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Jeevan R, Browne JP, Gulliver-Clarke C, Pereira J, Caddy CM, van der Meulen JHP, Cromwell DA. Patients' satisfaction with the reconstructive options provided to them measured 18 months after mastectomy surgery for breast cancer. Eur J Cancer Care (Engl) 2020; 30:e13362. [PMID: 33171000 DOI: 10.1111/ecc.13362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2019] [Revised: 08/27/2020] [Accepted: 10/14/2020] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Mastectomy patients' satisfaction with reconstructive options has not been examined. METHODS A national study measured 18-month satisfaction with reconstructive options and collected case-mix and reconstructive offer and uptake data on breast cancer patients having mastectomy with or without immediate reconstruction (IR) in England between January 2008 and March 2009. Multivariable logistic regression examined the relationship between satisfaction, age, IR offer and uptake, and clinical suitability. RESULTS Of 4796 patients, 1889 were not offered IR, 1489 declined an offer and 1418 underwent it. Women not offered IR were more likely older, obese or smokers and had higher ASA grades, ECOG scores, tumour burdens and adjuvant chemotherapy and radiotherapy likelihoods (9% of lowest suitability group offered IR; 81% in highest suitability group). 83.7% were satisfied with their reconstructive options, varying significantly by IR offer and uptake (76.1% for those not offered IR; 85.8% for those who declined IR; 91.7% following IR). Older women and women deemed more suitable for IR were more often satisfied (p-values <0.001). CONCLUSIONS Satisfaction varied by offer and uptake status, age and suitability score. Clinicians should target equity for women deemed unsuitable by exploring their needs and desired outcomes, standardising operative fitness assessments and utilising shared decision-making aids.
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Affiliation(s)
- Ranjeet Jeevan
- Clinical Effectiveness Unit, The Royal College of Surgeons of England, London, UK.,Manchester University NHS Foundation Trust, Wythenshawe Hospital, Wythenshawe, Manchester, UK
| | - John P Browne
- Health Services Research Unit, Department of Public Health & Policy, London School of Hygiene & Tropical Medicine, London, UK.,Department of Epidemiology and Public Health, University College Cork, Cork, Ireland
| | - Carmel Gulliver-Clarke
- Western Sussex Hospitals NHS Foundation Trust, Worthing Hospital, Worthing, West Sussex, UK
| | - Jerome Pereira
- James Paget University Hospitals NHS Foundation Trust, Gorleston, Norfolk, UK.,University of East Anglia, Norwich Research Park, Norwich, Norfolk, UK
| | - Christopher M Caddy
- Sheffield Teaching Hospitals NHS Foundation Trust, Royal Hallamshire Hospital, Sheffield, UK
| | - Jan H P van der Meulen
- Clinical Effectiveness Unit, The Royal College of Surgeons of England, London, UK.,Health Services Research Unit, Department of Public Health & Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - David A Cromwell
- Clinical Effectiveness Unit, The Royal College of Surgeons of England, London, UK.,Health Services Research Unit, Department of Public Health & Policy, London School of Hygiene & Tropical Medicine, London, UK
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Harrison R, Hinchcliff RA, Manias E, Mears S, Heslop D, Walton V, Kwedza R. Can feedback approaches reduce unwarranted clinical variation? A systematic rapid evidence synthesis. BMC Health Serv Res 2020; 20:40. [PMID: 31948447 PMCID: PMC6966854 DOI: 10.1186/s12913-019-4860-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Accepted: 12/22/2019] [Indexed: 01/07/2023] Open
Abstract
Background Assessment of clinical variation has attracted increasing interest in health systems internationally due to growing awareness about better value and appropriate health care as a mechanism for enhancing efficient, effective and timely care. Feedback using administrative databases to provide benchmarking data has been utilised in several countries to explore clinical care variation and to enhance guideline adherent care. Whilst methods for detecting variation are well-established, methods for determining variation that is unwarranted and addressing this are strongly debated. This study aimed to synthesize published evidence of the use of feedback approaches to address unwarranted clinical variation (UCV). Methods A rapid review and narrative evidence synthesis was undertaken as a policy-focused review to understand how feedback approaches have been applied to address UCV specifically. Key words, synonyms and subject headings were used to search the major electronic databases Medline and PubMed between 2000 and 2018. Titles and abstracts