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Azimzadeh S, Azami-Aghdash S, Tabrizi JS, Gholipour K. Reforms and innovations in primary health care in different countries: scoping review. Prim Health Care Res Dev 2024; 25:e22. [PMID: 38651337 DOI: 10.1017/s1463423623000725] [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: 04/25/2024] Open
Abstract
INTRODUCTION The World Health Organization (WHO) recommends focusing on primary health care (PHC) as the first strategy of countries to achieve the improvement of the health level of communities and has emphasized it again in 2021. Therefore, we intend to take a different look at the PHC system with reform, innovation, and initiative by using the experiences of leading countries and identify practical and evidence-based solutions to achieve greater health. METHODS This is a scoping review study that has identified innovations and reforms related to PHC since the beginning of 2000 to the end of 2022. In this study, Scopus, Web Of Science, and PubMed databases have been searched using appropriate keywords. This study is done in six steps using Arkesy and O'Malley framework. In this study, the framework of six building blocks of WHO was used to summarize and report the findings. RESULTS By searching in different databases, we identified 39426 studies related to reforms in primary care, and after the screening process, 106 studies were analyzed. Our findings were classified and reported into 9 categories (aims, stewardship/leadership, financing & payment, service delivery, health workforce, information, outcomes, policies/considerations, and limitations). CONCLUSION The necessity and importance of strengthening PHC is obvious to everyone due to its great consequences, which requires a lot of will, effort, and coordination at the macro-level of the country, various organizations, and health teams, as well as the participation of people and society.
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Affiliation(s)
- Solmaz Azimzadeh
- Health Policy, Department of Health Policy & Management, School of Management and Medical Informatics, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Saber Azami-Aghdash
- Health Policy, Medical Philosophy and History Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Jafar Sadegh Tabrizi
- Health Services Management, Tabriz Health Services Management Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Kamal Gholipour
- Health Services Management, Tabriz Health Services Management Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
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2
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Alfieri S, Brunelli C, Borreani C, Capri G, Angi M, Bianchi GV, Lo Dico S, Spada P, Fusetti V, Zecca E, Caraceni A. Characterizing Different Multidisciplinary Team Models Implemented Within One Comprehensive Cancer Center. J Multidiscip Healthc 2023; 16:1845-1855. [PMID: 37404961 PMCID: PMC10317525 DOI: 10.2147/jmdh.s402348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Accepted: 05/15/2023] [Indexed: 07/06/2023] Open
Abstract
Background The multidisciplinary approach is considered "best practice" in oncology. Multidisciplinary Teamwork (MDTW) can be broadly classified into Multidisciplinary Team Meetings (MDTM) and Multidisciplinary Cancer Clinics (MDCC; involving also patients), yet both models are heterogeneously implemented. Purpose This study aims at describing the different MDTW implemented models in a Comprehensive Cancer Center. Methods All clinical unit directors of the hospital were contacted to identify any MDTW activities the personnel of the unit were involved in. Structured interviews were carried out to collect MDTWs information, ie, type (MDTM vs MDCC), team composition, aims, disease phase, use of Patient Reported Outcome Measures (PROMs). Descriptive analyses and Social Network Analysis (SNA) were performed. Results Among 38 structured interviews, 25 concerned MDTMs and 13 in MDCCs. Responders were mainly surgeons (35%) and oncologists (29%), 35% of them were team leaders. Teams were mostly composed of physicians only (64% in MDTMs, 69% in MDCCs). Case managers (8% and 31%), palliative care specialists (12% and 23%) and psychologists (20% and 31%) were involved to a lesser extent, mainly when dealing with advanced disease. MDTWs were mainly aimed at integrating the skills of the different specialists (respectively 72% for MDTMs and 64% for MDCCs) and offering the best overall patient care pathway (64%, 61.5%). MDTWs were directed at patients in both diagnostic (72%, 61.5%) and locally advanced/metastatic (32%, 38.4%) disease. PROMs were seldom used (24%, 23%). SNA shows a similar density in the two MDTWs, but in the MDCCs two nodes remain isolated (pathologists and radiologists). Conclusion Despite a high number of MDTWs for advanced/metastatic disease, there is limited involvement of palliative care specialists, psychologists, and nurses.
