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Lopez CJ, Teggart K, Ahmed M, Borhani A, Kong J, Fazelzad R, Langelier DM, Campbell KL, Reiman T, Greenland J, Jones JM, Neil-Sztramko SE. Implementation of electronic prospective surveillance models in cancer care: a scoping review. Implement Sci 2023; 18:11. [PMID: 37101231 PMCID: PMC10134630 DOI: 10.1186/s13012-023-01265-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Accepted: 02/19/2023] [Indexed: 04/28/2023] Open
Abstract
BACKGROUND Electronic prospective surveillance models (ePSMs) for cancer rehabilitation include routine monitoring of the development of treatment toxicities and impairments via electronic patient-reported outcomes. Implementing ePSMs to address the knowledge-to-practice gap between the high incidence of impairments and low uptake of rehabilitation services is a top priority in cancer care. METHODS We conducted a scoping review to understand the state of the evidence concerning the implementation of ePSMs in oncology. Seven electronic databases were searched from inception to February 2021. All articles were screened and extracted by two independent reviewers. Data regarding the implementation strategies, outcomes, and determinants were extracted. The Expert Recommendations for Implementing Change taxonomy and the implementation outcomes taxonomy guided the synthesis of the implementation strategies and outcomes, respectively. The Consolidated Framework for Implementation Research guided the synthesis of determinants based on five domains (intervention characteristics, individual characteristics, inner setting, outer setting, and process). RESULTS Of the 5122 records identified, 46 interventions met inclusion criteria. The common implementation strategies employed were "conduct educational meetings," "distribute educational materials," "change record systems," and "intervene with patients to enhance uptake and adherence." Feasibility and acceptability were the prominent outcomes used to assess implementation. The complexity, relative advantage, design quality, and packaging were major implementation determinants at the intervention level. Knowledge was key at the individual level. At the inner setting level, major determinants were the implementation climate and readiness for implementation. At the outer setting level, meeting the needs of patients was the primary determinant. Engaging various stakeholders was key at the process level. CONCLUSIONS This review provides a comprehensive summary of what is known concerning the implementation of ePSMs. The results can inform future implementation and evaluation of ePSMs, including planning for key determinants, selecting implementation strategies, and considering outcomes alongside local contextual factors to guide the implementation process.
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Affiliation(s)
- Christian J Lopez
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada.
- Institute of Medical Science, University of Toronto, Toronto, Canada.
| | - Kylie Teggart
- Faculty of Health Sciences, McMaster University, Hamilton, Canada
| | - Mohammed Ahmed
- Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, Canada
| | - Anita Borhani
- Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, Canada
| | - Jeffrey Kong
- Department of Physical Therapy, University of British Columbia, Vancouver, Canada
| | - Rouhi Fazelzad
- Library and Information Services, University Health Network, Toronto, Canada
| | - David M Langelier
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada
- Institute of Medical Science, University of Toronto, Toronto, Canada
| | - Kristin L Campbell
- Department of Physical Therapy, University of British Columbia, Vancouver, Canada
| | - Tony Reiman
- Department of Oncology, Saint John Regional Hospital, Saint John, Canada
| | - Jonathan Greenland
- Faculty of Medicine, Memorial University of Newfoundland, St John's, Canada
| | - Jennifer M Jones
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada
- Institute of Medical Science, University of Toronto, Toronto, Canada
| | - Sarah E Neil-Sztramko
- Faculty of Health Sciences, McMaster University, Hamilton, Canada
- National Collaborating Centre for Methods and Tools, McMaster University, Hamilton, Canada
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2
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Cantisano N, Menei P, Roualdes V, Seizeur R, Allain P, Le Gall D, Roy A, Dinomais M, Laurent A, Besnard J. Relationships between executive functioning and health-related quality of life in adult survivors of brain tumor and matched healthy controls. J Clin Exp Neuropsychol 2022; 43:980-990. [PMID: 35230209 DOI: 10.1080/13803395.2022.2040432] [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: 10/19/2022]
Abstract
