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Collaço N, Lippiett KA, Wright D, Brodie H, Winter J, Richardson A, Foster C. Barriers and facilitators to integrated cancer care between primary and secondary care: a scoping review. Support Care Cancer 2024; 32:120. [PMID: 38252169 PMCID: PMC10803398 DOI: 10.1007/s00520-023-08278-1] [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: 06/22/2023] [Accepted: 12/18/2023] [Indexed: 01/23/2024]
Abstract
PURPOSE This scoping review identifies and characterises reported barriers and facilitators to providing integrated cancer care reported in the international literature, and develops recommendations for clinical practice. METHODS This scoping review included literature published between 2009 and 2022 and describes the delivery of integrated cancer care between primary and secondary care sectors. Searches were conducted of an online database Ovid Medline and grey literature. RESULTS The review included thirty-two papers. Barriers and facilitators to integrated cancer care were identified in three core areas: (1) at an individual user level around patient-healthcare professional interactions, (2) at an organisational level, and (3) at a healthcare system level. The review findings identified a need for further training for primary care professionals on cancer care, clarity in the delineation of primary care and oncologist roles (i.e. who does what), effective communication and engagement between primary and secondary care, and the provision of protocols and guidelines for follow-up care in cancer. CONCLUSIONS Information sharing and communication between primary and secondary care must improve to meet the increasing demand for support for people living with and beyond cancer. Delivering integrated pathways between primary and secondary care will yield improvements in patient outcomes and health economic costs.
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Affiliation(s)
- Nicole Collaço
- Centre for Psychosocial Research in Cancer (CentRIC+), School of Health Sciences, University of Southampton, Southampton, SO17 1BJ, England
| | - Kate A Lippiett
- School of Health Sciences, University of Southampton, Southampton, England
| | - David Wright
- Centre for Psychosocial Research in Cancer (CentRIC+), School of Health Sciences, University of Southampton, Southampton, SO17 1BJ, England
| | - Hazel Brodie
- School of Health Sciences, University of Southampton, Southampton, England
| | - Jane Winter
- Wessex Cancer Alliance, Oakley Road, Southampton, England
| | - Alison Richardson
- School of Health Sciences, University of Southampton, Southampton, England
- University Hospital Southampton NHS Foundation Trust, Southampton, England
| | - Claire Foster
- Centre for Psychosocial Research in Cancer (CentRIC+), School of Health Sciences, University of Southampton, Southampton, SO17 1BJ, England.
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Deva M, Osborne J, McGlynn A, Soars L, Loghdey S, Beath K, Gonski P, Dwyer P, Vasudeva N, Joshi P, Deva A. Disease Focused Integrated Care - a New Model of Healthcare Delivery for the Treatment of Skin Cancer. Int J Integr Care 2023; 23:12. [PMID: 37151779 PMCID: PMC10162353 DOI: 10.5334/ijic.7009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Accepted: 04/21/2023] [Indexed: 05/09/2023] Open
Abstract
Introduction As the most common cancer in Australia, skin cancer generates a considerable health burden. This study outlines the establishment of a new model of integrated care for the diagnosis and management of skin cancer. Methods A new model of integrated care was established to provide access to all aspects of skin cancer management. General practitioners (GPs) were upskilled through hands-on training and a 6-month skin cancer education program and partnered with specialist Dermatologists and Plastic Surgeons co-located in the same clinic. Data including median wait times between the initial consultation and treatment were prospectively collected and compared patients seen through the integrated pathway to patients referred from their primary GP to specialist Dermatologists and Plastic Surgeons directly (non-integrated pathway). The percentage of patients needing co-consultation with a specialist in the integrated pathway was also measured over time. Results A total of 25341 patients were seen from the commencement of the clinic in August 2015 to June 2021. In 2017 and 2018 the median wait time to be treated was 7 days for the integrated model compared to 54 days (2017) and 46 days (2018) for non-integrated care (p < 0.0001). The percentage of GPs requesting specialist co-consultations for assessment of skin cancer fell from 98% in 2015, to 5.6% in 2021. Histopathology shows that 66% of lesions excised by GPs in this model were malignant or pre-malignant. Conclusions This study firstly shows a significant reduction in time to treatment in an integrated skin cancer model over traditional models of health. Secondly it demonstrates GP upskilling over time in the integrated program. Integrating GP and specialist medical practitioners in the treatment of skin cancer offers potential for more efficient, accessible, and affordable care. This cooperative, co-located model may provide a template for the integrating the management of other conditions.
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Affiliation(s)
- Maya Deva
- Integrated specialist healthcare education and research foundation, Australia
| | - Julie Osborne
- South Eastern Sydney Local Health District, Australia
| | - Anna McGlynn
- South Eastern Sydney Local Health District, Australia
| | - Linda Soars
- New South Wales Agency for Clinical Innovation, Australia
| | - Saleem Loghdey
- Integrated specialist healthcare education and research foundation, Australia
| | - Kenneth Beath
- School of Mathematical and Physical Sciences, Macquarie University, Australia
| | - Peter Gonski
- Integrated specialist healthcare education and research foundation, Australia
| | - Phil Dwyer
- Integrated specialist healthcare education and research foundation, Australia
| | - Nicholas Vasudeva
- Integrated specialist healthcare education and research foundation, Australia
| | - Preeti Joshi
- Integrated specialist healthcare education and research foundation, Australia
| | - Anand Deva
- Integrated specialist healthcare education and research foundation, Australia
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Walraven JEW, van der Hel OL, van der Hoeven JJM, Lemmens VEPP, Verhoeven RHA, Desar IME. Factors influencing the quality and functioning of oncological multidisciplinary team meetings: results of a systematic review. BMC Health Serv Res 2022; 22:829. [PMID: 35761282 PMCID: PMC9238082 DOI: 10.1186/s12913-022-08112-0] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Accepted: 05/20/2022] [Indexed: 12/01/2022] Open
Abstract
Background Discussing patients with cancer in a multidisciplinary team meeting (MDTM) is customary in cancer care worldwide and requires a significant investment in terms of funding and time. Efficient collaboration and communication between healthcare providers in all the specialisms involved is therefore crucial. However, evidence-based criteria that can guarantee high-quality functioning on the part of MDTMs are lacking. In this systematic review, we examine the factors influencing the MDTMs’ efficiency, functioning and quality, and offer recommendations for improvement. Methods Relevant studies were identified by searching Medline, EMBASE, and PsycINFO databases (01–01-1990 to 09–11-2021), using different descriptions of ‘MDTM’ and ‘neoplasm’ as search terms. Inclusion criteria were: quality of MDTM, functioning of MDTM, framework and execution of MDTM, decision-making process, education, patient advocacy, patient involvement and evaluation tools. Full text assessment was performed by two individual authors and checked by a third author. Results Seventy-four articles met the inclusion criteria and five themes were identified: 1) MDTM characteristics and logistics, 2) team culture, 3) decision making, 4) education, and 5) evaluation and data collection. The quality of MDTMs improves when the meeting is scheduled, structured, prepared and attended by all core members, guided by a qualified chairperson and supported by an administrator. An appropriate amount of time per case needs to be established and streamlining of cases (i.e. discussing a predefined selection of cases rather than discussing every case) might be a way to achieve this. Patient centeredness contributes to correct diagnosis and decision making. While physicians are cautious about patients participating in their own MDTM, the majority of patients report feeling better informed without experiencing increased anxiety. Attendance at MDTMs results in closer working relationships between physicians and provides some medico-legal protection. To ensure well-functioning MDTMs in the future, junior physicians should play a prominent role in the decision-making process. Several evaluation tools have been developed to assess the functioning of MDTMs. Conclusions MDTMs would benefit from a more structured meeting, attendance of core members and especially the attending physician, streamlining of cases and structured evaluation. Patient centeredness, personal competences of MDTM participants and education are not given sufficient attention.
Supplementary information The online version contains supplementary material available at 10.1186/s12913-022-08112-0.
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Mériade L, Rochette C. Integrated care pathway for breast cancer: A relational and geographical approach. Soc Sci Med 2020; 270:113658. [PMID: 33421916 DOI: 10.1016/j.socscimed.2020.113658] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 12/07/2020] [Accepted: 12/22/2020] [Indexed: 10/22/2022]
Abstract
This paper examines how to apply a spatial approach (relational and geographical) to care pathways for their better integration within their territories. Based on the case study of a senology department of a French Cancer Diagnosis, Treatment and Research Centre, we apply a mixed research methodology using qualitative data (synthesis documents, meeting minutes, in-depth interviews) and quantitative data relating to the mobility and geographical location of a cohort of 1798 patients treated in this centre. Our results show the inseparable nature of the relational dimension and the geographical approach to move towards greater integration of breast cancer care pathways. This inseparability is constructed from the proposal of a method for mapping the integrated care pathways in their territories. This method, applied to our case study, allows us to identify four main categories of pathways for the cohort of patients studied.
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Affiliation(s)
- Laurent Mériade
- CleRMa - Research Chair "Health and Territories" - IAE School of Management - Clermont Auvergne University, 11, boulevard Charles de Gaulle, 63000, Clermont-Ferrand, France.
| | - Corinne Rochette
- CleRMa - Research Chair "Health and Territories" - IAE School of Management - Clermont Auvergne University, 11, boulevard Charles de Gaulle, 63000, Clermont-Ferrand, France.
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Cool L, Brewaeys C, Viaene S, Missiaen J, Lycke M, Lefebvre T, Tack L, Foulon V, Pottel H, Debruyne P, Vandijck D, Van Eygen K. Shifting specialized oncological care from hospital- to home-setting: is there support among patients, specialists and general practitioners? Acta Clin Belg 2020; 75:250-257. [PMID: 31003594 DOI: 10.1080/17843286.2019.1605467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
OBJECTIVES Oncological home-hospitalization (OHH) might be a patient-centred approach to deal with the increasing burden of cancer on health-care facilities and finances. Before implementation into practice, its feasibility, costs and support among stakeholders should be evaluated. The purpose of this trial was to explore patients', specialists' and general practitioners' (GPs) perspectives towards the opportunities of implementing OHH within the Belgian health-care system. METHODS A regional cross-sectional survey study was launched in order to investigate the stakeholders' views on OHH and the current cancer care focusing on integration of primary care and continuous care. RESULTS Of the responders, 37 out of 163 patients (23%), 45 of 62 GPs (73%) and 10 of 15 specialists (67%) feel positive about the opportunities for OHH. Nevertheless, 11/15 specialists (73%) and 51/62 GPs (82%) feel primary care might currently be (too) little involved in order to ensure continuous care for cancer patients. Opportunities for improved continuous care are seen in better communication between primary care and hospital, and more patient contacts for primary care during the cancer treatment process. CONCLUSION The results of this local survey study demonstrated there is support among different stakeholder groups for the implementation of OHH within the Belgian health-care context. However, some barriers impeding transmural continuous care should be tackled before implementing such model into practice. Better communication between health-care professionals and more patients contacts are suggested, and an adjusted legal and financial framework is required.
