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Parker M, Kazemi F, Ahmed AK, Kuo CC, Nair SK, Rincon-Torroella J, Jackson C, Gallia G, Bettegowda C, Weingart J, Brem H, Mukherjee D. Exploring the impact of primary care utilization and health information exchange upon treatment patterns and clinical outcomes of glioblastoma patients. J Neurooncol 2024; 168:345-353. [PMID: 38662150 DOI: 10.1007/s11060-024-04677-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2024] [Accepted: 04/05/2024] [Indexed: 04/26/2024]
Abstract
PURPOSE There is limited literature describing care coordination for patients with glioblastoma (GBM). We aimed to investigate the impact of primary care and electronic health information exchange (HIE) between neurosurgeons, oncologists, and primary care providers (PCP) on GBM treatment patterns, postoperative outcomes, and survival. METHODS We identified adult GBM patients undergoing primary resection at our institution (2007-2020). HIE was defined as shared electronic medical information between PCPs, oncologists, and neurosurgeons. Multivariate logistic regression analyses were used to determine the effect of PCPs and HIE upon initiation and completion of adjuvant therapy. Kaplan-Meier and multivariate Cox regression models were used to evaluate overall survival (OS). RESULTS Among 374 patients (mean age ± SD: 57.7 ± 13.5, 39.0% female), 81.0% had a PCP and 62.4% had electronic HIE. In multivariate analyses, having a PCP was associated with initiation (OR: 7.9, P < 0.001) and completion (OR: 4.4, P < 0.001) of 6 weeks of concomitant chemoradiation, as well as initiation (OR: 4.0, P < 0.001) and completion (OR: 3.0, P = 0.007) of 6 cycles of maintenance temozolomide thereafter. Having a PCP (median OS [95%CI]: 14.6[13.1-16.1] vs. 10.8[8.2-13.3] months, P = 0.005) and HIE (15.40[12.82-17.98] vs. 13.80[12.51-15.09] months, P = 0.029) were associated with improved OS relative to counterparts in Kaplan-Meier analysis and in multivariate Cox regression analysis (hazard ratio [HR] = 0.7, [95% CI] 0.5-1.0, P = 0.048). In multivariate analyses, chemoradiation (HR = 0.34, [95% CI] 0.2-0.7, P = 0.002) and maintenance temozolomide (HR = 0.5, 95%CI 0.3-0.8, P = 0.002) were associated with improved OS relative to counterparts. CONCLUSION Effective care coordination between neurosurgeons, oncologists, and PCPs may offer a modifiable avenue to improve GBM outcomes.
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Affiliation(s)
- Megan Parker
- Department of Neurosurgery, Johns Hopkins University School of Medicine, 1800 Orleans St, 21287, Baltimore, MD, USA
| | - Foad Kazemi
- Department of Neurosurgery, Johns Hopkins University School of Medicine, 1800 Orleans St, 21287, Baltimore, MD, USA
| | - A Karim Ahmed
- Department of Neurosurgery, Johns Hopkins University School of Medicine, 1800 Orleans St, 21287, Baltimore, MD, USA
| | - Cathleen C Kuo
- Department of Neurosurgery, University at Buffalo, Buffalo, NY, USA
| | - Sumil K Nair
- Department of Neurosurgery, Johns Hopkins University School of Medicine, 1800 Orleans St, 21287, Baltimore, MD, USA
| | - Jordina Rincon-Torroella
- Department of Neurosurgery, Johns Hopkins University School of Medicine, 1800 Orleans St, 21287, Baltimore, MD, USA
| | - Christopher Jackson
- Department of Neurosurgery, Johns Hopkins University School of Medicine, 1800 Orleans St, 21287, Baltimore, MD, USA
| | - Gary Gallia
- Department of Neurosurgery, Johns Hopkins University School of Medicine, 1800 Orleans St, 21287, Baltimore, MD, USA
| | - Chetan Bettegowda
- Department of Neurosurgery, Johns Hopkins University School of Medicine, 1800 Orleans St, 21287, Baltimore, MD, USA
| | - Jon Weingart
- Department of Neurosurgery, Johns Hopkins University School of Medicine, 1800 Orleans St, 21287, Baltimore, MD, USA
| | - Henry Brem
- Department of Neurosurgery, Johns Hopkins University School of Medicine, 1800 Orleans St, 21287, Baltimore, MD, USA
| | - Debraj Mukherjee
- Department of Neurosurgery, Johns Hopkins University School of Medicine, 1800 Orleans St, 21287, Baltimore, MD, USA.
