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Loy MH, Prisco L, Parikh C. Implementation of Virtual Integrative Oncology Shared Medical Appointment Series (VIOSMAS) Within Mixed Diagnosis Population. Integr Cancer Ther 2024; 23:15347354231223969. [PMID: 38243739 PMCID: PMC10799580 DOI: 10.1177/15347354231223969] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2023] [Revised: 11/09/2023] [Accepted: 12/15/2023] [Indexed: 01/21/2024] Open
Abstract
BACKGROUND Integrative oncology [IO] is sought-after by patients, endorsed by clinical guidelines, and valued within National Cancer Institute Centers. Shared Medical Appointments [SMA] leverage health education and social connection to deliver enhanced patient experience, population health, cost-reduction, and clinician well-being. Integrative Oncology Shared Medical Appointments increase access to integrative medicine but delivering these services via telehealth have not been evaluated. OBJECTIVE We created, and pilot tested a Virtual Integrative Oncology Shared Medical Appointment Series (VIOSMAS) to assess its feasibility, acceptability, and efficacy at an urban academic teaching hospital. METHODS The 7-session hour-long Living Well with and after Cancer series included didactics, multi-disciplinary experiential sessions, and group discussion. Topics included (1) Introduction, (2) Herbs/Botanicals/Fungi, (3) Mindful Movement, (4) Acupuncture, (5) Narratives and Nature, (6) Diet and Culinary Medicine, and (7) Vitamins/Supplements. Virtual visits via telehealth were offered to enhance patient participation during the pandemic. Outcome measures included recruitment, retention, pre/post-series patient survey and qualitative clinician feedback. RESULTS Between 9/2021 and 4/2023, 72 unique patients were recruited to 5 cohorts and had a total of 332 VIOSMAS visits. A total of 50 patients (69%) attended 4 or more of the 7-session series; 60 (83% were women); patients ranged in age from 28 to 93 years (median 66); 36 (50%) lived outside the city center; the most common cancer diagnoses were breast, lymphoma, and lung cancer. Patients were from diverse demographics. Pre-program, patients reported desiring assistance in addressing diverse symptoms including fatigue, insomnia, pain, gastrointestinal (GI) symptoms, anxiety, and depression. Post-series, patients reported that the VIOSMAS addressed their goals and symptoms; they also reported incorporating recommended lifestyle changes in diet, exercise, sleep, and stress management; they were satisfied with the number of sessions and telehealth format. The participating clinicians reported high levels of satisfaction with VIOSMAS. Revenue to the institution from VIOSMAS exceeded the revenue potential of equivalent time spent for individual visits while supporting extended physician-patient contact. CONCLUSION VIOSMAS is feasible for patients and clinicians, addresses patients' symptoms and questions about lifestyle and complementary therapies, and generates more revenue than individual visits. Larger implementation trials with appropriate comparison groups are recommended.
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Affiliation(s)
- Michelle H. Loy
- Cornell University, New York, NY, USA
- Weill Cornell Medicine/New York Presbyterian Hospital, New York, NY, USA
| | | | - Chiti Parikh
- Cornell University, New York, NY, USA
- Weill Cornell Medicine/New York Presbyterian Hospital, New York, NY, USA
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Attai DJ, Katz MS, Streja E, Hsiung JT, Marroquin MV, Zavaleta BA, Nekhlyudov L. Patient preferences and comfort for cancer survivorship models of care: results of an online survey. J Cancer Surviv 2023; 17:1327-1337. [PMID: 35113306 DOI: 10.1007/s11764-022-01177-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Accepted: 01/21/2022] [Indexed: 12/01/2022]
Abstract
PURPOSE Workforce shortages will impact oncologists' ability to provide both active and survivorship care. While primary care provider (PCP) or survivorship clinic transition has been emphasized, there is little evidence regarding patient comfort. METHODS We developed an online survey in partnership with patient advocates to assess survivors' comfort with PCP or survivorship clinic care and distributed the survey to online, cancer-specific patient communities from June to August 2020. Descriptive and logistic regression analyses were conducted. RESULTS A total of 975 surveys were complete. Most respondents were women (91%) and had private insurance (65%). Thirty-six cancer types were reported. Ninety-three percent had a PCP. Twenty-four percent were comfortable seeing a PCP for survivorship care. Higher odds of comfort were seen among respondents who were Black or had stage 0 cancer; female sex was associated with lower odds. Fifty-five percent were comfortable with a survivorship clinic. Higher odds of comfort were seen with lymphoma or ovarian cancer, > 15 years from diagnosis, and non-US government insurance. Lower odds were seen with melanoma, advanced stage, Medicaid insurance, and one late effect. Preference for PCP care was 87% for general health, 32% for recurrence monitoring, and 37% for late effect management. CONCLUSIONS One quarter of cancer survivors were comfortable with PCP-led survivorship care and about half with a survivorship clinic. Most preferred oncologist care for recurrence monitoring and late-effect management. IMPLICATIONS FOR CANCER SURVIVORS Patient preference and comfort should be considered when developing survivorship care models. Future efforts should focus on facilitating patient-centered transitions to non-oncologist care.
