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Hong TH, Kim TH, Lee G, Yun J, Jeon YJ, Lee J, Shin S, Park SY, Cho JH, Choi YS, Shim YM, Sun JM, Oh D, Kim HK. Practice pattern and risk of not receiving planned surgery after neoadjuvant chemoradiotherapy for locally advanced oesophageal squamous cell carcinoma. Eur J Cardiothorac Surg 2024; 66:ezae253. [PMID: 38913852 DOI: 10.1093/ejcts/ezae253] [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: 09/13/2023] [Revised: 06/01/2024] [Accepted: 06/21/2024] [Indexed: 06/26/2024] Open
Abstract
OBJECTIVES Unlike the initial plan, some patients with oesophageal squamous cell carcinoma cannot or do not receive surgery after neoadjuvant chemoradiotherapy (nCRT). This study aimed to report the epidemiology of patients not receiving surgery after nCRT and to evaluate the potential risk of refusing surgery. METHODS We analysed patients with clinical stage T3-T4aN0M0 or T1-T4aN1-N3M0 oesophageal squamous cell carcinoma who underwent nCRT as an initial treatment intent between January 2005 and March 2020. Patients not receiving surgery were categorized using predefined criteria. To evaluate the risk of refusing surgery, a propensity-matched comparison with those who received surgery was performed. Recurrence-free (RFS) and overall survival (OS) was compared between groups, according to clinical response to nCRT. RESULTS Among the study population (n = 715), 105 patients (14.7%) eventually failed to reach surgery. There were three major patterns of not receiving surgery: disease progression before surgery (n = 25), functional deterioration at reassessment (n = 47), and patient's refusal without contraindications (n = 33). After propensity-score matching, the RFS curves of the surgery group and the refusal group were significantly different (P < 0.001), while OS curves were not significantly different (P = 0.069). In patients who achieved clinical complete response on re-evaluation, no significant difference in the RFS curves (P = 0.382) and in the OS curves (P = 0.290) was observed between the surgery group and the refusal group. However, among patients who showed partial response or stable disease on re-evaluation, the RFS and OS curves of the refusal group were overall significantly inferior compared to those of the surgery group (both P < 0.001). The 5-year RFS rates were 10.3% for the refusal group and 48.2% for the surgery group, and the 5-year OS rates were 8.2% for the refusal group and 46.1% for the surgery group. CONCLUSIONS Patient's refusal remains one of the major obstacles in completing the trimodality therapy for oesophageal squamous cell carcinoma. Refusing surgery when offered may jeopardize oncological outcome, particularly in those with residual disease on re-evaluation after nCRT. These results provide significant implications for consulting patients who are reluctant to oesophagectomy after nCRT.
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Affiliation(s)
- Tae Hee Hong
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
- Department of Thoracic and Cardiovascular Surgery, Severance Hospital, Yonsei University School of Medicine, Seoul, Republic of Korea
| | - Tae Ho Kim
- Department of Thoracic and Cardiovascular Surgery, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Republic of Korea
| | - Genehee Lee
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Jeonghee Yun
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Yeong Jeong Jeon
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Junghee Lee
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Sumin Shin
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
- Department of Thoracic and Cardiovascular Surgery, School of Medicine, Ewha Womans University, Mok-dong Hospital, Seoul, Republic of Korea
| | - Seong Yong Park
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Jong Ho Cho
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Yong Soo Choi
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Young Mog Shim
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Jong-Mu Sun
- Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Dongryul Oh
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Hong Kwan Kim
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
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Booker J, Penn J, Koh CH, Newall N, Rowland D, Sinha S, Hanrahan JG, Williams SC, Sayal P, Marcus HJ. Mapping patient education encounters in elective surgery: a cohort study and cross-sectional survey. BMJ Open Qual 2024; 13:e002810. [PMID: 38802270 PMCID: PMC11131119 DOI: 10.1136/bmjoq-2024-002810] [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: 02/22/2024] [Accepted: 05/17/2024] [Indexed: 05/29/2024] Open
Abstract
OBJECTIVE Develop a process map of when patients learn about their proposed surgery and what resources patients use to educate themselves. DESIGN A mixed methods design, combining semistructured stakeholder interviews, quantitative validation using electronic healthcare records (EHR) in a retrospective cohort and a cross-sectional patient survey. SETTING A single surgical centre in the UK. PARTICIPANTS Fourteen members of the spinal multidisciplinary team were interviewed to develop the process map.This process map was validated using the EHR of 50 patients undergoing elective spine surgery between January and June 2022. Postprocedure, feedback was gathered from 25 patient surveys to identify which resources they used to learn about their spinal procedure. Patients below the age of 18 or who received emergency surgery were excluded. INTERVENTIONS Elective spine surgery and patient questionnaires given postoperatively either on the ward or in follow-up clinic. PRIMARY AND SECONDARY OUTCOME MEASURES The primary outcome was the percentage of the study cohort that was present at encounters on the process map. Key timepoints were defined if >80% of patients were present. The secondary outcome was the percentage of the study cohort that used educational resources listed in the patient questionnaire. RESULTS There were 342 encounters which occurred across the cohort, with 16 discrete event categories identified. The initial surgical clinic (88%), anaesthetic preoperative assessment (96%) and admission for surgery (100%) were identified as key timepoints. Surveys identified that patients most used verbal information from their surgeon (100%) followed by written information from their surgeon (52%) and the internet (40%) to learn about their surgery. CONCLUSIONS Process mapping is an effective method of illustrating the patient pathway. The initial surgical clinic, anaesthetic preoperative assessment and surgical admission are key timepoints where patients receive information. This has future implications for guiding patient education interventions to focus at key timepoints.
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Affiliation(s)
- James Booker
- Victor Horsely Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, London, UK
- Wellcome / EPSRC Centre for Interventional and Surgical Sciences, University College London, London, UK
| | - Jack Penn
- Victor Horsely Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, London, UK
- Wellcome / EPSRC Centre for Interventional and Surgical Sciences, University College London, London, UK
| | - Chan Hee Koh
- Victor Horsely Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, London, UK
- Wellcome / EPSRC Centre for Interventional and Surgical Sciences, University College London, London, UK
- Queen Square Institute of Neurology, University College London, London, UK
- Neurosciences Department, Cleveland Clinic London, London, UK
| | - Nicola Newall
- Victor Horsely Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, London, UK
- Wellcome / EPSRC Centre for Interventional and Surgical Sciences, University College London, London, UK
| | - David Rowland
- Victor Horsely Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, London, UK
| | - Siddharth Sinha
- Victor Horsely Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, London, UK
- Wellcome / EPSRC Centre for Interventional and Surgical Sciences, University College London, London, UK
| | - John G Hanrahan
- Victor Horsely Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, London, UK
- Wellcome / EPSRC Centre for Interventional and Surgical Sciences, University College London, London, UK
| | - Simon C Williams
- Wellcome / EPSRC Centre for Interventional and Surgical Sciences, University College London, London, UK
- Department of Neurosurgery, The Royal London Hospital, London, UK
| | - Parag Sayal
- Victor Horsely Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, London, UK
| | - Hani J Marcus
- Victor Horsely Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, London, UK
- Wellcome / EPSRC Centre for Interventional and Surgical Sciences, University College London, London, UK
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Paidisetty PS, Wang LK, Shin A, Urbina J, Mitchell D, Quan A, Obinero CG, Chen W. Gynecomastia Surgery Patient Education: An Information Quality Assessment of YouTube Videos. Ann Plast Surg 2024; 92:491-498. [PMID: 38563555 DOI: 10.1097/sap.0000000000003813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2024]
Abstract
BACKGROUND YouTube is a platform for many topics, including plastic surgery. Previous studies have shown poor educational value in YouTube videos of plastic surgery procedures. The purpose of this study was to evaluate the quality and accuracy of YouTube videos concerning gynecomastia surgery (GS). METHODS The phrases "gynecomastia surgery" (GS) and "man boobs surgery" (MB) were queried on YouTube. The first 50 videos for each search term were examined. The videos were rated using our novel Gynecomastia Surgery Specific Score to measure gynecomastia-specific information, the Patient Education Materials Assessment Tool (PEMAT) to measure understandability and actionability, and the Global Quality Scale to measure general quality. RESULTS The most common upload source was a board-certified plastic surgeon (35%), and content category was surgery techniques and consultations (51%). Average scores for the Global Quality Scale (x̄ = 2.25), Gynecomastia Surgery Specific Score (x̄ = 3.50), and PEMAT Actionability (x̄ = 44.8%) were low, whereas PEMAT Understandability (x̄ = 77.4%) was moderate to high. There was no difference in all scoring modalities between the GS and MB groups. Internationally uploaded MB videos tended to originate from Asian countries, whereas GS videos tended to originate from non-US Western countries. Patient uploaders had higher PEMAT Actionability scores than plastic surgeon uploaders. CONCLUSIONS The quality and amount of gynecomastia-specific information in GS videos on YouTube are low and contain few practical, take-home points for patients. However, understandability is adequate. Plastic surgeons and professional societies should strive to create high-quality medical media on platforms such as YouTube.
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Affiliation(s)
| | - Leonard K Wang
- John Sealy School of Medicine, The University of Texas Medical Branch, Galveston
| | - Ashley Shin
- From the McGovern Medical School at UTHealth, Houston
| | - Jacob Urbina
- From the McGovern Medical School at UTHealth, Houston
| | - David Mitchell
- Division of Plastic and Reconstructive Surgery, Department of Surgery, McGovern Medical School at the UTHealth, Houston, TX
| | - Amy Quan
- Department of Plastic and Reconstructive Surgery, Johns Hopkins School of Medicine, Baltimore, MD
| | - Chioma G Obinero
- Division of Plastic and Reconstructive Surgery, Department of Surgery, McGovern Medical School at the UTHealth, Houston, TX
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de Sa R, Hassan A, Soliman E, Al-Yaseen M, Kane P, Selmi H, Makki D. Traumatic rotator cuff injury: does delayed surgery worsen functional outcomes? INTERNATIONAL ORTHOPAEDICS 2024; 48:1271-1275. [PMID: 38403732 DOI: 10.1007/s00264-024-06127-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Accepted: 02/19/2024] [Indexed: 02/27/2024]
Abstract
PURPOSE The optimal timing of surgery after traumatic rotator cuff tears (RCT) is unclear, with its impact on functional outcomes under debate. This study aimed to review functional outcomes after RCT repair in patients who underwent early vs delayed surgery at our unit. METHODS This was single-centre retrospective evaluation. Patients with an acute traumatic RCT that underwent repair between 2017 and 2019 and had local follow-up were included and placed into two groups: early surgery (within 6 months from injury) and delayed surgery (more than 6 months from injury). Patient demographics, RCT data and pre- and post-operative (after 12 months) Oxford Shoulder Score (OSS) were extracted from medical records. Data was analysed to compare OSS scores between groups, as well as the effect of cuff tear sizes on OSS scores. RESULTS Forty-nine patients were included in the analysis (15 early, 34 delayed). There were no significant differences in age, sex or cuff tear sizes between groups. No difference was identified in the mean post-operative OSS between early vs delayed groups (40.9 ± 6.34 vs 40.5 ± 7.65, p = 0.86). The mean improvement in OSS after surgery was also similar between groups (22.5 ± 7.81 vs 20.97 ± 7.19, p = 0.498). Having a large or massive RCT did not worsen OSS compared to small or medium RCT (p = 0.44), even when stratified by early or delayed surgery. CONCLUSION Delayed surgery for traumatic RCT greater than 6 months from injury did not negatively impact long-term functional outcomes at our unit. Patients should be reassured as applicable before surgery in the event of prolonged or unavoidable delays.
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Affiliation(s)
- Russell de Sa
- Department of Trauma & Orthopaedics, West Hertfordshire Teaching Hospitals NHS Trust, Hertfordshire, UK.
| | - Abdelmonem Hassan
- Department of Trauma & Orthopaedics, West Hertfordshire Teaching Hospitals NHS Trust, Hertfordshire, UK
| | - Emad Soliman
- Department of Trauma & Orthopaedics, West Hertfordshire Teaching Hospitals NHS Trust, Hertfordshire, UK
| | - Mustafa Al-Yaseen
- Department of Trauma & Orthopaedics, West Hertfordshire Teaching Hospitals NHS Trust, Hertfordshire, UK
| | - Prathamesh Kane
- Department of Trauma & Orthopaedics, West Hertfordshire Teaching Hospitals NHS Trust, Hertfordshire, UK
| | - Hussain Selmi
- Department of Trauma & Orthopaedics, West Hertfordshire Teaching Hospitals NHS Trust, Hertfordshire, UK
| | - Daoud Makki
- Department of Trauma & Orthopaedics, West Hertfordshire Teaching Hospitals NHS Trust, Hertfordshire, UK
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Schooren L, Oberhoff G, Schipper S, Koch A, Kroh A, Olde Damink S, Ulmer TF, Neumann UP, Alizai PH, Schmitz SM. Students and physicians differ in perception of quality of life in patients with tumors of the upper gastrointestinal tract. Sci Rep 2024; 14:9460. [PMID: 38658620 PMCID: PMC11043386 DOI: 10.1038/s41598-024-59350-7] [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: 06/06/2023] [Accepted: 04/09/2024] [Indexed: 04/26/2024] Open
Abstract
Health-related quality of life (HRQoL) has recently gained importance as treatment options for tumors of the upper GI tract lead to improved long-term survival. HRQoL is often estimated by physicians even though their reliability and the impact of outside factors such as contact time and level of medical education is unclear. Therefore, in this study we investigated the correlation between physicians', students', and patients' assessment of HRQoL. 54 patients presenting with tumors of the upper GI tract were included and asked to fill out the standardized HRQoL questionnaires EORTC QLQ-C30 and QLQ-OG25. Attending physicians and medical students filled out the same questionnaires through estimation of patients' HRQoL. Correlation was assessed through Pearson's and Kendall's τb coefficients. Physicians' and patients' assessments correlated for one out of six of the functional and a third of the symptom scores. Students' and patients' assessments correlated for one third of the functional and two thirds of the symptom scores. Students tended to underestimate patients' symptom burden while physicians tended to overestimate it. Physicians failed to correctly assess several pathognomonic symptoms in this study. Students showed higher correlation with patients' symptoms than physicians. Even so, this adds to mounting evidence that shows the benefit of using patient-reported outcomes as a gold standard regarding HRQoL.
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Affiliation(s)
- Lena Schooren
- Department of General, Visceral- and Transplantation Surgery, RWTH Aachen University Hospital, Pauwelsstr. 30, 52074, Aachen, Germany
| | - Grace Oberhoff
- Department of General, Visceral- and Transplantation Surgery, RWTH Aachen University Hospital, Pauwelsstr. 30, 52074, Aachen, Germany
| | - Sandra Schipper
- Department of General, Visceral- and Transplantation Surgery, RWTH Aachen University Hospital, Pauwelsstr. 30, 52074, Aachen, Germany
- Department of Trauma and Reconstructive Sugery, BG Klinikum Bergmanntrost, 06112, Halle, Germany
| | - Alexander Koch
- Department of Gastroenterology, Digestive Diseases and Intensive Care Medicine, RWTH Aachen University Hospital, Pauwelsstr. 30, 52074, Aachen, Germany
| | - Andreas Kroh
- Department of General, Visceral- and Transplantation Surgery, RWTH Aachen University Hospital, Pauwelsstr. 30, 52074, Aachen, Germany
| | - Steven Olde Damink
- Department of General, Visceral- and Transplantation Surgery, RWTH Aachen University Hospital, Pauwelsstr. 30, 52074, Aachen, Germany
- Department of Surgery, Maastricht University Medical Center, P. Debyelaan 25, 6229 HX, Maastricht, The Netherlands
- Department of General-, Visceral- and Transplantation Surgery, University Hospital Essen, Hufelandstr. 55, 45147, Essen, Germany
| | - Tom F Ulmer
- Department of General, Visceral- and Transplantation Surgery, RWTH Aachen University Hospital, Pauwelsstr. 30, 52074, Aachen, Germany
- Department of Surgery, Maastricht University Medical Center, P. Debyelaan 25, 6229 HX, Maastricht, The Netherlands
- Department of General-, Visceral- and Transplantation Surgery, University Hospital Essen, Hufelandstr. 55, 45147, Essen, Germany
| | - Ulf P Neumann
- Department of General, Visceral- and Transplantation Surgery, RWTH Aachen University Hospital, Pauwelsstr. 30, 52074, Aachen, Germany
- Department of Surgery, Maastricht University Medical Center, P. Debyelaan 25, 6229 HX, Maastricht, The Netherlands
- Department of General-, Visceral- and Transplantation Surgery, University Hospital Essen, Hufelandstr. 55, 45147, Essen, Germany
| | - Patrick H Alizai
- Department of General, Visceral- and Transplantation Surgery, RWTH Aachen University Hospital, Pauwelsstr. 30, 52074, Aachen, Germany
- Klinik für Allgemein- und Viszeralchirurgie, Gemeinschaftskrankenhaus Bonn, Prinz-Albert-Straße 40, 53113, Bonn, Germany
| | - Sophia M Schmitz
- Department of General, Visceral- and Transplantation Surgery, RWTH Aachen University Hospital, Pauwelsstr. 30, 52074, Aachen, Germany.
- Department of General-, Visceral- and Transplantation Surgery, University Hospital Essen, Hufelandstr. 55, 45147, Essen, Germany.
