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Alonso-Jáudenes Curbera G, Gómez-Randulfe Rodríguez MI, Alonso de Castro B, Silva Díaz S, Parajó Vázquez I, Gratal P, López López R, García Campelo R. Improving quality of care by standardising patient data collection in electronic medical records in an oncology department in Spain. BMJ Open Qual 2024; 13:e002732. [PMID: 38901878 PMCID: PMC11191778 DOI: 10.1136/bmjoq-2023-002732] [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: 12/26/2023] [Accepted: 06/06/2024] [Indexed: 06/22/2024] Open
Abstract
BACKGROUND Evaluation of quality of care in oncology is key in ensuring patients receive adequate treatment. American Society of Clinical Oncology's (ASCO) Quality Oncology Practice Initiative (QOPI) Certification Program (QCP) is an international initiative that evaluates quality of care in outpatient oncology practices. METHODS We retrospectively reviewed free-text electronic medical records from patients with breast cancer (BR), colorectal cancer (CRC) or non-small cell lung cancer (NSCLC). In a baseline measurement, high scores were obtained for the nine disease-specific measures of QCP Track (2021 version had 26 measures); thus, they were not further analysed. We evaluated two sets of measures: the remaining 17 QCP Track measures, as well as these plus other 17 measures selected by us (combined measures). Review of data from 58 patients (26 BR; 18 CRC; 14 NSCLC) seen in June 2021 revealed low overall quality scores (OQS)-below ASCO's 75% threshold-for QCP Track measures (46%) and combined measures (58%). We developed a plan to improve OQS and monitored the impact of the intervention by abstracting data at subsequent time points. RESULTS We evaluated potential causes for the low OQS and developed a plan to improve it over time by educating oncologists at our hospital on the importance of improving collection of measures and highlighting the goal of applying for QOPI certification. We conducted seven plan-do-study-act cycles and evaluated the scores at seven subsequent data abstraction time points from November 2021 to December 2022, reviewing 404 patients (199 BR; 114 CRC; 91 NSCLC). All measures were improved. Four months after the intervention, OQS surpassed the quality threshold and was maintained for 10 months until the end of the study (range, 78-87% for QCP Track measures; 78-86% for combined measures). CONCLUSIONS We developed an easy-to-implement intervention that achieved a fast improvement in OQS, enabling our Medical Oncology Department to aim for QOPI certification.
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Affiliation(s)
| | | | - Beatriz Alonso de Castro
- Complexo Hospitalario Universitario A Coruña, A Coruña, Spain
- A Coruña Biomedical Research Institute, A Coruña, Spain
| | - Sofía Silva Díaz
- Complexo Hospitalario Universitario A Coruña, A Coruña, Spain
- A Coruña Biomedical Research Institute, A Coruña, Spain
| | - Iria Parajó Vázquez
- Complexo Hospitalario Universitario A Coruña, A Coruña, Spain
- A Coruña Biomedical Research Institute, A Coruña, Spain
| | | | - Rafael López López
- Fundación ECO, Madrid, Spain
- Health Research Institute of Santiago de Compostela, Santiago de Compostela, Spain
| | - Rosario García Campelo
- Complexo Hospitalario Universitario A Coruña, A Coruña, Spain
- A Coruña Biomedical Research Institute, A Coruña, Spain
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Hernández JJC, Arrula VA, Álvarez YE, Castaño AG, de Castro JJG, Docampo LI, Sorrosal JL, Segura PP, Domínguez AR, Campos-Lucas FJ, Rodríguez IS, Bessa M, Gratal P, Caballero-Martínez F, Martín DM, Antón-Rodríguez C, López R. Indicators to evaluate quality of care in head and neck cancer in Spain. Clin Transl Oncol 2024; 26:1089-1097. [PMID: 37848694 PMCID: PMC11026290 DOI: 10.1007/s12094-023-03298-z] [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: 05/18/2023] [Accepted: 07/25/2023] [Indexed: 10/19/2023]
Abstract
PURPOSE This study aimed to develop a set of criteria and indicators to evaluate the quality of care of patients with head and neck cancer (HNC). METHODS A systematic literature review was conducted to identify valuable criteria/indicators for the assessment of the quality of care in HNC. With the aid of a technical group, a scientific committee of oncologists specialised in HNC used selected criteria to propose indicators that were evaluated with a two-round Delphi method. Indicators on which consensus was achieved were then prioritised by the scientific committee to develop a final set of indicators. RESULTS We proposed a list of 50 indicators used in the literature or developed by us to be evaluated with a Delphi method. There was consensus on the appropriateness of 47 indicators in the first round; the remaining 3 achieved consensus in the second round. The 50 indicators were scored to prioritise them, leading to a final selection of 29 indicators related to structure (3), process (22), or outcome (4) and covering diagnosis, treatment, follow-up, and health outcomes in patients with HNC. Easy-to-use index cards were developed for each indicator, with their criterion, definition, formula for use in real-world clinical practice, rationale, and acceptable level of attainment. CONCLUSIONS We have developed a set of 29 evidence-based and expert-supported indicators for evaluating the quality of care in HNC, covering diagnosis, treatment, follow-up, and health outcomes.
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Affiliation(s)
- Juan Jesús Cruz Hernández
- Departamento de Medicina, Universidad de Salamanca, Consejero Emérito de la Fundación ECO, Campus Universitario Miguel de Unamuno s/n, 37007, Salamanca, Spain.
