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Tsai CH, Hsieh HF, Lai TW, Kung PT, Kuo WY, Tsai WC. Effect of multidisciplinary team care on the risk of recurrence in breast cancer patients: A national matched cohort study. Breast 2020; 53:68-76. [PMID: 32652461 PMCID: PMC7375674 DOI: 10.1016/j.breast.2020.07.001] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2020] [Accepted: 07/01/2020] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Cancer has been the leading cause of death in the past decade in Taiwan, with breast cancer being the most common type of cancer in females. Very few studies looked at the risk of recurrence in patients who received multidisciplinary team (MDT) care. We analyzed the influence of MDT on the risk of recurrence and death in breast cancer patients. METHOD In this retrospective study, we included newly diagnosed patients from 2004 to 2010. The study included 9,266 breast cancer patients who were enrolled in MDT care and 9,266 patients who were not. The study used log-rank test to analyze patients' characteristics, hospital characteristics, cancer staging, and treatment methods to compare the recurrence rates in MDT care and non-MDT care participants. We used Cox proportional hazards model to examine the effect of MDT and associated factors on the risk of recurrence and mortality of breast cancer patients. RESULTS Relative risk of recurrence was lower for patients who received MDT care than for patients who did not (HR, 0.84; 95%CI: 0.70-0.99) after matching. The mortality risk for breast cancer patients with relapse was 8.48 times (95%CI: 7.53-9.54) than that for patients without relapse. CONCLUSIONS The relative risk of recurrence and death was significantly lower for breast cancer patients who received MDT care than for those who did not. We suggest that MDT care be implanted in the National Health Policy settings of breast cancer patients.
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Affiliation(s)
- Chang-Hung Tsai
- Miao-Li General Hospital, Ministry of Health and Welfare, Taiwan, ROC; Department of Health Services Administration, China Medical University, Taichung, Taiwan, ROC; Department of Public Health, China Medical University, Taichung, Taiwan, ROC
| | | | - Ting-Wei Lai
- Management Center, China Medical University Hospital, Taichung, Taiwan, ROC
| | - Pei-Tseng Kung
- Department of Healthcare Administration, Asia University, Taichung, Taiwan, ROC; Department of Medical Research, China Medical University Hospital, China Medical University, Taichung, Taiwan, ROC
| | - Wei-Yin Kuo
- Department of Health Services Administration, China Medical University, Taichung, Taiwan, ROC
| | - Wen-Chen Tsai
- Department of Health Services Administration, China Medical University, Taichung, Taiwan, ROC.
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Back AL. Patient-Clinician Communication Issues in Palliative Care for Patients With Advanced Cancer. J Clin Oncol 2020; 38:866-876. [PMID: 32023153 DOI: 10.1200/jco.19.00128] [Citation(s) in RCA: 58] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
The delivery of palliative care to patients with advanced cancer and their families, whether done by oncology clinicians or palliative care clinicians, requires patient-centered communication. Excellent communication can introduce patients and families to palliative care in a nonthreatening way, build patient trust, enable symptom control, strengthen coping, and guide decision making. This review covers deficiencies in the current state of communication, patient preferences for communication about palliative care topics, best practices for communication, and the roles of education and system intervention. Communication is a two-way, relational process that is influenced by context, culture, words, and gestures, and it is one of the most important ways that clinicians influence the quality of medical care that patients and their families receive.
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Walter JK, Hill DL, DiDomenico C, Parikh S, Feudtner C. A conceptual model of barriers and facilitators to primary clinical teams requesting pediatric palliative care consultation based upon a narrative review. BMC Palliat Care 2019; 18:116. [PMID: 31864331 PMCID: PMC6925857 DOI: 10.1186/s12904-019-0504-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Accepted: 12/09/2019] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND Despite evidence that referral to pediatric palliative care reduces suffering and improves quality of life for patients and families, many clinicians delay referral until the end of life. The purpose of this article is to provide a conceptual model for why clinical teams delay discussing palliative care with parents. DISCUSSION Building on a prior model of parent regoaling and relevant research literature, we argue for a conceptual model of the challenges and facilitators a clinical team might face in shifting from a restorative-focused treatment plan to a plan that includes palliative aspects, resulting in a subspecialty palliative care referral. Like patients and families, clinicians and clinical teams may recognize that a seriously ill patient would benefit from palliative care and shift from a restorative mindset to a palliative approach. We call this transition "clinician regoaling". Clinicians may experience inhibitors and facilitators to this transition at both the individual and team level which influence the clinicians' willingness to consult subspecialty palliative care. The 8 inhibitors to team level regoaling include: 1) team challenges due to hierarchy, 2) avoidance of criticizing colleagues, 3) structural communication challenges, 4) group norms in favor of restorative goals, 5) diffusion of responsibility, 6) inhibited expression of sorrow, 7) lack of social support, 8) reinforcement of labeling and conflict. The 6 facilitators of team regoaling include: 1) processes to build a shared mental model, 2) mutual trust to encourage dissent, 3) anticipating conflict and team problem solving, 4) processes for reevaluation of goals, 5) sharing serious news as a team, 6) team flexibility. CONCLUSIONS Recognizing potential team level inhibitors to transitioning to palliative care can help clinicians develop strategies for making the transition more effectively when appropriate.