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Affiliation(s)
- Deanna J Attai
- Department of Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA.
- UCLA Health Burbank Breast Care, 191 S. Buena Vista #415, Burbank, CA, 91505, USA.
| | - Matthew S Katz
- Department of Radiation Medicine, Lowell General Hospital, Lowell, MA, USA
| | - Elani Streja
- Department of Medicine, University of California Irvine School of Medicine, Irvine, CA, USA
| | - Jui-Ting Hsiung
- Department of Medicine, University of California Irvine School of Medicine, Irvine, CA, USA
| | | | - Beverly A Zavaleta
- Department of Medicine, Valley Baptist Medical Center - Brownsville, Brownsville, TX, USA
| | - Larissa Nekhlyudov
- Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
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Allaire BT, Zabala D, Lines LM, Williams C, Halpern M, Mollica M. Associations between healthcare costs and care experiences among older adults with and without cancer. J Geriatr Oncol 2023; 14:101561. [PMID: 37392562 PMCID: PMC10527170 DOI: 10.1016/j.jgo.2023.101561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 04/26/2023] [Accepted: 06/09/2023] [Indexed: 07/03/2023]
Abstract
INTRODUCTION Care coordination and patient-provider communication are important for older adults with cancer, as they likely have additional, non-cancer chronic conditions requiring consultation across multiple providers. Suboptimal care coordination and patient-provider communication can lead to costly and preventable adverse outcomes. This study examines Medicare expenditures associated with patient-reported care coordination and patient-provider communication among older adults with and without cancer. MATERIALS AND METHODS We explore SEER-CAHPS® (Surveillance, Epidemiology and End Results-Consumer Assessment of Healthcare Providers and Systems) linked data for differences in health care expenditures by care coordination and patient-provider communication experiences for beneficiaries with and without cancer. The cancer cohort included beneficiaries with ten prevalent cancer types diagnosed 2011-2019 at least six months before completing a CAHPS survey. Medicare expenditures were abstracted from Medicare claims data. Care coordination and patient-provider communication composite scores (range 0-100, higher scores indicate better experiences) were patient-reported in the CAHPS® survey. We estimated expenditure differences per one-point change in composite scores for patients with and without cancer. RESULTS Our analysis included 16,778 matched beneficiaries with and without a previously diagnosed cancer (N = 33,556). Higher care coordination and patient-provider communication scores were inversely associated with Medicare expenditures among beneficiaries with and without cancer in the six months prior to survey response, ranging from -$83 (standard error [SE] = $7) to -$90 (SE = $6) per month. Six months post-survey, expenditures estimates ranging -$88 (SE = $6) to -$106 (SE = $8) were found. DISCUSSION We found that lower Medicare expenditures were associated with higher care coordination and patient-provider communication scores. As the number of survivors living longer both with and beyond their cancer grows, addressing their multifaceted care and improving outcomes will be critical.
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Affiliation(s)
| | - Diana Zabala
- RTI International, Research Triangle Park, NC 27709, USA
| | - Lisa M Lines
- RTI International, Research Triangle Park, NC 27709, USA; University of Massachusetts Chan Medical School, Worcester, MA, USA
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Carlsson SV, Clauss C, Benfante N, Manasia M, Sollazzo T, Lynch J, Frank J, Quadri S, Lin X, Vickers AJ, Ehdaie B. Shared Medical Appointments for Prostate Cancer Active Surveillance Follow-Up Visits. UROLOGY PRACTICE 2021; 8:541-545. [PMID: 34841012 PMCID: PMC8612701 DOI: 10.1097/upj.0000000000000247] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/10/2021] [Indexed: 11/25/2022]
Abstract
PURPOSE To accommodate for the rapidly increasing patient volume and follow-up visits of men with prostate cancer on active surveillance (AS), we carried out a quality improvement project to secure high-quality care and enhance patient experience. MATERIALS AND METHODS We proposed an innovative clinic systems redesign - "Shared Medical Appointments" (SMAs) - in which multiple patients were seen in a group format at the same time by the health care team led by a urologist leading the Institution's AS program. RESULTS We piloted four SMAs during July-November 2019. Running the SMAs was feasible and improved the contact time for each patient while at the same time being time- and resource efficient for the healthcare providers and using the standard billing processes. The group dynamic was open and pleasant. The majority of patients rated their overall experience with SMA as excellent. Almost all patients responded that they were likely or very likely to attend another SMA in the future. All patients said that they would either definitely or probably recommend this visit type to a friend of family member with prostate cancer. Most patients rated their overall satisfaction with the SMA as extremely high. CONCLUSIONS Utilizing SMAs for AS follow-up visits was feasible and acceptable. Our promising findings suggest that SMAs can ensure high-quality patient care. Well-controlled studies comparing SMAs to individual usual care visits should be conducted with endpoints including knowledge, patient and staff satisfaction, anxiety and quality-of-life outcomes, AS adherence, process measures and resource utilization.
