Habsi R, Divya GS, Singh A. The Colorectal Telephone Clinic: a new normal post-COVID-19? Ann R Coll Surg Engl 2021; 103:520-523. [PMID: 34192482 DOI: 10.1308/rcsann.2020.7070] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION In light of the COVID-19 recommendations from the Association of Coloproctology of Great Britain and Ireland, we aimed to study patient and clinician satisfaction with a newly established telephone (TP) colorectal clinic service in lieu of traditional face-to-face (FTF) appointments. Comparative outcomes included patient versus clinician satisfaction; patient versus clinician desire to continue TP clinics postpandemic; and views of Specialty Trainee 3+ (ST3+)/Specialty Associate Specialist (SAS) doctors versus consultants on TP compared with FTF appointments. METHODS We conducted a prospective service evaluation of patient and clinician satisfaction with colorectal surgery TP clinics between 1 June 2020 and 30 June 2020 in a British District General Hospital. RESULTS Patients had higher satisfaction than clinicians with TP clinics: 91.5% versus 66.6% reported above-average experience [odds ratio (OR) = 5.35, 95% confidence interval (CI) 1.53 to 18.75, p = 0.01]. Clinicians had lower demand to continue TP clinics post-COVID-19 versus patients, with a trend towards significance (60% versus 82.9%, OR = 0.31, 95% CI 0.10 to 0.97, p = 0.08). ST3+/SAS doctors were more likely than consultants to find TP clinics inferior to FTF consultation for patient assessment (48.3% versus 23.7%, OR = 3.00, 95% CI 1.17 to 7.71, p = 0.03). CONCLUSIONS While clinicians may be concerned that patient assessment suffers, patient satisfaction with TP clinics is high. There should be a place for TP clinics post-COVID-19 but there must be a robust process for patient selection as well as adequate training for current and future generations of clinicians.
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Affiliation(s)
- A Sagar
- Milton Keynes University Hospital, UK
| | - Dvc Mai
- Milton Keynes University Hospital, UK
| | - N Rumy
- Milton Keynes University Hospital, UK
| | | | - G S Divya
- Milton Keynes University Hospital, UK
| | - A Singh
- Milton Keynes University Hospital, UK
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Fishburn A, Fishburn N. Establishing a nurse-led thyroid cancer follow-up clinic. BRITISH JOURNAL OF NURSING (MARK ALLEN PUBLISHING) 2021; 30:S28-S35. [PMID: 33641396 DOI: 10.12968/bjon.2021.30.4.s28] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Thyroid cancer is a complex disease requiring management by a large multidisciplinary team. The number of patients with a diagnosis of thyroid cancer is significantly increasing year-on-year, and traditional models of consultant-led follow up are no longer sustainable. Although nurse-led cancer follow-up clinics are becomining increasingly common, thyroid cancer nurse-led follow-up clinics are rare. An excellent understanding of the disease, treatment and management of risk of disease recurrence is essential for safe patient care, and is discussed in this article. The clinic discussed uses the skill set of head and neck nurse specialists, including psychological support, coping strategies for long-term side effects of treatment and non-medical prescribing. A patient survey of the service revealed high levels of patient satisfaction and a desire to continue face-to-face consultations rather than telephone clinics.
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Affiliation(s)
- Andrew Fishburn
- Macmillan Lead Clinical Nurse Specialist in Head & Neck at the time of writing, and is now Nurse Consultant in Head & Neck, ENT Suite, Royal Preston Hospital, Lancashire Teaching Hospitals NHS Trust
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Johnston EA, van der Pols JC, Ekberg S. Needs, preferences, and experiences of adult cancer survivors in accessing dietary information post-treatment: A scoping review. Eur J Cancer Care (Engl) 2020; 30:e13381. [PMID: 33377564 DOI: 10.1111/ecc.13381] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Revised: 10/13/2020] [Accepted: 11/18/2020] [Indexed: 01/08/2023]
Abstract
INTRODUCTION To support provision of healthy lifestyle information tailored to patients' needs and preferences, this review maps adult cancer survivors' self-reported needs, preferences, and experiences accessing dietary information post-treatment. METHODS A scoping review of research published within the past decade conducted using PRISMA-ScR guidelines. Seven databases were searched in June 2020. RESULTS Of 15,973 articles identified, 57 met eligibility criteria. Studies most frequently included survivors of breast cancer (49%), persons aged 40+ years (95%), ≤5 years post-diagnosis (54%), and residing in North America (44%). Cancer survivors commonly identified needing information regarding healthy eating, particularly practical skills, and support in changing dietary behaviours. Preferences included specific recommendations, direct communication with healthcare professionals, and peer support from other cancer survivors. In practice, survivors frequently reported receiving generic advice from healthcare professionals, limited dietary follow-up, and lack of referral to support. Unmet needs in healthcare settings led to dietary information-seeking elsewhere; however, survivors indicated difficulty identifying credible sources. Personal beliefs and desire for involvement in care motivated dietary information-seeking post-treatment. CONCLUSION Cancer survivors' experiences accessing dietary information post-treatment do not align with needs and preferences. Less is known about survivors who are young adults, >5 years post-diagnosis, and living in rural areas.
