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Harrison RA, Tang M, Shih KK, Khan M, Pham L, De Moraes AR, O'Brien BJ, Bassett R, Bruera E. Characterization of patients with brain metastases referred to palliative care. BMC Palliat Care 2024; 23:13. [PMID: 38212765 PMCID: PMC10782691 DOI: 10.1186/s12904-023-01320-3] [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: 01/04/2023] [Accepted: 12/04/2023] [Indexed: 01/13/2024] Open
Abstract
PURPOSE In this study, we aimed to assess the clinical characteristics, reasons for referral, and outcomes of patients with brain metastases (BM) referred to the supportive care center. METHODS Equal numbers of patients with melanoma, breast cancer, and lung cancer with (N = 90) and without (N = 90) BM were retrospectively identified from the supportive care database for study. Descriptive statistics were used to analyze demographic, disease, and clinical data. Kaplan Meier method was used to evaluate survival outcomes. RESULTS While physical symptom management was the most common reason for referral to supportive care for both patients with and without BM, patients with BM had significantly lower pain scores on ESAS at time of referral (p = 0.002). They had greater interaction with acute care in the last weeks of life, with higher rates of ICU admission, emergency room visits, and hospitalizations after initial supportive care (SC) visit. The median survival time from referral to Supportive Care Center (SCC) was 0.90 years (95% CI 0.73, 1.40) for the brain metastasis group and 1.29 years (95% CI 0.91, 2.29) for the group without BM. CONCLUSIONS Patients with BM have shorter survival and greater interaction with acute care in the last weeks of life. This population also has distinct symptom burdens from patients without BM. Strategies to optimize integration of SC for patients with BM warrant ongoing study.
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Affiliation(s)
- Rebecca A Harrison
- Division of Neurology, BC Cancer, The University of British Columbia, Vancouver, BC, Canada.
| | - Michael Tang
- Department of Palliative Care, Rehabilitation, and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Kaoswi Karina Shih
- Department of Palliative Care, Rehabilitation, and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Maria Khan
- Department of Palliative Care, Rehabilitation, and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Lily Pham
- Department of Neurology, University of Maryland School or Medicine, Baltimore, MD, USA
| | - Aline Rozman De Moraes
- Department of Palliative Care, Rehabilitation, and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Barbara J O'Brien
- Department of Neuro-Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Roland Bassett
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Eduardo Bruera
- Department of Palliative Care, Rehabilitation, and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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2
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Semprini JT, Biddell CB, Eberth JM, Charlton ME, Nash SH, Yeager KA, Evans D, Madhivanan P, Brandt HM, Askelson NM, Seaman AT, Zahnd WE. Measuring and addressing health equity: an assessment of cancer center designation requirements. Cancer Causes Control 2023; 34:23-33. [PMID: 36939948 PMCID: PMC10512189 DOI: 10.1007/s10552-023-01680-4] [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: 10/31/2022] [Accepted: 02/27/2023] [Indexed: 03/21/2023]
Abstract
PURPOSE By requiring specific measures, cancer endorsements (e.g., accreditations, designations, certifications) promote high-quality cancer care. While 'quality' is the defining feature, less is known about how these endorsements consider equity. Given the inequities in access to high-quality cancer care, we assessed the extent to which equity structures, processes, and outcomes were required for cancer center endorsements. METHODS We performed a content analysis of medical oncology, radiation oncology, surgical oncology, and research hospital endorsements from the American Society of Clinical Oncology (ASCO), American Society of Radiation Oncology (ASTRO), American College of Surgeons Commission on Cancer (CoC), and the National Cancer Institute (NCI), respectively. We analyzed requirements for equity-focused content and compared how each endorsing body included equity as a requirement along three axes: structures, processes, and outcomes. RESULTS ASCO guidelines centered on processes assessing financial, health literacy, and psychosocial barriers to care. ASTRO guidelines related to language needs and processes to address financial barriers. CoC equity-related guidelines focused on processes addressing financial and psychosocial concerns of survivors, and hospital-identified barriers to care. NCI guidelines considered equity related to cancer disparities research, inclusion of diverse groups in outreach and clinical trials, and diversification of investigators. None of the guidelines explicitly required measures of equitable care delivery or outcomes beyond clinical trial enrollment. CONCLUSION Overall, equity requirements were limited. Leveraging the influence and infrastructure of cancer quality endorsements could enhance progress toward achieving cancer care equity. We recommend that endorsing organizations 1) require cancer centers to implement processes for measuring and tracking health equity outcomes and 2) engage diverse community stakeholders to develop strategies for addressing discrimination.
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Affiliation(s)
- Jason T Semprini
- Department of Health Management and Policy, College of Public Health, University of Iowa, 145 N. Riverside Dr. N277, Iowa City, IA, 52240, USA.
| | - Caitlin B Biddell
- Department of Health Policy and Management, Gillings School of Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Jan M Eberth
- Department of Health Management and Policy, Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA
| | - Mary E Charlton
- Department of Epidemiology, College of Public Health, University of Iowa, Iowa City, IA, USA
| | - Sarah H Nash
- Department of Epidemiology, College of Public Health, University of Iowa, Iowa City, IA, USA
- Department of Community and Behavioral Health, College of Public Health, University of Iowa, Iowa City, IA, USA
| | - Katherine A Yeager
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA, USA
| | - Donoria Evans
- National Partnerships and Innovations, American Cancer Society, Decatur, GA, USA
| | - Purnima Madhivanan
- Department of Health Promotion Sciences, Mel & Enid Zuckerman College of Public Health, University of Arizona. Tucson, Tuscon, AZ, USA
| | - Heather M Brandt
- St. Jude Children's Research Hospital and St. Jude Comprehensive Cancer Center, Memphis, TN, USA
| | - Natoshia M Askelson
- Department of Community and Behavioral Health, College of Public Health, University of Iowa, Iowa City, IA, USA
| | - Aaron T Seaman
- Department of Community and Behavioral Health, College of Public Health, University of Iowa, Iowa City, IA, USA
- Department of Internal Medicine, Carver College of Medicine, University of Iowa, Iowa City, IA, USA
| | - Whitney E Zahnd
- Department of Health Management and Policy, College of Public Health, University of Iowa, 145 N. Riverside Dr. N277, Iowa City, IA, 52240, USA
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3
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Gri N, Longhitano Y, Zanza C, Monticone V, Fuschi D, Piccioni A, Bellou A, Esposito C, Ceresa IF, Savioli G. Acute Oncologic Complications: Clinical-Therapeutic Management in Critical Care and Emergency Departments. Curr Oncol 2023; 30:7315-7334. [PMID: 37623012 PMCID: PMC10453099 DOI: 10.3390/curroncol30080531] [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: 05/07/2023] [Revised: 07/01/2023] [Accepted: 07/10/2023] [Indexed: 08/26/2023] Open
Abstract
Introduction. It is now known that cancer is a major public health problem; on the other hand, it is less known, or rather, often underestimated, that a significant percentage of cancer patients will experience a cancer-related emergency. These conditions, depending on the severity, may require treatment in intensive care or in the emergency departments. In addition, it is not uncommon for a tumor pathology to manifest itself directly, in the first instance, with a related emergency. The emergency unit proves to be a fundamental and central unit in the management of cancer patients. Many cancer cases are diagnosed in the first instance as a result of symptoms that lead the patient's admittance into the emergency room. Materials and Methods. This narrative review aims to analyze the impact of acute oncological cases in the emergency setting and the role of the emergency physician in their management. A search was conducted over the period January 1981-April 2023 using the main scientific platforms, including PubMed, Scopus, Medline, Embase and Google scholar, and 156 papers were analyzed. Results. To probe into the main oncological emergencies and their management in increasingly overcrowded emergency departments, we analyzed the following acute pathologies: neurological emergencies, metabolic and endocrinological emergencies, vascular emergencies, malignant effusions, neutropenic fever and anemia. Discussion/Conclusions. Our analysis found that a redefinition of the emergency department connected with the treatment of oncology patients is necessary, considering not only the treatment of the oncological disease in the strict sense, but also the comorbidities, the oncological emergencies and the palliative care setting. The need to redesign an emergency department that is able to manage acute oncological cases and end of life appears clear, especially when this turns out to be related to severe effects that cannot be managed at home with integrated home care. In conclusion, a redefinition of the paradigm appears mandatory, such as the integration between the various specialists belonging to oncological medicine and the emergency department. Therefore, our work aims to provide what can be a handbook to detect, diagnose and treat oncological emergencies, hoping for patient management in a multidisciplinary perspective, which could also lead to the regular presence of an oncologist in the emergency room.
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Affiliation(s)
- Nicole Gri
- Niguarda Cancer Center, ASST Grande Ospedale Metropolitano Niguarda, Piazza dell’Ospedale Maggiore, 3, 20162 Milano, Italy
| | - Yaroslava Longhitano
- Department of Anesthesiology and Perioperative Medicine, University of Pittsburgh, Pittsburgh, PA 15260, USA
| | - Christian Zanza
- Italian Society of Prehospital Emergency Medicine (SIS 118), 74121 Taranto, Italy
| | - Valentina Monticone
- Department of Otorhinolaryngology, University of Turin, San Luigi Gonzaga Hospital, 10043 Orbassano, Italy
| | - Damiano Fuschi
- Department of Italian and Supranational Public Law, School of Law, University of Milan, 20122 Milan, Italy
| | - Andrea Piccioni
- Department of Emergency Medicine, Polyclinic Agostino Gemelli/IRCCS, Catholic University of the Sacred Heart, 00168 Rome, Italy
| | - Abdelouahab Bellou
- Department of Emergency Medicine, Institute of Sciences in Emergency Medicine, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510080, China
| | - Ciro Esposito
- Unit of Nephrology and Dialysis, ICS Maugeri, University of Pavia, 27100 Pavia, Italy
| | | | - Gabriele Savioli
- Emergency Department, IRCCS Fondazione Policlinico San Matteo, 27100 Pavia, Italy
- PhD School in Experimental Medicine, Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, 27100 Pavia, Italy
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4
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Heung Y, Zhukovsky D, Hui D, Lu Z, Andersen C, Bruera E. Quality of End-of-Life Care during the COVID-19 Pandemic at a Comprehensive Cancer Center. Cancers (Basel) 2023; 15:2201. [PMID: 37190130 PMCID: PMC10136926 DOI: 10.3390/cancers15082201] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Revised: 04/01/2023] [Accepted: 04/06/2023] [Indexed: 05/17/2023] Open
Abstract
To evaluate how the COVID-19 pandemic impacted the quality of end-of-life care for patients with advanced cancer, we compared a random sample of 250 inpatient deaths from 1 April 2019, to 31 July 2019, with 250 consecutive inpatient deaths from 1 April 2020, to 31 July 2020, at a comprehensive cancer center. Sociodemographic and clinical characteristics, the timing of palliative care referral, timing of do-not-resuscitate (DNR) orders, location of death, and pre-admission out-of-hospital DNR documentation were included. During the COVID-19 pandemic, DNR orders occurred earlier (2.9 vs. 1.7 days before death, p = 0.028), and palliative care referrals also occurred earlier (3.5 vs. 2.5 days before death, p = 0.041). During the pandemic, 36% of inpatient deaths occurred in the Intensive Care Unit (ICU) and 36% in the Palliative Care Unit, compared to 48 and 29%, respectively, before the pandemic (p = 0.001). Earlier DNR orders, earlier palliative care referrals, and fewer ICU deaths suggest an improvement in the quality of end-of-life care in response to the COVID-19 pandemic. These encouraging findings may have future implications for maintaining quality end-of-life care post-pandemic.
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Affiliation(s)
- Yvonne Heung
- Department of Palliative Care, Rehabilitation and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA; (Y.H.)
| | - Donna Zhukovsky
- Department of Palliative Care, Rehabilitation and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA; (Y.H.)
| | - David Hui
- Department of Palliative Care, Rehabilitation and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA; (Y.H.)
| | - Zhanni Lu
- Department of Palliative Care, Rehabilitation and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA; (Y.H.)
| | - Clark Andersen
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Eduardo Bruera
- Department of Palliative Care, Rehabilitation and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA; (Y.H.)
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5
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Sedhom R, Gupta A, Shah M, Hsu M, Messmer M, Murray J, Browner I, Smith TJ, Marrone K. Oncology Fellow-Led Quality Improvement Project to Improve Rates of Palliative Care Utilization in Patients With Advanced Cancer. JCO Oncol Pract 2020; 16:e814-e822. [PMID: 32339469 DOI: 10.1200/jop.19.00714] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
PURPOSE ASCO guidelines recommend palliative care (PC) referral for patients with advanced or metastatic cancer. Despite this, implementation has considerable hurdles. First-year oncology fellows at our institution identified low rates of PC utilization in their longitudinal clinic as a metric needing improvement. METHODS A fellow-led multidisciplinary team aimed to increase PC utilization for patients with advanced cancer followed in he first-year fellows' clinic from a baseline of 11.5% (5 of 43 patients, July to December of 2018) to 30% over a 6-month period. Utilization was defined as evaluation in the outpatient PC clinic hosted in the cancer center. The team identified the following barriers to referral: orders difficult to find in the electronic medical record (EMR), multiple consulting mechanisms (EMR, by phone, or in person), EMR request not activating formal consult, no centralized scheduler to contact or confirm appointment, and poor awareness of team structure. Plan-Do-Study-Act (PDSA) cycles were implemented based on identified opportunities. Data were obtained from the EMR. RESULTS The first PDSA cycle included focus groups with stakeholders, standardizing referral process via single order set, identifying a single scheduler with bidirectional communication, and disseminating process changes. PDSA cycles were implemented from January to June of 2019. Rates of PC use increased from 11.5% before the intervention to 48.4% (48 of 99 patients) after the intervention. CONCLUSION A multidisciplinary approach and classic quality improvement methodology improved PC use in patients with advanced cancer. The pilot succeeded given the small number of fellows, buy-in from stakeholders, and institutional and leadership support. Straightforward EMR interventions and ancillary staff use are effective in addressing underreferrals.
