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Rogova A, Leal IM, Britton M, Chen TA, Lowenstein LM, Kyburz B, Casey K, Skeene K, Williams T, Reitzel LR. Implementing a tobacco-free workplace program at a substance use treatment center: a case study. BMC Health Serv Res 2024; 24:201. [PMID: 38355470 PMCID: PMC10865640 DOI: 10.1186/s12913-024-10629-5] [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: 10/05/2023] [Accepted: 01/23/2024] [Indexed: 02/16/2024] Open
Abstract
BACKGROUND People with substance use disorders smoke cigarettes at much higher rates than the general population in the United States and are disproportionately affected by tobacco-related diseases. Many substance use treatment centers do not provide evidence-based tobacco cessation treatment or maintain comprehensive tobacco-free workplace policies. The goal of the current work is to identify barriers and facilitators to a successful and sustainable implementation of a tobacco-free workplace program, which includes a comprehensive tobacco-free policy and evidence-based cessation treatment services, in a substance use treatment center. METHODS This study is based on an ethnographic approach and uses a qualitative case study design. Data were collected via interviews with staff (n = 6) and clients (n = 16) at the substance use treatment center and site visits (n = 8). Data were analyzed using thematic analysis guided by the extended Normalization Process Theory designed to inform the implementation of innovations in healthcare practice. RESULTS Staff at the substance use treatment center supported the implementation of the program and shared a good understanding of the purpose of the intervention and its potential benefits. However, the study identified significant challenges faced by the center during implementation, including widespread tobacco use among clients, contributing to attitudes among staff that tobacco cessation was a low-priority problem due to a perceived lack of interest in quitting and inability to quit among their clients. We identified several factors that contributed to changing this attitude, including provision of tobacco training to staff, active leadership support, low number of staff members who smoked, and access to material resources, including nicotine replacement products. The implementation and active enforcement of a comprehensive tobacco-free workplace program contributed to a gradual change in attitudes and improved the provision of evidence-based tobacco cessation care at the substance use treatment center. CONCLUSIONS Substance use treatment centers can integrate tobacco cessation practices in their daily operations, despite multiple challenges they face due to the complex behavioral health and socioeconomic needs of their clients. With proper support, substance use treatment centers can provide much needed tobacco cessation care to their clients who are disproportionately affected by tobacco-related health conditions and systemic health inequities.
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Affiliation(s)
- Anastasia Rogova
- The University of Texas MD Anderson Cancer Center, 1400 Pressler Street, 77230-1402, Houston, TX, Unit 1444, P.O. Box 301402, United States of America.
- University of Houston, 3657 Cullen Blvd, Stephen Power Farish Hall, 77204, Houston, TX, United States of America.
| | - Isabel Martinez Leal
- The University of Texas MD Anderson Cancer Center, 1400 Pressler Street, 77230-1402, Houston, TX, Unit 1444, P.O. Box 301402, United States of America
- University of Houston, 3657 Cullen Blvd, Stephen Power Farish Hall, 77204, Houston, TX, United States of America
| | - Maggie Britton
- The University of Texas MD Anderson Cancer Center, 1400 Pressler Street, 77230-1402, Houston, TX, Unit 1444, P.O. Box 301402, United States of America
- University of Houston, 3657 Cullen Blvd, Stephen Power Farish Hall, 77204, Houston, TX, United States of America
| | - Tzuan A Chen
- University of Houston, 3657 Cullen Blvd, Stephen Power Farish Hall, 77204, Houston, TX, United States of America
| | - Lisa M Lowenstein
- The University of Texas MD Anderson Cancer Center, 1400 Pressler Street, 77230-1402, Houston, TX, Unit 1444, P.O. Box 301402, United States of America
| | - Bryce Kyburz
- Integral Care, 1430 Collier St, 78704, Austin, TX, United States of America
| | - Kathleen Casey
- Integral Care, 1430 Collier St, 78704, Austin, TX, United States of America
| | - Kim Skeene
- Integral Care, 1430 Collier St, 78704, Austin, TX, United States of America
| | - Teresa Williams
- Integral Care, 1430 Collier St, 78704, Austin, TX, United States of America
| | - Lorraine R Reitzel
- The University of Texas MD Anderson Cancer Center, 1400 Pressler Street, 77230-1402, Houston, TX, Unit 1444, P.O. Box 301402, United States of America
