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Munhoz R, Sabesan S, Thota R, Merrill J, Hensold JO. Revolutionizing Rural Oncology: Innovative Models and Global Perspectives. Am Soc Clin Oncol Educ Book 2024; 44:e432078. [PMID: 38838274 DOI: 10.1200/edbk_432078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2024]
Abstract
For individuals living in rural areas, access to cancer care can be difficult. Barriers to access cross international boundaries and have a negative impact on treatment outcomes. Current models to increase rural access in the United States are reviewed, as is a system-wide approach to this problem in Australia. Ongoing efforts to increase access to clinical trials for patients in rural areas are also discussed.
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Affiliation(s)
- Rodrigo Munhoz
- Oncology Center, Hospital Sírio Libanês, São Paulo, Brazil
| | - Sabe Sabesan
- Townsville Cancer Centre, Townsville Hospital and Health Services, Townsville, Queensland, Australia
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Heredia-Ciuró A, Lazo-Prados A, Blasco-Valls P, Calvache-Mateo A, Lopez-Lopez L, Martin-Nuñez J, Valenza MC. Agreement between face-to-face and tele-assessment of upper limb disability in lung cancer survivors during COVID-19 era. J Telemed Telecare 2024; 30:668-674. [PMID: 35213263 PMCID: PMC8883128 DOI: 10.1177/1357633x221079543] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Accepted: 01/20/2022] [Indexed: 01/10/2023]
Abstract
INTRODUCTION Upper limb disability can limit the quality of life of lung cancer survivors. The COVID-19 era has required a finding of alternatives to attend the monitoring of presented disturbances with the minor risk of spread. Tele-assessment offers new possibilities for clinical assessment demonstrating good reliability compared to traditional face-to-face assessment in a variety of patients. No previous study has applied this type of assessment in lung cancer survivors. For this reason, the aim of this study was to evaluate the level of agreement between upper limb disability assessment using tele-assessment and the face-to-face method in lung cancer survivors. METHODS A reliability study was conducted with 20 lung cancer survivors recruited from the Oncological Radiotherapy Service of the "Hospital PTS" (Granada). Patients attended a session for clinical face-to-face and real-time online tele-assessment. The main outcome measurements of the study included upper limb function (shirt task) and musculoskeletal disturbances (active range of movement and trigger points), and these outcomes were recorded by two independent researchers. RESULTS The outcome measures showed good agreement between both assessments. The active range of movement presented heterogeneous results, being excellent reliability (ρ > 0.75) in extension, internal rotation, homolateral adduction, and contralateral abduction, good (0.4 < ρ < 0.75) for flexion, homolateral abduction, contralateral adduction and contralateral external rotation, and poor (ρ < 0.4) for homolateral external rotation. The measure evaluating upper limb function and trigger points show the highest interrater reliability with confidence interval lower limits ≥0.99. DISCUSSION The tele-assessment of upper limb function and musculoskeletal disorders of lung cancer survivors present a good interrater reliability compared to face-to-face assessment. It could be useful for monitoring the disability presented by cancer survivors whose access is difficult by the residential situation, physical limitations or the risk of COVID-19 spread.
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Affiliation(s)
| | - Antonio Lazo-Prados
- Oncological Radiotherapy Service of the “Hospital PTS”, Clínico San Cecilio University Hospital, Spain
| | - Paula Blasco-Valls
- Oncological Radiotherapy Service of the “Hospital PTS”, Clínico San Cecilio University Hospital, Spain
| | - Andrés Calvache-Mateo
- Department of Physiotherapy, Faculty of Health Sciences, University of Granada, Spain
| | - Laura Lopez-Lopez
- Department of Physiotherapy, Faculty of Health Sciences, University of Granada, Spain
| | - Javier Martin-Nuñez
- Department of Physiotherapy, Faculty of Health Sciences, University of Granada, Spain
| | - Marie C Valenza
- Department of Physiotherapy, Faculty of Health Sciences, University of Granada, Spain
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Hoffmann S, Beissner J, Hieber R, Jacoby J, Engler T, Walter CB. Demand-oriented design of telemedical services in gynecologic oncology. BMC Health Serv Res 2023; 23:1168. [PMID: 37891588 PMCID: PMC10604842 DOI: 10.1186/s12913-023-10176-5] [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: 12/05/2022] [Accepted: 10/18/2023] [Indexed: 10/29/2023] Open
Abstract
BACKGROUND The medical field is in the midst of a massive expansion in telemedical services. However, it is not possible to say to what extent telemedical offerings can be designed to meet needs in the German healthcare system. This study provides insights into demand-oriented care using telemedical services for gynecological patients. METHODS A total of 262 patients who received systemic therapy for gynecological oncology were surveyed anonymously using a questionnaire regarding their acceptance of telemedicine from February 2021 to April 2021. RESULTS Insufficient computer skills were associated with less acceptance of telemedicine treatment by gynecological oncology patients and presented a barrier. However, the patient's level of education was not related to the level of acceptance. Long travel distances from medical facilities and some types of patient occupations significantly increased the acceptance of telemedicine services. A high level of education, on the other hand, was not associated with the approval of telemedical approaches. Long journeys and work commitments increased the acceptance of telemedical visits. CONCLUSIONS The results of this study show that the factors investigated have an influence on the acceptance of telemedical offerings by patients. Barriers such as insufficient computer skills must be taken into account when implementing telemedicine services. Telemedicine can provide physical and economic relief for patients if telemedical planning is tailored to their needs.
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Affiliation(s)
- Sascha Hoffmann
- Department of Women's Health, University Women's Hospital Tübingen, Calwerstr. 7, 72076, Tübingen, Germany.
| | - Julia Beissner
- Department of Women's Health, University Women's Hospital Tübingen, Calwerstr. 7, 72076, Tübingen, Germany
| | - Rebekka Hieber
- Department of Women's Health, University Women's Hospital Tübingen, Calwerstr. 7, 72076, Tübingen, Germany
| | - Johann Jacoby
- Institute for Clinical Epidemiology and Applied Biometry, University of Tübingen, Silcherstr. 5, 72076, Tübingen, Germany
| | - Tobias Engler
- Department of Women's Health, University Women's Hospital Tübingen, Calwerstr. 7, 72076, Tübingen, Germany
| | - Christina Barbara Walter
- Department of Women's Health, University Women's Hospital Tübingen, Calwerstr. 7, 72076, Tübingen, Germany
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Anik AR, Hasan K, Islam MM, Hasan MM, Ali MF, Das SK. Non-Invasive Portable Technologies for Monitoring Breast Cancer Related Lymphedema to Facilitate Telehealth: A Scoping Review. IEEE J Biomed Health Inform 2023; 27:4524-4535. [PMID: 37247315 DOI: 10.1109/jbhi.2023.3280196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Breast cancer related lymphedema (BCRL) is a common, debilitating condition that can affect up to one in five breast cancer surviving patients (BCSP). BCRL can significantly reduce the quality of life (QOL) of patients and poses a significant challenge to healthcare providers. Early detection and continuous monitoring of lymphedema is crucial for the development of client-centered treatment plans for post-cancer surgery patients. Therefore, this comprehensive scoping review aimed to investigate the current technology methods used for the remote monitoring of BCRL and their potential to facilitate telehealth in the treatment of lymphedema. Initially, five electronic databases were systematically searched and analyzed following the PRISMA flow diagram. Studies were included, specifically if they provided data on the effectiveness of the intervention and were designed for the remote monitoring of BCRL. A total of 25 included studies reported 18 technological solutions to remotely monitor BCRL with significant methodological variation. Additionally, the technologies were categorized by method of detection and wearability. The findings of this comprehensive scoping review indicate that state-of-the-art commercial technologies were found to be more appropriate for clinical use than home monitoring, with portable 3D imaging tools being popular (SD 53.40) and accurate (correlation 0.9, p 0.05) for evaluating lymphedema in both clinic and home settings with expert practitioners and therapists. However, wearable technologies showed the most future potential for accessible and clinical long-term lymphedema management with positive telehealth outcomes. In conclusion, the absence of a viable telehealth device highlights the need for urgent research to develop a wearable device that can effectively track BCRL and facilitate remote monitoring, ultimately improving the quality of life for patients following post-cancer treatment.