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Rajeswaran T, Dawdy K, Bishop M, Amiel G, Heneghan K, Khader J, de Vries J, Silva FS, Wiljer D, Szumacher E. An Exploration of the Pillars of Leadership in Cancer Education. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2024; 39:288-296. [PMID: 38421568 DOI: 10.1007/s13187-024-02409-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 02/09/2024] [Indexed: 03/02/2024]
Abstract
Leadership plays a key role in cancer education (CE) and the success of its practices. Leaders in CE must effectively use their leadership skills to be able to communicate, collaborate, and educate their team members. There is a lack of formalized and standardized curriculums for institutions in developing leadership programs, including what themes to focus on in CE. In this article, the authors describe key pillars of leadership in CE that have presented themselves throughout their experience and within the literature. A search was conducted using the Ovid MEDLINE® database and articles were reviewed for eligibility. In this review, thirty articles were selected for their relevance to CE. With this literature search and the authors' reflections, four pillars of leadership in CE were identified: (1) leadership development, (2) collaboration, (3) diversity and equity, and (4) implementation. Within these themes, key areas of importance were discussed further, and barriers to CE leadership were identified. By reflecting upon pillars of leadership in CE, this article may be helpful for developing future leadership programs within CE. It is vital that initiatives continue to be held and barriers are addressed to increase leadership effectiveness within CE.
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Affiliation(s)
- Thenugaa Rajeswaran
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Krista Dawdy
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
- University of Toronto, Department of Radiation Oncology, Toronto, ON, Canada
| | - Maria Bishop
- Division of Hematology and Oncology, University of Arizona Cancer Center, Tucson, AZ, USA
| | - Gilad Amiel
- Department of Urology, Rambam Health Care Campus, Haifa, Israel
| | - Kathleen Heneghan
- Surgical Patient Education, American College of Surgeons, Chicago, IL, USA
| | - Jamal Khader
- Department of Radiation Oncology, King Hussein Cancer Center, Amman, Jordan
| | - Jakob de Vries
- University Medical Center Groningen, Groningen, Netherlands
| | - Filipe Santos Silva
- i3S-Institute for Research and Innovation in Health, University of Porto, Porto, Portugal
| | - David Wiljer
- Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Ewa Szumacher
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON, Canada.
- University of Toronto, Department of Radiation Oncology, Toronto, ON, Canada.
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Dürsch H, Boltenhagen U, Mahler C, Joos S, Szecsenyi J, Klafke N. A Qualitative Analysis of Cancer Patients' Perceptions of an Interprofessional Counseling Service on Complementary and Integrative Healthcare. QUALITATIVE HEALTH RESEARCH 2024:10497323241231530. [PMID: 38441438 DOI: 10.1177/10497323241231530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/10/2024]
Abstract
Medical guidelines recommend actively addressing patients' information needs regarding complementary and integrative healthcare (CIH). Within the CCC-Integrativ study, an interprofessional counseling program on CIH was developed and implemented at four comprehensive cancer centers (CCCs) in Germany. As part of the process evaluation, this study examines cancer patients' experiences with interprofessional CIH counseling sessions conducted by a physician and a nurse. Forty problem-centered interviews were conducted using a semi-structured interview guide. All interviews were audio-recorded, transcribed verbatim, and analyzed using deductive-inductive content analysis based on Kuckartz and Rädiker's approach. Findings revealed that most participants had prior experience with CIH approaches and were burdened by physiological and psychological symptoms. Counseling sessions focused on cancer- and treatment-related symptoms and appropriate CIH recommendations (e.g., herbal poultice against anxieties and acupressure against nausea). Participants appreciated the mutual exchange and integration of perspectives from different healthcare professions within the interprofessional approach. They noted that the counseling team comprehensively addressed their healthcare and CIH information needs. Suggestions for improvement included the specificity of the CIH recommendations. As the participants only received counseling and no CIH treatments, information about reputable CIH providers was particularly important to many seeking advice. Patients with cancer receiving tailored CIH counseling from two healthcare professionals experienced benefits in CIH counseling for symptom management. The interprofessional teams offered a comprehensive perspective on patients' needs, proposing personalized recommendations for symptom control. These insights may foster collaboration between healthcare professionals interested in CIH counseling, enabling them to expand and consolidate their counseling services.