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Affiliation(s)
- Sara Alfieri
- Clinical Psychology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Cinzia Brunelli
- Palliative Care, Pain Therapy and Rehabilitation Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Claudia Borreani
- Clinical Psychology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Giuseppe Capri
- Medical Oncology 1, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Martina Angi
- General Oncology Surgery 4, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Giulia V Bianchi
- Medical Oncology 1, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Silvia Lo Dico
- Palliative Care, Pain Therapy and Rehabilitation Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Pierangelo Spada
- Nursing, Technicians and Rehabilitation Management Service (SITRA), Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Viviana Fusetti
- Palliative Care, Pain Therapy and Rehabilitation Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
- Biomedicine and Prevention Department, University of Rome “Tor Vergata”, Rome, Italy
| | - Ernesto Zecca
- Palliative Care, Pain Therapy and Rehabilitation Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Augusto Caraceni
- Palliative Care, Pain Therapy and Rehabilitation Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
- Department of Clinical and Community Sciences, Università degli Studi, Milan, Italy
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3
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Guilabert M, Prades J, Borras JM, Maestu I, Guerra JA, Fumadó L, Mira JJ. A Web-Based Self-assessment Model for Evaluating Multidisciplinary Cancer Teams in Spain: Development and Validation Pilot Study. J Med Internet Res 2022; 24:e29063. [PMID: 35266870 PMCID: PMC8949680 DOI: 10.2196/29063] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Revised: 08/02/2021] [Accepted: 08/12/2021] [Indexed: 11/17/2022] Open
Abstract
Background Tumor boards constitute the main consensus and clinical decision–making body of multidisciplinary teams (MDTs) in cancer care. With the increasing clinical complexity of treatment options (eg, targeted therapies, multimodal treatments) and the progressive incorporation of new areas of intervention (eg, survivorship care), tumor boards are now required to play a central role in all cancer processes. However, although frameworks are in place to evaluate MDT quality, only few web-based tools are available for this purpose; indeed, no web-based MDT evaluation tools have been developed for or adapted to the Spanish National Health System. Objective The first aim of this study was to develop a web-based self-assessment model (Autoevaluación de Equipos Multidisciplinares de Atención al Cáncer [AEMAC]) for evaluating multidisciplinary cancer teams in Spain and the second aim was to validate this tool by testing its metric properties, acceptability, and usability. Methods We designed and validated the AEMAC program in 3 stages. In the first stage (research), we reviewed the available scientific evidence and performed a qualitative case study of good practice in multidisciplinary care within the Spanish National Health System (n=4 centers and 28 health care professionals). The results were used to define the thematic areas and quality criteria for the self-evaluation model, which were then discussed and validated by a group of experts. The second stage (development) involved the technological development of a web app that would be accessible from any mobile device. In the third stage (piloting and validation), we conducted 4 pilot tests (n=15 tumor boards, 243 professionals) and used the results to analyze the acceptability and usefulness of the tool. Results We designed a self-assessment model based on 5 thematic areas encompassing a total of 25 quality components, which users rated on a 3-option development scale. The evaluation process, which was managed entirely from the web app, consisted of individual self-assessment, group prioritization, and creation of an improvement plan. Cronbach alpha (.86), McDonald’s omega (0.88), and various fit indices (comparative fit index between 0.95 and 1 and goodness-of-fit index between 0.97 and 0.99 for all 5 aspects) confirmed internal consistency. The mean rating for overall satisfaction with the tool and for consistency between the content of the tool and the reality of tumor boards was 7.6 out of 10. Conclusions The results obtained during the period of research and piloting of the AEMAC program showed that it has an appropriate structure and metric properties and could therefore be implemented in a real context and generalized to other hospitals. As a virtual tool, it helps to measure the key aspects of MDT quality, such as effectiveness of collaboration and communication, leadership, and the organizational environment.
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Affiliation(s)
| | - Joan Prades
- Department of Health, Catalonian Cancer Strategy, Barcelona, Spain.,Department of Clinical Sciences, University of Barcelona, Instituto de Investigación Biomédica de Bellvitge, Barcelona, Spain
| | - Josep M Borras
- Department of Health, Catalonian Cancer Strategy, Barcelona, Spain.,Department of Clinical Sciences, University of Barcelona, Instituto de Investigación Biomédica de Bellvitge, Barcelona, Spain
| | - Inmaculada Maestu
- Medical Oncology Service, Doctor Peset University Hospital, Valencia, Spain
| | - Juan Antonio Guerra
- Department of Hematology and Oncology, Fuenlabrada University Hospital, Fuenlabrada, Spain
| | - Lluís Fumadó
- Urological Cancer Functional Unit, Hospital del Mar-Parc de Salut Mar-IMIM, Barcelona, Spain
| | - José Joaquin Mira