- Fundación ECO, Madrid, Spain.
| | | | - Yolanda Escobar Álvarez
- Fundación ECO, Madrid, Spain
- Servicio de Oncología Médica, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Almudena García Castaño
- Servicio de Oncología Médica, Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | | | | | - Julio Lambea Sorrosal
- Servicio de Oncología Médica, Hospital Clínico Universitario Lozano Blesa, Saragossa, Spain
| | - Pedro Pérez Segura
- Fundación ECO, Madrid, Spain
- Servicio de Oncología Médica, Hospital Clínico San Carlos, Madrid, Spain
| | - Antonio Rueda Domínguez
- Fundación ECO, Madrid, Spain
- Servicio de Oncología Médica, Hospital Regional Universitario de Málaga, Málaga, Spain
| | | | | | | | | | | | | | | | - Rafael López
- Fundación ECO, Madrid, Spain
- Servicio de Oncología Médica, Hospital Clínico Universitario e Instituto de Investigación Sanitaria (IDIS) de Santiago de Compostela, CIBERONC, Santiago de Compostela, Spain
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Feizpour CA, Turk A, Mohanty S. Quality of Life Outcomes in Stage IV Colorectal Cancer. Clin Colon Rectal Surg 2024; 37:102-107. [PMID: 38322606 PMCID: PMC10843882 DOI: 10.1055/s-0043-1761476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2024]
Abstract
With improvements across the colorectal cancer care continuum, from screening and earlier detection to better systemic options, patients are living longer with the disease. Given these improvements over the last several decades, quality of life outcomes have become important components when evaluating treatment efficacy and adverse effects. This article reviews quality of life measurement generally, discusses tools currently being used in colorectal cancer patients, and reviews outcomes following both surgical and nonsurgical management from clinical trials, observational studies, and meta-analyses.
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Affiliation(s)
- Cyrus Ali Feizpour
- Division of General Surgery, Department of Surgery, Indiana University School of Medicine, Indianapolis, Indiana
| | - Anita Turk
- Division of Hematology/Oncology, Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana
| | - Sanjay Mohanty
- Division of General Surgery, Department of Surgery, Indiana University School of Medicine, Indianapolis, Indiana
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McLeod M, Torode J, Leung K, Bhoo-Pathy N, Booth C, Chakowa J, Gralow J, Ilbawi A, Jassem J, Parkes J, Mallafré-Larrosa M, Mutebi M, Pramesh CS, Sengar M, Tsunoda A, Unger-Saldaña K, Vanderpuye V, Yusuf A, Sullivan R, Aggarwal A. Quality indicators for evaluating cancer care in low-income and middle-income country settings: a multinational modified Delphi study. Lancet Oncol 2024; 25:e63-e72. [PMID: 38301704 DOI: 10.1016/s1470-2045(23)00568-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Revised: 10/29/2023] [Accepted: 10/30/2023] [Indexed: 02/03/2024]
Abstract
This Policy Review sourced opinions from experts in cancer care across low-income and middle-income countries (LMICs) to build consensus around high-priority measures of care quality. A comprehensive list of quality indicators in medical, radiation, and surgical oncology was identified from systematic literature reviews. A modified Delphi study consisting of three 90-min workshops and two international electronic surveys integrating a global range of key clinical, policy, and research leaders was used to derive consensus on cancer quality indicators that would be both feasible to collect and were high priority for cancer care systems in LMICs. Workshop participants narrowed the list of 216 quality indicators from the literature review to 34 for inclusion in the subsequent surveys. Experts' responses to the surveys showed consensus around nine high-priority quality indicators for measuring the quality of hospital-based cancer care in LMICs. These quality indicators focus on important processes of care delivery from accurate diagnosis (eg, histologic diagnosis via biopsy and TNM staging) to adequate, timely, and appropriate treatment (eg, completion of radiotherapy and appropriate surgical intervention). The core indicators selected could be used to implement systems of feedback and quality improvement.
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Affiliation(s)
- Megan McLeod
- Department of Otolaryngology, Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, TN, USA.
| | - Julie Torode
- Institute of Cancer Policy, Centre for Cancer, Society and Public Health, King's College London, London, UK
| | - Kari Leung
- Guy's and St Thomas' NHS Trust, London, UK
| | - Nirmala Bhoo-Pathy
- Department of Clinical Epidemiology, Universiti Malaya Medical Centre, Kuala Lampar, Malaysia
| | - Christopher Booth
- Department of Medical Oncology, Queen's University, Kingston, ON, Canada
| | | | - Julie Gralow
- American Society of Clinical Oncology, Alexandria, VA, USA
| | | | - Jacek Jassem
- Department of Oncology and Radiotherapy, Medical University of Gdańsk, Gdańsk, Poland
| | - Jeannette Parkes
- Division of Radiation Oncology, Groote Schuur Hospital and University of Cape Town, Cape Town, South Africa
| | - Merixtell Mallafré-Larrosa
- City Cancer Challenge, Geneva, Switzerland; Department of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain
| | - Miriam Mutebi
- Department of Surgery, Aga Khan University, Nairobi, Kenya
| | - C S Pramesh
- Department of Thoracic Surgery, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Manju Sengar
- Department of Medical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Audrey Tsunoda
- Department of Gynecologic Oncology, Pontifical Catholic University of Paraná, Curitiba, Brazil
| | | | - Verna Vanderpuye
- National Centre for Radiotherapy, Korle-Bu Teaching Hospital, Accra, Ghana
| | - Aasim Yusuf
- Department of Gastroenterology, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Peshawar, Pakistan
| | - Richard Sullivan
- Institute of Cancer Policy, Centre for Cancer, Society and Public Health, King's College London, London, UK; Global Oncology Group, Centre for Cancer, Society and Public Health, King's College London, London, UK
| | - Ajay Aggarwal
- Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London, UK
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Grant MJ, Chiang AC. Telehealth and Outcomes in Patients With Cancer: Data and Innovation. Cancer J 2024; 30:16-21. [PMID: 38265921 DOI: 10.1097/ppo.0000000000000697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2024]
Abstract
ABSTRACT Despite that telehealth has been crucial to the delivery of oncology care during the COVID-19 pandemic, the impact of this care delivery mechanism on outcomes in cancer care has not been rigorously studied relative standard in-person care for patients with cancer. Patient-centered outcomes such as quality of life, patient satisfaction, and symptoms are important outcomes that have been the primary focus of many of the existing studies in this space, yet only a select few have evaluated overall survival and other objective efficacy endpoints. Studies have alluded to positive effects of telehealth on mitigating financial toxicity and enhancing cost-effective care delivery in oncology. Telehealth carries much potential for advancing care for patients with cancer, but future study should focus on additional efficacy endpoints, implementation, and ways to reduce disparities.