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Affiliation(s)
- Ramy Sedhom
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, Baltimore, MD
| | - Arjun Gupta
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, Baltimore, MD
| | - Mirat Shah
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, Baltimore, MD
| | - Melinda Hsu
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, Baltimore, MD
| | - Marcus Messmer
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, Baltimore, MD
| | - Joseph Murray
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, Baltimore, MD
| | - Ilene Browner
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, Baltimore, MD
| | - Thomas J Smith
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, Baltimore, MD
| | - Kristen Marrone
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, Baltimore, MD
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6
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Arnaboldi P, Oliveri S, Vergani L, Marton G, Guiddi P, Busacchio D, Didier F, Pravettoni G. The clinical-care focused psychological interview (CLiC): a structured tool for the assessment of cancer patients' needs. Ecancermedicalscience 2020; 14:1000. [PMID: 32153655 PMCID: PMC7032941 DOI: 10.3332/ecancer.2020.1000] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Indexed: 12/12/2022] Open
Abstract
Integrating the psychosocial perspective in oncology is warranted. Here, we introduce a structured psychological intervention, the clinical-care focused psychological interview (CLiC), to address patients' needs in the relationship with health professionals, clinical pathway and decision-making process. The perceived utility and feasibility of the CLiC were evaluated in a preliminary sample of 30 patients who were candidates to undergo a radical cystectomy at the European Institute of Oncology, Milan, Italy. Patients reported a very high satisfaction with the interview, because it prepared them for their upcoming surgery by gathering more information about their clinical pathway and allowed them to discover the information they still needed. 30% stated that CLiC helped them to reorganise their thoughts and 36.7% understood the role of psychological intervention in the clinical pathway. Only 20% considered the CLiC useful in helping to build their relationship with the clinical staff. Before an invasive surgery such as radical cystectomy, patients' need for information regarding the upcoming surgery seems to prevail. Knowing the future consequences and adjusting toward the disease could be paramount for patients in facing uncertainty and they might feel that creating a relationship with physicians could be a secondary issue. However, our data show that a structured psychological intervention such as the CLiC interview can collect important information for patients and healthcare professionals to develop real patient-centred care.
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Affiliation(s)
- Paola Arnaboldi
- Psychiatry and Medical Psychology Service (SPPM), Cantonal Socio-Psychiatric Organisation (OSC), Via Tesserete 67, 6942 Savosa, Switzerland.,Ticino League against Cancer, Piazza Nosetto, 3, 6500 Bellinzona, Switzerland
| | - Serena Oliveri
- Department of Oncology and Hemato-Oncology, University of Milan, Via Festa del Perdono, 7, 20122 Milan, Italy.,Applied Research Division for Cognitive Psychological Science, European Institute of Oncology IRCCS (IEO), via Ripamonti 435, 20141 Milan, Italy
| | - Laura Vergani
- Department of Oncology and Hemato-Oncology, University of Milan, Via Festa del Perdono, 7, 20122 Milan, Italy.,Applied Research Division for Cognitive Psychological Science, European Institute of Oncology IRCCS (IEO), via Ripamonti 435, 20141 Milan, Italy
| | - Giulia Marton
- Department of Oncology and Hemato-Oncology, University of Milan, Via Festa del Perdono, 7, 20122 Milan, Italy.,Applied Research Division for Cognitive Psychological Science, European Institute of Oncology IRCCS (IEO), via Ripamonti 435, 20141 Milan, Italy
| | - Paolo Guiddi
- Applied Research Division for Cognitive Psychological Science, European Institute of Oncology IRCCS (IEO), via Ripamonti 435, 20141 Milan, Italy
| | - Derna Busacchio
- Applied Research Division for Cognitive Psychological Science, European Institute of Oncology IRCCS (IEO), via Ripamonti 435, 20141 Milan, Italy
| | - Florence Didier
- Applied Research Division for Cognitive Psychological Science, European Institute of Oncology IRCCS (IEO), via Ripamonti 435, 20141 Milan, Italy
| | - Gabriella Pravettoni
- Department of Oncology and Hemato-Oncology, University of Milan, Via Festa del Perdono, 7, 20122 Milan, Italy.,Applied Research Division for Cognitive Psychological Science, European Institute of Oncology IRCCS (IEO), via Ripamonti 435, 20141 Milan, Italy
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7
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Bylicki O, Didier M, Riviere F, Margery J, Grassin F, Chouaid C. Lung cancer and end-of-life care: a systematic review and thematic synthesis of aggressive inpatient care. BMJ Support Palliat Care 2019; 9:413-424. [PMID: 31473652 PMCID: PMC6923940 DOI: 10.1136/bmjspcare-2019-001770] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2019] [Revised: 07/30/2019] [Accepted: 08/14/2019] [Indexed: 12/24/2022]
Abstract
OBJECTIVES Despite recent advances in thoracic oncology, most patients with metastatic lung cancer die within months of diagnosis. Aggressiveness of their end-of-life (EOL) care has been the subject of numerous studies. This study was undertaken to evaluate the literature on aggressive inpatient EOL care for lung cancer and analyse the evolution of its aggressiveness over time. METHODS A systematic international literature search restricted to English-language publications used terms associated with aggressiveness of care, EOL and their synonyms. Two independent researchers screened for eligibility and extracted all data and another a random 10% sample of the abstracts. Electronic Medline and Embase databases were searched (2000-20 September 2018). EOL-care aggressiveness was defined as follows: 1) chemotherapy administered during the last 14 days of life (DOL) or new chemotherapy regimen during the last 30 DOL; 2) >2 emergency department visits; 3) >1 hospitalisation during the last 30 DOL; 4) ICU admission during the last 30 DOL and 5) palliative care started <3 days before death. RESULTS Among the 150 articles identified, 42 were retained for review: 1 clinical trial, 3 observational cohorts, 21 retrospective analyses and 17 administrative data-based studies. The percentage of patients subjected to aggressive therapy seems to have increased over time. Early management by palliative care teams seems to limit aggressive care. CONCLUSIONS Our analysis indicated very frequent aggressive EOL care for patients with lung cancer, regardless of the definition used. The extent of that aggressiveness and its impact on healthcare costs warrant further studies.
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Affiliation(s)
- Olivier Bylicki
- Pneumologie, Hopital d'Instruction des Armees Percy, Clamart, France
| | - Morgane Didier
- Service de Pneumologie, Centre Hospitalier Intercommunal de Creteil, Creteil, France
| | - Frederic Riviere
- Pneumologie, Hopital d'Instruction des Armees Percy, Clamart, France
| | - Jacques Margery
- Pneumologie, Hopital d'Instruction des Armees Percy, Clamart, France
| | - Frederic Grassin
- Pneumologie, Hopital d'Instruction des Armees Percy, Clamart, France
| | - Christos Chouaid
- Service de Pneumologie, Centre Hospitalier Intercommunal de Creteil, Creteil, France
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8
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McCarthy B, Fitzgerald S, O'Shea M, Condon C, Hartnett-Collins G, Clancy M, Sheehy A, Denieffe S, Bergin M, Savage E. Electronic nursing documentation interventions to promote or improve patient safety and quality care: A systematic review. J Nurs Manag 2018; 27:491-501. [PMID: 30387215 DOI: 10.1111/jonm.12727] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Revised: 10/09/2018] [Accepted: 10/30/2018] [Indexed: 11/26/2022]
Abstract
AIM To review the evidence on the effects/impact of electronic nursing documentation interventions on promoting or improving quality care and/or patient safety in acute hospital settings. BACKGROUND Electronic documentation has been recommended to improve quality care and patient safety. With the gradual move from paper-based to electronic nursing documentation internationally, there is a need to identify interventions that can effectively improve quality care and patient safety. EVALUATION We conducted a systematic review on the effectiveness of electronic nursing documentation interventions on promoting or improving quality care and/or patient safety in acute hospital settings. KEY ISSUES Six articles reporting on six individual studies met all eligibility criteria. They were uncontrolled pre/post intervention studies reporting positive impacts on at least one or more outcomes. Most outcomes related to documentation practice and documentation of content. CONCLUSION Some evidence from our review indicates that implementing electronic nursing documentation in acute hospital settings is time saving, reduces rates of documentation errors, falls and infections. IMPLICATIONS FOR NURSING MANAGEMENT A planned approach from management over time to allow nurses adapt to new electronic systems of documentation would seem a good investment in terms of efficiency of work time, possibly resulting in more time for clinical care.
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9
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Nipp RD, Tramontano AC, Kong CY, Hur C. Patterns and predictors of end-of-life care in older patients with pancreatic cancer. Cancer Med 2018; 7:6401-6410. [PMID: 30426697 PMCID: PMC6308041 DOI: 10.1002/cam4.1861] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2018] [Revised: 09/25/2018] [Accepted: 09/26/2018] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Little is known about end-of-life care among patients with pancreatic adenocarcinoma (PDAC). We used the Surveillance, Epidemiology, and End Results-Medicare linked database to analyze patterns of hospice use and end-of-life treatment in patients with PDAC. METHODS We included patients diagnosed with PDAC between 2000-2011 and who had died by December 31, 2012. We assessed patterns of hospice use, chemotherapy receipt, and intensive care unit (ICU) admissions at end-of-life. We used multivariable logistic regression to investigate predictors of end-of-life care. RESULTS In our cohort of 16 309 patients, 70.5% enrolled in hospice, of which 29.1% enrolled in the last 7 days of life. Use of hospice increased over time, from 61.6% in 2000 to 77.5% in 2012 (P-value for trend <0.0001). Among the entire cohort, 6.4% received chemotherapy within the last 14 days of life and 13.1% were admitted to the ICU within the last 30 days of life. Late ICU admissions increased over time, while chemotherapy receipt at the end-of-life decreased. Patients who were older, female, with higher SES, or from the South or Midwest were more likely to enroll in hospice. Those who were younger or male were more likely to receive chemotherapy or have an ICU admission at the end-of-life. CONCLUSION Although hospice enrollment has increased among patients with PDAC, late enrollment still occurs in a substantial proportion of patients. While chemotherapy at the end-of-life has decreased slightly, ICU admissions at the end-of-life have continued to increase. Further research is needed to determine effective ways of enhancing end-of-life care for patients with PDAC.
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Affiliation(s)
- Ryan D Nipp
- Division of Hematology and Oncology, Department of Medicine, Massachusetts General Hospital Cancer Center, Boston, Massachusetts.,Harvard Medical School, Boston, Massachusetts
| | - Angela C Tramontano
- Institute for Technology Assessment, Massachusetts General Hospital, Boston, Massachusetts
| | - Chung Yin Kong
- Harvard Medical School, Boston, Massachusetts.,Institute for Technology Assessment, Massachusetts General Hospital, Boston, Massachusetts
| | - Chin Hur
- Harvard Medical School, Boston, Massachusetts.,Institute for Technology Assessment, Massachusetts General Hospital, Boston, Massachusetts
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10
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Hoerger M, Greer JA, Jackson VA, Park ER, Pirl WF, El-Jawahri A, Gallagher ER, Hagan T, Jacobsen J, Perry LM, Temel JS. Defining the Elements of Early Palliative Care That Are Associated With Patient-Reported Outcomes and the Delivery of End-of-Life Care. J Clin Oncol 2018; 36:1096-1102. [PMID: 29474102 DOI: 10.1200/jco.2017.75.6676] [Citation(s) in RCA: 152] [Impact Index Per Article: 25.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Purpose We describe the key elements of early palliative care (PC) across the illness trajectory and examine whether visit content was associated with patient-reported outcomes and end-of-life care. Methods We performed a secondary analysis of patients with newly diagnosed advanced lung or noncolorectal GI cancer (N = 171) who were randomly assigned to receive early PC. Participants attended at least monthly visits with board-certified PC physicians and advanced practice nurses at Massachusetts General Hospital. PC clinicians completed surveys documenting visit content after each encounter. Patients reported quality of life (Functional Assessment of Cancer Therapy-General) and mood (Hospital Anxiety and Depression Scale and Patient Health Questionnaire-9) at baseline and 24 weeks. End-of-life care data were abstracted from the electronic health record. We summarized visit content over time and used linear and logistic regression to identify whether the proportion of visits addressing a content area was associated with patient-reported outcomes and end-of-life care. Results We analyzed data from 2,921 PC visits, most of which addressed coping (64.2%) and symptom management (74.5%). By 24 weeks, patients who had a higher proportion of visits that addressed coping experienced improved quality of life ( P = .02) and depression symptoms (Depression subscale of the Hospital Anxiety and Depression Scale, P = .002; Patient Health Questionnaire-9, P = .004). Patients who had a higher proportion of visits address treatment decisions were less likely to initiate chemotherapy ( P = .02) or be hospitalized ( P = .005) in the 60 days before death. Patients who had a higher proportion of visits addressing advance care planning were more likely to use hospice ( P = .03). Conclusion PC clinicians' focus on coping, treatment decisions, and advance care planning is associated with improved patient outcomes. These data define the key elements of early PC to enable dissemination of the integrated care model.