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Affiliation(s)
- Elizabeth A Johnston
- School of Exercise and Nutrition Sciences, Queensland University of Technology (QUT), Kelvin Grove, QLD, Australia
| | - Jolieke C van der Pols
- School of Exercise and Nutrition Sciences, Queensland University of Technology (QUT), Kelvin Grove, QLD, Australia
| | - Stuart Ekberg
- School of Psychology and Counselling, Queensland University of Technology (QUT), Kelvin Grove, QLD, Australia
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Johnson H, Taylor S, Peat S, Booker J, Yorke J. Evaluation of the safety and effectiveness of prostate-specific antigen (PSA) monitoring in primary care after discharge from hospital-based follow-up following prostate cancer treatment. Eur J Cancer Care (Engl) 2020; 30:e13389. [PMID: 33336540 DOI: 10.1111/ecc.13389] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Revised: 10/01/2020] [Accepted: 11/27/2020] [Indexed: 01/07/2023]
Abstract
OBJECTIVE To examine follow-up procedures after men are discharged into primary care following prostate cancer and highlight any areas for service improvement. METHODS Patient record data from two Greater Manchester boroughs were retrieved retrospectively to investigate discharge instructions and monitoring adherence. Questionnaires were sent to patients exploring their understanding of the follow-up process. RESULTS A total of 300 records were accessed. Prostate-specific antigen (PSA) re-referral level was provided to GPs in 39% of cases. Forty- six percent of men were not tested frequently enough, and 6% had no PSA testing recorded post-discharge. A total of 222 patient questionnaires were returned. Sixty-seven percent felt GPs should be responsible for PSA monitoring, and 60% felt confident that their GP was doing so effectively. Conversely, 12% felt their PSA monitoring had been neglected. CONCLUSION The findings highlight the complex nature of the follow-up and monitoring processes for prostate cancer patients. There is an urgent need for consensus in terms of monitoring frequency and referral pathways. Many patients do not engage in accurate monitoring post-treatment which has implications for early diagnosis of recurrence. Findings will be used to create an evidence-based, uniform Greater Manchester PSA monitoring service which is safe, acceptable and effective for all.
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Affiliation(s)
| | - Sally Taylor
- The Christie Patient Centred Research Team, The Christie School of Oncology, The Christie NHS Foundation Trust, Manchester, UK
| | - Sara Peat
- The Christie Patient Centred Research Team, The Christie School of Oncology, The Christie NHS Foundation Trust, Manchester, UK
| | - Jane Booker
- The Christie NHS Foundation Trust, Manchester, UK
| | - Janelle Yorke
- The Christie Patient Centred Research Team, The Christie School of Oncology, The Christie NHS Foundation Trust, Manchester, UK.,Division of Nursing, Midwifery and Social Work, School of Health Sciences, University of Manchester, Manchester, UK
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Anderson A, Barnett K, Bhagat M, Steele R. A qualitative evaluation of the impact of a training programme on colorectal cancer risk reduction for Specialist Screening Practitioners on health promotion, knowledge and practice. Eur J Cancer Care (Engl) 2020; 30:e13350. [PMID: 33119181 PMCID: PMC7900982 DOI: 10.1111/ecc.13350] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Revised: 06/15/2020] [Accepted: 07/16/2020] [Indexed: 11/30/2022]
Abstract
Objective Colorectal cancer (CRC) is the fourth most common cancer in the UK. It is estimated that around 50% of the disease burden is caused by lifestyle factors. This paper evaluates the impact of a training programme for Specialist Screening Practitioners (SSPs) on knowledge of CRC risk reduction and subsequent health promotion activities. Method Attendees (n = 21) were invited to participate in semi‐structured qualitative telephone interviews developed in conjunction with programme organisers. An independent researcher undertook the interviews on the perceived impact of the training on knowledge about risk reduction, communicating health promotion messages and working practices. Results Ten interviews were conducted. The programme was perceived to be successful in increasing knowledge about CRC risk and methods to promote behavioural change. Participants questioned the suitability of the endoscopy setting to communicate health promotion messages given patient anxiety pre‐investigation and post‐investigation elation after negative results. Key barriers to health promotion activities were time, hesitancy over raising issues that could not be easily discussed and scepticism about the ability of older adults to change their lifestyle. Conclusions Training on CRC risk reduction increased knowledge and behaviour change skills among SSPs. Further work is needed to explore opportunities to optimise the screening environment for health promotion activities.
