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Mazariego CG, McKay S, Tyedmers E, Kelada L, McGill BC, Daly R, Wakefield CE, Ziegler DS, Taylor N. Co-design of a paediatric oncology medicines database (ProCure) to support complex care provision for children with a hard-to-treat cancer. Front Med (Lausanne) 2024; 11:1332434. [PMID: 38606155 PMCID: PMC11007026 DOI: 10.3389/fmed.2024.1332434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Accepted: 03/05/2024] [Indexed: 04/13/2024] Open
Abstract
Objectives Paediatric oncologists often encounter challenges when seeking compassionate access to off-label therapies for their patients. This study employed implementation science and co-design techniques to develop the ProCure medicines database, with the goal of streamlining the application process and addressing identified barriers in paediatric oncology. Methods This study utilised an exploratory qualitative research design. Seventeen healthcare providers, including oncologists, nurse consultants, and allied health professionals, participated in semi-structured interviews guided by the Consolidated Framework for Implementation Research (CFIR) and a visual process map aid. Deductive qualitative data analysis, according to the CFIR constructs, identified key barriers and facilitators. Collaborative design sessions engaged multidisciplinary teams to develop the ProCure beta version. Results Barriers to off-label therapy access included resource-intensive applications, time sensitive decision-making, and complex pharmaceutical information. Facilitators included Drug Access Navigators, Molecular Tumour Boards, and a multi-disciplinary approach. ProCure addressed end-user needs by centralising medicines information. Additional features suggested by healthcare providers included blood-brain-barrier penetrability data and successful application examples. Conclusion ProCure represents a promising solution to the challenges paediatric oncologists face in accessing off-label therapies. By centralising information, it simplifies the application process, aids decision-making, and promotes a collaborative approach to patient care. The potential of the database to stream and enhance off-label therapy access underscores its relevance in improving paediatric oncology practise. Further research and implementation efforts are warranted to assess ProCure's real-world impact and refine its features based on user feedback.
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Affiliation(s)
- Carolyn G. Mazariego
- School of Population Health, UNSW Medicine and Health, UNSW Sydney, Sydney, NSW, Australia
| | - Skye McKay
- School of Population Health, UNSW Medicine and Health, UNSW Sydney, Sydney, NSW, Australia
| | - Elijah Tyedmers
- School of Population Health, UNSW Medicine and Health, UNSW Sydney, Sydney, NSW, Australia
| | - Lauren Kelada
- School of Clinical Medicine, University of New South Wales (UNSW) Sydney, Sydney, NSW, Australia
- Kids Cancer Centre, Sydney Children’s Hospital, Sydney, NSW, Australia
| | - Brittany C. McGill
- School of Clinical Medicine, University of New South Wales (UNSW) Sydney, Sydney, NSW, Australia
- Kids Cancer Centre, Sydney Children’s Hospital, Sydney, NSW, Australia
| | - Rebecca Daly
- School of Clinical Medicine, University of New South Wales (UNSW) Sydney, Sydney, NSW, Australia
- Kids Cancer Centre, Sydney Children’s Hospital, Sydney, NSW, Australia
| | - Claire E. Wakefield
- School of Clinical Medicine, University of New South Wales (UNSW) Sydney, Sydney, NSW, Australia
- Kids Cancer Centre, Sydney Children’s Hospital, Sydney, NSW, Australia
| | - David S. Ziegler
- Kids Cancer Centre, Sydney Children’s Hospital, Sydney, NSW, Australia
- Children’s Cancer Institute Australia, Lowy Cancer Research Centre, Sydney, NSW, Australia
| | - Natalie Taylor
- School of Population Health, UNSW Medicine and Health, UNSW Sydney, Sydney, NSW, Australia
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Kohler BE, Baque E, Sandler CX, Jones T, Terranova CO, Brookes DSK, Hassall T, Bradford NK, Trost SG. Goal-directed therapeutic exercise for paediatric posterior fossa brain tumour survivors: a qualitative analysis of experiences. Support Care Cancer 2024; 32:125. [PMID: 38252320 PMCID: PMC10803389 DOI: 10.1007/s00520-024-08327-3] [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: 08/22/2023] [Accepted: 01/12/2024] [Indexed: 01/23/2024]
Abstract
PURPOSE To explore child and parent experiences of a 12-week goal-directed therapeutic exercise intervention in paediatric posterior fossa brain tumours survivors and to identify features of the program that influenced program adherence and acceptability. METHODS Eleven interviews were conducted; five parent-child dyads (mothers = 83%) and one parent only (mean child age = 10.6 ± 3.0 years; 83% male). Posterior fossa brain tumour survivors, who participated in a weekly goal-directed exercise program for 12 weeks, completed semi-structured interviews to discuss their experience of the program. An inductive content analysis was undertaken. Interviews were transcribed, imported into NVivo and independently coded by two reviewers. Code and content categories were iteratively discussed and refined. RESULTS Five content categories were generated: (1) perceived improvements, (2) program logistics, (3) activity selection, (4) connection with the therapist and (5) options for technology. All participants valued the tailored exercise program and described improvements in movement competence. Children and their parents discussed preferring home- and community-based locations and favoured face-to-face delivery. Occasionally, parents reported difficulty completing the home program due to low child motivation or family time restrictions. Multiple families suggested an interactive digital application would be an effective delivery channel for the supplemental home-based program. CONCLUSION A goal-directed exercise program delivered at home and in community-based locations was considered valuable and helpful for improving movement competence in paediatric survivors of posterior fossa brain tumour. TRIAL REGISTRATION ACTRN12619000841178 June 12, 2019.