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Affiliation(s)
- Lieselot Cool
- Cancer Centre, General Hospital Groeninge , Kortrijk, Belgium.,Faculty of Medicine and Health Sciences, Ghent University , Gent, Belgium
| | - Celine Brewaeys
- Faculty of Medicine and Health Sciences, Ghent University , Gent, Belgium
| | - Stefaan Viaene
- Association of primary care physicians Zuid West-Vlaanderen , Kortrijk, Belgium
| | - Jana Missiaen
- Cancer Centre, General Hospital Groeninge , Kortrijk, Belgium
| | - Michelle Lycke
- Cancer Centre, General Hospital Groeninge , Kortrijk, Belgium
| | - Tessa Lefebvre
- Cancer Centre, General Hospital Groeninge , Kortrijk, Belgium
| | - Laura Tack
- Cancer Centre, General Hospital Groeninge , Kortrijk, Belgium
| | - Veerle Foulon
- Department of Pharmaceutical and Pharmacological Sciences, Catholic University Leuven , Leuven, Belgium
| | - Hans Pottel
- Department of Public Health and Primary Care @ Kulak, Catholic University Leuven Kulak , Kortrijk, Belgium
| | - Philip Debruyne
- Cancer Centre, General Hospital Groeninge , Kortrijk, Belgium.,Faculty of Health, Social Care and Education, Anglia Ruskin University , Chelmsford, UK
| | - Dominique Vandijck
- Faculty of Medicine and Health Sciences, Ghent University , Gent, Belgium
| | - Koen Van Eygen
- Cancer Centre, General Hospital Groeninge , Kortrijk, Belgium
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Ferrua M, Minvielle E, Fourcade A, Lalloué B, Sicotte C, Di Palma M, Mir O. How to Design a Remote Patient Monitoring System? A French Case Study. BMC Health Serv Res 2020; 20:434. [PMID: 32429987 PMCID: PMC7236289 DOI: 10.1186/s12913-020-05293-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Accepted: 05/05/2020] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Remote Patient Monitoring Systems (RPMS) based on e-health, Nurse Navigators (NNs) and patient engagement can improve patient follow-up and have a positive impact on quality of care (by limiting adverse events) and costs (by reducing readmissions). However, the extent of this impact depends on effective implementation which is often restricted. This is partly due to the lack of attention paid to the RPMS design phase prior to implementation. The content of the RPMS can be carefully designed at this stage and various obstacles anticipated. Our aim was to report on an RPMS design case to provide insights into the methodology required in order to manage this phase. METHODS This study was carried out at Gustave Roussy, a comprehensive cancer centre, in France. A multidisciplinary team coordinated the CAPRI RPMS design process (2013-2015) that later produced positive outcomes. Data were collected during eight studies conducted according to the Medical Research Council (MRC) framework. This project was approved by the French National Data Protection Authorities. RESULTS Based on the study results, the multidisciplinary team defined strategies for resolving obstacles prior to the implementation of CAPRI. Consequently, the final CAPRI design includes a web app with two interfaces (patient and health care professionals) and two NNs. The NNs provide regular follow-up via telephone or email to manage patients' symptoms and toxicity, treatment compliance and care packages. Patients contact the NNs via a secure messaging system. Eighty clinical decision support tools enable NNs to prioritise and decide on the course of action to be taken. CONCLUSION In our experience, the RPMS design process and, more generally, that of any complex intervention programme, is an important phase that requires a sound methodological basis. This study is also consistent with the notion that an RPMS is more than a technological innovation. This is indeed an organizational innovation, and principles identified during the design phase can help in the effective use of a RPMS (e.g. locating NNs if possible within the care organization; recruiting NNs with clinical and managerial skills; defining algorithms for clinical decision support tools for assessment, but also for patient decision and orientation).
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Affiliation(s)
- Marie Ferrua
- Capri program, Research Division, Gustave Roussy, Villejuif, France.
| | - Etienne Minvielle
- Capri program, Research Division, Gustave Roussy, Villejuif, France
- I3, CRG, Ecole Polytechnique, CNRS, Palaiseau, France
| | - Aude Fourcade
- Capri program, Research Division, Gustave Roussy, Villejuif, France
| | | | - Claude Sicotte
- Capri program, Research Division, Gustave Roussy, Villejuif, France
- EHESP, Department of Health Care Management, Rennes, France
| | - Mario Di Palma
- Capri program, Research Division, Gustave Roussy, Villejuif, France
- American Hospital, Neuilly-sur-Seine, France
| | - Olivier Mir
- Capri program, Research Division, Gustave Roussy, Villejuif, France
- Outpatient Department, Gustave Roussy, Villejuif, France
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7
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Walraven J, Desar I, Hoeven van der J, Aben K, Hillegersberg van R, Rasch C, Lemmens V, Verhoeven R. Analysis of 105.000 patients with cancer: have they been discussed in oncologic multidisciplinary team meetings? A nationwide population-based study in the Netherlands. Eur J Cancer 2019; 121:85-93. [DOI: 10.1016/j.ejca.2019.08.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Revised: 08/14/2019] [Accepted: 08/14/2019] [Indexed: 12/24/2022]
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8
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Satyaraj E, Wedner HJ, Bousquet J. Keep the cat, change the care pathway: A transformational approach to managing Fel d 1, the major cat allergen. Allergy 2019; 74 Suppl 107:5-17. [PMID: 31498459 PMCID: PMC7156987 DOI: 10.1111/all.14013] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2019] [Accepted: 08/01/2019] [Indexed: 12/22/2022]
Abstract
Background Allergies to cats are the most common animal‐origin allergy, and affect approximately 1 in 5 adults worldwide. The prevalence of allergy to furry animals has been increasing, and allergy to cats is a major risk factor for the development of asthma and rhinitis. The diagnosis of cat allergy is now well established. The exact significance of component‐resolved diagnosis in the diagnosis of cat allergy remains to be fully understood. Allergen avoidance is effective but often has a psychologic impact. Allergen immunotherapy is not well demonstrated. There is a need for innovative approaches to better manage cat allergens. Next‐generation care pathways for asthma and rhinitis will define the place of cat allergen avoidance. Methods and Results This manuscript, based on content presented at the European Academy of Allergy and Clinical Immunology Congress 2019, provides information on the prevalence and impact of cat allergies and the molecular biology of Fel d 1, the major cat allergen. Discussion The authors present the scientific basis of a novel care pathway that utilizes anti‐Fel d 1 IgY antibodies to safely and effectively neutralize Fel d 1 after its production by the cat but before human exposure. Conclusion Efficacy of a feline diet with an egg product ingredient containing anti‐Fel d 1 IgY antibodies was demonstrated in vitro, ex vivo, and in vivo, and further validated by a pilot exposure study involving cat‐allergic human participants.
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Affiliation(s)
| | - Harold James Wedner
- Division of Allergy and Immunology, Department of Medicine Washington University School of Medicine St. Louis MO USA
| | - Jean Bousquet
- University Hospital Montpellier France
- MACVIA‐France Fondation partenariale FMC VIA‐LR Montpellier France
- INSERM U 1168 VIMA: Ageing and Chronic Diseases Epidemiological and Public Health Approaches Villejuif France
- UMR‐S 1168 Université Versailles St‐Quentin‐en‐Yvelines Montigny le Bretonneux France
- Charité, Universitätsmedizin Berlin Humboldt‐Universität zu Berlin Berlin Germany
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Liljas AEM, Brattström F, Burström B, Schön P, Agerholm J. Impact of Integrated Care on Patient-Related Outcomes Among Older People - A Systematic Review. Int J Integr Care 2019; 19:6. [PMID: 31367205 PMCID: PMC6659761 DOI: 10.5334/ijic.4632] [Citation(s) in RCA: 49] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Accepted: 07/10/2019] [Indexed: 11/20/2022] Open
Abstract
INTRODUCTION The growing number of older adults with multiple needs increases the pressure to reform existing healthcare systems. Integrated care may be part of such reforms. The aim of this systematic review was to identify important patient-related outcomes of integrated care provided to older adults. METHODS A systematic search of 5 databases to identify studies comprising older adults assessing hospital admission, length of hospital stay, hospital readmission, patient satisfaction and mortality in integrated care settings. Retrieved literature was analysed employing a narrative synthesis. RESULTS Twelve studies were included (2 randomised controlled trials, 7 quasi-experimental design, 2 comparison studies, 1 survey evaluation). Five studies investigated patient satisfaction, 9 hospital admission, 7 length of stay, 3 readmission and 5 mortality. Findings show that integrated care tends to have a positive impact on hospital admission rates, some positive impact on length of stay and possibly also on readmission and patient satisfaction but not on mortality. CONCLUSIONS Integrated care may reduce hospital admission rates and lengths of hospital stay. However due to lack of robust findings, the effectiveness of integrated care on patient-related outcomes in later life remain largely unknown. Further research is needed to establish the effect of integrated care on these patient-related outcomes. PROSPERO REGISTRATION NUMBER CRD42018110491.