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Affiliation(s)
- Helena Dürsch
- Department of General Practice and Health Services Research, University Hospital Heidelberg, Heidelberg, Germany
| | - Ursula Boltenhagen
- Department of Nursing Science, University Hospital Tuebingen, Tuebingen, Germany
| | - Cornelia Mahler
- Department of Nursing Science, University Hospital Tuebingen, Tuebingen, Germany
| | - Stefanie Joos
- Institute of General Practice and Interprofessional Care, University Hospital Tuebingen, Tuebingen, Germany
| | - Joachim Szecsenyi
- Department of General Practice and Health Services Research, University Hospital Heidelberg, Heidelberg, Germany
| | - Nadja Klafke
- Department of General Practice and Health Services Research, University Hospital Heidelberg, Heidelberg, Germany
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Odeh Y, Al-Balas M. Implications of Agile Values in Software Engineering for Agility in Breast Cancer Treatment: Protocol for a Comparative Study. JMIR Res Protoc 2023; 12:e53124. [PMID: 38051558 PMCID: PMC10731560 DOI: 10.2196/53124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Revised: 10/29/2023] [Accepted: 11/03/2023] [Indexed: 12/07/2023] Open
Abstract
BACKGROUND Breast cancer treatment has been described as a dynamic and patient-centered approach that emphasizes adaptability and flexibility throughout the treatment process. Breast cancer is complex, with varying subtypes and stages, making it important to tailor treatment plans to each patient's unique circumstances. Breast cancer treatment delivery relies on a multidisciplinary team of health care professionals who collaborate to provide personalized care and quick adaptation to changing conditions to optimize outcomes while minimizing side effects and maintaining the patient's quality of life. However, agility in breast cancer treatment has not been defined according to common agile values and described in language comprehensible to breast cancer professionals. In the rapidly evolving landscape of breast cancer treatment, the incorporation of agile values from software engineering promises to enhance patient care. OBJECTIVE Our objective is to propose agile values for breast cancer treatment adopted and adapted from software engineering. We also aim to validate how these values conform to the concept of agility in the breast cancer context through referencing past work. METHODS We applied a structured research methodology to identify and validate 4 agile values for breast cancer treatment. In the elicitation phase, through 2 interviews, we identified 4 agile values and described them in language that resonates with breast cancer treatment professionals. The values were then validated by a domain expert and discussed in the context of supporting work from the literature. Final validation entailed a domain expert conducting a walkthrough of the 4 identified agile values to adjust them as per the reported literature. RESULTS Four agile values were identified for breast cancer treatment, and among them, we validated 3 that conformed to the concept of agility. The fourth value, documentation and the quality of documentation, is vital for breast cancer treatment planning and management. This does not conform to agility. However, its nonagility is vital for the agility of the other values. None of the identified agile values were validated as partially conforming to the concept of agility. CONCLUSIONS This work makes a novel contribution to knowledge in identifying the first set of agile values in breast cancer treatment through multidisciplinary research. Three of these values were evaluated as conforming to the concept of agility, and although 1 value did not meet the concept of agility, it enhanced the agility of the other values. It is anticipated that these 4 agile values can drive oncology practice, strategies, policies, protocols, and procedures to enhance delivery of care. Moreover, the identified values contribute to identifying quality assurance and control practices to assess the concept of agility in oncology practice and breast cancer treatment and adjust corresponding actions. We conclude that breast cancer treatment agile values are not limited to 4. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) RR1-10.2196/53124.