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Nash J, Brims F. International standards of care in thoracic oncology: A narrative review of clinical quality indicators. Lung Cancer 2023; 186:107421. [PMID: 37988782 DOI: 10.1016/j.lungcan.2023.107421] [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: 05/19/2023] [Revised: 10/09/2023] [Accepted: 11/07/2023] [Indexed: 11/23/2023]
Abstract
Unwarranted variations in lung cancer care are widely described. Clinical Quality Indicators (CQIs) enable the systematic identification and alleviation of variations in care and other evidence-practice gaps. The aim of this review was to describe and evaluate lung cancer CQIs utilised internationally, in order to provide a substrate for the development of Australasian lung cancer CQIs and future quality improvement initiatives. A literature search was performed to identify relevant publications; references were excluded if they did not explicitly define original lung cancer-specific quality indicators, or were review or opinion articles. Ultimately, 48 publications containing 661 individual CQIs were evaluated. Although almost all references were published in the last decade, CQIs did not always reflect contemporary standards of care. For example, there were just sixteen CQIs regarding biomarker profiling, eleven CQIs regarding multidisciplinary team review, and three clinical trial enrolment CQIs. Of 307 lung cancer treatment CQIs, almost half (137) pertain to surgical resection; a treatment option available to a minority of lung cancer patients. Consumer engagement during indicator development was uncommon. In conclusion, whilst CQIs are widely measured and reported, they are not always consistent with evidence-based practice, nor do they reliably support the holistic evaluation of the lung cancer care continuum. Moving forward, Australia and New Zealand must adopt a unified, evidence-based and patient-centred approach to drive meaningful improvements in practice.
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Affiliation(s)
- Jessica Nash
- Department of Respiratory Medicine, Sir Charles Gairdner Hospital, Perth, Australia; Curtin Medical School, Curtin University, Perth, Australia
| | - Fraser Brims
- Department of Respiratory Medicine, Sir Charles Gairdner Hospital, Perth, Australia; Curtin Medical School, Curtin University, Perth, Australia; National Centre for Asbestos Related Diseases, Institute for Respiratory Health, Perth, Australia.
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Puckett LL, Titi M, Kujundzic K, Dawes SL, Gore EM, Katsoulakis E, Park JH, Solanki AA, Kapoor R, Kelly M, Palta J, Chetty IJ, Jabbour SK, Liao Z, Movsas B, Thomas CR, Timmerman RD, Werner-Wasik M, Kudner R, Wilson E, Simone CB. Consensus Quality Measures and Dose Constraints for Lung Cancer From the Veterans Affairs Radiation Oncology Quality Surveillance Program and ASTRO Expert Panel. Pract Radiat Oncol 2023; 13:413-428. [PMID: 37075838 DOI: 10.1016/j.prro.2023.04.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 04/01/2023] [Accepted: 04/03/2023] [Indexed: 04/21/2023]
Abstract
PURPOSE For patients with lung cancer, it is critical to provide evidence-based radiation therapy to ensure high-quality care. The US Department of Veterans Affairs (VA) National Radiation Oncology Program partnered with the American Society for Radiation Oncology (ASTRO) as part of the VA Radiation Oncology Quality Surveillance to develop lung cancer quality metrics and assess quality of care as a pilot program in 2016. This article presents recently updated consensus quality measures and dose-volume histogram (DVH) constraints. METHODS AND MATERIALS A series of measures and performance standards were reviewed and developed by a Blue-Ribbon Panel of lung cancer experts in conjunction with ASTRO in 2022. As part of this initiative, quality, surveillance, and aspirational metrics were developed for (1) initial consultation and workup; (2) simulation, treatment planning, and treatment delivery; and (3) follow-up. The DVH metrics for target and organ-at-risk treatment planning dose constraints were also reviewed and defined. RESULTS Altogether, a total of 19 lung cancer quality metrics were developed. There were 121 DVH constraints developed for various fractionation regimens, including ultrahypofractionated (1, 3, 4, or 5 fractions), hypofractionated (10 and 15 fractionations), and conventional fractionation (30-35 fractions). CONCLUSIONS The devised measures will be implemented for quality surveillance for veterans both inside and outside of the VA system and will provide a resource for lung cancer-specific quality metrics. The recommended DVH constraints serve as a unique, comprehensive resource for evidence- and expert consensus-based constraints across multiple fractionation schemas.