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Affiliation(s)
- Brooke E Kohler
- Faculty of Health at the Queensland Centre for Children's Health Research, Queensland University of Technology (QUT) Brisbane, Brisbane, Australia
| | - Emmah Baque
- School of Health Sciences and Social Work, Griffith University, Nathan, Australia
| | - Carolina X Sandler
- Sport and Exercise Science, School of Health Sciences, Western Sydney University, Sydney, Australia
- UNSW Fatigue Research Program, Kirby Institute, University of New South Wales, Sydney, Australia
- Menzies Health Institute Queensland, Griffith University, Brisbane, Australia
| | - Taryn Jones
- Faculty of Health at the Queensland Centre for Children's Health Research, Queensland University of Technology (QUT) Brisbane, Brisbane, Australia
| | - Caroline O Terranova
- Faculty of Health at the Queensland Centre for Children's Health Research, Queensland University of Technology (QUT) Brisbane, Brisbane, Australia
| | - Denise S K Brookes
- Faculty of Health at the Queensland Centre for Children's Health Research, Queensland University of Technology (QUT) Brisbane, Brisbane, Australia
| | | | - Natalie K Bradford
- Faculty of Health at the Queensland Centre for Children's Health Research, Queensland University of Technology (QUT) Brisbane, Brisbane, Australia
- Cancer and Palliative Care Outcomes Centre, at Centre for Children's Health Research, Queensland University of Technology, South Brisbane, Australia
| | - Stewart G Trost
- Children's Health Queensland, Brisbane, Australia.
- School of Human Movement and Nutrition Sciences, University of Queensland, Brisbane, Australia.
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Chileshe M, Bunkley EN, Hunleth J. The Rural Household Production of Health Approach: Applying Lessons from Zambia to Rural Cancer Disparities in the U.S. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19020974. [PMID: 35055795 PMCID: PMC8776173 DOI: 10.3390/ijerph19020974] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Revised: 12/14/2021] [Accepted: 01/12/2022] [Indexed: 12/10/2022]
Abstract
The recent focus on rural-urban cancer disparities in the United States (U.S.) requires a comprehensive understanding of the processes and relations that influence cancer care seeking and decision making. This is of particular importance for Black, Latino, and Native populations living in rural areas in the U.S., who remain marginalized in health care spaces. In this article, we describe the household production of health approach (HHPH) as a contextually-sensitive approach to examining health care seeking and treatment decisions and actions. The HHPH approach is based on several decades of research and grounded in anthropological theory on the household, gender, and therapy management. This approach directs analytical attention to how time, money, and social resources are secured and allocated within the household, sometimes in highly unequal ways that reflect and refract broader social structures. To demonstrate the benefits of such an approach to the study of cancer in rural populations in the U.S., we take lessons from our extensive HHPH research in Zambia. Using a case study of a rural household, in which household members had to seek care in a distant urban hospital, we map out what we call a rural HHPH approach to bring into focus the relations, negotiations, and interactions that are central to individual and familial health care seeking behaviors and clinical treatment particular to rural regions. Our aim is to show how such an approach might offer alternative interpretations of existing rural cancer research in the U.S. and also present new avenues for questions and for developing interventions that are more sensitive to people's realities.
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Affiliation(s)
- Mutale Chileshe
- Behavioural Science Unit, Clinical Sciences Department, Michael Chilufya Sata School of Medicine, Copperbelt University, Ndola P.O. Box 21692, Zambia
| | - Emma Nelson Bunkley
- Department of Surgery, Division of Public Health Sciences, Washington University School of Medicine, St. Louis, MO 63110, USA;
| | - Jean Hunleth
- Department of Surgery, Division of Public Health Sciences, Washington University School of Medicine, St. Louis, MO 63110, USA;
- Correspondence:
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