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Giannitrapani KF, Lin K, Hafi LA, Maheta B, Isenberg SR. Codesign Use in Palliative Care Intervention Development: A Systematic Review. J Pain Symptom Manage 2024; 68:e235-e253. [PMID: 38909694 DOI: 10.1016/j.jpainsymman.2024.06.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2024] [Revised: 06/07/2024] [Accepted: 06/10/2024] [Indexed: 06/25/2024]
Abstract
CONTEXT Codesign is a methodology that includes active collaboration between stakeholders in designing solutions and has been used in the development and implementation of palliative care (PC) interventions. OBJECTIVES To synthesize the state of evidence for codesign in the development of PC interventions. METHODS We searched PubMed, EMBASE, and CINAHL for peer-reviewed studies published after 1995 that reported evidence of codesigned interventions and outcomes in patients receiving palliative, hospice, or end-of-life care. We screened studies through independent and blinded dual review within Covidence and assessed study quality with the 2018 Mixed Methods Appraisal Tool. We narratively synthesized codesign duration, engagement approach, stakeholders involved, intervention designs, follow-ups, and outcomes, comparing among codesigns reporting meaningful improvement in outcomes. We created a best practice checklist which we used to evaluate codesign use in each study. RESULTS About 1,036 abstracts and 54 full text articles were screened. Twenty-eight studies met inclusion criteria and were abstracted. Feedback collection modalities ranged from iterative drafting, pilot testing, advisory panels, workshops, focus groups, and interviews. Thirteen studies applied pretesting/prototyping through pretest post-test, focus groups, prototypes, alpha and beta testing, and mock-ups. Eleven studies reported improved outcomes, eight of which utilized iterative codesign. All the studies reporting improved outcomes mentioned meeting with stakeholders at least twice. Two studies met all criteria in our codesign best practice checklist. CONCLUSION Codesigned PC interventions demonstrate high variance in the modality of acquiring feedback and application of codesign. Successful codesign leading to improvement in outcomes is achieved by involving patients, caregivers, and providers in iterating intervention design.
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Affiliation(s)
- Karleen F Giannitrapani
- Center for Innovation to Implementation (Ci2i) (K.F.G, K.L, B.M), VA Palo Alto Health Care System, Menlo Park, USA; Department of Primary Care and Population Health (K.F.G), Stanford University School of Medicine, Palo Alto, USA.
| | - Kendall Lin
- Center for Innovation to Implementation (Ci2i) (K.F.G, K.L, B.M), VA Palo Alto Health Care System, Menlo Park, USA
| | - Ladees Al Hafi
- Department of Rehabilitation Sciences (L.A.H), Queen's University, Kingston, Canada
| | - Bhagvat Maheta
- Center for Innovation to Implementation (Ci2i) (K.F.G, K.L, B.M), VA Palo Alto Health Care System, Menlo Park, USA; College of Medicine (B.M), California Northstate University, Elk Grove, USA
| | - Sarina R Isenberg
- Department of Medicine (S.R.I), Bruyère Research Institute, University of Ottawa, Ottawa, Canada
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Sun S, Krishnan M, Alcorn S. Prognostication for Patients Receiving Palliative Radiation Therapy. Semin Radiat Oncol 2023; 33:104-113. [PMID: 36990628 DOI: 10.1016/j.semradonc.2023.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/29/2023]
Abstract
Estimation of patient prognosis plays a central role in guiding decision making for the palliative management of metastatic disease, and a number of statistical models have been developed to provide survival estimates for patients in this context. In this review, we discuss several well-validated survival prediction models for patients receiving palliative radiotherapy to sites outside of the brain. Key considerations include the type of statistical model, model performance measures and validation procedures, studies' source populations, time points used for prognostication, and details of model output. We then briefly discuss underutilization of these models, the role of decision support aids, and the need to incorporate patient preference in shared decision making for patients with metastatic disease who are candidates for palliative radiotherapy.
