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Donmez E, Kilic B, Dulger Z, Ozdas T. Innovative Cancer Follow-Up with Telehealth: A New Method for Oncology Nurses. Semin Oncol Nurs 2024; 40:151649. [PMID: 38734572 DOI: 10.1016/j.soncn.2024.151649] [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: 02/19/2024] [Revised: 03/31/2024] [Accepted: 04/14/2024] [Indexed: 05/13/2024]
Abstract
OBJECTIVES Telenavigation (TN) is an innovative cancer follow-up method for oncology nurses. Little is known about the effectiveness of tele-navigation on cancer patients. This study investigated the opinions of healthcare providers (HCPs) and colorectal cancer patients' experience regarding patient follow-up with TN. DATA SOURCES This is a phenomenological qualitative study. Semistructured interviews were conducted with fifteen patients and eight healthcare providers. Participants were selected by purposive sampling. Data were collected from March to October 2022 and analyzed by thematic content analysis. CONCLUSION Six themes emerged that described the experiences of TN: (1) beneficial; (2) psychological state; (3) level of knowledge, (4) technology, (5) health care system, and (6) recommendations. Patients and HCPs found TN practice helpful and reassuring and they recommended expanding these practices within the health system. As a result of the research, the TN program is described as beneficial to patients and healthcare providers. IMPLICATIONS FOR NURSING PRACTICE The TN follow-up is a beneficial implication for colorectal cancer patients undergoing treatment, and it deserves to be more widely deployed. It brings reassurance regarding psychological, reliable data access, and home follow-up. Patients and HCPs reported positive views on telephone follow-up. There is a recommendation that the innovative follow-up technique should be disseminated to the healthcare system and that cancer nurses should be more familiar with this method.
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Affiliation(s)
- Elif Donmez
- Department of Oncology Nursing, Hamidiye Nursing Faculty, University of Health Sciences, Üsküdar, Istanbul, Turkiye.
| | - Bulent Kilic
- Department of Public Health, Medical Faculty, Dokuz Eylul University, Izmir, Turkiye
| | - Zeynep Dulger
- Department of Oncology Nursing, Hamidiye Nursing Faculty, University of Health Sciences, Üsküdar, Istanbul, Turkiye
| | - Turkan Ozdas
- Department of Oncology Nursing, Hamidiye Nursing Faculty, University of Health Sciences, Üsküdar, Istanbul, Turkiye
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Chen M, Wu VS, Falk D, Cheatham C, Cullen J, Hoehn R. Patient Navigation in Cancer Treatment: A Systematic Review. Curr Oncol Rep 2024; 26:504-537. [PMID: 38581470 PMCID: PMC11063100 DOI: 10.1007/s11912-024-01514-9] [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] [Accepted: 03/04/2024] [Indexed: 04/08/2024]
Abstract
PURPOSE OF REVIEW Patient navigation promotes access to timely treatment of chronic diseases by eliminating barriers to care. Patient navigation programs have been well-established in improving screening rates and diagnostic resolution. This systematic review aimed to characterize the multifaceted role of patient navigators within the realm of cancer treatment. RECENT FINDINGS A comprehensive electronic literature review of PubMed and Embase databases was conducted to identify relevant studies investigating the role of patient navigators in cancer treatment from August 1, 2009 to March 27, 2023. Fifty-nine articles were included in this review. Amongst studies focused on cancer treatment initiation, 70% found a significant improvement in treatment initiation amongst patients who were enrolled in patient navigation programs, 71% of studies focused on treatment adherence demonstrated significant improvements in treatment adherence, 87% of studies investigating patient satisfaction showed significant benefits, and 81% of studies reported a positive impact of patient navigators on quality care indicators. Three palliative care studies found beneficial effects of patient navigation. Thirty-seven studies investigated disadvantaged populations, with 76% of them concluded that patient navigators made a positive impact during treatment. This systematic review provides compelling evidence supporting the value of patient navigation programs in cancer treatment. The findings suggest that patient navigation plays a crucial role in improving access to care and optimizing treatment outcomes, especially for disadvantaged cancer patients. Incorporating patient navigation into standard oncology practice can reduce disparities and improve the overall quality of cancer care.
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Affiliation(s)
- Matthew Chen
- Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Victoria S Wu
- Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Derek Falk
- Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Chesley Cheatham
- Division of Surgical Oncology, Department of Surgery, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Jennifer Cullen
- Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Richard Hoehn
- Division of Surgical Oncology, Department of Surgery, University Hospitals Cleveland Medical Center, Cleveland, OH, USA.
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Lai JH, Han S, Park C, Avanceña AL. Association Between Alcohol Use Disorder and Hospital Readmission Rates and Outcomes in Cancer Survivors: A Population Cohort Study. J Natl Compr Canc Netw 2024; 22:e237076. [PMID: 38394782 PMCID: PMC11188046 DOI: 10.6004/jnccn.2023.7076] [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: 07/05/2023] [Accepted: 08/29/2023] [Indexed: 02/25/2024]
Abstract
BACKGROUND Alcohol use disorder (AUD) is the most common substance use disorder and is characterized by heavy alcohol use and the inability to control drinking. This study sought to compare the rate, timing, length, and total costs of hospital readmissions among cancer survivors with and without AUD. METHODS We used the Nationwide Readmissions Database in 2017 and 2018 in this cohort study. Cancer survivors with an AUD diagnosis during their index hospitalization were included in the exposure group. Propensity score matching was used to identify cancer survivors without AUD for the control group. The primary outcome was all-cause readmission, and secondary outcomes included days to, length of, and total cost of readmission. Outcomes were measured after 90 and 180 days of follow-up. Logistic regression was used to measure the likelihood of readmission, and negative binomial regression and gamma regression were used for the other outcomes. RESULTS Of 485,962 cancer survivors, 13,953 (2.9%) had co-occurring AUD. Cancer survivors with AUD had slightly higher odds of 90-day (odds ratio, 1.14; 95% CI, 1.06-1.22) and 180-day (odds ratio, 1.11; 95% CI, 1.05-1.18) readmission compared with those without AUD. Cancer survivors with AUD who were readmitted after 90 days also had higher readmission costs ($3,785 vs $3,376; P=.03). No differences in time to and length of readmission were observed between groups. The odds of readmission were higher among cancer survivors with AUD irrespective of age and type of cancer. Male, but not female, cancer survivors with AUD were more likely than those without AUD to be readmitted in both follow-up periods. CONCLUSIONS This population-based cohort study of cancer survivors in the United States found that AUD is associated with higher 90- and 180-day readmission rates and higher related health care costs after 90 days of follow-up. Hospitalized cancer survivors with AUD may benefit from addiction treatment and discharge planning that addresses their co-occurring AUD.
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Affiliation(s)
- Jyun-Heng Lai
- Health Outcomes Division, College of Pharmacy, The University of Texas at Austin, Austin, Texas
| | - Sola Han
- Health Outcomes Division, College of Pharmacy, The University of Texas at Austin, Austin, Texas
| | - Chanhyun Park
- Health Outcomes Division, College of Pharmacy, The University of Texas at Austin, Austin, Texas
| | - Anton L.V. Avanceña
- Health Outcomes Division, College of Pharmacy, The University of Texas at Austin, Austin, Texas
- Department of Internal Medicine, Dell Medical School, The University of Texas at Austin, Austin, Texas
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Yu J, Petersen C, Reid S, Rosenbloom ST, Warner JL. Telehealth and Technology: New Directions in Cancer Care. Cancer J 2024; 30:40-45. [PMID: 38265926 DOI: 10.1097/ppo.0000000000000692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2024]
Abstract
ABSTRACT Telehealth is a broad concept that refers to any delivery of health care in real time using technologies to connect people or information that are not in the same physical location. Until fairly recently, telehealth was more aspiration than reality. This situation changed radically due in part to the COVID-19 pandemic, which led to a near-overnight inability for patients to be seen for routine management of chronic health conditions, including those with cancer. The purpose of this brief narrative review is to outline some areas where emerging and future technology may allow for innovations with specific implications for people with a current or past diagnosis of cancer, including underserved and/or historically excluded populations. Specific topics of telehealth are broadly covered in other areas of the special issue.
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Affiliation(s)
| | - Carolyn Petersen
- Department of Artificial Intelligence and Informatics, Mayo Clinic, Rochester, MN
| | - Sonya Reid
- Division of Hematology/Oncology, Department of Medicine
| | - S Trent Rosenbloom
- Department of Biomedical Informatics, Vanderbilt University, Nashville, TN
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Frosch ZAK, Jacobs LM, O'Brien CS, Brecher AC, McKeown CJ, Lynch SM, Geynisman DM, Hall MJ, Edelman MJ, Bleicher RJ, Fang CY. "Cancer's a demon": a qualitative study of fear and multilevel factors contributing to cancer treatment delays. Support Care Cancer 2023; 32:13. [PMID: 38060063 DOI: 10.1007/s00520-023-08200-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Accepted: 11/21/2023] [Indexed: 12/08/2023]
Abstract
PURPOSE Delays initiating cancer therapy are increasingly common, impact outcomes, and have implications for health equity. However, it remains unclear (1) whether patients' beliefs regarding acceptable diagnostic to treatment intervals align with current guidelines, and (2) to what degree psychological factors contribute to longer intervals. We conducted a qualitative study with patients and cancer care team members ("providers"). METHODS We interviewed patients with several common solid tumors as well as providers. Interviews were analyzed using an interpretive approach, guided by modified grounded theory. RESULTS Twenty-two patients and 12 providers participated. Half of patients had breast cancer; 27% waited >60 days between diagnosis and treatment. Several themes emerged. (1) Patients felt treatment should begin immediately following diagnosis, while providers' opinion on the goal timeframe to start treatment varied. (2) Patients experienced psychological distress while waiting for treatment. (3) Participants identified logistical, social, and psychological sources of delay. Fear related to multiple aspects of cancer care was common. Emotion-driven barriers could manifest as not taking steps to move ahead, or as actions that delayed care. (4) Besides addressing logistical challenges, patients believed that education and anticipatory guidance, from their care team and from peers, may help overcome psychological barriers to treatment and facilitate the start of therapy. CONCLUSIONS Patients feel an urgency to start cancer therapy, desiring time frames shorter than those included in guidelines. Psychological distress is frequently both a contributor to, and a consequence of, treatment delays. Addressing multilevel barriers, including psychological ones, may facilitate timely treatment and reduce distress.
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Affiliation(s)
- Zachary A K Frosch
- Department of Hematology/Oncology, Fox Chase Cancer Center, 333 Cottman Ave, Philadelphia, PA, 19111, USA.
- Cancer Prevention and Control Research Program, Fox Chase Cancer Center, 333 Cottman Ave, Philadelphia, PA, 19111, USA.
| | - Lisa M Jacobs
- Mixed Methods Research Laboratory, University of Pennsylvania, Philadelphia, PA, USA
| | - Caroline S O'Brien
- Mixed Methods Research Laboratory, University of Pennsylvania, Philadelphia, PA, USA
| | - Alison C Brecher
- Cancer Prevention and Control Research Program, Fox Chase Cancer Center, 333 Cottman Ave, Philadelphia, PA, 19111, USA
| | - Colleen J McKeown
- Cancer Prevention and Control Research Program, Fox Chase Cancer Center, 333 Cottman Ave, Philadelphia, PA, 19111, USA
| | - Shannon M Lynch
- Cancer Prevention and Control Research Program, Fox Chase Cancer Center, 333 Cottman Ave, Philadelphia, PA, 19111, USA
| | - Daniel M Geynisman
- Department of Hematology/Oncology, Fox Chase Cancer Center, 333 Cottman Ave, Philadelphia, PA, 19111, USA
| | - Michael J Hall
- Department of Hematology/Oncology, Fox Chase Cancer Center, 333 Cottman Ave, Philadelphia, PA, 19111, USA
- Cancer Prevention and Control Research Program, Fox Chase Cancer Center, 333 Cottman Ave, Philadelphia, PA, 19111, USA
| | - Martin J Edelman
- Department of Hematology/Oncology, Fox Chase Cancer Center, 333 Cottman Ave, Philadelphia, PA, 19111, USA
| | - Richard J Bleicher
- Department of Surgical Oncology, Fox Chase Cancer Center, Philadelphia, PA, USA
| | - Carolyn Y Fang
- Cancer Prevention and Control Research Program, Fox Chase Cancer Center, 333 Cottman Ave, Philadelphia, PA, 19111, USA
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Seghers PALN, Rostoft S, O'Hanlon S, O'Sullivan B, Portielje JEA, Wildiers H, Soubeyran P, Hamaker ME. Challenges of caring for older patients with multimorbidity including cancer. J Geriatr Oncol 2023; 14:101588. [PMID: 37454533 DOI: 10.1016/j.jgo.2023.101588] [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: 01/02/2023] [Revised: 05/15/2023] [Accepted: 07/07/2023] [Indexed: 07/18/2023]
Abstract
INTRODUCTION As the population is ageing, the number of older patients with multimorbidity including cancer continues to increase. To improve care for these patients, the European Union-funded project "Streamlined Geriatric and Oncological evaluation based on IC Technology" (GERONTE) was initiated to develop a new, patient-centred, holistic care pathway. The aim of this paper is to analyse what challenges are encountered in everyday clinical practice according to patients, their informal caregivers, and healthcare professionals as a starting point for the development of the care pathway. MATERIALS AND METHODS An expert panel of cancer and geriatrics specialists participated in an online survey to answer what challenges they experience in caring for older patients with multimorbidity including cancer and what treatment outcomes could be improved. Furthermore, in-depth interviews with older patients and their informal caregivers were organised to assess what challenges they experience. RESULTS Healthcare professionals (n = 36) most frequently mentioned the challenge of choosing the best treatment in light of the lack of evidence in this population and how to handle interactions between the (cancer) treatment and multimorbidities. Twelve patients and caregivers participated, and they most frequently mentioned challenges related to treatment outcomes, such as how to deal with symptoms of disease or treatment and how to maintain quality of life. From the challenges, five main themes emerged that should be taken into account when developing a new care pathway for older patients with multimorbidity including cancer. Two themes focus on decision making aspects such as personalized treatment recommendations and inclusion of non-oncologic information, two focus on patient support and monitoring to maintain quality of life and functioning, and one overarching theme addresses care coordination to prevent fragmentation of care. DISCUSSION In conclusion, the management of older patients with multimorbidity including cancer is complex and although progress has been made on improving aspects of their care, challenges remain and patients are at risk of receiving inappropriate, unnecessary, and potentially harmful treatment. A patient-centred care pathway that integrates solutions to the five main themes and that moves away from a single-disease centred approach is needed.
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Affiliation(s)
- P A L Nelleke Seghers
- Department of Geriatric Medicine, Diakonessenhuis, Utrecht 3582 KE, the Netherlands.
| | - Siri Rostoft
- Department of Geriatric Medicine, Oslo University Hospital, Oslo 0424, Norway; Institute of Clinical Medicine, University of Oslo, Oslo 0318, Norway.
| | - Shane O'Hanlon
- Department of Geriatric Medicine, St Vincent's University Hospital, Dublin D04 T6F4, Ireland; Department of Geriatric Medicine, University College Dublin, Dublin D04 V1W8, Ireland.
| | - Bridget O'Sullivan
- School of Nursing, Psychotherpay, & Community Health, Dublin City Univeristy, Ireland.
| | - Johanneke E A Portielje
- Department of Medical Oncology, Leiden University Medical Center-LUMC,Leiden 2333 ZA, the Netherlands.
| | - Hans Wildiers
- Department of General Medical Oncology, University Hospitals Leuven, Leuven, Belgium.
| | - Pierre Soubeyran
- Department of Medical Oncology, Institut Bergonié, Inserm U1312, SIRIC BRIO, Université de Bordeaux, Bordeaux 33076, France.
| | - Marije E Hamaker
- Department of Geriatric Medicine, Diakonessenhuis, Utrecht 3582 KE, the Netherlands.