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Lindsay D, Bates N, Callander E, Johnston K, Carlisle K, Smith D, Evans R, Larkins S. Evaluating the quality and safety of the BreastScreen remote radiology assessment model of service delivery in Australia. J Telemed Telecare 2023; 29:203-210. [PMID: 33283606 DOI: 10.1177/1357633x20975653] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
INTRODUCTION Breast cancer is the most commonly diagnosed cancer in Australian women. Given the diverse geography and populations within Australia, the ability to offer a telemedicine-supported breast screening and assessment service may increase access. The aim of this study was to assess clinical outcomes of a telemedicine-based remote radiology assessment service delivery model for detecting breast cancer in regional Australian women compared to the traditional radiologist onsite model. METHODS This study was a pre-post intervention study using de-identified administrative data. Data were collected from seven sites across three health jurisdictions within Australia. There were a total of 21,117 assessment visits, with 10,508 (49.8%) pre- and 10,609 (50.2%) post-remote model implementation. Of the 10,609 post-remote model visits, 3,904 (36.8%) were under the remote model. The main outcome was cancer detection, split into any cancer, any invasive cancer or any small invasive cancer. Timeliness of assessment was also examined. RESULTS After adjusting for multiple factors, there were no statistically significant differences in cancer detection rates between the remote and onsite models (adjusted odds ratio (AOR) = 1.02, 95% CI 0.86-1.19, n.s.). Implementing the remote assessment model had statistically significant positive effects on the timeliness of assessment (AOR = 0.68, 95% CI 0.59-0.77, p < 0.001). DISCUSSION This study found the remote model delivers safe and high-quality assessment services, with equivalent rates of cancer detection and improved timeliness of assessment when compared to the traditional onsite model. Careful monitoring and ongoing evaluation of any health-service model is important for ongoing safety, efficiency and acceptability.
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Affiliation(s)
- Daniel Lindsay
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Australia.,Menzies School of Health Research, Charles Darwin University, Australia
| | - Nicole Bates
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Australia
| | - Emily Callander
- School of Public Health and Preventive Medicine, Monash University, Australia
| | - Karen Johnston
- College of Medicine and Dentistry, James Cook University, Australia.,Australian Institute of Tropical Health and Medicine, James Cook University, Australia
| | - Karen Carlisle
- College of Medicine and Dentistry, James Cook University, Australia.,Australian Institute of Tropical Health and Medicine, James Cook University, Australia
| | - Deb Smith
- College of Medicine and Dentistry, James Cook University, Australia.,Australian Institute of Tropical Health and Medicine, James Cook University, Australia
| | - Rebecca Evans
- College of Medicine and Dentistry, James Cook University, Australia.,Australian Institute of Tropical Health and Medicine, James Cook University, Australia
| | - Sarah Larkins
- College of Medicine and Dentistry, James Cook University, Australia.,Australian Institute of Tropical Health and Medicine, James Cook University, Australia
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Pye S, Webster E, Zielinski R, Honeyball F. 'The best thing since sliced bread': Patient experiences of teleoncology in western NSW. Aust J Rural Health 2023; 31:90-97. [PMID: 36053275 DOI: 10.1111/ajr.12921] [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: 05/22/2022] [Revised: 08/11/2022] [Accepted: 08/15/2022] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE This study explored experiences of rural cancer patients who were receiving treatments by remote video-assisted chemotherapy (RVAC) or participating in clinical trials remotely. SETTING Participants lived in Coonabarabran or Dubbo in western NSW. PARTICIPANTS Seven cancer patients undergoing treatment for breast, bladder or colon cancer, renal cell carcinoma or lymphoma. DESIGN Appreciative inquiry informed this qualitative study. Semi-structured interviews were conducted between July 2018 and January 2019 and thematically analysed. RESULTS The patient experience of teleoncology was overwhelmingly positive. Patients explained the value of relationships that developed with the local and virtual care team. Patients felt they received better care if they saw the same oncologist for the duration of their treatment and felt RVAC had accommodated this. Teleoncology allowed patients to remain independent because they were able to maintain their usual support mechanisms including family, friends and health care team. Patients described the reduced physical and emotional travel burden in addition to reduction in travel time and cost. CONCLUSIONS These findings highlight the acceptability of teleoncology for rural patients as chemotherapy can be added to the health care and social and emotional supports, which exist in their hometown. Expansion of teleoncology should be codesigned with local communities with a focus on establishing care teams with consistent staffing to build trust between the treating team and the patient. These relationships improve the patient experience and enhance patient independence, which is a desirable attribute of cancer survivorship. Recruitment to clinical trials using teleoncology is acceptable and should be factored into trial development.