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Affiliation(s)
- Jennifer K. Walter
- The Children’s Hospital of Philadelphia, 2716 South St 11th Floor, Philadelphia, PA 19146 USA
| | - Douglas L. Hill
- The Children’s Hospital of Philadelphia, 2716 South St 11th Floor, Philadelphia, PA 19146 USA
| | - Concetta DiDomenico
- The Children’s Hospital of Philadelphia, 2716 South St 11th Floor, Philadelphia, PA 19146 USA
| | - Shefali Parikh
- The Children’s Hospital of Philadelphia, 2716 South St 11th Floor, Philadelphia, PA 19146 USA
| | - Chris Feudtner
- The Children’s Hospital of Philadelphia, 2716 South St 11th Floor, Philadelphia, PA 19146 USA
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Walter JK, Schall TE, DeWitt AG, Faerber J, Griffis H, Galligan M, Miller V, Arnold RM, Feudtner C. Interprofessional Team Member Communication Patterns, Teamwork, and Collaboration in Pre-family Meeting Huddles in a Pediatric Cardiac Intensive Care Unit. J Pain Symptom Manage 2019; 58:11-18. [PMID: 31004773 PMCID: PMC6800217 DOI: 10.1016/j.jpainsymman.2019.04.009] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Revised: 04/10/2019] [Accepted: 04/12/2019] [Indexed: 11/28/2022]
Abstract
CONTEXT Interprofessional teams often develop a care plan before engaging in a family meeting in the pediatric cardiac intensive care unit (CICU)-a process that can affect the course of the family meeting and alter team dynamics but that has not been studied. OBJECTIVES To characterize the types of interactions that interprofessional team members have in pre-family meeting huddles in the pediatric CICU by 1) evaluating the amount of time each team member speaks; 2) assessing team communication and teamwork using standardized instruments; and 3) measuring team members' perceptions of collaboration and satisfaction with decision making. METHODS We conducted a prospective observational study in a pediatric CICU. Subjects were members of the interprofessional team attending preparation meetings before care meetings with families of patients admitted to the CICU for longer than two weeks. We quantitatively coded the amount each team member spoke. We assessed team performance of communication and teamwork using the PACT-Novice tool, and we measured perception of collaboration and satisfaction with decision making using the Collaboration and Satisfaction About Care Decisions questionnaire. RESULTS Physicians spoke for an average of 83.9% of each meeting's duration (SD 7.5%); nonphysicians averaged 9.9% (SD 5.2%). Teamwork behaviors were present and adequately performed as judged by trained observers. Significant differences in physician and nonphysician perceptions of collaboration were found in three of 10 observed meetings. CONCLUSION Interprofessional team members' interactions in team meetings provide important information about team dynamics, revealing potential opportunities for improved collaboration and communication in team meetings and subsequent family meetings.
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Affiliation(s)
- Jennifer K Walter
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.