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Affiliation(s)
- Michael Hoerger
- Michael Hoerger and Laura M. Perry, Tulane Cancer Center, New Orleans, LA; Joseph A. Greer, Vicki A. Jackson, Elyse R. Park, Areej El-Jawahri, Emily R. Gallagher, Juliet Jacobsen, and Jennifer S. Temel, Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, MA; William F. Pirl, Sylvester Comprehensive Cancer Center/University of Miami, Miami, FL; and Teresa Hagan, University of Pittsburgh, Pittsburgh, PA
| | - Joseph A Greer
- Michael Hoerger and Laura M. Perry, Tulane Cancer Center, New Orleans, LA; Joseph A. Greer, Vicki A. Jackson, Elyse R. Park, Areej El-Jawahri, Emily R. Gallagher, Juliet Jacobsen, and Jennifer S. Temel, Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, MA; William F. Pirl, Sylvester Comprehensive Cancer Center/University of Miami, Miami, FL; and Teresa Hagan, University of Pittsburgh, Pittsburgh, PA
| | - Vicki A Jackson
- Michael Hoerger and Laura M. Perry, Tulane Cancer Center, New Orleans, LA; Joseph A. Greer, Vicki A. Jackson, Elyse R. Park, Areej El-Jawahri, Emily R. Gallagher, Juliet Jacobsen, and Jennifer S. Temel, Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, MA; William F. Pirl, Sylvester Comprehensive Cancer Center/University of Miami, Miami, FL; and Teresa Hagan, University of Pittsburgh, Pittsburgh, PA
| | - Elyse R Park
- Michael Hoerger and Laura M. Perry, Tulane Cancer Center, New Orleans, LA; Joseph A. Greer, Vicki A. Jackson, Elyse R. Park, Areej El-Jawahri, Emily R. Gallagher, Juliet Jacobsen, and Jennifer S. Temel, Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, MA; William F. Pirl, Sylvester Comprehensive Cancer Center/University of Miami, Miami, FL; and Teresa Hagan, University of Pittsburgh, Pittsburgh, PA
| | - William F Pirl
- Michael Hoerger and Laura M. Perry, Tulane Cancer Center, New Orleans, LA; Joseph A. Greer, Vicki A. Jackson, Elyse R. Park, Areej El-Jawahri, Emily R. Gallagher, Juliet Jacobsen, and Jennifer S. Temel, Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, MA; William F. Pirl, Sylvester Comprehensive Cancer Center/University of Miami, Miami, FL; and Teresa Hagan, University of Pittsburgh, Pittsburgh, PA
| | - Areej El-Jawahri
- Michael Hoerger and Laura M. Perry, Tulane Cancer Center, New Orleans, LA; Joseph A. Greer, Vicki A. Jackson, Elyse R. Park, Areej El-Jawahri, Emily R. Gallagher, Juliet Jacobsen, and Jennifer S. Temel, Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, MA; William F. Pirl, Sylvester Comprehensive Cancer Center/University of Miami, Miami, FL; and Teresa Hagan, University of Pittsburgh, Pittsburgh, PA
| | - Emily R Gallagher
- Michael Hoerger and Laura M. Perry, Tulane Cancer Center, New Orleans, LA; Joseph A. Greer, Vicki A. Jackson, Elyse R. Park, Areej El-Jawahri, Emily R. Gallagher, Juliet Jacobsen, and Jennifer S. Temel, Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, MA; William F. Pirl, Sylvester Comprehensive Cancer Center/University of Miami, Miami, FL; and Teresa Hagan, University of Pittsburgh, Pittsburgh, PA
| | - Teresa Hagan
- Michael Hoerger and Laura M. Perry, Tulane Cancer Center, New Orleans, LA; Joseph A. Greer, Vicki A. Jackson, Elyse R. Park, Areej El-Jawahri, Emily R. Gallagher, Juliet Jacobsen, and Jennifer S. Temel, Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, MA; William F. Pirl, Sylvester Comprehensive Cancer Center/University of Miami, Miami, FL; and Teresa Hagan, University of Pittsburgh, Pittsburgh, PA
| | - Juliet Jacobsen
- Michael Hoerger and Laura M. Perry, Tulane Cancer Center, New Orleans, LA; Joseph A. Greer, Vicki A. Jackson, Elyse R. Park, Areej El-Jawahri, Emily R. Gallagher, Juliet Jacobsen, and Jennifer S. Temel, Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, MA; William F. Pirl, Sylvester Comprehensive Cancer Center/University of Miami, Miami, FL; and Teresa Hagan, University of Pittsburgh, Pittsburgh, PA
| | - Laura M Perry
- Michael Hoerger and Laura M. Perry, Tulane Cancer Center, New Orleans, LA; Joseph A. Greer, Vicki A. Jackson, Elyse R. Park, Areej El-Jawahri, Emily R. Gallagher, Juliet Jacobsen, and Jennifer S. Temel, Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, MA; William F. Pirl, Sylvester Comprehensive Cancer Center/University of Miami, Miami, FL; and Teresa Hagan, University of Pittsburgh, Pittsburgh, PA
| | - Jennifer S Temel
- Michael Hoerger and Laura M. Perry, Tulane Cancer Center, New Orleans, LA; Joseph A. Greer, Vicki A. Jackson, Elyse R. Park, Areej El-Jawahri, Emily R. Gallagher, Juliet Jacobsen, and Jennifer S. Temel, Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, MA; William F. Pirl, Sylvester Comprehensive Cancer Center/University of Miami, Miami, FL; and Teresa Hagan, University of Pittsburgh, Pittsburgh, PA
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11
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Clough JD, Strawbridge LM, LeBlanc TW, Hammill BG, Kamal AH. Association of Practice-Level Hospital Use With End-of-Life Outcomes, Readmission, and Weekend Hospitalization Among Medicare Beneficiaries With Cancer. J Oncol Pract 2017; 12:e933-e943. [PMID: 27531384 DOI: 10.1200/jop.2016.013102] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE To determine the relationships between hospital use of treating oncology practices and patient outcomes. PATIENTS AND METHODS Retrospective analysis of 397,646 Medicare beneficiaries who received anticancer therapy in 2012. Each beneficiary was associated with a practice; practices were ranked on the basis of risk-adjusted hospital use, that is, inpatient intensity. Outcomes included 30-day readmission, weekend admissions, intensive care unit stays in the last month of life, and hospice stay of ≥ 7 days. Outcomes were measured for each quartile of practice-level inpatient intensity. We fit multivariable logistic regression models to calculate adjusted odds ratios (ORs) for each outcome for each quartile of inpatient intensity. RESULTS Total 30-day readmissions were 22.8% and 31.9% (OR, 1.45; 95% CI, 1.39 to 1.50) for patients in practices with the lowest versus highest quartiles of inpatient intensity, respectively; unplanned readmissions were 19.8% and 27.1% (OR, 1.36; 95% CI, 1.31 to 1.41), respectively. The proportion of admissions that occurred on weekends was similar across quartiles. Patients of practices in the highest quartiles of inpatient intensity had higher rates of death in an ICU stay in the last month of life (25.5% versus 18.0%; OR, 1.33; 95% CI, 1.19 to 1.49) and a lower rate of hospice stay of at least 7 days (50.9% to 42.5%; OR, 0.79; 95% CI, 0.74 to 0.86). CONCLUSION Medical oncology practices that seek to reduce hospitalizations should consider focusing initially on processes related to end-of-life care and care transitions.
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Affiliation(s)
- Jeffrey D Clough
- Duke University School of Medicine, Durham, NC; and Centers for Medicare & Medicaid Services, Baltimore, MD
| | - Larisa M Strawbridge
- Duke University School of Medicine, Durham, NC; and Centers for Medicare & Medicaid Services, Baltimore, MD
| | - Thomas W LeBlanc
- Duke University School of Medicine, Durham, NC; and Centers for Medicare & Medicaid Services, Baltimore, MD
| | - Bradley G Hammill
- Duke University School of Medicine, Durham, NC; and Centers for Medicare & Medicaid Services, Baltimore, MD
| | - Arif H Kamal
- Duke University School of Medicine, Durham, NC; and Centers for Medicare & Medicaid Services, Baltimore, MD
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12
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Wang R, Zeidan AM, Halene S, Xu X, Davidoff AJ, Huntington SF, Podoltsev NA, Gross CP, Gore SD, Ma X. Health Care Use by Older Adults With Acute Myeloid Leukemia at the End of Life. J Clin Oncol 2017; 35:3417-3424. [PMID: 28783450 DOI: 10.1200/jco.2017.72.7149] [Citation(s) in RCA: 54] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Purpose Little is known about the patterns and predictors of the use of end-of-life health care among patients with acute myeloid leukemia (AML). End-of-life care is particularly relevant for older adults with AML because of their poor prognosis. Methods We performed a population-based, retrospective cohort study of patients with AML who were ≥ 66 years of age at diagnosis and diagnosed during the period from 1999 to 2011 and died before December 31, 2012. Medicare claims were used to assess patterns of hospice care and use of aggressive treatment. Predictors of these end points were evaluated using multivariable logistic regression analyses. Results In the overall cohort (N = 13,156), hospice care after AML diagnosis increased from 31.3% in 1999 to 56.4% in 2012, but the increase was primarily driven by late hospice enrollment that occurred in the last 7 days of life. Among the 5,847 patients who enrolled in hospice, 47.4% and 28.8% started their first hospice enrollment in the last 7 and 3 days of life, respectively. Among patients who transferred in and out of hospice care, 62% received transfusions outside hospice. Additionally, the use of chemotherapy within the last 14 days of life increased from 7.7% in 1999 to 18.8% in 2012. Patients who were male and nonwhite were less likely to enroll in hospice and more likely to receive chemotherapy or be admitted to intensive care units at the end of life. Conversely, older patients were less likely to receive chemotherapy or have intensive care unit admission at the end of life, and were more likely to enroll in hospice. Conclusion End-of-life care for older patients with AML is suboptimal. Additional research is warranted to identify reasons for their low use of hospice services and strategies to enhance end-of-life care for these patients.
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Affiliation(s)
- Rong Wang
- Rong Wang, Amy J. Davidoff, and Xiaomei Ma, Yale School of Public Health; Rong Wang, Amer M. Zeidan, Xiao Xu, Amy J. Davidoff, Scott F. Huntington, Cary P. Gross, and Xiaomei Ma, Yale Cancer Outcomes, Public Policy, and Effectiveness Research Center; Amer M. Zeidan, Stephanie Halene, Xiao Xu, Scott F. Huntington, Nikolai A. Podoltsev, Cary P. Gross, and Steven D. Gore, Yale School of Medicine, New Haven, CT
| | - Amer M Zeidan
- Rong Wang, Amy J. Davidoff, and Xiaomei Ma, Yale School of Public Health; Rong Wang, Amer M. Zeidan, Xiao Xu, Amy J. Davidoff, Scott F. Huntington, Cary P. Gross, and Xiaomei Ma, Yale Cancer Outcomes, Public Policy, and Effectiveness Research Center; Amer M. Zeidan, Stephanie Halene, Xiao Xu, Scott F. Huntington, Nikolai A. Podoltsev, Cary P. Gross, and Steven D. Gore, Yale School of Medicine, New Haven, CT
| | - Stephanie Halene
- Rong Wang, Amy J. Davidoff, and Xiaomei Ma, Yale School of Public Health; Rong Wang, Amer M. Zeidan, Xiao Xu, Amy J. Davidoff, Scott F. Huntington, Cary P. Gross, and Xiaomei Ma, Yale Cancer Outcomes, Public Policy, and Effectiveness Research Center; Amer M. Zeidan, Stephanie Halene, Xiao Xu, Scott F. Huntington, Nikolai A. Podoltsev, Cary P. Gross, and Steven D. Gore, Yale School of Medicine, New Haven, CT
| | - Xiao Xu
- Rong Wang, Amy J. Davidoff, and Xiaomei Ma, Yale School of Public Health; Rong Wang, Amer M. Zeidan, Xiao Xu, Amy J. Davidoff, Scott F. Huntington, Cary P. Gross, and Xiaomei Ma, Yale Cancer Outcomes, Public Policy, and Effectiveness Research Center; Amer M. Zeidan, Stephanie Halene, Xiao Xu, Scott F. Huntington, Nikolai A. Podoltsev, Cary P. Gross, and Steven D. Gore, Yale School of Medicine, New Haven, CT
| | - Amy J Davidoff
- Rong Wang, Amy J. Davidoff, and Xiaomei Ma, Yale School of Public Health; Rong Wang, Amer M. Zeidan, Xiao Xu, Amy J. Davidoff, Scott F. Huntington, Cary P. Gross, and Xiaomei Ma, Yale Cancer Outcomes, Public Policy, and Effectiveness Research Center; Amer M. Zeidan, Stephanie Halene, Xiao Xu, Scott F. Huntington, Nikolai A. Podoltsev, Cary P. Gross, and Steven D. Gore, Yale School of Medicine, New Haven, CT
| | - Scott F Huntington
- Rong Wang, Amy J. Davidoff, and Xiaomei Ma, Yale School of Public Health; Rong Wang, Amer M. Zeidan, Xiao Xu, Amy J. Davidoff, Scott F. Huntington, Cary P. Gross, and Xiaomei Ma, Yale Cancer Outcomes, Public Policy, and Effectiveness Research Center; Amer M. Zeidan, Stephanie Halene, Xiao Xu, Scott F. Huntington, Nikolai A. Podoltsev, Cary P. Gross, and Steven D. Gore, Yale School of Medicine, New Haven, CT
| | - Nikolai A Podoltsev
- Rong Wang, Amy J. Davidoff, and Xiaomei Ma, Yale School of Public Health; Rong Wang, Amer M. Zeidan, Xiao Xu, Amy J. Davidoff, Scott F. Huntington, Cary P. Gross, and Xiaomei Ma, Yale Cancer Outcomes, Public Policy, and Effectiveness Research Center; Amer M. Zeidan, Stephanie Halene, Xiao Xu, Scott F. Huntington, Nikolai A. Podoltsev, Cary P. Gross, and Steven D. Gore, Yale School of Medicine, New Haven, CT
| | - Cary P Gross
- Rong Wang, Amy J. Davidoff, and Xiaomei Ma, Yale School of Public Health; Rong Wang, Amer M. Zeidan, Xiao Xu, Amy J. Davidoff, Scott F. Huntington, Cary P. Gross, and Xiaomei Ma, Yale Cancer Outcomes, Public Policy, and Effectiveness Research Center; Amer M. Zeidan, Stephanie Halene, Xiao Xu, Scott F. Huntington, Nikolai A. Podoltsev, Cary P. Gross, and Steven D. Gore, Yale School of Medicine, New Haven, CT
| | - Steven D Gore
- Rong Wang, Amy J. Davidoff, and Xiaomei Ma, Yale School of Public Health; Rong Wang, Amer M. Zeidan, Xiao Xu, Amy J. Davidoff, Scott F. Huntington, Cary P. Gross, and Xiaomei Ma, Yale Cancer Outcomes, Public Policy, and Effectiveness Research Center; Amer M. Zeidan, Stephanie Halene, Xiao Xu, Scott F. Huntington, Nikolai A. Podoltsev, Cary P. Gross, and Steven D. Gore, Yale School of Medicine, New Haven, CT
| | - Xiaomei Ma
- Rong Wang, Amy J. Davidoff, and Xiaomei Ma, Yale School of Public Health; Rong Wang, Amer M. Zeidan, Xiao Xu, Amy J. Davidoff, Scott F. Huntington, Cary P. Gross, and Xiaomei Ma, Yale Cancer Outcomes, Public Policy, and Effectiveness Research Center; Amer M. Zeidan, Stephanie Halene, Xiao Xu, Scott F. Huntington, Nikolai A. Podoltsev, Cary P. Gross, and Steven D. Gore, Yale School of Medicine, New Haven, CT
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Wagner LI, Pugh SL, Small W, Kirshner J, Sidhu K, Bury MJ, DeNittis AS, Alpert TE, Tran B, Bloom BF, Mai J, Yeh A, Sarma K, Becker M, James J, Bruner DW. Screening for depression in cancer patients receiving radiotherapy: Feasibility and identification of effective tools in the NRG Oncology RTOG 0841 trial. Cancer 2016; 123:485-493. [PMID: 27861753 DOI: 10.1002/cncr.29969] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2015] [Revised: 01/08/2016] [Accepted: 01/12/2016] [Indexed: 01/06/2023]
Abstract
BACKGROUND Brief tools are needed to screen oncology outpatients for depressive symptoms. METHODS Patients starting radiotherapy for the first diagnosis of any tumor completed distress screening tools, including the 9-item Patient Health Questionnaire (PHQ-9), the 2-item Patient Health Questionnaire (PHQ-2), the National Comprehensive Cancer Network Distress Thermometer (NCCN-DT), and the Hopkins Symptom Checklist (HSCL) (25-item version). Patients exceeding validated cutoff scores and a systematic sample of patients whose screening was negative completed the Structured Clinical Interview for DSM-IV (SCID) mood disorder modules via telephone. RESULTS Four hundred sixty-three patients from 35 community-based radiation oncology sites and 2 academic radiation oncology sites were recruited. Sixty-six percent of the 455 eligible patients (n = 299) were women, and the eligible patients had breast (45%), gastrointestinal (11%), lung (10%), gynecologic (6%), or other cancers (27%). Seventy-five (16.5%) exceeded screening cutoffs for depressive symptoms. Forty-two of these patients completed the SCID. Another 37 patients whose screening was negative completed the SCID. Among the 79 patients completing the SCID, 8 (10.1%) met the criteria for major depression, 2 (2.5%) met the criteria for dysthymia, and 6 (7.6%) met the criteria for an adjustment disorder. The PHQ-2 demonstrated good psychometric properties for screening for mood disorders with a cutoff score of ≥3 (receiver operating characteristic area under the curve [AUC], 0.83) and was comparable to the PHQ-9 ( > 9; AUC = 0.85). The NCCN-DT did not detect depression (AUC = 0.59). CONCLUSIONS The PHQ-2 demonstrated good psychometric properties for screening for mood disorders, which were equivalent to the PHQ-9 and superior to the NCCN-DT. These findings support using the PHQ-2 to identify patients in need of further assessment for depression, which has a low prevalence but is a clinically significant comorbidity. These findings could inform the implementation of distress screening accreditation standards. Cancer 2017;123:485-493. © 2016 American Cancer Society.