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Hladkowicz E, Auais M, Kidd G, McIsaac DI, Miller J. "I can't imagine having to do it on your own": a qualitative study on postoperative transitions in care from the perspectives of older adults with frailty. BMC Geriatr 2023; 23:848. [PMID: 38093180 PMCID: PMC10716948 DOI: 10.1186/s12877-023-04576-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Accepted: 12/06/2023] [Indexed: 12/17/2023] Open
Abstract
BACKGROUND Adults aged 65 and older have surgery more often than younger people and often live with frailty. The postoperative transition in care from hospital to home after surgey is a challenging time for older adults with frailty as they often experience negative outcomes. Improving postoperative transitions in care for older adults with frailty is a priority. However, little knowledge from the perspective of older adults with frailty is available to support meaningful improvements in postoperative transitions in care. OBJECTIVE To explore what is important to older adults with frailty during a postoperative transition in care. METHODS This qualitative study used an interpretive description methodology. Twelve adults aged ≥ 65 years with frailty (Clinical Frailty Scale score ≥ 4) who had an inpatient elective surgery and could speak in English participated in a telephone-based, semi-structured interview. Audio files were transcribed and analyzed using thematic analysis. RESULTS Five themes were constructed: 1) valuing going home after surgery; 2) feeling empowered through knowledge and resources; 3) focusing on medical and functional recovery; 4) informal caregivers and family members play multiple integral roles; and 5) feeling supported by healthcare providers through continuity of care. Each theme had 3 sub-themes. CONCLUSION Future programs should focus on supporting patients to return home by empowering patients with resources and clear communication, ensuring continuity of care, creating access to homecare and virtual support, focusing on functional and medical recovery, and recognizing the invaluable role of informal caregivers.
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Affiliation(s)
- Emily Hladkowicz
- School of Rehabilitation Therapy, Queen's University, Kingston, Canada.
- Clinical Epidemiology Program, The Ottawa Hospital Research Institute, Ottawa, Canada.
- Department of Anesthesiology and Pain Medicine, The Ottawa Hospital, Ottawa, Canada.
| | - Mohammad Auais
- School of Rehabilitation Therapy, Queen's University, Kingston, Canada
| | - Gurlavine Kidd
- Patient Engagement in Research Activities, The Ottawa Hospital Research Institute, Ottawa, Canada
| | - Daniel I McIsaac
- Clinical Epidemiology Program, The Ottawa Hospital Research Institute, Ottawa, Canada
- Department of Anesthesiology and Pain Medicine, University of Ottawa, The Ottawa Hospital, Ottawa, Canada
- School of Epidemiology & Public Health, University of Ottawa, Ottawa, Canada
| | - Jordan Miller
- School of Rehabilitation Therapy, Queen's University, Kingston, Canada
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Larsen MK, Schultz H, Mortensen MB, Birkelund R. Decision making in the oesophageal cancer trajectory a source of tension and edginess to patients and relatives: a qualitative study. Int J Qual Stud Health Well-being 2023; 18:2170018. [PMID: 36727528 PMCID: PMC9897738 DOI: 10.1080/17482631.2023.2170018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
PURPOSE The curative oesophageal cancer continuum-diagnosis, treatment and survivorship represents different phases with its own challenges for the involved parties. The process of treatment decisions and interactions between patients with oesophageal cancer (EC), relatives and health professionals is vital yet not well described. The purpose of the study was to explore patients' and relatives' experiences with the process of decision-making through the EC illness and treatment trajectory. METHODS Longitudinal explorative design was employed based on ethnographic fieldwork in the form of participant observations inspired by the American anthropologist James Spradley. RESULTS Sixteen patients and 18 relatives were recruited for participant observations. In total, 184 hours of participant observations were conducted. The study showed that decision-making was filled with tension and edginess. Four themes were identified: 1) The encounter with the medical authority, 2) The need to see the big picture in the treatment trajectory, 3) A predetermined treatment decision, and 4) Meeting numerous different health professionals. CONCLUSION The EC trajectory and decision-making were filled with anxiety. Patients and relatives lacked an overview of the treatment pathway, leading to their role in decision-making often being governed by the medical authority. Timing information and continuity are vital factors in decision-making.
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Affiliation(s)
- Malene Kaas Larsen
- Department of Surgery, Odense University Hospital, Odense, Denmark,Institute of Clinical Research, University of Southern Denmark, Odense M, Denmark,CONTACT Malene Kaas Larsen Department of Surgery, Odense University Hospital, J.B. Winsløws Vej 4, Odense C5000, Denmark
| | - Helen Schultz
- Department of Surgery, Odense University Hospital, Odense, Denmark,Institute of Clinical Research, University of Southern Denmark, Odense M, Denmark
| | - Michael Bau Mortensen
- Department of Surgery, Odense University Hospital, Odense, Denmark,Institute of Clinical Research, University of Southern Denmark, Odense M, Denmark
| | - Regner Birkelund
- Health Services Research Unit, Lillebaelt Hospital, Vejle, Denmark,Institute of Regional Health Research, University of Southern Denmark, Odense M, Denmark
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Rosen CB, Roberts SE, Wirtalla CJ, Keele LJ, Kaufman EJ, Halpern S, Kelz RR. Emergency Surgery, Multimorbidity and Hospital-Free Days: A Retrospective Observational Study. J Surg Res 2023; 291:660-669. [PMID: 37556878 PMCID: PMC10530175 DOI: 10.1016/j.jss.2023.06.049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 05/17/2023] [Accepted: 06/12/2023] [Indexed: 08/11/2023]
Abstract
INTRODUCTION Analyzing hospital-free days (HFDs) offers a patient-centered approach to health services research. We hypothesized that, within emergency general surgery (EGS), multimorbidity would be associated with fewer HFDs, whether patients were managed operatively or nonoperatively. METHODS EGS patients were identified using national Medicare claims data (2015-2018). Patients were classified as multimorbid based on the presence of a Qualifying Comorbidity Set and stratified by treatment: operative (received surgery within 48 h of index admission) and nonoperative. HFDs were calculated through 180 d, beginning on the day of index admission, as days alive and spent outside of a hospital, an Emergency Department, or a long-term acute care facility. Univariate comparisons were performed using Kruskal-Wallis tests and risk-adjusted HFDs were compared between multimorbid and nonmultimorbid patients using multivariable zero-inflated negative binomial regression models. RESULTS Among 174,891 operative patients, 45.5% were multimorbid. Among 398,756 nonoperative patients, 59.2% were multimorbid. Multimorbid patients had fewer median HFDs than nonmultimorbid patients among operative and nonoperative cohorts (P < 0.001). At 6 mo, among operative patients, multimorbid patients had 6.5 fewer HFDs (P < 0.001), and among nonoperative patients, multimorbid patients had 7.9 fewer HFDs (P < 0.001). When length of stay was included as a covariate, nonoperative multimorbid patients still had 7.9 fewer HFDs than nonoperative, nonmultimorbid patients (P < 0.001). CONCLUSIONS HFDs offer a patient-centered, composite outcome for claims-based analyses. For EGS patients, multimorbidity was associated with less time alive and out of the hospital, especially when patients were managed nonoperatively.
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Affiliation(s)
- Claire B Rosen
- Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania; Center for Surgery and Health Economics, Perelman School of Medicine, Philadelphia, Pennsylvania.
| | - Sanford E Roberts
- Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania; Center for Surgery and Health Economics, Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Chris J Wirtalla
- Center for Surgery and Health Economics, Perelman School of Medicine, Philadelphia, Pennsylvania; Leonard Davis Institute, Philadelphia, Pennsylvania
| | - Luke J Keele
- Center for Surgery and Health Economics, Perelman School of Medicine, Philadelphia, Pennsylvania; Leonard Davis Institute, Philadelphia, Pennsylvania
| | - Elinore J Kaufman
- Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania; Center for Surgery and Health Economics, Perelman School of Medicine, Philadelphia, Pennsylvania; Leonard Davis Institute, Philadelphia, Pennsylvania
| | - Scott Halpern
- Leonard Davis Institute, Philadelphia, Pennsylvania; Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Rachel R Kelz
- Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania; Center for Surgery and Health Economics, Perelman School of Medicine, Philadelphia, Pennsylvania; Leonard Davis Institute, Philadelphia, Pennsylvania
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Warner BE, Lound A, Grailey K, Vindrola-Padros C, Wells M, Brett SJ. Perspectives of healthcare professionals and older patients on shared decision-making for treatment escalation planning in the acute hospital setting: a systematic review and qualitative thematic synthesis. EClinicalMedicine 2023; 62:102144. [PMID: 37588625 PMCID: PMC10425683 DOI: 10.1016/j.eclinm.2023.102144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Revised: 07/18/2023] [Accepted: 07/24/2023] [Indexed: 08/18/2023] Open
Abstract
Background Shared Decision-Making (SDM) between patients and clinicians is increasingly considered important. Treament Escalation Plans (TEP) are individualised documents outlining life-saving interventions to be considered in the event of clinical deterioration. SDM can inform subjective goals of care in TEP but it remains unclear how much it is considered beneficial by patients and clinicians. We aimed to synthesise the existing knowledge of clinician and older patient (generally aged ≥65 years) perspectives on patient involvement in TEP in the acute setting. Methods Systematic database search was performed in MEDLINE, EMBASE, PsycInfo and CINAHL databases as well as grey literature from database inception to June 8, 2023, using the Sample (older patients, clinicians, acute setting; studies relating to patients whose main diagnosis was cancer or single organ failure were excluded as these conditions may have specific TEP considerations), Phenomenon of Interest (Treatment Escalation Planning), Design (any including interview, observational, survey), Evaluation (Shared Decision-Making), Research type (qualitative, quantitative, mixed methods) tool. Primary data (published participant quotations, field notes, survey results) and descriptive author comments were extracted and qualitative thematic synthesis was performed to generate analytic themes. Quality assessment was made using the Critical Appraisal Skills Programme and Mixed Methods Appraisal Tools. The GRADE-CERQual (Grading of Recommendations Assessment, Development and Evaluation-Confidence in the Evidence from Reviews of Qualitative research) approach was used to assess overall confidence in each thematic finding according to methodology, coherence, adequacy and relevance of the contributing studies. The study protocol was registered on PROSPERO, CRD42022361593. Findings Following duplicate exclusion there were 1916 studies screened and ultimately 13 studies were included, all from European and North American settings. Clinician-orientated themes were: treatment escalation is a medical decision (high confidence); clinicians want the best for their patients amidst uncertainty (high confidence); involving patients and families in decisions is not always meaningful and can involve conflict (high confidence); treatment escalation planning exists within the clinical environment, organisation and society (moderate confidence). Patient-orientated themes were: patients' relationships with Treatment Escalation Planning are complex (low confidence); interactions with doctors are important but communication is not always easy (moderate confidence); patients are highly aware of their families when considering TEP (moderate confidence). Interpretation Based on current evidence, TEP decisions appear dominated by clinicians' perspectives, motivated by achieving the best for patients and challenged by complex decisions, communication and environmental factors; older patients' perspectives have seldom been explored, but their input on decisions may be modest. Presenting the context and challenge of SDM during professional education may allow reflection and a more nuanced approach. Future research should seek to understand what approach to TEP decision-making patients and clinicians consider to be optimum in the acute setting so that a mutually acceptable standard can be defined in policy. Funding HCA International and the NIHR Imperial Biomedical Research Centre.
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Affiliation(s)
- Bronwen E. Warner
- Division of Anaesthetics, Pain Management and Intensive Care, Department of Surgery and Cancer, Imperial College London, UK
| | - Adam Lound
- Patient Experience Research Centre, School of Public Health, Imperial College London, London, UK
| | - Kate Grailey
- Centre for Health Policy, Institute for Global Health Innovation, Department of Surgery and Cancer, Imperial College London, UK
| | | | - Mary Wells
- Department of Surgery and Cancer, Imperial College London, UK
- Imperial College Healthcare NHS Trust, London, UK
| | - Stephen J. Brett
- Division of Anaesthetics, Pain Management and Intensive Care, Department of Surgery and Cancer, Imperial College London, UK
- Department of Intensive Care Medicine, Imperial College Healthcare NHS Trust London, London, UK
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Shaw SE, Hughes G, Pearse R, Avagliano E, Day JR, Edsell ME, Edwards JA, Everest L, Stephens TJ. Opportunities for shared decision-making about major surgery with high-risk patients: a multi-method qualitative study. Br J Anaesth 2023; 131:56-66. [PMID: 37117099 PMCID: PMC10308437 DOI: 10.1016/j.bja.2023.03.022] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Revised: 03/27/2023] [Accepted: 03/28/2023] [Indexed: 04/30/2023] Open
Abstract
BACKGROUND Little is known about the opportunities for shared decision-making when older high-risk patients are offered major surgery. This study examines how, when, and why clinicians and patients can share decision-making about major surgery. METHODS This was a multi-method qualitative study, combining video recordings of preoperative consultations, interviews, and focus groups (33 patients, 19 relatives, 36 clinicians), with observations and documentary analysis in clinics in five hospitals in the UK undertaking major orthopaedic, colorectal, and/or cardiac surgery. RESULTS Three opportunities for shared decision-making about major surgery were identified. Resolution-focused consultations (cardiac/colorectal) resulted in a single agreed preferred option related to a potentially life-threatening problem, with limited opportunities for shared decision-making. Evaluative and deliberative consultations offered more opportunity. The former focused on assessing the likelihood of benefits of surgery for a presenting problem that was not a threat to life for the patient (e.g., orthopaedic consultations) and the latter (largely colorectal) involved discussion of a range of options while also considering significant comorbidities and patient preferences. The extent to which opportunities for shared decision-making were available, and taken up by surgeons, was influenced by the nature of the presenting problem, clinical pathway, and patient trajectory. CONCLUSIONS Decisions about major surgery were not always shared between patients and doctors. The nature of the presenting problem, comorbidities, clinical pathways, and patient trajectories all informed the type of consultation and opportunities for sharing decision-making. Our findings have implications for clinicians, with shared decision-making about major surgery most feasible when the focus is on life-enhancing treatment.
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Affiliation(s)
- Sara E Shaw
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK.
| | - Gemma Hughes
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Rupert Pearse
- Faculty of Medicine & Dentistry, Queen Mary University of London, London, UK
| | - Ester Avagliano
- Hammersmith Hospital Imperial College Healthcare NHS Trust London, London, UK
| | - James R Day
- Department of Anaesthesia, Oxford University Hospitals Foundation Trust, Oxford, UK
| | - Mark E Edsell
- Department of Anaesthesia, The Royal Brompton & Harefield Hospitals, London, UK
| | | | | | - Timothy J Stephens
- Faculty of Medicine & Dentistry, Queen Mary University of London, London, UK
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11
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Qureshi MM, Kam A, Suzuki K, Litle V, Tapan U, Balasubramaniyan R, Dyer MA, Truong MT, Mak KS. Association between hospital safety-net burden and receipt of trimodality therapy and survival for patients with esophageal cancer. Surgery 2023; 173:1153-1161. [PMID: 36774317 DOI: 10.1016/j.surg.2022.12.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Revised: 12/12/2022] [Accepted: 12/22/2022] [Indexed: 02/12/2023]
Abstract
BACKGROUND To examine the relationship between hospital safety-net burden and (1) receipt of surgery after chemoradiation (trimodality therapy) and (2) survival in esophageal cancer patients. METHODS The National Cancer Database was queried to identify 22,842 clinical stage II to IVa esophageal cancer patients diagnosed in 2004 to 2015. The treatment facilities were categorized by proportion of uninsured/Medicaid-insured patients into percentiles. No safety-net burden hospitals (0-37th percentile) treated no uninsured/Medicaid-insured patients, whereas low (38-75th percentile) and high (76-100th percentile) safety-net burden hospitals treated a median (range) of 8.8% (0.87%-16.7%) and 23.6% (16.8%-100%), respectively. Adjusted odds ratios and hazard ratios with 95% confidence intervals were computed, adjusting for patient, tumor, and treatment characteristics. RESULTS Compared to no safety-net burden hospital patients, high safety-net burden hospital patients were significantly more likely to be young, Black, and low-income. Age, female sex, Black race, Hispanic ethnicity, nonprivate insurance, lower income, higher comorbidity score, upper esophageal location, squamous cell histology, higher stage, time to treatment, and treatment at a community program or a low-volume facility were associated with lower odds of receiving trimodality therapy. Adjusting for these factors, high safety-net burden hospital patients were less likely to receive surgery after chemoradiation versus no safety-net burden hospital patients (adjusted odds ratio 0.77 [95% confidence interval 0.68-0.86], P < .0001); no difference was detected comparing low safety-net burden hospitals versus no safety-net burden hospitals (adjusted odds ratio 1.01 [0.92-1.11], P = .874). No significant survival difference was noted by safety-net burden (low safety-net burden hospitals versus no safety-net burden hospitals: adjusted hazard ratio 1.01 [0.96-1.06], P = .704; high safety-net burden hospital versus no safety-net burden hospitals: adjusted hazard ratio 0.99 [0.93-1.06], P = .859). CONCLUSION Adjusting for patient, tumor, and treatment factors, high safety-net burden hospital patients were less likely to undergo surgery after chemoradiation but without significant survival differences.
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Affiliation(s)
- Muhammad M Qureshi
- Department of Radiation Oncology, Boston Medical Center, Boston University Chobanian & Avedisian School of Medicine, Boston, MA
| | - Ariana Kam
- Department of Radiation Oncology, Boston Medical Center, Boston University Chobanian & Avedisian School of Medicine, Boston, MA
| | - Kei Suzuki
- Department of Thoracic Surgery, Boston Medical Center, Boston University Chobanian & Avedisian School of Medicine, Boston, MA
| | - Virginia Litle
- Department of Thoracic Surgery, Boston Medical Center, Boston University Chobanian & Avedisian School of Medicine, Boston, MA
| | - Umit Tapan
- Section of Hematology & Medical Oncology, Department of Medicine, Boston Medical Center, Boston University Chobanian & Avedisian School of Medicine, Boston, MA
| | - Ramkumar Balasubramaniyan
- Department of Radiation Oncology, Boston Medical Center, Boston University Chobanian & Avedisian School of Medicine, Boston, MA
| | - Michael A Dyer
- Department of Radiation Oncology, Boston Medical Center, Boston University Chobanian & Avedisian School of Medicine, Boston, MA
| | - Minh Tam Truong
- Department of Radiation Oncology, Boston Medical Center, Boston University Chobanian & Avedisian School of Medicine, Boston, MA
| | - Kimberley S Mak
- Department of Radiation Oncology, Boston Medical Center, Boston University Chobanian & Avedisian School of Medicine, Boston, MA.