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Affiliation(s)
- Sigrid V. Carlsson
- Department of Surgery (Urology Service), Memorial Sloan Kettering Cancer Center, New York, USA
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, USA
- Department of Urology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Sweden
| | - Corinne Clauss
- Department of Surgery (Urology Service), Memorial Sloan Kettering Cancer Center, New York, USA
| | - Nicole Benfante
- Department of Surgery (Urology Service), Memorial Sloan Kettering Cancer Center, New York, USA
| | - Michael Manasia
- Department of Surgery (Urology Service), Memorial Sloan Kettering Cancer Center, New York, USA
| | - Tina Sollazzo
- Department of Surgery (Urology Service), Memorial Sloan Kettering Cancer Center, New York, USA
| | - Janine Lynch
- Department of Surgery (Urology Service), Memorial Sloan Kettering Cancer Center, New York, USA
| | - Jodi Frank
- Department of Surgery (Urology Service), Memorial Sloan Kettering Cancer Center, New York, USA
| | - Safia Quadri
- Department of Surgery (Urology Service), Memorial Sloan Kettering Cancer Center, New York, USA
| | - Xin Lin
- Department of Surgery (Urology Service), Memorial Sloan Kettering Cancer Center, New York, USA
| | - Andrew J. Vickers
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, USA
| | - Behfar Ehdaie
- Department of Surgery (Urology Service), Memorial Sloan Kettering Cancer Center, New York, USA
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Lee J, Kim RJY, Choi H. Most surface learning in the third year: Dental student learning approaches and implications for curriculum and assessment. J Dent Educ 2020; 84:464-472. [PMID: 32030761 DOI: 10.1002/jdd.12043] [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: 07/22/2019] [Revised: 12/03/2019] [Accepted: 12/17/2019] [Indexed: 11/08/2022]
Abstract
CONTEXT Dental schools seek to educate students to become inclined toward self-directed, lifelong learning, an important mindset for healthcare professionals that may be linked to deep versus surface learning approaches. Students using a deep learning approach are more intrinsically motivated and actively engage in higher-order thinking, while those using a surface learning approach are more extrinsically motivated and aim for passive learning. OBJECTIVES Because student learning approaches can be influenced by a wide variety of learning experiences, we sought to understand how student approaches to learning differ by year in dental school and are related to academic achievement. METHODS A total of 244 students in a 4-year dental school program in South Korea voluntarily participated in this study. We collected data on school year and academic achievement, and approaches to learning of participants using the validated Study Processes Questionnaire to assess learning approach, which included the constructs of deep motive, deep strategy, surface motive, and surface strategy. RESULTS We conducted 3 sets of statistical analyses and found that most students adopted a deep approach to learning (DAL) in their first and second years (Y1 and Y2), with third-year students (Y3) showing heavy dependence on a surface approach to learning (SAL) and sharp drops in intrinsic motives. Student approaches to learning were not significantly related to academic achievement. In the first 2 years of dental school, students tended to adopt a DAL, and viewed their learning as personal growth and their profession as necessitating deep intellectual inquiry. CONCLUSIONS In the third year, the change from a DAL to a SAL coincided with entry to clinical training. The lack of integration of biomedical science (Y1 and Y2) and clinical science (Y3 and Y4), and increased stress in the initial clinical context may account for this difference. The poor correlation between a DAL and high achievement may indicate a need for change in assessment methods. This study hopes to stimulate reflection regarding student learning approaches and educational efforts that prepare future dentists for lifelong learning.