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Affiliation(s)
- Ann E. M. Liljas
- Department of Public Health Sciences, Division of Social Medicine, Karolinska Institutet, Stockholm, SE
| | - Fanny Brattström
- Department of Public Health Sciences, Division of Social Medicine, Karolinska Institutet, Stockholm, SE
| | - Bo Burström
- Department of Public Health Sciences, Division of Social Medicine, Karolinska Institutet, Stockholm, SE
- Centre for Epidemiology and Community Medicine, Stockholm County Council Health Services, Stockholm, SE
| | - Pär Schön
- Aging Research Center, Karolinska Institutet and Stockholm University, Stockholm, SE
| | - Janne Agerholm
- Department of Public Health Sciences, Division of Social Medicine, Karolinska Institutet, Stockholm, SE
- Centre for Epidemiology and Community Medicine, Stockholm County Council Health Services, Stockholm, SE
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10
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Witt CM, Balneaves LG, Cardoso MJ, Cohen L, Greenlee H, Johnstone P, Kücük Ö, Mailman J, Mao JJ. A Comprehensive Definition for Integrative Oncology. J Natl Cancer Inst Monogr 2018; 2017:4617827. [PMID: 29140493 DOI: 10.1093/jncimonographs/lgx012] [Citation(s) in RCA: 102] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2016] [Accepted: 08/14/2017] [Indexed: 11/12/2022] Open
Abstract
Background Integrative oncology, which is generally understood to refer to the use of a combination of complementary medicine therapies in conjunction with conventional cancer treatments, has been defined in different ways, but there is no widely accepted definition. We sought to develop and establish a consensus for a comprehensive definition of the field of integrative oncology. Methods We used a mixed-methods approach that included a literature analysis and a consensus procedure, including an interdisciplinary expert panel and surveys, to develop a comprehensive and acceptable definition for the term "integrative oncology." Results The themes identified in the literature and from the expert discussion were condensed into a two-sentence definition. Survey respondents had very positive views on the draft definition, and their comments helped to shape the final version. The final definition for integrative oncology is: "Integrative oncology is a patient-centered, evidence-informed field of cancer care that utilizes mind and body practices, natural products, and/or lifestyle modifications from different traditions alongside conventional cancer treatments. Integrative oncology aims to optimize health, quality of life, and clinical outcomes across the cancer care continuum and to empower people to prevent cancer and become active participants before,during, and beyond cancer treatment." Conclusions This short and comprehensive definition for the term integrative oncology will facilitate a better understanding and communication of this emerging field. This definition will also drive focused and cohesive effort to advance the field of integrative oncology.
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Affiliation(s)
- Claudia M Witt
- Institute for Complementary and Integrative Medicine, University of Zurich and University Hospital Zurich, Zurich, Switzerland; Institute for Social Medicine, Epidemiology and Health Economics, Charité - Universitätsmedizin Berlin, Berlin, Germany; Center for Integrative Medicine, University of Maryland School of Medicine, Baltimore, MD; College of Nursing, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada; Breast Cancer Unit, Champalimaud Cancer Center, Lisbon, Portugal; Mama Help Association, Support Centre for Breast Cancer Patients, Porto, Portugal; Integrative Medicine Program, The University of Texas MD Anderson Cancer Center, Houston, TX; Department of Epidemiology, Mailman School of Public Health, and Herbert Irving Comprehensive Cancer Center, Columbia University, New York, NY; Moffitt Cancer Center and Research Institute, Tampa, FL; Winship Cancer Institute of Emory University, Atlanta, GA; NorCal CarciNET Community, Oakland, CA; Memorial Sloan Kettering Cancer Center, New York, NY
| | - Lynda G Balneaves
- Institute for Complementary and Integrative Medicine, University of Zurich and University Hospital Zurich, Zurich, Switzerland; Institute for Social Medicine, Epidemiology and Health Economics, Charité - Universitätsmedizin Berlin, Berlin, Germany; Center for Integrative Medicine, University of Maryland School of Medicine, Baltimore, MD; College of Nursing, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada; Breast Cancer Unit, Champalimaud Cancer Center, Lisbon, Portugal; Mama Help Association, Support Centre for Breast Cancer Patients, Porto, Portugal; Integrative Medicine Program, The University of Texas MD Anderson Cancer Center, Houston, TX; Department of Epidemiology, Mailman School of Public Health, and Herbert Irving Comprehensive Cancer Center, Columbia University, New York, NY; Moffitt Cancer Center and Research Institute, Tampa, FL; Winship Cancer Institute of Emory University, Atlanta, GA; NorCal CarciNET Community, Oakland, CA; Memorial Sloan Kettering Cancer Center, New York, NY
| | - Maria J Cardoso
- Institute for Complementary and Integrative Medicine, University of Zurich and University Hospital Zurich, Zurich, Switzerland; Institute for Social Medicine, Epidemiology and Health Economics, Charité - Universitätsmedizin Berlin, Berlin, Germany; Center for Integrative Medicine, University of Maryland School of Medicine, Baltimore, MD; College of Nursing, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada; Breast Cancer Unit, Champalimaud Cancer Center, Lisbon, Portugal; Mama Help Association, Support Centre for Breast Cancer Patients, Porto, Portugal; Integrative Medicine Program, The University of Texas MD Anderson Cancer Center, Houston, TX; Department of Epidemiology, Mailman School of Public Health, and Herbert Irving Comprehensive Cancer Center, Columbia University, New York, NY; Moffitt Cancer Center and Research Institute, Tampa, FL; Winship Cancer Institute of Emory University, Atlanta, GA; NorCal CarciNET Community, Oakland, CA; Memorial Sloan Kettering Cancer Center, New York, NY
| | - Lorenzo Cohen
- Institute for Complementary and Integrative Medicine, University of Zurich and University Hospital Zurich, Zurich, Switzerland; Institute for Social Medicine, Epidemiology and Health Economics, Charité - Universitätsmedizin Berlin, Berlin, Germany; Center for Integrative Medicine, University of Maryland School of Medicine, Baltimore, MD; College of Nursing, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada; Breast Cancer Unit, Champalimaud Cancer Center, Lisbon, Portugal; Mama Help Association, Support Centre for Breast Cancer Patients, Porto, Portugal; Integrative Medicine Program, The University of Texas MD Anderson Cancer Center, Houston, TX; Department of Epidemiology, Mailman School of Public Health, and Herbert Irving Comprehensive Cancer Center, Columbia University, New York, NY; Moffitt Cancer Center and Research Institute, Tampa, FL; Winship Cancer Institute of Emory University, Atlanta, GA; NorCal CarciNET Community, Oakland, CA; Memorial Sloan Kettering Cancer Center, New York, NY
| | - Heather Greenlee
- Institute for Complementary and Integrative Medicine, University of Zurich and University Hospital Zurich, Zurich, Switzerland; Institute for Social Medicine, Epidemiology and Health Economics, Charité - Universitätsmedizin Berlin, Berlin, Germany; Center for Integrative Medicine, University of Maryland School of Medicine, Baltimore, MD; College of Nursing, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada; Breast Cancer Unit, Champalimaud Cancer Center, Lisbon, Portugal; Mama Help Association, Support Centre for Breast Cancer Patients, Porto, Portugal; Integrative Medicine Program, The University of Texas MD Anderson Cancer Center, Houston, TX; Department of Epidemiology, Mailman School of Public Health, and Herbert Irving Comprehensive Cancer Center, Columbia University, New York, NY; Moffitt Cancer Center and Research Institute, Tampa, FL; Winship Cancer Institute of Emory University, Atlanta, GA; NorCal CarciNET Community, Oakland, CA; Memorial Sloan Kettering Cancer Center, New York, NY
| | - Peter Johnstone
- Institute for Complementary and Integrative Medicine, University of Zurich and University Hospital Zurich, Zurich, Switzerland; Institute for Social Medicine, Epidemiology and Health Economics, Charité - Universitätsmedizin Berlin, Berlin, Germany; Center for Integrative Medicine, University of Maryland School of Medicine, Baltimore, MD; College of Nursing, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada; Breast Cancer Unit, Champalimaud Cancer Center, Lisbon, Portugal; Mama Help Association, Support Centre for Breast Cancer Patients, Porto, Portugal; Integrative Medicine Program, The University of Texas MD Anderson Cancer Center, Houston, TX; Department of Epidemiology, Mailman School of Public Health, and Herbert Irving Comprehensive Cancer Center, Columbia University, New York, NY; Moffitt Cancer Center and Research Institute, Tampa, FL; Winship Cancer Institute of Emory University, Atlanta, GA; NorCal CarciNET Community, Oakland, CA; Memorial Sloan Kettering Cancer Center, New York, NY
| | - Ömer Kücük
- Institute for Complementary and Integrative Medicine, University of Zurich and University Hospital Zurich, Zurich, Switzerland; Institute for Social Medicine, Epidemiology and Health Economics, Charité - Universitätsmedizin Berlin, Berlin, Germany; Center for Integrative Medicine, University of Maryland School of Medicine, Baltimore, MD; College of Nursing, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada; Breast Cancer Unit, Champalimaud Cancer Center, Lisbon, Portugal; Mama Help Association, Support Centre for Breast Cancer Patients, Porto, Portugal; Integrative Medicine Program, The University of Texas MD Anderson Cancer Center, Houston, TX; Department of Epidemiology, Mailman School of Public Health, and Herbert Irving Comprehensive Cancer Center, Columbia University, New York, NY; Moffitt Cancer Center and Research Institute, Tampa, FL; Winship Cancer Institute of Emory University, Atlanta, GA; NorCal CarciNET Community, Oakland, CA; Memorial Sloan Kettering Cancer Center, New York, NY
| | - Josh Mailman
- Institute for Complementary and Integrative Medicine, University of Zurich and University Hospital Zurich, Zurich, Switzerland; Institute for Social Medicine, Epidemiology and Health Economics, Charité - Universitätsmedizin Berlin, Berlin, Germany; Center for Integrative Medicine, University of Maryland School of Medicine, Baltimore, MD; College of Nursing, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada; Breast Cancer Unit, Champalimaud Cancer Center, Lisbon, Portugal; Mama Help Association, Support Centre for Breast Cancer Patients, Porto, Portugal; Integrative Medicine Program, The University of Texas MD Anderson Cancer Center, Houston, TX; Department of Epidemiology, Mailman School of Public Health, and Herbert Irving Comprehensive Cancer Center, Columbia University, New York, NY; Moffitt Cancer Center and Research Institute, Tampa, FL; Winship Cancer Institute of Emory University, Atlanta, GA; NorCal CarciNET Community, Oakland, CA; Memorial Sloan Kettering Cancer Center, New York, NY
| | - Jun J Mao
- Institute for Complementary and Integrative Medicine, University of Zurich and University Hospital Zurich, Zurich, Switzerland; Institute for Social Medicine, Epidemiology and Health Economics, Charité - Universitätsmedizin Berlin, Berlin, Germany; Center for Integrative Medicine, University of Maryland School of Medicine, Baltimore, MD; College of Nursing, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada; Breast Cancer Unit, Champalimaud Cancer Center, Lisbon, Portugal; Mama Help Association, Support Centre for Breast Cancer Patients, Porto, Portugal; Integrative Medicine Program, The University of Texas MD Anderson Cancer Center, Houston, TX; Department of Epidemiology, Mailman School of Public Health, and Herbert Irving Comprehensive Cancer Center, Columbia University, New York, NY; Moffitt Cancer Center and Research Institute, Tampa, FL; Winship Cancer Institute of Emory University, Atlanta, GA; NorCal CarciNET Community, Oakland, CA; Memorial Sloan Kettering Cancer Center, New York, NY
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11
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Cai M, Liu E, Tao H, Qian Z, Fu Q(J, Lin X, Wang M, Xu C, Ni Z. Does A Medical Consortium Influence Health Outcomes of Hospitalized Cancer Patients? An Integrated Care Model in Shanxi, China. Int J Integr Care 2018; 18:7. [PMID: 30127691 PMCID: PMC6095089 DOI: 10.5334/ijic.3588] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2017] [Accepted: 03/28/2018] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE To assess the effect of the medical consortium policy on the outcomes of cancer patients admitted to secondary hospitals in Shanxi, China. METHOD Electronic medical records of lung cancer (n = 8,193), stomach cancer (n = 5,693) and esophagus cancer (n = 2,802) patients hospitalized in secondary hospitals were used. Propensity score matching was used to match each patient enrolled in medical consortium hospitals with a counterpart admitted in non-medical consortium hospitals. Cox proportional hazard models were used to estimate the hazard ratio of patients enrolled different categories of hospitals. RESULTS The hazards of lung, stomach and esophageal cancer patients admitted in medical consortium hospitals were consistently and significantly lower than those admitted in non-medical consortium hospitals after adjusting for a number of potential confounders. Lower hazard ratios were associated with lung (hazard ratio (HR) = 0.533, p < 0.001), stomach (HR = 0.494, p < 0.001), and esophagus (HR = 0.505, p < 0.001) cancer patients in medical consortium hospitals. CONCLUSION The medical consortium provides an effective strategy to improve the outcomes of cancer patients in Shanxi, China. The partnerships between top-tier hospitals and grassroots medical services bridge the gap in resources and plays a critical role in the quality of care in China.
