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Liu L, Cao Y, Su M, Zhang J, Miao Y, Yao N. Financial toxicity among older cancer survivors in China: a qualitative study of oncology providers' perceptions and practices. Support Care Cancer 2022; 30:9433-9440. [PMID: 35917024 PMCID: PMC9343566 DOI: 10.1007/s00520-022-07303-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Accepted: 07/26/2022] [Indexed: 12/02/2022]
Abstract
Objective Despite oncology providers’ significant roles in patient care, few studies have been conducted to investigate oncology providers’ understanding of financial toxicity. This study aimed to explore oncology providers’ perceptions and practices relating to the financial toxicity of older cancer survivors in China. Methods A qualitative study was conducted. Individual interviews were conducted with 14 oncology providers at four general hospitals and two cancer specialist hospitals in China. Qualitative data was analyzed using descriptive coding and thematic analysis methods. Results The perceptions of participants about the financial toxicity of older cancer survivors include (1) older adults with cancer are especially vulnerable to financial toxicity; (2) inadequate social support may lead to financial toxicity; and (3) cancer-related financial toxicity increased the risk of poor treatment outcomes. The interventions to mitigate its negative effects include (1) effective communication about the cancer-related costs; (2) improving the professional ability to care for the patient; (3) cancer education program as a way to reduce knowledge gaps; and (4) clinical empathy as an effective treatment strategy. Conclusion Oncology providers perceive that older cancer patients’ financial toxicity plays a key role in increasing the negative effects of diagnosis and treatment of cancer, as well as possibly worsening cancer outcomes. Some potential practices of providers to mitigate financial toxicity include utilizing effective cost communication, improving professional ability in geriatric oncology care, and promoting further cancer education and clinical empathy.
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Affiliation(s)
- Li Liu
- School of Nursing and Rehabilitation, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
- Qilu Hospital of Shandong University, Shandong, Jinan, China
| | - Yingjuan Cao
- School of Nursing and Rehabilitation, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
- Qilu Hospital of Shandong University, Shandong, Jinan, China
| | - Mingzhu Su
- Qilu Hospital of Shandong University, Shandong, Jinan, China.
- School of Public Health, Centre for Health Management and Policy Research, Cheeloo College of Medicine, Shandong University, 44 Wenhuaxi Road, Jinan, 250012, Shandong, China.
- NHC Key Lab of Health Economics and Policy Research, Shandong University, Jinan, Shandong, China.
| | - Jinxin Zhang
- School of Public Health, Centre for Health Management and Policy Research, Cheeloo College of Medicine, Shandong University, 44 Wenhuaxi Road, Jinan, 250012, Shandong, China
- NHC Key Lab of Health Economics and Policy Research, Shandong University, Jinan, Shandong, China
| | - Yajun Miao
- Department Oncology, Shandong Province Third Hospital, Jinan, Shandong, China
| | - Nengliang Yao
- School of Public Health, Centre for Health Management and Policy Research, Cheeloo College of Medicine, Shandong University, 44 Wenhuaxi Road, Jinan, 250012, Shandong, China
- NHC Key Lab of Health Economics and Policy Research, Shandong University, Jinan, Shandong, China
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Alarcón-Yaquetto DE, de Ferrari A, Málaga G. The road to patient-centred care in Peru: The difficulties and opportunities to achieve participatory health care. ZEITSCHRIFT FUR EVIDENZ, FORTBILDUNG UND QUALITAT IM GESUNDHEITSWESEN 2022; 171:113-116. [PMID: 35610135 DOI: 10.1016/j.zefq.2022.04.027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Revised: 04/21/2022] [Accepted: 04/25/2022] [Indexed: 06/15/2023]
Abstract
Patient-centred care (PCC) is a pillar of quality health services, where decision-making power is shared between the clinician and the patient. Although, this approach could be adopted with easiness in high income settings or in countries with unified health systems, in settings such as Peru, where universal access and other structural problems remain a challenge, the practice of PCC is not a priority. In Peru, research on PCC has been conducted for almost two decades, but this has not generated a need for development in academia, decision makers, health personnel or patients. Here, we give an overview of the road that PCC research has taken in Peru and the challenges that remain to translate it into clinical practice.