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Affiliation(s)
- Annie Anderson
- Division of Population Health & Genomics, Centre for Research into Cancer Prevention and Screening, Ninewells Hospital and Medical School, University of Dundee, Dundee, UK
| | - Karen Barnett
- Division of Population Health & Genomics, Centre for Research into Cancer Prevention and Screening, Ninewells Hospital and Medical School, University of Dundee, Dundee, UK
| | - Meena Bhagat
- Division of Population Health & Genomics, Centre for Research into Cancer Prevention and Screening, Ninewells Hospital and Medical School, University of Dundee, Dundee, UK
| | - Robert Steele
- Division of Population Health & Genomics, Centre for Research into Cancer Prevention and Screening, Ninewells Hospital and Medical School, University of Dundee, Dundee, UK
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Qaderi SM, Swartjes H, Custers JAE, de Wilt JHW. Health care provider and patient preparedness for alternative colorectal cancer follow-up; a review. Eur J Surg Oncol 2020; 46:1779-1788. [PMID: 32571636 DOI: 10.1016/j.ejso.2020.06.017] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Revised: 05/06/2020] [Accepted: 06/11/2020] [Indexed: 12/15/2022] Open
Abstract
Follow-up after curative treatment for colorectal cancer (CRC) puts pressure on outpatient services due to the growing number of CRC survivors. The aim of this state-of-the-art review was to evaluate setting, manner and provider of follow-up. Moreover, perceptions of CRC survivors and health care providers regarding standard and alternative follow-up were examined. After a comprehensive literature search of the PubMed database, 69 articles were included reporting on CRC follow-up in the hospital, primary care and home setting. Hospital-based follow-up is most common and has been provided by surgeons, medical oncologists, and gastroenterologists, as well as nurses. Primary care-based follow-up has been provided by general practitioners or nurses. Even though most hospital- or primary care-based follow-up care requires patients to visit the clinic, telephone-based care has proven to be a feasible alternative. Most patients perceived follow-up as positive; valuing screening and detection for disease recurrence and appreciating support for physical and psychosocial symptoms. Hospital-based follow-up performed by the medical specialist or nurse is highly preferred by patients and health care providers. However, willingness of both patients and health care providers for alternative, primary care or remote follow-up exists. Nurse-led and GP-led follow-up have proven to be cost-effective alternatives compared to specialist-led follow-up. If proven safe and acceptable, remote follow-up can become a cost-effective alternative. To decrease the personal and financial burden of follow-up for a growing number of colorectal cancer survivors, a more acceptable, flexible and dynamic care follow-up mode consisting of enhanced communication and role definitions among clinicians is warranted.
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Affiliation(s)
- S M Qaderi
- Department of Surgical Oncology, Radboud University Medical Center, Nijmegen, the Netherlands.
| | - H Swartjes
- Department of Surgical Oncology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - J A E Custers
- Department of Medical Psychology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - J H W de Wilt
- Department of Surgical Oncology, Radboud University Medical Center, Nijmegen, the Netherlands
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Haase K, Drury A, Puts M. Supportive Care and eHealth: A Narrative Review of Technologies, Interventions, and Opportunities for Optimizing Care in Patients With Cancer. Clin J Oncol Nurs 2020; 24:32-41. [DOI: 10.1188/20.cjon.s1.32-41] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Mole G, Murali M, Carter S, Gore D, Broadhurst J, Moore T, Vickers P, Miles A. A service evaluation of specialist nurse telephone follow-up of bowel cancer patients after surgery. ACTA ACUST UNITED AC 2020; 28:1234-1238. [PMID: 31680571 DOI: 10.12968/bjon.2019.28.19.1234] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
INTRODUCTION the NHS Long Term Plan has called for a reduction in the number of outpatient appointments to reduce pressure on hospital services and increase ease of access for patients. This article presents a service evaluation of an innovative, nurse-led telephone follow-up service for a group of elective bowel cancer patients following surgery. METHODS the records of patients who underwent surgery over a 2-year period were accessed to determine the number of telephone follow-ups and other investigations. This was used to model the potential cost saving for commissioners against traditional clinic follow-up. Patient satisfaction was assessed by the European Organisation for Research and Treatment of Cancer questionnaire on Outpatient Satisfaction in 30 patients. RESULTS feedback on the service was overwhelmingly positive, with patients praising the care received from the specialist nurses, but also commenting on increased continuity of care, ease of access and convenience. The service also potentially creates significant savings for commissioners as the agreed tariff for nurse telephone follow-up is significantly less than the outpatient tariff. DISCUSSION this innovative follow-up system is well liked by patients and should provide savings for commissioners. The hospital also benefits from an increase in capacity to see new or more unwell patients, and a reduction in carbon emissions. Such a service, however, is dependent on people, and although it has functioned effectively in this department for approximately 20 years, it would only be generalisable to other units if staff had appropriate expertise.
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Affiliation(s)
- Guy Mole
- National Medical Directors Clinical Fellow, NHS England, London, UK
| | - Mayur Murali
- National Medical Directors Clinical Fellow, NHS England, London, UK
| | - Sarah Carter
- Specialist Colorectal Nurse, Department of Colorectal Surgery, Royal Hampshire Hospital, Winchester, UK
| | - David Gore
- Consultant Colorectal Surgeon, Department of Colorectal Surgery, Royal Hampshire Hospital, Winchester, UK
| | - Jack Broadhurst
- Consultant Colorectal Surgeon, Department of Colorectal Surgery, Royal Hampshire Hospital, Winchester, UK
| | - Tim Moore
- Consultant Colorectal Surgeon, Department of Colorectal Surgery, Royal Hampshire Hospital, Winchester, UK
| | - Philip Vickers
- Senior Policy Analyst and Economist, British Columbia Ministry of Health, Victoria, Canada
| | - Andrew Miles
- Consultant Colorectal Surgeon, Department of Colorectal Surgery, Royal Hampshire Hospital, Winchester, UK
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Rosato R, Di Cuonzo D, Ritorto G, Fanchini L, Bustreo S, Racca P, Pagano E. Tailoring chemotherapy supply according to patients' preferences: a quantitative method in colorectal cancer care. Curr Med Res Opin 2020; 36:73-81. [PMID: 31535573 DOI: 10.1080/03007995.2019.1670475] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Objectives: The aim of this study was to conduct a discrete choice experiment with patients affected by colorectal cancer to understand their preferences for different attributes of the chemotherapy supply. Our overall goal is to provide evidence on the relative importance of each attribute in order to tailor chemotherapy supply according to patients' priorities in the design or reorganization processes of cancer services.Methods: Focus groups were used to identify the attributes and levels for the discrete choice experiment. The attributes were: continuity of care, understanding, information, treatment choice, and time for therapy. Respondents were asked to choose between two mutually exclusive hypothetical alternatives of chemotherapy supply. Patients completed the discrete choice experiment along with the health-related quality of life and patients' satisfaction questions. Conditional and mixed logistic models were used to analyses the data.Results: Patients with colorectal cancer treated with chemotherapy (n = 76) completed the survey. The most important aspects of chemotherapy supply were: "Providing detailed and complete information" and "High ability in understanding" patients. Preferences were also influenced by the availability of a trusted doctor. Except for one attribute (waiting time for therapy), all other characteristics significantly influenced respondents' preferences.Conclusions: Results should support a policy of strengthening medical doctors' capabilities to communicate with patients, providing them complete information and involving them in the clinical decisions. Specifically, the findings should be used to improve the current provision of cancer care by identifying areas of preferred intervention from the perspectives of patients in order to tailor the service supply accordingly.