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Affiliation(s)
- Sid Pye
- School of Rural Health (currently Westmead Hospital), University of Sydney, Westmead, NSW, Australia
| | - Emma Webster
- School of Rural Health, University of Sydney, Dubbo, NSW, Australia
| | - Rob Zielinski
- Western NSW Local Health District, Western Sydney University, Orange, NSW, Australia
| | - Florian Honeyball
- Western NSW Local Health District, School of Rural Health, University of Sydney, Dubbo, NSW, Australia
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Ohlsen TJD, Doody DR, Mueller BA, Desai AD, Chow EJ. Population-Based Impact of Rurality and Neighborhood-Level Socioeconomic Disadvantage on Pediatric Cancer Mortality in Washington State. Cancer Epidemiol Biomarkers Prev 2023; 32:141-148. [PMID: 36343539 PMCID: PMC9839485 DOI: 10.1158/1055-9965.epi-22-0897] [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: 08/15/2022] [Revised: 09/19/2022] [Accepted: 10/31/2022] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Childhood cancer-related mortality differs by socioeconomic factors, but the impact of residential location, including rurality and neighborhood-level socioeconomic disadvantage, is not well-characterized. METHODS This retrospective cohort study linked Washington State cancer registry data (1992-2013) to state birth (1974-2013) and death records (1992-2013) to identify residents <20 years diagnosed with cancer (n = 4,306). Census-based rural-urban commuting area codes and Area Deprivation Index (ADI) defined rural residence and neighborhood socioeconomic disadvantage at time of cancer diagnosis, respectively. Neighborhoods in the highest state ADI quintile were classified as the most disadvantaged. Kaplan-Meier estimates and Cox hazards models, adjusted for key characteristics, were used to compare mortality by rural and ADI classification. RESULTS Five-year overall survival for children from non-rural low ADI neighborhoods (referent) was 80.9%±0.8%, versus 66.4%±2.9% from non-rural high ADI neighborhoods, 69.4%±3.8% from rural low ADI neighborhoods, and 66.9%±3.8% from rural high ADI neighborhoods (P < 0.01 for each comparison versus referent). Compared with the referent group, children from comparator neighborhoods had a greater mortality risk: Rural low ADI [hazard ratio (HR), 1.50; 95% confidence interval (CI), 1.12-2.02], rural high ADI (HR, 1.53; 95% CI, 1.16-2.01), and non-rural high ADI (HR, 1.64; 95% CI, 1.32-2.04). Associations of ADI and rurality with mortality varied in sub-analyses by cancer type. CONCLUSIONS Children with cancer living in rural and/or socioeconomically disadvantaged neighborhoods at diagnosis experienced greater mortality relative to those without either factor. IMPACT Future investigation is needed to examine how rurality and poverty potentially impact healthcare utilization and health-related outcomes in pediatric oncology.
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Affiliation(s)
- Timothy J. D. Ohlsen
- Ben Towne Center for Childhood Cancer Research, Seattle Children’s Research Institute,Department of Pediatrics, Seattle Children’s Hospital, University of Washington,Center for Child Health, Behavior, and Development, Seattle Children’s Research Institute
| | - David R. Doody
- Public Health Sciences Division, Fred Hutchinson Cancer Center
| | - Beth A. Mueller
- Public Health Sciences Division, Fred Hutchinson Cancer Center,Department of Epidemiology, University of Washington
| | - Arti D. Desai
- Department of Pediatrics, Seattle Children’s Hospital, University of Washington,Center for Child Health, Behavior, and Development, Seattle Children’s Research Institute
| | - Eric J. Chow
- Department of Pediatrics, Seattle Children’s Hospital, University of Washington,Public Health Sciences Division, Fred Hutchinson Cancer Center
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Totten AM, Womack DM, Griffin JC, McDonagh MS, Davis-O'Reilly C, Blazina I, Grusing S, Elder N. Telehealth-guided provider-to-provider communication to improve rural health: A systematic review. J Telemed Telecare 2022:1357633X221139892. [PMID: 36567431 DOI: 10.1177/1357633x221139892] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
INTRODUCTION Telehealth may address healthcare disparities for rural populations. This systematic review assesses the use, effectiveness, and implementation of telehealth-supported provider-to-provider collaboration to improve rural healthcare. METHODS We searched Ovid MEDLINE®, CINAHL®, EMBASE, and Cochrane CENTRAL from 1 January 2010 to 12 October 2021 for trials and observational studies of rural provider-to-provider telehealth. Abstracts and full text were dual-reviewed. We assessed the risk of bias for individual studies and strength of evidence for studies with similar outcomes. RESULTS Seven studies of rural uptake of provider-to-provider telehealth documented increases over time but variability across geographic regions. In 97 effectiveness studies, outcomes were similar with rural provider-to-provider telehealth versus without for inpatient consultations, neonatal care, outpatient depression and diabetes, and emergency care. Better or similar results were reported for changes in rural clinician behavior, knowledge, confidence, and self-efficacy. Evidence was insufficient for other clinical uses and outcomes. Sixty-seven (67) evaluation and qualitative studies identified barriers and facilitators to implementing rural provider-to-provider telehealth. Success was linked to well-functioning technology, sufficient resources, and adequate payment. Barriers included lack of understanding of rural context and resources. Methodologic weaknesses of studies included less rigorous study designs and small samples. DISCUSSION Rural provider-to-provider telehealth produces similar or better results versus care without telehealth. Barriers to rural provider-to-provider telehealth implementation are common to practice change but include some specific to rural adaptation and adoption. Evidence gaps are partially due to studies that do not address differences in the groups compared or do not include sufficient sample sizes.
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Affiliation(s)
| | - Dana M Womack
- Oregon Health & Science University, Portland, OR, USA
| | | | | | | | - Ian Blazina
- Oregon Health & Science University, Portland, OR, USA
| | - Sara Grusing
- Oregon Health & Science University, Portland, OR, USA
| | - Nancy Elder
- Oregon Health & Science University, Portland, OR, USA
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Hay‐Hansson A, Eldevik S, Strømgren B. Videoconference to supervise early intensive behavioral intervention: A preliminary evaluation of acceptability. BEHAVIORAL INTERVENTIONS 2022. [DOI: 10.1002/bin.1924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022]
Affiliation(s)
- Aina Hay‐Hansson
- The Habilitation Centre for Children and Adolescents Vestre Viken Health Trust Drammen Norway
- Department of Behavioural Science Oslo Metropolitan University Oslo Norway
| | - Sigmund Eldevik
- Department of Behavioural Science Oslo Metropolitan University Oslo Norway
| | - Børge Strømgren
- Department of Behavioural Science Oslo Metropolitan University Oslo Norway
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Teleoncology: A Solution for Everyone? A Single-Center Experience with Telemedicine during the Coronavirus Disease 2019 (COVID-19) Pandemic. Curr Oncol 2022; 29:8565-8578. [PMID: 36421328 PMCID: PMC9689494 DOI: 10.3390/curroncol29110675] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Revised: 11/03/2022] [Accepted: 11/08/2022] [Indexed: 11/13/2022] Open
Abstract
Since the beginning of the COVID-19 pandemic, the use of telehealth was rapidly implemented without previous evidence. The ONCOTELEMD study aimed to evaluate the opinion of patients attended via telemedicine during this period and to study factors that condition patient preferences on its use. Included patients had a confirmed cancer diagnosis and were contacted by telephone between 13 March and 30 April 2020, in the Medical Oncology Service of Hospital Parc Taulí, Sabadell. A 12-question survey was presented to them between 4 February and 19 April 2021. Statistical analysis was carried out using chi-square and multivariable logistic regression tests. Six hundred forty-six patients were included; 487 responded to the survey. The median age was 68 years (27-90), 55.2% were female. Most patients had a surveillance visit (65.3%) and were diagnosed with colorectal or breast cancer (43% and 26.5%, respectively); 91.8% of patients were satisfied, and 60% would accept the use of telemedicine beyond the pandemic. Patients aged more than 50 years (OR 0.40; 95% CI, 0.19-0.81; p = 0.01) and diagnosed with breast cancer (OR 0.45; 95% CI, 0.26-0.69; p < 0.001) were less predisposed to adopt telehealth in the future. Patients agreed to be informed via telehealth of scan or lab results (62% and 84%, respectively) but not of new oral or endovenous treatments (52% and 33.5%, respectively). Additionally, 75% of patients had a medium or low-null technologic ability, and 51.3% would only use the telephone or video call to contact health professionals. However, differences were found according to age groups (p < 0.0001). In total, patients surveyed were satisfied with telemedicine and believed telehealth could have a role following the COVID-19 pandemic. Moreover, our results remark on the importance of individualizing the use of telehealth, showing relevant data on patient preferences and digital literacy.