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Hu FY, Tabata-Kelly M, Johnston FM, Walling AM, Lindvall C, Bernacki RE, Pusic AL, Cooper Z. Surgeon-reported Factors Influencing Adoption of Quality Standards for Goal-concordant Care in Patients With Advanced Cancer: A Qualitative Study. Ann Surg 2023; 277:e1000-e1005. [PMID: 35766368 PMCID: PMC9797615 DOI: 10.1097/sla.0000000000005441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
OBJECTIVE This study explored surgical oncologists' perspectives on factors influencing adoption of quality standards in patients with advanced cancer. BACKGROUND The American College of Surgeons Geriatric Surgery Verification Program includes communication standards designed to facilitate goal-concordant care, yet little is known about how surgeons believe these standards align with clinical practice. METHODS Semistructured video-based interviews were conducted from November 2020 to January 2021 with academic surgical oncologists purposively sampled based on demographics, region, palliative care certification, and years in practice. Interviews addressed: (1) adherence to standards documenting care preferences for life-sustaining treatment, surrogate decision-maker, and goals of surgery; and (2) factors influencing their adoption into practice. Interviews were audio-recorded, transcribed, qualitatively analyzed, and conducted until thematic saturation was reached. RESULTS Twenty-six surgeons participated (57.7% male, 8.5 mean years in practice, 19.2% palliative care board-certified). Surgeons reported low adherence to documenting care preferences and surrogate decision-maker and high adherence to discussing, but not documenting, goals of surgery. Participants held conflicting views about the relevance of care preferences to preoperative conversations and surrogate decision-maker documentation by the surgeon and questioned the direct connection between documentation of quality standards and higher value patient care. Key themes regarding factors influencing adoption of quality standards included organizational culture, workflow, and multidisciplinary collaboration. CONCLUSIONS Although surgeons routinely discuss goals of surgery, documentation is inconsistent; care preferences and surrogate decision-makers are rarely discussed or documented. Adherence to these standards would be facilitated by multidisciplinary collaboration, institutional standardization, and evidence linking standards to higher value care.
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Affiliation(s)
- Frances Y Hu
- Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, MA
- Department of Surgery, Brigham and Women's Hospital, Boston, MA
| | - Masami Tabata-Kelly
- Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, MA
| | | | - Anne M Walling
- Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine at University of California, Los Angeles, CA
| | - Charlotta Lindvall
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, MA
| | - Rachelle E Bernacki
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, MA
| | - Andrea L Pusic
- Department of Surgery, Brigham and Women's Hospital, Boston, MA
- Brigham and Women's Hospital, Patient-Reported Outcomes, Value & Experience (PROVE) Center, Boston, MA
| | - Zara Cooper
- Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, MA
- Department of Surgery, Brigham and Women's Hospital, Boston, MA
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13
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Development of a Core Set of Self-Management Support Needs of Esophageal Cancer Patients: Results from a Delphi Study among Healthcare Professionals. Eur J Cancer Care (Engl) 2023. [DOI: 10.1155/2023/3164450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/16/2023]
Abstract
Objective. We aimed to gain consensus on HCPs’ perspectives on self-management support information needs of patients with esophageal cancer during the preoperative phase. Methods. Based on the literature, observations of clinical consultations, and hospital patient information leaflets, a survey was created. HCPs were surveyed twice about their opinion on importance of information, from “not essential” to “absolutely essential,” using Delphi methods. Topics were included in the second round if predetermined criteria were met. To be included in the final list, topics had to meet criteria for consensus and stability. Results. 64 information items and 6 sources of support were identified. Survey response rates were 59% (68 out of 116, first round) and 75% thereafter. The final list included 33 topics, including logistical information, expectations for future health condition, complications, follow-up care, nutrition during treatment, and nutrition during recovery as topics with 100% agreement. Consensus on the source of support was reached for face-to-face contact, written information, information video, and a case manager. Conclusion. This study provides a list of important topics, from the perspectives of HCPs, to guide the systematic provision of education to support EC patients’ self-management during the preoperative phase. Additionally, the most preferred sources of support were face-to-face contact and a case manager.
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14
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Carlisle EM, Shinkunas LA, Lieberman MT, Hoffman RM, Reisinger HS. "Reading the room:" A qualitative analysis of pediatric surgeons' approach to clinical counseling. J Pediatr Surg 2023; 58:503-509. [PMID: 35973862 PMCID: PMC11108180 DOI: 10.1016/j.jpedsurg.2022.08.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Revised: 06/30/2022] [Accepted: 08/03/2022] [Indexed: 11/18/2022]
Abstract
BACKGROUND In our prior analysis of parental preferences for discussions with pediatric surgeons, we identified that parents prefer more guidance from surgeons when discussing cancer surgery, emergency surgery, or surgery for infants, and they prefer to engage surgeons by asking questions. In this study, we investigate surgeon preferences for decision making discussions in pediatric surgery. METHODS We conducted a thematic content analysis of interviews of pediatric surgeons regarding their preferences for discussing surgery with parents. Board certified/board eligible pediatric surgeons who had been in practice for at least one year and spoke English were eligible. Fifteen surgeons were invited, and twelve 30-minute semi-structured interviews were completed (80%). Interviews were recorded and transcribed. Thematic content analysis was performed using deductive and inductive methods. RESULTS Data saturation was achieved after 12 interviews [6 women (50%), median years in practice 6.25, 10 in academic practice (83%), 8 from Midwest (67%)]. 5 themes emerged: (1) Collaboration to promote parental engagement; (2) "Cancer is distinct but not unique;" (3) "Read the room:" tailoring discussions to specific parental needs; (4) Perceived role of the surgeon; (5) Limited experience with decision support tools in pediatric surgery. CONCLUSIONS Pediatric surgeons prefer a collaborative approach to counseling that engages parents through education. They prioritize tailoring discussions to meet parental needs. Few have utilized decision support tools, however most expressed interest. Insight gained from our work will guide development of a decision support tool that empowers parental participation in counseling for pediatric surgery. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Erica M Carlisle
- University of Iowa Hospitals and Clinics, Department of Surgery, Division of Pediatric Surgery, Iowa City, IA, USA; University of Iowa Carver College of Medicine, Program in Bioethics and Humanities, Iowa City, IA, USA.
| | - Laura A Shinkunas
- University of Iowa Carver College of Medicine, Program in Bioethics and Humanities, Iowa City, IA, USA
| | | | - Richard M Hoffman
- University of Iowa Hospitals and Clinics, Iowa City, IA, Department of Internal Medicine, USA
| | - Heather Schacht Reisinger
- University of Iowa Carver College of Medicine, Program in Bioethics and Humanities, Iowa City, IA, USA; University of Iowa Hospitals and Clinics, Iowa City, IA, Department of Internal Medicine, USA; University of Original article Iowa, Institute for Clinical and Translational Science, Iowa City, IA, USA
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15
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Rus IA, Kudela M, Suffredini G, Ariyo PT, Hensley NB, Abernathy JH. Implementing change in the care of the complex cardiac patient. Curr Opin Anaesthesiol 2023; 36:57-60. [PMID: 36550605 DOI: 10.1097/aco.0000000000001213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
PURPOSE OF REVIEW Development of advanced and minimally invasive surgical procedures is providing treatment opportunities to older and higher risk patients. This has also led to highly specialized physicians and a need for better communication and planning with the patients and within the care team. RECENT FINDINGS In the field of cardiac surgery, the heart team model has been advocated and implemented as a vehicle to optimize decision making prior to procedure, care during the procedure and in the recovery process. The goal is to provide a treatment path that prioritizes the patient's goals and to anticipate and minimize complications. SUMMARY In this review, we discuss the concepts of shared decision making (SDM) and implementation science in the context of the complex cardiac patient. We also review the most recent evidence for their use in cardiac surgery. We argue that a team model not only bridges knowledge gaps but provides a multidisciplinary environment for the practice of SDM and implementation of evidence-based practices. Be believe this will provide patients with a better experience as they navigate their care and improve their medical outcomes as well.
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Affiliation(s)
- Ioana A Rus
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins Hospital, 1800 Orleans St, Baltimore, MD, USA
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16
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Castle-Kirszbaum M, Wang YY, King J, Kam J, Goldschlager T. The HACKD Score-Predicting Extent of Resection of Pituitary Macroadenomas Through an Endoscopic Endonasal Transsphenoidal Approach. Oper Neurosurg (Hagerstown) 2023; 24:154-161. [PMID: 36354325 DOI: 10.1227/ons.0000000000000488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Accepted: 08/26/2022] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Predicting extent of resection before pituitary surgery is imperative for operative planning and patient counseling. In the era of endoscopic endonasal transsphenoidal surgery (EEA), a specific, reliable tool for predicting resection of macroadenomas would have widespread applications. OBJECTIVE To identify factors that predict resection of pituitary macroadenomas through the EEA. METHODS A prospectively maintained, multicenter database of 277 consecutive macroadenomas resected through the EEA was analyzed. Multivariate logistic regression identified predictors of gross total resection (GTR). A simple scoring system, the Hardy, Age, Clival, Knosp, Depth (HACKD) Score, was developed and tested. RESULTS GTR was achieved in 82.3% (228/277) of cases. Older than 50 years (odds ratio [OR] 2.96, P = .01), clival extension (OR 5.87, P < .01), Hardy grade C or D suprasellar extension (OR 3.91, P = .01), Knosp grade 3 or 4 cavernous sinus invasion (OR 7.62, P < .01), and tumor depth >20 mm (OR 5.14, P < .01) were all associated with subtotal resection. The HACKD score, awarding 1 point each for Hardy grade C or D, and older than 50 years, and 2 points each for clival extension, Knosp grades 3 or 4, and tumor depth >20 mm, demonstrated excellent discriminative ability (AUROC 0.887, 95% CI: 0.839-0.934). The rate of GTR progressively decreased with a higher HACKD score. Rates of GTR were 95.8% (182/190) for low (HACKD ≤2), 59.5% (44/74) for moderate (HACKD 3-5), and 15.4% (2/13) for high (HACKD 6+) HACKD scores. CONCLUSION The HACKD score is a simple and accurate tool based on the largest study analyzing predictors of GTR in pituitary macroadenomas operated through the EEA.
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Affiliation(s)
- Mendel Castle-Kirszbaum
- Department of Neurosurgery, Monash Health, Melbourne, Australia.,Department of Surgery, Monash University, Melbourne, Australia
| | - Yi Yuen Wang
- Department of Neurosurgery, St Vincent's Health, Melbourne, Australia
| | - James King
- Department of Neurosurgery, Royal Melbourne Hospital, Melbourne, Australia
| | - Jeremy Kam
- Department of Neurosurgery, Monash Health, Melbourne, Australia.,Department of Neurosurgery, Royal Melbourne Hospital, Melbourne, Australia
| | - Tony Goldschlager
- Department of Neurosurgery, Monash Health, Melbourne, Australia.,Department of Surgery, Monash University, Melbourne, Australia
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Mori M, Dhruva SS, Geirsson A, Krumholz HM. Characterization of multi-domain postoperative recovery trajectories after cardiac surgery using a digital platform. NPJ Digit Med 2022; 5:192. [PMID: 36564550 PMCID: PMC9789027 DOI: 10.1038/s41746-022-00736-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2022] [Accepted: 11/29/2022] [Indexed: 12/25/2022] Open
Abstract
Understanding postoperative recovery is critical for guiding efforts to improve post-acute phase care. How recovery evolves during the first 30 days after cardiac surgery is not well-understood. A digital platform may enable granular quantification of recovery by frequently capturing patient-reported outcome measures (PROM) that can be clinically implemented to support recovery. We conduct a prospective cohort study using a digital platform to measure recovery after cardiac surgery using a PROM sent every 3 days for 30 days after surgery to characterize recovery in multiple domains (e.g., pain, sleep, activities of daily living, anxiety) and to identify factors related to the patient's perception of overall recovery. We enroll patients who underwent cardiac surgery at a tertiary center between January 2019 and March 2020 and automatically deliver PROMs and reminders electronically. Of the 10 surveys delivered per patient, 8 (IQR 6-10) are completed. Patients who experienced postoperative complications more commonly belong to the worst overall recovery trajectory. Of the 12 domains modeled, only the worst anxiety trajectory is associated with the worse overall recovery trajectory membership, suggesting that even when patients struggle in the recovery of other domains, the patient may still feel progress in their recovery. We demonstrate that using a digital platform, automated PROM data collection, and characterization of multi-domain recovery trajectories is feasible and likely implementable in clinical practice. Overall recovery may be impacted by complications, while slow progress in constituent domains may still allow for the perception of overall recovery progression.
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Affiliation(s)
- Makoto Mori
- Division of Cardiac Surgery, Yale School of Medicine, New Haven, CT, USA
- Center for Outcomes Research and Evaluation, Yale New Haven Hospital, New Haven, CT, USA
| | - Sanket S Dhruva
- Department of Medicine, University of California San Francisco School of Medicine, San Francisco, CA, USA
- Section of Cardiology, San Francisco VA Medical Center, San Francisco, CA, USA
| | - Arnar Geirsson
- Division of Cardiac Surgery, Yale School of Medicine, New Haven, CT, USA
| | - Harlan M Krumholz
- Center for Outcomes Research and Evaluation, Yale New Haven Hospital, New Haven, CT, USA.
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine and the Department of Health Policy and Management, Yale School of Public Health, New Haven, CT, USA.
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Rivard SJ, Vitous CA, Bamdad MC, Varlamos C, Duby A, Suwanabol PA. "Their Whole Lives Are Going To Change": A Photo-Elicitation Study of Rectal Cancer Survivorship. Dis Colon Rectum 2022; 65:1456-1463. [PMID: 36382839 PMCID: PMC9674372 DOI: 10.1097/dcr.0000000000002474] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Rectal cancer survivors experience persistent symptoms, which may lead to unmet needs. OBJECTIVE This study aimed to explore the rectal cancer survivor experience and identify the impacts of treatment using photo-elicitation. DESIGN This was a novel study in which patients were instructed to take photographs that showed aspects of life that have been challenging to deal with since undergoing treatment. Participants underwent subsequent qualitative interviews using the photographs as prompts. SETTING The study was conducted in a cancer center in a tertiary medical center. PATIENTS Twenty patients were included who underwent curative-intent rectal cancer treatment. MAIN OUTCOME MEASURES Interviews were designed to explore the lived experiences of patients with rectal cancer after treatment. RESULTS Three major themes with regard to life after rectal cancer and its treatments emerged: physical symptoms, lifestyle changes, and changes over time. Physical symptoms encompassed GI issues, ostomy difficulties, and genitourinary symptoms. Lifestyle changes included those relating to diet, social life, and hobbies as well as major life changes and finances. Finally, patients spoke of improvement during the time of symptoms and impact on daily life. LIMITATIONS There may be bias because of the homogeneity of our study population, which may not represent the experiences of younger patients, those of lower socioeconomic status, or those who chose not to participate. Our sample was also overrepresented by patients with a complete pathologic response after neoadjuvant chemotherapy and excluded individuals with recurrence. Finally, single interviews with each individual at different points from their treatment may have resulted in recall bias. CONCLUSIONS This photo-elicitation study provided rectal cancer survivors with a unique opportunity to share how rectal cancer treatment has impacted their lives beyond traditional metrics such as postoperative complications and long-term survival. In addition to improving preoperative counseling and expectation setting, future efforts should focus on postoperative symptom surveillance and appropriate referral when needed. See Video Abstract at http://links.lww.com/DCR/C7. SUS VIDAS ENTERAS VAN A CAMBIAR UN ESTUDIO DE OBTENCIN DE IMGENES SOBRE LA SUPERVIVENCIA AL CNCER DE RECTO ANTECEDENTES:Los sobrevivientes de cáncer de recto experimentan síntomas persistentes, lo que puede dar lugar a necesidades no satisfechas.OBJETIVO:Explorar la experiencia de los sobrevivientes de cáncer de recto e identificar los impactos del tratamiento mediante el uso de fotoestimulación.DISEÑO:En este nuevo estudio, se instruyó a los pacientes para que tomaran fotografías que mostraran aspectos de la vida que han sido difíciles de manejar desde que se sometieron al tratamiento. Los participantes se sometieron posteriormente a entrevistas cualitativas utilizando las fotografías como estimuladores.ESCENARIO:Centro oncológico en un centro médico terciario.PARTICIPANTES:Veinte pacientes que se sometieron a tratamiento de cáncer de recto con intención curativa.PRINCIPALES MEDIDAS DE RESULTADO:Las entrevistas se diseñaron para explorar las experiencias vividas por los pacientes con cáncer de recto después del tratamiento.RESULTADOS:Surgieron tres temas principales con respecto a la vida después del cáncer de recto y sus tratamientos: síntomas físicos; cambios en el estilo de vida; y cambios en el tiempo. Los síntomas físicos abarcaron problemas gastrointestinales, dificultades de las ostomías y síntomas genitourinarios. Los cambios en el estilo de vida incluyeron aquellos relacionados con la dieta, la vida social y los pasatiempos, así como cambios importantes en la vida y las finanzas. Por último, los pacientes hablaron de una mejoría con el tiempo de los síntomas y el impacto en la vida diaria.LIMITACIONES:Puede haber sesgo debido a la homogeneidad de nuestra población de estudio, que puede no representar las experiencias de los pacientes más jóvenes, los de nivel socioeconómico más bajo o los que optaron por no participar. Nuestra muestra también estuvo sobrerrepresentada por pacientes con una respuesta patológica completa después de la quimioterapia neoadyuvante y excluyó a los individuos con recurrencia. Finalmente, las entrevistas individuales con cada paciente en diferentes puntos de su tratamiento pueden dar lugar a que los participantes experimenten un sesgo de recuerdo.CONCLUSIONES:Este estudio de obtención de fotografías brinda a los sobrevivientes de cáncer de recto una oportunidad única de compartir cómo el tratamiento del cáncer de recto ha impactado sus vidas más allá de las métricas tradicionales, como las complicaciones posoperatorias y la supervivencia a largo plazo. Además de mejorar el asesoramiento preoperatorio y el establecimiento de expectativas, los esfuerzos futuros deben centrarse en la vigilancia de los síntomas posoperatorios y la derivación adecuada cuando sea necesario. Consulte Video Resumen en http://links.lww.com/DCR/C7.
