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Collaço N, Lippiett KA, Wright D, Brodie H, Winter J, Richardson A, Foster C. Barriers and facilitators to integrated cancer care between primary and secondary care: a scoping review. Support Care Cancer 2024; 32:120. [PMID: 38252169 PMCID: PMC10803398 DOI: 10.1007/s00520-023-08278-1] [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: 06/22/2023] [Accepted: 12/18/2023] [Indexed: 01/23/2024]
Abstract
PURPOSE This scoping review identifies and characterises reported barriers and facilitators to providing integrated cancer care reported in the international literature, and develops recommendations for clinical practice. METHODS This scoping review included literature published between 2009 and 2022 and describes the delivery of integrated cancer care between primary and secondary care sectors. Searches were conducted of an online database Ovid Medline and grey literature. RESULTS The review included thirty-two papers. Barriers and facilitators to integrated cancer care were identified in three core areas: (1) at an individual user level around patient-healthcare professional interactions, (2) at an organisational level, and (3) at a healthcare system level. The review findings identified a need for further training for primary care professionals on cancer care, clarity in the delineation of primary care and oncologist roles (i.e. who does what), effective communication and engagement between primary and secondary care, and the provision of protocols and guidelines for follow-up care in cancer. CONCLUSIONS Information sharing and communication between primary and secondary care must improve to meet the increasing demand for support for people living with and beyond cancer. Delivering integrated pathways between primary and secondary care will yield improvements in patient outcomes and health economic costs.
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Affiliation(s)
- Nicole Collaço
- Centre for Psychosocial Research in Cancer (CentRIC+), School of Health Sciences, University of Southampton, Southampton, SO17 1BJ, England
| | - Kate A Lippiett
- School of Health Sciences, University of Southampton, Southampton, England
| | - David Wright
- Centre for Psychosocial Research in Cancer (CentRIC+), School of Health Sciences, University of Southampton, Southampton, SO17 1BJ, England
| | - Hazel Brodie
- School of Health Sciences, University of Southampton, Southampton, England
| | - Jane Winter
- Wessex Cancer Alliance, Oakley Road, Southampton, England
| | - Alison Richardson
- School of Health Sciences, University of Southampton, Southampton, England
- University Hospital Southampton NHS Foundation Trust, Southampton, England
| | - Claire Foster
- Centre for Psychosocial Research in Cancer (CentRIC+), School of Health Sciences, University of Southampton, Southampton, SO17 1BJ, England.
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Chien SC, Chang YH, Yen CM, Chen YE, Liu CC, Hsiao YP, Yang PY, Lin HM, Lu XH, Wu IC, Hsu CC, Chiou HY, Chung RH. Predicting Long-Term Care Service Demands for Cancer Patients: A Machine Learning Approach. Cancers (Basel) 2023; 15:4598. [PMID: 37760567 PMCID: PMC10526410 DOI: 10.3390/cancers15184598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 09/11/2023] [Accepted: 09/14/2023] [Indexed: 09/29/2023] Open
Abstract
BACKGROUND Long-term care (LTC) service demands among cancer patients are significantly understudied, leading to gaps in healthcare resource allocation and policymaking. OBJECTIVE This study aimed to predict LTC service demands for cancer patients and identify the crucial factors. METHODS 3333 cases of cancers were included. We further developed two specialized prediction models: a Unified Prediction Model (UPM) and a Category-Specific Prediction Model (CSPM). The UPM offered generalized forecasts by treating all services as identical, while the CSPM built individual predictive models for each specific service type. Sensitivity analysis was also conducted to find optimal usage cutoff points for determining the usage and non-usage cases. RESULTS Service usage differences in lung, liver, brain, and pancreatic cancers were significant. For the UPM, the top 20 performance model cutoff points were adopted, such as through Logistic Regression (LR), Quadratic Discriminant Analysis (QDA), and XGBoost (XGB), achieving an AUROC range of 0.707 to 0.728. The CSPM demonstrated performance with an AUROC ranging from 0.777 to 0.837 for the top five most frequently used services. The most critical predictive factors were the types of cancer, patients' age and female caregivers, and specific health needs. CONCLUSION The results of our study provide valuable information for healthcare decisions, resource allocation optimization, and personalized long-term care usage for cancer patients.
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Affiliation(s)
- Shuo-Chen Chien
- Institute of Population Health Sciences, National Health Research Institutes, Miaoli County 350, Taiwan
| | - Yu-Hung Chang
- Institute of Population Health Sciences, National Health Research Institutes, Miaoli County 350, Taiwan
| | - Chia-Ming Yen
- National Center for Geriatrics and Welfare Research, National Health Research Institutes, Yunlin County 632, Taiwan
| | - Ying-Erh Chen
- Department of Risk Management and Insurance, Tamkang University, New Taipei City 251, Taiwan
| | - Chia-Chun Liu
- Institute of Population Health Sciences, National Health Research Institutes, Miaoli County 350, Taiwan
| | - Yu-Ping Hsiao
- Institute of Population Health Sciences, National Health Research Institutes, Miaoli County 350, Taiwan
| | - Ping-Yen Yang
- Institute of Population Health Sciences, National Health Research Institutes, Miaoli County 350, Taiwan
| | - Hong-Ming Lin
- Institute of Population Health Sciences, National Health Research Institutes, Miaoli County 350, Taiwan
| | - Xing-Hua Lu
- Institute of Population Health Sciences, National Health Research Institutes, Miaoli County 350, Taiwan
| | - I-Chien Wu
- Institute of Population Health Sciences, National Health Research Institutes, Miaoli County 350, Taiwan
| | - Chih-Cheng Hsu
- Institute of Population Health Sciences, National Health Research Institutes, Miaoli County 350, Taiwan
- National Center for Geriatrics and Welfare Research, National Health Research Institutes, Yunlin County 632, Taiwan
| | - Hung-Yi Chiou
- Institute of Population Health Sciences, National Health Research Institutes, Miaoli County 350, Taiwan
- School of Public Health, College of Public Health, Taipei Medical University, Taipei 110, Taiwan
| | - Ren-Hua Chung
- Institute of Population Health Sciences, National Health Research Institutes, Miaoli County 350, Taiwan
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Alizadeh Z, Rohani C, Rassouli M, Ilkhani M, Hazrati M. Challenges of Integrated Home-Based Palliative Care Services for Cancer Patients during the COVID-19 Pandemic: A Qualitative Content Analysis. HOME HEALTH CARE MANAGEMENT AND PRACTICE 2023; 35:180-189. [PMID: 38603240 PMCID: PMC9672982 DOI: 10.1177/10848223221134780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Given the situation of cancer patients as vulnerable patients and the threat of COVID-19 in the society, integration of home-based palliative care services into the healthcare system is essential. The aim of this qualitative study was to explore the current barriers of integration of palliative care services from hospital to home for cancer patients during the COVID-19 Pandemic and to provide suggestions to resolve them. Semi-structured interviews were conducted with 25 stakeholders in the healthcare system, including health policy makers, healthcare providers, clinical home healthcare experts, home healthcare researchers, university faculty members, clergy, family caregivers, and cancer patients. Data were analyzed using directed content analysis method based on the World Health Organization Public Health Strategy for Palliative Care. Challenges were extracted in 4 main categories, containing education barriers (3 subcategories), implementation barriers (9 subcategories), policy barriers (5 subcategories), and drug availability barriers (2 subcategories). Based on the results, removing the barriers and establishing a strong infrastructure for home-based palliative care services is recommended in the healthcare system by concentrating on 4 essential factors, that is, utilizing a coordinating nurse during the process of patient's hospital discharge, establishment of connecting outpatient palliative care clinics to home healthcare centers, access to palliative care tele-medicine and development of a comprehensive and flexible home-based palliative cancer care model in our context.