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Telemedicine and cancer care in India: promises, opportunities and caveats. Future Sci OA 2022; 8:FSO821. [PMID: 36788987 PMCID: PMC9912275 DOI: 10.2144/fsoa-2022-0001] [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: 01/10/2022] [Accepted: 12/06/2022] [Indexed: 01/11/2023] Open
Abstract
Telemedicine has revolutionized areas of medical practice and care. It has a potential in field of continuum of cancer care in India. SARS-CoV-2 has highlighted the potential use of this tool effectively. Scope of newer applications of telemedicine in field of cancer is reviewed in current paper enlisting benefits to patient, healthcare providers and centers in a developing country like India. Each of them is supported by appropriate evidence and examples. An analysis of strengths and opportunities when compared with weakness and threats brings out how telemedicine can redistribute oncology work force in a rational way and minimize disruption caused by the pandemic. Telemedicine can be utilized in cancer management starting from prevention, screening, diagnosis, treatment and rehabilitation to palliative care.
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12
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Morris BB, Rossi B, Fuemmeler B. The role of digital health technology in rural cancer care delivery: A systematic review. J Rural Health 2021; 38:493-511. [PMID: 34480506 DOI: 10.1111/jrh.12619] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
PURPOSE Rural residents face higher cancer incidence rates and mortality rates, disparities that could be mitigated with health technology interventions, yet a digital divide is also apparent. This paper systematically and critically examines existing literature to understand how digital technologies have been used to support rural oncology care. METHODS PubMed, CINAHL Complete, PsycINFO, and Embase were searched using Medical Subject Headings terms and keywords. Studies were eligible if they presented empirical data investigating the use of technology in rural oncology and were published in English in a peer-reviewed journal within the last decade. The Mixed Methods Appraisal Tool was used to assess methodological quality. FINDINGS Digital health has been less extensively utilized in rural oncology compared with the general cancer population and other chronic diseases. We identified 54 studies that used technology in rural cancer care delivery, a comparatively small number, representing a significant gap in the literature. Studies were classified into 4 categories: Telemedicine (n = 32), phone calls (n = 11), Internet (n = 9), and mobile phone (n = 2). Of the 54 articles, 12 were RCTs, 17 were quasi-experimental, 3 were descriptive, 12 were mixed methods, and 10 were qualitative. Most of the studies involved patients only (n = 31) and were not specific to a cancer type (n = 41). CONCLUSIONS Further implementation and expansion of telemedicine and phone-based strategies in rural cancer care delivery are warranted. Rural cancer survivors value digital approaches to their care. However, social and behavioral determinants of health and access to technology must be considered.
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Affiliation(s)
- Bonny B Morris
- School of Medicine, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Brianna Rossi
- School of Medicine, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Bernard Fuemmeler
- School of Medicine, Virginia Commonwealth University, Richmond, Virginia, USA
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Zon RT, Kennedy EB, Adelson K, Blau S, Dickson N, Gill D, Laferriere N, Lopez AM, Mulvey TM, Patt D, Pickard TA, Purdom T, Royce TJ, Sumrall AL, Page RD. Telehealth in Oncology: ASCO Standards and Practice Recommendations. JCO Oncol Pract 2021; 17:546-564. [PMID: 34319760 DOI: 10.1200/op.21.00438] [Citation(s) in RCA: 69] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
PURPOSE To provide standards and practice recommendations specific to telehealth in oncology. METHODS A systematic review of the literature on telehealth in oncology was performed, including the use of technologies and telecommunications systems, and other electronic methods of care delivery and sharing of information with patients. The evidence base was combined with the opinion of the ASCO Telehealth Expert Panel to develop telehealth standards and guidance. Public comments were solicited and considered in preparation of the final manuscript. RESULTS The Expert Panel determined that general guidance on implementing telehealth across general and specialty settings has been published previously and these resources are endorsed. A systematic search for studies on topics specific to oncology resulted in the inclusion of two clinical practice guidelines, 12 systematic reviews, and six primary studies. STANDARDS AND GUIDANCE Standards and guidance are provided for which patients in oncology can be seen via telehealth, establishment of the doctor-physician relationship, role of allied health professionals, role of advanced practice providers, multidisciplinary cancer conferences, and teletrials in oncology. Additional information is available at www.asco.org/standards.
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Affiliation(s)
| | | | - Kerin Adelson
- Smilow Cancer Hospital, Yale School of Medicine, Guilford, CT
| | - Sibel Blau
- Northwest Medical Specialties, Seattle, WA
| | | | - David Gill
- Intermountain Healthcare, Salt Lake City, UT
| | - Nicole Laferriere
- North West Regional Cancer Center and Northern Ontario School of Medicine, Thunder Bay, Ontario, Canada
| | - Ana Maria Lopez
- Jefferson Health New Jersey, Sidney Kimmel Cancer Center, Sewell, NJ
| | | | | | - Todd A Pickard
- University of Texas MD Anderson Cancer Center, Houston, TX
| | | | - Trevor J Royce
- Lineberger Comprehensive Cancer Center, Chapel Hill, NC.,Flatiron Health, New York, NY
| | | | - Ray D Page
- The Center for Cancer and Blood Disorders, Fort Worth, TX
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Hasson SP, Waissengrin B, Shachar E, Hodruj M, Fayngor R, Brezis M, Nikolaevski-Berlin A, Pelles S, Safra T, Geva R, Wolf I. Rapid Implementation of Telemedicine During the COVID-19 Pandemic: Perspectives and Preferences of Patients with Cancer. Oncologist 2021; 26:e679-e685. [PMID: 33453121 PMCID: PMC8013179 DOI: 10.1002/onco.13676] [Citation(s) in RCA: 72] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2020] [Accepted: 12/18/2020] [Indexed: 12/24/2022] Open
Abstract
Introduction The use of telemedicine in oncology practice is rapidly expanding and is considered safe and cost effective. However, the implications of telemedicine on patient‐physician interaction, patient satisfaction, and absence of the personal touch have not been studied to date. Following the spread of COVID‐19, telemedicine services were rapidly incorporated at the Oncology Division of Tel Aviv Medical Center. We aimed to evaluate patients' perspectives and preferences regarding telemedicine and to assess whether this virtual communication platform affects the patient‐physician relationship. Methods Between March 2020 and May 2020, adult cancer patients who conducted at least one successful telemedicine meeting were interviewed by trained medical personnel. The interview was based on validated patient satisfaction questionnaires and focused on patient‐physician interaction in relation to the last in‐patient visit. Results Of 236 patients, 172 (74%) patients agreed to participate. The study population comprised mainly patients with gastrointestinal malignancies (n = 79, 46%) with a median age of 63 years (range 21–88). The majority of patients were male (n = 93, 54%). Eighty‐nine (51.7%) patients were receiving active oncologic treatment, and 58 (33.7%) were under routine surveillance following completion of active therapy. Almost all had a sense of secured privacy (n = 171, 96%), the majority of patients affirmed that their concerns were met (n = 166, 93%) and perceived that eye contact with the treating physician was perceived (n = 156, 87%). Only a minority felt that the absence of physical clinic visits harmed their treatment (n = 36, 20%). Most patients (n = 146, 84.9%) wished to continue telemedicine services. A multivariate analysis revealed that higher satisfaction and visits for routine surveillance were both predictors of willingness to continue future telemedicine meetings over physical encounters (odds ratio [OR] = 2.41, p = .01; OR = 3.34, p = .03, respectively). Conclusion Telemedicine is perceived as safe and effective, and patients did not feel that it compromised medical care or the patient‐physician relationship. Integration of telemedicine is ideal for patients under surveillance after completion of active oncologic treatment. Physician communication skills workshops are warranted with implementing this platform. Implications for Practice During the COVID‐19 pandemic, telemedicine was rapidly implemented worldwide to facilitate continuity of quality care and treatment. Despite many potential setbacks, telemedicine has become a useful and safe tool for oncology practitioners to care for their patients. The use of telemedicine regarding patients' perspectives, emotions, and patient‐physician communication in daily oncology practice has not been studied to date. This study demonstrated telemedicine is perceived as safe and effective and does not compromise medical care or the patient‐physician relationship. Its use is ideal for surveillance after completion of active oncologic treatment. Physician communication skills workshops are warranted with implementing this platform. The use of telemedicine in oncology practice is rapidly expanding; however, the implications for patient‐physician interaction and patient satisfaction have not been well studied. This article evaluates patients' perspectives and preferences regarding telemedicine and whether a virtual communication platform affects the patient‐physician relationship.