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Affiliation(s)
| | - Aldo de Ferrari
- Unidad de Conocimiento y Evidencia, Universidad Peruana Cayetano Heredia. Lima, Peru
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González Moreno IM, Trejo-Falcón J, Matsumoto MM, Huertas Moreno M, Martínez Gálvez M, Farfán Quispe GR, Chavez Pareja FY, Mollura DJ, Pollack E, Scheel JR, García Santos JM. Radiology volunteers to support a breast cancer screening program in Peru: Description of the project, preliminary results, and impressions. RADIOLOGIA 2022; 64:256-265. [PMID: 35676057 DOI: 10.1016/j.rxeng.2021.04.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Accepted: 04/12/2021] [Indexed: 10/18/2022]
Abstract
Breast cancer is the second most common cancer in Peruvian women. Due to limitations in national breast cancer screening programs, especially in rural areas, more than 50% of cases of breast cancer in Peru are diagnosed in advanced stages. In collaboration with a local clinic registered as a nongovernmental organization (CerviCusco), RAD-AID International aims to create a sustainable diagnostic structure to improve breast cancer screening in Cuzco. With the support of local, national, and international partners that have collaborated in analyzing radiological resources, raising awareness in the population, acquiring equipment, training clinical staff, and building referral networks, our teams of radiologists, included in the RAD-AID team, have participated in training CerviCusco staff in breast ultrasound, thus enabling additional training for radiology residents through a regulated international collaboration.
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Affiliation(s)
- I M González Moreno
- Servicio de Radiodiagnóstico, Hospital General Universitario Jose M.(a) Morales Meseguer, Murcia, Spain.
| | - J Trejo-Falcón
- Servicio de Radiodiagnóstico, Hospital General Universitario Jose M.(a) Morales Meseguer, Murcia, Spain
| | - M M Matsumoto
- Pritzker Medicine, University of Chicago, Chicago, IL, United States
| | - M Huertas Moreno
- Servicio de Radiodiagnóstico, Hospital General Universitario Jose M.(a) Morales Meseguer, Murcia, Spain
| | - M Martínez Gálvez
- Servicio de Radiodiagnóstico, Hospital General Universitario Jose M.(a) Morales Meseguer, Murcia, Spain
| | | | | | | | - E Pollack
- RAD-AID Internacional; Department of Radiology and Medical Imaging, Denver Health and Hospital Authority, Denver, CO, United States
| | - J R Scheel
- RAD-AID Internacional; Departments of Radiology and Global Health, University of Washington, Seattle, WA, United States; Fred Hutchinson Cancer Research Center, Seattle, WA, United States
| | - J M García Santos
- Servicio de Radiodiagnóstico, Hospital General Universitario Jose M.(a) Morales Meseguer, Murcia, Spain; RAD-AID Internacional
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4
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Taleghani F, Farzi S, Yazdannik A, Esfahani MS. The shadow of paternalism on patient-centeredness in oncology nursing care: A barrier of health-care promotion. JOURNAL OF EDUCATION AND HEALTH PROMOTION 2022; 11:126. [PMID: 35677286 PMCID: PMC9170218 DOI: 10.4103/jehp.jehp_793_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/29/2021] [Accepted: 07/30/2021] [Indexed: 06/15/2023]
Abstract
BACKGROUND Patient-centered care (PCC) is a key component of high-quality care. Given the different effects of cancer on patients, patient-centeredness is very important in oncology nursing care. The aim of this study was to explore nurses' perceptions of the patient-centered in oncology nursing care. MATERIALS AND METHODS This descriptive qualitative study was conducted in 2018-2020, Iran. Data collection methods included observation and semi-structured interviews. Patient, family, and nurse behaviors were observed (total: 318 h). In addition, interviews were conducted with nurses and nursing managers (12 interviews). Data analysis was performed using Graneheim and Lundman's approach. RESULTS Data analysis resulted in the emergence of four themes: "Organizational structure as a barrier to the PCC," "Lack of institutionalization of PCC in nurses," "Understanding and paying attention to the patient as PCC," and "Situational PCC." The final theme of this study is "PCC in the shadow of paternalism." CONCLUSIONS The paternalism approach in the context of oncology nursing care has made the realization of PCC difficult. The first step to promote PCC is increasing nurses' awareness of the impact of paternalism on patient-centeredness. Providing patient-centered oncology nursing care requires changing attitudes, values, and behaviors at individual, professional, and organizational levels.