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Affiliation(s)
- Zahra Alizadeh
- Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Camelia Rohani
- Department of Health Care Sciences, Palliative Care Center, Marie Cederschiöld Högskola, Stockholm, Sweden
- Deparment of Community Health Nursing, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Maryam Rassouli
- Cancer Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mahnaz Ilkhani
- Deparment of Medical-Surgical Nursing, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Maryam Hazrati
- Community Based Psychiatric Care Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
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Broadhurst D, Cooke M, Sriram D, Barber L, Caccialanza R, Danielsen MB, Ebersold SL, Gorski L, Hirsch D, Lynch G, Neo SHS, Roubaud-Baudron C, Gray B. International Consensus Recommendation Guidelines for Subcutaneous Infusions of Hydration and Medication in Adults: An e-Delphi Consensus Study. JOURNAL OF INFUSION NURSING 2023; 46:199-209. [PMID: 37406334 PMCID: PMC10306332 DOI: 10.1097/nan.0000000000000511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/07/2023]
Abstract
Infusion of fluids and medications is traditionally performed intravenously. However, venous depletion in patients has led to the quest for vessel health preservation. A safe, effective, acceptable, and efficient alternative is the subcutaneous route. A lack of organizational policies may contribute to the slow uptake of this practice. This modified e-Delphi (electronic) study aimed to derive international consensus on practice recommendations for subcutaneous infusions of fluids and medications. A panel of 11 international clinicians, with expertise in subcutaneous infusion research and/or clinical practice, rated and edited subcutaneous infusion practice recommendations from evidence, clinical practice guidelines, and clinical expertise within an Assessment, Best Practice, and Competency (ABC) domain guideline model. The ABC Model for Subcutaneous Infusion Therapy provides a systematic guideline of 42 practice recommendations for the safe delivery of subcutaneous infusions of fluids and medications in the adult population in all care settings. These consensus recommendations provide a guideline for health care providers, organizations, and policy makers to optimize use of the subcutaneous access route.
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Affiliation(s)
- Daphne Broadhurst
- Alliance for Vascular Access Teaching and Research (AVATAR) Group, Menzies Health Institute Queensland, Gold Coast, Queensland, Australia (Mss Broadhurst, Cooke, and Sriram); Infusion Excellence Consulting, Ottawa, Ontario, Canada (Ms Broadhurst); School of Nursing and Midwifery, Nathan Campus, Griffith University, Nathan, Queensland, Australia (Ms Cooke); Needle Calm Pty, Melbourne, Victoria, Australia (Ms Barber); Clinical Nutrition and Dietetics Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy (Mr Caccialanza); Department of Geriatric Medicine, Aalborg University Hospital, Aalborg, Denmark [ORCID https://orcid.org/0000-0001-7431-5257] (Mr Danielsen); Optum Complex Care Management, Horsham, Pennsylvania (Ms Ebersold); Ascension at Home, Indianapolis, Indiana (Ms Gorski); The Johns Hopkins Home Care Group, Baltimore, Maryland (Mr Hirsch); Centre for Nurse Education, Cork University Hospital, Cork, Ireland (Ms Lynch); FAMS Institution: Division of Supportive and Palliative Care, National Cancer Centre, Singapore (Ms Neo); Roubaud CHU de Bordeaux, Pôle de Gérontologie Clinique, Bordeaux, France (Ms Roubaud-Baudron); Clinical Pharmacy Partners, Tampa, Florida (Ms Gray)
| | - Marie Cooke
- Alliance for Vascular Access Teaching and Research (AVATAR) Group, Menzies Health Institute Queensland, Gold Coast, Queensland, Australia (Mss Broadhurst, Cooke, and Sriram); Infusion Excellence Consulting, Ottawa, Ontario, Canada (Ms Broadhurst); School of Nursing and Midwifery, Nathan Campus, Griffith University, Nathan, Queensland, Australia (Ms Cooke); Needle Calm Pty, Melbourne, Victoria, Australia (Ms Barber); Clinical Nutrition and Dietetics Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy (Mr Caccialanza); Department of Geriatric Medicine, Aalborg University Hospital, Aalborg, Denmark [ORCID https://orcid.org/0000-0001-7431-5257] (Mr Danielsen); Optum Complex Care Management, Horsham, Pennsylvania (Ms Ebersold); Ascension at Home, Indianapolis, Indiana (Ms Gorski); The Johns Hopkins Home Care Group, Baltimore, Maryland (Mr Hirsch); Centre for Nurse Education, Cork University Hospital, Cork, Ireland (Ms Lynch); FAMS Institution: Division of Supportive and Palliative Care, National Cancer Centre, Singapore (Ms Neo); Roubaud CHU de Bordeaux, Pôle de Gérontologie Clinique, Bordeaux, France (Ms Roubaud-Baudron); Clinical Pharmacy Partners, Tampa, Florida (Ms Gray)
| | - Deepa Sriram
- Alliance for Vascular Access Teaching and Research (AVATAR) Group, Menzies Health Institute Queensland, Gold Coast, Queensland, Australia (Mss Broadhurst, Cooke, and Sriram); Infusion Excellence Consulting, Ottawa, Ontario, Canada (Ms Broadhurst); School of Nursing and Midwifery, Nathan Campus, Griffith University, Nathan, Queensland, Australia (Ms Cooke); Needle Calm Pty, Melbourne, Victoria, Australia (Ms Barber); Clinical Nutrition and Dietetics Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy (Mr Caccialanza); Department of Geriatric Medicine, Aalborg University Hospital, Aalborg, Denmark [ORCID https://orcid.org/0000-0001-7431-5257] (Mr Danielsen); Optum Complex Care Management, Horsham, Pennsylvania (Ms Ebersold); Ascension at Home, Indianapolis, Indiana (Ms Gorski); The Johns Hopkins Home Care Group, Baltimore, Maryland (Mr Hirsch); Centre for Nurse Education, Cork University Hospital, Cork, Ireland (Ms Lynch); FAMS Institution: Division of Supportive and Palliative Care, National Cancer Centre, Singapore (Ms Neo); Roubaud CHU de Bordeaux, Pôle de Gérontologie Clinique, Bordeaux, France (Ms Roubaud-Baudron); Clinical Pharmacy Partners, Tampa, Florida (Ms Gray)
| | - Lauren Barber
- Alliance for Vascular Access Teaching and Research (AVATAR) Group, Menzies Health Institute Queensland, Gold Coast, Queensland, Australia (Mss Broadhurst, Cooke, and Sriram); Infusion Excellence Consulting, Ottawa, Ontario, Canada (Ms Broadhurst); School of Nursing and Midwifery, Nathan Campus, Griffith University, Nathan, Queensland, Australia (Ms Cooke); Needle Calm Pty, Melbourne, Victoria, Australia (Ms Barber); Clinical Nutrition and Dietetics Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy (Mr Caccialanza); Department of Geriatric Medicine, Aalborg University Hospital, Aalborg, Denmark [ORCID https://orcid.org/0000-0001-7431-5257] (Mr Danielsen); Optum Complex Care Management, Horsham, Pennsylvania (Ms Ebersold); Ascension at Home, Indianapolis, Indiana (Ms Gorski); The Johns Hopkins Home Care Group, Baltimore, Maryland (Mr Hirsch); Centre for Nurse Education, Cork University Hospital, Cork, Ireland (Ms Lynch); FAMS Institution: Division of Supportive and Palliative Care, National Cancer Centre, Singapore (Ms Neo); Roubaud CHU de Bordeaux, Pôle de Gérontologie Clinique, Bordeaux, France (Ms Roubaud-Baudron); Clinical Pharmacy Partners, Tampa, Florida (Ms Gray)
| | - Riccardo Caccialanza