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Affiliation(s)
- Shira Peleg Hasson
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Division of Oncology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Barliz Waissengrin
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Division of Oncology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Eliya Shachar
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Division of Oncology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Marah Hodruj
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Rochelle Fayngor
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Mirika Brezis
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Division of Oncology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | | | - Sharon Pelles
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Division of Oncology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Tamar Safra
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Division of Oncology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Ravit Geva
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Division of Oncology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Ido Wolf
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Division of Oncology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
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15
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O'Reilly D, Carroll H, Lucas M, Sui J, Al Sendi M, McMahon D, Darwish W, McLaughlin R, Khan MR, Sullivan HO, Chew S, Dennehy C, Kelly CM, McCaffrey J, Greally M, Carney D, Higgins MJ. Virtual oncology clinics during the COVID-19 pandemic. Ir J Med Sci 2021; 190:1295-1301. [PMID: 33449331 PMCID: PMC7809230 DOI: 10.1007/s11845-020-02489-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Accepted: 12/17/2020] [Indexed: 02/08/2023]
Abstract
Background The COVID-19 pandemic has resulted in radical changes in the delivery of healthcare worldwide. Our oncology service (at an Irish national cancer centre) rapidly transitioned to the use of telemedicine or virtual clinics (VC) to minimise potential risk of exposure to COVID-19 amongst an immunosuppressed, high-risk population. Our study aimed to evaluate the use of VC in this setting. Methods An 18-point questionnaire was designed to investigate the patient experience of VC during the COVID-19 pandemic in Ireland and compliance with guidelines developed in Ireland to conduct VC and the role of VC in the future. Questionnaires were distributed following the receipt of verbal consent from patients during the VC. Descriptive statistics were utilised for data analysis using SPSS®. Results One hundred and four patients returned completed surveys (n = 104/164, 63% response rate). Overall satisfaction levels were high with most patients (n = 58/100, 58%; no answer provided (NAP), n = 4) equally satisfied or nearly equally satisfied with VC in comparison to a usual clinic encounter. The majority of patients felt that there should be a role for VC in the future (n = 84/102, 82%; NAP, n = 2). The majority of patients (n = 61/99, 61%; NAP, n = 5) were very relieved to avoid a hospital visit due to perceived risk of potential exposure to COVID-19. Conclusion The majority of oncology patients were satisfied with a VC encounter. VC may have a role in the future of medical care in Ireland post the COVID-19 pandemic.
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Affiliation(s)
- David O'Reilly
- Department of Medical Oncology, Mater Misericordiae University Hospital, Eccles Street, Dublin, 7, Ireland.
| | - Hailey Carroll
- Department of Medical Oncology, Mater Misericordiae University Hospital, Eccles Street, Dublin, 7, Ireland
| | - Mairi Lucas
- Department of Medical Oncology, Mater Misericordiae University Hospital, Eccles Street, Dublin, 7, Ireland
| | - Jane Sui
- Department of Medical Oncology, Mater Misericordiae University Hospital, Eccles Street, Dublin, 7, Ireland
| | - Maha Al Sendi
- Department of Medical Oncology, Mater Misericordiae University Hospital, Eccles Street, Dublin, 7, Ireland
| | - David McMahon
- Department of Medical Oncology, Mater Misericordiae University Hospital, Eccles Street, Dublin, 7, Ireland
| | - Waseem Darwish
- Department of Medical Oncology, Mater Misericordiae University Hospital, Eccles Street, Dublin, 7, Ireland
| | - Ronan McLaughlin
- Department of Medical Oncology, Mater Misericordiae University Hospital, Eccles Street, Dublin, 7, Ireland
| | - Mohammed Raza Khan
- Department of Medical Oncology, Mater Misericordiae University Hospital, Eccles Street, Dublin, 7, Ireland
| | - Hazel O Sullivan
- Department of Medical Oncology, Mater Misericordiae University Hospital, Eccles Street, Dublin, 7, Ireland
| | - Sonya Chew
- Department of Medical Oncology, Mater Misericordiae University Hospital, Eccles Street, Dublin, 7, Ireland
| | - Colum Dennehy
- Department of Medical Oncology, Mater Misericordiae University Hospital, Eccles Street, Dublin, 7, Ireland
| | - Catherine M Kelly
- Department of Medical Oncology, Mater Misericordiae University Hospital, Eccles Street, Dublin, 7, Ireland
| | - John McCaffrey
- Department of Medical Oncology, Mater Misericordiae University Hospital, Eccles Street, Dublin, 7, Ireland
| | - Megan Greally
- Department of Medical Oncology, Mater Private Hospital, Eccles Street, Dublin, 7, Ireland
| | - Desmond Carney
- Department of Medical Oncology, Mater Private Hospital, Eccles Street, Dublin, 7, Ireland
| | - Michaela J Higgins
- Department of Medical Oncology, Mater Misericordiae University Hospital, Eccles Street, Dublin, 7, Ireland
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16
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Challinor JM, Alqudimat MR, Teixeira TOA, Oldenmenger WH. Oncology nursing workforce: challenges, solutions, and future strategies. Lancet Oncol 2020; 21:e564-e574. [DOI: 10.1016/s1470-2045(20)30605-7] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 09/15/2020] [Accepted: 10/02/2020] [Indexed: 12/25/2022]
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17
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Johnston K, Smith D, Preston R, Evans R, Carlisle K, Lengren J, Naess H, Phillips E, Shephard G, Lydiard L, Lattimore D, Larkins S. "From the technology came the idea": safe implementation and operation of a high quality teleradiology model increasing access to timely breast cancer assessment services for women in rural Australia. BMC Health Serv Res 2020; 20:1103. [PMID: 33256724 PMCID: PMC7708244 DOI: 10.1186/s12913-020-05922-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Accepted: 11/13/2020] [Indexed: 12/18/2022] Open
Abstract