| | - Theodore E Schall
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Aaron G DeWitt
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Jennifer Faerber
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Heather Griffis
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Meghan Galligan
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Victoria Miller
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Robert M Arnold
- University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Chris Feudtner
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
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Quiñoa-Salanova C, Porta-Sales J, Monforte-Royo C, Edo-Gual M. The experiences and needs of primary family caregivers of patients with multiple myeloma: A qualitative analysis. Palliat Med 2019; 33:500-509. [PMID: 30761947 DOI: 10.1177/0269216319830017] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND Family caregivers play a key role in the lives of patients with multiple myeloma. However, very little is known about the impact that the disease (its diagnosis, course and prognosis) has on the main family caregiver. AIM To achieve a deeper understanding of the lived experience of individuals who are the primary caregiver of a relative with multiple myeloma and to shed light on their needs. DESIGN Interpretative phenomenological study. SETTING AND PARTICIPANTS A total of 12 individuals who were the main family caregivers of a relative with multiple myeloma who was under outpatient follow-up at a cancer unit in Barcelona were recruited via purposive sampling until data saturation was reached. In semi-structured in-depth interviews, participants described their experiences of caring for their relative with multiple myeloma. Interviews were recorded, transcribed and analysed using ATLAS.ti v7.2. The seven steps proposed by Colaizzi were used for data analysis, and the relationships among emerging themes were examined. FINDINGS Four main themes emerged: (a) a new life, adapting to the disease, (b) commitment to the patient, (c) the emotional sphere and (d) experiences in relation to the care and support received. The analysis also revealed a core overarching theme: uncertainty. CONCLUSION Primary family caregivers experienced intense uncertainty, and they described a strong need to air their feelings. Specific practical initiatives, targeting both health-related and logistical aspects of care, need to be developed in order to support family caregivers of myeloma patients.
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Affiliation(s)
- Carmen Quiñoa-Salanova
- 1 Department of Nursing, Faculty of Medicine and Health Sciences, Universitat Internacional de Catalunya, Barcelona, Spain.,2 Consorci Corporació Sanitària Parc Taulí, Sabadell, Spain
| | - Josep Porta-Sales
- 3 Palliative Care Service, Institut Català d'Oncologia (ICO), Barcelona, Spain.,4 Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain.,5 Faculty of Medicine and Health Sciences, Universitat Internacional de Catalunya, Barcelona, Spain
| | - Cristina Monforte-Royo
- 1 Department of Nursing, Faculty of Medicine and Health Sciences, Universitat Internacional de Catalunya, Barcelona, Spain
| | - Montserrat Edo-Gual
- 6 Department of Nursing, Escola Universitària d'Infermeria Gimbernat, Barcelona, Spain
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Bowman P, Slusser K, Allen D. Collaborative Practice Model: Improving the Delivery of Bad News. Clin J Oncol Nurs 2018; 22:23-27. [DOI: 10.1188/18.cjon.23-27] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Dodd GD, Restauri NL, Kondo KL, Lewis PJ. Driving Innovation in Radiology: A Summary of the 2015 Intersociety Committee Summer Conference. J Am Coll Radiol 2016; 13:1477-1482. [DOI: 10.1016/j.jacr.2016.06.027] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2016] [Revised: 06/16/2016] [Accepted: 06/17/2016] [Indexed: 11/24/2022]
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Russo A, De Luca R, Cicero G, Civilleri A, Bronte G, Dispenza J, Vieni S, Guarneri R, Cascio VL, Guadagna FP, Foddai E, Pace F. Well-being among Italian medical oncologists: an exploratory study. Oncology 2014; 86:72-8. [PMID: 24401657 DOI: 10.1159/000354642] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2013] [Accepted: 07/16/2013] [Indexed: 11/19/2022]
Abstract
BACKGROUND Recently, attention has been focused on physicians' stress and quality-of-life improvement. Due to their relationship with patients, oncologists in particular are overloaded physically, emotionally and psychologically. Previous studies showed that training of communication skills improves the satisfaction and well-being of physicians and patients. AIMS Our research investigates the relationship between work stress and engagement and personal well-being in physicians working in Italian hospitals. MATERIALS AND METHODS 176 physicians were included. Doctors filled out self-report questionnaires to evaluate work stress and coping strategies, personal well-being, work engagement and two purpose-built scales to measure the degree of perceived organizational support and the level of specific training of social and relational skills. Descriptive statistics were used to analyze data, as well as correlation analysis (Pearson's r), hierarchical regression analysis (enter step) and analysis of variance (one-way ANOVA). RESULT Positive and significant correlations were found between variables. Moreover, physicians who obtained higher levels of specific training on social and relational skills reported lower levels of stress. Oncologists experienced greater stress than other physicians in terms of maladaptive coping and lack of additional training. CONCLUSIONS The study suggests that physicians' well-being is mediated by professional aspects, such as social skills in relationships with patients.