- Alliance for Vascular Access Teaching and Research (AVATAR) Group, Menzies Health Institute Queensland, Gold Coast, Queensland, Australia (Mss Broadhurst, Cooke, and Sriram); Infusion Excellence Consulting, Ottawa, Ontario, Canada (Ms Broadhurst); School of Nursing and Midwifery, Nathan Campus, Griffith University, Nathan, Queensland, Australia (Ms Cooke); Needle Calm Pty, Melbourne, Victoria, Australia (Ms Barber); Clinical Nutrition and Dietetics Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy (Mr Caccialanza); Department of Geriatric Medicine, Aalborg University Hospital, Aalborg, Denmark [ORCID https://orcid.org/0000-0001-7431-5257] (Mr Danielsen); Optum Complex Care Management, Horsham, Pennsylvania (Ms Ebersold); Ascension at Home, Indianapolis, Indiana (Ms Gorski); The Johns Hopkins Home Care Group, Baltimore, Maryland (Mr Hirsch); Centre for Nurse Education, Cork University Hospital, Cork, Ireland (Ms Lynch); FAMS Institution: Division of Supportive and Palliative Care, National Cancer Centre, Singapore (Ms Neo); Roubaud CHU de Bordeaux, Pôle de Gérontologie Clinique, Bordeaux, France (Ms Roubaud-Baudron); Clinical Pharmacy Partners, Tampa, Florida (Ms Gray)
| | - Mathias Brix Danielsen
- Alliance for Vascular Access Teaching and Research (AVATAR) Group, Menzies Health Institute Queensland, Gold Coast, Queensland, Australia (Mss Broadhurst, Cooke, and Sriram); Infusion Excellence Consulting, Ottawa, Ontario, Canada (Ms Broadhurst); School of Nursing and Midwifery, Nathan Campus, Griffith University, Nathan, Queensland, Australia (Ms Cooke); Needle Calm Pty, Melbourne, Victoria, Australia (Ms Barber); Clinical Nutrition and Dietetics Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy (Mr Caccialanza); Department of Geriatric Medicine, Aalborg University Hospital, Aalborg, Denmark [ORCID https://orcid.org/0000-0001-7431-5257] (Mr Danielsen); Optum Complex Care Management, Horsham, Pennsylvania (Ms Ebersold); Ascension at Home, Indianapolis, Indiana (Ms Gorski); The Johns Hopkins Home Care Group, Baltimore, Maryland (Mr Hirsch); Centre for Nurse Education, Cork University Hospital, Cork, Ireland (Ms Lynch); FAMS Institution: Division of Supportive and Palliative Care, National Cancer Centre, Singapore (Ms Neo); Roubaud CHU de Bordeaux, Pôle de Gérontologie Clinique, Bordeaux, France (Ms Roubaud-Baudron); Clinical Pharmacy Partners, Tampa, Florida (Ms Gray)
| | - Stacie Lynne Ebersold
- Alliance for Vascular Access Teaching and Research (AVATAR) Group, Menzies Health Institute Queensland, Gold Coast, Queensland, Australia (Mss Broadhurst, Cooke, and Sriram); Infusion Excellence Consulting, Ottawa, Ontario, Canada (Ms Broadhurst); School of Nursing and Midwifery, Nathan Campus, Griffith University, Nathan, Queensland, Australia (Ms Cooke); Needle Calm Pty, Melbourne, Victoria, Australia (Ms Barber); Clinical Nutrition and Dietetics Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy (Mr Caccialanza); Department of Geriatric Medicine, Aalborg University Hospital, Aalborg, Denmark [ORCID https://orcid.org/0000-0001-7431-5257] (Mr Danielsen); Optum Complex Care Management, Horsham, Pennsylvania (Ms Ebersold); Ascension at Home, Indianapolis, Indiana (Ms Gorski); The Johns Hopkins Home Care Group, Baltimore, Maryland (Mr Hirsch); Centre for Nurse Education, Cork University Hospital, Cork, Ireland (Ms Lynch); FAMS Institution: Division of Supportive and Palliative Care, National Cancer Centre, Singapore (Ms Neo); Roubaud CHU de Bordeaux, Pôle de Gérontologie Clinique, Bordeaux, France (Ms Roubaud-Baudron); Clinical Pharmacy Partners, Tampa, Florida (Ms Gray)
| | - Lisa Gorski
- Alliance for Vascular Access Teaching and Research (AVATAR) Group, Menzies Health Institute Queensland, Gold Coast, Queensland, Australia (Mss Broadhurst, Cooke, and Sriram); Infusion Excellence Consulting, Ottawa, Ontario, Canada (Ms Broadhurst); School of Nursing and Midwifery, Nathan Campus, Griffith University, Nathan, Queensland, Australia (Ms Cooke); Needle Calm Pty, Melbourne, Victoria, Australia (Ms Barber); Clinical Nutrition and Dietetics Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy (Mr Caccialanza); Department of Geriatric Medicine, Aalborg University Hospital, Aalborg, Denmark [ORCID https://orcid.org/0000-0001-7431-5257] (Mr Danielsen); Optum Complex Care Management, Horsham, Pennsylvania (Ms Ebersold); Ascension at Home, Indianapolis, Indiana (Ms Gorski); The Johns Hopkins Home Care Group, Baltimore, Maryland (Mr Hirsch); Centre for Nurse Education, Cork University Hospital, Cork, Ireland (Ms Lynch); FAMS Institution: Division of Supportive and Palliative Care, National Cancer Centre, Singapore (Ms Neo); Roubaud CHU de Bordeaux, Pôle de Gérontologie Clinique, Bordeaux, France (Ms Roubaud-Baudron); Clinical Pharmacy Partners, Tampa, Florida (Ms Gray)
| | - David Hirsch
- Alliance for Vascular Access Teaching and Research (AVATAR) Group, Menzies Health Institute Queensland, Gold Coast, Queensland, Australia (Mss Broadhurst, Cooke, and Sriram); Infusion Excellence Consulting, Ottawa, Ontario, Canada (Ms Broadhurst); School of Nursing and Midwifery, Nathan Campus, Griffith University, Nathan, Queensland, Australia (Ms Cooke); Needle Calm Pty, Melbourne, Victoria, Australia (Ms Barber); Clinical Nutrition and Dietetics Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy (Mr Caccialanza); Department of Geriatric Medicine, Aalborg University Hospital, Aalborg, Denmark [ORCID https://orcid.org/0000-0001-7431-5257] (Mr Danielsen); Optum Complex Care Management, Horsham, Pennsylvania (Ms Ebersold); Ascension at Home, Indianapolis, Indiana (Ms Gorski); The Johns Hopkins Home Care Group, Baltimore, Maryland (Mr Hirsch); Centre for Nurse Education, Cork University Hospital, Cork, Ireland (Ms Lynch); FAMS Institution: Division of Supportive and Palliative Care, National Cancer Centre, Singapore (Ms Neo); Roubaud CHU de Bordeaux, Pôle de Gérontologie Clinique, Bordeaux, France (Ms Roubaud-Baudron); Clinical Pharmacy Partners, Tampa, Florida (Ms Gray)
| | - Gerardine Lynch
- Alliance for Vascular Access Teaching and Research (AVATAR) Group, Menzies Health Institute Queensland, Gold Coast, Queensland, Australia (Mss Broadhurst, Cooke, and Sriram); Infusion Excellence Consulting, Ottawa, Ontario, Canada (Ms Broadhurst); School of Nursing and Midwifery, Nathan Campus, Griffith University, Nathan, Queensland, Australia (Ms Cooke); Needle Calm Pty, Melbourne, Victoria, Australia (Ms Barber); Clinical Nutrition and Dietetics Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy (Mr Caccialanza); Department of Geriatric Medicine, Aalborg University Hospital, Aalborg, Denmark [ORCID https://orcid.org/0000-0001-7431-5257] (Mr Danielsen); Optum Complex Care Management, Horsham, Pennsylvania (Ms Ebersold); Ascension at Home, Indianapolis, Indiana (Ms Gorski); The Johns Hopkins Home Care Group, Baltimore, Maryland (Mr Hirsch); Centre for Nurse Education, Cork University Hospital, Cork, Ireland (Ms Lynch); FAMS Institution: Division of Supportive and Palliative Care, National Cancer Centre, Singapore (Ms Neo); Roubaud CHU de Bordeaux, Pôle de Gérontologie Clinique, Bordeaux, France (Ms Roubaud-Baudron); Clinical Pharmacy Partners, Tampa, Florida (Ms Gray)
| | - Shirlyn Hui-Shan Neo
- Alliance for Vascular Access Teaching and Research (AVATAR) Group, Menzies Health Institute Queensland, Gold Coast, Queensland, Australia (Mss Broadhurst, Cooke, and Sriram); Infusion Excellence Consulting, Ottawa, Ontario, Canada (Ms Broadhurst); School of Nursing and Midwifery, Nathan Campus, Griffith University, Nathan, Queensland, Australia (Ms Cooke); Needle Calm Pty, Melbourne, Victoria, Australia (Ms Barber); Clinical Nutrition and Dietetics Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy (Mr Caccialanza); Department of Geriatric Medicine, Aalborg University Hospital, Aalborg, Denmark [ORCID https://orcid.org/0000-0001-7431-5257] (Mr Danielsen); Optum Complex Care Management, Horsham, Pennsylvania (Ms Ebersold); Ascension at Home, Indianapolis, Indiana (Ms Gorski); The Johns Hopkins Home Care Group, Baltimore, Maryland (Mr Hirsch); Centre for Nurse Education, Cork University Hospital, Cork, Ireland (Ms Lynch); FAMS Institution: Division of Supportive and Palliative Care, National Cancer Centre, Singapore (Ms Neo); Roubaud CHU de Bordeaux, Pôle de Gérontologie Clinique, Bordeaux, France (Ms Roubaud-Baudron); Clinical Pharmacy Partners, Tampa, Florida (Ms Gray)