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Affiliation(s)
- Lynne I Wagner
- Department of Social Sciences and Health Policy, Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Stephanie L Pugh
- NRG Oncology Statistics and Data Management Center, Philadelphia, Pennsylvania
| | - William Small
- Department of Radiation Oncology, Loyola University, Chicago, Illinois
| | - Jeffrey Kirshner
- Hematology-Oncology Associates of Central New York (Community Clinical Oncology Program), East Syracuse, New York
| | - Kulbir Sidhu
- Southeast Cancer Control Consortium (Community Clinical Oncology Program), Winston-Salem, North Carolina
| | - Martin J Bury
- Grand Rapids Clinical Oncology Program, Grand Rapids, Michigan
| | - Albert S DeNittis
- Main Line Health (Community Clinical Oncology Program), Philadelphia, Pennsylvania
| | - Tracy E Alpert
- Hematology-Oncology Associates of Central New York (Community Clinical Oncology Program), East Syracuse, New York
| | - Binh Tran
- Northern Indiana Cancer Research Consortium (Community Clinical Oncology Program), South Bend, Indiana
| | - Beatrice F Bloom
- North Shore University Hospital (Community Clinical Oncology Program), Manhasset, New York
| | - Julie Mai
- Mercy Hospital St. Louis, St. Louis, Missouri
| | - Alexander Yeh
- St. Vincent Anderson Regional Hospital, Anderson, Indiana
| | - Kalika Sarma
- Carle Cancer Center (Community Clinical Oncology Program), Urbana, Illinois
| | - Mark Becker
- Columbus Community Clinical Oncology Program, Columbus, Ohio
| | - Jennifer James
- NRG Oncology Statistics and Data Management Center, Philadelphia, Pennsylvania
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Bergerot CD, Philip EJ, Bergerot PG, Elias S, Guimarães DP, Forones NM, Baiocchi OCCG, Batista NA, De Domenico EBL. Quality Oncology Practice Initiative Can Guide and Improve Oncology Providers' Training in Brazil. J Glob Oncol 2016; 3:189-193. [PMID: 28717759 PMCID: PMC5493225 DOI: 10.1200/jgo.2016.006148] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE It has become crucial to translate scientific findings and to find ways by which to mobilize local resources to improve the quality and accessibility of cancer care in developing countries. This study seeks to provide insight into challenge through examining differences in clinician documentation of patients with cancer treated at a Brazilian Public University Hospital. METHODS ASCO Quality Oncology Practice Initiative (QOPI) measures were used to examine the care provided in the departments of breast, colorectal, lymphoma, gynecology, and lung cancers. For this study, data from a representative sample of patients receiving chemotherapy in the previous month were extracted and quality of cancer care indicators examined. RESULTS Certain elements of medical care were consistently and appropriately documented, including cancer diagnosis and stage, chemotherapy planning, administration, and summary. In general, considering the specific cancer management measures, patients received recommended care in accordance with recognized guidelines. Despite this, a number of important gaps in care were identified, including the assessment and treatment of pain, documentation of chemotherapy intention, symptom and toxicity management, patients' psychosocial status, and provision of a treatment summary at care completion. CONCLUSION These findings are encouraging in terms of adherence to core treatment guidelines in cancer care in Brazil. However, results suggest important opportunities for improving care across a number of domains, many of which represent a challenge throughout both developing and developed countries. This study may also provide preliminary guidance for enhancing educational and training programs for professionals and students alike, to implement high-quality, comprehensive cancer care.
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Affiliation(s)
- Cristiane Decat Bergerot
- , , , , , , , and , Universidade Federal de São Paulo, São Paulo, Brazil; and , University of Notre Dame, Notre Dame, IN
| | - Errol J Philip
- , , , , , , , and , Universidade Federal de São Paulo, São Paulo, Brazil; and , University of Notre Dame, Notre Dame, IN
| | - Paulo Gustavo Bergerot
- , , , , , , , and , Universidade Federal de São Paulo, São Paulo, Brazil; and , University of Notre Dame, Notre Dame, IN
| | - Simone Elias
- , , , , , , , and , Universidade Federal de São Paulo, São Paulo, Brazil; and , University of Notre Dame, Notre Dame, IN
| | - Daiane Pereira Guimarães
- , , , , , , , and , Universidade Federal de São Paulo, São Paulo, Brazil; and , University of Notre Dame, Notre Dame, IN
| | - Nora Manoukian Forones
- , , , , , , , and , Universidade Federal de São Paulo, São Paulo, Brazil; and , University of Notre Dame, Notre Dame, IN
| | - Otavio Cesar Carvalho Guimarães Baiocchi
- , , , , , , , and , Universidade Federal de São Paulo, São Paulo, Brazil; and , University of Notre Dame, Notre Dame, IN
| | - Nildo Alves Batista
- , , , , , , , and , Universidade Federal de São Paulo, São Paulo, Brazil; and , University of Notre Dame, Notre Dame, IN
| | - Edvane Birelo Lopes De Domenico
- , , , , , , , and , Universidade Federal de São Paulo, São Paulo, Brazil; and , University of Notre Dame, Notre Dame, IN
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15
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Ganz PA, Hassett MJ, Miller DC. Challenges and Opportunities in Delivering High-Quality Cancer Care: A 2016 Update. Am Soc Clin Oncol Educ Book 2016; 35:e294-e300. [PMID: 27249735 DOI: 10.1200/edbk_159303] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Herein, both the rationale and scope of current initiatives aimed at improving the quality of cancer care delivery in the United States are described. First, we discuss a recent report from the Institute of Medicine that issued a strong call for both the development of quality measures in oncology and implementation of a learning health care system in which data and experience from clinical practice can inform continuous improvements in cancer care. Second, we review the multiple, diverse initiatives that are underway to identify, test, and validate quality measures for the entire spectrum of cancer care. Finally, we discuss regional quality improvement collaboratives as one successful approach to creating a cycle of quality measurement, identification of best practices, and implementation of changes in practice patterns that ultimately yield improved care and outcomes for patients with cancer.
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Affiliation(s)
- Patricia A Ganz
- From the Department of Health Policy and Management, UCLA Fielding School of Public Health, Center for Cancer Prevention and Control Research, Jonsson Comprehensive Cancer Center, Los Angeles, CA; Department of Medicine, Harvard Medical School, Division of Population Sciences, Dana-Farber Cancer Institute, Boston, MA; Dow Division of Health Services Research, Department of Urology, Institute for Healthcare Policy and Innovation, University of Michigan Medical School, Ann Arbor, MI
| | - Michael J Hassett
- From the Department of Health Policy and Management, UCLA Fielding School of Public Health, Center for Cancer Prevention and Control Research, Jonsson Comprehensive Cancer Center, Los Angeles, CA; Department of Medicine, Harvard Medical School, Division of Population Sciences, Dana-Farber Cancer Institute, Boston, MA; Dow Division of Health Services Research, Department of Urology, Institute for Healthcare Policy and Innovation, University of Michigan Medical School, Ann Arbor, MI
| | - David C Miller
- From the Department of Health Policy and Management, UCLA Fielding School of Public Health, Center for Cancer Prevention and Control Research, Jonsson Comprehensive Cancer Center, Los Angeles, CA; Department of Medicine, Harvard Medical School, Division of Population Sciences, Dana-Farber Cancer Institute, Boston, MA; Dow Division of Health Services Research, Department of Urology, Institute for Healthcare Policy and Innovation, University of Michigan Medical School, Ann Arbor, MI
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16
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Mukai H, Higashi T, Sasaki M, Sobue T. Quality evaluation of medical care for breast cancer in Japan. Int J Qual Health Care 2015; 28:110-3. [DOI: 10.1093/intqhc/mzv109] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
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Dalal S, Bruera S, Hui D, Yennu S, Dev R, Williams J, Masoni C, Ihenacho I, Obasi E, Bruera E. Use of Palliative Care Services in a Tertiary Cancer Center. Oncologist 2015; 21:110-8. [PMID: 26614711 PMCID: PMC4709207 DOI: 10.1634/theoncologist.2015-0234] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2015] [Accepted: 09/23/2015] [Indexed: 12/25/2022] Open
Abstract
This study analyzed palliative/supportive care use in a single cancer center over 8 years. Billing data showed the inpatient consultations as a percentage of hospital admissions and the ratio of inpatient consultations to hospital beds almost doubled. In the outpatient setting, data revealed earlier access to outpatient referrals to palliative care service (from 4.8 months to 7.9 months; p = .001) during the study period. Background. Despite increasing prevalence of palliative care (PC) services in cancer centers, most referrals to the service occur exceedingly late in the illness trajectory. Over the years, we have made several attempts to promote earlier patient access to our PC program, such as changing the name of our service from PC to supportive care (SC). This study was conducted to determine the use of PC/SC service over the past 8 years. Methods. We reviewed billing data for all PC/SC encounters. We examined five metrics for use: inpatient consultations as a percentage of hospital admissions, ratio of inpatient consultations to average number of operational beds, time from hospital registration to outpatient consultation, time from advanced cancer diagnosis to consultation, and time from first outpatient consultation to death/last follow-up. Results. Over the years, we found a consistent increase in patient referrals to the PC/SC program. In the inpatient setting, we found approximate doubling of the inpatient consultations as a percentage of hospital admissions and the ratio of inpatient consultations to hospital beds (from 10% to 19% and from 2.4 to 4.9, respectively; p < .001). In the outpatient setting, we observed variations in referral pattern between oncology services, but, overall, the time from consultation to death/last follow-up increased from 4.8 months to 7.9 months (p = .001), which was accompanied by a significant decrease in the interval to consultation from hospital registration and advanced cancer diagnosis (p < .001). Conclusion. We have observed a consistent annual increase in new patient referrals as well as earlier access for outpatient referrals to our SC service, supporting increased use of palliative care at our cancer center. Implications for Practice: In response to accumulating evidence on the benefits of palliative care (PC) referral to oncology patients, efforts are being made to increase PC use. This study, conducted at MD Anderson Cancer Center, demonstrates consistent annual growth in PC referrals, which was accompanied by a significant increase in the outpatient referral of patients with nonadvanced cancer and earlier referral of those with advanced cancer. However, significant variations in the referral patterns between oncology services were observed. These results have implications for other cancer centers looking to enhance use of PC services by having a business model that allows for appropriate space and staff expansion.