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Affiliation(s)
- Rosalba Rosato
- Department of Psychology, University of Turin, Torino, Italy
- Unit of Clinical Epidemiology, Città Della Salute e Della Scienza di Torino Hospital-CPO Piemonte, Turin, Italy
| | - Daniela Di Cuonzo
- Department of Psychology, University of Turin, Torino, Italy
- Unit of Clinical Epidemiology, Città Della Salute e Della Scienza di Torino Hospital-CPO Piemonte, Turin, Italy
| | - Giuliana Ritorto
- Dipartimento di Oncologia, SSD Colorectal Cancer Unit, Città Della Salute e Della Scienza di Torino Hospital, Torino, Italy
| | - Laura Fanchini
- Dipartimento di Oncologia, SSD Colorectal Cancer Unit, Città Della Salute e Della Scienza di Torino Hospital, Torino, Italy
| | - Sara Bustreo
- Dipartimento di Oncologia, SSD Colorectal Cancer Unit, Città Della Salute e Della Scienza di Torino Hospital, Torino, Italy
| | - Patrizia Racca
- Dipartimento di Oncologia, SSD Colorectal Cancer Unit, Città Della Salute e Della Scienza di Torino Hospital, Torino, Italy
| | - Eva Pagano
- Unit of Clinical Epidemiology, Città Della Salute e Della Scienza di Torino Hospital-CPO Piemonte, Turin, Italy
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Drury A, Payne S, Brady AM. Identifying associations between quality of life outcomes and healthcare-related variables among colorectal cancer survivors: A cross-sectional survey study. Int J Nurs Stud 2020; 101:103434. [DOI: 10.1016/j.ijnurstu.2019.103434] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2019] [Revised: 09/10/2019] [Accepted: 09/13/2019] [Indexed: 01/28/2023]
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Decker K, Moineddin R, Kendell C, Urquhart R, Biswanger N, Groome P, McBride ML, Winget M, Whitehead M, Grunfeld E. Changes in primary care provider utilization by phase of care for women diagnosed with breast cancer: a CanIMPACT longitudinal cohort study. BMC FAMILY PRACTICE 2019; 20:161. [PMID: 31752693 PMCID: PMC6873454 DOI: 10.1186/s12875-019-1052-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Accepted: 11/15/2019] [Indexed: 12/14/2022]
Abstract
BACKGROUND Primary care providers (PCPs) have always played an important role in cancer diagnosis. There is increasing awareness of the importance of their role during treatment and survivorship. We examined changes in PCP utilization from pre-diagnosis to survival for women diagnosed with breast cancer, factors associated with being a high user of primary care, and variation across four Canadian provinces. METHODS The cohorts included women 18+ years of age diagnosed with stage I-III invasive breast cancer in years 2007-2012 in British Columbia (BC), Manitoba (MB), Ontario (ON), and Nova Scotia (NS) who had surgery plus adjuvant chemotherapy and were alive 30+ months after diagnosis (N = 19,589). We compared the rate of PCP visits in each province across phases of care (pre-diagnosis, diagnosis, treatment, and survival years 1 to 4). RESULTS PCP use was greatest during treatment and decreased with each successive survival year in all provinces. The unadjusted difference in PCP use between treatment and pre-diagnosis was most pronounced in BC where PCP use was six times higher during treatment than pre-diagnosis. Factors associated with being a high user of primary care during treatment included comorbidity and being a high user of care pre-diagnosis in all provinces. These factors were also associated with being a higher user of care during diagnosis and survival. CONCLUSIONS Contrary to the traditional view that PCPs focus primarily on cancer prevention and early detection, we found that PCPs are involved in the care of women diagnosed with breast cancer across all phases of care.