- University of Houston, 3657 Cullen Blvd, Stephen Power Farish Hall, 77204, Houston, TX, United States of America
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Kenis I, Van Hecke A, Foulon V. The cocreation of care pathways for patients treated with oral anticancer drugs: From assessment data to an actual care pathway. J Eval Clin Pract 2023; 29:1354-1362. [PMID: 36949720 DOI: 10.1111/jep.13840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Revised: 02/23/2023] [Accepted: 03/09/2023] [Indexed: 03/24/2023]
Abstract
RATIONALE Due to the emergence of oral anticancer therapies, existing care processes in oncology - that are mainly focused on in-hospital treatments - must be rethought. The development of a care pathway is a well-known methodology to reorganise and standardise care for a specific patient group. However, care pathway development might be complex and burdensome for healthcare teams, requiring a well-thought-out methodology that provides guidance to the teams. AIMS AND OBJECTIVES In 10 Belgian oncology departments, multidisciplinary teams developed a tailored care pathway, aimed to offer high-quality patient-centred care. Each department followed a cocreation methodology, consisting of a current practice assessment, a priority setting, and the actual development of the care pathway. The aim of this study was to investigate how and to which extent underperformed evidence-based key elements (KEs), identified in the current practice assessment, guided the development of the care pathway, and how compliant the final care pathways are with the list of evidence-based KEs. METHODS A qualitative content analysis was conducted to describe and compare the results of each phase of the cocreation methodology. RESULTS This study shows that much of the evidence and feedback on current practice that was used as a starting point, got lost throughout the cocreation process. Only a limited proportion of the (seriously) underperformed KEs were prioritised by the multidisciplinary teams. Furthermore, several prioritised KEs could not be retrieved in the care pathway documents. Also, the final care pathways were not fully compliant with existing evidence. CONCLUSION Based on the findings, a more rigorous cocreation methodology seems needed, offering very concrete support for multidisciplinary teams to integrate the prioritised KEs in the care process (e.g., by using a model care pathway). Next to the selfreported performance data from healthcare professionals and patients, more objective data (e.g., walkthrough, medical records) and more extensive patient involvement should be considered in the priority setting.
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Affiliation(s)
- Ilyse Kenis
- Department of Pharmaceutical and Pharmacological Sciences, Clinical Pharmacology and Pharmacotherapy, KU Leuven, Leuven, Belgium
- Department of Public Health and Primary Care, University Centre for Nursing and Midwifery, Ghent University, Ghent, Belgium
| | - Ann Van Hecke
- Department of Public Health and Primary Care, University Centre for Nursing and Midwifery, Ghent University, Ghent, Belgium
- Nursing Department, Ghent University Hospital, Ghent, Belgium
| | - Veerle Foulon
- Department of Pharmaceutical and Pharmacological Sciences, Clinical Pharmacology and Pharmacotherapy, KU Leuven, Leuven, Belgium
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van Zelm R, Coeckelberghs E, Sermeus W, Wolthuis A, Bruyneel L, Panella M, Vanhaecht K. A mixed methods multiple case study to evaluate the implementation of a care pathway for colorectal cancer surgery using extended normalization process theory. BMC Health Serv Res 2021; 21:11. [PMID: 33397382 PMCID: PMC7784254 DOI: 10.1186/s12913-020-06011-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Accepted: 12/10/2020] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND Specific factors that facilitate or prevent the implementation of enhanced recovery protocols for colorectal cancer surgery have been described in previous qualitative studies. This study aims to perform a concurrent qualitative and quantitative evaluation of factors associated with successful implementation of a care pathway (CP) for patients undergoing surgery for colorectal cancer. METHODS This comparative mixed methods multiple case study was based on a sample of 10 hospitals in 4 European countries that implemented a specific CP and performed pre- and post-implementation measurements. In-depth post-implementation interviews were conducted with healthcare professionals who were directly involved. Primary outcomes included protocol adherence and improvement rate. Secondary outcomes included length of stay (LOS) and self-rated protocol adherence. The hospitals were ranked based on these quantitative findings, and those with the highest and lowest scores were included in this study. Qualitative data were summarized on a