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Affiliation(s)
| | - C. Ann Vitous
- Qualitative Research Analyst, Center for Healthcare Outcomes and Policy, University of Michigan
| | | | | | - Ashley Duby
- Department of Surgery, University of Michigan
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Visual Preoperative Risk Depiction Tools for Shared Decision-making: A Pilot Study from the Surgeon's Perspective. Plast Reconstr Surg Glob Open 2022; 10:e4690. [PMID: 36467117 PMCID: PMC9708169 DOI: 10.1097/gox.0000000000004690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Accepted: 10/04/2022] [Indexed: 01/25/2023]
Abstract
UNLABELLED Shared decision-making (SDM) and effective risk communication improve patient satisfaction, adherence to treatment, and understanding of perioperative care pathways. Available risk calculators are less relevant for low-risk operations. The aim of this pilot study was to develop graphical risk visualization tools to enhance surgical SDM discussions preoperatively. METHODS Complications for reduction mammoplasty and skin grafting in a burns setting were sourced from the American College of Surgeons National Surgical Quality Improvement Program Surgical Risk Calculator, the American Society of Plastic Surgeons website, peer-reviewed literature, and available clinical data. Pre- and postoperative patient satisfaction data were collected from the published literature on Breast-Q patient-reported outcomes for reduction mammoplasty. Everyday risk comparisons were collected from a general online database search. Three distinct risk depiction tools (spiral, tile, and scatter plot) were developed in the Microsoft Office Suite. Anonymous REDCap surveys were sent to healthcare practitioners for feedback. RESULTS Twenty-six survey results were collected. Twenty-four respondents (92%) agreed these graphics would be useful for SDM discussions. Nineteen respondents (73%) either agreed or strongly agreed that these graphics depicted risk in a meaningful way. Fifteen respondents (58%) indicated they would use these graphics in daily practice. The majority of respondents preferred the spiral design (58%). Areas for improvement included design simplification and written explanations to accompany graphics. Feedback from the survey was incorporated into the spiral design. CONCLUSIONS Risk visualization tools meaningfully depict surgical risks to improve communication in SDM. This study proposes a tool that can be adapted for many surgical procedures.
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Rosen CB, Roberts SE, Wirtalla CJ, Ramadan OI, Keele LJ, Kaufman EJ, Halpern SD, Kelz RR. Analyzing Impact of Multimorbidity on Long-Term Outcomes after Emergency General Surgery: A Retrospective Observational Cohort Study. J Am Coll Surg 2022; 235:724-735. [PMID: 36250697 PMCID: PMC9583235 DOI: 10.1097/xcs.0000000000000303] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Little is known about the impact of multimorbidity on long-term outcomes for older emergency general surgery patients. STUDY DESIGN Medicare beneficiaries, age 65 and older, who underwent operative management of an emergency general surgery condition were identified using Centers for Medicare & Medicaid claims data. Patients were classified as multimorbid based on the presence of a Qualifying Comorbidity Set (a specific combination of comorbid conditions known to be associated with increased risk of in-hospital mortality in the general surgery setting) and compared with those without multimorbidity. Risk-adjusted outcomes through 180 days after discharge from index hospitalization were calculated using linear and logistic regressions. RESULTS Of 174,891 included patients, 45.5% were identified as multimorbid. Multimorbid patients had higher rates of mortality during index hospitalization (5.9% vs 0.7%, odds ratio [OR] 3.05, p < 0.001) and through 6 months (17.1% vs 3.4%, OR 2.33, p < 0.001) after discharge. Multimorbid patients experienced higher rates of readmission at 1 month (22.9% vs 11.4%, OR 1.48, p < 0.001) and 6 months (38.2% vs 21.2%, OR 1.48, p < 0.001) after discharge, lower rates of discharge to home (42.5% vs 74.2%, OR 0.52, p < 0.001), higher rates of discharge to rehabilitation/nursing facility (28.3% vs 11.3%, OR 1.62, p < 0.001), greater than double the use of home oxygen, walker, wheelchair, bedside commode, and hospital bed (p < 0.001), longer length of index hospitalization (1.33 additional in-patient days, p < 0.001), and higher costs through 6 months ($5,162 additional, p < 0.001). CONCLUSIONS Older, multimorbid patients experience worse outcomes, including survival and independent function, after emergency general surgery than nonmultimorbid patients through 6 months after discharge from index hospitalization. This information is important for setting recovery expectations for high-risk patients to improve shared decision-making.
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Affiliation(s)
- Claire B Rosen
- Department of Surgery, Hospital of the University of Pennsylvania; Philadelphia, PA
- The Perelman School of Medicine at the University of Pennsylvania; Philadelphia, PA
| | - Sanford E Roberts
- Department of Surgery, Hospital of the University of Pennsylvania; Philadelphia, PA
- The Perelman School of Medicine at the University of Pennsylvania; Philadelphia, PA
| | - Chris J Wirtalla
- The Perelman School of Medicine at the University of Pennsylvania; Philadelphia, PA
| | - Omar I Ramadan
- Department of Surgery, Hospital of the University of Pennsylvania; Philadelphia, PA
| | - Luke J Keele
- The Perelman School of Medicine at the University of Pennsylvania; Philadelphia, PA
| | - Elinore J Kaufman
- Department of Surgery, Hospital of the University of Pennsylvania; Philadelphia, PA
- The Perelman School of Medicine at the University of Pennsylvania; Philadelphia, PA
| | - Scott D Halpern
- The Perelman School of Medicine at the University of Pennsylvania; Philadelphia, PA
- Department of Medicine, Hospital of the University of Pennsylvania; Philadelphia, PA
| | - Rachel R Kelz
- Department of Surgery, Hospital of the University of Pennsylvania; Philadelphia, PA
- The Perelman School of Medicine at the University of Pennsylvania; Philadelphia, PA
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21
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Stephens TJ, Pearse RM. The limitations of shared decision-making in surgery. Br J Surg 2022; 109:1051-1052. [DOI: 10.1093/bjs/znac292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Accepted: 07/28/2022] [Indexed: 11/13/2022]
Affiliation(s)
- Timothy J Stephens
- Faculty of Medicine and Dentistry, Queen Mary, University of London , London , UK
- Adult Critical Care Unit, The Royal London Hospital, Barts Health NHS Trust , London , UK
| | - Rupert M Pearse
- Faculty of Medicine and Dentistry, Queen Mary, University of London , London , UK
- Adult Critical Care Unit, The Royal London Hospital, Barts Health NHS Trust , London , UK
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22
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Murakami L, Rua ES, Santos VB, Lopes JDL. Effectiveness of educational intervention with manual for anxiety and stress reduction: controlled clinical trial. Rev Bras Enferm 2022; 75Suppl 3:e20210757. [PMID: 36074457 DOI: 10.1590/0034-7167-2021-0757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Accepted: 05/18/2022] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To evaluate the effectiveness of the educational intervention through an informative manual in reducing anxiety, stress, and changes in vital signs in patients awaiting cardiac catheterization. METHODS Parallel, randomized, controlled, blind clinical trial. The study excluded patients waiting for cardiac catheterization; those who received the information manual were randomized to the intervention group, and those who received routine information from the unit went to the control group. The study used the State Anxiety Inventory and Perceived Stress Scale and the ANOVA test to analyze the outcomes between the groups. Clinical Trials NCT03369873. RESULTS There was no change concerning time, first and second moment (anxiety, P=0.225; and stress, P=0.696), interaction (anxiety, P=0.183; and stress, P=0.444), or groups, control, and intervention (anxiety, P=0.341; and stress, p=0.624). CONCLUSION Although the educational intervention performed did not have an impact on the reduction of anxiety and stress, this type of intervention should be maintained for greater comfort and safety of patients and family members.
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Affiliation(s)
- Luisa Murakami
- Universidade Federal de São Paulo. São Paulo, São Paulo, Brazil
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Pico-Camacho AJ, Vega-Peña NV. La comunicación en el consentimiento informado. REVISTA COLOMBIANA DE CIRUGÍA 2022. [DOI: 10.30944/20117582.2147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Introducción. El consentimiento informado es un elemento importante en la relación médico-paciente, que involucra la trasmisión de un mensaje. En este contexto, se describe la teoría de la comunicación implícita en un consentimiento informado, las barreras para una transmisión adecuada del mensaje, la responsabilidad en la comunicación y los requisitos para el logro de estos propósitos. El objetivo fue analizar de forma reflexiva los procesos de comunicación surtidos y necesarios durante su diligenciamiento, con algunas propuestas factibles de implementar.
Discusión. El proceso comunicativo implica evaluar la calidad, el contexto, la intencionalidad, la pedagogía y la recepción-emisión del mensaje. La naturaleza de la actividad quirúrgica requiere el perfeccionamiento de la comunicación como una competencia necesaria en los cirujanos. Se señalan oportunidades de mejoramiento para una adecuada ejecución de esta habilidad no técnica, habitualmente no contemplada en la formación médica.
Conclusiones. El consentimiento informado es un acto que trasciende a la transmisión de la información y es el resultado de un proceso complejo, que involucra habilidades comunicativas. Su efectividad se deriva de una toma de decisiones respaldada por el entendimiento claro de la situación y del procedimiento a efectuar. Existen puntos críticos durante su realización que podrían ser objeto de intervenciones futuras, desde esta perspectiva comunicativa.
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Collet R, Major M, van Egmond M, van der Leeden M, Maccow R, Eskes A, Stuiver M. Experiences of interaction between people with cancer and their healthcare professionals: A systematic review and meta-synthesis of qualitative studies. Eur J Oncol Nurs 2022; 60:102198. [DOI: 10.1016/j.ejon.2022.102198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Revised: 08/16/2022] [Accepted: 08/25/2022] [Indexed: 11/29/2022]
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Cuijpers ACM, Lubbers T, van Rens HA, Smit-Fun V, Gielen C, Reynders K, Kimman ML, Stassen LPS. The patient perspective on the preoperative colorectal cancer care pathway and preparedness for surgery and postoperative recovery-a qualitative interview study. J Surg Oncol 2022; 126:544-554. [PMID: 35579864 PMCID: PMC9543138 DOI: 10.1002/jso.26920] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Revised: 04/22/2022] [Accepted: 05/05/2022] [Indexed: 12/09/2022]
Abstract
BACKGROUND AND OBJECTIVES This study aimed to explore colorectal cancer (CRC) patients' perspectives and experiences regarding the preoperative surgical care pathway and their subsequent preparedness for surgery and postoperative recovery. METHODS CRC patients were recruited using purposive sampling and were interviewed three times (preoperatively, and 6 weeks and 3 months postoperatively) using semistructured telephone interviews. Interviews were audiotaped, transcribed verbatim and analysed independently by two researchers using thematic analysis with open coding. RESULTS Data saturation was achieved after including 18 patients. Preoperative factors that contributed to a feeling of preparedness for surgery and recovery were patient-centred- and professional healthcare organization, sincere and personal guidance, and thorough information provision. Postoperatively, patients with complications or physical complaints experienced unmet information needs regarding the impact of complications and what to expect from postoperative recovery. CONCLUSIONS The preoperative period is a vital period to prepare patients for surgery and recovery in which patients most value personalized information, personal guidance and professionalism. According to CRC patients, the feeling of preparedness for surgery and recovery can be improved by continually providing dosed information. This information should provide the patient with patient-tailored perspectives regarding the impact of (potential) complications and what to expect during recovery.
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Affiliation(s)
- Anne C M Cuijpers
- Department of Surgery, Maastricht University Medical Centre+, Maastricht, The Netherlands.,Department of Surgery, School for Oncology and Developmental Biology (GROW), Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
| | - Tim Lubbers
- Department of Surgery, Maastricht University Medical Centre+, Maastricht, The Netherlands.,Department of Surgery, School for Oncology and Developmental Biology (GROW), Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
| | - Heleen A van Rens
- Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
| | - Valerie Smit-Fun
- Department of Anaesthesiology, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Christel Gielen
- Department of Surgery, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Kim Reynders
- Department of Surgery, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Merel L Kimman
- Department of Clinical Epidemiology and Medical Technology Assessment, Care and Public Health Research Institute (CAPHRI), Maastricht University Medical Centre, Maastricht, Netherlands
| | - Laurents P S Stassen
- Department of Surgery, Maastricht University Medical Centre+, Maastricht, The Netherlands.,Department of Surgery , School of Nutrition and Translational Research in Metabolism (NUTRIM), Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
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26
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Cherba M, Brummans BHJM, Hier MP, Giguère L, Chartier G, Jacobs H, Forest VI, Mlynarek A, Sultanem K, Henry M. Framing Concerns about Body Image during Pre- and Post-Surgical Consultations for Head and Neck Cancer: A Qualitative Study of Patient–Physician Interactions. Curr Oncol 2022; 29:3341-3363. [PMID: 35621662 PMCID: PMC9139818 DOI: 10.3390/curroncol29050272] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Revised: 04/25/2022] [Accepted: 05/02/2022] [Indexed: 12/04/2022] Open
Abstract
Patients with head and neck cancer report high unmet psychosocial needs as they undergo lifesaving treatments that can significantly alter their appearance and cause functional impairments. This qualitative analysis of recordings of 88 pre- and post-surgical consultations involving 20 patients respond to the need for empirical studies of patient–provider conversations about body image concerns. It indicates that the emphasis on concerns about survival, cure, and physical recovery during clinical consultations may leave concerns about the impacts of surgery on appearance and function unexplored and even silenced. The interviews with patients and medical team members that complement the analysis of the recordings suggest that an emphasis on survival, cure, and physical recovery can respond to the need for reassurance in the context of serious illness. However, it can also be problematic as it contributes to the silencing of patients’ concerns and to a potential lack of preparedness for the consequences of surgery. The results of this study can contribute to raising surgeons’ awareness of the interactional dynamics during clinical consultations. Moreover, the results highlight the unique role that surgeons can play in validating patients’ psychosocial concerns to support patients’ rehabilitation in both physical and psychosocial domains.
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Affiliation(s)
- Maria Cherba
- Department of Communication, University of Ottawa, Ottawa, ON K1N 6N5, Canada
- Correspondence:
| | | | - Michael P. Hier
- Department of Otolaryngology—Head and Neck Surgery, McGill University, Montreal, QC H3A 0G4, Canada; (M.P.H.); (V.-I.F.); (A.M.)
- Department of Otolaryngology—Head and Neck Surgery, Jewish General Hospital, Montreal, QC H3T 1E2, Canada
| | - Lauriane Giguère
- School of Psychology, University of Ottawa, Ottawa, ON K1N 6N5, Canada;
| | - Gabrielle Chartier
- Department of Nursing, Oncology Division, Jewish General Hospital, Montreal, QC H3T 1E2, Canada;
| | - Hannah Jacobs
- Department of Audiology and Speech-Language Pathology, Jewish General Hospital, Montreal, QC H3T 1E2, Canada;
| | - Véronique-Isabelle Forest
- Department of Otolaryngology—Head and Neck Surgery, McGill University, Montreal, QC H3A 0G4, Canada; (M.P.H.); (V.-I.F.); (A.M.)
- Department of Otolaryngology—Head and Neck Surgery, Jewish General Hospital, Montreal, QC H3T 1E2, Canada
| | - Alex Mlynarek
- Department of Otolaryngology—Head and Neck Surgery, McGill University, Montreal, QC H3A 0G4, Canada; (M.P.H.); (V.-I.F.); (A.M.)
- Department of Otolaryngology—Head and Neck Surgery, Jewish General Hospital, Montreal, QC H3T 1E2, Canada
| | - Khalil Sultanem
- Division of Radiation Oncology, Jewish General Hospital, Montreal, QC H3T 1E2, Canada;
- Gerald Bronfman Department of Oncology, McGill University, Montreal, QC H3A 0G4, Canada;
| | - Melissa Henry
- Gerald Bronfman Department of Oncology, McGill University, Montreal, QC H3A 0G4, Canada;
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, QC H3T 1E2, Canada
- Segal Cancer Centre, Jewish General Hospital, Montreal, QC H3T 1E2, Canada
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Qian L, Liu X, Yin M, Zhao Y, Tie B, Wang Q, Zhang Y, Yuan S. Coding the negative emotions of family members and patients among the high-risk preoperative conversations with the Chinese version of VR-CoDES. Health Expect 2022; 25:1591-1600. [PMID: 35447002 PMCID: PMC9327824 DOI: 10.1111/hex.13502] [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] [Received: 09/22/2021] [Revised: 04/02/2022] [Accepted: 04/05/2022] [Indexed: 12/04/2022] Open
Abstract
Background Little is known about family members' and patients' expression of negative emotions among high‐risk preoperative conversations. Objectives This study aimed to identify the occurrence and patterns of the negative emotions of family members and patients in preoperative conversations, to investigate the conversation themes and to explore the correlation between the negative emotions and the conversation themes. Methods A retrospective study was conducted using the Chinese version of Verona Coding Definitions of Emotional Sequences (VR‐CoDES‐C) to code 297 conversations on high‐risk procedures. Inductive content analysis was used to analyse the topics in which negative emotions nested. The χ2 Test was used to test the association between the cues and the conversation themes. Results The occurrence rate of family members' and patients' negative emotions was very high (85.9%), much higher when compared to most conversations under other medical settings. The negative emotions were mainly expressed by cues (96.4%), and cue‐b (67.4%) was the most frequent category. Cues and concerns were mostly elicited by family members and patients (71.6%). Negative emotions were observed among seven themes, in which ‘Psychological stress relating to illness severity, family's care and financial burden’ (30.3%) ranked the top. Cue‐b, cue‐c and cue‐d had a significant correlation (p < .001) with certain themes. Conclusions Family members and patients conveyed significantly more negative emotions in the high‐risk preoperative conversations than in other medical communications. Certain categories of cues were induced by specific emotional conversation contents. Patient Contribution Family members and patients contributed to data.