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Affiliation(s)
- Jihyun Lee
- Department of Dental Education, School of Dentistry, Seoul National University, Seoul, South Korea
| | - Ryan Jin Young Kim
- Department of Dental Education, School of Dentistry, Seoul National University, Seoul, South Korea
| | - Hyoseon Choi
- Department of Medical Education, College of Medicine, Chosun University, Gwangju, South Korea
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Hohmann NS, McDaniel CC, Mason SW, Cheung WY, Williams MS, Salvador C, Graves EK, Camp CN, Chou C. Patient perspectives on primary care and oncology care coordination in the context of multiple chronic conditions: A systematic review. Res Social Adm Pharm 2019; 16:1003-1016. [PMID: 31812499 DOI: 10.1016/j.sapharm.2019.11.014] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Revised: 11/12/2019] [Accepted: 11/24/2019] [Indexed: 12/11/2022]
Abstract
BACKGROUND Patients' views on the optimal model for care coordination between primary care providers (PCPs) and oncologists in the context of cancer and multiple chronic conditions (MCC) are unclear. Thus, the purpose of this systematic review is to evaluate the perceptions of patients with both cancer and MCC regarding their care coordination needs. METHODS Following PRISMA guidelines, the literature was systematically searched through PubMed, CINAHL, and PsycINFO for articles pertaining to patients' perspectives, experiences, and needs regarding care coordination between PCPs and oncologists during the cancer care continuum, in the context of patients with cancer and MCC. English-language articles were included if they met the following criteria: 1) published between 2008 and 2018; 2) peer-reviewed study; 3) patients aged 18 years or older diagnosed with any type or stage of cancer; 4) patients have one or more chronic comorbid condition; 5) inclusion of patient perceptions, experiences, or needs related to care coordination between PCPs and oncologists; and 6) ability to extract results. Data extraction was performed with a standardized form, and themes were developed through qualitative synthesis. A grounded theory approach was used to qualitatively evaluate data extracted from articles and create a framework for providers to consider when developing patient-centered care coordination strategies for these complex patients. Risk of bias within each study was assessed independently by two authors using the Mixed Methods Appraisal Tool. RESULTS A total of 22 articles were retained, representing the perspectives of 8,114 patients with cancer and MCC. Studies were heterogeneous in the patients' respective phases of cancer care and study design. From qualitative synthesis, four themes emerged regarding patients' needs for cancer care coordination and were included as constructs to develop the Patient-centered Care Coordination among Patients with Multiple Chronic Conditions and Cancer (PCP-MC) framework. Constructs included: 1) Communication; 2) Defining provider care roles; 3) Information access; and 4) Individualized patient care. Care navigators served as a communication bridge between providers and patients. CONCLUSIONS Findings highlight the importance that patients with both cancer and MCC place on communication with and between providers, efficient access to understandable care information, defined provider care roles, and care tailored to their individual needs and circumstances. Providers and policymakers may consider the developed PCP-MC framework when designing, implementing, and evaluating patient-centered care coordination strategies for patients with both cancer and MCC.
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Affiliation(s)
- Natalie S Hohmann
- Auburn University, Harrison School of Pharmacy, Department of Pharmacy Practice, 4201 Walker Building, Auburn University, AL, 36849, USA
| | - Cassidi C McDaniel
- Auburn University, Harrison School of Pharmacy, Health Outcomes Research and Policy, 4306 Walker Building, Auburn University, AL, 36849, USA
| | - S Walker Mason
- University of North Carolina Medical Center, Department of Pharmacy, 101 Manning Dr, Chapel Hill, NC, 27514, USA
| | - Winson Y Cheung
- University of Calgary, Cumming School of Medicine, Department of Oncology: Tom Baker Cancer Centre, 1331 29th Street NW, Calgary, Alberta, T2N 4N2, Canada
| | - Michelle S Williams
- University of Mississippi Medical Center, Cancer Institute and Department of Population Health Science, 2500 North State Street, Jackson, MS, 39216, USA
| | - Carolina Salvador
- University of Alabama at Birmingham, School of Medicine, Division of Hematology/Oncology, 1720 2nd Avenue South, NP2540, Birmingham, AL, 35294, USA
| | - Edith K Graves
- Cancer Center of East Alabama Medical Center, Medical Oncology, 2501 Village Professional Dr, Opelika, AL, 36801, USA
| | - Christina N Camp
- Auburn University, Harrison School of Pharmacy, Health Outcomes Research and Policy, 4306 Walker Building, Auburn University, AL, 36849, USA
| | - Chiahung Chou
- Auburn University, Harrison School of Pharmacy, Health Outcomes Research and Policy, 4306 Walker Building, Auburn University, AL, 36849, USA; China Medical University Hospital, Department of Medical Research, No.2 Yude Road, North District, Taichung City, 40447, Taiwan.