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Affiliation(s)
- Lindsay L Puckett
- Department of Radiation Oncology, Medical College of Wisconsin and Clement J. Zablocki VA Medical Center, Milwaukee, Wisconsin.
| | - Mohammad Titi
- Department of Radiation Oncology, Medical College of Wisconsin and Clement J. Zablocki VA Medical Center, Milwaukee, Wisconsin
| | | | | | - Elizabeth M Gore
- Department of Radiation Oncology, Medical College of Wisconsin and Clement J. Zablocki VA Medical Center, Milwaukee, Wisconsin
| | - Evangelia Katsoulakis
- Department of Radiation Oncology, James A. Haley Veterans Affairs Healthcare System, Tampa, Florida
| | - John H Park
- Department of Radiation Oncology, Kansas City VA Medical Center, Kansas City, Missouri; Department of Radiology, University of Missouri Kansas City School of Medicine, Kansas City, Missouri
| | - Abhishek A Solanki
- Department of Radiation Oncology, Loyola University and Hines VA Medical Center, Chicago, Illinois
| | - Rishabh Kapoor
- Department of Radiation Oncology, Virginia Commonwealth University and Hunter Holmes McGuire VA Medical Center, Richmond, Virginia
| | - Maria Kelly
- Department of Radiation Oncology, VHA National Radiation Oncology Program Office, Richmond, Virginia
| | - Jatinder Palta
- Department of Radiation Oncology, Virginia Commonwealth University and Hunter Holmes McGuire VA Medical Center, Richmond, Virginia; Department of Radiation Oncology, VHA National Radiation Oncology Program Office, Richmond, Virginia
| | - Indrin J Chetty
- Department of Radiation Oncology, Henry Ford Cancer Institute, Detroit, Michigan
| | - Salma K Jabbour
- Department of Radiation Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey
| | - Zhongxing Liao
- Division of Radiation Oncology, Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Benjamin Movsas
- Department of Radiation Oncology, Henry Ford Cancer Institute, Detroit, Michigan
| | - Charles R Thomas
- Radiation Oncology, Dartmouth Cancer Institute, Hanover, New Hampshire
| | - Robert D Timmerman
- Department of Radiation Oncology, University of Texas Southwestern Medical School, Dallas, Texas
| | - Maria Werner-Wasik
- Department of Radiation Oncology, Sydney Kimmel Cancer Center of Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Randi Kudner
- American Society for Radiation Oncology, Arlington, Virginia
| | - Emily Wilson
- American Society for Radiation Oncology, Arlington, Virginia
| | - Charles B Simone
- Department of Radiation Oncology, New York Proton Center, New York, New York
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Gross-Erne M, Zimmerli L, Bassetti S, Li Q, Feller A, Mingrone W. A long-term retrospective observational study at a medium-sized medical oncology service in Switzerland: comparison of overall survival with a national cohort and adherence to treatment guidelines. Swiss Med Wkly 2023; 153:40091. [PMID: 37459836 DOI: 10.57187/smw.2023.40091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/20/2023] Open
Abstract
AIMS There is a lack of national and international publicly available long-term survival outcome data from individual healthcare providers in medical oncology. In this study, the overall survival at a medium-sized medical oncology service at Olten Cantonal Hospital was evaluated and compared as a local benchmark report with national data from the Swiss Cancer Registries. Furthermore, adherence to treatment guidelines was investigated as an additional quality indicator. METHODS The 1- and 5-year overall survival of all patients with breast cancer, testicular cancer, colon cancer, non-small-cell lung cancer, Hodgkin lymphoma, and diffuse large B-cell lymphoma in Switzerland from 2008 to 2017 with at least one outpatient visit at the in-house medical oncology service at Olten Cantonal Hospital was analysed and compared with the specific overall population-based outcome data provided by the National Agency for Cancer Registration (NACR), which were set as a national benchmark. Until 2020, no data from the Canton of Solothurn, to which Olten belongs, were reported to the NACR. Further, adherence to internationally recognized clinical guidelines for stage-specific treatment was assessed. RESULTS Until September 8, 2020, data on 842 patients with a median follow-up period of 70 months were collected and analysed. The 1- and 5-year overall survival for colon and non-small cell cancer, Hodgkin lymphoma, and diffuse large B-cell lymphoma and the 5-year overall survival for testicular cancer in the Olten cohort did not significantly differ from the NACR data. The 1-year overall survival for testicular cancer was not comparable statistically. The 5-year overall survival for breast cancer (unadjusted for stage) was significantly higher in the NACR collective (84.5%) than in the Olten collective (79.7%) but not for the individual breast cancer stages. The Olten collective included approximately 2.5 times as many patients with stage 4 breast cancer (17.5%) as the NACR collective (6.9%). Approximately 92.4% of the patients in the curative setting and 85.8% of the patients in the palliative setting received first-line treatment according to guidelines. CONCLUSIONS The statistically comparable local 1- and 5-year overall survival of the analysed malignancies, with adjustment for stage for the 5-year overall survival for breast cancer, is in line with the national benchmark. Adherence to treatment guidelines is high.