- Health Psychology Department, Miguel Hernandez University, Elche, Spain.,Atenea Research Group, Foundation for the Promotion of Health and Biomedical Research, Sant Joan d'Alacant, Spain.,Alicante-Sant Joan Health Department, Alicante, Spain
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- see Authors' Contributions,
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4
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Belda-Ferre M, Garcia-Segui A, Pacheco-Bru JJ, Valencia-Guadalajara VJ, Verdú-Verdú LP, Sánchez-Cano E, Chillón-Sempere FS, Vázquez-Mazón F. Multicenter study on multidisciplinary committees in advanced prostate cancer. Actas Urol Esp 2022; 46:106-113. [PMID: 35135737 DOI: 10.1016/j.acuroe.2021.09.004] [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] [Received: 06/20/2021] [Accepted: 09/12/2021] [Indexed: 06/14/2023]
Abstract
INTRODUCTION AND OBJECTIVE Although Multidisciplinary Teams (MDTs) are recommended in the management of Advanced Prostate Cancer (APC), their functioning in real practice has been poorly evaluated. We carried out a multicenter study with the objective of evaluating the functioning of uro-oncology MDTs in 6 hospitals. MATERIALS AND METHODS A descriptive cross-sectional study was performed. The level of Compliance with the Fundamental Quality Requirements (CFQR) of the MDTs was evaluated by means of a questionnaire filled out by the coordinators of the MDTs in each hospital. The information on the perspective of the members of the MDTs was evaluated through an anonymous survey. RESULTS A high level of CFQR in MDTs was evidenced (75%), showing deficiencies in terms of protocol update, agendas, audits, and scientific production. The survey was answered by 62.32% of the 69 physicians surveyed (urologists, oncologists, radiation therapists, radiologists, and pathologists). The 88.4% consider the duration of the meetings appropriate. There are disparate opinions concerning the protection of the MDT meeting time as well as protocol update. Of the patients with APC presented at the MDTs meeting, 62,8% require intervention from two specialties. Only 50% of respondents believe that all CRPC cases are discussed and that there is a prior agenda. The decisions made by the MDTs are reflected in the clinical history in 65.1% and are binding only in 60.5% of the cases. Half of the respondents have not been trained in MDTs. Most participants (90.7%) agree on the fact that MDTs. convey benefits. CONCLUSIONS The evaluations of the MDTs identify rectifiable deficiencies by modifying hospital inertia and care planning.
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Affiliation(s)
- M Belda-Ferre
- Servicio de Urología, Hospital General Universitario de Elche, Elche, Alicante, Spain.
| | - A Garcia-Segui
- Servicio de Urología, Hospital General Universitario de Elche, Elche, Alicante, Spain
| | - J J Pacheco-Bru
- Servicio de Urología, Hospital Universitari Sant Joan d'Alacant, Alicante, Spain
| | | | - L P Verdú-Verdú
- Servicio de Urología, Hospital Marina Baixa, Alicante, Spain
| | - E Sánchez-Cano
- Servicio de Urología, Hospital Universitario del Vinalopó, Alicante, Spain
| | - F S Chillón-Sempere
- Servicio de Urología, Hospital General Universitario de Alicante, Alicante, Spain
| | - F Vázquez-Mazón
- Servicio de Oncología, Hospital General Universitario de Elche, Alicante, Spain
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5
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Belda-Ferre M, Garcia-Segui A, Pacheco-Bru J, Valencia-Guadalajara V, Verdú-Verdú L, Sánchez-Cano E, Chillón-Sempere S, Vázquez-Mazón F. Estudio multicéntrico sobre los comités multidisciplinarios en cáncer de próstata avanzado. Actas Urol Esp 2022. [DOI: 10.1016/j.acuro.2021.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Guirado M, Sanchez-Hernandez A, Pijuan L, Teixido C, Gómez-Caamaño A, Cilleruelo-Ramos Á. Quality indicators and excellence requirements for a multidisciplinary lung cancer tumor board by the Spanish Lung Cancer Group. Clin Transl Oncol 2021; 24:446-459. [PMID: 34665437 PMCID: PMC8525055 DOI: 10.1007/s12094-021-02712-8] [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: 08/03/2021] [Accepted: 09/18/2021] [Indexed: 12/24/2022]
Abstract
Multidisciplinary care is needed to decide the best therapeutic approach and to provide optimal care to patients with lung cancer (LC). Multidisciplinary teams (MDTs) are optimal strategies for the management of patients with LC and have been associated with better outcomes, such as an increase in quality of life and survival. The Spanish Lung Cancer Group has promoted this review about the current situation of the existing national LC-MDTs, which also offers a set of excellence requirements and quality indicators to achieve the best care in any patient with LC. Time and sufficient resources; leadership; administrative and institutional support; and recording of activity are key factors for the success of LC-MDTs. A set of excellence requirements in terms of staff, resources and organization of the LC-MDT have been proposed. At last, a list of quality indicators has been agreed to achieve and measure the performance of current LC-MDTs.
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Affiliation(s)
- M Guirado
- Medical Oncology Department, Hospital General Universitario de Elche, 03203, Elche, Spain
| | - A Sanchez-Hernandez
- Medical Oncology Department, Consorcio Hospitalario Provincial de Castellón, 12002, Castellón de la Plana, Spain
| | - L Pijuan
- Pathology Department, Bellvitge University Hospital, 08907, L'Hospitalet de Llobregat, Spain
| | - C Teixido
- Thoracic Oncology Unit, Department of Pathology, IDIBAPS, Hospital Clinic of Barcelona, C. de Villarroel, 170, 08036, Barcelona, Spain.