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Affiliation(s)
- Liru Qian
- Department of Clinical Psychology, Third Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Xinchun Liu
- Department of Clinical Psychology, Third Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Meng Yin
- Department of Clinical Psychology, Third Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Ya Zhao
- Department of Clinical Psychology, Third Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Bingyu Tie
- Department of Clinical Psychology, Third Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Qingyan Wang
- Department of International Exchange and Cooperation, Third Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Yi Zhang
- Department of Medical Administration, Third Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Siyang Yuan
- Dental Health Services Research Unit, University of Dundee, Dundee, UK
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A multi-modal study examining long-term bowel, urinary, and sexual function after rectal cancer surgery. Am J Surg 2022; 224:562-568. [DOI: 10.1016/j.amjsurg.2022.02.046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Accepted: 02/16/2022] [Indexed: 11/19/2022]
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Spoon EQW, Kortram K, Ismail SY, Nieboer D, d’Ancona FCH, Christiaans MHL, Dam RE, Hofker HS, Hoksbergen AWJ, van der Pant KA, Toorop RJ, van de Wetering J, Ijzermans JNM, Dor FJMF. Living Kidney Donor Knowledge of Provided Information and Informed Consent: The PRINCE Study. J Clin Med 2022; 11:jcm11030698. [PMID: 35160147 PMCID: PMC8837079 DOI: 10.3390/jcm11030698] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2021] [Revised: 01/12/2022] [Accepted: 01/21/2022] [Indexed: 02/04/2023] Open
Abstract
Background: Informed consent for living kidney donation is paramount, as donors are healthy individuals undergoing surgery for the benefit of others. The informed consent process for living kidney donors is heterogenous, and the question concerns how well they are actually informed. Knowledge assessments, before and after donor education, can form the basis for a standardized informed consent procedure for live kidney donation. Methods: In this prospective, a multicenter national cohort study conducted in all eight kidney transplant centers in The Netherlands, we assessed the current status of the informed consent practice for live donor nephrectomy. All of the potential living kidney donors in the participating centers were invited to participate. They completed a pop quiz during their first outpatient appointment (Cohort A). Living kidney donors completed the same pop quiz upon admission for donor nephrectomy (Cohort B). Results: In total, 656 pop quizzes were completed (417 in Cohort A, and 239 in Cohort B). The average donor knowledge score was 7.0/25.0 (±3.9, range 0–18) in Cohort A, and 10.5/25.0 (±2.8, range 0–17.5) in Cohort B. Cohort B scored significantly higher on overall knowledge, preparedness, and the individual item scores (p < 0.0001), except for the long-term complications (p = 0.91). Conclusions: Donor knowledge generally improves during the live donor workup, but it is still quite disappointing. Long-term complications, especially, deserve more attention during living kidney donor education.
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Affiliation(s)
- Emerentia Q. W. Spoon
- Erasmus MC University Medical Centre, Department of Surgery, 3015 GD Rotterdam, The Netherlands; (E.Q.W.S.); (K.K.); (J.N.M.I.)
| | - Kirsten Kortram
- Erasmus MC University Medical Centre, Department of Surgery, 3015 GD Rotterdam, The Netherlands; (E.Q.W.S.); (K.K.); (J.N.M.I.)
| | - Sohal Y. Ismail
- Erasmus MC University Medical Centre, Department of Psychiatry, 3015 GD Rotterdam, The Netherlands;
| | - Daan Nieboer
- Erasmus MC University Medical Centre, Department of Public Health, 3015 GD Rotterdam, The Netherlands;
| | - Frank C. H. d’Ancona
- Radboud University Medical Centre, Department of Urology, 6525 GA Nijmegen, The Netherlands;
| | - Maarten H. L. Christiaans
- Maastricht University Medical Centre, Department of Internal Medicine, 6229 HX Maastricht, The Netherlands;
| | - Ruth E. Dam
- Leiden University Medical Centre, Department of Nephrology, 2333 ZA Leiden, The Netherlands;
| | - Hendrik Sijbrand Hofker
- University Medical Centre Groningen, Department of Surgery, 9713 GZ Groningen, The Netherlands;
| | | | - Karlijn Ami van der Pant
- Amsterdam University Medical Centre, Renal Transplant Unit, Department of Internal Medicine, 1105 AZ Amsterdam, The Netherlands;
- Amsterdam University Medical Centre, Renal Transplant Unit, Department of Nephrology, 1105 AZ Amsterdam, The Netherlands
| | - Raechel J. Toorop
- Utrecht University Medical Centre, Department of Surgery, 3584 CX Utrecht, The Netherlands;
| | | | - Jan N. M. Ijzermans
- Erasmus MC University Medical Centre, Department of Surgery, 3015 GD Rotterdam, The Netherlands; (E.Q.W.S.); (K.K.); (J.N.M.I.)
| | - Frank J. M. F. Dor
- Erasmus MC University Medical Centre, Department of Surgery, 3015 GD Rotterdam, The Netherlands; (E.Q.W.S.); (K.K.); (J.N.M.I.)
- Department of Surgery and Cancer, Imperial College, London SW7 2AZ, UK
- Correspondence:
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Murakami L, Rua ES, Santos VB, Lopes JDL. Efetividade da intervenção educativa com manual para redução da ansiedade e estresse: ensaio clínico controlado. Rev Bras Enferm 2022. [DOI: 10.1590/0034-7167-2021-0757pt] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
RESUMO Objetivo: Avaliar a efetividade da intervenção educativa mediante manual informativo na redução da ansiedade, estresse e alterações dos sinais vitais em pacientes que aguardavam o cateterismo cardíaco. Métodos: Ensaio clínico paralelo, randômico, controlado, cego. Incluíram-se pacientes que aguardavam o cateterismo cardíaco; os que receberam o manual informativo foram randomizados para o grupo-intervenção; e os que receberam informações rotineiras da unidade, para o grupo controle. Utilizaram-se Inventário de Ansiedade-Estado e Escala de Estresse Percebido. Realizou-se teste ANOVA para análise dos desfechos entre os grupos. Clinical Trials NCT03369873. Resultados: Não houve alteração em relação ao tempo, primeiro e segundo momento (ansiedade, p=0,225; e estresse, p=0,696), interação (ansiedade, p=0,183; e estresse, p=0,444) ou grupos, controle e intervenção (ansiedade, p=0,341; e estresse, p=0,624). Conclusão: Embora a intervenção educativa realizada não tenha apresentado impacto na redução da ansiedade e estresse, esse tipo de intervenção deve ser mantido, para maior conforto e segurança dos pacientes e familiares.
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Castle-Kirszbaum M, Wang YY, King J, Goldschlager T. Quality of Life After Endoscopic Surgical Management of Pituitary Adenomas. Neurosurgery 2022; 90:81-91. [PMID: 34982874 DOI: 10.1227/neu.0000000000001740] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Accepted: 08/21/2021] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Patient-reported quality of life (QOL) is a vital metric for surgical success. OBJECTIVE To assess the effect of surgery on QOL in the largest prospectively collected, longitudinal cohort of surgically managed pituitary adenomas. METHODS A consecutive surgical adenoma cohort (n = 304) between late 2016 and mid-2020 underwent a scheduled overall (Anterior Skull Base Questionnaire-35) and sinonasal-specific (Sinonasal Outcome Test-22) QOL assessment. Scores were stratified by adenoma subtype and analyzed for clinical predictors of QOL changes. RESULTS The average age was 53.8 ± 16 yr, and 53% of participants were female. 60.9% of adenomas were nonfunctioning while adrenocorticotropic hormone adenomas (16.4%), growth hormone adenomas (14.1%), and prolactinomas (5.9%) were the most prevalent secreting adenomas. Baseline overall QOL differed between tumor types (P = .006), with adrenocorticotropic hormone adenomas worse than growth hormone adenomas (P = .03) and nonfunctioning pituitary adenomas (NFPA) (P < .001). Sinonasal QOL worsened in the 3 wk after surgery but returned to baseline by 6 wk and beyond. Overall QOL worsened at 3 wk after surgery (P < .001) but significantly improved from baseline by 3 mo (P = .009) and beyond (P < .001). Emotional functioning improved soon after surgery, followed by performance and pain, and then, by 6 mo, physical function and vitality. Predictors of improved QOL were sellar/suprasellar lesions (P = .01), prolactinomas (P = .003), and NFPA (P = .04). Conversely, new postoperative hypopituitarism (P = .04) and larger adenoma volume (P = .04) predicted QOL worsening. CONCLUSION QOL is worsened after surgery at early time points. Prolactinomas and NFPA enjoy significant QOL improvements from surgery as early as 3 mo postoperatively. Other functional tumors may experience early benefits in younger patients without hypopituitarism and when isolated to the sellar/suprasellar region. These findings provide valuable information for counseling patients and setting expectations for surgery.
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Affiliation(s)
| | - Yi Yuen Wang
- Department of Neurosurgery, St Vincent's Health, Melbourne, Australia
| | - James King
- Department of Neurosurgery, Royal Melbourne Hospital, Melbourne, Australia
| | - Tony Goldschlager
- Department of Neurosurgery, Monash Health, Melbourne, Australia.,Department of Surgery, Monash University, Melbourne, Australia
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Toh Y, Morita M, Yamamoto M, Nakashima Y, Sugiyama M, Uehara H, Fujimoto Y, Shin Y, Shiokawa K, Ohnishi E, Shimagaki T, Mano Y, Sugimachi K. Health-related quality of life after esophagectomy in patients with esophageal cancer. Esophagus 2022; 19:47-56. [PMID: 34467435 DOI: 10.1007/s10388-021-00874-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Accepted: 08/27/2021] [Indexed: 02/03/2023]
Abstract
Esophageal cancer is one of the malignant tumors with the poorest prognosis. Esophagectomy, which is the mainstay of curative-intent treatments, imposes excessive surgical stress on the patients, and postoperative morbidity and mortality rates after esophagectomy remain high. On the other hand, the number of survivors after esophagectomy for esophageal cancer is increasing due to recent improvements in surgical techniques and multidisciplinary treatments for this cancer. However, esophagectomy still has a great influence on the fundamental aspect of patients' lives, that is, the health-related quality of life (HR-QOL), including their physical, emotional, and social functions in the short- and long-term postoperatively. HR-QOL is a multifactorial concept used to assess the symptoms and functional changes caused by the disease itself and treatments from the patients' perspectives. Therefore, assessing the HR-QOL of patients with esophageal cancer after esophagectomy is becoming increasingly important. However, the status of HR-QOL changes after esophagectomy has not been satisfactorily evaluated, and there is no worldwide consensus as to how the postoperative HR-QOL can be improved. This review aimed to raise awareness of healthcare providers, such as surgeons and nurses, on the importance of HR-QOL in patients with esophageal cancer after curative-intent esophagectomy by providing multifaceted information concerning the short- and long-term HR-QOLs, including the status of changes and the determinants of HR-QOL after esophagectomy, and furthermore, essential points for improvement of HR-QOL after esophagectomy.
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Affiliation(s)
- Yasushi Toh
- Department of Gastroenterological Surgery, National Hospital Organization Kyushu Cancer Center, Fukuoka, 811-1395, Japan.
| | - Masaru Morita
- Department of Gastroenterological Surgery, National Hospital Organization Kyushu Cancer Center, Fukuoka, 811-1395, Japan
| | - Manabu Yamamoto
- Department of Gastroenterological Surgery, National Hospital Organization Kyushu Cancer Center, Fukuoka, 811-1395, Japan
| | - Yuichiro Nakashima
- Department of Gastroenterological Surgery, National Hospital Organization Kyushu Cancer Center, Fukuoka, 811-1395, Japan
| | - Masahiko Sugiyama
- Department of Gastroenterological Surgery, National Hospital Organization Kyushu Cancer Center, Fukuoka, 811-1395, Japan
| | - Hideo Uehara
- Department of Gastroenterological Surgery, National Hospital Organization Kyushu Cancer Center, Fukuoka, 811-1395, Japan
| | - Yoshiaki Fujimoto
- Department of Gastroenterological Surgery, National Hospital Organization Kyushu Cancer Center, Fukuoka, 811-1395, Japan
| | - Yuki Shin
- Department of Gastroenterological Surgery, National Hospital Organization Kyushu Cancer Center, Fukuoka, 811-1395, Japan
| | - Keiichi Shiokawa
- Department of Gastroenterological Surgery, National Hospital Organization Kyushu Cancer Center, Fukuoka, 811-1395, Japan
| | - Emi Ohnishi
- Department of Hepato-Biliary and Pancreatic Surgery, National Hospital Organization Kyushu Cancer Center, Fukuoka, Japan
| | - Tomonari Shimagaki
- Department of Hepato-Biliary and Pancreatic Surgery, National Hospital Organization Kyushu Cancer Center, Fukuoka, Japan
| | - Yohei Mano
- Department of Hepato-Biliary and Pancreatic Surgery, National Hospital Organization Kyushu Cancer Center, Fukuoka, Japan
| | - Keishi Sugimachi
- Department of Hepato-Biliary and Pancreatic Surgery, National Hospital Organization Kyushu Cancer Center, Fukuoka, Japan
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Kuo M, Schroeder R, Barbeito A, Pieper CF, Krishnamoorthy V, Wellman S, Hastings SN, Raghunathan K. Preoperative Care Assessment of Need Scores Are Associated With Postoperative Mortality and Length of Stay in Veterans Undergoing Knee Replacement. Fed Pract 2021; 38:316-324. [PMID: 34733081 DOI: 10.12788/fp.0148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Background Care Assessment of Need (CAN) scores predicting 90-day mortality and hospitalization are automatically computed each week for patients receiving care at Veterans Health Administration facilities. While currently used only by primary care teams for care coordination, we explored their value as a perioperative risk stratification tool before major elective surgery. Methods We collected relevant demographic and perioperative data along with perioperative CAN scores for veterans who underwent total knee replacement between July 2014 and December 2015. We examined score distribution, relationships of preoperative CAN 1-year mortality scores with 1-year postoperative mortality and index hospital length of stay (LOS), and patterns of mortality. Results Among 8206 patients, 1-year mortality was 1.4% (110 patients), and CAN scores exhibited near-normal distribution. Median scores among survivors were significantly higher than those of in nonsurvivors (45 vs 75; P < .001). The Kaplan-Meier curves showed an approximately 4-fold higher rate of death at 1 year in the highest tercile for 1-year mortality CAN scores compared with those with lower scores (2.0% vs 0.5% respectively; P < .001). Locally estimated scatterplot smoothing curves revealed a significant and nonlinear increase in hospital LOS across preoperative CAN scores. Conclusions Although designed for ambulatory care use, CAN scores can identify patients at high risk for mortality and extended hospital LOS in an elective surgery population. The CAN scores may prove valuable in supporting informed decision making and preoperative planning in high-risk and vulnerable populations. Further study is needed to confirm the validity of CAN scores and compare them to other more widely used surgical risk calculators.