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Affiliation(s)
- Antonio Russo
- Department of Surgical, Oncological and Oral Sciences, University of Palermo, Palermo, Italy
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Bellardita L, Donegani S, Spatuzzi AL, Valdagni R. Multidisciplinary Versus One-on-One Setting: A Qualitative Study of Clinicians' Perceptions of Their Relationship With Patients With Prostate Cancer. J Oncol Pract 2013; 7:e1-5. [PMID: 21532797 DOI: 10.1200/jop.2010.000020] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/22/2010] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Previous studies indicate that a multidisciplinary approach could be suitable for dealing with the complex issues faced by physicians in the management of prostate cancer; however, few studies have investigated clinicians' perceptions of multidisciplinary care. Our aim was to evaluate clinicians' perceptions of the patient-clinician relationship in a multidisciplinary context, and to compare this with physicians' perceptions of providing care independently. METHODS A qualitative observational study was performed in 2009. Three radiation oncologists, three urologists, three medical oncologists and one psychologist from the multidisciplinary clinic (MDC) team at the Prostate Program of Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy, were interviewed to assess their perceptions of their relationship with the patient. RESULTS Clinicians reported that the MDC has advantages regarding providing patients with more accurate information and acquiring information from patients, but a clear preference for a multidisciplinary setting did not emerge. Clinicians reported that in one-on-one examinations (1) they feel more comfortable listening to the patient and more able to manage communication, and that (2) the process of building trust is easier. CONCLUSION Clinicians appear to recognize the value of the MDC in terms of effective communication with patients but feel that other aspects of relationship building are hindered in a multidisciplinary setting. Organizational and teamwork issues need to be addressed to optimize the implementation of a multidisciplinary approach.
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Affiliation(s)
- Lara Bellardita
- Prostate Program Scientific Director's Office, Fondazione Istituto di Ricovera e Cura a Carattere Scientifico, Istituto Nazionale dei Tumori, Milan, Italy
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11
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Mangel L, Kövér E, Szilágyi I, Varga Z, Bércesi E, Nagy Z, Holcz T, Karádi O, Farkas R, Csák S, Csere T, Kásler M. [Novel quality assurance method in oncology: the two-level, multi-disciplinary and oncotherapy oncology team system]. Orv Hetil 2012; 153:1984-91. [PMID: 23220364 DOI: 10.1556/oh.2012.29512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
By now therapy decision taken by a multi-disciplinary oncology team in cancer care has become a routine method in worldwide. However, multi-disciplinary oncology team has to face more and more difficulties in keeping abreast with the fast development in oncology science, increasing expectations, and financial considerations. Naturally the not properly controlled decision mechanisms, the permanent lack of time and shortage of professionals are also hindering factors. Perhaps it would be a way out if the staff meetings and discussions of physicians in the oncology departments were transformed and provided with administrative, legal and decision credentials corresponding to those of multi-disciplinary oncology team. The new form of the oncotherapy oncoteam might be able to decide the optimal and particular treatment after previous consultation with the patient. The oncotherapy oncoteam is also suitable to carry out training and tasks of a cancer centre and by diminishing the psychological burden of the doctors it contributes to an improved patient care. This study presents the two-level multi-disciplinary and oncotherapy oncology team system at the University of Pécs including the detailed analysis of the considerations above.
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Affiliation(s)
- László Mangel
- Pécsi Tudományegyetem, Klinikai Központ Onkoterápiás Intézet Pécs Édesanyák útja.
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12
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Olver IN, Eliott JA, Long L, McKinnon M, Rumsby G. The impact of receiving treatment for cancer at a large metropolitan teaching hospital as recorded by patients using unstructured journals. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2012; 27:625-630. [PMID: 23007854 DOI: 10.1007/s13187-012-0415-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
The aim was to obtain patients' experiences of the cancer treatment pathway at a tertiary teaching hospital using unstructured journals to enable health care professionals to be educated on how to improve patient care. Most of 38 patients (22 females and 16 males), average age of 58 (range 29-80), who returned diaries were starting chemotherapy for a range of cancers. Data entries were transcribed and entered into the NVIVO software to facilitate thematic analysis. Women wrote more, and more often than men, and disclosed more. For most, physical side effects dominated, comprising 25-75 % of diary entries. The most commonly mentioned were fatigue (74 %), pain (63 %), sleep disturbances (50 %), nausea (45 %) and changes in appetite (45 %). Collectively, 22 patients reported 261 separate emotional reactions including depression, anger, guilt, shame, grief, panic and confusion. The treatment environment, including personnel, impacted upon patients. Where survival is unpredictable, evidence of consistency of practitioners' approaches attains heightened significance.