| | - A Gómez-Caamaño
- Department of Radiation Oncology, Hospital Clínico Universitario Santiago de Compostela, 15706, Santiago de Compostela, Spain
| | - Á Cilleruelo-Ramos
- Thoracic Surgery Department, Hospital Clínico Universitario Valladolid, 47005, Valladolid, Spain
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7
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Sabell Pérez-Salgado F, Vázquez-Estévez S, Anido-Herranz U, Blanco-Parra M, Casas-Nebra FJ, Fernández-Calvo O, Lázaro-Quintela M, López-García S. Approach of the patient with renal cancer: Is there a collaboration between urology and oncology? Actas Urol Esp 2018; 42:1-4. [PMID: 28587846 DOI: 10.1016/j.acuro.2017.04.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2017] [Revised: 04/18/2017] [Accepted: 04/19/2017] [Indexed: 12/24/2022]
Affiliation(s)
| | - S Vázquez-Estévez
- Servicio de Oncología Médica, Hospital Universitario Lucus Augusti, Lugo, España
| | - U Anido-Herranz
- Servicio de Oncología Médica, Hospital Clínico Universitario de Santiago de Compostela, Santiago de Compostela, A Coruña, España
| | - M Blanco-Parra
- Servicio de Urología, Hospital Clínico Universitario de Santiago de Compostela, Santiago de Compostela, A Coruña, España
| | - F J Casas-Nebra
- Servicio de Urología, Hospital Universitario Lucus Augusti, Lugo, España
| | - O Fernández-Calvo
- Servicio de Oncología Médica, Complejo Universitario de Orense, Ourense, España
| | - M Lázaro-Quintela
- Servicio de Oncología Médica, Complejo Universitario de Vigo, Vigo, Pontevedra, España
| | - S López-García
- Servicio de Urología, Complejo Universitario de Vigo, Vigo, Pontevedra, España
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8
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Cortis LJ, Ward PR, McKinnon RA, Koczwara B. Integrated care in cancer: What is it, how is it used and where are the gaps? A textual narrative literature synthesis. Eur J Cancer Care (Engl) 2017; 26. [PMID: 28426142 DOI: 10.1111/ecc.12689] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/13/2017] [Indexed: 11/30/2022]
Abstract
Integrated care is an underpinning concept of contemporary health care policy proffered as a strategy to overcome the fragmentations in care encountered by people with complex care needs (Shaw et al. [2011] What is Integrated Care? An Overview of Integrated Care in the NHS). Cancer patients have potential to benefit from such policy, often having needs that extend beyond cancer. This paper seeks to understand how the concept of integrated care is used in the cancer literature. A search of leading databases was conducted for original research relating to integrated care or an integration intervention aiming to improve outcomes of cancer patients, and analysed using textual narrative synthesis. 38 papers were included, each with a focus on improving cancer-specific aspects of care enhancing the capabilities of the cancer multidisciplinary team. Of the eight studies involving integration between the cancer service and other care providers, all focused on utilising the external provider to deliver aspects of cancer care or placed them in a passive role, as survey participant, a recipient of cancer-related clinical information or as the comparator "usual care" arm. Within the cancer literature, integration is predominantly used to describe initiatives to improve cancer-related aspects of care. Less attention is given to integration initiatives that enhance coordination across levels of the healthcare system or service providers.
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Affiliation(s)
- L J Cortis
- Flinders Centre for Innovation in Cancer, Flinders University, Adelaide, SA, Australia
| | - P R Ward
- Discipline of Public Health, School of Health Sciences, Flinders University, Adelaide, SA, Australia
| | - R A McKinnon
- Flinders Centre for Innovation in Cancer, Flinders University, Adelaide, SA, Australia
| | - B Koczwara
- Flinders Centre for Innovation in Cancer, Flinders University, Adelaide, SA, Australia
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9
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Garralda E, Hasselaar J, Carrasco JM, Van Beek K, Siouta N, Csikos A, Menten J, Centeno C. Integrated palliative care in the Spanish context: a systematic review of the literature. BMC Palliat Care 2016; 15:49. [PMID: 27177608 PMCID: PMC4865984 DOI: 10.1186/s12904-016-0120-9] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2016] [Accepted: 05/04/2016] [Indexed: 11/10/2022] Open
Abstract
Background Integrated palliative care (IPC) involves bringing together administrative, organisational, clinical and service aspects in order to achieve continuity of care between all actors involved in the care network of patients receiving palliative care (PC) services. The purpose of this study is to identify literature on IPC in the Spanish context, either in cancer or other advanced chronic diseases. Methods Systematic review of the literature about IPC published in Spain between 1995 and 2013. Sources searched included PubMed, Cochrane Library, Cinahl, the national palliative care Journal (Medicina Paliativa), and Google. Evidence on IPC in care models, pathways, guidelines and other relevant documents were searched. Additionally, data were included from expert sources. Elements of IPC were considered based on the definition of IPC and the Emmanuel´s IPC tool. The main inclusion criterion was a comprehensive description of PC integration. Results Out of a total of 2,416 titles screened, 49 were included. We found two models describing IPC interventions achieving continuity and appropriateness of care as a result, 12 guidelines or pathways (most of them with a general approach including cancer and non-cancer and showing a theoretical IPC inclusion as measured by Emmanuel’s tool) and 35 other significant documents as for their context relevance (17 health strategy documents, 14 analytical studies and 4 descriptive documents). These last documents comprised respectively: regional and national plans with an IPC inclusion evidence, studies focused on IPC into primary care and resource utilisation; and descriptions of fruitful collaboration programmes between PC teams and oncology departments. Conclusions The results show that explications of IPC in the Spanish literature exist, but that there is insufficient evidence of its impact in clinical practice. This review may be of interest for Spanish-speaking countries and for others seeking to know the status of IPC in the literature in their home nations. Electronic supplementary material The online version of this article (doi:10.1186/s12904-016-0120-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Eduardo Garralda
- Atlantes Research Programme, Institute for Culture and Society, University of Navarra, Campus Universitario, 31009, Pamplona, Navarra, Spain. .,Instituto de investigación sanitaria de Navarra (IdiSNA), Pamplona, Navarra, Spain.