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Arem H, Lewin D, Cifu G, Bires J, Goldberg E, Kaltman R, Power MC, Mauro LA, Kogan M. A Feasibility Study of Group-Delivered Behavioral Interventions for Insomnia Among Breast Cancer Survivors: Comparing Cognitive Behavioral Therapy for Insomnia and a Mind–Body Intervention. J Altern Complement Med 2019; 25:840-844. [DOI: 10.1089/acm.2019.0038] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Hannah Arem
- Department of Epidemiology and Biostatistics, Milken Institute School of Public Health, George Washington University, Washington, District of Columbia
- GW Cancer Center, Washington, District of Columbia
| | - Daniel Lewin
- Children's National Health System, Washington, District of Columbia
| | - Gabriella Cifu
- Department of Epidemiology and Biostatistics, Milken Institute School of Public Health, George Washington University, Washington, District of Columbia
| | - Jennifer Bires
- Smith Center for Healing and the Arts, Washington, District of Columbia
| | | | | | - Melinda C. Power
- Department of Epidemiology and Biostatistics, Milken Institute School of Public Health, George Washington University, Washington, District of Columbia
| | | | - Mikhail Kogan
- GW Center for Integrative Medicine, Washington, District of Columbia
- George Washington University Medical Faculty Associates, Washington, District of Columbia
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Alfano CM, Mayer DK, Bhatia S, Maher J, Scott JM, Nekhlyudov L, Merrill JK, Henderson TO. Implementing personalized pathways for cancer follow-up care in the United States: Proceedings from an American Cancer Society-American Society of Clinical Oncology summit. CA Cancer J Clin 2019; 69:234-247. [PMID: 30849190 PMCID: PMC7376887 DOI: 10.3322/caac.21558] [Citation(s) in RCA: 59] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
A new approach to cancer follow-up care is necessary to meet the needs of cancer survivors while dealing with increasing volume and provider shortages, knowledge gaps, and costs to both health care systems and patients. An approach that triages patients to personalized follow-up care pathways, depending on the type(s) and level(s) of resources needed for patients' long-term care, is in use in the United Kingdom and other countries and has been shown to meet patients' needs, more efficiently use the health care system, and reduce costs. Recognizing that testing and implementing a similar personalized approach to cancer follow-up care in the United States will require a multipronged strategy, the American Cancer Society and the American Society of Clinical Oncology convened a summit in January 2018 to identify the needed steps to move this work from concept to implementation. The summit identified 4 key strategies going forward: 1) developing a candidate model (or models) of care delivery; 2) building the case for implementation by conducting studies modeling the effects of personalized pathways of follow-up care on patient outcomes, workforce and health care resources, and utilization and costs; 3) creating consensus-based guidelines to guide the delivery of personalized care pathways; and 4) identifying and filling research gaps to develop and implement needed care changes. While these national strategies are pursued, oncology and primary care providers can lay the groundwork for implementation by assessing their patients' risk of recurrence and the chronic and late effects of cancer as well as other health care needs and resources available for care and by considering triaging patients accordingly, referring patients to appropriate specialized survivorship clinics as these are developed, helping to support patients who are capable of self-managing their health, setting expectations with patients from diagnosis onward for the need for follow-up in primary care and/or a survivorship clinic, and improving coordination of care between oncology and primary care.
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Affiliation(s)
| | - Deborah K. Mayer
- Director of Cancer Survivorship and Professor, University of North Carolina at Chapel Hill School of Nursing, Chapel Hill, NC
| | - Smita Bhatia
- Director, Institute for Cancer Outcomes and Survivorship, University of Alabama at Birmingham (UAB) School of Medicine, Professor and Vice Chair for Outcomes, Department of Pediatrics, UAB; and Associate Director for Cancer Outcomes Research, UAB Comprehensive Cancer Center, UAB, Birmingham, AL
| | - Jane Maher
- Joint Chief Medical Officer, Macmillan Cancer Support, London, United Kingdom
| | - Jessica M. Scott
- Principal Investigator, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Larissa Nekhlyudov
- Associate Professor, Brigham & Women’s Hospital, Harvard Medical School, Boston, MA
| | - Janette K. Merrill
- Associate Director, Health Policy, American Society of Clinical Oncology, Alexandria, VA
| | - Tara O. Henderson
- Associate Professor, Department of Pediatrics, and Medical Director, Childhood Cancer Survivor Center, The University of Chicago Comer Children’s Hospital, Chicago, IL
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Parikh M, Rajendran I, D'Amico S, Luo M, Gardiner P. Characteristics and Components of Medical Group Visits for Chronic Health Conditions: A Systematic Scoping Review. J Altern Complement Med 2019; 25:683-698. [PMID: 30945935 DOI: 10.1089/acm.2018.0524] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Objectives: Chronic health conditions are a major challenge to the health care system. Medical Group Visits (MGVs) are a valuable health care delivery model used in a variety of medical settings and patient populations. We conducted a systematic scoping review of MGV research literature for chronic health conditions to summarize the characteristics and individual components of MGVs in the United States of America and Canada. Design: We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses scoping review methodology and searched five databases using nine widely used MGV-related terms. Subjects: We included studies conducted in the United States and Canada, whose participants were >18 years old and attended an MGV conducted in a medical setting by a billable health care provider. We excluded groups related to diabetes, pregnancy, and cancer. Results: Of 3777 studies identified, we found 55 eligible studies of which 9 are randomized controlled trials and 46 are observational studies. The majority of studies were conducted in academic medical centers, were observational in design, and recruited patients using physician referrals. The three most frequently studied groups include a combination of several chronic conditions (n = 12), chronic pain conditions (n = 10), and cardiovascular disease (n = 9). Curriculum components included didactics (n = 55), experiential activities (n = 27), and socializing components (n = 12). Didactic areas include (1) medical topics such as symptoms management (n = 27) of which 14 included pain management, and (2) lifestyle/educational component (n = 33) that comprised of talks on nutrition (n = 29), exercise (n = 20), stress (n = 16), and sleep (n = 10). The top integrative medicine (IM) modalities (n = 13) included: mindfulness techniques (n = 8), meditation (n = 6), and yoga (n = 5). Substantial heterogeneity was observed in the recruitment, implementation, curriculum components, and outcomes reported. Conclusion: The MGV is a model of patient-centered care that has captured the attention of researchers. IM modalities are well represented in the curriculum components of MGVs. Further investigation into the components identified by this study, may help in better targeting of group interventions to patients and contexts, where it is most likely to be effective.