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Affiliation(s)
- Shalini Dalal
- Department of Palliative Care and Rehabilitation Medicine, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Sebastian Bruera
- Department of Internal Medicine, Baylor College of Medicine, Houston, Texas, USA
| | - David Hui
- Department of Palliative Care and Rehabilitation Medicine, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Sriram Yennu
- Department of Palliative Care and Rehabilitation Medicine, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Rony Dev
- Department of Palliative Care and Rehabilitation Medicine, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Janet Williams
- Department of Palliative Care and Rehabilitation Medicine, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Charles Masoni
- Department of Palliative Care and Rehabilitation Medicine, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Ijeoma Ihenacho
- Department of Palliative Care and Rehabilitation Medicine, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Emmanuel Obasi
- Department of Palliative Care and Rehabilitation Medicine, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Eduardo Bruera
- Department of Palliative Care and Rehabilitation Medicine, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
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Hui D, Bansal S, Strasser F, Morita T, Caraceni A, Davis M, Cherny N, Kaasa S, Currow D, Abernethy A, Nekolaichuk C, Bruera E. Indicators of integration of oncology and palliative care programs: an international consensus. Ann Oncol 2015; 26:1953-1959. [PMID: 26088196 DOI: 10.1093/annonc/mdv269] [Citation(s) in RCA: 95] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2015] [Accepted: 05/29/2015] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Recently, the concept of integrating oncology and palliative care has gained wide professional and scientific support; however, a global consensus on what constitutes integration is unavailable. We conducted a Delphi Survey to develop a consensus list of indicators on integration of specialty palliative care and oncology programs for advanced cancer patients in hospitals with ≥100 beds. METHODS International experts on integration rated a list of indicators on integration over three iterative rounds under five categories: clinical structure, processes, outcomes, education, and research. Consensus was defined a priori by an agreement of ≥70%. Major criteria (i.e. most relevant and important indicators) were subsequently identified. RESULTS Among 47 experts surveyed, 46 (98%), 45 (96%), and 45 (96%) responded over the three rounds. Nineteen (40%) were female, 24 (51%) were from North America, and 14 (30%) were from Europe. Sixteen (34%), 7 (15%), and 25 (53%) practiced palliative care, oncology, and both specialties, respectively. After three rounds of deliberation, the panelists reached consensus on 13 major and 30 minor indicators. Major indicators included two related to structure (consensus 95%-98%), four on processes (88%-98%), three on outcomes (88%-91%), and four on education (93%-100%). The major indicators were considered to be clearly stated (9.8/10), objective (9.4/10), amenable to accurate coding (9.5/10), and applicable to their own countries (9.4/10). CONCLUSIONS Our international experts reached broad consensus on a list of indicators of integration, which may be used to identify centers with a high level of integration, and facilitate benchmarking, quality improvement, and research.
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Affiliation(s)
- D Hui
- Department of Palliative Care and Rehabilitation Medicine, The University of Texas MD Anderson Cancer Center, Houston, USA.
| | - S Bansal
- Department of Palliative Care and Rehabilitation Medicine, The University of Texas MD Anderson Cancer Center, Houston, USA
| | - F Strasser
- Oncological Palliative Medicine, Hematology-Oncology, Cantonal Hospital, St. Gallen, Switzerland
| | - T Morita
- Department of Palliative and Supportive Care and Seirei Hospice, Seirei Mikatahara General Hospital, Hamamatsu, Japan
| | - A Caraceni
- Palliative Care, Pain Therapy and Rehabilitation, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy
| | - M Davis
- Department of Solid Tumor Oncology, Taussig Cancer Institute, Cleveland, USA
| | - N Cherny
- Cancer Pain and Palliative Medicine Service, Department of Medical Oncology, Shaare Zedek Medical Center, Jerusalem, Israel
| | - S Kaasa
- European Palliative Care Research Centre, Department of Cancer Research and Molecular Medicine, Norwegian University of Science and Technology and The Cancer Clinic, St. Olavs Hospital - Trondheim University Hospital, Trondheim, Norway
| | - D Currow
- Palliative and Supportive Services, Flinders University, Adelaide, South Australia
| | - A Abernethy
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, USA
| | - C Nekolaichuk
- Division of Palliative Care Medicine, Department of Oncology, University of Alberta, Edmonton, Canada
| | - E Bruera
- Department of Palliative Care and Rehabilitation Medicine, The University of Texas MD Anderson Cancer Center, Houston, USA
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Passalacqua R, Annunziata MA, Borreani C, Diodati F, Isa L, Saleri J, Verusio C, Caminiti C. Feasibility of a quality improvement strategy integrating psychosocial care into 28 medical cancer centers (HuCare project). Support Care Cancer 2015; 24:147-155. [PMID: 25957011 DOI: 10.1007/s00520-015-2756-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2014] [Accepted: 04/27/2015] [Indexed: 12/31/2022]
Abstract
PURPOSE This study examines the development and feasibility of a quality improvement strategy for the translation of evidence-based psychosocial care into clinical practice. METHODS The project involved all staff (oncologists, psychologists, and nurses) of the participating centers. Recommendations concerned: improvement of clinician communication skills; use of a patient question prompt list; assignment of a specialist nurse to each patient; screening for psychological distress and social needs; opportunity to attend a Point of Information and Support. The implementation strategy hinged on context analysis and problem solving. Four to six visits were held in each center by the project team to assist staff in identifying obstacles, finding solutions, and strengthening motivation. The primary variable was the adherence percentage to the recommendations (proportion of subjects receiving each intervention). The number of centers that failed to reach the objective was also reported (adherence percentage <75%). RESULTS Twenty-seven of twenty-eight centers completed the study. Lack of resources was the most commonly perceived barrier preimplementation. Five-hundred-forty-five clinicians were actively involved in the project and completed training. The adherence percentage for each recommendation was greater than 85% except for the question prompt list (78%; 95% CI, 73-83%), where seven centers did not reach the objective. CONCLUSIONS Our findings demonstrate that evidence-based interventions to improve the psychosocial care of people with cancer can be implemented in a diverse range of oncology wards. This requires the involvement and motivation of the entire staff of the ward, support by an expert team, and promotion by policymakers.
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Affiliation(s)
- Rodolfo Passalacqua
- Division of Medical Oncology, Istituti Ospitalieri di Cremona, Viale Concordia, 1, Cremona, 26100, Italy.
| | | | - Claudia Borreani
- Unit of Clinical Psychology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Francesca Diodati
- Research and Innovation Unit, University Hospital of Parma, Parma, Italy
| | - Luciano Isa
- Division of Oncology, Hospital of Melegnano, Milan, Italy
| | - Jessica Saleri
- Division of Medical Oncology, Istituti Ospitalieri di Cremona, Viale Concordia, 1, Cremona, 26100, Italy
| | - Claudio Verusio
- Division of Medical Oncology, Hospital of Saronno, Saronno, Varese, Italy
| | - Caterina Caminiti
- Research and Innovation Unit, University Hospital of Parma, Parma, Italy
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20
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Cooley ME, Blonquist TM, Catalano PJ, Lobach DF, Halpenny B, McCorkle R, Johns EB, Braun IM, Rabin MS, Mataoui FZ, Finn K, Berry DL, Abrahm JL. Feasibility of using algorithm-based clinical decision support for symptom assessment and management in lung cancer. J Pain Symptom Manage 2015; 49:13-26. [PMID: 24880002 PMCID: PMC4621015 DOI: 10.1016/j.jpainsymman.2014.05.003] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2013] [Revised: 04/25/2014] [Accepted: 05/06/2014] [Indexed: 12/22/2022]
Abstract
CONTEXT Distressing symptoms interfere with the quality of life in patients with lung cancer. Algorithm-based clinical decision support (CDS) to improve evidence-based management of isolated symptoms seems promising, but no reports yet address multiple symptoms. OBJECTIVES This study examined the feasibility of CDS for a Symptom Assessment and Management Intervention targeting common symptoms in patients with lung cancer (SAMI-L) in ambulatory oncology. The study objectives were to evaluate completion and delivery rates of the SAMI-L report and clinician adherence to the algorithm-based recommendations. METHODS Patients completed a web-based symptom assessment and SAMI-L created tailored recommendations for symptom management. Completion of assessments and delivery of reports were recorded. Medical record review assessed clinician adherence to recommendations. Feasibility was defined as 75% or higher report completion and delivery rates and 80% or higher clinician adherence to recommendations. Descriptive statistics and generalized estimating equations were used for data analyses. RESULTS Symptom assessment completion was 84% (95% CI=81-87%). Delivery of completed reports was 90% (95% CI=86-93%). Depression (36%), pain (30%), and fatigue (18%) occurred most frequently, followed by anxiety (11%) and dyspnea (6%). On average, overall recommendation adherence was 57% (95% CI=52-62%) and was not dependent on the number of recommendations (P=0.45). Adherence was higher for anxiety (66%; 95% CI=55-77%), depression (64%; 95% CI=56-71%), pain (62%; 95% CI=52-72%), and dyspnea (51%; 95% CI=38-64%) than for fatigue (38%; 95% CI=28-47%). CONCLUSION The CDS systems, such as SAMI-L, have the potential to fill a gap in promoting evidence-based care.
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Affiliation(s)
- Mary E Cooley
- Dana-Farber Cancer Institute, Boston, Massachusetts, USA.
| | | | | | | | | | | | - Ellis B Johns
- Virginia Commonwealth University Shenandoah Valley, Front Royal, Virginia, USA
| | - Ilana M Braun
- Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | | | | | | | - Donna L Berry
- Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Janet L Abrahm
- Dana-Farber Cancer Institute, Boston, Massachusetts, USA
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Blayney DW, McNiff K, Eisenberg PD, Gilmore T, Jacobsen PB, Jacobson JO, Kadlubek PJ, Neuss MN, Simone J. Development and Future of the American Society of Clinical Oncology's Quality Oncology Practice Initiative. J Clin Oncol 2014; 32:3907-13. [DOI: 10.1200/jco.2014.56.8899] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Douglas W. Blayney
- Stanford Cancer Institute, Stanford University School of Medicine, Stanford, CA
| | | | | | - Terry Gilmore
- American Society of Clinical Oncology, Alexandria, VA
| | | | | | | | - Michael N. Neuss
- Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, TN
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Lim C, Cheung MC, Franco B, Dharmakulaseelan L, Chong E, Iyngarathasan A, Singh S. Quality Improvement: An Assessment of Participation and Attitudes of Medical Oncologists. J Oncol Pract 2014; 10:e408-14. [DOI: 10.1200/jop.2014.001515] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Canadian medical oncologists face limitations to participating in QI initiatives as a result of lack of time, publication resources, and knowledge about ongoing initiatives. Improving networking opportunities and prioritizing QI at the institutional level can address this need.
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Affiliation(s)
- Charles Lim
- Sunnybrook Health Sciences Center, Odette Cancer Center, Toronto, Ontario, Canada
| | - Matthew C. Cheung
- Sunnybrook Health Sciences Center, Odette Cancer Center, Toronto, Ontario, Canada
| | - Bryan Franco
- Sunnybrook Health Sciences Center, Odette Cancer Center, Toronto, Ontario, Canada
| | | | - Evan Chong
- Sunnybrook Health Sciences Center, Odette Cancer Center, Toronto, Ontario, Canada
| | - Amesha Iyngarathasan
- Sunnybrook Health Sciences Center, Odette Cancer Center, Toronto, Ontario, Canada
| | - Simron Singh
- Sunnybrook Health Sciences Center, Odette Cancer Center, Toronto, Ontario, Canada
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Amano K, Morita T, Tatara R, Katayama H, Uno T, Takagi I. Association between early palliative care referrals, inpatient hospice utilization, and aggressiveness of care at the end of life. J Palliat Med 2014; 18:270-3. [PMID: 25210851 DOI: 10.1089/jpm.2014.0132] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Palliative care has a positive effect on many clinical outcomes, yet most referrals to palliative care have occurred late. End-of-life (EOL) cancer care has become increasingly aggressive. There have been no studies investigating the association between early palliative care referrals and aggressive EOL care in Japan. OBJECTIVE This study was designed to explore the association between early palliative care referrals, inpatient hospice utilization, and aggressiveness of EOL care by investigating cancer decedents. DESIGN A retrospective cohort study in a cancer-designated hospital in Japan. SETTING/SUBJECTS This study examined 266 consecutive cancer decedents. Inclusion criteria were adults and patients who died from cancer or causes related to cancer. Patients who died from causes unrelated to cancer were excluded. A total of 265 patients met the criteria. MEASUREMENTS We explored the association between early referrals (>3 months before death) and inpatient hospice utilization and the relationship between the timing of referrals and aggressive EOL care measured by a composite score adapted from Earle and colleagues. RESULTS Patients were divided into an early referral group (n=54) and a control group (n=211). The rate of inpatient hospice utilization was significantly higher in the early referral group (74% versus 47%, adjusted p<0.001). While each of six indicators of aggressiveness of EOL care did not differ significantly, the composite score was significantly lower in the early referral group (1.91±0.59 versus 2.14±0.78, adjusted p<0.001). CONCLUSIONS Early palliative referrals were associated with more inpatient hospice utilization and less aggressive EOL care.