INTRODUCTION Few studies have considered health-related quality of life (HRQOL) as a primary outcome measure in adult survivors of primary brain tumor (PBT), and fewer still have studied the cognitive factors that may influence it. Research suggests that executive functions (EFs) are associated with HRQOL, but there is scant evidence to support this. The present study was conducted to (1) extend prior findings about HRQOL limitations in a sample of stable, long-term adult survivors of PBT, (2) investigate the associations between objective/reported EFs and HRQOL, and (3) identify the EFs that contribute most to HRQOL. METHOD We recruited 40 survivors of PBT (> 2 years post-treatment) and 40 matched healthy controls. Participants completed an objective EF assessment (inhibition, working memory, shifting, and rule detection) and two self-report questionnaires probing EFs (Behavior Rating Inventory of Executive Function-Adult) and HRQOL (Medical Outcomes Study Short-Form 36). Participants' relatives completed observer-rated versions of these questionnaires. RESULTS Patients' objective EF performances were relatively intact. However, patients and caregivers reported significantly more problems than healthy controls and their relatives, for both EFs and HRQOL. There were only negligible links between objective EFs and HRQOL, whereas numerous associations were found between reported EFs and HRQOL components. ANCOVA models revealed that specific reported EF processes contributed to both the physical and mental components of HRQOL, regardless of group. CONCLUSIONS From a clinical point of view, this study demonstrates that even several years after end of treatment, adult PBT survivors experience substantial problems across different HRQOL domains. HRQOL assessment should therefore be part of the long-term follow-up of PBT survivors, and clinicians should consider EF limitations when designing appropriate survivorship care plans. These findings indicate that cognitive interventions targeting EFs could improve HRQOL.
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Affiliation(s)
- Nicole Cantisano
- Centre d'Etudes En Psychopathologie Et Psychologie de la Santé (Ea 7411), University of Toulouse Jean Jaurès, Toulouse, France
| | - Philippe Menei
- Department of Neurosurgery, Angers University Hospital, Angers, France
| | - Vincent Roualdes
- Department of Neurosurgery, Nantes University Hospital, Nantes, France
| | - Romuald Seizeur
- Department of Neurosurgery, Brest Regional University Hospital, Brest, France
| | - Philippe Allain
- Department of Neurology, Angers University Hospital, Angers, France.,Univ Angers, Department of Psychology, Nantes Université, Laboratoire de psychologie des Pays de la Loire (LPPL, UR 4638), SFR CONFLUENCES, F-49000, Angers, France
| | - Didier Le Gall
- Department of Neurology, Angers University Hospital, Angers, France.,Univ Angers, Department of Psychology, Nantes Université, Laboratoire de psychologie des Pays de la Loire (LPPL, UR 4638), SFR CONFLUENCES, F-49000, Angers, France
| | - Arnaud Roy
- Univ Angers, Department of Psychology, Nantes Université, Laboratoire de psychologie des Pays de la Loire (LPPL, UR 4638), SFR CONFLUENCES, F-49000, Angers, France.,Centre Référent Des Troubles d'Apprentissage Et Centre de Compétence Nantais de Neurofibromatose, Nantes University Hospital, Nantes, France
| | - Mickaël Dinomais
- Department of Paediatric Physical Medicine and Rehabilitation, Angers University Hospital, Angers, France
| | | | - Jérémy Besnard
- Univ Angers, Department of Psychology, Nantes Université, Laboratoire de psychologie des Pays de la Loire (LPPL, UR 4638), SFR CONFLUENCES, F-49000, Angers, France
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Oort Q, Zwinkels H, Koekkoek JAF, Vos MJ, Reijneveld JC, Taphoorn MJB, Dirven L. Is the EORTC QLQ-C30 emotional functioning scale appropriate as an initial screening measure to identify brain tumour patients who may possibly have a mood disorder? Psychooncology 2022; 31:995-1002. [PMID: 35083812 PMCID: PMC9303778 DOI: 10.1002/pon.5889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Revised: 11/22/2021] [Accepted: 12/20/2021] [Indexed: 11/12/2022]
Abstract
Background Screening glioma patients regularly for possible mood disorders may facilitate early identification and referral of patients at risk. This study evaluated if the EORTC QLQ‐C30 Emotional Functioning (EF) scale could be used as an initial screening measure to identify patients possibly having a mood disorder. Methods EORTC QLQ‐C30 EF and Hospital Anxiety and Depression Scale (HADS) scores were collected as part of a study assessing the impact of timing of patient‐reported outcome assessments on actual health‐related quality of life outcomes (N = 99). Spearman correlations and Mann‐Whitney U tests were used to determine the association between the EF and HADS (sub)scales. Receiver Operating Characteristic analyses were performed to determine optimal cut‐off EF scores to identify patients possibly having a mood disorder (i.e. HADS subscale score ≥8 points). Results EF and HADS (sub)scales correlated moderately (HADS‐A: r = −0.65; HADS‐D: r = −0.52). Significant EF score differences were found between patients with HADS ≥8 versus <8 points (HADS‐A: mean difference (MD) = 32 and HADS‐D: MD = 23). The EF scale had excellent (HADS‐A; AUC = 0.88) and borderline excellent (HADS‐D; AUC = 0.78) distinguishing capabilities. A statistically optimal (EF score <80) and a most inclusive (sensitivity of 100%, corresponding to an EF score <97) EF cut‐off score correctly identified 88.0% and 96.0% of patients with a possible mood disorder, respectively. Conclusion EORTC QLQ‐C30 EF scale seems to be an appropriate screening measure to identify glioma patients possibly having a mood disorder in need of further assessment.