per-case basis using extended Normalization Process Theory (eNPT) as theoretical framework. The data were then combined and analyzed using joint display methodology. RESULTS Data from 381 patients and 30 healthcare professionals were included. Mean protocol adherence rate increased from 56 to 62% and mean LOS decreased by 2.1 days. Both measures varied greatly between hospitals. The two highest-ranking hospitals and the three lowest-ranking hospitals were included as cases. Factors which could explain the differences in pre- and post-implementation performance included the degree to which the CP was integrated into daily practice, the level of experience and support for CP methodology provided to the improvement team, the intrinsic motivation of the team, shared goals and the degree of management support, alignment of CP development and hospital strategy, and participation of relevant disciplines, most notably, physicians. CONCLUSIONS Overall improvement was achieved but was highly variable among the 5 hospitals evaluated. Specific factors involved in the implementation process that may be contributing to these differences were conceptualized using eNPT. Multidisciplinary teams intending to implement a CP should invest in shared goals and teamwork and focus on integration of the CP into daily processes. Support from hospital management directed specifically at quality improvement including audit may likewise facilitate the implementation process. TRIAL REGISTRATION NCT02965794 . US National Library of Medicine, ClinicalTrials.gov . Registered 4 August 2014.
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Affiliation(s)
- R van Zelm
- Leuven Institute for Healthcare Policy, Katholieke Universiteit Leuven, Leuven, Belgium.
| | - E Coeckelberghs
- Leuven Institute for Healthcare Policy, Katholieke Universiteit Leuven, Leuven, Belgium
| | - W Sermeus
- Depertment of Abdominal Surgery, University Hospital Leuven, Leuven, Belgium
| | - A Wolthuis
- Depertment of Abdominal Surgery, University Hospital Leuven, Leuven, Belgium
| | - L Bruyneel
- Leuven Institute for Healthcare Policy, Katholieke Universiteit Leuven, Leuven, Belgium
| | - M Panella
- Department of Translational Medicine, University of Eastern Piemonte (UPO), Novarra, Italy
| | - K Vanhaecht
- Leuven Institute for Healthcare Policy, Katholieke Universiteit Leuven, Leuven, Belgium.,Department of Quality, Academic Policy Advisor, University Hospital Leuven, Leuven, Belgium
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Flierman I, van Rijn M, de Meij M, Poels M, Niezink DM, Willems DL, Buurman BM. Feasibility of the PalliSupport care pathway: results from a mixed-method study in acutely hospitalized older patients at the end of life. Pilot Feasibility Stud 2020; 6:129. [PMID: 32944277 PMCID: PMC7490875 DOI: 10.1186/s40814-020-00676-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Accepted: 09/01/2020] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND A transitional care pathway (TCP) could improve care for older patients in the last months of life. However, barriers exist such as unidentified palliative care needs and suboptimal collaboration between care settings. The aim of this study was to determine the feasibility of a TCP, named PalliSupport, for older patients at the end of life, prior to a stepped-wedge randomized controlled trial. METHODS A mixed-method feasibility study was conducted at one hospital with affiliated primary care. Patients were ≥ 60 years and acutely hospitalized. The intervention consisted of (1) training on early identification of the palliative phase and end of life conversations, (2) involvement of a transitional palliative care team during admission and post-discharge and (3) intensified collaboration between care settings. Outcomes were feasibility of recruitment, data collection, patient burden and protocol adherence. Experiences of 14 professionals were assessed through qualitative interviews. RESULTS Only 16% of anticipated participants were included which resulted in difficulty assessing other feasibility criteria. The qualitative analysis identified misunderstandings about palliative care, uncertainty about professionals' roles and difficulties in initiating end of life conversations as barriers. The training program was well received and professionals found the intensified collaboration beneficial for patient care. The patients that participated experienced low burden and data collection on primary outcomes and protocol adherence seems feasible. DISCUSSION This study highlights the importance of performing a feasibility study prior to embarking on effectiveness studies. Moving forward, the PalliSupport care pathway will be adjusted to incorporate a more active recruitment approach, additional training on identification and palliative care, and further improvement on data collection.