Breast cancer is the most commonly diagnosed cancer in Australian women. Providing timely diagnostic assessment services for screen-detected abnormalities is a core quality indicator of the population-based screening program provided by BreastScreen Australia. However, a shortage of local and locum radiologists with availability and appropriate experience in breast work to attend onsite assessment clinics, limits capacity of services to offer assessment appointments to women in some regional centres. In response to identified need, local service staff developed the remote radiology assessment model for service delivery. This study investigated important factors for establishing the model, the challenges and enablers of successful implementation and operation of the model, and factors important in the provision of a model considered safe and acceptable by service providers. METHODS Semi-structured interviews were conducted with service providers at four assessment services, across three jurisdictions in Australia. Service providers involved in implementation and operation of the model at the service and jurisdictional level were invited to participate. A social constructivist approach informed the analysis. Deductive analysis was initially undertaken, using the interview questions as a classifying framework. Subsequently, inductive thematic analysis was employed by the research team. Together, the coding team aggregated the codes into overarching themes. RESULTS 55 service providers participated in interviews. Consistently reported enablers for the safe implementation and operation of a remote radiology assessment clinic included: clinical governance support; ability to adapt; strong teamwork, trust and communication; and, adequate technical support and equipment. Challenges mostly related to technology and internet (speed/bandwidth), and maintenance of relationships within the group. CONCLUSIONS Understanding the key factors for supporting innovation, and implementing new and safe models of service delivery that incorporate telemedicine, will become increasingly important as technology evolves and becomes more accessible. It is possible to take proposed telemedicine solutions initiated by frontline workers and operationalise them safely and successfully: (i) through strong collaborative relationships that are inclusive of key experts; (ii) with clear guidance from overarching bodies with some flexibility for adapting to local contexts; (iii) through establishment of robust teamwork, trust and communication; and, (iv) with appropriate equipment and technical support.
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Affiliation(s)
- Karen Johnston
- College of Medicine and Dentistry, James Cook University, QLD, Douglas, 4814, Australia.
| | - Deborah Smith
- College of Medicine and Dentistry, James Cook University, QLD, Douglas, 4814, Australia
| | - Robyn Preston
- School of Health, Medical and Applied Sciences, CQUniversity, QLD, Townsville, 4810, Australia
| | - Rebecca Evans
- College of Medicine and Dentistry, James Cook University, QLD, Douglas, 4814, Australia
| | - Karen Carlisle
- College of Medicine and Dentistry, James Cook University, QLD, Douglas, 4814, Australia
| | - Janet Lengren
- BreastScreen Queensland, PO Box 2368, Fortitude Valley BC, Qld, 4006, Australia
| | - Helen Naess
- BreastScreen Queensland, PO Box 2368, Fortitude Valley BC, Qld, 4006, Australia
| | - Elizabeth Phillips
- BreastScreen Queensland, PO Box 2368, Fortitude Valley BC, Qld, 4006, Australia
| | - Greg Shephard
- BreastScreen Queensland, PO Box 2368, Fortitude Valley BC, Qld, 4006, Australia
| | | | | | - Sarah Larkins
- College of Medicine and Dentistry, James Cook University, QLD, Douglas, 4814, Australia
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18
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Sato D. Effectiveness of Telenursing for Postoperative Complications in Patients with Prostate Cancer. Asia Pac J Oncol Nurs 2020; 7:396-403. [PMID: 33062837 PMCID: PMC7529028 DOI: 10.4103/apjon.apjon_28_20] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Accepted: 05/04/2020] [Indexed: 12/30/2022] Open
Abstract
Objective: This study is addressing the question of whether a telenursing system using information and communication technology is effective for improving postoperative complications and quality of life (QOL) in patients with prostate cancer. Methods: Using a tablet computer, the participants were asked to provide information on various items, including urinary frequency, number of incontinence pads used, and presence of sexual desire and erections. Both the participants and researchers monitored automatically graphed time-dependent changes in symptoms, and the researchers could propose concrete measures to reduce patients' complications. The primary endpoint was an improved score on the expanded prostate cancer index composite (EPIC) and improved urinary incontinence based on a positive stress test. The secondary endpoint was an evaluation of self-care responses to the Functional Assessment of Cancer Therapy-General (FACT-G) instrument. Results: This study asked 33 patients who met all inclusion criteria to participate in the study, 30 of whom agreed. We compared the scores of EPIC, FACT-G, and stress test for prostate cancer patients 1 month and 3 months after surgery. The scores of urinary incontinence and urinary bother for both groups were significantly higher in 3 months after surgery than in 1 month after surgery, showing improvement in symptoms. The amount of urine left in the bladder after stress test increased showing the improvement in urinary incontinence (P = 0.001). Conclusions: The relationship between prostate cancer patients' complications after surgery and QOL showed that their physical well-being improved as they found relief from their symptoms. Telenursing was shown to be effective for symptom management of patients with chronic diseases including cancer.
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Affiliation(s)
- Daisuke Sato
- Department of Nursing, Faculty of Health Sciences, Komatsu University, Komatsu, Ishikawa, Japan
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19
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Thomas PS, Class CA, Gandhi TR, Bambhroliya A, Do KA, Brewster AM. Demographic, clinical, and geographical factors associated with lack of receipt of physician recommended chemotherapy in women with breast cancer in Texas. Cancer Causes Control 2019; 30:409-415. [PMID: 30868330 PMCID: PMC7239038 DOI: 10.1007/s10552-019-01151-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2018] [Accepted: 02/22/2019] [Indexed: 01/07/2023]
Abstract
PURPOSE Identifying demographic, clinical, and geographical factors that contribute to disparities in the receipt of physician recommended chemotherapy in breast cancer patients. METHODS The Texas Cancer Registry was used to identify women aged ≥ 18 years with invasive breast cancer diagnosed from 2007 to 2011 who received a recommendation for chemotherapy. Multivariable logistic regression was performed to determine associations between demographic and clinical factors and the receipt of chemotherapy. Cox proportional regression was used to estimate the hazard ratio (HR) for overall survival. Spatial analysis was conducted using Poisson models for breast cancer mortality and receipt of chemotherapy. RESULTS Age ≥ 65 years, residence in areas with > 20% poverty index, and early disease stage were associated with lack of receipt of chemotherapy (all p < 0.001). Lack of receipt of chemotherapy was associated with decreased overall survival (HR 1.33, 95% CI 1.12-1.59, p = 0.001). A 38-county cluster in West Texas had lower receipt of chemotherapy (relative risk 0.88, p = 0.02) and increased breast cancer mortality (p = 0.03) compared to the rest of Texas. CONCLUSION Older age, increased poverty and rural geographical location are barriers to the receipt of chemotherapy. Interventions that target these barriers may reduce health disparities and improve breast cancer survival.