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Affiliation(s)
- Koji Amano
- 1 Department of Palliative Medicine, Palliative Care Team, Osaka City General Hospital , Osaka, Japan
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Hassett MJ, McNiff KK, Dicker AP, Gilligan T, Hendricks CB, Lennes I, Murray T, Krzyzanowska MK. High-Priority Topics for Cancer Quality Measure Development: Results of the 2012 American Society of Clinical Oncology Collaborative Cancer Measure Summit. J Oncol Pract 2014; 10:e160-6. [DOI: 10.1200/jop.2013.001240] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Addressing the high-priority topics identified by this effort will help fill the gaps left by existing cancer quality measures, including care coordination and transitions, quality of life, safety, experience of care, and outcomes.
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Affiliation(s)
- Michael J. Hassett
- Dana-Farber Cancer Institute; Harvard Medical School; Massachusetts General Hospital, Boston, MA; American Society of Clinical Oncology, Alexandria, VA; Thomas Jefferson University, Philadelphia, PA; Cleveland Clinic, Cleveland, OH; Center for Breast Health, Bethesda, MD; and Princess Margaret Hospital, Toronto, Ontario, Canada
| | - Kristen K. McNiff
- Dana-Farber Cancer Institute; Harvard Medical School; Massachusetts General Hospital, Boston, MA; American Society of Clinical Oncology, Alexandria, VA; Thomas Jefferson University, Philadelphia, PA; Cleveland Clinic, Cleveland, OH; Center for Breast Health, Bethesda, MD; and Princess Margaret Hospital, Toronto, Ontario, Canada
| | - Adam P. Dicker
- Dana-Farber Cancer Institute; Harvard Medical School; Massachusetts General Hospital, Boston, MA; American Society of Clinical Oncology, Alexandria, VA; Thomas Jefferson University, Philadelphia, PA; Cleveland Clinic, Cleveland, OH; Center for Breast Health, Bethesda, MD; and Princess Margaret Hospital, Toronto, Ontario, Canada
| | - Timothy Gilligan
- Dana-Farber Cancer Institute; Harvard Medical School; Massachusetts General Hospital, Boston, MA; American Society of Clinical Oncology, Alexandria, VA; Thomas Jefferson University, Philadelphia, PA; Cleveland Clinic, Cleveland, OH; Center for Breast Health, Bethesda, MD; and Princess Margaret Hospital, Toronto, Ontario, Canada
| | - Carolyn B. Hendricks
- Dana-Farber Cancer Institute; Harvard Medical School; Massachusetts General Hospital, Boston, MA; American Society of Clinical Oncology, Alexandria, VA; Thomas Jefferson University, Philadelphia, PA; Cleveland Clinic, Cleveland, OH; Center for Breast Health, Bethesda, MD; and Princess Margaret Hospital, Toronto, Ontario, Canada
| | - Inga Lennes
- Dana-Farber Cancer Institute; Harvard Medical School; Massachusetts General Hospital, Boston, MA; American Society of Clinical Oncology, Alexandria, VA; Thomas Jefferson University, Philadelphia, PA; Cleveland Clinic, Cleveland, OH; Center for Breast Health, Bethesda, MD; and Princess Margaret Hospital, Toronto, Ontario, Canada
| | - Thomas Murray
- Dana-Farber Cancer Institute; Harvard Medical School; Massachusetts General Hospital, Boston, MA; American Society of Clinical Oncology, Alexandria, VA; Thomas Jefferson University, Philadelphia, PA; Cleveland Clinic, Cleveland, OH; Center for Breast Health, Bethesda, MD; and Princess Margaret Hospital, Toronto, Ontario, Canada
| | - Monika K. Krzyzanowska
- Dana-Farber Cancer Institute; Harvard Medical School; Massachusetts General Hospital, Boston, MA; American Society of Clinical Oncology, Alexandria, VA; Thomas Jefferson University, Philadelphia, PA; Cleveland Clinic, Cleveland, OH; Center for Breast Health, Bethesda, MD; and Princess Margaret Hospital, Toronto, Ontario, Canada
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Vichare A, Eads N, Punglia R, Potters L. American Society for Radiation Oncology's Performance Assessment for the Advancement of Radiation Oncology Treatment: A practical approach for informing practice improvement. Pract Radiat Oncol 2014; 3:e37-43. [PMID: 24674319 DOI: 10.1016/j.prro.2012.09.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2012] [Revised: 09/18/2012] [Accepted: 09/24/2012] [Indexed: 11/17/2022]
Abstract
PURPOSE Performance Assessment for the Advancement of Radiation Oncology Treatment (PAAROT) is a practice quality improvement program. This study seeks to determine baseline performance rates and practice variation from PAAROT data. METHODS AND MATERIALS The cohort includes all physicians from academic, hospital, and free-standing settings who completed at least 10 consecutive self-audited medical records in the PAAROT program (version 2.5) from 2010 to 2011 (n = 519 medical records). Mean performance rates were analyzed at the physician and medical record levels and, where appropriate, were stratified by the physician's practice setting. RESULTS Forty-nine physicians were included in the study; 22 (45%), 17 (35%), and 10 (20%) physicians practiced in a hospital, academic, or a free-standing setting, respectively. The measures with a high adoption rate (more than 80%) include the following: documentation of history and physical; review of physics and dosimetry plan by radiation oncologist; patient informed risks of therapy; evaluation of acute symptoms during therapy; pathology in consultation note; communication of treatment summary within 30 days of treatment completion; documentation of intent of treatment, use of clinical guidelines or published data; and documentation of American Joint Committee on Cancer staging. Lower rates of adoption were noted (mean, 65%; range, 0-100%) when these measures were converted to a composite measure. Low adherence was noted for screening of a pain using a standard scale (mean, 58%; range, 0-100%). Physicians from an academic setting scored higher on the composite measure (40%) compared with those from a hospital setting (36%) and from a free-standing setting (24%); (P < .001). Physicians from a hospital setting scored higher on the quality indicator of screening for pain (54%) compared with physicians from an academic setting (35%) and free-standing setting (11%) (P < .001). CONCLUSIONS This first assessment of PAAROT (version 2.5) data provides an initial snapshot on the use of quality indicators and practice patterns for radiation oncology. Self-reported practice data and the use of quality indicators will become important for the purpose of continuous, prospective evidence-based learning on an individual basis. Despite the small sample size, the data from this study will help address potential improvement opportunities for the next iteration of the PAAROT program.
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Affiliation(s)
| | - Nadine Eads
- American Society for Radiation Oncology, Fairfax, Virginia
| | | | - Louis Potters
- North Shore-Long Island Jewish Health System, New Hyde Park, New York
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Dy SM, Walling AM, Mack JW, Malin JL, Pantoja P, Lorenz KA, Tisnado DM. Evaluating the quality of supportive oncology using patient-reported data. J Oncol Pract 2014; 10:e223-30. [PMID: 24618077 DOI: 10.1200/jop.2013.001237] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Patient-reported data may provide valuable information for oncology quality measurement. We evaluated applying patient-reported data from the Cancer Care Outcomes Research and Surveillance Consortium national study to quality indicators addressing supportive oncology domains. METHODS We analyzed surveys including validated instruments for symptoms and care planning from 4,174 patients newly diagnosed with lung or colorectal cancer. We adapted existing supportive oncology indicators for use with patient-reported data from Cancer Quality-ASSIST and the American Society of Clinical Oncology Quality Oncology Practice Initiative. Where feasible, we examined indicators using medical record data for comparison purposes. RESULTS Using patient-reported data, the percentage of patients meeting indicator criteria for screening ranged from 74% (significant depressive symptoms) to 93% (pain, nausea/vomiting). The percentage meeting indicator criteria for symptom treatment ranged from 73% (significant depressive symptoms) to 99% (nausea/vomiting). Symptom severity did not affect the results. Using medical record data, the percentage meeting indicator criteria varied between 4% (significant depressive symptoms) and 23% (pain). For information and care planning, 44% met criteria for discussion about resuscitation and 32% for hospice discussion using survey data. Using medical record data, 11% met criteria for goals-of-care discussion in intensive care and 46% for hospice/pain management/palliative care referral before death. CONCLUSION Quality of care for symptoms measured using patient self-report was higher than when including medical record data. Use of patient-reported and medical record data allowed measurement of different perspectives on care planning indicators. Patient-reported data provide a complementary, patient-centered perspective on the quality of supportive oncology care.
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Affiliation(s)
- Sydney M Dy
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; University of California, Los Angeles; Veterans Health Administration of Greater Los Angeles, Los Angeles, CA; and Dana-Farber Cancer Institute, Boston, MA
| | - Anne M Walling
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; University of California, Los Angeles; Veterans Health Administration of Greater Los Angeles, Los Angeles, CA; and Dana-Farber Cancer Institute, Boston, MA
| | - Jennifer W Mack
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; University of California, Los Angeles; Veterans Health Administration of Greater Los Angeles, Los Angeles, CA; and Dana-Farber Cancer Institute, Boston, MA
| | - Jennifer L Malin
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; University of California, Los Angeles; Veterans Health Administration of Greater Los Angeles, Los Angeles, CA; and Dana-Farber Cancer Institute, Boston, MA
| | - Philip Pantoja
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; University of California, Los Angeles; Veterans Health Administration of Greater Los Angeles, Los Angeles, CA; and Dana-Farber Cancer Institute, Boston, MA
| | - Karl A Lorenz
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; University of California, Los Angeles; Veterans Health Administration of Greater Los Angeles, Los Angeles, CA; and Dana-Farber Cancer Institute, Boston, MA
| | - Diana M Tisnado
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; University of California, Los Angeles; Veterans Health Administration of Greater Los Angeles, Los Angeles, CA; and Dana-Farber Cancer Institute, Boston, MA
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Hui D, Kim SH, Roquemore J, Dev R, Chisholm G, Bruera E. Impact of timing and setting of palliative care referral on quality of end-of-life care in cancer patients. Cancer 2014; 120:1743-9. [DOI: 10.1002/cncr.28628] [Citation(s) in RCA: 260] [Impact Index Per Article: 26.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- David Hui
- Department of Palliative Care and Rehabilitation Medicine; The University of Texas MD Anderson Cancer Center; Houston Texas
| | - Sun Hyun Kim
- Department of Palliative Care and Rehabilitation Medicine; The University of Texas MD Anderson Cancer Center; Houston Texas
- Department of Family Medicine; Kwandong University, College of Medicine; Republic of Korea
| | - Joyce Roquemore
- Clinical Operations Informatics; The University of Texas MD Anderson Cancer Center; Houston Texas
| | - Rony Dev
- Department of Palliative Care and Rehabilitation Medicine; The University of Texas MD Anderson Cancer Center; Houston Texas
| | - Gary Chisholm
- Department of Biostatistics; The University of Texas MD Anderson Cancer Center; Houston Texas
| | - Eduardo Bruera
- Department of Palliative Care and Rehabilitation Medicine; The University of Texas MD Anderson Cancer Center; Houston Texas
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Abstract
The author concludes that quality cancer care needs to be high-value care, and it is up to the clinicians who are actually providing cancer care to determine how best to achieve the desired outcomes for individual patients.
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Siegel EM, Jacobsen PB, Lee JH, Malafa M, Fulp W, Fletcher M, Smith JCR, Brown R, Levine R, Cartwright T, Abesada-Terk G, Kim G, Alemany C, Faig D, Sharp P, Markham MJ, Shibata D. Florida Initiative for Quality Cancer Care: improvements on colorectal cancer quality of care indicators during a 3-year interval. J Am Coll Surg 2013; 218:16-25.e1-4. [PMID: 24275073 DOI: 10.1016/j.jamcollsurg.2013.09.008] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2013] [Revised: 08/26/2013] [Accepted: 09/16/2013] [Indexed: 10/26/2022]
Abstract
BACKGROUND The quality of cancer care has become a national priority; however, there are few ongoing efforts to assist medical oncology practices in identifying areas for improvement. The Florida Initiative for Quality Cancer Care is a consortium of 11 medical oncology practices that evaluates the quality of cancer care across Florida. Within this practice-based system of self-assessment, we determined adherence to colorectal cancer quality of care indicators (QCIs) in 2006, disseminated results to each practice and reassessed adherence in 2009. The current report focuses on evaluating the direction and magnitude of change in adherence to QCIs for colorectal cancer patients between the 2 assessments. STUDY DESIGN Medical records were reviewed for all colorectal cancer patients seen by a medical oncologist in 2006 (n = 489) and 2009 (n = 511) at 10 participating practices. Thirty-five indicators were evaluated individually and changes in QCI adherence over time and by site were examined. RESULTS Significant improvements were noted from 2006 to 2009, with large gains in surgical/pathological QCIs (eg, documenting rectal radial margin status, lymphovascular invasion, and the review of ≥ 12 lymph nodes) and medical oncology QCIs (documenting planned treatment regimen and providing recommended neoadjuvant regimens). Documentation of perineural invasion and radial margins significantly improved; however, adherence remained low (47% and 71%, respectively). There was significant variability in adherence for some QCIs across institutions at follow-up. CONCLUSIONS The Florida Initiative for Quality Cancer Care practices conducted self-directed quality-improvement efforts during a 3-year interval and overall adherence to QCIs improved. However, adherence remained low for several indicators, suggesting that organized improvement efforts might be needed for QCIs that remained consistently low over time. Findings demonstrate how efforts such as the Florida Initiative for Quality Cancer Care are useful for evaluating and improving the quality of cancer care at a regional level.