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Affiliation(s)
- Fariba Taleghani
- Nursing and Midwifery Care Research Center, Faculty of Nursing and Midwifery, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Saba Farzi
- Student Research Center, Faculty of Nursing and Midwifery, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Ahmadreza Yazdannik
- Nursing and Midwifery Care Research Center, Faculty of Nursing and Midwifery, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mehran Sharifi Esfahani
- Department of Internal Medicine, School of Medicine, Cancer Prevention Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
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González Moreno IM, Trejo-Falcón J, Matsumoto MM, Huertas Moreno M, Martínez Gálvez M, Farfán Quispe GR, Chavez Pareja FY, Mollura DJ, Pollack E, Scheel JR, García Santos JM. Radiology volunteers to support a breast cancer screening program in Peru: description of the project, preliminary results, and impressions. RADIOLOGIA 2021; 64:S0033-8338(21)00089-8. [PMID: 34083079 DOI: 10.1016/j.rx.2021.04.003] [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: 09/29/2020] [Revised: 03/31/2021] [Accepted: 04/12/2021] [Indexed: 11/20/2022]
Abstract
Breast cancer is the second most common cancer in Peruvian women. Due to limitations in national breast cancer screening programs, especially in rural areas, more than 50% of cases of breast cancer in Peru are diagnosed in advanced stages. In collaboration with a local clinic registered as a nongovernmental organization (CerviCusco), RAD-AID International aims to create a sustainable diagnostic structure to improve breast cancer screening in Cuzco. With the support of local, national, and international partners that have collaborated in analyzing radiological resources, raising awareness in the population, acquiring equipment, training clinical staff, and building referral networks, our teams of radiologists, included in the RAD-AID team, have participated in training CerviCusco staff in breast ultrasound, thus enabling additional training for radiology residents through a regulated international collaboration.
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Affiliation(s)
- I M González Moreno
- Servicio de Radiodiagnóstico, Hospital General Universitario Jose M.ª Morales Meseguer, Murcia, España.
| | - J Trejo-Falcón
- Servicio de Radiodiagnóstico, Hospital General Universitario Jose M.ª Morales Meseguer, Murcia, España
| | - M M Matsumoto
- Pritzker Medicine, University of Chicago, Chicago, Illinois, Estados Unidos
| | - M Huertas Moreno
- Servicio de Radiodiagnóstico, Hospital General Universitario Jose M.ª Morales Meseguer, Murcia, España
| | - M Martínez Gálvez
- Servicio de Radiodiagnóstico, Hospital General Universitario Jose M.ª Morales Meseguer, Murcia, España
| | | | | | | | - E Pollack
- RAD-AID Internacional; Department of Radiology and Medical Imaging, Denver Health and Hospital Authority, Denver, Colorado, Estados Unidos
| | - J R Scheel
- RAD-AID Internacional; Departments of Radiology and Global Health, University of Washington, Seattle, Washington, Estados Unidos; Fred Hutchinson Cancer Research Center, Seattle, Washington, Estados Unidos
| | - J M García Santos
- Servicio de Radiodiagnóstico, Hospital General Universitario Jose M.ª Morales Meseguer, Murcia, España; RAD-AID Internacional
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Matsumoto MM, Widemon S, Farfán G, Vidaurre T, Dunstan J, Krotish DE, Ferris DG, García Santos JM, Mollura DJ, Pollack E, Scheel JR. Earlier Breast Cancer Detection in Peru: Establishing a Comprehensive Program in an Underserved Region. J Am Coll Radiol 2020; 17:1520-1524. [PMID: 32645288 PMCID: PMC7338027 DOI: 10.1016/j.jacr.2020.06.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Accepted: 06/05/2020] [Indexed: 12/12/2022]
Affiliation(s)
- Monica M Matsumoto
- Department of Radiology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Scott Widemon
- Department of Radiology, Columbia University, New York, New York