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Affiliation(s)
- Marissa Kuo
- is a Medical Student at Emory University School of Medicine in Atlanta, Georgia. is a Staff Physician at the Anesthesia Service, Durham Veterans Affairs Health Care System (DVAHCS) in North Carolina and an Associate Professor, Critical Care and Perioperative Epidemiologic Research (CAPER) Unit, Department of Anesthesiology, Duke University Medical Center (DUMC). is a Staff Physician at the DVAHCS Anesthesia Service and Associate Professor CAPER Unit, DUMC. is an Associate Professor of Biostatistics and Bioinformatics at Duke University Center for Aging and Duke University Department of Medicine and is a Senior Researcher at the Geriatrics Research Education and Clinical Center (GRECC) and Health Services Research and Development, DVAHCS. is an Assistant Professor CAPER Unit DUMC. is Chief, Orthopedic Service, DVAHCS and an Associate Professor, Department of Orthopedic Surgery, Duke University Health System (DUHS). is a Senior Researcher Duke University Center for Aging and Duke University Department of Medicine and is Director of the Center of Innovation to Accelerate Discovery and Practice Transformation; Senior Researcher GRECC and Health Services Research and Development, DVAHCS, and Professor, Department of Medicine and Department of Population Health DUHS. is a Staff Physician Anesthesia Service, DVAHCS and an Associate Professor with Tenure, and Codirector CAPER Unit, Department of Anesthesiology, DUMC
| | - Rebecca Schroeder
- is a Medical Student at Emory University School of Medicine in Atlanta, Georgia. is a Staff Physician at the Anesthesia Service, Durham Veterans Affairs Health Care System (DVAHCS) in North Carolina and an Associate Professor, Critical Care and Perioperative Epidemiologic Research (CAPER) Unit, Department of Anesthesiology, Duke University Medical Center (DUMC). is a Staff Physician at the DVAHCS Anesthesia Service and Associate Professor CAPER Unit, DUMC. is an Associate Professor of Biostatistics and Bioinformatics at Duke University Center for Aging and Duke University Department of Medicine and is a Senior Researcher at the Geriatrics Research Education and Clinical Center (GRECC) and Health Services Research and Development, DVAHCS. is an Assistant Professor CAPER Unit DUMC. is Chief, Orthopedic Service, DVAHCS and an Associate Professor, Department of Orthopedic Surgery, Duke University Health System (DUHS). is a Senior Researcher Duke University Center for Aging and Duke University Department of Medicine and is Director of the Center of Innovation to Accelerate Discovery and Practice Transformation; Senior Researcher GRECC and Health Services Research and Development, DVAHCS, and Professor, Department of Medicine and Department of Population Health DUHS. is a Staff Physician Anesthesia Service, DVAHCS and an Associate Professor with Tenure, and Codirector CAPER Unit, Department of Anesthesiology, DUMC
| | - Atilio Barbeito
- is a Medical Student at Emory University School of Medicine in Atlanta, Georgia. is a Staff Physician at the Anesthesia Service, Durham Veterans Affairs Health Care System (DVAHCS) in North Carolina and an Associate Professor, Critical Care and Perioperative Epidemiologic Research (CAPER) Unit, Department of Anesthesiology, Duke University Medical Center (DUMC). is a Staff Physician at the DVAHCS Anesthesia Service and Associate Professor CAPER Unit, DUMC. is an Associate Professor of Biostatistics and Bioinformatics at Duke University Center for Aging and Duke University Department of Medicine and is a Senior Researcher at the Geriatrics Research Education and Clinical Center (GRECC) and Health Services Research and Development, DVAHCS. is an Assistant Professor CAPER Unit DUMC. is Chief, Orthopedic Service, DVAHCS and an Associate Professor, Department of Orthopedic Surgery, Duke University Health System (DUHS). is a Senior Researcher Duke University Center for Aging and Duke University Department of Medicine and is Director of the Center of Innovation to Accelerate Discovery and Practice Transformation; Senior Researcher GRECC and Health Services Research and Development, DVAHCS, and Professor, Department of Medicine and Department of Population Health DUHS. is a Staff Physician Anesthesia Service, DVAHCS and an Associate Professor with Tenure, and Codirector CAPER Unit, Department of Anesthesiology, DUMC
| | - Carl F Pieper
- is a Medical Student at Emory University School of Medicine in Atlanta, Georgia. is a Staff Physician at the Anesthesia Service, Durham Veterans Affairs Health Care System (DVAHCS) in North Carolina and an Associate Professor, Critical Care and Perioperative Epidemiologic Research (CAPER) Unit, Department of Anesthesiology, Duke University Medical Center (DUMC). is a Staff Physician at the DVAHCS Anesthesia Service and Associate Professor CAPER Unit, DUMC. is an Associate Professor of Biostatistics and Bioinformatics at Duke University Center for Aging and Duke University Department of Medicine and is a Senior Researcher at the Geriatrics Research Education and Clinical Center (GRECC) and Health Services Research and Development, DVAHCS. is an Assistant Professor CAPER Unit DUMC. is Chief, Orthopedic Service, DVAHCS and an Associate Professor, Department of Orthopedic Surgery, Duke University Health System (DUHS). is a Senior Researcher Duke University Center for Aging and Duke University Department of Medicine and is Director of the Center of Innovation to Accelerate Discovery and Practice Transformation; Senior Researcher GRECC and Health Services Research and Development, DVAHCS, and Professor, Department of Medicine and Department of Population Health DUHS. is a Staff Physician Anesthesia Service, DVAHCS and an Associate Professor with Tenure, and Codirector CAPER Unit, Department of Anesthesiology, DUMC
| | - Vijay Krishnamoorthy
- is a Medical Student at Emory University School of Medicine in Atlanta, Georgia. is a Staff Physician at the Anesthesia Service, Durham Veterans Affairs Health Care System (DVAHCS) in North Carolina and an Associate Professor, Critical Care and Perioperative Epidemiologic Research (CAPER) Unit, Department of Anesthesiology, Duke University Medical Center (DUMC). is a Staff Physician at the DVAHCS Anesthesia Service and Associate Professor CAPER Unit, DUMC. is an Associate Professor of Biostatistics and Bioinformatics at Duke University Center for Aging and Duke University Department of Medicine and is a Senior Researcher at the Geriatrics Research Education and Clinical Center (GRECC) and Health Services Research and Development, DVAHCS. is an Assistant Professor CAPER Unit DUMC. is Chief, Orthopedic Service, DVAHCS and an Associate Professor, Department of Orthopedic Surgery, Duke University Health System (DUHS). is a Senior Researcher Duke University Center for Aging and Duke University Department of Medicine and is Director of the Center of Innovation to Accelerate Discovery and Practice Transformation; Senior Researcher GRECC and Health Services Research and Development, DVAHCS, and Professor, Department of Medicine and Department of Population Health DUHS. is a Staff Physician Anesthesia Service, DVAHCS and an Associate Professor with Tenure, and Codirector CAPER Unit, Department of Anesthesiology, DUMC
| | - Samuel Wellman
- is a Medical Student at Emory University School of Medicine in Atlanta, Georgia. is a Staff Physician at the Anesthesia Service, Durham Veterans Affairs Health Care System (DVAHCS) in North Carolina and an Associate Professor, Critical Care and Perioperative Epidemiologic Research (CAPER) Unit, Department of Anesthesiology, Duke University Medical Center (DUMC). is a Staff Physician at the DVAHCS Anesthesia Service and Associate Professor CAPER Unit, DUMC. is an Associate Professor of Biostatistics and Bioinformatics at Duke University Center for Aging and Duke University Department of Medicine and is a Senior Researcher at the Geriatrics Research Education and Clinical Center (GRECC) and Health Services Research and Development, DVAHCS. is an Assistant Professor CAPER Unit DUMC. is Chief, Orthopedic Service, DVAHCS and an Associate Professor, Department of Orthopedic Surgery, Duke University Health System (DUHS). is a Senior Researcher Duke University Center for Aging and Duke University Department of Medicine and is Director of the Center of Innovation to Accelerate Discovery and Practice Transformation; Senior Researcher GRECC and Health Services Research and Development, DVAHCS, and Professor, Department of Medicine and Department of Population Health DUHS. is a Staff Physician Anesthesia Service, DVAHCS and an Associate Professor with Tenure, and Codirector CAPER Unit, Department of Anesthesiology, DUMC
| | - Susan Nicole Hastings
- is a Medical Student at Emory University School of Medicine in Atlanta, Georgia. is a Staff Physician at the Anesthesia Service, Durham Veterans Affairs Health Care System (DVAHCS) in North Carolina and an Associate Professor, Critical Care and Perioperative Epidemiologic Research (CAPER) Unit, Department of Anesthesiology, Duke University Medical Center (DUMC). is a Staff Physician at the DVAHCS Anesthesia Service and Associate Professor CAPER Unit, DUMC. is an Associate Professor of Biostatistics and Bioinformatics at Duke University Center for Aging and Duke University Department of Medicine and is a Senior Researcher at the Geriatrics Research Education and Clinical Center (GRECC) and Health Services Research and Development, DVAHCS. is an Assistant Professor CAPER Unit DUMC. is Chief, Orthopedic Service, DVAHCS and an Associate Professor, Department of Orthopedic Surgery, Duke University Health System (DUHS). is a Senior Researcher Duke University Center for Aging and Duke University Department of Medicine and is Director of the Center of Innovation to Accelerate Discovery and Practice Transformation; Senior Researcher GRECC and Health Services Research and Development, DVAHCS, and Professor, Department of Medicine and Department of Population Health DUHS. is a Staff Physician Anesthesia Service, DVAHCS and an Associate Professor with Tenure, and Codirector CAPER Unit, Department of Anesthesiology, DUMC
| | - Karthik Raghunathan
- is a Medical Student at Emory University School of Medicine in Atlanta, Georgia. is a Staff Physician at the Anesthesia Service, Durham Veterans Affairs Health Care System (DVAHCS) in North Carolina and an Associate Professor, Critical Care and Perioperative Epidemiologic Research (CAPER) Unit, Department of Anesthesiology, Duke University Medical Center (DUMC). is a Staff Physician at the DVAHCS Anesthesia Service and Associate Professor CAPER Unit, DUMC. is an Associate Professor of Biostatistics and Bioinformatics at Duke University Center for Aging and Duke University Department of Medicine and is a Senior Researcher at the Geriatrics Research Education and Clinical Center (GRECC) and Health Services Research and Development, DVAHCS. is an Assistant Professor CAPER Unit DUMC. is Chief, Orthopedic Service, DVAHCS and an Associate Professor, Department of Orthopedic Surgery, Duke University Health System (DUHS). is a Senior Researcher Duke University Center for Aging and Duke University Department of Medicine and is Director of the Center of Innovation to Accelerate Discovery and Practice Transformation; Senior Researcher GRECC and Health Services Research and Development, DVAHCS, and Professor, Department of Medicine and Department of Population Health DUHS. is a Staff Physician Anesthesia Service, DVAHCS and an Associate Professor with Tenure, and Codirector CAPER Unit, Department of Anesthesiology, DUMC
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Daniels SL, Burton M, Lee MJ, Moug SJ, Kerr K, Wilson TR, Brown SR, Wyld L. Healthcare professional preferences in the health and fitness assessment and optimization of older patients facing colorectal cancer surgery. Colorectal Dis 2021; 23:2331-2340. [PMID: 34046988 DOI: 10.1111/codi.15758] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Revised: 04/26/2021] [Accepted: 05/18/2021] [Indexed: 12/14/2022]
Abstract
AIM There are few age- and fitness-specific, evidence-based guidelines for colorectal cancer surgery. The uptake of different assessment and optimization strategies is variable. The aim of this study was to explore healthcare professional opinion about these issues using a mixed methods design. METHODS Semi-structured qualitative interviews were undertaken with healthcare professionals from a single UK region involved in the treatment, assessment and optimization of colorectal surgery patients. Interviews were analysed using the framework approach. An online questionnaire survey was subsequently designed and disseminated to UK surgeons to quantitatively assess the importance of interview themes. Descriptive statistics were used to analyse questionnaire data. RESULTS Thirty-seven healthcare professionals out of 42 approached (response rate 88%) were interviewed across five hospitals in the south Yorkshire region. Three broad themes were developed: attitudes towards treatment of the older patient, methods of assessment of suitability and optimization strategies. The questionnaire was completed by 103 out of an estimated 256 surgeons (estimated response rate 40.2%). There was a difference in opinion regarding the role of major surgery in older patients, particularly when there is coexisting dementia. Assessment was not standardized. Access to optimization strategies was limited, particularly in the emergency setting. CONCLUSION There is wide variation in the process of assessment and provision of optimization strategies in UK practice. Lack of evidence-based guidelines, cost and time constraints restrict the development of services and pathways. Differences in opinion between surgeons towards patients with frailty or dementia may account for some of the variation in colorectal cancer outcomes.
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Affiliation(s)
- Sarah L Daniels
- Department of Oncology and Metabolism, University of Sheffield, Sheffield, UK.,Department of General Surgery, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | | | - Matthew J Lee
- Department of Oncology and Metabolism, University of Sheffield, Sheffield, UK.,Department of General Surgery, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Susan J Moug
- Royal Alexandra Hospital, Paisley, UK.,University of Glasgow, Glasgow, UK
| | - Karen Kerr
- Department of Anaesthesia, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Tim R Wilson
- Department of Oncology and Metabolism, University of Sheffield, Sheffield, UK.,Doncaster and Bassetlaw NHS Foundation Trust, Doncaster, UK
| | - Steven R Brown
- Department of Oncology and Metabolism, University of Sheffield, Sheffield, UK.,Department of General Surgery, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Lynda Wyld
- Department of Oncology and Metabolism, University of Sheffield, Sheffield, UK.,Doncaster and Bassetlaw NHS Foundation Trust, Doncaster, UK
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Predictors of visual and endocrine outcomes after endoscopic transsphenoidal surgery for pituitary adenomas. Neurosurg Rev 2021; 45:843-853. [PMID: 34618249 DOI: 10.1007/s10143-021-01617-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Revised: 06/24/2021] [Accepted: 07/25/2021] [Indexed: 02/02/2023]
Abstract
Surgery for pituitary adenoma is indicated for relief of mass effect and control of endocrinopathy. Setting benchmarks for visual and hormonal outcomes is important for monitoring performance of surgical centres, while understanding the preoperative factors that predict endocrine cure and visual improvement facilitates tailored counselling for patients prior to surgery. A prospective, consecutive cohort of surgically managed (endoscopic transsphenoidal) pituitary adenoma (n = 304) were analysed. Preoperative and postoperative endocrine and visual field assessments were performed and compared to demographic, imaging and pathological data. Larger adenomas tended to have preoperative endocrine deficiency (p < 0.001) and visual field defects (p < 0.001). The largest tumours did not experience normalisation of their endocrinopathy or visual fields with surgery. Of the adenomas with normal preoperative endocrine function, 92.0% (126/137) maintained this postoperatively; only 2 of the 11 patients with new hypopituitarism required long-term hormone replacement. Functional tumour cure was achieved in 65.2% (86/116) after surgery; 74.4% (32/43) of acromegalics and 70.0 (35/50) of Cushing's disease patients achieved hormonal control. All patients with isolated hyperprolactinaemia from stalk effect normalised with surgery, while only 15.9% (7/44) with hypopituitarism recovered normal endocrine function. New hypopituitarism was predicted by younger age and functional adenoma, particularly Cushing's disease. Resolution of endocrinopathy was less likely with reoperative cases and those with cavernous sinus invasion (Knosp grade > 2) or preoperative ophthalmoplegia. One-third of the cohort (102/304, 33.6%) had a preoperative field cut, most commonly an incomplete (51.0%) or complete (31.4%) bitemporal hemianopsia. Only two patients (2/304, 0.7%) had visual field worsening after surgery, while 71.6% (73/102) experienced partial or complete resolution of their field cut after surgery. Complete resolution of visual field defect was predicted by younger age and incomplete bitemporal hemianopsia. Surgery is a safe and effective therapy for pituitary adenomas. Nearly all patients experience improvement in visual fields, especially the young and those with incomplete bitemporal defects. Reoperative cases and those with cavernous sinus involvement (high Knosp grade/ophthalmoplegia) are less likely to have resolution of endocrinopathy. Visual worsening, new ophthalmoplegia or endocrinopathy were rare complications of surgery.
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36
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Cheng JYJ, Wong BWZ, Chin YH, Ong ZH, Ng CH, Tham HY, Samarasekera DD, Devi KM, Chong CS. Preoperative concerns of patients undergoing general surgery. PATIENT EDUCATION AND COUNSELING 2021; 104:1467-1473. [PMID: 33303283 DOI: 10.1016/j.pec.2020.11.010] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/18/2020] [Revised: 11/02/2020] [Accepted: 11/07/2020] [Indexed: 06/12/2023]
Abstract
OBJECTIVES This qualitative review aims to provide a clearer understanding of concerns general surgery (GS) patients face in the preoperative period. METHODS Medline, CINAHL, PsycINFO and Web of Science were searched for articles describing the preoperative concerns of GS patients. Qualitative and mixed method studies were included. Key quotes were extracted, coded, and thematically analyzed according to Thomas and Harden's methodology. RESULTS 27 articles were included. Three main themes were generated: (1) lead-up to surgery, (2) postoperative recovery process and (3) standard of care. While waiting for surgery, patients were often shrouded with uncertainty and concerned themselves with the potential impacts of their disease and surgery on their wellbeing and recovery. Furthermore, patients' trust and confidence in Healthcare Professionals (HCPs) was compromised when standard of care was perceived to be deficient, resulting in doubts about HCPs' credibility and capabilities. CONCLUSION Patients' preoperative concerns often stem from the uncertainty and unfamiliarity surrounding surgery. To address this, a combination of effective preoperative education, individualised communication and involvement of social support should be considered. PRACTICE IMPLICATIONS Preoperative concerns can negatively impact patients and effective interventions will result in a better perioperative experience with fewer negative consequences arising from patients' fear and anxiety.
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Affiliation(s)
| | - Bryan Wei Zhi Wong
- Yong Loo Lin School of Medicine, National University Singapore, Singapore
| | - Yip Han Chin
- Yong Loo Lin School of Medicine, National University Singapore, Singapore
| | - Zhi Hao Ong
- Yong Loo Lin School of Medicine, National University Singapore, Singapore
| | - Cheng Han Ng
- Yong Loo Lin School of Medicine, National University Singapore, Singapore
| | - Hui Yu Tham
- Division of Colorectal Surgery, Department of Surgery, University Surgical Cluster, National University Hospital, Singapore
| | - Dujeepa D Samarasekera
- Centre for Medical Education, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Kamala M Devi
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Choon Seng Chong
- Yong Loo Lin School of Medicine, National University Singapore, Singapore; Division of Colorectal Surgery, Department of Surgery, University Surgical Cluster, National University Hospital, Singapore.