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Affiliation(s)
- Manasi Parikh
- 1Department of Family Medicine and Boston Medical Center, Boston, MA
| | - Iniya Rajendran
- 2Department of Internal Medicine, Boston Medical Center, Boston, MA
| | - Salvatore D'Amico
- 1Department of Family Medicine and Boston Medical Center, Boston, MA
| | - Man Luo
- 1Department of Family Medicine and Boston Medical Center, Boston, MA
| | - Paula Gardiner
- 3Department of Family Medicine and Community Health, UMass Memorial Health Care, University of Massachusetts Medical School, Worcester, MA
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Thompson-Lastad A. Group Medical Visits as Participatory Care in Community Health Centers. QUALITATIVE HEALTH RESEARCH 2018; 28:1065-1076. [PMID: 29781398 PMCID: PMC6500445 DOI: 10.1177/1049732318759528] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
In this article, I examine group medical visits, a clinic-based intervention that aims to improve patient health by combining clinical care, health education and peer support. Research shows that health care inequalities are reproduced through the interplay of interpersonal, institutional, and structural factors. I examine changing social relations made possible by group visits, including peer support and an expanded role for patient knowledge. The qualitative data presented here are part of a mixed-methods study of how group medical visits and integrative medicine are combined and implemented for low-income people with chronic conditions. I find that patients take active roles in each other's care, supporting, challenging, and advocating in ways that shift patient-provider relationships. Such shifts demand reflection about what kinds of knowledge matter for health. Health care encounters can reproduce inequality for marginalized patients; this study suggests group visits can restructure patient-provider encounters to interrupt healthcare inequalities.
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Coates J, Gething F, Johnson MI. Shared medical appointments for managing pain in primary care settings? Pain Manag 2017; 7:223-227. [PMID: 28699374 DOI: 10.2217/pmt-2017-0016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Affiliation(s)
- Jonathan Coates
- St. Anthony's Health Centre, St. Anthony's Road, Walker, Newcastle NE6 2NN, UK
| | - Fraser Gething
- Pain Management Team, Newcastle upon Tyne Hospitals NHS Foundation Trust, Elswick Health Centre, Newcastle upon Tyne NE4 6SH, UK
| | - Mark I Johnson
- Centre for Pain Research, School of Clinical & Applied Sciences, Leeds Beckett University City Campus, Leeds LS1 3HE, UK
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Fujita T, Iida Y, Tanaka C, Nakamura K, Yamanaka K, Ueno J, Iino Y, Chitose H, Sakamoto H, Daiko H. Development and evaluation of an "Interdisciplinary Postoperative Support Program" in outpatient clinics after thoracic esophagectomy. Int J Surg 2017; 43:58-66. [PMID: 28529190 DOI: 10.1016/j.ijsu.2017.05.036] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2017] [Revised: 05/13/2017] [Accepted: 05/15/2017] [Indexed: 12/01/2022]
Abstract
BACKGROUND To support patients discharged from the hospital after surgery, we launched an "Interdisciplinary Postoperative Support Program" in outpatient clinics for patients who were discharged within 1 month after thoracic esophagectomy and their families. We introduce our program and clarify the patient's physical and psychologic status by analyzing the questionnaire provided from this program. MATERIALS AND METHODS From August 2014 to January 2015, we conducted the Interdisciplinary Postoperative Support Program every month. Thus, questionnaires regarding physical and psychologic symptoms as well as the meaningfulness of the program were obtained from 59 patients and prospectively analyzed. RESULTS We obtained valid responses from 48 patients (81.4%). Frequent postoperative difficulties included dysphagia (50%) and decreased physical strength (39.5%). Oral intake decreased to half (55.3%) and one-fourth (25.5%) of that before esophagectomy. Frequent requests made by patients to medical staff included explanations of the postoperative symptoms (97.9%), further information on the treatments of esophageal cancer (93.8%), and the typical postoperative course experienced by other patients (76.6%). A higher percentage of positive comments were obtained regarding the management of symptoms (87.8%) and optimal access to the consultations (78.9%). The incidences of unscheduled outpatient visits were 4.1% and 14.0%, respectively, under conditions with and without this postoperative program (P = 0.03). CONCLUSION We found that our program could provide appropriate information with higher levels of satisfaction after thoracic esophagectomy. Further investigations regarding longer periods of physical and psychologic symptoms, as well as the needs of patients and their families should be conducted to augment our program.