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Affiliation(s)
- Miao Cai
- Department of Epidemiology and Biostatistics, College for Public Health and Social Justice, Saint Louis University, Saint Louis, Missouri, 63104, US
| | - Echu Liu
- Department of Health Management and Policy, College for Public Health and Social Justice, Saint Louis University, Saint Louis, Missouri, 63104, US
| | - Hongbing Tao
- School of Health Management and Medicine, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, 430030, CN
| | - Zhengmin Qian
- Department of Epidemiology and Biostatistics, College for Public Health and Social Justice, Saint Louis University, Saint Louis, Missouri, 63104, US
| | - Qiang (John) Fu
- Department of Epidemiology and Biostatistics, College for Public Health and Social Justice, Saint Louis University, Saint Louis, Missouri, 63104, US
| | - Xiaojun Lin
- School of Health Management and Medicine, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, 430030, CN
| | - Manli Wang
- School of Health Management and Medicine, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, 430030, CN
| | - Chang Xu
- School of Health Management and Medicine, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, 430030, CN
| | - Ziling Ni
- School of Health Management and Medicine, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, 430030, CN
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12
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Youssef AT, Constantino R, Chaudhary ZK, Lee A, Wiljer D, Mylopoulos M, Sockalingam S. Mapping Evidence of Patients' Experiences in Integrated Care Settings: A Protocol for a Scoping Review. BMJ Open 2017; 7:e018311. [PMID: 29247100 PMCID: PMC5736037 DOI: 10.1136/bmjopen-2017-018311] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
INTRODUCTION Integrated care (IC) models have emerged to address gaps in care for individuals with complex healthcare needs. Although the clinical and cost-effectiveness of IC models are well-established, our understanding of whether IC models facilitate a patient-centred care experience from the patients' perspective is not well understood. This scoping review aims to comprehensively map the literature to provide a broad overview of patients' experiences in IC settings with a focus on the experiences of complex patients with comorbid mental and physical illnesses. It also aims to describe current gaps identified in the literature in our understanding of aspects of care that are often unrecognised. METHODS AND ANALYSIS Using established scoping review frameworks and guidelines, we will perform a comprehensive search in the following databases: MEDLINE, EMBASE, PsycINFO, CINAHL, AMED and the Cochrane Library to identify relevant studies on patients' experiences in IC models. Grey literature sources and studies bibliographies will also be searched to identify relevant studies and documents. Data will be extracted and summarised using descriptive statistical and qualitative analyses. We will also consult with stakeholders from various backgrounds to enhance the comprehensiveness of this review. ETHICS AND DISSEMINATION This review requires no ethical approval. Findings from this study will be disseminated through publication in a peer-reviewed journal, clinical conferences and in knowledge translation settings, aiming to improve clinical practice and care delivery.
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Affiliation(s)
- Alaa T Youssef
- Institute for Medical Sciences, University of Toronto, Toronto, Ontario, Canada
- Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Centre for Mental Health, University Health Network, Toronto, Ontario, Canada
| | - Rosa Constantino
- Centre for Mental Health, University Health Network, Toronto, Ontario, Canada
| | - Zarah K Chaudhary
- The Wilson Centre, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Andrew Lee
- Centre for Mental Health, University Health Network, Toronto, Ontario, Canada
| | - David Wiljer
- Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Education, University of Toronto, Toronto, Ontario, Canada
- UHN Digital, University Health Network, Toronto, ON, Canada
| | - Maria Mylopoulos
- The Wilson Centre, University Health Network, University of Toronto, Toronto, Ontario, Canada
- Department of Paediatrics, University of Toronto, Toronto, Ontario, Canada
| | - Sanjeev Sockalingam
- Institute for Medical Sciences, University of Toronto, Toronto, Ontario, Canada
- Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Centre for Mental Health, University Health Network, Toronto, Ontario, Canada
- The Wilson Centre, University Health Network, University of Toronto, Toronto, Ontario, Canada
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13
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Jefford M, Emery J, Grunfeld E, Martin A, Rodger P, Murray AM, De Abreu Lourenco R, Heriot A, Phipps-Nelson J, Guccione L, King D, Lisy K, Tebbutt N, Burgess A, Faragher I, Woods R, Schofield P. SCORE: Shared care of Colorectal cancer survivors: protocol for a randomised controlled trial. Trials 2017; 18:506. [PMID: 29084595 PMCID: PMC5663101 DOI: 10.1186/s13063-017-2245-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2017] [Accepted: 10/10/2017] [Indexed: 12/20/2022] Open
Abstract
Background Colorectal cancer (CRC) is the most common cancer affecting both men and women. Survivors of CRC often experience various physical and psychological effects arising from CRC and its treatment. These effects may last for many years and adversely affect QoL, and they may not be adequately addressed by standard specialist-based follow-up. Optimal management of these effects should harness the expertise of both primary care and specialist care. Shared models of care (involving both the patient’s primary care physician [PCP] and specialist) have the potential to better support survivors and enhance health system efficiency. Methods/design SCORE (Shared care of Colorectal cancer survivors) is a multisite randomised controlled trial designed to optimise and operationalise a shared care model for survivors of CRC, to evaluate the acceptability of the intervention and study processes, and to collect preliminary data regarding the effects of shared care compared with usual care on a range of patient-reported outcomes. The primary outcome is QoL measured using the European Organisation for Research and Treatment of Cancer QLQ-C30 questionnaire. Secondary outcomes are satisfaction with care, unmet needs, continuity of care and health resource use. The shared care model involves replacement of two routine specialist follow-up visits with PCP visits, as well as the provision of a tailored survivorship care plan and a survivorship booklet and DVD for CRC survivors. All consenting patients will be randomised 1:1 to either shared care or usual care and will complete questionnaires at three time points over a 12-month period (baseline and at 6 and 12 months). Health care resource use data will also be collected and used to evaluate costs. Discussion The evaluation and implementation of models of care that are responsive to the holistic needs of cancer survivors while reducing the burden on acute care settings is an international priority. Shared care between specialists and PCPs has the potential to enhance patient care and outcomes for CRC survivors while offering improvements in health care resource efficiency. If the findings of the present study show that the shared care intervention is acceptable and feasible for CRC survivors, the intervention may be readily expanded to other groups of cancer survivors. Trial registration Australian New Zealand Clinical Trials Registry, ACTRN12617000004369p. Registered on 3 January 2017; protocol version 4 approved 24 February 2017. Electronic supplementary material The online version of this article (doi:10.1186/s13063-017-2245-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Michael Jefford
- Department of Cancer Experiences Research, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia. .,Sir Peter MacCallum Department of Oncology, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, VIC, Australia. .,Division of Cancer Medicine, Peter MacCallum Cancer Centre, 305 Grattan Street, Melbourne, VIC, 3000, Australia.
| | - Jon Emery
- Department of General Practice and Centre for Cancer Research, University of Melbourne, Victorian Comprehensive Cancer Centre, Melbourne, VIC, Australia
| | - Eva Grunfeld
- Ontario Institute for Cancer Research, Toronto, ON, Canada.,Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
| | - Andrew Martin
- National Health and Medical Research Council (NHMRC) Clinical Trials Centre, University of Sydney, Sydney, NSW, Australia
| | - Paula Rodger
- Department of Cancer Experiences Research, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | - Alexandra M Murray
- Department of Cancer Experiences Research, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | - Richard De Abreu Lourenco
- Centre for Health Economics Research and Evaluation, University of Technology Sydney, Sydney, NSW, Australia
| | - Alexander Heriot
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | - Jo Phipps-Nelson
- Department of Cancer Experiences Research, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | - Lisa Guccione
- Department of Cancer Experiences Research, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia.,Psychology Department, School of Health and Biomedical Sciences, RMIT University, Melbourne, VIC, Australia
| | - Dorothy King
- Department of Cancer Experiences Research, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | - Karolina Lisy
- Department of Cancer Experiences Research, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | - Niall Tebbutt
- Department of Medical Oncology, Olivia Newton-John Cancer Wellness and Research Centre, Austin Health, Heidelberg, VIC, Australia
| | - Adele Burgess
- Colorectal Surgery Unit, Austin Health, Heidelberg, VIC, Australia
| | - Ian Faragher
- Colorectal Surgery, Western Health, Footscray, VIC, Australia
| | - Rodney Woods
- Colorectal Surgery Unit, St Vincent's Hospital, Fitzroy, VIC, Australia
| | - Penelope Schofield
- Department of Cancer Experiences Research, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia.,Sir Peter MacCallum Department of Oncology, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, VIC, Australia.,Department of Psychology, School of Health Sciences, Faculty of Health, Arts and Design, Swinburne University of Technology, Heidelberg, VIC, Australia
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14
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Weller D. The growing number of cancer survivors in western countries: How can our health systems best meet their needs? Eur J Cancer Care (Engl) 2017; 26. [DOI: 10.1111/ecc.12731] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- D. Weller
- Centre for Population Health Sciences; University of Edinburgh; Edinburgh UK
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15
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Cortis LJ, Ward PR, McKinnon RA, Koczwara B. Integrated care in cancer: What is it, how is it used and where are the gaps? A textual narrative literature synthesis. Eur J Cancer Care (Engl) 2017; 26. [PMID: 28426142 DOI: 10.1111/ecc.12689] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/13/2017] [Indexed: 11/30/2022]
Abstract
Integrated care is an underpinning concept of contemporary health care policy proffered as a strategy to overcome the fragmentations in care encountered by people with complex care needs (Shaw et al. [2011] What is Integrated Care? An Overview of Integrated Care in the NHS). Cancer patients have potential to benefit from such policy, often having needs that extend beyond cancer. This paper seeks to understand how the concept of integrated care is used in the cancer literature. A search of leading databases was conducted for original research relating to integrated care or an integration intervention aiming to improve outcomes of cancer patients, and analysed using textual narrative synthesis. 38 papers were included, each with a focus on improving cancer-specific aspects of care enhancing the capabilities of the cancer multidisciplinary team. Of the eight studies involving integration between the cancer service and other care providers, all focused on utilising the external provider to deliver aspects of cancer care or placed them in a passive role, as survey participant, a recipient of cancer-related clinical information or as the comparator "usual care" arm. Within the cancer literature, integration is predominantly used to describe initiatives to improve cancer-related aspects of care. Less attention is given to integration initiatives that enhance coordination across levels of the healthcare system or service providers.
