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Ruble K, Carey LB, Paré-Blagoev JE, Thornton CP, Northrup RA, Northman L, Hayashi RJ, Paltin I, Foster R, Greenzang K, Hobbie WL, Jacobson LA. Communicating neurocognitive impacts of childhood cancer: Engaging stakeholders to identify research priorities. PATIENT EDUCATION AND COUNSELING 2023; 116:107935. [PMID: 37579619 DOI: 10.1016/j.pec.2023.107935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Revised: 07/31/2023] [Accepted: 08/02/2023] [Indexed: 08/16/2023]
Abstract
OBJECTIVE Supporting childhood cancer survivors with neurocognitive late effects is critical and requires additional attention in the research arena. This convening project's aim was to engage parents, healthcare providers, and education stakeholders in order to identify research priorities regarding patient/family-provider communication about neurocognitive impacts associated with childhood cancer. METHODS Specific components of the Stakeholder Engagement in quEstion Development (SEED) method were combined with an online e-Delphi consensus building approach. Multiple modalities were utilized for engagement including in-person/hybrid meetings, email/Zoom/call communications, targeted-asynchronous learning activities by stakeholders, iterative surveys, and hands-on conceptual modeling. RESULTS Twenty-four (parents n = 10, educators n = 5, healthcare providers n = 9) participated in the year-long project, generating 8 research questions in the stakeholder priority domains of training families/caregiver, access of neuropsychological assessment, tools to facilitate communication and training medical providers. CONCLUSIONS This paper illustrates a successful stakeholder convening process using multi-modal engagement to establish research priorities. The resulting questions can be utilized to guide research projects that will fill gaps to providing optimal care to children with neurocognitive late effects. PRACTICE IMPLICATIONS This process can be used as a template for tackling other healthcare issues that span across disciplines and domains, where stakeholders have rare opportunities to collaborate.
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Affiliation(s)
- Kathy Ruble
- Johns Hopkins University, School of Medicine, Baltimore, MD, USA.
| | - Lisa B Carey
- Kennedy Krieger Institute, Baltimore, MD, USA; Johns Hopkins University, School of Education, Baltimore, MD, USA
| | | | | | | | | | | | - Iris Paltin
- Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Rebecca Foster
- Washington University, School of Medicine, St. Louis, MO, USA
| | | | - Wendy L Hobbie
- Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Lisa A Jacobson
- Johns Hopkins University, School of Medicine, Baltimore, MD, USA; Kennedy Krieger Institute, Baltimore, MD, USA
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Ruble K, Paré-Blagoev J, Carey LB, Milla K, Thornton CP, Henegan S, Jacobson LA. Strategies to improve communication about neurocognitive impacts in pediatric oncology: Quality improvement findings. Pediatr Blood Cancer 2023; 70:e30072. [PMID: 36326122 DOI: 10.1002/pbc.30072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Revised: 09/07/2022] [Accepted: 10/03/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND Neurocognitive deficits are common among children who receive central nervous system (CNS)-directed therapy for childhood cancer. Parents report that they lack information from and communication with oncology providers about neurocognitive impacts of therapy. Furthermore, oncology providers report they lack training and institutional support to appropriately address the neurocognitive needs of these patients/families. METHODS A parent/provider stakeholder informed, quality improvement (QI) project was conducted to educate providers about neurocognitive impacts, increase parent/provider communication, and improve adherence to supportive care guidelines for neuropsychological assessment for children receiving CNS-directed therapy. A 1-h Continuing Medical Education (CME) course was developed to educate providers about neurocognitive impacts and their relation to schooling. A provider-focused electronic medical record (EMR) strategy was used to deliver parent stakeholder-informed return-to-school "roadmaps," with prompts to scaffold parent/provider communication and enhance documentation of findings. RESULTS Hospital-based CME sessions were attended by 76% (41 out of 54) of providers from our institution. Among the 34 who completed both pretest and posttest, the mean knowledge score improved from 56% at pretest to 74% at posttest. Compliance with the EMR strategy was 80% and there was a 42% increase in neuropsychological assessment referrals. CONCLUSIONS We conclude that this QI project is an example of a successful parent/provider stakeholder collaboration that achieved demonstrable positive change in the areas of provider knowledge, patient/provider communication, and alignment of neuropsychological assessment referrals with existing guidelines. Our results confirm that improving knowledge, communication, and compliance with neuropsychological standards of care is possible with this evidence-based approach.