| | - Claire Roubaud-Baudron
- Alliance for Vascular Access Teaching and Research (AVATAR) Group, Menzies Health Institute Queensland, Gold Coast, Queensland, Australia (Mss Broadhurst, Cooke, and Sriram); Infusion Excellence Consulting, Ottawa, Ontario, Canada (Ms Broadhurst); School of Nursing and Midwifery, Nathan Campus, Griffith University, Nathan, Queensland, Australia (Ms Cooke); Needle Calm Pty, Melbourne, Victoria, Australia (Ms Barber); Clinical Nutrition and Dietetics Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy (Mr Caccialanza); Department of Geriatric Medicine, Aalborg University Hospital, Aalborg, Denmark [ORCID https://orcid.org/0000-0001-7431-5257] (Mr Danielsen); Optum Complex Care Management, Horsham, Pennsylvania (Ms Ebersold); Ascension at Home, Indianapolis, Indiana (Ms Gorski); The Johns Hopkins Home Care Group, Baltimore, Maryland (Mr Hirsch); Centre for Nurse Education, Cork University Hospital, Cork, Ireland (Ms Lynch); FAMS Institution: Division of Supportive and Palliative Care, National Cancer Centre, Singapore (Ms Neo); Roubaud CHU de Bordeaux, Pôle de Gérontologie Clinique, Bordeaux, France (Ms Roubaud-Baudron); Clinical Pharmacy Partners, Tampa, Florida (Ms Gray)
| | - Brenda Gray
- Alliance for Vascular Access Teaching and Research (AVATAR) Group, Menzies Health Institute Queensland, Gold Coast, Queensland, Australia (Mss Broadhurst, Cooke, and Sriram); Infusion Excellence Consulting, Ottawa, Ontario, Canada (Ms Broadhurst); School of Nursing and Midwifery, Nathan Campus, Griffith University, Nathan, Queensland, Australia (Ms Cooke); Needle Calm Pty, Melbourne, Victoria, Australia (Ms Barber); Clinical Nutrition and Dietetics Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy (Mr Caccialanza); Department of Geriatric Medicine, Aalborg University Hospital, Aalborg, Denmark [ORCID https://orcid.org/0000-0001-7431-5257] (Mr Danielsen); Optum Complex Care Management, Horsham, Pennsylvania (Ms Ebersold); Ascension at Home, Indianapolis, Indiana (Ms Gorski); The Johns Hopkins Home Care Group, Baltimore, Maryland (Mr Hirsch); Centre for Nurse Education, Cork University Hospital, Cork, Ireland (Ms Lynch); FAMS Institution: Division of Supportive and Palliative Care, National Cancer Centre, Singapore (Ms Neo); Roubaud CHU de Bordeaux, Pôle de Gérontologie Clinique, Bordeaux, France (Ms Roubaud-Baudron); Clinical Pharmacy Partners, Tampa, Florida (Ms Gray)
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Tremblay D, Touati N, Usher S, Gentil B, Courval MJ. The challenge of optimizing supports for people living with and beyond cancer: creating proximity between cancer and non-profit community-based providers. Support Care Cancer 2023; 31:108. [PMID: 36625923 PMCID: PMC9831956 DOI: 10.1007/s00520-022-07569-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2022] [Accepted: 12/30/2022] [Indexed: 01/11/2023]
Abstract
PURPOSE Non-profit community-based organizations (CO) remain insufficiently integrated into cancer networks. Drawing on dimensions of proximity, this study explores how and why coordination between cancer teams and COs is established and solidified. METHODS A descriptive interpretive study is undertaken in Québec (Canada), where a cancer program has long promoted the integration of COs in the cancer trajectory. Semi-directed interviews with providers, managers and people living with and beyond cancer (total n = 46) explore the challenges of coordination between cancer and CO providers, along with facilitating or impeding factors. Three main themes related to coordination in cancer networks emerge, which are analyzed by operationalizing the multi-dimensional framework of proximity. RESULTS Findings reveal a lack of cognitive proximity, which calls for efforts to both identify patient needs and increase cancer team knowledge and appreciation of CO resources. Organizational proximity refers to systems and rules that facilitate interactions, and we find that referral mechanisms and communication channels are inadequate, with patients often playing a linking role despite barriers. Coordination improves when relational proximity is established between cancer and CO teams, and this can be enhanced by geographic proximity; in one region, COs have a physical presence within the cancer center. CONCLUSION Integrating COs into the cancer network can help meet the spectrum of needs faced by people living with and beyond cancer. This study offers managers and decision-makers insight into how coordination between cancer teams and COs can be supported. Proximity allows the distinct contributions of actors to be considered in context and contributes to understanding the "how" of integrated practice.
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Affiliation(s)
- Dominique Tremblay
- School of Nursing, Université de Sherbrooke, Longueuil Campus, 150 Place Charles-Le Moyne, Longueuil, Québec, J4K 0A8, Canada. .,Centre de Recherche Charles-Le Moyne, 150 Place Charles-Le Moyne, Longueuil, Québec, J4K 0A8, Canada.
| | - Nassera Touati
- École nationale d’administration Publique, 4750 Ave Henri-Julien, 5E Étage, Montréal, Québec H2T 3E5 Canada
| | - Susan Usher
- Centre de Recherche Charles-Le Moyne, 150 Place Charles-Le Moyne, Longueuil, Québec J4K 0A8 Canada ,École nationale d’administration Publique, 4750 Ave Henri-Julien, 5E Étage, Montréal, Québec H2T 3E5 Canada
| | - Barbara Gentil
- Centre de Recherche Charles-Le Moyne, 150 Place Charles-Le Moyne, Longueuil, Québec J4K 0A8 Canada
| | - Marie-Josée Courval
- Centre Intégré de Santé et de Services Sociaux (CISSS) de la Montérégie-Centre, 3120 Boul. Taschereau, Greenfield Park, Québec J4V 2H1 Canada
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6
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Richmond JP, Johnston A, Kelly MG, Roche K, Murphy PJ, Murphy AW. Stakeholders' perceptions of a community-based advanced nurse practitioner-led integrated oncology care model for adults receiving oral anti-cancer medication-A qualitative study. Eur J Cancer Care (Engl) 2022; 31:e13733. [PMID: 36259243 DOI: 10.1111/ecc.13733] [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: 07/15/2022] [Revised: 09/13/2022] [Accepted: 09/26/2022] [Indexed: 12/31/2022]
Abstract
Oral anti-cancer medications (OAMs) are increasingly prescribed in oncology, and although administered at home, ongoing monitoring generally requires the patient to attend an acute hospital. With the requirement to provide safe yet convenient care and to increase hospital capacity, the potential exists to transition this cohort of patients to the community to be assessed by oncology health care professionals (HCPs). The onset of COVID-19 facilitated this planned transition. OBJECTIVE The primary objective was to understand stakeholders' perceptions of a community-based advanced nurse practitioner (ANP)-led integrated OAM care model for adults. METHODS Qualitative data from interviews and focus groups were obtained from 33 individuals; either service users who attended ANP-led OAM clinics or stakeholders involved in OAM care. Data were subsequently analysed using thematic analysis. RESULTS Four themes were identified and included reflection on pre-COVID-19 system, role of ANP in current OAM care, importance of robust communication and infrastructural requirements for transition to an integrated OAM care model. CONCLUSION This study demonstrated that patients and HCPs perceived the proposal positively. They identified the ANP as the appropriate HCP to care for this cohort and the importance of communication and strategic planning for transitioning this model of care to the community setting. CLINICAL TRIAL REGISTRATION ISRCTN10401455.