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Affiliation(s)
- Mirjam Gross-Erne
- Division of Medical Oncology, Kantonsspital Olten, Olten, Switzerland
| | - Lukas Zimmerli
- Department of Internal Medicine, Kantonsspital Olten, Olten, Switzerland
| | - Stefano Bassetti
- Division of Internal Medicine, University Hospital Basel and University of Basel, Basel, Switzerland
| | - Qiyu Li
- SAKK Coordinating Center, Bern, Switzerland
| | - Anita Feller
- Foundation National Institute for Cancer Epidemiology and Registration (NICER), Zurich, Switzerland
- National Agency for Cancer Registration (NACR) operated by NICER, Zurich, Switzerland
| | - Walter Mingrone
- Division of Medical Oncology, Kantonsspital Olten, Olten, Switzerland
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Koh HJW, Whitelock-Wainwright E, Gasevic D, Rankin D, Romero L, Frydenberg M, Evans S, Talic S. Quality Indicators in the Clinical Specialty of Urology: A Systematic Review. Eur Urol Focus 2022:S2405-4569(22)00288-7. [PMID: 36577611 DOI: 10.1016/j.euf.2022.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Revised: 11/11/2022] [Accepted: 12/06/2022] [Indexed: 12/27/2022]
Abstract
CONTEXT In health care, monitoring of quality indicators (QIs) in general urology remains underdeveloped in comparison to other clinical specialties. OBJECTIVE To identify, synthesise, and appraise QIs that monitor in-hospital care for urology patients. EVIDENCE ACQUISITION This systematic review included peer-reviewed articles identified via Embase, MEDLINE, Web of Science, CINAHL, Global Health, Google Scholar, and grey literature from 2000 to February 19, 2021. The review was carried out under the Preferred Reporting Items of Systematic Reviews and Meta-Analyses (PRISMA) guidelines and used the Appraisal of Indicators through Research and Evaluation (AIRE) tool for quality assessment. EVIDENCE SYNTHESIS A total of 5111 articles and 62 government agencies were screened for QI sets. There were a total of 57 QI sets included for analysis. Most QIs focused on uro-oncology, with prostate, bladder, and testicular cancers the most represented. The most common QIs were surgical QIs in uro-oncology (positive surgical margin, surgical volume), whereas in non-oncology the QIs most frequently reported were for treatment and diagnosis. Out of 61 articles, only four scored a total of ≥50% on the AIRE tool across four domains. Aside from QIs developed in uro-oncology, general urological QIs are underdeveloped and of poor methodological quality and most lack testing for both content validity and reliability. CONCLUSIONS There is an urgent need for the development of methodologically robust QIs in the clinical specialty of general urology for patients to enable standardised quality of care monitoring and to improve patient outcomes. PATIENT SUMMARY We investigated a range of quality indicators (QIs) that provide health care professionals with feedback on the quality of their care for patients with general urological diseases. We found that aside from urological cancers, there is a lack of QIs for general urology. Hence, there is an urgent need for the development of robust and disease-specific QIs in general urology.
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Affiliation(s)
- Harvey Jia Wei Koh
- Faculty of Information Technology, Monash University, Clayton, Australia; Digital Health Cooperative Research Centre, Sydney, Australia
| | - Emma Whitelock-Wainwright
- Faculty of Information Technology, Monash University, Clayton, Australia; Digital Health Cooperative Research Centre, Sydney, Australia
| | - Dragan Gasevic
- Faculty of Information Technology, Monash University, Clayton, Australia; Digital Health Cooperative Research Centre, Sydney, Australia
| | - David Rankin
- Digital Health Cooperative Research Centre, Sydney, Australia; Cabrini Healthcare, Malvern, Australia
| | - Lorena Romero
- Ian Potter Library, Monash University, Melbourne, Australia; School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Mark Frydenberg
- Department of Surgery, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia; Cabrini Institute, Cabrini Health, Malvern, Australia
| | - Sue Evans
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia; Cancer Council Victoria, Melbourne, Australia
| | - Stella Talic
- Digital Health Cooperative Research Centre, Sydney, Australia; School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia.
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Patterns of palliative care referral in platinum resistant ovarian cancer demonstrate reactive rather than proactive approach. Gynecol Oncol Rep 2022; 43:101053. [PMID: 35958954 PMCID: PMC9358431 DOI: 10.1016/j.gore.2022.101053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2022] [Revised: 07/25/2022] [Accepted: 07/26/2022] [Indexed: 11/19/2022] Open
Abstract
Referral to palliative care within eight weeks of advanced cancer diagnosis is recommended. Rates of palliative care referral in ovarian cancer patients are high compared with prior literature. Timing of referral suggests a reaction to clinical decline, rather than proactive approach. Diagnosis of platinum resistance should serve as a stimulus for palliative care referral.
Objective To evaluate patterns of palliative care (PC) integration in patients with platinum resistant ovarian cancer. Methods Single institution retrospective study of patients with ovarian, tubal, or peritoneal high-grade carcinoma treated 2011–2020. Platinum resistance was identified by chemotherapy regimen or provider definition. Data was extracted evaluating treatment regimens, time to progression, PC and hospice referrals, and survival. Descriptive statistics and survival analyses were performed. Results We identified 258 patients with platinum resistant ovarian cancer. Median survival from diagnosis of platinum resistance was 15 months (range 0–161). Most (71 %) patients were referred to PC, with 43 % of referrals within 3 months of death. Fourteen percent of patients were referred directly to hospice without PC involvement. Of 46 patients living with platinum resistant disease, 93 % meet criteria for early PC referral, but less than half have seen PC. Median time from platinum resistance to PC referral was 9 months (range 0–157) and from PC referral to death was 3 months (range 0–110). Median time from platinum resistance to hospice referral was 7 months (range 1–57) and from hospice referral to death was < 1 month (range 0–12). Conclusion While rates of PC referral in our cohort are high compared with other single institution cohorts, timing of PC referral suggests referral patterns that are reactive to clinical decline rather than proactive as per national recommendations. A significant percentage of patients are directly referred to hospice for end-of-life care, reflecting missed opportunity for concurrent PC and oncology care earlier in the disease course. Diagnosis of platinum resistance should serve as a stimulus for PC involvement.