of publications were screened by two reviewers and independently checked by a third reviewer. Full text articles were screened against the eligibility criteria. Key findings were extracted and integrated in a narrative synthesis. Results Feedback approaches that occurred over a duration of 1 month to 9 years to address clinical variation emerged from 27 publications with quantitative (20), theoretical/conceptual/descriptive work (4) and mixed or multi-method studies (3). Approaches ranged from presenting evidence to individuals, teams and organisations, to providing facilitated tailored feedback supported by a process of ongoing dialogue to enable change. Feedback approaches identified primarily focused on changing clinician decision-making and behaviour. Providing feedback to clinicians was identified, in a range of a settings, as associated with changes in variation such as reducing overuse of tests and treatments, reducing variations in optimal patient clinical outcomes and increasing guideline or protocol adherence. Conclusions The review findings suggest value in the use of feedback approaches to respond to clinical variation and understand when action is warranted. Evaluation of the effectiveness of particular feedback approaches is now required to determine if there is an optimal approach to create change where needed.
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Affiliation(s)
- Reema Harrison
- School of Public Health and Community Medicine, University of New South Wales, Samuels Building (f25), Sydney, NSW, 2052, Australia.
| | - Reece Amr Hinchcliff
- School of Public Health and Social Work, Queensland University of Technology, Brisbane, QLD, 4059, Australia
| | - Elizabeth Manias
- Melbourne School of Health Sciences, The University of Melbourne, Melbourne, Australia.,School of Nursing and Midwifery, Deakin University, Geelong, Australia
| | - Steven Mears
- Information Specialist, Hunter New England Medical Library, New Lambton, NSW, 2350, Australia
| | - David Heslop
- School of Public Health and Community Medicine, University of New South Wales, Samuels Building (f25), Sydney, NSW, 2052, Australia
| | - Victoria Walton
- Cancer Institute New South Wales, Level 9, 8 Central Avenue, Australian Technology Park, Eveleigh NSW 2015, PO Box 41, Alexandria, NSW, 1435, Australia
| | - Ru Kwedza
- Cancer Institute New South Wales, Level 9, 8 Central Avenue, Australian Technology Park, Eveleigh NSW 2015, PO Box 41, Alexandria, NSW, 1435, Australia.,Centre for Rural Health-North Coast, School of Rural Health, University of Sydney, Lismore, New South Wales, Australia
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3
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Jeevan R, Browne JP, Gulliver-Clarke C, Pereira J, Caddy CM, van der Meulen JHP, Cromwell DA. Association between age and access to immediate breast reconstruction in women undergoing mastectomy for breast cancer. Br J Surg 2017; 104:555-561. [PMID: 28176303 DOI: 10.1002/bjs.10453] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2016] [Revised: 07/05/2016] [Accepted: 11/04/2016] [Indexed: 12/31/2022]
Abstract
BACKGROUND National guidelines state that patients with breast cancer undergoing mastectomy in England should be offered immediate breast reconstruction (IR), unless precluded by their fitness for surgery or the need for adjuvant therapies. METHODS A national study investigated factors that influenced clinicians' decision to offer IR, and collected data on case mix, operative procedures and reconstructive decision-making among women with breast cancer having a mastectomy with or without IR in the English National Health Service between 1 January 2008 and 31 March 2009. Multivariable logistic regression was used to examine the relationship between whether or not women were offered IR and their characteristics (tumour burden, functional status, planned radiotherapy, planned chemotherapy, perioperative fitness, obesity, smoking status and age). RESULTS Of 13 225 women, 6458 (48·8 per cent) were offered IR. Among factors the guidelines highlighted as relevant to decision-making, the three most strongly associated with the likelihood of an offer were tumour burden, planned radiotherapy and performance status. Depending on the combination of their values, the probability of an IR offer ranged from 7·4 to 85·1 per cent. A regression model that included all available factors discriminated well between whether or not women were offered IR (c-statistic 0·773), but revealed that increasing age was associated with a fall in the probability of an IR offer beyond that expected from older patients' tumour and co-morbidity characteristics. CONCLUSION Clinicians are broadly following guidance on the offer of IR, except with respect to patients' age.