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Affiliation(s)
- K. Decker
- CancerCare Manitoba, 675 McDermot Avenue, Winnipeg, Manitoba R0E 0V9 Canada
- University of Manitoba, 750 Bannatyne Avenue, Winnipeg, Manitoba R3E 0W2 Canada
| | - R. Moineddin
- University of Toronto, 500 University Avenue, Toronto, Ontario M5G 1V7 Canada
| | - C. Kendell
- Dalhousie University, 1276 South Park Street, Halifax, Nova Scotia B3H 2Y9 Canada
- Nova Scotia Health Authority, 1276 South Park Street, Halifax, Nova Scotia B3H 2Y9 Canada
| | - R. Urquhart
- Dalhousie University, 1276 South Park Street, Halifax, Nova Scotia B3H 2Y9 Canada
| | - N. Biswanger
- CancerCare Manitoba, 675 McDermot Avenue, Winnipeg, Manitoba R0E 0V9 Canada
| | - P. Groome
- Queen’s University, 62 Fifth Field Company Lane, Kingston, Ontario K7L 3N6 Canada
| | - M. L. McBride
- BC Cancer Agency, 686 West Broadway, Suite 500, Vancouver, British Columbia V5Z 1G1 Canada
| | - M. Winget
- Stanford University, 1265 Welch Road, Stanford, California, 94305 USA
| | - M. Whitehead
- Queen’s University, 62 Fifth Field Company Lane, Kingston, Ontario K7L 3N6 Canada
| | - E. Grunfeld
- University of Toronto, 500 University Avenue, Toronto, Ontario M5G 1V7 Canada
- Ontario Institute for Cancer Research, 661 University Avenue, Suite 510, Toronto, Ontario M5G 0A3 Canada
| | - for the Canadian Team to Improve Community-Based Cancer Care Along the Continuum (CanIMPACT)
- CancerCare Manitoba, 675 McDermot Avenue, Winnipeg, Manitoba R0E 0V9 Canada
- University of Manitoba, 750 Bannatyne Avenue, Winnipeg, Manitoba R3E 0W2 Canada
- University of Toronto, 500 University Avenue, Toronto, Ontario M5G 1V7 Canada
- Dalhousie University, 1276 South Park Street, Halifax, Nova Scotia B3H 2Y9 Canada
- Nova Scotia Health Authority, 1276 South Park Street, Halifax, Nova Scotia B3H 2Y9 Canada
- Queen’s University, 62 Fifth Field Company Lane, Kingston, Ontario K7L 3N6 Canada
- BC Cancer Agency, 686 West Broadway, Suite 500, Vancouver, British Columbia V5Z 1G1 Canada
- Stanford University, 1265 Welch Road, Stanford, California, 94305 USA
- Ontario Institute for Cancer Research, 661 University Avenue, Suite 510, Toronto, Ontario M5G 0A3 Canada
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Campbell HE, Gray AM, Watson J, Jackson C, Moseley C, Cruickshank ME, Kitchener HC, Rivero-Arias O. Preferences for interventions designed to increase cervical screening uptake in non-attending young women: How findings from a discrete choice experiment compare with observed behaviours in a trial. Health Expect 2019; 23:202-211. [PMID: 31659850 PMCID: PMC6978852 DOI: 10.1111/hex.12992] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Revised: 10/02/2019] [Accepted: 10/04/2019] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Young women's attendance at cervical screening in the UK is continuing to fall, and the incidence of invasive cervical cancer is rising. OBJECTIVES We assessed the preferences of non-attending young women for alternative ways of delivering cervical screening. DESIGN Postal discrete choice experiment (DCE) conducted during the STRATEGIC study of interventions for increasing cervical screening uptake. Attributes included action required to arrange a test, location of the test, availability of a nurse navigator and cost to the National Health Service. SETTING AND PARTICIPANTS Non-attending young women in two UK regions. MAIN OUTCOME MEASURES Responses were analysed using a mixed multinomial logit model. A predictive analysis identified the most preferable strategy compared to current screening. Preferences from the DCE were compared with observed behaviours during the STRATEGIC trial. RESULTS The DCE response rate was 5.5% (222/4000), and 94% of respondents agreed screening is important. Preference heterogeneity existed around attributes with strong evidence for test location. Relative to current screening, unsolicited self-sampling kits for home use appeared most preferable. The STRATEGIC trial showed this same intervention to be most effective although many women who received it and were screened, attended for conventional cytology instead. CONCLUSIONS The DCE and trial identified the unsolicited self-sampling kit as the most preferred/effective intervention. The DCE suggested that the decision of some women receiving the kit in the trial to attend for conventional cytology may be due to anxieties around home testing coupled with a knowledge that ignoring the kit could potentially have life-changing consequences.
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Affiliation(s)
- Helen E Campbell
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Alastair M Gray
- Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Judith Watson
- Department of Health Sciences, University of York, York, UK
| | - Cath Jackson
- Department of Health Sciences, University of York, York, UK
| | - Carly Moseley
- Institute of Cancer Sciences, The University of Manchester, St Mary's Hospital, Manchester, UK
| | | | - Henry C Kitchener
- Institute of Cancer Sciences, The University of Manchester, St Mary's Hospital, Manchester, UK
| | - Oliver Rivero-Arias
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
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The role of primary care in supporting patients living with and beyond cancer. Curr Opin Support Palliat Care 2019; 12:261-267. [PMID: 30074923 DOI: 10.1097/spc.0000000000000369] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
PURPOSE OF REVIEW The prevalence of cancer survivors is increasing. Those living with and beyond a cancer diagnosis have a range of physical, psychosocial and practical needs. This review aims to discuss the role of primary care in meeting these needs. RECENT FINDINGS Patients have increased contact with primary care after a cancer diagnosis but the role of the primary care team in the formal delivery of cancer aftercare is not clearly defined and varies depending on setting and context. Research suggests that both patients and health professionals are receptive to greater involvement of primary care, with informational and personal continuity of care, and good co-ordination of care being particularly valued by patients. Recent evidence indicates that shared care between oncologists and primary care physicians can be as effective as and more cost effective than secondary care-led follow-up, and that primary-care nurses could play a role in optimizing survivorship care. SUMMARY The four pillars of primary care - contact, comprehensiveness, continuity and coordination - are recurring themes in the cancer survivorship literature and emphasize that the traditional core values of general practice lend themselves to innovative interventions to improve the efficiency and efficacy of survivorship care.