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Fink AKC, DeRenzis AC, Awasthi S, Jahan N, Johnstone PAS, Pow‐Sang J, Torres‐Roca J, Grass D, Fernandez D, Naghavi A, Tan S, Manley B, Li R, Poch M, Yu A, Little N, Bass E, Ercole CE, Katsoulakis E, Burri R, Smith R, Stanley NB, Vadaparampil ST, Yamoah K. Identifying and overcoming barriers to participation of minority populations in clinical trials: Lessons learned from the VanDAAM study. Cancer Med 2022; 12:1869-1877. [PMID: 35796421 PMCID: PMC9883445 DOI: 10.1002/cam4.5000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 05/16/2022] [Accepted: 06/03/2022] [Indexed: 02/03/2023] Open
Abstract
Participation in cancer research trials by minority populations is imperative in reducing disparities in clinical outcomes. Even with increased awareness of the importance of minority patient inclusion in clinical research to improve cancer care and survival, significant barriers persist in accruing and retaining minority patients into clinical trials. This study sought to identify and address barriers to minority accrual to a minimal risk clinical research study in real-time.
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Affiliation(s)
- Angelina K. C. Fink
- Cancer EpidemiologyH. Lee Moffitt Cancer Center & Research InstituteTampaFloridaUSA
| | - Amanda C. DeRenzis
- Cancer EpidemiologyH. Lee Moffitt Cancer Center & Research InstituteTampaFloridaUSA
| | - Shivanshu Awasthi
- Cancer EpidemiologyH. Lee Moffitt Cancer Center & Research InstituteTampaFloridaUSA
| | | | | | - Julio Pow‐Sang
- Genitourinary OncologyH. Lee Moffitt Cancer Center & Research InstituteTampaFloridaUSA
| | - Javier Torres‐Roca
- Radiation OncologyH. Lee Moffitt Cancer Center & Research InstituteTampaFloridaUSA
| | - Daniel Grass
- Radiation OncologyH. Lee Moffitt Cancer Center & Research InstituteTampaFloridaUSA
| | - Daniel Fernandez
- Radiation OncologyH. Lee Moffitt Cancer Center & Research InstituteTampaFloridaUSA
| | - Arash Naghavi
- Radiation OncologyH. Lee Moffitt Cancer Center & Research InstituteTampaFloridaUSA
| | - Susan Tan
- Radiation OncologyH. Lee Moffitt Cancer Center & Research InstituteTampaFloridaUSA
| | - Brandon Manley
- Genitourinary OncologyH. Lee Moffitt Cancer Center & Research InstituteTampaFloridaUSA
| | - Roger Li
- Genitourinary OncologyH. Lee Moffitt Cancer Center & Research InstituteTampaFloridaUSA
| | - Michael Poch
- Genitourinary OncologyH. Lee Moffitt Cancer Center & Research InstituteTampaFloridaUSA
| | - Alice Yu
- Genitourinary OncologyH. Lee Moffitt Cancer Center & Research InstituteTampaFloridaUSA
| | - Nikki Little
- Genitourinary OncologyH. Lee Moffitt Cancer Center & Research InstituteTampaFloridaUSA
| | - Eppie Bass
- Genitourinary OncologyH. Lee Moffitt Cancer Center & Research InstituteTampaFloridaUSA
| | - Cesar E. Ercole
- Urology SectionJames A. Haley Veterans' HospitalTampaFloridaUSA
| | | | - Ryan Burri
- RadiationBay Pines VA Healthcare SystemBay PinesFloridaUSA
| | - Riley Smith
- Cancer EpidemiologyH. Lee Moffitt Cancer Center & Research InstituteTampaFloridaUSA
| | - Nathanael B. Stanley
- Office of Community Outreach, Engagement & Equity (COEE)H. Lee Moffitt Cancer Center & Research InstituteTampaFloridaUSA
| | - Susan T. Vadaparampil
- Office of Community Outreach, Engagement & Equity (COEE)H. Lee Moffitt Cancer Center & Research InstituteTampaFloridaUSA,Health Outcomes & BehaviorH. Lee Moffitt Cancer Center & Research InstituteTampaFloridaUSA
| | - Kosj Yamoah
- Cancer EpidemiologyH. Lee Moffitt Cancer Center & Research InstituteTampaFloridaUSA,Radiation OncologyH. Lee Moffitt Cancer Center & Research InstituteTampaFloridaUSA
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12
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Wen FH, Chou WC, Chen JS, Chang WC, Hsu MH, Tang ST. Sufficient Death Preparedness Correlates to Better Mental Health, Quality of Life, and EOL Care. J Pain Symptom Manage 2022; 63:988-996. [PMID: 35192878 DOI: 10.1016/j.jpainsymman.2022.02.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Revised: 02/14/2022] [Accepted: 02/16/2022] [Indexed: 10/19/2022]
Abstract
CONTEXT Patients can prepare for end of life and their forthcoming death to enhance the quality of dying. OBJECTIVES We aimed to longitudinally evaluate the never-before-examined associations of cancer patients' death-preparedness states by conjoint cognitive prognostic awareness and emotional preparedness for death with psychological distress, quality of life (QOL), and end-of-life care received. METHODS In this cohort study, we simultaneously evaluated associations of four previously identified death-preparedness states (no-death-preparedness, cognitive-death-preparedness-only, emotional-death-preparedness-only, and sufficient-death-preparedness states) with anxiety symptoms, depressive symptoms, and QOL over 383 cancer patients' last six months and end-of-life care received in the last month using multivariate hierarchical linear modeling and logistic regression modeling, respectively. Minimal clinically important differences (MCIDs) have been established for anxiety- (1.3-1.8) and depressive- (1.5-1.7) symptom subscales (0-21 Likert scales). RESULTS Patients in the no-death-preparedness and cognitive-death-preparedness-only states reported increases in anxiety symptoms and depressive symptoms that exceed the MCIDs, and a decline in QOL from those in the sufficient-death-preparedness state. Patients in the emotional-death-preparedness-only state were more (OR [95% CI]=2.38 [1.14, 4.97]) and less (OR [95% CI]=0.38 [0.15, 0.94]) likely to receive chemotherapy/immunotherapy and hospice care, respectively, than those in the sufficient-death-preparedness state. Death-preparedness states were not associated with life-sustaining treatments received in the last month. CONCLUSION Conjoint cognitive and emotional preparedness for death is associated with cancer patients' lower psychological distress, better QOL, reduced anti-cancer therapy, and increased hospice-care utilization. Facilitating accurate prognostic awareness and emotional preparedness for death is justified when consistent with patient circumstances and preferences.