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Affiliation(s)
- Ian N Olver
- Cancer Council Australia, 477 Pitt Street, Sydney, 2000, Australia.
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Brown J, Lewis L, Ellis K, Stewart M, Freeman TR, Kasperski MJ. Conflict on interprofessional primary health care teams – can it be resolved? J Interprof Care 2010; 25:4-10. [DOI: 10.3109/13561820.2010.497750] [Citation(s) in RCA: 153] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Bernhardt BA, Silver R, Rushton CH, Micco E, Geller G. What keeps you up at night? Genetics professionals' distressing experiences in patient care. Genet Med 2010; 12:289-97. [PMID: 20386316 DOI: 10.1097/gim.0b013e3181db82d9] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
PURPOSE To explore specific patient care experiences that genetics professionals associate with distress and the emotions engendered by those experiences. METHODS We conducted semistructured telephone interviews with clinical geneticists, genetic counselors, and genetic nurses that focused on a single distressing experience. RESULTS Fourteen clinical geneticists, 25 genetic counselors, and 14 nurses were interviewed. We categorized the situations that interviewees associated with distressing patient care experiences into seven major types: patient/family decisions (27% of total situations), giving bad news (17%), colleague behavior (15%), end-of-life issues (12%), unintended outcomes (12%), difficult patients (8%), and injustice/inhumanity (8%). Interviewees reported experiencing a variety of negative emotions during these situations, including anger, guilt, helplessness, and inadequacy. CONCLUSIONS The distress and resulting emotions experienced by genetic service providers must be acknowledged. Interventions are needed to assist the clinician in becoming self-aware by reflecting on experienced emotions, examining belief systems and values, and understanding the connection between their emotions and behavior. Involvement in mindfulness meditation, reflective writing, peer support groups or additional communication skill-based training could address this need. In addition, clinicians should seek ways to increase personal meaning derived from providing patient care.
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Affiliation(s)
- Barbara A Bernhardt
- Department of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania 19104, USA.
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Jazieh AR, Al Hadab A, Howington J. Thoracic oncology multidisciplinary teams: between the promises and challenges. Ann Thorac Med 2010; 3:34-7. [PMID: 19561883 PMCID: PMC2700435 DOI: 10.4103/1817-1737.38395] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2007] [Accepted: 12/15/2007] [Indexed: 11/18/2022] Open
Abstract
The thoracic oncology multidisciplinary teams are playing an increasing role in the management of thoracic malignancies. These teams have a great potential to improve the patient care and the health care system, however, they are faced by many challenges. To realize the full potential of these teams, a better understanding of their functions, roles, benefits and challenges from all involved including teams members and leadership is crucial.
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Affiliation(s)
- Abdul-Rahman Jazieh
- Department of Oncology, King Abdul-Aziz Medical City, King Fahad National Guard Hospital, Saudi Arabia.
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Affiliation(s)
- Jeffrey Braithwaite
- Australian Institute of Health Innovation, Faculty of Medicine, University of New South Wales NSW 2052, Australia.
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Geffen JR. Integrative Oncology for the Whole Person: A Multidimensional Approach to Cancer Care. Integr Cancer Ther 2010; 9:105-21. [DOI: 10.1177/1534735409355172] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Today, more than ever before, millions of people are seeking an approach to medicine and health care that is more comprehensive, more holistic and integrative, and more compassionate and sensitive to their needs as a whole person. This is particularly true for those dealing with cancer. Changing patient demographics, heightened consumer demand for complementary and alternative medicine (CAM) products and services, advances in medical science and technology, expanding access to the Internet and health information, and other factors have contributed to a wave of transformation that is unprecedented in its impact on the entire health care system. These trends have fueled the emerging fields of integrative medicine and oncology, which are growing rapidly. As these fields continue to evolve, they will move beyond the present integrative model to a broader vision of whole-person, multidimensional care that will more fully and coherently address and embrace all dimensions of the human experience. This article describes 6 major driving forces behind the wave of transformation presently under way in medicine and health care. It provides a brief, historical overview of integrative medicine and oncology and summarizes the present status of these emerging fields. It discusses the future of integrative medicine and oncology, including a multidimensional approach to care, and highlights 5 key elements that underlie this approach. Finally, it describes The Seven Levels of Healing — a model of multidimensional care—and concludes with a discussion of 3 important challenges and opportunities for medicine and health care that lie on the horizon.
