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Yackel HD, Halpenny B, Abrahm JL, Ligibel J, Enzinger A, Lobach DF, Cooley ME. A qualitative analysis of algorithm-based decision support usability testing for symptom management across the trajectory of cancer care: one size does not fit all. BMC Med Inform Decis Mak 2024; 24:63. [PMID: 38443870 PMCID: PMC10913367 DOI: 10.1186/s12911-024-02466-7] [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: 02/22/2024] [Indexed: 03/07/2024] Open
Abstract
BACKGROUND Adults with cancer experience symptoms that change across the disease trajectory. Due to the distress and cost associated with uncontrolled symptoms, improving symptom management is an important component of quality cancer care. Clinical decision support (CDS) is a promising strategy to integrate clinical practice guideline (CPG)-based symptom management recommendations at the point of care. METHODS The objectives of this project were to develop and evaluate the usability of two symptom management algorithms (constipation and fatigue) across the trajectory of cancer care in patients with active disease treated in comprehensive or community cancer care settings to surveillance of cancer survivors in primary care practices. A modified ADAPTE process was used to develop algorithms based on national CPGs. Usability testing involved semi-structured interviews with clinicians from varied care settings, including comprehensive and community cancer centers, and primary care. The transcripts were analyzed with MAXQDA using Braun and Clarke's thematic analysis method. A cross tabs analysis was also performed to assess the prevalence of themes and subthemes by cancer care setting. RESULTS A total of 17 clinicians (physicians, nurse practitioners, and physician assistants) were interviewed for usability testing. Three main themes emerged: (1) Algorithms as useful, (2) Symptom management differences, and (3) Different target end-users. The cross-tabs analysis demonstrated differences among care trajectories and settings that originated in the Symptom management differences theme. The sub-themes of "Differences between diseases" and "Differences between care trajectories" originated from participants working in a comprehensive cancer center, which tends to be disease-specific locations for patients on active treatment. Meanwhile, participants from primary care identified the sub-theme of "Differences in settings," indicating that symptom management strategies are care setting specific. CONCLUSIONS While CDS can help promote evidence-based symptom management, systems providing care recommendations need to be specifically developed to fit patient characteristics and clinical context. Findings suggest that one set of algorithms will not be applicable throughout the entire cancer trajectory. Unique CDS for symptom management will be needed for patients who are cancer survivors being followed in primary care settings.
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Affiliation(s)
| | - Barbara Halpenny
- Dana-Farber Cancer Institute, 450 Brookline Ave, LW-508, 02215, Boston, MA, USA
| | - Janet L Abrahm
- Dana-Farber Cancer Institute, 450 Brookline Ave, LW-508, 02215, Boston, MA, USA
| | - Jennifer Ligibel
- Dana-Farber Cancer Institute, 450 Brookline Ave, LW-508, 02215, Boston, MA, USA
| | - Andrea Enzinger
- Dana-Farber Cancer Institute, 450 Brookline Ave, LW-508, 02215, Boston, MA, USA
| | - David F Lobach
- Elimu Informatics, 1709 Julian Court, 94530, El Cerrito, CA, USA
| | - Mary E Cooley
- Dana-Farber Cancer Institute, 450 Brookline Ave, LW-508, 02215, Boston, MA, USA.
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Blaes AH. Research contributions from the First Cancer Center Survivorship Research Forum. J Cancer Surviv 2022; 16:1-3. [PMID: 35107799 PMCID: PMC8809209 DOI: 10.1007/s11764-021-01137-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Accepted: 11/06/2021] [Indexed: 01/22/2023]
Affiliation(s)
- Anne H Blaes
- Masonic Cancer Center, University of Minnesota, Minneapolis, MN, USA.
- Hematology/Oncology, Cancer Survivorship Services and Translational Research, University of Minnesota, Minneapolis, MN, USA.
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O’Malley DM, Alfano CM, Doose M, Kinney AY, Lee SJC, Nekhlyudov L, Duberstein P, Hudson SV. Cancer prevention, risk reduction, and control: opportunities for the next decade of health care delivery research. Transl Behav Med 2021; 11:1989-1997. [PMID: 34850934 PMCID: PMC8634312 DOI: 10.1093/tbm/ibab109] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
In this commentary, we discuss opportunities to optimize cancer care delivery in the next decade building from evidence and advancements in the conceptualization and implementation of multi-level translational behavioral interventions. We summarize critical issues and discoveries describing new directions for translational behavioral research in the coming decade based on the promise of the accelerated application of this evidence within learning health systems. To illustrate these advances, we discuss cancer prevention, risk reduction (particularly precision prevention and early detection), and cancer treatment and survivorship (particularly risk- and need-stratified comprehensive care) and propose opportunities to equitably improve outcomes while addressing clinician shortages and cross-system coordination. We also discuss the impacts of COVID-19 and potential advances of scientific knowledge in the context of existing evidence, the need for adaptation, and potential areas of innovation to meet the needs of converging crises (e.g., fragmented care, workforce shortages, ongoing pandemic) in cancer health care delivery. Finally, we discuss new areas for exploration by applying key lessons gleaned from implementation efforts guided by advances in behavioral health.
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Affiliation(s)
- Denalee M O’Malley
- Department of Family Medicine and Community Health, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
- Rutgers Cancer Prevention and Control, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA
- Northwell Health Cancer Institute, New Hyde Park, NY, USA
| | - Catherine M Alfano
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
| | - Michelle Doose
- Health Systems and Interventions Research Branch, Healthcare Delivery Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Anita Y Kinney
- Department of Epidemiology and Biostatistics, Rutgers School of Public Health, Piscataway, NJ, USA
| | - Simon J Craddock Lee
- Harold C. Simmons Comprehensive Cancer Center, Department of Population and Data Sciences, UT-Southwestern, Dallas, TX, USA
| | - Larissa Nekhlyudov
- Harvard Medical School, Brigham & Womens’ Primary Care Medical Associates, Boston, MA, USA
| | - Paul Duberstein
- Department of Family Medicine and Community Health, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
- Rutgers Cancer Prevention and Control, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA
- Department of Health Behavior, Society, and Policy, Rutgers School of Public Health, Piscataway, NJ, USA
| | - Shawna V Hudson
- Department of Family Medicine and Community Health, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
- Rutgers Cancer Prevention and Control, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA
- Northwell Health Cancer Institute, New Hyde Park, NY, USA
- Department of Health Behavior, Society, and Policy, Rutgers School of Public Health, Piscataway, NJ, USA
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