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Affiliation(s)
- Quirien Oort
- Department of Neurology and Brain Tumor Center Amsterdam, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Hanneke Zwinkels
- Department of Neurology, Haaglanden Medical Center, The Hague, The Netherlands
| | - Johan A F Koekkoek
- Department of Neurology, Haaglanden Medical Center, The Hague, The Netherlands.,Department of Neurology, Leiden University Medical Center, Leiden, The Netherlands
| | - Maaike J Vos
- Department of Neurology, Haaglanden Medical Center, The Hague, The Netherlands
| | - Jaap C Reijneveld
- Department of Neurology and Brain Tumor Center Amsterdam, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.,Department of Neurology, Stichting Epilepsie Instellingen Nederland (SEIN), Heemstede, The Netherlands
| | - Martin J B Taphoorn
- Department of Neurology, Haaglanden Medical Center, The Hague, The Netherlands.,Department of Neurology, Leiden University Medical Center, Leiden, The Netherlands
| | - Linda Dirven
- Department of Neurology, Haaglanden Medical Center, The Hague, The Netherlands.,Department of Neurology, Leiden University Medical Center, Leiden, The Netherlands
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Gómez Vecchio T, Corell A, Buvarp D, Rydén I, Smits A, Jakola AS. Classification of Adverse Events Following Surgery in Patients With Diffuse Lower-Grade Gliomas. Front Oncol 2022; 11:792878. [PMID: 34993147 PMCID: PMC8724913 DOI: 10.3389/fonc.2021.792878] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Accepted: 11/25/2021] [Indexed: 12/21/2022] Open
Abstract
Background Recently, the Therapy-Disability-Neurology (TDN) was introduced as a multidimensional reporting system to detect adverse events in neurosurgery. The aim of this study was to compare the novel TDN score with the Landriel–Ibanez classification (LIC) grade in a large cohort of patients with diffuse lower-grade glioma (dLGG). Since the TDN score lacks validation against patient-reported outcomes, we described health-related quality of life (HRQoL) change in relation to TDN scores in a subset of patients. Methods We screened adult patients with a surgically treated dLGG World Health Organization (WHO) grade 2 and 3 between 2010 and 2020. Up until 2017, it consists of a retrospective cohort (n = 158). From 2017 and onwards, HRQoL was registered using EuroQoL-5-dimension, three levels of response (EQ-5D 3L) questionnaire at baseline and 3 months follow-up, in a prospectively recruited cohort (n = 102). Both the LIC grade and TDN score were used to classify adverse events. Results In total, 231 patients were included. In 110/231 (47.6%) of the surgical procedures, a postoperative complication was registered. When comparing the TDN score to LIC grades, only a minor shift towards complications of higher order could be observed. EQ-5D 3L was reported for 45 patients. Patients with complications related to surgery had pre- to postoperative changes in EQ-5D 3L index values (n = 27; mean 0.03, 95% CI −0.06 to 0.11) that were comparable to patients without complications (n = 18; mean −0.06, 95% CI −0.21 to 0.08). In contrast, patients with new-onset neurological deficit had a deterioration in HRQoL at follow-up, with a mean change in the EQ-5D 3L index value of 0.11 (n = 13, 95% CI 0.0 to 0.22) compared to −0.06 (n = 32, 95% CI −0.15 to 0.03) for all other patients. Conclusions In patients with dLGG, TDN scores compared to the standard LIC tend to capture more adverse events of higher order. There was no clear relation between TDN severity and HRQoL. However, new-onset neurological deficit caused impairment in HRQoL. For the TDN score to better align with patient-reported outcomes, more emphasis on neurological deficit and function should be considered.