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Affiliation(s)
- Fur-Hsing Wen
- Department of International Business, Soochow University, Taiwan, China
| | - Wen-Chi Chou
- Division of Hematology-Oncology, Chang Gung Memorial Hospital at Linkou, Taiwan, China; Chang Gung University College of Medicine, Taiwan, China
| | - Jen-Shi Chen
- Division of Hematology-Oncology, Chang Gung Memorial Hospital at Linkou, Taiwan, China; Chang Gung University College of Medicine, Taiwan, China
| | - Wen-Cheng Chang
- Division of Hematology-Oncology, Chang Gung Memorial Hospital at Linkou, Taiwan, China; Chang Gung University College of Medicine, Taiwan, China
| | - Mei Huang Hsu
- School of Nursing, Chang Gung University, Taiwan, China
| | - Siew Tzuh Tang
- Division of Hematology-Oncology, Chang Gung Memorial Hospital at Linkou, Taiwan, China; School of Nursing, Chang Gung University, Taiwan, China; Department of Nursing, Chang Gung Memorial Hospital at Kaohsiung, Taiwan, China.
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13
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Ellsworth BL, Metz AK, Mott NM, Kazemi R, Stover M, Hughes T, Dossett LA. Review of Cancer-Specific Quality Measures Promoting the Avoidance of Low-Value Care. Ann Surg Oncol 2022; 29:3750-3762. [DOI: 10.1245/s10434-021-11303-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Accepted: 12/18/2021] [Indexed: 12/28/2022]
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14
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Guillem Porta V, Camps C, Climent Durán MÁ, Gallardo E, González Del Alba A, Lázaro-Quintela M, Méndez Vidal MJ, Pinto Marín Á, Puente J, Antón-Rodríguez C, Caballero-Martínez F, Campos-Lucas FJ, Lugo I, Rogado Á, Durán I. Measures to evaluate quality of care in renal cancer: results of a Delphi study in Spain. Clin Transl Oncol 2021; 24:495-502. [PMID: 34482526 DOI: 10.1007/s12094-021-02703-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Accepted: 08/24/2021] [Indexed: 11/30/2022]
Abstract
PURPOSE To review current measures for renal cancer care and develop a comprehensive and updated list of measures for their practical use in Spain. METHODS The study was developed by Fundación ECO, a Spanish foundation aiming to improve oncology quality of care. A systematic literature review was carried out to identify measures and knowledge gaps. A scientific committee composed of nine experts reviewed the literature findings and added measures. A preliminary list of 42 measures was evaluated with the Delphi method to gather feedback from 47 medical oncology experts in Spain. Experts scored the appropriateness of the measures and ranked their priority in two consecutive online surveys. The scientific committee reviewed the Delphi results and developed the measures. A technical group from Universidad Francisco de Vitoria conducted and oversaw the Delphi method. RESULTS The Delphi method led to consensus on all 42 measures. The scientific committee used a prioritisation matrix to select 25 of these measures for evaluating quality of care in renal cancer. These measures regarded structure, process, and outcome and covered general management, diagnosis, treatment, follow-up, and evaluation of health outcomes. Easy-to-use index cards were developed for all 25 measures, including their definition, formula, acceptable level of attainment, and rationale. CONCLUSIONS This manuscript aims to provide healthcare professionals with expert- and evidence-based measures that are useful for evaluating quality of care in renal cancer in Spain and cover all aspects and stages.