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Bidstrup PE, Johansen C, Kroman N, Belmonte F, Duriaud H, Dalton SO, Andersen KG, Mertz B. Effect of a Nurse Navigation Intervention on Mental Symptoms in Patients With Psychological Vulnerability and Breast Cancer: The REBECCA Randomized Clinical Trial. JAMA Netw Open 2023; 6:e2319591. [PMID: 37351885 PMCID: PMC10290249 DOI: 10.1001/jamanetworkopen.2023.19591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Accepted: 05/08/2023] [Indexed: 06/24/2023] Open
Abstract
Importance The unmet needs regarding symptom management of psychological distress among patients with breast cancer must be addressed. However, little evidence exists on effective interventions, such as nurse navigation. Objective To compare the long-term effects of the REBECCA (Rehabilitation After Breast Cancer) nurse navigation intervention vs usual care in patients with breast cancer who were psychologically vulnerable. Design, Setting, and Participants This parallel randomized clinical trial recruited and evaluated for eligibility adult female patients with newly diagnosed breast cancer and symptoms of psychological distress (distress score of ≥7 points on Distress Thermometer) at Rigshospitalet in Copenhagen, Denmark, from August 2017 to October 2019. This study continued the work of a pilot study, extending the follow-up to 18 months. Patients who met the inclusion criteria were randomized to either standard care or the REBECCA intervention. Intention-to-treat analyses were performed from June 2021 to October 2022. Interventions Patients who were randomized to the REBECCA intervention received nurse navigation and symptom screening as well as standard care. Standard care included regular treatment, nurse support at chemotherapy and radiotherapy appointments, and municipality-based rehabilitation. Main Outcomes and Measures The primary outcome was distress, as measured using the Distress Thermometer. The secondary outcomes included symptoms of anxiety, symptoms of depression, breast cancer-specific health-related quality of life, fear of recurrence, sleep, cognitive function, patient activation, pain, health behavior, body mass index, and need for support. Long-term effects at 6, 12, and 18 months were examined using mixed-effect models, adjusting for randomization strata of age and treatment modality. Results A total of 309 female patients were included in the analysis, with 153 patients randomized to the standard care group and 156 patients randomized to the REBECCA intervention group. Mean (SD) age was 56 (11) years with only small between-group differences. Patients receiving the REBECCA intervention compared with standard care had reduced (although not significant) symptoms of distress, especially at the 12-month follow-up (estimated effect = -0.51 [95% CI, -1.05 to 0.04]; effect size [ES] = -0.49). Significant effects were seen for symptoms of depression at 6 months (estimated effect = -1.39 [95% CI, -2.33 to -0.44]; ES = -0.27), and breast cancer-specific health-related quality of life at 12 months (estimated effect = 4.03 [95% CI, 1.28- 6.77]; ES = 0.31). Nonsignificant reductions were seen for symptoms of anxiety at 6 months (estimated effect = -1.00 [95% CI, -1.95 to -0.06]; ES = -0.21) and 12 months (estimated effect = -1.01 [95% CI, -1.97 to -0.04]; ES = -0.21), and a nonsignificant increase was seen for patient activation at 18 months (estimated effect = 3.52 [95% CI, -0.09 to 7.12]; ES = 0.25). Stronger intervention effects were observed for younger age, low patient activation, less education, and low social support. Conclusions and Relevance Results of this study indicate that patients with breast cancer who were psychologically vulnerable (ie, having moderate to high psychological distress) did not experience significant reduction in distress with nurse navigation. Further research is needed to develop the intervention's framework and investigate its potential use in clinical practice. Trial Registration ClinicalTrials.gov Identifier: NCT03254875.
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Affiliation(s)
- Pernille Envold Bidstrup
- Psychological Aspects of Cancer, Danish Cancer Society Research Center, Copenhagen, Denmark
- Department of Psychology, University of Copenhagen, Copenhagen, Denmark
| | - Christoffer Johansen
- Psychological Aspects of Cancer, Danish Cancer Society Research Center, Copenhagen, Denmark
- Late Effect Research Unit, CASTLE, Oncology Clinic, University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Niels Kroman
- Danish Cancer Society, Copenhagen, Denmark
- Department of Breast Surgery, Herlev/Gentofte Hospital, Copenhagen, Denmark
| | - Federica Belmonte
- Statistics and Data Analysis, Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Helle Duriaud
- Department of Breast Surgery, Herlev/Gentofte Hospital, Copenhagen, Denmark
| | - Susanne Oksbjerg Dalton
- Survivorship and Inequality in Cancer, Danish Cancer Society Research Center, Copenhagen, Denmark
- Department of Clinical Oncology and Palliative Care, Zealand University Hospital, Næstved, Denmark
| | - Kenneth Geving Andersen
- Department of Anesthesiology, Hvidovre Hospital, Copenhagen, Denmark
- Section for Surgical Pathophysiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Birgitte Mertz
- Department of Breast Surgery, Herlev/Gentofte Hospital, Copenhagen, Denmark
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Acero MX, Minvielle E, Waelli M. Are Nurse Coordinators Really Performing Coordination Pathway Activities? A Comparative Analysis of Case Studies in Oncology. Healthcare (Basel) 2023; 11:healthcare11081090. [PMID: 37107925 PMCID: PMC10137695 DOI: 10.3390/healthcare11081090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Revised: 03/29/2023] [Accepted: 04/07/2023] [Indexed: 04/29/2023] Open
Abstract
Patient Pathway Coordination (PPC) improves patient care quality and safety, particularly in oncology. PPC roles, such as nurse coordinators (NCs), have positively impacted the quality of patient care and reduced financial costs. However, NCs and their real activities in Health Care Organizations (HCOs) are unclear. Our aim was to identify, quantify, and compare all activities performed by NCs in oncology care settings from an organizational approach. Methods: We used qualitative and quantitative approaches based on case study principles. We accumulated 325 observation hours by shadowing and timing the activities of 14 NCs in four French HCO in oncology. Data analysis was conducted using an analytical framework to investigate the Activity of PAtient PAthway Nurse Coordinators in Oncology (APANCO). Results: Our research generated important findings: (1) NC roles and job titles are not standardized. (2) Non-coordination related activities are important in NC work content. Non-coordination times were consistent with distribution times between ward NCs and NCs in centralized structures. Ward NCs had higher non-coordination activities when compared with NCs in centralized structures. (3) PPC times varied for both ward NCs and NCs in centralized structures. Ward NCs performed less design coordination when compared with NCs in centralized structures, and this latter group also performed more external coordination than ward NCs. Conclusions: NCs do not just perform PPC activities. Their position in HCO structures, wards, or centralized structures, influence their work content. Centralized structures allow NCs to focus on their PPC roles. We also highlight different dimensions of NC work and training requirements. Our study could help managers and decision-makers develop PPC roles in oncology.
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Affiliation(s)
- Maria-Ximena Acero
- ARENES-UMR 6051, EHESP, French School of Public Health, University of Rennes, 15 Avenue du Professeur Léon Bernard, 35043 Rennes, France
| | - Etienne Minvielle
- i3-CRG Ecole Polytechnique, CNRS, Institut Polytechnique de Paris, Route de Saclay, 91120 Palaiseau, France
- Gustave Roussy, 114 Rue Edouard Vaillant, 94800 Villejuif, France
| | - Mathias Waelli
- ARENES-UMR 6051, EHESP, French School of Public Health, University of Rennes, 15 Avenue du Professeur Léon Bernard, 35043 Rennes, France
- Global Health Institute, University of Geneva, 24 rue du Général-Dufour, 1211 Geneva, Switzerland
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Logan CD, Feinglass J, Halverson AL, Durst D, Lung K, Kim S, Bharat A, Merkow RP, Bentrem DJ, Odell DD. Rural-Urban Disparities in Receipt of Surgery for Potentially Resectable Non-Small Cell Lung Cancer. J Surg Res 2023; 283:1053-1063. [PMID: 36914996 PMCID: PMC10289009 DOI: 10.1016/j.jss.2022.10.097] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 08/25/2022] [Accepted: 10/15/2022] [Indexed: 12/15/2022]
Abstract
INTRODUCTION Access to cancer care, especially surgery, is limited in rural areas. However, the specific reasons rural patient populations do not receive surgery for non-small cell lung cancer (NSCLC) is unknown. We investigated geographic disparities in reasons for failure to receive guideline-indicated surgical treatment for patients with potentially resectable NSCLC. METHODS The National Cancer Database was used to identify patients with clinical stage I-IIIA (N0-N1) NSCLC between 2004 and 2018. Patients from rural areas were compared to urban areas, and the reason for nonreceipt of surgery was evaluated. Adjusted odds of (1) primary nonsurgical management, (2) surgery being deemed contraindicated due to risk, (3) surgery being recommended but not performed, and (4) overall failure to receive surgery were determined. RESULTS The study included 324,785 patients with NSCLC with 42,361 (13.0%) from rural areas. Overall, 62.4% of patients from urban areas and 58.8% of patients from rural areas underwent surgery (P < 0.001). Patients from rural areas had increased odds of (1) being recommended primary nonsurgical management (adjusted odds ratio [aOR]: 1.14, 95% confidence interval [CI]: 1.05-1.23), (2) surgery being deemed contraindicated due to risk (aOR: 1.19, 95% CI: 1.07-1.33), (3) surgery being recommended but not performed (aOR: 1.13, 95% CI: 1.01-1.26), and (4) overall failure to receive surgery (aOR: 1.21, 95% CI: 1.13-1.29; all P < 0.001). CONCLUSIONS There are geographic disparities in the management of NSCLC. Rural patient populations are more likely to fail to undergo surgery for potentially resectable disease for every reason examined.
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Affiliation(s)
- Charles D Logan
- Surgical Outcomes and Quality Improvement Center, Department of Surgery, Northwestern University, Feinberg School of Medicine, 420 East Superior Street, Chicago, Illinois 60611; Canning Thoracic Institute, Department of Surgery, Northwestern University, Feinberg School of Medicine, 420 East Superior Street, Chicago, Illinois 60611
| | - Joe Feinglass
- Department of Medicine, Northwestern University, Feinberg School of Medicine, 420 East Superior Street, Chicago, Illinois 60611
| | - Amy L Halverson
- Surgical Outcomes and Quality Improvement Center, Department of Surgery, Northwestern University, Feinberg School of Medicine, 420 East Superior Street, Chicago, Illinois 60611
| | - Dalya Durst
- Surgical Outcomes and Quality Improvement Center, Department of Surgery, Northwestern University, Feinberg School of Medicine, 420 East Superior Street, Chicago, Illinois 60611
| | - Kalvin Lung
- Canning Thoracic Institute, Department of Surgery, Northwestern University, Feinberg School of Medicine, 420 East Superior Street, Chicago, Illinois 60611
| | - Samuel Kim
- Canning Thoracic Institute, Department of Surgery, Northwestern University, Feinberg School of Medicine, 420 East Superior Street, Chicago, Illinois 60611
| | - Ankit Bharat
- Canning Thoracic Institute, Department of Surgery, Northwestern University, Feinberg School of Medicine, 420 East Superior Street, Chicago, Illinois 60611
| | - Ryan P Merkow
- Surgical Outcomes and Quality Improvement Center, Department of Surgery, Northwestern University, Feinberg School of Medicine, 420 East Superior Street, Chicago, Illinois 60611
| | - David J Bentrem
- Surgical Outcomes and Quality Improvement Center, Department of Surgery, Northwestern University, Feinberg School of Medicine, 420 East Superior Street, Chicago, Illinois 60611
| | - David D Odell
- Surgical Outcomes and Quality Improvement Center, Department of Surgery, Northwestern University, Feinberg School of Medicine, 420 East Superior Street, Chicago, Illinois 60611; Canning Thoracic Institute, Department of Surgery, Northwestern University, Feinberg School of Medicine, 420 East Superior Street, Chicago, Illinois 60611.
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Blum TG, Morgan RL, Durieux V, Chorostowska-Wynimko J, Baldwin DR, Boyd J, Faivre-Finn C, Galateau-Salle F, Gamarra F, Grigoriu B, Hardavella G, Hauptmann M, Jakobsen E, Jovanovic D, Knaut P, Massard G, McPhelim J, Meert AP, Milroy R, Muhr R, Mutti L, Paesmans M, Powell P, Putora PM, Rawlinson J, Rich AL, Rigau D, de Ruysscher D, Sculier JP, Schepereel A, Subotic D, Van Schil P, Tonia T, Williams C, Berghmans T. European Respiratory Society guideline on various aspects of quality in lung cancer care. Eur Respir J 2023; 61:13993003.03201-2021. [PMID: 36396145 DOI: 10.1183/13993003.03201-2021] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Accepted: 09/23/2022] [Indexed: 11/18/2022]
Abstract
This European Respiratory Society guideline is dedicated to the provision of good quality recommendations in lung cancer care. All the clinical recommendations contained were based on a comprehensive systematic review and evidence syntheses based on eight PICO (Patients, Intervention, Comparison, Outcomes) questions. The evidence was appraised in compliance with the GRADE (Grading of Recommendations Assessment, Development and Evaluation) approach. Evidence profiles and the GRADE Evidence to Decision frameworks were used to summarise results and to make the decision-making process transparent. A multidisciplinary Task Force panel of lung cancer experts formulated and consented the clinical recommendations following thorough discussions of the systematic review results. In particular, we have made recommendations relating to the following quality improvement measures deemed applicable to routine lung cancer care: 1) avoidance of delay in the diagnostic and therapeutic period, 2) integration of multidisciplinary teams and multidisciplinary consultations, 3) implementation of and adherence to lung cancer guidelines, 4) benefit of higher institutional/individual volume and advanced specialisation in lung cancer surgery and other procedures, 5) need for pathological confirmation of lesions in patients with pulmonary lesions and suspected lung cancer, and histological subtyping and molecular characterisation for actionable targets or response to treatment of confirmed lung cancers, 6) added value of early integration of palliative care teams or specialists, 7) advantage of integrating specific quality improvement measures, and 8) benefit of using patient decision tools. These recommendations should be reconsidered and updated, as appropriate, as new evidence becomes available.