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Delman AM, Ammann AM, Turner KM, Vaysburg DM, Van Haren RM. A narrative review of socioeconomic disparities in the treatment of esophageal cancer. J Thorac Dis 2021; 13:3801-3808. [PMID: 34277070 PMCID: PMC8264668 DOI: 10.21037/jtd-20-3095] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2020] [Accepted: 12/31/2020] [Indexed: 12/11/2022]
Abstract
The persistent challenges of disparities in healthcare have led to significantly distinct outcomes among patients from different racial, ethnic, and underserved populations. Esophageal Cancer, not unlike other surgical diseases, has seen significant disparities in care. Esophageal cancer is currently the 6th leading cause of death from cancer and the 8th most common cancer in the world. Surgical disparities in the care of patients with Esophageal Cancer have been described in the literature, with a prevailing theme associating minority status with worse outcomes. The goal of this review is to provide an updated account of the literature on disparities in Esophageal Cancer presentation and treatment. We will approach this task through a conceptual framework that highlights the five main themes of surgical disparities: patient-level factors, provider-level factors, system and access issues, clinical care and quality, and postoperative outcomes, care and rehabilitation. All five categories play a complex role in the delivery of high-quality, equitable care for patients with Esophageal Cancer. While describing disparities in care is the first step to correcting them, moving forward, we should focus on developing effective interventions to mitigate disparities, policies linking disparities to quality-of-care metrics, and delivery system change to enable minority patients to more easily access high volume centers.
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Affiliation(s)
- Aaron M Delman
- Cincinnati Research in Outcomes and Safety in Surgery (CROSS), Department of Surgery, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Allison M Ammann
- Cincinnati Research in Outcomes and Safety in Surgery (CROSS), Department of Surgery, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Kevin M Turner
- Cincinnati Research in Outcomes and Safety in Surgery (CROSS), Department of Surgery, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Dennis M Vaysburg
- Cincinnati Research in Outcomes and Safety in Surgery (CROSS), Department of Surgery, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Robert M Van Haren
- Cincinnati Research in Outcomes and Safety in Surgery (CROSS), Department of Surgery, University of Cincinnati College of Medicine, Cincinnati, OH, USA.,Division of Thoracic Surgery, Department of Surgery, University of Cincinnati College of Medicine, Cincinnati, OH, USA
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Keinki C, Momberg A, Clauß K, Bozkurt G, Hertel E, Freuding M, Josfeld L, Huebner J. Effect of question prompt lists for cancer patients on communication and mental health outcomes-A systematic review. PATIENT EDUCATION AND COUNSELING 2021; 104:1335-1346. [PMID: 33593643 DOI: 10.1016/j.pec.2021.01.012] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 12/03/2020] [Accepted: 01/11/2021] [Indexed: 06/12/2023]
Abstract
OBJECTIVE To provide a systematic review on the effects of question prompt lists (QPL) in oncological settings. METHODS A systematic literature search was conducted in Medline, PsycINFO and the Cochrane Collaboration. Randomized controlled studies (RCTs) that evaluated QPL-only interventions were included. Risk of bias of included studies was evaluated using the Cochrane RoB 2 tool. Data concerning effects on communicative processes in patient-physician relationship and psychological outcomes were analyzed. RESULTS 10 RCTs met the inclusion criteria. Results suggest that QPLs lead to a shift of topics discussed. There were weak indications that QPL interventions increase anxiety shortly before and after consultations, but may decline anxiety during follow-up. Patients consistently perceive QPLs as more helpful than usual information sheets. QPL-only interventions show limited impact on communicative processes and psychological outcomes. They help not to forget or discuss important questions. CONCLUSION With a better integration in patient-physician communication QPLs may become a useful tool for patients and physicians. Future research is needed to investigate if there is greater benefit from QPL interventions in specific settings. PRACTICE IMPLICATIONS QPLs are an inexpensive tool to influence communicative processes positively in oncological consultations.
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Affiliation(s)
- Christian Keinki
- Dept. of Hematology and Medical Oncology, University Hospital Jena, Am Klinikum 1, 07747 Jena, Germany.
| | - Annika Momberg
- Dept. of Hematology and Medical Oncology, University Hospital Jena, Am Klinikum 1, 07747 Jena, Germany
| | - Katrin Clauß
- Dept. of Hematology and Medical Oncology, University Hospital Jena, Am Klinikum 1, 07747 Jena, Germany
| | - Gültekin Bozkurt
- Dept. of Hematology and Medical Oncology, University Hospital Jena, Am Klinikum 1, 07747 Jena, Germany
| | - Elizabeth Hertel
- Dept. of Hematology and Medical Oncology, University Hospital Jena, Am Klinikum 1, 07747 Jena, Germany
| | - Maren Freuding
- Dept. of Hematology and Medical Oncology, University Hospital Jena, Am Klinikum 1, 07747 Jena, Germany
| | - Lena Josfeld
- Dept. of Hematology and Medical Oncology, University Hospital Jena, Am Klinikum 1, 07747 Jena, Germany
| | - Jutta Huebner
- Dept. of Hematology and Medical Oncology, University Hospital Jena, Am Klinikum 1, 07747 Jena, Germany
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Multimedia in preoperative patient education for adults undergoing cancer surgery: A systematic review. Eur J Oncol Nurs 2021; 52:101981. [PMID: 34091407 DOI: 10.1016/j.ejon.2021.101981] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Revised: 05/11/2021] [Accepted: 05/17/2021] [Indexed: 01/22/2023]
Abstract
PURPOSE The purpose of this systematic review was to determine whether adequate research evidence exists to support utilizing multimedia technology in the preoperative education of adult cancer patients. METHODS A systematic search of Medline, CINAHL, Web of Science, and PsycINFO databases from 2010 through September 24, 2020, was performed. The review included quantitative studies that examined whether education delivered by multimedia impacted levels of anxiety, knowledge acquisition, satisfaction, and compliance. The research quality was evaluated using the Joanna Briggs Institute Critical Appraisal Tool specific to the study design. RESULTS The database search identified 529 scientific articles, of these nine studies met the eligibility criteria (n = 5 randomized controlled trials; n = 4 quasi-experimental studies). The education interventions included a variety of researcher-developed, multimedia modalities, consisting of video (n = 7), a computer program (n = 1), and a tablet application (n = 1). The methodological rigor varied among these studies. Multimedia patient education resulted in decreased anxiety and improved knowledge acquisition within groups; however, there was no significant difference when compared to traditional methods. Patients were also similarly satisfied and compliant with both education methods. CONCLUSIONS In all studies, the healthcare provider played a prominent role in both multimedia and traditional interventions, revealing the strong influence of the interpersonal connection in the delivery of preoperative education. Future research is needed to investigate whether more interactive technology could improve patient outcomes.
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Lee MJ, Jones GL, Lobo AJ, Brown SR. Survey to define informational needs of patients undergoing surgery for Crohn's anal fistula. Colorectal Dis 2021; 23:132-144. [PMID: 33140914 DOI: 10.1111/codi.15423] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Revised: 09/24/2020] [Accepted: 10/13/2020] [Indexed: 12/13/2022]
Abstract
AIM There are many surgical treatments used in Crohn's anal fistula, although none is perfect. Decisions about surgery in this condition may be preference sensitive. The aim of this study was to identify what information patients would like in order to make treatment decisions and to explore experiences of making decisions in this setting. METHOD A survey was designed based upon qualitative interviews and input from patients and clinicians. It included a long list of informational items to be ranked on a scale of importance, a control preference scale, the decision regret scale, and items exploring preferred information formats. This was distributed through 10 English hospitals to patients with recent surgical treatment for Crohn's anal fistula. Results were analysed using principal component analysis, to identify key informational needs, and other appropriate descriptive statistics. RESULTS In total 92 questionnaires were returned (response rate 41.8%); 48 (52.5%) respondents were women and 54 (58.7%) had undergone seton insertion. Principal component analysis identified three information needs: wound and aftercare, effect on perianal symptoms, severity of surgery. Decision-making preferences showed a desire to participate in decision-making. Median decision regret score was 25/100 (i.e., low). The preferred format for sharing information to support decision-making was from the surgeon, 80/92 (87.0%), and from a booklet, 58/92 (63.0%). CONCLUSION Key informational needs in this condition are wound and after care, effect on perianal symptoms, and severity of surgery. Patients would like this information to help engage in shared decision-making.
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Affiliation(s)
- Matthew J Lee
- General Surgery, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK.,Department of Oncology and Metabolism, The Medical School, University of Sheffield, Sheffield,, UK
| | | | - Alan J Lobo
- Gastroenterology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Steven R Brown
- General Surgery, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
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van Stralen KJ, Ruijter L, Frissen J, den Boer RH, Struben VMD, van Oostveen CJ. Patients want to be seen: The top 3 information needs of patients with inguinal hernia. PLoS One 2020; 15:e0240433. [PMID: 33048961 PMCID: PMC7553313 DOI: 10.1371/journal.pone.0240433] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Accepted: 09/27/2020] [Indexed: 12/20/2022] Open
Abstract
Background Good patient information has shown to improve surgical outcomes. In this study we explore what kind of pre-surgical information patients need and if the provision of a 360˚ video of a surgical procedure can be of added value to the information provided by the hospital. Methods An explorative qualitative study using semi-structured interviews on information needs was conducted among 17 inguinal hernia patients to gain more insight in the patients’ present surgical information needs. Patients either were planned to receive or already had received a surgical procedure. Questions were asked about the current information provision and, after being shown a 360˚ video of the surgery, whether this would be of added value. Results Of the total group of 17 patients (mean age 56, interquartile range 45–64) 16 were male and one was female. Most had no previous experience with virtual reality (14/17), already had undergone a surgical procedure (11/17). Patient information needs were all about “seeing” which can be viewed from three different perspectives [1] being seen as a unique person in the treatment process, [2] being seen as a partner, and [3] seeing is understanding. Patients wanted the contact with the doctor to be more personal, with the possibility to see the anesthetist in person, the surgeon to see their wound in the recovery phase, and to receive personal answers to questions about their specific situation. Patients found the 360-video not fearsome, and believed that visual content could be beneficial as it appeals more to their imagination than written or oral information and increases their understanding. It also provided them with a better understanding of their treatment options, their pre-, peri-, and post-surgical procedures and identification of the cause of post-operative side effects. Conclusion To address patients’ information needs, complementary tools or services are needed that increase personal contact as well as tailor it to individual patient’s needs. Even though video-apps are a partial alternative, hospitals should still offer patients the possibility of having face-to-face meetings with physicians as this is highly valued by patients and leads to increased trust in physicians’ performance.
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Affiliation(s)
| | - Lotte Ruijter
- Spaarne Gasthuis Academy, Spaarne Gasthuis Hospital, Hoofddorp, Netherlands
| | - Judith Frissen
- Spaarne Gasthuis Academy, Spaarne Gasthuis Hospital, Hoofddorp, Netherlands
| | | | | | - Catharina J. van Oostveen
- Spaarne Gasthuis Academy, Spaarne Gasthuis Hospital, Hoofddorp, Netherlands
- Erasmus School for Health Policy & Management, Erasmus University Rotterdam, Rotterdam, Netherlands
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Hladkowicz E, Yachnin D, Boland L, Wilson K, McKinnon A, Hawrysh K, Hawrysh T, Bell C, Atkinson K, van Walraven C, Taljaard M, Thavorn K, Stacey D, Yang H, Pysyk C, Moloo H, Manuel D, MacDonald D, Lavallée LT, Gagne S, Forster AJ, Bryson GL, McIsaac DI. Evaluation of a preoperative personalized risk communication tool: a prospective before-and-after study. Can J Anaesth 2020; 67:1749-1760. [PMID: 32929659 DOI: 10.1007/s12630-020-01809-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Revised: 05/20/2020] [Accepted: 05/22/2020] [Indexed: 12/31/2022] Open
Abstract
PURPOSE Patients want personalized information before surgery; most do not receive personalized risk estimates. Inadequate information contributes to poor experience and medicolegal complaints. We hypothesized that exposure to the Personalized Risk Evaluation and Decision Making in Preoperative Clinical Assessment (PREDICT) app, a personalized risk communication tool, would improve patient knowledge and satisfaction after anesthesiology consultations compared with standard care. METHODS We conducted a prospective clinical study (before-after design) and used patient-reported data to calculate personalized risks of morbidity, mortality, and expected length of stay using a locally calibrated National Surgical Quality Improvement Program risk calculator embedded in the PREDICT app. In the standard care (before) phase, the application's materials and output were not available to participants; in the PREDICT app (after) phase, personalized risks were communicated. Our primary outcome was knowledge score after the anesthesiology consultation. Secondary outcomes included patient satisfaction, anxiety, feasibility, and acceptability. RESULTS We included 183 participants (90 before; 93 after). Compared with standard care phase, the PREDICT app phase had higher post-consultation: knowledge of risks (14.3% higher; 95% confidence interval [CI], 6.5 to 22.0; P < 0.001) and satisfaction (0.8 points; 95% CI, 0.1 to 1.4; P = 0.03). Anxiety was unchanged (- 1.9%; 95% CI, - 4.2 to 0.5; P = 0.13). Acceptability was high for patients and anesthesiologists. CONCLUSION Exposure to a patient-facing, personalized risk communication app improved knowledge of personalized risk and increased satisfaction for adults before elective inpatient surgery. TRIAL REGISTRATION www.clinicaltrials.gov (NCT03422133); registered 5 February 2018.
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Affiliation(s)
- Emily Hladkowicz
- Department of Anesthesiology & Pain Medicine, The Ottawa Hospital, Ottawa, ON, Canada.,School of Rehabilitation Therapy, Queens' University, Kingston, ON, Canada.,Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - David Yachnin
- Department of Anesthesiology & Pain Medicine, The Ottawa Hospital, Ottawa, ON, Canada.,Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Laura Boland
- Ottawa Hospital Research Institute, Ottawa, ON, Canada.,School of Health Studies, Western University, London, ON, Canada
| | - Kumanan Wilson
- Ottawa Hospital Research Institute, Ottawa, ON, Canada.,Department of Medicine, University of Ottawa and The Ottawa Hospital, Ottawa, ON, Canada
| | | | | | | | - Cameron Bell
- Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Katherine Atkinson
- Department of Public Health Science, Karolinska Institute, Solna, Sweden
| | - Carl van Walraven
- Ottawa Hospital Research Institute, Ottawa, ON, Canada.,Department of Medicine, University of Ottawa and The Ottawa Hospital, Ottawa, ON, Canada.,School of Epidemiology & Public Health, University of Ottawa, Ottawa, ON, Canada
| | - Monica Taljaard
- Ottawa Hospital Research Institute, Ottawa, ON, Canada.,School of Epidemiology & Public Health, University of Ottawa, Ottawa, ON, Canada
| | - Kednapa Thavorn
- Ottawa Hospital Research Institute, Ottawa, ON, Canada.,School of Epidemiology & Public Health, University of Ottawa, Ottawa, ON, Canada
| | - Dawn Stacey
- Ottawa Hospital Research Institute, Ottawa, ON, Canada.,School of Nursing, University of Ottawa, Ottawa, ON, Canada
| | - Homer Yang
- Department of Anesthesia and Perioperative Medicine, Western University, London, ON, Canada
| | - Christopher Pysyk
- Department of Anesthesiology & Pain Medicine, The Ottawa Hospital, Ottawa, ON, Canada.,Ottawa Hospital Research Institute, Ottawa, ON, Canada.,Department of Anesthesiology & Pain Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Husein Moloo
- Ottawa Hospital Research Institute, Ottawa, ON, Canada.,Departments of Surgery, University of Ottawa and The Ottawa Hospital, Ottawa, ON, Canada
| | - Doug Manuel
- Ottawa Hospital Research Institute, Ottawa, ON, Canada.,School of Epidemiology & Public Health, University of Ottawa, Ottawa, ON, Canada
| | - David MacDonald
- Department of Anesthesiology, Dalhousie University, Halifax, NS, Canada
| | - Luke T Lavallée
- Ottawa Hospital Research Institute, Ottawa, ON, Canada.,Departments of Surgery, University of Ottawa and The Ottawa Hospital, Ottawa, ON, Canada
| | - Sylvain Gagne
- Department of Anesthesiology & Pain Medicine, The Ottawa Hospital, Ottawa, ON, Canada.,Department of Anesthesiology & Pain Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Alan J Forster
- Ottawa Hospital Research Institute, Ottawa, ON, Canada.,Department of Medicine, University of Ottawa and The Ottawa Hospital, Ottawa, ON, Canada.,School of Epidemiology & Public Health, University of Ottawa, Ottawa, ON, Canada
| | - Gregory L Bryson
- Department of Anesthesiology & Pain Medicine, The Ottawa Hospital, Ottawa, ON, Canada.,Ottawa Hospital Research Institute, Ottawa, ON, Canada.,Department of Anesthesiology & Pain Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Daniel I McIsaac
- Department of Anesthesiology & Pain Medicine, The Ottawa Hospital, Ottawa, ON, Canada. .,Ottawa Hospital Research Institute, Ottawa, ON, Canada. .,School of Epidemiology & Public Health, University of Ottawa, Ottawa, ON, Canada. .,Department of Anesthesiology & Pain Medicine, University of Ottawa, Ottawa, ON, Canada.
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Larsen MK, Schultz H, Mortensen MB, Birkelund R. Patients' Experiences With Illness, Treatment, and Decision-Making for Esophageal Cancer: A Qualitative Study in a Danish Hospital Setting. Glob Qual Nurs Res 2020; 7:2333393620935098. [PMID: 32656299 PMCID: PMC7328478 DOI: 10.1177/2333393620935098] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Revised: 05/22/2020] [Accepted: 05/26/2020] [Indexed: 12/12/2022] Open
Abstract
Patients with curable esophageal cancer or cancer in the esophageal
junction face several challenges during the course of their treatment
because of the burden of uncertainty in their prognoses and complexity
and side effects of the treatment. The aim of this study is to explore
patient experiences with illness, treatment, and decision-making in
the context of esophageal cancer. A qualitative approach using
phenomenological–hermeneutical methodology was used. Data consisted of
participant observations and interviews. We analyzed the data based on
Ricoeur’s theory of interpretation. The results show that patients
with esophageal cancer are putting their ordinary lives on hold and
experiencing the meal as a battleground during treatment. Patients
strive to maintain autonomy, gain control, and take ownership. The
results emphasize the need for a systematic approach to establish an
ongoing dialogue with patients throughout the course of treatment.