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Affiliation(s)
- L J Cortis
- Flinders Centre for Innovation in Cancer, Flinders University, Adelaide, SA, Australia
| | - P R Ward
- Discipline of Public Health, School of Health Sciences, Flinders University, Adelaide, SA, Australia
| | - R A McKinnon
- Flinders Centre for Innovation in Cancer, Flinders University, Adelaide, SA, Australia
| | - B Koczwara
- Flinders Centre for Innovation in Cancer, Flinders University, Adelaide, SA, Australia
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16
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Tomasone JR, Brouwers MC, Vukmirovic M, Grunfeld E, O'Brien MA, Urquhart R, Walker M, Webster F, Fitch M. Interventions to improve care coordination between primary healthcare and oncology care providers: a systematic review. ESMO Open 2016; 1:e000077. [PMID: 27843639 PMCID: PMC5070279 DOI: 10.1136/esmoopen-2016-000077] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2016] [Revised: 06/21/2016] [Accepted: 06/22/2016] [Indexed: 12/22/2022] Open
Abstract
Coordination of patient care between primary care and oncology care providers is vital to care quality and outcomes across the cancer continuum, yet it is known to be challenging. We conducted a systematic review to evaluate current or new models of care and/or interventions aimed at improving coordination between primary care and oncology care providers for patients with adult breast and/or colorectal cancer. MEDLINE, EMBASE, CINAHL, Cochrane Library Database of Systematic Reviews, and the Centre for Reviews and Dissemination were searched for existing English language studies published between January 2000 and 15 May 2015. Systematic reviews, meta-analyses, randomised controlled trials (RCTs) and non-randomised studies were included if they evaluated a specific model/intervention that was designed to improve care coordination between primary care and oncology care providers, for any stage of the cancer continuum, for patients with adult breast and/or colorectal cancer. Two reviewers extracted data and assessed risk of bias. Twenty-two studies (5 systematic reviews, 6 RCTs and 11 non-randomised studies) were included and varied with respect to the targeted phase of the cancer continuum, type of model or intervention tested, and outcome measures. The majority of studies showed no statistically significant changes in any patient, provider or system outcomes. Owing to conceptual and methodological limitations in this field, the review is unable to provide specific conclusions about the most effective or preferred model/intervention to improve care coordination. Imprecise results that lack generalisability and definitiveness provide limited evidence to base the development of future interventions and policies. TRIAL REGISTRATION NUMBER CRD42015025006.
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Affiliation(s)
- Jennifer R Tomasone
- School of Kinesiology and Health Studies, Queen's University, Kingston, Ontario, Canada
| | - Melissa C Brouwers
- Department of Oncology, McMaster University & the Escarpment Cancer Research Institute, Hamilton, Ontario, Canada
| | - Marija Vukmirovic
- Department of Oncology, McMaster University & the Escarpment Cancer Research Institute, Hamilton, Ontario, Canada
| | - Eva Grunfeld
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Mary Ann O'Brien
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Robin Urquhart
- Department of Surgery, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Melanie Walker
- Division of Cancer Care and Epidemiology, Cancer Research Institute, Queen's University, Kingston, Ontario, Canada
| | - Fiona Webster
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Margaret Fitch
- Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
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17
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Bauer A, Vordermark D, Seufferlein T, Schmoll HJ, Dralle H, Mau W, Unverzagt S, Boese S, Fach EM, Landenberger M. Trans-sectoral care in patients with colorectal cancer: Protocol of the randomized controlled multi-center trial Supportive Cancer Care Networkers (SCAN). BMC Cancer 2015; 15:997. [PMID: 26694748 PMCID: PMC4689007 DOI: 10.1186/s12885-015-2002-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2015] [Accepted: 12/11/2015] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Managing therapy-related side-effects and improving health-related quality of life in patients with colorectal cancer is still challenging. The need for an effective management of adverse events and unmet supportive care needs have been widely discussed. In the past decade, interventions by nursing staff gained more and more importance. Evidence suggests that a majority of patients even in early stages of the disease experience substantial impairments potentially resulting in diminished therapy adherence as well as impaired quality of life. However, evidence for the effectiveness of nurse-led interventions on symptom management and quality of life is still very limited. This especially applies to care transitions between different inpatient and outpatient health care providers throughout the course of treatment and aftercare. METHODS/DESIGN Supportive Cancer Care Networkers (SCAN) is a prospective randomized controlled trial conducted in eight large and middle-sized German cancer centers and municipal hospitals. The target population is adults with colorectal cancer UICC I-III after initial R-0 resection scheduled for adjuvant chemotherapy or guideline-based aftercare only. 370 patients will be randomly assigned to either intervention or control group. Patients in the intervention group will receive an additional support by specialized oncology nurses for eight weeks after discharge from hospital by telephone, consisting of symptom monitoring, counselling on self-assessment and self-management and dealing with individual resources for coping and psychosocial well-being. The primary endpoint will be health-related quality of life (HRQoL) at eight weeks after discharge from the initial treating hospital. DISCUSSION The presented SCAN trial is to provide information that will be useful to advance our understanding of complex interdependencies between symptom severity, supportive care needs, functioning and the risk for diminished HRQoL. Most importantly, these patient-reported outcomes are not fully implemented in today's clinical routine practice potentially resulting in therapy cessations and lower chemotherapy treatment rates for colorectal cancer especially in older patients. TRIAL REGISTRATION ClinicalTrials.gov Identifier NCT01651832.
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Affiliation(s)
- Alexander Bauer
- Martin-Luther-University Halle-Wittenberg, Medical Faculty, Institute for Health and Nursing Science, Magdeburger Strasse 8, D-06112, Halle, Germany.
| | - Dirk Vordermark
- Department of Radiation Oncology, University Hospital Halle, Ernst-Grube-Strasse 40, D-06120, Halle, Germany.
| | - Thomas Seufferlein
- Department of Internal Medicine I, University Hospital Ulm, Albert Einstein Allee 23, Ulm, D-89081, Germany.
| | - Hans-Joachim Schmoll
- University Hospital Halle, Clinic for Internal Medicine IV, Ernst-Grube-Strasse 40, D-06120, Halle, Germany.
| | - Henning Dralle
- Department of General, Visceral and Vascular Surgery, University Hospital, Ernst-Grube-Strasse 40, D-06120, Halle, Germany.
| | - Wilfried Mau
- Martin-Luther-University Halle-Wittenberg, Medical Faculty, Institute for Rehabilitation Medicine, Magdeburger Strasse 8, D-06112, Halle, Germany.
| | - Susanne Unverzagt
- Martin-Luther-University Halle-Wittenberg, Medical Faculty, Institute for Medical Epidemiology, Biostatistics and Informatics, Magdeburger Strasse 8, D-06112, Halle, Germany.
| | - Stephanie Boese
- Martin-Luther-University Halle-Wittenberg, Medical Faculty, Institute for Health and Nursing Science, Magdeburger Strasse 8, D-06112, Halle, Germany.
| | - Eva-Maria Fach
- Martin-Luther-University Halle-Wittenberg, Medical Faculty, Institute for Health and Nursing Science, Magdeburger Strasse 8, D-06112, Halle, Germany.
| | - Margarete Landenberger
- Martin-Luther-University Halle-Wittenberg, Medical Faculty, Institute for Health and Nursing Science, Magdeburger Strasse 8, D-06112, Halle, Germany.
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18
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Ward C, Glass N, Ford R. Care in the home for seriously ill children with complex needs: A narrative literature review. J Child Health Care 2015; 19:524-31. [PMID: 24982427 DOI: 10.1177/1367493514538327] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This article reviews contemporary literature on home care of the seriously ill child with complex care needs and the sick child/parent dyad. The literature search revealed three major themes, namely the increasing acuity of child illness, the evolving role of the parent as care provider, and the health professional as care provider. While there is much known about the complexity of care of children and the role of family in that care, little is known about what families require in terms of support and sustenance during the long years of care provision.
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Affiliation(s)
| | - Nel Glass
- Australian Catholic University, Australia
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19
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Rubin G, Berendsen A, Crawford SM, Dommett R, Earle C, Emery J, Fahey T, Grassi L, Grunfeld E, Gupta S, Hamilton W, Hiom S, Hunter D, Lyratzopoulos G, Macleod U, Mason R, Mitchell G, Neal RD, Peake M, Roland M, Seifert B, Sisler J, Sussman J, Taplin S, Vedsted P, Voruganti T, Walter F, Wardle J, Watson E, Weller D, Wender R, Whelan J, Whitlock J, Wilkinson C, de Wit N, Zimmermann C. The expanding role of primary care in cancer control. Lancet Oncol 2015; 16:1231-72. [PMID: 26431866 DOI: 10.1016/s1470-2045(15)00205-3] [Citation(s) in RCA: 355] [Impact Index Per Article: 39.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2015] [Revised: 07/25/2015] [Accepted: 07/27/2015] [Indexed: 12/21/2022]
Abstract
The nature of cancer control is changing, with an increasing emphasis, fuelled by public and political demand, on prevention, early diagnosis, and patient experience during and after treatment. At the same time, primary care is increasingly promoted, by governments and health funders worldwide, as the preferred setting for most health care for reasons of increasing need, to stabilise health-care costs, and to accommodate patient preference for care close to home. It is timely, then, to consider how this expanding role for primary care can work for cancer control, which has long been dominated by highly technical interventions centred on treatment, and in which the contribution of primary care has been largely perceived as marginal. In this Commission, expert opinion from primary care and public health professionals with academic and clinical cancer expertise—from epidemiologists, psychologists, policy makers, and cancer specialists—has contributed to a detailed consideration of the evidence for cancer control provided in primary care and community care settings. Ranging from primary prevention to end-of-life care, the scope for new models of care is explored, and the actions needed to effect change are outlined. The strengths of primary care—its continuous, coordinated, and comprehensive care for individuals and families—are particularly evident in prevention and diagnosis, in shared follow-up and survivorship care, and in end-of-life care. A strong theme of integration of care runs throughout, and its elements (clinical, vertical, and functional) and the tools needed for integrated working are described in detail. All of this change, as it evolves, will need to be underpinned by new research and by continuing and shared multiprofessional development.