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Affiliation(s)
- Torsten Gerriet Blum
- Department of Pneumology, Lungenklinik Heckeshorn, HELIOS Klinikum Emil von Behring, Berlin, Germany
| | - Rebecca L Morgan
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
| | - Valérie Durieux
- Bibliothèque des Sciences de la Santé, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Joanna Chorostowska-Wynimko
- Department of Genetics and Clinical Immunology, National Institute of Tuberculosis and Lung Diseases, Warsaw, Poland
| | - David R Baldwin
- Department of Respiratory Medicine, Nottingham University Hospitals, Nottingham, UK
| | | | - Corinne Faivre-Finn
- Division of Cancer Sciences, University of Manchester and The Christie NHS Foundation Trust, Manchester, UK
| | | | | | - Bogdan Grigoriu
- Intensive Care and Oncological Emergencies and Thoracic Oncology, Institut Jules Bordet, Centre des Tumeurs de l'Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Georgia Hardavella
- Department of Respiratory Medicine, King's College Hospital London, London, UK
- Department of Respiratory Medicine and Allergy, King's College London, London, UK
| | - Michael Hauptmann
- Institute of Biostatistics and Registry Research, Brandenburg Medical School Theodor Fontane and Faculty of Health Sciences Brandenburg, Neuruppin, Germany
| | - Erik Jakobsen
- Department of Thoracic Surgery, Odense University Hospital, Odense, Denmark
| | | | - Paul Knaut
- Department of Pneumology, Lungenklinik Heckeshorn, HELIOS Klinikum Emil von Behring, Berlin, Germany
| | - Gilbert Massard
- Faculty of Science, Technology and Medicine, University of Luxembourg and Department of Thoracic Surgery, Hôpitaux Robert Schuman, Luxembourg, Luxembourg
| | - John McPhelim
- Lung Cancer Nurse Specialist, Hairmyres Hospital, NHS Lanarkshire, East Kilbride, UK
| | - Anne-Pascale Meert
- Intensive Care and Oncological Emergencies and Thoracic Oncology, Institut Jules Bordet, Centre des Tumeurs de l'Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Robert Milroy
- Scottish Lung Cancer Forum, Glasgow Royal Infirmary, Glasgow, UK
| | - Riccardo Muhr
- Department of Pneumology, Lungenklinik Heckeshorn, HELIOS Klinikum Emil von Behring, Berlin, Germany
| | - Luciano Mutti
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
- SHRO/Temple University, Philadelphia, PA, USA
| | - Marianne Paesmans
- Data Centre, Institut Jules Bordet, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | | | - Paul Martin Putora
- Departments of Radiation Oncology, Kantonsspital St Gallen, St Gallen and University of Bern, Bern, Switzerland
| | | | - Anna L Rich
- Department of Respiratory Medicine, Nottingham University Hospitals, Nottingham, UK
| | - David Rigau
- Iberoamerican Cochrane Center, Barcelona, Spain
| | - Dirk de Ruysscher
- Maastricht University Medical Center, Department of Radiation Oncology (Maastro Clinic), GROW School for Oncology and Developmental Biology, Maastricht, The Netherlands
- Erasmus Medical Center, Department of Radiation Oncology, Rotterdam, The Netherlands
| | - Jean-Paul Sculier
- Intensive Care and Oncological Emergencies and Thoracic Oncology, Institut Jules Bordet, Centre des Tumeurs de l'Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Arnaud Schepereel
- Pulmonary and Thoracic Oncology, Université de Lille, Inserm, CHU Lille, Lille, France
| | - Dragan Subotic
- Clinic for Thoracic Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Paul Van Schil
- Department of Thoracic and Vascular Surgery, Antwerp University Hospital, Edegem, Belgium
| | - Thomy Tonia
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | | | - Thierry Berghmans
- Thoracic Oncology, Institut Jules Bordet, Centre des Tumeurs de l'Université Libre de Bruxelles (ULB), Brussels, Belgium
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11
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Schindel D, Gebert P, Frick J, Letsch A, Grittner U, Schenk L. Associations among navigational support and health care utilization and costs in patients with advanced cancer: An analysis based on administrative health insurance data. Cancer Med 2023; 12:8662-8675. [PMID: 36622058 PMCID: PMC10134282 DOI: 10.1002/cam4.5574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Revised: 12/15/2022] [Accepted: 12/16/2022] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Fragmented and complex healthcare systems make it difficult to provide continuity of care for patients with advanced cancer near the end of life. Nurse-based cross-sectoral navigation support has the potential to increase patients' quality of life. The objective of this paper was to evaluate associations between navigation support and health care utilization, and the associated costs of care. METHODS The evaluation is based on claims data from 37 statutory health insurance funds. Non-randomized recruitment of the intervention group (IG) took place between 2018 and 2019 in four German hospitals. The comparison group (CG) was defined ex post. It comprises nonparticipating clients of the involved health insurance funds matched on age, gender, and diagnosis in a 1:4 ratio to the IG. Healthcare resource utilization was compared using incident rate ratios (IRRs) based on negative binomial regression models. Linear mixed models were performed to compare differences in lengths of hospital stays and costs between groups. RESULTS A total of 717 patients were included (IG: 149, CG: 568). IG patients showed shorter average lengths of hospital stays (IG: 11 days [95% CI: 10, 13] vs. CG: 15 days [95% CI: 14, 16], p < 0.001). In the IG, 21% fewer medications were prescribed and there were on average 15% fewer outpatient doctor contacts per month. Average billed costs in the IG were 23% lower than in the CG (IG: 6754 EUR [95% CI: 5702, 8000] vs. CG: 8816 EUR [95% CI: 8153, 9533], p < 0.001). CONCLUSIONS The intervention was associated with decreased costs mainly as a result of a non-intended navigation effect. The social care nurses had navigated patients within the hospital early, needs-oriented and effectively but interpreted their function less cross-sectorally. Linkage of hospital-based navigators with the outpatient care sector needs further exploration.
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Affiliation(s)
- Daniel Schindel
- Institute of Medical Sociology and Rehabilitation Science, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Pimrapat Gebert
- Institute of Biometry and Clinical Epidemiology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Johann Frick
- Institute of Medical Sociology and Rehabilitation Science, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Anne Letsch
- Department of Medicine II, Hematology and Oncology, University Hospital Schleswig-Holstein, Kiel, Germany
| | - Ulrike Grittner
- Institute of Biometry and Clinical Epidemiology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Liane Schenk
- Institute of Medical Sociology and Rehabilitation Science, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
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12
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Frey MK, Ahsan MD, Badiner N, Lin J, Narayan P, Nitecki R, Rauh-Hain JA, Moss H, Fowlkes RK, Thomas C, Bergeron H, Christos P, Levi SR, Blank SV, Holcomb K, Cantillo E, Sharaf RN, Lipkin S, Offit K, Chapman-Davis E. What happens in the long term: Uptake of cancer surveillance and prevention strategies among at-risk relatives with pathogenic variants detected via cascade testing. Cancer 2022; 128:4241-4250. [PMID: 36305018 PMCID: PMC10041659 DOI: 10.1002/cncr.34482] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Revised: 08/12/2022] [Accepted: 08/18/2022] [Indexed: 01/31/2023]
Abstract
BACKGROUND Cascade genetic testing for hereditary cancer syndromes offers affected relatives the opportunity to pursue cancer screening and risk-reducing surgery and thus reduces morbidity and mortality. The purpose of this study was to measure the long-term utilization of targeted cancer prevention and quality of life among at-risk relatives offered clinician-facilitated cascade genetic testing. METHODS In a pilot study, at-risk relatives of patients with a hereditary cancer syndrome were contacted directly by the clinical team and offered telephone genetic counseling and genetic testing via an at-home, mailed saliva kit. Two-year follow-up results evaluating the use of targeted cancer prevention strategies and the quality of life for enrolled relatives were reported. Quality-of-life was measured with validated surveys, and scores were compared to the time of initial contact by the Wilcoxon signed-rank test. RESULTS Ninety-five at-risk relatives were enrolled in the initial pilot study, and 72 (76%) participated in the 2-year follow-up; 57 of these (79%) had completed genetic testing. Twenty-five of those 57 relatives (44%) were found to harbor an inherited pathogenic variant. Guideline-based cancer surveillance was recommended to 18 relatives; 13 (72%) completed at least one recommended screening, and six (33%) completed all recommended screenings. Risk-reducing surgery was recommended to 10 relatives; four (40%) completed a total of eight procedures. Quality-of-life surveys demonstrated low levels of anxiety, depression, distress, and uncertainty. CONCLUSIONS The 2-year follow-up of the original pilot study revealed that clinician-facilitated cascade testing resulted in genetically targeted cancer screening and prevention with preserved quality of life. These results, to be confirmed by larger randomized controlled trials, suggest that medical systems should consider supporting clinician-facilitated cascade testing programs.
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Affiliation(s)
| | | | | | - Jenny Lin
- Weill Cornell Medicine, New York, New York, USA
| | | | - Roni Nitecki
- The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | | | - Haley Moss
- Duke University Medical Center, Durham, North Carolina, USA
| | | | | | | | | | | | | | | | | | | | | | - Kenneth Offit
- Memorial Sloan Kettering Cancer Center, New York, New York, USA
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13
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Nurse's Roles in Colorectal Cancer Prevention: A Narrative Review. JOURNAL OF PREVENTION (2022) 2022; 43:759-782. [PMID: 36001253 DOI: 10.1007/s10935-022-00694-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 06/21/2022] [Indexed: 02/07/2023]
Abstract
The objective of this paper is to investigate the different roles of nurses as members of healthcare teams at the primary, secondary, and tertiary levels of colorectal cancer prevention. The research team conducted a narrative review of studies involving the role of nurses at different levels of colorectal cancer prevention, which included a variety of quantitative, qualitative, and mixed-method studies. We searched PubMed, Scopus, Web of Science, Cochrane Reviews, Magiran, the Scientific Information Database (SID), Noormags, and the Islamic Science Citation (ISC) databases from ab initio until 2021. A total of 117 studies were reviewed. Nurses' roles were classified into three levels of prevention. At the primary level, the most important role related to educating people to prevent cancer and reduce risk factors. At the secondary level, the roles consisted of genetic counseling, stool testing, sigmoidoscopy and colonoscopy, biopsy and screening test follow-ups, and chemotherapy intervention, while at the tertiary level, their roles were made up of pre-and post-operative care to prevent further complications, rehabilitation, and palliative care. Nurses at various levels of prevention care also act as educators, coordinators, performers of screening tests, follow-up, and provision of palliative and end-of-life care. If these roles are not fulfilled at some levels of colorectal cancer, it is generally due to the lack of knowledge and competence of nurses or the lack of instruction and legal support for them. Nurses need sufficient clinical knowledge and experience to perform these roles at all levels.
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14
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Valentine MA, Asch SM, Ahn E. Who Pays the Cancer Tax? Patients’ Narratives in a Movement to Reduce Their Invisible Work. ORGANIZATION SCIENCE 2022. [DOI: 10.1287/orsc.2022.1627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Many studies examine the division of labor inside organizations. Yet there is also an expected division of labor between organizations and their clients, which research to date has tended to ignore or has treated as static and easily accepted by both parties. How might clients change the expected division of labor with a service organization? We developed this question while studying an academic cancer center (ACC), where patient activists led a movement to bring to light the burdensome invisible work they and their families did to coordinate their treatment. They shared their own stories, developed formal channels for collecting more stories, and worked to broadcast the growing set of stories across ACC. Their stories became a resource for change and mobilized a coalition of staff allies. Coalition members drew on the patient stories to develop a new diagnostic framing of the “Cancer Tax”—the burdensome coordination work ACC required of patients. They also developed a prognostic frame for how ACC could help, which inspired a new program that took on some of the patients’ coordination tasks. In this way, the patients’ stories created new awareness of the problem and provided resources for staff allies to make the case for taking on some of the patients’ invisible work. This study shows that clients can effectively influence organizational change through movements fueled by personal narratives (for instance, lessening the coordination work they must do to coproduce complex services).
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Affiliation(s)
| | - Steven M. Asch
- Division of Primary Care and Population Health, Stanford, California 94305
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15
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O’Banion LA, Qumsiyeh Y, Matheny H, Siada SS, Yan Y, Hiramoto JS, Rome C, Dirks RC, Prentice A. Lower Extremity Amputation Protocol (LEAP): A pilot enhanced recovery pathway for vascular amputees. J Vasc Surg Cases Innov Tech 2022; 8:740-747. [PMID: 36438667 PMCID: PMC9691462 DOI: 10.1016/j.jvscit.2022.08.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Accepted: 08/05/2022] [Indexed: 12/03/2022] Open
Abstract
Vascular patients, an inherently older, frail population, account for >80% of major lower extremity amputations (transtibial or transfemoral) in the United States. Retrospective data have shown that early physical therapy and discharge to an acute rehabilitation facility decreases the postoperative length of stay (LOS) and expedites ambulation. In the present study, we sought to determine whether patients treated with the lower extremity amputation protocol (LEAP) will have improved outcomes. We performed a nonrandomized prospective study of vascular patients undergoing an amputation from January 2019 to February 2020. Patients who were nonambulatory or had undergone a previous contralateral major amputation were excluded. LEAP is a multidisciplinary team approach to the perioperative care of amputees using an outlined protocol. The prospective patients were compared with historic controls treated before the initiation of LEAP (January 2016 to December 2018). The primary outcomes included the postoperative LOS, time to receipt of a prosthesis, and time to ambulation. Of the 141 included patients, 130 were in the retrospective group and 11 in the LEAP group. The demographics and comorbidities were similar. All 11 LEAP patients had undergone a below-the-knee amputation, with 1 requiring revision to an above-the-knee amputation. Of the 130 retrospective patients, 122 (94%) had undergone a below-the-knee amputation, with 1 requiring revision to an above-the-knee amputation. The LEAP patients were more likely to be discharged to acute rehabilitation (100% vs 27%; P < .001), receive a prosthesis (100% vs 45%; P < .001), and ambulate with the prosthesis (100% vs 43%; P < .001). The LEAP patients had received physical therapy 2 days sooner than had the retrospective controls (P = .006) with a shorter postoperative LOS (3 days vs 6 days; P < .001). Of the patients who had received their prosthesis, the LEAP patients had received their prosthesis, on average, 2 months sooner than had the retrospective cohort (81 ± 39 days vs 137 ± 97 days, respectively; P = .002) and had ambulated with their prosthesis sooner (86 ± 53 days vs 146 ± 104 days, respectively; P = .002). No differences were found in the incidence of surgical site complications or unplanned readmissions between the two groups. The results from the present pilot study have demonstrated that the use of LEAP can significantly decrease postoperative LOS and expedite the time to independent ambulation with a prosthesis for vascular patients undergoing a major lower extremity amputation. These findings suggest a powerful ability to bridge the healthcare gap for this high-risk, underserved, and ethnically diverse population using a disease-specific standardized protocol.
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16
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Valverde PA, Kennedy Sheldon L, Gentry S, Dwyer AJ, Saavedra Ferrer EL, Wightman PD. Flexibility, adaptation, and roles of patient navigators in oncology during COVID-19. Cancer 2022; 128 Suppl 13:2610-2622. [PMID: 35699607 DOI: 10.1002/cncr.33962] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Revised: 08/10/2021] [Accepted: 09/07/2021] [Indexed: 02/06/2023]
Abstract
BACKGROUND The impact of COVID-19 on cancer care during the first 6 months of the pandemic has been significant. The National Navigation Roundtable Workforce Development Task Group conducted a national survey to highlight the role of patient navigators (PNs). METHODS An anonymous online survey captured how cancer care navigation changed during 2 phases: 1) March 13 to May 31, 2020; and 2) June 1 to September 4, 2020. Differences between the 2 time periods for categorical variables were assessed using χ2 tests, and 1-way analyses of variance were used for ordinal variables. RESULTS Almost one-half of PNs expected changes in duties (49%) during phase 1. By phase 2, PNs showed greater confidence in retaining PN work (P < .001) and reduced changes to duties (P < .01). PNs reported new training on COVID-19 and telehealth during phase 1 (64% and 27%, respectively) and phase 2 (54% and 19%, respectively). Significant decreases in service delays were identified by phase 2 for cancer screening (P < .001), preventive care (P < .001), medical treatment (P < .01), cancer treatment (P < .001), and cancer survivorship services (P < .01). PNs reported that the top patient issues were COVID-19 concerns, medical care disruptions, and finances, and there were decreases in medical care disruptions (P < .01) during phase 2. PNs addressed myths related to mask use, COVID-19 spread, disbelief, risk, clinical changes, transmission prevention, and finances/politics. CONCLUSIONS The PN role demonstrated resiliency and adaptability. Both clinical and nonclinical oncology PNs identified key patient needs and can provide connections with patient populations that have been economically and socially marginalized, which is necessary to build trust throughout the pandemic.