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Affiliation(s)
| | | | | | - Kevin Roche
- HRB Primary Care Clinical Trials Network, Discipline of General Practice, NUI Galway, Galway, Ireland
| | - Patrick J Murphy
- HRB Primary Care Clinical Trials Network, Discipline of General Practice, NUI Galway, Galway, Ireland
| | - Andrew W Murphy
- HRB Primary Care Clinical Trials Network, Discipline of General Practice, NUI Galway, Galway, Ireland
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7
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Meyer SB, Lunnay B, Warin M, Foley K, Olver IN, Wilson C, Macdonald S. S, Ward PR. Examining social class as it relates to heuristics women use to determine the trustworthiness of information regarding the link between alcohol and breast cancer risk. PLoS One 2022; 17:e0270936. [PMID: 36095014 PMCID: PMC9467310 DOI: 10.1371/journal.pone.0270936] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Accepted: 06/21/2022] [Indexed: 11/19/2022] Open
Abstract
Background High rates of alcohol consumption by midlife women, despite the documented risks associated with breast cancer, varies according to social class. However, we know little about how to develop equitable messaging regarding breast cancer prevention that takes into consideration class differences in the receipt and use of such information. Objective To explore the heuristics used by women with different (inequitable) life chances to determine the trustworthiness of information regarding alcohol as a modifiable risk factor for breast cancer risk. Methods and materials Interviews were conducted with 50 midlife (aged 45–64) women living in South Australia, diversified by self-reported alcohol consumption and social class. Women were asked to describe where they sought health information, how they accessed information specific to breast cancer risk as it relates to alcohol, and how they determined whether (or not) such information was trustworthy. De-identified transcripts were analysed following a three-step progressive method with the aim of identifying how women of varying life chances determine the trustworthiness of alcohol and breast cancer risk information. Three heuristics were used by women: (1) consideration of whose interests are being served; (2) engagement with ‘common sense’; and (3) evaluating the credibility of the message and messenger. Embedded within each heuristic are notable class-based distinctions. Conclusions More equitable provision of cancer prevention messaging might consider how social class shapes the reception and acceptance of risk information. Class should be considered in the development and tailoring of messages as the trustworthiness of organizations behind public health messaging cannot be assumed.
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Affiliation(s)
- Samantha B. Meyer
- School of Public Health Sciences, University of Waterloo, Waterloo, ON, Canada
- * E-mail:
| | - Belinda Lunnay
- Research Centre on Public Health, Equity and Human Flourishing, Torrens University Australia, Adelaide, South Australia, Australia
| | - Megan Warin
- School of Social Sciences, University of Adelaide, Adelaide, South Australia, Australia
| | - Kristen Foley
- Research Centre on Public Health, Equity and Human Flourishing, Torrens University Australia, Adelaide, South Australia, Australia
| | - Ian N. Olver
- School of Psychology, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, South Australia, Australia
| | - Carlene Wilson
- School of Psychology and Public Health and the Olivia Newton-John Cancer Wellness and Research Centre at Austin Health, La Trobe University, Melbourne, Victoria, Australia
| | - Sara Macdonald S.
- Institute of Health & Wellbeing, University of Glasgow, Glasgow, Scotland
| | - Paul R. Ward
- Research Centre on Public Health, Equity and Human Flourishing, Torrens University Australia, Adelaide, South Australia, Australia
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8
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Ehab J, Powers B, Kim R, Haider M, Utuama O, Chin A, Denbo J, Kis B, Frakes J, Jeong D, Lauwers G, Vadaparampil S, Fleming JB, Anaya DA. Integrating a Disease-Focused Tumor Board as a Delivery-of-Care Model to Expedite Treatment Initiation for Patients With Liver Malignancies. Ann Surg Oncol 2021; 29:2371-2380. [PMID: 34671878 DOI: 10.1245/s10434-021-10909-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Accepted: 08/18/2021] [Indexed: 01/08/2023]
Abstract
BACKGROUND Patients with hepatobiliary malignancies are especially vulnerable to treatment delays. This study sought to evaluate the impact of implementing a new delivery-of-care model centered around a hepatobiliary multidisciplinary tumor board (HB-MTB) and integrated with an optimized patient workflow process to expedite treatment initiation. METHODS A hybrid type 2 study (effectiveness-implementation) was performed. Implementation measures were examined prospectively using the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) approach during 5 years after the HB-MTB program deployment (2015-2020). The primary outcome was effectiveness, measured as time to treatment initiation (TTI) using a before and after design (1 year each). The patients were grouped into before (BP) and after (AP) categories based on date of HB-MTB program implementation. Multivariable Cox and linear regression analyses were performed to examine and compare time to treatment initiation between groups. RESULTS The HB-MTB program enrolled 2457 patients (reach). The RE-AIM measures were favorable and improved over time (P < 0.01 for all). The median TTI was lower for the AP group than for the BP group (17 vs 24 days; P < 0.01). In the multivariable Cox and linear regressions, treatment in the AP group was associated with a faster TTI (hazard ratio, 1.75; 95 % confidence interval, 1.31-2.35; p < 0.01), and a mean of 13 days faster treatment initiation than the BP group (P < 0.01). CONCLUSIONS Implementation of an HB-MTB program integrated with an optimized patient workflow was successful and led to faster treatment initiation. This delivery-of-care model can serve as a blueprint to expedite treatment of patients with cancer.
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Affiliation(s)
- Jasmina Ehab
- Section of Hepatobiliary Tumors, Department of Gastrointestinal Oncology, Moffitt Cancer Center, 12902 Magnolia Drive, Tampa, FL, 33612, USA
| | - Benjamin Powers
- Section of Hepatobiliary Tumors, Department of Gastrointestinal Oncology, Moffitt Cancer Center, 12902 Magnolia Drive, Tampa, FL, 33612, USA
| | - Richard Kim
- Section of Hepatobiliary Tumors, Department of Gastrointestinal Oncology, Moffitt Cancer Center, 12902 Magnolia Drive, Tampa, FL, 33612, USA
| | - Mintallah Haider
- Section of Hepatobiliary Tumors, Department of Gastrointestinal Oncology, Moffitt Cancer Center, 12902 Magnolia Drive, Tampa, FL, 33612, USA
| | - Ovie Utuama
- Section of Hepatobiliary Tumors, Department of Gastrointestinal Oncology, Moffitt Cancer Center, 12902 Magnolia Drive, Tampa, FL, 33612, USA
| | - Alicia Chin
- Section of Hepatobiliary Tumors, Department of Gastrointestinal Oncology, Moffitt Cancer Center, 12902 Magnolia Drive, Tampa, FL, 33612, USA
| | - Jason Denbo
- Section of Hepatobiliary Tumors, Department of Gastrointestinal Oncology, Moffitt Cancer Center, 12902 Magnolia Drive, Tampa, FL, 33612, USA
| | - Bela Kis
- Section of Hepatobiliary Tumors, Department of Gastrointestinal Oncology, Moffitt Cancer Center, 12902 Magnolia Drive, Tampa, FL, 33612, USA.,Department of Diagnostic Imaging and Interventional Radiology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Jessica Frakes
- Section of Hepatobiliary Tumors, Department of Gastrointestinal Oncology, Moffitt Cancer Center, 12902 Magnolia Drive, Tampa, FL, 33612, USA.,Department of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Daniel Jeong
- Section of Hepatobiliary Tumors, Department of Gastrointestinal Oncology, Moffitt Cancer Center, 12902 Magnolia Drive, Tampa, FL, 33612, USA.,Department of Diagnostic Imaging and Interventional Radiology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Gregory Lauwers
- Section of Hepatobiliary Tumors, Department of Gastrointestinal Oncology, Moffitt Cancer Center, 12902 Magnolia Drive, Tampa, FL, 33612, USA.,Department of Pathology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Susan Vadaparampil
- Department of Health Outcomes and Behavior, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Jason B Fleming
- Section of Hepatobiliary Tumors, Department of Gastrointestinal Oncology, Moffitt Cancer Center, 12902 Magnolia Drive, Tampa, FL, 33612, USA
| | - Daniel A Anaya
- Section of Hepatobiliary Tumors, Department of Gastrointestinal Oncology, Moffitt Cancer Center, 12902 Magnolia Drive, Tampa, FL, 33612, USA. .,Department of Health Outcomes and Behavior, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA.