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Affiliation(s)
- Greg Rubin
- School of Medicine, Pharmacy and Health, Durham University, Stockton on Tees, UK.
| | - Annette Berendsen
- Department of General Practice, University of Groningen, Groningen, Netherlands
| | | | - Rachel Dommett
- School of Clinical Sciences, University of Bristol, Bristol, UK
| | - Craig Earle
- Ontario Institute for Cancer Research, Toronto, ON, Canada
| | - Jon Emery
- Department of General Practice, University of Melbourne, Melbourne, VIC, Australia
| | - Tom Fahey
- Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Luigi Grassi
- Department of Biomedical and Specialty Surgical Sciences, University of Ferrara, Ferrara, Italy
| | - Eva Grunfeld
- Ontario Institute for Cancer Research, Toronto, ON, Canada
| | - Sumit Gupta
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | | | | | - David Hunter
- School of Medicine, Pharmacy and Health, Durham University, Stockton on Tees, UK
| | | | - Una Macleod
- Hull-York Medical School, University of Hull, Hull, UK
| | - Robert Mason
- Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - Geoffrey Mitchell
- Faculty of Medicine and Biomedical Sciences, University of Queensland, Brisbane, QLD, Australia
| | - Richard D Neal
- North Wales Centre for Primary Care Research, Bangor University, Bangor, Wales
| | | | - Martin Roland
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Bohumil Seifert
- Department of General Practice, Charles University, Prague, Czech Republic
| | - Jeff Sisler
- Department of Family Medicine, University of Manitoba, Winnipeg, MB, Canada
| | | | - Stephen Taplin
- Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD, USA
| | - Peter Vedsted
- Department of Public Health, Aarhus University, Aarhus, Denmark
| | - Teja Voruganti
- Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Fiona Walter
- Department of General Practice, University of Groningen, Groningen, Netherlands
| | - Jane Wardle
- Department of Epidemiology and Public Health, University College London, London, UK
| | - Eila Watson
- Department of Clinical Health Care, Oxford Brookes University, Oxford, UK
| | - David Weller
- Centre for Population Health Sciences, University of Edinburgh, Edinburgh, UK
| | | | - Jeremy Whelan
- Research Department of Oncology, University College London, London, UK
| | - James Whitlock
- Department of Paediatrics, University of Toronto, Toronto, ON, Canada
| | - Clare Wilkinson
- North Wales Centre for Primary Care Research, Bangor University, Bangor, Wales
| | - Niek de Wit
- Department of General Practice, University Medical Center Utrecht, Utrecht, Netherlands
| | - Camilla Zimmermann
- Division of Medical Oncology and Haematology, Department of Medicine, University of Toronto, Toronto, ON, Canada
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Petersen GS, Knudsen JL, Vinter MM. Cancer patients' preferences of care within hospitals: a systematic literature review. Int J Qual Health Care 2015; 27:384-95. [PMID: 26265160 DOI: 10.1093/intqhc/mzv059] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/09/2015] [Indexed: 11/14/2022] Open
Abstract
PURPOSE Knowledge about cancer patients' preferences in health care is important because it enables care to be patient centered. However, the literature does not provide an overview. The aim of this study was to identify the dimensions of hospital-based cancer care that patients evaluate the most important using Patient-rated importance as a method. DATA SOURCE PubMed was searched in 2013/2014. STUDY SELECTION Studies were identified, if they were in accordance with specific search terms and focused on hospital-based cancer care. Totally, 11 studies were found. DATA EXTRACTION The 11 studies comprised a total of 598 items. Of these, 592 items were categorized into 19 care dimensions. The highest rated quartile of items was identified as care elements patients evaluated to be the most important. Identification of the most important dimensions was done by calculating the percentages of items within each dimension that were within the highest quartile. RESULTS OF DATA SYNTHESIS The 11 studies varied a lot in regard to aim and patient characteristics. The three most important dimensions were as follows: Rapid diagnosis and treatment; High professional standard; and Information about treatment and side(effects)/consequences. Within four dimensions, Psychosocial support, Physical facilities, Waiting time and Transparency in care, no items were within the highest quartile. CONCLUSION Patient-rated importance was a useful method in identifying the care patients preferred. Due to a limited number of studies and great diversity within studies evaluated, interpretation of results should be cautious. However, it seems that cancer patients treated in hospitals with a curative intent find treatment-related information, professional standard and short delay of diagnosis and treatment most important.
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Affiliation(s)
| | - Janne Lehmann Knudsen
- Danish Cancer Society, Documentation & Quality, Strandboulevarden 49, Copenhagen DK-2100, Denmark
| | - Mette Marianne Vinter
- Danish Cancer Society, Documentation & Quality, Strandboulevarden 49, Copenhagen DK-2100, Denmark
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Tzelepis F, Sanson-Fisher RW, Zucca AC, Fradgley EA. Measuring the quality of patient-centered care: why patient-reported measures are critical to reliable assessment. Patient Prefer Adherence 2015; 9:831-5. [PMID: 26150703 PMCID: PMC4484696 DOI: 10.2147/ppa.s81975] [Citation(s) in RCA: 94] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
PURPOSE The Institute of Medicine (IOM) identified patient-centeredness as crucial to quality health care. The IOM endorsed six patient-centeredness dimensions that stipulated that care must be: respectful to patients' values, preferences, and expressed needs; coordinated and integrated; provide information, communication, and education; ensure physical comfort; provide emotional support; and involve family and friends. Patient-reported measures examine the patient's perspective and are essential to the accurate assessment of patient-centered care. This article's objectives are to: 1) use the six IOM-endorsed patient-centeredness dimensions as a framework to outline why patient-reported measures are crucial to the reliable measurement of patient-centered care; and 2) to identify existing patient-reported measures that assess each patient-centered care dimension. METHODS For each IOM-endorsed patient-centeredness dimension, the published literature was searched to highlight the essential role of patients in assessing patient-centered care and informing quality improvement efforts. Existing literature was also searched to identify examples of patient-reported measures that assess each patient-centeredness dimension. CONCLUSION Patient-reported measures are arguably the best way to measure patient-centeredness. For instance, patients are best positioned to determine whether care aligns with patient values, preferences, and needs and the Measure of Patient Preferences is an example of a patient-reported measure that does so. Furthermore, only the patient knows whether they received the level of information desired, and if information was understood and can be recalled. Patient-reported measures that examine information provision include the Lung Information Needs Questionnaire and the EORTC QLQ-INFO25. In relation to physical comfort, only patients can report the severity of physical symptoms and whether medications provide adequate relief. Patient-reported measures that investigate physical comfort include the Pain Care Quality Survey and the Brief Pain Inventory. Using patient-reported measures to regularly measure patient-centered care is critical to identifying areas of health care where improvements are needed.
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Affiliation(s)
- Flora Tzelepis
- Priority Research Centre for Health Behaviour, University of Newcastle and Hunter Medical Research Institute, Newcastle, NSW, Australia
| | - Robert W Sanson-Fisher
- Priority Research Centre for Health Behaviour, University of Newcastle and Hunter Medical Research Institute, Newcastle, NSW, Australia
| | - Alison C Zucca
- Priority Research Centre for Health Behaviour, University of Newcastle and Hunter Medical Research Institute, Newcastle, NSW, Australia
| | - Elizabeth A Fradgley
- Priority Research Centre for Health Behaviour, University of Newcastle and Hunter Medical Research Institute, Newcastle, NSW, Australia
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Ngune I, Jiwa M, McManus A, Parsons R, Hodder R. A trial of a self-assessment tool of problems following treatment of colorectal cancer: a prospective study in Australia primary care. Eur J Cancer Care (Engl) 2015; 25:69-78. [DOI: 10.1111/ecc.12340] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/07/2015] [Indexed: 11/30/2022]
Affiliation(s)
- I. Ngune
- School of Nursing and Midwifery; Faculty of Health; Engineering and Science; Edith Cowan University; Perth WA Australia
| | - M. Jiwa
- Health Innovation (Chronic Diseases); Medical Education; Curtin University; Perth WA Australia
| | - A. McManus
- Centre of Excellence for Science, Seafood & Health (CoESSH); Faculty of Health Sciences; Curtin University; Perth WA Australia
| | - R. Parsons
- School of Occupational Therapy and Social Work; Faculty of Health Sciences; Curtin University; Perth WA Australia
| | - R. Hodder
- Department of Surgery; Sir Charles Gardiner Hospital; Perth WA Australia
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Ngune I, Jiwa M, McManus A, Hughes J. Do patients with long-term side effects of cancer treatment benefit from general practitioner support? A literature review. Int J Integr Care 2015; 15:e023. [PMID: 26150761 PMCID: PMC4491325 DOI: 10.5334/ijic.1987] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2014] [Revised: 04/07/2015] [Accepted: 04/24/2015] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND Alongside specialist cancer clinics, general practitioners have an important role in cancer patients' follow-up care, yet no literature summarises the nature, extent and impact of their involvement. This paper addresses this issue through a review of the literature. METHODS Studies were sourced from six academic databases - AustHealth (n = 202), CINAHL (n = 500), the Cochrane Library (reviews and trials; n = 200), Embase (n = 368), PHCRIS (n = 132) and PubMed/Medline (n = 410). Studies that focused on interventions designed for patients receiving follow-up care and reported cancer care provided by a general practitioner delivered alongside specialist care were reviewed. RESULTS A total of 19 papers were identified as relevant for this review (3 randomised control trials; 4 cross-sectional, 5 cohort and 3 qualitative studies, and 3 systematic reviews). The reviewed studies indicated that providing general practitioner-led supportive interventions for post-treatment care of cancer patients is feasible and acceptable to patients. General practitioner involvement resulted in improved physical and psychosocial well-being of patients and continuity of care, especially for patients with concomitant health conditions. CONCLUSION Involving general practitioners in post-treatment cancer care is beneficial to patients. However, proactive initiatives that encourage and facilitate patients to consult their general practitioner about their needs or symptoms of recurrence should be considered.