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Affiliation(s)
- Patricia A Valverde
- Department of Community and Behavioral Health, Colorado School of Public Health, Aurora, Colorado
| | - Lisa Kennedy Sheldon
- Clinical and Scientific Affairs, Oncology Nursing Society, Pittsburgh, Pennsylvania
| | - Sharon Gentry
- Academy of Oncology Nurse and Patient Navigators, Cranbury, New Jersey
| | - Andrea J Dwyer
- Department of Community and Behavioral Health, Colorado School of Public Health, Aurora, Colorado
| | - Elba L Saavedra Ferrer
- Center for Collaborative Research and Community Engagement, College of Education and Human Sciences, University of New Mexico, Albuquerque, New Mexico
| | - Patrick D Wightman
- Arizona Health Sciences-Center for Population Health Sciences, University of Arizona, Tucson, Arizona
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17
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Frick J, Gebert P, Grittner U, Letsch A, Schindel D, Schenk L. Identifying and handling unbalanced baseline characteristics in a non-randomized, controlled, multicenter social care nurse intervention study for patients in advanced stages of cancer. BMC Cancer 2022; 22:560. [PMID: 35585571 PMCID: PMC9118792 DOI: 10.1186/s12885-022-09646-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Accepted: 05/06/2022] [Indexed: 12/13/2022] Open
Abstract
Purpose Given the psychosocial burdens patients in advanced stages of cancer face, innovative care concepts are needed. At the same time, such vulnerable patient groups are difficult to reach for participation in intervention studies and randomized patient inclusion may not be feasible. This article aims to identify systematic biases respectively selection effects occurring during the recruitment phase and to discuss their potential causes based on a non-randomized, multicenter intervention study with patients in advanced stages of cancer. Methods Patients diagnosed with at least one of 16 predefined cancers were recruited at four hospitals in three German cities. The effect of social care nurses’ continuous involvement in acute oncology wards was measured by health-related quality of life (EORTC QLQ-C30), information and participation preferences, decisional conflicts, doctor-patient communication, health literacy and symptom perception. Absolute standardized mean difference was calculated as a standardized effect size to test baseline characteristics balance between the intervention and control groups. Results The study enrolled 362 patients, 150 in the intervention and 212 in the control group. Except for gender, both groups differed in relevant socio-demographic characteristics, e.g. regarding age and educational background. With respect to the distribution of diagnoses, the intervention group showed a higher symptom burden than the control group. Moreover, the control group reported better quality of life at baseline compared to the intervention group (52.6 points (SD 21.7); 47.8 points (SD 22.0), ASMD = 0.218, p = 0.044). Conclusion Overall, the intervention group showed more social and health vulnerability than the control group. Among other factors, the wide range of diagnoses included and structural variation between the recruiting clinics increased the risk for bias. We recommend a close, continuous monitoring of relevant social and health-related characteristics during the recruitment phase as well as the use of appropriate statistical analysis strategies for adjustment, such as propensity score methods. Trial registration: German Clinical Trials Register (DRKS-ID: DRKS00013640); registered on 29th December 2017. Supplementary Information The online version contains supplementary material available at 10.1186/s12885-022-09646-6.
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Affiliation(s)
- Johann Frick
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Institute of Medical Sociology and Rehabilitation Science, Charitéplatz 1, 10117, Berlin, Germany
| | - Pimrapat Gebert
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Institute of Medical Sociology and Rehabilitation Science, Charitéplatz 1, 10117, Berlin, Germany.,Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Institute of Biometry and Clinical Epidemiology, Charitéplatz 1, 10117, Berlin, Germany.,Berlin Institute of Health (BIH), Anna-Louisa-Karsch-Str. 2, 10178, Berlin, Germany
| | - Ulrike Grittner
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Institute of Biometry and Clinical Epidemiology, Charitéplatz 1, 10117, Berlin, Germany.,Berlin Institute of Health (BIH), Anna-Louisa-Karsch-Str. 2, 10178, Berlin, Germany
| | - Anne Letsch
- Department of Medicine II, Hematology and Oncology, University Hospital Schleswig-Holstein, Arnold-Heller-Straße 3, 24105, Kiel, Germany.,Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Charité Comprehensive Cancer Center, Charitéplatz 1, 10117, Berlin, Germany
| | - Daniel Schindel
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Institute of Medical Sociology and Rehabilitation Science, Charitéplatz 1, 10117, Berlin, Germany.
| | - Liane Schenk
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Institute of Medical Sociology and Rehabilitation Science, Charitéplatz 1, 10117, Berlin, Germany
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18
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Sinnamon AJ, Hodul PJ, Pimiento JM. Removing Barriers to Access Starts with a Phone Call: Impact of Pre-Visit Coordination of Care in Efficiency of Therapy and Patient and Provider Satisfaction. Ann Surg Oncol 2021; 29:1506-1508. [PMID: 34853937 DOI: 10.1245/s10434-021-11150-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Accepted: 11/17/2021] [Indexed: 11/18/2022]
Affiliation(s)
- Andrew J Sinnamon
- Department of Gastrointestinal Oncology, Moffitt Cancer Center and Research Institute, 12902 Magnolia Drive, Tampa, FL, 33612, USA
| | - Pamela J Hodul
- Department of Gastrointestinal Oncology, Moffitt Cancer Center and Research Institute, 12902 Magnolia Drive, Tampa, FL, 33612, USA
| | - Jose M Pimiento
- Department of Gastrointestinal Oncology, Moffitt Cancer Center and Research Institute, 12902 Magnolia Drive, Tampa, FL, 33612, USA.
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19
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[Rapid outpatient diagnostic pathways for lung cancer: Evaluation after one year]. Rev Mal Respir 2021; 38:904-913. [PMID: 34756758 DOI: 10.1016/j.rmr.2021.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Accepted: 07/28/2021] [Indexed: 11/23/2022]
Abstract
INTRODUCTION The introduction of coordinated care pathways for lung cancer diagnosis and treatment is a complex process. The purpose of the French Cancer Plan 2014-2019 was to improve referral to treatment waiting times in people with suspected malignancy. The aim of this study was to assess a rapid outpatient diagnostic program for lung cancer established in 2016. METHOD This retrospective study was carried out in the Pulmonology Department at Tenon Hospital, Paris, France between May 2016 and May 2017. RESULTS During this period, 118 patients (60%) of patients in the pathway were diagnosed with lung cancer. The median waiting time to first consultation (D1) was 4 (2-7) days. The median waiting time between diagnosis and treatment decision (D4) was 4 (0-8) days. The median waiting time to the first treatment (D5) was 10 (4-15) days for chemotherapy and 27 (16-34) days for surgery. The median waiting time between the first abnormal chest X-ray and the first treatment (D6) was 49 days (34-70). CONCLUSION Referral to treatment waiting times was consistent with international recommendations. Coordinating nurses improved care pathways in lung cancer patients.
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20
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Lamba N, Catalano PJ, Whitehouse C, Martin KL, Mendu ML, Haas-Kogan DA, Wen PY, Aizer AA. Emergency department visits and inpatient hospitalizations among older patients with brain metastases: a dual population- and institution-level analysis. Neurooncol Pract 2021; 8:569-580. [PMID: 34691748 DOI: 10.1093/nop/npab029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background Older patients with brain metastases (BrM) commonly experience symptoms that prompt acute medical evaluation. We characterized emergency department (ED) visits and inpatient hospitalizations in this population. Methods We identified 17 789 and 361 Medicare enrollees diagnosed with BrM using the Surveillance, Epidemiology, and End Results (SEER)-Medicare database (2010-2016) and an institutional database (2007-2016), respectively. Predictors of ED visits and hospitalizations were assessed using Poisson regression. Results The institutional cohort averaged 3.3 ED visits/1.9 hospitalizations per person-year, with intracranial disease being the most common reason for presentation/admission. SEER-Medicare patients averaged 2.8 ED visits/2.0 hospitalizations per person-year. For patients with synchronous BrM (N = 7834), adjusted risk factors for ED utilization and hospitalization, respectively, included: male sex (rate ratio [RR] = 1.15 [95% CI = 1.09-1.22], P < .001; RR = 1.21 [95% CI = 1.13-1.29], P < .001); African American vs white race (RR = 1.30 [95% CI = 1.18-1.42], P < .001; RR = 1.25 [95% CI = 1.13-1.39], P < .001); unmarried status (RR = 1.07 [95% CI = 1.01-1.14], P = .02; RR = 1.09 [95% CI = 1.02-1.17], P = .01); Charlson comorbidity score >2 (RR = 1.27 [95% CI = 1.17-1.37], P < .001; RR = 1.36 [95% CI = 1.24-1.49], P < .001); and receipt of non-stereotactic vs stereotactic radiation (RR = 1.44 [95% CI = 1.34-1.55, P < .001; RR = 1.49 [95% CI = 1.37-1.62, P < .001). For patients with metachronous BrM (N = 9955), ED visits and hospitalizations were more common after vs before BrM diagnosis (2.6 vs 1.2 ED visits per person-year; 1.8 vs 0.9 hospitalizations per person-year, respectively; RR = 2.24 [95% CI = 2.15-2.33], P < .001; RR = 2.06 [95% CI = 1.98-2.15], P < .001, respectively). Conclusions Older patients with BrM commonly receive hospital-level care secondary to intracranial disease, especially in select subpopulations. Enhanced care coordination, closer outpatient follow-up, and patient navigator programs seem warranted for this population.
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Affiliation(s)
- Nayan Lamba
- Harvard Radiation Oncology Program, Harvard University, Boston, Massachusetts, USA.,Department of Radiation Oncology, Dana-Farber Cancer Institute, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Paul J Catalano
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, and Department of Biostatistics and Computational Biology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Colleen Whitehouse
- Department of Radiation Oncology, Dana-Farber Cancer Institute, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Kate L Martin
- Department of Radiation Oncology, Dana-Farber Cancer Institute, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Mallika L Mendu
- Partners Healthcare Center for Population Health Management and Department of Quality and Safety, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Daphne A Haas-Kogan
- Department of Radiation Oncology, Dana-Farber Cancer Institute, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Patrick Y Wen
- Center for Neuro-Oncology, Dana-Farber/Brigham and Women's Cancer Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Ayal A Aizer
- Department of Radiation Oncology, Dana-Farber Cancer Institute, Brigham and Women's Hospital, Boston, Massachusetts, USA
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21
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The effect of navigation programme on the management of symptoms related to head and neck radiotherapy. Transpl Immunol 2021; 69:101488. [PMID: 34687909 DOI: 10.1016/j.trim.2021.101488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2021] [Accepted: 10/18/2021] [Indexed: 11/21/2022]
Abstract
BACKGROUND This study aims to determine the effect of navigation programme in the management of symptoms related to head and neck cancer (HNC) radiotherapy. METHODS This randomized, controlled and experimental study was conducted between November 2018 and March 2020 with the participation of 88 patients with HNC receiving radiotherapy. Referring to the pre-prepared randomization checklist, 41 people were randomized to the experimental group and 47 to the control group. While the standard treatment approaches of the hospital were applied to all patients, the patients in the experimental group were applied an additional nursing navigation program. At the beginning of the navigation program, the patients were given a 30-minute visual training on the first day of radiotherapy and a handbook related to the expected adverse effects. Throughout subsequent seven weeks, the patient continued to be followed up via phone reminders, providing daily counseling and a weekly follow-up. Patient identification form, CTCAE v5.0 toxicity criteria and EORTC QLQ-30, H&N35 assessment questionnaires were used in the study. The first result was the difference observed in quality of life scores at the beginning, middle and end of radiotherapy. RESULTS Data obtained from the study revealed that the quality of life scores (p < 0.05) improved while the navigation program reduced the severity of symptoms such as mucositis, dysphagia, oral pain and weight loss (p < 0.05). CONCLUSION It was concluded that navigation programme is an effective approach for patients receiving head and neck radiotherapy. TRIAL REGISTRATION NCT04857749.
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22
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Wang T, Huilgol YS, Black J, D'Andrea C, James J, Northrop A, Belkora J, Esserman LJ. Pre-Appointment Nurse Navigation: Patient-Centered Findings From a Survey of Patients With Breast Cancer. Clin J Oncol Nurs 2021; 25:E57-E62. [PMID: 34533526 DOI: 10.1188/21.cjon.e57-e62] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Research indicates that nurse navigators can play key roles in promoting empowerment for patients with cancer through advocacy, educational support, resource navigation, and psychosocial care. OBJECTIVES This study attempted to elucidate the efficacy of nurse navigation in patient knowledge, care coordination, and well-being before a breast oncology appointment. METHODS Staff provided a nine-question survey to 50 newly referred patients before their initial appointment. After survey completion, patients had the option to participate in an open-ended interview about their experience. FINDINGS A greater proportion of patients with initial nurse navigation than those without felt informed before their appointment and thought that their care was effectively coordinated. Although some patients without nurse navigation experienced delays and confusion in scheduling their appointment, no patients with nurse navigators reported such issues.
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Affiliation(s)
| | | | - Janet Black
- University of California, San Francisco Helen Diller Family Comprehensive Cancer Center
| | | | - Jennifer James
- Institute for Health and Aging at University of California, San Francisco
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23
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Hu B, Boselli D, Pye LM, Chen T, Bose R, Symanowski JT, Blackley K, Moyo TK, Jacobs R, Park SI, Soni A, Avalos BR, Copelan EA, Raghavan D, Ghosh N. Equal access to care and nurse navigation leads to equitable outcomes for minorities with aggressive large B-cell lymphoma. Cancer 2021; 127:3991-3997. [PMID: 34289094 DOI: 10.1002/cncr.33779] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Revised: 06/04/2021] [Accepted: 06/10/2021] [Indexed: 01/01/2023]
Abstract
BACKGROUND Aggressive large B-cell lymphomas (LBCLs) are curable, but previous studies have shown inferior outcomes in minorities. Nurse navigation programs can improve patient outcomes by providing patient support. This study presents the outcomes of White and minority patients with aggressive LBCL at an institution with an active nurse navigation program. METHODS The authors prospectively collected baseline characteristics, treatment regimens, and outcome data for patients with aggressive LBCL. Navigation encounters were characterized as low or high intensity. Overall survival (OS) and progression-free survival (PFS) were calculated with Kaplan-Meier methods. Baseline characteristics were compared with Fisher exact tests. RESULTS Two hundred four consecutive patients (47 minority patients and 157 White patients) were included. Results were presented as minorities versus Whites. There were no differences in prognostic scores (Revised International Prognostic Index score of 3-5, 43% vs 47%; P = .50), frontline chemotherapy (98% vs 96%; P = .68), or the incidence of relapsed/refractory disease (40% vs 38%; P = .74). For relapsed/refractory LBCL, similar proportions of patients underwent hematopoietic stem cell transplantation (32% vs 29%; P > .99) or chimeric antigen receptor T-cell therapy (16% vs 19%; P > .99). Enrollment in clinical trials was comparable (17% vs 14%; P = .64). More than 85% received nurse navigation, but minorities had higher intensity navigation encounters (42% vs 21%; P = .01). The 2-year OS rates were 81% and 76% for minorities and Whites, respectively (P = .27); the 2-year PFS rates were 62% and 65%, respectively (P = .78). CONCLUSIONS This study shows similar survival between Whites and minorities with aggressive LBCL, which was likely due to equal access to guideline-concordant therapy. Minorities received higher intensity navigation encounters, which may have helped them to overcome socioeconomic disadvantages.
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Affiliation(s)
- Bei Hu
- Department of Hematologic Oncology and Blood Disorders, Levine Cancer Institute/Atrium Health, Charlotte, North Carolina
| | - Danielle Boselli
- Department of Biostatistics, Levine Cancer Institute/Atrium Health, Charlotte, North Carolina
| | - Lisa M Pye
- Department of Patient Navigation, Levine Cancer Institute/Atrium Health, Charlotte, North Carolina
| | - Tommy Chen
- Department of Biostatistics, Levine Cancer Institute/Atrium Health, Charlotte, North Carolina
| | - Rupali Bose
- Department of Biostatistics, Levine Cancer Institute/Atrium Health, Charlotte, North Carolina
| | - James T Symanowski
- Department of Biostatistics, Levine Cancer Institute/Atrium Health, Charlotte, North Carolina
| | - Kris Blackley
- Department of Patient Navigation, Levine Cancer Institute/Atrium Health, Charlotte, North Carolina
| | - Tamara K Moyo
- Department of Hematologic Oncology and Blood Disorders, Levine Cancer Institute/Atrium Health, Charlotte, North Carolina
| | - Ryan Jacobs
- Department of Hematologic Oncology and Blood Disorders, Levine Cancer Institute/Atrium Health, Charlotte, North Carolina
| | - Steven I Park
- Department of Hematologic Oncology and Blood Disorders, Levine Cancer Institute/Atrium Health, Charlotte, North Carolina
| | - Amy Soni
- Department of Hematologic Oncology and Blood Disorders, Levine Cancer Institute/Atrium Health, Charlotte, North Carolina
| | - Belinda R Avalos
- Department of Hematologic Oncology and Blood Disorders, Levine Cancer Institute/Atrium Health, Charlotte, North Carolina
| | - Edward A Copelan
- Department of Hematologic Oncology and Blood Disorders, Levine Cancer Institute/Atrium Health, Charlotte, North Carolina
| | - Derek Raghavan
- Levine Cancer Institute/Atrium Health, Charlotte, North Carolina
| | - Nilanjan Ghosh
- Department of Hematologic Oncology and Blood Disorders, Levine Cancer Institute/Atrium Health, Charlotte, North Carolina
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24
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Bargoin M, Rey P, Maffre N, Hudde T, Sérange E, Chalard N, Guérin B, Moluçon Chabrot C, Collombet-Migeon F, Bay JO, Bahadoor MRK. [Place of coordination of complex pathways in oncology by coordinating private nurses]. Bull Cancer 2021; 108:686-695. [PMID: 34049669 DOI: 10.1016/j.bulcan.2021.03.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 03/22/2021] [Accepted: 03/30/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND The complexity of the hospital-city care pathway is a real challenge because of the lack of coordination and communication between many stakeholders. As part of a call for projects from the General Directorate of Healthcare Provision, an experiment involving private oncology coordinating nurses was developed to address this issue. To our knowledge, there is no evaluation so far of such a protocol . METHODS This single-center retrospective study focused on data from the ONC'IDEC program between 2015 and 2018, where 28 private nurses provided a 24/7 hotline. The objective was to qualitatively assess the coordination of this system. The nature and number of calls, patient satisfaction and medico-economic parameters were assessed. RESULTS More than a hundred patients (n=114) were included in this device (mean age: 72 ± 12 years). The most frequent reasons for calls concerned the patient's general condition (35 %) and home treatment follow-ups (13 %) but also referrals to the primary doctor (4 %), which helped avoiding hospitalizations. The patients were satisfied with the experiment (overall score of 8.4/10). DISCUSSION Thanks to the ONC'IDEC program, patients were able to benefit from more appropriate care through a privileged interlocutor by making their care pathway more fluid and avoiding hospitalizations. It would be interesting to confirm these results by means of a study with a higher level of evidence, by comparing this protocol to conventional hospital coordination.