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Affiliation(s)
- Tomás Gómez Vecchio
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Alba Corell
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Neurosurgery, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Dongni Buvarp
- Department of Neurosurgery, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Isabelle Rydén
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Anja Smits
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Neuroscience, Uppsala University, Uppsala, Sweden
| | - Asgeir S Jakola
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Neurosurgery, Sahlgrenska University Hospital, Gothenburg, Sweden
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Fernández-Méndez R, Wong MY, Rastall RJ, Rebollo-Díaz S, Oberg I, Price SJ, Joannides AJ. Improvement of the Efficiency and Completeness of Neuro-Oncology Patient Referrals to a Tertiary Center Through the Implementation of an Electronic Referral System: Retrospective Cohort Study. J Med Internet Res 2020; 22:e15002. [PMID: 32134389 PMCID: PMC7082731 DOI: 10.2196/15002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Revised: 11/03/2019] [Accepted: 12/16/2019] [Indexed: 12/03/2022] Open
Abstract
Background Quality referrals to specialist care are key for prompt, optimal decisions about the management of patients with brain tumors. Objective This study aimed to determine the impact of introducing a Web-based, electronic referral (eReferral) system to a specialized neuro-oncology center, using a service-developed proforma, in terms of waiting times and information completeness. Methods We carried out a retrospective cohort study based on the review of medical records of referred adult patients, excluding follow-ups. Primary outcome measures were durations of three key phases within the referral pathway and completion rates of six referral fields. Results A total of 248 patients were referred to the specialist center during the study period. Median (IQR) diagnostic imaging to referral intervals were 3 (1-5) days with eReferrals, and 9 (4-19), 19 (14-49), and 8 (4-23) days with paper proforma, paper letter, and internal referrals, respectively (P<.001). Median (IQR) referral to multidisciplinary team decision intervals were 3 (2-7), 2 (1-3), 8 (2-24), and 3 (2-6) days respectively (P=.01). For patients having surgery, median (IQR) diagnostic imaging to surgery intervals were 28 (21-41), 34 (27-51), 104 (69-143), and 32 (15-89) days, respectively (P<.001). Proportions of complete fields differed significantly by referral type in all study fields (all with Ps <.001) except for details of presentation, which were present in all referrals. All study fields were always present in eReferrals, as these are compulsory for referral submission. Depending on the data field, level of completeness in the remaining referral types ranged within 69% (65/94) to 87% (82/94), 15% (3/20) to 65% (13/20), and 22% (8/41) to 63% (26/41) in paper proforma, paper letter, and internal referrals, respectively. Conclusions An electronic, Web-based, service-developed specific proforma for neuro-oncology referrals performs significantly better, with shorter waiting times and greater completeness of information than other referral types. A wider application of eReferrals is an important first step to streamlining specialist care pathways and providing excellent care. International Registered Report Identifier (IRRID) RR2-10.2196/10.2196/15002
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Affiliation(s)
- Rocío Fernández-Méndez
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, United Kingdom.,NIHR Brain Injury MedTech Co-operative, Department of Clinical Neurosciences, University of Cambridge, Cambridge, United Kingdom
| | - Mei Yin Wong
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, United Kingdom
| | - Rebecca J Rastall
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, United Kingdom
| | | | - Ingela Oberg
- Neurosurgery Department, Cambridge University Hospitals NHS Trust, Cambridge, United Kingdom
| | - Stephen J Price
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, United Kingdom.,NIHR Brain Injury MedTech Co-operative, Department of Clinical Neurosciences, University of Cambridge, Cambridge, United Kingdom.,Neurosurgery Department, Cambridge University Hospitals NHS Trust, Cambridge, United Kingdom
| | - Alexis J Joannides
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, United Kingdom.,NIHR Brain Injury MedTech Co-operative, Department of Clinical Neurosciences, University of Cambridge, Cambridge, United Kingdom.,Obex Technologies, Cambridge, United Kingdom.,Neurosurgery Department, Cambridge University Hospitals NHS Trust, Cambridge, United Kingdom
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