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Affiliation(s)
- Irene Ngune
- Curtin University, Faculty of Health Sciences, Bentley, Perth, WA, Australia
| | - Moyez Jiwa
- Curtin University, Medical Education, Bentley, Perth, WA, Australia
| | - Alexandra McManus
- Curtin University, Faculty of Health Sciences, Bentley, Perth, WA, Australia
| | - Jeff Hughes
- Curtin University, School of Pharmacy, Bentley, Perth, WA, Australia
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Landenberger M, Boese S, Fach EM, Bauer A. [Trans-sectoral care for patients with colorectal cancer: Design of a prospective randomized controlled multi-center trial (FKZ 01GY1143)]. ZEITSCHRIFT FUR EVIDENZ FORTBILDUNG UND QUALITAET IM GESUNDHEITSWESEN 2014; 109:171-80. [PMID: 26028456 DOI: 10.1016/j.zefq.2014.06.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/23/2013] [Revised: 05/01/2014] [Accepted: 06/06/2014] [Indexed: 11/26/2022]
Abstract
BACKGROUND Health-related quality of life (HrQoL) is an increasingly focused aim in the care for patients with colorectal cancer that are treated with curative intent. Achieving this aim partly depends on the quality of the transsectoral management of these patients throughout the entire treatment course. However, recent population-based surveys have shown that HrQoL in patients with colorectal cancer is significantly impaired over a long time following initial diagnosis. This also applies to patients for whom adjuncant chemotherapy is not indicated according to the German medical S3 guideline. In addition, the patients' need for medical and psychosocial support has repeatedly been reported to persist at a significantly increased level - despite the extensive establishment of certified cancer centres which has apparently failed to solve this problem sufficiently. AIM The SCAN intervention aims to increase the percentage of patients reaching an enhancement of their HrQoL by at least 12 points (range: 0-100 pts.) within eight weeks after hospital discharge by 15 percent compared to standard care. DESIGN AND METHODS The SCAN intervention is carried out as a randomised controlled multicentre trial in seven large- and middle-sized hospitals all over Saxony-Anhalt. 370 patients have been enrolled, 185 of whom are offered additional nurse-led outpatient counselling. INTERVENTION Patients in the intervention group are offered transitional guidance and support consisting of routine symptom assessment and patient counselling regarding self-management, informed therapy-related decision-making and psychosocial support. ENDPOINTS The primary endpoint of the study is the patients' global health-related quality of life (HrQoL), assessed by the EORTC Quality of Life Questionnaire QLQ C-30 V3.0, item 30. Disease-free survival within eight months, the utilisation of indicated adjuvant chemotherapies as well as therapy-related side effects, e. g., anxiety and depression and the patients' symptom burden are monitored as secondary endpoints. EXPECTED RESULTS We assume that the SCAN intervention will be effective in increasing the percentage of patients reaching a clinically relevant enhancement of their HrQoL within eight weeks after hospital discharge by 15 percent compared to standard care.
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Affiliation(s)
- Margarete Landenberger
- Martin-Luther-Universität Halle-Wittenberg, Medizinische Fakultät, Institut für Gesundheits- und Pflegewissenschaft, Halle, Deutschland
| | - Stephanie Boese
- Martin-Luther-Universität Halle-Wittenberg, Medizinische Fakultät, Institut für Gesundheits- und Pflegewissenschaft, Halle, Deutschland
| | - Eva-Maria Fach
- Martin-Luther-Universität Halle-Wittenberg, Medizinische Fakultät, Institut für Gesundheits- und Pflegewissenschaft, Halle, Deutschland
| | - Alexander Bauer
- Martin-Luther-Universität Halle-Wittenberg, Medizinische Fakultät, Institut für Gesundheits- und Pflegewissenschaft, Halle, Deutschland.
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Martínez-González NA, Berchtold P, Ullman K, Busato A, Egger M. Integrated care programmes for adults with chronic conditions: a meta-review. Int J Qual Health Care 2014; 26:561-70. [PMID: 25108537 PMCID: PMC4195469 DOI: 10.1093/intqhc/mzu071] [Citation(s) in RCA: 148] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE To review systematic reviews and meta-analyses of integrated care programmes in chronically ill patients, with a focus on methodological quality, elements of integration assessed and effects reported. DESIGN Meta-review of systematic reviews and meta-analyses identified in Medline (1946-March 2012), Embase (1980-March 2012), CINHAL (1981-March 2012) and the Cochrane Library of Systematic Reviews (issue 1, 2012). MAIN OUTCOME MEASURES Methodological quality assessed by the 11-item Assessment of Multiple Systematic Reviews (AMSTAR) checklist; elements of integration assessed using a published list of 10 key principles of integration; effects on patient-centred outcomes, process quality, use of healthcare and costs. RESULTS Twenty-seven systematic reviews were identified; conditions included chronic heart failure (CHF; 12 reviews), diabetes mellitus (DM; seven reviews), chronic obstructive pulmonary disease (COPD; seven reviews) and asthma (five reviews). The median number of AMSTAR checklist items met was five: few reviewers searched for unpublished literature or described the primary studies and interventions in detail. Most reviews covered comprehensive services across the care continuum or standardization of care through inter-professional teams, but organizational culture, governance structure or financial management were rarely assessed. A majority of reviews found beneficial effects of integration, including reduced hospital admissions and re-admissions (in CHF and DM), improved adherence to treatment guidelines (DM, COPD and asthma) or quality of life (DM). Few reviews showed reductions in costs. CONCLUSIONS Systematic reviews of integrated care programmes were of mixed quality, assessed only some components of integration of care, and showed consistent benefits for some outcomes but not others.
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Affiliation(s)
- Nahara Anani Martínez-González
- Institute of Social and Preventive Medicine (ISPM), University of Bern, CH-3012 Bern, Switzerland Institute of General Practice and Health Services Research, University of Zurich, CH-8091 Zurich, Switzerland
| | - Peter Berchtold
- College M, College for Management in Health Care, CH-3010 Bern, Switzerland
| | - Klara Ullman
- Institute of Social and Preventive Medicine (ISPM), University of Bern, CH-3012 Bern, Switzerland
| | - André Busato
- Institute of Social and Preventive Medicine (ISPM), University of Bern, CH-3012 Bern, Switzerland
| | - Matthias Egger
- Institute of Social and Preventive Medicine (ISPM), University of Bern, CH-3012 Bern, Switzerland
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Grassi L, Caruso R, Hammelef K, Nanni MG, Riba M. Efficacy and safety of pharmacotherapy in cancer-related psychiatric disorders across the trajectory of cancer care: a review. Int Rev Psychiatry 2014; 26:44-62. [PMID: 24716500 DOI: 10.3109/09540261.2013.842542] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
At least 25-30% of patients with cancer and an even higher percentage of patients in an advanced phase of illness meet the criteria for a psychiatric diagnosis, including depression, anxiety, stress-related syndromes, adjustment disorders, sleep disorders and delirium. A number of studies have accumulated over the last 35 years on the use of psychotropic drugs as a pillar in the treatment of psychiatric disorders. Major advances in psycho-oncology research have also shown the efficacy of psychotropic drugs as adjuvant treatment of cancer-related symptoms, such as pain, hot flushes, pruritus, nausea and vomiting, fatigue, and cognitive impairment. The knowledge about pharmacokinetics and pharmacodynamics, clinical use, safety, side effects and efficacy of psychotropic drugs in cancer care is essential for an integrated and multidimensional approach to patients treated in different settings, including community-based centres, oncology, and palliative care. A search of the major databases (MEDLINE, Embase, PsycLIT, PsycINFO, the Cochrane Library) was conducted in order to summarize relevant data concerning the efficacy and safety of pharmacotherapy for cancer-related psychiatric disorders in cancer patients across the trajectory of the disease.
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Affiliation(s)
- Luigi Grassi
- Institute of Psychiatry, Department of Biomedical and Specialty Surgical Sciences, University of Ferrara , Ferrara , Italy
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27
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Ottevanger N, Hilbink M, Weenk M, Janssen R, Vrijmoeth T, de Vries A, Hermens R. Oncologic multidisciplinary team meetings: evaluation of quality criteria. J Eval Clin Pract 2013; 19:1035-43. [PMID: 23441961 DOI: 10.1111/jep.12022] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/11/2013] [Indexed: 11/30/2022]
Abstract
RATIONALE, AIMS AND OBJECTIVES To develop a guideline with quality criteria for an optimal structure and functioning of a multidisciplinary team meeting (MTM), and to assess to what extent the Dutch MTMs complied with these criteria. METHOD A literature search and expert opinions were used to develop a guideline for optimal MTMs. In order to assess adherence to the guideline, we conducted interviews with MTM chairs and observed general and tumour-specific MTMs in seven hospitals. RESULTS The new guideline included the following domains: (i) organization of the MTMs; (ii) membership of the MTM and roles and responsibilities of the members; (iii) the meeting itself; and (iv) documentation of meeting-recommendations. We observed good adherence to the quality criteria on the organization of the MTMs. Only the required coordinator/administrative support was often absent, particularly during general MTMs. Regarding membership of MTMs and roles, the recommended average attendance of 100% of the core disciplines was never reached and particularly the role of the chair needs improvement. Regarding the meeting itself, many interruptions took place and relevant information about the diagnoses of the cases was not available in 4-5% of the cases. Concerning the documentation of meeting-recommendations, only in a quarter of the meetings a specific form was used for the documentation. CONCLUSIONS We found a lot of diversity in the organization of MTMs. The variation in compliance with the quality criteria may decrease with better knowledge about the quality criteria around MTMs and by overcoming practical barriers for the effective organization of MTMs.