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Solberg M, Berg GV, Andreassen HK. In Limbo: Seven Families' Experiences of Encounter with Cancer Care in Norway. Int J Integr Care 2021; 21:24. [PMID: 34899103 PMCID: PMC8622148 DOI: 10.5334/ijic.5700] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Accepted: 11/11/2021] [Indexed: 11/20/2022] Open
Abstract
INTRODUCTION Like many other countries, Norway has seen a shift from inpatient to outpatient cancer care, with pathways aimed at improving the integration and coordination of health services. This study explores the perspectives of seven patients and their family members in light of this change. We focus on one particular phase of the pathway: the first encounter. Our interviews were set in the period from referral until the start of treatment. METHODS Nineteen individual in-depth interviews were conducted in seven families. Seven patients with cancer and 12 family members were interviewed. RESULTS Three categories of experiences stood out in the empirical material: 'Being in between different health professionals', 'Overwhelmed by written and oral information' and 'Lack of involvement'. CONCLUSION This study provides insight into families' experiences with cancer care from referral until the start of treatment. Our findings indicate that families often experience cancer care as fragmented and confusing. Although evaluations have shown that the introduction of cancer pathways seems to have a positive effect on waiting times and standardization of examinations across hospitals and regions, there is still potential for improvement in coordination between services, family involvement, and emotional and practical support. We argue that our findings highlight the tension between two ideals of professional care: standardization and patient-centredness. The study illustrates shortcomings in translating the ideal of patient-centredness into professional practice.
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Affiliation(s)
- Monica Solberg
- Norwegian University of Science and Technology and Innlandet Hospital Trust, NO
| | - Geir Vegard Berg
- Norwegian University of Science and Technology and Innlandet Hospital Trust, NO
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10
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Ciucă A, Moldovan R, Băban A. Developing genetic counselling services in an underdeveloped healthcare setting. J Community Genet 2021; 12:539-548. [PMID: 34545547 PMCID: PMC8554932 DOI: 10.1007/s12687-021-00546-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Accepted: 07/30/2021] [Indexed: 12/24/2022] Open
Abstract
Genetic counselling services are well established in North America, Western Europe and Australia. In other regions, genetic counselling services are still emerging. Where this is the case, an in-depth understanding of the main stakeholders’ needs, challenges and opportunities will inform the changes and innovations required to bring genetic counselling closer to the community. The present study explored the needs and challenges of patients, family members and professionals with a view to setting up a cancer genetic counselling service in Romania. In order to get a comprehensive outlook, key stakeholders were interviewed using data source triangulation method. Thirty-four semi-structured interviews were conducted (13 patients, 11 family members and 10 professionals). Thematic analysis was used to explore and identify needs, barriers and opportunities in emerging cancer genetic counselling services. Three major themes were identified: (1) the “Needs” theme mainly focuses on various types of support that participants mentioned wanting: psychosocial, peer and additional support; (2) the “Challenges” theme includes aspects related to limited access to healthcare, lack of integrated services and pressure on the families; (3) the “Hopes” theme highlights the wish for integrated healthcare and an empathic rapport with healthcare providers. Our findings highlighted the main needs, challenges and hopes the patients, family members and professionals have and provides the groundwork for setting up cancer genetic counselling services.
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Affiliation(s)
- Andrada Ciucă
- Department of Psychology, Babeş-Bolyai University, Cluj-Napoca, Romania
| | - Ramona Moldovan
- Department of Psychology, Babeş-Bolyai University, Cluj-Napoca, Romania. .,Division of Evolution and Genomic Sciences, School of Biological Science, University of Manchester, Manchester, UK. .,Manchester Centre for Genomic Medicine, St Mary's Hospital, Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK.
| | - Adriana Băban
- Department of Psychology, Babeş-Bolyai University, Cluj-Napoca, Romania
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11
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Giannitrapani KF, Silveira MJ, Azarfar A, Glassman PA, Singer SJ, Asch SM, Midboe AM, Zenoni MA, Gamboa RC, Becker WC, Lorenz KA. Cross Disciplinary Role Agreement is Needed When Coordinating Long-Term Opioid Prescribing for Cancer: a Qualitative Study. J Gen Intern Med 2021; 36:1867-1874. [PMID: 33948790 PMCID: PMC8298631 DOI: 10.1007/s11606-021-06747-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Accepted: 03/18/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND Cancer pain is highly prevalent and often managed in primary care or by oncology providers in combination with primary care providers. OBJECTIVES To understand interdisciplinary provider experiences coordinating opioid pain management for patients with chronic cancer-related pain in a large integrated healthcare system. DESIGN Qualitative research. PARTICIPANTS We conducted 20 semi-structured interviews with interdisciplinary providers in two large academically affiliated VA Medical Centers and their associated community-based outpatient clinics. Participants included primary care providers (PCPs) and oncology-based personnel (OBPs). APPROACH We deductively identified 94 examples of care coordination for cancer pain in the 20 interviews. We secondarily used an inductive open coding approach and identified themes through constant comparison coming to research team consensus. RESULTS Theme 1: PCPs and OBPs generally believed one provider should handle all opioid prescribing for a specific patient, but did not always agree on who that prescriber should be in the context of cancer pain. Theme 2: There are special circumstances where having multiple prescribers is appropriate (e.g., a pain crisis). Theme 3: A collaborative process to opioid cancer pain management would include real-time communication and negotiation between PCPs and oncology around who will handle opioid prescribing. Theme 4: Providers identified multiple barriers in coordinating cancer pain management across disciplines. CONCLUSIONS Our findings highlight how real-time negotiation about roles in opioid pain management is needed between interdisciplinary clinicians. Lack of cross-disciplinary role agreement may result in delays in clinically appropriate cancer pain management.
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Affiliation(s)
- K F Giannitrapani
- Center for Innovation to Implementation (Ci2i), VA Palo Alto Health Care System, Menlo Park, CA, USA. .,Division of Primary Care and Population Health, Stanford University School of Medicine, Stanford, CA, USA.
| | - M J Silveira
- Geriatric Research Education Clinical Center (GRECC), Ann Arbor VA Health Care System, University of Michigan, Ann Arbor, MI, USA.,Division of Geriatric and Palliative Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| | - A Azarfar
- Center for Innovation to Implementation (Ci2i), VA Palo Alto Health Care System, Menlo Park, CA, USA.,University of Central Florida, Orlando, FL, USA
| | - P A Glassman
- Pharmacy Benefits Management Services, Department of Veterans Affairs, Washington, DC, USA.,Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - S J Singer
- Center for Innovation to Implementation (Ci2i), VA Palo Alto Health Care System, Menlo Park, CA, USA.,Division of Primary Care and Population Health, Stanford University School of Medicine, Stanford, CA, USA
| | - S M Asch
- Center for Innovation to Implementation (Ci2i), VA Palo Alto Health Care System, Menlo Park, CA, USA.,Division of Primary Care and Population Health, Stanford University School of Medicine, Stanford, CA, USA
| | - A M Midboe
- Center for Innovation to Implementation (Ci2i), VA Palo Alto Health Care System, Menlo Park, CA, USA
| | - M A Zenoni
- Pain Research Informatics, Multimorbidities and Education (PRIME) Center, VA Connecticut Health Care System, West Haven, CT, USA.,Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
| | - R C Gamboa
- Center for Innovation to Implementation (Ci2i), VA Palo Alto Health Care System, Menlo Park, CA, USA
| | - W C Becker
- Pain Research Informatics, Multimorbidities and Education (PRIME) Center, VA Connecticut Health Care System, West Haven, CT, USA.,Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
| | - K A Lorenz
- Center for Innovation to Implementation (Ci2i), VA Palo Alto Health Care System, Menlo Park, CA, USA.,Division of Primary Care and Population Health, Stanford University School of Medicine, Stanford, CA, USA
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12
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Ullgren H, Sharp L, Olofsson A, Fransson P. Factors associated with healthcare utilisation during first year after cancer diagnose-a population-based study. Eur J Cancer Care (Engl) 2020; 30:e13361. [PMID: 33216423 PMCID: PMC8047913 DOI: 10.1111/ecc.13361] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Revised: 08/24/2020] [Accepted: 10/14/2020] [Indexed: 12/24/2022]
Abstract
Background Improved cancer treatments and models of care (such as early palliative care) has developed during recent years. Aspects of healthcare utilisation—unplanned care have been used for evaluation of coordination and quality. The aim was to explore factors associated with cancer healthcare utilisation, during the first year after a cancer diagnosis. Methods Population‐based registry and patient‐reported data, (The European Organisation of Research and Treatment of Cancer (EORTC), QLQ‐ C30 questionnaire and study‐specific questions) were collected. Descriptive statistics and multivariate regression models were performed. Results The sample consists of 1718 patients (haematological, gynaecological, upper gastrointestinal and head and neck cancers). Living alone were associated with unplanned hospital admissions (OR 1.35; 95% CI [1.15, 1.59], p < 0.001). Patients with specialised palliative home care had a higher likelihood of unplanned hospital admissions, (OR 4.35; 95% CI [3.22‐5.91], p < 0.001) and re‐admissions within 30 days, (OR, 5.8; 95% CI [4.12‐8.19], p < 0.001). Conclusions Sociodemographic and clinical factors, such as living alone and disease stage, is associated with healthcare utilisation. Patients with specialised palliative home care report lower levels of HRQoL and higher levels of unplanned care, and our findings stresses the importance of a holistic view when planning care.