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Affiliation(s)
- Maxence Bargoin
- Service de thérapie cellulaire et d'hématologie clinique Adulte, CHU ESTAING, 1, place Lucie-Aubrac, 63100 Clermont-Ferrand, France.
| | - Philippe Rey
- Union régional des professionnels de santé infirmiers libéraux d'Auvergne Rhône-Alpes, 21, quai Antoine-Riboud, 69002 Lyon, France
| | - Nadia Maffre
- Infirmiers libéraux coordinateurs ONC'IDEC, 15, rue Pré-La-Reine, 63000 Clermont-Ferrand, France
| | - Thierry Hudde
- Infirmiers libéraux coordinateurs ONC'IDEC, 15, rue Pré-La-Reine, 63000 Clermont-Ferrand, France
| | - Eric Sérange
- Infirmiers libéraux coordinateurs ONC'IDEC, 15, rue Pré-La-Reine, 63000 Clermont-Ferrand, France
| | - Nathalie Chalard
- Union régional des professionnels de santé infirmiers libéraux d'Auvergne Rhône-Alpes, 21, quai Antoine-Riboud, 69002 Lyon, France
| | - Bénédicte Guérin
- Réseau régional en cancérologie ONCAUVERGNE, 58, rue Montalembert, 63011 Clermont-Ferrand, France
| | - Cécile Moluçon Chabrot
- Service de thérapie cellulaire et d'hématologie clinique Adulte, CHU ESTAING, 1, place Lucie-Aubrac, 63100 Clermont-Ferrand, France
| | - Frédérique Collombet-Migeon
- DGOS : direction générale de l'offre de soins, sous-direction régulation de l'offre de soins, bureau plateaux techniques et prise en charge hospitalière aigüe - R3, 14, avenue Duquesne, 75350 Paris, France
| | - Jacques-Olivier Bay
- Service de thérapie cellulaire et d'hématologie clinique Adulte, CHU ESTAING, 1, place Lucie-Aubrac, 63100 Clermont-Ferrand, France
| | - Mohun R K Bahadoor
- Réseau régional en cancérologie ONCAUVERGNE, 58, rue Montalembert, 63011 Clermont-Ferrand, France
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25
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Takano T, Matsuda A, Ishizuka N, Ozaki Y, Suyama K, Tanabe Y, Miura Y, Matsushima E. Effectiveness of self-help workbook intervention on quality of life in cancer patients receiving chemotherapy: results of a randomized controlled trial. BMC Cancer 2021; 21:588. [PMID: 34022838 PMCID: PMC8141256 DOI: 10.1186/s12885-021-08333-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2020] [Accepted: 05/10/2021] [Indexed: 12/02/2022] Open
Abstract
Background A self-help workbook is expected to support cancer patients to cope with physical and psychosocial distress, to facilitate communication with medical staff, and to improve quality of life (QOL). We conducted a randomized controlled trial to evaluate the effectiveness of a self-help workbook intervention on QOL and survival. Methods From June 2014 to March 2015, patients with breast, colorectal, gastric, and lung cancer receiving outpatient chemotherapy were randomized into an intervention group (n = 100) or control group (n = 100). Intervention group participants received workbooks originally made for this study, read advice on how to cope with distress, and filled out questionnaires on the workbooks periodically. EORTC QLQ-C30 was evaluated at baseline, at 12 weeks, and at 24 weeks. The primary endpoint was Global Health Status / QOL scale (GQOL). Results No significant interaction was observed between the intervention and time in terms of GQOL or any of the functional scales. Among the 69 patients who continued cytotoxic chemotherapy at 24 weeks, the intervention was significantly associated with improved emotional functioning scores (P = 0.0007). Overall survival was not significantly different between the two groups. Conclusions Self-help workbook intervention was feasible in cancer patients receiving chemotherapy. Although the effect of the intervention was limited, a post-hoc subset analysis suggested that the intervention may improve emotional functioning among patients who receive long-term cytotoxic chemotherapy. Trial registration UMIN Clinical Trials Registry, UMIN000012842. Registered 14 January 2014.
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Affiliation(s)
- Toshimi Takano
- Department of Medical Oncology, Toranomon Hospital, 2-2-2 Toranomon, Minato-ku, Tokyo, 105-8470, Japan. .,Section of Liaison Psychiatry and Palliative Medicine, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan.
| | - Ayako Matsuda
- Department of Hygiene and Public Health, School of Medicine, Teikyo University, Tokyo, Japan
| | - Noriko Ishizuka
- Section of Liaison Psychiatry and Palliative Medicine, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Yukinori Ozaki
- Department of Medical Oncology, Toranomon Hospital, 2-2-2 Toranomon, Minato-ku, Tokyo, 105-8470, Japan
| | - Koichi Suyama
- Department of Medical Oncology, Toranomon Hospital, 2-2-2 Toranomon, Minato-ku, Tokyo, 105-8470, Japan.,Kumamoto University Hospital Cancer Center, Kumamoto, Japan
| | - Yuko Tanabe
- Department of Medical Oncology, Toranomon Hospital, 2-2-2 Toranomon, Minato-ku, Tokyo, 105-8470, Japan
| | - Yuji Miura
- Department of Medical Oncology, Toranomon Hospital, 2-2-2 Toranomon, Minato-ku, Tokyo, 105-8470, Japan
| | - Eisuke Matsushima
- Section of Liaison Psychiatry and Palliative Medicine, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
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26
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Rodrigues RL, Schneider F, Kalinke LP, Kempfer SS, Backes VMS. Clinical outcomes of patient navigation performed by nurses in the oncology setting: an integrative review. Rev Bras Enferm 2021; 74:e20190804. [PMID: 33886831 DOI: 10.1590/0034-7167-2019-0804] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Accepted: 10/18/2020] [Indexed: 01/24/2023] Open
Abstract
OBJECTIVE to evidence the clinical outcomes of navigation performed by nurses in cancer patients. METHODS this is an integrative literature review with collection in MEDLINE via PUBMED, LILACS, Web of Science, Scopus, and CINAHL databases. The final sample consisted of seven studies. The data were analyzed and presented descriptively. Data related to clinical outcomes were compiled and described in full. The Agency for Healthcare Research and Quality categorization was used to assess the level of evidence. RESULTS the clinical outcomes demonstrated were decreased distress, anxiety and depression, improved control and management of symptoms, improved physical conditioning, improved quality and continuity of care, improved quality of life, reduced time to start treatment. FINAL CONSIDERATIONS there is research that shows better clinical outcomes in cancer patients through navigation by nurses across the continuum of health care.
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Affiliation(s)
| | - Franciane Schneider
- Universidade Federal de Santa Catarina. Florianópolis, Santa Catarina, Brazil
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27
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Integrating Academic and Community Cancer Care and Research through Multidisciplinary Oncology Pathways for Value-Based Care: A Review and the City of Hope Experience. J Clin Med 2021; 10:jcm10020188. [PMID: 33430334 PMCID: PMC7825796 DOI: 10.3390/jcm10020188] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Revised: 12/10/2020] [Accepted: 12/29/2020] [Indexed: 12/15/2022] Open
Abstract
As the US transitions from volume- to value-based cancer care, many cancer centers and community groups have joined to share resources to deliver measurable, high-quality cancer care and clinical research with the associated high patient satisfaction, provider satisfaction, and practice health at optimal costs that are the hallmarks of value-based care. Multidisciplinary oncology care pathways are essential components of value-based care and their payment metrics. Oncology pathways are evidence-based, standardized but personalizable care plans to guide cancer care. Pathways have been developed and studied for the major medical, surgical, radiation, and supportive oncology disciplines to support decision-making, streamline care, and optimize outcomes. Implementing multidisciplinary oncology pathways can facilitate comprehensive care plans for each cancer patient throughout their cancer journey and across large multisite delivery systems. Outcomes from the delivered pathway-based care can then be evaluated against individual and population benchmarks. The complexity of adoption, implementation, and assessment of multidisciplinary oncology pathways, however, presents many challenges. We review the development and components of value-based cancer care and detail City of Hope’s (COH) academic and community-team-based approaches for implementing multidisciplinary pathways. We also describe supportive components with available results towards enterprise-wide value-based care delivery.
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28
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Ejegi-Memeh S, Darlison L, Moylan A, Tod A, Sherborne V, Warnock C, Taylor BH. Living with mesothelioma: A qualitative study of the experiences of male military veterans in the UK. Eur J Oncol Nurs 2020; 50:101889. [PMID: 33422732 DOI: 10.1016/j.ejon.2020.101889] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Revised: 12/14/2020] [Accepted: 12/14/2020] [Indexed: 11/18/2022]
Abstract
PURPOSE The UK has the highest incidence of mesothelioma in the world. Evidence in the United States suggests that mesothelioma may disproportionately affect military veterans. However, there has been no investigation of the experience of UK veterans living with mesothelioma. The Military Mesothelioma Experience Study (MiMES) aimed to understand the experience and health/support needs of British Armed Forces personnel/veterans with mesothelioma. METHODS Semi-structured interviews were conducted with 13 veterans living with mesothelioma, and nine family members of veterans living with mesothelioma. Participants were recruited via charities and asbestos support groups. Data were analysed using thematic analysis. RESULTS Participants' experiences are presented using three themes, i) exposure to asbestos and awareness of asbestos related diseases, ii) using military strategies to cope with mesothelioma and iii) preferences for information and support. MiMES indicates that the nature and range of UK military veterans' asbestos exposure is varied and not limited to high risk occupations. Participants' knowledge of asbestos and experience of mesothelioma influenced their experiences of diagnosis. Participants had coping strategies influenced by their military experiences. Assistance in navigating health and military systems was considered beneficial, especially if support was provided by professionals with knowledge or experience of the military. Attributes which may inhibit veterans from seeking professional support are discussed. CONCLUSION MiMES provides insight into how UK military veterans experience and cope with mesothelioma. Key implications focus on the role that Mesothelioma Nurse Specialists, Asbestos Support Groups and veterans groups play in providing acceptable support for UK veterans.
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Affiliation(s)
- Stephanie Ejegi-Memeh
- Division of Nursing and Midwifery, Health Sciences School, University of Sheffield, Barber House, 3 Clarkehouse Road, Sheffield, S10 2LA, United Kingdom.
| | - Liz Darlison
- University Hospitals of Leicester, Leicester, United Kingdom
| | - Anne Moylan
- Queen Alexandra Hospital, Cosham, United Kingdom
| | - Angela Tod
- Division of Nursing and Midwifery, Health Sciences School, University of Sheffield, Sheffield, United Kingdom
| | - Virginia Sherborne
- Division of Nursing and Midwifery, Health Sciences School, University of Sheffield, Sheffield, United Kingdom
| | | | - Bethany Hope Taylor
- Division of Nursing and Midwifery, Health Sciences School, University of Sheffield, Sheffield, United Kingdom
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29
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Anand SK, Macki M, Culver LG, Wasade VS, Hendren S, Schwalb JM. Patient navigation in epilepsy care. Epilepsy Behav 2020; 113:107530. [PMID: 33232897 DOI: 10.1016/j.yebeh.2020.107530] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Accepted: 09/28/2020] [Indexed: 12/20/2022]
Abstract
The concept of patient navigation was first introduced in 1989 by the American Cancer Society and was first implemented in 1990 by Dr. Harold Freeman in Harlem, NY. The role of a patient navigator (PN) is to coordinate care between the care team, the patient, and their family while also providing social support. In the last 30 years, patient navigation in oncological care has expanded internationally and has been shown to significantly improve patient care experience, especially in the United States cancer care system. Like oncology care, patients who require epilepsy care face socioeconomic and healthcare system barriers and are at significant risk of morbidity and mortality if their care needs are not met. Although shortcomings in epilepsy care are longstanding, the COVID-19 pandemic has exacerbated these issues as both patients and providers have reported significant delays in care secondary to the pandemic. Prior to the pandemic, preliminary studies had shown the potential efficacy of patient navigation in improving epilepsy care. Considering the evidence that such programs are helpful for severely disadvantaged cancer patients and in enhancing epilepsy care, we believe that professional societies should support and encourage PN programs for coordinated and comprehensive care for patients with epilepsy.
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Affiliation(s)
- Sharath Kumar Anand
- Wayne State University School of Medicine, 540 E Canfield St., Detroit, MI, USA.
| | - Mohamed Macki
- Department of Neurosurgery, Henry Ford Hospital, 2799 W Grand Blvd, Detroit, MI, USA
| | - Lauren G Culver
- Wayne State University School of Medicine, 540 E Canfield St., Detroit, MI, USA
| | - Vibhangini S Wasade
- Department of Neurology, Henry Ford Hospital, 2799 W Grand Blvd, Detroit, MI, USA; Department of Neurology, Wayne State University School of Medicine, 540 E Canfield St., Detroit, MI, USA
| | - Samantha Hendren
- Division of Colorectal Surgery, Department of Surgery, University of Michigan, 1500 E Medical Center Dr., Ann Arbor, MI, USA
| | - Jason M Schwalb
- Department of Neurosurgery, Henry Ford Hospital, 2799 W Grand Blvd, Detroit, MI, USA; Center for Health Policy and Health Services Research, Henry Ford Health System, 2799 W Grand Blvd, Detroit MI 48202, USA
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30
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Sjövall A, Söderqvist L, Martling A, Buchli C. Improvement of the experience of colorectal cancer patients in Sweden with a regional cancer plan. Colorectal Dis 2020; 22:1965-1973. [PMID: 32737954 PMCID: PMC7818195 DOI: 10.1111/codi.15289] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Accepted: 05/30/2020] [Indexed: 02/08/2023]
Abstract
AIM The Stockholm-Gotland Regional Cancer Plan was launched in 2012 to improve cancer care. A personal contact nurse (CN), an individual written care plan (IWCP) and a standardized care pathway (SCP) were introduced. The aim of the current study was to evaluate whether these efforts have resulted in an improved experience for patients treated for colorectal cancer. METHOD Patients treated with bowel resection for colorectal cancer in the Stockholm-Gotland region between 1 January 2013 and 31 December 2017 were identified through the Swedish Colorectal Cancer Registry. Six to eight months postoperatively, the patients received a patient-reported experience questionnaire. Patients were classified as 'satisfied' or 'not satisfied'. RESULTS The questionnaire was sent to 4465 patients, and 3154 (70.64%) responded. The proportion of patients assigned a CN increased over time (79.84%-88.44%) and so did the proportion of patients receiving an IWCP (39.36%-70.00%). The waiting times were significantly shortened during the study period. In multivariable analysis, access to a CN and an IWCP was independently associated with increased patient satisfaction (OR 3.03, 95% CI 2.28-4.02 and OR 1.64, 95% CI 1.38-1.94). Patients with a long waiting time were significantly less satisfied than patients with a short waiting time (OR 0.72, 95% CI 0.60-0.88). CONCLUSION Implementation of a CN, IWCP and SCP has been successful, measured by a higher proportion of patients gaining access to these assets and shortened waiting times. This has led to an improved patient experience in patients treated for colorectal cancer in the Stockholm-Gotland region.