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Affiliation(s)
- Erin M Siegel
- Department of Cancer Epidemiology, Moffitt Cancer Center, Tampa, FL.
| | - Paul B Jacobsen
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, FL
| | - Ji-Hyun Lee
- Department of Biostatistics, Moffitt Cancer Center, Tampa, FL
| | - Mokenge Malafa
- Department of Gastrointestinal Oncology, Moffitt Cancer Center, Tampa, FL
| | - William Fulp
- Department of Biostatistics, Moffitt Cancer Center, Tampa, FL
| | - Michelle Fletcher
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, FL
| | | | - Richard Brown
- Florida Cancer Specialists/Sarasota Memorial Hospital, Sarasota, FL
| | | | | | | | | | - Carlos Alemany
- Florida Institute of Research, Medicine, and Surgery, Orlando, FL
| | - Douglas Faig
- North Broward Medical Center, Deerfield Beach, FL
| | - Philip Sharp
- Tallahassee Memorial Healthcare, Tallahassee, FL
| | | | - David Shibata
- Department of Gastrointestinal Oncology, Moffitt Cancer Center, Tampa, FL
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Hui D, Bruera E. Personalizing treatment decisions for cancer patients at the end of life: reply to Soh and Wong. J Pain Symptom Manage 2013; 45:e4-5. [PMID: 23522519 DOI: 10.1016/j.jpainsymman.2013.02.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2013] [Accepted: 02/01/2013] [Indexed: 11/27/2022]
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Hermes-Moll K, Klein G, Buschmann-Maiworm RE, Baumann W, Otremba B, Lebahn H, Steinmetz HT, Geraedts M, Kleeberg UR, Schmitz S. WINHO-Qualitätsindikatoren für die ambulante onkologische Versorgung in Deutschland. ZEITSCHRIFT FUR EVIDENZ FORTBILDUNG UND QUALITAET IM GESUNDHEITSWESEN 2013; 107:548-59. [DOI: 10.1016/j.zefq.2013.09.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/23/2011] [Revised: 08/06/2013] [Accepted: 09/10/2013] [Indexed: 12/01/2022]
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Partridge AH, Norris VW, Blinder VS, Cutter BA, Halpern MT, Malin J, Neuss MN, Wolff AC. Implementing a breast cancer registry and treatment plan/summary program in clinical practice: a pilot program. Cancer 2012. [PMID: 23197186 DOI: 10.1002/cncr.27625] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND There is a need to better measure and improve the quality of oncology care and improve communication with patients and other providers. The American Society of Clinical Oncology Breast Cancer Registry (BCR) pilot evaluated the feasibility and acceptability of prospective data collection for quality assessment in daily clinical practice. Data were used to create and share treatment plans/summaries (TPSs) at the point of care. METHODS Using a web-based tool, 20 diverse practices entered clinical data on each new early-stage breast cancer patient into the BCR for 14 months (September 2009 through November 2010). The tool created individual TPSs that were shared with patients. Practices received practice-specific and aggregate BCR quality measures data, participated in a survey, and received a participation stipend. RESULTS Twenty practices entered 2014 patients into the BCR, collecting demographic, clinical, and treatment information. Fifty-two percent of practice participants replied to an end-of-pilot survey: 73% were satisfied with the BCR and web-based tool, 31% expressed concern regarding time and effort, and 52% reported additional practice costs during the pilot. Among those who created or shared the TPSs, 90% thought the documents improved oncologist-patient communication, and 95% favored using BCR data for practice quality improvement. CONCLUSIONS Prospective data collection for quality assessment is feasible and allows sharing of TPSs with patients at the point of care. Future efforts should focus on decreasing implementation burden to practices, broadening participation, examining costs, and, most importantly, assessing its effects on patient outcomes.
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Woitha K, Van Beek K, Ahmed N, Hasselaar J, Mollard JM, Colombet I, Radbruch L, Vissers K, Engels Y. Development of a set of process and structure indicators for palliative care: the Europall project. BMC Health Serv Res 2012; 12:381. [PMID: 23122255 PMCID: PMC3529116 DOI: 10.1186/1472-6963-12-381] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2011] [Accepted: 10/31/2012] [Indexed: 01/27/2023] Open
Abstract
Background By measuring the quality of the organisation of palliative care with process and structure quality indicators (QIs), patients, caregivers and policy makers are able to monitor to what extent recommendations are met, like those of the council of the WHO on palliative care and guidelines. This will support the implementation of public programmes, and will enable comparisons between organisations or countries. Methods As no European set of indicators for the organisation of palliative care existed, such a set of QIs was developed. An update of a previous systematic review was made and extended with more databases and grey literature. In two project meetings with practitioners and experts in palliative care the development process of a QI set was finalised and the QIs were categorized in a framework, covering the recommendations of the Council of Europe. Results The searches resulted in 151 structure and process indicators, which were discussed in steering group meetings. Of those QIs, 110 were eligible for the final framework. Conclusions We developed the first set of QIs for the organisation of palliative care. This article is the first step in a multi step project to identify, validate and pilot QIs.
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Affiliation(s)
- Kathrin Woitha
- Department of Anaesthesiology, Pain and Palliative Medicine, Radboud University Nijmegen Medical Centre, Geert Grote Plein 10, Nijmegen 6500 HB, The Netherlands.
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Bruera E, Hui D. Conceptual models for integrating palliative care at cancer centers. J Palliat Med 2012; 15:1261-9. [PMID: 22925157 PMCID: PMC3533890 DOI: 10.1089/jpm.2012.0147] [Citation(s) in RCA: 88] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/26/2012] [Indexed: 11/12/2022] Open
Abstract
Palliative care programs are rapidly evolving in acute care facilities. Increased and earlier access has been advocated for patients with life-threatening illnesses. Existing programs would need major growth to accommodate the increased utilization. The objective of this review is to provide an update on the current structures, processes, and outcomes of the Supportive and Palliative Care Program at the University of Texas M.D. Anderson Cancer Center (UTMDACC), and to use the update as a platform to discuss the challenges and opportunities in integrating palliative and supportive services in a tertiary care cancer center. Our interprofessional program consists of a mobile consultation team, an acute palliative care unit, and an outpatient supportive care clinic. We will discuss various metrics including symptom outcomes, quality of end-of-life care, program growth, and financial issues. Despite the growing evidence to support early palliative care involvement, referral to palliative care remains heterogeneous and delayed. To address this issue, we will discuss various conceptual models and practical recommendations to optimize palliative care access.
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Affiliation(s)
- Eduardo Bruera
- Department of Palliative Care and Rehabilitation Medicine, The University of Texas M.D. Anderson Cancer Center, Houston, TX 77030, USA.
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Siegel EM, Jacobsen PB, Malafa M, Fulp W, Fletcher M, Lee JH, Smith JCR, Brown R, Levine R, Cartwright T, Abesada-Terk G, Kim G, Alemany C, Faig D, Sharp P, Markham MJ, Shibata D. Evaluating the quality of colorectal cancer care in the state of Florida: results from the Florida Initiative for Quality Cancer Care. J Oncol Pract 2012. [PMID: 23180990 DOI: 10.1200/jop.2011.000477] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
PURPOSE The Florida Initiative for Quality Cancer Care (FIQCC) was established to evaluate the quality of cancer care at the regional level across the state of Florida. This study assessed adherence to validated quality indicators in colorectal cancer (CRC) and the variability in adherence by practice site, volume, and patient age. METHODS The FIQCC is a consortium of 11 medical oncology practices in Florida. Medical record reviews were conducted for 507 patients diagnosed with CRC and seen as new medical oncology patients in 2006. Thirty-five indicators were evaluated individually and categorized across clinical domains and components of care. RESULTS The mean adherence for 19 of 35 individual indicators was > 85%. Pathology reports were compliant on reporting depth of tumor invasion (96%; range, 86% to 100%), grade (93%; range, 72% to 100%), and status of proximal and distal surgical resection margins (97%; range. 86% to 100%); however, documentation of lymphovascular and perineural invasion did not meet adherence standards (76%; range, 53% to 100% and 39%; range, 5% to 83%, respectively). Among patients with nonmetastatic rectal cancer, documentation of the status of surgical radial margins was consistently low across sites (42%; range, 0% to 100%; P = .19). Documentation of planned treatment regimens for adjuvant chemotherapy was noted in only 58% of eligible patients. CONCLUSION In this large regional initiative, we found high levels of adherence to more than half of the established quality indicators. Although the quality of care delivered within FIQCC practices seems to be high, several components of care were identified that warrant further scrutiny on both a systemic level and at individual centers.
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Albert JM, Das P. Quality assessment in oncology. Int J Radiat Oncol Biol Phys 2012; 83:773-81. [PMID: 22445001 DOI: 10.1016/j.ijrobp.2011.12.079] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2011] [Accepted: 12/23/2011] [Indexed: 01/05/2023]
Abstract
The movement to improve healthcare quality has led to a need for carefully designed quality indicators that accurately reflect the quality of care. Many different measures have been proposed and continue to be developed by governmental agencies and accrediting bodies. However, given the inherent differences in the delivery of care among medical specialties, the same indicators will not be valid across all of them. Specifically, oncology is a field in which it can be difficult to develop quality indicators, because the effectiveness of an oncologic intervention is often not immediately apparent, and the multidisciplinary nature of the field necessarily involves many different specialties. Existing and emerging comparative effectiveness data are helping to guide evidence-based practice, and the increasing availability of these data provides the opportunity to identify key structure and process measures that predict for quality outcomes. The increasing emphasis on quality and efficiency will continue to compel the medical profession to identify appropriate quality measures to facilitate quality improvement efforts and to guide accreditation, credentialing, and reimbursement. Given the wide-reaching implications of quality metrics, it is essential that they be developed and implemented with scientific rigor. The aims of the present report were to review the current state of quality assessment in oncology, identify existing indicators with the best evidence to support their implementation, and propose a framework for identifying and refining measures most indicative of true quality in oncologic care.
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Affiliation(s)
- Jeffrey M Albert
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
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Baldotto CS, Cronemberger EH, de Biasi P, Zamboni M, Sousa A, Zukin M, Small IA, Ferreira CG. Palliative care in poor-performance status small cell lung cancer patients: is there a mandatory role for chemotherapy? Support Care Cancer 2012; 20:2721-7. [DOI: 10.1007/s00520-012-1392-0] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2011] [Accepted: 01/25/2012] [Indexed: 11/29/2022]
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Hsu C. End-of-life care for cancer patients in Taiwan. J Formos Med Assoc 2012; 110:799. [PMID: 22248839 DOI: 10.1016/j.jfma.2011.11.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2011] [Revised: 08/24/2011] [Accepted: 08/25/2011] [Indexed: 11/16/2022] Open
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Claessen SJJ, Francke AL, Belarbi HE, Pasman HRW, van der Putten MJA, Deliens L. A new set of quality indicators for palliative care: process and results of the development trajectory. J Pain Symptom Manage 2011; 42:169-82. [PMID: 21429703 DOI: 10.1016/j.jpainsymman.2010.10.267] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2010] [Revised: 10/08/2010] [Accepted: 10/17/2010] [Indexed: 11/26/2022]
Abstract
CONTEXT In some countries (the United States in particular), quality indicators for palliative care have already been developed. However, these quality indicators often cover one specific setting or target group, for example, palliative cancer care or palliative home care. OBJECTIVES This article describes the development and initial testing of a set of quality indicators for palliative care, applicable for all settings in which palliative care is being provided for adult patients in The Netherlands. METHODS AND RESULTS In the first phase of the project, an inventory was made of existing relevant quality indicators. Most quality indicators focused on the process or outcome of palliative care, and quality indicators for the structure of palliative care were rare. Most of the existing quality indicators fall within the domain of physical care, and very few concern the social and spirituals domains of palliative care. In the second phase, a new draft set of quality indicators was developed. In addition to the previous inventory of existing indicators, interviews with patients, relatives, and caregivers provided input for the development of the draft set. Drafts of the set were tested among experts. In the third phase, the feasibility and usability of a draft set was established in 14 Dutch care organizations providing palliative care. CONCLUSION As a result of these phases, a set of quality indicators for palliative care has been developed, consisting of 33 indicators for palliative patient care and 10 indicators for support for relatives before and/or after the patient's death.
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Affiliation(s)
- Susanne J J Claessen
- Department of Public and Occupational Health, EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands.
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McNiff KK, Bonelli KR, Jacobson JO. Quality oncology practice initiative certification program: overview, measure scoring methodology, and site assessment standards. J Oncol Pract 2011; 5:270-6. [PMID: 21479069 DOI: 10.1200/jop.091045] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/16/2009] [Indexed: 11/20/2022] Open
Abstract
More than a decade ago, the Institute of Medicine created the National Cancer Policy Board and identified a need to assess national quality of cancer care, generating a cascade of projects, including ASCO's QOPI.
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Affiliation(s)
- Kristen K McNiff
- American Society of Clinical Oncology, Alexandria, VA; and North Shore Medical Center, Salem, MA
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Hassett MJ, Rao SR, Brozovic S, Stahl JE, Schwartz JH, Maloney B, Jacobson JO. Chemotherapy-related hospitalization among community cancer center patients. Oncologist 2011; 16:378-87. [PMID: 21349949 DOI: 10.1634/theoncologist.2010-0354] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
PURPOSE To describe the frequency, nature, trends, predictors, and outcomes of chemotherapy-related hospitalizations (CRHs) among a nonselected population of cancer patients treated at a community cancer center, and to explore the feasibility of implementing continuous quality improvement methodologies in routine oncology practice. METHODS We conducted a prospective cohort study of consecutive adult cancer patients who received chemotherapy at a community cancer center January 2003 to December 2006. Demographic, comorbidity, diagnosis, treatment, and laboratory data were collected via medical record abstraction. Hospitalizations were classified as chemotherapy related or unrelated by a multidisciplinary panel. Patients who experienced CRHs were compared with those who did not. Using a randomly sampled subset of cases and controls, we built a logistic regression model to identify independent predictors of CRH. RESULTS Of 2,068 chemotherapy recipients, 179 (8.7%) experienced 262 CRHs. Most hospitalizations were not chemotherapy related (73.7%). The mean monthly rate of CRH was 1.5%, the median length of stay was 5 days, the most common type of CRH was gastrointestinal (46.1%) followed by infectious (31.4%), and 0.9% of chemotherapy recipients had a fatal CRH. Significant predictors of CRH included having a comorbidity score of 3-4 versus 0 and having a higher creatinine level. CONCLUSIONS Although the vast majority of chemotherapy recipients did not experience a CRH, these events were, unfortunately, not without serious consequences. Care should be taken when offering chemotherapy to patients with multiple comorbid conditions. Systematic efforts to monitor toxicity can lead directly to improvements in quality of care.