| | - Jeroen Hasselaar
- Department of Anesthesiology, Pain and Palliative Medicine, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - José Miguel Carrasco
- Atlantes Research Programme, Institute for Culture and Society, University of Navarra, Campus Universitario, 31009, Pamplona, Navarra, Spain.,Instituto de investigación sanitaria de Navarra (IdiSNA), Pamplona, Navarra, Spain
| | - Karen Van Beek
- Department of Radiation-Oncology and Palliative Medicine, University Hospital Gasthuisberg, Leuven, Belgium
| | - Naouma Siouta
- Department of Radiation-Oncology and Palliative Medicine, University Hospital Gasthuisberg, Leuven, Belgium
| | - Agnes Csikos
- Faculty of Medicine, Institute of Family Medicine, University of Pécs Medical School, Pécs, Hungary
| | - Johan Menten
- Department of Radiation-Oncology and Palliative Medicine, University Hospital Gasthuisberg, Leuven, Belgium
| | - Carlos Centeno
- Atlantes Research Programme, Institute for Culture and Society, University of Navarra, Campus Universitario, 31009, Pamplona, Navarra, Spain.,Instituto de investigación sanitaria de Navarra (IdiSNA), Pamplona, Navarra, Spain
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10
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Díez JJ, Galofré JC, Oleaga A, Grande E, Mitjavila M, Moreno P. [Consensus statement for accreditation of multidisciplinary thyroid cancer units]. ACTA ACUST UNITED AC 2015; 63:e1-15. [PMID: 26456892 DOI: 10.1016/j.endonu.2015.07.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2015] [Revised: 07/21/2015] [Accepted: 07/22/2015] [Indexed: 12/24/2022]
Abstract
Thyroid cancer is the leading endocrine system tumor. Great advances have recently been made in understanding of the origin of these tumors and the molecular biology that makes them grow and proliferate, which have been associated to improvements in diagnostic procedures and increased availability of effective local and systemic treatments. All of the above makes thyroid cancer a paradigm of how different specialties should work together to achieve the greatest benefit for the patients. Coordination of all the procedures and patient flows should continue throughout diagnosis, treatment, and follow-up, and is essential for further optimization of resources and time. This manuscript was prepared at the request of the Working Group on Thyroid Cancer of the Spanish Society of Endocrinology and Nutrition, and is aimed to provide a consensus document on the definition, composition, requirements, structure, and operation of a multidisciplinary team for the comprehensive care of patients with thyroid cancer. For this purpose, we have included contributions by several professionals from different specialties with experience in thyroid cancer treatment at centers where multidisciplinary teams have been working for years, with the aim of developing a practical consensus applicable in clinical practice.
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Affiliation(s)
- Juan José Díez
- Servicio de Endocrinología, Hospital Universitario Ramón y Cajal, Universidad de Alcalá de Henares, Madrid, España.
| | - Juan Carlos Galofré
- Departamento de Endocrinología, Clínica Universidad de Navarra, Pamplona, España
| | - Amelia Oleaga
- Servicio de Endocrinología, Hospital Universitario Basurto, Bilbao, España
| | - Enrique Grande
- Servicio de Oncología Médica, Hospital Universitario Ramón y Cajal, Madrid, España
| | - Mercedes Mitjavila
- Servicio de Medicina Nuclear, Hospital Universitario Puerta de Hierro, Madrid, España
| | - Pablo Moreno
- Servicio de Cirugía General y Digestiva, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, España
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Dew K, Stubbe M, Signal L, Stairmand J, Dennett E, Koea J, Simpson A, Sarfati D, Cunningham C, Batten L, Ellison-Loschmann L, Barton J, Holdaway M. Cancer care decision making in multidisciplinary meetings. QUALITATIVE HEALTH RESEARCH 2015; 25:397-407. [PMID: 25281239 DOI: 10.1177/1049732314553010] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
Little research has been undertaken on the actual decision-making processes in cancer care multidisciplinary meetings (MDMs). This article was based on a qualitative observational study of two regional cancer treatment centers in New Zealand. We audiorecorded 10 meetings in which 106 patient cases were discussed. Members of the meetings categorized cases in varying ways, drew on a range of sources of authority, expressed different value positions, and utilized a variety of strategies to justify their actions. An important dimension of authority was encountered authority-the authority a clinician has because of meeting the patient. The MDM chairperson can play an important role in making explicit the sources of authority being drawn on and the value positions of members to provide more clarity to the decision-making process. Attending to issues of process, authority, and values in MDMs has the potential to improve cancer care decision making and ultimately, health outcomes.