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Affiliation(s)
- Vicente Guillem Porta
- Fundación ECO (Excelencia Y Calidad de La Oncología), Madrid, Spain. .,Medical Oncology Department, Servicio de Oncología Médica, Instituto Valenciano de Oncología, Carrer del Professor Beltrán Báguena, 8, 46009, València, Spain.
| | - Carlos Camps
- Fundación ECO (Excelencia Y Calidad de La Oncología), Madrid, Spain.,Medical Oncology Department, Hospital General de Valencia, CIBERONC, València, Spain
| | - Miguel Ángel Climent Durán
- Fundación ECO (Excelencia Y Calidad de La Oncología), Madrid, Spain.,Medical Oncology Department, Servicio de Oncología Médica, Instituto Valenciano de Oncología, Carrer del Professor Beltrán Báguena, 8, 46009, València, Spain
| | - Enrique Gallardo
- Oncology Department, Parc Taulí Hospital Universitari. Institut d'Investigació I Innovació Parc Taulí I3PT, Universitat Autònoma de Barcelona, Sabadell, Spain
| | - Aránzazu González Del Alba
- Fundación ECO (Excelencia Y Calidad de La Oncología), Madrid, Spain.,Medical Oncology Department, Hospital Universitario Puerta de Hierro-Majadahonda, Madrid, Spain
| | - Martín Lázaro-Quintela
- Fundación ECO (Excelencia Y Calidad de La Oncología), Madrid, Spain.,Medical Oncology Department, Complexo Hospitalario Universitario de Vigo, Vigo, Spain.,Oncology Translational Research Group (ONCOINVES), Galicia Sur Health Research Institute, Vigo, Spain
| | - María José Méndez Vidal
- Medical Oncology Department, Maimonides Institute for Biomedical Research of Córdoba, Hospital Reina Sofía, Córdoba, Spain
| | - Álvaro Pinto Marín
- Medical Oncology Department, Hospital Universitario La Paz, Madrid, Spain
| | - Javier Puente
- Fundación ECO (Excelencia Y Calidad de La Oncología), Madrid, Spain.,Medical Oncology Department, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), CIBERONC, Madrid, Spain
| | - Cristina Antón-Rodríguez
- Unidad de apoyo a La Investigación, Facultad de Medicina, Universidad Francisco de Vitoria, Madrid, Spain
| | | | - Francisco J Campos-Lucas
- Unidad de Consultoría E Investigación en Salud, Facultad de Medicina, Universidad Francisco de Vitoria, Madrid, Spain
| | - Ilse Lugo
- Fundación ECO (Excelencia Y Calidad de La Oncología), Madrid, Spain
| | - Álvaro Rogado
- Fundación ECO (Excelencia Y Calidad de La Oncología), Madrid, Spain
| | - Ignacio Durán
- Fundación ECO (Excelencia Y Calidad de La Oncología), Madrid, Spain.,Hospital Universitario Marqués de Valdecilla, Instituto de Investigación Marqués de Valdecilla (IDIVAL), Santander, Spain
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15
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Fiano RM, Merrick GS, Innes KE, Mattes MD, LeMasters TJ, Shen C, Sambamoorthi U. Associations of multimorbidity and patient-reported experiences of care with conservative management among elderly patients with localized prostate cancer. Cancer Med 2020; 9:6051-6061. [PMID: 32628817 PMCID: PMC7433828 DOI: 10.1002/cam4.3274] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Revised: 06/17/2020] [Accepted: 06/17/2020] [Indexed: 12/21/2022] Open
Abstract
Background Many elderly localized prostate cancer patients could benefit from conservative management (CM). This retrospective cohort study examined the associations of patient‐reported access to care and multimorbidity on CM use patterns among Medicare Fee‐for‐Service (FFS) beneficiaries with localized prostate cancer. Methods We used linked Surveillance, Epidemiology, and End Results cancer Registry, Medicare Claims, and the Medicare Consumer Assessment of Healthcare Providers and Systems (MCAHPS) survey files. We identified FFS Medicare Beneficiaries (age ≥ 66; continuous enrollment in Parts A & B) with incident localized prostate cancer from 2003 to 2013 and a completed MCAHPS survey measuring patient‐reported experiences of care within 24 months after diagnosis (n = 496). We used multivariable models to examine MCAHPS measures (getting needed care, timeliness of care, and doctor communication) and multimorbidity on CM use. Results Localized prostate cancer patients with multimorbidity were less likely to use CM (adjusted odds ratio (AOR)=0.42 (0.27‐ 0.66), P < .001); those with higher scores on timeliness of care (AOR = 1.21 (1.09, 1.35), P < .001), higher education attainment (3.21 = AOR (1.50,6.89), P = .003), and impaired mental health status (4.32 = AOR (1.86, 10.1) P < .001) were more likely to use CM. Conclusion(s) Patient‐reported experience with timely care was significantly and positively associated with CM use. Multimorbidity was significantly and inversely associated with CM use. Addressing specific modifiable barriers to timely care along the cancer continuum for elderly localized prostate cancer patients with limited life expectancy could reduce the adverse effects of overtreatment on health outcomes and costs.
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Affiliation(s)
- Ryan M Fiano
- Wheeling Hospital, Urologic Research Institute, Schiffler Cancer Center, Wheeling, WV, USA.,West Virginia Clinical and Translational Science Institute, Morgantown, WV, USA
| | - Gregory S Merrick
- Wheeling Hospital, Urologic Research Institute, Schiffler Cancer Center, Wheeling, WV, USA
| | - Kim E Innes
- Department of Epidemiology, West Virginia University, Morgantown, WV, USA
| | - Malcolm D Mattes
- Department of Radiation Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA
| | - Traci J LeMasters
- West Virginia University School of Pharmacy, Pharmaceutical Systems & Policy, Morgantown, WV, USA
| | - Chan Shen
- Penn State Health Milton S Hershey Medical Center, Hershey, PA, USA
| | - Usha Sambamoorthi
- West Virginia University School of Pharmacy, Pharmaceutical Systems & Policy, Morgantown, WV, USA
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