| | | | | | - Jorge Dunstan
- Director General of Cancer Control at Instituto Nacional de Enfermedades Neoplásicas, Lima, Peru
| | - Debra E Krotish
- Executive Director of CerviCusco, Cusco, Peru; University of South Carolina, School of Medicine, Columbia, South Carolina; Prisma Health, Family Medicine-Global Health, Columbia, South Carolina
| | - Daron G Ferris
- Founder and President of CerviCusco; Department of Obstetrics and Gynecology, Augusta University, Augusta
| | - José M García Santos
- Chair of the Department of Radiology Servicio de Radiología, Hospital General Universitario Morales Meseguer, Murcia, Spain; RAD-AID International, Chevy Chase, Maryland
| | | | - Erica Pollack
- Director of RAD-AID Breast Imaging, Chevy Chase, Maryland
| | - John R Scheel
- Fellowship Director of Breast Imaging, Department of Radiology and Global Health, University of Washington, Seattle, Washington; Fred Hutchinson Cancer Research Center, Seattle, Washington; Program Manager of RAD-AID Peru.
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Chebli P, Lemus J, Avila C, Peña K, Mariscal B, Merlos S, Guitelman J, Molina Y. Multilevel determinants of financial toxicity in breast cancer care: perspectives of healthcare professionals and Latina survivors. Support Care Cancer 2020; 28:3179-3188. [PMID: 31712953 PMCID: PMC7214214 DOI: 10.1007/s00520-019-05119-y] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Accepted: 10/02/2019] [Indexed: 12/28/2022]
Abstract
PURPOSE Financial toxicity is a multidimensional side effect of cancer treatment. Yet, most relevant research has focused on individual-level determinants of financial toxicity and characterized only patient perspectives. This study examined the multilevel determinants of financial toxicity from the perspectives of Latina breast cancer survivors and healthcare professionals. METHODS We analyzed qualitative data from focus groups with 19 Latina breast cancer survivors and interviews with 10 healthcare professionals recruited through community partners and venues in Chicago. RESULTS At the individual-level, the lack of knowledge and prioritization regarding financial aspects of care (e.g., costs of treatment, insurance coverage) was identified as important determinants of financial toxicity. However, healthcare professionals emphasized the need for early financial planning, while survivors prioritized survival over financial concerns immediately after diagnosis. At the interpersonal-level, social networks were identified as important platforms for disseminating information on financial resources. At the community-level, community norms and dynamics were identified as important barriers to seeking financial assistance. Access to culturally astute community-based organizations was considered one potential solution to eliminate these barriers. At the organizational/healthcare policy-level, financial assistance programs' restrictive eligibility criteria, lack of coverage post-treatment, limited availability, and instability were identified as major determinants of financial toxicity. CONCLUSION Our findings suggest that multilevel interventions at the individual-, interpersonal-, community-, and organizational/healthcare policy-levels are needed to adequately address financial toxicity among Latina and other survivors from disadvantaged communities.
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Affiliation(s)
- Perla Chebli
- School of Public Health, University of Illinois at Chicago, 649 SPHPI MC923, Chicago, IL, USA
| | - Jocelyne Lemus
- School of Public Health, University of Illinois at Chicago, 649 SPHPI MC923, Chicago, IL, USA
| | - Corazón Avila
- School of Public Health, University of Illinois at Chicago, 649 SPHPI MC923, Chicago, IL, USA
| | - Kryztal Peña
- School of Public Health, University of Illinois at Chicago, 649 SPHPI MC923, Chicago, IL, USA
| | | | | | | | - Yamilé Molina
- School of Public Health, University of Illinois at Chicago, 649 SPHPI MC923, Chicago, IL, USA.
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