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Affiliation(s)
- Malene Kaas Larsen
- Odense University Hospital, Odense, Denmark.,University of Southern Denmark, Odense, Denmark
| | - Helen Schultz
- Odense University Hospital, Odense, Denmark.,University of Southern Denmark, Odense, Denmark
| | - Michael Bau Mortensen
- Odense University Hospital, Odense, Denmark.,University of Southern Denmark, Odense, Denmark
| | - Regner Birkelund
- University of Southern Denmark, Odense, Denmark.,Lillebaelt Hospital, Vejle, Denmark
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Convie LJ, Carson E, McCusker D, McCain RS, McKinley N, Campbell WJ, Kirk SJ, Clarke M. The patient and clinician experience of informed consent for surgery: a systematic review of the qualitative evidence. BMC Med Ethics 2020; 21:58. [PMID: 32653008 PMCID: PMC7353438 DOI: 10.1186/s12910-020-00501-6] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Accepted: 07/05/2020] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Informed consent is an integral component of good medical practice. Many researchers have investigated measures to improve the quality of informed consent, but it is not clear which techniques work best and why. To address this problem, we propose developing a core outcome set (COS) to evaluate interventions designed to improve the consent process for surgery in adult patients with capacity. Part of this process involves reviewing existing research that has reported what is important to patients and doctors in the informed consent process. METHODS This qualitative synthesis comprises four phases: identification of published papers and determining their relevance; appraisal of the quality of the papers; identification and summary of the key findings from each paper while determining the definitiveness of each finding against the primary data; comparison of key themes between papers such that findings are linked across studies. RESULTS Searches of bibliographic databases returned 11,073 titles. Of these, 16 studies met the inclusion criteria. Studies were published between 1996 and 2016 and included a total of 367 patients and 74 health care providers. Thirteen studies collected data using in-depth interviews and constant comparison was the most common means of qualitative analysis. A total of 94 findings were extracted from the primary papers and divided into 17 categories and ultimately 6 synthesised findings related to: patient characteristics, knowledge, communication, the model patient, trust and decision making. CONCLUSIONS This qualitative meta-aggregation is the first to examine the issue of informed consent for surgery. It has revealed several outcomes deemed important to capture by patients and clinicians when evaluating the quality of a consent process. Some of these outcomes have not been examined previously in research comparing methods for informed consent. This review is an important step in the development of a COS to evaluate interventions designed to improve the consent process for surgery. REGISTRATION The study protocol was registered on the international prospective register for systematic reviews (PROSPERO ID: CRD42017077101).
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Affiliation(s)
- L. J. Convie
- Department of General Surgery, Ulster Hospital Dundonald, Belfast, UK
- Centre for Public Health, Queen’s University Belfast, Belfast, UK
| | - E. Carson
- Department of General Surgery, Ulster Hospital Dundonald, Belfast, UK
| | - D. McCusker
- Department of General Surgery, Ulster Hospital Dundonald, Belfast, UK
| | - R. S. McCain
- Department of General Surgery, Ulster Hospital Dundonald, Belfast, UK
| | - N. McKinley
- Centre for Public Health, Queen’s University Belfast, Belfast, UK
| | - W. J. Campbell
- Department of General Surgery, Ulster Hospital Dundonald, Belfast, UK
| | - S. J. Kirk
- Department of General Surgery, Ulster Hospital Dundonald, Belfast, UK
| | - M. Clarke
- Centre for Public Health, Queen’s University Belfast, Belfast, UK
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Schultz KS, de Geus SWL, Sachs TE, Morgan RB, Ng SC, McAneny D, Tseng JF. Influence of race and sociodemographic factors on declining resection for gastric cancer: A national study. Am J Surg 2020; 221:155-161. [PMID: 32758359 DOI: 10.1016/j.amjsurg.2020.06.022] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2020] [Revised: 06/18/2020] [Accepted: 06/18/2020] [Indexed: 12/26/2022]
Abstract
BACKGROUND The purpose of this study was to determine whether racial or other demographic characteristics were associated with declining surgery for early stage gastric cancer. METHODS Patients with clinical stage I-II gastric adenocarcinoma were identified from the NCDB. Multivariable logistic models identified predictors for declining resection. Patients were stratified based on propensity scores, which were modeled on the probability of declining. Overall survival was evaluated using the Kaplan-Meier method. RESULTS Of 11,326 patients, 3.68% (n = 417) declined resection. Patients were more likely to refuse if they were black (p < 0.001), had Medicaid or no insurance (p < 0.001), had shorter travel distance to the hospital (p < 0.001) or were treated at a non-academic center (p = 0.001). After stratification, patients who declined surgery had worse overall survival (all strata, p < 0.001). CONCLUSIONS Racial and sociodemographic disparities exist in the treatment of potentially curable gastric cancer, with patients who decline recommended surgery suffering worse overall survival.
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Affiliation(s)
- Kurt S Schultz
- Department of Surgery, Boston Medical Center, Boston University, 88 East Newton Street Collamore - C500, Boston, MA, 02118, USA; University of Massachusetts Medical School, 55 North Lake Avenue, Worcester, MA, 01655, USA.
| | - Susanna W L de Geus
- Department of Surgery, Boston Medical Center, Boston University, 88 East Newton Street Collamore - C500, Boston, MA, 02118, USA
| | - Teviah E Sachs
- Department of Surgery, Boston Medical Center, Boston University, 88 East Newton Street Collamore - C500, Boston, MA, 02118, USA
| | - Ryan B Morgan
- Department of Surgery, The University of Chicago, 5841 S. Maryland Avenue, Chicago, IL, 60637, USA
| | - Sing Chau Ng
- Department of Surgery, Boston Medical Center, Boston University, 88 East Newton Street Collamore - C500, Boston, MA, 02118, USA
| | - David McAneny
- Department of Surgery, Boston Medical Center, Boston University, 88 East Newton Street Collamore - C500, Boston, MA, 02118, USA
| | - Jennifer F Tseng
- Department of Surgery, Boston Medical Center, Boston University, 88 East Newton Street Collamore - C500, Boston, MA, 02118, USA.
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Lee MJ, Marshall JH, Jones GL, Lobo AJ, Brown SR. The informational and decisional preferences of patients undergoing surgery for Crohn's anal fistula: a qualitative study. Colorectal Dis 2020; 22:703-712. [PMID: 31868981 DOI: 10.1111/codi.14936] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2019] [Accepted: 10/08/2019] [Indexed: 12/17/2022]
Abstract
AIM One in three patients with Crohn's disease will develop a perianal fistula, but only a few achieve long-term healing. Treatment is both medical and surgical. Since there is no 'best' surgical procedure, patient preference is important in selecting the appropriate treatment for this condition. The aim of this study was to investigate the informational and decisional preferences of patients when surgical treatment is being considered. METHOD Patients who had undergone surgery for Crohn's anal fistula underwent face-to-face semi-structured interviews. These explored the experience of treatments for fistula, of receiving information and of participation in decision-making. Transcripts were analysed by two investigators through inductive thematic analysis. Saturation was assessed for at 12 interviews and then after each subsequent interview. RESULTS Seventeen patients completed interviews, and saturation was achieved. Five themes were identified, of which two (desired information and decision-making) were relevant to this study. Other themes included experience of Crohn's disease, experience of receiving information and procedure-specific comments. Participants wanted to have information on any risks, high-level outcomes (e.g. success), impact on day-to-day life and aftercare. Participants felt they did not always receive the information they needed to select the best treatment option. Participants felt uninvolved in treatment decisions and would have liked to trade off operations to reach their treatment goal. CONCLUSION Information provided to patients about surgical treatment of Crohn's perianal fistula does not meet their needs. Clinicians should address aftercare, impact on quality of life and the risks and benefits of the any proposed procedure.
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Affiliation(s)
- M J Lee
- Academic Department of General Surgery, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK.,Department of Oncology and Metabolism, The Medical School, University of Sheffield, Sheffield, UK
| | - J H Marshall
- The Medical School, University of Sheffield, Sheffield, UK
| | - G L Jones
- Department of Psychology, Leeds Beckett University, Leeds, UK
| | - A J Lobo
- Academic Unit of Gastroenterology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - S R Brown
- Academic Department of General Surgery, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
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Lafaro KJ, Li A, Rodriguez J, Clark K, Loscalzo M, Wong FL, Melstrom LG, Warner SG. Surgeon and patient perceptions of cure in advanced gastrointestinal malignancies: Are we on the same page? J Surg Oncol 2020; 122:489-494. [PMID: 32441359 DOI: 10.1002/jso.25986] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Accepted: 05/09/2020] [Indexed: 11/06/2022]
Abstract
BACKGROUND AND OBJECTIVES Effective communication is essential to complex shared decision making and is associated with improved recovery and pain control. However, patients and surgeons often have disparate expectations of treatment efficacy and perceptions of cure for advanced malignancies. This study measures correlation of patient and surgeon expectations with perceptions of cure. METHODS Our prospective study surveying surgeon-patient dyads before and after surgical consultation was performed for advanced abdominal malignancy between July and November 2017 at a single NCI designated cancer center using electronic questionnaires. RESULTS Patients and surgeons' own opinions regarding surgical candidacy (Q1), chance at cure (Q2), and life expectancy (Q3) did not measurably change from pre- to postvisit survey as evidenced by unchanged response concordance (patients Q1 P = .82; Q2 P = .81; and Q3 P = .53; surgeon responses Q1: P = .17; Q2: P = .32; and Q3: P = .50). Patient and surgeon perception of likelihood of cure and of estimated life expectancy remained discordant in pre- and postvisit surveys (Q2: P = .006 and Q3: P = .03). CONCLUSIONS These data highlight the stark differences between patient and surgeon perceptions of cure and prognosis of gastrointestinal cancers. These results prove that a larger scale study using this electronic questionnaire is feasible and important to better understand these differences and enhance shared decision making.
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Affiliation(s)
- Kelly J Lafaro
- Department of Surgery, Johns Hopkins University, Baltimore, Maryland
| | - Arthur Li
- Department of Population Sciences, City of Hope National Medical Center, Duarte, California
| | - Jenny Rodriguez
- Department of Supportive Care Medicine, City of Hope National Medical Center, Duarte, California
| | - Karen Clark
- Department of Supportive Care Medicine, City of Hope National Medical Center, Duarte, California
| | - Matthew Loscalzo
- Department of Supportive Care Medicine, City of Hope National Medical Center, Duarte, California
| | - F Lennie Wong
- Department of Population Sciences, City of Hope National Medical Center, Duarte, California
| | - Laleh G Melstrom
- Department of Surgery, City of Hope National Medical Center, Duarte, California
| | - Susanne G Warner
- Department of Surgery, City of Hope National Medical Center, Duarte, California
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Shaw S, Hughes G, Stephens T, Pearse R, Prowle J, Ashcroft RE, Avagliano E, Day J, Edsell M, Edwards J, Everest L. Understanding decision making about major surgery: protocol for a qualitative study of shared decision making by high-risk patients and their clinical teams. BMJ Open 2020; 10:e033703. [PMID: 32376751 PMCID: PMC7223149 DOI: 10.1136/bmjopen-2019-033703] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Surgical treatments are being offered to more patients than ever before, and increasingly to high-risk patients (typically multimorbid and over 75). Shared decision making is seen as essential practice. However, little is currently known about what 'good' shared decision making involves nor how it applies in the context of surgery for high-risk patients. This new study aims to identify how high-risk patients, their families and clinical teams negotiate decision making for major surgery. METHODS AND ANALYSIS Focusing on major joint replacement, colorectal and cardiac surgery, we use qualitative methods to explore how patients, their families and clinicians negotiate decision making (including interactional, communicative and informational aspects and the extent to which these are perceived as shared) and reflect back on the decisions they made. Phase 1 involves video recording 15 decision making encounters about major surgery between patients, their carers/families and clinicians; followed by up to 90 interviews (with the same patient, carer and clinician participants) immediately after a decision has been made and again 3-6 months later. Phase 2 involves focus groups with a wider group of (up to 90) patients and (up to 30) clinicians to test out emerging findings and inform development of shared decision making scenarios (3-5 summary descriptions of how decisions are made). ETHICS AND DISSEMINATION The study forms the first part in a 6-year programme of research, Optimising Shared decision-makIng for high-RIsk major Surgery (OSIRIS). Ethical challenges around involving patients at a challenging time in their lives will be overseen by the programme steering committee, which includes strong patient representation and a lay chair. In addition to academic outputs, we will produce a typology of decision making scenarios for major surgery to feed back to patients, professionals and service providers and inform subsequent work in the OSIRIS programme.
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Affiliation(s)
- Sara Shaw
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Gemma Hughes
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Tim Stephens
- School of Medicine & Dentistry, Queen Mary University of London, London, UK
| | - Rupert Pearse
- Barts and the London School of Medicine & Dentistry, Queen Mary University of London, London, UK
| | - John Prowle
- Barts and the London School of Medicine & Dentistry, Queen Mary University of London, London, UK
| | | | - Ester Avagliano
- Department of Anaesthesia, St. George's University Hospitals Foundation Trust, London, UK
| | - James Day
- Department of Anaesthesia, John Radcliffe Hospital, Oxford, UK
| | - Mark Edsell
- Department of Anaesthesia, St. George's University Hospitals Foundation Trust, London, UK
| | - Jennifer Edwards
- Department of Anaesthesia, Royal Alexandra Hospital, Paisley, UK
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Larsen MK, Birkelund R, Mortensen MB, Schultz H. Being a relative on the sideline to the patient with oesophageal cancer: a qualitative study across the treatment course. Scand J Caring Sci 2020; 35:277-286. [PMID: 32271481 DOI: 10.1111/scs.12845] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Revised: 02/19/2020] [Accepted: 03/11/2020] [Indexed: 01/10/2023]
Abstract
BACKGROUND Being a relative of patients with oesophageal cancer or cancer in the oesophageal junction is stressful, as the healthcare system often overlooks concerns about the future as well as the roles and needs of relatives. There is a lack of research addressing relatives' experiences, roles and needs for participation in decisions. AIMS AND OBJECTIVES To explore relatives' experiences before the start of treatment and their subsequent roles and needs for participation in treatment decisions. DESIGN A qualitative approach based on a phenomenological - hermeneutical methodology was used. METHODS Data consisted of participant observations and semi-structured interviews with 19 relatives of patients with oesophageal cancer. We analysed data with inspiration from Ricœur's theory of interpretation. RESULTS The relatives were fellow sufferers, experiencing uncertainties and fear for the future with the patients, but they were simultaneously a challenged anchor during a difficult time, actively involved in handling the diagnosis and the everyday life. The relatives were positioned on the sideline both by the professionals and by themselves; they took a passive and subordinate part in decisions. CONCLUSION Relatives are central to cancer care and treatment. Adequate and timely information is imperative for relatives as well for patients in order to facilitate shared decision-making. We advocate for a new approach to relatives in order to prepare the relatives for their roles and support their individual needs but also to acknowledge relatives' knowledge about everyday life from the relatives' perspective.
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Affiliation(s)
- Malene Kaas Larsen
- Department of Surgery, Odense University Hospital, Odense C, Denmark.,Institute of Regional Health Research, University of Southern Denmark, Odense M, Denmark
| | - Regner Birkelund
- Institute of Regional Health Research, University of Southern Denmark, Odense M, Denmark
| | - Michael Bau Mortensen
- Department of Surgery, Odense University Hospital, Odense C, Denmark.,Institute of Clinical Research, University of Southern Denmark, Odense M, Denmark
| | - Helen Schultz
- Department of Surgery, Odense University Hospital, Odense C, Denmark.,Institute of Clinical Research, University of Southern Denmark, Odense M, Denmark
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Shauly O, Gould DJ, Patel KM. Cost-Utility Analysis of Surgical Decompression Relative to Injection Therapy for Chronic Migraine Headaches. Aesthet Surg J 2019; 39:NP462-NP470. [PMID: 30868158 DOI: 10.1093/asj/sjz069] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Common treatments for chronic migraine headaches include injection of corticosteroid and anesthetic agents at local trigger sites. However, the effects of therapy are short term, and lifelong treatment is often necessary. In contrast, surgical decompression of migraine trigger sites accomplishes the same goal yet demonstrates successful long-term elimination of chronic migraines. OBJECTIVES Our primary objective was to perform a cost-utility analysis to determine which patients would benefit most from available treatment options in a cost-conscious model. METHODS A cost-utility analysis was performed, taking into consideration costs, probabilities, and health state utility scores of various interventions. RESULTS Injection therapy offered a minor improvement in quality-adjusted life-years (QALYs) compared with surgical decompression (QALY Δ = 0.6). However, long-term injection therapy was significantly costlier to society than surgical decompression: injection treatment was estimated to cost $106,887.96 more than surgery. The results of our cost-utility analysis thus conferred a positive incremental cost-utility ratio of $178,163.27 in favor of surgical decompression. CONCLUSIONS Surgery provides a durable intervention and has been shown in this study to be extremely cost effective despite a very minor QALY deficit compared with injection therapy. If patients are identified who require treatment in the form of injections for less than 8.25 years, they may fall into a group that should not be offered surgery.
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Affiliation(s)
- Orr Shauly
- Department of Plastic and Reconstructive Surgery, Keck Hospital of USC, Los Angeles, CA
| | - Daniel J Gould
- Department of Plastic and Reconstructive Surgery, Keck Hospital of USC, Los Angeles, CA
| | - Ketan M Patel
- Department of Plastic and Reconstructive Surgery, Keck Hospital of USC, Los Angeles, CA
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