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Affiliation(s)
- Helena Ullgren
- Department of nursing, Umeå University, Umeå, Sweden.,Regional Cancer Center, Stockholm-Gotland, Sweden.,Head & Neck, Lung -and Skin cancer, Theme Cancer, Karolinska University Hospital, Stockholm, Sweden
| | - Lena Sharp
- Regional Cancer Center, Stockholm-Gotland, Sweden.,Department of Innovative Care, LIME, Innovative care, Stockholm, Sweden
| | | | - Per Fransson
- Department of nursing, Umeå University, Umeå, Sweden
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13
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Peters VJT, Meijboom BR, Bunt JEH, Bok LA, van Steenbergen MW, de Winter JP, de Vries E. Providing person-centered care for patients with complex healthcare needs: A qualitative study. PLoS One 2020; 15:e0242418. [PMID: 33196659 PMCID: PMC7668580 DOI: 10.1371/journal.pone.0242418] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Accepted: 11/03/2020] [Indexed: 11/18/2022] Open
Abstract
Background People with chronic conditions have complex healthcare needs that lead to challenges for adequate healthcare provision. Current healthcare services do not always respond adequately to their needs. A modular perspective, in particular providing visualization of the modular service architecture, is promising for improving the responsiveness of healthcare services to the complex healthcare needs of people with chronic conditions. The modular service architecture provides a comprehensive representation of the components and modules of healthcare provision. In this study, we explore this further in a qualitative multiple case study on healthcare provision for children with Down syndrome in the Netherlands. Methods Data collection for four cases involved 53 semi-structured interviews with healthcare professionals and 21 semi-structured interviews with patients (the parents of children with Down syndrome as proxy). In addition, we gathered data by means of practice observations and analysis of relevant documents. The interviews were audio-recorded, transcribed verbatim and analyzed utilizing the Miles and Huberman approach. Results Our study shows that the perspectives on healthcare provision of professionals and patients differ substantially. The visualization of the modular service architecture that was based on the healthcare professionals’ perspective provided a complete representation of (para)medical outcomes relevant to the professionals’ own discipline. In contrast, the modular service architecture based on the patients’ perspective, which we define as a person-centered modular service architecture, provided a representation of the healthcare service that was primarily based on functional outcomes and the overall wellbeing of the patients. Conclusion Our study shows that visualization of the modular service architecture can be a useful tool to better address the complex needs and requirements of people with a chronic condition. We suggest that a person-centered modular service architecture that focuses on functional outcomes and overall wellbeing, enables increased responsiveness of healthcare services to people with complex healthcare needs and provision of truly person-centered care.
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Affiliation(s)
- Vincent J. T. Peters
- Department of Management, Tilburg School of Economics and Management, Tilburg University, Tilburg, Noord-Brabant, The Netherlands
| | - Bert R. Meijboom
- Department of Management, Tilburg School of Economics and Management, Tilburg University, Tilburg, Noord-Brabant, The Netherlands
- Department of Tranzo, Tilburg School of Social and Behavioral Sciences, Tilburg University, Tilburg, Noord-Brabant, The Netherlands
- Department of Marketing, Innovation and Organization, Ghent University, Ghent, Belgium
- * E-mail:
| | - Jan Erik H. Bunt
- Department of Pediatrics, Elisabeth-Tweesteden Ziekenhuis, Tilburg, Noord-Brabant, The Netherlands
| | - Levinus A. Bok
- Department of Pediatrics, Máxima Medisch Centrum, Veldhoven, Noord-Brabant, The Netherlands
| | | | - J. Peter de Winter
- Department of Pediatrics, Spaarne Gasthuis, Haarlem, Noord-Holland, The Netherlands
| | - Esther de Vries
- Department of Tranzo, Tilburg School of Social and Behavioral Sciences, Tilburg University, Tilburg, Noord-Brabant, The Netherlands
- Department of Jeroen Bosch Academy Research, Jeroen Bosch Ziekenhuis, ‘s-Hertogenbosch, Noord-Brabant, The Netherlands
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14
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Zhao Y, Liu L, Qi Y, Lou F, Zhang J, Ma W. Evaluation and design of public health information management system for primary health care units based on medical and health information. J Infect Public Health 2019; 13:491-496. [PMID: 31831397 DOI: 10.1016/j.jiph.2019.11.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2019] [Revised: 11/16/2019] [Accepted: 11/25/2019] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE The objective is to understand the role of information management systems in the public health perspective of primary care units more accurately. METHODS A public health information management system for primary medical units, which is based on electronic health records, virtual private network technology, real-time data storage, and other technologies, is designed on the premise of economical and straightforward operation. Besides, Xinhua Community Health Service Center Around the Wulong Street, Longsha District, Qiqihar City is selected as the experimental unit of the public health information management system, and the work efficiency of the system in the public health perspective of the primary medical unit is evaluated after 12 months of system operation. RESULTS The public health information management system of primary medical units has following comprehensive management functions: health record management, child health, maternal health, health of the elderly, health of patients with chronic diseases, health of severe psychiatric patients, health education, infectious diseases and public emergencies, health events, health supervision, and management information. In addition, after 12 months of information management system operates in the grassroots units, the results show that patients and doctors have a very high satisfaction rate with the system. The system not only cultivates the excellent health and disease prevention awareness of residents but also improves the efficiency of primary care institutions, as well as reducing the number of patients seeking medical cares. CONCLUSION The public health information management system of primary health care units based on medical and health information design is rich in functions with prominent work efficiency, which significantly improves the public health of grass-roots medical units. The research is useful and significant for follow-up studies on public health care systems.
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Affiliation(s)
- Yan Zhao
- College of Public Health, Qiqihar Medical University, Qiqihar 161006, China.