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Affiliation(s)
- Kevin Dew
- Victoria University of Wellington, Wellington, New Zealand
| | | | | | | | | | | | | | | | | | | | | | - Josh Barton
- Victoria University of Wellington, Wellington, New Zealand
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12
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Multidisciplinary cancer care may impact on the postoperative mortality and survival of patients with oesophageal and oesophagogastric junction cancer: a retrospective cohort study. Clin Transl Oncol 2014; 17:247-56. [DOI: 10.1007/s12094-014-1221-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2014] [Accepted: 08/23/2014] [Indexed: 10/24/2022]
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13
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Beermann S, Chakkalakal D, Muckelbauer R, Weißbach L, Holmberg C. "We talk it over"--mixed-method study of interdisciplinary collaborations in private practice among urologists and oncologists in Germany. BMC Cancer 2014; 14:746. [PMID: 25282479 PMCID: PMC4197317 DOI: 10.1186/1471-2407-14-746] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2014] [Accepted: 09/23/2014] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Utilisation of multidisciplinary teams is considered the best approach to care and treatment for cancer patients. However, the multidisciplinary approach has mainly focused on inpatient care rather than routine outpatient care. The situation in private practice care and outpatient care is gradually changing. We aimed to 1), investigate interdisciplinary cooperations in the care of tumor patients among urologists and oncologists in the community setting, 2), establish an estimate of the prevalence of cooperation among oncologists and organ-specific providers in community settings in Germany and 3), characterise existing cooperations among oncologists and urologists. METHODS We conducted simultaneously a cross-sectional survey with private practice urologists (n=1,925) and a qualitative study consisting of semi-structured interviews with urologists and oncologists (n=42), primarily with private practices, who had indicated cooperation the care of urological tumor patients. RESULTS Most of the participants (66%) treated their own tumor patients. When physicians referred patients, they did so for co- and subsequent treatments (43%). Most cooperating urologists were satisfied with the partnership and appreciated the competency of their partners. Qualitative interviews revealed two types of collaboration in the community setting: formal and informal. Collaborations were usually ongoing with many physicians and depended equally on both patient preference and diagnosis. CONCLUSION Joint patient treatment requires clear delineation of roles and responsibilities and simple means of communication. Formal frameworks should allow for incorporation of patients' critical role in collaboration decisions in treatment and care.
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Affiliation(s)
| | | | | | | | - Christine Holmberg
- Berlin School of Public Health, Charité - Universitätsmedizin Berlin, Seestr 73, Haus 10, 10117 Berlin, Germany.
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Prades J, Remue E, van Hoof E, Borras JM. Is it worth reorganising cancer services on the basis of multidisciplinary teams (MDTs)? A systematic review of the objectives and organisation of MDTs and their impact on patient outcomes. Health Policy 2014; 119:464-74. [PMID: 25271171 DOI: 10.1016/j.healthpol.2014.09.006] [Citation(s) in RCA: 246] [Impact Index Per Article: 24.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2013] [Revised: 09/08/2014] [Accepted: 09/09/2014] [Indexed: 02/06/2023]
Abstract
Multidisciplinary teams (MDTs) are considered the gold standard of cancer care in many healthcare systems, but a clear definition of their format, scope of practice and operational criteria is still lacking. The aims of this review were to assess the impact of MDTs on patient outcomes in cancer care and identify their objectives, organisation and ability to engage patients in their care. We conducted a systematic review of the literature in the Medline database. Fifty-one peer-reviewed papers were selected from November 2005 to June 2012. MDTs resulted in better clinical and process outcomes for cancer patients, with evidence of improved survival among colorectal, head and neck, breast, oesophageal and lung cancer patients in the study period. Also, it was observed that MDTs have been associated with changes in clinical diagnostic and treatment decision-making with respect to urological, pancreatic, gastro-oesophageal, breast, melanoma, bladder, colorectal, prostate, head and neck and gynaecological cancer. Evidence is consistent in showing positive consequences for patients' management in multiple dimensions, which should encourage the development of structured multidisciplinary care, minimum standards and exchange of best practices.