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de Ligt KM, van Egdom LS, Koppert LB, Siesling S, van Til JA. Opportunities for personalised follow‐up care among patients with breast cancer: A scoping review to identify preference‐sensitive decisions. Eur J Cancer Care (Engl) 2019; 28:e13092. [PMID: 31074162 PMCID: PMC9285605 DOI: 10.1111/ecc.13092] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Revised: 03/21/2019] [Accepted: 04/20/2019] [Indexed: 12/24/2022]
Abstract
Introduction Current follow‐up arrangements for breast cancer do not optimally meet the needs of individual patients. We therefore reviewed the evidence on preferences and patient involvement in decisions about breast cancer follow‐up to explore the potential for personalised care. Methods Studies published between 2008 and 2017 were extracted from MEDLINE, PsycINFO and EMBASE. We then identified decision categories related to content and form of follow‐up. Criteria for preference sensitiveness and patient involvement were compiled and applied to determine the extent to which decisions were sensitive to patient preferences and patients were involved. Results Forty‐one studies were included in the full‐text analysis. Four decision categories were identified: “surveillance for recurrent/secondary breast cancer; consultations for physical and psychosocial effects; recurrence‐risk reduction by anti‐hormonal treatment; and improving quality of life after breast cancer.” There was little evidence that physicians treated decisions about anti‐hormonal treatment, menopausal symptoms, and follow‐up consultations as sensitive to patient preferences. Decisions about breast reconstruction were considered as very sensitive to patient preferences, and patients were usually involved. Conclusion Patients are currently not involved in all decisions that affect them during follow‐up, indicating a need for improvements. Personalised follow‐up care could improve resource allocation and the value of care for patients.
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Affiliation(s)
- Kelly M. de Ligt
- Department of Research Netherlands Comprehensive Cancer Organisation (IKNL) Utrecht The Netherlands
- Department of Health Technology and Services Research, Technical Medical Centre University of Twente Enschede The Netherlands
| | - Laurentine S.E. van Egdom
- Department of Surgical Oncology Erasmus MC Cancer Institute, University Medical Centre Rotterdam Rotterdam The Netherlands
| | - Linetta B. Koppert
- Department of Surgical Oncology Erasmus MC Cancer Institute, University Medical Centre Rotterdam Rotterdam The Netherlands
| | - Sabine Siesling
- Department of Research Netherlands Comprehensive Cancer Organisation (IKNL) Utrecht The Netherlands
- Department of Health Technology and Services Research, Technical Medical Centre University of Twente Enschede The Netherlands
| | - Janine A. van Til
- Department of Health Technology and Services Research, Technical Medical Centre University of Twente Enschede The Netherlands
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Soekhai V, de Bekker-Grob EW, Ellis AR, Vass CM. Discrete Choice Experiments in Health Economics: Past, Present and Future. PHARMACOECONOMICS 2019; 37:201-226. [PMID: 30392040 PMCID: PMC6386055 DOI: 10.1007/s40273-018-0734-2] [Citation(s) in RCA: 390] [Impact Index Per Article: 78.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
OBJECTIVES Discrete choice experiments (DCEs) are increasingly advocated as a way to quantify preferences for health. However, increasing support does not necessarily result in increasing quality. Although specific reviews have been conducted in certain contexts, there exists no recent description of the general state of the science of health-related DCEs. The aim of this paper was to update prior reviews (1990-2012), to identify all health-related DCEs and to provide a description of trends, current practice and future challenges. METHODS A systematic literature review was conducted to identify health-related empirical DCEs published between 2013 and 2017. The search strategy and data extraction replicated prior reviews to allow the reporting of trends, although additional extraction fields were incorporated. RESULTS Of the 7877 abstracts generated, 301 studies met the inclusion criteria and underwent data extraction. In general, the total number of DCEs per year continued to increase, with broader areas of application and increased geographic scope. Studies reported using more sophisticated designs (e.g. D-efficient) with associated software (e.g. Ngene). The trend towards using more sophisticated econometric models also continued. However, many studies presented sophisticated methods with insufficient detail. Qualitative research methods continued to be a popular approach for identifying attributes and levels. CONCLUSIONS The use of empirical DCEs in health economics continues to grow. However, inadequate reporting of methodological details inhibits quality assessment. This may reduce decision-makers' confidence in results and their ability to act on the findings. How and when to integrate health-related DCE outcomes into decision-making remains an important area for future research.