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Affiliation(s)
- Parijatham S Thomas
- Department of Clinical Cancer Prevention, The University of Texas at MD Anderson Cancer Center, Houston, TX, USA.
| | - Caleb A Class
- Department of Biostatistics, The University of Texas at MD Anderson Cancer Center, Houston, TX, USA
| | - Tanmay R Gandhi
- Department of Biostatistics, The University of Texas at MD Anderson Cancer Center, Houston, TX, USA
| | - Arvind Bambhroliya
- Department of Neurology, The University of Texas Health Sciences Center at Houston, Houston, TX, USA
| | - Kim-Anh Do
- Department of Biostatistics, The University of Texas at MD Anderson Cancer Center, Houston, TX, USA
| | - Abenaa M Brewster
- Department of Clinical Cancer Prevention, The University of Texas at MD Anderson Cancer Center, Houston, TX, USA
- Department of Epidemiology, The University of Texas at MD Anderson Cancer Center, Houston, TX, USA
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20
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Abstract
Telemedicine uses telecommunications technology as a tool to deliver health care to populations with limited access to care. Telemedicine has been tested in multiple clinical settings, demonstrating at least equivalency to in-person care and high levels of patient and health professional satisfaction. Teleoncology has been demonstrated to improve access to care and decrease health care costs. Teleconsultations may take place in a synchronous, asynchronous, or blended format. Examples of successful teleoncology applications include cancer telegenetics, bundling of cancer-related teleapplications, remote chemotherapy supervision, symptom management, survivorship care, palliative care, and approaches to increase access to cancer clinical trials. Telepathology is critical to cancer care and may be accomplished synchronously and asynchronously for both cytology and tissue diagnoses. Mobile applications support symptom management, lifestyle modification, and medication adherence as a tool for home-based care. Telemedicine can support the oncologist with access to interactive tele-education. Teleoncology practice should maintain in-person professional standards, including documentation integrated into the patient's electronic health record. Telemedicine training is essential to facilitate rapport, maximize engagement, and conduct an accurate virtual exam. With the appropriate attachments, the only limitation to the virtual exam is palpation. The national telehealth resource centers can provide interested clinicians with the latest information on telemedicine reimbursement, parity, and practice. To experience the gains of teleoncology, appropriate training, education, as well as paying close attention to gaps, such as those inherent in the digital divide, are essential.
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Affiliation(s)
- S Joseph Sirintrapun
- From Memorial Sloan Kettering Cancer Center, New York, NY; University of Utah, Salt Lake City, UT
| | - Ana Maria Lopez
- From Memorial Sloan Kettering Cancer Center, New York, NY; University of Utah, Salt Lake City, UT
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21
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Cancer care in regional Australia from the health professional’s perspective. Support Care Cancer 2018; 26:3507-3515. [DOI: 10.1007/s00520-018-4218-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2017] [Accepted: 04/16/2018] [Indexed: 01/05/2023]
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22
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Penny RA, Bradford NK, Langbecker D. Registered nurse and midwife experiences of using videoconferencing in practice: A systematic review of qualitative studies. J Clin Nurs 2018; 27:e739-e752. [PMID: 29149507 DOI: 10.1111/jocn.14175] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/04/2017] [Indexed: 12/17/2022]
Abstract
AIM AND OBJECTIVE To synthesise evidence of registered nurses' and midwives' experiences with videoconferencing and identify perceptions of the appropriateness, meaningfulness and feasibility of this technology in professional and clinical practice. BACKGROUND Videoconferencing is a form of telehealth that can facilitate access to high-quality care to improve health outcomes for patients and enable clinicians working in isolation to access education, clinical supervision, peer support and case review. Yet use of videoconferencing has not translated smoothly into routine practice. Understanding the experiences of registered nurses and midwives may provide practitioners, service managers and policymakers with vital information to facilitate use of the technology. DESIGN A qualitative meta-synthesis of primary qualitative studies undertaken according to Joanna Briggs Institute methodology. METHOD A systematic search of 19 databases was used to identify qualitative studies that reported on registered nurses' or midwives' experiences with videoconferencing in clinical or professional practice. Two reviewers independently appraised studies, extracted data and synthesised findings to construct core concepts. RESULTS Nine studies met the criteria for inclusion. Five key synthesised findings were identified: useful on a continuum; broader range of information; implications for professional practice; barriers to videoconferencing; and technical support, training and encouragement. CONCLUSIONS While videoconferencing offers benefits, it comes with personal, organisational and professional consequences for nurses and midwives. Understanding potential benefits and limitations, training and support required and addressing potential professional implications all influence adoption and ongoing use of videoconferencing. RELEVANCE TO CLINICAL PRACTICE Registered nurses and midwives are well placed to drive innovations and efficiencies in practice such as videoconferencing. Nursing and midwifery practice must be reframed to adapt to the virtual environment while retaining valued aspects of professional practice. This includes ensuring professional standards keep pace with the development of knowledge in this area and addressing the findings highlighted in this meta-synthesis.
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Affiliation(s)
- Robyn A Penny
- Children's Health Queensland Hospital and Health Service, Child and Youth Community Health Service, Brisbane, Qld, Australia.,School of Nursing, Queensland University of Technology, Brisbane, Qld, Australia
| | - Natalie K Bradford
- School of Nursing, Queensland University of Technology, Brisbane, Qld, Australia.,Centre for Online Health, The University of Queensland, Brisbane, Qld, Australia.,Queensland Youth Cancer Service, Children's Health Queensland, Brisbane, Qld, Australia
| | - Danette Langbecker
- Centre for Online Health, The University of Queensland, Brisbane, Qld, Australia
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23
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Rodriguez NM, Brant JM, Pendharkar D, Arreola-Ornelas H, Bhadelia A, de Lima Lopes G, Knaul FM. Thinking Differently in Global Health in Oncology Using a Diagonal Approach: Harnessing Similarities, Improving Education, and Empowering an Alternative Oncology Workforce. Am Soc Clin Oncol Educ Book 2017; 37:416-425. [PMID: 28561680 DOI: 10.1200/edbk_175246] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Cancer is a leading global cause of death, and diverse and minority populations suffer worse outcomes compared with white people from Western societies. Within the United States, African Americans and other blacks, Hispanics, Asians, and American Indians have lower cancer survival rates than whites. In the rest of the world, those from low- and middle-income countries have the greatest disparities, but even those from non-Western high-income countries such as Oman and the United Arab Emirates are diagnosed with cancer at later stages and suffer increased mortality. Although considerable differences exist among these populations, similarities and synergies are also apparent. Challenges can be very similar in reaching these populations effectively for cancer control to improve outcomes, and innovative strategies are needed to effectively make change. In this review, the authors discuss new approaches to the prevention and early detection of cancer as well as the implementation of programs in global oncology and put in evidence cultural similarities and challenges of different populations, highlighting strategies to improve cancer survival and quality care around the world through innovations in training and education, empowerment of an alternative workforce, and a diagonal approach to cancer care using case studies drawn from the authors' work and experience.