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Affiliation(s)
- Isabelle Flierman
- Amsterdam UMC, Department of General Practice, Section of Medical Ethics, Amsterdam Public Health research institute, University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
- Amsterdam UMC, Department of Internal Medicine, Section of Geriatric Medicine, Amsterdam Public Health research institute, University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
| | - Marjon van Rijn
- Amsterdam UMC, Department of Internal Medicine, Section of Geriatric Medicine, Amsterdam Public Health research institute, University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
- Center of Expertise Urban Vitality, Faculty of Health, Amsterdam University of Applied Science, Amsterdam, the Netherlands
| | - Marike de Meij
- OLVG, Palliative and Supportive Care Team, Oncology Centre Amsterdam, Oosterpark 9, Amsterdam, The Netherlands
| | - Marjolein Poels
- Care2research, Mattenbiesstraat 133, Amsterdam, the Netherlands
| | - Dorende M. Niezink
- Amsterdam UMC, Department of Internal Medicine, Section of Geriatric Medicine, Amsterdam Public Health research institute, University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
| | - Dick L. Willems
- Amsterdam UMC, Department of General Practice, Section of Medical Ethics, Amsterdam Public Health research institute, University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
| | - Bianca M. Buurman
- Amsterdam UMC, Department of Internal Medicine, Section of Geriatric Medicine, Amsterdam Public Health research institute, University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
- Center of Expertise Urban Vitality, Faculty of Health, Amsterdam University of Applied Science, Amsterdam, the Netherlands
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Sun J, Liu J, Zhu Q, Xu F, Kang L, Shi X. Hsa_circ_0001806 Acts as a ceRNA to Facilitate the Stemness of Colorectal Cancer Cells by Increasing COL1A1. Onco Targets Ther 2020; 13:6315-6327. [PMID: 32636650 PMCID: PMC7335295 DOI: 10.2147/ott.s255485] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Accepted: 06/12/2020] [Indexed: 12/20/2022] Open
Abstract
Background The aberrant expression of circular RNAs (circRNAs) has been identified as a novel trait of cancers. However, the role of circRNAs in colorectal cancer (CRC) remains to be elucidated. Methods Informatic analysis was performed to identify circRNAs in CRC tissues and adjacent tissues. Gain- and loss-of-function experiments were constructed to analyze hsa_circ_001806 roles in CRC cell stemness by sphere-formation, ALDH activity, stemness marker expression and tumor-initiating ability assays. CCK8 cell viability was carried out to evaluate hsa_circ_0001806 roles in CRC cell viability. Luciferase reporter and pull-down assays were used to reveal the underlying mechanisms. Results Hsa_circ_0001806 was significantly upregulated in CRC tissues and correlated with TNM stage, depth of invasion, lymphatic metastasis and distant metastasis. Hsa_circ_0001806 promoted the stemness of CRC cells, as evident by increasing sphere-formation ability, ALDH1 activity and stemness marker expression while had no effect on cell viability. Mechanistically, the same miR-193-5p-binding sites are shared between hsa_circ_0001806 and COL1A1. Hsa_circ_0001806 upregulates COL1A1 expression in a miR-193-5p-dependent manner, which is essential for hsa_circ_0001806-mediated regulation on CRC cell stemness. Conclusion CircRNA hsa_circ_0001806 may act as a promising therapeutic target by facilitating the stemness of CRC cells via activating the hsa_circ_0001806/miR-193a-5p/COL1A1 axis.