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Affiliation(s)
- Takeo Fujita
- Division of Esophageal Surgery, National Cancer Center Hospital East, Kashiwa, Japan.
| | - Yoko Iida
- Supportive Care Center, National Cancer Center Hospital East, Kashiwa, Japan
| | - Chiharu Tanaka
- Supportive Care Center, National Cancer Center Hospital East, Kashiwa, Japan
| | - Kumi Nakamura
- Supportive Care Center, National Cancer Center Hospital East, Kashiwa, Japan
| | - Keiko Yamanaka
- Supportive Care Center, National Cancer Center Hospital East, Kashiwa, Japan
| | - Junya Ueno
- Division of Rehabilitation Medicine, National Cancer Center Hospital East, Kashiwa, Japan
| | - Yoshie Iino
- Division of Rehabilitation Medicine, National Cancer Center Hospital East, Kashiwa, Japan
| | - Haruka Chitose
- Division of Nutrition, National Cancer Center Hospital East, Kashiwa, Japan
| | - Hatoe Sakamoto
- Supportive Care Center, National Cancer Center Hospital East, Kashiwa, Japan
| | - Hiroyuki Daiko
- Division of Esophageal Surgery, National Cancer Center Hospital East, Kashiwa, Japan
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13
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Walsh K. Addressing psychosocial issues in cancer survivorship: past, present and future. Future Oncol 2016; 12:2823-2834. [PMID: 27467398 DOI: 10.2217/fon-2016-0138] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
With a burgeoning population of cancer survivors, organizations in the USA and around the world are considering how to address the many long-term and late psychosocial effects of cancer and cancer treatment. This article reviews the changing landscape of survivorship care over the past 50 years, from the time when there were relatively few survivors to the future, when the number of cancer survivors in the USA alone is expected to reach close to 20 million. Institute of Medicine Reports, intra-organizational summits and accrediting standards that have influenced the development of survivorship care plans and programs and the roles of the Internet and smartphone applications along with oncology specialist and primary care providers are discussed.
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14
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Chou WC, Chang PH, Lu CH, Liu KH, Hung YS, Hung CY, Liu CT, Yeh KY, Lin YC, Yeh TS. Effect of Comorbidity on Postoperative Survival Outcomes in Patients with Solid Cancers: A 6-Year Multicenter Study in Taiwan. J Cancer 2016; 7:854-61. [PMID: 27162545 PMCID: PMC4860803 DOI: 10.7150/jca.14777] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2015] [Accepted: 03/15/2016] [Indexed: 12/16/2022] Open
Abstract
Purpose: Patients with comorbidities are more likely to experience treatment-related toxicities and death. Our aim was to examine the effect of comorbidity on postoperative survival outcomes in patients with solid cancers. Methods: In total, 37,288 patients who underwent potentially curative operations for solid cancers at four affiliated hospitals of the Chang Gung Memorial Hospital, between 2007 and 2012, were stratified according to the Charlson Comorbidity Index (CCI) for postoperative survival analysis. Multivariate Cox regression was used to adjust hazard ratios of survival outcomes among different CCI subgroups. Results: A significantly greater proportion of patients with comorbidities presented with poorer clinicopathological characteristics compared to those without. After cancer surgery, 26% of patients died after a median follow-up duration of 38.9 months. Overall mortality rates of patients with CCI scores of 0, 1, 2, 3, 4, and 5-8 were 22.9%, 29.5%, 38.2%, 43.2%, 50.2%, and 56.4%, respectively. After adjusting for other clinicopathological factors, patients with increasing CCI scores were associated with significantly reduced overall and noncancer-specific survival rates, while only patients with CCI scores of >2 were associated with higher cancer-specific mortality rates. Conclusions: Patients with increasing numbers of comorbidities were associated with reduced postoperative survival outcomes. Patients with multiple comorbidities were most vulnerable to both cancer- and noncancer-specific deaths in the first 6 months after cancer surgery. Our results suggest that for both the patient and clinician, it should be taken into consideration about cancer surgery when dealing with multiple comorbidities.