| | - Li Liu
- Xinhua Community Health Service Center Around the Wulong Street, Longsha District, Qiqihar 161005, China
| | - Yanbo Qi
- College of Public Health, Qiqihar Medical University, Qiqihar 161006, China
| | - Fengge Lou
- College of Public Health, Qiqihar Medical University, Qiqihar 161006, China
| | - Jingdan Zhang
- Xinhua Community Health Service Center Around the Wulong Street, Longsha District, Qiqihar 161005, China
| | - Wenhui Ma
- Computer Laboratory of Experimental Training Center, Qiqihar Medical University, Qiqihar 161006, China
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15
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Pergolotti M, Alfano CM, Cernich AN, Yabroff KR, Manning PR, Moor JS, Hahn EE, Cheville AL, Mohile SG. A health services research agenda to fully integrate cancer rehabilitation into oncology care. Cancer 2019; 125:3908-3916. [DOI: 10.1002/cncr.32382] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Revised: 05/28/2019] [Accepted: 06/07/2019] [Indexed: 12/26/2022]
Affiliation(s)
- Mackenzi Pergolotti
- ReVital Cancer Rehabilitation, Select Medical Mechanicsburg Pennsylvania
- Department of Occupational Therapy Colorado State University Fort Collins Colorado
| | | | - Alison N. Cernich
- National Center for Medical Rehabilitation Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development National Institutes of Health Rockville Maryland
| | - K. Robin Yabroff
- Surveillance and Health Services Research, Intramural Research Department American Cancer Society Inc Atlanta Georgia
| | - Peter R. Manning
- ReVital Cancer Rehabilitation, Select Medical Mechanicsburg Pennsylvania
| | - Janet S. Moor
- Division of Cancer Control and Population Sciences National Cancer Institute Rockville Maryland
| | - Erin E. Hahn
- Research and Evaluation, Kaiser Permanente Southern California Pasadena California
| | - Andrea L. Cheville
- Department of Physical Medicine and Rehabilitation Mayo Clinic Rochester Minnesota
| | - Supriya G. Mohile
- Department of Medicine University of Rochester Medical Center Rochester New York
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16
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Clarke AL, Roscoe J, Appleton R, Parashar D, Muthuswamy R, Khan O, Dale J, Nanton V. Promoting integrated care in prostate cancer through online prostate cancer-specific holistic needs assessment: a feasibility study in primary care. Support Care Cancer 2019; 28:1817-1827. [PMID: 31338642 PMCID: PMC7036062 DOI: 10.1007/s00520-019-04967-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Accepted: 06/26/2019] [Indexed: 12/04/2022]
Abstract
Purpose This study assessed the feasibility of implementing a novel model of integrated prostate cancer care involving an online prostate cancer-specific holistic needs assessment (sHNA) and shared digital communication between patients and their healthcare professionals (HCPs). The sHNA produces a semi-automated care plan that is finalised in consultation between the patient and their practice nurse. Methods Men living with and beyond prostate cancer were invited to participate in a 9-month non-randomised cluster controlled feasibility study. The intervention group was asked to complete the sHNA on three occasions. Data were collected using Patient Reported Outcome Measures (PROMs) at baseline, 10 and 24 weeks, and 9 months. Outcomes included recruitment, retention, acceptability, and engagement with the sHNA and PROMs. Results Fourteen general practices (8 intervention and 6 control), and 41 men (29 intervention and 12 control) participated. Initial patient engagement with the sHNA was high, with all but one receiving practice nurse-led follow-up and an individualised care plan. The sHNA proved useful in identifying ‘red flag’ symptoms, and helping practice nurses decide when to seek further medical care for the patients. There was a high level of acceptability for patients and HCPs. However, integration of care did not occur as intended because of problems linking hospital and general practice IT systems. Conclusion While the study demonstrated the feasibility of implementing the sHNA, it did not meet the a priori progression criteria; as such, undertaking a definitive randomised controlled trial is not appropriate until the identified methodological and technical issues have been addressed.
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Affiliation(s)
| | | | | | - Deepak Parashar
- Statistics and Epidemiology Unit, Warwick Medical School, University of Warwick, Coventry, UK.,The Alan Turing Institute, London, UK.,Warwick Cancer Research Centre, University of Warwick, Coventry, UK
| | - Radha Muthuswamy
- Prostate Cancer UK Information Technology Consultant, London, UK
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17
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Young J, Snowden A. A qualitative study on the perceived impact of using an integrated community-based supportive cancer service. Eur J Cancer Care (Engl) 2019; 28:e13001. [PMID: 30734383 DOI: 10.1111/ecc.13001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Revised: 09/24/2018] [Accepted: 01/08/2019] [Indexed: 11/28/2022]
Abstract
OBJECTIVE "Improving the Cancer Journey" (ICJ) is an original, community-based, multidisciplinary service offering holistic support to people diagnosed with cancer in Scotland. It is the first service of its kind in the UK. The aim of this qualitative study was to explore the experiences of people who have used this service. METHOD Twenty service users were purposively sampled to capture a diverse range of age, sex, cancer types, and deprivation status. Semi-structured interviews explored their experiences of using ICJ. Interviews were transcribed verbatim and thematically analysed. RESULTS Thirteen women and seven men (mean age 58 years) were interviewed. Three themes were identified: "one person, one place," "routes to unexpected support" and "safety net." CONCLUSION Improving the Cancer Journey was perceived to be beneficial because it met the holistic needs of the ICJ service users. By helping people address concerns earlier rather than later, it prevented problems becoming unmanageable. Having an accessible expert to guide and support them through a range of services provided reassurance and created the space to self-manage at a time of distress. These original findings are internationally relevant because there is little evidence on the impact of holistic support services from the patient perspective.
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18
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Buchman S, Evans JM, Mackinnon M, Gradin S, Wright FC. Bridging silos: Delivering integrated care to patients with cancer in Ontario, Canada. Psychooncology 2018; 27:2673-2676. [PMID: 30187984 DOI: 10.1002/pon.4858] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Accepted: 08/02/2018] [Indexed: 12/25/2022]
Affiliation(s)
- Sandy Buchman
- The Temmy Latner Centre for Palliative Care, Sinai Health System, Toronto, Canada.,Family and Community Medicine, University of Toronto, Toronto, Canada
| | - Jenna M Evans
- Enhanced Program Evaluation Unit, Cancer Care Ontario, Toronto, Canada.,Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Canada
| | | | - Sharon Gradin
- Integrated Care, Cancer Care Ontario, Toronto, Canada
| | - Frances C Wright
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Canada.,Department of Surgery, Sunnybrook Health Sciences Centre, Toronto, Canada.,Odette Cancer Research Program, Sunnybrook Research Institute, Toronto, Canada.,Department of Surgery, University of Toronto, Toronto, Canada
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19
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Hunter J, Ussher J, Parton C, Kellett A, Smith C, Delaney G, Oyston E. Australian integrative oncology services: a mixed-method study exploring the views of cancer survivors. BMC COMPLEMENTARY AND ALTERNATIVE MEDICINE 2018; 18:153. [PMID: 29743054 PMCID: PMC5944107 DOI: 10.1186/s12906-018-2209-6] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/29/2017] [Accepted: 04/17/2018] [Indexed: 12/22/2022]
Abstract
Background The significant use of traditional and complementary medicine (T&CM) by cancer survivors is well documented. The aim of this study was to explore cancer survivors’ views on integrating T&CM services with conventional cancer care. Method A mixed-method study design with an emphasis on qualitative methodology was used to conduct and analyse four focus group interviews and an on-line survey. Purposive sampling recruited 33 cancer survivors and caregivers from Arabic, Vietnamese, Chinese and Anglo-European Australian backgrounds who participated in one of four focus group interviews, and 121 cancer survivors who responded to an on-line survey. The inductive thematic analysis was augmented with a descriptive statistical analysis. Results Most participants had used T&CM therapies or consulted T&CM practitioners as an adjuvant during and/or after their initial cancer treatment. Two themes emerged: ‘positive perceptions and experiences’ and ‘barriers and unmet needs’. Participants emphasised that T&CM was not a ‘luxury item’, rather it was considered important for managing side effects and comorbidities, rehabilitation and quality of life. A wide range of complex, interrelated barriers and solutions to IO service provision and access were identified. Structural barriers included inadequate service provision, medical practitioner attitudes, logistical constraints and funding. Personal barriers were influenced by the severity of impairment and disability; attitudes, beliefs and knowledge about T&CM; and available resources (e.g. finances, time, transport). Unmet need and inequitable access was exacerbated by geographical location, ethnicity and ability to pay. There was a mismatch between where participants were accessing T&CM services and their preference for IO service delivery. Participants perceived hospital-based IO services availability to have several benefits, including the T&CM practitioners having more expert knowledge about cancer care, the convenience of co-locating oncology services, and potentially lower out-of-pocket costs. Conclusion Patients’ use, preferences and needs for T&CM services in the oncology setting are important for informing service provision. Inequitable, unmet need reflected the increasing demand and expectation from patients for their oncology teams to be well informed about the benefits, risks and indications for T&CM use, and for the public and private health sectors to formally integrate and fund IO services. Electronic supplementary material The online version of this article (10.1186/s12906-018-2209-6) contains supplementary material, which is available to authorized users.
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20
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Weller D. The growing number of cancer survivors in western countries: How can our health systems best meet their needs? Eur J Cancer Care (Engl) 2017; 26. [DOI: 10.1111/ecc.12731] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- D. Weller
- Centre for Population Health Sciences; University of Edinburgh; Edinburgh UK
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