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Affiliation(s)
- A. Sjövall
- Division of ColoproctologyDepartment of Pelvic CancerKarolinska University HospitalStockholmSweden,Department of Molecular Medicine and SurgeryKarolinska InstitutetStockholmSweden,Regional Cancer Centre Stockholm‐GotlandStockholmSweden
| | | | - A. Martling
- Department of Molecular Medicine and SurgeryKarolinska InstitutetStockholmSweden
| | - C. Buchli
- Division of ColoproctologyDepartment of Pelvic CancerKarolinska University HospitalStockholmSweden,Department of Molecular Medicine and SurgeryKarolinska InstitutetStockholmSweden
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Yin YN, Wang Y, Jiang NJ, Long DR. Can case management improve cancer patients quality of life?: A systematic review following PRISMA. Medicine (Baltimore) 2020; 99:e22448. [PMID: 33019431 PMCID: PMC7535784 DOI: 10.1097/md.0000000000022448] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Cancer patients are associated with a series of long lasting and stressful treatments and experiencing, and case management (CM) has been widely used and developed with the aim to increase the quality of treatments and improve the patient care services. The purpose of this review is to identify and synthesize the evidence of randomized controlled trial studies to prove that case management could be one way to address the quality of life of cancer patients. METHODS We performed a literature search in 4 electronic bibliographic databases and snowball searches were performed to ensure a complete collection. Two review authors independently extracted and analyzed data. A data extraction form was used to collect the characteristics of case management intervention, report outcomes, and quality assessment. RESULTS Our searches identified 3080 articles, of which 7 randomized controlled trials met the inclusion criteria. The intervention was varied from the target population, measurement tools, duration of intervention, and so on, and 5 studies consistently showed improvement in the intervention group compared with control groups, no significant difference was found between health care costs of case management care services and the routine care services. CONCLUSION There is some evidence that case management can be effective in cancer patients quality of life. However, due to the heterogeneity in the target population, measurement tools, and results applied, no conclusion can be made from a meta-analysis on the present bias. More rigorously multi-centered randomized controlled studies should be provided with detailed information about intervention in future research.
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Affiliation(s)
- Ya-nan Yin
- Department of Gynecology and Obstetrics Nursing, West China Second University Hospital, Sichuan University
- Key Laboratory of Birth Defects and Related Diseases of Women and Children Sichuan University, Ministry of Education
- West China Nursing School, Sichuan University, Chengdu, Sichuan, China
| | - Yun Wang
- Department of Gynecology and Obstetrics Nursing, West China Second University Hospital, Sichuan University
- Key Laboratory of Birth Defects and Related Diseases of Women and Children Sichuan University, Ministry of Education
- West China Nursing School, Sichuan University, Chengdu, Sichuan, China
| | - Ni-jie Jiang
- Department of Gynecology and Obstetrics Nursing, West China Second University Hospital, Sichuan University
- Key Laboratory of Birth Defects and Related Diseases of Women and Children Sichuan University, Ministry of Education
- West China Nursing School, Sichuan University, Chengdu, Sichuan, China
| | - De-rong Long
- Department of Gynecology and Obstetrics Nursing, West China Second University Hospital, Sichuan University
- Key Laboratory of Birth Defects and Related Diseases of Women and Children Sichuan University, Ministry of Education
- West China Nursing School, Sichuan University, Chengdu, Sichuan, China
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Buote R, Cameron E, Collins R, McGowan E. Understanding Men's Experiences With Prostate Cancer Stigma: A Qualitative Study. Oncol Nurs Forum 2020; 47:577-585. [PMID: 32830795 DOI: 10.1188/20.onf.577-585] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE The purpose of this study was to explore the experiences and perspectives of men who have had prostate cancer to better understand the effect of prostate cancer and associated stigmas on men in the Canadian province Newfoundland and Labrador (NL). PARTICIPANTS & SETTING Eleven men from NL who have had prostate cancer participated in semistructured interviews exploring their perspectives and experiences of prostate cancer and stigma. METHODOLOGIC APPROACH A social-ecological framework was used to understand experiences from different domains. Interviews were analyzed using Lichtman's three Cs approach. Analysis focused on establishing themes of the participants' lived experience of prostate cancer and related stigma. FINDINGS Participants described how emasculating a prostate cancer diagnosis can feel. They identified ways prostate cancer negatively affected their behaviors and sense of self, described coping with the diagnosis and different strategies, and talked about broader system change required to address prostate cancer stigma. Participants expressed a need for additional support from healthcare providers (HCPs). IMPLICATIONS FOR NURSING HCPs, such as oncology nurses, may be able to reduce stigmatization by providing patient navigation, improving information delivery, or providing psychosocial counseling to individuals experiencing feelings of internal or external stigmatization related to prostate cancer.
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Berezowska A, Passchier E, Bleiker E. Professional patient navigation in a hospital setting: a randomized controlled trial. Support Care Cancer 2020; 29:2111-2123. [PMID: 32864723 DOI: 10.1007/s00520-020-05721-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2020] [Accepted: 08/26/2020] [Indexed: 11/24/2022]
Abstract
PURPOSE This study aimed to determine the effect of patient navigation on health-related quality of life, distress, self-care knowledge, self-efficacy, satisfaction, and healthcare usage. METHODS Patients newly diagnosed with ovarian, vulvar, endometrial, melanoma stage III/IV, lung, or renal cancer were randomly assigned to either care as usual or care as usual plus consultations with a patient navigator (i.e., specially trained oncology nurse who monitors, advises, and refers patients to supportive cancer care). Measures included the EORTC-QLQ-C30, distress thermometer, and study-specific questions inspired by the Symptom-Management Self-Efficacy Scale Breast Cancer, Patient Satisfaction with Cancer Care Scale, and the Medical Consumption Questionnaire. Measures were completed before randomization (baseline) and at 1 month, 3 months, and 5 months after baseline. RESULTS In the case of health-related quality of life, no significant difference was observed between the intervention (n = 42) and the control group (n = 47). Consumption of supportive cancer care was low for both the intervention and the control group but relatively lower for the intervention group. Also, participants who consulted the patient navigator seemed to have higher levels of self-efficacy and satisfaction. CONCLUSION Although the intervention sorted no relevant effects on health-related quality of life, it did affect patients' experience of cancer care and self-efficacy. We recommend that patient navigators monitor and advise on unmet supportive care needs, but only in the case of high-risk patients. Furthermore, considering current and prior research, it is wise to study patient navigation using more sensitive outcome measures than health-related quality of life.
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Affiliation(s)
- Aleksandra Berezowska
- Center for Quality of Life, Netherlands Cancer Institute, Mailbox 90203, 1006 BE, Amsterdam, Netherlands.,Division of Psychosocial Research and Epidemiology, Netherlands Cancer Institute, Mailbox 90203, 1006 BE, Amsterdam, Netherlands
| | - Ellen Passchier
- Center for Quality of Life, Netherlands Cancer Institute, Mailbox 90203, 1006 BE, Amsterdam, Netherlands
| | - Eveline Bleiker
- Division of Psychosocial Research and Epidemiology, Netherlands Cancer Institute, Mailbox 90203, 1006 BE, Amsterdam, Netherlands.
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Bernhard JC, Robert G, Ricard S, Michiels C, Capon G, Boulenger de Hautecloque A, Bensadoun H, Gay J, Rogier J, Tauzin-Fin P, Gross-Goupil M, Benard A, Nouette K, Roullet S, Ferrière JM. Day-case robotic-assisted partial nephrectomy: feasibility and preliminary results of a prospective evaluation (UroCCR-25 AMBU-REIN study). World J Urol 2020; 40:1351-1357. [PMID: 32514670 DOI: 10.1007/s00345-020-03283-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Accepted: 05/26/2020] [Indexed: 12/13/2022] Open
Abstract
PURPOSE Robotic partial nephrectomy (RPN) is a minimally-invasive technique used to treat renal tumors. A clinical pathway and prospective research protocol (AMBU-REIN) were specifically set up to establish and assess the routine use of day-case RPN. METHODS The AMBU-REIN study was conducted in the framework of the French research network on kidney cancer UroCCR (NCT03293563). We present our initial experience of patients treated using day-case RPN and released from our hospital on the same day, focusing on patient selection, safety and patient satisfaction using the EVAN-G validated questionnaire. RESULTS Between September 2016 and September 2019, 429 RPN were performed and 82 patients were consecutively selected for day-case RPN. Patients were managed using transperitoneal RPN with off-clamp tumorectomy for 66/82 cases. Mean tumor size was 2.7 ± 1.2 cm. There were no immediate severe postoperative complications; 7/82 patients were kept under observation overnight and discharged the following day. The follow-up at day 30 indicated postoperative complications, readmissions, and mortality rates of 1.2, 1.2, and 0%, respectively. Next-day patient satisfaction questionnaires indicated that patients were generally highly satisfied, with a mean ± standard deviation global score of 83.6 ± 10.3%. "Attention" was rated the highest overall (mean 94.8 ± 10.5%), while "pain management" scored the lowest (61.2 ± 20.5%). CONCLUSIONS This prospective case series is the first to demonstrate the safety and feasibility of day-case RPN. For selected patients and through a dedicated, nurse-led clinical pathway, it provided a high level of patient satisfaction. Expected benefits on healthcare cost savings warrant further investigation.
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Affiliation(s)
- Jean-Christophe Bernhard
- Department of Urology, University Hospital of Bordeaux, CHU Bordeaux, Place Amélie Raba Léon, 33076, Bordeaux Cedex, France.
- French Research Network on Kidney Cancer UroCCR, Bordeaux, France.
| | - Grégoire Robert
- Department of Urology, University Hospital of Bordeaux, CHU Bordeaux, Place Amélie Raba Léon, 33076, Bordeaux Cedex, France
| | - Solène Ricard
- Department of Urology, University Hospital of Bordeaux, CHU Bordeaux, Place Amélie Raba Léon, 33076, Bordeaux Cedex, France
- French Research Network on Kidney Cancer UroCCR, Bordeaux, France
| | - Clément Michiels
- Department of Urology, University Hospital of Bordeaux, CHU Bordeaux, Place Amélie Raba Léon, 33076, Bordeaux Cedex, France
| | - Grégoire Capon
- Department of Urology, University Hospital of Bordeaux, CHU Bordeaux, Place Amélie Raba Léon, 33076, Bordeaux Cedex, France
| | | | - Henri Bensadoun
- Department of Urology, University Hospital of Bordeaux, CHU Bordeaux, Place Amélie Raba Léon, 33076, Bordeaux Cedex, France
| | - Joséphine Gay
- Department of Urology, University Hospital of Bordeaux, CHU Bordeaux, Place Amélie Raba Léon, 33076, Bordeaux Cedex, France
- French Research Network on Kidney Cancer UroCCR, Bordeaux, France
| | - Julien Rogier
- Department of Anesthesiology, University Hospital of Bordeaux, Bordeaux, France
| | - Patrick Tauzin-Fin
- Department of Anesthesiology, University Hospital of Bordeaux, Bordeaux, France
| | - Marine Gross-Goupil
- Department of Medical Oncology, University Hospital of Bordeaux, Bordeaux, France
| | - Antoine Benard
- Methodology Unit, Public Health Department, University Hospital of Bordeaux, Bordeaux, France
| | - Karine Nouette
- Department of Anesthesiology, University Hospital of Bordeaux, Bordeaux, France
| | - Stéphanie Roullet
- Department of Anesthesiology, University Hospital of Bordeaux, Bordeaux, France
| | - Jean-Marie Ferrière
- Department of Urology, University Hospital of Bordeaux, CHU Bordeaux, Place Amélie Raba Léon, 33076, Bordeaux Cedex, France
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Emfield Rowett K, Christensen D. Oncology Nurse Navigation: Expansion of the Navigator Role Through Telehealth. Clin J Oncol Nurs 2020; 24:24-31. [DOI: 10.1188/20.cjon.s1.24-31] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Bjerring OS, Larsen MK, Fristrup CW, Lundell L, Mortensen MB. The role of home visits by a nurse to improve palliation in patients treated with self-expandable metallic stents due to incurable esophageal cancer. Dis Esophagus 2020; 33:5628033. [PMID: 31738406 DOI: 10.1093/dote/doz076] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Self-expandable metallic stent (SEMS) is a preferred option to relieve dysphagia and to palliate patients with incurable esophageal or gastro-esophageal junction (GEJ) cancer. Health Related Quality of Life (QoL) represents a clinically relevant outcome measure in research focused on palliation of patients with advanced GI cancer. In this context, home visits by a nurse carry the potential to offer important advantages. Eighty patients with incurable esophageal or GEJ cancer were randomized to either standard follow up or to an intervention containing regular home visits by a nurse. The primary outcome variable QoL was assessed by EORTC QLQ-C30 and OES-18 before insertion of SEMS, and at 2, 7 and 12 weeks thereafter. Secondary outcomes were; need for re-interventions, number of patients receiving palliative oncological therapy and overall survival. Sixty-six males and 13 females, with a median age of 71, were included. Self-reported overall QoL was significantly higher in the intervention group (P = 0.03). The organ specific module OES-18 revealed a significant reduction in dysphagia by the intervention (P = 0.03) as well as fewer eating disabilities (P = 0.04). No differences were observed in secondary outcomes except for overall survival, where the median survival was increased from 114 to 183 days by the active intervention (P = 0.02). Home visits by a nurse seem to play an important palliative role after placement of SEMS in patients with incurable esophageal or GEJ cancer by improving QoL and may carry the potential to increase overall survival.
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Affiliation(s)
- O S Bjerring
- Upper GI & HPB Section, Department of Surgery, Odense University Hospital, Odense, Denmark
| | - M K Larsen
- Upper GI & HPB Section, Department of Surgery, Odense University Hospital, Odense, Denmark
| | - C W Fristrup
- Upper GI & HPB Section, Department of Surgery, Odense University Hospital, Odense, Denmark
| | - L Lundell
- Upper GI & HPB Section, Department of Surgery, Odense University Hospital, Odense, Denmark.,Department of Surgery, CLINTEC, Karolinska Institute, Stockholm, Sweden
| | - M B Mortensen
- Upper GI & HPB Section, Department of Surgery, Odense University Hospital, Odense, Denmark
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Nyhof BB, Wright FC, Look Hong NJ, Groot G, Helyer L, Meiers P, Quan ML, Baxter NN, Urquhart R, Warburton R, Gagliardi AR. Identifying opportunities to support patient-centred care for ductal carcinoma in situ: qualitative interviews with clinicians. BMC Cancer 2020; 20:364. [PMID: 32354355 PMCID: PMC7191683 DOI: 10.1186/s12885-020-06821-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Accepted: 04/02/2020] [Indexed: 11/29/2022] Open
Abstract
Background Women with ductal carcinoma in situ (DCIS) report poor patient-clinician communication, and long-lasting confusion and anxiety about their treatment and prognosis. Research shows that patient-centred care (PCC) improves patient experience and outcomes. Little is known about the clinician experience of delivering PCC for DCIS. This study characterized communication challenges faced by clinicians, and interventions they need to improve PCC for DCIS. Methods Purposive and snowball sampling were used to recruit Canadian clinicians by specialty, gender, years of experience, setting, and geographic location. Qualitative interviews were conducted by telephone. Data were analyzed using constant comparison. Findings were mapped to a cancer-specific, comprehensive PCC framework to identify opportunities for improvement. Results Clinicians described approaches they used to address the PCC domains of fostering a healing relationship, exchanging information, and addressing emotions, but do not appear to be addressing the domains of managing uncertainty, involving women in making decisions, or enabling self-management. However, many clinicians described challenges or variable practices for all PCC domains but fostering a healing relationship. Clinicians vary in describing DCIS as cancer based on personal beliefs. When exchanging information, most find it difficult to justify treatment while assuring women of a good prognosis, and feel frustrated when women remain confused despite their efforts to explain it. While they recognize confusion and anxiety among women, clinicians said that patient navigators, social workers, support groups and high-quality information specific to DCIS are lacking. Despite these challenges, clinicians said they did not need or want communication interventions. Conclusions Findings represent currently unmet opportunities by which to help clinicians enhance PCC for DCIS, and underscore the need for supplemental information and supportive care specific to DCIS. Future research is needed to develop and test communication interventions that improve PCC for DCIS. If effective and widely implemented, this may contribute to improved care experiences and outcomes for women diagnosed with and treated for DCIS.