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Affiliation(s)
- Jie Sun
- Department of Gastroenterology, The Affiliated Suzhou Science and Technology Town Hospital of Nanjing Medical University, Suzhou, Jiangsu 215153, People's Republic of China
| | - Jie Liu
- Department of Gastroenterology, The Affiliated Suzhou Science and Technology Town Hospital of Nanjing Medical University, Suzhou, Jiangsu 215153, People's Republic of China
| | - Qilin Zhu
- Department of Gastroenterology, The Affiliated Suzhou Science and Technology Town Hospital of Nanjing Medical University, Suzhou, Jiangsu 215153, People's Republic of China
| | - Feng Xu
- Department of Gastroenterology, The Affiliated Suzhou Science and Technology Town Hospital of Nanjing Medical University, Suzhou, Jiangsu 215153, People's Republic of China
| | - Liumin Kang
- Department of Gastroenterology, The Affiliated Suzhou Science and Technology Town Hospital of Nanjing Medical University, Suzhou, Jiangsu 215153, People's Republic of China
| | - Xiaohua Shi
- Department of Gastroenterology, The Affiliated Suzhou Science and Technology Town Hospital of Nanjing Medical University, Suzhou, Jiangsu 215153, People's Republic of China
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van Zelm R, Coeckelberghs E, Sermeus W, Wolthuis A, Bruyneel L, Panella M, Vanhaecht K. Effects of implementing a care pathway for colorectal cancer surgery in ten European hospitals: an international multicenter pre-post-test study. Updates Surg 2020; 72:61-71. [PMID: 31993994 DOI: 10.1007/s13304-020-00706-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Accepted: 01/15/2020] [Indexed: 01/28/2023]
Abstract
Adherence to evidence-based recommendations is variable and generally low. This is also followed in colorectal surgery, despite the availability of the ERAS® protocol. The aim of the study was to evaluate the effect of implementing a care pathway for perioperative care in colorectal cancer surgery on outcomes and protocol adherence. So, we performed an international pre-test-post-test multicenter study, performed in ten hospitals in four European countries. The measures used included length of stay, morbidity and mortality, and documentation and adherence on intervention and patient level. Unadjusted pre-test-post-test differences were analyzed following an analysis adjusted for patient-mix variables. Importance-performance analysis was used to map the relationship between importance and performance of individual interventions. In total, 381 patients were included. Length of stay decreased from 12.6 to 10.7 days (p = 0.0230). Time to normal diet and walking also decreased significantly. Protocol adherence improved from 56 to 62% (p < 0.00001). Adherence to individual interventions remained highly variable. Importance-performance analysis showed 30 interventions were scored as important, of which 19 had an adherence < 70%, showing priorities for improvement. Across hospitals, change in protocol adherence ranged from a 13% decrease to a 22% increase. Implementing a care pathway for colorectal cancer surgery reduced length of stay, time to normal diet and walking. Documentation and protocol adherence improved after implementing the care pathway. However, not in all participating hospitals protocol adherence improved. Only in 25% of patients, protocol adherence of ≥ 70% was achieved, suggesting a large group is at risk for underuse. Importance-performance analysis showed which interventions are important, but have low adherence, prioritizing improvement efforts.
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Affiliation(s)
- Ruben van Zelm
- Leuven Institute for Healthcare Policy, KU Leuven, Kapucijnenvoer 35/3, 3000, Louvain, Belgium. .,European Pathway Association, Louvain, Belgium.
| | - Ellen Coeckelberghs
- Leuven Institute for Healthcare Policy, KU Leuven, Kapucijnenvoer 35/3, 3000, Louvain, Belgium
| | - Walter Sermeus
- Leuven Institute for Healthcare Policy, KU Leuven, Kapucijnenvoer 35/3, 3000, Louvain, Belgium.,European Pathway Association, Louvain, Belgium
| | - Albert Wolthuis
- Department of Abdominal Surgery, University Hospital Leuven, KU Leuven, Louvain, Belgium
| | - Luk Bruyneel
- Leuven Institute for Healthcare Policy, KU Leuven, Kapucijnenvoer 35/3, 3000, Louvain, Belgium.,University Hospitals Leuven, Louvain, Belgium
| | - Massimiliano Panella
- European Pathway Association, Louvain, Belgium.,Department of Translational Medicine, University of Eastern Piemonte (UPO), Novarra, Italy
| | - Kris Vanhaecht
- Leuven Institute for Healthcare Policy, KU Leuven, Kapucijnenvoer 35/3, 3000, Louvain, Belgium.,European Pathway Association, Louvain, Belgium.,Department of Quality, University Hospital Leuven, Louvain, Belgium
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