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Affiliation(s)
- R Jeevan
- Clinical Effectiveness Unit, Royal College of Surgeons of England, London, UK.,Mersey Regional Burns, Plastic and Reconstructive Surgery Unit, St Helens and Knowsley Teaching Hospitals NHS Trust, Prescot, UK
| | - J P Browne
- Department of Health Services Research and Policy, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK.,Department of Epidemiology and Public Health, University College Cork, Cork, Ireland
| | - C Gulliver-Clarke
- Integrated Breast Service, Western Sussex Hospitals NHS Foundation Trust, Worthing Hospital, Worthing, UK
| | - J Pereira
- Department of General Surgery, James Paget University Hospitals NHS Foundation Trust, Great Yarmouth, UK.,Norwich Medical School, University of East Anglia, Norwich, UK
| | - C M Caddy
- Department of Plastic Surgery, Sheffield Teaching Hospitals NHS Foundation Trust, Royal Hallamshire Hospital, Sheffield, UK
| | - J H P van der Meulen
- Clinical Effectiveness Unit, Royal College of Surgeons of England, London, UK.,Department of Health Services Research and Policy, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - D A Cromwell
- Clinical Effectiveness Unit, Royal College of Surgeons of England, London, UK.,Department of Health Services Research and Policy, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
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Beverly A, Kaye AD, Urman RD. SCAMPs for Multimodal Post-Operative Analgesia: A Concept to Standardize and Individualize Care. Curr Pain Headache Rep 2017; 21:5. [DOI: 10.1007/s11916-017-0603-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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Caterson SA, Singh M, Orgill D, Ghazinouri R, Han E, Ciociolo G, Laskowski K, Greenberg JO. Erratum: Development of Standardized Clinical Assessment and Management Plans (SCAMPs) in the Field of Plastic & Reconstructive Surgery: A Quality Improvement Project: Erratum. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2016; 4:e510. [PMID: 27536468 PMCID: PMC4977117 DOI: 10.1097/gox.0000000000000726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Stephanie A Caterson
- Division of Plastic Surgery, Brigham and Women's Hospital, Boston, Mass.; and Department of Medicine, Brigham and Women's Hospital, Boston, Mass
| | - Mansher Singh
- Division of Plastic Surgery, Brigham and Women's Hospital, Boston, Mass.; and Department of Medicine, Brigham and Women's Hospital, Boston, Mass
| | - Dennis Orgill
- Division of Plastic Surgery, Brigham and Women's Hospital, Boston, Mass.; and Department of Medicine, Brigham and Women's Hospital, Boston, Mass
| | - Roya Ghazinouri
- Division of Plastic Surgery, Brigham and Women's Hospital, Boston, Mass.; and Department of Medicine, Brigham and Women's Hospital, Boston, Mass
| | - Elizabeth Han
- Division of Plastic Surgery, Brigham and Women's Hospital, Boston, Mass.; and Department of Medicine, Brigham and Women's Hospital, Boston, Mass
| | - George Ciociolo
- Division of Plastic Surgery, Brigham and Women's Hospital, Boston, Mass.; and Department of Medicine, Brigham and Women's Hospital, Boston, Mass
| | - Karl Laskowski
- Division of Plastic Surgery, Brigham and Women's Hospital, Boston, Mass.; and Department of Medicine, Brigham and Women's Hospital, Boston, Mass
| | - Jeffery O Greenberg
- Division of Plastic Surgery, Brigham and Women's Hospital, Boston, Mass.; and Department of Medicine, Brigham and Women's Hospital, Boston, Mass
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