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Affiliation(s)
- Yousra Odeh
- Software Engineering Department, Faculty of Information Technology, Philadelphia University, Amman, Jordan
| | - Mahmoud Al-Balas
- Department of General Surgery, Anesthesia and Urology, Faculty of Medicine, Hashemite University, Zarqa, Jordan
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Yackel HD, Montano ARL. Attitudes Toward Interprofessional Health Care Teams in a Regional Cancer Institute: A Cross-Sectional Survey Study. Semin Oncol Nurs 2023; 39:151468. [PMID: 37385871 DOI: 10.1016/j.soncn.2023.151468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Revised: 05/26/2023] [Accepted: 06/07/2023] [Indexed: 07/01/2023]
Abstract
OBJECTIVES Oncology is a rapidly changing clinical setting. Research has shown improved patient outcomes and staff satisfaction following interprofessional collaborative education, but there has been limited research on perceptions of interprofessional collaboration among oncology health care professionals. The aims of this study were to: 1) assess attitudes of health care professionals toward interprofessional teams in oncology care, and 2) assess for differences in attitudes across various demographic and workplace groups. DATA SOURCES The research design was an electronic cross-sectional survey. The main instrument utilized was the Attitudes Toward Interprofessional Health Care Teams (ATIHCT) survey. A total of 187 oncology health care professionals from a regional New England cancer institute completed the survey. The ATIHCT mean score was high (M = 4.07, SD = 0.51). Analysis revealed statistically significant differences in mean score among participant age groups (P = .03). Significant differences (P = .01) were also noted between different professional groups and their time constraints sub-scale score on the ATIHCT scale. A higher mean score occurred in participants who had a current certification (M = 4.13, SD = 0.50) compared to those without (M = 4.05, SD = 0.46). CONCLUSION High overall scores in attitudes toward health care teams suggest that cancer care settings are primed for interprofessional care model implementation. Future studies should examine strategies to improve attitudes among specific groups. IMPLICATIONS FOR NURSING PRACTICE Nurses are in a position to lead interprofessional teamwork in the clinical setting. Further research is necessary to examine best collaborative models in health care to support interprofessional teamwork.
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Affiliation(s)
- Hayley Dunnack Yackel
- Clinical Research Nurse and Scientist, Hartford HealthCare Cancer Institute, Hartford, Connecticut, USA.
| | - Anna-Rae L Montano
- Program Director of Inpatient Geriatric Services, Hartford Hospital, Hartford, Connecticut, USA
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Kurniasih DAA, Setiawati EP, Pradipta IS, Subarnas A. Patients' Perspectives of Interprofessional Collaboration in Breast Cancer Unit. Healthcare (Basel) 2023; 11:healthcare11030332. [PMID: 36766907 PMCID: PMC9914250 DOI: 10.3390/healthcare11030332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 01/20/2023] [Accepted: 01/20/2023] [Indexed: 01/24/2023] Open
Abstract
Interprofessional teamwork provides significant benefits for patients. However, qualitative research on interprofessional collaboration in the breast cancer unit is uncommon. Therefore, a qualitative study was conducted to assess the perceptions of outpatient breast cancer patients regarding interprofessional collaboration in the breast care unit of an Indonesian referral center hospital. The teamwork involved in the interprofessional collaboration included breast cancer specialists, pharmacists, and nurses. In this study, in-depth interviews were performed with nine breast cancer outpatients. All interviews were audio recorded, transcribed verbatim, and analyzed using thematic analysis. The findings were divided into two categories to gather breast cancer patients' viewpoints on interprofessional collaboration: (1) obstacle components to interprofessional collaboration: incompleteness of health personnel, no justification from health personnel, no knowledge of patients about health professionals, no involvement of patients in the therapy decision making; (2) enabling elements: patient-oriented, patient expectations, collaboration among healthcare personnel, patient participation in interprofessional collaboration, health personnel responsibilities, comprehensive hospital services. Respondents assumed interprofessional collaboration positively. However, several obstacles must be overcome to implement interprofessional collaboration in a breast care setting effectively. The research findings can be utilized to establish interprofessional collaborations aimed at improving quality healthcare in breast cancer units.
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Affiliation(s)
- Dea Anita Ariani Kurniasih
- Department of Pharmacology and Clinical Pharmacy, Faculty of Pharmacy, Universitas Padjadjaran, Sumedang 45360, Indonesia
- Doctoral Program of Pharmacy, Faculty of Pharmacy, Universitas Padjadjaran, Sumedang 45360, Indonesia
- Pharmacy Study Program, Akademi Farmasi YPF, Bandung 40293, Indonesia
| | - Elsa Pudji Setiawati
- Department of Public Health, Faculty of Medicine, Universitas Padjadjaran, Sumedang 45360, Indonesia
| | - Ivan Surya Pradipta
- Department of Pharmacology and Clinical Pharmacy, Faculty of Pharmacy, Universitas Padjadjaran, Sumedang 45360, Indonesia
- Drug Utilization and Pharmacoepidemiology Research Group, Center of Excellence in Higher Education for Pharmaceutical Care Innovation, Universitas Padjadjaran, Sumedang 45360, Indonesia
| | - Anas Subarnas
- Department of Pharmacology and Clinical Pharmacy, Faculty of Pharmacy, Universitas Padjadjaran, Sumedang 45360, Indonesia
- Correspondence: ; Tel.: +62-812-2390-067
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