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Affiliation(s)
- Natalia M Rodriguez
- From the Harvard T. H. Chan School of Public Health, Boston, MA; Billings Clinic, Billings, MT; Asian Cancer Institute, Mumbai, India; Mexican Health Foundation, Mexico City, Mexico; Harvard Global Equity Initiative, Boston, MA; Sylvester Comprehensive Cancer Center, Miami, FL; University of Miami Institute for Advanced Study of the Americas, Coral Gables, FL
| | - Jeannine M Brant
- From the Harvard T. H. Chan School of Public Health, Boston, MA; Billings Clinic, Billings, MT; Asian Cancer Institute, Mumbai, India; Mexican Health Foundation, Mexico City, Mexico; Harvard Global Equity Initiative, Boston, MA; Sylvester Comprehensive Cancer Center, Miami, FL; University of Miami Institute for Advanced Study of the Americas, Coral Gables, FL
| | - Dinesh Pendharkar
- From the Harvard T. H. Chan School of Public Health, Boston, MA; Billings Clinic, Billings, MT; Asian Cancer Institute, Mumbai, India; Mexican Health Foundation, Mexico City, Mexico; Harvard Global Equity Initiative, Boston, MA; Sylvester Comprehensive Cancer Center, Miami, FL; University of Miami Institute for Advanced Study of the Americas, Coral Gables, FL
| | - Hector Arreola-Ornelas
- From the Harvard T. H. Chan School of Public Health, Boston, MA; Billings Clinic, Billings, MT; Asian Cancer Institute, Mumbai, India; Mexican Health Foundation, Mexico City, Mexico; Harvard Global Equity Initiative, Boston, MA; Sylvester Comprehensive Cancer Center, Miami, FL; University of Miami Institute for Advanced Study of the Americas, Coral Gables, FL
| | - Afsan Bhadelia
- From the Harvard T. H. Chan School of Public Health, Boston, MA; Billings Clinic, Billings, MT; Asian Cancer Institute, Mumbai, India; Mexican Health Foundation, Mexico City, Mexico; Harvard Global Equity Initiative, Boston, MA; Sylvester Comprehensive Cancer Center, Miami, FL; University of Miami Institute for Advanced Study of the Americas, Coral Gables, FL
| | - Gilberto de Lima Lopes
- From the Harvard T. H. Chan School of Public Health, Boston, MA; Billings Clinic, Billings, MT; Asian Cancer Institute, Mumbai, India; Mexican Health Foundation, Mexico City, Mexico; Harvard Global Equity Initiative, Boston, MA; Sylvester Comprehensive Cancer Center, Miami, FL; University of Miami Institute for Advanced Study of the Americas, Coral Gables, FL
| | - Felicia M Knaul
- From the Harvard T. H. Chan School of Public Health, Boston, MA; Billings Clinic, Billings, MT; Asian Cancer Institute, Mumbai, India; Mexican Health Foundation, Mexico City, Mexico; Harvard Global Equity Initiative, Boston, MA; Sylvester Comprehensive Cancer Center, Miami, FL; University of Miami Institute for Advanced Study of the Americas, Coral Gables, FL
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24
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Weller D. Screening, resilience, patient navigation and information needs--key areas in cancer control. Eur J Cancer Care (Engl) 2017; 25:3-5. [PMID: 26768700 DOI: 10.1111/ecc.12439] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/07/2015] [Indexed: 12/31/2022]
Affiliation(s)
- D Weller
- Centre for Population Health Sciences, University of Edinburgh, Edinburgh, UK
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25
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Kessel KA, Vogel MME, Schmidt-Graf F, Combs SE. Mobile Apps in Oncology: A Survey on Health Care Professionals' Attitude Toward Telemedicine, mHealth, and Oncological Apps. J Med Internet Res 2016; 18:e312. [PMID: 27884810 PMCID: PMC5146327 DOI: 10.2196/jmir.6399] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2016] [Revised: 10/19/2016] [Accepted: 11/08/2016] [Indexed: 12/11/2022] Open
Abstract
Background Mobile apps are an evolving trend in the medical field. To date, few apps in an oncological context exist. Objective The aim was to analyze the attitude of health care professionals (HCPs) toward telemedicine, mHealth, and mobile apps in the field of oncology. Methods We developed and conducted an online survey with 24 questions evaluating HCPs’ general attitude toward telemedicine and patients using medical mobile apps. Specific questions on the possible functionality for patients and the resulting advantages and disadvantages for both the patients’ and HCPs’ daily clinical routine were evaluated. Results A total of 108 HCPs completed the survey. In all, 88.9% (96/108) considered telemedicine useful and 84.3% (91/108) supported the idea of an oncological app complementing classical treatment. Automatic reminders, timetables, and assessment of side effects and quality of life during therapy were rated as the most important functions. In contrast, uncertainty regarding medical responsibility and data privacy were reasons mostly named by critics. Most (64.8%, 70/108) were in favor of an alert function due to data input needing further clarification, and 94% (66/70) were willing to contact the patient after a critical alert. In all, 93.5% (101/108) supported the idea of using the collected data for scientific research. Moreover, 75.0% (81/108) believed establishing a mobile app could be beneficial for the providing hospital. Conclusions A majority of HCPs are in favor of telemedicine and the use of oncological apps by patients. Assessing side effects can lead to quicker response and thus lower inconvenience for patients. Clinical data, such as life quality and treatment satisfaction, could be used to evaluate and improve the therapy workflow. Eventually, a mobile app would enhance the patients’ relationship to their treating department because they are in permanent contact.
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Affiliation(s)
- Kerstin A Kessel
- Klinikum rechts der Isar, Department of Radiation Oncology, Technical University of Munich (TUM), Munich, Germany.,Institute for Innovative Radiotherapy (iRT), Department of Radiation Sciences (DRS), Helmholtz Zentrum München (HMGU), Neuherberg, Germany
| | - Marco M E Vogel
- Klinikum rechts der Isar, Department of Radiation Oncology, Technical University of Munich (TUM), Munich, Germany.,Institute for Innovative Radiotherapy (iRT), Department of Radiation Sciences (DRS), Helmholtz Zentrum München (HMGU), Neuherberg, Germany
| | - Friederike Schmidt-Graf
- Klinikum rechts der Isar, Department of Neurology, Technical University of Munich (TUM), Munich, Germany
| | - Stephanie E Combs
- Klinikum rechts der Isar, Department of Radiation Oncology, Technical University of Munich (TUM), Munich, Germany.,Institute for Innovative Radiotherapy (iRT), Department of Radiation Sciences (DRS), Helmholtz Zentrum München (HMGU), Neuherberg, Germany
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