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Affiliation(s)
- Nelleke Ottevanger
- Department of Medical Oncology, Radboud University Nijmegen Medical Centre (RUNMC), Nijmegen, The Netherlands
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Developing an active implementation model for a chronic disease management program. Int J Integr Care 2013; 13:e020. [PMID: 23882169 PMCID: PMC3718271 DOI: 10.5334/ijic.994] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2012] [Revised: 03/05/2013] [Accepted: 03/20/2013] [Indexed: 11/23/2022] Open
Abstract
Background Introduction and diffusion of new disease management programs in healthcare is usually slow, but active theory-driven implementation seems to outperform other implementation strategies. However, we have only scarce evidence on the feasibility and real effect of such strategies in complex primary care settings where municipalities, general practitioners and hospitals should work together. The Central Denmark Region recently implemented a disease management program for chronic obstructive pulmonary disease (COPD) which presented an opportunity to test an active implementation model against the usual implementation model. The aim of the present paper is to describe the development of an active implementation model using the Medical Research Council’s model for complex interventions and the Chronic Care Model. Methods We used the Medical Research Council’s five-stage model for developing complex interventions to design an implementation model for a disease management program for COPD. First, literature on implementing change in general practice was scrutinised and empirical knowledge was assessed for suitability. In phase I, the intervention was developed; and in phases II and III, it was tested in a block- and cluster-randomised study. In phase IV, we evaluated the feasibility for others to use our active implementation model. Results The Chronic Care Model was identified as a model for designing efficient implementation elements. These elements were combined into a multifaceted intervention, and a timeline for the trial in a randomised study was decided upon in accordance with the five stages in the Medical Research Council’s model; this was captured in a PaTPlot, which allowed us to focus on the structure and the timing of the intervention. The implementation strategies identified as efficient were use of the Breakthrough Series, academic detailing, provision of patient material and meetings between providers. The active implementation model was tested in a randomised trial (results reported elsewhere). Conclusion The combination of the theoretical model for complex interventions and the Chronic Care Model and the chosen specific implementation strategies proved feasible for a practice-based active implementation model for a chronic-disease-management-program for COPD. Using the Medical Research Council’s model added transparency to the design phase which further facilitated the process of implementing the program. Trial registration: http://www.clinicaltrials.gov/(NCT01228708).
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Effectiveness of nurse case management compared with usual care in cancer patients at a single medical center in Taiwan: a quasi-experimental study. BMC Health Serv Res 2013; 13:202. [PMID: 23725552 PMCID: PMC3673875 DOI: 10.1186/1472-6963-13-202] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2012] [Accepted: 05/16/2013] [Indexed: 11/20/2022] Open
Abstract
Background In order to improve treatment and care quality for cancer patients, nurse case management model has applied generally in the clinical practice. However there were only few evidence-based studies on the relative benefits in Taiwan. Further analysis and feedback application are needed. The aim of this study is to evaluate the effectiveness of care quality in cancer patients with nurse case management. Methods This study was conducted with a quasi-experimental design in a national medical center in Northern Taiwan. Patients diagnosed as lung, liver, breast, colon, buccal or cervical cancers were eligible for inclusion. A total number of 600 subjects randomly selected from the cancer case management system enrolled in the case managed group, and 600 patients who received usual care were randomly selected from cancer registry and enrolled in the control group. The study instrument was developed to measure care effectiveness, including the rates of patient continuing treatment, non-adherence to treatment, prolonged hospitalization, unplanned readmission, and planned admission for active treatment. The content validity of expert was assessed as 0.9. Results The nurse case management significantly decreased the unplanned readmission rate caused by infection (1.5% vs. 4.7% in the control group, p = 0.002). The rate of patient continuing treatment in the institution significantly increased in the case managed group (93.8% vs. 84.8% in the control group, p < 0.001). The planned admission rates in 14 days and in 15–30 days for active treatment also significantly increased in the case managed group (18.4.% vs. 3.9% in the control group and 34.5% vs. 10.4% in the control group, respectively, p < 0.001). The results indicated that nurse case management provided better control in timeliness and continuity of patient treatment. Conclusions This study demonstrated that cancer case management could improve the effectiveness of cancer care services and concretely illustrated a comprehensive model for oncology patients in Taiwan. In addition, the model could be optimized for further application and improvement of cancer care. Future investigations are needed to develop precise and rigorous evaluation to optimize the utilization of cancer case management.
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Abstract
PURPOSE OF REVIEW Self-management in the palliative care domain means equipping patients and carers to manage medical aspects of illness, managing life roles and allowing adaptation to the changing dynamics brought on by illness and its progression. As well as dealing with the psychological consequences of living with a life-threatening illness in which the aim is to optimise living. This review will consider the rationale for developing and adopting self-management as a model of care. RECENT FINDINGS Health policy currently advocates de-investment in traditional approaches to patient management paralleled with a re-engineering of services towards approaches required to underpin self-management care. However, the literature suggests that patients lack a fundamental knowledge and more importantly an understanding of the progression of their illness or what palliative of hospice care is. As a first step, this issue must be addressed in any self-management intervention. In terms of outcomes evidence continues to emerge that when compared with care self-management imparts sustainable understanding in targeted areas and has the potential to create a preventive spend environment. SUMMARY The role of self-management in palliative care requires further elucidation yet based on the evidence which is predominately gleaned from long-term conditions it would seem sensible if not ethical to educate patients/carers to actively be involved in decision making.
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Costa Junior ÁL, Doca FNP, Araújo I, Martins L, Mundim L, Penatti T, Sidrim AC. Preparação psicológica de pacientes submetidos a procedimentos cirúrgicos. ESTUDOS DE PSICOLOGIA (CAMPINAS) 2012. [DOI: 10.1590/s0103-166x2012000200013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Este trabalho tem por objetivo identificar, entre artigos publicados em periódicos indexados pelo PubMed/MedLine, informações sobre as principais modalidades e efeitos de intervenção psicossocial em procedimentos pré e pós-operatórios com pacientes adultos, bem como, apontar algumas lacunas na produção científica acerca do tema. Foram selecionados 32 artigos, sendo oito teórico-conceituais e 24 empíricos, dos quais um era estudo de caso, nove se referiam à avaliação específica de efeitos de preparação psicológica e 14 tratavam de temas associados ao contexto de preparação psicológica e cuidados cirúrgicos. As intervenções psicológicas foram divididas em oito categorias, baseadas em características funcionais das respectivas intervenções. Verificou-se uma deficiência de estudos na área de atuação específica da Psicologia, sendo os profissionais de enfermagem e medicina os que mais produziram estudos sobre o tema. Constatou-se, também, a ausência de protocolos sistematizados de intervenção psicológica relacionados a procedimentos cirúrgicos.
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Specialist breast care and research nurses’ attitudes to adjuvant chemotherapy in older women with breast cancer. Eur J Oncol Nurs 2012; 16:78-86. [DOI: 10.1016/j.ejon.2011.03.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2011] [Revised: 03/24/2011] [Accepted: 03/29/2011] [Indexed: 11/18/2022]
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Lundstrøm LH, Johnsen AT, Ross L, Petersen MA, Groenvold M. Cross-sectorial cooperation and supportive care in general practice: cancer patients' experiences. Fam Pract 2011; 28:532-40. [PMID: 21427204 DOI: 10.1093/fampra/cmr011] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Cancer care usually involves several health professionals from different parts of the health care system. Often, the GP has an important role. Patients' experiences of continuity and support may be related to characteristics of health care, disease or patients. OBJECTIVES To investigate Danish cancer patients' experiences of their contact to the GP and the cooperation between the GP and the hospital. METHODS A national cross-sectional questionnaire study in three representative counties of Denmark. Based on a review of medical records from all hospital departments treating cancer patients, a random sample of 1490 patients completed a validated questionnaire regarding patient experiences. A mixed methods approach was applied. Associations between patient experiences and background variables were analysed in ordinal logistic regression models and patients' written comments were analysed qualitatively. RESULTS One-third of the patients evaluated the cooperation between hospitals and primary care as suboptimal. Younger patients and patients from the capital Copenhagen were most dissatisfied. A third had needed support from their GP, and 41% of these patients had not fully received what they needed. Older patients, patients in Stage 1 and patients from surgical departments were least likely to have needed their GP's support. Patients described support from the GP as empathic behaviour and help with coordinating health services. CONCLUSIONS A substantial number of cancer patients experienced suboptimal cross-sectorial cooperation and supportive care. Efforts to improve cancer care cooperation may focus on the possible supportive role of the GP as it seems that there is an untapped potential in primary care.
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Affiliation(s)
- Louise Hyldborg Lundstrøm
- The Research Unit, Department of Palliative Medicine, Bispebjerg Hospital, Bispebjerg Bakke 23, DK-2400 Copenhagen, Denmark.
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Jacobson JO. Multidisciplinary cancer management: a systems-based approach to deliver complex care. J Oncol Pract 2011; 6:274-5. [PMID: 21358953 DOI: 10.1200/jop.2010.000164] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/23/2010] [Indexed: 12/24/2022] Open
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Gardner TB, Barth RJ, Zaki BI, Boulay BR, McGowan MM, Sutton JE, Ripple GH, Colacchio TA, Smith KD, Byock IR, Call M, Suriawinata AA, Tsapakos MJ, Mills JB, Srivastava A, Stannard M, Lisovsky M, Gordon SR, Pipas JM. Effect of initiating a multidisciplinary care clinic on access and time to treatment in patients with pancreatic adenocarcinoma. J Oncol Pract 2011; 6:288-92. [PMID: 21358957 DOI: 10.1200/jop.2010.000041] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/14/2010] [Indexed: 01/11/2023] Open
Abstract
PURPOSE Neoadjuvant therapy for pancreatic adenocarcinoma requires referral to multiple specialists before initiating therapy. We evaluated the effect of establishing a multidisciplinary clinic (MDC) for patients with newly diagnosed pancreatic adenocarcinoma on treatment access and time to therapy. METHODS Patients with newly diagnosed pancreatic adenocarcinoma diagnosed and treated at our center were included. Two patient groups were defined: preclinic represented those patients diagnosed before 2008 and MDC represented those patients diagnosed since 2009 who were treated in the newly created MDC and were initially candidates for neoadjuvant therapy. The primary outcomes were days from diagnosis to first treatment (initiation of chemotherapy or external beam radiation), days to completion of all required consultations, and number of visits needed before initiation of therapy. RESULTS Ninety-seven patients were diagnosed and treated at our medical center from 2003 to 2008; 22 were treated in 2009 after the implementation of the MDC. Compared with the preclinic group, patients treated in the MDC had shorter times from biopsy to treatment (7.7 days v 29.5 days, P < .001), shorter time to completion of all required pretreatment consultations (7.1 days v 13.9 days, P < .001), and fewer visits to complete all consultations (1.1 v 4.3, P < .001). Thirty-three percent of patients seen in the MDC enrolled onto clinical research trials. CONCLUSION In patients with pancreatic adenocarcinoma undergoing neoadjuvant therapy, the establishment of a multidisciplinary pancreas tumor clinic led to improved patient access to consultations and shorter time to initial treatment.
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Affiliation(s)
- Timothy B Gardner
- Dartmouth-Hitchcock Medical Center, Norris Cotton Cancer Center, Lebanon, NH
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