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Affiliation(s)
- Michael J Hassett
- Center for Outcomes and Policy Research, Dana-Farber Cancer Institute, Boston, MA 02215, USA.
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Bakitas M, Bishop MF, Caron P, Stephens L. Developing successful models of cancer palliative care services. Semin Oncol Nurs 2010; 26:266-84. [PMID: 20971407 PMCID: PMC2976669 DOI: 10.1016/j.soncn.2010.08.006] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
OBJECTIVES This article describes successful institutionally based programs for providing high-quality palliative care to persons with cancer and their family members. Challenges and opportunities for program development are also described. DATA SOURCES Published literature from 2000 to present describing concurrent oncology palliative care clinical trials, standards, and guidelines were reviewed. CONCLUSION Clinical trials have shown feasibility and positive outcomes and formed the basis for consensus guidelines that support concurrent oncology palliative care models. IMPLICATIONS FOR NURSING PRACTICE Oncology nurses should advocate for all patients with advanced cancer and their families to have access to concurrent oncology palliative care from the time of diagnosis with a life-limiting cancer.
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Affiliation(s)
- Marie Bakitas
- Section of Palliative Medicine, Department of Anesthesiology, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA.
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Hui D, Elsayem A, Li Z, De La Cruz M, Palmer JL, Bruera E. Antineoplastic therapy use in patients with advanced cancer admitted to an acute palliative care unit at a comprehensive cancer center: a simultaneous care model. Cancer 2010; 116:2036-43. [PMID: 20162701 DOI: 10.1002/cncr.24942] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
BACKGROUND Cancer patients admitted to a palliative care unit generally have a poor prognosis. The role of antineoplastic therapy (ANT) in these patients remains controversial. In the current study, the authors examined the frequency and predictors associated with ANT use in hospitalized patients who required admission to an acute palliative care unit (APCU). METHODS Included in the study were all 2604 patients admitted over a 5-year period to a 12-bed APCU located within a National Cancer Institute comprehensive cancer center, in which patients had access to both palliative care and ANT. Institutional databases were used to retrospectively retrieve data regarding patient demographics, cancer diagnosis, ANT use, length of hospital stay, and survival from time of admission. RESULTS The median hospital stay was 11 days, and the median survival was 22 days. During hospitalization, 435 patients (17%) received ANT, including chemotherapy (N = 297; 11%), hormonal agents (N = 54; 2%), and targeted therapy (N = 155; 6%). No significant change in the frequency of ANT use was detected over the 5-year period. Multivariate logistic regression analysis revealed that younger age, specific cancer diagnoses, and longer admissions were independently associated with ANT use. CONCLUSIONS The use of ANT during hospitalization that included an APCU stay was limited to a small percentage of patients and did not increase over time. ANT use was associated with younger age, specific cancer diagnoses, and longer admissions. The APCU facilitates simultaneous care for patients receiving ANT.
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Affiliation(s)
- David Hui
- Department of Palliative Care and Rehabilitation Medicine, The University of Texas M. D. Anderson Cancer Center, Houston, Texas 77030, USA
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Fishman J, Ten Have T, Casarett D. Cancer and the media: how does the news report on treatment and outcomes? ARCHIVES OF INTERNAL MEDICINE 2010; 170:515-8. [PMID: 20233800 PMCID: PMC4255973 DOI: 10.1001/archinternmed.2010.11] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
BACKGROUND Cancer receives a great deal of news media attention. Although approximately half of all US patients with cancer die of their illness or of related complications, it is unknown whether reports in the news media reflect this reality. METHODS To determine how cancer news coverage reports about cancer care and outcomes, we conducted a content analysis of US cancer news reporting in 8 large-readership newspapers and 5 national magazines. Trained coders determined the proportion of articles reporting about cancer survival, cancer death and dying, aggressive cancer treatment, cancer treatment failure, adverse events of cancer treatment, and end-of-life palliative or hospice care. RESULTS Of 436 articles about cancer, 140 (32.1%; 95% confidence interval [CI], 28%-37%) focused on survival and only 33 (7.6 %; 5%-10%) focused on death and dying (P < .001, chi(2) test). Only 57 articles (13.1%; 10%-17%) reported that aggressive cancer treatments can fail, and 131 (30.0%; 26%-35%) reported that aggressive treatments can result in adverse events. Although most articles (249 of 436 [57.1%]; 95% CI, 52%-62%) discussed aggressive treatments exclusively, almost none (2 of 436; [0.5%]; 0%-2%) discussed end-of-life palliative or hospice care exclusively (P < .001, chi(2) test), and only a few (11 of 436 [2.5%]; 1%-6%) discussed aggressive treatment and end-of-life care. CONCLUSIONS News reports about cancer frequently discuss aggressive treatment and survival but rarely discuss treatment failure, adverse events, end-of-life care, or death. These portrayals of cancer care in the news media may give patients an inappropriately optimistic view of cancer treatment, outcomes, and prognosis.
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Affiliation(s)
- Jessica Fishman
- Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, 19104, USA.
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Neuss MN, Jacobson JO, McNiff KK, Kadlubek P, Eisenberg PD, Simone JV. Evolution and elements of the quality oncology practice initiative measure set. Cancer Control 2010; 16:312-7. [PMID: 19910917 DOI: 10.1177/107327480901600405] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Over the past 5 years, the American Society of Clinical Oncology (ASCO) has supported the development of a Web-based quality-reporting tool in response to a recognized need to provide medical oncologists the opportunity to demonstrate the quality of care that they are providing to patients. METHODS The development of quality measures, their basis in the literature, and the descriptions and organizational structure of the measures are discussed. RESULTS Specific results are the property of practices and are not shared outside of the practices except in aggregate. The system allows collection of information concerning a wide range of quality measures in a short period of time. In the last data collection period in the fall of 2008, information was submitted concerning 81 measures of quality divided into one required and six optional modules from over 250 practices concerning 15,000 patients. CONCLUSIONS The timely collection of information on a wide range of quality measures regarding cancer patients can be efficiently collected using a Web-based data collection tool allowing for practice self-examination and comparison with other practices.
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Affiliation(s)
- Michael N Neuss
- Quality Oncology Practice Initiative Steering Group, American Society of Clinical Oncology, Alexandria, Virginia, USA.
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Schneider EC. Improving the quality of cancer care: crossroads or convergence? J Oncol Pract 2009; 5:284-6. [PMID: 21479075 DOI: 10.1200/jop.091051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/03/2009] [Indexed: 11/20/2022] Open
Abstract
Insurers and payers are demanding performance measurement, whereas professional boards are urging practice-based quality improvement projects. Will these two streams improve day-to-day practice or add administrative burden?
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Affiliation(s)
- Eric C Schneider
- RAND Corporation; Division of General Medicine, Brigham and Women's Hospital; and Department of Health Policy and Management, Harvard School of Public Health, Boston, MA
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Malafa MP, Corman MM, Shibata D, Siegel EM, Lee JH, Jacobsen PB. The Florida Initiative for Quality Cancer Care: A Regional Project to Measure and Improve Cancer Care. Cancer Control 2009; 16:318-27. [DOI: 10.1177/107327480901600406] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Affiliation(s)
- Mokenge P. Malafa
- Departments of Gastrointestinal Oncology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida
| | - Michelle M. Corman
- Health Outcomes and Behavior, H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida
| | - David Shibata
- Departments of Gastrointestinal Oncology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida
| | - Erin M. Siegel
- Risk Assessment, Detection & Intervention, H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida
| | - Ji-Hyun Lee
- Biostatistics Core, H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida
| | - Paul B. Jacobsen
- Health Outcomes and Behavior, H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida
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Bakitas M, Lyons KD, Hegel MT, Balan S, Brokaw FC, Seville J, Hull JG, Li Z, Tosteson TD, Byock IR, Ahles TA. Effects of a palliative care intervention on clinical outcomes in patients with advanced cancer: the Project ENABLE II randomized controlled trial. JAMA 2009; 302:741-9. [PMID: 19690306 PMCID: PMC3657724 DOI: 10.1001/jama.2009.1198] [Citation(s) in RCA: 1228] [Impact Index Per Article: 81.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
CONTEXT There are few randomized controlled trials on the effectiveness of palliative care interventions to improve the care of patients with advanced cancer. OBJECTIVE To determine the effect of a nursing-led intervention on quality of life, symptom intensity, mood, and resource use in patients with advanced cancer. DESIGN, SETTING, AND PARTICIPANTS Randomized controlled trial conducted from November 2003 through May 2008 of 322 patients with advanced cancer in a rural, National Cancer Institute-designated comprehensive cancer center in New Hampshire and affiliated outreach clinics and a VA medical center in Vermont. INTERVENTIONS A multicomponent, psychoeducational intervention (Project ENABLE [Educate, Nurture, Advise, Before Life Ends]) conducted by advanced practice nurses consisting of 4 weekly educational sessions and monthly follow-up sessions until death or study completion (n = 161) vs usual care (n = 161). MAIN OUTCOME MEASURES Quality of life was measured by the Functional Assessment of Chronic Illness Therapy for Palliative Care (score range, 0-184). Symptom intensity was measured by the Edmonton Symptom Assessment Scale (score range, 0-900). Mood was measured by the Center for Epidemiological Studies Depression Scale (range, 0-60). These measures were assessed at baseline, 1 month, and every 3 months until death or study completion. Intensity of service was measured as the number of days in the hospital and in the intensive care unit (ICU) and the number of emergency department visits recorded in the electronic medical record. RESULTS A total of 322 participants with cancer of the gastrointestinal tract (41%; 67 in the usual care group vs 66 in the intervention group), lung (36%; 58 vs 59), genitourinary tract (12%; 20 vs 19), and breast (10%; 16 vs 17) were randomized. The estimated treatment effects (intervention minus usual care) for all participants were a mean (SE) of 4.6 (2) for quality of life (P = .02), -27.8 (15) for symptom intensity (P = .06), and -1.8 (0.81) for depressed mood (P = .02). The estimated treatment effects in participants who died during the study were a mean (SE) of 8.6 (3.6) for quality of life (P = .02), -24.2 (20.5) for symptom intensity (P = .24), and -2.7 (1.2) for depressed mood (P = .03). Intensity of service did not differ between the 2 groups. CONCLUSION Compared with participants receiving usual oncology care, those receiving a nurse-led, palliative care-focused intervention addressing physical, psychosocial, and care coordination provided concurrently with oncology care had higher scores for quality of life and mood, but did not have improvements in symptom intensity scores or reduced days in the hospital or ICU or emergency department visits. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT00253383.
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Affiliation(s)
- Marie Bakitas
- Department of Anesthesiology, Section of Palliative Medicine, Dartmouth Medical School, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire 03756, USA.
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Hashimoto K, Yonemori K, Katsumata N, Hotchi M, Kouno T, Shimizu C, Tamura K, Ando M, Takeuchi M, Fujiwara Y. Factors that affect the duration of the interval between the completion of palliative chemotherapy and death. Oncologist 2009; 14:752-9. [PMID: 19596665 DOI: 10.1634/theoncologist.2008-0257] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND The purpose of this study was to identify factors that affect the duration of the interval between the completion of palliative chemotherapy and death. METHODS We retrospectively analyzed 255 cases in which patients had received palliative chemotherapy in the medical oncology division and died during the period 2002-2006. Univariate and multivariate analyses were performed to identify factors that affected the duration of the interval between the completion of chemotherapy and death. RESULTS There were 133 cases of breast cancer, 77 cases of gynecological cancer, 24 cases of primary unknown cancer, and 21 cases of other cancers. The median interval between the completion of chemotherapy and death was 100 days (range, 5-1,206 days). Thirty-two patients (12.6%) died within 30 days, and 82 patients (32.3%) died within 60 days. Fifty-eight (22.7%) patients were symptomatic when chemotherapy was started, and 205 patients (80.4%) were provided information about palliative care units at the start of chemotherapy. The factors associated with a short interval between the completion of chemotherapy and death (< or = 90 days) according to the univariate analysis were male sex, young age (< or = 45 years), attending physician, poor Eastern Cooperative Oncology Group performance status score (3 or 4), obvious symptoms, and not having been given information about palliative care units. The results of the multivariate analysis indicated that young patients (< or = 45 years) who had not been referred to a palliative care unit and who had symptoms survived for a significantly shorter time interval. CONCLUSION Young patients who were symptomatic tended to choose chemotherapy instead of entering a palliative care unit until the very near-the-end-of-life stage.
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Affiliation(s)
- Kenji Hashimoto
- Breast and Medical Oncology Division, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo 104-0045, Japan
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Ozanne EM, Partridge A, Moy B, Ellis KJ, Sepucha KR. Doctor–Patient Communication about Advance Directives in Metastatic Breast Cancer. J Palliat Med 2009; 12:547-53. [DOI: 10.1089/jpm.2008.0254] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Elissa M. Ozanne
- Institute for Technology Assessment, Massachusetts General Hospital, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
| | - Ann Partridge
- Harvard Medical School, Boston, Massachusetts
- Dana Farber Cancer Institute, Brigham and Women's Hospital, Boston, Massachusetts
| | - Beverly Moy
- Harvard Medical School, Boston, Massachusetts
- Cancer Center, Massachusetts General Hospital, Boston, Massachusetts
| | - Katherine J. Ellis
- Harvard Medical School, Boston, Massachusetts
- Cancer Center, Massachusetts General Hospital, Boston, Massachusetts
| | - Karen R. Sepucha
- Harvard Medical School, Boston, Massachusetts
- Health Decision Research Unit, Massachusetts General Hospital, Boston, Massachusetts
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