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Affiliation(s)
- Kathy Ruble
- Division of Pediatric Oncology, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Juliana Paré-Blagoev
- Division of Advanced Studies in Education, Johns Hopkins University School of Education, Baltimore, MD, United States
| | - Lisa B Carey
- Division of Neuropsychology, Kennedy Krieger Institute, Baltimore, MD, United States
| | - Kimberly Milla
- Division of Neuropsychology, Kennedy Krieger Institute, Baltimore, MD, United States
| | - Clifton P Thornton
- Center for Pediatric Nursing Research and Evidence-Based Practice, Children's Hospital of Phildelphia, Philadelphia, United States
| | - Sydney Henegan
- Department of Nursing, Children's Hospital of Philadelphia, Philadelphia, MD, United States
| | - Lisa A Jacobson
- Division of Neuropsychology, Kennedy Krieger Institute, Baltimore, MD, United States.,Division of Psychiatry, Johns Hopkins School of Medicine, Baltimore, MD, United States
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Conway Keller M, King C, Hart L, Engelke K, Needham A, Holden E, Foy K, Lucas R. The end of cancer treatment experience for children, adolescents, and their parents: A systematic review of the literature. J Psychosoc Oncol 2020; 38:573-591. [DOI: 10.1080/07347332.2020.1769795] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- Mary Conway Keller
- Division of Hematology-Oncology, Connecticut Children’s Medical Center, Hartford, Connecticut, USA
| | - Courtney King
- Center for Cancer and Blood Disorders, Connecticut Children’s Medical Center, Hartford, Connecticut, USA
| | - Leigh Hart
- Center for Cancer and Blood Disorders, Connecticut Children’s Medical Center, Hartford, Connecticut, USA
| | - Karina Engelke
- Division of Hematology-Oncology, Connecticut Children’s Medical Center, Hartford, Connecticut, USA
| | - Andrew Needham
- Center for Cancer and Blood Disorders, Connecticut Children’s Medical Center, Hartford, Connecticut, USA
| | - Elizabeth Holden
- Center for Cancer and Blood Disorders, Connecticut Children’s Medical Center, Hartford, Connecticut, USA
| | - Kelly Foy
- Division of Hematology-Oncology, Connecticut Children’s Medical Center, Hartford, Connecticut, USA
| | - Ruth Lucas
- School of Nursing, University of Connecticut, Storrs, Connecticut, USA
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Mellblom AV, Korsvold L, Finset A, Loge J, Ruud E, Lie HC. Providing Information About Late Effects During Routine Follow-Up Consultations Between Pediatric Oncologists and Adolescent Survivors: A Video-Based, Observational Study. J Adolesc Young Adult Oncol 2015; 4:200-8. [PMID: 26697269 PMCID: PMC4684659 DOI: 10.1089/jayao.2015.0037] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
PURPOSE Information about late effects is a prerequisite for survivors of childhood cancers to engage in self-management of their health. Yet, many lack such knowledge. This study investigated to what extent: (1) potential late effects were discussed with adolescent and young adult (AYA)-aged survivors (of pediatric cancer), and (2) information about late effects was provided by the pediatric oncologists (POs) during routine follow-up consultations. METHODS Consultations were recorded with 10 POs and 66 adolescents, aged 12-20 years, treated for leukemia (72.7%) or lymphoma (21.2%), or who had received hematopoietic stem-cell transplantation for a benign disease (7.6%). Discussions of potential late effects were identified and coded, and then the amount of information about late effects provided was categorized into three levels: none, basic, and extended information. RESULTS Potential late effects were discussed in 85% of the consultations. Of these, 71% were PO initiated, and 60% concerned existing health problems. The POs provided none, basic, and extended information about late effects in 41%, 30%, and 29% of these discussions. Patients' age, time since treatment, and risk of late effects were not associated with amount of potential late effects discussed, but the type of potential late effect (physical vs. psychosocial and current vs. future risk) and PO were. CONCLUSION Potential late effects were frequently discussed, thus providing ample opportunity to provide information about late effects to adolescent cancer survivors. The observed PO variability in providing such information indicates a need for standardization of information practices.
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Affiliation(s)
- Anneli V Mellblom
- Department of Behavioral Sciences in Medicine, Institute of Basic Medical Sciences, Faculty of Medicine, University of Oslo , Oslo, Norway
| | - Live Korsvold
- Department of Behavioral Sciences in Medicine, Institute of Basic Medical Sciences, Faculty of Medicine, University of Oslo , Oslo, Norway . ; Department of Pediatric Medicine, Women and Children's Unit, Oslo University Hospital , Rikshospitalet, Oslo, Norway
| | - Arnstein Finset
- Department of Behavioral Sciences in Medicine, Institute of Basic Medical Sciences, Faculty of Medicine, University of Oslo , Oslo, Norway
| | - Jon Loge
- Department of Behavioral Sciences in Medicine, Institute of Basic Medical Sciences, Faculty of Medicine, University of Oslo , Oslo, Norway . ; Regional Centre for Excellence in Palliative Care, Department of Oncology, Oslo University Hospital (OUS) , Oslo, Norway
| | - Ellen Ruud
- Department of Behavioral Sciences in Medicine, Institute of Basic Medical Sciences, Faculty of Medicine, University of Oslo , Oslo, Norway
| | - Hanne C Lie
- Department of Behavioral Sciences in Medicine, Institute of Basic Medical Sciences, Faculty of Medicine, University of Oslo , Oslo, Norway . ; National Resource Centre for Late Effects After Cancer Treatment, Oslo University Hospital , Radiumhospitalet, Oslo, Norway
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