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Affiliation(s)
- Joan Prades
- Catalan Cancer Plan, Duran i Reynals Hospital, 199-203 Gran Via de l'Hospitalet Av., Hospitalet de Llobregat, 08908 Barcelona, Spain.
| | - Eline Remue
- Belgian Cancer Centre, Scientific Institute of Public Health, Rue Juliette Wytsman 14, 1050 Brussels, Belgium.
| | - Elke van Hoof
- Experimental and applied psychology, Faculty of educational an psychology sciences, Vrije Universiteit Brusel, Brussels, Belgium.
| | - Josep M Borras
- Catalan Cancer Plan, Duran i Reynals Hospital, 199-203 Gran Via de l'Hospitalet Av., Hospitalet de Llobregat, 08908 Barcelona, Spain; Department of Clinical Sciences, Bellvitge Biomedical Research Institute (IDIBELL), University of Barcelona (UB), Spain.
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15
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Sarkar S, Arora S, Lamb BW, Green JSA, Sevdalis N, Darzi A. Case review in urology multidisciplinary team meetings: What members think of its functioning. JOURNAL OF CLINICAL UROLOGY 2014. [DOI: 10.1177/2051415814532459] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Objective: To improve communication and decision making between specialists, multidisciplinary teams (MDTs) were introduced with the premise they would improve cancer care for patients. Minimal evidence exists on MDT functionality. We investigated MDT members’ views on barriers to optimal functioning and explored their suggestions for improvements. Materials and methods: Twenty urology MDT members from seven hospitals including surgeons, oncologists, pathologists, radiologists and clinical nurse specialists took part in a semi-structured interview study. Interviews focused on information presentation, case discussion, factors affecting the multidisciplinary team meeting (MDM) and potential improvements. Interviews were transcribed and analysed through emergent theme analysis. Results: Factors negatively influencing the MDMs included insufficient time to prepare cases so that enough information is available to make appropriate decisions; absence of the clinician in charge or not knowing the patient; and lack of a systematic approach to case discussion. Recommendations included protected time for case preparation, focusing on performance and comorbidities of the patient, standardising the MDT meeting and improving case selection. Conclusions: MDTs in urology have contributed to advances in cancer care but there is significant scope for further improvement. Implementing recommendations from team members on the front line may help drive quality in this sensitive domain.
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Affiliation(s)
- Somita Sarkar
- Department of Surgery and Cancer, Imperial College London, St Mary’s Hospital, UK
| | - Sonal Arora
- Department of Surgery and Cancer, Imperial College London, St Mary’s Hospital, UK
| | - Benjamin W Lamb
- Department of Surgery and Cancer, Imperial College London, St Mary’s Hospital, UK
- Whipps Cross University Hospital, UK
| | - James SA Green
- Whipps Cross University Hospital, UK
- Faculty of Health and Social Care, London South Bank University, UK
| | - Nick Sevdalis
- Department of Surgery and Cancer, Imperial College London, St Mary’s Hospital, UK
| | - Ara Darzi
- Department of Surgery and Cancer, Imperial College London, St Mary’s Hospital, UK
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16
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Clinical audit of multidisciplinary care at a medium-sized hospital in Spain. World J Surg Oncol 2014; 12:53. [PMID: 24597686 PMCID: PMC3973861 DOI: 10.1186/1477-7819-12-53] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2013] [Accepted: 02/10/2014] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Multidisciplinary care is a key enabler in the provision of high quality care for cancer patients. Despite compelling evidence supporting their benefit to patients and for providers, multidisciplinary cancer conferences (MCC) are not universally occurring. Team composition of MCC reflects the multidisciplinary nature of the body. Lack of nursing input can have a negative impact on team decision making. The objective of this study was to evaluate multidisciplinary care and adherence to national recommendations at a medium-sized hospital through a clinical audit of cancer conferences and clinical records. METHODS A total of 77 multidisciplinary cancer conferences were visited and 496 electronic health records were reviewed. The regularity of meetings and multidisciplinary attendance were evaluated. Each electronic health record was checked to verify documented prospective discussion before any treatment was started. RESULTS Nine multidisciplinary teams meet on a weekly or biweekly basis at the hospital with an average number of ten people and six different specialties represented. Average duration of meetings was 46.8 min. Though most patients (64.5%) were discussed at some point at the relevant cancer conference, only 40% had a documented multidisciplinary team discussion prior to the first treatment. Pathological stage (pTNM) was documented in 53.6% of clinical records. CONCLUSIONS Nursing representatives should be included as usual attendees at cancer conferences. Prospective discussion of all cancer cases should be encouraged. Use of checklists and systematic collection of key information, specifically cancer staging, could improve clinical documentation in the electronic clinical record.