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Affiliation(s)
- Vikas Soekhai
- Section of Health Technology Assessment (HTA) and Erasmus Choice Modelling Centre (ECMC), Erasmus School of Health Policy & Management (ESHPM), Erasmus University Rotterdam (EUR), P.O. Box 1738, Rotterdam, 3000 DR The Netherlands
- Department of Public Health, Erasmus MC, University Medical Center, P.O. Box 2040, Rotterdam, 3000 CA The Netherlands
| | - Esther W. de Bekker-Grob
- Section of Health Technology Assessment (HTA) and Erasmus Choice Modelling Centre (ECMC), Erasmus School of Health Policy & Management (ESHPM), Erasmus University Rotterdam (EUR), P.O. Box 1738, Rotterdam, 3000 DR The Netherlands
| | - Alan R. Ellis
- Department of Social Work, North Carolina State University, Raleigh, NC USA
| | - Caroline M. Vass
- Manchester Centre for Health Economics, The University of Manchester, Manchester, UK
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Kostecka M. The Potential Influence of Dietary Counseling on Nutritional Status and Dietary Supplement Consumption in Breast Cancer Patients: A Pilot Study. Nutr Cancer 2019; 71:749-755. [PMID: 30632832 DOI: 10.1080/01635581.2018.1531138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
INTRODUCTION Cancer, in particular breast cancer, is one of the leading causes of death among women. Good nutritional status contributes to the efficacy of treatment and recovery, and nutritional interventions can minimize the adverse effects of cancer therapy. AIM The aim of this study was to describe the potential role of dietary counseling in breast cancer patients. The impact of nutritional advice on the nutritional status of patients, the use of dietary supplements, and the knowledge of phytoestrogens were assessed. MATERIALS AND METHODS The study was conducted between April and July 2016 in the Lublin Oncology Center on a group of 173 female patients undergoing breast cancer treatment. The patients filled out a questionnaire containing 34 open-ended and closed-ended questions. The collected data were processed in Excel and Statistica 5.0 programs, and the results were regarded as significant at P < 0.05. RESULTS The mean age of the evaluated patients was 66.8 ± 11.3 years. The duration of disease was significantly correlated with the patients' nutritional status expressed by the body mass index (P = 0.0368). The main sources of knowledge about nutrition in cancer care were nurses (29.71%), physicians (12.31%), and nutritionists (13.78%). Patients who received nutritional advice had significantly greater knowledge about phytoestrogens (P = 0.0001), and they were of the opinion that a diet rich in phytoestrogens was safe (P = 0.001). More than 85% of the polled subjects used dietary supplements during treatment, and 2/3 of them did so without professional advice. In this study, 73.07% of the respondents regularly monitored their body weight. Patients who did not receive dietary advice less frequently informed their physician about weight changes. CONCLUSIONS The nutritional status of patients was correlated with access to nutrition and dietary advice during illness. The risk of malnutrition was minimized when patients received and understood educational materials. The patients who did not receive dietary advice more frequently overdosed on dietary supplements. Phytoestrogens were more widely used by patients who regularly attended a dietitian.
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Affiliation(s)
- Małgorzata Kostecka
- a University of Life Sciences in Lublin , Faculty of Food Science and Biotechnology , Lublin , Poland
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32
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Follow-up after surgical treatment in older patients with colorectal cancer: The evaluation of emerging health problems and quality of life after implementation of a standardized shared-care model. J Geriatr Oncol 2019; 10:126-131. [DOI: 10.1016/j.jgo.2018.07.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Revised: 05/22/2018] [Accepted: 07/23/2018] [Indexed: 11/20/2022]
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Cleland J, Porteous T, Skåtun D. What can discrete choice experiments do for you? MEDICAL EDUCATION 2018; 52:1113-1124. [PMID: 30259546 DOI: 10.1111/medu.13657] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/18/2018] [Accepted: 06/05/2018] [Indexed: 06/08/2023]
Abstract
CONTEXT In everyday life, the choices we make are influenced by our preferences for the alternatives available to us. The same is true when choosing medical education, training and jobs. More often than not, those alternatives comprise multiple attributes and our ultimate choice will be guided by the value we place on each attribute relative to the others. In education, for example, choice of university is likely to be influenced by preferences for institutional reputation, location, cost and course content; but which of these attributes is the most influential? An understanding of what is valued by applicants, students, trainees and colleagues is of increasing importance in the higher education and medical job marketplaces because it will help us to develop options that meet their needs and preferences. METHODS In this article, we describe the discrete choice experiment (DCE), a survey method borrowed from economics that allows us to quantify the values respondents place on the attributes of goods and services, and to explore whether and to what extent they are willing to trade less of one attribute for more of another. CONCLUSIONS To date, DCEs have been used to look at medical workforce issues but relatively little in the field of medical education. However, many outstanding questions within medical education could be usefully addressed using DCEs. A better understanding of which attributes have most influence on, for example, staff or student satisfaction, choice of university and choice of career, and the extent to which stakeholders are prepared to trade one attribute against another is required. Such knowledge will allow us to tailor the way medical education is provided to better meet the needs of key stakeholders within the available resources.