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Affiliation(s)
- Bryanna B Nyhof
- Toronto General Hospital Research Institute, University Health Network, 200 Elizabeth Street, Toronto, Ontario, M5G2C4, Canada.
| | | | | | - Gary Groot
- University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | | | - Pamela Meiers
- University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | | | - Nancy N Baxter
- St Michael's Hospital Department of Surgery and Li Ka Shing Knowledge Institute, Department of Surgery and the Institute for Health Policy Management and Evaluation, Toronto, Canada.,University of Toronto, Toronto, Canada
| | | | | | - Anna R Gagliardi
- Toronto General Hospital Research Institute, University Health Network, 200 Elizabeth Street, Toronto, Ontario, M5G2C4, Canada
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Byrne A, Hegney D, Harvey C, Baldwin A, Willis E, Heard D, Judd J, Palmer J, Brown J, Heritage B, Thompson S, Ferguson B. Exploring the nurse navigator role: A thematic analysis. J Nurs Manag 2020; 28:814-821. [DOI: 10.1111/jonm.12997] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Revised: 02/26/2020] [Accepted: 03/01/2020] [Indexed: 02/07/2023]
Affiliation(s)
- Amy‐Louise Byrne
- School of Nursing Midwifery and Social Science Central Queensland University Townsville Qld Australia
| | - Desley Hegney
- Research Division Central Queensland University Brisbane Campus School of NursingBrisbane
| | - Clare Harvey
- School of Nursing Midwifery and Social Science Central Queensland University Townsville Qld Australia
| | - Adele Baldwin
- School of Nursing Midwifery and Social Science Central Queensland University Townsville Qld Australia
| | - Eileen Willis
- School of Nursing Midwifery and Social Science Central Queensland University Adelaide SA Australia
| | - David Heard
- School of Nursing Midwifery and Social Science Central Queensland University Townsville Qld Australia
| | - Jenni Judd
- School of Health Medical and Applied Sciences Central Queensland University Bundaberg Qld Australia
| | - Janine Palmer
- Hawke’s Bay District Health Board Hastings New Zealand
| | - Janie Brown
- School of Nursing, Midwifery and Paramedicine Curtin University Perth WA Australia
| | - Brody Heritage
- College of Science Health, Engineering and Education Murdoch University Perth WA Australia
| | | | - Bridget Ferguson
- School of Nursing Midwifery and Social Science Central Queensland University Townsville Qld Australia
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Deluche E, Salle H, Facchini-Joguet T, Leobon S, Troussel A, Tubiana-Mathieu N, Caire F, Fourcade L. [High fidelity simulation training for medical oncology announcement consultation]. Bull Cancer 2020; 107:417-427. [PMID: 32245605 DOI: 10.1016/j.bulcan.2020.02.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2019] [Revised: 01/11/2020] [Accepted: 02/07/2020] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Medical oncology bad news consultation is a particularly stressful situation for both the patient and the physician. High-fidelity simulation is a learning option that has never been evaluated in France in this field. MATERIALS AND METHODS This is a feedback from simulated announcement consultations carried out from January 2018 to May 2019. Residents from the medical oncology and radiotherapy departments performed high-fidelity simulations at the announcement consultation with an announcement nurse, a psychologist, a certified coach and an oncologist. A competency assessment was completed in pre-test, immediate post-test and after 5 months. RESULTS Fourteen of the 16 eligible interns participated. The pre-test competency assessment showed that interns over 5 semesters reported being more comfortable at the consultation (P=0.04) and thought they were clearly explaining the disease (P=0.03). However, all residents, regardless of the semester, felt stressed before a consultation. The evolution of parameters skills after the simulation was positive for all criteria, particularly for adaptation to patient reactions, use of appropriate vocabulary and reduction of stress (P<0.05). This evolution was independent of the gender, curriculum, semester, or previous completion of a medical oncology internship. More than 80% of the students were ready to repeat this type of training. CONCLUSION This training demonstrates the value of simulation training for medical oncology advertising consultation.
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Affiliation(s)
- Elise Deluche
- Service d'oncologie médicale, 2, avenue Martin-Luther-King, 87042 Limoges cedex, France; Faculté de médecine de Limoges, département universitaire d'enseignement numérique en santé, 2, rue du Docteur-Marcland, 87025 Limoges cedex, France.
| | - Henri Salle
- Hôpital Dupuytren, service de neurochirurgie, 2, avenue Martin-Luther-King, 87042 Limoges cedex, France; Faculté de médecine de Limoges, département universitaire d'enseignement numérique en santé, 2, rue du Docteur-Marcland, 87025 Limoges cedex, France
| | | | - Sophie Leobon
- Service d'oncologie médicale, 2, avenue Martin-Luther-King, 87042 Limoges cedex, France
| | - Alexandre Troussel
- Service d'oncologie médicale, 2, avenue Martin-Luther-King, 87042 Limoges cedex, France
| | | | - François Caire
- Hôpital Dupuytren, service de neurochirurgie, 2, avenue Martin-Luther-King, 87042 Limoges cedex, France; Faculté de médecine de Limoges, département universitaire d'enseignement numérique en santé, 2, rue du Docteur-Marcland, 87025 Limoges cedex, France
| | - Laurent Fourcade
- Hôpital des Enfants, service de chirurgie viscérale pédiatrique, 8, avenue Dominique-Larrey, 87042 Limoges cedex, France; Faculté de médecine de Limoges, département universitaire d'enseignement numérique en santé, 2, rue du Docteur-Marcland, 87025 Limoges cedex, France
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Hua A, Sesto ME, Zhang X, Wassenaar TR, Tevaarwerk AJ. Impact of Survivorship Care Plans and Planning on Breast, Colon, and Prostate Cancer Survivors in a Community Oncology Practice. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2020; 35:249-255. [PMID: 30610655 PMCID: PMC6609493 DOI: 10.1007/s13187-018-1457-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
With a growing number of cancer survivors, survivorship care plans (SCPs) are recommended to communicate information about late effects of treatment and follow-up care. Community oncology practices follow 85% of adult cancer survivors but report more difficulty in providing SCPs compared to academic centers. Our objective was to evaluate the impact of delivering SCPs in a community oncology practice by examining awareness of SCP receipt as well as how provision affects survivors' perception of care quality and of their condition. Survivors who accepted a SCP as standard of care were recruited from a community oncology practice in the Midwest and completed surveys prior to SCP provision (baseline) and 4 weeks later (follow-up). Within-survivor changes in knowledge of SCP receipt, satisfaction and perceived care coordination were assessed. Thirty cancer survivors (breast, colon, and prostate) completed the baseline survey, while 24 completed the follow-up survey (80% response rate). Participants reported receiving SCPs and treatment summaries more frequently at follow-up after receiving a SCP. At follow-up, there was a significant increase in survivor activation and involvement in care along with satisfaction of knowledge of care. Communication about and during SCP provision may need to be clearer: 34% of survivors could not correctly identify SCP receipt in this study. This may place these survivors at a disadvantage, if this leads to less awareness of important information regarding follow-up surveillance and management. Of those aware of SCP receipt, SCP provision had positive impacts in this small, short-term study.
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Affiliation(s)
- Alexandra Hua
- University of Wisconsin, School of Medicine & Public Health, Madison, USA
| | - Mary E Sesto
- University of Wisconsin, School of Medicine & Public Health, Madison, USA
- Carbone Cancer Center, Madison, WI, USA
| | | | | | - Amye J Tevaarwerk
- University of Wisconsin, School of Medicine & Public Health, Madison, USA.
- Carbone Cancer Center, Madison, WI, USA.
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Loiselle CG, Attieh S, Cook E, Tardif L, Allard M, Rousseau C, Thomas D, Saha-Chaudhuri P, Talbot D. L'infirmière pivot associée à une expérience de soins oncologiques positive et à une satisfaction accrue des patients. Can Oncol Nurs J 2020; 30:54-60. [PMID: 33118969 DOI: 10.5737/236880763015460] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Contexte et objectifs Un nombre croissant de résultats probants indique que l'infirmière pivot en oncologie (IPO) joue un rôle de premier plan dans l'optimisation des processus et des résultats de soins. Il faudra toutefois mener des études d'envergure pour comparer les perceptions de l'expérience de soins liés au cancer des patients traités par des infirmières pivots et de ceux qui n'ont pas bénéficié de ce type de suivi. Méthodologie Des participants (N = 2 858) traités au cours des six derniers mois dans un centre de traitement du cancer situé à Montréal, au Québec, et affilié à une université ont répondu au sondage sur la satisfaction des patients en traitement anticancéreux ambulatoire, c'est-à-dire le Ambulatory Oncology Patient Satisfaction Survey (AOPSS). Résultats L'expérience des soins oncologiques était significativement plus positives et la satisfaction plus élevée dans le groupe suivi par une infirmière pivot (n = 2 003) pour les six domaines de soins (différences moyennes de 3,32 à 8,95) et les quatre fonctions infirmières (différences moyennes de 5,64 à 10,39), comparativement au groupe sans IPO (n = 855). Discussion L'infirmière pivot joue un rôle important dans l'amélioration de l'expérience de soins et la satisfaction des patients. Les recherches futures devront explorer les potentielles relations de cause à effet entre les infirmières pivots, les processus de soins et les résultats des patients.
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Affiliation(s)
- Carmen G Loiselle
- (aut. et chercheuse principale), Université McGill, Département d'oncologie, École de sciences infirmières Ingram, Montréal (Québec) ; Centre du cancer Segal, Hôpital général juif (Québec), Canada
| | - Samar Attieh
- (aut. principale), Université McGill, Département de médecine, Division de médecine expérimentale, Montréal (Québec), Canada
| | - Erin Cook
- Centre du cancer Segal, Hôpital général juif, Montréal (Québec), Canada
| | - Lucie Tardif
- Centre universitaire de santé McGill, Centre du cancer des Cèdres, Montréal (Québec), Canada
| | - Manon Allard
- Centre intégré universitaire de santé et de service sociaux de l'Ouest-de-l'île-de-Montréal (Québec), Canada ; Centre hospitalier de St. Mary, Montréal (Québec), Canada
| | | | - Doneal Thomas
- Réseau de cancérologie Rossy, Montréal (Québec), Canada
| | - Paramita Saha-Chaudhuri
- Université McGill, Département d'épidémiologie, de biostatistique et de santé au travail, Montréal (Québec) Canada
| | - Denis Talbot
- Université Laval, Département de médecine sociale et préventive, Québec (Québec), Canada
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Loiselle CG, Attieh S, Cook E, Tardif L, Allard M, Rousseau C, Thomas D, Saha-Chaudhuri P, Talbot D. The nurse pivot-navigator associated with more positive cancer care experiences and higher patient satisfaction. Can Oncol Nurs J 2020; 30:48-53. [PMID: 33118978 DOI: 10.5737/236880763014853] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Background and objectives Growing evidence indicates that the nurse navigator-pivot (NN), is key to optimizing care processes and outcomes. However, large scale studies are needed to examine how patients exposed to NNs (as opposed to non-NN) differentially perceived their cancer care experiences. Method Participants (N = 2,858) treated for cancer in the last six months at university-affiliated cancer centres in Montréal, Québec, completed the Ambulatory Oncology Patient Satisfaction Survey (AOPSS). Results Cancer care experiences and satisfaction were significantly higher in the NN group (n = 2,003) for all six care domains (Ds from 3.32 to 8.95) and all four nursing functions (Ds from 5.64 to 10.39) when compared to the non-NN group (n = 855). Discussion The NN role is significantly related to enhanced cancer care experiences and higher patient satisfaction. Future research should explore potential causal effects between NNs and care processes, as well as patient outcomes.
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Affiliation(s)
- Carmen G Loiselle
- (Senior and corresponding author), McGill University, Department of Oncology and Ingram School of Nursing, Montreal, QC; Segal Cancer Centre, Jewish General Hospital, Montreal, QC
| | - Samar Attieh
- (Senior author), McGill University, Department of Medicine, Division of Experimental Medicine, Montreal, QC
| | - Erin Cook
- Segal Cancer Centre, Jewish General Hospital, Montreal, QC
| | - Lucie Tardif
- McGill University Health Centre, Cedars Cancer Centre, Montreal, QC
| | - Manon Allard
- Centre intégré universitaire de santé et de service sociaux de l'Ouest-de-l'île-de-Montréal, QC ; Centre hospitalier de St. Mary, Montreal, QC
| | | | | | - Paramita Saha-Chaudhuri
- McGill University, Department of Epidemiology, Biostatistics & Occupational Health, Montreal QC
| | - Denis Talbot
- Laval University, Department of Social and Preventive Medicine, Quebec City, QC
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Roberts TJ, Lennes IT, Hawari S, Sequist LV, Park ER, Willers H, Frank A, Gaissert H, Shepard JA, Ryan D. Integrated, Multidisciplinary Management of Pulmonary Nodules Can Streamline Care and Improve Adherence to Recommendations. Oncologist 2019; 25:431-437. [PMID: 31876321 DOI: 10.1634/theoncologist.2019-0519] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Accepted: 11/13/2019] [Indexed: 01/03/2023] Open
Abstract
Every year millions of pulmonary nodules are discovered incidentally and through lung cancer screening programs. Management of these nodules is often suboptimal, with low follow-up rates and poor provider understanding of management approaches. There is an emerging body of literature about how to optimize management of pulmonary nodules. The Pulmonary Nodule and Lung Cancer Screening Clinic (PNLCSC) at Massachusetts General Hospital was founded in 2012 to manage pulmonary nodules via a multidisciplinary approach with optimized support staff. Recommendations from clinic providers and treatment details were recorded for all patients seen at the PNLCSC. Adherence to recommendations and outcomes were also tracked and reviewed. From October 2012 to September 2019, 1,136 patients were seen at the PNLCSC, each for a mean of 1.8 appointments (range, 1-10). A total of 356 procedures were recommended by the clinic and 271 patients were referred for surgery and/or radiation. The majority of interventions (74%) were recommended at the initial PNLCSC appointment. In total, 211 patients (19%) evaluated at the PNLCSC had pathologically confirmed pulmonary malignancies or were treated empirically with radiation. Among patients followed by the clinic, the adherence rate to clinic recommendations was 95%. This study shows how a multidisciplinary approach to pulmonary nodule management can streamline care and optimize follow-up. The PNLCSC provides a template that can be replicated in other health systems. It also provides an example of how multidisciplinary approaches can be applied to other complex conditions. IMPLICATIONS FOR PRACTICE: This work demonstrates how an integrated, multidisciplinary approach to management of pulmonary nodules can streamline patient care and improve adherence to provider recommendations. This approach has the potential to improve patient outcomes and reduce health care costs.