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Calvo FA, Murillo LA, Sallabanda M, Martinez-Villanueva J, Herranz R, Sole CV. Intraoperative radiation therapy, opportunities for clinical practice normalization: MEDTING, a scientific platform. Rep Pract Oncol Radiother 2013; 19:253-8. [PMID: 25061518 DOI: 10.1016/j.rpor.2013.08.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2013] [Revised: 06/01/2013] [Accepted: 08/22/2013] [Indexed: 11/29/2022] Open
Abstract
AIM To use a platform to analyze a subgroup specialized in evaluation of patients candidates to IOERT. BACKGROUND Medting is a project that was initiated to support daily clinical activity, knowledge management and medical education by sharing information with other physicians. The project began at the "Hospital General Universitario Gregorio Marañón", which has a dedicated oncology physician's multi-specialist committee. There are many scientific social networks all over the world. Medting is the only platform that specializes in healthcare and has been developed for hospital purposes. MATERIALS AND METHODS Medting brings all together the relevant clinical information from electronic medical records and picture archiving about the patient to study. Subplatform Medting-IORT was created on February 2, 2012 at the Hospital General Universitario Gregorio Marañon. It has 23 members, have been registered 18 cases with 238 multimedia images. RESULTS Medting started with 28 physicians and five departments. After 6 months, proof of concept period, there are 225 physicians, more than 120 medical students and 39 departments in 3 hospitals using the scientific social network. Furthermore, the project is being extended on three more hospitals in Madrid. CONCLUSION Medting gives the opportunity to oncology physicians to access all relevant clinical information with the ability to discuss case notes and view images at any time. The impact of the Medting platform in a subgroup working team to evaluate IOERT patients candidates is included in the analysis. The use of a constantly updated repository based on real cases and the documentation of the internal activity of the tumor committee beyond the medical record, has become an extraordinary tool for teaching, training and learning.
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Affiliation(s)
- Felipe A Calvo
- Department of Oncology, Hospital General Universitario Gregorio Marañón, Madrid, Spain ; School of Medicine, Complutense University, Madrid, Spain ; Institute for Sanitary Research, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | | | | | | | - Rafael Herranz
- Department of Oncology, Hospital General Universitario Gregorio Marañón, Madrid, Spain ; School of Medicine, Complutense University, Madrid, Spain ; Institute for Sanitary Research, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Claudio V Sole
- Department of Oncology, Hospital General Universitario Gregorio Marañón, Madrid, Spain ; School of Medicine, Complutense University, Madrid, Spain ; Institute for Sanitary Research, Hospital General Universitario Gregorio Marañón, Madrid, Spain
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Mangel L, Kövér E, Szilágyi I, Varga Z, Bércesi E, Nagy Z, Holcz T, Karádi O, Farkas R, Csák S, Csere T, Kásler M. [Novel quality assurance method in oncology: the two-level, multi-disciplinary and oncotherapy oncology team system]. Orv Hetil 2012; 153:1984-91. [PMID: 23220364 DOI: 10.1556/oh.2012.29512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
By now therapy decision taken by a multi-disciplinary oncology team in cancer care has become a routine method in worldwide. However, multi-disciplinary oncology team has to face more and more difficulties in keeping abreast with the fast development in oncology science, increasing expectations, and financial considerations. Naturally the not properly controlled decision mechanisms, the permanent lack of time and shortage of professionals are also hindering factors. Perhaps it would be a way out if the staff meetings and discussions of physicians in the oncology departments were transformed and provided with administrative, legal and decision credentials corresponding to those of multi-disciplinary oncology team. The new form of the oncotherapy oncoteam might be able to decide the optimal and particular treatment after previous consultation with the patient. The oncotherapy oncoteam is also suitable to carry out training and tasks of a cancer centre and by diminishing the psychological burden of the doctors it contributes to an improved patient care. This study presents the two-level multi-disciplinary and oncotherapy oncology team system at the University of Pécs including the detailed analysis of the considerations above.
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Affiliation(s)
- László Mangel
- Pécsi Tudományegyetem, Klinikai Központ Onkoterápiás Intézet Pécs Édesanyák útja.
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[We must remove the taxi driver from the tumour committee]. ACTA ACUST UNITED AC 2011; 27:117-22. [PMID: 22119226 DOI: 10.1016/j.cali.2011.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2011] [Revised: 08/09/2011] [Accepted: 08/30/2011] [Indexed: 11/23/2022]
Abstract
The increasing complexity of cancer care makes organisation of clinical decision-making one of the key elements in high-quality cancer care. The great number of professionals involved in this disease means that communication and co-ordination among such professionals is of pivotal importance. The prospect of an organised multidisciplinary care is highlighted for its ability to move from a sequential model of care to progress towards an inclusive process led by a multidisciplinary team. Scientific evidence shows that such a perspective contributes to improved survival and quality of life of cancer patients. In the context of highly frequent, costly and clinically complex cancer diseases, the priority is to develop a different approach to its management, based on the expertise of professionals and teams by tumour location. The organisation and management of many hospitals, however, does not generally reflect this dimension. The process of care is based on very rigid hospital services which restrict cross-communication. This hinders a redistribution of responsibilities of the professionals with the greatest potential to improve clinical effectiveness. The present paper shows the difficulty in developing a model of integrated professional cooperation and identifies the different models of implementation of multidisciplinary care, using cancer as an example, in the context of the Spanish National Health System.
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