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Wong BM, Quan S, Shadowitz S, Etchells E. Implementation and evaluation of an alpha-numeric paging system on a resident inpatient teaching service. J Hosp Med 2009; 4:E34-40. [PMID: 19827043 DOI: 10.1002/jhm.488] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Numeric pagers are commonly used communication devices in healthcare, but cannot convey important information such as the reason for or urgency of the page. Alphanumeric pagers can display both numbers and text, and may address some of these communication problems. OBJECTIVE Our primary aim was to implement an alphanumeric paging system. DESIGN Continuous quality improvement study using rapid-cycle change methods. SETTING General Internal Medicine (GIM) inpatient wards at 1 tertiary care academic teaching hospital. PARTICIPANTS All residents, attending physicians, nurses, and allied health staff working on the general medicine (GM) wards. MEASUREMENTS We measured: (1) the proportion of pages sent as text pages, (2) the source of the pages, (3) the content of the text pages, (4) the pages that disrupted scheduled education activities, and (5) satisfaction with the alphanumeric paging system. RESULTS After implementation, 52% of pages sent from physicians or the GM wards were sent as text pages (P < 0.001). 93% of pages between physicians were text pages, compared to 27% of pages from the GM wards to physicians (P < 0.001). The most common reason for text paging among physicians was to arrange work or teaching rounds (33%). The most common reason for text paging from the GM wards was to request a patient assessment or for notification of a patient's clinical status (25%). There was a 29% reduction in disruptive pages sent during scheduled educational rounds (P < 0.001). CONCLUSIONS We successfully implemented an alphanumeric paging system that reduced disruptive pages on a GM inpatient service.
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Affiliation(s)
- B M Wong
- Division of General Internal Medicine, Department of Medicine, University of Toronto, Toronto, Ontario, Canada.
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Kuziemsky CE, Borycki EM, Purkis ME, Black F, Boyle M, Cloutier-Fisher D, Fox LA, MacKenzie P, Syme A, Tschanz C, Wainwright W, Wong H. An interdisciplinary team communication framework and its application to healthcare 'e-teams' systems design. BMC Med Inform Decis Mak 2009; 9:43. [PMID: 19754966 PMCID: PMC2753306 DOI: 10.1186/1472-6947-9-43] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2009] [Accepted: 09/15/2009] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND There are few studies that examine the processes that interdisciplinary teams engage in and how we can design health information systems (HIS) to support those team processes. This was an exploratory study with two purposes: (1) To develop a framework for interdisciplinary team communication based on structures, processes and outcomes that were identified as having occurred during weekly team meetings. (2) To use the framework to guide 'e-teams' HIS design to support interdisciplinary team meeting communication. METHODS An ethnographic approach was used to collect data on two interdisciplinary teams. Qualitative content analysis was used to analyze the data according to structures, processes and outcomes. RESULTS We present details for team meta-concepts of structures, processes and outcomes and the concepts and sub concepts within each meta-concept. We also provide an exploratory framework for interdisciplinary team communication and describe how the framework can guide HIS design to support 'e-teams'. CONCLUSION The structures, processes and outcomes that describe interdisciplinary teams are complex and often occur in a non-linear fashion. Electronic data support, process facilitation and team video conferencing are three HIS tools that can enhance team function.
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Affiliation(s)
- Craig E Kuziemsky
- Telfer School of Management, University of Ottawa, Ottawa, Ontario, Canada.