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Affiliation(s)
- Jennifer Cleland
- Centre for Healthcare Education Research and Innovation (CHERI), University of Aberdeen, Aberdeen, UK
| | - Terry Porteous
- Centre for Healthcare Education Research and Innovation (CHERI), University of Aberdeen, Aberdeen, UK
| | - Diane Skåtun
- Health Economics Research Unit, University of Aberdeen, Aberdeen, UK
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van Egmond S, Wakkee M, Droger M, Bastiaens MT, van Rengen A, de Roos KP, Nijsten T, Lugtenberg M. Needs and preferences of patients regarding basal cell carcinoma and cutaneous squamous cell carcinoma care: a qualitative focus group study. Br J Dermatol 2018; 180:122-129. [PMID: 29927480 DOI: 10.1111/bjd.16900] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/17/2018] [Indexed: 12/24/2022]
Abstract
BACKGROUND Despite the high and rising incidence rate of keratinocyte cancer (KC) and the importance of incorporating patient values into evidence-based care, few studies have focused on the perspectives of patients with KC. OBJECTIVES To identify the needs and preferences of patients with basal cell carcinoma (BCC) and squamous cell carcinoma (SCC) regarding care. METHODS A qualitative study was conducted consisting of three focus groups with patients with BCC and three focus groups with patients with SCC. In total 42 patients participated. In each focus group, the patients' needs and preferences regarding treatment and follow-up were discussed, using a predefined topic list. All sessions were transcribed verbatim and analysed by two researchers. RESULTS The following needs and preferences were identified: (i) the need to receive all relevant, tailored information; (ii) a physician who takes you seriously and communicates well; (iii) a short waiting period and the best treatment with direct results; (iv) to be seen by the same physician; a preference for a dermatologist during (v) treatment and (vi) follow-up; (vii) a general need for structured follow-up care and (viii) a full-body skin examination during follow-up. Patients with BCC additionally expressed the need for openness and transparency and wanting to participate in shared decision making. CONCLUSIONS It is advocated to organize skin cancer care that is better tailored to the needs of patients with KC, providing patient-centred care. This should include investing in the patient-physician relationship, and personalizing the type and form of information and the follow-up schedules. Adding the patient's perspective to current guidelines could facilitate this process.
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Affiliation(s)
- S van Egmond
- Department of Dermatology, Erasmus MC Cancer Institute, Rotterdam, the Netherlands.,Department of Public Health, Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - M Wakkee
- Department of Dermatology, Erasmus MC Cancer Institute, Rotterdam, the Netherlands
| | - M Droger
- Department of Public Health, Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - M T Bastiaens
- Department of Dermatology, Elisabeth-TweeSteden Hospital, Tilburg, the Netherlands
| | - A van Rengen
- Department of Dermatology, Mohs Klinieken, Dordrecht, the Netherlands
| | - K P de Roos
- Department of Dermatology, DermaPark, Uden, the Netherlands
| | - T Nijsten
- Department of Dermatology, Erasmus MC Cancer Institute, Rotterdam, the Netherlands
| | - M Lugtenberg
- Department of Dermatology, Erasmus MC Cancer Institute, Rotterdam, the Netherlands.,Department of Public Health, Erasmus MC University Medical Center, Rotterdam, the Netherlands
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Makimoto G, Kubo T, Oze I, Ohashi K, Hotta K, Tabata M, Soh J, Toyooka S, Katsui K, Takigawa N, Tanimoto M, Kiura K. Second primary cancer in survivors of locally advanced non-small cell lung cancer treated with concurrent chemoradiation followed by surgery. Jpn J Clin Oncol 2018; 48:287-290. [PMID: 29409038 DOI: 10.1093/jjco/hyy003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2017] [Accepted: 01/15/2018] [Indexed: 11/12/2022] Open
Abstract
The standard treatment for patients with locally advanced non-small-cell lung cancer (LA-NSCLC) is chemoradiotherapy (CRT), but surgical resection following induction CRT can extend overall survival in a select population. However, patients who survive longer are at risk of developing a second primary cancer (SPC). This is the first report to determine the incidence of SPC in survivors with LA-NSCLC after trimodal therapy. Between October 1997 and October 2013, 112 Stage III NSCLC patients underwent trimodal therapy in our hospital. The 5-year overall survival rate was 71.8%. SPC developed in 10 of the 112 patients 0.60-15.0 (median 5.49) years after initiating CRT. The observed incidence of SPC was 1.8 per 100 patient-years. Although trimodal therapy can prolong patient survival, the estimated incidence of SPC does not increase. A large prospective study with a longer follow-up time is required to determine the effects of trimodal therapy, including the development of SPC.
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Affiliation(s)
- Go Makimoto
- Department of Allergy and Respiratory Medicine, Okayama University Hospital
| | - Toshio Kubo
- Center for Clinical Oncology, Okayama University Hospital, Okayama
| | - Isao Oze
- Division of Molecular & Clinical Epidemiology, Aichi Cancer Center Research Institute, Nagoya
| | - Kadoaki Ohashi
- Department of Allergy and Respiratory Medicine, Okayama University Hospital
| | - Katsuyuki Hotta
- Center of Innovative Clinical Medicine, Okayama University Hospital, Okayama
| | - Masahiro Tabata
- Center for Clinical Oncology, Okayama University Hospital, Okayama
| | - Junichi Soh
- Department of Thoracic Surgery, Okayama University Hospital
| | | | - Kuniaki Katsui
- Department of Proton Beam Therapy, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences
| | - Nagio Takigawa
- Department of General Internal Medicine 4, Kawasaki Hospital, Kawasaki Medical School, Okayama
| | - Mitsune Tanimoto
- Department of Allergy and Respiratory Medicine, Okayama University Hospital.,Department of Hematology, National Hospital Organization Iwakuni Clinical Center, Yamaguchi, Japan
| | - Katsuyuki Kiura
- Department of Allergy and Respiratory Medicine, Okayama University Hospital
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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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