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Affiliation(s)
- Thomas J Roberts
- Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Inga T Lennes
- Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
- Department of Hematology/Oncology, Massachusetts General Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
- Massachusetts General Hospital Cancer Center, Boston, Massachusetts, USA
| | - Saif Hawari
- Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Lecia V Sequist
- Department of Hematology/Oncology, Massachusetts General Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
- Massachusetts General Hospital Cancer Center, Boston, Massachusetts, USA
| | - Elyse R Park
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, USA
- Health Policy Research Center, Massachusetts General Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Henning Willers
- Thoracic Radiation Oncology Program, Massachusetts General Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Angela Frank
- Department of Pulmonary & Critical Care Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Henning Gaissert
- Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Jo-Anne Shepard
- Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - David Ryan
- Department of Hematology/Oncology, Massachusetts General Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
- Massachusetts General Hospital Cancer Center, Boston, Massachusetts, USA
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Cantril C, Moore E, Yan X. Diagnosis Disclosure: Patient Preferences and the Role of the Breast Nurse Navigator. Clin J Oncol Nurs 2019; 23:619-626. [PMID: 31730594 DOI: 10.1188/19.cjon.619-626] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Receiving a breast cancer diagnosis can be traumatic and anxiety-producing. The way the diagnosis is disclosed to patients can affect their experience. OBJECTIVES The aim of this article is to determine patient preferences for being informed of a breast cancer diagnosis and the breast nurse navigator (BNN) role during the diagnostic experience. METHODS A survey was mailed to 517 patients with breast cancer. Summary statistics were performed on 199 completed surveys. FINDINGS Patients preferred to hear their diagnosis in person. BNNs were more likely to provide the right amount of support and resources compared to other providers. Patients described the following preferences.
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Frick J, Schindel D, Gebert P, Grittner U, Schenk L. Improving quality of life in cancer patients through higher participation and health literacy: study protocol for evaluating the oncological social care project (OSCAR). BMC Health Serv Res 2019; 19:754. [PMID: 31655598 PMCID: PMC6815389 DOI: 10.1186/s12913-019-4585-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Accepted: 10/09/2019] [Indexed: 11/14/2022] Open
Abstract
Background Cancer patients experience psychological and social distress due to their medical treatment and social issues. However, continuous and specialized social support is still lacking. In Germany, a group of company health insurance funds has developed an approach to support cancer patients with monthly structured interviews conducted by specially trained Social Care Nurses. The nurses will identify patient needs in order to provide help with medical, personal, and social matters. One aim of the scientific evaluation is to analyze the effect of the consultations on various patient-reported outcomes, especially quality of life. The evaluation concept will be described in this study protocol. Methods/design The evaluation is a non-randomized, controlled, multi-center intervention study with a mixed-method design. It consists of three research modules which include primary data from questionnaires, and claims data from the health insurance funds. In Module 1, cancer patients will be recruited to form an intervention group (OSCAR, n = 150) and a control group (n = 200) in four study centers for a period of 1 year. One baseline and three follow-up questionnaires will be conducted to survey the patient-reported outcomes. Relevant secondary outcomes are health literacy, participation, and physician-patient communication. In Module 2, claims data will be used to analyze cost effects and thereby assess effectivity and hospitalization. Module 3 will involve a qualitative analysis of project diaries kept by the Social Care Nurses. The diaries will record the nurses’ practical experiences and the benefits of deploying OSCAR across the German healthcare system. Discussion OSCAR is an innovative way of providing cancer patients with continuous support to improve their quality of life. The evaluation concept aims to assess the effects of the monthly consultations by the Social Care Nurses on the patients, and will use a mixed-method design. The results are important for assessing the transferability of OSCAR to the healthcare system as a whole. Trial registration German Clinical Trials Register (DRKS-ID: DRKS00013640). Registered 29 December 2017.
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Affiliation(s)
- Johann Frick
- Institute of Medical Sociology and Rehabilitation Science, Charité - Universitätsmedizin Berlin, Campus Charité Mitte, Charitéplatz 1, 10117, Berlin, Germany.
| | - Daniel Schindel
- Institute of Medical Sociology and Rehabilitation Science, Charité - Universitätsmedizin Berlin, Campus Charité Mitte, Charitéplatz 1, 10117, Berlin, Germany
| | - Pimrapat Gebert
- Institute of Medical Sociology and Rehabilitation Science, Charité - Universitätsmedizin Berlin, Campus Charité Mitte, Charitéplatz 1, 10117, Berlin, Germany.,Institute of Biometry and Clinical Epidemiology, Charité - Universitätsmedizin Berlin, Campus Charité Mitte, Charitéplatz 1, 10117, Berlin, Germany.,Berlin Institute of Health (BIH), Anna-Louisa-Karsch-Str. 2, 10178, Berlin, Germany
| | - Ulrike Grittner
- Institute of Biometry and Clinical Epidemiology, Charité - Universitätsmedizin Berlin, Campus Charité Mitte, Charitéplatz 1, 10117, Berlin, Germany.,Berlin Institute of Health (BIH), Anna-Louisa-Karsch-Str. 2, 10178, Berlin, Germany
| | - Liane Schenk
- Institute of Medical Sociology and Rehabilitation Science, Charité - Universitätsmedizin Berlin, Campus Charité Mitte, Charitéplatz 1, 10117, Berlin, Germany
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Warnock C, Lord K, Taylor B, Tod A. Patient experiences of participation in a radical thoracic surgical trial: findings from the Mesothelioma and Radical Surgery Trial 2 (MARS 2). Trials 2019; 20:598. [PMID: 31627746 PMCID: PMC6798336 DOI: 10.1186/s13063-019-3692-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Accepted: 08/30/2019] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND The Mesothelioma and Radical Surgery Trial (MARS 2) aims to evaluate a surgical procedure by comparing chemotherapy and surgery against chemotherapy alone. The pilot study for MARS 2 evaluated the viability of recruitment. Challenges have been reported in conducting clinical research into thoracic surgical treatments and evidence is required to improve our understanding of patient experiences of trial procedures, trial treatments and the factors that influence participation. METHODS This longitudinal qualitative study was nested within the MARS 2 pilot. Semi-structured telephone interviews were conducted with 15 participants in the MARS 2 trial. Interviews were conducted post-randomisation, post-surgery (surgery arm) and at 6 and 12 months. Altogether, 41 interviews were carried out. The data were analysed using framework techniques. RESULTS Challenges were identified regarding the volume and complexity of information given to participants, and their understanding of clinical equipoise and randomisation. Factors influencing participation included having an opportunity to undergo surgery, a self-assessment of their ability to cope with trial treatments, maintaining a positive approach and altruism. Obstacles included the logistics of traveling for treatment in an unfamiliar setting. Negative consequences of trial participation included increased uncertainty amplified by multiple care providers and unclear transition arrangements after the trial. CONCLUSIONS Participants' descriptions provided insights that have implications for care for mesothelioma trial patients. The need for healthcare staff to be alert to the potential for misunderstanding, particularly when presenting treatment options, was identified. Patients perceived and derived benefits from taking part in the trial but experienced some negative consequences. These should be anticipated and managed proactively. TRIAL REGISTRATION ClinicalTrials.gov, NCT02040272 . Registered on 20 January 2014.
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Affiliation(s)
- Clare Warnock
- Specialist Cancer Services, Weston Park Hospital, Sheffield Teaching Hospital NHS Foundation Trust, Whitham Road, Sheffield, S10 2SJ England
| | - Karen Lord
- Glenfield Hospital, Mesothelioma UK/University Hospitals of Leicester NHS Trust, Groby Rd, Leicester, LE3 9QP England
| | - Bethany Taylor
- School of Nursing and Midwifery, The University of Sheffield, Barber House Annex, 3a Clarkehouse Rd, Sheffield, S10 2LA England
| | - Angela Tod
- School of Nursing and Midwifery, The University of Sheffield, Barber House Annex, 3a Clarkehouse Rd, Sheffield, S10 2LA England
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[HeiMeKOM (Heidelberg Milestones Communication): development of an interprofessional intervention for improvement of communication in patients with limited prognosis]. ZEITSCHRIFT FUR EVIDENZ FORTBILDUNG UND QUALITAET IM GESUNDHEITSWESEN 2019; 147-148:28-33. [PMID: 31350189 DOI: 10.1016/j.zefq.2019.06.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Revised: 06/25/2019] [Accepted: 06/25/2019] [Indexed: 11/23/2022]
Abstract
BACKGROUND The care for patients with advanced disease and limited prognosis and their relatives is complex and characterized by insufficient communication and lack of coordination and continuity. AIM Development of an interprofessional, practice-guided concept of longitudinally structured communication with the goal of fostering communication, improving quality of life and facilitating early integration of palliative care. METHODS Multi-level process starting from a draft with discussion and approval within the multiprofessional team and correlation with interviews with patients and relatives. Preparation of a comprehensive concept with review of the literature, problem analysis, theoretical foundation, goal setting and intervention components. Discussion of suitability for daily use, adaptation and further development of the concept. RESULTS AND CONCLUSIONS Concept with the following components: interprofessional communication training, structured conversations at defined moments in a tandem of physician and nurse with patient and relative, follow-up conversations conducted by the nurse, and respective instruments (conversation protocol, question prompt list, memory cards). Only iterative discussion with and the approval of patients, relatives and the multiprofessional team and their approval will put the concept into practice.
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Clarke AL, Roscoe J, Appleton R, Parashar D, Muthuswamy R, Khan O, Dale J, Nanton V. Promoting integrated care in prostate cancer through online prostate cancer-specific holistic needs assessment: a feasibility study in primary care. Support Care Cancer 2019; 28:1817-1827. [PMID: 31338642 PMCID: PMC7036062 DOI: 10.1007/s00520-019-04967-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Accepted: 06/26/2019] [Indexed: 12/04/2022]
Abstract
Purpose This study assessed the feasibility of implementing a novel model of integrated prostate cancer care involving an online prostate cancer-specific holistic needs assessment (sHNA) and shared digital communication between patients and their healthcare professionals (HCPs). The sHNA produces a semi-automated care plan that is finalised in consultation between the patient and their practice nurse. Methods Men living with and beyond prostate cancer were invited to participate in a 9-month non-randomised cluster controlled feasibility study. The intervention group was asked to complete the sHNA on three occasions. Data were collected using Patient Reported Outcome Measures (PROMs) at baseline, 10 and 24 weeks, and 9 months. Outcomes included recruitment, retention, acceptability, and engagement with the sHNA and PROMs. Results Fourteen general practices (8 intervention and 6 control), and 41 men (29 intervention and 12 control) participated. Initial patient engagement with the sHNA was high, with all but one receiving practice nurse-led follow-up and an individualised care plan. The sHNA proved useful in identifying ‘red flag’ symptoms, and helping practice nurses decide when to seek further medical care for the patients. There was a high level of acceptability for patients and HCPs. However, integration of care did not occur as intended because of problems linking hospital and general practice IT systems. Conclusion While the study demonstrated the feasibility of implementing the sHNA, it did not meet the a priori progression criteria; as such, undertaking a definitive randomised controlled trial is not appropriate until the identified methodological and technical issues have been addressed.
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Affiliation(s)
| | | | | | - Deepak Parashar
- Statistics and Epidemiology Unit, Warwick Medical School, University of Warwick, Coventry, UK.,The Alan Turing Institute, London, UK.,Warwick Cancer Research Centre, University of Warwick, Coventry, UK
| | - Radha Muthuswamy
- Prostate Cancer UK Information Technology Consultant, London, UK
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McNaughton CH, Horst M, Gehron E, Sivendran S, Nguyen J, Holliday R, Newport K. Patterns of Support Service, Emergency Department, and Hospital Utilization in Patients with Advanced Cancer: A Descriptive Study. J Palliat Care 2019; 35:34-39. [DOI: 10.1177/0825859719851492] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Context: Palliative care in oncology provides multiple benefits, however access to specialty palliative clinicians is limited in community cancer centers. Individual support services are more often available, but little is known on the utilization and impact of these services. Objectives: To describe the utilization of outpatient support services in the advanced cancer population and the association with ED and hospital use in a community setting. Methods: A retrospective chart review of 314 patients with advanced cancer of lung, gastrointestinal, genitourinary, and gynecologic origin was conducted. Data collected included demographics, descriptive data, type and number of support services (symptom management, nurse navigator, social worker, nutrition, financial counselor, chaplain, and oncology clinical counselor) within 90 days of diagnosis and descriptions of ED visits/hospitalizations within 12 months of diagnosis. Support services were available to patients by referral. Results: 29.6% of patients were deceased within 6 months and were considered to have severe disease. Patients with severe disease had a significantly greater mean number of support services than patients with non-severe disease (8.9 vs 6.0, p=0.001) and had a greater mean number of visits per year to the ED (6.4 vs 1.8, p<0.001). A greater proportion of patients with severe disease had palliative consultations (48.9% vs 21.7%, p<0.001), but 65.5% of palliative consultations occurred after an ED or hospital visit. Conclusion: Our data demonstrated that advanced cancer patients with severe disease had increased healthcare utilization in all areas measured. Despite high utilization, outpatient support services used in a reactive manner were not effective in reducing ED or hospital visits.
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Affiliation(s)
- Caitlyn H. McNaughton
- Penn Medicine at Lancaster General Health, Ann B Barshinger Cancer Institute, Lancaster, PA, USA
| | - Michael Horst
- Penn Medicine at Lancaster General Health, Ann B Barshinger Cancer Institute, Lancaster, PA, USA
| | - Emily Gehron
- Penn Medicine at Lancaster General Health, Ann B Barshinger Cancer Institute, Lancaster, PA, USA
| | - Shanthi Sivendran
- Penn Medicine at Lancaster General Health, Ann B Barshinger Cancer Institute, Lancaster, PA, USA
| | - Julie Nguyen
- Penn Medicine at Lancaster General Health, Ann B Barshinger Cancer Institute, Lancaster, PA, USA
| | - Rachel Holliday
- Penn Medicine at Lancaster General Health, Ann B Barshinger Cancer Institute, Lancaster, PA, USA
| | - Kristina Newport
- Pennsylvania State University College of Medicine, Section of Palliative Care, Hershey, PA, USA
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Reiser V, Rosenzweig M, Welsh A, Ren D, Usher B. The Support, Education, and Advocacy (SEA) Program of Care for Women With Metastatic Breast Cancer: A Nurse-Led Palliative Care Demonstration Program. Am J Hosp Palliat Care 2019; 36:864-870. [PMID: 30974954 DOI: 10.1177/1049909119839696] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Women with metastatic breast cancer (MBC) experience unique symptom management and psychosocial needs due to aggressive, yet palliative treatment with a progressive, chronic illness. OBJECTIVE This article describes the effect of a quality improvement project for coordination of supportive care in MBC. Program evaluations included referral rates for supportive services, patient-reported outcomes of symptom distress, generalized anxiety, and overall well-being. DESIGN An interdisciplinary Support, Education and Advocacy Program (MBC-SEA) was developed. The 1-hour, weekly, patient review included collaborative assessments to determine needs for social service, psychological counseling, and palliative care. A prospective pre- and postexperimental cohort design with convenience sampling was used. Analysis was conducted with paired t test analysis of pre- and postimplementation outcomes. SETTING/PARTICIPANTS Program outcomes of 118 women with MBC visiting an urban outpatient breast cancer clinic during September 2016 to November 2016 (pre) and January 2017 to March 2017 (post) were evaluated. MEASUREMENTS Referral rates to social work and palliative care, symptom, anxiety, and overall well-being scores. RESULTS Following program implementation, referrals to palliative care and social work supportive services increased significantly including patient-reported outcomes symptom distress scores mean difference 1.4 (95% confidence interval [CI]: 0.4306-2.6428), P = .004; generalized anxiety scores mean difference 1.5 (95% CI: 0.5406-2.5781), P = .003; and overall well-being mean difference of -0.7 (95% CI: -1.3498 to -0.0570), P = .03. CONCLUSIONS Purposeful nurse-led assessment for social service and palliative care needs increases referrals with improvement in patient-reported outcomes.
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Affiliation(s)
- Victoria Reiser
- 1 University of Pittsburgh School of Nursing, Pittsburgh, PA, USA
| | | | - Ann Welsh
- 2 Magee Women's Hospital of UPMC, University of Pittsburgh School of Nursing, Pittsburgh, PA, USA
| | - Dianxu Ren
- 3 Department of Health and Community Systems, University of Pittsburgh School of Nursing, Pittsburgh, PA, USA
| | - Barbara Usher
- 3 Department of Health and Community Systems, University of Pittsburgh School of Nursing, Pittsburgh, PA, USA
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