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Porter-Williamson K, Parker M, Babbott S, Steffen P, Stites S. A Model to Improve Value: The Interdisciplinary Palliative Care Services Agreement. J Palliat Med 2009; 12:609-15. [DOI: 10.1089/jpm.2009.0014] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Affiliation(s)
| | - Marilyn Parker
- Department of Internal Medicine, University of Kansas Medical Center, Kansas City, Kansas
| | - Stewart Babbott
- Department of Internal Medicine, University of Kansas Medical Center, Kansas City, Kansas
| | - Patrick Steffen
- Department of Internal Medicine, University of Kansas Medical Center, Kansas City, Kansas
| | - Steven Stites
- Department of Internal Medicine, University of Kansas Medical Center, Kansas City, Kansas
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Robinson KM, Reinhard SC. Looking Ahead in Long-Term Care: The Next 50 Years. Nurs Clin North Am 2009; 44:253-62. [DOI: 10.1016/j.cnur.2009.02.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Baker J, Ajani J, Scotté F, Winther D, Martin M, Aapro MS, von Minckwitz G. Docetaxel-related side effects and their management. Eur J Oncol Nurs 2009; 13:49-59. [PMID: 19201649 DOI: 10.1016/j.ejon.2008.10.003] [Citation(s) in RCA: 171] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Docetaxel is an effective treatment approved in five key cancers, but its effectiveness in clinical practice can be compromised by sub-optimal side-effect management. The aim of this review was to investigate the extent of the published work on specific docetaxel-related side effects and to provide, where possible, evidence-based recommendations for their prevention and management. PubMed and the American Society of Clinical Oncology (ASCO) databases were systematically searched for articles published in English over the past 5 years and 2 years, respectively, and pertaining to six side effects identified as being common to the majority of docetaxel regimens and indications and of particular relevance to the oncology nurse. The Cochrane library was also searched. A total of 103 citations were identified, 14 of which discussed strategies for the prevention or management of febrile neutropenia (n=6), hypersensitivity reactions (3), fluid retention (1) and nail changes (4). No articles were identified that related to asthenia or neuropathy. Based on the literature review, evidence/guidelines-based advice for the use of G-CSF in febrile neutropenia is provided. The evidence base with respect to the other side effects does not permit the formulation of recommendations. It is the experience of the authors, however, that the severity of symptoms experienced by patients is generally mild and the side effects are for the most part easily managed with prophylactic and supportive care measures. It is, therefore, important to share and build on experiences, through research and discussion, to maximise the healthcare professional's ability to offer the best standard of care to patients.
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Affiliation(s)
- Jackie Baker
- University of Texas MD Anderson Cancer Center, Gastrointestinal Medical Oncology, Faculty Center, Houston, TX 77030, USA.
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Cashavelly BJ, Donelan K, Binda KD, Mailhot JR, Clair-Hayes KA, Maramaldi P. The forgotten team member: meeting the needs of oncology support staff. Oncologist 2008; 13:530-8. [PMID: 18515738 DOI: 10.1634/theoncologist.2008-0023] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION The impact of working in an oncology setting has been widely researched for physicians, nurses, social workers, and chaplains. The experiences of nonlicensed support staff in an oncology setting have rarely been acknowledged or addressed. Few studies have addressed support or education initiatives for support staff caring for oncology patients. The intent of this study was to understand the work experiences of oncology support staff. Emotional impact, patient relationships, and team relationships were addressed. These data would help shape the development of an oncology support staff program. METHODS A qualitative and quantitative approach was used to explore the experiences of support staff. Seven focus groups and individual interviews were conducted addressing work life in a cancer center. The quantitative survey collected baseline data on job satisfaction, working relationships, patient relationships, burnout, and support programs. RESULTS Four predominant themes emerged from the focus groups. These included: relationships with patients and families, coping with death and dying, value and recognition, and balancing function with emotion. The quantitative survey reported the highest satisfaction with patient relationships and the lowest satisfaction with job recognition and supervisor support. High personal accomplishment scores declined with duration of employment. Educational grand rounds were a high interest. DISCUSSION This study provides insight into the impact of caring for oncology patients on support staff. Burnout and job satisfaction can be costly. Recognizing the challenges inherent in the oncology environment is essential to supporting a successful oncology practice for licensed and nonlicensed support staff.
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Affiliation(s)
- Barbara J Cashavelly
- MGH Cancer Center, Massachusetts General Hospital, Boston, Massachusetts 02114, USA.
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Levetown M. Communicating with children and families: from everyday interactions to skill in conveying distressing information. Pediatrics 2008; 121:e1441-60. [PMID: 18450887 DOI: 10.1542/peds.2008-0565] [Citation(s) in RCA: 279] [Impact Index Per Article: 17.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Health care communication is a skill that is critical to safe and effective medical practice; it can and must be taught. Communication skill influences patient disclosure, treatment adherence and outcome, adaptation to illness, and bereavement. This article provides a review of the evidence regarding clinical communication in the pediatric setting, covering the spectrum from outpatient primary care consultation to death notification, and provides practical suggestions to improve communication with patients and families, enabling more effective, efficient, and empathic pediatric health care.
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