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Alcorn SR, LaVigne AW, Elledge CR, Fiksel J, Hu C, Kleinberg L, Levin A, Smith T, Cheng Z, Kim K, Rao AD, Sloan L, Page B, Stinson SF, Voong KR, McNutt TR, Bowers MR, DeWeese TL, Zeger S, Wright JL. Evaluation of the Clinical Utility of the Bone Metastases Ensemble Trees for Survival Decision Support Platform (BMETS-DSP): A Case-Based Pilot Assessment. JCO Clin Cancer Inform 2022; 6:e2200082. [PMID: 36306499 PMCID: PMC9848564 DOI: 10.1200/cci.22.00082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Revised: 07/26/2022] [Accepted: 08/25/2022] [Indexed: 11/06/2022] Open
Abstract
PURPOSE The Bone Metastases Ensemble Trees for Survival Decision Support Platform (BMETS-DSP) provides patient-specific survival predictions and evidence-based recommendations to guide multidisciplinary management for symptomatic bone metastases. We assessed the clinical utility of the BMETS-DSP through a pilot prepost design in a simulated clinical environment. METHODS Ten Radiation Oncology physicians reviewed 55 patient cases at two time points: without and then with the use of BMETS-DSP. Assessment included 12-month survival estimate, confidence in and likelihood of sharing estimates with patients, and recommendations for open surgery, systemic therapy, hospice referral, and radiotherapy (RT) regimen. Paired statistics compared pre- versus post-DSP outcomes. Reported statistical significance is P < .05. RESULTS Pre- versus post-DSP, overestimation of true minus estimated survival time was significantly reduced (mean difference -2.1 [standard deviation 4.1] v -1 month [standard deviation 3.5]). Prediction accuracy was significantly improved at cut points of < 3 (72 v 79%), ≤ 6 (64 v 71%), and ≥ 12 months (70 v 81%). Median ratings of confidence in and likelihood of sharing prognosis significantly increased. Significantly greater concordance was seen in matching use of 1-fraction RT with the true survival < 3 months (70 v 76%) and < 10-fraction RT with the true survival < 12 months (55 v 62%) and appropriate use of open surgery (47% v 53%), without significant changes in selection of hospice referral or systemic therapy. CONCLUSION This pilot study demonstrates that BMETS-DSP significantly improved physician survival estimation accuracy, prognostic confidence, likelihood of sharing prognosis, and use of prognosis-appropriate RT regimens in the care of symptomatic bone metastases, supporting future multi-institutional validation of the platform.
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Affiliation(s)
- Sara R. Alcorn
- Department of Radiation Oncology, University of Minnesota Medical School, Minneapolis, MN
| | - Anna W. LaVigne
- Department of Radiation Oncology, University of Minnesota Medical School, Minneapolis, MN
| | - Christen R. Elledge
- Department of Radiation Oncology, University of Minnesota Medical School, Minneapolis, MN
| | - Jacob Fiksel
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins School of Medicine, Baltimore, MD
| | - Chen Hu
- Department of Radiation Oncology, University of Minnesota Medical School, Minneapolis, MN
| | - Lawrence Kleinberg
- Department of Radiation Oncology, University of Minnesota Medical School, Minneapolis, MN
| | - Adam Levin
- Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Thomas Smith
- Department of Orthopedic Surgery, Johns Hopkins School of Medicine, Baltimore, MD
| | - Zhi Cheng
- Department of Radiation Oncology, University of Minnesota Medical School, Minneapolis, MN
| | - Kibem Kim
- Department of Radiation Oncology, University of Minnesota Medical School, Minneapolis, MN
| | - Avani D. Rao
- Department of Radiation Oncology, University of Minnesota Medical School, Minneapolis, MN
| | - Lindsey Sloan
- Department of Radiation Oncology, University of Minnesota Medical School, Minneapolis, MN
| | - Brandi Page
- Department of Radiation Oncology, University of Minnesota Medical School, Minneapolis, MN
| | - Susan F. Stinson
- Department of Radiation Oncology, University of Minnesota Medical School, Minneapolis, MN
| | - K. Ranh Voong
- Department of Radiation Oncology, University of Minnesota Medical School, Minneapolis, MN
| | - Todd R. McNutt
- Department of Radiation Oncology, University of Minnesota Medical School, Minneapolis, MN
| | - Michael R. Bowers
- Department of Radiation Oncology, University of Minnesota Medical School, Minneapolis, MN
| | - Theodore L. DeWeese
- Department of Radiation Oncology, University of Minnesota Medical School, Minneapolis, MN
| | - Scott Zeger
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins School of Medicine, Baltimore, MD
| | - Jean L. Wright
- Department of Radiation Oncology, University of Minnesota Medical School, Minneapolis, MN
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