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Affiliation(s)
- Wen-Chi Chou
- 1. Department of Medical Oncology, Chang Gung Memorial Hospital, Linkou, Taiwan;; 2. Graduate Institute of Clinical Medical Sciences, Chang Gung University College of Medicine, Taiwan
| | - Pei-Hung Chang
- 3. Department of Medical Oncology, Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Chang-Hsien Lu
- 4. Department of Medical Oncology, Chang Gung Memorial Hospital, Keelung, Taiwan
| | - Keng-Hao Liu
- 5. Department of Surgery, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Yu-Shin Hung
- 1. Department of Medical Oncology, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Chia-Yen Hung
- 1. Department of Medical Oncology, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Chien-Ting Liu
- 6. Department of Medical Oncology, Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - Kun-Yun Yeh
- 3. Department of Medical Oncology, Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Yung-Chang Lin
- 1. Department of Medical Oncology, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Ta-Sen Yeh
- 5. Department of Surgery, Chang Gung Memorial Hospital, Linkou, Taiwan
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15
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Prescott LS, Dickens AS, Guerra SL, Tanha JM, Phillips DG, Patel KT, Umberson KM, Lozano MA, Lowe KB, Brown AJ, Taylor JS, Soliman PT, Garcia EA, Levenback CF, Bodurka DC. Fighting cancer together: Development and implementation of shared medical appointments to standardize and improve chemotherapy education. Gynecol Oncol 2016; 140:114-9. [PMID: 26549108 PMCID: PMC4698218 DOI: 10.1016/j.ygyno.2015.11.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2015] [Revised: 11/03/2015] [Accepted: 11/04/2015] [Indexed: 12/16/2022]
Abstract
OBJECTIVE Shared medical appointments offer a novel approach to improve efficiency and quality of care consistent with the goals of the Institute of Medicine. Our objective was to develop and implement a shared medical appointment for gynecologic cancer patients initiating chemotherapy. METHODS We first assessed the level of interest in shared medical appointments among our patients and providers through qualitative interviews. Both patients and providers identified pre-chemotherapy as an optimal area to pilot shared medical appointments. We subsequently created a multidisciplinary team comprised of physicians, advanced practice providers, nurses, pharmacists, administrators, health education specialists and members of the Quality Improvement Department to establish a Shared Medical Appointment and Readiness Teaching (SMART) program for all gynecologic oncology patients initiating chemotherapy with platinum- and/or taxane-based regimens. We developed a standardized chemotherapy education presentation and provided patients with a tool kit that consisted of chemotherapy drug education, a guide to managing side effects, advance directives, and center contact information. RESULTS From May 9, 2014 to June 26, 2015, 144 patients participated in 51 SMART visits. The majority of patients had ovarian cancer and were treated with carboplatin/paclitaxel. Surveyed patients reported being highly satisfied with the group visit and would recommend shared medical appointments to other patients. CONCLUSIONS This model of care provides patient education within a framework of social support that empowers patients. Shared medical appointments for oncology patients initiating chemotherapy are both feasible and well accepted.
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Affiliation(s)
- Lauren S Prescott
- Departments of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, United States.
| | - Andrea S Dickens
- Pharmacy, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Sandra L Guerra
- Departments of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Jila M Tanha
- The Learning Center, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Desiree G Phillips
- Patient Education, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Katherine T Patel
- Pharmacy, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Katie M Umberson
- Clinical Operations, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Miguel A Lozano
- Performance Improvement, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Kathryn B Lowe
- Department of Supportive Medicine, Memorial Hermann Healthcare System, Houston, TX, United States
| | - Alaina J Brown
- Departments of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Jolyn S Taylor
- Departments of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Pamela T Soliman
- Departments of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Elizabeth A Garcia
- Departments of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Charles F Levenback
- Departments of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Diane C Bodurka
- Departments of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
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16
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Borycki E, Cummings E, Dexheimer JW, Gong Y, Kennebeck S, Kushniruk A, Kuziemsky C, Saranto K, Weber J, Takeda H. Patient-Centred Coordinated Care in Times of Emerging Diseases and Epidemics. Contribution of the IMIA Working Group on Patient Safety. Yearb Med Inform 2015; 10:207-15. [PMID: 26123904 PMCID: PMC4587040 DOI: 10.15265/iy-2015-019] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES In this paper the researchers describe how existing health information technologies (HIT) can be repurposed and new technologies can be innovated to provide patient-centered care to individuals affected by new and emerging diseases. METHODS The researchers conducted a focused review of the published literature describing how HIT can be used to support safe, patient-centred, coordinated care to patients who are affected by Ebola (an emerging disease). RESULTS New and emerging diseases present opportunities for repurposing existing technologies and for stimulating the development of new HIT innovation. Innovative technologies may be developed such as new software used for tracking patients during new or emerging disease outbreaks or by repurposing and extending existing technologies so they can be used to support patients, families and health professionals who may have been exposed to a disease. The paper describes the development of new technologies and the repurposing and extension of existing ones (such as electronic health records) using the most recent outbreak of Ebola as an example.
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Affiliation(s)
- E Borycki
- Elizabeth Borycki, Health Information Science, University of Victoria, PO Box 1700 STN CSC, Victoria BC V8W 2Y2, Canada, E-Mail:
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